The Need to Develop Ethics in Public Health - Coursework Example

Person-centred Care and Interprofessional Working The nursing roles in mental health care setting, particularly on the delivery quality and person-centred health care for elderly are not an easy task. I remember several instances where I am nearly put off to study and accept the future roles of a mental health nurse after having visited and been exposed to a hospital which catered services to the mentally ill. How patients were treated was slightly peculiar, and made me asked myself how much courage do I have in order to cope with the situation. Despite the unpleasing circumstance, I ended giving up the idea, went out of the system, and brought back my precise level of self awareness as well as nurse attitude regarding how people with illness are treated in institutions, like those that I have been exposed to. Until today, these issues still bother everyone in the healthcare arena. I was surfing the internet for my research and was astound on one article headed with “Healthcare Commission criticises NHS complaints procedure”, a February 2009 episode featured online. The article featured the cases reviewed by the Healthcare Commission on the 7,827 people’s complaints on healthcare outcomes in the year 2007-2008, with 1,112 cases that are still unresolved. Majority of these cases are complaints about effectiveness of NHS care, the attitude of NHS staff, patient treatment, delayed diagnosis, wrong diagnosis and forced waiting for health care services. At the end of the article was a conclusion that, much improvement is still needed on patient care (NursingTimes, 2009). If the above cases are to be linked to mental health care patients, indeed, it can be observed that, several patients have been let down by some health professionals providing them care. While others are harmed, others cannot even retaliate from the wrong doings of their health care providers. Health and Social Care Practice and Policies Government policies and strategies aimed to provide a wide range of health care services as well as facilities (Department of Heath, 2009) for quality care of patients. Quality care (Dazi, 2008) has been defined as personal, clinically effective, and safe care that protects patients by eliminating healthcare acquired infections and also avoidable accidents. It is about the effectiveness of care from the clinical procedure the patient receives to their quality of life after treatment. It is also related to patient’s overall experience of the National Health System (NHS) and ensures that they are treated with utmost compassion, dignity as well as respect in a clean, well managed and safe environment. To achieve the more improve quality of care, NHS formulated the Quality Framework which will support local clinical teams which encompass the following: (1) Bring clarity to quality by providing access to evidences regarding best practice; (2) Publication of quality information to make it available to the public; (3) Providing rewards to high quality care providers; (4) Safeguarding basic standards by utilizing new independent regulator which is the Care Quality Commission; (5) Ensuring innovation in medical advances as well as service design; (6) Recognising the role of clinicians being the leaders as well as giving them the freedom to restrict improvements in quality of care. In England the chief institution responsible as watchdog in the field of healthcare is the Healthcare Commission. It is an independent body which assesses and reports the quality, plus the safety of services given by the NHS and other independent healthcare sector. This is so, to improve patients’ social and health care services. Similarly, health systems in the United States as well as other areas abroad strive to implement the principles and practices of patient-centered care (Davies, 2005; p1 par 1), in fact, they have started to conduct survey to patients about their perceptions on care experiences. The Hospitals, medical practices, and some large government organizations such as Medicaid Services, Centers for Medicare, the Veterans Health Administration, and United Kingdom’s National Health Service have been seeking for patients’ feedback. Person-centered Care in Relation to the Central Patient/client in the incident. In recent years, countries have been devoted in designing the health care facility based from the patients perspective. Patient-centered care has been popular and being promoted from both the business and the medical point of view. Health professionals increasingly acknowledged the concept of ‘person-centred’ or also coined as ‘patient-centred’, particularly in providing care of people in long-term conditions. Health care professionals maximize the use of health care which aligns with both medical evidence as well as what is appropriate for the patient (The National Asthma Council of Australia, 2007; p 1 par 1). To them, there are key attributes of patient-centered care and are summarized according to the systematic review of nine (9) models as well as frameworks for describing patient-centered care: (1) Education and shared knowledge; (2) Involvement of family as well as friends; (3) Collaboration and team management; (4) Sensitivity to nonmedical and also the spiritual dimensions of care; (5) Respect for patient preferences and needs; and (6) the free flow and accessibility of information. The National Asthma Council Australia (2007) defined person-centred