Competency 1: Design evidence-based advanced nursing care for achieving high-quality population outcomes.
Propose a policy and guidelines that will lead to improved outcomes and quality of care for a specific issue in a target population.
Competency 2: Evaluate the efficiency and effectiveness of interprofessional interventions in achieving desired population health outcomes.
Analyze the potential for an interprofessional approach to implementing a proposed policy to increase the efficiency or effectiveness of the care setting to achieve high-quality outcomes.
Competency 3: Analyze population health outcomes in terms of their implications for health policy advocacy.
Advocate the need for a proposed policy in the context of current outcomes and quality of care for a specific issue in a target population.
Competency 4: Communicate effectively with diverse audiences, in an appropriate form and style, consistent with organizational, professional, and scholarly standards.
Communicate in a professional and persuasive manner, writing content clearly and logically with correct use of grammar, punctuation, and spelling.
Integrate relevant sources to support assertions, correctly formatting citations and references using current APA style.
Running head: BIOPSYCHOSOCIAL POPULATION HEALTH POLICY PROPOSAL 1
Copyright ©2018 Capella University. Copy and distribution of this document are prohibited.
Biopsychosocial Population Health Policy Proposal
Learner’s Name
Capella University
Biopsychosocial Concepts for Advanced Nursing Practice II
Biopsychosocial Population Health Policy Proposal
November, 2018
BIOPSYCHOSOCIAL POPULATION HEALTH POLICY PROPOSAL 2
Copyright ©2018 Capella University. Copy and distribution of this document are prohibited.
Biopsychosocial Population Health Policy Proposal
The health care industry has come to acknowledge the rise of the opioid crisis over the
past two decades. However, this does not take away from the necessity of pain relief for patients
suffering from chronic pain, who are most often prescribed opioid treatment. Opioid treatment
does show promise in short-term trials (Sehgal, Colson, & Smith, 2013), but long-term
treatments carry with them significant risk of addiction, adverse side effects, and prescription
drug abuse (Franklin, 2014). The issue of opioid abuse and addiction is further complicated by
the comorbidity of mental health problems in patients. In this context, veterans are a particularly
vulnerable population because they often present with chronic noncancer pain while being
comorbid with mental health issues such as post-traumatic stress disorder or substance abuse
disorder (Sullivan & Howe, 2013). Given this vulnerability, it is necessary to take steps to
prevent or reduce the potential for addiction or medication abuse among veterans who are
prescribed
long-term opioid treatment.
Substance Abuse among U.S. Veterans: A Brief Retrospective
Opioids came to be used in the treatment of chronic pain in cancer patients as a result of
two WHO guidelines that were issued in 1985 and 1996 (Sullivan & Howe, 2013). Eventually,
the treatment was extended to chronic noncancer pain and suggested as a safe, non-addictive
method of treating pain. However, this claim was extrapolated from short-term opioid treatment
studies. The issue then becomes primarily about the lack of evidence to support the safe long-
term use of opioids. Opioids carry a significant risk of addiction and an array of unpleasant side
effects (Franklin, 2014). Further, opioids also complicate matters of mental health. Opioids can
relieve pain and produce a feeling of euphoria in patients. This physical relief could
inadvertently soothe the psychological or emotional pain that a patient is experiencing. However,
BIOPSYCHOSOCIAL POPULATION HEALTH POLICY PROPOSAL 3
Copyright ©2018 Capella University. Copy and distribution of this document are prohibited.
this leads to the patient doubly associating the opioid drug with both physical and psychological
relief, potentially resulting in drug abuse and drug-seeking behavior. In this context, veterans’
health becomes a particularly complicated and layered issue to tackle. Many of them suffer
from
chronic pain because of injuries and exposure to hazards during their military career and often
present with behavioral issues such as post-traumatic stress disorder or substance abuse disorder.
Veterans are seven times more likely to abuse prescription opioids than civilians (Snow &
Wynn, 2018). Further, Newhouse states that opioid medications were prescribed to over 400,000
veterans for pain relief and that approximately 1.7 million opioid medications were prescribed to
them in 2014 (as cited in Snow & Wynn, 2018), indicating that opioid treatments are quite
widespread.
