How do I answer the following posts on Population Health and Care Equity – Concept

How do I answer the following posts on Population Health and Care Equity – Concept analysis competency. Please be as detailed as possible. Please provide a list of references no older than 5 years of age for each answer separately. Answer each post separately. Thank you. Post 1: Viktoriia Population health is not merely the health status of a group of individuals but a much broader term that includes outcomes and determinants of health and associated interventions and policies (Kindig & Stoddart, 2003). Populations can be geographic regions like communities or other types of groups like ethnic groups, disabled people, or employees of a particular organization. Centers for Disease Control and Prevention (2020) emphasizes that population health brings up essential health concerns and focuses on the allocation of needed resources to address the issues that provoke poor health conditions within the population. The knowledge and skills of the population’s health can be utilized to foster a culture of health and wellness instead of solely treating illness. An essential priority in reaching population health is eliminating or at least reducing health disparities among various population groups. Advanced practice nurses (APNs) can serve as change agents in achieving population health by incorporating the aspects of community-based care and disease management, improving access to care, and reducing disparities. Saha et al. (2017) highlight six foundational concepts intended to support healthcare professionals, including APNs and nursing leaders, to come up with pathways for their organizations to optimize the health and well-being of their patients and the communities they serve. As an initial step, a healthcare professionals must realize that health and well-being develop over a lifetime, starting to form before birth and long before disease appears. For example, childhood obesity is associated with an increased risk for cardiometabolic disease in adulthood (Weihrauch-Blüher et al., 2019). As a result, APNs can provide education and guidance on healthy eating from early childhood to decrease health issues later in life. Saha et al. (2017) specify that social determinants play an essential role in the health and well-being of individuals. The researchers pay special attention to place as a determinant of health and equity. The unfavorable conditions in which people live, grow, and work may improve or worsen their ability to attain and maintain their optimal level of health. Individuals who are exposed to racism, violence, and inadequate housing are more likely to be in poor health and experience premature death (Gomez et al., 2021). APNs can address social determinants of health by advocating for policies that impact people’s lives and provide culturally competent care. Working in underserved communities can improve patient care access gaps to healthcare. There is a well-known shortage of physicians willing to work with the medically underserved, and APNs can undoubtedly expand healthcare service delivery in those areas and make the needed changes for the best patient outcomes. Another foundational concept Sara et al. (2017) proposed is that the health system can appropriately respond to the main demographic shifts of our time. Rising rates of chronic disease, mental health problems, and inequity are the major issues healthcare systems are facing nowadays. These issues considerably affect health outcomes and costs and should not be managed at the individual level. Healthcare organizations and their leadership teams need to unite to improve the health of populations, proactively addressing the factors of poor health outcomes by embracing innovative financial models and utilizing already existing assets. Sara et al. (2017) rightly observe that health care plays a vital role in creating health and well-being, a crucial part of the puzzle. However, the most efficient and sustainable way to achieve population health is to partner effectively with stakeholders that hold other pieces of that puzzle. The COVID-19 pandemic was a devastating phenomenon, affecting every community in one way or another. Data shows it primarily negatively influences socially disadvantaged and underserved communities worldwide (McNeely et al., 2020). The major factors that were found to be directly related to adverse health outcomes were the social determinants of vulnerable populations. This was thought to be related to the fact that individuals living in disadvantaged communities usually have higher rates of comorbidities, are more prone to exposure to the virus at work, and are likely to have limited access to health care (McNeely et al., 2020). As far as the nursing community is concerned, COVID-19 has done a lot of mental and physical damage, some of it is permanent. For example, many nurses had to retire early as they could no longer keep up with the heavy patient load and mental demands of the job. The surveys during the COVID-19 pandemic revealed unacceptably high levels of stress and depression, raising serious concerns (Rosa et al., 2020). The COVID-19 pandemic emphasizes the importance of a population health approach to identify and implement strategies to improve the health and well-being of communities. APNs and other healthcare professionals are equipped with the necessary skills, knowledge, and experiences learned from the COVID-19 pandemic to find innovative approaches to improve patient care, especially in populations in need, those facing high unemployment rates, hunger, or the threat of homelessness. APNs and many nursing leaders are well‐positioned to help reduce and alleviate health disparities through structural interventions seeking to change the social and environmental factors that sustain health and social inequalities (Brown et al., 2019). Post 2: Ashley Compared to other developed nations, the United States spends more per capita on healthcare (DeHaven et al., 2020). However, overall, our country ranks bottom regarding access to quality care, healthcare disparity, and healthcare outcomes (DeHaven et al., 2020). These dire results demonstrate how, as a nation, our healthcare system is not producing safe or quality care for all communities. As a nurse leader, it is crucial to address community-based health care, disproportioned access to quality health care, and chronic disease management with the principles of social determinants of health (SDoH) in mind to be