1-You made some good points Judy, but the U.S is not the only one struggling with the health care . I was reading different articles and realized there are so many countries going through the same things and maybe even worser. The Pakistan’s health profile portrays high maternal and child mortality, increase population growth rate, and the twofold burden of infectious and non-infectious diseases (WHO, 2007).Just 27% of the Pakistani people avail advantage from full coverage of health care that include armed force members, beneficiaries and government employees, whereas, the rest 73% of the population pay out of pocket (Settle, 2010).They are viewed as a country that is not really important and get overlooked and struggle with health care. People are still paying a crazy amount of money just to get the care they need to stay healthy. With everything going on it makes it hard and for people to reach out when they really need it and it progresses to where it can not be reversed and as a nurse it just sucks seeing people go through this and hope it gets better as the years pass.
2-Many American families have a limited access to health and are uninsured. Our healthcare system focuses more on treatment and medical services than preventive care. Health care spending has been increasing over the years, yet there isn’t a significant improvement in health outcomes (Kaiser Family Foundation, 2017). In 2013, $2.9 trillion dollars was spent on the healthcare alone, which is about $9,255 per person (Levitt, Claxton, Cox, Gonzales & Kamal, 2014). For insured families, insurance premiums have risen about 11% and household earnings only 3% increase from 1996-2003. Soon, family premiums will cost more than the family income by 2025 if trends continue. All that money spent, yet there coverage in limited/inadequate. Over recent years, insurance premium cost increases have slowed, but this places more of the financial burden on the family (Devoe, 2008).
In 2016, 27.6 million people are not insured. Many low income families cannot afford to pay for health insurance, so they gamble and delay any medical services in fear of how much it will cost them (Kaiser Family Foundation, 2017). Many fear that it could lead to financial ruin. Among families with health insurance, almost half of all personal bankruptcies were due to high medical costs (Devoe, 2008).
There is also the issue of people uninsured when they’re in between jobs or waiting for approval of Medicare/Medicaid. About 82 million Americans have these coverage gaps during a 2-year period (Devoe, 2008). Life is unpredictable, and something can during these gap periods.
References
Devoe, J. (2008). The Unsustainable US Health Care System: A Blueprint for Change. The Annals of Family Medicine, 6(3), 263-266. doi:10.1370/afm.837
Levitt, L., Claxton, G., Cox, C., Gonzales, S., & Kamal, R. (2014). Assessing the performance of the U.S. health system. Retrieved May 24, 2018, from https://www.healthsystemtracker.org/brief/assessing-the-cost-and-performance-of-the-u-s-health-system/#item-start
Kaiser Family Foundation. (2017, December 07). Key Facts about the Uninsured Population. Retrieved May 23, 2018, from https://www.kff.org/uninsured/fact-sheet/key-facts-about-the-uninsured-population/
3-I have found that the health care system in the United States is expensive and not easily obtained. There is much room for improvement. The concern about quality arises more from fear and anecdote than from facts; there is little systematic evidence about quality of care in the United States. We have no mandatory national system and few local systems to track the quality of care delivered to the American people. More information is available on the quality of airlines, restaurants, cars, and VCRs than on the quality of health care (Scuster, 2005). The U.S. does not have a uniform health system, has no universal health care coverage, and only recently enacted legislation mandating health care coverage for almost everyone. This can be difficult for someone who is working minimum wage and has a job that does not require to give employees benefits such as health care insurance. One could argue that minimum wage is not meant to be a long term job for an adult. Though the theory of minimum wage jobs might have originally been meant for minors, the reality of our nation is that many adults living in poverty are employed at minimum wage paying jobs. It should be our duty to provide affordable health care for all members of our nation regardless of our own personal beliefs. Obama Care may not be a perfect system because even though it is said to be afforable health care, it has shown to still not be as affordable as one might need based on their income. However, I believe that this was a good start and can be improved to fit our nation and every individual in it as needed. Health care is only getting more and more expensive with the new medications and technology that we are developing as time goes by. Our nation leaders need to think of someway to have health care available for everyone. One option could be to provide health care for everyone like Canada has for their citizens. Though this comes with problems of its own, I believe that it is a system that cares for all and would great individuals that cannot afford health care. Whatever the United States decides to do regarding the issue of so many Americans being uninsured, something needs to be done quick. With so many people being uninsured, many diseases go untreated or even diagnosed due to the financial fear individuals that are uninsured face. People would rather not see a doctor or a clinic because of the fear that they will bring financial burden to their family. As a nurse, this breaks my heart.
