week 8 modules

Monica Janssen

Aspen University

Health Care System

N502

Dr. Carmen Herbal Spears RN, MSN, BSN

February 5, 2017

WEEK 8 MODULE1

week 8 modules

Question one:

The pWHO states the following:”Health-care systems hemorrhage money. A recent study by the PricewaterhouseCoopers’ Health Research Institute estimated that more than half of the US$2 trillion-plus that the United States of America spends on health each year is wasted; a Thomson-Reuters study reported a lower but still substantial figure of US$600–850billion per year.”(WHO Universal Coverage financing, 2010, Chapter 4)

Choosing Wisely lists about 96 test and procedures and not necessary.

Healthcare professionals are often put in a situation of doing the right thing with checking each and everything rather than missing something vital. But seeing money wasted one would ask themselves is this reallynecessary? Questions that arise among our patients daily are for example why do they have to draw blood every day? Why do we screen for C-diff if the patient is on laxatives and has loose bowl movments? Why do we do we request a serology test for H.pylori if a breath test or stool sample can provide the results as well? Is an Amylasenecessary to diagnosePancreatitis or is testing the Lipase?

Over usage of Antibiotics: should the patient receive antibiotic treatment with new diagnosed C-Diff?Is an antibiotic appropriate for redness of the lower extrimites with no clear evidence of infection. Avoid removing ovaries in premenopausal women with no signs of cancer. Avoid bi lateral mastectomy if no evidence exists for the second breast to have cancer.

These are just a few to name the list goes on and on. It is also known that it is cheaper to treat a patient than preventing an illness and that technology pays better than manual or visual diagnostics.

With having the possibility of electronic charting and an electronic medical record test duplicates should be eliminated, and tests results can be viewed by everyone that is treating this patient. The downfall of this system is that it is not a nationwide one for all program and therefor the providers with the same system and mostly in the same enterprise have access to the electronic medical records.

Patients are often unsecure of asking a provider if the suggested test is really a necessity and that this test or procedure will benefit the outcome of the disease or the treatment plan. Most patients come to a provider for treatment and or prevention and assume that they are ordering these tests in good faith, but as healthcare professionals, we know that this is not always the case.

The best way of having control over what is ordered and from whom as well as for what would be a unified electronic medical record for each and every provider accessible and with a computerized program that would send alerts for unnecessary treatments and procedures.

Question two

Nursing has changed tremendously throughout the past decades. Nurses have more opportunities to work at besides, bedside. One factor of the shortage we see in nurses. Another factor is becoming a nurse difficult since nursing schools are limited and not enough nursing educators exist. To eliminate the lack of teachers, the government should consider in investing into the pay of nursing instructors and make this more attractive since it is known that a nurse at thebedside can earn more than a nurse educating.

Most nurses in an acute care setting work 12 hours shifts, these long shifts are known to burn out nurses quicker than working five eight hour shifts even with these facts nurses prefer to work the 12 hours plus and therefor have more time to replenish from the stressful environment. Often nurses have to work mandatory overtime due to the nursing shortage and staff members calling out and no resources available to replace the missing staff. Like in retail working in the medical field requires working odd hours, holidays, weekends and this can put stress on the social life as well. At the bedside, they must work to the fullest of their licenses overseeing the licensed practical nurses and nursing aids as well as all orders placed by the providers. If a mistake happends, the nurses are made accountable even if they did not place the order or fulfilled the task.

In some states, nurses have no protection or limited protection towards patient abuse physical as well as verbal. They must provide excellent customer services and patient experience due to the fact of reimbursement towards the facilities. Merit increase is often value based, and nurses are payed by the performance of the “Unit and facility” rather of what they have accomplished.

Nurses must put up with a lot they have to work in there scope of license and oversee the licensedpractical nurses, and nursing aids. Their duty is also to review and check doctor orders as well as medication orders. They are held accountable if a mistake happens even if they did not place the order. Within a twelve-hourshift, it is estimated that a nurse spends about two hours in direct patient care the rest is documentation and reviewing the patient's chart. In today's nursing world, we are pushed to do more for less with having a high nurse patient ratio as well. Some facilities are trying to work smarter not harder by implementing, for example, the LEAN concept to eliminatewaste and provide standards.

How can nursing be made more attractive in today's world?

Taking examples from other countries could help. For example, nursing schools to have more classes available we could consider in having hospitals having there owned nursing schools. Therefore,they could establish relationships with the nursing students and have well educated and facility oriented new staff members. Nurse educators should be compensated more than a staff nurse since most have a master degree or higher.