successful. This nation has learned how COVID-19 exacerbated the inequality of SDoH in many communities (Macchi et al., 2021). As a future nurse leader, learning from and incorporating these lessons into practice is essential. To address the quality and safety of healthcare, leaders must address health’s social determinants of health as a system (DeHaven et al., 2020). Social determinants of health are the environment in which a person is born, lives, works, and matures, influencing their health (Saha et al., 2017). McCartney et al. (2019) found that communities that address the SDoH, such as access to education, safe workplaces, housing security, and equality in policy and law, have improved overall health. A nurse leader in the United States must focus on creating systematic community-based care while addressing the principles of SDoH to improve chronic disease and access to quality healthcare inequality (Saha et al., 2017). Nurse leaders must understand that to foster a successful community-based healthcare program, one must understand the culture and limitations of the community and be willing to enter the community (DeHaven et al., 2020). DeHaven et al. (2020) developed a community-based healthcare project in a low-income area by showing commitment to the community’s health and well-being and developing relationships with key leaders. Not only did the health institution go into the community to show investment, but healthcare workers who were community-based and culturally aware were installed to help those in the community gain understanding and access to healthcare where barriers once lived (DeHaven et al., 2020). DeHaven et al. (2020) found that patients better understood their healthcare through these efforts, and the healthcare institution saw a cost reduction. This future nurse leader will continue the practice of community-based medicine, understanding that to be successful in a community, the healthcare institution must be a part of it. Once a community has gained trust, the healthcare institution can help foster change to improve chronic disease management (DeHaven et al., 2020). This nurse leader will incorporate community members, such as religious organizations, with health care education to help support chronic disease management. For example, DeHaven et al. (2020) educated local church members on being peer health champions for each other. DeHaven et al. (2020) found an improvement in healthy eating habits and risk factors for cardiovascular disease. A health improvement program implemented in a religious community reduced weight and overall improved health (DeHaven et al., 2020). As the DeHaven et al. (2020) study demonstrated, improving community-based health care can improve the community’s access to health care. However, community-based health care must address the inequity of quality health care. By incorporating value-based healthcare, practitioners and institutions may be motivated to provide more equitable care (DeHaven et al., 2020). This nurse leader understands that it is imperative to incorporate advocating for policy change to improve healthcare inequities, which will be an integral part of practice in the community (Saha et al., 2017). Unfortunately, because the United States continues to have a healthcare system that lacks focus on SDoH, COVID-19 highlighted these inadequacies and inflated the burdens on the chronically ill and underserved populations (Macchi et al., 2021). Macchi et al. (2021) found that those with chronic diseases became isolated and lost the community support these patients once relied on, causing a worsening of conditions. Those who relied on community-based medicine, like home health care or hospice, could no longer receive the needed services (Macchi et al., 2021). COVID-19 demonstrated that those who relied on a community or had financial inequality would not be prioritized during the health crisis (Macchi et al., 2021). Not only did COVID-19 exacerbate the disparities of those who rely on a community for support and health care, but it also intensified the disparities of access to health care in a vulnerable community (Cole et al., 2023). Before the pandemic, Federally Qualified Health Centers (FQHCs) provided access to health care for nearly 30 million low-income patients (Cole et al., 2023). Cole et al. (2023) fund that FQHCs were the primary access point for many low-income patients during the pandemic, and even though there had been improvements in screening and management of chronic conditions like blood pressure or diabetes prior to the pandemic, during the pandemic care visits and management of conditions such as these declined. At-risk populations had worsening chronic conditions and health disparities due to the decline in care they receive (Cole et al., 2023). COVID-19 changed how people access healthcare, and telehealth became a standard form to access healthcare that had not been used as readily before (Macchi et al., 2021). During the pandemic, practitioners learned to use telehealth to triage those who required in-person services and those who did not (Joshi et al., 2021). Even though telehealth improved access to healthcare practitioners, Macchi et al. (2021) demonstrated that telehealth did not replace the need for community and the importance of social engagement, which is vital to the SDoH for a chronically ill patient. As a future nurse leader, it is essential to remember the lessons learned from COVID-19 and the importance of incorporating the SDoH into a patient’s whole plan of care. This future nurse leader plans to include telehealth to help improve access to care, but also remember that it is not the only access point for many vulnerable patients (Macchi et al., 2021). This nurse leader has discovered that it is crucial to work in partnership with community leaders, political leaders, and healthcare institutions to enable communication and organization of healthcare to address all aspects of SDoH to prevent neglecting of those who are more vulnerable in the community and the growth of health disparities (DeHaven et al., 2020). The United States continues to overlook the SDoH, which experts have documented as a crucial aspect of individual and community health (DeHaven et al., 2020). This future nurse leader plans to implement and continue to advocate a systematic approach to healthcare in order to help improve and maintain community health. Only with a commitment to the SDOH in healthcare practice can a nurse leader or future Advanced Practice Nurse