Category: Nursing

Infection control and the use of medical tape

Please write a Infection control and the use of medical tape paper detailing how medical tape used in the operating room should be used for 1 patient then thrown out. This is versus using 1 roll of medical tape for multiple patients. We examined 7 rolls of tape from different operating rooms and all the tape came back showing germs under a blue light. Infection control practices prove this tape should be thrown out to keep infection rates down. Please use journal articles to prove point.

 

Infection control and the use of medical tape

Infection Control and Medical Tape Use in the Operating Room

A health care-associated infection (HAI) is a major healthcare system problem, of which various medical institutions in countries around the world are a part, and it plays a large role in mortality, morbidity, and healthcare costs that patients face. Operating room (OR) environment, as carefully moderate and regulated as it is, does not exclude the dangers of pathogen transmission, specifically related to surgical site infections (SSIs). Of the numerous fomites that can carry microorganisms, medical tape, an ubiquitous consumable, has become a possible though not obvious vehicle of cross contamination. In this paper, I will be discussing the alarming aspect of medical tape contamination in the operating room by proposing a paradigm change in the use of multi-patient medical tapes to using single patient medical tapes. Based on the concept of Evidence-Based Practice (EBP), this dialog will develop a PICOT question, explain the specified problem observed, organize the literature synthesis and present the implications regarding the improved infection control.

PICOT Question

In hospitalized patients undergoing surgical procedures (P), does implementing a policy of single-patient use for medical tape rolls (I), compared to the current practice of using one medical tape roll for multiple patients (C), reduce the incidence of surgical site infections (O) during their hospital stay (T)?

Problem Description and Evidence-Based Practice Rationale

A high standard of aseptic practice with excellent infection control strategies is required in the operating room in order to protect patient outcomes. Although environmental cleaning and incorporation of sterile technique can be extremely rigorous, minute and important reservoirs of pathogens may remain and ideally add to the risk of HAIs. Another important, sometimes underestimated issue is associated with the risk of cross-contamination through shared medical supplies, namely, medical tape rolls. Seven observation rooms showed some worrying consistency: tape rolls of all those inspected, regardless of the look, presented evidence of there being microbial contamination when viewed in a blue light (which makes such contamination visible). This is an empirical evidence that practice(s) of re-using single roll of medical tapes across more than one patient have a risk of pathogen transfer in themselves.

This is an indication that the existing infection prevention strategies have a gap that emphasizes the need of the Evidence-Based Practice (EBP) approach. EBP is the use of the best available evidence in collaboration with clinical expertise and the values of the subjects to make clinical judgments to enhance the outcome of people. The Centers of Disease Control and Prevention (CDC) and other national healthcare organizations have been repeatedly insisting on the prevention of HAIs, especially SSIs, that may cause extended hospital stays, enhanced antimicrobial resistance, and extreme financial burden (Klompas et al., 2021). As has been observed by Bernatchez and Schommer (2020), the absence of special recommendations on the medical tape use as a possible source of cross-contamination is currently a neglectful gap and immediately needs to be considered through the prism of EBP. A change in practice and probably evidence of contamination should be implemented and justified by the concepts of infection control to alleviate this unidentified danger.

Evidence from Literature

The issue of contamination by medical tape is not limited by the presented empirical data; it appears in peer-reviewed literature to a greater extent as well. In their review of the American Journal of Infection Control, Bernatchez and Schommer (2020) even distinguish that the medical tape, as well as many other products used in healthcare, is ubiquitous, and there is not yet guidance on its storage, use, or whether tape can be or should be cleaned and/or disinfected. In their own studies they are referring to various published studies and case reports of contamination incidents related to usage of medical tape and other adhesive devices. The reports show examples of cross-contamination that causes healthcare-related infections, in particular, the infections that caused patients harm and death (Bernatchez & Schommer, 2020). The authors urge specifically the introduction of national guidelines that will help to decrease the possibility of the cross-contamination that may occur in regards to the medical tape and claim that there has been an apparent gap in infection prevention that has to be filled.

Secondary research supports the possible use of tape as a fomite. Although it may be difficult to identify direct evidence that multi-patient tape rolls can be responsible to cause a certain SSI outbreak because SSIs are a multi-factorial problem, the general principles of microbiology and infection control lead to a strong argument in favor of the risk. It is known that microorganisms, even pathogenic bacteria can live on unliving surfaces over a long time (Kramer et al., 2021). When medical staff uses a roll of tape on one patient, puts it away and uses it again on a different patient it provides a direct route of indirect contact transmission. The adhesive quality of the tape itself has the potential of collecting contaminants in the environment or even patient flora and then transporting them to a succeeding patient or worse still directly to the hands of the medical professional. The transmissive process is already proven to be effective regarding other common non-essential objects in the clinical setting (Donskey, 2020). Hence, the visualization of germs under a blue-light is a visual equivalence to the presence of microorganisms, which is a physical risk that can be described with respect to the documented routes of HAIs transmission. Infection control and the use of medical tape.

Proposed Intervention: Single-Patient Use for Medical Tape Rolls

The offered intervention implies the use of a stringent regulation of the single-patient use of operating room rolls of medical tape. In this policy, every person who is undergoing a surgical procedure would be issued with a special roll of medical tapes, which would remain unpeeled. Unused segment of this roll would also be discarded once the case of the patient is exhausted. This strategy directly interferes with the determined risk of cross-contamination since it prevents the existence of the common fomite.

Comparison: Current Multi-Patient Tape Use

The existing practice, that this proposal aims to eliminate, is related to the usage of the same roll of the medical tape by several patients. This implies that a tape roll which is used once and opened is stored and re-used again and again on different patients in the OR over the period of a day or even into another day. As this practice has turned out to be one of the culprits as indicated by the blue light test, there is a possibility of accruing microorganisms, and their transfer inter-patiently or inter-environment within a patient.

Outcome

The key outcome measure is reduction in the surgical site infection (SSI) frequency. The result can be evaluated by means of a well-developed surveillance, as well as post-discharge surveillance protocols. Infection control departments actively monitor SSI rates, which is accomplished with universally accepted definitions (e.g., those of CDC National Healthcare Safety Network [NHSN]). Decreased SSI rates after implementing the use of single-patient tapes would furnish strong support of the effectiveness of the intervention. Although the specific effects of tape cannot be separated, other infection control interventions need to be used in well-designed studies, the consistent trend of the increased reduction of SSI rates, especially without evident alternative causes, would help prove the effect of the intervention.

Conclusion

Microbial contamination of the medical tape rolls employed to tape across various patients in the operating room constitutes a realistic and avoidable threat to healthcare-related infections, especially those that can compromise surgical-site infections. Available literature, albeit suggesting greater details, allows assuming that both general principles are desirable, namely that universal items, shared by non-critical entities, may be vehicles of spreading pathogens. This risk can be directly addressed by a policy of single-patient use on medical tape rolls since a single-patient use policy will result in an Evidence-Based Practice approach working to reduce this risk. Such simple intervention, in comparison to the current practice of multi-patient use, will help to reduce the cases of SSIs dramatically and, therefore, will improve patient safety, enhance healthcare quality, and support the fundamental frameworks of the infection control in perioperative setting. The apparently modest modification in practice can be viewed as an important step to more resistant and holistic approach to preventing infections.

References

Bernatchez, S., & Schommer, K. (2020). Infection prevention practices and the use of medical tape.
American Journal of Infection Control, 49
(1), 1177-1182.

Donskey, C. J. (2020). The role of the inanimate environment in the transmission of
Clostridioides difficile
and other healthcare-associated pathogens.
Infection Control & Hospital Epidemiology, 41
(S1), S19-S24.

Klompas, M., Baker, D., & DeRycke, E. (2021). The epidemiology of hospital-acquired pneumonia in the United States.
Clinical Infectious Diseases, 72
(Supplement_2), S105-S113.

Kramer, A., Schwebke, I., & Kampf, G. (2021). How long do nosocomial pathogens persist on inanimate surfaces? A systematic review.
BMC Infectious Diseases, 21
(1), 1-10 Infection control and the use of medical tape.

National healthcare issue or stressor – Review of Current Healthcare Issues

Medicare reimbursement

Before 2011, home health agencies could bill Medicare for separate services such as therapy, nursing, or supplies. Medicare changed to bundled payment models in 2011. This created a single payment system where all costs of services and supplies are placed into one payment. The provider is then expected to cooperate with other disciplines and consider how to contain their cost for services and supplies into the new single payment. This payment is based on a case mix depending on the patient’s diagnosis and functional data. The more ill patients are, the higher the reimbursement. This was to prevent overutilization of services like therapy in previous payment systems. This change in payment has caused significant stress in the home health world.

How this has impacted my work setting

 
In the previous PPS system, the home health agency was paid for each service or supply needed.  For example, the agency had a tracheostomy patient with a gastrostomy and a urinary catheter and wounds. The nurse went out thrice weekly for wound care and managed the other medical needs. The home health agency was paid for the nurse’s visits and reimbursed for all wound supplies, catheter supplies, and tracheostomy supplies, from saline bullets to tracheostomy inner cannulas. The nursing payment didn’t matter if the nurse went daily fifty miles away or once a week, they received the same payment based on the patient condition. An additional payment was added for the therapy care if therapy was needed. The agency was paid half upfront and the other half once the care was given at the end of the sixty days. Example: Nursing costs $1200, therapy $2300, and supplies $3000.

Today, here is an example of one of my current patients with a bundled payment based on case mix. $2000 per 30-day period for everything, and this is a high payment. Some are less than $1000. So the nurse goes three times a week for wound care for a stage IV with a wound vac, PICC line care for IV therapy, a Gastrostomy tube, pure wick, and a tracheostomy.  That payment must cover nursing, mileage, and supplies. Home health must order each monthly tracheostomy replacement, closed suction systems, inner cannulas, etc, through agencies like Medline. This is due to the higher reimbursement due to patients leaving the hospital. The MD then orders PT, OT, speech, MSW, and aide because of the complexity of care. This is not possible with the reimbursement if just the PT  evaluation is $90 plus mileage. This is why many agencies went under over the last 10 years, and many more closed when PDGM hit. There is no extra for an in-house biller, QA nurse, or marketer. Many agencies are barely surviving.

 BUY A HUMAN-WRITTEN DISCUSSION POST HERE

The goal of home care when it comes to Medicare is to treat them, get them better then discharge them. What about this patient? These are chronic, long-term, or lifetime illnesses. The longer they stay on services, the less money you get. Outcomes-based reimbursement. Based on functional skills, if this patient is paralyzed, how do I get them better to discharge from services?

Most case mix prospective payment models rely on functional assessment and health-related data to project payment for home health care. This offers only a limited view of the patient’s needs and care in the home. One study used home nurses and health insurers to look at case mix characteristics in the home and found holistic care, such as social networking and mental functioning, to be important indicators of successful home health care (Van den Bulck 2022).

Many countries are utilizing case-mix models for home health payment. Different models are used, and no one system is the most effective (Van den Bulck et al., 2020).

A study with cardiac patients in the hospital and ninety days post-discharge noted changes in spending costs, care utilization, or improvements by using a bundled payment model Review of Current Healthcare Issues
What social determinants affect this issue?

Fewer agencies are even willing to take complex patients like this because their payment is in the negative. They cannot discharge the patient either due to the patient’s needs. Healthcare access and quality is compromised. Different patients have different healthcare payments. They have more difficulty finding providers to care for them if they live in a rural area. Many therapy companies in my area will not travel to surrounding towns due to their decreased payment and use. Agencies must buy generic supplies due to cost.

Many of these patients are low-income or even middle-income, and cannot afford in-home care from providers, and do not qualify for state services. They cannot afford payments on DME like a hospital bed or a shower chair, so they do without. Patient safety is compromised. Patient outcomes are not improved. The bundled payment is a great idea for utilizing services more efficiently, but the payment is not enough to cover patient needs and expenses, much less for an agency to stay afloat. This is with zero profit for the agency.

How has my agency responded

My agency cannot accept medically complex patients like the one described. We cannot afford their supplies much less extra services. We purchase generic wound care supplies and ask for cheaper alternatives to expensive treatments that may have been used in the hospital. We have downsized staff to the bare minimum, and everyone wears multiple hats. Small companies are dying out in this system. These mom-and-pop shops give great personalized care. Hospitals are enduring the same and cutting costs wherever possible. The patient and the agencies giving their care are the ones paying the extra cost.

References

Shashikumar, S. A., Jie Zheng, Orav, E. J., Epstein, A. M., & Maddox, K. E. J. (2023). Changes in Cardiovascular Spending, Care Utilization, and Clinical Outcomes Associated With Participation in Bundled Payments for Care Improvement – Advanced. 
Circulation
, 
148
(14), 1074–1083. https://doi.org/10.1161/CIRCULATIONAHA.123.065109

Van den Bulck, A. O. E., de Korte, M. H., Elissen, A. M. J., Metzelthin, S. F., Mikkers, M. C., & Ruwaard, D. (2020). A systematic review of case-mix models for home health care payment: Making sense of variation. 
Health Policy (Amsterdam, Netherlands)
, 
124
(2), 121–132. 
https://doi.org/10.1016/j.healthpol.2019.12.012
Links to an external site.

Van den Bulck, A. O. E. 
et al.
 Identifying client characteristics to predict homecare use more accurately: a Delphi-study involving nurses and homecare purchasing specialists. 
BMC Health Services Research
, 
[s. l.]
, v. 22, n. 1, p. 1–10, 2022. DOI 10.1186/s12913-022-07733-9. Disponível em: https://search.ebscohost.com/login.aspx?direct=true&AuthType=shib&db=rzh&AN=155953624&site=eds-live&scope=site. Acesso em: 26 fev. 2025.