health care as, a system that is designed to respect the patient’s preferences, values (Harkness, 2007) and/or needs. The approach involves joint venture between health professional and patient, in the midst of shared aspirations for treatment and so acknowledgement of clients’ life goals. For people in life term conditions, it simply means giving patients the understanding as well as skills in order to optimise their investment of time, so they keep themselves well. This principle supported by clinical evidence, particularly in the areas of diabetes, asthma and arthritis. The principles of person-centred health care consider that the priorities of patients as well as their families differ, based on one’s respective culture and medical condition and integrate the elements are essential to person-centred health care (Davis, 2005; International Alliance of Patients’ Organizations, 2006; and Institute of Medicine, 2001). The said elements include: (1) Respect for the individual’s values, preferences and expressed needs; (2) Patients’ Choice to participate in health care decisions like treatment and management; (3) Access to services necessary for the patient’s medical condition; (4) Support in terms of acknowledging and addressing the patients’ emotional and social needs; (5) Education and information which is accurate, relevant and one that answers the person’s concerns with respect to the person’s condition, educational status, age, language, and culture. Person-centred primary health care incorporates practices being organised within the principles of informed choice, partnership, respect, a holistic approach as well as good communication. The primary health care providers’ capacity to propose this type of care is assisted by a health system which is designed to ensure access, patient participation in policy making between levels and the types of health services. Professional Identity, Roles and Responsibilities of Professional Practitioners in Meeting Clients’ Needs Professional practitioners must be responsible in listening as well as in answering patients’ concerns regarding medical conditions, treatment options and questions about medications. This rank high among patients’ chief concerns but health care professionals have limited time during their consultation thus, cannot provide what their clients need. To address this issue, the former can use their available time as they include the following: (1) Organising the practice in such a way that an appropriately trained nurse would be able to provide the disease-specific information which the patients want; (2) Make sure that the patients know also that their pharmacists can give them expert advice on medications as well as side effects; (3) Provide patients the relevant information prior to the consultation, e.g. disease-specific information indicated in leaflets; (4) Collect patients’ medical history in advance by the practice nurse. The health care team may also inform their patients that they can utilize the internet as one source of information. The internet may provide better explanations than a doctor or a health educator. Other than that, mobile phone text messaging can also be used as an effective and welcome means of reminding teenagers to take their medication (Neville RG, Greene AC, McLeod J, et al. 2002). The health care team must remember that patients need support to productively manage the effects of long-term conditions on their lives. It is essential that self-management programs particularly developed for people with multifaceted care needs generally consist these guiding principles: Encourage and allow the patient to define their health problems; Explore options for working out on these problems; Offer them choice and respect rather than directing and prescribing; and collaboratively set goals and also action plans in addressing problems (Wagner, Austin, and Korff, 1996). Importance of Interprofessional Collaboration There are numerous ways to describe collaboration as far as the health and social services are concerned, and some examples include: interprofessional collaboration, multiprofessional collaboration, interagency coordination, interdisciplinary collaboration, (Zwarenstein, Jarr, Hammick, KoppelI, and Reeves, 1999) and integrated care. Kodner and Spreeuwenberg ( 2002) assert that integrated care has several meanings and defined it as “a set of methods and models about the founding, administrative, service delivery, organizational, and clinical levels created for connectivity, alignment and collaboration surrounding and between the cure as well as the care sectors’’ (p. 3). To Biggs (1997), the term “interprofessional” means relations between different professionals and each one will have a distinguishing professional culture. According to Barr. et al. (2005), collaboration refers to an active and ongoing partnership, frequently between people from varied backgrounds, who work mutually to solve problems or offer services. Integration of mental health services within the overall system of health care has long been supported by research. Findings revealed that psychiatric consultation as well as treatment improved the health status and also the consequent health care expenditures for patients who have somatization disorder (Hellman, Budd, Borysenko, McClelland, & Benson, 1990). Diverse forms of psychotherapy, alone or mixed with monitored medications, had constructive outcomes in primary care services intended for