Introduction
Nurses play a vital role in healthcare settings by ensuring that patients, their families, and the entire community receive skilled, responsive, and ethical care that upholds wellbeing, equity, dignity, and quality for all recipients. The provision of ethical care entails promoting the recovery of patients, assuaging their suffering, and helping them deal with longstanding disorders to avoid further injury. Other components of ethical care include patient education and advocacy initiatives. Therefore, nursing care is an intellectually stimulating process that necessitates skills and knowledge. However, it is delivered in a multifaceted setting that is full of ethical encounters and predicaments. Additionally, the current focus on value-based care compels nurses to provide quality care to all people without discrimination. This paper provides a critical analysis of the role of nursing in fostering an equitable healthcare system. The key ethical and legal issues, as well as barriers associated with the process, are highlighted. The potential solutions to address these barriers are also discussed in this paper.
Ethical and Legal Issues in Mental Health Care
Working in a mental health setting provides nurses with dilemmas concerning regard for independence as opposed to patriarchal behavior. The nursing code of ethics is useful in directing the actions of nurses when faced with such dilemmas. Therefore, it is important to be familiar with ethical conventions and the prerequisites of moral decision making. The five main ethical codes are the principles of beneficence and no malevolence, autonomy, justice, fidelity, and veracity (Winland-Brown, Lachman, & Swanson, 2015). The principle of beneficence requires nurses to act in ways that benefit all involved parties, whereas autonomy entails showing consideration to the rights of other people when making choices. The tenet of justice encompasses the equal distribution of resources while fidelity expects nurses to maintain loyalty and dedication to their patients. The principle of veracity entails honesty in all communications.
Mental health care is also guided by a set of laws that ensure the rights of mental health patients are upheld. Mentally-ill patients have the same civil rights and freedoms as other people. As a result, the confinement of patients in mental hospitals should be done according to the due process in civil commitment. Involuntary confinement is against the law and can be challenged by patients. In this regard, the least constricting alternative doctrine decrees that modest measures be taken to realize specific objectives. Admission to mental hospitals should be voluntary, which can only happen when required by patients or their custodians. Hence, patients have the right to demand their release. However, compulsory commitment can take place if patients pose threats to themselves or other people. Obligatory confinement can also occur if patients cannot sustain their basic needs due to the prevailing mental disorders. Emergency obligatory admission usually involves confinement for a specified period to forestall deleterious behavior.
All mental patients have the right to receive medical and psychiatric care that is given to all patients admitted to a public health facility. Under this rule, patients can refuse treatment at any time. This freedom has sparked controversies among healthcare professionals (Dawson, 2015). However, there is no clear direction yet. Physicians and other health providers should also seek informed consent from mental patients before performing any treatment or procedure. This rule must be observed even in the presence of insanity.
Psychiatric patients may have unpredictable behaviors, thereby leading to the display of aggressive tendencies. The use of restraint and seclusion may be necessary to guarantee the safety of patients and other people. The law requires that restrictive means should only be used in the shortest time possible. The use of restraint and isolation is justifiable when patients’ behaviors present physical dangers to other people and when mentally-ill individuals feel that a regulated environment will be beneficial to them and request to be secluded (Szmukler, Daw, & Callard, 2014). In instances where the treatment regimen requires minimal sensory stimulation, only isolation should be used. Current legislative modifications have led to the restriction of restraint and seclusion measures. Some institutions have gone as far as establishing “restraint-free” policies.
Nurses’ Role in Fostering an Equitable Healthcare System
In most settings, health systems are marked by inequities, which are manifested by the tendency to provide higher quality services to the affluent, who do not need them much, than to the deprived (who are incapable of getting them). Without collaborative efforts to guarantee that health services reach underprivileged groups efficiently, such inequities will continue to subsist. The disadvantaged groups arise due to social determinants of health (socioeconomic standing, social relationships, and racial intolerance) or stigmatization of people with “special needs.” There is growing evidence that circumstances such as HIV/AIDS, sexual orientation, and mental illness are stigmatized by the society in many fields, including the healthcare realm (Hatzenbuehler, Phelan, & Link, 2013). Outward stigmatization often leads to self-stigmatization. The aforementioned conditions, coupled with stigma from the society, contribute to stress in the stigmatized individuals. The social disadvantage and stress associated with stigma lead to high morbidity and mortality rates at the population level. Stigma exploits people, promotes the enforcement of certain norms, and keeps people away (Hatzenbuehler et al., 2013). Nurses can foster equitable healthcare systems by fighting the indictment of patients.
Fighting stigma begins with creating awareness about the situations surrounding the conditions that lead to vilification. For example, a lack of awareness about the spread of HIV/AIDS and the possibility of leading healthy, productive lives even after one is diagnosed with HIV is responsible for the continued castigation of HIV-positive people, many decades after the first HIV case was discovered (Abara, Coleman, Fairchild, Gaddist, & White, 2015). As a result, HIV-positive people may shy away from seeking medical treatment (Clement et al., 2015). Mentally-ill patients continue to be slurred due to misconceptions about the causes of mental illness. For example, some people believe that mental disorders are curses that have been earned by wrongdoing (Patel & Krishnamurthy, 2018). Therefore, they do not wish to associate with mentally-ill patients for the fear of being afflicted by the alleged curse.
