Appraising Evidence Based Practice (MH Nursing)

Delivering Healthcare in America
Name
Institution
Abstract
The healthcare in the United States has changed today due to the new technologies that have been introduced in the health sector. The healthcare system has been expended to ensure that the patients get the right medical care and quality healthcare in all health institutions. Quality healthcare is nowadays achieved in the hospitals, rehabilitative care and many other places. The expansion in this sector has made it easier for patients to receive the quality treatment that they desire. The healthcare delivery was introduced to ensure that patients get an affordable health care within the sector. Some factors including the reduction of healthcare cost in the health industry and the length of time that patients take in hospitals while awaiting treatment have been discussed and solutions implemented.
Key Words: Healthcare delivery systems
Introduction
Nurses in the United States and many other parts of the world have had an issue when it comes to reporting abuse at the work place. Ethical factors have been cited as the main reason for many nurses failing to report these abuses. Some of them normally claim being threatened as another reason for their failure to acknowledge the abuses at work. Despite these facts, abuses at work normally affect quality service delivery in the hospitals. The article explores the factors that lead to abuses at the work place, which students might report to the relevant authorities.

Factors
Ethical factors have played a role in nurse’s decision against reporting abuse at the work place. Many of them usually get warned of dare consequences that might arise in the event of their reporting. In most cases, their superiors usually threaten them with the sack to an extent that they usually have no choice. Many of them always claim that silence is not their fault due to the circumstances involved. The nurses usually go through ethical approval under an umbrella boy of the University Ethics Committee by being deployed to various hospitals in the country. It is under this body that nurses are usually required to maintain high degree of maturity and integrity while performing their medical duties. In the United States, many employers normally buy the health insurance program for their workers. They usually buy the health insurance from an insurance organization of their choice. Even though the employers usually engage in this activity, some always face financial barriers regarding this aspect. Due to this, many employees usually chose the government-sponsored healthcare plan for their families. The government is the chief financier of the government-based healthcare plans.
Some of the nurses who are usually brave enough to report the existent abuses at work normally use “I had no choice” as an excuse for reporting. Despite their jobs being on the line, an interview carried out suggested that many nurses used the excuse for their reason to report. It is an excuse that they have continued to use for their explanation due to some various factors. An interview done suggested that one nurse cited the abuse as disturbing and traumatizing. It is for those factors that the nurse decided to report the matter (Young, 2017). It can be argued that the reason for the excuse given by nurses does not meet the required ethical values of the position that they hold at work. “I had no choice” as an excuse does not fit to be used as a reputable reason for not reporting some vices that occur at work. In a logical thought, the nurses should hold their positions with high integrity that can justify their employment as nurses. Because of this fact, it is necessary for nurses to report the vices that occur a work regardless of the nature of intimidation by their superiors.
The enhancement of service delivery is another role of the health delivery system. The health delivery system does not necessarily deliver service but ensures that the health industry delivers the desired quality services required. The health institutions are tasked with the responsibility of ensuring that patients receive the best treatment for any related health issue. The healthcare delivery system ensures that the service is provided and delivered to the patients who might be in need of the quality services. The providers in this regard refer o the physicians, doctors, and all the other health practitioners who have a significant role to play in ensuring that patients are well taken care of regarding service delivery. The providers fall under both the private and government-sponsored healthcare program. In terms of quality healthcare delivery, the organizations that supply medical equipments in the health institutions are also referred to as the providers in the health industry. In some cases, the providers have been noted to offer services to only those patients that are covered by health insurance. It is a move that the providers have taken to ensure that the quality health delivery that they are offering to the patient is paid for indirectly by the patient (Sultz & Young, 2006). In some rare cases, the patients that have been covered under the government-sponsored program have been witnessed to receive service delivery from private institutions. In such cases, there is normally an agreement between these institutions regarding the means of payment for the health service offered to the patient.