Schuster, M. A., McGlynn, E. A., & Brook, R. H. (2005). How Good Is the Quality of Health Care in the United States? The Milbank Quarterly, 83(4), 843–895. http://doi.org/10.1111/j.1468-0009.2005.00403.x
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The PPACA was aimed to improve the health care system, offering affordable health insurance to more Americans, expand the Medicaid program to cover all adults that live below the poverty level, and to support innovative medical care delivery methods designed to lower the costs of health care generally (Lampert, 2009). The PPACA mandates that everyone that is legal will have health coverage in the United States or a penalty will have to be paid at the end of the year. With the influx of people now receiving healthcare, they will be seeking medical attention where in the past they would not. The increase in people seeking medical attention will result in a needed increase in nurses to take care of these patients and more training to gain more expertise and skills to be able to manage the emerging needs and diseases.
A key nursing provision is the health care workforce loan repayment program (Section 5203). This section focuses more on children. It has a focus on pediatric medical or surgical and children mental and behavioral health care. The repayment program will offer psychiatric nurses, social workers, and professional/school counselors up $35,000 a year in loan repayments for their participation in an accredited pediatric specialty residency program. A second key provision is public health workforce recruitment and retention programs (Section 5204). This provision is aimed at eliminating the shortage of public health agencies. This provision has offered a one third repayment of loans for an exchange of a contract of employment acceptance with a public health agency for three years. This program is offered to eligible public health or health professions.
I know my nursing career will be affected by the provisions that were listed above along with all the other provisions listed in the PPACA. Offering loan repayments will give nurses the incentive to obtain higher degrees. Recruitment and retention would likely decrease the nurse shortage by new nurses coming in and showing loyalty to the season nurses.
Comment 2
The effect of the Patient Protection and Affordable Care Act (PPACA) resonates profoundly in the U.S. healthcare environment and among the public. Two key provisions of the act include: 1) Guaranteed issue prohibits insurers from denying coverage to individuals due to pre-existing conditions; 2) Section 5204 Public health workforce recruitment and retention programs.
With the first requirement, health care setting experienced a rise in the number of new patients, as expected. Many of these patients were probably afraid or restricted from going to the hospital or seeking medical care due to the lack of healthcare coverage. The impact is that more people are seeking medical care. From my nursing practice, I observe some of these patients have chronic illnesses that have been neglected and thus require more care. Also, more patients come for medical services; emergency rooms fill with more patients. This increases patients’ population. In return, this affects nurse to patient ratios. Nurses have to care for more patients. They have to work extra time due to shortage of staff. The downsides is that nurse morale is low and the risks for medical errors are high.
The second nursing provision (Section 5204) retained refers to the established “Public Health Workforce Loan Repayment Program.” This provision gird to assure an adequate supply of public health professionals to eliminate workforce shortages in public health agencies. The positive impact of this provision is that government will repay up to “1/3 of loans incurred by a health professions student in exchange for an agreement to accept employment with a public health agency for at least three years” (CDC). Ultimately, this provision makes it easier to attract young people to the field of nursing. This will have a positive impact on the nursing shortage. It is an attract incentive for many current nurses to pursue their studies and opt for advanced degree in nursing. This is exactly what I am intended to do.
Comment 3
Nice post! Some important aspects of the ACA, include the consumer assistance program, which is a program that helps people enroll in coverage as well as file complaints if a person is denied payment for any type of healthcare service. There are also preventative healthcare services if eligible, paid by insurance. Seniors that are on Medicare who are struggling with prescription costs, can find assistance with discounts and rebates as well. The ACA also offers more options when choosing insurance coverage. There is also a pre-existing condition insurance plan for people who may have a disability or chronic condition, that were previously denied coverage under regular insurance options. In addition, parents are able to cover their children under the age of twenty-six if they are unable to get insurance. The ACA has given people the ability to choose any doctor they wish to see, whether or not they are affiliated with a network or not. Additionally, the Children’s Health Insurance Program (CHIP) will be extended from 2015 through 2019, providing coverage to children in low-income families (KHN, 2018).
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/in Uncategorized /by developerComment 1
Many provisions are being done to the affordable care act most of which are trying to demonstrate reducing the cost, which is not proving to be enough. Another approach that is becoming primary is focusing on the overall quality, and coordination of the patients care. By focusing on the overall quality of care, this includes everyone who is involved in the care of the patient. Medical/Health homes are homes that provide patients with a central primary care practice or provider. The homes allow providers to focus on preventative care and chronic care management. This program will also help reduce dependence on specialist and emergency care.
The Patient Protection and Affordable Care Act authorizes who how contracts directly with the state to establish community-based interdisciplinary and interprofessional teams in supporting the patients’ primary care.
The interdisciplinary and interprofessional teams may then decided if medical specialist, nurses, pharmacists, nutritionists, dieticians, social work, behavioral health and mental health providers are necessary for care.
