Diversity in nursing

In the world that we are currently living, nurses are operating in culturally diverse settings. The modern healthcare setting is integrating both the experts and the patients with diverse backgrounds and social levels. It is therefore very important for professional nurses to have a good understanding of the diverse needs of their patients and take into account their cultural diversity as well as individual habits of the different patients so as to offer them with quality health care services. The modern diverse health care setting inspires the improvement of tolerance among the nurses and maximizes the nurse's efficiency in their work within the diverse environment (Vandenberg, 2008).

Diversity in nursing is quite important as it offers chances for nurses to administer quality care to their patients. Through diversity and inclusion, different cultures, prospects, and attitudes are brought together and thus they bring forth greater integration, creativity as well as innovation that ultimately result in better patient care and satisfaction. Employers in the health sector who make diversity a priority allows the nurses to have a fair access to job openings, promotions and other employment benefits (Vandenberg, 2008). The nurses are also able to support one another and thus creating a diverse team that can allow them to do things in a great way. A diverse team usually presents unique ideas and prospects that the entire team of nurses can use in treating the patients. This, therefore, results in the formation of strong bonds among all nurses which continues for a lifetime (Vandenberg, 2008).

Networking in nursing is quite important as it allows professional linkage. It is therefore very essential to have people who contribute to a person’s professional identity and clinical skills as this enhances mutual support and influence. Having a day to day connection with people that I meet in the day to day basis is one of the ways I intend on a network with fellow nurses at a personal level (Jeffreys, 2012). Having an interpersonal relationship is also important and it will be nurtured through having a nurtured conversation and through mutual support with the people that I intend on networking with. Networking will also be established through attending seminars and conferences where one is able to identify a potential person to link with. Conference friends may form part of good networking colleagues who might be as helpful as they may be of great support (Jeffreys, 2012).

Having a professional development is one of the main strategies that enhance networking in future professional life as a nurse. This offers a huge potential for growth and through registering with a nursing organization will enhance a better platform for future networking. Being a member of this kind of organization allows one to have unrestricted networking opportunities. This may be of importance in the future as the organization may link a nurse to career boards as well as scholarship chances (Jeffreys, 2012).

One of the core reasons behind building a professional network in nursing is due to the fact that it assists in developing a strong system among nurses. Networking allows for a platform where nurses can encourage, advice and support one another hence enhancing nurses to gain the right attitude in the midst of challenging times (Jeffreys, 2012). Professional networking enhances nurses to attain the basic knowledge that is required for them to take the next step. For instance, nurses may develop relationships with people who work in their desired departments or in the desired roles with an aim of gaining knowledge.

References

Jeffreys, M. R. (2012). Nursing Student Retention: Understanding the Process and Making a Difference. New York: Springer Pub. Co.

Vandenberg, H. (2008). Concepts of culture, diversity and cultural care among undergraduate nursing students: a nursing education perspective (Doctoral dissertation, Lethbridge, Alta.: the University of Lethbridge, School of Health Sciences).

Centers for Disease Control and Prevention (CDC)

Description and services offered

CDC is a federal agency that is tasked with the role of performing and supporting health promotion, prevention and health preparedness in the US with the aim of improving the entire public health system. This agency is under the management of the Department of Health and Human Services. The agency works together in creating knowledge, information and important tools that people and the entire community requires in safeguarding their health. Some of the popular services that this agency offers to the people include control and prevention of A to Z diseases and Ebola conditions. Following the high prevalence of asthma in children between the ages of 0-17 years, CDC is working in collaboration with health departments so as to bring this disease under control (National Academy of Sciences, 2012).

Partnership

The Joint Commission and the CDC are in a partnership that is geared to adapt, enable and publicize CDC guidance associated with infection prevention and control in the setting of the ambulatory health care system. This is aimed at establishing model infection control plans and expounding on the reach, the uptake and acceptance of these and other more infection prevention and management guidance materials so as to enhance infection prevention in outpatient surroundings.

Accreditation

CDC is accredited by the Public health accreditation board (PHAB). To receive accreditation through PHAB, the CDC has to undergo thorough, all-around peer-reviewed evaluation process so as to ensure that it attains the specific standards and measures. The CDC agency is up to date with the PHAB accreditation program. PHAB was established to serve as a state board of public health that accredits the various departments and agencies within the public health. The program was launched in 2011 and since then, more than 125 health departments and public health practitioners across the nation have applied to PHAB (Riegelman 2015).

Accreditation validity

Once accreditation is awarded to an agency, it is valid for five years if there is no significant transformation in the agencies operations. The CDC agency is up to date with the accreditation by PHAB since they have been submitting an annual report to PHAB where they usually describe their progress in the targeted areas of betterment and its overall quality development efforts. After five years the agency reaccredits themselves by applying for reaccreditation. 

Impacts of accreditation

Lack of accreditation may result in poor accountability and lack of credibility among stakeholders within an organization. It may also result in lack of preparedness in an organization and hence health organizations may not be in a position to respond proactively to the emerging and re-emerging health issues.

Through this accreditation, the public health departments including the CDC are being driven into attaining a continuo improvement on the quality of services that they convey to their clients and they ensure that accountability and credibility are adhered to.

Researching a health agency or hospital for a client

While carrying a research for a healthcare or hospital, I would evaluate the access to care, the health care expenditures and processes and the end product of the health care services for the consumer. The hospital or agency will have to meet these three standards, it should care should be accessible, the expenditure should be affordable and fair and the outcomes of the health services offered by the agency or the hospital ought to be good for the client (Steinwachs, & Hughes, 2008). If the health agency or hospital in question meets these three most important aspects, I will definitely recommend it to my client.

References

National Academy of Sciences. (2012). Primary Care and Public Health: Exploring Integration to Improve Population Health. Washington DC.

Riegelman, R. K., & Kirkwood, B. (2015). Public health 101: Healthy people--healthy populations.

Steinwachs, D. M., & Hughes, R. G. (2008). Health services research: Scope and significance.

Gray market pharmaceutical drugs

According to Hemphill, (2015), the high rate of drug shortages in the US has resulted in the emergence and the aggravating drug market problem. Shortages affect a large number of pharmaceuticals in the United States marketplace as the majority of the drugs that are in shortages include the generic drugs as compared to the patented drugs. Therefore, with this shortage in the US drug market, people are unable to access drugs as they are not available through the traditional drug channels and this result in the emergence of the gray markets. Even though the subject on gray markets has been there for quite a long time, contemporary participants are becoming more active and more visible with the increasing shortages. Gray markets are thus involved with the trading of stockpiled drugs by wholesalers. This activity is illegal and unauthorized by the manufacturer but it is however very much profitable since these shortages smooth the progress of price gouging. This practice of price scraping by secondary wholesalers is not doing any good to the control of the gray markets. This is because they are the large contributors to gray markets. This is unacceptable and poses serious issues for patient safety as it cannot be guaranteed that the drug products have been properly handled in a way that meets and sustains the health standards and integrity.

According to Cohen, (2014), prescription drugs have contributed greatly o the evolution of the gray market into becoming a more serious black drug market, including controlled and counterfeit drugs that are detrimental and risky to a person’s safety. Though the Food and Drug Act agency has been proactive in prosecuting these pharmacists taking part in the black market, there is still a high record of sensational arrest that makes the headline. This is a strong indication that the black market is increasing rapidly rather than decreasing. Physicians are the number one contributors to the increasing drug market cases. This is because they are the ones who are responsible for prescribing these drugs to the patients hence causing drug abuse crises. Drug manufacturers have also proved to take up a large part in causing drug shortages. This is due to the fact that they choose to under-produce some of the less profitable drugs that are regarded as life-saving so as to make more of lucrative medications. Politicians, on the other hand, have been affiliated with this problem as they are the ones responsible for creating an environment where such kind of decisions are permissible and even economically regarded as rational.

