Running head: H.R.

5130: SIMARRA ACT 1

Analysis of H.R. 3150: the Stop Infant Mortality and Recidivism Reduction Act (SIMARRA)

LaRie Burgoyne

Azusa Pacific University

H.R. 5130: SIMARRA ACT

Analysis of H.R. 3150: the Stop Infant Mortality and Recidivism Reduction Act (SIMARRA)

Across nations, women and their children are considered at risk populations. Currently

within the United States, more than 200,00 women circulate through the prison system daily,

many of them pregnant or recent mothers (Jackson Lee, 2016). The SIMARRA Act (Stop Infant

Mortality and Recidivism Reduction Act), introduced to congress by Representative Shelia

Jackson Lee on July 26, 2017, seeks to reduce the high infant mortality and recidivism rate for

female inmates by implementing pilot programs around separate but federal based housing and

nurseries for pregnant inmates as well as the use of risks and needs assessment as the cornerstone

of care for pregnancy during incarceration. This paper seeks to explore the moral and social

implications of the proposed problem and interventions as well as examine the SIMARRA Act

through the policy analysis frameworks by Patton, Zalon, and Ludwick (2015).

Background

Estelle vs. Gamble ruled in 1976 that medical services be provided to all prisoners in

accordance with the Eighth Amendment (Cardaci, 2013). Between the year 1980 to 2010, the

United States witnessed a nearly 646 percent increase in the number of incarcerated women,

bringing it to its highest census in US history (Kajstura, 2017). Risk factors for incarceration

include altered mental health, poverty, substance abuse, domestic violence, and limited access to

resources such as health care (Cardaci, 2013). While in prison, inmates face an increased risk for

violence, mental instability, nutritional and social deficits, and contracting of infectious diseases

such as AIDS, Tuberculosis or Hepatitis (The Rebecca Project for Human Rights, 2010).

Pregnant or not, prison is considered a daunting and dangerous environment and with majority of

female prisoners being of childbearing age, their health risks increase considerably.
H.R. 5130: SIMARRA ACT

Today, of the more than 200,000 female inmates, 25% are estimated to be pregnant

(Jackson Lee, 2016). For most of these women, domestic or sexual violence lie at the root of

their incarceration pathway and poverty and substance abuse, coupled with limited access to

health care resulted in a complex dynamic (Cardaci, 2013). Crimes and addictions once

traditionally handled with treatment, now result in increased incarcerations as the main tool for

the war on drugs. This has resulted in an increased incidence of incarceration while pregnant

(The Rebecca Project for Human Rights, 2010). Coupled with these risk factors, pregnancy while

incarcerated more than triples the likelihood of an adverse outcome (Shlafer, Stang, Dallaire,

Forestell, & Hellerstedt, 2017).

General standards of care vary state by state and for some women, incarceration may

increase the positivity of the prognosis for their pregnancies (The Rebecca Project for Human

Rights, 2010). Resources once unavailable such as food, shelter and health care are standard

parts of everyday life. However, this makes a small percentage and most pre- and post- natal

programs as well as rehabilitation programs fail to meet the full needs of their patients (Clarke,

2011). The infant mortality rate is 29.6% for the female prison population compared to 6.1% of

the general United States census (Jackson Lee, 2016). Coupled with a 2017 recidivism rate of

nearly 60%; for chronic repeat offenders and their families, a vicious cycle results in further

marginalized communities (Jackson Lee, 2016).

The Rebecca Project for Human Rights published an article in October of 2010

documenting the variety in standard of care for pregnant inmates by state. The organization

quantified the quality of care by assigning each state’s prison system a grade, A-F, based on pre-

natal care, shackling and family-based treatment as an alternative to incarceration (The Rebecca

Project for Human Rights, 2010). Nearly half of the states (21) received an overall score of D or
H.R. 5130: SIMARRA ACT

F, the other half (22) mostly receiving a score of C, and only one state, Pennsylvania scoring

above an A with an A-. Forty-three states did not require assessment and examination as part of

pre-natal care or provide screening and treatment for high risk pregnancies. HIV testing was not

provided during pregnancy in forty-eight states. Over forty-four states did not provide education

on appropriate activity levels and safety nor make advanced arrangements for hospital deliveries.