I believe that this can be beneficial to patients and healthcare in the fact that it reduces that amount of emergent and acute care issues. If a patient is coming into one provider for preventative care check with hope to detect symptoms early and treat with a primary doctor avoiding the need to see a specialist reducing the cost to the patient and the healthcare provider. The Patient Protection and Affordable Care Act determines who is eligible for an interdisciplinary team so not everyone will be at the mercy of the team also reducing the cost. The quality of care should remain at the same level the Medical/Health Homes just won’t be utilizing as many providers if the patient does not require them. Not to mention patient will have access to Medical/Health 24/7 interviewees reported that 24/7 access to a care provider is also an essential element of the medical home equation even if only through telephonic or electronic means, helps reduce reliance on emergency rooms and resultant preventable hospitalizations (ANA, 2010).
According to Nester (2016), succeeding in the current care environment can only be possible if inter-professional teams will come together and work as a unit. As such, the inter-disciplinary or interprofessional Practice Model as emphasized in the Institute of Medicine report can be termed as innovative.
Comment 2
One innovative health care delivery model which incorporates an interdisciplinary care delivery team is a systematic approach to the flow of care. First a patient presents with certain symptoms or complaints related to his or her health. There might be positive screenings from tests they have already received related to their symptoms. Following a diagnostic workup, a tentative diagnosis regarding their concern can be made. Following this diagnosis, it might be necessary to send the patient to a medical/surgical bed or ICU. They might require medical or surgical intensive care, or simply be sent home. Each stream follows a different set of procedures and personnel responsible for determining the correct path for each patient. This is advantageous to patient outcomes because it ensures that they receive the optimal treatment for their ailments. Standardizing the process and keeping it organizational will greatly benefit patient outcomes and ensure that there is no delay in care. “Each of these steps potentially involves a myriad of options, each of which is directed by a different specialist. This can sometimes result in care that is not clinically appropriate” (Osarogiagbon et. al, 2016, p. 984). All members of the interdisciplinary team need to communicate with one another, rather than just making care decisions based on individual assertions and collecting data together. This can cause disjunction in critical information, delay treatment, and have adverse effects in patient outcomes.
Comment 3
As science has advanced to allow for more treatment options and cures for patients, providers have found themselves providing a more distanced type of care. With the distance of care, patient and families have been left less educated of their health status and reason for treatments leaving the patients to not feel as secure or in control of their health (Barry & Edgman-Levitan, 2012). In the Institute of Medicine report called Crossing the Quality Chasm, the IOM attempted to introduce an approach to assist in the reform of health care by explaining patient-centered care (Barry & Edgman-Levitan, 2012). The IOM described patient-centered care as care that is respectful of and responsive to individual patient preferences, needs and values (Barry & Edgman-Levitan, 2012). This care model calls clinicians to work as partners and coaches in a patient’s health care journey rather than as a dictator (Barry & Edgman-Levitan, 2012). Such a care model asks patients and their families to become allies with the health care team in designing, implementing and evaluating medical options (Barry & Edgman-Levitan, 2012). Treatment and interventions must be presented to the patient as an option as they always have a choice, especially when options are deemed to have consequences.
As clinicians relinquish their authority role of decision making and move towards a shared-decision making approach they are more equipped to view the experience through the patient’s eyes (Barry & Edgman-Levitan, 2012). This will allow providers to be more responsive to patient’s needs and treat their patients better. Also, clinicians are able to embrace the ethical principles of autonomy and beneficence with this type of model (Reuben & Tinetti, 2012). Patient centered and shared decision care benefits patients by increasing their knowledge of their disease, allow decisions to be aligned with their values, reduced internal conflict and more inclined for positive outcomes when patients are actively engaged (Barry & Edgman-Levitan, 2012). One of the largest barriers to goal-oriented and shared-decision modeled patient care is that medicine is deeply rooted in a disease-outcome–based rather than asking what patients want; the culture values managing each disease as well as possible according to guidelines (Reuben & Tinetti, 2012).
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The role of health care reform in shifting the focus from a disease-orientated health care system toward one of wellness and prevention is to avert disease in the public. One of the ideal choices is to promote and encourage good health within groups of people across ages, gender, ethnicity, race, and social economic status. Health care reform, in this context, can strive to help people change the social behavior. Help care reform can enhance people’s ability to care for their health. They can lessen health disparities within the population. In the meantime, help care reform targets non-help care policy that impact people good health. That is, decisions related to social, economic, housing, nutrition, and environment might have a direct effect on wellness and prevention.
In terms of prevention, health care reform can converge health care practitioners’ attentions and the public’s focus on screenings, immunizations, counseling, and disease management to avert complications. This will encourage health care professional to always encourage patients and their loved ones to take preventive measures and steps to avert unhealthy circumstances in their lives.
The profession of nursing has the obligation to educate nursing students and current nursing practitioners to understand the benefits of wellness and prevention in the practice of nursing. Nurse spend most of their working times with patients than any other health care professional. They are the first who witness patients’ calamities. This makes them more apt to embrace this shift because integrating prevention in their practices can avert acute and chronic diseases, and other non-desirable health conditions. Nurse can participate in consumer education or awareness campaigns for the good of society.
