Health Care in the United States Nursing’s Challenge.

SMSU Department Of Nursing

NURS 300
Module 11

Health Care in the United States
Nursing’s Challenge: To Continue to Evolve

Description of Module: This module will provide the student with an opportunity to use a case
study to discuss the objectives for this module.
Module Objectives:
1. Discuss cost-containment efforts and their effect on nursing practice
2. Discuss the roles of nurses in healthcare teams and in managing costs
3. Describe some major challenges facing the profession of nursing in the current
healthcare environment
4. Integrate patient-centered care by an interdisciplinary team into an individual’s care
model
5. Assess health literacy within case study
6. Articulate the role of the nurse as leader and activist
Essentials: I, II, V, VIII, & IX
QSEN Competencies: Patient Centered Care, Teamwork and Collaboration, & Safety
Readings
Black, B. P. (2020). Professional nursing: Concepts, and challenges (9 th ed.). St Louis,
MO: Elsevier.
Chapter 14: Health Care in the United States
Chapter 16: Nursing’s Challenge: To Continue to Evolve
Blegen, M. A., Goode, C. J., & Park, S., H. (2013). Baccalaureate education in nursing and
patient outcomes. JONA, 43(2), 89-94. doi:10.1097/NNA.0b013e31827f2028. Retrieved
from
https://www.researchgate.net/publication/234123932_Baccalaureate_Education_in_N
ursing_and_Patient_Outcomes
Clark, C. M. (2015). Conversations to inspire and promote a more workplace. American Nurse
Today, 10(11), 18-22.
Eadie, C. (2014). Health literacy: A conceptual review. Med-Surg Matters, 23(1), 1-13.
Laschinger, H., K., S., & Wong, C. A. (2014). Resonant leadership and workplace
empowerment: The value of positive organizational cultures in reducing workplace
incivility. Nursing Economic$, 32(1), 5-44.
Resources
American Psychological Association. (2020). Publication manual of the American
Psychological Association (7 th ed.). Washington, DC: APA

Optional Readings
Ramsey, S. (2015). Enemies of ethics equals environmental exodus, part 2. Plastic Surgery
Nursing, 35(3), 108-117. Retrieved from
http://www.nursingcenter.com/pdfjournal?AID=3183579&an=00006527-201507000-
00005&Journal_ID=496448&Issue_ID=3183560

(You may also refer back to NURS 300 Module 3 readings/resources regarding incivility,
bullying, and workplace violence.)
__________________________________________________________________________
Assignment
1) Utilize Readings/Resources

2) Discussion 5 (10 points)
a. Post a response to all the questions about the case study below.  Be sure to follow
the discussion rubric guidelines found in the NURS 300 syllabus, Appendix B. I will
also provide the rubric below. Please note the due dates for postings on the NURS
300 calendar. It is important to know that as your instructor, I am sensitive to your
busy schedules with family, work, and school. There are due dates for postings,
created to allow productive discussions between yourself and your peers. If you ever
feel that meeting a due date creates a significant challenge for you, please let me
know and we will discuss an alternative plan for you. If I do not hear from you, the
grading criteria for late submissions will be followed.
b. After the student completes their initial posting, and has responded to at least two
other students, the student will self-grade their discussion using the discussion quiz,
located within NURS 300 Module 11 content area. The student’s self grade will be
reviewed by the course instructor for accuracy, and adjusted as needed.

Please respond to all of the questions below:
Isabella is a 4-year-old girl who showed signs of a viral illness that did not seem to get better for
2 days. Her mother, Sonia Ramirez, took her to a local walk-in clinic, where she was reassured
that Isabella had a bad cold but would recover within a few days. She was given a teaching
sheet about viral illnesses that, after getting home, she realized she could not understand. The
next day, however, Isabella was barely responsive and had numerous dark purple spots. Her
mother rushed her to a local emergency room. Isabella was intubated and airlifted via
helicopter to a major medical center, where she was diagnosed with meningococcemia, a life-
threatening infection.
Isabella subsequently had bilateral amputations of her legs for gangrene secondary to poor
perfusion. After a long hospitalization, she was transferred to a rehabilitation facility where she