To curb this problem, pharmacies, as well as hospitals, should be in the front row in ensuring that they purchase drugs that meet the right pedigree. According to the federal laws, wholesale distributors of drugs are expected to provide to their clients a record of their distribution route indicating the route that these drugs have traveled from the time they left the manufacturer. Hence, pharmacies and hospitals ought to ensure that they obtain this record once the drugs are distributed to them and should carry out a thorough inspection.

References

Cohen. H. E.  (2014). Black Is the New Gray in Pharmaceuticals. Retrieved from: https://www.uspharmacist.com/article/black-is-the-new-gray-in-pharmaceuticals

Hemphill. T. A. (2015). Eliminating Pharmaceutical Gray Markets. Retrieved from: https://www.realclearpolicy.com/blog/2015/07/07/eliminating_pharmaceutical_gray_markets_1356.html

What is euthanasia, and why is it considered to be morally different to murder or suicide? Is it?

Introduction

This report will seek to answer the question on what is euthanasia, and why is it considered to be morally different to murder or suicide? Euthanasia is a term that is utilized differently by most individuals. According to Rhee, et al (14) euthanasia is considered to be a subject of moral debates in the contemporary society. Euthanasia can best be described as the general act of ending an individual’s life without causing any pain for the reason of showing compassion (Carmichael 5). This act is to most regard as mercy killing despite the fact that its definition is a source of moral controversy. Euthanasia is considered morally different from suicide and murder based on the fact that it is conducted for some clinical and justified reasons for ending suffering to an ailing patient. On the other hand, suicide can best be described as the intentional ending of life while murder is more of a criminal conduct that best describes killing or ending a person’s life with the intention of causing pain and when self-defense is not needed (Carmichael 5). However, where active euthanasia is involved which is accounted as the deliberate killing of an individual by administering lethal doses, then that is accounted as murder and morally unjustified. Morally speaking, euthanasia is considered different to murder and suicide because, despite the fact that death is inevitable for all humans, critical suffering prior to death is intolerable not just for the fatally ailing patients but also for the family and friends.

Euthanasia to most is considered as the deliberate ending of an individual’s life. unlike assisted suicide Euthanasia normally involves mercy killing by permitting the suffering patients to die a rather natural death without the provision of clinical life support, where assisted suicide incorporate the use of an active but voluntary suicide machine (De-Beaufort and De-Vathorst 1464). The controversy of the issue lies on the ground that the terminally ailing are in most cases not in a position to state their wishes to die and thus a decision that seeks to end their pain and the psychological and financial anguish of the families is made on their behalf. Murder is a crime which has no moral justification given that it involves the brutal killing which is in most cases intentional without any justified reason or mercy involved. Assisted suicide is accounted as morally unethical on the ground that although the patient communicates their need to die, their death is usually painful and mainly incorporates denying them the needed medical assistance which would have been beneficial to their wellness (Carmichael 5).

Morally, healthcare has the obligation of ending suffering and pain to an ailing person by subjecting them to the most suitable treatment that would thus create wellness. In other words, Euthanasia and physician supported suicide are distinct subject (Math and Santosh 890). This is because there are numerous factors that play part such as the consideration of the intensity of suffering, the probability of survival and consciousness for making the voluntary choices for suicide or Euthanasia if needed. Murder is morally wrong because it is not just a crime but also a matter of making deliberate and destructive choices (Carmichael 6). In the current era, most individuals hold the agreement that rather than allowing an individual to suffer and they will ultimately die from the terminal disease allowing them to die without causing pain is an ethical choice. Assisted suicide is considered to be morally unjustified on the ground that it is practiced for selfish reasons. In that most patients tend to believe that they are a major burden to their families either psychologically or financially thus opting for immediate death which is unethical (Math and Santosh 890). The primary distinction amid physical supported suicide and euthanasia lies on the fact that one is an intentional technical death while the other is accounted as natural.

In my opinion, I do believe that the fact that death is inevitable makes Euthanasia morally accepted. On the other hand, given that physicians have a clinical responsibility of ensuring that they provide the needed medications to all patients as a form of ending their pain and ensuring that the occurring suffering is reduced (Rollin 1082). However, it is rather evident that even though euthanasia is morally different from suicide and murder because its intentions are to end pain and suffering both for the patient and family members, it is evident that the act can best be categorized as intentional killing because it involves the actual denial of treatment which ultimately results in the death of those that are involved (Banović, Veljko and Miloradović 173). In order for the death to be accounted as natural or unintentional then it must be as a result of the offered treatment that was believed helpful to the noted patient even though they were in a rather unhopeful situation. It is worth noting that, the diagnosis part of treatment has always been accounted with varying mistakes which means that the recommendations by the physician might not be the end as one the Euthanasia option is implemented the final outcome is only death thus the fact that the patient might recover from the illness is eliminated (Rollin 1082). The justification of euthanasia is derived from the fact that it is clinically connected and it is more focused on instilling mercy as the means of ending an individual pain which might not be recovered.

Suicide is considered to be unjust on the ground that it involves participating in ending an individual’s death which is similar to murder rather than permitting them to die naturally (Rollin 1083). Suicide has the tendency of created intense guilt on those that are involved and thus if there are no other means of relieving a terminally ailing patient from suffering then it is rather evident that the most humane alternative rather than conducting suicide would be euthanasia. Euthanasia is widely supported by the public and clinically because it leads to the ending of psychological and physical pain for those that are involved. This is thus considered to be a defensible killing of a terminally ailing person in instances that the patient is not able to make reasonable choices but the involved family can. Unlike the use of deadly approaches, Euthanasia is widely acknowledged and preferred because it is normally a gentle and painless approach. In most cases where euthanasia is applied, it is normally noted that the life of the patient ends by the injection of certain doses or withdrawing medication and life support systems to allow the patients to die (Math and Santosh 890). Most individuals that oppose euthanasia do so on the ground that it is rather a deliberate killing which is not natural since it is not certain that the patient will not survive.

Most believe and oppose the notion that euthanasia s morally distinct from murder or assisted suicide on the ground that it leads to deliberate killing by denying the patients the needed treatments (Banović, Veljko and Miloradović 173). In addition, it is held that if euthanasia becomes acceptable in the contemporary society then this would result in the loss of many innocent lives in general in the name of mercy killing. In that even though chronic illnesses once they reach the last phases are unpredictable and patients have usually subjected to unending pain it is rather apparent that ending their lives is a selfish choice that objects nature taking action on its own. Euthanasia is widely being used in the society today which is a result of technology advancement which despite being a source of hope to most by offering treatment options has proved to be a source of controversy (Rollin 1084).

In conclusion, euthanasia is considered morally different from assisted suicide or murder because it is intended to end suffering to terminally ailing patients. In that euthanasia causes no pain but leads to the death of the involved patients which is accounted to be a natural but intentional death that is aimed at creating relief. Euthanasia is a form of a modern clinical alternative that exists for chronically ailing persons in instances where medical treatment is not beneficial or where death is the only existing option. I believe that euthanasia is morally different because it is intended to end pain and is conducted in a more lethal manner that accounts for the level of the patient’s pain, ailment as well as clinical alternatives. However, the approach is only justified only when used with the consent of the patient.

Work Cited

Banović, Božidar, Veljko Turanjanin, and Anđela Miloradović. “An Ethical Review of Euthanasia and Physician-Assisted Suicide.” Iranian Journal of Public Health 46.2 (2017): 173–179. Print.

Carmichael, Hannah. Euthanasia: Is it ethically and Morally Acceptable. Diss. 2016.

De Beaufort, Inez D., and Suzanne van de Vathorst. "Dementia and assisted suicide and euthanasia." Journal of neurology 263.7 (2016): 1463-1467.