Comment 2
n 2010, the Affordable Care Act became law, and the law aims to improve the health care system of the U.S. by widening the health coverage to more Americans and by protecting existing health insurance policyholders (Nordqvist, 2016). Cherry & Jacob (2016) state that the ACA is expected to provide insurance coverage for 32 million previously uninsured Americans. America faces the increased medical expenditures which can be the burden of the American economy. Moreover, the shortage of health care providers and facilities, as well as the rise in health awareness also alter the care from the treatment of disease to health promotion and disease prevention. As a result, health care reform plays an important role to lead the way in determining the type of providers needed to care for patients (Cherry & Jacob, 2016).
The shift from disease-oriented healthcare towards wellness and prevention provides a health resource to assist in creating a balance to promote health and cure disease. “Health care is a human right and that all persons are entitled to ready access affordable, high-quality health care service” (ANA, 2008). Restructuring the health care system will reinforce and ensure universal access to health care. The primary focus points are affordability, availability, acceptability, and quality of care. Access to care alone is not enough if the quality of care and safety is not satisfactory. A restructured health care system must provide dependable, high-quality care across the country.
There are six specific aims described to raise the quality of care that includes: Safe health care, Effective health care, Patient-Centered Health Care, Timely Health Care, Efficient Health Care, and Equitable Health Care. These aims of health care are essential to the nursing staff because many outcomes are associated with the care provided by the nursing staff. It is our job as nurses to positively embrace the change in health care reform and implement the changes with the highest standards. The agenda for the shift in health care reform can be considered a new step in health care and requires all associated with health care to participate.
Comment 3
Two-thirds of American adults are overweight or obese. Americans get less exercise, spending work and leisure time in from of screens. Diabetes and other chronic diseases are on the rise, a leading driver of escalating medical care costs. More and better medical care will not fix this countries declining health status or slow the rising costs of health care. History and science show that a multifaceted public health effort, including delivery of clinical preventative services, to protect the nations health. America must invest in the policies, programs, community environments and preventative care that are known to protect and restore health. By doing so, this can lower the disease and disability resulting in a decrease in the cost of expensive medical treatment in the future.
Three major reforms re required to make prevention and wellness the cornerstone of national policy.
1. Provide consistent policy leadership that advocates for and funds mutifaceted approaches to prevention and wellness.
2. Strengthen the ability of the public health system to facilitate and provide community-based prevention, health promotion, and early detection of disease.
3. Assure that all Americans have access to recommended clinical preventitive serices.
Nurses are on the frontline for providing valuable education to patients, the public and communities relating to nutrition, exercise and disease prevention. Health promotion should be done everywhere, at every level of our health care system. Nurses are innovative and know how to expand car and improve quality at a lower cost. Emphasizing the use of master-prepared nurses to oversee care from the hospital to within the home reduces hospitalizations.
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/in Uncategorized /by developerComment 1
Working in a hospital, or any type of medical facility, is not limited to one type of nurse or nursing education. Nurses with both ADNs and BSNs are typically employed at any number of facilities. Under the proper instruction and motivation, nurses can adequately perform the functions of their positions with ease. However, there have been studies which link patient safety outcomes and nursing education. Research from Weinberg et. al (2012) “links higher proportions of nurses with baccalaureate of science in nursing (BSN) degrees to lower patient mortality rates” (Weinberg et. al, 2012, p. 4). It is likely that nurses who have pursued a higher degree than the ADN simply receive more knowledge about specific interventions and procedures. From my own real-life experiences, I do not really agree with this research. Nurses who are compassionate, caring, meticulous and focus on the needs of the patients will generate positive outcomes for their patients. The contribution of the work environment and the use of interdisciplinary teams are essential to providing adequate patient safety. These factors must also be considered when making assertions regarding patient safety outcomes and nursing education. It is difficult to solely pin the claim that patient safety is lessened by the effects of lower education, separating it from all the other components which can contribute.
Comment 2
Multiple studies were found that link patient safety outcomes to ADN and BSN nurses. It is believed that one’s level education have a lot to say on how much he or she knows and how well he or she practices. In a study by Aiken, Clarke, Cheung, Sloane, & Silber (2003), it was concluded that changing the educational background of hospital nurses by increasing the percentage of those having a BSN or higher, would decrease substantially the mortality rate for patients that have surgery in general and for those developing complications. A growing body of research suggests that hospital having a higher proportion of Nurses with a BSN on staff is linked to better patient outcomes, and other studies supported an association between BSN staffing and outcomes such as lower incidence of pressure ulcers, hospital acquired pneumonia, postoperative deep vein thrombosis and post surgical mortality rate (Robert Wood Johnson Foundation, 2013).