 

Review of Current Healthcare Issues

If you were to ask 10 people what they believe to be the most significant issue facing healthcare today, you might get 10 different answers. Escalating costs? Regulation? Technology disruption? Social Determinant such as environment/community, education, access/quality to healthcare?

These and many other topics are worthy of discussion. Not surprisingly, much has been said in the research, within the profession, and in the news about these topics. Whether they are issues of finance, quality, workload, or outcomes, there is no shortage of changes to be addressed.

In this Discussion, you examine a national healthcare issue and consider how that issue may impact your work setting. You also analyze how your organization has responded to this issue.

Resources

Be sure to review the Learning Resources before completing this activity.

Click the weekly resources link to access the resources. 

WEEKLY RESOURCES

To Prepare:

Review the Resources and select one current
national healthcare issue/stressor
to focus on.

Reflect on the current national healthcare issue/stressor you selected and think about how this issue/stressor may be addressed in your work setting.

By Day 3 of Week 1

Post
 a description of the national healthcare issue/stressor you selected for analysis, and explain how the healthcare issue/stressor may impact your work setting. Which social determinant(s) most affects this health issue? Then, describe how your health system work setting has responded to the healthcare issue/stressor, including a description of what changes may have been implemented. Be specific and provide examples.

By Day 6 of Week 1

Respond
 to at least 
two
 of your colleagues 
on two different days
 who chose a different national healthcare issue/stressor than you selected. Explain how their chosen national healthcare issue/stressor may also impact your work setting and what (if anything) is being done to address the national healthcare issue/stressor.

WEEK 1 DISCUSSION

MAIN POST

Post a description of the national healthcare issue/stressor you selected for analysis.

The national healthcare issue I selected to analyze is work-related stress in healthcare workers. This stress affects healthcare workers’ physical and mental well-being and interferes with the quality of care provided to patients. Healthcare workers often
encounter significant stressors that lead to burnout and job dissatisfaction
(Bangani et al., 2021).

Explain how the healthcare issue/stressor may impact your work setting.

Work-related stress impacts my work setting regarding delivering adequate and efficient nursing care when treating patients. I often hear amongst my colleague the feeling of burnout and inability to take vacation due to nursing staff shortage and emotional exhaustion, which may affect their ability to provide high-quality care. Sometimes, some of my co-workers can be impaired with decision-making interventions and not focus on attention to detail because of being overworked and fatigued. This can compromise patient safety and well-being, resulting in increased medical errors, longer patient recovery times, and potentially adverse health outcomes due to delay or oversight in care (Greco et al., 2022). Additionally, we have many calls off because of the overwhelming exhaustion that my co-workers may experience from an overwhelming workload they experienced during their previous shifts; this can result in staff shortage, causing more stress and pressure on my colleague’s workload.

Which social determinant(s) most affects this health issue?

Socioeconomic status is the social determinant affecting work-related stress in nursing healthcare staff (Senanayake et al., 2019). Nursing staff with lower social and socioeconomic status experience financial insecurity and have access to fewer resources, leading to higher stress and anxiety both at work and in their personal lives. In the workplace, these individuals may feel a loss of control over their jobs, leading to feelings of being overworked, having fewer benefits, and receiving less support from management (Senanayake et al., 2019). This emotional and physical toll on their work ethics creates a stressful work environment, making it more challenging to manage patient workload. This stress also significantly impacts the job performance of nursing staff, as well as their mental and physical health and overall well-being.

Describe how your health system work setting has responded to the healthcare issue/stressor, including a description of what changes may have been implemented. Be specific and provide examples.

My healthcare facility has implemented different strategies in my work setting to reduce the workload stress amongst nursing staff. For example, to help reduce the call-offs, my health system has introduced flexible scheduling that allows for better work-life balance and the introduction of new nursing staff positions. These changes help ensure that nursing staff reduce the pressure to meet high demands and improve the quality of care they can provide. There are also serenity rooms where nursing staff can take breaks and engage in mindfulness and stress-reduction relaxation time. My facility has implemented these steps in my work setting to address work-related stress and improve staff retention and patient care outcomes.

REFERENCES

Bangani, R. G., Menon, V., & Jovanov, E. (2021). Personalized Stress Monitoring AI System For Healthcare Workers. 
2021 IEEE International Conference on Bioinformatics and Biomedicine (BIBM)
, 2992–2997. 
https://doi.org/10.1109/bibm52615.2021.9669321
Links to an external site.

Greco, E., Graziano, E. A., Stella, G. P., Mastrodascio, M., & Cedrone, F. (2022). The impact of leadership on perceived work-related stress in healthcare facilities organisations. 
Journal of Organizational Change Management
, 
35
(4/5), 734–748. 
https://doi.org/10.1108/jocm-07-2021-0201
Links to an external site.

Links to an external site.
Senanayake, B., Wickramasinghe, S. I., Edirippulige, S., & Arambepola, C. (2019). Stress and its Social Determinants – A Qualitative Study Reflecting the Perceptions of a Select Small Group of the Public in Sri Lanka. 
Indian Journal of Psychological Medicine
, 
42
(1), 69–79. 
https://doi.org/10.4103/ijpsym.ijpsym_482_18
Links to an external site.

 

 
National Healthcare Issue: Nurse Staffing Shortages

One of the most pressing healthcare stressors in the U.S. is nurse staffing shortages. The increasing demand for healthcare services, the aging nursing workforce, and high burnout rates contribute to this ongoing issue. The COVID-19 pandemic further exacerbated shortages, leading to increased workloads, stress, and job dissatisfaction among nurses.

Impact on My Work Setting

As a Charge Nurse in the PACU at Mary Washington Healthcare, staffing shortages directly impact patient care and nurse well-being by increasing workloads, leading to fatigue and burnout. Inadequate staffing also results in longer patient wait times, affecting post-anesthesia recovery and overall satisfaction, while higher turnover rates create a continuous need for training new staff. Additionally, limited nurse availability reduces the time for crucial patient education on post-operative care. For instance, when fewer nurses are available to manage the 20-bed PACU, patient assessments and discharges are delayed, placing added pressure on the team to maintain safe, high-quality care under stressful conditions.

 
Social Determinants Affecting Nurse Staffing Shortages

Nurse staffing shortages are influenced by several social determinants, including economic stability, working conditions, and education access. Budget constraints in hospitals limit the ability to hire and retain nurses, while long hours, mandatory overtime, and high patient loads contribute to burnout. Additionally, a shortage of nursing faculty and training programs restricts the pipeline of new nurses entering the workforce, further exacerbating the issue. “Nursing shortages, especially in emergency medicine (EM), where nurses face significant burnout rates, are predicted to worsen.”
 (
Hodgson et al., 2024)

 
Response of My Health System

To address these challenges, Mary Washington Healthcare has implemented several strategies to improve staffing and support nurse retention. Competitive salaries, sign-on bonuses, and retention incentives encourage nurses to stay, while flexible scheduling options, including self-scheduling and PRN shifts, help maintain work-life balance. Cross-training PACU nurses in multiple areas ensures adequate coverage during staffing shortages. Additionally, the integration of electronic health records (EHRs) and remote monitoring tools streamlines documentation and reduces nurse workload. To support mental health and well-being, the hospital also offers wellness programs, counseling services, and resilience training to help staff manage stress and prevent burnout. Companies have also begun using social media to promote job openings and share valuable information to increase visibility. “Hospital and health system recruiters use social media to connect with top talent locally, regionally, and nationally.”  (Hale, 2021) Review of Current Healthcare Issues

Example of Change Implemented

One specific change is the float pool expansion, where nurses from different units are cross trained to work in PACU when needed. This has helped fill staffing gaps during peak hours and high-acuity cases. Additionally, leadership has worked on improving communication and collaboration by implementing daily staff huddles to assess needs and reallocate resources effectively.

Conclusion

While staffing shortages remain a challenge, proactive strategies such as retention incentives, cross-training, and mental health support help mitigate the impact on both nurses and patients. “National work to improve nurse staffing offers specific recommendations and actions for short-term and long-term change, including recommendations to build healthy work environments and test new approaches to care delivery.” (Delgado, 2024) Continued efforts in recruitment and workforce well-being will be crucial in sustaining quality patient care.

 

References:

Delgado, S. D. (2024). Evidence-Based Approach to Appropriate Staffing. 
Critical Care Nurse
, 
44
(6), 69–72. https://doi.org/10.4037/ccn2024614

Hale, K. (2021). 
Benefits and challenges of social media in health careLinks to an external site.
Links to an external site.
. 
Critical Care Nursing Quarterly
, 
44
(3), 309–315.

Hodgson, N. R., Kwun, R., Gorbatkin, C., Davies, J., & Fisher, J. (2024). Emergency department responses to nursing shortages. 
International Journal of Emergency Medicine
, 
17
(1), 1–5. https://doi.org/10.1186/s12245-024-00628-y

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Andre Perrenoud

Feb 26 11:55pm
| 
Last reply Mar 1 3:21pm

Reply from Andre Perrenoud

Week 1 Discussion: Main Post

Dr. Donnelli and Classmates,

An ongoing national healthcare issue and stressor is the burnout and shortage of nurses. The burnout of nurses has been an issue even since the start of my career as a nurse. I have experienced the impact in the psychiatric inpatient setting. A study by Bekelepi and Martin (2022) in Cape Town, South Africa states that one in five patients in the psychiatric inpatient unit will have an incidence of violence. The exposure to high incidences of violence in the workplace is stressful for nurses who are trying to care for patients. It causes physical and psychological trauma which eventually leads to burnout. Social norms and community context may contribute to this issue because it has been said that the violence is just part of the job. This perspective does not help the fight for a safer workplace. This burnout in turn contributes to the shortage of nurses. As stated by Speroni (2024), nurses during the Covid-19 pandemic listed psychosocial support as a key factor in staying with their employer. When nurses are not provided adequate support, they seek employment elsewhere. I have experienced this personally, as well as seen it many times with coworkers. My workplace has addressed this issue by routinely sending surveys to staff in order to keep open communication and address the staff’s concerns. According to an article by Li et al. (2024), Congress passed legislation allocating $100 million of funding toward the promotion of mental health, fostering resilience, and reducing the stigma among healthcare professionals. This legislation along with changes in the workplace are needed to address the ongoing burnout and shortage of nurses in healthcare.

References

Bekelepi, N., & Martin, P. (2022). Experience of violence, coping and support for nurses working in acute psychiatric wards. 
South African Journal of Psychiatry
, 
28
(0), e1–e7. https://doi.org/10.4102/sajpsychiatry.v28i0.1700

Li, L.Z., Yang, P., and Singer, S. (2024). Nurse burnout and patient safety, satisfaction, and quality of care: A Systematic review and meta-analysis. 
JAMA Network Open, 7
(11). Retrieved from https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2825639′

Speroni, K. (2024). Overview and Summary: Today’s Nursing Shortage: Workforce Considerations. 
Online Journal of Issues in Nursing
, 
29
(2). https://doi.org/10.3912/ojin.vol29no02manos

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Nadege Lima

Feb 26 10:25pm
| 
Last reply Mar 3 4:07am

Reply from Nadege Lima

Main Post
 

Healthcare issue: The High Cost of Healthcare
 

For many decades, one of the greatest obstacles facing the US healthcare system has been the exorbitant expense of medical care. It is a major national problem that impacts the economy, families, and individuals (Steinreich, 2022).

Social determinants of health
 

The high cost of healthcare has led to significant problems in terms of socioeconomic determinants. Social variables like socioeconomic level, education, insurance coverage, cultural views, and accessibility to medical services are contributing factors to the rising expense of healthcare (KFF, 2025). People in rural areas with little to no access to healthcare facilities, as well as individuals from lower-income families, frequently struggle to get the healthcare they need, which causes delays in treatment and, eventually, higher expenses. The high costs and high percentage of underinsured or uninsured individuals put many people at risk of becoming bankrupt in the event of a catastrophic illness, according to Harvard professor Dr. Shmerling, MD. He also emphasized that the United States does poorly on several key health measures, including life expectancy, preventable hospital admissions, suicide, and maternal mortality, while spending significantly more on healthcare than other high-income nations. In other words, the US healthcare system is not the greatest, despite its high cost. In addition, Americans are dissatisfied with the current state of the healthcare system despite all that investment (Shmerling, 2021).

How your health system work setting has responded to the healthcare issue
 

The Division of Public Health in Delaware offers services to uninsured adults and children, as well as those on Medicaid, at minimal or no cost, contingent upon income. We offer cost-effective immunizations for children and treatments for infectious disease control, including tuberculosis for immigrants or anyone at risk of exposure, as well as sexual and reproductive health services. For individuals who lack access to healthcare due to prohibitive costs and limited availability of healthcare facilities, we offer a community mobile unit that operates from Monday to Saturday, providing services such as blood pressure and cholesterol monitoring, HIV and other sexually transmitted disease testing, lead screening, and immunizations.

 
Conclusion,
 

Debates on how to address the high cost of healthcare issues such as insurance reform, government-provided health coverage, drug price regulation, and the sustainability of the healthcare system have been ongoing for decades. Although the Affordable Care Act was introduced, it has had little to no effect on these issues. To guarantee that everyone has access to competent and reasonably priced healthcare without experiencing financial hardship, these issues necessitate comprehensive policy adjustments.

