Standard of Care

 

 

Introduction:

            Why is it that our health is very important? Health defines as a complete physical and psychosocial well being without the absence of disease (Potter, H. Fundamentals of Nursing. ed 2, Vol. 1). Unfortunately there are factors that hinders the individual to maintain there wellness. These factors could be environmental or biological aspect. It depends how the individual handles their selves. In improving our standard of care, it is not only the person who is being sick is responsible for caring of their own. We can achieve a better health care quality if every one of us especially the health care team doing their job and seeking for the goodness of their patients not only for their own interest. It is clearly defined in here that we should help each other to improve our standard of care and achieve the quality of care we’ve always wanted. In this article it is presented here the factors that affect the cause of poor standard of care. It is cited the different areas namely; the individual itself, government, poverty, the health care personnel, population, geographical location, economy, standard of living, heath care facilities etc. In this article also we are sited the possible recommendation on how to improve our system in health care delivery as well the people who are responsible to our health.

AREAS AFFECTING POOR HEALTH CARE DELIVERY:

As mentioned above, there are lots of factors that affect our system of health care, it is believed that in order for us to achieve our goal, let us examined first our selves before we blame to other people. Each one of us is a unique individual and has different level of capacity of understanding in doing things. Through this uniqueness we can change into something better. In order for us to achieve a healthy living and prevent from any diseases, we individuals must change our usual practices. According to time magazine, many people got sick because of their unhygienic practices. In which out of 100 individual only 21 percent washed their hands before eating and 79 percent did not wash their hands (Time Magazine 2002). Washing of hands is our primary defense from any foreign body that threatened our immune system and cause illness and it is very important also because according to American Health Institute (AMI), it is also one way of preventing of transmitting microorganisms to other people whom we meet everyday (Nurses Journal 2003, Vol 14). Aside from not washing their hands, there are also people did not clean their surrounding. For instance, they don’t dispose their garbage properly and their pet’s waste. Statistics showed only 40 percent out of 150 populations clean their surrounding and dispose it properly (Time Magazine 2002). Through these improper practices lots of people got sick especially to those children ages 1-8 years and to those pregnant mother. Children who belong on this age have low immune system and it is a high risk to the pregnant mother because it can cause deformity of the fetus especially on the first trimester if pet’s wastes not properly dispose more specifically the cat’s waste (Pellitiri, Maternal and Child, 4th ed. Vol 2). Florence Nightingale stated that in order to have a better health we must take care our environment.  In this statement, it is clearly stated that we are free from illness if we have a clean environment. As individual, we must have discipline with in our selves. Through discipline we can really identify what is right and wrong and through this we can limit our id and contribute goodness to all mankind which can help us to achieve our goal in making our health care system more accessible. In relation to the individual factors, the religion, culture and races of each individual also matter because the health care personnel must consider to it and it will lead to limit their giving of standard of care to the patient. In this matter it will hinder the individual to follow the standard of care of which the health care provider provides and further more it will make the patient’s condition more vulnerable. In this problem, the health personnel must find any strategies to overcome this problem. In finding any solutions to this problem, as part of health care team, it has to be to have a proper communication with other health care provider. Proper communication is vital in a sense to protect the institutions as well the staff of the institutions. For instance, a client or patient needs a blood transfusion and if ever the client will not able to secure a bag of blood because it against to their religion, eventually he will die. As health personnel you won’t allow it to happen, you will discuss it properly to the client and let him understand the possible effect if he won’t allow his self. If the client still insists that it is against to their religion and you’ve done everything you could that’s the time that you will let him sign a waiver to protect the institution as well as the personnel of the institution. Religion, culture and races are the areas we need to consider for the cause of poor giving of standard of care. Why is it so, there is a theory by Madeline Leininger that need to apply in nursing practice. In this theory, it is emphasized the culture, races and religion of each individual that as a nurses we need to respect their practices but it doesn’t mean that we are not going to inform them what are the possible effect if they do not follow the care needed to them because it is against to their practices whom they believe. In this case the roles of the nurses are to give them accurate and enough information to let them understand the quality of care which the institution up to.