Nearly all states, forty-nine out of the fifty, failed at regularly reporting female inmate pregnancy

rates and delivery outcomes. Thirty-six continue to regularly practice shackling prisoners during

delivery. Finally, thirty-eight states do not provide prison based nurseries, and of the thirteen

that do, only two allow children to stay past the age of two or provide mother-child therapeutic

services (The Rebecca Project for Human Rights, 2010).

Currently, the Federal Bureau of Prisons (BOP) and National Commission on

Correctional Health Care (NCCHC) dictate prenatal care policy for US federal prisons (The

Rebecca Project for Human Rights, 2010). While their policies are comprehensive in writing,

little implementation is evident and reporting on the issue is limited. Programs such as Mothers

and Infants Nurturing Together (by BOP), which allows new mothers with short sentences the

opportunity to complete time in a community based setting or "P-G-O7: Care of the Pregnant

Inmate", part of the Standards of Health Services (by NCCHC) that states best practices for

pregnant inmates, are readily available, but used by less than 5% of the federal prison system

(The Rebecca Project for Human Rights, 2010). There are no laws requiring state adherence to

BOP or NCCHC policy. With the SIMARRA Act, Representative Jackson Lee proposes to

standardize prenatal care for all female inmates as well as provide specialized care for high risk

individuals by instituting separate housing and federal based nurseries to provide treatment to

stop the cycle of high infant mortality and recidivism (2016).

H.R. 5130: SIMARRA ACT

H.R. 5130 SIMARRA ACT

The SIMARRA Act was introduced to congress on April 29, 2016 by Representative

Jackson Lee and subsequently referred to the House Committee on the Judiciary on May 3, 2016.

On May 6, 2016, the act was referred to the Subcommittee on Crime, Terrorism, Homeland

Security, and Investigations where it was examined and voted on. The Bill was supported and

cosponsored by forty-two representatives from twenty-one different states and had no

amendments since introduction. Despite strong support of the bill, as seen in the many

cosponsors and endorsement from organizations such as National WIC Association, the bill died

in the 114th Congress. However, not to be detoured, the bill was reintroduced to congress by

Representative Jackson Lee on July 26, 2017 and once again referred to the Subcommittee on

Crime, Terrorism, Homeland Security, and Investigations on September 9, 2017 were it now sits.

The bill projected chance of passing is 2%.

Policy Analysis

During introduction of the bill, Representative Jackson Lee expresses the need to

finally address the long-standing cycle of generational incarceration of “mothers convicted of

non-violent crimes and the children they birth behind prison bars” (2017). Jackson Lee clearly

expresses the belief that for children born in prison, incarceration both reduces the chances of

their survival and foster future life inequality (2017). For Jackson Lee, it is evident that not

addressing the needs of incarcerated pregnant women or recent mothers (within 30 months of

birth) and their children is a violation of the 8th and 9th Amendment (2017). Denying the access

to appropriate care and safe environments denies an innocent community (the children) of the

rights to an equal future and ultimately puts our nation’s future generations at risk.
H.R. 5130: SIMARRA ACT

Approval of H.R. 5130 would allow for the implementation of a piolet program

consisting of separate housing for pregnant women and recent mothers (within 30 months of

birth) and their children, as well as standardized pre- and post-natal care and assessment of high

risk individuals with specialized interventions (Jackson Lee, 2016). Current policy dictates that

most expecting women are to remain in the general population during pregnancies and must

relinquish the child once born (Cardaci, 2013). With a recent report by the National revealing

nearly 10,000 babies are born behind bars each year, for those who do not have friends or family

to take the child, many end up in the foster system (Jackson Lee, 2016). In addition, more studies

reveal that early separation of a child from its mother due to incarceration increases the child’s

risk for mental illness, domestic abuse and use of illicit drugs (The Rebecca Project for Human

Rights, 2010). Neo-natal science states that positive early social interactions are essential to a

child’s development (Jackson Lee, 2016). There are currently 10 state run programs similar to

the SIMARRA Act that illustrate a 71% attainment of secure infant-mother bonding and

attachment when placed in a prison nursery. With this, incarcerated mothers who have

participated in such programs are two times less likely to return to prison (The Rebecca Project

for Human Rights, 2010). This not only serves the needs of the specific population, but reduces

the future costs to our nation by reducing recidivism and producing individuals that can give

back to society.

