Advocating for the Nursing Role in Program Design and Implementation

Nurses identify new ways to provide high-quality care with the necessary education and training to facilitate purposeful changes or innovation for improved patient and population health outcomes (Cusson et al., 2020). Due to their unique background, they can provide constructive feedback and help create and even lead the design of innovative health care spaces. This study explains nurses’ roles in developing, designing, and implementing programs that promote optimal healthcare.

Advocating for the Nursing Role in Program Design and Implementation

Interviewer: Tell us about a healthcare program within your practice. What are the costs and projected outcomes of this program?

Responder: The health program within my practice I advocate for is a personalized care program called Wilderness/Adventure Drug Rehab program which will include a drug detox program, residential drug rehab, and outpatient drug rehab. Addiction recovery is an adventure in itself, and hence recovery process doesn’t have to be boring.

By combining outdoor activities with traditional therapy and counseling, clients experience the physical and emotional benefits and rid themselves of harmful drug and alcohol abuse behaviors, leading to a more balanced lifestyle (Harper et al., 2019). This program will also focus on older adults as they are at higher risk of depression, leading to a spiral of decline.

With the help of professionals, they will get guidance on basic outdoor survival and therapeutic growth. Experiences like this may benefit older adults facing serious challenges who want to approach them differently. The actual cost per person is estimated to be $500 to $600 per day for weeks or months (Magazine, 2020). As it is a new modality, insurance companies will start recognizing and authorizing its coverage, but it might be a lengthy process.

Interviewer: Who is your target population?

Responder: This healthcare program targets the age group of eleven to twenty-nine years old and older clients sixty-five and above. Experiences like this may benefit older adults who are facing serious challenges and want to approach them in a new way.

Interviewer: What is the nurse’s role in providing input for the design of this healthcare program? Can you provide examples?

Responder: Nurse leadership in most mental health institutions contributes significantly to the design of a drug abuse program, from intake unit assignment criteria to treatments and discharge. For example, if an injury does occur, first aid may be required. First aid may only be able to stabilize the individual until professional help arrives, depending on the severity of the event and related injury. The good news is that many first-aid skills are already covered in nurse training.

Interviewer: What is your role as an advocate for your target population for this healthcare program? Do you have input into design decisions? How else do you impact design?

Nurses have a more significant influence in designing the program because they are familiar with and understand the patient’s needs, such as making appropriate medical decisions. For example, a nurse can incorporate activities based on the needs of adolescents and older clients. Like exercise or music therapy in an open environment for older clients will positively impact recovery. More importantly, patients must be educated on the importance of participating in the program, an evidence-based approach that has been shown to be effective in reducing relapse in the long run.

Interviewer: What is the role of the nurse in healthcare program implementation? How does this role vary between the design and implementation of healthcare programs? Can you provide examples?

Respondent: The nurse’s role in implementing healthcare programs is to coordinate and monitor activities, particularly when multiple age groups are involved. Upon assessment of a patient, if a problem does arise, make sure they are solved to the best of her knowledge, or it has to be passed on to the higher healthcare worker. It is crucial to assess the implementation outcome using quantifiable data to determine whether the goal has been achieved or if revisions are necessary. (Miller, 2017)

Interviewer: Who are the members of a healthcare team that you believe are most needed to implement a program? Can you explain why?

Respondent: A multidisciplinary team is involved in healthcare programs to ensure the successful completion of the program’s objectives. Doctors, physician assistants, nurses, pharmacists, dentists, technologists and technicians, therapists, and rehabilitation specialists make up most of the healthcare team composition, but they are not the only ones. Providers of emotional, social, and spiritual support, patient navigators, office and support personnel, and community health workers should also be involved