Health care professionals must put some attention with regards to these matters. The quality of care achieves not only with individual, it also needs with some assistance, and the health care team must conduct any organization to educate the people through teaching with every one. Thru teaching and parting some ideas to the individual I do believe that they will become more aware and more concern to their health with less worry. And if that happen it will help improve the accessible of health care system in each community.

The quality of health care system is also depend the finances available in certain community. With regards in achieving good quality of care, the government plays a major role in providing a good quality of care. It is in good governance of government that it will follow everything to have a good service to the people. A government who has a good service to its people will also have a competent and knowledgeable servant. For instance, the country will not suffer from brain –drain if the government provides good benefits to the professionals. No one will go abroad to seek better future in other countries and serve with foreign people and leaving their   fellow country men. In this case the incompetent and lack of knowledge that left behind are serving the people, thus making the health care system less effective. It also makes the professionals to have no interest to serve the people because of low wages they receive which will not compensate their daily living. Having a low wages, it encourages the professionals to fly abroad and most of all it encourages the professionals not to do their duties properly, thus making it to have poor giving of care to the communities. It is also the government’s duty to provide good and advance medical supplies to the government hospitals.   But instead of doing so, the government provides surplus, secondhand and defective medical facilities to the hospital. In these incompetent practices of government it will surely contribute the low grading in providing health care to the people. Some government officials also deceit there  people they give expired medicines and sell the newly manufactured medicines to the different private sectors for their own interest only, this incidence is more prevalent in third world counties (Asia Magazines 2000, Vol.32).  In giving budget to the different sectors of government agency, there are some countries give only insufficient budget to the health sectors instead they invest more on military equipment. In this situation the health sectors most of the time recycled their equipment due to lack of budget which is not advisable by the World Health Organization (WHO). For instance, using of the same face mask for different patient, using the same syringes and giving low dose of medication due to lack of supply. This situation threatened the health of the patient thus it will add the damages of the health care system (Asia Magazines 2000, Vol.32). Further more for the government, to those people living in remote or rural areas, don’t receive enough care from the health care team due to lack or no budget for transportation or the government does not provide any vehicle for those area (Asia Magazines 2000, Vol.32). Another factor that the government needs some attention is the population. If there is too much population in a certain community, there is a tendency that the hospital becomes overcrowded especially those community lacks of health care institutions and facilities. Overcrowded patients in one hospital can threaten the condition of the patient because the microorganisms can easily be transported to the other patient especially the airborne diseases. 

 The solution of these problems is simple, yet it’s hard to do. It may sound too political but that’s the truth. In order for to have a good quality of care we must choose the right leader who is responsible, loyal and concerns the wellness of every people in the community. As people we should not easily believe the promises made by the politician. We must see to it, what are the platforms and objectives of the politicians pertaining to the welfare of every citizen. To those professional people, they must group themselves and identify what they want to happen to the government system. In line with health care professionals they must see to it the objectives and platforms of the politicians that there must be a specific considerations pertaining to the health care facilities and advancement of medical technology. In this, there is a way might a politician become aware the problem encountered by health care provider. Furthermore, the government also is the one who will appoint the leaders of the health care agency, before he will appoint a leader, he must consult first the members or the staff of the health care agency if the leader he will going to appoint is capable and deserving to their position. Thru helping each other as a team, with the help of the government, it will surely uplift in giving a quality health care system. In choosing a good leader we can expect he will render a service to the people as well as the people render quality service to the community.