The SIMARRA Act offers a solution to the highest infant mortality rate in all developed

countries, address the issue of a generational cycle of incarceration, and supplies methods for

reducing costs to an overly stretched prison system (Jackson Lee, 2016). This will ultimately be

done by developing risks and needs assessment of pregnant inmates, providing necessary

interventions and regularly evaluation of such measures to ensure evidenced based practice.
H.R. 5130: SIMARRA ACT

Pregnant inmates would be allowed to apply for the program with inclusion factors being the

status of pregnancy at the onset of incarceration and under the custody of the Federal Bureau of

Prisons (Jackson Lee, 2016). If approved, participants would serve the remainder of their

pregnancies and up to thirty-months post birth in housing and nurseries separate from the general

prison population. Program participation would require all participants to meet standards such as

accepting responsibility for primary child care, complying with medical standards and

participation in educational and counseling therapies focused on child care, parenting skills,

abuse (substance, domestic, sexual), and career training. Termination of participation could only

result in the instance of failure to comply with medical terms, release from prison or exceeding

postpartum time (Jackson Lee, 2016).

Ethical Discussion

If approved, the SIMARRA Act would grant pregnant inmates separate standards of care

from the general prison population. It is for this reason that the ethical implications of such

policies be examined prior to execution. There are many applicable principles, but it is the

principles of justice and beneficence (Beauchamp and Childress, 2016) that best evaluate

Representative Jackson Lee’s argument for the benefit of the SIMARRA Act.

Justice

Representative Jackson Lee argues that it is an injustice not to supply children born to

incarcerated women, with specialized assistance during what the CDC states is the most critical

period in a child’s life, the first 30 months (Jackson Lee, 2016). But is this truly the case?

Beauchamp and Childress (2016) define justice as the fair handling of both goods and services.

Six frameworks are listed in which justice can be examined, however, the frameworks of equal

share and according to need are the most relevant. With the aid of Mills’ (1991) utilitarian
H.R. 5130: SIMARRA ACT

theory of justice, the issue of justice for unborn children born to incarcerated woman can

simultaneously be examined with regard to morality.

Mills (1991) proclaimed that justice is a subcategory of morality. He stated that

“injustice involves the violation of the rights of some identifiable individual” and with this,

“justice implies something which is not only right to do, and wrong not to do, but which some

individual person can claim from us as his moral right” (Mills, 1991). With the well documented

statistics regarding life trajectories of children born behind bars, it would be unjust not to provide

specific specialized interventions for this population (Jackson Lee, 2016). A fair chance at life is

a moral right and equal share implies that each of us have access to resources in regard to this

moral right. Given the physical, mental and spiritual implications of early separation of mother

and child as well as cyclical patterns within families of recidivism and incarceration, it is not

only a violation of justice but a violation of morals not to take steps that have been evidenced to

alleviate these disparities. Beauchamp and Childress (2016) also assert that those who have an

innate advantage (such as birth status) should receive benefits simply because of it and those

who do not, should not suffer simple because of the lack of it. This means that children born

within the prison system should not be deprived of the same care as those born outside simply

because of the disadvantage of their birth status. Once again, a fair chance at life is a moral right

and not granting it would be a violation of justice and morality.

Ethics regarding pregnant inmates is further complexed due to the involvement of three

different populations; non-pregnant inmates, pregnant inmates, and the children born to them.

The financial difficulties of the United States are well known, especially within the correctional

system. With limited resources, is it ethical to invest more resources into one portion of the

population than the rest? In this case, yes. When presenting this question with the framework;
H.R. 5130: SIMARRA ACT

according to need (Mills, 1991), it is evident that pregnant inmates have a special need. Children

born to inmates did not choose to be so, nor did they choose their placement after birth. With the

CDC recommendations (Jackson Lee, 2016), it can once again be seen as a violation of justice at

a fair chance in life if the system continues to separate mothers from their children. These

children are a part of the American future, and thus must be granted equal opportunity to

contribute to society’s future.