Several institutes, including the American Osteopathic Academy of Addiction Medicine,
the American Society of Addiction Medicine, and the American Academy of Neurology, have
stated publicly that opioids present a significant challenge in the health care industry. These
institutes encourage raising awareness of the adverse side effects of opioid treatments, the use of
naloxone (an opioid antagonist), and proper procedure in case of an opioid overdose (The
American Osteopathic Academy of Addiction Medicine, n.d.; American Society of Addiction
Medicine, 2016; Franklin, 2014). Given how widespread the prescription of opioids is among
veterans suffering from chronic pain, it would be necessary to reevaluate the guidelines
associated with prescription as well. Further, the primary problems associated with prescription
opioids are the abuse of prescribed opioids and the transition from prescription opioids to black
market drugs such as heroin (Kolodny, Courtwright, Hwang, Kreiner, Eadie, Clark, &
Alexander, 2015; Snow & Wynn, 2018).
BIOPSYCHOSOCIAL POPULATION HEALTH POLICY PROPOSAL 4
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In 2007, the National Drug Intelligence Center of the U.S. Department of Justice
estimated that a cumulative cost of approximately $200 billion resulted from direct and indirect
drug use in the form of lost productivity, health care, and law enforcement (as cited in Crowley,
Kirschner, Dunn, & Bornstein, 2017). Further, Ronan and Herzig note that the costs associated
with opioid use disorder were approximately $15 billion in 2012 (as cited in Crowley et al.,
2017). Rydell and Everingham and the National Institute for Drug Abuse state that money
invested in preventing drug abuse and subsequent treatment would lead to substantial savings on
a national level (as cited in Crowley et al., 2017). It is then necessary from an industry standpoint
to revisit the guidelines associated with the issue of opioid prescriptions, given the significant
costs associated with it.
An Interprofessional Approach to Substance Abuse and Health Care for Veterans
The proposed policy addressed below consists primarily of two aspects: raising public
awareness and encouraging interdepartmental communication and coordination. The first aspect
would help individuals learn about the crisis and identify potentially harmful patterns of
behavior, and the second would improve the condition of individuals who have been prescribed
long-term opioid treatment.
Raising Public Awareness
To approach the issue of the opioid crisis, it is important to understand it as a problem of
scale (given how widespread the issue is) and as a problem of understanding among the public
and those receiving opioids. Raising awareness would improve the public’s understanding of the
nature of the opioid crisis and would thereby help individuals recognize how and when opioids
would be helpful. It would also improve the public’s understanding of the potential harm opioid
use might mean for an individual being treated with opioids. A committee would be formed with
BIOPSYCHOSOCIAL POPULATION HEALTH POLICY PROPOSAL 5
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physicians who specialize in pain treatment, behavioral health specialists, and senior nurses to
oversee public awareness drives and educational programs to help raise awareness in the
community. The duties of the committee would include ensuring that these drives and programs
are organized effectively and regularly, evaluating the efficacy of holding such programs, and
understanding how to improve outreach. Trained physicians would oversee the educational
programs, while nurses would provide demonstrations of the correct procedure when
administering naloxone. The programs would contain information on how to identify potential
signs of opioid misuse and addiction (such as patients obtaining their prescriptions early or
patients sharing their prescriptions with those who are close to them) and how to approach such
situations. The committee would also work in close association with the closest veterans’ affairs
office to identify and cater to veterans who require opioid treatment for chronic pain, thereby
improving their understanding of the risks involved in prescription opioids and their misuse.
Precautions and Prescriptions
It is important to critically evaluate the current state of how opioids are prescribed and to
whom they are prescribed. Further, it is necessary to address each individual patient’s physical
and behavioral needs together rather than to focus solely on the pain that a patient might
experience. Individuals with behavioral issues are more likely to be prescribed opioids than those
without. However, they are also more likely to become addicted to opioids or misuse them.
Patients who have been prescribed long-term opioid treatment would be required to meet with a
psychiatrist regularly to monitor and evaluate the risk they present for addiction and misuse. The
psychiatrist would then be required to keep the attending physician informed about the state of
the patient’s mental health and whether any further action would be required while still
maintaining the confidentiality of the conversations the patient has had with the psychiatrist.
BIOPSYCHOSOCIAL POPULATION HEALTH POLICY PROPOSAL 6
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Further, during the initial diagnosis, physicians would be required to screen patients for histories
of behavioral issues, including post-traumatic stress disorder and substance abuse disorders.