Telesford, I.
 
Links to an external site.
Winger
Links to an external site.
, A. & Rae, M. (2024). Beyond cost, what barriers do health care consumers 
 

face? (Peterson-KFF)
 
https://www.healthsystemtracker.org/chart-collection/beyond-cost-what-barriers-to
Links to an external site.
. (February 24, 2025).
 

 

Steinreich, D. (2022). Big Med: Megaproviders and the High Cost of Health Care in
 

America. Quarterly Journal of Austrian Economics, 25(2), 501–528.
 

https://doi.org/10.35297/qjae.010135
 

 

Shmerling, R. (2021). Is our healthcare system broken? Harvard Health publishing 
 

https://www.health.harvard.edu/blog/is-our-healthcare-system-broken-202107132542
Links to an external site.
 
 (February 24, 2025).
 

 
 

 
 

 

 

 

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Anaisabel Montenegro

Feb 26 9:52pm
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Last reply Feb 27 11:11pm

Reply from Anaisabel Montenegro

Healthcare issue/stressor

The US is in such a dire healthcare worker shortage that subgroups of healthcare that deal with non-physical symptoms suffer in greater capacity. Less than one-third of the U.S. population (28%) lives in an area where there are enough mental health professionals available to meet the needs of the community; sadly, most states have fewer than 40% of the mental health professionals, such as psychiatrists and nurses, needed (Modi et al., 2022). The percentage of need met ranges from a shocking low of 5% in the District of Columbia to an insufficient high of 69% in New Jersey (Modi et al., 2022).

This great disparity in mental healthcare leads to a strain on psychiatric in-patient units due to persistent readmissions. Specifically in the hospital I work at in a metropolitan city in New Jersey, I care for adult patients with poor insight into their mental illness that causes them to be repeatedly readmitted for adequate care across their lifetime. We often see readmissions due to not receiving or having access to quality out-patient mental health services in the local community. This constant strain puts an immense amount of pressure on the scarce psychiatric facilities and the limited resources available to them; not only the strain on resources, but psychiatric readmission also reduces the patients’ quality of life and increases the years of life lost in care (Owusu et ai., 2022). While the number of aspiring psychiatrists matched to a medical residency program has grown over the past five years, it takes well over a decade to effectively educate and train psychiatrists; mental health professionals who can be trained more quickly than psychiatrists (such as psychologists, or nurse practitioners) play a vital role in expanding access to mental health care (Modi et al., 2022).

Social determinants

Largely at play for these lack of resources are two social determinants: economic stability and healthcare access/quality. Communities highly impacted by these determinants are often densely populated urban communities or sparsely populated rural communities. People often are driven to live in these places due to financial need, and often their overall well-being and health is something too costly to consider. When children grow up in socioeconomic disadvantage, they are up to 3 times more likely to experience mental health issues than their non-disadvantaged peers, with elevated risk associated with long duration exposure in addition to severity of exposure (Kirkbride et al., 2024). Financial stress among other socioeconomic disadvantages had more consistent effects on risk for common mental disorders than income and employment (Kirkbride et al., 2024). These financial strains not only affect children in their adolescence, but also prenatally. When families don’t have adequate financial resources, they are much less likely to have basic needs met, which can increase the risk of some psychiatric disorders, like schizophrenia, later in life (Kirkbride et al., 2024).

The second social determinant, healthcare access and quality, is the determinant I most consistently see in my unit of work. As discussed in the beginning, having access to adequate out-patient mental healthcare is a direct correlation to readmissions in our unit. Often patients will cite their inability to access ongoing care, and this lack of resources affects our ability to create an adequate discharge plan. In a qualitative study that looked at different strategies to reduce readmissions in psychiatric units, the study revealed that having discharge plans with quality care were vital in successful transitions from in-patient to out-patient care (Owusu et ai., 2022). The support services offered were not necessarily methods of care that are outside the scope of an inpatient unit, but did extend their abilities much further into the patient’s care. These support services often looked like follow-up calls, discharge services, bridge visits, and psychoeducation (Owusu et ai., 2022).

Addressing the issue

Much of the strain we see in inpatient care is in the lack of care continuity in outpatient care. Specifically, preventative and early intervention care is essential to providing quality and comprehensive mental health care throughout a person’s lifespan. A clearer understanding of the factors surrounding readmission can assist in improving the management of patients in inpatient care units and establishing measures of early intervention to reduce readmission (Owusu et ai., 2022). Traditionally, mental health illnesses have been isolated in their diagnosis and treatment from physically presenting illnesses and different healthcare disciplines work their scope of practice hindering collaboration (Modi et al., 2022). This is fostered through a combination of factors such as regulatory requirements, and a deficit of integrated technology and training (Modi et al., 2022). I believe that to address this issue with longevity, the health care system needs to create a new model of care that integrates mental health care into primary health. This new model of care can ensure that a person receives lifelong comprehensive and quality mental health care from prenatal care to geriatric care.

References

Kirkbride JB, Anglin DM, Colman I, Dykxhoorn J, Jones PB, Patalay P, Pitman A, Soneson E, Steare T, Wright T, Griffiths SL. (2024). The social determinants of mental health and disorder: evidence, prevention and recommendations. World Psychiatry. 2024. 
https://pmc.ncbi.nlm.nih.gov/articles/PMC10786006/
Links to an external site.

Modi H, Orgera K, Grover A. (2024). Exploring Barriers to Mental Health Care in the U.S. Washington, DC: AAMC;. 
https://doi.org/10.15766/rai_a3ewcf9p
Links to an external site.

Owusu E, Oluwasina F, Nkire N, Lawal MA, Agyapong VIO. (2022). Readmission of Patients to Acute Psychiatric Hospitals: Influential Factors and Interventions to Reduce Psychiatric Readmission Rates. Healthcare (Basel). 
https://pmc.ncbi.nlm.nih.gov/articles/PMC9498532/
Links to an external site.

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Jessica O Bonsu

Feb 26 9:49pm
| 
Last reply Feb 27 10:14pm

Reply from Jessica O Bonsu

Main Post:

The United States has been battling Nursing Staff Shortage for many decades. Being in the healthcare field for almost 10 years, I believe that it has gotten worse each year after the pandemic.  This healthcare issue has significant implications for the quality, accessibility, and cost of healthcare services. The nursing shortage impacts not only inpatient services but outpatient as well. According to the World Health Organization (WHO) report, it was estimated that there will be a shortage of 7.2 million health workers to deliver healthcare services worldwide, and by 2035, the demand of nursing will reach 12.9 million.

The impact of nursing staff shortage in a work setting is nurses’ experiencing burnout. Burnout syndrome has been characterized by emotional exhaustion, depersonalization, and a diminished sense of personal accomplishment and is typically observed to be the result of chronic workplace stress (Li et al,2024). Nurses can also experience significant physical, emotional, and mental stress due to the nature of their work. Nurses work long shifts with high patient to nurse ratios and physical demands that can contribute to burnout. I currently work in an outpatient service and the staff is overworked with the influx of patients. With the inadequate supply of nurses has notably created many negative impacts on the patient’s health-related outcome as well as challenges to fight diseases and improving health, which causes increased workload and stress levels on nurses and later results in decreasing the quality of nursing care (Tamata and Mohammed, 2022).

Social determinants that affect the nursing staff shortage is income and financial stability, often nurses are underpaid in comparison to the level of responsibility they bear. Another social determinant is lack of cultural competence and support in a healthcare environment can lead to discrimination or unequal treatment of nurses from diverse backgrounds. Work- life balance has become big in healthcare. Nurses, especially women may face pressure to balance professional demands with family responsibilities. The lack of flexible working hours, paid family leave, and affordable childcare can discourage nurses. Multiple national medical professional associations recommend social risk screening and documentation in healthcare settings because of the compelling evidence that social risks are associated with poorer adherence to treatment plans, worse health outcomes, and increased costs of care (Tiase et al, 2022).

 

The healthcare system that I work for has implemented mental health days and recruitment programs. I work in Outpatient so there is some flexibility for nurses that are mothers and have children to work 5×8 hour days or 4–10-hour days. The manager is very big on work life balance and takes the extra step by gifting us with treat, food, and celebratory parties to show her appreciation for our hard work.

Broome, M., & Marshall, E. S. (2021). Transformational leadership in nursing: From expert clinician to influential leader (3rd ed.). New York, NY: Springer. 
https://bookshelf.vitalsource.com/books/9780826135056
Links to an external site.

Li, L. Z., Yang, P., Singer, S.J., Mathur, M. B., & Shanafelt, T. (2024). Nurse Burnout and Patient Safety, Satisfaction, and Quality of Care: A Systemic Review and Meta-Analysis. JAMA network open, 7 (11), e2443059. https://doi.org/10.1001/jamanetworkopen.2024.43059

Tiase, V., Crookston, C. D., Schoenbaum, A., & Valu, M. (2022). Nurses’ role in addressing social determinants of health. 
Nursing
, 
52
(4), 32–37. 
https://doi.org/10.1097/01.nurse.0000823284.16666.96
Links to an external site.

Tamata, A. T., & Mohammadnezhad, M. (2022). A systematic review study on the factors affecting the shortage of nursing workforce in the hospitals. 
Nursing Open
, 
10
(3), 1247–1257. 
https://doi.org/10.1002/nop2.1434
Links to an external site.

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Alejandra Izaguirre

Feb 26 9:21pm
| 
Last reply Feb 28 7:57pm

Reply from Alejandra Izaguirre

Main Post: Healthcare Issue/stressor

National healthcare issue/stressor

There are many issues and stressors that impact healthcare, one is the lack of adequate healthcare providers. The healthcare industry is facing a shortage of multiple disciplines, impacting the number of patients receiving treatment. By the year 2033 there is an expected shortage of 124,000 physicians, and hospitals are having to replace 200,000 nurses each year to keep up with care demands (American Hospital Association, 2021).  The population is increasing due to people living longer, however the number of providers to render treatment is diminishing. The population expectancy is 2 billion people by the year 2050 with most of the population having at least one chronic health condition (Amalberti et al., 2019). The number of healthcare providers needs to increase to meet the demands of the growing population.

Impact on work setting

The shortage of healthcare providers impacts on the work environment by not allowing patients to receive adequate treatment for illnesses. Patients are forced to go without treatment or receive less than treatment because there are not enough providers to render care. Patients are having to wait long periods of time to visit with providers and are having the least informed healthcare works decide on whether the patient should see a physician (Slonim, 2023). The number of patients a healthcare worker is having to care for is increasing, adding stress to providers and decreasing the quality-of-care patients are receiving. Healthcare providers are having to render treatment as tasks, such as needing to give medications and drawing labs, rather than being able to listen to patients, spend time with them, while still performing tasks. Physicians often spend very little time with patients due to their workload, leaving patients feeling unheard and uncared for (Slonim, 2023).

Social determinant affected  

Healthcare and quality are the social determinants that are affected by the lack of health care providers. People already do not seek healthcare treatment for many reasons, one being the lack proximity to provider, some people do not seek specialized screenings because the provider who do the screens are not nearby (Healthy People 2030, 2018). If people are currently finding it difficult to find providers in close proximity with a even greater shortage of providers expected, then the number of people not choosing to seek treatment could increase. This leaves people at a disadvantage and an increased risk for many illnesses.

Responded to the healthcare issue/stressor

The changes I have witnessed in healthcare facilities are hiring providers that are from outside of the country to help with the staffing shortages. For example, one facility I worked with employed nurses that were from the Philippines and Africa, to help with nursing shortages. This phenomenon is not new and help physicians and nurses alike from other countries receive an expedited Visa authorization process in order to have these healthcare workers help with staff shortages (American Hospital Association, 2021).  While it may not be a new concept it seems that with healthcare provider shortages more facilities are using this method to help with increasing staff needs.

 

References

Amalberti, R., Vincent, C., Nicklin, W., & Braithwaite, J. (2019). Coping with more people with more illness. Part 1: The nature of the challenge and the implications for safety and quality. 
International Journal for Quality in Health Care
, 
31
(2), 154–158. 
https://doi.org/10.1093/intqhc/mzy235
Links to an external site.

American Hospital Association. (2021). 
Fact Sheet: Strengthening the Health Care Workforce | AHA
. Www.aha.org; American Hospital Association. 
https://www.aha.org/fact-sheets/2021-05-26-fact-sheet-strengthening-health-care-workforce
Links to an external site.

Healthy People 2030. (2018). 
Health Care Access and Quality – Healthy People 2030 | health.gov
. Health.gov. 
https://odphp.health.gov/healthypeople/objectives-and-data/browse-objectives/health-care-access-and-quality
Links to an external site.

Slonim, Anthony (2023). Top Challenges Facing Healthcare: Back to Basics.
 Physician Leadership Journal, 10
(2), 12-14. 
https://www.proquest.com/scholarly-journals/top-challenges-facing-healthcare-back-basics/docview/2788462727/se-2
Links to an external site.

 

 

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Brianna Johnson

Feb 26 9:10pm
| 
Last reply Mar 1 9:14pm

Reply from Brianna Johnson

Discussion 1 initial post:

Healthcare Issue
 

The rise in healthcare costs makes it very difficult for anyone to afford basic medical care. The gaps in health insurance coverage along with high deductibles leave people without insurance or underinsured. I work in a rural healthcare setting that resides in an underserved community. Most individuals that seek healthcare don’t do so until they’re very sick due to them having no insurance or not being able to afford the cost of what their health insurance doesn’t cover. Many of the individuals we see have to be transferred to other facilities for further care or evaluation, which costs them even more in healthcare bills. 40% of U.S. adults have delayed or refused medical care because of the cost (NHCC, 2024). 
 