Despite the rights due to children born to inmates, the issue still remains that pregnant

inmates can ultimately gain benefits not enjoyed by their non-pregnant counterparts simply

because they are pregnant. Thus, is it just to provide special privileges to those who are being

punished? On first examination, one would answer no. It can be argued that prisoners chose the

actions that resulted in their circumstances. If H.R. 5130 were implemented, there is a fear that

some women would become pregnant on purpose to ease their prison terms. However, a child is

a lifelong commitment and participation in the program would require active participation in

child care and life counseling and training. With a documented reduction in recidivism with

individuals who participate in the program (Jackson Lee, 2016), the benefits far outweigh the

risks. There is a need to address the needs of this populations and in accordance with Mill’s

theory on Justice (1991), it would be of the heights justice to not separate our nations moral

obligation to the marginalized communities of women in jail and their children. Thus, with these

arguments put in place, through the lens of Mills’ (1991) framework and Beauchamp and

Childress (2016) definition of justice, the SIMARRA Act does illustrate justice.

Beneficence

Beauchamp and Childress (2016) assert that morality involves not only respecting a

person’s autonomy and refraining from harm, but contributing to their benefit as well (p. 259).
H.R. 5130: SIMARRA ACT

As stated earlier, in introductory remarks to congress, Jackson Lee (2016) proclaims that it is the

nation’s moral responsibility to ensure the wellbeing of all future generations. But does the

SIMARRA Act meet this standard? Being that it was established that it does meet the standards

of justice, if examining the relevance of moral responsibility of the SIMARRA Act through the

framework of Frankena (2009), Beauchamp and Childress (2016), it then also meets the criteria

of beneficence.

Frankena (2009) divides beneficence into four specific obligations; one should not harm,

one should prevent harm, one should remove harm, and one should promote/ do good. The first

obligation reflects non-maleficence, which according to Frankena, cannot be separated from

beneficence (Beauchamp et al, 2016). Not causing harm is a form of doing good, thus one is

acting beneficently by being non-maleficent. The second obligation goes further stating that in

meeting moral responsibility, one should not only, not do hard, but prevent it as well

(Beauchamp et al, 2016). Further, with obligation three, in addition to preventing harm, moral

responsibility to beneficence requires the removal of harm. Finally, to truly adhere to the

standards of beneficence, one needs to do good (Beauchamp et al, 2016). When examining the

SIMARRA Act with these four obligations, the role of beneficence is clear.

Obligation one of Frankena’s (2009) framework is illustrated in the SIMARRA Act

through the desire to keep children born behind bars with their mothers for the first 30 months of

life (Jackson Lee, 2016). By refraining from early separation of mother and child, society will

cease an action that has been documented to do harm to the development of an individual. Thus,

H.R. 5130 would do no harm. Obligation two (Frankena, 2009) is illustrated in the SIMARRA

Act through its focus on risks and needs assessment as well as recognizing that maternal health is

a large part of the equation in reducing the high infant mortality rate (Jackson Lee, 2016).
H.R. 5130: SIMARRA ACT

Jackson Lee states “the most likely long-term mechanism through which imprisonment affects

infant mortality is through its effects on maternal health” (2016). Infant deaths to female

prisoners cannot be reduced until maternal health is improved. Supplying for maternal wellbeing

prevents harm to the wellbeing of the unborn or newly born child, thus upholding the second

obligation. Obligation three (Frankena, 2009) is met through the desire to place expecting

mothers or mothers who have recently given birth in separate housing from the general

population. The environment of prison is known to be an unsafe place (Jackson Lee, 2016).

With the presence of gangs, female jealousy, assaults, murders, uninhibited sexual activity,

tattooing and unsanitary surfaces, the risks to anyone’s health is astronomical. However,

pregnant inmates are at an even higher risk due to the physiological changes caused by

pregnancy to the body. Removing pregnant inmates from the general population would also be

removing their unborn children, thus removing harm. Finally, obligation four (Frankena, 2009)

is illustrated through the requirement of program participants to participate in family therapy and

counseling as well as educational courses on parenting skills, career training, conflict

management, and drug abuse (Jackson Lee, 2016). Providing resources that would help reduce

the female recidivism rate and foster more capable parents and members of society would be

doing good. Thus, with H.R. 5130 meeting all four obligations of Frankena’s framework (2009),

it can qualify as beneficent and thus moral in accordance with Beauchamp and Childress

(2016).