Certain populations such as veterans are likely to be at a higher risk of opioid addiction and
misuse. To improve patient care, it would be necessary for physicians and nurses to sensitize
themselves to these at-risk populations to better serve their health care needs. For example,
veteran populations are known to present with both behavioral issues and chronic pain resulting
from their time in the military; it would be the responsibility of the physicians and the nurses
attending to a patient to familiarize themselves with the context of the patient so as to develop a
nurturing relationship in such a situation. To enable this, human patient simulators will be made
available to health care providers to train them through simulations that would provide
knowledge that can be used in real situations.
BIOPSYCHOSOCIAL POPULATION HEALTH POLICY PROPOSAL 7
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References
American Society of Addiction Medicine. (2016). Use of naloxone for the prevention of opioid
overdose deaths. Retrieved September 27, 2018, from https://asam.org/advocacy/find-a-
policy-statement/view-policy-statement/public-policy-statements/2014/08/28/use-of-
naloxone-for-the-prevention-of-drug-overdose-deaths
Crowley, R., Kirschner, N., Dunn, A. S., & Bornstein, S. S. (2017). Health and public policy to
facilitate effective prevention and treatment of substance use disorders involving illicit
and prescription drugs: An American College of Physicians position paper. Annals of
Internal Medicine, 166(10), 733–736. http://dx.doi.org/10.7326/M16-2953
Franklin, G. M. (2014). Opioids for chronic noncancer pain: A position paper of the American
Academy of Neurology. Neurology, 83(14), 1277–1284. Retrieved from
https://doi.org/10.1212/WNL.0000000000000839
Kolodny, A., Courtwright, D. T., Hwang, C. S., Kreiner, P., Eadie, J. L., Clark, T. W., &
Alexander, G. C. (2015). The prescription opioid and heroin crisis: A public health
approach to an epidemic of addiction. Annual Review of Public Health, 36(1), 559–
574. https://doi.org/10.1146/annurev-publhealth-031914-122957
Sehgal, N., Colson, J., & Smith, H. S. (2013). Chronic pain treatment with opioid analgesics:
Benefits versus harms of long-term therapy. Expert Review of Neurotherapeutics, 13(11),
1201–1220. http://dx.doi.org/10.1586/14737175.2013.846517
Snow, R., & Wynn, S. T. (2018). Managing opioid use disorder and co-occurring posttraumatic
stress disorder among veterans. Journal of Psychosocial Nursing and Mental Health
Services, 56(6), 36–42. http://dx.doi.org/10.3928/02793695-20180212-03
BIOPSYCHOSOCIAL POPULATION HEALTH POLICY PROPOSAL 8
Copyright ©2018 Capella University. Copy and distribution of this document are prohibited.
Sullivan, M. D., & Howe, C. Q. (2013). Opioid therapy for chronic pain in the US: Promises and
perils. Pain, 154(Suppl 1), S94–100. Retrieved from
https://ncbi.nlm.nih.gov/pmc/articles/PMC4204477/
The American Osteopathic Academy of Addiction Medicine. (n.d.). Naloxone public policy
statement: The use of naloxone for the prevention of opioid overdose deaths. Retrieved
from
https://c.ymcdn.com/sites/www.aoaam.org/resource/resmgr/Docs/AOAAM_NALOXON
E_POLICY_2015
1
Vulnerable Population Health Policy Proposal
Kyla Hoag
NURS-FPX6026: Biopsychosocial Concepts for Advanced Nursing Practice
2
Capella University
Kathryn Sheppard
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Need for Policy
The homeless is an example of a vulnerable population and they face an assortment of
healthcare challenges, both physical and mental. The homeless population is susceptible to many
physical health related problems such as chronic pain, impaired mobility, impaired hearing or
vision, and obesity. “Chronic pain is thought to be common among homeless people, in part due
to frequent injuries and the high prevalence of concurrent health conditions” (Hwang et. al.,
2011, p. 1). For many people with chronic pain, common pain relief methods are ineffective, and
opioids are used an alternative. It is easy for this population to end up addicted to opioids and
other substances because of chronic pain. Homelessness causes a lack of stability, which can lead
to drug addiction. The homeless population often self-medicates with street drugs, and they use
substances to numb the pain and stressors that comes with living on the street. “According to the
National Coalition for the Homeless, substance abuse is more prevalent in people who are
homeless than in those who are not” (Mosel, 2022). It can be challenging for homeless people to
stop using substances because they have smaller support networks. They also typically do not
have easy access to traditional recovery programs, detox centers, and rehab programs. It is then
crucial to look for a solution that will allow the homeless population to effectively manage their
chronic health conditions such as pain or mental health issues, and to most importantly get them
into a safe environment, where they do not have access to substances to continue feeding their
addiction.