Math, Suresh Bada, and Santosh K. Chaturvedi. “Euthanasia: Right to Life vs Right to Die.” The Indian Journal of Medical Research 136.6 (2012): 899–902. Print.

Rhee, John Y., et al. "Physician-Assisted Suicide and Euthanasia Is Incompatible With Medicine: A Response from Medical Students." Critical care medicine 45.6 (2017): e626-e627.

Rollin, Bernard E. “Ethics and Euthanasia.” The Canadian Veterinary Journal 50.10 (2009): 1081–1086. Print.

Prevention Interventions Can Be Therapeutic

According to Gelatt, Adler-Baeder & Seeley (2010), couples and children in stepfamilies suffer from stress gained during marital and partner transition. They also face adjustment problems in psychosocial adjustment since they have to accept the individual differences and ensure strong family relationships. They may come across family conflict, social stress and other factors in social arena which end up affecting the psychological well-being.  However, the authors show that prevention interventions can be therapeutic by focusing on family life education programs which can act as protective factors. The purpose of these programs is to improve communication, strengthen connection,   build a normative step-family development and help the stepfamilies adjust and create family stability (Gelatt, Adler-Baeder & Seeley, 2010). The article introduces programs known as ‘web-based interactive multimedia (IMM) and self-administered marriage programs which play an important role in providing general education.  The web-based interactive multimedia is an online learning where participants have self-administered programs. This means that participants have the opportunity to select prams based on family matters and also engage in social-cognitive learning. A good example that shows prevention interventions can be therapeutic is that IMM programs such as parenting toolkit helps parents learn more on effective parenting and stepparenting practices (Gelatt, Adler-Baeder & Seeley, 2010).

 According to Huebner et al, (2009), the deployment of military has led to long term and short term effects to military families. Challenges include divorce, lack of marital satisfaction, stress, lack of marriage stability, incidents of remarriage, relationship conflict and more (Huebner et al, 2009).   However, the human service delivery system in U.S supports these families cope with positive challenges. The article introduces a new approach based on family support programs which is connected with informal community to offer support to the military families. The role of community is to build a support system that ensures partnership between community and families. The introduced prevention intervention is called ‘community-capacity building approach’ which develops social actions and achievable goals (Huebner et al, 2009).  It comprises shared responsibility and collective competence where the community shows concern on the general welfare and addresses community needs effectively.  Examples of programs designed by community support system include ‘Youth Development Project’ which its role is to recognize the need of young people and build family resilience.  The community also provides   relational and practical skills which aids the family to cope with challenges.  The goal of these programs is to promote family resilience, provide relationship skills, problem solving skills and social support (Huebner et al, 2009).

References

Gelatt, V. A., Adler-Baeder, F., & Seeley, J. R. (2010). An interactive web-based program for stepfamilies:

Development and evaluation of efficacy. Family Relations, 59(5), 572–586.

Huebner, J,A., Mancini A,J., Bowen, L, G., & Orthner K, D. (2009).Shadowed by War: Building Community

Capacity to Support Military Families. Family Relations, 58, 216-228.

Policy action bulletin

Poverty and Health

Low income families face challenges in accessing the health care due to barriers such as lack of insurance coverage and unaffordable costs to quality health care. Poverty is the major issue that is hindering the poor families to access care since lack of finance hinders them to porches quality food as well as care (Silverman, 2013). Poor families also lack information based on health-promoting practices and they end up suffering from chronic illnesses and poverty.  Note that poverty increases the vulnerability to stress and uncertainties and this leads to high level of health risks. This being an issue of concern, the policy action is that the government should offer support to the poor families and establish a strong health care system where the families access quality health care (Silverman, 2013).

Policy action questions

What should be done to eliminate poverty and ensure access to quality health care?

 To eliminate poverty, there should be creation of jobs to help the unemployed poor families enter in the labor force. This will create an economy security and eliminate both long-term and short-term challenges which the poor families experience.  There should be an expansion of Medicaid to allow the poor families to access quality health care. The Medicaid will aid them in paying medical bills; reduce financial strains and bankruptcy (Bogenschneider & Corbett, 2010). 

Who will be responsible in ensuring equal access to quality health care?

 The government has a bigger role in poverty and health care sector since it is expected to control and regulate spending by creating a fundamental policy reforms on health care market and health insurance. The government should also encourage the need to create community development programs to educate the poor families on health and well-being.  The programs should be also designed to eliminate discrimination and inequality and strengthen the opportunities and equal access to public services (Bogenschneider & Corbett, 2010).

  Who else apart from the government should take actions in addressing these challenges and which specific actions should be implemented?

 The World Bank should offer financial protection to ensure equal access to health care.  The financial protection will play a big role in eliminating poverty and vulnerability to health care risks. The World Bank should join hand with the government to establishing programs that will work to expand health insurance, increase efficiency, reduce inequalities and expand access (Eshleman & Bulcroft, 2010).

References

Bogenschneider, K., & Corbett, T. J. (2010). Family policy: Becoming a field of inquiry and subfield of

social policy. Journal of Marriage & Family, 72(3), 783–803.

Eshleman, J. R., & Bulcroft, R. A. (2010). The family (Family Social Policy). ((12th ed.). Boston, MA: Allyn

& Bacon.

Silverman, R. D. (2013). Poverty, Health, and Law: Readings and Cases for Medical–Legal

Partnership. Journal Of Legal Medicine, 34(3), 327-336. doi:10.1080/01947648.2013.831305

Gerontology

Gait Pattern Comparison

The selected older person gaits differ from a younger person in terms of speed and stability. Gait pattern is normally driven more by an individual’s personality, age, and social factors. In that, the older person demonstrated a later slow, extensive based, shuffling and hesitating walking patterns. Young people are characterized by rather rapid walks that never follows a specific pattern with no hesitation or stops. The pattern is, however, different from abnormal gait patterns because the client demonstrated some form of coordination and sensibility even though she lacked adequate strength and functionality. Even though the client would walk a distance, the walk was characterized by cautions and regular stops.  From observations, I believe that my client is at risk of immobility consequences. This is because, with the lowered movement, this will result in the stiffening of the muscles, painful movement with mobility growing to be more challenging. This is because they seem to move less and with that, the muscles will get stiff in the instance that she is not exposed to adequate movement.

The assessment revealed some useful facts that although the client appears to be stable while walking it is apparent that they necessitate more clinical care to strengthen their muscles and better concentration. Rising without getting support using the arms appeared to be a challenge and with the frequent walking stops, it appeared that the muscles were beginning to stiffen thus creating a form of walking strain and soreness.

Cardiovascular Disease Risk (CVD) in an Older Adult

Cardiovascular Disease remains to be among the leading mortality and morbidity sources particularly among the aging population and thus some rather strategic preventative approaches are necessitated. My client is a 68 years female who has retired from economic activities but does a few things for herself. The client is considered to be independent on the ground that she accomplishes some tasks on how own without needing any kind of support. Having been a smoker in the past she stopped like two years back after the doctor recommended that she needed to adopt a healthy living lifestyle for better existing. She lives with diagnosed diabetes which is under control but her unregulated anger and stress which has turned to depression are the main divers of her constant blood pressure. The patient has for years struggled with a weight which is accounted for her current hypertension state but she remains physically inactive as she is aging.

With the condition, it is rather evident that my client is at risk of Cardiovascular Disease and immobility. This is because her medical history indicates that she has been under diabetes treatment for more than 20 years. In addition, with obesity and physical inactivity Cardiovascular Disease is unavoidable which implies that even though the consequences of immobility are severe cardiovascular problems will make the condition even worse which will also lead to the risk of mortality. The client is hesitant to walk not only based on her weight but on the ground that her muscles seem to be growing less responsive to movement and it appears that the mobility generates some soreness. In order to lower the risks, I would recommend that the patient is placed under a dieting program that will be useful in controlling diabetes progress and lead to weight reduction. In addition, therapy would do her good in learning how to control irritation and stress (Wilmoth & Ferraro, 2013).

