| Course | NU706 Ethics, Policy, and Advocacy in Population Health |
|---|---|
| Unit | Unit 4 |
| Paper type | Culturally proficient policy revision |
| Length | About 1,030 words, 6 pages double-spaced |
| Format | APA 7 student paper |
| School | Purdue University Global |
| Program | Doctor of Nursing Practice (DNP) |
| Updated | October 2026 |
Free sample paper for NU706 Unit 4
A Policy Written for Patients With Phones and Insurance: A Unit 4 Culturally Proficient Revision of an Insulin Discharge Policy for Amish Families
[Student Name]
Purdue University Global
NU706: Ethics, Policy, and Advocacy in Population Health
Unit 4 Culturally Proficient Policy Revision
[Instructor Name]
[Date]
The hospital, its policy, its patients and its figures are composite and illustrative; the studies cited are real.
The Policy and the Families It Missed
The insulin discharge policy adopted with the bundle in 2025 has five requirements: a supervised return demonstration with the patient's own pen, a written plan in plain language, a pen prescription sent to the patient's pharmacy before discharge, a follow-up telephone call within 72 hours and a referral to the outpatient diabetes class. Each was chosen from evidence, and each quietly assumes a patient who lives like most of the staff.
Last year 9 of the 214 patients who went home on new insulin came from Old Order Amish households, according to case management notes. Their 30-day return rate was 3 of 9. The numbers are too small for any firm conclusion, but the chart notes are consistent. Two follow-up calls went to a neighbor's business line and were never returned. One patient was sent home with pens at a cash price of more than $500 for the month and went back to the vial and syringe his brother used. Another had no electric refrigerator and stored the unopened pens in a springhouse in a hard freeze.
Every requirement was sound for the patient the policy imagined, and that was the problem.
What the Literature Says About These Families
Old Order Amish communities are not a population with unusually high diabetes. In the Amish Family Diabetes Study, the prevalence of type 2 diabetes was about half that of white adults in the national survey of the same era, but the disease clustered strongly in families: more than a quarter of the probands' siblings had it, against 7 percent of spouses (Hsueh et al., 2000). A nurse should therefore expect that a newly diagnosed Amish patient may have a parent, brother or sister already managing insulin, and that family practice will shape what the patient does at home.
Most Old Order families do not buy commercial health insurance. Rohrer and Dundes (2016) describe how communities pay medical bills instead through church alms, community hospital aid funds and benefit auctions, and how families often negotiate cash prices with hospitals before or after care. A pen prescription that assumes an insurance card is, for these patients, a bill the church district may have to meet.
Storage matters too. Heinemann et al. (2021) reviewed the evidence on insulin storage and found that unopened insulin is damaged by freezing and by sustained heat, while insulin in use tolerates room temperature for several weeks. Many Amish homes use propane refrigerators or iceboxes, and many have none, so storage teaching written for an electric kitchen refrigerator can mislead.
Revised Policy: Four Sections
The revision keeps the bundle's goals and changes how four requirements are carried out.
1. Follow-up contact. The 72-hour call becomes a 72-hour contact. At discharge, the nurse asks how the patient prefers to be reached and records one of four routes: a home telephone, a scheduled call to a community telephone at an agreed time, a home health visit or a return visit to the clinic. For a scheduled call, the nurse writes the day and hour on the discharge plan so the patient can be at the telephone.
2. Prescription and price. Before the prescription is sent, the nurse or case manager asks whether the patient will pay cash. If so, the case manager obtains the cash price of the prescribed pen and of a vial-and-syringe option at the patient's chosen pharmacy, and the prescriber chooses with the patient. Teaching is then done with the device the patient will actually use.
3. Storage teaching. The storage section of the written plan is rewritten in two parts: keeping unopened insulin cold but never frozen, with options for propane refrigerators and iceboxes, and keeping the pen or vial in use at room temperature away from a stove or a sunny window for the number of days on its label.
4. Family at the teaching session. The return demonstration remains required, but the nurse asks whether the patient wants a family member present, and if a relative already uses insulin, asks what that relative does. Differences between the family's practice and the new plan are discussed openly rather than corrected in silence.
Why These Changes Are Culturally Proficient
Cross et al. (1989) describe cultural proficiency as the point at which an organization holds culture in high regard and builds that regard into policy and practice, not only into attitudes. Each change above is a design feature rather than a value statement. None requires the patient to explain or defend the community's way of life, and none assumes that every Amish family lives the same way, since the nurse asks rather than presumes. The revision also helps other patients: a cash-price check serves the 10 uninsured English-speaking patients from last year as well, and a scheduled-call option helps anyone without a reliable phone.
Implementation and Monitoring
The case manager, the diabetes educator and two staff nurses from 5 West will draft the cash-price script and the storage handout. The draft handout will be reviewed with two Amish patients or family members willing to read it, and changed after that review. Staff will be taught the four contact routes at the monthly huddle.
Monitoring will track, for every patient on new insulin, the contact route chosen, whether contact was made within 72 hours and returns within 30 days. Results will be reported for all patients and for patients choosing a non-telephone route, with the caution that the second group will remain small.
Conclusion
The bundle's policy was built for patients with phones, insurance and electric refrigerators. Revising four sections, the follow-up route, the price check, the storage teaching and the family's place at the demonstration, makes the same evidence-based bundle work for Amish families and for other patients the old version also missed.
References
Cross, T. L., Bazron, B. J., Dennis, K. W., & Isaacs, M. R. (1989). Towards a culturally competent system of care: A monograph on effective services for minority children who are severely emotionally disturbed (Vol. 1). Georgetown University Child Development Center, CASSP Technical Assistance Center.