Social Determinants Affected
 

Geographic location, income, and social support are the main social determinants that affect this health issue and influence how individuals determine their health outcomes. Unfortunately, individuals with poor social determinants are at an increased risk of experiencing chronic health problems, leading to increased hospital or clinic visits, and increased costs (McCarthy et al., 2022). Addressing the above social determinants can improve patient outcomes. 
 

Working to Solve the Issue
 

To address this issue, our facility has focused on what we can do to prevent chronic illnesses, such as early and preventative screening. Depending on the patient and their situation, these screenings can be free of charge. Providing preventive care services at low to no cost has shown to improve vaccination rates, increase screening for chronic conditions and cancers, and improve the overall health for individuals (CMS, 2024). 
 

References
 

CMS. (2024). 
Background: The affordable care act’s new rules on Preventive Care
. CMS.gov. 
https://www.cms.gov/cciio/resources/fact-sheets-and-faqs/preventive-care-background
Links to an external site.
 

McCarthy, M. L., Li, Y., Elmi, A., Wilder, M. E., Zheng, Z., & Zeger, S. L. (2022, September). 
Social Determinants of health influence future health care costs in the Medicaid cohort of the District of Columbia study
. The Milbank quarterly. 
https://pmc.ncbi.nlm.nih.gov/articles/PMC9576227/#:~:text=economically%20stressed%20neighborhood.-,5,and%20beyond%20past%20comorbidity%20burdens
Links to an external site.
.
 

NHCC (2024, May 3). 
Identifying challenges facing the U.S. Healthcare System 
. NHCC. 
https://healthcarecouncil.com/identifying-challenges-facing-the-u-s-healthcare-system/#:~:text=According%20to%20the%20Kaiser%20Family%20Foundation%2C%20half,seeing%20costs%20increase%2C%20primarily%20brought%20about%20by
Links to an external site.
:
 

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Jesse Cochran

Feb 26 8:24pm
| 
Last reply Mar 1 2:54pm

Reply from Jesse Cochran

Healthcare issue

 

Access to healthcare is a significant national challenge, as many individuals encounter obstacles that prevent them from obtaining the care they need. These obstacles can include financial difficulties, lack of insurance, and limited healthcare options, especially in rural or underserved regions (Franco et al., 2021). In healthcare settings, this issue often results in delayed treatments, increased emergency room visits, and pressure on healthcare resources. Patients may also experience heightened stress, which negatively impacts their health and recovery.

Social Determinants

Key social determinants that influence this issue are income, education, geographic location, and social support, all of which affect a person’s ability to access and navigate healthcare services (Pratt et al., 2023). These factors play a strong role in a person’s ability to access and navigate healthcare services, making it crucial to address them for better patient outcomes. Overall, addressing these factors is essential for improving health outcomes.

Addressing the issue

To address the issue of access to healthcare, my health system has made several changes. One of the main changes is the expansion of telehealth services, which allows patients, especially those in rural areas, to see healthcare providers remotely, reducing the need for travel. The system has also introduced sliding-scale payment options for patients with financial difficulties, making healthcare more affordable for those with lower incomes. Additionally, the health system works with community organizations to provide education and resources, such as health fairs and workshops, to help patients understand affordable healthcare options and how to enroll in insurance (Maganty et al.,2023). These changes have improved access to care, reduced emergency room visits, and helped more people receive timely treatment, especially those who might have otherwise gone without. By focusing on factors like income, education, and location, these efforts aim to improve health outcomes for all patients.

 

 

 

 

Sources

 

Franco, C. M., Lima, J. G., & Giovanella, L. (2021). Primary healthcare in rural areas: access, organization, and health workforce in an integrative literature review. Atenção primária à saúde em áreas rurais: acesso, organização e força de trabalho em saúde em revisão integrativa de literatura. 
Cadernos de saude publica
, 
37
(7), e00310520. 
https://doi.org/10.1590/0102-311X00310520
Links to an external site.

Maganty, A., Byrnes, M. E., Hamm, M., Wasilko, R., Sabik, L. M., Davies, B. J., & Jacobs, B. L. (2023). Barriers to rural health care from the provider perspective. 
Rural and remote health
, 
23
(2), 7769. https://doi.org/10.22605/RRH7769

Pratt, C., Taylor, R., & Smith, S. D. (2023). Health Equity and Access to Health Care as a Social Determinant of Health: The Role of the Primary Care Provider. 
Primary care
, 
50
(4), 549–559. https://doi.org/10.1016/j.pop.2023.04.006

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Ritah L N Kabonge

Feb 26 8:16pm
| 
Last reply Mar 1 9:39pm

Reply from Ritah L N Kabonge

MAIN POST.
 

 

Mental Health – A National Health Issue. 
 

One of the most pressing issues facing healthcare today is mental health disorders that has swept across multiple demographic groups in the country. Ongoing concerns like the COVID –19 pandemic, economic instability and social isolation have worsened mental health issues leading to a heightened demand for mental health services
 
(Reform of the national institute of mental health, 2025). 
The surge has highlighted the existing gaps in mental health provision, accessibility as well as stigma, making it a critical situation that calls for immediate attention.
 

The impact on work setting.
 

The rising demand for mental health services has placed a significant burden on healthcare systems, impacting healthcare operation costs, provider workload and patient outcomes
 
(James, 2020)
.
 The limited resources in rural and underserved areas, including shortages of qualified mental health professionals and high patient loads has led to an increase in the complexity of the healthcare issue resulting in delayed care, overcrowding in the E.D., unmet needs for many individuals suffering from mental health conditions. As a bedside nurse working in the hospital, I have seen first-hand how discharges are delayed because of limited psychiatrists and how work sometimes gets more stressful, which leads to staff burnout and healthcare outcomes for the patients.
 

Social Determinants Affecting Mental Health.
 

Research by 
Satcher and Shim (2024) supports the fact that 
s
everal social determinants of health (SDOH) play a significant role in mental health outcomes, the most important ones being economic stability, access to healthcare, lower levels of education and support networks. Economic stability can lead to increased stress, anxiety, and depression yet limited access to mental health services further worsens the condition 
(
Fisher
 et al.,
 2023
).
 
 

Trinity Health’s Response to the Mental Health crisis.
 

In response to the rising mental health crisis, Trinity Health has applied a comprehensive strategy that has taken steps to improve their mental health services and some of the changes include hiring more mental health specialists like psychologists, social workers and psychiatrists, it has initiated programs to integrate mental health screenings within primary care settings, has increased its community outreach efforts, has increased support for healthcare workers and has expanded their Telehealth services, all in an effort to improve access, reduce stigma and to foster community wellness. By addressing the root causes, they are contributing to improved mental health outcomes in their patient population.
 

 

References. 
 

 

Fisher, M., Newton, C., & Sainsbury, E. (2023). 
Mental health social work observed (national institute social services library)
 (1st ed.). Routledge. 
 

 

James, J. M. (2020). 
Mental health & mental illness
. Joan M. James.
 

 

Reform of the national institute of mental health: A proposal. (2025). 
Journal of Neurology and Neurocritical Care
, 
8
(1). 
https://doi.org/10.31038/jnnc.2025811
Links to an external site.
 

 

Satcher, D., & Shim, R. S. (2024). Chapter 11. a call to action: Addressing the social determinants of mental health. In 
The social determinants of mental health
 (pp. 235–254). American Psychiatric Association Publishing. 
https://doi.org/10.1176/appi.books.9781615378470.lg11
Links to an external site.
 

 

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Marissa Hansen

Feb 26 7:57pm
| 
Last reply Mar 1 10:33am

Reply from Marissa Hansen

National Health Care Issue:

 

Working in the pediatric and pediatric intensive care units, I noticed a gap in care regarding pediatric mental health. This is one of the reasons I decided to become a psychiatric mental health nurse practitioner. In a 2018 national health survey of over 1,400 practices that care for children, 85% said they found it challenging to obtain mental health services for children in their practice.  (Chien et al., 2022) 15% of children in America have a behavioral, mental, or developmental disorder that the MBDD diagnoses. There is a national shortage of mental health providers. These shortages affect children in rural areas and living in poverty at higher rates. (CDC, 2024) Inadequate treatment for children with mental health disorders can negatively impact their ability to learn and develop healthy relationships with others.  (
Factors Associated with Not Receiving Mental Health Services among Children with a Mental Disorder in Early Childhood in the United States, 2021–2022
, 2024)

 

Impact On Pediatric Units

 

The lack of mental health support leads to longer lengths of stay, increased complications during treatment, and higher risks for readmission. These children often experience higher rates of anxiety, feelings of distress, and inability to cooperate with medical staff. (
Why Children Are Stranded in the Hospital
, 2023) In my hospital, I have had children as young as seven attempt suicide. Taking care of children after a suicide attempt is challenging, and these patients often experience complex family dynamics. Taking care of these patients can put intense emotional distress on practitioners. (Wei et al., 2020) My hospital does not provide psychiatric treatment for children. In some cases, children are stuck at our hospital for days to weeks while we find placement. Younger children and children with severe cases are some of the most difficult to place. I feel defeated at times seeing children struggle in an unfamiliar environment without adequate treatment.

 

Implementations

 

One way we overcome the challenges of treating children with mental health disorders is by relying on our child life specialists. Child life specialists can reduce fear and anxiety and teach positive coping mechanisms. (Mayo Clinic College of Medicine & Science, 2016) When we have children with behavioral problems, we can provide therapeutic play and reward them with prizes for good behavior. Child life specialists work with nurses and support staff to provide education on how to create a positive and nurturing environment for children with mental health disorders. We are taught to acknowledge and validate children’s feelings and develop routines to make a more comfortable environment where children know what to expect from staff.

 

Factors Associated With Not Receiving Mental Health Services Among Children With A Mental Disorder in Early Childhood in the United States, 2021–2022
. (2024). https://www.cdc.gov/pcd/issues/2024/24_0126.htm

‌Chien, A. T., Leyenaar, J., Tomaino, M., Woloshin, S., Leininger, L., Barnett, E. R., McLaren, J. L., & Meara, E. (2022). Difficulty Obtaining Behavioral Health Services for Children: A National Survey of Multiphysician Practices. 
The Annals of Family Medicine
, 
20
(1), 42–50. https://doi.org/10.1370/afm.2759

‌CDC. (2024). 
Child Mental Health: Rural Policy Brief
. Rural Health. 
https://www.cdc.gov/rural-health/php/policy-briefs/child-mental-health-policy-brief.html
Links to an external site.

Why Children Are Stranded in the Hospital
. (2023, May 9). Penn LDI. 
https://ldi.upenn.edu/our-work/research-updates/why-children-are-stranded-in-the-hospital-and-how-to-get-them-out/
Links to an external site.

Wei, H., Kifner, H., Dawes, M. E., Wei, T. L., & Boyd, J. M. (2020). Self-care Strategies to Combat Burnout Among Pediatric Critical Care Nurses and Physicians. 
Critical Care Nurse
, 
40
(2), 44–53. https://doi.org/10.4037/ccn2020621

‌Mayo Clinic College of Medicine & Science. (2016). 
Child Life Specialist
. Mayo.edu. https://college.mayo.edu/academics/explore-health-care-careers/careers-a-z/child-life-specialist/

‌

 

 

‌

 

‌

 

 

 

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Keisha Reed

Feb 26 7:54pm
| 
Last reply Mar 5 12:32pm

Reply from Keisha Reed

                             Nursing and Clinician Shortage: A National Healthcare Issue
 
 

Nursing is a highly demanding and stressful profession. Many nurses are experiencing burnout, fatigue, and dissatisfaction with their working conditions at the bedside. According to a study by Petterson et al. (2015), cited in Broome and Marshall (2020), by the year 2035, there is expected to be a shortage of 33,000 primary care physicians. Additionally, it is estimated that 20% of nurses leave their jobs within the first year of employment. 
 

Impact on the Work Setting
 

Due to
nursing shortage
s, hospitalized patients are at an increased risk of unsafe events, such as falls, reduced quality of care, poor health outcomes, and decreased patient satisfaction ratings (Quaranta, 2024). According to Lasater et al. (2021, cited in Quaranta, 2024), “The lack of nurses in hospital settings increases errors, morbidity, and mortality, and decreases patient satisfaction.” As healthcare evolves and patient demographics change, with patients living longer, there is a strong push to enhance the quality of care. Hospital reimbursement models are increasingly focusing on quality of care rather than volume of services. Furthermore, there is a growing demand for patient care outside of hospital settings, leading to a shift towards more home care and telemedicine. However, the shortage of nurses and clinicians can negatively impact the quality of care delivered through these alternatives as well.
 

Social Determinants Affecting Shortage
 

Some argue that the COVID-19 pandemic significantly contributed to the trend of nurses leaving the profession, while I contend that COVID may have merely been the last straw. Nurses are facing burnout, fatigue, and dissatisfaction with their working conditions at the bedside. Sixty percent of the 3.2 million nurses in the United States are employed in hospital settings (Quaranta, 2024). In 2021, over 100,000 nurses exited the profession (Auerbach et al., 2022, as cited in Quaranta, 2024). According to Quaranta (2024), nurses leave bedside positions due to unfavorable working conditions, including unsafe patient ratios, low pay, long shifts, and poor management. 
 