Although most nurses call to the profession are from a caring, compassionate nurse heart and the love for this profession, nurses also need to be prepared and have the knowledge to be able to fulfill this passion to the highest level of expectation. Researches that link patient’s safety and outcomes to ADN and BSN or higher level are based on real life experiences. Nurses with higher education such as a BSN or higher, communicate better, they are better critical thinkers, problem solvers and are able to better assess and evaluate patients’ situations. Although I am not done with my BSN, I had put into my current practice so much I have learned from my previous BSN classes. With a BSN level, nurses learn to give better care to patients with chronic illness and most importantly we learn to promote wellness and work toward disease prevention to prevent chronic illness; we learn to apply appropriate method to help our patients understand our teaching; we learn leadership and management skills and many more. BSN level helps nurses deliver care to a higher level while considering actions that impact health care costs and patients’ outcomes. BSN or higher help nurses deliver quality care to the patients to prevent complications and increase outcomes.
Comment 3
“Nursing is unique among the health care professions in the United States in that it has multiple educational pathways leading to an entry-level license to practice” (Institute of Medicine ,2010). Associate nursing degree (ADN) is designed to be completed within two years. The main focuses are provision of patient care in a safe manner professional and ethical behavior, effective collaboration and application of nursing knowledge. Baccalaureate nursing program (BSN) is designed to be completed within four years. This program is designed to educate nurses with core and upper level courses. Nurses in this program are expected to function in basic leadership capacity after completion (American Association of Colleges of Nursing, 2017)
Both BSN nurses and ADN nurses are trained to perform certain basic skills like medication administration and wound care for example. In any given situation that involved patient care both nurses are expected to critically think to improve the patient’s outcome. Whether having a BSN degree or ADN degree, saving lives are what all nurses are entrusted to do. Nurses have one of the most well respected professions. We are trained to critically think and administer care in the most severe situations. And almost all the time we rise to the occasion and beyond. As nurses we are always edifying ourselves because technology and medicine are always evolving; this only gives us the opportunity to prepared and produce the best nursing care possible for our patients in treating their illnesse
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/in Uncategorized /by developerComment 1
The projected nursing shortage can incur significant impact to the nursing profession and to the public. For one, the anticipated increase of the U.S aging population, this will put more strain on the nursing profession to find nursing to care for this population. At the same token, there is a great proportion of the nursing workforce that will reach retirement age. This will create an imbalance situation in terms of nurse-to-patient ratios. Such event will indubitably trigger anxiety, job burnout, turnover, absenteeism, and low morality within the nursing profession.
The nursing shortage can have adverse impacts to patients’ health-care outcomes. The public might suffer considerably from medical errors; nurses may have less time to spend and care with patients. As a result, the proportions of hospital readmission and patient death can increase exponentially.
The nursing profession will face with the urgency to provide answers to the nursing workforce disparity in relation to the growing aging population. Such ageing population are suffering from chronic diseases that require long-term care. That is, the nursing profession must increase the nursing workforce pool to compensate for the projected shortage.
One way that the nursing profession is dealing with resolving this issue is through public-private partnerships. Such a strategy can put emphasis on encouraging nurses to access to higher education so that they become nurse educator. This will require providing incentives to nurse. In the same perspective, efforts should be done to launch advertising programs that show positive aspects of the nursing profession. Coupled with these, community leaders, healthcare associations, and Nursing Association should advocate elected officials to provide more funds to help the nursing profession.
Comment 2
The nursing shortage is not only related to the “baby boomers” retiring. It is also the qualified nurse not willing to work in the present conditions. These conditions are inadequate workforce planning, understaffed, poor recruitment, retention, return policies, and the ineffective availability of nursing resources. High patient to nurse ratios is causing the nurses today to have “burn out” and they eventually leave their nursing career. The failure to deal with the nursing shortage will lead to the failure to maintain and improve health care and it will have a huge impact on the nursing profession and the public. Addressing the nurse shortage and providing a more positive staffing environment in which the clinical practice can actually be delivered is a resolution to the nursing shortage. Providing a more positive staffing environment includes motivating the nurses, providing support, really looking at patient acuity and nurse to patient ratios, providing incentives on nurse retention and nurse recruitment. Nurses should be able to have the opportunities to develop professionally, have opportunities for growth, gain autonomy, and have a say in the decision making and truly be listened to by their managers and administration team. (Buchan & Aiken, 2014). Most individuals become nurses because they truly care and have compassion. They want to help people get better, this includes on their job along outside their jobs. Nurses take their profession very serious but there is only so much one person can do. Nurses have families also and should be able to come into work and take care of their patients in a safe environment and go home to spend time with their families at the end of the day.
Comment 3
The nursing profession is at risk of an increased shortage of nurses. The increased shortage of nurses can strongly impact health care corporations. In my current position in both the Nursing home/Rehab and the hospital setting, I have noticed that when we have shortages nurses are placed at risk for harm. Nurses become responsible for increased workload, which can lead to physical and emotional stress. This places both you and your patients at danger.