acute and continuation stages of depression (Scott, Tacchi, Jones, & Scott, 1997). Mental health treatment has enhanced the outcome of the behavioral changes important for treating patients suffering from hypertension and coronary heart diseases. The Canadian Health Services Research Foundation (2005) shared that; collaboration can improve performance in countless aspects of the healthcare system, so with the primary healthcare and public health. Healthcare system which supports effective teamwork can progress the quality of patient care, improve patient safety, and reduce workload issues which cause burnout among healthcare professionals. The teams work most effectively if they have an apparent purpose; excellent communication; co-ordination; protocols as well as procedures; and also effective process in conflict resolution when it arises. The active involvement of all members is an additional key feature. Successful teams distinguish the professional and personal involvement of all members; support individual development as well as team interdependence; be acquainted with the benefits of performing the tasks together; and see accountability as a joint responsibility. Successful team interventions are time and again embedded in initiatives working to enhance the quality of care all the way through better co-ordination of healthcare services as well as the effective use of health resources with a center of attention on the determinants of health. If based on current evidence, greater insight must still be drawn specially on how collaboration is perceived, accepted and implemented by patients, health care professionals and other stakeholders. This may give new ways to assess collaboration processes, by utilizing research as a data for data gathering and to enhance service delivery to consequently increase the quality of services for families like those suffering from mental health problems. Barriers to Interprofessional Working and Its Impact on Person-centred Care In the earlier period, the health care delivery system in Western societies (Blane, 1986) exists in hierarchy of health care workers. Back then, the interdisciplinary interactions were essentially organized in a succession of command, whereby physicians are known to be at the top of the organization while the rest of the health care professionals such as nurses would have to be submissive to the physicians’ orders. But nowadays, the practice has changed. Other members of the health care team, patients as their families are now more empowered to become clients of the health care system that acquired abilities to select choices for their own health care. Most patients have already the preference to be cared for as individuals innate with rights as opposed to diseased subjects; in fact, they demand a more holistic as well as less invasive come close to to health care. These are the salient values that have been traditionally promoted by many some health care professions but were declined by mainstream medicine (Biggs, 1988). Lately, there is increasing public recognition of the work made by nurses as well. A numeral of recent studies initiated that patients in Western societies essentially are more satisfied by way of the care from nurses as far as primary care settings are concerned, as nurses spent extra time with patients. Most patients are more contented with care from a nurse practitioner rather than from a doctor, that is with no difference in terms of the health outcomes. In fact, there were some cases that nurse practitioners offer longer consultations and perform more investigations than doctors (Denoon, 2002; Horrocks, 2002). The abovementioned findings confirmed that patients are grateful for the care from health care professionals aside from medical doctors, thus, it may a good idea for physicians to be partners or collaborate more directly with other health professionals in accomplishing patient satisfaction as well as high quality health care. Davies and Cleary (2005) have synthesized most common barriers to interprofessional working in the health care systems. First is categorized under organizational barriers, the obstacle which are created by a structure of traditional hierarchical management and characterized by a lack of quality improvement infrastructure. Consequently, this barrier results in a feeling in the part of the team as if they don’t get paid for listening as well as supporting people. Second is called the professional barriers. These are the obstacles which limit professional growth among health care personnel. Many reported doubtful or defensive attitudes by staff in the clinical setting. The third one is referred to as the data-related barriers, which are basically the limitations as part of the lack of special expertise in working by the health care providers as far as data collection for analysis and feedback is concerned. Further time delays from responses or opinions to intervention to additional measurement can also make it difficult to resolve whether interventions were essentially effective or if improvements had been due or caused by other intervening factors. In one research conduct on the adoption of physicians’ patient-centered care practices (PCPs), (Audet, Davis, K., & Schoenbaum, 2006) eighty-three percent (80%) of PCPs are found in favor of sharing medical records with the patients. Most of the physicians (87%) maintain the support on team-based care. Except that, only 16% of PCPs converse with their