Proposed Policy
The proposed policy I will be discussing is an interdisciplinary pain rehabilitation
program. The interdisciplinary approach to institutional and community problems occurs when
members of different disciplines work inter-dependently (as opposed to the term “multi-
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3
disciplinary,” which describes members of different disciplines who function independently”
(Hamel, 2001, p. 58). An interdisciplinary program is necessary for this population because they
face a variety of issues that make traditional drug rehabilitation programs less efficient. An
interdisciplinary program addresses the contributors to chronic pain which include behavioral,
psychological, and physical aspects. “To effectively serve the homeless population, rehab
programs must do at least three things: provide services that address the needs for employment,
income, and housing; offer access to affordable interventions; and provide long-term care,
treatment, and support” (Smith, 2020). The most effective rehab programs for the homeless
population understand that substance abuse cannot be managed without addressing the needs of
the person as a whole.
Interprofessional Approach
Effective rehab programs for the homeless population should provide patient-centered
services that are multidisciplinary, meaning competent enough to treat various conditions and
coordinate further services. Chronic pain is important to get under control, but most importantly,
the homeless population’s primary concern that needs to be addressed is housing. Substance
abuse often correlates directly with homelessness, therefore, the sooner the patient can find
stable housing, their chances of falling into addiction are drastically reduced. For treatment to be
effective, the homeless must have a stable living situation. Once basic needs are met, problems
with addicted can be focused on. An interprofessional team should be established to help develop
this type of patient’s plan of care. This team should include: a primary care provider, a pain
specialist, nurses, a mental health professional such as a therapist or psychiatrist, and social
services. There needs to be coordination between inpatient and outpatient social services as this
population is ready to transition into the community again.
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Conclusion
Individuals experiencing homelessness face unusual challenges in accessing healthcare.
These challenges include lack of transportation, loss of housing, financial hardships, lack of
insurance, and negative encounters within the health care system. There are many aspects of
being homeless that can cause a person to struggle with drug addiction. However, traditional
rehab programs hardly work for the homeless as they face a wide range of problems, including
mental, behavioral, and physical. I am proposing an interdisciplinary pain rehabilitation program
to help these patients lessen drug use, increase psychological functioning, promote healthy
behaviors, and have a safe place to call home, temporarily.
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References
Hamel, Pauline. (2001). Interdisciplinary perspectives, service learning, and advocacy:
A nontraditional approach to geriatric rehabilitation. Topics in Geriatric Rehabilitation.
17(1):53–70. https://doi.org/10.1097/00013614-200109000-00005
Hwang S., Wilkins E., Chambers C., Estrabillo E., Berends J., MacDonald A. (2011). Chronic
pain among homeless persons: Characteristics, treatment, and barriers to management.
BMC Fam Pract. 12(73), 2-9. https://doi.org/10.1186/1471-2296-12-73\
Mosel, S. (2022). Substance abuse & homelessness: statistics & rehab treatment. American
Addictions Center. Retrieved from https://americanaddictioncenters.org/rehab-
guide/homeless
Smith, Johnelle. (2020). Drug And alcohol rehab programs for homeless individuals. Addiction
Resources. Retrieved from
https://www.addictionresource.net/treatment/inpatient/homeless-
individuals/#homelessness-and-addiction
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ADDICTION.
ABUSE OF ALCOHOL, HOMELESSNESS PRESCRIPTION DRUGS, TOBACCO, ILLEGAL SUBSTANCES.
·
Develop a 2-4 page policy proposal that seeks to improve the outcomes for your chosen health care issue and target population.
Introduction
·
·
Note: Cost and access to care continue to be main concerns for patients and providers. As technology improves our ability to care for and improve outcomes in patients with chronic and complex illnesses, questions of cost and access become increasingly important. As a master’s-prepared nurse, you must be able to develop policies that will ensure the delivery of care that is effective and can be provided in an ethical and equitable manner. As a master’s-prepared nurse, you have a valuable viewpoint and voice with which to advocate for policy developments.