Another issue that arise within my hospital when short staffed is the ability to admit patients. If we have reached a full census we are unable to admit patients from the emergency room. This will place the emergency room on full capacity, meaning patients will need to go to the nearest hospital. This potentially can delay care for patients that urgently need it. Management also prefers that we keep all of our beds full to ensure maximum revenue and with out the appropriate staff we are unable to do so. The nursing shortage is quickly approaching. According to The Health Resources and Services Administration “more than 1 million registered nurses will reach retirement age within the next 10 to 15 years” (AACN, 2014). This will create a major set back reinforcing the issue stated above. Many organizations are working on hiring young graduate students in order to replace the baby boomers class. This provides a company and the nursing community with longevity in an attempt to replace the baby boomer class. Many states are working to expand the nursing programs as well as create more in order to keep up with the current and up and coming shortage.
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/in Uncategorized /by developerComment 1You correctly stated that Mr. C is a candidate for bariatric surgery based on his poor health history including high cholesterol, an elevated BMI level of 45, OSA, high fasting blood glucose (FBG) of 146 mg/dl, has a high respiratory rate of 26 which can point to pulmonary disease. Good candidates for weight-loss surgery are obese adults who also have an obesity-related health condition, who are aware of the risks and benefits of surgery, and are willing to make lifestyle changes after surgery, especially in regard to eating habits. Following bariatric surgery many patients show improvement in obesity-related conditions, such as diabetes, high blood pressure, obstructive sleep apnea and arthritis.
Comment 2
Nice post! You bring up very good points when speaking about the functional health patterns and problems the patient has. I particularly liked how you brought up assessing for sleep apnea. People don’t really understand the implications of having sleep apnea and energy levels throughout the day. People can also suffer from headaches/migraines if they have obstructive sleep apnea. It’s so important for our body to recharge while sleeping and part of that recharging has to do with proper oxygenation. Many people who are obese are unaware that they may have this problem and need to have a sleep study. Many of my patients don’t know they have it until I or another nurse notices they are snoring and desaturated while sleeping. This can be a scary finding.
Comment 3
Hi Diona, one specific thing that caught my attention from reading Mr. C’s case study was that this patient takes multiple medications at different times throughout the day because of multiple diseases that are present. This requires the patient to place a lot of attention and plan accordingly. The patient also has to make sure to manage their medications in order to decrease their chances of overdosing, missing a medication, or drug contraindications. Some strategies that can be used are: fill the prescriptions at one pharmacy, use a pill dispenser, and make a list.
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I agree with you that over use of NSAIDS is probable for his development of peptic ulcer disease (PUD). All though Mr. C is essentially taking three medications, the dosing schedule really requires a high level of compliance. It is very important to stress the importance of maintaining a steady regime. Some of the complications of PUD include “bleeding, perforation, and gastric outlet obstruction with hemorrhage being the most common complication” (Fashner & Gitu, 2015).
Comment 2
Before Mr. C would undergo surgery, he would need an extensive psychosocial evaluation to determine if he is an appropriate candidate. During the examination, several aspects of Mr. C’s life would be assessed, such as, eating pattern, history of weight loss attempts, family history, substance use history, cognition, social support, coping skills, adherence and motivation/expectation about the surgery (Marek et al., 2016, p. 1143). As someone in the medical field, I would want to know how serious Mr. C was about wanting to lose weight and have him on a trial diet regimen for a few months to see if he can be compliant. I wouldn’t suggest that he undergoes bariatric surgery if he was unwilling to change his lifestyle prior to the procedure.
Comment 3
like that you brought up a mental health issue with Mr. C as one of his actual/potential problems. There have been many studies regarding obesity and mental illness and it made me look deeper into research. I read in a recent study that lack of exercise can decrease serotonin synthesis and worsen depression and anxiety (Lu et al., 2018, p. 4). Also, because of the stigmatism of obesity, some people become socially isolated and are less likely to eat healthy (Lu et al., 2018, p. 4). On the other hand, depression and/or anxiety could’ve begun 2 to 3 years ago for Mr. C and therefore has resulted in the increased weight gain.
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/in Uncategorized /by developer1-I agree with you. Advocating for mental health is important. These groups are also found in this category due to a lot of issues. Some of them started with depression due to one thing or the other and since they don’t have access to healthcare for treatment, they may start overeating which may lead to obesity and other health issues, some will start using drugs which will even make things worse.
2-I work night so I do not typically interact with social workers face to face. I do however put in many social worrk consults for patients that I believe may benefit from one. At Baylor Scott and White you can put a social work consult for someone if they simpley over the age of 80 and you feel that they need one. I picked up day shift for a week this past month and saw how much social workers interact with patients on a daily basis. They do a great job at making sure patients are well taken care of out side of the hospital.
3-Great points. These minority groups are dying in silence because they have no one to cry to, and they believed even if they cry no one will listen to them. As an African American, and considering where I come from, sometimes I think only the influential and the upper class are getting what they need/want. These groups have little or no access to health care, even if they are sick, they can’t afford the huge bills. Some will rather stay at home to use home remedies which may not work and their lives will be in danger. Therefore, as nurses, advocating for these groups will be great achievements for us. God help us.