The government should step up and provide the protection that is needed for abuse and safety as well as safe nurse patient ratios. They must come to the realization that the acuity of the patients has changed and revise the decade's old ratios.

Also, tuition should be made affordable, and tuition reimbursement programs should be in place to make it more attractive for young people to consider a career in nursing.

Senior nurses should be paid by the level of education and certifications since often it is made a requirement for them to have so that for example, hospitals can receive magnet status. Nurses wanting to stay at bedside must be willing to attend school for their BSN and further certifications with out of pocket costs that most likely do not relate into a higher pay but puts a burden on them to maintain and recertify to their ownexpense.

Our nurses have been asking for help for years, and with one of the strongest professions, they are still not heard making this job less desirable then ever since passion alone is not enough anymore.

Question three:

The Commonwealth Fund has made the following statement:” ... 80 percent of physicians conclude that addressing patients’ social needs is as critical as addressing their medical needs. Until recently, providers rarely addressed patients’ unmet social needs in clinical settings. However, changes in the health care landscape are catapulting social determinants of health into an on the-ground reality for providers. The Affordable Care Act is expanding insurance coverage to millions more low- and modest-income individuals, and, for many, social and economic circumstances will define their health.”(Bachrach, Pfister, Wallis, & Lipson, 2014, p. 3)

Rocco Pearla states the following:”A recent studyconducted by researchers at Massachusetts General Hospital, in conjunction with my company,Health Leads, affirmed that social comorbidities are an inescapable reality of patients’ lives. Likewise, they should be an inescapable reality of the business of health care. We found that unmet social needs are associated with:

  • nearly twice the rate of depression
  • 60 percent higher prevalence of diabetes
  • more than 50 percent higher prevalence of high cholesterol and elevated hemoglobin A1c, a signal of diabetes
  • more than double the rate of emergency department visits, and
  • more than double the rate of no-shows to clinic appointments.

Today, it’s widely recognized that just 10 percent of health outcomes are attributable to medical care, while 70 percent are tied tosocial and environmental factors.”

These numbers are alarming, and one would think that it is the best interest of the patient to put these factors under consideration and determine how they can or could be eliminated, decreased or prevented.

Living in rural areas below the estimated poverty guideline can cause tremendous stress to the health of a human being. Worries on how to provide for themselves or loved ones with the ability to provide nutritional food to prevent diabetes for example. Stress can lead to depression as well financial issues, being unemployed, no access to affordable health care just to name a few. What can we as healthcare professionals do? First and for most, we must educate the patient in incorporating the literacy level of the individual. The patients need to know that good healthy food does not always mean it must be high in price; it must be available as well. It is upon the government to change the way we choose to purchase food. Why would one consider buying a bottle of water for $2.49 if a large carbonated flavored drink can be purchased for $1 or salad for $4.99 if one can get a “ Macbox” which includes two Big Macs, two regular cheeseburgers, 10-piece Chicken McNuggets, and four small fries for $9.99?Providing real healthy food in schools rather than process and high sugary foods would help as well. Basic needs such as having electricity, clean water, refrigeration available as well as living in a nontoxic environment could reduce and prevent certain diseases.

If healthcare is not available and or affordable, the only source is the emergency room. Patients often have this as the only source of receiving treatment since no one can be denied. With this being the only option it is also noticed that patients most likely wait to seek treatment when the illness has progressed and calls for immediate treatment.

Healthcare needs should be met and made available to all and if required free to cost to prevent in the long howl manifestation and or comorbidities.

Pearla also states:”. For example, in the Seattle-King County Healthy Homes Project, community health workers conduct home visits to low-income families with children with uncontrolled asthma. Urgent care costs for participants in a high-intensity intervention were projected to be up to $334 per child lower than among those receiving a less intensive intervention. The share of individuals using urgent care services also fell by almost two-thirds during the intervention.” So in the long run if one invests in health care from day one and provides resources and cost efficient care it can save cost in the future.”(Pearla, 2016, p. 1)

References

Bachrach, D., Pfister, H., Wallis, K., & Lipson, M. (2014). Addressing Patient Social Needs: An Emerging Business Case Provider Investment. Retrieved from

Pearla, R. (2016, August 1). It’s Time To Incorporate Social Needs Into Patient Care . . Retrieved from

The World Report Financing for Universal Coverage [White paper]. (2010). Retrieved from