Advocating for the Nursing Role in Program Design and Implementation References

  • Cusson, R. M., Meehan, C., Bourgault, A., & Kelley, T. (2020). Educating the next generation of nurses to be innovators and change agents. Journal of Professional Nursing, 36(2), 13– 19. https://doi.org/10.1016/j.profnurs.2019.07.004
  • Harper, N., Mott, A., & Obee, P. (2019). Client perspectives on wilderness therapy as a component of adolescent residential treatment for problematic substance use and mental health issues. Children and Youth Services Review, 105, 104450. https://doi.org/10.1016/j.childyouth.2019.104450
  • Magazine, U. (2020, January 29). Does science support the ‘wilderness’ in wilderness therapy?
  • Undark Magazine. https://undark.org/2020/01/29/does-science-support-the-wilderness-in-wilderness-therapy/

Advocating for the Nursing Role in Program Design and Implementation Example 2

The Care at Home (CAH) Medicaid Waiver Program

  • Tell us about a healthcare program, within your practice. What are the costs and projected outcomes of this program?

The Care at Home (CAH) Medicaid waiver program will be a state-run community-based program that allow severely disabled children to access home care and healthcare coverage within the community. The waiver program is based on the proposition that children with disabilities should have a proper support to enable them to become active participants in determining their future. The waiver program is a federally approved deferral of the Medicaid rules to enable disabled children to remain home and still benefit from the Medicaid coverage (Yingling et al, 2019).

Typically, such a waiver program disregards the guardian’s or parent’s resources and income when determining the eligibility for the means-tested program. This allows parents to benefit from services that they would otherwise not benefit from due to their low-income levels. The program the program is funded with a mix of both state and federal dollars and overseen by the state health agency. It allows physically disabled children to remain with their families at home while receiving healthcare, nursing and vehicle and home modifications.

  • Who is your target population?

This program benefits families that struggle with meeting their healthcare costs: drug coverage for disabled children and uncovered therapies. It especially targets autistic children and at-risk infants because of their low survival rates.

  • What is the role of the nurse in providing input for the design of this healthcare program? Can you provide examples?

The program spans from financing home care for children with disabilities to ensuring an adaptive, healthy and safe home environment for the children. As such, nurses are directly involved in ensuring safety and wellbeing of the beneficiaries by designing their living environment and ensuring those environments respond to each child’s unique disabilities.

Depending on the child’s specific needs, the nurse is responsible not only for care delivery but also for home modification. Considering home modification may be overwhelming to some families, the nurses are directly involved in advising on the necessary changes that parents or guidance need to make within the home environment to guarantee safety and wellbeing of the beneficiary children.

Key to the nurses’ role is ensuring that the home environment is accessible so that those using wheelchair can easily and safely get in and out of the rooms. The nurse would then present these environment modification requirements to the program design committee to justify the waiver and support other crucial decisions regarding the program. For instance, disabled children whose home environment require more modifications are prioritized as beneficiaries compared to those whose home environment require lesser modification. The idea is that those who require more home modification would need more resources, and are therefore eligible for the program’s support.

The nurse also plays a key role in designing the respite component of the program. Because respite is provided at home by the nurses or other healthcare professionals, these caregivers will help in design the schedule for respite services as well as the resources required for those services. Typically, the respite services relieve families from the challenges associated with care or deliver the care when the families are not around.

Because the nurse services are the most needed and most difficult to access as a result of the shortage of nurses (Marć et al 2019), nurses’ input is required in terms of designing the care shifts depending on the needs of each beneficiary. More importantly, the nurses will play a significant role in the program evaluation stages, where they provide feedback to the program advisory committee on the program’s impact and any points for improvement.

  • What is your role as an advocate for your target population for this healthcare program? Do you have input into design decisions? How else do you impact design?

Information is a key resource for advocates; they need to have facts about the program and how it addresses the children’s special needs. Typically, the advocate is responsible for knowing the when, how, who and where about the program; documenting the information and using them as references during the program design process. Similarly, the advocate must be extremely aware of the special needs involved, including the relevant federal laws so that they can inform the program design process form a legal standpoint.

