Introduction
Health care system is the cornerstone of a nation’s success, unless a nation is healthy physically, mentally and socially, she can not be healthy financially or economically. There have been a continue delivery of hard work, efforts, and newly designed strategies in making the health care system of USA satisfactory but there still have been areas where we are lacking. It is a multidirectional area and obviously needs a multidisciplinary approach to it but still there are areas where the impact of intervention can be very effective and that are health care system invention and its delivery.
Main body
Health resources department and management bodies are the ones dealing with health care system designing and refining but even in the design and implementation, implementation is rather more important due to certain reason. If we are tracing back our design we can easily do that from the written record, designed and approved schematic documents but if we want to know how it was delivered then that requires a lot more than just reviewing documents. If designing is an office theoretical work then delivery of the decided system is a more practical work and is done in the field. In health care system for designing one there are different bodies involved like administration, management, human resources, and a lot more on the administration side but when it comes to the delivery of it then nursing staff is primarily involved and then doctors. In order to ensure a good flow of a good health care provision it is very important to make sure that nursing practice is up to the standard. In order to understand all this and the importance of it, it is highly required to define clearly what a health care system is? How is it designed? Who is it required for? What will be the advantages and disadvantages of wrong implementation of it? What milder measure can make it better without causing major changes in the system? In order to deal with health care system to transform it into one of the best ones it needs to be taken as a system first in general and then specificities are addressed and taken care of. Calling it a medical filed from the beginning will leave a lot of issues unattended in it which will lead to a failure of the system in long term. “There exist models, principles, and laws that apply to generalized systems or their subclasses, irrespective of their particular kind, the nature of their component elements, and the relation or ‘forces’ between them. It seems legitimate to ask for a theory, not of systems of a more or less special kind, but of universal principles applying to systems in general”(Bertalanffy,V.L 1986). After this is done a system is dealt with in general then we need to define our population and their needs and then according to that we should modulate the general system into a somewhat more specific one according to the needs and demands. “Ideas confine a man to certain social groups and social groups confine a man to certain ideas. Many ideas are more easily changed by aiming at a group than by aiming at an individual”. (Klein, J. 1966). Once the system is created then how to operate it should be tackled and monitored on regular basis with a solid research going on to assesses a continuum of the activities. Nursing staff is the major operator of the health care system; they are the ones physically more in contact with the clients of the health care system. In- order to have them work better towards achieving the set goals we need to keep them up to date too. “Learning theorists say that the hardest aspect of learning, particularly for highly educated and successful individuals such as nurses and doctors, is unlearning. A person who would learn (or even better create) something new must have a mindset willing to doubt what he or she knows. Only after admitting that what we know might be inaccurate or incomplete or non-functional, can we consider alternatives. Thus, we must unlearn into order to learn”. (Waldman, D. & Yourstone, S.A.2007). in order to have a sound health care system only through upgrading clinical practice it has to happen in a systematic way, Nursing staff has to have a continuum of learning, dedication to the profession, and they also have to be an active body in the chain of people that are working towards empowering health care system to fulfill the newly emerging needs.
There is a theory that is being in used in the design of the health care system in USA it says that one should be learning new useful tasks and unlearning the ones that get obsolete on continues basis and this can lead to affective advancement. In this new era there is information available on each and every aspect of life, patient come to us with a good deal of information in their minds regarding their disease but most of the time it will not be an authentic information so there a nursing staff needs to have an appropriate amount of knowledge to handle that. Similarly everyday there is emergence of new medical problems and most of them require techniques to prevent the spread of them or to make the recovery of them quicker and that all can be achieved easily by an up to date staff. Management makes a scheme of system, doctors do not directly deal with the system most of the times but nursing staff most of the time does that so they are the most effective people to get hold of and make them implement the changes. Whole of this should be an active process and they should be doing it out of their own knowledge and not by just merely asking them. “The aphorism practice makes perfect is generally considered the way to improve. In common parlance, it translates to repeating the same action or thought process. Practice can be in three modes: (1) Rote practice, such as creating muscle memory in athletes or mental grooves in anyone; (2) Practice choosing, such as airline pilots do in simulators; and (3) Practice creating (practicing for the unknown)”.(Waldman, D. & Yourstone, S.A 2007). Doctors in our system maximally show two or three times a day to in-patients but the nursing staff are the ones stay by the in-patients every min and then deal with everything, whether eating, drinking, taking medicine, their all other biological functions. Nursing staff are the ones needed to be there all the time to entertain any queries from the patients or their families. Similarly on out patient basis again patients go through basic health assessment with a nursing staff that asks all the important pertinent points and put them down on a medical record sheet and then the patient is forwarded for a very brief time to review the whole previous time with the nursing staff. This scenario makes the position of a nurse very clear in the provision of health care system. In book Diffusion of Innovations, Rogers defines the diffusion process as one “which is the spread of a new idea from its source of invention or creation to its ultimate users or adopters”. Rogers differentiates the adoption process from the diffusion process in that the diffusion process occurs within society, as a group process; whereas, the adoption process is pertains to an individual. Rogers defines “the adoption process as the mental process through which an individual passes from first hearing about an innovation to final adoption”. (2007).