H.R.5310 and Nursing

A common theme is seen in the career paths of many nurses, the desire to help. Yet, few

are prepared for the moral crisis that may come with different career situations. This can be

especially true when it comes to working with certain populations, like prisoners. However, the
H.R. 5130: SIMARRA ACT

Nursing Code of Ethics by the American Nurses Association (ANA) is a tool that can be used to

help navigate choices (2015). H.R. 5130 aligns with certain standards of the Code of Ethics

allowing nurses the opportunity to better serve a population in need, particularly provisions one

through three (American Nurses Association, 2016).

Provision one of the Nursing Code of Ethics states that nurses have a responsibility to

recognize the equality and human dignity in all individuals and must therefore practice with

unbiased compassion (American Nurses Association, 2016). The SIMARRA Act explicitly

meets this insofar as it recognizes both the female prison population and their children as

members of society that still deserve care and consideration (Jackson Lee, 2016). Enactment of

H.R. 5130 would better allow nurses to serve these populations especially since programs such

as federal nurseries, medical treatment and risks and needs assessments would mostly likely be

completed by nurses. In a constantly morphing health care system, this could be one additional

avenue for change. In addition, a cornerstone of the Act is to facilitate programs that supply

patients with education and nurses would be the best healthcare professionals to do so. Provision

two states that the primary concern of the nurse is the patient without regard to the patient’s

status as an individual or within a community (American Nurses Association, 2016). It is the

health and what is best for the patient that should be primary concern, not public opinion. The

SIMARRA Act supplies nurses the tools to abide by this provision by implementing programs

that supply care tailored to the needs of the specific population (Jackson Lee, 2016). Separate

housing, education and constant reevaluation may be a conflict of interest in the opinion of

society for the treatment of prisoners as punishment, but for the nurse, it is document as what

best serves the patient and society as a whole. Finally, Provision three states that the nurse is to

“seek to protect the health, safety, and rights of the patient” (American Nurses Association,
H.R. 5130: SIMARRA ACT

2016). Implementation of the SIMARRA Act would meet this, especially portion 3.5; acting on

questionable practice (American Nurses Association, 2016). As stated many times, it is

documented that early separation of mother and child is a detriment to the child’s development

and can be seen in familial patterns of incarceration (Jackson Lee, 2016). Yet, it is still the

common practice. By keeping mother and children together, nurses would not be required to act

on the questionable practice of family separation and continue to seek the health, safety, and

rights of the patients. Thus, when considering both ethics and implications on nursing, H.R.

5130 would appear to have more of an overall benefit than detriment.

Personal Reflection

The topic of marginalized women and children has always been a passion and it is for this

reason that I desired to work with a bill concerning them. Upon first encountering H.R. 5130, I

was instantly for it, however, after closer examination it is both my calling as a nurse and a

Catholic that drives my desire to see more legislation such as this. As a child, I was raised on

two core principle; we are all equal children of God, therefore Christ is in all of us, and only God

is God, therefore it is not my right nor my responsibility to be the judge and jury of others but

simply to love them as Christ would. I firmly believe that H.R. 5130 would allow practicing and

future nurses like myself the opportunity to act on core beliefs that recognize the human dignity

in all.

One of the most poignant biblical stories of my youth comes from Matthew 25: 31-46

(New International Version). In this passage, Matthew discusses the day of Final Judgement in

which Christ returns and grants the righteous eternal life and the wicked eternal damnation. In

particular verses 41-43 states, “then the King will turn to those on the left and say, ‘Away with

you, you cursed ones, into the eternal fire prepared for the devil and his demons. For I was
H.R. 5130: SIMARRA ACT

hungry, and you didn’t feed me. I was thirsty, and you didn’t give me a drink. I was a stranger,

and you didn’t invite me into your home. I was naked, and you didn’t give me clothing. I was

sick and in prison, and you didn’t visit me.’” ( Matthew 25: 41-43,New International Version).

There can be many interpretations but I always saw this as Christ proclaiming that He is in all of

us, even the lowest of society and it is because of this that as Christians, we are required to care

for all. The verse even clearly includes prisoners. The SIMARRA Act upholds this biblical

principle for me. It recognizes that female prisoners and their children are still human and

therefore loved by Christ. The program’s provisions would not only allow nurses to act in

accordance with the Nurse’s Code of Ethics, but Christian and loving values as well.