References

Wilmoth, J. M., & Ferraro, K. F. (2013). Gerontology: Perspectives and issues. New York: Springer.

Two basic types of patient classification systems exist: prototype and factor. A prototype evaluation system is considered both subjective and descriptive. It classifies patients into broad categories and uses these categories to predict patient care needs. The relative intensity measures (RIMs) system is a prototype system. This system classifies patient care needs based on their diagnosis-related group (DRG). The data are then fed to an electronic decision support system that integrates clinical and financial information. A factor evaluation system is considered more objective than a prototype evaluation system. It gives each task, thought process, and patient care activity a time or rating. These associations are then summed to determine the hours of direct care required, or they are weighted for each patient. Each intervention is given a name and a definition and is further specified to incorporate a list of all associated interventional activities. The list of interventions is comprehensive and applicable to inpatient, outpatient, home care, and long-term care patients. Typically, if these systems are used for staffing decisions, organizations use a combination. Some patient types with a single healthcare focus, such as maternal deliveries or outpatient surgical patients, would be appropriately classified with a prototype system. Patients with more complex care needs and a less predictable disease course, such as those with pneumonia or stroke, are more appropriately evaluated with a factor system.

 Numerous potential problems exist with patient classification systems. The issue most often raised by administrators relates to the questionable reliability and validity of the data collected through a self-reporting mechanism. Another concern with patient classification data relates to the inability of the organization to meet the prescribed staffing levels outlined by the patient classification system.

Yoder-Wise, P. S. (2014). Leading and managing in nursing. St. Louis, Mo: Elsevier Mosby. 266-268

Harper, K., & McCully, C. (2007). Acuity systems dialogue and patient classification system essentials. Nursing administration quarterly, 31(4), 284-299.

Hopfe, M., Stucki, G., Marshall, R., Twomey, C. D., Üstün, T. B., & Prodinger, B. (2015). Capturing patients’ needs in casemix: a systematic literature review on the value of adding functioning information in reimbursement systems. BMC health services research, 16(1), 40.

Patient classification system

Patient classification system offers a method through which the needs of the patients in relation to relevant nursing care are quantitatively estimated and assessed.  The systems include prototype and factor systems of classification. A prototype system is normally both descriptive and subjective and patients are broadly classified into categories that are used in prediction of their care needs.   The basis of diagnosing the care needs is patient’s DRG (diagnosis- related group) (Yoder-Wise, 2014).  The collected data are put into a system that supports decision making and integrates relevant information of the patients, including financial and clinical data.  The factor system of evaluation is normally more objective, in that every thought process, tasks or care activity of the patient is issued a rating or time. After this association is done, they are then totaled to establish the required periods of direct care and in some instances the association are weighted for every patient.  A definition and name are given to every intervention, after which further classification is made to integrate all the relevant interventional activities (Yoder-Wise, 2014).  

The interventional activities are listed in a way that all patients can understand and apply in the intended care. The relevant organizations use various systems combined together in an objective and effective way to provide support needed, improve the needed care and in controlling costs so that financial resources can effectively and appropriately be used. The systems assist the organizations bottom-line managing in an environment that involves reimbursements and various risks. Getting resources needed to offer quality care to the patient is a big responsibility charged to the nurse leaders and they require information that is accurate since budgeting occurs in a political environment (Harper & McCully, 2007).  The need for the leaders to control costs, use available financial resources and at the same time enhancing the patients care cannot be understated. The administrators in health care organizations are constantly reviewing their budgets and the amount of time a patient need so as to facilitate the financial security. Moreover, changes in the methods of reimbursement of hospital services by Medicaid or Medicare programs and insurance firms have made leads to change the manner of patient care management (Harper & McCully, 2007). This highlights the need for patient care systems in helping to contain costs and check the utilization of resources. Managers are able to track the expenses incurred in providing health care. The systems are also important in assisting a leader in nursing healthcare to find out requirements and needs in the staffing process. This enables the leader to address the necessary patient –care ratios in every department and even in the prediction of such needs on the basis of system being used (Harper & McCully, 2007).

There are many problems associated with the systems used in patient classification with the basic issue that concerns the administrators relating to reliability and validity of information obtained through mechanism of self-reporting.   This result from failure to affirm that the information used in patient classification has been captured effectively (Harper & McCully, 2007).  This may happen if there is no enough education required in completing the tool in the right manner, especially if there is not computerization of the system. In addition, the inability of the leaders in the organization to meet the require levels of staffing highlighted as per the classification data in the systems works towards it. The concern by leaders involves the risk of liability if the staff recommendations as per the systems are not followed.  The issue of accuracy of potentially biased data and the failure to achieve the required levels of staffing has led to abandonment of the system by the organization in establishing the appropriate level (Yoder-Wise, 2014).  

The issue of patient acuity is very significant in providing care and safety of patients, and presumably, a rise in acuity means that additional nursing resources are required in provision of safe care.  Findings from various researches done on the use of patient classification systems have not been consistent (Barton, 2009). Various issues such as design bring about such differences which leave a room for deriving a better understanding of the relationship between the systems, patient safety and nursing outcomes.  However, some systems are simple enough to making them unique and leading to positive nursing outcomes.  The differentiation of patient characteristics makes it easier to manage clients since all the patients cannot be cared by one nurse. The information collected and related nurse-patient assignment leads to a better likelihood that positive outcomes will be achieved due to a careful balance between the needs of care patients with skill mix and nurse workload (Hopfe, 2015).  Having the appropriate nurses with the desired competences and skills combination that are directed to the appropriate patient and the right time is important in helping obtain patient safety and care.  Where needs are evaluated using valid and reliable data, consistency can be achieved on the part of the patients while at health care facilities (Hopfe, 2015). Nursing may be able to learn more about their patients through this system.

References

Barton, A. (2009). Patient safety and quality: an evidence-based handbook for nurses. Aorn Journal, 90(4), 601-602.

Yoder-Wise, P. S. (2014). Leading and managing in nursing. St. Louis, Mo: Elsevier Mosby. 266-268

Harper, K., & McCully, C. (2007). Acuity systems dialogue and patient classification system essentials. Nursing administration quarterly, 31(4), 284-299.

Hopfe, M., Stucki, G., Marshall, R., Twomey, C. D., Üstün, T. B., & Prodinger, B. (2015). Capturing patients’ needs in casemix: a systematic literature review on the value of adding functioning information in reimbursement systems. BMC health services research, 16(1), 40.

The gift of therapy by Yalom

    In his book, Yalom attempts to condense his forty-five years of practicing psychiatric into a guidebook dedicated to therapists and their patients. The book presents short and concise chapters which are detailed with tips that are offered as reminders, complications to avoid and lessons learned from Yalom’s wealth of know-how in regards to psychotherapeutic setting. He describes the text as a resource for upcoming and new therapists and their patients. However, this book seems to be more helpful as a guide for beginners and probably more experienced psychotherapists. Yalom discusses the 85 concepts and techniques in his book which are loosely organized into sections.