Furthermore, financial concerns contribute to the shortages of nursing staff. Hospitals spend substantial amounts of money on hiring, training, paying salaries, covering insurance, and providing benefits such as retirement plans. These expenses may hinder hospitals from hiring additional nurses. 
Hospital CEOs, policymakers, and legislators may not fully grasp the importance of adequate nurse staffing for ensuring the safety of both patients and nurses, improving patient outcomes, and reducing nurse burnout. Additionally, the personal experiences of those in positions of power can significantly influence these decisions, making them less empathetic to the actual needs of nurses and patients.
 

Healthcare System Response 
 

There is a growing population of aging individuals with health problems. In brief, people are living longer due to advancements in medicine and technology. According to Amalberti et al. (2019), “By the 2050s, over 50% of the global population will be living with a chronic illness.”
 

In response to the shortage of clinicians, some states are granting Advanced Practice Registered Nurses (APRNs) greater autonomy and flexibility. While this may help alleviate the shortage of clinicians, it does not address the ongoing shortage of nurses or the trend of nurses leaving the bedside profession. Many states in the United States do not have mandated nurse-to-patient ratios. There are currently bills pending that aim to address nursing ratios, but they have not made progress or received approval.
 

Conclusion 
 

The
nursing and clinician shortage remains a pressing national healthcare issue
with far-reaching consequences for patient care and safety. The challenges faced by nurses, including burnout, inadequate working conditions, and insufficient staffing ratios, contribute to high turnover rates and diminished quality of care. As the healthcare landscape evolves, it is crucial to address these underlying issues to cultivate a sustainable workforce. While initiatives to enhance the autonomy of Advanced Practice Registered Nurses (APRNs) may provide some relief, a comprehensive strategy that also focuses on improving the workplace environment for all nurses is necessary. This includes advocating for mandated nurse-to-patient ratios, addressing financial constraints for hospitals, and fostering supportive management practices. By prioritizing these changes, we can ensure a healthier future for both healthcare professionals and the patients they serve.
 

 

References 
 

Amalberti, R., Vincent, C., Nicklin, W., Braithwaite, J. (2019).  Coping with more people with more illness part 1: The nature of the challenge and the implications for safety and quality. 
International Journal for Quality in Health Care
, vol 31 (2), pages 154–158.
 
https://doi.org/10.1093/intqhc/mzy235
Links to an external site.
 

Broome, M., & Marshall, E. (2020). 
Transformational Leadership in Nursing (3rd ed.). Springer Publishing LLC.
 
https://mbsdirect.vitalsource.com/books/9780826135056
Links to an external site.
 

Quaranta, N. (2024). Team nursing: An innovative approach to address the nursing shortage. 
MEDSURG Nursing
, 
33
(2), 79–84. 
https://doi.org/10.62116/MSJ.2024.33.2.79
Links to an external site.
 

 

.
 

 

 

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Antonia Debellotte

Feb 26 7:53pm
| 
Last reply Mar 1 1:19pm

Reply from Antonia Debellotte

National Healthcare Issue

One of the most pressing national healthcare issues today is the accessibility of mental health services. Despite the growing awareness of the importance of mental health, many individuals still face significant barriers to obtaining the care that they need. These barriers can include a lack of available providers, financial constraints, stigma surrounding mental health issues, and limited insurance coverage for mental health services(Coombs et al.,2021). Moreover, the COVID-19 pandemic has only exacerbated these challenges, leading to increased demand for mental health care while simultaneously straining the resources available(American Psychiatric Association,n.d) Review of Current Healthcare Issues.

Impact on My Work Setting

I currently work in a community health hospital serving a diverse population; the issue of mental health access profoundly impacts our healthcare delivery operations and the overall health outcomes of our patients. Many of our patients face socioeconomic challenges, such as low income and lack of transportation, which can hinder their ability to seek timely mental health care(WHO,n.d). Furthermore, the stigma associated with mental illness can prevent individuals from reaching out for help, leading to worsening conditions that strain healthcare organizations’ emergency services and other healthcare services, healthcare resources (Corrigan,2004).

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Social Determinants  of Health Affecting Mental Health Access

The social determinants of health (SDOH) that most significantly affect mental health access include economic stability, social and community context, and access to healthcare. Moreover, lower-income individuals may lack insurance coverage or the financial means to afford out-of-pocket costs. At the same time, those in marginalized communities may experience a lack of culturally competent care or face discrimination, further encouraging them to seek help (Kirkbride et al.,2024).

Response from My Healthcare Organization

In response to the mental health access issue,  my healthcare organization has implemented several strategic changes to improve mental health service delivery and reduce barriers to care. For example, my organization has expanded its mental service team by hiring additional licensed counselors, social workers, and mental health providers to reduce appointment wait times. Furthermore, my organization has initiated a telehealth program, allowing patients to access mental health services from the comfort of their homes, which is particularly beneficial for individuals facing transportation issues (Bashshur et al.,2016).

Additionally, my healthcare organization has partnered with local organizations to provide outreach and education programs about mental health services available in our community. This includes workshops to reduce mental health stigma and increase awareness of mental health issues; overall, my organization has witnessed positive engagement from members of the community (Ahad et al.,2023). My organization also provides sliding scale fees based on income, ensuring that our services are accessible to individuals who may not be able to afford the services they need.

In conclusion, addressing the issue of mental health access requires a multifaceted approach that considers the various social determinants of health affecting our patients. My healthcare organization’s proactive measures are a step in the right direction. Moreover, ongoing collaboration and innovation will ensure that all individuals in our community and beyond receive the mental health support they need.

References

Ahad, A. A., Sanchez-Gonzalez, M., & Junquera, P. (2023). Understanding and addressing mental health stigma across cultures for improving psychiatric care: A narrative review. 
Cureus
. https://doi.org/10.7759/cureus.39549

American Psychological Association. (n.d.). Monitor on psychology. https://www.apa.org/monitor/2021/01/trends-national-crisis

Bashshur, R. L., Shannon, G. W., Bashshur, N., & Yellowlees, P. M. (2016). The empirical evidence for telemedicine interventions in mental disorders. 
Telemedicine and E-Health
, 
22
(2), 87–113. https://doi.org/10.1089/tmj.2015.0206

Coombs, N. C., Meriwether, W. E., Caringi, J., & Newcomer, S. R. (2021). Barriers to healthcare access among U.S. adults with mental health challenges: A population-based study. 
SSM – Population Health
, 
15
, 100847. https://doi.org/10.1016/j.ssmph.2021.100847

Corrigan, P. (2004). How stigma interferes with mental health care. 
American Psychologist
, 
59
(7), 614–625. https://doi.org/10.1037/0003-066x.59.7.614

Kirkbride, J. B., Anglin, D. M., Colman, I., Dykxhoorn, J., Jones, P. B., Patalay, P., Pitman, A., Soneson, E., Steare, T., Wright, T., & Griffiths, S. L. (2024). The social determinants of mental health and disorder: Evidence, prevention and recommendations. 
World Psychiatry
, 
23
(1), 58–90. https://doi.org/10.1002/wps.21160

World Health Organization. (n.d.-d). 
Social Determinants of Mental Health
. World Health Organization. https://www.who.int/publications/i/item/9789241506809

 

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Krista Lee Hemphill

Feb 26 7:27pm
| 
Last reply Mar 1 9:22pm

Reply from Krista Lee Hemphill

The national healthcare issue I chose for this discussion is the shortage of nurses in healthcare. There are many factors to consider when discussing the nursing shortage. Burnout, pandemic challenges, unhealthy working environments, pay rate variances, staffing constraints, management issues, nurses retiring, nurses leaving the profession early, and not enough nursing educators all contribute to the current nursing shortage (Speroni, 2024).

Nurse executives suggest the following to combat the nursing shortage: listening to nurses’ concerns, prioritizing workplace culture, adjusting protocols, increasing diversity and representation in nursing, addressing the need for nurse educators, and supporting nurses leading healthcare innovation (Jean, 2023).

I no longer work in bedside nursing, but my background is in the emergency department and the nursing shortage affects the emergency department. Short staffed emergency departments can lead to longer wait times, overcrowded waiting rooms, patient dissatisfaction, medication errors, poor patient outcomes, nurse burnout, and hostility from patients or coworkers.

Nurses play a huge part in addressing health and social inequities by promoting quality healthcare for all (Tiase et al., 2022). So, social determinants of health are affected with the shortage of nurses. Longer wait times can prevent access to care. The quality of care decreases with the shortage, which can lead to poor outcomes among patients, especially vulnerable patients.

In my experience, I have seen very little done to fix the nursing shortage. The facility I used to work for did offer sign on bonuses and recently created a shared governance. At times, they would offer incentive pay if staffing was critical, but that rarely happened. The manager would be open to suggestions on improvement, but the environment stayed the same.

 

References

Jean, J. (2023, November 10). 
Proven strategies from nurse execs to combat the nursing shortage in 2022
. NurseJournal. https://nursejournal.org/articles/proven-strategies-to-survive-the-nursing-shortage-2022/

Speroni, K. (2024). Overview and Summary: Today’s Nursing Shortage: Workforce Considerations. 
Online Journal of Issues in Nursing
, 
29
(2). 
https://doi.org/10.3912/ojin.vol29no02manos
Links to an external site.

Tiase, V., Crookston, C. D., Schoenbaum, A., & Valu, M. (2022). Nurses’ role in addressing social determinants of health. 
Nursing
, 
52
(4), 32–37. https://doi.org/10.1097/01.nurse.0000823284.16666.96

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Yokasta Campana

Feb 26 7:12pm
| 
Last reply Feb 26 7:55pm

Reply from Yokasta Campana

Module 1: Main Post

Culturally Competent Care in Home Health Care

Culturally competent care is essential in-home health care, where patients come from diverse backgrounds. It ensures respectful and effective care, improving communication and patient trust (Shepherd et al., 2019). Without cultural competence, misunderstandings can occur, leading to poor health outcomes.

Impact on Home Health Care

Home health providers work with patients from different cultures, languages, and beliefs. If caregivers lack cultural awareness, patients may struggle to follow treatment plans. For example, a Muslim patient may need dietary accommodations, while a Spanish-speaking patient may require a translator (Purnell & Fenkl, 2019). Often, our nurses encounter multiple challenges when patients struggle to follow doctors’ orders after hospitalization. This issue is most evident in patients for whom English is a second language or those with low literacy skills.

Key Social Factors Affecting Culturally Competent Care

Language barriers
: Patients with limited English may misunderstand instructions.

Economic status
: Low-income patients may have trouble accessing culturally appropriate care.

Education and health literacy
: Different cultural beliefs affect how patients understand health conditions.

Bias and discrimination
: Implicit bias can lead to unequal treatment.

How Home Health Care Agencies Are Responding

To address these challenges, home health organizations are:

Providing Cultural Competency Training
: Staff receive education on cultural awareness and communication.

Offering Language Support
: Agencies use bilingual staff, interpreters, and translation apps.

Tailoring Care to Patient Needs
: Care plans respect cultural and religious preferences.

Updating Policies
: Agencies follow national standards for culturally appropriate care.

For example, some agencies such as my workplace match Spanish-speaking patients with bilingual caregivers or adjust meal plans to fit religious diets.

Conclusion

Culturally competent care is vital for quality home health care. Addressing language barriers, training staff, and respecting cultural preferences improve patient outcomes and satisfaction.

References

Broome, M., & Marshall, E. S. (2021). Transformational leadership in nursing: From expert clinician to influential leader (3rd ed.). Springer.

Purnell, L. D., & Fenkl, E. A. (2019). Transcultural diversity and health care. In L. D. Purnell & E. A. Fenkl (Eds.), Handbook for culturally competent care(pp. 1–15).

Springer. https://doi.org/10.1007/978-3-030-21946-8_1

Shepherd, S. M., Willis-Esqueda, C., Newton, D., Sivasubramaniam, D., Paradies, Y., & Dunn, K. (2019). The challenge of cultural competence in the workplace: Perspectives

of healthcare providers. BMC Health Services Research, 19(1), 135. https://doi.org/10.1186/s12913-019-3959-7

 

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Daniela Constantin

Feb 26 6:23pm
| 
Last reply Feb 28 1:16pm

Reply from Daniela Constantin

National Healthcare Issue: Heart Disease

Cardiovascular disease is a significant national health concern that continues to impact millions of people across the United States. Cardiovascular diseases (CVD), being the leading cause of death, account for about one in four deaths each year (Tsao et al., 2022). The occurrence of conditions such as coronary artery disease, heart failure, and arrhythmias imposes a significant strain on the healthcare system. However, the impact of heart disease extends beyond the healthcare system. It affects society’s social and economic structure, leading to decreased productivity due to illness and increased healthcare costs. Heart disease burdens healthcare providers, facilities, and resources, from initial diagnosis and prevention to efficient management and prolonged care.

Impact on the Work Setting

Heart disease significantly impacts daily operations in healthcare settings, particularly in telemetry departments. Telemetry units, which monitor patients with acute cardiac conditions, are experiencing increased patient volumes due to the rising rates of cardiovascular disease. The continuous monitoring of patients’ vital signs, such as heart rate and rhythm, blood pressure, and oxygen levels, is essential in managing those with heart disease. Nonetheless, as the need for this type of care rises, telemetry units encounter difficulties sustaining adequate staffing and handling a patient surge. This may result in extended wait times for admission, a higher patient-to-nurse ratio, and increased pressure on healthcare professionals to deliver prompt interventions. Furthermore, managing patients with multiple comorbidities common in individuals with heart disease adds complexity to their care, requiring multidisciplinary teams to collaborate effectively (Batchelor et al., 2023).