It gives me joy to see that H.R. 5310 has so much support from various representatives

and organizations. However, the stark reality for the bill cannot be ignored. It died once before

in the 114th Congress and now, since reintroduction, has only 2% probability of being passed

(Jackson Lee, 2016). In addition, with an all democratic support group, it would be hard to

consider cooperation in a republic senate. Yet, one can continue to hope and through getting

involved, potentially change the chances of such Acts coming to fruition.

Conclusion

Recent laws discontinuing the practice of shackling prisoners during labor and delivery is

a good first step towards addressing the high rates of adverse outcomes for pregnant inmates and

the children born to them (American Psychological Association, 2016). Representative Jackson

Lee (2016) clearly illustrates the link between maternal wellbeing and infant mortality in her

introduction and provisions of H.R. 5130 (SIMARRA Act). It exemplifies moral theories such as

justice and beneficence (Beauchamp et al, 2016) while granting nurses the opportunity to treat an

underserved community in accordance to the code of ethics. Organizations that support the
H.R. 5130: SIMARRA ACT

wellbeing of mothers and children, such as WIC, strongly support the SIMARRA Act and it is

for this reason that nurses should as well. There are countless stories like MS A, a twenty-five-

year-old woman who reflects how her treatment while pregnant and incarcerated was decent, but

it was the requirement to relinquish the rights to her child immediately after birth that resulted in

the most pain and suffering (Clarke, 2011). The SIMARRA act can combat this sad reality.

Being that all nurses have a duty to policy and advocacy, support of this bill is just one way

nurses can help progress steps towards a healthier and happier future.
H.R. 5130: SIMARRA ACT

References

American Nurses Association. Code of ethics for nurses with interpretive statements. Author,

Silver Spring, MD; 2015.

Beauchamp, T. L., & Childress, J. F. (2016). Principles of biomedical ethics (Fourth ed.). New

York, New York: Oxford University Press.

Cardaci, R. (2013). Care of Pregnant Women in the Criminal Justice System. American Journal

of Nursing, 113(9), 40-48. Retrieved March 31, 2018.

Clarke, J. G. (2011). Perinatal Care for Incarcerated Patients. Jama, 305(9), 923.

doi:10.1001/jama.2011.125

House judiciary passes bill containing a top APA priority on pregnant incarcerated women.

(2016). American Psychological Association. doi:10.1037/e503152016-001

Jackson Lee, S. (2016). Congressional Record Volume 162, Number 69 (Tuesday, May 3, 2016)

[Transcript]. Retrieved from https://www.gpo.gov/fdsys/pkg/CREC-2016-05-

03/html/CREC-2016-05-03-pt1-PgE647-6.htm

Jackson Lee. (2016, May 17). Text - H.R.5130 - 114th Congress (2015-2016): SIMARRA Act.

Retrieved April 06, 2018, from https://www.congress.gov/bill/114th-congress/house-

bill/5130/text

Jackson Lee, S. (2017, April 26). SIMARRA Act (2016 - H.R. 5130). Retrieved April 06, 2018,

from https://www.govtrack.us/congress/bills/114/hr5130

Kajstura, A. (2017, October 19). Women's Mass Incarceration: The Whole Pie 2017. Retrieved

March 15, 2018, from https://www.prisonpolicy.org/reports/pie2017women.html

Patton, R.M., Zalon, M.L., & Ludwick, R. (2015). Nurses making policy: From bedside to

boardroom. Springer Publishing Co: New York.

H.R. 5130: SIMARRA ACT

Shlafer, R. J., Stang, J., Dallaire, D., Forestell, C. A., & Hellerstedt, W. (2017). Best Practices

for Nutrition Care of Pregnant Women in Prison. Journal of Correctional Health Care,

23(3), 297-304. doi:10.1177/1078345817716567

The Rebecca Project for Human Rights. (2010). Mother's Behind Bars: A state-by-state report

card and analysis of federal policy on conditions of confinement for pregnant and

parenting women and the effect of their children [Abstract]. National Women's Law

Center: Expanding the Posibilities. Retrieved March 28, 2018.