    In chapter 1-40 section of the book, Yalom looks at the relationship between therapists and their patients, here-and-now practice problems, and therapists’ self-discovery. Yalom writes this section from an interpersonal and ongoing theoretical outline while the lessons in these chapters center on the relevance of the nonspecific aspects which catalyze therapists’ work. However, it is quite evident that Yalom is impenitent about the power he places on the therapeutic relationship (Yalom 2002). In chapter 41-51 section, Yalom addresses the current themes in therapy. For instances, he addresses the issue of death anxiety, searches for life meaning and the paradoxes of personal liberty. In other words, today’s mental health care environment may fail to be supportive of the ongoing discovery for its own sake. However, this section provides pieces of wisdom that will be useful to most of the therapists and most of all of those working in populations where end end-of-life subjects are less distal realism (Yalom 2002). Yalom’s wise treatment of liberty and patients’ conscientiousness for their conducts has applicability to a wide range of clinical contexts. In chapters’ 52-76 section, Yalom talks about a pragmatic topic relevant to the daily practice of therapy. He uses simple and valuable reminders such as the relevance of taking a clinical history and inquiring (Yalom 2002).

    In addition, Yalom’s point of view is exactly what I have been looking forward to seeing in the psychotherapeutic setting. He is more of humane and non-commercial as he really cares about reaching out to his fellow colleagues in this profession and to some of his patients through discovering his relationship with them. One of the subject matter that I have enjoyed while reading the book, is the one that advice therapists to focus on maintaining a good relationship with their patients. This chapter highlights why therapists are having difficulties with their patients outside relationships. There are so many relevant insights provided in the book and hence one cannot afford to miss out reading the book. Yalom’s wise words about therapeutic process perfectly illustrate my attitude towards the benefit walking with the patients in their walk of change.

    To sum it up, the gift of therapy book is not all about the exposition of theory and philosophy but rather it is a successful and useful guide to building healing connections with patients. Yalom has greatly serviced the entire psychotherapeutic setting by demystifying the action of connecting with patients about their crucial anxieties in the moments of great life change that physicians are privileged to share with patients. The book is readable, short and very knowledgeable and thus it is recommended that all clinicians should have a read as it will offer them with great insights about changes in therapeutic settings.

References

Yalom, I.D. (2002). The Gift Of Therapy. Harper Collins Publishers, New York.  

            Special population: Mentally Ill individuals

            Introduction

Mentally ill delinquents are a norm in every prison in America and globally, a reality that affects both the special populace and the criminal justice system (Morgan et al, 2012). Mental ailment can best be described as a variety of cognitive disorder conditions that alter an individual’s thoughtfulness, behavior and attitude. A populace between two hundred and three hundred thousand people in the United States prison suffer from some form of mental ailments such as depression, Schizophrenia, and other behavioral disorders. A projection of 70 percent of this populace is accounted as psychotic on daily basis. However, despite this statistics, most of the incarceration mental health services remains to be inadequate and characterized by low staffing, inadequate facilities and restricted programs (HRW, 2009). In most cases, ailing prisoners acquire little to zero treatment and their mental needs are ignored with their issues being categorized as disciplinary issues. The outcome of cases that involves mentally ill offenders have always been questionable because these people are not only unable to fully defend themselves but also they cannot understand the severity of the situation. The criminal justice system is obligated to offer justice to every individual regardless of their status and thus in order for this goal to be achieved the needs of the special populace must be addressed fully.

Special Population Description

Mental is a disorder that impacts an individual’s mindfulness ability, attitude, and behavior. Such a state can alter an individual’s capability to associate with other people and daily functioning (Morgan et al, 2012). Mental illness differs from an individual to another as each person is bound to experience distinct responding changes based on their mental condition. Despite the fact that the actual cause of the disorders is not well established, it is known that the interaction of social, biological and psychological experiences play a major role.  Mental ailment is accounted as a disorder given that it affects an individual’s ability to respond to issues as a normal being. However, despite the rising concerns and issues raised by mentally ill delinquents the treatment that this special populace receives is not one to be desired (Elsayed, Al-Zahrani & Rashad, 2010).

The state and treatment offended to the mentally ailing offenders are one that raises some ethical worries. The mental health requirements of this populace are in most cases neglected or unmet which is not only a violation of their rights but their wellbeing as well (Elsayed, Al-Zahrani & Rashad, 2010). Based on some statistical projections more than 50 percent of the American prisoners are affected by some sort of mental illness. As a result, yearly thousands of mentally ailing persons are referred to prison facilities that are characterized by limited resources that are caused by overcrowding and thus they acquire inadequate healthcare treatment. Based on the solitude that they become part of they end up serving longer terms than the normal populace leading to the death and health deterioration of many (Elsayed, Al-Zahrani & Rashad, 2010). There are a number of factors that affect the outcome of mentally ailing criminals like the incapability to understand the charges or defend their actions. In that, most of them will plead as guilty without even having to be tried enough to examine their issues. Mentally ailing delinquents are not normally conscious of their operations or decisions and thus they are unable to fully defend or justify the cause of such things.

Most of the needs of this special populace particularly the healthcare ones are never met. The closure of mental facilities that were previously dealing with this populace and reduction of funding by the American government has led to the rise of some critical problems for this populace (Prins, 2014). Individuals who should be placed under treatment facilities and programs are in turn sent to the correctional facilities without any consideration of their mental state and long run healthcare also missing on the ground of infringing the law and causing severe offenses. Morally, any individual who gets into the Criminal Justice System is to be offered adequate care and enjoy similar rights as those that are part of the rest of the prisoners such as rehabilitation and treatment. The condition that they won, however, makes it particularly hard for such privileges to be enjoyed because they are disadvantaged (Prins, 2014). A significant number of this populace suffers from some controllable diseases such as depression but due to the lack of adequate care, the conditions normally worsens. A mental condition is considered to be a mental disease in instances that the associated symptoms exist for a prolonged period thus affecting their ability to meet their daily needs. It is accounted that about 10 percent of the populace commit offenses not intentionally but due to the mental impairment that affects their judgment (Elsayed, Al-Zahrani & Rashad, 2010).

Challenges faced by Mental Ill Offenders

Every set of offenders are subjected to a set of challenges but for the mentally ill the situation is worse. America has the utmost level of adult prisoners globally owning about 25 percent of the global incarcerated populace (Prins, 2014). With more than 2 million prisoners the percentage of mentally incarcerated persons has been raising rather steadily over the last decades mainly because of mental health facilities deinstitutionalization (Prins, 2014). In repetition, mentally ailing delinquent’s accounts to a significant part of the country’s prison populace that leads to some challenges to the institution’s management and correctional staffs who are not fully equipped in terms of knowledge and skills in regard to the treatment, care and protection of this specific population (HRW, 2009). Offering mental clinical care and substance treatment for the delinquents is difficult based on the ground that most of the institutions are not adequately equipped to handle mental illnesses properly. Offenders convicted with mental illnesses are more prone as compared to all other prisoners to be part of the solitary imprisonment, financial exploitation, bodily and sexual persecution, suicide and self-destruction.  

For mentally ill individuals they face a number of challenges. To begin with, in the instance that they are accused of committing a certain crime, they are not only subjected to the challenge of being able to fully defend themselves but also the inability to fully understand their situation (Arboleda-Flórez, 2009). Those without the financial means acquires representation support from the government which is usually not effective as most of those accountable, are not fully trained to handle such conditions. On the other hand, some people financially exploited by attorneys that seek to harvest from them in the name of defending them (Morgan et al, 2012). Their mental condition places them at a major disadvantage and they are not able to understand all that. In addition, when compared to normal people who can justify and defend their actions for them they end up pleading guilty as they are not able to account for all that occurred. Leniency in their sentencing is not normed on the ground that, they are a threat to the public and themselves (Prins, 2014).

On the other hand, for this particular populace in prison, one of the leading ethical problems lies in treatment. In that, the general needs of the mentally ailing persons are physiological, emotional and pharmaceutical (Arboleda-Flórez, 2009). In most cases even though an individual demonstrates a number of issues that are associated with mental disorder some of them are not diagnosed before the imprisonment. In this case, programs such as counseling might be useful in creating psychological wellness which in turn leads to stability. It is sad that the American prisons have become the caretakers of mentally ill persons while still restraining them in the name of justice and protection. There are a number of severe and long run mentally ailing persons that are retrained in the correctional facilities today more than those that are within the hospital facilities as a whole. It is rather evident that prisons are not accommodative of the mental ailing populace as they lack the needed designs for dealing with a terrific incursion of people with notable mental disorder degrees (Prins, 2014).