4-I actually believe that there is very little known about the cause of diabetees and that researchers have barely scratched the surface of studying and understanding the disease. After watching the program “What The Health” I started to question a lot of what I was taught in school. This program was actually trying to prove that the information given on ADA websites and everything is actually very inaccurate. Websites for diabetees give you healthy food options to cook such as bacon wrapped scallops and chicken. MD’s on this program were actually saying that meat is the cause of diabetees because the proteins and fats block the cells from allowing sugar to go in so the sugar then roams free in your blood. So even if you are eating the best fruits or the darkest most nutrient dense fruits it doesn’t matter. As long as you are still consuming meat or any processed foods no matter how good the sugar is for you it will be roaming free in your blood stream because the proteins and fat are blocking it from going into the cell and being of any actual use for your body. Most of the diabetic organizations get their money from dairy farms or meat industries so they continue to advertise that all is a part of a healthy diet. Like they say ..just follow where the companies get their money and you will see the truth.
5-Shands at the University of Florida, where I work focuses a lot on Cultural diversity. All health care professionals are required to take a mandatory cultural diversity class. The goal is to increase cultural awareness, knowledge and skills in our delivery of care. Another example of cultural accomadation that comes to mind in my practice is I was taking care of an Indian patient who used Reiki treatments in her past for anxiety and depression. “Reiki is an energy-healing practice that is considered safe with no side effects. Under the notion that the body is more than a physical entity, Reiki focuses on all aspects of being including mentally, emotionally and spiritually”. I was able to get in touch with the therapy department and find a practioner that had training in Reiki. I arranged for him to come atleast twice a week for treatments. This helped the patient relax and promoted healing.
6-What a sad story. You are very correct in that people, including people in health care, may be quick to assume or judge as to why a patient may be refusing treatment. This is just another case that confirms how messed up our health care system is. The are so many people out there in the same situation as we have talked about this week with vulnerable and at risk communities. We see a lot of sad stories in our profession. Thankfully we have good stories too to balance us out.
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/in Uncategorized /by developer1-You made some good points Judy, but the U.S is not the only one struggling with the health care . I was reading different articles and realized there are so many countries going through the same things and maybe even worser. The Pakistan’s health profile portrays high maternal and child mortality, increase population growth rate, and the twofold burden of infectious and non-infectious diseases (WHO, 2007).Just 27% of the Pakistani people avail advantage from full coverage of health care that include armed force members, beneficiaries and government employees, whereas, the rest 73% of the population pay out of pocket (Settle, 2010).They are viewed as a country that is not really important and get overlooked and struggle with health care. People are still paying a crazy amount of money just to get the care they need to stay healthy. With everything going on it makes it hard and for people to reach out when they really need it and it progresses to where it can not be reversed and as a nurse it just sucks seeing people go through this and hope it gets better as the years pass.
2-Many American families have a limited access to health and are uninsured. Our healthcare system focuses more on treatment and medical services than preventive care. Health care spending has been increasing over the years, yet there isn’t a significant improvement in health outcomes (Kaiser Family Foundation, 2017). In 2013, $2.9 trillion dollars was spent on the healthcare alone, which is about $9,255 per person (Levitt, Claxton, Cox, Gonzales & Kamal, 2014). For insured families, insurance premiums have risen about 11% and household earnings only 3% increase from 1996-2003. Soon, family premiums will cost more than the family income by 2025 if trends continue. All that money spent, yet there coverage in limited/inadequate. Over recent years, insurance premium cost increases have slowed, but this places more of the financial burden on the family (Devoe, 2008).
In 2016, 27.6 million people are not insured. Many low income families cannot afford to pay for health insurance, so they gamble and delay any medical services in fear of how much it will cost them (Kaiser Family Foundation, 2017). Many fear that it could lead to financial ruin. Among families with health insurance, almost half of all personal bankruptcies were due to high medical costs (Devoe, 2008).
There is also the issue of people uninsured when they’re in between jobs or waiting for approval of Medicare/Medicaid. About 82 million Americans have these coverage gaps during a 2-year period (Devoe, 2008). Life is unpredictable, and something can during these gap periods.
