Last year, Alaska state governor, Mike Dunleavy, proposed a budget for the 2022 fiscal year that aimed to stabilize and strengthen the state’s economy following the adverse effects of the global pandemic that had affected virtually all aspects of Alaskan’s lives. Among the areas that the budget focused on include protecting Alaskan’s health and safety, with the focus being restoring the state’s residents to work and normalcy and infrastructural investments in public transportation to lay the foundation for creating jobs. Many of Alaska’s major challenges in the previous fiscal year resulted from the pandemic. Oil revenue declined significantly as the Alaska North Slope crude tumbled and the generated tax revenue failed to meet the projected record. Alaska’s fiscal year currently stands at $700 million less than what was projected at a time like this last year, necessitating strategic measures to balance the budget (Andreassen, 2021). Hence, this report provides informative proposals to help implement Alaska State’s budget for the current fiscal year, considering the current fiscal position and the longer 10-year plan.
As per the statutory requirement, Governor Mike Dunleavy has already published a 10-year fiscal outlook balancing the state expenditure and revenue sources while guaranteeing the state’s economic security and, at the same time, providing essential services to the citizens. The 2024 budget focuses on strategic investments for the public sector and portrays the governor’s vision for the state (Andreassen, 2021). However, amid making predictions for the state’s source of revenue, it is important to note that the past several years have shown volatile oil prices, creating a significant level of uncertainty (Townsend, 2021). The administration seeks to attain $3.4 billion for the fiscal year 2024, based on a price forecast of $81 per barrel for 503,700 daily.
One of the most significant state revenue sources is the Permanent Fund earnings reserve account, also known as a percentage of market value (POMV draw. Senate Bill 26, which the Trump Administration passed in 2018, provided the statutory framework allowing states to draw up to 5% of the average value of the past five years in the Permanent Fund (WARD & BRIDGE, 2019). Hence, Alaska’s Fund draw for FY2024 is $3.53 billion from the allowance.
10-Year Fiscal Outlook
The following tables present the state’s projected expenditure and revenue sources for ten years, from 2023 to 2033 (OFFICE OF GOVERNOR MIKE DUNLEAVY, 2022).
Table 1: Expenditure
The data shows that Alaska had to make changes where more funds were used to fund the healthcare system. The operating budget has been increasing in state departments that are more critical such as disaster relief funds (OFFICE OF GOVERNOR MIKE DUNLEAVY, 2022). The funds help the state manage financial emergencies when they emerge (Andreassen, 2021). The expenditure is organized to ensure the state can spend its resources effectively to ensure the resources that the state has meet the expenditure. The expenditure is based on the projected revenue that the state aims to raise during the financial year.
Table 2: Revenue Sources (Including Status Quo Revenues)
The table’s projections solely use savings to balance the state’s fiscal position (OFFICE OF GOVERNOR MIKE DUNLEAVY, 2022).
Table 3: Revenue Sources (New Target)
By implementing the new revenues all through to the fiscal year 2027, the projections bring balance to Alaska’s fiscal structure to ensure stability throughout the projected period. The state aims to increase its revenue through new tax interventions that will enable it to meet all its financial needs (OFFICE OF GOVERNOR MIKE DUNLEAVY, 2022). The revenues will be generated in areas with great potential to grow based on growth projections over the years (Townsend, 2021). The Alaska government has invested resources in rapidly growing areas, thus increasing the tax base. The budget process should adopt a long-term perspective beyond a single fiscal year. Taking into consideration the state’s strategic goals, economic forecasts, and anticipated challenges, this perspective will enable the government to develop sustainable budgets that address the long-term needs of Alaska and its citizens. Multi-year planning ensures consistency, stability, and greater alignment with the state’s overall vision.
(OFFICE OF GOVERNOR MIKE DUNLEAVY, 2022)
Public participation is ideal for the successful implementation of any state project as it provides avenues for the creation of awareness on the various aspects of the project and encourages its support. Likewise, public interaction will be essential in both the creation of awareness of the state’s budget and its implementation (Andreassen, 2021). Many of the state’s projected sources of revenue require active participation by the state residents, hence the need for their inclusion. For instance, revenue sources such as savings from pension systems provide the state government with the necessary funds to keep the economy running while at the same time building the necessary infrastructure for the creation of more jobs (Seifert et al., 2013). In such instances, the resident’s participation in the pension programs is essential in securing their future, but its successful implementation requires the full participation of every citizen. Ultimately, Alaska requires extra funding to balance its fiscal year, and many of the increased revenue sources demand higher taxation of the citizens and businesses. Hence, the successful implementation of the tax programs will require public participation, hence the need for their inclusion in the budgeting process.