Other factors that affect in rendering good service to the community are the institution or hospitals itself on how they manage their setting, as well as the personnel who are working in that institution. Poor management of the manager of a certain institution will create a great impact on the establishments. Here you can really evaluate the reputation of establishments and their poor system approach to the people. Poor management will contribute an unsatisfactory and low grading service to the people. Misunderstanding, chaos and unorganized reports occur between colleagues if taken for granted by the management. Misunderstanding usually happened if there is lack of communication by the head of the department to the staff and staff between staff. Through miscommunications there will be an overlapping of duties and responsibilities between colleagues. The management should have a proper implementation of delegation, controlling and directing to the staff. To obtain these objectives, the management should implement a strict rules and regulations to the staff. Proper directing to the staff will help them to work efficiently. In controlling, this will help the staff to report any unremarkable situation regarding to their client. Delegation plays also an important role to have proper set-up and easy communication between both staff and to their heads. In this manner, there will be improvement of giving care to the client that will uplift the reputation to the health care provider. In having a remarkable management there will be remarkable reports. In relation to proper communication, there should weekly reports of each health care personnel to their heads. With this weekly reports, it will help the heads of every institution to determine the weakness of institution and able to improve by helping with one another. In continuation of proper communication, as a nurse, she must know their limitations and responsibilities of their duty. As a health care team and part of the institution there must be a proper communication and relationship between employees. It is through the proper communication between personnel that there will be a smooth sailing in rendering service to the patient and there will be no mistakes happen. For instance, the doctor must inform the staff nurse if there are any changes of medication to avoid further complications or mistakes as well as the nurse ask questions to the doctors and nurse to nurse communications. Each nurse is requires to communicate regarding the progress of their patient and compare their assessments. Malpractice and negligence are often happen if one personnel fails to communicate with their colleagues. Before doing anything to the client you must check first the doctor’s order and if there is any confusion with the doctor’s order, feel free to ask questions and clarify it to the doctors. She must check also the progress notes of the nurse from different shifts to avoid committing mistakes, like giving medications twice that can lead a patient into overdosing. Giving medication sited in this example of negligence and malpractice because there is a research that lots of health care practitioners failed to administer correct medications, such as administering it in a wrong route wrong dose, wrong time and wrong person (Nurses Journal 2003 vol.16).  

It is better to ask than to do mistakes. It is important also to know the responsibilities of a nurse. She must know when or when not to delegate her tasks. The nurse must not delegate the medications, assessments, and blood transfusion to the other health care team.   

Malpractice and negligence of the personnel are the main factors that cause the health care into low grading quality. Malpractice happens if the person is not competent enough to do their job. To avoid this to happen, there must be a proper delegation of each staff according to their capacity. In determining their capabilities, capacity and where they really fit, the institution must conduct a written exam aside from taking an exam for licensure. This test is according to the institutions and it is divided according to their different departments. The purpose of this test is to determine the applicant to where she good at, so that to enhance his skills and update his knowledge in terms of advance medical technology. After assessing their knowledge the hospitals must also assess their skills in performing their duty before hiring them. In assessing their skills the applicants must undergo rigid training on where they are good at, this is base on the written exam. This strategy helps the health care practitioner to enhance and improve their skills and knowledge through the help of the employer (pertaining to the hospitals). Institutions not only limit their employee of what they’ve already known. They must conduct also trainings in different areas because in this world there is nothing constant, from time to time there are changes and new discoveries exist. As health care professionals we are not limited only into one aspect. Here the institution must conduct monthly training to employee on the different fields in providing care. The purpose of this training is to practice and improve of what we are lacking in practicing in nursing field. Being a health care practitioner, you must help yourselves by keep updating the new strategies and new evolve therapy and advance medicines.  

