Question Components

Your Question

P – Patient or Population

Describe the most important characteristics of the patient.

(e.g., age, disease/condition, gender)

I – Intervention; Prognostic Factor; Exposure

Describe the main intervention.

(e.g., drug or other treatment, diagnostic/screening test)

C – Comparison (if appropriate)

Describe the main alternative being considered.

(e.g., placebo, standard therapy, no treatment, the gold standard)

O – Outcome

Describe what you’re trying to accomplish, measure, improve, affect.

(e.g., reduced mortality or morbidity, improved memory, accurate and timely diagnosis)

The well-built clinical question:

Type of Question

Ideal Type of Study

 Therapy

RCT

 Prevention

RCT > Cohort Study > Case Control

 Diagnosis

Prospective, blind controlled trial comparison to gold standard

 Prognosis

Cohort Study > Case Control > Case Series/Case Report

 Etiology/Harm

RCT > Cohort Study > Case Control

 Cost analysis

economic analysis

Note: Meta-analyses and systematic reviews, when available, often provide the best answers to clinical questions.

OR

AND

Main Concepts (PICO concepts)

MeSH/Subject Headings

Synonyms

Primary search term

Synonym 1

Synonym 2

P

I

C

O

Proposed Legislation

Summary/

Description

Process &

Update

My Advocacy Actions

Current

Status

of Proposed Legislation

Next Steps

State: HB 135/SB 640: Florida Kidcare Program Eligibility

Increases income eligibility threshold for coverage under Florida Kidcare program; excludes undocumented immigrant children from eligibility

9/20/21: HB Filed

10/26/21: SB Filed

9/29/21: HB

referred to Finance & Facilities Subcommittee; Healthcare Appropriations Subcommittee; and Health & Human Services Committee.

11/16/21: S 640 referred to Health Policy; Appropriations Subcommittee on Health; and Human Services; Appropriations.

Sent email thanking Representative Bartleman and Senator Hooper for sponsoring and introducing the legislation. Neither are from my district, so I wrote as a member of the Florida Association of Nurse Practitioners (FANP).

After reviewing the bill co-sponsors, I saw that my elected officials were not listed. Sent an email to my district legislators, Representative Joseph and Senator Pizzo to encourage them to co-sponsor the bill.

Signed up with Florida Senate Tracker to receive legislative updates on the status of the House and Senate bills.

Wrote a 250-word editorial for the Miami Herald praising the bill and pointing out the need to include undocumented children. It was published on 11/10/21.

I talked with co-workers at the clinic about the legislation, of which most were unaware. I was able to provide more information to those who were interested in taking action.

I’m a member of the county’s Women’s Democratic Club and talked about the legislation at our monthly meeting.

Neither of my elected legislators sit on any of these committees. I worked with FANP and Catholic Charities Immigration & Refugee Services to develop testimony about my experiences with undocumented immigrant families and children in South Florida; and worked collaboratively to develop a fact sheet comparing the health of immigrant and nonimmigrant children in Florida. Both were presented by organization lobbyists at the Health Policy Committee hearing for the Senate bill, with a request to amend the legislation to include undocumented immigrant children.

1/5/22: HB 135 was withdrawn.

3/14/22: SB 640 died in Health Policy.

Send thank you emails (as a member of FANP) to all sponsors and co-sponsors of the House and Senate bill.

I am on the Legislative Action Committee for FANP. Plan to attend meeting at the end of the session with our lobbyist to determine why the bill failed in two committees.

Work with FANP, Catholic Charities, and the bill’s legislative sponsors to research opposition to the bill and determine future plans to reintroduce a revised version.

Suggest to FANP that, moving forward, we consider forming a coalition with other nursing organizations, safety-net providers, and immigrant advocacy organizations. This would give us more resources, broader support across the state, and a more developed grassroots presence.

Federal: H.R.3149/S.1660: HEAL for Immigrant Families Act of 2021

Eliminates the 5-year wait for immigrants to enroll in Medicaid and Children's Health Insurance Program coverage; excludes undocumented children and families from eligibility

5/12/21: HR filed 5/13/21: HR referred to Subcommittee on Health

5/17/21: S filed and referred to Committee on Finance.

Sent email thanking Representative Jayapal and Senator Booker for sponsoring and introducing the legislation. Neither are from my district, so I wrote as a member of the ANA and the American Association of Nurse Practitioners (AANP).

After reviewing the 90 co-sponsors in the House and 11 co-sponsors in the Senate, I saw that my elected officials were not listed. I used GovTrack.us to send an email to my congressmen, Representative Salazar and Senator Rubio encouraging them to co-sponsor the bill; there are no Republican co-sponsors in the House or the Senate.

Signed up with the Congress.gov tracking service to receive legislative updates on the status of the House and Senate bills.

