| Course | NURS 8100 Healthcare Policy and Analysis |
|---|---|
| Week | Week 2 |
| Paper type | Discussion post with two peer replies |
| Length | About 570 words, 4 pages |
| Format | Discussion post, APA 7 citations |
| School | Walden University |
| Program | Doctor of Nursing Practice (DNP) |
| Updated | September 2026 |
Free sample paper for NURS 8100 Week 2
Week 2 Discussion: Initial Post
Why Hearing Aids Moved Onto the Shelf When They Did: Reading the Over-the-Counter Hearing Aid Law Through Kingdon's Three Streams
Federal law letting adults buy hearing aids off a store shelf reached the agenda in 2017, and the rule putting it into effect followed in 2022, when the three streams Kingdon (2011) describes converged: a recognized problem, a ready policy and a political opening, joined by entrepreneurs who pushed them together.
The problem stream. Untreated hearing loss had been a known problem for decades. A national analysis estimated that tens of millions of Americans had hearing loss, most of them older adults, and that it was far more common with age (Lin et al., 2011). Hearing aids were expensive, rarely covered by Medicare and available only through a licensed dispenser, and most adults who could benefit did not use them. What changed was not the problem but its framing: hearing loss began to be linked in public discussion to social isolation and cognitive decline, which turned a quality-of-life issue into a public health concern.
The policy stream. A solution had been prepared in advance. A National Academies committee recommended in 2016 that the Food and Drug Administration create a category of hearing aids that adults with mild to moderate loss could buy without a professional fitting (National Academies of Sciences, Engineering, and Medicine, 2016). The proposal was specific, technically vetted and ready when an opening came.
The political stream. The opening was a rare bipartisan pairing. Senators Warren and Grassley, from opposite parties, co-sponsored the legislation and made the case publicly that regulatory barriers kept prices high (Warren & Grassley, 2017). The bill was attached to must-pass legislation reauthorizing FDA user fees, which gave it a vehicle. The streams met in 2017, and the FDA's 2022 final rule completed the policy by defining the new category and its safeguards (Food and Drug Administration, 2022).
For nurses, the case shows that a solution prepared years in advance, by a respected expert body, can wait for its moment. Question: what nursing policy proposal do you think is waiting in the policy stream right now?
Reply to Jordan
Jordan, you argued that punctuated equilibrium explains this case better than Kingdon, because hearing aid regulation was stable for decades and then changed suddenly. Baumgartner and Jones (2009) describe policy as long periods of stability interrupted by bursts of change when an issue's image shifts and it moves to a new venue. I think you are right that the image shifted, from a professional device to a consumer product, and that the venue moved from the FDA's device staff to Congress. Where I would still use Kingdon is in explaining why 2017: the punctuated equilibrium account tells us change was coming, but the three streams tell us why it arrived in that particular session. The two models may answer different questions about the same event.
Reply to Keisha
Keisha, you asked whether recent cases like this are too new to analyze, since the effects of over-the-counter hearing aids on use and prices are still emerging. For agenda setting, I think a recent case is an advantage: the documents that show how the streams met, the expert report, the senators' public statements and the final rule are all available. What we cannot yet say is whether the policy worked. That is a question for implementation and evaluation, the later phases this course will reach.
References
Baumgartner, F. R., & Jones, B. D. (2009). Agendas and instability in American politics (2nd ed.). University of Chicago Press.
Food and Drug Administration. (2022). Medical devices; ear, nose, and throat devices; establishing over-the-counter hearing aids [Final rule]. Federal Register.
Kingdon, J. W. (2011). Agendas, alternatives, and public policies (Updated 2nd ed.). Longman.