Another effect of poor management is to have under staff and the attitude of the staff toward the patients especially the unsupervised staff. In every institution there must be enough staff to do their tasks. Having in medical field is very complicated; it can not be done by one personnel only. In medical institution, like other field there must be a team who is helping each other. Being part of the medical team each one of us must contribute their knowledge and skills to promote life. They are dealing lives of other people, their safety lies on the hand of the medical team. So it is important to have enough staff of a certain hospitals. In having an enough personnel, there will be no confusion and overstressing work environment.  Here we can easily and properly monitor the client of their present condition. Properly monitor, in a sense that we can check the condition of the client and do the doctor’s order with no rush and have enough time to document the report about the progress of the client on the progress note which the other staff can be aware of the interventions being given to the client.  Compare to the situation of having lack personnel of a certain hospitals, there will be misinterpretation of data being documented that lead to committing mistakes of the staff. For instance, there will be three staff nurse in charge in medical unit and they are covering 20 patients.  They are using the functional system in caring to their patients. Nurse A is in charge for medications, Nurse B is in charge for getting the temperature, pulse and blood pressure (TPR) and carry out the doctor’s order and Nurse C is for documentation.  The problem of this scenario is there will be skipping of tasks and skipping of patients. The problem of Nurse A, she will not be to administer the medications on time. In a sense, that there are possible case that her patient in medical units has the same time in administrating the medications thus it will delay the effect of the medications. In this case also he might skip some other patient or may be administrating it to the wrong patient. In Nurse B, the problem this is he might not able to cover all patients in getting temperature, pulse and blood pressure (TPR) in a sense that he only choose the critical or close monitoring patient and hunches the result of some patient. In carrying doctor’s order, there is a tendency also that he was not able to carry out in time and or may not perform his tasks. In case also sterility may not maintain because you are concern of saving the time and wanting to finish early. For example, the doctor orders to remove the catheter of four patients on the same time. As in charge of carrying the doctor’s order, she will perform the tasks on the same time also. In this case the nurse might use the same equipments for the three patients. Like example, she uses the same gloves in cleaning the perineal area of the three client she only wash it with plain water after using it and when transferring with other patient. In this scenario the transmission of infectious disease is more prevalent and this kind of attitude needs some attention from the management because it is against the provision of law in standard protocol in caring the client in health care professionals. In Nurse C, the problem of this case is that she might document wrong information pertaining to the client and it has greater chances that Nurse C might commit mistakes in documenting the chart of the client and if that case the she might sue from the client, and it makes damages to the institution and adding insult to those other health care provider. Greater chances of committing mistakes take place, in a reason that you are not actually performing the tasks being carried out and Nurse C does not know what her colleagues is actually doing that she cannot justify to herself. It is the Nurse C who is responsible in answering question if there is any problem exists. In this situation being presented above, it is clearly stated the disadvantages of having under staff and unsupervised staff of hospitals.

On the other hand, hospitals that lack of sufficient facilities and supplies in every department are also factors that contribute in giving less quality service in caring the health of the people. This allows the patient to seek another alternative treatment because they are not satisfied with the equipments they’ve seen in the institution especially those which is not upgraded. For example, there is patient who has increase intracranial pressure (ICP) but the medical team did not know the condition of the client there is no MRI available in the hospitals another is in the operating room the lights of the operating room shuts down, the operation might postpone this will lead to prolonging of agony of the patient. Hospitals, which has less supplies and delayed in upgrading their technology is also a minus factor in promoting a healthy life. Advance technology helps the medical team to make their diagnosis and treatments make possible with the aid of knowledge and skills of the medical practitioner.

Conclusion      

I conclude that there are areas concerning on how to improve our service to the humanity. First, we cannot perform well if we don’t examine first our self. Through examining our self we can easily identify our weaknesses and strength; it is in examining oneself that we can help to change for the better. Our health is important to our daily living but unfortunately there are some of us cannot maintain the wellness of their health. That’s why there are institutions in providing health to the people, but unfortunately there some institutions did not achieve their objectives in giving quality of care to the people. There are areas that we need to consider of what is the cause of rendering poor quality of care. First is the uniqueness of the individual, then the government. In Government Issue, it is cited there the poor quality of leader that resulting to low grading of the health care service. Under the government also lies the appointing the right person for managing the health agency. On the other hand the poor management of hospitals is the main cause of having the less and not achieving the quality one. Through the poor management there are lots of problems rises between colleagues that create greater chances of committing mistakes and there is no proper updating their facilities that help a lot in achieving the goal with the aid of competent health care professionals. Proper management of the institution is a key to achieve to have a good quality service of the humanity.

 

 

 

References:

 

 

Pellitire, ( Maternal and Child, 4th ed. Vol.2) New York; Gale Group.

 

Potter, H (Fundamentals of Nursing 2nd ed. Vol. 2) New York; Gale group

 

 

Smith, A.B. and Kuffler, J ( 2003). The Internet Shopper. Nurses Journal, Vol.14.

 

 

Terry, B and Dale N. (Asia Magazines 2000. Vol.32)

 

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