Another nurse who was interviewed regarding the issue of abuse that occurs in both private and public health institutions showed concern by saying this, “I had been on training courses about safeguarding vulnerable people and so I was aware of what was bad practice and what good practice was. This made me a bit stronger in terms of reporting things because I had a background of knowing what was deemed to be wrong” (Sultz & Young, 2006). In her statement, it is clear to the audience that the nurse showed great courage and integrity while taking into account the negative aspects of abuse. In spite of this, some nurses that report such matters to the authorities sometimes feel guilty. Their guilt is always compounded by the fact that their working environment and the integrity of the health institution will be jeopardized. It is a matter that has caused much concern in the health sector. The actions of some nurses in cases that regard reporting might be considered to be a personal challenge that they continue to explore in their lives. The confusion that some of them normally undergo while concerning themselves whether they are doing the right thing or not can also be regarded as a personal challenge. The clarity regarding the timing of when to make a report is still an issue that some of them still grapple with at their work places.
Ineffective Management
The fact that the United States health care system is not controlled by any agency in the United States makes it vulnerable to wastage of resources. It is a factor that the health care delivery system has been neglectful in solving, which leads to its lack of contribution towards safeguarding the resources in the health industry. It can be argued that the resources in the health industry would be better saved and well taken care of if the healthcare system were to be run by an agency. In this case, the healthcare resources would be carefully monitored and accounted for before any spending is sanctioned. Establishing a central would assist the health delivery system to control the cost associated with service delivery in some health institutions (Young, 2017). The central agency for the regulation of the healthcare system would allow the healthcare delivery system to use the global budgets in the determination of the total expense of the delivered services. Currently, the healthcare delivery system does not have the required capability to help in the safeguarding of healthcare resources. The payment of services to healthcare providers, especially those that supply the related healthcare materials is subject to a particular budget and the right management of resources. System-wide resource regulation determines the total amount of expenditure that the government-based healthcare services will incur in costs. It is a means of cost justification that helps to budget the total amount of funds that will be needed for a particular health project. The United States introduced a private system to obtain the required funds for the health industry. The private financing is a way that the healthcare delivery system uses to collect the much-needed resources for its functions in the healthcare sector. The government or private employees play a significant role in the contribution of resources to the healthcare kitty. It was estimated that about 53% of their contribution through their salaries are channeled to the healthcare sector. The employees’ contribution to the healthcare sector is much more than the government’s contribution, which is estimated at 47%. The only problem that occurs is the fact there is no central agency in place to control the use of these funds. The 100% contribution by both the private sector and the government accounts for the total expenditure required to run the healthcare sector in the United States.
The inability for patients to access the much-needed quality healthcare can also lead to the wastage of resources in the healthcare industry. The partial access to healthcare is another problem that the healthcare delivery system is still grappling with in terms of safeguarding resources. The inability by some Americans to attain the required quality healthcare means that they do not have the health insurance to cover for the expenses. The lack of insurance cover will mean that they will be required to pay cash for the services received. Some health institutions might overcharge for their services due to lack of payment control by an insurance company or the healthcare delivery system. It has been a case for concern in the healthcare industry due to the wastage of resources involved (Whitman, 2008). The insurance cover can help to control the amount of expenditure that might be required for a particular service in the hospital due to its limitation on the amount of funds that the patient is entitled to after service delivery. The working-class Americans are able to purchase their health insurance cover by the help of their employers. The unemployed Americans who are not covered by the government are normally forced to pat with the required amount to obtain the required healthcare service. Health insurance is deemed the most affordable and primary means to achieve quality healthcare in the United States. The healthcare delivery system might not have the ability to manage the resources in the healthcare sector in the absence of the health insurance cover. The lack of insurance cover normally leads to overcharging by health institutions that wish to make extra profit for their services. It can be argued that the healthcare delivery system has failed in its capacity to regulate the spending of the healthcare funds in the health industry by failing to establish a means to control this fact. It is a case that is different from the healthcare institutions that are either supported by the government or non-governmental organizations. These health institutions usually put a limit to the amount of money charged for a particular service. They limitation is based on the agreeable amount imposed by the government of the nongovernmental organizations. The only negative aspect with these health institutions is that they are located at specific areas, which means that not all Americans can access them.