The advocate is also responsible for liaison between parents and the service providers. They are responsible for ensuring that there is a good relationship between the caregivers and the parents because sometimes it is easier for the two set of individuals to fall into a blame game whenever something is not right. Therefore, it is the advocate’s role to ensure that the disappointments and bureaucracies involved in the program does not impede the relationship between the program managers, caregivers and parents. They are the program’s vision keepers and are responsible for advocating for meeting the kid’s needs regardless of the bureaucracies involved.

  • What is the role of the nurse in healthcare program implementation? How does this role vary between design and implementation of healthcare programs? Can you provide examples?

Community health nurses’ role in implementing the program spans from protecting, promoting and preserving the children’s health. As per Barbero et al (2021), their roles are based on various fundamental principles including educating patients on making healthy choices and maintaining healthy lifestyles and providing direct care.  the nurses primarily focus on delivering the children’s health needs. They coordinate with physicians and other health workers to ensure the children receive care that is equally as good as what they would receive in the hospital.

When they make home visits, they assess the children’s health conditions, deliver wound care, check vital signs (e.g. blood pressure) and manage prescription medicine when a child needs it. Furthermore, they are responsible for educating families and other community members on maintaining the children’s health and wellbeing (Assefa et al, 2019). Nurses also act as the gatekeepers for the children’s rights and protection, primarily protecting them from child abuse, sexual harassment, poor nutrition and teen pregnancy.

These roles are different from their program design roles in many senses. For instance, their program design roles involve identifying when to visit each home and how long they should take in each home. Contrastingly, the implementation role involves determining what they do in every visit, including conducting medical checks on the patients.  In short, program design mainly entails the where, how and when the services are delivered, while program implementation roles entail what services are delivered and by who.

  • Who are the members of a healthcare team that you believe are most needed to implement a program? Can you explain why?

Medicaid senior leaders are important in the implementation process because they must communicate with the service providers about the program’s success and areas of improvement. According to Schwartz et al (2018), keeping the Medicaid senior leadership will help manage expectations and enhance the leader’s support.

Other state agencies may also be important in the implementation process. This is especially for the purpose of gaining feedback and identifying any potential partnership benefits between the care management team and the program (Assefa et al, 2019). For example, the state’s Department of Health Disability Program   might need to partner with the program managers in exploring other opportunities for enhancing the program.

The providers should also be involved in the implementation stage to ensure they buy in the idea. This can be done by forming provider advisory groups or board that provide feedback on the program strategies, guidelines and measures (Barbero et al, 2021). They may also help in developing quality improvement goals based on reported performance.

References

  • Assefa, Y., Gelaw, Y. A., Hill, P. S., Taye, B. W., & Van Damme, W. (2019). Community health extension program of Ethiopia, 2003–2018: successes and challenges toward universal coverage for primary healthcare services. Globalization and Health, 15(1), 1-11. https://link.springer.com/article/10.1186/s12992-019-0470-1
  • Barbero, C., Mason, T., Rush, C., Sugarman, M., Bhuiya, A. R., Fulmer, E. B., Feldstein, J., Cottoms, N. & Wennerstrom, A. (2021). Processes for Implementing Community Health Worker Workforce Development Initiatives. Frontiers in Public Health, 9, 828. https://doi.org/10.3389/fpubh.2021.659017
  • Marć, M., Bartosiewicz, A., Burzyńska, J., Chmiel, Z., & Januszewicz, P. (2019). A nursing shortage–a prospect of global and local policies. International Nursing Review, 66(1), 9-16. https://doi.org/10.1111/inr.12473
  • Schwartz, P. M., Kelly, C., Cheadle, A., Pulver, A., & Solomon, L. (2018). The Kaiser Permanente Community Health Initiative: A decade of implementing and evaluating community change. American Journal Of Preventive Medicine, 54(5), S105-S109. DOI:https://doi.org/10.1016/j.amepre.2018.02.004
  • Yingling, M. E., Bell, B. A., & Hock, R. M. (2019). Comparing neighborhoods of children with autism spectrum disorder in a Medicaid waiver program and a state population, 2007–2015. Psychiatric Services, 70(11), 1034-1039. https://doi.org/10.1176/appi.ps.201800479