Community Nursing Chapter 3

Equality

closing racial, ethnic, gender, and socioeconomic gaps in care and outcomes

Policy modification (policy making)

he policy can be maintained, changed, or eliminated, according to its level of appropriateness.

Health policies

impact on the health of an individual, a family, and a population or community

Patient-centeredness

involving patients thoroughly in the decision-making process about their care, thereby respecting their culture, social circumstances, and needs

Policy assessment (policy making)

: Evaluation of the implemented policy in terms of being compliant or congruent with the statutory requirements, and whether it really serves the goal of solving the problem.

Policy implementation (policy making)

Actual carrying out of the policy takes place by using the available human and financial resources

Healthcare Workforce diversity

As the minority populations increase at rapid rates, there is an increasing need for a diverse workforce of healthcare providers who can provide culturally competent care. The less diverse the workforce, the less representative and influential will be the impact of the healthcare providers on healthcare policies. The United States has an increasing healthcare professional immigration from other countries.

Politics and healthcare

Both state legislatures and the U.S. Congress are responsible for determining appropriate healthcare policies. Government representatives work on creating policies to solve problems affecting a specific group, a geographic area, or the entire population ( These policies usually take the form of legislation, which provides substantial solutions for the health problems that threaten the health and safety of the citizens. Politicians can work collaboratively to solve problems and distribute resources, however, disagreement between major political parties cause delays.

Ethical dilemmas

Ohio Nurses Association (2013) developed a process to guide RNs in the process of working through ethical ambiguity or dilemmas, Identifying the existence of the ethical dilemma (conflict in values) Gathering and analyzing relevant information—including identification of stakeholders, interdisciplinary team members, and other sources of relevant information Clarifying personal values and moral position, including the moral perspectives of other "players" in the scenario Determining options, based on careful consideration of alternatives' benefits and risks Making responsible decisions about actions or recommendations, in collaboration with other interested parties Evaluating the impact of the action and outcomes.

Nursing's Role in Shaping Healthcare Policy

Nursing has a rich history as a unique profession, with its own values, ethics, respect, integrity, and responsibility. Responsible for magnet hospitals, school health clinics and staffing ratios Policy-makers need to hear from nurses because they are in the best position to communicate citizens' problems, represent them, and be advocates for their rights and healthcare needs. Nurses' contributions to the policies are unlimited; there is a need for greater coordination of action to ensure that nursing is actively supported and involved in influencing and shaping health and healthcare policies.

Policy formulating (policy making)

Possible and available alternative policies are identified and a specific policy is selected.

Quality of care

Quality of care is defined by the Institute of Medicine (2001) as the degree to which health services for individuals and populations increase the likelihood of desired outcomes, and are consistent with current knowledge. It is extremely difficult to evaluate the complexities of the quality of care for the U.S. population.

Health Services Research

Research continues to be an influencing power by documenting the need for accelerated reform in order to achieve quality care, proper information management, insurance for all, and equity of access. 1.Measurement and dissemination of health outcomes must be shared. 2.The delivery of prevention, wellness, screening, and routine health maintenance services must be fundamentally restructured. 3.Care delivery must be reorganized around medical conditions. 4. A reimbursement program for healthcare professionals as incentives to achieve better outcomes for patients should be introduced. 5.Providers must compete for patients, based on the quality of the care provided. 6.All providers must establish electronic medical records. 7.Patients' involvement in their health must improve and incentives for patient involvement should be considered.

Policy adoption (policy making)

Selecting the policy that should gain support, power, and directions for the legislators.

Setting an agenda (policy making)

The problem of common interest is identified for a specific community or a group.

Information Management

U.S. policy-makers have made the adoption of health information technology a priority so that health records can be kept electronically, assisting patients, providers, and insurers. Implementing electronic information systems could greatly improve the efficiency of the healthcare system and the health of Americans Through ARRA, $17 billion in financial aid was used as incentive for doctors and hospitals to utilize EHRs. Physicians who adopt and use EHRs meaning-fully, can be reimbursed for their services up to $44,000 over 5 years. An estimated 17% of doctors and 10% of hospitals utilize EHRs.

Effectiveness

assuring that "evidence-based" care is actually delivered, by avoiding overuse of medically unproven care, and underuse of medically sound care

Safety

avoiding injury and harm from care that is meant to aid patients

Timeliness

avoiding unwanted delays in treatment

Health Advocacy and Healthcare Reform

•Because of the vast disparities in healthcare access and quality, President Obama has made healthcare his top priority, promising affordable and adequate healthcare insurance for all Americans. •Patient Protection and ACA has the goals of improving the overall healthcare system and the quality of care include expanding health insurance coverage, shifting the focus of the healthcare delivery system from treatment to prevention, and reducing the costs and improving the efficiency of healthcare •Although most politicians agree that reform must take place, many cannot agree on what the change should look like. •Healthcare reform in the United States has been a long political battle for quite some time.

Equality in Healthcare Access and Quality

•Concerns regarding racial/ethnic minorities, low-income groups, and uninsured groups overlap because of similar barriers these populations experience in accessing healthcare and obtaining quality services. •Many low-income and uninsured populations are from diverse racial and ethnic minorities. •National programs for improvement of access to quality healthcare for low-income and ethnic and racial minorities in United States are often addressed simultaneously.

Cost Benefit analysis

•Direct costs: Costs the patient as a consumer is supposed to pay at the time of service. •Indirect costs: Costs that are not assigned directly to the patient •Related to the provision of services at the organizational level. •Health benefits or outcomes can vary from simple, direct benefits to more complicated benefits. •Can be difficult to express in dollars •Patients are concerned with personal cost as well as psychological costs, suffering, and pain, which are difficult to quantify yet have long-lasting negative effects •On the other hand, hospital days or dollars spent in a specific health service, for example, can be easily measured and evaluated. •Third party payers generally concerned with monetary costs only. •Use can be limited as cost and benefits are not distributed evenly among individuals, consumers, or providers

Ethical Consideration

•Healthcare is closely linked with ethical issues and decisions, and has implications for patients, providers, and healthcare leaders. •Nurses are required to hold the responsibility of both safeguarding the values of their society and developing their own moral framework for dealing with the moral dilemmas. •The role of the nurse, as a member of the interprofessional care team, is to identify potentially ethics-related situations, work with others to address these issues, and provide holistic support for patients, families, and colleagues. •

Public health policy

•decisions made in regard to the health of the individual and the community •State, local or national level •1) health-related decisions guided by the stated laws written by legislators •2) rules and regulations designed to operate the health-related activities and programs •3) the judicial decisions related to health, which involve both federal and state governments

Policies

•set of principles that govern an action to achieve a given outcome, or guidelines that direct individuals' behavior toward a specific goal