Social Determinants Affecting Heart Disease

Several social determinants of health (SDOH) significantly influence the onset and advancement of heart disease. Socioeconomic status (SES) is one of the most significant factors, as individuals with lower SES are more likely to experience poor cardiovascular health due to limited access to healthcare, lower-quality diets, and increased stress levels (Yong et al., 2023). Additionally, individuals residing in low-income areas may lack access to healthcare facilities or preventive care, leading to delayed diagnoses and inadequate management of heart conditions. Access to healthcare is another key determinant, as individuals without insurance or with insufficient coverage may not have regular check-ups or timely interventions, leading to a deterioration of their health (Kris-Etherton et al., 2020). Health habits also impact heart disease, with poor lifestyle choices such as smoking, physical inactivity, and an unhealthy diet contributing significantly to cardiovascular risks. Environments that limit access to healthy foods or safe spaces for exercise exacerbate these factors, increasing the overall burden of heart disease, especially in disadvantaged communities.

Healthcare System Response and Changes Implemented

Healthcare systems have made several adjustments in response to the growing burden of heart disease. One significant change has been integrating advanced monitoring technologies in care settings. These technologies, such as continuous ECG monitors and remote patient monitoring systems, allow for real-time monitoring of patients, enabling healthcare providers to identify early signs of deterioration, such as arrhythmias before they become life-threatening. This proactive approach has improved patient outcomes by enabling timely interventions (Kuan et al., 2022).

Expanding telehealth services is another response to the increased demand for heart disease management. Telehealth allows healthcare providers to monitor patients remotely, which has been particularly beneficial for individuals with chronic heart conditions who may not require hospitalization but still need frequent monitoring. By utilizing telehealth platforms, healthcare systems can extend care beyond the hospital setting, offering greater patient convenience and reducing the burden on in-person resources (Kuan et al., 2022).

Additionally, healthcare systems have emphasized the importance of multidisciplinary care teams in managing heart disease. In these teams, cardiologists, nurses, dietitians, physical therapists, and pharmacists collaborate to provide comprehensive care that addresses the multiple aspects of heart disease management, from medication adherence to lifestyle modifications and rehabilitation. This approach has been particularly effective in improving long-term outcomes for patients with heart disease, as it ensures holistic care and fosters patient education and empowerment. The effectiveness of these teams in providing comprehensive care reassures patients and their families that they are receiving the best possible treatment, enhancing their confidence in the healthcare system (Batchelor et al., 2023).

In response to socioeconomic barriers to heart disease management, many healthcare organizations have worked to improve access to care through programs such as community health initiatives, mobile clinics, and expanded insurance coverage. These initiatives aim to bridge gaps in healthcare access, ensuring that individuals from underserved communities can receive timely interventions and preventive care. In addition, hospitals have implemented patient education programs to raise awareness about heart disease prevention, focusing on healthy lifestyle choices such as improved diet, regular exercise, and smoking cessation. These programs provide valuable information and empower individuals to take control of their health, fostering a sense of responsibility and encouraging proactive health behaviors. These programs also empower individuals to make informed decisions and take an active role in their well-being by equipping them with the knowledge and tools to manage their health (Kris-Etherton et al., 2020).

Heart disease remains a significant
healthcare issue in the United States
, with far-reaching consequences for individuals, healthcare providers, and systems. The increasing demand for care has highlighted the need for advanced technologies, expanded access to care, and interdisciplinary treatment approaches. While social determinants such as socioeconomic status and access to healthcare significantly affect the prevalence and outcomes of heart disease, healthcare systems have implemented strategies aimed at improving care and reducing disparities. These efforts are essential in addressing the ongoing challenges of heart disease and improving the quality of life for individuals affected by this condition (Tsao et al., 2022).

References

Batchelor, W. B., Anwaruddin, S., Wang, D. D., Perpetua, E. M., Krishnaswami, A., Velagapudi, P., Wyman, J. F., Fullerton, D., Keegan, P., Phillips, A., Ross, L., Maini, B., Bernacki, G., Panjrath, G. S., Lee, J., Geske, J. B., Welt, F., Thakker, P. D., Deswal, A., … Holmes, D. (2023). The multidisciplinary heart team in cardiovascular medicine: Current role and future challenges. 
JACC: Advances, 2
(1). 
https://doi.org/10.1016/j.jacadv.2022.100160
Links to an external site.

Kris-Etherton, P. M., Petersen, K. S., Velarde, G., Barnard, N. D., Miller, M., Ros, E., O’Keefe, J. H., Williams, K., Sr, Horn, L. V., Na, M., Shay, C., Douglass, P., Katz, D. L., & Freeman, A. M. (2020). Barriers, opportunities, and challenges in addressing disparities in diet-related cardiovascular disease in the United States. 
Journal of the American Heart Association, 9
(7), e014433. 
https://doi.org/10.1161/JAHA.119.014433
Links to an external site.

Kuan, P. X., Chan, W. K., Fern Ying, D. K., Rahman, M. A. A., Peariasamy, K. M., Lai, N. M., Mills, N. L., & Anand, A. (2022). Efficacy of telemedicine for the management of cardiovascular disease: A systematic review and meta-analysis. 
The Lancet Digital Health, 4
(9), e676–e691. 
https://doi.org/10.1016/S2589-7500(22)00124-8
Links to an external site.

Tsao, C. W., Aday, A. W., Almarzooq, Z. I., Alonso, A., Beaton, A. Z., Bittencourt, M. S., Boehme, A. K., Buxton, A. E., Carson, A. P., Commodore-Mensah, Y., Elkind, M. S. V., Evenson, K. R., Eze-Nliam, C., Ferguson, J. F., Generoso, G., Ho, J. E., Kalani, R., Khan, S. S., Kissela, B. M., … Martin, S. S. (2022). Heart disease and stroke statistics-2022 update: A report from the American Heart Association. 
Circulation, 145
(8), e153–e639. 
https://doi.org/10.1161/CIR.0000000000001052
Links to an external site.

Yong, C., Palaniappan, L., Ibebuogu, U., Tran, A., Bacong, A. M., Lundberg, G., & Watson, K. (2023). Assessing and addressing social determinants of cardiovascular health: JACC state-of-the-art review. 
Journal of the American College of Cardiology, 81
(14), 1368–1385. 
https://doi.org/10.1016/j.jacc.2023.01.042
Links to an external site.

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Georgina Ann Adkins

Feb 26 5:39pm
| 
Last reply Feb 27 9:15pm

Reply from Georgina Ann Adkins

The Impact of Vascular Access Disparities on Dialysis Care

One of the biggest
challenges in healthcare
today, especially for patients with kidney disease, is vascular access for dialysis. For patients who require hemodialysis, their access type can make a significant difference in their overall health. Ideally, an arteriovenous fistula (AVF) or graft (AVG) should be placed before starting dialysis, but many patients, particularly those from underserved communities, begin treatment with a central venous catheter (CVC) instead. Unfortunately, catheters come with serious risks, including a higher chance of infection, blood clots, and hospitalizations (Allon et al., 2018).

 

Social Determinants of Health and Vascular Access

It’s easy to assume that vascular access issues are just a medical problem, but in reality, social determinants of health (SDOH) play a major role. Many patients don’t receive early kidney care because of financial barriers, transportation issues, or a lack of awareness about their condition. Research shows that individuals from lower-income backgrounds are significantly more likely to start dialysis with a catheter rather than a fistula or graft, which increases their risk for complications (Pisoni et al., 2018). Additionally, education is a key factor—patients who don’t fully understand their condition and the importance of vascular access may not seek care in time, leading to last-minute catheter placements Review of Current Healthcare Issues.

 

How does this issue affect my work?

As a Clinical Educator RN, I see the consequences of vascular access disparities every day. When a patient starts dialysis with a catheter instead of a fistula or graft, it often leads to frequent hospitalizations due to infections or clotting. I’ve worked with patients who return to the clinic multiple times with bloodstream infections, requiring antibiotics, hospital stays, and sometimes even surgical interventions. This not only impacts patient quality of life but also strains healthcare resources, increasing costs and workload for providers (Ravani et al., 2013).

 

How is my organization addressing the issue?

Recognizing the serious impact of vascular access complications, my organization has taken several steps to improve outcomes:

Early Patient Education:
 We’ve expanded pre-dialysis education efforts, ensuring that patients and families understand why AVF placement is important.

Vascular Access Coordinators:
 Specialists now work closely with nephrologists and surgeons to schedule access procedures before dialysis starts.

Telehealth and Mobile Clinics:
 To address transportation barriers, we’ve increased telehealth options and set up mobile clinics for patients who struggle to reach appointments (Crews & Novick., 2018).

Community Partnerships:
 We collaborate with local health programs to identify at-risk patients early and connect them to the right care before they reach kidney failure.

 

These efforts have already made a difference—more patients are receiving timely AVF placements, and fewer are starting dialysis with a catheter. However, there’s still work to be done. Reducing health disparities requires continued advocacy, policy changes, and additional resources to ensure every patient has access to optimal vascular care.

Addressing social determinants of health isn’t just about improving clinical outcomes—it’s about improving lives. By tackling these barriers head-on, we can create a healthcare system that gives every patient the best chance for a healthier future.

 

References

Allon, M., Imrey, P. B., Cheung, A. K., Radeva, M., Alpers, C. E., Beck, G. J., Dember, L. M., Farber, A., Greene, T., Himmelfarb, J., Huber, T. S., Kaufman, J. S., Kusek, J. W., Roy-Chaudhury, P., Robbin, M. L., Vazquez, M. A., Feldman, H. I., & Hemodialysis Fistula Maturation (HFM) Study Group (2018). Relationships Between Clinical Processes and Arteriovenous Fistula Cannulation and Maturation: A Multicenter Prospective Cohort Study. 
American journal of kidney diseases: the official journal of the National Kidney Foundation, 71
(5), 677–689. 
https://doi.org/10.1053/j.ajkd.2017.10.027
Links to an external site.

Crews, D. C., & Novick, T. K. (2019). Social Determinants of CKD Hotspots. 
Seminars in nephrology, 39
(3), 256–262. 
https://doi.org/10.1016/j.semnephrol.2019.02.003
Links to an external site.

Pisoni, R. L., Zepel, L., Fluck, R., Lok, C. E., Kawanishi, H., Süleymanlar, G., Wasse, H., Tentori, F., Zee, J., Li, Y., Schaubel, D., Burke, S., & Robinson, B. (2018). International Differences in the Location and Use of Arteriovenous Accesses Created for Hemodialysis: Results from the Dialysis Outcomes and Practice Patterns Study (DOPPS). 
American journal of kidney diseases: the official journal of the National Kidney Foundation, 71
(4), 469–478. 
https://doi.org/10.1053/j.ajkd.2017.09.012
Links to an external site.

Ravani, P., Palmer, S. C., Oliver, M. J., Quinn, R. R., MacRae, J. M., Tai, D. J., Pannu, N. I., Thomas, C., Hemmelgarn, B. R., Craig, J. C., Manns, B., Tonelli, M., Strippoli, G. F., & James, M. T. (2013). Associations between hemodialysis access type and clinical outcomes: a systematic review. 
Journal of the American Society of Nephrology: JASN, 24
(3), 465–473. 
https://doi.org/10.1681/ASN.2012070643
Links to an external site
. Review of Current Healthcare Issues

NRNP 6675 final exam Walden university Question 1                                                                 1 pts

A claim of malpractice requires that a patient/plaintiff prove which of the following? Select all that apply.

Group of answer choices

 

The existence of a client-professional relationship – duty to care.

 

Behavior below the appropriate standard of care for professionals dealing in like circumstances.

 

A causal link between the practitioner’s failure to conform to treatment standards and harm to the patient.

 

Actual injury to the patient.

 

Question 4                                                               1 pts

The differences in the quality of healthcare across individuals or groups in regard to access, treatment options, and preventative services is known as which of the following?

Group of answer choices

 

Racism

 

Health disparities

 

Vulnerable populations

 

Social determinants of health

Question 5                                                             1 pts

The antipsychotics which are most likely to cause neuroleptic-induced parkinsonism are which have which of the following effects?

Group of answer choices

 

High potency drugs with low levels of anticholinergic activity.

 

Low potency drugs with low levels of anticholinergic activity.

 

High potency drugs with high levels of anticholinergic activity.

 

Low potency drugs with high levels of anticholinergic activity.

 

Question 7                                                                    1 pts

According to the AANP Process of Care Standards, performing or ordering preventative and diagnostic procedures based on the patient’s age and history is part of which of the following components?

Group of answer choices

 

Assessment of health status

 

Development of a treatment plan

 

Implementation of the treatment plan

 

Care priorities

 

Question 8                                                          1 pts

Cluster A personality disorders are more common in biological families of patients with which of the following disorders?

Group of answer choices

 

Depression

 

Obsessive-compulsive disorder

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Alcohol use disorders

 

Schizophrenia

 

NRNP 6675 final exam Walden university Question 9                                                          1 pts

At a minimum, a psychiatric evaluation in an emergency should include which of the following? Select all that apply.

Group of answer choices

 

Is the patient psychotic?

 

Is the patient suicidal or homicidal?

 

Is the problem organic, functional, or a combination?

 

Is it safe for the patient to be in the emergency room?

 

Question 10                                                                  1 pts

Acknowledging a person’s right to make choices, to hold views, and to take actions based on personal value is known as which of the following?

Group of answer choices

 

Justice

 

Fidelity

 

Beneficence

 

Respect for autonomy

 

Question 11                                                                     1 pts

Which of the following is consistent with recommendations regarding assessing for suicidal ideations?