Assessing Participation in the Budget Process
One could identify several components when assessing the presence and effectiveness of any public participation in the budgeting process (Andreassen, 2021). Such components include the existence of a participatory mechanism in any stage of the budget process, such as public expenditure tracking surveys, the inclusivity of the participatory mechanism, the extent of the mechanism’s formal institutionalization, the adequacy of the resources allocated to the citizens and civil society stakeholders, the intensity of the deliberations, and the extent to which the process loops back to the participants by informing them on how their views influenced the decision-making process (Pino, 2013).
One of the main benefits of public participation in the budget decision-making process is that it guarantees openness and transparency in the process. Effective participation is marked by the presence of legal frameworks through which legislature or civil society members can express their viewpoints on the budgeting process and gain consideration (Townsend, 2021). While the presence of legal frameworks provides a broad assessment methodology for the public’s participation in the budget process, there are other tools that would be more effective at assessing the participation and providing a more detailed assessment of the same (Townsend, 2021).
IBP’s Open Budget Survey
The IBP’s pen Budget Survey is an effective method to assess the extent of public participation in the budgeting process and its effectiveness in the process. The methodology would be effective in the Alaska budgeting process as it would provide insights into the level of transparency in the process and the availability of the budget information to the public (Pino, 2013). The IBP Open Budget Survey has been effective in the past, having successfully assessed the level of public participation in other countries, hence its viability for the Alaska state budgeting process (Seifert et al., 2013). Using the methodology, the researchers would set the survey questions with the intention of identifying whether the budgeting process considered the public’s voice, whether the government shared the feedback it received and its application in the decision-making process, and whether the process generally embedded participation in the budget process, thereby allowing input into the process.
The improved budget process for the State of Alaska should align with its fiscal year, commencing on the first day of the fiscal year. This annual cycle will enable better planning, timely execution, and effective management of the state’s financial resources (Seifert et al., 2013). By adhering to a consistent timeline, stakeholders will have clear expectations and can prepare the necessary information and data for budget development.
Public participation is a sign of democracy, as it guarantees that everyone’s voice is heard and included in the decision-making processes. The V-Dem indicators allow researchers to test public participation in any democratic process by measuring performance against an established range of democratic principles (Coppedge, 2016). While assessing the level of public interaction in the Alaska budgeting process, right from the awareness creation stage to the more active participatory stages in the decision-making processes, the V-Dem indicators will provide an effective tool for the assessment process.
Improving the annual budget process for the State of Alaska requires a systematic and comprehensive approach. The state can enhance transparency, efficiency, and effectiveness in budget development by following the annotated process improvement plan presented in this essay. Regular measurement, assessment, and iteration will ensure that the budget process remains responsive to the state’s strategic goals and development.
Andreassen, N. (2021, November 3). Increased revenues are bringing Alaska’s budget back to baseline. Anchorage Daily News. https://www.adn.com/opinions/2021/11/02/increased-revenues-are-bringing-alaskas-budget-back-to-baseline/#:~:text=Itmeansthatthestatecaninflation-adjustits,andmatchinggrantsforwaterandsewerprojects.
Brooks, J. (2022, February 28). Expecting an influx of oil money, Alaska lawmakers say they’re interested in saving for later. Yahoo! News. https://news.yahoo.com/expecting-influx-oil-money-alaska-230100224.html?guccounter=1&guce_referrer=aHR0cHM6Ly93d3cuYmluZy5jb20v&guce_referrer_sig=AQAAABvgEam9-6RFxPxFN5cEkWG92muOnkYnZ9tDAPUfxlSXqp4CWo1JlUz_nZ9_wDI2z7PnznnlC5miiE9_MixdLAzLYo8XBehxQaSis7ZOAyohvz0rf4Ed1OVvgMCTiY4JOfblEe51tZljBQH2gOMxWsbRmnRSaO57HnY9MfxSbEuW
Coppedge, M., Lindberg, S., Skaaning, S. E., & Teorell, J. (2016). Measuring high level democratic principles using the V-Dem data. International Political Science Review, 37(5), 580-593.