References
Devoe, J. (2008). The Unsustainable US Health Care System: A Blueprint for Change. The Annals of Family Medicine, 6(3), 263-266. doi:10.1370/afm.837
Levitt, L., Claxton, G., Cox, C., Gonzales, S., & Kamal, R. (2014). Assessing the performance of the U.S. health system. Retrieved May 24, 2018, from https://www.healthsystemtracker.org/brief/assessing-the-cost-and-performance-of-the-u-s-health-system/#item-start
Kaiser Family Foundation. (2017, December 07). Key Facts about the Uninsured Population. Retrieved May 23, 2018, from https://www.kff.org/uninsured/fact-sheet/key-facts-about-the-uninsured-population/
3-I have found that the health care system in the United States is expensive and not easily obtained. There is much room for improvement. The concern about quality arises more from fear and anecdote than from facts; there is little systematic evidence about quality of care in the United States. We have no mandatory national system and few local systems to track the quality of care delivered to the American people. More information is available on the quality of airlines, restaurants, cars, and VCRs than on the quality of health care (Scuster, 2005). The U.S. does not have a uniform health system, has no universal health care coverage, and only recently enacted legislation mandating health care coverage for almost everyone. This can be difficult for someone who is working minimum wage and has a job that does not require to give employees benefits such as health care insurance. One could argue that minimum wage is not meant to be a long term job for an adult. Though the theory of minimum wage jobs might have originally been meant for minors, the reality of our nation is that many adults living in poverty are employed at minimum wage paying jobs. It should be our duty to provide affordable health care for all members of our nation regardless of our own personal beliefs. Obama Care may not be a perfect system because even though it is said to be afforable health care, it has shown to still not be as affordable as one might need based on their income. However, I believe that this was a good start and can be improved to fit our nation and every individual in it as needed. Health care is only getting more and more expensive with the new medications and technology that we are developing as time goes by. Our nation leaders need to think of someway to have health care available for everyone. One option could be to provide health care for everyone like Canada has for their citizens. Though this comes with problems of its own, I believe that it is a system that cares for all and would great individuals that cannot afford health care. Whatever the United States decides to do regarding the issue of so many Americans being uninsured, something needs to be done quick. With so many people being uninsured, many diseases go untreated or even diagnosed due to the financial fear individuals that are uninsured face. People would rather not see a doctor or a clinic because of the fear that they will bring financial burden to their family. As a nurse, this breaks my heart.
Schuster, M. A., McGlynn, E. A., & Brook, R. H. (2005). How Good Is the Quality of Health Care in the United States? The Milbank Quarterly, 83(4), 843–895. http://doi.org/10.1111/j.1468-0009.2005.00403.x
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/in Uncategorized /by developer1-This is a tough topic. Here you are, a working family, you are going to school to better yourself even further and you millions of others are still faced with these decisions about health care. When you say you pray I know you mean that literally because our daughter is in the same boat. My husband keeps talking about wanting to retire early but he just does not understand the cost of having good health care. I will probably be working until I am 90 because I will be afraid of Medicare and not being able to afford good care. Wish we had better answers but we are not getting anywhere fast…that’s for sure.
2-The most important elements of the Affordable Care Act were to get more people insured, to keep costs down and to improve overall care and outcomes. New laws were to make affordable health insurance available to more people. The law would provide consumers with premium tax credits that will lower costs for households that qualify. To qualify households must have incomes between 100% and 400% of the federal poverty level. Another component was to expand the Medicaid program. This would now cover all adults with income below 138% of the federal poverty level. In addition, the goal was to support medical care delivery methods designed to lower costs of health care overall.
As nurses, we need to continue to be innovators and continue our work in research. We need to focus on continuing to improve on patient safety and improving quality of care. Nurses need to continue to be lifelong learners and meet demands of a changing society. We must also continue to raise the bar for education with advanced degrees. We must continue to push for more diversity in our profession to keep up with our diverse society to make patients more comfortable. We also need to continue to bring our ideas to the table and be leaders within our organizations. As we foster interprofessional collaboration the patients will benefit from teams working more closely together to improve patient care.
3-The key elements of the Affordable Care Act are the following: providing national access to healthcare coverage for the entire population from birth through retirement, this will provide coverage for about 94 percent of the American people, to improve quality, affordability and fairness of health insurance coverage, to enhance healthcare efficiency, quality, diversity and values, to reduce wasteful spending, and to improve public health by expanding clinical preventive care and community investments.
The Act focuses on improving public health by investing in primary health care, especially in medically underserved communities. It also increased insurance coverage for clinical preventive services and procedures. For instance, physical examination, annual wellness visits, well child visits, immunizations, screening exams, like colonoscopy, mammograms and cervical cancer, are all covered by insurance with no cost sharing. In addition, the development of a national preventive plan and the establishment of a Prevention and Public Health Trust Fund, to fund investments in communities that will improve public health. Further investments are being made to in school-based health programs, preventive oral health care, tobacco cessation and adding prevention planning to Medicare.
Nurses are play a vital role and a an extremely important driving force in the implementation of this law. By developing innovative care models like transition of care, home care, care management, and nurse managed clinics, nurses will improve quality of care and lower health care cost. Also, participating in research to aid in scientific evidence-based practices which improves quality, safety and patient outcome. Advanced practices nurses help increase the availability of primary care providers and provide cost effective care. Lastly, nursing leadership will be needed to implement better workflows to reduce medication errors, improve quality and care coordination, and increasing access to medical care. For these reasons and many others, nurses are of upmost importance in the implementation process of this Act.
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