Group of answer choices

 

The clinician should always ask about suicidal ideations as part of every mental status examination.

 

Assessing for suicidal ideations is only required if patient is depressed.

 

Asking a psychotic patient if they are having suicidal ideations is not advised as this could introduce the idea to the patient.

 

If a patient who has been threatening suicide becomes quiet and less agitated, it is safe to assume the suicidal ideations have subsided.

Question 12                                                        1 pts

A patient on lithium with a history of alcohol use disorder presents with dry mouth, ataxia, dizziness, abdominal pain, and slurred speech. The ARNP should do which of the following?

Group of answer choices

 

The ARNP recognizes this is likely a relapse on alcohol so sends the patient home to sleep it off.

 

The ARNP recognizes these are symptoms of mild to moderate lithium toxicity, decreases the lithium by half, and encourages the patient to drink more fluids.

 

The ARNP recognizes these are symptoms of mild to moderate lithium toxicity, discontinues the lithium immediately, orders lithium level, serum electrolytes, and renal function tests.

 

The ARNP recognizes these are symptoms of moderate to severe lithium toxicity, discontinues the lithium and tells the patient hemodialysis will most probably be needed.

 

Question 13                                                     1 pts

A method of therapy used to treat individuals with substance abuse based on the fundamental principle of a psychology that reinforced behaviors are likely to be repeated is known as which of the following?

Group of answer choices

 

Exposure therapy

 

Contingency management

 

Motivational interviewing

 

Cognitive behavioral therapy

 

Question 14                                                        1 pts

Which of the following are criteria for a particular suicide to be considered inevitable?

Group of answer choices

 

Strong genetic history of suicide in one or more family members.

 

A strong genetic loading of mental illness in the family.

 

The patient must have received the highest standard of treatment and that treatment failed.

 

All of the above.

 

Question 15                                               1 pts

“Walking on eggshells” and appeasement and avoidance behaviors by the victim is characteristic of which phase of the cycle of domestic violence?

Group of answer choices

 

Honeymoon phase

 

Abusive incident phase

 

Tension-building phase

 

Refractory phase

 

NRNP 6675 final exam Walden university Question 16                            1 pts

The NP can impact health policy and healthcare by doing which of the following?

Group of answer choices

 

Become an active member of local, state, and/or national NP organizations.

 

Become familiar with the resources available on NP organization websites.

 

Volunteer to serve on legislative committees within professional NP organizations.

 

All the above

 

Question 17                                                             1 pts

“Assumes complex and advanced leadership roles to initiate and guide change” is a NP core competency for which NP competency area?

Group of answer choices

 

Policy competencies

 

Quality competencies

 

Leadership competencies

 

Practice inquiry competencies

Question 87                                                                       1 pts

Which of the following selective serotonin-reuptake inhibitors (SSRIs) has the most pronounced effect on prolongation of QT interval?

Group of answer choices

 

Sertraline (Zoloft)

 

Citalopram (Celexa)

 

Escitalopram (Lexapro)

 

Fluoxetine (Prozac)

 

Question 88                                                                                  1 pts

Self-care strategies for the ARNP in preparing for the certification exam include all of the following EXCEPT:

Group of answer choices

 

Study in a distraction free environment.

 

Six to eight hours of sleep is recommended.

 

Drink lot of caffeine and eat high-concentrated sugars.

 

Plan to study for short periods of time over a longer time period.

 

Question 91                                                                          1 pts

An ARNP takes a position in which a specific amount is paid according to a set job description. This type of pay structure is known as which of the following?

Group of answer choices

 

Straight salary

 

Average percentage of net receipts

 

Base salary plus percentage

 

Hourly rate

 

Question 92                                                               1 pts

The treatment of choice for patients with histrionic personality disorder include which of the following?

Group of answer choices

 

Psychoanalytic oriented individual psychotherapy

 

Psychoanalytic oriented group psychotherapy

 

Exposure therapy

 

A or B

 

Question 93                                                                        1 pts

In the judicial system one organization may publish one standard of care and an expert my testify to an alternate version of the standard of care. In this scenario who is the final arbiter of the standard of care?

Group of answer choices

 

The organization where the practitioner worked at the time

 

The judicial system

 

The expert testifying

 

The professional organization for the practitioner

 

Question 95                                                                    1 pts

The ARNP working as an at will employee realizes which of the following?

Group of answer choices

 

Unless the ARNP has a contract for a specified term of employment, the employee has no legal right to a job.

 

Employment will not be covered by equal opportunity or disability laws.

 

He or she must negotiate terms of employment on a piecemeal basis.

 

A and C only

 

Question 96                                            1 pts

Being knowledgeable about one’s own thoughts, feelings, and sensations as well as the ability to reflect on how these can affect one’s interactions with others is known as which of the following?

Group of answer choices

 

Cultural Awareness

 

Cultural Competence

 

Cultural Humility

 

Cultural Sensitivity

 

Question 97                                                  1 pts

A late-appearing adverse effect of neuroleptic drugs is known as which of the following?

Group of answer choices

 

Akathisia

 

Parkinsonism

 

Neuroleptic malignant syndrome

 

Neuroleptic-induced tardive dyskinesia

 

Question 99                                                1 pts

Type of employment in which either party may terminate for any reason at any time is known as which of the following?

Group of answer choices

 

Locum tenens

 

At will employment

 

Employment by contract

 

Profit sharing employment

 

Question 100                                                                  1 pts

The obligation to not inflict harm or balancing unavoidable harm with benefits of good achieved is known as which of the following?

Group of answer choices

 

Fidelity

 

Beneficence

 

Non-maleficence

 

Respect for autonomy

National healthcare issue/ stressor – Opioid use disorder (OUD)

National Healthcare Issue

Opioid use disorder (OUD) is characterized by the persistent consumption of opioids resulting in clinically significant suffering or impairment. The symptoms of this sickness encompass an intense compulsion to utilize opioids, heightened opioid tolerance, and withdrawal syndrome upon cessation of opioid use. Consequently, OUD may encompass a spectrum from opioid dependency to addiction. Opioid Use Disorder (OUD) impacts more than 16 million individuals globally and exceeds 2.1 million in the United States. Opioid dependency and addiction result from a multitude of biochemical, environmental, genetic, and psychological influences. The majority of opioids in circulation are prescribed; however, a significant quantity is acquired unlawfully. Following a reasonably short duration, several people utilizing opioids exhibit opioid dependency. Opioid dependency may be present as physical dependence, psychological dependence, or a combination of both. Patients reliant on opioids will have withdrawal symptoms if opioids are discontinued suddenly. Consequently, numerous opioid-dependent individuals may want ongoing access to opioids, through either lawful or unlawful channels, to avert withdrawal symptoms. Persistent opioid dependency can result in addiction and unregulated opioid use (Dydyk et al., 2024).

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Impact On Work Setting.

Opioid Use Disorder has a significant impact on my work environment, affecting both healthcare professionals and patients. Patients often who have opioid use disorder sometimes resort to self-injurious behaviors to obtain prescriptions, which leads to a heavier workload and high emotional demands on staff. This can result in burnout and fewer healthcare providers, as many patients require complex, long-term care. Additionally, the high emotional demands and frequent exposure to trauma can contribute to fatigue and secondary traumatic stress among staff. According to Gabriel and Aguinis (2021), burnout arises from prolonged work-related stress.
Individuals experiencing burnout are emotionally exhausted
and exhibit negativity and detachment from their jobs, resulting in diminished performance, stifled creativity and innovation, workplace accidents, absenteeism, and both physical and mental health issues.

Which social determinant(s) most affects this health issue

Opioid Use Disorder affects individuals across all educational and socioeconomic strata. Individuals at heightened risk for opioid use disorder include those with neurotransmitter deficiencies, particularly in dopamine, or those with first-degree relatives who have a drug use issue. Individuals exposed to an environment including opioid use may exhibit a heightened propensity for developing opioid use disorder. Environmental hazards for opioid use disorder (OUD) including peer consumption of opioids or exposure to opioid analgesics resulting from a prior injury. Individuals with a history of untreated depression, post-traumatic stress disorder, anxiety, or early trauma are at increased risk for opioid use disorder (Dydyk et al., 2024).

How  work setting has responded to the healthcare issue/what changes may have been implemented

In my workplace, healthcare providers have been using medications, including opioids in reduced dosages, to prevent withdrawals along with behavioral skills to treat patients with opioid use disorders; this increased patient recovery as well as discharge, reducing workload. According to Common Comorbidities with Substance Use Disorders Research Report (2020), behavioral treatment, whether administered independently or in conjunction with pharmacotherapy, is fundamental to achieving favorable long-term results for numerous persons afflicted with substance use disorders or other mental health conditions. Multiple treatments have demonstrated efficacy in addressing particular comorbid disorders.  Cognitive Behavioral Therapy (CBT) aims to alter detrimental attitudes and maladaptive behaviors, demonstrating significant effectiveness for people with drug use problems. Cognitive Behavioral Therapy is the most efficacious treatment for children and adolescents with anxiety and mood problems. Dialectical Behavior Therapy is particularly formulated to mitigate self-harm behaviors, encompassing suicidal ideations, attempts, self-injury, and substance abuse. This is one of the few therapies beneficial for patients diagnosed with borderline personality disorder.

References

Common Comorbidities with Substance Use Disorders Research Report. (2020). National Institutes on Drug Abuse (US). https://www.ncbi.nlm.nih.gov/books/NBK571451/

Dydyk, A. M., Jain, N. K., & Gupta, M. (2024). Opioid Use Disorder. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK553166/

Gabriel, K. P., & Aguinis, H. (2021). How to prevent and combat employee burnout and create healthier workplaces during crises and beyond. Business Horizons, 65(2), 183–192. https://doi.org/10.1016/j.bushor.2021.02.037 National healthcare issue/ stressor – Opioid use disorder (OUD)

NURS-6521 Walden University Final exam 

Question 1                                                            1 pts

A 45-year-old patient with a history of anxiety presents to the clinic with complaints of excessive worry, restlessness, and muscle tension. Which class of medications primarily works by increasing the frequency of chloride flow through GABA A receptors to alleviate these symptoms?

Group of answer choices

 

Antidepressants (e.g., Prozac)

 

Antipsychotics (e.g., Abilify)

 

Benzodiazepines (e.g., Xanax)

 

Antihistamines (e.g., Benadryl)

 

Anticonvulsants (e.g., Neurontin)

 

Question 2                                                                                                            1 pts

Why is oral vancomycin not used for systemic infections?

Group of answer choices

 

It is rapidly inactivated by gastric acid.

 

It is not absorbed from the gastrointestinal tract.

 

It has a high risk of causing systemic allergic reactions.

 

It is too potent for systemic use and can lead to toxicity.

 

It is rapidly metabolized by liver enzymes, reducing its efficacy.

 

Question 3                                                                                                        1 pts

Which change is likely with the administration of dipyridamole (Persantine)?

Group of answer choices

 

Increase in platelet cAMP levels

 

Inhibition of adenosine deaminase

 

Inhibition of the cellular reuptake of adenosine

 

All changes listed are likely.

 

Inhibition of phosphodiesterase

 

Question
4                                                                                                    1 pts

How does allopurinol contribute to the management of gout?

Group of answer choices

 

It decreases urate production.

 

It increases urate excretion.

 

It inhibits leukocyte migration.

 

It blocks the action of interleukin-1.

 

It inhibits urate absorption.

GET EXAM HELP HERE

Question 8                       1 pts

Which statement about penicillins is FALSE?

Group of answer choices

 

Oxacillin is a narrow spectrum penicillin.

 

Ticarcillin is contraindicated with administration of aminoglycosides.

 

Methicillin is associated with interstital nephritis.

 

Nafcillin is associated with neutropenia.

 

Ampicillin is a wide spectrum antibiotic that is susceptible to beta lactamases.

 

Question  5                                                                  1 pts

Initial inhibition of which factor(s) by warfarin leads to its immediate procoagulant effect?

Group of answer choices

 

Factor X

 

Factor II

 

Factor IX

 

Factor VII

Question 6                                                                                       1 pts

A patient presents with a severe cutaneous reaction characterized by diffuse flushing following vancomycin administration. The nurse practitioner recognizes this reaction as:

Group of answer choices

 

Stevens-Johnson syndrome

 

Erythema multiforme

 

Red man syndrome

 

Urticaria

 

Drug rash with eosinophilia and systemic symptoms (DRESS)

 

Question 7                                                                        1 pts

What is NOT a side effect of DES (diethylstilbestrol)?

Group of answer choices

 

Vaginal adenocarcinoma

 

Menopause

 

Ectopic pregnancy

 

Increased risk of breast cancer

 

Infertility

 

NURS-6521
Walden University Final exam Question 13                                                   1 pts

According to some guidelines, lithium is contraindicated in which condition?

Group of answer choices

 

Bipolar disorder I

 

Breastfeeding

 

Bipolar disorder II

 

In combination with antipsychotics for schizophrenia

 

In combination with antidepressants for major depressive disorder

 

Question 14                                                                                    1 pts

Tazobactam is a:

Group of answer choices

 

Penicillin-binding protein inhibitor

 

Beta-lactamase-sensitive penicillin

 

Beta-lactamase inhibitor

 

Dehydropeptidase inhibitor

 

Aminopenicillin

Question 25                                                                                          1 pts

What is an indication to prescribe a barbiturate?