OFFICE OF GOVERNOR MIKE DUNLEAVY. (2022). (rep.). FY2024 Budget Overview and 10‐Year Plan (pp. 1–10).
Pino, H. (2013). The Impact of the International Budget Partnership’s Open Budget Survey and Its Partner Institutions’ Advocacy on Budget Transparency in Honduras. International Budget Partnership Impact Case Study.
Seifert, J., Carlitz, R., & Mondo, E. (2013). The Open Budget Index (OBI) as a comparative statistical tool. Journal of Comparative Policy Analysis: Research and Practice, 15(1), 87-101.
Townsend, Q. (2021, May 10). Alaska Policy Forum. It’s Time for a Responsible Alaska Budget. https://alaskapolicyforum.org/2021/05/its-time-for-a-responsible-alaska-budget/
WARD, B., & BRIDGE, B. (2019). BUREAU OF BUSINESS AND ECONOMIC RESEARCH.
In “The Things They Carried,” The Soldiers Carry Tangible And Intangible Things. Discuss How Physical And Mental/Emotional Burdens Impact The Soldiers.
During combat operations, soldiers grapple with heavy physical burdens that weigh heavily on their well-being and mental health. Though soldiers are required to transport various supplies, including food, water, weapons and ammunition, their body weight mainly bears down upon them most significantly. Carrying extra weight compared to their non-combat load takes a hefty toll on the soldier’s muscles, causing immense pain and extreme fatigue from exhaustion. After that, eventual disillusionment sets in, leaving them hopeless (Currier and Holland 5). Nevertheless, these actual weights are an essential element for survival within dangerous conflict zones where personal guns’, bullets count, along with other varied gear become the vital defining factors critical for each moment of each day. This essay seeks to show how war’s physical, mental, and emotional tolls have a significant and lasting effect on the soldiers, as seen by the tangible items they carry, the intangible tolls they endure, and the intricate relationships between the two.
The iconic novel “The Things They Carried” vividly portrays the overwhelming load shouldered by soldiers during combat operations, delving into both physical and mental burdens they face during wartime. In this work, O’Brien explores in detail the visceral experiences of battle-weary personnel burdened with hefty supplies across dangerous environments (O’Brien 49). In this book, troops face an arduous physical burden beyond description. Heavy backpacks, helmets, flak jackets, and weapons represent reminders of grueling tasks performed under harsh conditions. With meticulous precision, while documenting heavy loads exceeding 100 pounds borne by these valiant souls strengthened with a keen sensitivity for detail, including muscle aches related to carrying such tremendous amounts of gear, readers empathize with his characters’ discomfort on every page turn throughout this story arch, which depicts service people experiencing wear-and-tear from the loads they carry (O’Brien 57). Each step represents a taxing exercise, sapping energy that exhausts soldiers. Throughout the narrative, O’Brien illustrates how this substantial weight quickly exacts a considerable toll on the individual’s physical abilities, waxing poetic about pain, fatigue and many more limiting factors that, in reflection, characterize contemporary warfare.
Moreover, it is worth pointing out that substantial burdens carried by soldiers serve as concrete symbols alluding to survival skills exercised while fighting on battlefields successfully. Arguably speaking, the personal weapons and ammunition capabilities alongside gear employed by military personnel form an integral part reflecting every person’s reliance on this singular object-focused composite safety machinery self-defense mechanism (Currier and Holland 10). In other words, every soldier meticulously chooses equipment reflective of his/her reliance on specific tangible objects essential to thriving during combat scenarios leading to life-or-death situations. Also noteworthy is that individual weapons’ total weight symbolizes perspective force-feebleness indicative of every soldier’s effectiveness – correlating directly with the responsibility shouldered after engaging in lethal-force-driven activities.