The market imperfection is another factor that leads to the lack of proper contribution by the healthcare delivery system in terms of management of resources. The delivery of services in the healthcare sector in the United States is largely considered to be controlled by the private sector. Even though the government plays a role in the control, the private sector has also been credited with playing a major role in the industry (Shi & Singh, 2008). The free market forces in the healthcare industry are also collectively known as the imperfect market. The free market makes it difficult for the healthcare delivery system to control the funding and expenditure that is involved in the delivery of quality services to the patients. The free market gives both buyers and sellers of various healthcare services an opportunity to set their preferred cost of service delivery in the health industry. The free market makes it difficult for the healthcare delivery system to enforce a mechanism that would help control the costs of healthcare service in the sector. In the United States, the free market allows sellers to control the market prices depending on the demand for the service. The market price of a particular drug or service can be inflated due to lack of resource regulation in the industry. It is a factor that might lead to the failure of the healthcare delivery system to set the required cost for service. The free market also allows patients to receive healthcare from a health institution of their choosing. In this regard, they might not be aware of the best health institution in terms of both service delivery and cost. It is an issue that makes it difficult for the healthcare delivery system to control at an appropriate level. The independent act of both the sellers and the healthcare providers gives room for one party to have the upper hand over another in terms of accessing the much-needed healthcare. Even though the prices of healthcare might be influenced by the demand, some healthcare providers normally inflate these prices to their satisfaction. The healthcare providers might collude to increase the price of health service depending on the high demand that is witnessed. The healthcare delivery system, in this case, might not have enough power to set a limit for a particular service largely due to the free market forces.
The healthcare delivery system has not been able to manage the resources in the healthcare industry due to the third-party insurers and payers. The third-party insurers take the opportunity to set the cost for the healthcare service in the industry (Shi & Singh, 2004). It is almost the same as in the case of the free market where the health providers seek to inflate the cost of healthcare in the sector. In the case of the third-party insurers, the healthcare delivery system might not have the capability of advocating for quality healthcare delivery or set the cost of the service. The third-party insurers normally have the responsibility of enforcing the prices of the service. It equally becomes an expensive affair due to the long chain of command involved. Due to the chain of command in the case of payment, the healthcare delivery system normally fails to put a cap on the rising cost of healthcare services in the health industry.
The healthcare delivery system has also proved to be ineffective when managing the healthcare resources due to the existence of multiple payers in the health industry. The healthcare system in the United States has in most cases been referred to as the single-payer system due to the government regulation. The government’s involvement in the regulation of the health industry makes it hard for the healthcare delivery system to fully assert its authority in the control of the healthcare budget. Although the private sector contributes the majority of funds to the healthcare sector, the federal government plays a role in its regulation too. The role that the federal government plays has sidelined the healthcare delivery system in its efforts to fully manage the resources spent in the industry.
Conclusion
Just like other workers, nurses have a responsibility of ensuring that justice prevails at their work places. It means that cases of biasness and abuse should be reported regardless of the people involved in the matter. A quantitative analysis was carried out among nurses in the health institution regarding matters related to reporting abuse. Some of them gave conflicting reasons for their actions while some gave reasons that justified their reporting of the abuses to the authorities. The decision that a nurse makes while reporting an abuse usually reflects on the past experience or the integrity of the person. Some nurses usually fee guilty after reporting such an issue while others are often sure of their actions. The self-believe of a person when reporting is vital for every nurse who intends to uphold the integrity that her job requires. During the interviews conducted, some nurses did not have the courage to be interviewed regarding the matter. Others were strong, while some did not give accurate answers to some questions posed due to guilt. Some agreed to the interview merely because they had already been transferred to another health institution. It was an opportunity for them to give past accounts of what transpired in their former work places. The consequences that are associated with reporting an abuse were some of the concerns that the nurses had during one session of the interview. One can conclude that some of the nurses did not give accurate answers to the interviewers for fear of the consequences that they would face as a result. The uncertainty of their answers for fear of backlash from their superiors does not provide the clarity needed to justify their answers. Students are often aware of the consequences of reporting some of the abuses that they witness in their workplaces. Some fear losing their positions or getting permanent employment with either the same institution or another one in their minds. The fear to talk is compounded by the fact that the student nurses do not usually have a choice while administering their duties. During the interview, most of the student nurses affirmed the fact that they did not have a choice to report the matter at hand.
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