Posted my support of the legislation, a link to a fact sheet on HEAL, and a “Contact your Legislator” link on my Facebook page. I also tweeted my support of the legislation to my Twitter account.

I talked with co-workers at the clinic about the federal legislation, of which most were unaware. I was able to provide more information to those who were interested in taking action.

I’m a member of the county’s Women’s Democratic Club and talked about the federal legislation at our monthly meeting. They were able to refer me to other local and regional groups that may be interested in learning more about and supporting the bill.

Pending: Still in the Subcommittee on Health and Ways and Means Committee in the House and the Committee on Finance in the Senate.

The ANA and AANP have not published positions on this legislation; legislation is not listed as a specific priority on the website.

I researched 19 advocacy groups supporting the legislation. I decided to join and financially donate to two—First Focus: Campaign for Children, and National Partnership for New Americans.

Both have legislative alert services and a national grassroots activism initiative.

Since neither of my congressmen serve on the committees that will be hearing the bill, working through an advocacy coalition complements my individual activism.

I will contact them to see how I can best support their efforts to advance this bill.

Kingdon’s Three Streams

Relevance to My Personal Legislative Agenda & Action Plan

Problem

The problem is that many immigrants do not have access to health insurance in South Florida and other parts of the country. The problem is further complicated by the fact that all immigrants are not seen as equally important or of value. They are separated into two groups—those who are here lawfully and those who are undocumented. It is important to my Personal Legislative Agenda & Action Plan that the problem definition be inclusive of all immigrants so that the most vulnerable among them—the undocumented—are included in the proposed policy solutions. Unfortunately, inclusivity creates divisiveness in how the problem is defined.

Politics

Nationally, there is no consensus across party lines regarding the provision of healthcare services or health insurance to undocumented immigrants. In Florida, the legislative and executive branches of government are controlled by the party that is unsupportive of undocumented immigrants. Also, healthcare is not seen as a basic human right in the U.S. Non-citizens cannot vote and therefore have no voice in the legislative processes. As a citizen and as a nurse, I have a moral and ethical responsibility to advocate for vulnerable populations who are denied the opportunity to speak for themselves.

Policy

While there have been some initiatives to expand Medicaid or offer the opportunity to purchase health insurance for immigrants who are here lawfully, undocumented immigrants are excluded from these proposals. While I support all policies that address the unmet needs of immigrants, I also must ask that policies excluding the undocumented be amended to include them. Policies that separate families, defund sanctuary cities, or unduly limit immigration exacerbate the problem and contribute to ongoing poor health outcomes and health disparities among immigrants. Part of my Personal Legislative Agenda & Action Plan is to monitor health policies that negatively impact (or exclude) this population as well as be aware of—and challenge—other immigration policies and regulations that indirectly contribute to the problem.

Likelihood of Policy Change

It is unlikely that the state and federal immigration and health reforms, I support, will be approved any time soon. There are deeply ingrained challenges in both the politics and policy streams at both levels of government, and the “legal” vs. “Illegal” differentiation prevents a single definition of the problem. My Personal Legislative Agenda & Action Plan, however, reflects my long-term commitment to raising awareness on this issue and advancing these policy priorities.

Next Steps

It is important for me to remain aware of issues and public/political opinion that frame the issue of immigration reform. To that end, my Personal Legislative Agenda & Action Plan includes subscriptions to legislative alert services at the state and federal levels. I also belong to two organizations that advocate for immigrants at the state and federal levels, which send alerts when state or federal proposals or regulations are introduced that impact the immigrant population. I already participated in one online campaign on this issue.

I am learning to carefully read and analyze proposed legislation, so I can engage with my elected officials in an informed manner.

As a Catholic, I have also financially contributed to and become a grassroots member of Catholic Charities-Immigration and Refugee Services, which has allowed me the opportunity to raise awareness and discuss my experiences with immigrants to congregations in my area.

I was recently asked to prepare committee hearing testimony that could be adapted and submitted at some future point, when needed.

I am also a member of the Florida Association of Nurse Practitioners, and I serve on the organization’s Legislative Action Committee. In that role, I have been able to raise awareness of immigrant health issues in the organization and in our “Policy Watch” endeavors at the national level. I am a member of the American Association of Nurse Practitioners and the American Nurses Association (ANA). (The ANA has an Issue Brief

supporting healthcare for undocumented immigrants.)

Although I am not a “single issue” voter, I am mindful of candidate positions on immigration reform and plan to contribute financially to—and vote for—those who most align with my values and priorities as a nurse and citizen.

I need to learn more about the opposition to these reforms, so I am better prepared to address their arguments. I plan to listen to media sources more aligned with the opposition and to search the literature to separate fact from hype and opinion. I have learned that the key to policy advocacy is to be informed and prepared, so when engagement with my elected officials is needed (on an issue I am passionate about), I’m ready to engage.

