NURS 6226 Week 5 Discussion Post Example

Course	NURS 6226 Introduction to Healthcare Policy
Week	Week 5
Paper type	Discussion post with two peer replies
Length	About 500 words, 3 pages
Format	Discussion post, APA 7 citations
School	Walden University
Program	Master of Science in Nursing (MSN)
Updated	October 2026

Free sample paper for NURS 6226 Week 5

Week 5 Discussion: Initial Post

The Patient Self-Determination Act Survives as a Checkbox

The Patient Self-Determination Act, passed as part of the Omnibus Budget Reconciliation Act of 1990 (Pub. L. No. 101-508), had a clear intent: that patients' wishes about life-sustaining treatment would be known and honored. Providers paid by Medicare and Medicaid, hospitals among them, had to tell each adult patient on admission what state law allowed them to decide about their own care, including the right to write an advance directive, and to record whether one already existed. My argument is that the requirement survives, but mostly as a checkbox, while its purpose largely does not.

At my composite medical-surgical hospital, implementation looks like this. An admission screen asks whether the patient has an advance directive. Registration staff, often before any clinician has seen the patient, read the question, offer a brochure and check a box. If the patient says yes, the screen asks the patient to bring a copy, which rarely arrives. The question is asked and the box is checked in nearly every admission. The law is complied with. Nobody on the unit is later assigned to ask what the patient would actually want.

Whether its aim is met is a different matter. A systematic review of studies published between 2011 and 2016 found that only about a third of U.S. adults had completed any advance directive, a proportion that was similar among people with chronic illness and healthy adults (Yadav et al., 2017). And completing one does not guarantee it will guide care. In a large study of seriously ill hospitalized patients after the act took effect, most directives simply named a proxy or restated a standard living will, and very few gave specific instructions that could direct treatment in the patient's actual situation (Teno et al., 1997).

Edelman (1964) described how some policies function symbolically: they reassure the public that a problem is being addressed while changing little in practice. The act fits that description. It reassures patients and legislators that rights to self-determination exist and are communicated, while the conversation that would test those rights, a clinician asking what matters to the patient and what they would want if they became too ill to say, is not required. What would have tested the law's intent is not a question at admission but a conversation during the stay. Nurses are well placed to hold that conversation.

What this page is doingThe law's intent is separated from its measure, and the evidence is used to show where the two diverge.

Reply to Mariah

Mariah, you called the act a success because nearly every chart shows the advance directive question was asked. That measures compliance with the requirement, not achievement of the goal. Could you separate them? If the goal is care that matches patients' wishes, what would you measure instead?

Reply to Jordan

Jordan, you argued that low completion rates show the law failed. I would be more cautious. The act only required that patients be informed and asked; it never required anyone to complete a directive. Its failure is narrower: it measured the easiest step and left the harder one, the conversation, to chance.

References

Edelman, M. (1964). The symbolic uses of politics. University of Illinois Press.

Omnibus Budget Reconciliation Act of 1990, Pub. L. No. 101-508, §§ 4206, 4751, 104 Stat. 1388 (1990).

Teno, J. M., Licks, S., Lynn, J., Wenger, N., Connors, A. F., Phillips, R. S., O'Connor, M. A., Murphy, D. P., Fulkerson, W. J., Desbiens, N., & Knaus, W. A. (1997). Do advance directives provide instructions that direct care? Journal of the American Geriatrics Society, 45(4), 508-512. https://doi.org/10.1111/j.1532-5415.1997.tb05179.x

Yadav, K. N., Gabler, N. B., Cooney, E., Kent, S., Kim, J., Herbst, N., Mante, A., Halpern, S. D., & Courtright, K. R. (2017). Approximately one in three US adults completes any type of advance directive for end-of-life care. Health Affairs, 36(7), 1244-1251. https://doi.org/10.1377/hlthaff.2017.0175

The Walden NURS 6226 Week 5 instructions

The fifth NURS 6226 thread commonly asks you to compare a health policy's intent with its implementation. You state the intent, choose a standard for success, examine evidence on implementation and give a clear verdict. Faculty credit a stated standard and a conclusion, and posts that describe the law and its critics without judging lose points. Cite the statute and outcome research in APA 7. The Patient Self-Determination Act requires providers to ask about and inform patients of advance directive rights, not to complete directives. Edelman's symbolic politics explains laws that reassure more than they change, without being a simple criticism. Other policies work too if evidence on implementation exists.