Soldiers often bear intangible burdens that inflict deep wounds upon them. Their mental and emotional weight outweighs their physical loads by far. Guilt is one such intangible burden that haunts soldiers as they try to make sense of moral dilemmas that arise from their actions during combat situations or fallout, afterward such as the death of comrades or other costs associated with making hard choices in wartime contexts. These haunting memories may linger long after wars end – creating an invisible weight on each character generated from internal conflicts such as trauma sustained while serving in combat zones (Currier and Holland 10). Even those who remain alive find themselves emotionally drained under intense pressure from constant guilt shadows born by difficult decisions faced daily during conflict zones affecting survivors’ long-term, giving them challenges beyond just physical repair when adjusting back to civilian life and society at large. Even though they attempt to maintain composure and bravery, survivors suffer from a deep sense of guilt, knowing that others did not make it back alive. They cannot accept this guilt – a tragedy that haunts them for life. In portraying how soldiers resort to absurd means as a way out, O’Brien highlights this emotional trauma vividly. Apart from this mental anguish, wars also leave behind a physical scar in terms of destruction and violence on innocent people, including women and children, during non-combat situations in Vietnam described by the author (O’Brien 96). Desolate hamlets symbolize human conflict’s catastrophic consequences throughout history, painting an unenviable picture. Through such vivid writings, O’Brien infers on themes like futility or perplex suitability, highlighting detrimental outcomes wars cause directly or otherwise.
Undoubtedly, one of the greatest intangible burdens troops face is fear – a pervasive mood that affects each person differently. In Tim O’Brien’s The Things They Carried novel, each soldier experiences formidable fears that are tangible enough to render normal coping more challenging than usual during wartime experience. For example, Jimmy Cross feels immense guilt for his affection towards Martha, which he finds hard to protect amidst war (O’Brien 38). Meanwhile, Henry Dobbins’ greatest worry is death itself. Unfortunately, since these fears cannot be wished away, they become an integral part of these soldiers’ everyday existence; unless dealt with consciously, they can leave one immobilized (Currier and Holland 8). As such, challenges on anxiety upon anxiety while also worrying over matters as basic as survivability create ever-present background noise. Through this novel, the author clarifies how fear takes root in people’s mindsets controlling them and determining actions.
In times of battle, our actions are often defined by what we carry along: physical objects or deeply ingrained thoughts and feelings. Such was true with every man in this instance- each soldier’s possessions held purpose or tremendous sentimental value. For Father Mulcahy, it was his crucifix, whereby its mere presence kept him mindful of God’s benevolence in troubling times (O’Brien 156). Similar sentiments rang true for Jimmy Cross when it came to carrying pictures of Martha – although at first burdened by guilt regarding his fondness for her – it eventually helped him come to terms with her presence at such turbulent times (O’Brien 38). Over time spent serving out on those bleak fields- one thing became evident to all of them: what they carry holds a significant emotional and psychological impact that shapes their behavior and actions.
Exploring the intricate layers of responsibility loaded onto soldiers during their service time, the book showcases how material possessions required to operate in combat operations effectively can also have lasting impacts on the soldiers’ well-being. Along with these physical loads come equally significant immaterial weights, such as trauma, shame or fear which further aggravate an already stressful situation. The author focuses on illuminating how these burdens (physical or emotional) have long come to influence soldiers’ experiences and define their lives even long after they leave behind military life (O’Brien 105). This powerful examination challenges readers to fully explore understanding wars’ consequences on those who face their daily tolls – both tangible and intangible – by examining what’s involved physically and mentally while exploring deep-seated connections between each factor.
Currier, Joseph M., and Jason P. Holland. “Examining the Role of Combat Loss among Vietnam War Veterans.” Journal of Traumatic Stress, vol. 25, no. 1, Wiley-Blackwell, Feb. 2012, pp. 102–05. https://doi.org/10.1002/jts.21655.