Group of answer choices

 

Hypotension

 

Extubation

 

Depression

 

Narcolepsy

 

Seizure control

 

Question 42 
                                                                                           1 pts

Which medication, acting as a vitamin K antagonist affecting coagulation factors II, VII, IX, and X, is typically used for months after a thrombosis episode and for life in patients with mechanical heart valves?

Group of answer choices

 

Warfarin

 

Heparin

 

Rivaroxaban

 

Aspirin

 

Streptokinase

 

Question 53                                                                                             1 pts

Which of the following is NOT a common side effect of aromatase inhibitors?

Group of answer choices

 

Anorexia

 

Musculoskeletal pain

 

Decreased libido

 

Vaginal dryness

 

Cholesterol elevation

 

NURS-6521 Walden University Final exam Question 84                                                                                      1 pts

What resistance mechanism have Enterobacteriaceae developed against macrolides?

Group of answer choices

 

Adding a methyl group to change the binding site

 

Potentiation of CYP450 enzymes

 

Ejector pumps

 

Beta-lactamases

 

Drug-destroying esterases

 

Question 85                                                                        1 pts

What is the best initial treatment for a premenopausal woman who is found to have a mild microcytic anemia and low iron studies?

Group of answer choices

 

Oral iron supplementation

 

Intravenous iron dextran

 

Oral folic acid

 

Vitamin B12 injections

 

Blood transfusion

 

Question 86                                   1 pts

Which item is NOT an opioid analgesic?

Group of answer choices

 

Opium

 

Fentanyl

 

Naloxone

 

Synthetic opiates

 

Question 87                                                   1 pts

Which of the
following medications
reversibly inhibits the adenosine diphosphate (ADP) receptor?

Group of answer choices

 

Ticagrelor

 

Clopidogrel

 

Prasugrel

 

Ticlopidine

 

Tirofiban

 

Question 88                                                                     1 pts

Which of the following is the enzyme required for conversion of inactive coagulation
factors
II, VII, IX, and X into active factors?

Group of answer choices

 

Vitamin K reductase

 

Vitamin K epoxide reductase

 

Vitamin K epoxide hydrogenase

 

Vitamin K hydrogenase

 

Gamma-glutamyl carboxylase

 

Question 89                                                                            1 pts

What is the mechanism of action for eptifibatide?

Group of answer choices

 

Glycoprotein IIb/IIIa receptor antagonist, reversibly inhibiting platelet aggregation and adhesion

 

Cyclooxygenase-1 (COX-1) inhibitor, irreversibly inhibiting platelet aggregation

 

Increases the conversion of plasminogen to plasmin, promoting the breakdown of fibrin clots

 

Direct thrombin inhibitor, preventing the conversion of fibrinogen to fibrin

 

P2Y12 adenosine diphosphate (ADP) receptor antagonist, irreversibly inhibiting platelet aggregation and activation

 

Question 90                                             1 pts

Which of the following is NOT a route of administration of heparin?

Group of answer choices

 

Intravenous

 

None of the options is correct.

 

Oral

 

Subcutaneous

 

Question 91                                                          1 pts

What is a feature of tricyclic antidepressants?

Group of answer choices

 

Dialyzable

 

Lower seizure threshold

 

Insignificant first-pass metabolism

 

Low side effect profile

 

Low volume of distribution

 

Question 92                                                                                     1 pts

A woman comes to your clinic for a legal abortion at eight weeks’ gestation. You recommend a combination of mifepristone and misoprostol. What side effects are you NOT concerned with when treating patients with this regimen?

Group of answer choices

 

Nausea

 

Cramping

 

Hirsutism

 

Vomiting

 

Bleeding

 

Question 93
                                                                                           1 pts

Which patient is least likely to benefit from estrogen therapy?

Group of answer choices

 

A 51-year-old woman who is experiencing hot flashes

 

A 35-year-old woman who often has painful and heavy periods

 

A 55-year-old woman with osteopenia

 

All of these patients will benefit greatly from estrogen therapy.

 

A 45-year-old mother with a history of DVT

 

Question 94                                                                                               1 pts

Which of the following statements correctly describes the dual mechanism of action for cilostazol?

Group of answer choices

 

Inhibits phosphodiesterase and adenosine uptake to increase cAMP levels and reduce platelet aggregation

 

Inhibits phosphodiesterase and increases adenosine uptake to increase cAMP levels and reduce platelet aggregation

 

Activates phosphodiesterase and reduces adenosine uptake to decrease cAMP levels and reduce platelet aggregation

 

Activates phosphodiesterase and increases adenosine uptake to increase cAMP levels and reduce platelet aggregation

 

Inhibits phosphodiesterase and adenosine uptake to reduce cAMP levels and reduce platelet aggregation

 

Question 95                                                                                     1 pts

Which vitamin is antagonized by warfarin?

Group of answer choices

 

Vitamin D

 

Vitamin C

 

Vitamin B1

 

Vitamin K

 

Vitamin E

 

Question 96                                                                                       1 pts

A patient with a history of depression has been prescribed a monoamine oxidase inhibitor (MAOI). Which dietary restriction should the nurse practitioner emphasize to prevent a potentially life-threatening reaction?

Group of answer choices

 

Limiting caffeine intake

 

Avoiding foods high in tyramine

 

Reducing sodium intake

 

Eliminating dairy products

 

Restricting carbohydrate consumption

 

Question 97                                                                                            1 pts

Which beta blocker also stimulates nitric oxide?

Group of answer choices

 

Labetalol

 

Levobunolol

 

Propranolol

 

Acebutolol

 

Nebivolol

 

Question 98                                                                                    1 pts

Dopamine antagonists can be used to decrease the effects of dopamine in order to improve symptoms of nausea and vomiting. Which of the following tracts is the likely primary target?

Group of answer choices

 

Chemoreceptor trigger zone

 

Tuberoinfundibular tract

 

Mesocortical tract

 

Mesolimbic tract

 

Nigrostriatal tract

 

Question 99                                                                                 1 pts

What is the mechanism of action of rituximab?

Group of answer choices

 

Inhibitor of MAP kinase

 

COX-1 inhibitor

 

Monoclonal antibody to CD20

 

COX-2 inhibitor

 

Monoclonal antibody to CD19

 

SOLVED WITH ANSWERS –
NURS-6521 Walden University Final exam
Question 100                                                                               1 pts

Which medications are most effective in treating benign prostatic hypertrophy (BPH)?

Group of answer choices

 

Alpha-1 adrenergic agonists and a beta 2 agonist

 

5-alpha reductase inhibitor and calcium channel blocker

 

5-alpha reductase inhibitor and nitroglycerin

 

Alpha-1 adrenergic antagonists and a 5-alpha reductase inhibitor

NURS-6053 Module 1: Discussion

By Day 3 of Week 1

Post
 a description of the national healthcare issue/stressor you selected for analysis, and explain how the healthcare issue/stressor may impact your work setting. Which social determinant(s) most affects this health issue? Then, describe how your health system work setting has responded to the healthcare issue/stressor, including a description of what changes may have been implemented. Be specific and provide examples.

By Day 6 of Week 1

Respond
 to at least 
two
 of your colleagues 
on two different days
 who chose a different national healthcare issue/stressor than you selected. Explain how their chosen national healthcare issue/stressor may also impact your work setting and what (if anything) is being done to address the national healthcare issue/stressor.

 

NURS-6053 Module 1: Discussion

What is the Selected Healthcare Issue?

The national healthcare issue selected for analysis is access and equity in healthcare. Despite significant advancements in medical technology and treatments, access to healthcare services remains a critical challenge, particularly in the United States, the only high-income country that does not guarantee universal health coverage. For many individuals, access to healthcare is constrained by various factors, including socioeconomic status, employment conditions, and systemic inequities across the healthcare landscape (Mainous, 2024). The importance of healthcare access cannot be overstated, as it is a fundamental determinant of health outcomes and overall quality of life.

How Does This Issue Impact My Work Setting?

In my work setting, which focuses on delivering care, the issue of healthcare access and equity significantly impacts our operational efficiency and patient care approaches. Some of the patients we serve come from disadvantaged backgrounds, facing financial and logistical barriers to care, including those related to lack of insurance, transportation difficulties, and prior authorization processes that further delay necessary treatments (Chen, 2025). Moreover, utilization of these treatments, prescription abandonment, and worse health status among such population groups are reported (Chen, 2025). Slonim (2023) observes that patient experience differs due to the healthcare facilities available, thereby calling for organizations to consider addressing such differences.

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Which Social Determinant Affects This Health Issue Most?

When it comes to the issue of access and equity in healthcare, the socioeconomic status of the society can be deemed the most potent determinant factor. Low-income or fixed-income earners struggle with issues in their job security, their level of education, and inadequate shelter or housing; other issues arise and form a systematic way of isolating such people and denying them quality healthcare (Chen, 2025). Other dynamics include structural racism, where aspects like “redlining,” a deliberate act to deny people of color equal access to specific neighborhoods, which leads to minorities lacking equal access to resources today, have a direct impact on the quality of care received by racial and ethnic minorities (Mainous,  2024). Mainous (2024) states that these determinants tend to escalate health disparities, whereby socioeconomic status is a key element in gauging health access.

How Has My Health System Responded to the Issue?

Regarding healthcare availability and equality, my organization has taken specific measures to
increase the quality of the services
we provide to communities with limited access to such services—for example, growing community-popular programs like mobile clinics and telehealth to ensure that those with limited access to regular care centers are addressed (Chen, 2025). In addition, it gives educational sessions intended to enhance the utilization of various healthcare services because of patients’ enhanced health literacy skills (Dixon-Woods et al., 2012).

Furthermore, my organization will actively engage with other nonprofits to address several health determinants, including nutrition and housing. The vision of developing a better healthcare provision that includes medical and social services is about promoting a new way of health facility delivery, a successful approach to improving healthcare delivery (Broome & Marshall, 2021).

In conclusion, there is a significant need to review access and equitable use of health care in the current delivery system and its impact on the population’s health. With more knowledge of the effects of the social determinants of health, such as socioeconomic status, it will be possible to address the challenges effectively. By maintaining collaborative efforts and implementing solutions to address this issue, my organization aims to reduce the existing inequalities in patient access, underscoring our dedication to providing equal and quality healthcare services. As Slonim (2023) stated, further reflections and adjustments would be necessary to entrust these care qualities to be more responsible, accessible, and fair for everybody. NURS-6053 Module 1: Discussion

References

Chen, A. M. (2025). Barriers to health equity in the United States of America: Can they be overcome? 
International Journal for Equity in Health
, 
24
(1). 
https://doi.org/10.1186/s12939-025-02401-w
Links to an external site.

Mainous, A. G. (2024). The Vexing Problem of Access to Health Care in America: Is Employer-Based Health Insurance the Real Culprit? 
Family Medicine
, 
56
(3), 145–147. 
https://doi.org/10.22454/fammed.2024.894966
Links to an external site.

Slonim, A. (2023). Top Challenges Facing Healthcare: Back to Basics. 
Physician Leadership Journal
, 
10
(2). 
https://openurl.ebsco.com/EPDB%3Agcd%3A16%3A19626432/detailv2?sid=ebsco%3Aplink%3Ascholar&id=ebsco%3Agcd%3A162444310&crl=c&link_origin=scholar.google.com
Links to an external site.

Dixon-Woods, M., McNicol, S., & Martin, G. (2012). Ten challenges in improving quality in healthcare: lessons from the Health Foundation’s programme evaluations and relevant literature. 
BMJ quality & safety
, 
21
(10), 876–884. 
https://qualitysafety.bmj.com/content/21/10/876.short
Links to an external site.

Broome, M. E. (2021). 
Transformational leadership in nursing: From expert clinician to influential leader
. Springer Publishing Company. NURS-6053 Module 1: Discussion

NURS-6521 Walden University Final exam  – What is the primary mechanism of action of heparin in anticoagulation therapy?

Question 631 pts

What is the primary mechanism of action of heparin in anticoagulation therapy?

Group of answer choices

 

It blocks ADP receptors on platelets.

 

It acts as a vitamin K antagonist.

 

It prevents the activation of factor X.

 

It directly inhibits thrombin.

 

It increases anti-thrombin activity.

NURS-6521 Walden University Final exam  – Which beta-lactam antibiotic has no cross-allergy with penicillin?

Question 44                    1 pts

Which beta-lactam antibiotic has no cross-allergy with penicillin?

Group of answer choices

 

Aztreonam

 

Ampicillin

 

Dicloxacillin

 

Amoxicillin-clavulanate

 

Piperacillin-tazobactam

What is an important drug-drug interaction to be aware of when prescribing linezolid? – NURS-6521 Walden University Final exam

Question 351 pts

What is an important drug-drug interaction to be aware of when prescribing linezolid?

Group of answer choices

 

Serotonin syndrome when combined with selective serotonin reuptake inhibitors (SSRIs)

 

Gastrointestinal bleeding when combined with nonsteroidal anti-inflammatory drugs (NSAIDs)

 

Reduced effectiveness when combined with benzodiazepines

 

Hypotension when combined with antihypertensive drugs

 

Hypertensive crisis when combined with tricyclic antidepressants (TCAs)

NURS-6521 Walden University Final exam  –
What is NOT an appropriate use of estrogen therapy?

Question 34                                  1 pts

What is NOT an appropriate use of estrogen therapy?

Group of answer choices

 

Hormone replacement therapy in bilateral oophorectomy

 

Hormone replacement therapy in premature ovarian failure

 

Hormone replacement
therapy
in postmenopausal women

 

Treatment of hypogonadism

 

Treatment of deep vein thrombosis