Introduction
Even though nursing is fast-paced with constantly changing obstacles, many nurse supervisors describe encountering similar moral conundrums. According to a recent study, decision-making, staffing, advanced care planning, and defending patients’ rights are the most frequent and stressful ethical circumstances (Duquesne University School of Nursing, 2020). The fact that so many novice nurses are entering the profession and many of them have never had to deal with ethical dilemmas in nursing is aggravating the issue. Due to these difficulties, skilled nurse managers are even more essential to the nation’s ongoing healthcare demands.
Before being qualified, nurses must complete years of schooling and practical training, but managing ethical dilemmas in the real world of nursing can be much more challenging. Through experience and patient interaction, nurses can learn how to handle ethical situations. Although nurses have a high level of empathy, it can be advantageous for them to put limits on each patient early in their careers.
Acute care is a subset of secondary care, the stage following primary care. Treatment for patients with short-term, critical diseases is known as acute care. Critically ill patients are cared for by acute care nurses, who arehighly experienced and trained nurses working in acute care or hospital settings.
Patients who need pre- and post-operative care, have undergone severe illness or trauma, or have other urgent medical issues are included in critical care—acute care registered nurses concentrate on enhancing a patient’s health through prompt intervention in time-critical situations. Acute care nurses are frequently relied upon to treat a variety of medical conditions, including serious injuries, chronic illnesses, strokes, and infectious diseases.
Settings for Acute Care Nurses
The following settings are frequent places for acute care nursesto work:
- Trauma units in emergency rooms.
- Sub-acute facilities.
- Inpatient care unit.
- Surgery or medical unit.
- Cardiology and pulmonology.
- Neurology and radiology.
Responsibilities of Acute Care Nurses
Nurses should have the ability to undertake complex, invasive diagnostic or therapeutic operations as well as provide pre-and post-operative care for patients; perform emergency medical techniques, including BLS, ACLS, and other interventions aimed at stabilizing the patient’s condition; provide pharmacologic and non-pharmacologic therapies, observe patient reactions, and adjust care plans as necessary to control patients’ pain relief and sedation; record information on patients’ care, such as assessment results, treatments, drugs, patient reactions, or changes in therapy.
Skills Required for Nurses in Acute Care Settings
The capacity to be kind, sympathetic, and patient is essential for acute care workers as they work with many patients with various diseases. Critical nurses may work with patients who have dementia or learning difficulties, which calls for exceptional communication ability. Nurses should be ready to respond swiftly, on their feet, and adapt to the needs of ongoing medical problems, given the fluid nature of the position. Candidates for the acute care nurse must have previously earned a nursing degree.
Nursing in Ambulatory and Managed Care Settings
Ambulatory care nursing practice is a sophisticated, diverse specialty that includes independent and group practice. Unlike other nurses, ambulatory care nurses practice in different environments. They work in non-acute surgical and diagnostic outpatient settings in the community, primary and specialty care outpatient settings, and during encounters over long distances in a virtual context. In the past, the patient was the one who made the first contact with the ambulatory healthcare setting (Chan et al., 2018). Today, the patient or the ambulatory care nurse initiates communication to guarantee optimum health or educational purposes.
Patient Education in the Ambulatory Settings
The primary focus is on providing high-quality patient education, which helps patients adhere to the recommended course of therapy. The emphasis on disease prevention and health promotion highlights the need for efficient patient education in all ambulatory settings, even if it is crucial in all locations for health care. Nurses must combine three crucial patient education characteristics with being good educators. The first aspect is a belief that patient education will result in beneficial and noteworthy effects for the patient. The second factor is that every nurse-patient interaction must prioritize patient education. Effective patient education is the third and final dimension.
Role of the Nurse
Registered nurses (RNs), who typically care for large numbers of patients in a short time and frequently deal with unforeseen problems, are the standard for ambulatory care nursing. Ambulatory care RNs handle patients’ well-being, acute illnesses, chronic diseases, disabilities, and end-of-life requirements in collaboration and partnership with other healthcare providers. RNs are in charge of patient advocacy, the use of evidence-based nursing knowledge in clinical settings, the nursing process during encounters, the coordination of nursing and other health services, the delivery of health education services, and continuity of care for patients as they move between various types and levels of health care continuum services.
Three Aspects to Achieve Goals in Ambulatory Nursing
Three aspects of achieving goals in ambulatory nursing are competencies for care coordination and transitional care must be identified and verified by ambulatory nurse experts; educational modules with outcome measures related to these competencies must then be developed; ambulatory care nursing leadership must take a proactive role as interdisciplinary teams develop and implement needed structures and processes.
Managed Health Care Organizations
The federal government, medical schools, hospitals, corporations, labor unions, consumer organizations, insurance companies, and hospital medical plans may all support Managed Health Care Organizations.
To be federally certified as a managed healthcare organization, the organization must meet three criteria:
- A structured system for delivering health care in a specific geographic region.
- A package of fundamental and additional health maintenance and treatment services has been agreed upon.
- A group of people who have voluntarily registered.
Types of Managed Healthcare Organizations
- Staff model: A healthcare delivery system in which providers work as direct employees and are often paid a defined wage. This is an example of a closed-panel Managed Healthcare Organization in which contracted physicians solely care for the Managed Healthcare Organization’s patients.
- Independent practice association model: A distinct legal body negotiates a price with a Managed Healthcare Organization.
- A health plan enters into a contract with a multi-specialty group to offer care to plan members. The providers have not Managed Healthcare Organization employees but rather group practice workers who are paid a negotiated compensation.