A jail plays part in regard to shorter sentences thus there are limited resources and abilities to make a diagnosis as well as treatment. On the other hand, prisons are characterized by limited resources for conducting adequate treatment for the affected persons. The availability of mental treatment and proper care remains to be of serious concerns. Most of the incarceration institutes have a low number of staffs and those that are present have no adequate knowledge in regard to clinical treatment (Arboleda-Flórez, 2009). More so, most of this institutions do not incorporate mental health assessments when the individuals are being introduced to the setting thus leaving most of them with unattended healthcare needs. Due to staffing and resources strains the incarceration period and the period that is set for rehabilitation is usually short and in most cases, they do not exist. Even within the incarceration facilities where mental experts are included as staffs their services are usually limited thus decreasing the accessibility of extended counseling services. This might imply that the only contact with a cognitive health expert might is usually done in grouped programs. This grouping interactions incorporate prisoners with large disorders variation and counseling is done collectively along with offering and recommending medications that seek to lower the illnesses effects (Arboleda-Flórez, 2009). This is challenged by limited follow up on the progress of each inmate and the inability to understand and concentrate on the needs of each individual.

The psychological needs of the incarcerated populace are usually not fulfilled and while most of them are accounted as mentally fit to participate in trials emotional distress usually affects the outcome of these cases (Reingle-Gonzalez & Connell, 2014). This is caused by the fact that the changes that come with the process lead to the intensification of depression and anxiety particularly since the new nature of the environment present many challenges. The interaction with the legal team is a complex one as the populace might appear to be avoiding or not trusting the assigned legal team. Stigma is an additional reason as to why most individuals with mental issues never acquire adequate support and treatment as necessitated. This kind of stigma is mainly dominant in the prison setting and beyond. Based on the trauma that such a situation, this implies that most of them, will serve their complete sentences while their problems have not been identified (Reingle-Gonzalez & Connell, 2014). The aggressive assaults that might be subjected to them by the officers and prisoners and the change of environment can worsen their behaviors based on the control exerted by those surrounding them leading to the rise of fear and doubts.

For the mentally affected offender's fraud is also a primary issue. In that, the normal populace tends to mimic their behaviors in order to get access to the drugs and better treatment which usually leads to the reduction of the available resources (Reingle-Gonzalez & Connell, 2014). Their behaviors which might at times be aggressive usually create disadvantages for them to the point of losing their privileges as they are not allowed to interact with the rest and the isolation increases stigma and stress. The representation of this populace by the media is one that has also raised a number of issues in the recent years (Beale, 2006). In that, they are portrayed as disadvantaged persons with the ability to defend themselves and a threat to selves and the public. This has therefore played part in the rise of a negative perception in general where they are considered to be delinquents who deserve nothing less but restriction (Beale, 2006). This situation is however inaccurate as it has played part in deinstitutionalization of mental facilities and funds support reduction in general. It is a fact that this population is mentally disabled but this does not mean that they do not deserve proper care or that their needs and disorders cannot be solved with the availability of the needed resources.

Organizations, Policies, Procedures, or Processes That Continue To Exploit, Discriminate Against, and/or Neglect the Special Population

The design of prisons does not fit within the proper provision of mental healthcare but this remains to be one of their prime obligation in the contemporary society. This has been caused by the lack of accountability by the policy developers and the government. Most people cannot acquire any mental health management in the community which is mainly driven by the fact that they are taken away after committing an offense. The incarcerated populace continues to increase rather steadily in the recent years which includes the mentally ill people. However, the needs of the special populations have for the longest period been neglected (Reingle-Gonzalez & Connell, 2014). The criminal justice system, governmental agencies, policy developers and human rights fighters have in a way neglected addressing the discrimination, poor treatment, and abuse issues that are faced by the mentally ill populace within correctional facilities across the nation. Under the human rights provisions, it is evident that mentally ill persons are entitled to proper treatment and restoration through counseling and rehabilitation initiatives. Health and right to being free from any form of abuse of discrimination are also highlighted (Peters, Wexler & Lurigio, 2015). This is also backed up by the persons with disabilities convention rights and the discrimination act. There is lack adequate policies that directly demonstrate the proper treatment that this populace should be subjected to on the ground that even though they are entitled to treatment and proper case this is not the actual case.

Across America, prison staffs in most cases utilize unneeded and extreme force for the offenders diagnosed with mental illnesses such as bipolar. Such aggression is mainly applied as a form of punishment which is against the provisions of the law (Peters, Wexler & Lurigio, 2015). These viciousness results in trauma to the already vulnerable populace thus worsening their conditions which make additional health interventions as difficult ones. In most instances that incorporates most of the documented ones, it has been established that such acts lead to the death of the inmates. Prisons are undeniably dangerous and thus the operating employees are entitled to the use of extreme power only in cases where the security and safety of others are being threatened (Arboleda-Flórez, 2009). As provided by the constitution and human rights provisions holds that the use extreme force to any offender with mental disorder might not only be utilized only in instances when the needed responses are needed and not to be applied as a form of punishment. Based on national reports the use of force it has not been indicated on such reports which clearly demonstrates that there is lack of responsibility that leads to the use of extreme force with the lack of adequate training and abilities (Peters, Wexler & Lurigio, 2015). One thing that raises concerns in regard to mental illnesses is exposed to physical threats by those that surround them.

Changes You Might Make To the Current Criminal Justice System to Address Challenges Faced By Mentally Ill Individuals

It is evident that a number of changes need to be done on the current Criminal Justice system in order to address the challenges that are currently faced by mentally ill individuals (Fagan & Ax, 2010). As offenders, it is not mainly about treating this populace as the wrongdoers but basically ensuring that their rights as provided by the constitution are upheld. To begin with, mental healthcare facilities should be institutionalized across of prison facilities to cater for the medical needs of this populace (Gideon, 2013). Mental health treatment can best play an assisting role in ensuring that these offenders fully recover while for most their painful and disturbing symptoms and issues are solved fully. This can be essential in reducing the number of deaths and illness deterioration thus saving the government and public millions of dollars that are spent annually in catering for these health needs. This will also improve the individual functioning of every prisoner thus encouraging the growth of more effective inner control strengths, by assisting prisoners in regaining their health stability and enhancing their abilities to cope with their condition and the environment this will, in turn, enhance safety for everyone even after their release (Fagan & Ax, 2010).

In addition, adequate staffing and resources should is the other change that is needed. These facilities should be well funded and equipped with adequate staffs that are well trained in addition to providing the needed resources (Gideon, 2013). These will help in catering to the needs of the populace fully while ensuring that their rights are guarded. Practices within the facilities should be transformed to ensure that these people are given special treatment that will create a better inner feeling thus increasing their coping capabilities. Without the provision of adequate and the required care, the condition of most of the offenders gets worse. The use of violence to address issues should also be addressed by creating better working policies that mainly guards individuals against such acts. The main thing that is required from the system is to bring about responsibility and accountability for the wellness of these people not only to ensure that they are well but also their privileges are upheld (Gideon, 2013). This can best be achieved by changing the practices, ensuring that the offenders are engaged in rehabilitation and treatment programs. This can also be achieved through increased awareness among the public to eradicate the negative perception.