At times the staff available on duty will be good in terms of their knowledge and understanding of the issues but will just not be putting efforts in achieving the set goal. Here the staff just needs to have a realization in the serious nature of this business and should have the willingness to serve. It needs a lot of dedication and trustworthiness on their part to deal with people’s lives. I will quote an example from daily life: A nurse that is very well educated about sudden hypoglycemia secondary to any cause, the staff is appointed at CICU and is at work at 5am and she finds out that a patient’s blood sugar level is 50, she gave some dextrose and then no further action till it gets checked again after an hour according to the set protocol of hourly check and this time it had dropped to 27 she again administered some dextrose and slept on it for 20 minutes. Patient remained comatose for 3 days and her EEG was done which showed changes which were most likely because of hypoglycemic encephalopathy or in other words the patient that was recover post open heart surgery had a brain death due to hypoglycemia now here the staff writes the values of hourly check which are within normal range. In this whole scenario the point to me made clear is that health system is so strongly dependent on nursing staff, along with knowledge they also need to have a sound knowledge or morals and ethics I order to prevent major unfavorable things from happening. Roger in his book Diffusion of Innovations describes five adoption which are 1) awareness, (2) interest, (3) valuation, (4) trial, and (5) adoption. (2007) He further explains these components as in the awareness stage “the individual is exposed to the innovation but lacks complete information about it”. At the interest or information stage “the individual becomes interested in the new idea and seeks additional information about it”. At the evaluation stage the “individual mentally applies the innovation to his present and anticipated future situation, and then decides whether or not to try it”. During the trial stage “the individual makes full use of the innovation”. At the adoption stage “the individual decides to continue the full use of the innovation” (2007) if one is going through things according to learning theory, and innovation and adoption theory practicing health provision will become more rationalized.
The last but most important duty of a nurse is to consider herself a part of a health care provider team, to understand her/his position and her/his and duties in the team. Health care provision as all other critical cares is a very intricate chain of services. We can simplify this concept by reconsidering this example of an in patient at CICU discussed in the above paragraph, which goes into hypoglycemia due to some reasons. Here every member of the team has a responsibility but one is bound to take the other one in consideration and not to take thing on him or herself alone. Like here the staff was to check the blood sugar level if it normal nothing to be done, low just watch and repeat it in half and hour, it is significantly low inform the doctor on duty and if its fatally low then give rush call for it. On the other hand its mildly high let the body take care of moderately high give insulin according to specific regimen established but if it is significantly high inform the doctor on duty. If this chain of responsibilities and command is taken care of a system will work in harmony towards the betterment of health and there will be no major flaws in the system. There should be set protocol and they should always be in action once one gets down the line this is where problems occur and the efficacy of the implemented system keeps going.
In order to have a good quality health care system nursing staff has a very crucial role to play. They are the ones kind of living with the patient. Doctors come and go but nursing staff is always there. They should be the one presenting their patients and issues related to them. The theories mentioned above are being used actively in US and their use has brought positive changes in the system. General theory has got non health field related bodies involved in designing and assessing the system on timely basis and the diffusion innovation theory has made learning and adaptation the main theme of practice there. They should be knowledgeable enough to present their patient’s problems whether directly or indirectly related to health. In the other hand doctors should also give them their due respect and should deal with directly as presenter of their patient. They should be kept trained and up to date for their learning of new emerging things in the system, unless there is continuity of learning practice can not keep up with the new demands. Similarly nursing staff has to understand the importance of their position and should not let things go out of their hands to be taken care of somebody else. They should have the willingness to dedicate their self to their profession. Along with above two very important factors they should also take care of the sequence of flow of responsibilities amongst the members of the health care provider’s team. If a nurse start taking up the responsibilities this will lead to discrepancies in the system and health care system is not the kind of system in which discrepancies can be afforded to have. Health care system is actually of system of dealing with lives so any measures that can it better should be taken whether it is regarding the system designing, system operation or training the staff, doctors and administration.
Conclusion
The most easiest and practical approach to achieving this goal is to focus on the nursing staff because they are the ones influence this system the most. There is a nursing referencing system available which is very refined and precise and is actively functioning for programming nursing activities and keeping their knowledge up to date.
References
Deane Waldman, D. & Yourstone, S. A. Learning – the only way to improve Health-care outcomes. Health services management research; 20: 227–237.
Waldman JD, Yourstone S.A, and Smith H.L. Learning curves In healthcare. Health Care Manage Rev 2003; 28: 43–56.
Bertalanffy,V.L (1986). General system theory. The quest for general system theory; George Braziller; Revised edition (1976).
Rogers, Everett M. (1962). Diffusion of Innovations. The Free Press. New York.
Klein J. (1966) Working with groups. The Social Psychology of Dis-. cussion And Decision. Hutchison, London. Oppenheim A.N. (1976) Questionnaire Design.