Misconstructions that mental illness is contagious are also responsible for the continued discrimination, which discourages the families of mentally-ill patients from seeking treatment for their loved ones (Corrigan, Druss, & Perlick, 2014). Nurses can organize and lead awareness campaigns about HIV, mental illness, and other situations that are pilloried by society. Improved awareness of these conditions will enhance self-acceptance as well as societal acceptance and allow equitable access to health services.
Nurses can also foster an equitable healthcare system by mitigating the social determinants of health within healthcare settings that serve populations with high inequalities. Nurses are best suited to tackle the social determinants of health holistically by addressing the root, stem, and branch of the issue. The American Nurses Association (Marion et al., 2016) defines nursing as the preclusion of diseases and injury as well as activism in the care of individuals, families, and groups of people. Therefore, nurses can have a positive impact on health either directly or indirectly. Nurses can act as the link between disadvantaged patient groups and community resources with the capacity to bridge this gap. However, various obstacles get in the way of nurses’ ability to foster an equitable healthcare system. These barriers are discussed in the next section.
Barriers to Attaining an Equitable Healthcare System
Time is the biggest constraint to tackling health disparities, particularly the issue of social health needs. Getting hold of the right community services, creating care plans, and making recommendations is a complex, slow process. As much as electronic health records and mobile gadgets have enhanced the connectivity of health workers, similar benefits have not been realized between healthcare providers and external organizations such as community-based groups, faith-based establishments, and government benefit plans, which are crucial in helping the disadvantaged members of the society. The problem of time constraints is aggravated by heavy workloads attributed to the intricacy of patients’ needs, nursing staff shortage, disregard for nursing careers, professional wrangles, distancing from leadership in healthcare administrations, and despotic decisions. Other barriers are a lack of motivation, inadequate knowledge regarding the appropriate ways of providing unbiased health care, and a lack of competency. Limitations placed on the nurses’ scope of practice also contribute to the inability of nurses to maximize their potential.
Strategies to Overcome the Barriers
One strategy to overcome the described barriers is to use nurse-led innovations. Nurses can increase access to quality care at relatively low costs through the development of innovative care models. Instances of such reproductions include health clinics managed by nurses and visiting programs for low-income populations. A classic example is the Transitional Care Model (TCM) where nurses trained at the master’s level supervise the changeover of patients from healthcare institutions to home settings (Hirschman, Shaid, McCauley, Pauly, & Naylor, 2015). This model has reduced the number of re-admissions among elderly patients at a significantly low cost and can be applied in other nursing areas such as mental health nursing.
Lack of knowledge can be addressed by producing evidence and participating in research. Nursing research advances the scientific foundation for clinical practice, disease preclusion, and enhanced patient outcomes. Nurses are innovators who help in influencing the quality of health. Therefore, nurse researchers should receive adequate funding to support their research initiatives.
The problem of incompetency among nurses can be solved by redesigning nursing education so that all nurses acquire essential competencies to meet the needs of the population. Areas that may require emphasis include evidence-based practice, quality and safety, leadership, research, and patient advocacy. This goal can be attained by incorporating these aspects into the nursing education curriculum. Also, it is important to eliminate impediments to getting baccalaureate and advanced nursing degrees by forming strong partnerships between community colleges and institutions of higher learning. It is also necessary to have a good rapport between healthcare practice organizations and academic institutions to develop a harmonized residency program, which will provide nurses with hands-on training. Teamwork and cooperation are key to attaining continuous quality care. Consequently, professional wrangles can be avoided by fostering intra and inter-professional collaboration.
Expanding the scope of practice for nurses would enable advanced practice nurses to maximize their potential, thus leading to improved health outcomes. The passing of the Affordable Care Act in 2010 led to a significant increase in patients who could access healthcare services (Snavely, 2016). However, the rampant shortage of health workers was aggravated by the increase in the nurse to patient ratio. Eliminating scope of practice restrictions would permit advanced practice nurses to take up roles as primary care providers and ease the problem of limited access to primary health care. Additionally, this move would lower health costs, which would be pivotal to eliminating disparities in health care.
Nurses should assume leadership roles and take part in making decisions concerning matters that affect health. This task implies that nurses must be at the center of policy-making processes. Due to their active involvement indirect patient care, nurses are better placed to lead various healthcare areas, for instance, quality enhancement, promoting access to care, creating systems to minimize medical errors, augmenting the synchronization of care, and reducing workforce turnover (Arabi, Rafii, Cheraghi, & Ghiyasvandian, 2014). However, clinical knowledge alone is insufficient to accomplish this task. Nurses need to boost their knowledge of policy issues, governance, strategy, health law, advocacy, and financing to function as successful and well-informed board members. They also need to believe in their ability to provide outstanding care and implement the changes required to overhaul incompetent systems.
Conclusion
Equity in the provision of health care is an important value in the nursing profession. Equitable care strives to provide all people with safe, competent, and quality services at all times. However, various barriers may thwart nurses’ efforts to promote equitable health care. Nurses need to identify these barriers and overcome them to work effectively as patient advocates.
References
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