O’Brien Tim. The Things They Carried. Houghton Mifflin Harcourt 1990. https://www.worldcat.org/title/781921866
Increasing Quality And Safety
Medical institutions are responsible for ensuring their patients’ health and safety. Medical errors have constantly affected the safety of patients. Medical errors can happen at various stages when healthcare personnels discharge their duties, from drug administration, prescription, and paperwork, and even when a physician issues a drug order. To eliminate these errors, nurses must be on close professional watch with their patients, keen, and work with due diligence. Guidelines and policies are set up to ensure proper adherence by healthcare staff to prevent them from committing medical errors (Rodziewicz & Hipskind, 2020). Because of this, nurses can now focus on the five rights to ensure patient safety; proper dose, patient, time, route and medicine. Healthcare can combat administration errors through well-arranged teamwork and objective effort, taking in staff across all departments (PMC, 2019).
Medical errors adversely affect patients and, in the worst cases, can lead to death (Assiri et al., 2018). The outcomes of pharmaceutical administration errors include unnecessary extra costs, drastic effects, damage to the medical facility’s reputation, and even patient death. This case is a big blow to the facility and society and should, therefore, firmly be dealt with at all costs early enough. This research aims to find out the cause of medical errors, identify strategies that can be used to prevent the occurrence of these errors, the role that nurses have in ensuring patient safety and the influence that all health stakeholders could have in the plan to reduce medication errors occurrence in health institutions.
Causes of Medication Administration Errors
Many factors can cause medical administration errors. According to Europe PMC, 2019), lack of enough records, problematic issues of drugs, and improper dosage are the most common causes of pharmaceutical administration errors. Moreover, there are other causes of medication administration errors; inaccurate patient identification for a certain amount, administering the wrong drug and even using improper channels in providing prescriptions. According to Hammoudi et al. (2018), erroneous patient diagnoses can also result in medical administration errors. As found by the research, lack of expertise, failure to apply established pharmaceutical procedures, and lack of experience can all contribute to medication administration errors (Hammoudi et al., 2018).
Some circumstances can also lead to medication administration errors, such as working night shifts and interruptions when a practitioner is administering medication. Failure to observe proper communication between physicians and pharmacists and lack of adherence to the five rights of drug administration can lead to more incidences of errors in medication delivery (Assiri et al., 2018). From what we have learned, it is clear that medication administration errors are so complex that the issue cannot be dealt with by an individual or department single-handedly but through a coordinated multimodal approach.
Evidence-based and Best-Practice Interventions
Healthcare practitioners can use evidence-based interventions and a variety of best practices to prevent drug delivery errors. Assiri et al. (2018) state that physicians should employ computerized order entry (CPOE) and automated dispensing systems in facilities to reduce MAEs. In addition, the researchers insisted that the two technological interventions are evidence-based mitigation strategies for reducing medication administration errors(Assiri et al., 2018). Furthermore, to reduce the lack of enough records, which is the most common cause of medication, healthcare practitioners can use the computerized provider order entry to share medication errors. According to Hammoudi et al. (2018), The CPOE’s component CDS is a clinical decision engine that supports the CDS framework and reduces medication errors, improving patient care and safety. The CPOE can also lower medication errors by issuing medication in the right dosage to the right patient and at the right time. Due to the reasons stated, CPOE is an efficient and effective intervention in dealing with medication delivery errors. Healthcare practitioners have to double-check best practice strategies to ensure that they counter medication errors. Double checking is scrutinizing whether the dispensed prescription is in the right dosage, is being done at the right time, and is for the right patient. CPOE deals with the risk of error due to a lack of sufficient records, combating medical administration errors by ensuring that the administered drug is in line with the patient’s medical history.
According to Hammoudi et al. (2018), encouraging voluntary error reporting will be an excellent practice strategy. The strategy will help in eliminating future drug errors. Patient safety will be much improved due to this strategy since it encourages the development of quick techniques to reduce error occurrence. Healthcare facilities should create a culture and environment that encourage voluntary drug error reporting freely. Health facility administrators should instruct departments on the proper ways to report medication errors and provide sufficient resources to promote the efficiency of this intervention strategy.
According to Hammoudi et al., (2018). Healthcare administrators should ensure that practitioners receive proper training to ensure organizational compliance; training will be comprehensive to ensure that the practitioners understand error detection and do away with the long process of voluntary reporting, therefore, minimizing future errors. Medical administration errors will be best dealt with by combining electronic medical data and an automated dispensing system. Medication administration errors can be prevented by harmonious collaboration between pharmacists, medical reconciliation, and patient education.