How the NURS 6226 Week 5 example is put together

About 470 words, followed by two replies of around 170. The post states the law's intent in one sentence: patients' wishes about life-sustaining treatment would be known and honored. It then describes implementation as a nurse encounters it: an admission screen asking whether a directive exists, a brochure offered, a box checked, often by registration staff before any clinician arrives. Evidence comes from published research reporting low directive completion and documents missing when decisions arise, summarized without figures. Murray Edelman's account of symbolic politics frames the verdict: the law reassures that rights exist while changing little at the bedside. What would have tested intent, a conversation rather than a question, is named at the close. One reply asks a peer to separate a policy's goal from its measure; the other tests a classmate's claim of success.

Reading the NURS 6226 Week 5 rubric

Implementation threads draw credit for a stated standard and a clear verdict against it. A post that describes the law and its critics without concluding whether the intent survived leaves the analysis share unclaimed. Accuracy about the statute is checked in many sections: the act requires information and documentation, not completed directives, and posts claiming otherwise misstate the very policy they judge. Evidence ought to be research on completion and availability at the point of care, not one family's dispute retold. A framework counts when it explains the gap, and Edelman cited in a closing sentence adds little. Replies earn their portion by applying the intent-measure test to a peer's example, and they forfeit it by agreeing that implementation is always hard, a truism every thread already contains.

NURS 6226 Week 5 help from the desk

Implementation posts lose the most when they never reach a verdict. Say whether the law meets its intent. Another common gap is no standard. Name the test you apply. Writers also misstate the law's requirements. Check what it actually asks. Avoid citing old data as current without noting its date. Explain the SUPPORT findings briefly. In replies, test whether a classmate's standard is fair to the law's actual reach. A sentence on what would change the verdict, such as directives retrievable in the record at the point of care, shows balance. End on a single change that would narrow the gap.

Get a NURS 6226 Week 5 example written to your instructions

Drop the Week 5 discussion question and rubric into a request, with the policy you mean to test, if chosen. The desk returns a NURS 6226 discussion post and its two replies within 24 to 48 hours, the first at no cost. The hospital and nurse in this sample are imaginary; a state or payer policy can replace the federal law.

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NURS 6226 Week 5 questions, answered

What does the Patient Self-Determination Act require?

Hospitals, nursing facilities and other providers participating in Medicare and Medicaid must inform adult patients in writing of their rights under state law to accept or refuse treatment and to prepare advance directives, and must document whether a directive exists. It does not require anyone to complete one. The example's argument rests on that distinction, and your post can use it to separate notification from conversation.

Is Edelman's symbolic politics a criticism of the law?

It is an explanation rather than an accusation. Murray Edelman argued that some policies work mainly by reassuring the public that a problem is handled, while material outcomes change little. The example applies the idea carefully: the act created real rights and real documentation, but its implementation settled into a ritual. Your post can use the frame without implying bad faith by anyone involved.

Which policy works for an intent-versus-implementation post?

One with a clearly stated purpose and a visible implementation record. The example chooses a federal law nurses encounter at admission, which gives the author a bedside view of the gap. Nutrition standards for school meals or a state's expansion of newborn screening would serve as well. Avoid policies too new to have a record, since your verdict would then be a prediction.

Where can I find a free NURS 6226 Week 5 sample paper?

The Patient Self-Determination Act post is reproduced here with the intent, the standard, the verdict, Edelman's framing and replies to Mariah and Jordan.

Does the NURS 6226 Week 5 post say the law failed?

It concludes the law survives mostly as an admission checkbox, measured against whether wishes are known at the bedside when decisions are made.