be committed to the quality and safety of healthcare today. Post 3: Ryan How will you incorporate tenets of community based care, chronic disease management, access to care and disparities in care into your practice as a leader and/or Advanced Practice Nurse? While completing my RN to BSN program from Rutgers University, we were tasked with completing clinical hours for our Community Health and Public Health Nursing seminar. Given my background as an emergency medical technician and firefighter, I sought out opportunities to interact with my community on a more intimate level. I missed the fulfillment from being invited into people’s homes in their time of greatest need and helping them with everything from their medical complaints to calling their grandchildren, to figuring out how to use their brand new blood pressure machine. I pursued the advice of one of the nurse practitioners I worked with, a seasoned clinical professor, flight nurse and mobile intensive care nurse. Through her, I was connected with a paramedic who spearheaded Atlantic Mobile Integrated Health, a program dedicated to reducing 30-day re-admission rates and improving overall quality of life among discharged patients — two focus areas I was already investigating within my emergency department. The program was different from a visiting nurse since this division was completely staffed by paramedics and their services were provided free of charge. This underutilized asset was often the only follow-up or home care that many uninsured or independent older adult patients had at their disposal. I’ve discussed creating a Mobile Nurse Practitioner position at Atlantic Mobile Health once I finish this program. The utility of having a nurse practitioner in the field that can provide orders to paramedics and visit patients in their own homes would be invaluable. Many of these patients struggle with getting to the hospital or a multitude of appointments, so why not bring the practitioner to them and coordinate with their specialists? What have we learned so far from the impact of the COVID-19 pandemic on various communities and how can you incorporate those learnings into your practice as nursing leaders and/or Advanced Practice Nurses? It’s no secret that the sector of public health nursing had been chronically underfunded since the pre-COVID era. Disease prevention and health promotion has fallen by the wayside and a greater emphasis has been placed on medical care and interventions. A study by Families USA found that preventative care and screening and management of chronic diseases drastically reduced in both quantity of appointments and quality of exams from pre-COVID statistics (Isasi, 2021). They found that rates of blood pressure assessment dropped by 50 percent, cholesterol level assessment by 37 percent, colonoscopies by 88 percent and mammograms by 77 percent in the spring of 2022. This decline was precipitated by virtual primary care appointments only being offered by certain practices with patients of color facing the greatest barriers to this mode of care. Delayed or deferred care, especially in routine screenings, affects all age groups and services. There is a growing concern among pediatric providers that the decline in vaccine administration in the post-COVID period will increase disease vulnerability in the future and predispose the population to further outbreaks (Santoli, 2020). The resurgence of measles prior to the COVID outbreak following controversy over the Measles, Mumps and Rubells (MMR) vaccine demonstrates the importance of this preventative medicine. It is important that we educate our patients to make the most informed decisions for themselves. There is a stockpile of false or deceptively presented information in easy to digest online formats that instigate health misinformation that our patients are reading at home. As providers we should be keeping in touch with the most up-to-date well grounded research to optimize our care delivery. Following patient education and empowering our patients comes self-management or enabling our patients to become responsible for their own health. To optimize outcomes for our patients, we have to engage them to participate in their own care, otherwise our influence ends the second they leave our offices. Yale University’s School of Nursing conducted an analysis on self-management in patients with cancer as a chronic illness to see how they could affect levels of self-care, self-help, psychological adjustment and confidence in disease knowledge (McCorkle, 2011). Project ENABLE (Educate, Nurture, Advise, Before Life Ends) was a hands-on project that tested effects of involving an APN as a coach and educator to address symptom management and treatment decisions and to communicate with their health team. Subjective reports following the APN intervention demonstrated higher quality of life outcomes, lower depressive symptoms and a mild decrease in symptom-intensity scores and health care service use. The SNIP (Standard Nursing Intervention Protocol) implemented clinical assessments, complication monitoring and teaching of skills to patients and families by advanced practice oncology nurses. This trial managed to significantly increase survival among late-stage patients (p=.0001) and subjects reported substantial improvement in mental and physical quality of life, less uncertainty and less symptom distress. Self-management is applicable both healthy and ill individuals, and for those with chronic diseases it is a lifetime task. As nursing leaders and advanced practice nurses we have a unique ability to more intimately involve our patients in the management of their own care. We have seen the benefits that self-management provides, so we should be looking to incorporate systems that allow patients to assess their own health status and initiate treatment plans. Another study from the Yale University study incorporated this mindset into a pain management plan for cancer patients. The PRO-SELF program had patients assess their pain status and use self-administered analgesics around the clock (McCorkle, 2011). They found that patients in this program ultimately had better controlled pain levels and used their medication more appropriately than the control groups. Going forward I would be interested to see how this mentality could be expanded into other disease processes such as patients suffering from heart failure, chronic pulmonary diseases, hypertension, etc.

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