H.R. 5130: SIMARRA ACT

LaRie Burgoyne
4681 Lisann Street
San Diego, CA 92117

April 6, 2018

The Honorable Senator Dianne Feinstein

880 Front Street, Suite 4236
San Diego, CA 92101

Dear Senator Feinstein,

Service to marginalized communities is a core value I have work towards my entire life. My
involvement spans from volunteering with underserved youth for summer camp as a teen to
volunteering a year of my life in fulltime community service by assisting teachers in inner city
classrooms. This is further evident through my career choice as a nurse, for I feel it is the best
and purest way I can give back to the community. Through personal interactions with the
individuals I served, to my own personal extended familial experience with the justice system, I
have been made aware of an unfortunate pattern that has befallen certain communities. Like
poverty, teen pregnancy and many other modern day epidemics, I feel family patterns of
incarceration is a vicious cycle that must be addressed. It is the countless stories of women,
battered by life and the system only to produce future generations that suffer the same fate, that
drives me to write and thank you for your support of H.R 5130, the Stop Infant Mortality and
Recidivism Reduction Act of 2016 by the Honorable Shelia Jackson Lee of Texas in the house of
representative.

The high recidivism and infant mortality rate for incarcerated mothers is a sad reality that
continues to be overlooked by the public. Nearly $7.7 billion a year was revealed to be spent in
a 2011 fiscal report of correctional medical care. Your support of H.R. 5130 would be just one
way this budget can be addressed.

It is not only vital to our country’s future that we begin to invest in all of our communities, but
our moral responsibility to as well. With a female incarceration rate that has exploded over the
past 30 years and an infant mortality rate highest in all developed countries, it is time these
cycles are stopped. By investing in generations that still have uninhibited potential such as
through the SIMARRA Act and its focus on maternal health and early childhood development,
one further step towards equality for all humanity is recognized.

It is with my greatest delight that I thank you for your support of H.R. 5130 and for your
continued embodiment of such needed leadership.

Sincerely,

LaRie L. Burgoyne
H.R. 5130: SIMARRA ACT

Nursing Clinical Ethical Issue & Public Policy Paper – Rubric

20 points possible

Purpose/Objective of this assignment:

1. To address an ethical issue in nursing of the student’s choice, and the current or
emerging, dynamics of this ethical issue on nursing practice.
2. Identify a healthcare policy that pertains to the selected ethical issue and determine
recommendations or suggestions for modifications or changes.
3. Prepare for political advocacy by writing a letter to a Congressman (local, state or
national) summarizing the concern and suggested policy changes.
4. Address Student Learning Outcomes 1, 2, 4, and 5

Assignment Requirements and Instructions:

1. Select a current ethical issue in nursing. The paper will include the issue, its dimensions,
relevant ethical theory and principles, the position of nursing as a profession,
ethical/cultural dynamics and the writer’s personal views. Examples and illustrations will
be an important part of this paper as they are in any ethical discussion.
2. Identify the healthcare policy that pertains to the identified ethical issue. The policy
section must indicate current health care and nursing policy on this issue, and any
recommendations or suggestions you may have for modification or changes. Utilize a
framework for examining the key concepts of the policy.
3. Identify two nursing code of ethics and incorporate in discussion
4. Write a letter to a Congressperson summarizing the concerns about the healthcare policy
and provide recommended policy changes.
5. The reference list should include a variety of sources and demonstrate the student’s
research of the topic. The paper is considered a scholarly paper that incorporates
readings of substance, not opinions. Sources from nursing must be incorporated.
6. Present a brief summary of paper to the class at the end of the semester on the selected
dates. Time will be allowed for presentation and then questions.
7. All papers must conform to the standard academic format, APA style 6th Edition, and be
free of spelling, grammatical, and typographical errors. The paper should be cleanly type
written, and submitted to SAKAI in the assignment section on the due date and time.
Must include an introduction and a conclusion
8. All paper submissions will also go through Turn-It-In.com

9. Page lengths (15 pages max)/presentation time (10 minutes):

a. Background – 1 page: what is the problem, demographics, what has been
previously done, why is this topic so important
b. Ethics – 10 pages:
i. apply at least 2 ethical principles
ii. incorporate citations from more than course texts
iii. include nursing position papers on topic
iv. 2 nursing code of ethics
c. Health policy – 3 pages: identify a framework that you are using to analyze and
cite, include who supports/opposes bill, what is nursing’s position, lengthy policy
statements may be included in Appendix.
d. Letter to Congressperson – 1 page: place after References & before rubric (not
part of 15-page limit for paper)
e. Presentation – 10 minutes and 10 powerpoint slides (not including slides for title
and references