Heinemann, L., Braune, K., Carter, A., Zayani, A., & Krämer, L. A. (2021). Insulin storage: A critical reappraisal. Journal of Diabetes Science and Technology, 15(1), 147-159. https://doi.org/10.1177/1932296819900258
Hsueh, W. C., Mitchell, B. D., Aburomia, R., Pollin, T., Sakul, H., Gelder Ehm, M., Michelsen, B. K., Wagner, M. J., St. Jean, P. L., Knowler, W. C., Burns, D. K., Bell, C. J., & Shuldiner, A. R. (2000). Diabetes in the Old Order Amish: Characterization and heritability analysis of the Amish Family Diabetes Study. Diabetes Care, 23(5), 595-601. https://doi.org/10.2337/diacare.23.5.595
Rohrer, K., & Dundes, L. (2016). Sharing the load: Amish healthcare financing. Healthcare, 4(4), 92. https://doi.org/10.3390/healthcare4040092
NU706 Unit 4 instructions, in plain terms
In Unit 4 the course asks for a revision rather than a critique: take a real or realistic organizational policy and rewrite it so it serves a community it currently fails. Prompts generally ask students to describe the current policy and its gaps, bring evidence about the community, present the revised sections and justify each change, then plan implementation and monitoring. The community should be specific, and the evidence should describe that group rather than minorities in general. Instructors want cultural proficiency shown as policy design, such as contact routes, pricing steps or teaching arrangements, not as a statement of respect in the preamble. Evidence about the group should come from peer-reviewed work wherever it exists. The revised text should be clear enough to adopt, so many students write the changed sections as numbered requirements beside a short rationale for each one.
Inside the NU706 Unit 4 example
The revision opens with the five requirements the bundle policy already has and the assumption hidden in each. Case management notes from nine Amish patients follow: calls to a neighbor's business line, a $500 pen price and pens stored in a freezing springhouse, with a margin note on what nine cases can prove. The literature section draws on the Amish Family Diabetes Study for family clustering, on Rohrer and Dundes for church aid and cash prices, and on Heinemann's storage review. Four numbered sections then rewrite contact, price, storage and family presence, with a note on line-by-line comparison. A short section ties the changes to Cross and colleagues' definition and shows they help uninsured English-speaking patients too. Implementation names who drafts the handout and how two community members review it, and monitoring reports results by contact route.
Reading the NU706 Unit 4 grading rubric
Scoring on this revision rests mostly on two things: whether the gaps in the current policy are shown with evidence, and whether each revised section fixes a gap it names. Evidence about the community earns credit when it is specific to that group and used to shape a change, not merely cited. The revised policy text is judged on clarity and feasibility, since a reviewer should be able to adopt it. Justification for each change is often a separate rubric row. Cultural proficiency is graded as design, and graders reward revisions that avoid assuming every member of a community lives the same way. Implementation and monitoring plans need named roles and measures. The rest of the grade comes from organization, sources and APA 7 mechanics, with some sections adding a row for involving the community in review before adoption.
NU706 Unit 4 help from the desk
Revisions lose ground most often by describing the community at length and then changing almost nothing in the policy. Another weak spot is a rewrite that adds one sentence about respecting culture and leaves every requirement as it was. Some papers rely on general sources about cultural competence rather than evidence about the specific group. Others assume uniformity, writing as if every Amish family lacks a phone or refuses devices, which the nurse should ask rather than presume. Monitoring is often forgotten, so nobody can tell whether the revision worked. Begin with your current policy's requirements in a list and ask, for each, who it quietly assumes the patient is. A custom revision can rework your organization's own policy for the community your unit serves, with the sections rewritten in adoptable language.
Get an NU706 Unit 4 example written to your instructions
Send the current policy, the community involved and the revision instructions with the rubric. A custom revision rewrites the policy's key sections and explains each change. It arrives within 24-48h; first requests are free. The paper above is an original model document written by our desk, not a submitted student paper and not an official Purdue University Global document.
More NU706 papers and DNP samples
- NU706 Unit 1: Informed Refusal Ethics Post
- NU706 Unit 2: Distributive Justice Analysis
- NU706 Unit 3: Insulin Cap Policy Analysis
- NU706 Unit 5: Seminar Reflection
- NU706 Unit 6: Moral Distress Analysis
- NU706 Unit 7: Advocacy Testimony
- NU706 Unit 8: Global Health Policy Analysis
- NU706 Unit 9: Program Ethics Analysis
- NU706 Unit 10: Position Paper
- NU713 Unit 4: Fundamental Cause Paper, Colon Cancer
- NU704 Unit 4: Statistical Test Selection Worksheet
- NU733 Unit 4: Population Profile, Unsheltered Adults
- NU703 Unit 4: Competency Self-Assessment, Essentials
NU706 Unit 4 questions, answered
What makes a policy culturally proficient rather than only culturally aware?
Culture is built into how the policy works, through its routes of contact, its handling of cost and its teaching, rather than stated as a value in its preamble.
How do Amish families usually pay for hospital care?
Most Old Order families do not buy commercial insurance. Bills are commonly met through church alms, community aid funds and negotiated cash prices.
Should the revised policy be tested with the community?
Yes. Reviewing drafts with members of the community before adoption catches assumptions staff cannot see.
Where can I find a free NU706 Unit 4 sample paper?
The complete NU706 Unit 4 culturally proficient policy revision is on this page. It rewrites four sections of an insulin discharge policy for Old Order Amish families and explains each change.
Which four policy sections does the NU706 Unit 4 sample rewrite?
Follow-up contact, which offers four routes including a scheduled call to a community telephone; a cash-price check before the prescription is chosen; storage teaching for homes without electric refrigerators; and family presence at the return demonstration.