- A network model provides services through contracts with two or more independent group practices and/or independent practice associations. Enrolled members pay a monthly subscription fee.
Patient Rights in Ambulatory and Managed Health Care
Patient rights in ambulatory and managed healthcare include several essential aspects:
- Information sharing. Customers have a right to accurate information that is simple to understand.
- Options for plans and providers. Customers have a right to a good selection of healthcare providers to guarantee access to appropriate, high-quality care.
- Emergency services are available. Customers can receive emergency medical treatment whenever and wherever they need it.
- Involvement in treatment selection. Customers have the right to take full responsibility for all decisions about their medical treatment.
- Nondiscrimination and respect. Consumers always have the right to compassionate, respectful treatment from all members of the health care system.
- Health information confidentiality. Consumers have the right to speak in confidence with health care providers.
- Disputes and appeals. All customers have the right to a fair and efficient mechanism for resolving disagreements with their health plans, healthcare providers, and the institutions that support them.
- Consumer obligations. It is legitimate to expect and encourage customers to assume reasonable obligations in a healthcare system that safeguards their rights.
Ethical Issues in Ambulatory and Managed Health Care
One of the more obvious difficulties is the need for more time to personally examine the patient who seeks health care guidance over the phone. Another issue with telenursing is the requirement for certification or further credentialing for nurses working in this field. Violence, whether in the workplace or in the nursing care of people who have been victims or perpetrators of violent acts, raises a number of ethical considerations. When nurses are asked not to report violence, they may be presented with a dilemma since the victim may be frightened that reporting the violence may result in additional threats of violent action in the future.
Public and Community Healthcare
The overall well-being of a community is referred to as community health. These communities frequently share socioeconomic situations, racial or cultural backgrounds, and health traits in addition to residing in the same area or neighborhood. For instance, a lack of nutrient-dense food options at neighborhood grocery stores may contribute to high obesity rates in some low-income regions. They are presently in an area that is sometimes referred to as a food desert.
Also possible is the exposure of a community to pollutants from a nearby plant or waste facility. Community health programs increase public participation in healthcare choices, improve access to preventive healthcare services, and work to reduce medical expenses.
Community Health’s Essential Components
Community health specialists who work with the public understand how factors associated with socioeconomic statuses, such as income levels, dietary choices, crime rates, and transportation options, affect individuals. Community health’s essential components include the following:
- Determining the leading public health issues in a particular region, such as the social and environmental influences on healthy lifestyle decisions.
- Creating an intervention strategy to fill in the community’s resource shortfalls, such as opening community health centers, mobile clinics, and outreach initiatives.
- Providing essential services, including screenings, social assistance, and counseling.
- Assisting locals in accessing inexpensive dental, medical, and mental health care, insurance, interpreting and transportation, housing, food, and education.
- Lowering the need for costly hospital stays and emergency care.
Goals
A community health provider’s mission is to provide complete services that give local populations direct access to necessary resources, such as medical, dental, pharmacy, and mental health care. Public health professionals enable individuals to take charge of their health by teaching locals about the resources available and providing them with the means to receive care. Community health specialists establish close relationships with residents, social services, and healthcare providers. This allows them to complete crucial jobs like identifying local health concerns, advising locals on healthy habits, or setting up community health services to fill care shortages.
Importance
Health disparities can be particularly pronounced in rural and low-income areas when hospitals have closed and there is a dearth of doctors. According to an article by Tulane University, there are currently more than 7,000 primary care, 6,000 dentistry, and 5,500 mental health shortage regions in the US (2020). The total standard of care for the community can be significantly raised when a community health system is established to address unmet requirements while considering the community’s unique characteristics.
Patient Care
Patients are given a voice in treatment decisions by community health providers who follow a patient-centered care approach. Using this technique, healthcare professionals may direct patients away from expensive ER visits and assist them in preventing relapses. In public health programs like fighting the opioid crisis and halting the HIV epidemic, community health resources have transformed into crucial assets. Community health centers are at the forefront of federal efforts to reduce avoidable drug overdose deaths, as the number of opioid deaths in the United States has overtaken those from homicides and traffic accidents.
Conclusion
In conclusion, community and public health nurses are responsible for home health care nursing, parish nursing, occupational nursing, school health nursing, correctional nursing, and disaster nursing. The catastrophe nursing standard of care is similar to the emergency nursing standard of care because it allows individual nurses to fully employ their nursing and critical thinking talents. Ambulatory Nursing refers to nursing care that is provided in settings outside of typical acute care and long-term care settings. The number of ambulatory nurse practice locations has continuously expanded with the introduction of managed care, which has boosted the need for outpatient care services. Home health care nursing, parish nursing, occupational nursing, school health nursing, correctional nursing, and disaster nursing are all responsibilities that community and public health nurses do.
References
Chan, R. J., Marx, W., Bradford, N., Gordon, L., Bonner, A., Douglas, C., Schmalkuche, D., & Yates, P. (2018). Clinical and economic outcomes of nurse-led services in the ambulatory care setting: A systematic review. International Journal of Nursing Studies, 81, 61-80. Web.
Duquesne University School of Nursing. (2020). Ethical issues in nursing: Explanations & solutions. Duquesne University School of Nursing. Web.
Guido, G. W. (2020). Legal and ethical issues in nursing (7th Ed.). Pearson.
Tulane University. (2020). Why community health is important for public health. Publichealth.tulane.edu. Web.