The Role of Nurses in Care Coordinating
Nurses are crucial practitioners in healthcare facilities. Through proper collaboration and coordination, nurses can deal with medication errors. Nurses can reduce errors through medication reconciliation; this is when a nurse inspects any anomalies in drug dispensing, checks prescription histories, and counter-checks and follows up to correct an error identified. Nurses must also collaborate with other healthcare practitioners to eliminate medicine delivery errors. Nurses can seek clarity from pharmacists through collaboration before educating nurses on the drugs provided. According to Salar et al. (2020), Nurses should always ensure adherence when offering medication and make the patients understand the importance of the drugs administered. Nurses have a role to play in following up with the patients after being discharged to ensure that the patients are taking the drugs in the right dosage and at the right time; in this way, nurses can check the progress of patients. The above discussion proves that nurses are ideal professionals in reducing medication administration errors (Chan et al., 2020).
Stakeholders’ Influence on Medication Administration
Stakeholder dynamics are a vital factor to consider in dealing with medication errors because this greatly influences the frequency of medication administration errors. In collaboration, these stakeholders can eliminate several issues that result in medication errors, according to Chen et al. (2019). Stakeholders can improve patients’ healthcare quality and safety through proper collaboration, improving patient outcomes. Many kinds of literature have been published that emphasize that teamwork effort plays a vital role in reducing and eliminating issues that contribute to pharmaceutical delivery errors (Chan et al., 2020). For example, in reducing prescription administration errors in the healthcare facility, the action team should collaborate with a nurse, a physician, and a pharmacist. Poor communication between healthcare practitioners can result in errors. Patients and their families also have a role in reducing medication administration errors. Proper patient education on their medication can help them identify an error based on their medical history. Nurses can work with pharmacists to ensure that drugs are administered correctly; they can also work with physicians and pharmacists to ensure that incorrect medicine administration or errors are reported on time, ensuring that care delivery and patient safety are achieved (Chen et al., 2019).
Medication administration errors are now a daily turmoil in healthcare facilities. By using technology solutions, such as CPOEs and automated dispensing systems, practitioners can reduce the frequency of medication error occurrence. Best practices involving an interdisciplinary approach can be put in place to ensure error prevention; such include voluntary error reporting, counter-checking, and educating healthcare personnels to identify medication errors before they cause harm to patients. Nurses have been identified as crucial practitioners in reducing medication errors because they can counter-check drug administration against patient history. In coordinating treatment, they can discover errors early enough before they cause harm. Due to this, medical institutions must ensure proper training for nurses in detecting medication errors to reduce the frequency of MAEs in healthcare facilities.
Assiri, G. A., Shebl, N. A., Mahmoud, M. A., Aloudah, N., Grant, E., Aljadhey, H., & Sheikh, A. (2018). What is the epidemiology of medication errors, adverse events and risk factors for errors in adults managed in community care contexts? A systematic review of the international literature. BMJ Open, 8(5), e019101. https://doi.org/10.1136/bmjopen-2017-019101
Chan, A. H. Y., Horne, R., Hankins, M., & Chisari, C. (2020). The Medication Adherence Report Scale: A measurement tool for eliciting patients’ reports of nonadherence. British Journal of Clinical Pharmacology, 86(7), 1281–1288.
Chen, Y., Wu, X., Huang, Z., Lin, W., Li, Y., Yang, J., & Li, J. (2019). Evaluation of a medication error-monitoring system to reduce the incidence of medication errors in a clinical setting. Research in Social and Administrative Pharmacy, 15(7), 883–888. https://doi.org/10.1016/j.sapharm.2019.02.006
Europe PMC. (2019). Europe PMC. Europepmc.org. https://europepmc.org/article/nbk/nbk499956
Hammoudi, B. M., Ismail, S., & Abu Yahya, O. (2018). Factors associated with medication administration errors and why nurses fail to report them. Scandinavian Journal of Caring Sciences, 32(3), 1038–1046.
Rodziewicz, T., & Hipskind, J. (2020). Medical error prevention (pp. 1–37). http://www.saludinfantil.org/Postgrado_Pediatria/Pediatria_Integral/papers/MedicalErrorPrevention-StatPearls-NCBIBookshelf.pdf