· As a nurse leader and health care practitioner, often on the front lines of helping individuals and populations, you are able to articulate and advocate for the patient more than any other professional group in health care. This is especially true of populations that may be underserved, underrepresented, or are otherwise lacking a voice. By advocating for and developing policies, you are able to help drive improvements in outcomes for specific populations.
· The policies you advocate for could be internal ones (just within a specific department or health care setting) that ensure quality care and compliance. Or they could be external policies (local, state, or federal) that may have more wide-ranging effects on best practices and regulations. Professional Context As a master’s-prepared nurse, you have a valuable viewpoint and voice with which to advocate for policy developments.
· As a nurse leader and health care practitioner, often on the front lines of helping individuals and populations, you are able to articulate and advocate for the patient more than any other professional group in health care. This is especially true of populations that may be underserved, underrepresented, or are otherwise lacking a voice. By advocating for and developing policies, you are able to help drive improvements in outcomes for specific populations. The policies you advocate for could be internal ones (just within a specific department or health care setting) that ensure quality care and compliance. Or they could be external policies (local, state, or federal) that may have more wide-ranging effects on best practices and regulations.
·
·
Scenario The analysis of position papers that your interprofessional team presented to the committee has convinced them that it would be worth the time and effort to develop a new policy to address your specific issue in the target population. To that end, your interprofessional team has been asked to submit a policy proposal that outlines a specific approach to improving the outcomes for your target population. This proposal should be supported by evidence and best practices that illustrate why the specific approaches are likely to be successful. Additionally, you have been asked to address the ways in which applying your policy to interprofessional teams could lead to efficiency or effectiveness gains. This assessment will build upon your previous Analysis of Position Papers for Vulnerable Populations assessment. If, for some reason, you wish to change your specific issue or target population, contact your faculty for approval. Instructions For this assessment, you will develop a policy proposal that seeks to improve the outcomes for your chosen health care issue and target population. The bullet points below correspond to the grading criteria in the scoring guide. Be sure that your assessment submission addresses all of them. You may also want to read the Biopsychosocial Population Health Policy Proposal Scoring Guide and
Guiding Questions: Biopsychosocial Population Health Policy Proposal [DOC]
to better understand how each grading criterion will be assessed.
· Propose a policy and guidelines that will lead to improved outcomes and quality of care for a specific issue in a target population.
· Advocate the need for a proposed policy in the context of current outcomes and quality of care for a specific issue in a target population.
· Analyze the potential for an interprofessional approach to implementing a proposed policy to increase the efficiency or effectiveness of the care setting to achieve high-quality outcomes.
· Communicate proposal in a professional and persuasive manner, writing content clearly and logically with correct use of grammar, punctuation, and spelling.
· Integrate relevant sources to support assertions, correctly formatting citations and references using APA style.
·
Length of proposal: 2–4 double-spaced, typed pages, not including title page or reference list. Your proposal should be succinct yet substantive. No abstract is required.
·
Number of references: Cite a minimum of 3–5 sources of scholarly or professional evidence that support the relevance of or need for your policy, as well as interprofessional considerations. Resources should be no more than five years old.
·
APA formatting: Use the
APA Style Paper Template [DOCX]
. An
APA Style Paper Tutorial [DOCX]
is also provided to help you in writing and formatting your proposal.
RUBRIC
· Competencies Measured By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and scoring guide criteria:
· Competency 1: Design evidence-based advanced nursing care for achieving high-quality population outcomes.
· Propose a policy and guidelines that will lead to improved outcomes and quality of care for a specific issue in a target population.
· Competency 2: Evaluate the efficiency and effectiveness of interprofessional interventions in achieving desired population health outcomes.
· Analyze the potential for an interprofessional approach to implementing a proposed policy to increase the efficiency or effectiveness of the care setting to achieve high-quality outcomes.
· Competency 3: Analyze population health outcomes in terms of their implications for health policy advocacy.
· Advocate the need for a proposed policy in the context of current outcomes and quality of care for a specific issue in a target population.
· Competency 4: Communicate effectively with diverse audiences, in an appropriate form and style, consistent with organizational, professional, and scholarly standards.
· Communicate in a professional and persuasive manner, writing content clearly and logically with correct use of grammar, punctuation, and spelling.
· Integrate relevant sources to support assertions, correctly formatting citations and references using current APA style.
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