was fitted with prosthetic legs. Sonia quit her job to stay with Isabella throughout her illness
and recovery. When Sonia quit her job, her insurance benefits ended, and she could not afford
to pay for continuing insurance coverage.
Discuss all of the questions below:
Isabella's health care bills were enormous.
 What is the role of private insurance in paying these bills?
 What is the role of public assistance?
 What is the role of the nurse in containing these costs?
 Do you feel that health literacy played a role in the patient’s outcome?
 If so, how?
 Do you think Sonia should have continued working through Isabella's illness in order to
continue insurance coverage?
 Would you feel differently about who is accountable for paying the bills for caring for
this patient if the patient had been a morbidly obese adult who lived with unhealthy
eating and exercise habits?
Discuss these questions as well:
You are a nurse working in this rehabilitation facility. You have a peer in this facility who
disagrees with your feelings about Isabella’s current employment decisions. This peers make
derogatory, demeaning statements about your feelings for this situation.
 Is this a display of incivility?
 If so, what are some possible destructive consequences of this incivility, including the
financial implications for the patient and rehabilitation facility?
 How could each of the following nursing roles advocate for Isabella: educator, manager,
researcher, activist?
 How could the contemporary care delivery model of patient-centered care, used by an
interdisciplinary team, effect the care and outcomes for Isabella?
 What is the RN’s role on that team?

Congratulations! You have completed the last discussion for this course. I hope you have
enjoyed learning together through your discussions.
Updated 12-5-19
_____________________________________________________________________________

Discussion Evaluation Rubric

Please note: Initial assigned discussion posts are due by 11:59 PM on Thursday of the assignment week
and a response to at least two other people is due by 11:59 PM on the following Sunday. Any discussion
posts after the 11:59 PM deadline on Sunday will be given zero credit. It is expected that students
actively participate in the discussion forums. Each student is expected to contribute one initial
discussion posting for each assigned discussion question, read all student’s initial discussion posts, and
contribute participation discussion responses to at least two other student’s posts.
Students self-grade their discussion assignment by the following Thursday at 11:59 PM under the
Assessment/Quiz section in the NURS 300 course-room.
The faculty member will review the student’s self-grades for accuracy and reserves the right to adjust
any grades.
Read the entire rubric below – this will guide your discussion grade.
10 points are possible for each discussion and will be assigned as follows:

Rating Points Mechanics of Posting
2 Complete sentences, well organized, grammatically correct and free of spelling errors (have used spell

check to help ensure this)

1.5 Complete sentences, well organized, but some (2 or less per paragraph) grammar and/or spelling errors
1 Complete sentences, comprehensible, organization could be improved to present a more coherent
argument or statement, has three or more grammar and/or spelling errors per paragraph
0 Poor sentence structure inadequate organization, several grammar and/or spelling errors; run-on

sentences.
Initial discussion posting not completed by Sunday night
Rating Points Participation in Discussion
2 Makes postings on at least two different days (Thursday initial post due by 11:59PM, response to two

peer postings are due by Sunday at 11:59PM). Responds to at least 2 peers’ postings.
1.5 Late first post and/or posts everything 1 day only. Responds to at least 2 peers’ postings
1 Responds to only 1 peer’s posting
0 Does not reply to or provides minimal comments and information to other participants.

Initial discussion posting not completed by Sunday night
Rating Points Content of Initial Posting
2 Initial posting thoroughly addresses all parts of the discussion, is clearly and concisely stated, and
demonstrates that the content was appropriately reviewed, understood, and synthesized. At least two
references are presented for student’s initial posting.
Posting includes a question related to the topic to stimulate further discussion. Posts by 11:59PM
Thursday.

1.5 Initial posting addresses most, but not all, of the discussion. Comments are reasonably organized and
demonstrate adequate familiarity and analysis of the content and posts by 11:59PM Thursday
1 Initial posting shows limited knowledge and evaluation of the topic or limited to information that could

be derived from prior posts and/or late initial post

0 Message was unrelated to discussion.

Initial discussion posting not completed by Sunday night

Rating Points Critical Thinking Evidenced by Replies to Peer’s Postings
2

In replies to peer’s postings, offered a critical analysis of an existing posted idea or introduced a
different interpretation to an existing idea. Critical analysis must be substantial, including support by a
valid resource/reference, and may include a story about a related experience, a probing question, or
point(s).

1.5 Agreed or disagreed with existing discussion and provided limited justification/explanation
1 Agreed or disagreed with existing discussion but provided no justification/explanation or support
0 Provided no evidence of agreement or disagreement with existing discussion.

Initial discussion posting not completed by Sunday night
Rating Points APA Format

2

Provides evidence-based, scholarly resources to support one’s position on the posed topic or idea;
References for initial posting are correctly & accurately presented in APA format — uses in-text
referencing within the posting

1.5 Provides evidence-based, scholarly resources, but uses incorrect APA Format for in-text referencing
1 Provides evidence-based, scholarly references and incorrect APA Format OR provides non-scholarly

references with correct APA Format in-text

0 Provides no scholarly reference to support position/ideas in postings/discussion AND/OR uses no APA

format.
Initial discussion posting not completed by Sunday night

Rubric authored by Laura M. Schwarz, adapted by Nancyruth Leibold, further adapted by Laurie
Johansen/Nancyruth Leibold, and further adapted by Laurie Johansen