Lin, F. R., Niparko, J. K., & Ferrucci, L. (2011). Hearing loss prevalence in the United States. Archives of Internal Medicine, 171(20), 1851-1852. https://doi.org/10.1001/archinternmed.2011.506
National Academies of Sciences, Engineering, and Medicine. (2016). Hearing health care for adults: Priorities for improving access and affordability. The National Academies Press. https://doi.org/10.17226/23446
Warren, E., & Grassley, C. (2017). Over-the-counter hearing aids: The path forward. JAMA Internal Medicine, 177(5), 609-610. https://doi.org/10.1001/jamainternmed.2017.0464
The Walden NURS 8100 Week 2 instructions
This thread has you explain why a health policy issue reached the government's agenda at a particular time, using a theory such as Kingdon's multiple streams. Plan on an initial post of five to six hundred words and two replies. Choose a case with a clear moment of action and a public record. Name the case and your verdict in the first sentence. Document each stream separately with its own evidence rather than asserting that they converged. Identify the policy entrepreneurs who joined the streams and the window that opened. Close by drawing a lesson for nurses about how proposals wait for their moment, and ask classmates what proposal is waiting now.
How this NURS 8100 Week 2 example is built
The opening sentence names the case and the three streams. A problem stream paragraph cites Lin and colleagues on hearing loss prevalence and describes the reframing toward public health. A policy stream paragraph cites the National Academies' 2016 report and its recommendation. A political stream paragraph cites Warren and Grassley's public case and describes the FDA reauthorization vehicle, ending in a highlighted sentence on the FDA's 2022 final rule. A closing paragraph draws a lesson for nurses. The reply to Jordan compares Baumgartner and Jones' punctuated equilibrium with Kingdon. The reply to Keisha separates agenda setting, which can be analyzed now, from outcomes, which cannot. Each stream gets its own paragraph and its own sources.
NURS 8100 Week 2 rubric: what earns full marks
Agenda-setting posts are typically graded on correct application of the theory, evidence for each element and engagement with alternative explanations. Application earns credit when each stream is documented with specific evidence. Faculty look for identification of the window and the entrepreneurs, since those are central to Kingdon's account. Evidence should come from primary documents, expert reports and statements by the actors, not only from news coverage. Replies that engage a competing theory show depth. A lesson for nursing practice connects the analysis to the course. APA citations for books, reports and articles, and a clear structure, complete the usual criteria for this thread. Graders often check that the policy stream holds a worked-out proposal rather than a general wish.
Common NURS 8100 Week 2 mistakes, and how to avoid them
Agenda-setting posts lose marks when they assert that the streams converged without showing each one. Another common loss is confusing the policy stream with the political stream, for example describing a senator's speech as a policy proposal. Some posts choose a case whose timing cannot be explained. Others ignore competing theories raised by classmates. Name the case, document each stream with sources, identify the entrepreneurs and the window, draw a lesson for nurses and engage other theories in replies. The desk can draft a post on the case your section chooses. Prefer expert reports and official records over commentary when you document each stream.
Get a NURS 8100 Week 2 example written to your instructions
Pass along the Week 2 prompt, the rubric and whatever reply rules apply, and a NURS 8100 agenda-setting thread is drafted, opening post plus two responses. 24 to 48 hours; nothing to pay for the first. A different case, or a model other than Kingdon, can anchor it if your module leans elsewhere.
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NURS 8100 Week 2 questions, answered
Why read agenda setting through Kingdon?
Timing is the payoff. In Kingdon's account, problems, policy proposals and politics develop largely independently, and change grows likely when they couple, often through a policy entrepreneur during a window. The example applies that account to surprise billing protections, asking why they passed when they did rather than years earlier. Your post can run the same test on any issue with a visible moment of movement.
How does punctuated equilibrium differ?
Baumgartner and Jones describe long periods of policy stability broken by bursts of rapid change, often when an issue's public image shifts or it moves to a new venue. Where Kingdon focuses on the convergence that opens a window, punctuated equilibrium focuses on why stasis lasts and what breaks it. The example's reply uses it for a colleague's issue that sat unchanged for decades.
Where can I find a free NURS 8100 Week 2 sample paper?
The complete post on over-the-counter hearing aids and both replies, with six references, are open here with no fee. Your own section's case can be written on request.
What opened the political window in the NURS 8100 Week 2 post?
A bipartisan pairing of senators who co-sponsored the legislation and a must-pass bill reauthorizing FDA user fees, which gave the proposal a vehicle.
What was waiting in the policy stream in NURS 8100 Week 2?
A National Academies recommendation that the FDA create a category of hearing aids adults with mild to moderate loss could buy without a professional fitting.