Promoting Fairer Treatment of the Mentally Ill Individuals

There are a number of resources such as the setting of clinical facilities within the prison settings that are needed in ensuring wellness for mentally ailing persons. The institutions should provide adequate staffs with the needed skills to address the problems of these persons (Peters, Wexler & Lurigio, 2015). Adequate staffs cannot fully address the needs of these people if the resources are not fully equipped. In that equipment’s such as drugs and counseling facilities should be provided this is along with facilities that encourage the incarceration of these people without isolating them. In addition, policies that address the use of force, discrimination and seek to ensure that adequate treatment is offered should be implemented. The existing policies are all inclusive but more different policies are required in addressing issues directly as they affect the mentally ill people.

How the Changes You Suggested Might Contribute To Social Change

The suggested changes such as increasing funding, resources, staffs and changing the practices to ensure that discrimination and force use is not encouraged can lead to a more stable society. In that, while the needs of the mentally ill are fully addressed through taking different measures that promote their health and enhances their interaction abilities, this will not only transform them individually but will also ensure that once they are released they become fully responsible for their actions (Fagan & Ax, 2010). On the other hand by increasing awareness and familiarity regarding the existence of mentally ill offenders and the surrounding challenges the negative perception will be eliminated thus resulting in a more accommodative society that cares and values the wellness of these people without judging them based on their mistakes (Doyle, 2006).

Conclusion

It is evident from the above analysis that, mentally ill represent one of the most disadvantaged and venerable special group in the American Criminal justice system. Mentally ill individuals face some challenges based on their inability to fully defend themselves or understand the situation. Once they have been incarcerated their rights are infringed repeatedly thus raising some ethical concerns. In order for these issues to be addressed, there is a need to develop policies that fully guard these people and increase awareness to ensure that their problems are understood fully. By increasing resources and creating mental healthcare programs the psychological and mental health will be regained which will, in turn, lead to a more stable society where the individuals can work independently for the wellness of everyone.

ReferencesTop of Form

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Arboleda-Flórez, J. (2009). Mental patients in prisons. World Psychiatry, 8(3), 187–189.

Beale, S. S. (2006). The news media’s influence on criminal justice policy: How market-driven news promotes punitiveness. William and Mary Law Review, 48(2), 397–481.   

Doyle, A. (2006). How not to think about crime in the media. Canadian Journal of Criminology & Criminal Justice, 48, 867–885.

Elsayed, Y. A., Al-Zahrani, M., & Rashad, M. M. (2010). Characteristics of mentally ill offenders from 100 psychiatric court reports. Annals of General Psychiatry, 9, 4. http://doi.org/10.1186/1744-859X-9-4

Fagan, T. J., & Ax, R. K. (2010). Correctional Mental Health: From Theory to Best Practice. SAGE.

Gideon, L. (2013). Special needs offenders in correctional institutions. Thousand Oaks: SAGE.

HRW. (2009). Mental Illness, Human Rights, and US Prisons. Human Rights Watch News. Retrieved from https://www.hrw.org/news/2009/09/22/mental-illness-human-rights-and-us-prisons

Morgan, R. D., Flora, D. B., Kroner, D. G., Mills, J. F., Varghese, F., & Steffan, J. S. (2012). Treating Offenders with Mental Illness: A Research Synthesis. Law and Human Behavior, 36(1), 37–50. http://doi.org/10.1037/h0093964

Peters, R. H., Wexler, H. K., & Lurigio, A. J. (2015). Co-occurring substance use and mental disorders in the criminal justice system: A new frontier of clinical practice and research.Top of Form

Prins, S. J. (2014). The Prevalence of Mental Illnesses in U.S. State Prisons: A Systematic Review. Psychiatric Services (Washington, D.C.), 65(7), 862–872. http://doi.org/10.1176/appi.ps.201300166

Reingle Gonzalez, J. M., & Connell, N. M. (2014). Mental Health of Prisoners: Identifying Barriers to Mental Health Treatment and Medication Continuity. American Journal of Public Health, 104(12), 2328–2333. http://doi.org/10.2105/AJPH.2014.302043

Significant Medicare and Medicaid healthcare event

            Medicaid plays an important function in making sure that over 50 million low-income earners gain access to health care. The expansion of the Medicare and Medicaid programs over the past 2 decades has contributed towards improved health care access for millions and millions of people who are disadvantaged due to financial constraints. At the time that Medicare and Medicaid were enacted only a few percentage of the total population were enrolled. However, today, the number of people enrolled in this program has risen to great numbers. Medicaid is a multiparty state-federal plan which was originally small as it only comprised of those people who received help from the government (Carlson et al 2006). It is, however, one of the largest insurance organizations in the US and it is responsible for covering millions of low-income earners. Changes in Medicare and Medicaid programs have occurred over the years and it has contributed towards a considerable shift in public insurance. These two health care programs have thus become a framework of the healthcare industry. This paper will, therefore, seek to present the impacts of Medicare and Medicaid programs both in short-term and in long-term. Secondly, the paper will seek to discuss on how the Medicare and Medicaid program impact the historical evolution of the health care system, how it contributes to the formation of Affordable Care Act. Lastly, the paper will seek to present the unanticipated outcomes and new problems brought about by Medicare and Medicaid programs.

            Medicare and Medicaid have contributed to the remarkable development in contact with the medical care by the financially disadvantaged persons and have greatly increased the access of the aged of all income economic classes to institutional services, for instance, nursing home care. It is also important to note that the Medicare plays much more role than offer health insurance to poor Americans. It plays a significant role in influencing the pricing for most of the medical treatments offered in the United States. For most of all procedures, Medicare comes up with prices which they regard as fair prices for service rendering (Carlson et al 2006). Due to its big size and popularity, Medicare’s pricing seems to influence on the pricing by other health insurers.

            The programs have done exceedingly great things as they not only covered millions of people, but they eliminated the racial segregation that is often practiced by healthcare amenities and in many ways, it has assisted in delivering quality health care. By making sure that admittance to care is guaranteed, Medicare has added the life expectancy higher than the one witnessed in the past when the act was passed. Children, who are enrolled in the Medicaid plan, grow into in good health adolescents and young people (Carlson et al 2006).

            Innovations have been vital to the advancement of the healthcare system in the US. Medicare and Medicaid government-sponsored health insurance have enormously related a way for these advancements.  Medicare has been ranked to be in the front position of increasing new approaches, and the private division tends to follow it. At the time when Medicare was signed into law, it only comprised of hospital and doctor services coverage. However, with time the state enacted Medicaid and in the present day, all plans are inclusive of prescription drug coverage (Carlson et al 2006).

            Medicare and Medicaid have significantly helped the American population to make better use of their resources. Home care is a good example of how Medicare and Medicaid have made better use of resources. Due to Medicare and Medicaid programs, home care amenities may play a vital role in the delivery of healthcare services and long-term care in the future than it has in the past years. Medicare and Medicaid programs are empowering the growth of comprehensive services through the use of home health agencies. Through the home care benefit, Medicare and Medicaid programs have promoted a concept of care that is patient oriented. It promotes a continuous focus on the patients and his or her needs (Quinn et al 2016).

            Medicare and Medicaid programs are also playing an important role in the sector of human rights all the way through its relations with title VI of the civil rights Act. This is concerned with prejudice in amenities participating in the federal plans. Across the world and across all parts of US, quality medical care is offered equally to sick people regardless of their personality or ethnic group. Black Americans are now able to visit and receive treatment from hospitals that were previously reserved for white people. Therefore, with Medicare and Medicaid programs as an instrument, the issues of discrimination in health care systems are being brought to an end (Carlson et al 2006). Medicare and Medicaid programs offer us a foundation for promoting alternatives to hospital healthcare systems. It has the aspect of one system of enhanced and coordinated services. It offers coverage for a variety of services such as the outpatient health care, extended care amenities, managed home care services and professional review of the practices of utilization.

            Medicare programs have also helped in creating a new picture of the state health department and that of the public health experts. It has thus enabled the preparing of responsibilities that are in the present day so as to strengthen Medicare plan in the service of the ill people. Thus they are focused to continually improve the potential of the all-inclusive health care for all the US citizens (DeWalt 2005).

