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NURS 6050 Discussion 1: Evidence Base in Design

DQ :Improving Social Determinants of Health Act

Week 7 Discussion: First Response :  Improving Social Determinants of Health Act

of 2021

Hello Diana,

I am delighted that you chose to highlight a bill seeking to improve the Social
Determinants of Health (SDoH). I think it is key to numerous disparities in access and delivery
of healthcare. According to the Center for Disease Control and Prevention [CDC] (n.d.), SDoH
are the conditions in the place we live, learn, work, and play which affect a wide range of health
and quality of life risks and outcomes.

Like you pointed out, Healthy People 2030 (n.d.) breaks down SDoH and groups them
into economic stability, education access and quality, healthcare access and quality,
neighborhood and built environment, and social and community context. Without breaking them
down further, these discrete areas directly impact our functioning, our quality of life, as well as
our health risks. It is therefore gratifying to note that this senate bill (S. 104), “Improving Social
Determinants of Health Act of 2021”, is a proposal to authorize the CDC to carry out
implementation of some SDoH programs. I am also thrilled that congressional policymakers see
and agree on the need to “create social, physical, and economic environments that promote
attaining the full potential for health and well-being for all” (ISDOH, 2021).

Many nursing organizations have urged congress to hurry up and pass this bill into law.
Looking at the house version of this bill (H.R 379), the National Association of School Nurses
[NASN] (2021) argued that it will not only improve health outcomes and health inequalities, but

it will also increase the capacity of public health agencies and communities to boldly address


Center for Disease Control and Prevention [CDC] (n.d.) Social determinants of health: Know
what affects health. Retrieved July 14 2021, from
Health People 2030. (n.d.). Social determinants of health. Retrieved July 14 2021, from
Improving Social Determinants of Health Act [ISDOH], S.104,117th Cong. (2021).

National Association of School Nurses [NASN]. (2012). The Improving the Social Determinants
of Health Act. Retrieved July 14, 2021, from
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1 year ago
Eucharia Ofokansi
RE: Discussion – Week 7

Discussion 1: Evidence Base in Design

Proposed health policy: Healthcare Workforce Resilience Act, 2021

The Healthcare Workplace Resilience Act is geared towards enhancing this country’s
nurse and physician workforce during the covid-19 crisis by recapturing unused immigrant visas
for professional nurses and physicians (HWRA, 2021). The bill, sponsored and introduced by
Senator Richard Durbin on March 25, 2021, and co-sponsored by 5 others, has been read twice
on the floor of the senate and referred to the Committee on the Judiciary. The objective of the
bill is to contribute to addressing the severe shortage of healthcare workers (mainly nurses and
physicians) with the corona virus pandemic in view.

Prior to the advent of the corona virus epidemic, there was already an alarming shortage
of nurses. On the international front, the International Council of Nurses, who had all along been
alerting the international community on this trend, used its policy brief to highlight how heavy
workloads, insufficient resourcing, burnout and stress related to the pandemic response are
driving a growing numbers of nurses to leave the nursing profession (ICN, 2021). It turned out
that, while the media attention during this pandemic was focused on matters like news of
shortages of ventilators, tests, and personal protective equipment, the rapidly dwindling nursing
workforce went largely unnoticed (Lynch et al., 2021).

The nursing staff shortage was evident in all categories of direct patient care – from the
ICUs (the critical center of covid-19 response) to nursing homes. Xu et al. (2020) highlighted the
nursing home dilemma by which, in the absence of appropriate nursing staff, they may not be
able to fulfill the requirement of infection control even under the risk of monetary penalties. We
witnessed how the first wave of the pandemic got disastrous for nursing homes. Xu et al. feared
that the availability of high-quality direct care workers will become more critical as many states
are reopening their economy and lifting bans on visitors to nursing homes. It makes economic

and safety sense, according to the American Nurses Association (n.d.), for federal and state
governments as well as healthcare facilities to pay attention to appropriate staffing levels. ANA
reasoned that doing so will reduced mortality rates, reduce length of patient stays and reduce
preventable events like falls and infections.

According to ANA (n.d), flexible staffing plans are a huge factor in successfully
accomplishing the goal of coping with the full weight of the healthcare system – with respect to
staffing. The Healthcare Workforce Resilience Act, if passed, will be a commendable
government contribution at the federal level to the nursing staff shortage which is threatening to
cripple our healthcare system. So, HWRA is a proposed policy that has my valued support.


American Nurses Association. [ANA]. (n.d.). Nurse Staffing Crisis. Retrieved July 11, 2021,
from https://www.nursingworld.org/practice-policy/nurse-staffing/nurse-staffing-crisis/
Healthcare Workforce Resilience Act [HWRA], S. 1024, 117 th Cong. (2021).
International Council of Nurses [ICN] (2021). Policy brief: The global nursing shortage and
nurse retention. Retrieved July 12, 2021, from
Lynch, J., Evans, N., Ice, E., & Costa, D. K. (2021). Ignoring nurses: Media coverage during the
covid-19 pandemic. Annals of American Thoracic Society.