NURS_8100_Week5-7_Assignment_Rubric

Criteria

Ratings

Pts

This criterion is linked to a Learning OutcomeDescribe the proposed legislation with a clear summary/description and process and update information (the first three columns of the Personal Legislative Action Plan).

20 to >17.0 ptsExcellentThe response comprehensively and clearly describes the prosed legislation with all pertinent detail: summary/description and process and update information.

17 to >15.0 ptsGoodThe response clearly describes the prosed legislation with all pertinent detail: summary/description and process and update information.

15 to >13.0 ptsFairThe response inaccurately and vaguely describes the prosed legislation with all pertinent detail: summary/description and process and update information.

13 to >0 ptsPoorThe response includes inaccurate and vague examples that do not describe the prosed legislation with all pertinent detail: summary/description and process and update information, or it is missing.

20 pts

This criterion is linked to a Learning OutcomeDescribe your advocacy actions (the fourth column of the Personal Legislative Action Plan).

25 to >22.0 ptsExcellentThe response comprehensively and clearly describes your advocacy actions. … The response includes relevant, specific, and appropriate examples that fully support the advocacy actions.

22 to >19.0 ptsGoodThe response clearly describes your advocacy actions. The response includes relevant, specific, and accurate examples that support the advocacy actions.

19 to >17.0 ptsFairThe response inaccurately or vaguely describes your advocacy actions. The response includes inaccurate and irrelevant examples that may support the advocacy actions.

17 to >0 ptsPoorThe response inaccurately and vaguely describes your advocacy actions, or it is missing. The response includes inaccurate and vague examples that do not support the advocacy actions, or it is missing.

25 pts

This criterion is linked to a Learning OutcomeAssesses the current status of the proposed legislation (the fifth column of the Personal Legislative Action Plan).

20 to >17.0 ptsExcellentThe response comprehensively and fully details the current status of the proposed legislation.

17 to >15.0 ptsGoodThe response clearly details the current status of the proposed legislation.

15 to >13.0 ptsFairThe response inaccurately or vaguely details the current status of the proposed legislation.

13 to >0 ptsPoorThe response includes inaccurate and vague examples that do not support the current status of the proposed legislation, or it is missing.

20 pts

This criterion is linked to a Learning OutcomeExplain next steps (the sixth column of the Personal Legislative Action Plan).

20 to >17.0 ptsExcellentThe response accurately and clearly explains next steps for the proposed legislation. … The response includes relevant, specific, and appropriate examples that fully support next steps.

17 to >15.0 ptsGoodThe response accurately explains next steps for the proposed legislation. … The response includes relevant, specific, and accurate examples that support the next steps.

15 to >13.0 ptsFairThe response inaccurately or vaguely explains next steps for the proposed legislation. … The response includes inaccurate and irrelevant examples that may support the next steps.

13 to >0 ptsPoorThe response inaccurately and vaguely explains next steps for the proposed legislation, or it is missing. … The response includes inaccurate and vague examples that do not support the next steps, or it is missing.

20 pts

This criterion is linked to a Learning OutcomeWritten Expression and Formatting—Paragraph Development and Organization: Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction is provided which delineates all required criteria.

5 to >4.0 ptsExcellentParagraphs and sentences follow writing standards for flow, continuity, and clarity. … A clear and comprehensive purpose statement, introduction, and conclusion is provided which delineates all required criteria.

4 to >3.5 ptsGoodParagraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time. … Purpose, introduction, and conclusion of the assignment is stated, yet is brief and not descriptive.

3.5 to >3.0 ptsFairParagraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time. … Purpose, introduction, and conclusion of the assignment is vague or off topic.

3 to >0 ptsPoorParagraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time. … No purpose statement, introduction, or conclusion was provided.

5 pts

This criterion is linked to a Learning OutcomeWritten Expression and Formatting—English writing standards: Correct grammar, mechanics, and proper punctuation

5 to >4.0 ptsExcellentUses correct grammar, spelling, and punctuation with no errors.

4 to >3.5 ptsGoodContains a few (1 or 2) grammar, spelling, and punctuation errors.

3.5 to >3.0 ptsFairContains several (3 or 4) grammar, spelling, and punctuation errors.

3 to >0 ptsPoorContains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.

5 pts

This criterion is linked to a Learning OutcomeWritten Expression and Formatting: The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, parenthetical/in-text citations, and reference list.

5 to >4.0 ptsExcellentUses correct APA format with no errors.

4 to >3.5 ptsGoodContains a few (1 or 2) APA format errors.

3.5 to >3.0 ptsFairContains several (3 or 4) APA format errors.

3 to >0 ptsPoorContains many (≥ 5) APA format errors.

5 pts