patients through e-mail; about 36% get feedback from the patients while seventy-four percent (74%) of PCPs still encounter problems with availability of patients medical records or test results. ; less than 50% have adopted patient reminder systems. Although few PCPs have been adopted by the majority PCPs, other practices still have not yet been broadly adopted, particularly those aiming team-based care, coordination, and support from suitable information systems. As supported by evidences, once health care institutions are able to limit or prevent the barriers towards patient-centered care practices and interprofesionalism among health care providers, there will be opportunities in the enhancement of care effectiveness in complex patient encounters. As demonstrated by Lein, & Wills (2007) in their case study, only minimal investment of energy and time has positive yields in observance to advancements in longer term, specifically on treatment adherence, quality of life, physiological status, patient-provider working relationship, and also on patient and nurse practitioner satisfaction. The use of patient-centered practices like interviewing strategies create positive impacts; it can enhance effectiveness on processes which relates to patient care as well as outcomes at the same time retaining efficiency of patient management. If nurses as well consider changing to a model of care in the manner in which patients are able to define their needs as well as priorities creates various unique issues in health care. Therefore, nursing, with its long-standing pledge to being patient focused, requires to lead the research initiative in order to develop patient-centered frameworks or models of care which consider and incorporate the patients preferences. Conclusions It takes a higher level of leadership for health care providers, in order to achieve an effective, patient-centred health care outcomes at all levels of the healthcare system, to put into practice collaboration across disciplines. Given the complexity in processes and policies of the health care system, proper program design, implementation, maintenance of collaborative health care teams and continuing professional education requires a significant long-term commitment. The professional regulation and current malpractice laws in various health care institutions position enormous constraints on teamwork. Available funding and remuneration models or framework do not support teams, while the educational system has been sluggish to adopt new approaches for professional training. Some researchers revealed that nurses and other medical professionals felt uncomfortable to busy and were previously unaware of any problems. It is about time that health care organizations should consider paradigm shifting. They must develop cultures which support quality improvement and patient-centered care in order to improve the situation. One thing, more commitment and ingenuity will be required from health care professionals, so with policymakers, to understand shortcomings at the same time develop solutions. It must be clearly reiterated that there is a close relationship between law and health ethics, both are entangled but practically all public health laws have an unambiguously moral purpose in the rear them: that of promoting as well as protecting the lives of citizens. Here, it can be noted that to promote the discussion and development of ethics in public health is very necessary, thus, (American Journal of Public Health, 2002) the following recommendations may be considered: 1. Leaders in public health should prop up the development of conferences and also series of symposia on the theme of ethics and also about public health; 2. The editors of leading public health as well as bioethics journals be supposed to give high precedence to accepting and soliciting rigorous function in public health ethics for publication. 3. Consider efforts that can be undertaken to accumulate a set of case materials for ethics dialogue and teaching. 4. As for professionals, public health should develop and push forward the continuing education requirements and build ethics prominent among them. This form of initiative could be initiated at the governmental level; 5. Public health institutions and supervisors at the federal, state, and even at local levels should be encouraged to make available the time and resources obligatory for periodic in-service ethics sessions. In all disciplines in health and health services, patients are the utmost beneficiaries where health professionals ideally should pay attention to the principles and guidelines as far as collaborative partnerships with them is concerned, offering patients an opportunity to formulate informed decisions regarding their health care based on efficiently communicated medical evidence and creating mutually agreed vision and goals for care. References Audet, A. M., Davis, K., & Schoenbaum, S. C. 2006. Adoption of patient-centered care practices by physicians: Results from a national survey. Archives of internal medicine, 166(7), 754-759 Barr H, Koppel I, Reeves S, Hammick M, Freeth D. 2005. Effective interprofessional education. Argument, assumption and evidence. Oxford: Blackwell Publishingy CAIPE. Biggs L. 1988. The Professionalization of Chiropractic in Canada: Its Current Status and Future Prospects. In: Sociology of Health Care in Canada. Eds Bolaria BS and Dickinson HD. 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