Xu, H., Intrator, O., & Bowblis, J. R. (2020). Shortages of staff in nursing homes during the
covid-19 pandemic: What are the driving factors? Journal of the American Medical
Directors Association, 21(10), 1371–1377. https://doi.org/10.1016/j.jamda.2020.08.002

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1 year ago
Crystal Dodson Walden Instructor Manager
RE: Discussion – Week 7
Great post, Yukay!  What is the importance of basing health policies on evidence?
Dr. Dodson

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1 year ago
Eucharia Ofokansi
RE: Discussion – Week 7
I believe, Dr Dodson, that it is crucial that we base public policies, especially healthcare
policies, on sound evidence versus basing them on party ideology or the whims of interest groups
or even common sense which could mean different things for different persons or groups.

Milstead and Short (2019) recommended adapting a process model like evidence-based practice
(EBP) in the policy arena. They opined that it facilitates rule making as it provides an organized
framework for problem-solving. They are encouraged by the fact that it combines evidence with
expert opinion and stakeholder values and ethics to leverage policy discussion and negotiation.
Evidence Informed Health Policy (EIHP) – an adaptation of EBP – is said to facilitate decision-
making in all phases from regulation promulgation, through rollout and implementation, to
evaluation (Milstead & Short, 2019).

EBP may be the right approach to fashioning a public health policy, but Chandra and
Baicker (2017) call for caution in their use. They argue that even a rich body of evidence does
not guarantee that a policy will achieve its goals. The key here is expediency – what is needful
and what is fitting. Policy choice is as important as evidence.


Chandra, A. & Baicker, K. (2017). Evidence-based health policy. New England Journal of
Medicine, 377 (pp. 2413-2415). https://www.nejm.org/doi/full/10.1056/NEJMp1709816
Milstead, J. A., & Short, N. M. (2019). Health policy and politics: A nurse’s guide (6th ed.).
Burlington, MA: Jones & Bartlett Learning.

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1 year ago
Lance Nesle
RE: Discussion – Week 7

Hi Eucharia! Thank you for your informative post!
I agree that during the Covid-19 pandemic, the healthcare workforce shortage only
became worse as physicians and nurses alike left the profession because of the fear of
contracting the virus and bringing it home to their families and the worsening,
exhausting situation that they were in because of the virus. The government has
implemented several policies to address the nursing shortage – allowing nursing
graduates to practice as nurses, reactivate licenses, enable nurses to practice across
state lines, and incentivize nurses to serve in the most affected areas (Spetz, 2020). I
believe and support the Healthcare Workforce Resilience Act and its positive effect on
our workforce if it passes.
I would also like to share an article I came across as I was researching the nursing
shortage. Chen (2019) said, “There is no ‘nursing shortage.’ There’s just a good
nursing job shortage.” She mentioned that nurses are getting burned out and leaving
the profession due to the circumstances they are “trapped in” because of the
unwillingness of the facilities and hospital to staff appropriately. I used to work in a
hospital where they were so quick to downsize and send a staff home whenever we
discharge a patient but gives our floor two-fold of admissions afterward, leaving the
remaining staff burdened with a heavy workload. I have seen colleagues left to pursue
an entirely different profession because they felt undervalued as nurses.
I fully support the Healthcare Workforce Resilience Act. However, I also hope we
will figure out a solution for a standardized nurse-patient ratio and a resolution to the
high turnover rate of healthcare professionals.

Chen, M. (2019, August 7). There is no ‘nursing shortage.’ There’s just a good
nursing job shortage. The Nation. https://www.thenation.com/article/archive/health-
Spetz, J. (2020, March 31). There are not nearly enough nurse to handle the surge of
coronavirus patients: Here’s how to close the gap quickly. Health Affairs.

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1 year ago
Jennifer Martin
RE: Discussion – Week 7
Hi Lance,

Thank you for your enlightening post. I did not realize there is a fear amongst
doctors about reporting mental health issues for themselves. Stigma and mental health
are still real, and it causes a lot of unnecessary negative consequences. As medical
professionals, we have a lot of empathy for our patients, and at the end of the day, we
have taken on our patient's pain and problems. Unfortunately, our empathy for our
patients can make us burn out if we don't care for ourselves (How to Overcome Barriers
to Empathy in Health Care, n.d.)—taking down the barriers that prevent medical professionals
from seeking help during their time of need. A recent article pointed out that suicide is the 10th
leading cause of death in the United States, and physicians have the highest suicide rate of any
profession in the U.S. An estimated 300 to 400 doctors kill themselves each year, a rate
of 28 to 40 per 100,000 or more than double that of general population (Anderson,
2018). This alarming fact is evidence of the need for the Dr. Lorna Breen Health Care Provider
Protection Act.

Anderson, P. (2018, May 8). Doctors’ Suicide Rate Highest of Any Profession. WebMD.

How to Overcome Barriers to Empathy in Health Care. (n.d.). Greater Good. Retrieved
July 15, 2021, from
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