            Medicaid was approved in 1965 and it primarily covered people who received welfare. It lacked its own eligibility restrictions and application process. They used to use a card for those who qualified for cash assistance from the program. Its reach was limited as they only assisted the very deserving poor. However, for the program to keep up with the operative welfare standards and budget deliberations, enrolment was discouraged. Therefore, most low-income earners in America remained uninsured (Klees et al 2010).

            The Affordable Care Act completed Medicaid’s evolution process from being a welfare program into being an insurance program for low-income earners in America. It removed the reschedule from the welfare of covering only a certain group of low-income people. It is after this that the Medicaid was made available to all the adults in all nations depending on their income regardless of whether they had children or not (Klees et al 2010). The ACA significantly established a new Medicaid eligibility standards and processes that are not associated with welfare but with the marketplace. Medicare and Medicaid’s evolution and transformation is a significant lens through which one can reflect on the present day policies as well as the next generation policies.

            Before the inception of the Affordable Care Act, the healthcare system in the United States was subject to a fee for service reimbursement system. These systems often reprimanded health care institutions and health care experts who searched for ways to convey care more competently. Due to this weakness, Medicare came in to prove that it was a blank check for the healthcare systems. Medicare’s goal was to finance access for the aged people to mainstream medicine. It is quite evident that the Medicare and Medicaid effectively enhanced access to medical care for both the low-income earners and the aged people in the US. Most importantly, the Medicare and Medicaid programs have a huge influence on the healthcare industry (Klees et al 2010). The evolution of the Medical care starting from its financing and the various expectations attached to it by the American people for high-quality health care and the coherent use of resources, have associated CMS to clinical medicine.

            The Affordable Care Act was established so as to make amendments to the health insurance plans that were assisted by the government. This was aimed at increasing the number of people covered under these plans. ACA, therefore, aims at expanding Medicaid program to a more disadvantaged group f people who are inclusive of middle range people who tried so hard to save so much money so as to qualify for Medicaid but also failed to afford to buy private insurance. It is through this covering of numerous amounts of people that the ACT contributed towards change that is witnessed in five decades of Medicare and Medicaid (Klees et al 2010).

            The ACA is one of the foundations of the Obama management’s hard work to strengthen Medicare. Therefore, the ACA was formed with an aim of reducing costs so as to make the Medicare program a success and more sustainable and still help in improving the quality of healthcare delivered to the aged and the disabled people on the Medicare plan. In addition, the formation of the ACA has enabled the Centers for Medicare and Medicaid services to tie reimbursement to quality standards, providing patient’s safety and providing for new incentives for health providers who offer high quality and coordinated care (Klees et al 2010).

            Unintended costs of health care legislation intimidate the financial and social welfare of the United States. Spending for Medicare and Medicaid is now seen as unsustainable of the federal budget. If this continues under the current law without necessary amendments in administration and funding, the projected Medicare and Medicaid programs cost will increase to a high level of the state expenditure and in the Gross Domestic Product over the next decades (Thrall 2011). This will create a need for considerable reduction in the amount of the federal budget for other divisions. This may result in the cutting of providers’ compensation so as to reduce Medicare and Medicaid programs expenditure. However, this could increase the rate of occurrence of unanticipated outcomes. Most beneficiaries, therefore, use the traditional Medicare while only a small percentage use the Medicare Advantage which is a private sector alternative that settles at least some of the payments that are not covered by Medicare (Thrall 2011).

            Medicaid and Medicare are one of the programs that have the largest items in the government budget. Expenses typically increase during the economic downturns as registration into the programs increases rapidly when people lose their employment and health benefits. That puts the government in a quandary since they struggle to keep up with the higher expenditures as the tax revenues also decrease. Medicaid registration and expenditures increased strikingly during the last recession and the enrollment exploded further in 2014 following the 2010 health law (Klees et al 2010). Governments normally try to control these expenditures through cutting of payments rates to the doctors and the hospitals or even minimizing on the benefits. All these strategies are risky as they pose a negative effect on enrollees by making it difficult for them to enroll in the program.

            According to the ruling made by the Supreme Court in 2012, it stated that states could choose to get involved in the health laws and in specific the Medicaid expansion. This weakened Democrats’ efforts to develop their eligibility countrywide. More than twenty states have refused to participate in these programs raising concerns about the program’s efficiency and cost (Grabowski 2007). As a result of this a large number of people have been left out uncovered as are lack any health insurance to cover them due to their inadequate ability to make enough money to qualify them for federal subsidies so as to purchase the private coverage on the health laws exchange despite them being ineligible for the Medicare and Medicaid plans.

            Medicaid is often associated with helping the poor and is regarded as the safety net for millions of the middle range people who need long-term care at long-term at home care facilities or even nursing homes. Approximately, more than 60% of the entire population of the nursing homes solely depends on Medicaid for help (Grabowski 2007). With the rapid increase in the aging population in the next two decades, the demand for this long-term care is expected to rise high. US people are aging while the elderly use better health care services. Their population is expected to double over the years. It is also important to note that most of these aging people are currently living longer and this means that they will use additional Medicare and Medicaid assistance and enrollments for a longer period of time than it is expected. Demographic changes form one component of the trouble as the health care expenditures are increasing faster as compared to the economy. The core rationale for these high levels of expenditure on health care in America is due to the high cost of treatment in the US healthcare industry including the high charge of compensation for physicians and other health professionals with high prices for prescribed medicine and rise in the use of medical technology (Grabowski 2007).

            Currently, the state is overspending by billions on Medicare and Medicaid programs. However, due to the influence that these programs have on pricing set by private insurance organizations, these errors are being repeated by payers across the healthcare industry. Economists confidently believe that rectifying Medicare and Medicaid pricing mistakes will be vital in stabilizing health care costs (Thrall 2011).

            According to the discussion above, it is important to note that the Medicare and Medicaid programs are not so much interested in what they are but rather they are so much interested in what they can offer to their consumers. Their accomplishments, as well as failures, have only helped in improving the health care system. The effect of Medicare and Medicaid programs has been to speed up the progression through an increase in the use of services among the population that was deprived of accessing the health care system. In regards to quality, the major direct contribution of Medicare and Medicaid programs has been to increase the utilization of health care systems. However, the net effect of these programs has been to provide more accessible and better health care to all. In the long term, the greatest achievement that Medicare and Medicaid programs will have made to the quality of the healthcare systems is to have paid attention to all of their downfalls and to have institutionalized the public task on it. Medicare and Medicaid programs have therefore in the past 40 years contributed to the improvement of the quality of life for the poor and the aged. Without the necessary changes, this program will require resources that are expected to severely affect the health care system and potentially other divisions.

References

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Carlson, M. J., DeVoe, J., & Wright, B. J. (2006). Short-Term Impacts of Coverage Loss in a       Medicaid Population: Early Results From a Prospective Cohort Study of the Oregon Health Plan. Annals of Family Medicine, 4(5), 391.

Grabowski, D. C. (2007). Medicare and Medicaid: Conflicting Incentives for Long-Term Care.    The Milbank Quarterly, 85(4), 579-610.

Thrall, J. H. (2011). Unintended consequences of health care legislation. Journal of the American             College of Radiology: JACR, 8(10), 687.

Klees, B. S., Wolfe, C. J., & Curtis, C. A. (2010). Brief Summaries of Medicare and Medicaid:    Title XVIII & Title XIX of the Social Security Act as of November 1, 2010. Retrieved             May 26, 2011.

Quinn, K., Weimar, D., Gray, J., & Davies, B. (2016). Thinking About Clinical Outcomes in        Medicaid. JOURNAL OF AMBULATORY CARE MANAGEMENT.