Assignment Weight/Points: Paper = 20 points (27% of grade), Presentation = 5 points (3% of grade)

Grading Rubric for Presentation

4 – 5 points 3 points 2 points 1 point
Clear, 10 slides, stays within time limit, 3 of the criteria met 2 of the criteria met None of the criteria met
includes all elements of paper, quality of
presentation/discussion
H.R. 5130: SIMARRA ACT

Grading Rubric for Ethics/Policy Paper

Category Exemplary Meets Requirements Needs Improvement Points

Background Clearly identifies a current issue in nursing. Topic is identified and Topic and purpose of
Maximum Topic is introduced and defined; focus, defined. Significance and the paper is unclear.
2 points significance, and direction of the paper clear direction are identified.
to reader.
Ethics Provides an in-depth discussion of the Topic addressed Topic not addressed
Discussion ethical issues involved. adequately. adequately.
• At least 2 ethical principles • Information provides • Information provides
Maximum • 2 nursing code of ethics reader with introductory little knowledge on
4 points • Criteria that must be met for decision- knowledge of topic. topic.
making. • Organization by • Lacks organization.
• Nursing’s perspectives in the discussion. theme/issue. • Many or significant
• Cultural & faith integration perspectives • Minor problems with problems with
• Own personal values. transition and order of transition and order of
• Topic addressed in depth & thoughtful & paragraphs or sections. paragraphs or
detailed synthesis of literature • Content vocabulary sections.
• Themes and issues are clearly identified. generally accurate. • Significant errors in
• Transitions link sections and paragraphs • 1 ethical principle is content vocabulary
well. discussed. • Little insight
• Content vocabulary used appropriately • 1 nursing code of ethics demonstrated.
and well. • Minimal insight • Required components
demonstrated. absent
Health Healthcare policy is identified and clearly Healthcare policy is Healthcare policy is not
Policy described. identified, but not clearly clearly discussed.
• Policy analysis framework is identified discussed. • No policy framework
Maximum and applied • Framework is identified utilized.
2 points • Themes and issues are clearly identified. and applied. • Information provides
• Transitions link sections and paragraphs • Organization by little knowledge on
well. theme/issue. topic.
• Content vocabulary used appropriately • Minor problems with • Lacks organization.
and well. transition and order of • Many or significant
• Supporters/opponents clearly identified paragraphs or sections. problems with
• Content vocabulary transition and order of
generally accurate. paragraphs or
• Supporters/opponents not sections.
clearly identified • Significant errors in
content vocabulary
Conclusion Clear conclusions based on findings. Conclusions based on Conclusions not
Insights and inferences appropriate and well findings. connected to findings.
Maximum supported from the literature reviewed. Inferences appropriate. Inferences
2 Points inappropriate.
Letter Clear, concise, points made. Points implied, content not Missing
Max 1 points Business letter format (APA 6th ed) clear.
Assignment Addresses all required elements of Addresses all required All required elements of
Max. 2 assignment & expands them. elements of assignment. assignment not
points addressed
Grammar & No grammar or spelling errors. Coherent. 1-2 minor errors per page. 3 or more errors per
Spelling Flows well Minor problems with page. Problems with
Max. 3 coherence and flow coherence and flow
points Adjusted Turn-it-in Score < 10%
Adjusted Turn-it-in score 10 Adjusted Turn-it-in score
– 15% > 15%
APA Format All citations include all elements of APA No more than two minor More than two minor
for Citations formatting, including an intro/conclusion, errors in APA style errors or one significant
according to examples in APA 7.01. formatting in all citations. error in formatting in all
Max. 2 Adequate quality and quantity of sources Follows examples in APA citations. Does not
points used 7.01. follow APA 7.01.
Insufficient quantity and No additional sources
quality of sources used. used
*Formatting Follows all APA formatting guidelines; uses Follows all formatting Formatting errors; page
Max. 2 Word functions appropriately, includes an guidelines; minor problems length incorrect; poor
points introduction and a conclusion with Word functions. use of Word functions.