Nursing (127)

Friday, 08 December 2017 11:38

Health Insurance

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Current health care environment is faced by several challenges that need to be focused in order to provide clients with better health care services. Some of these challenges can easily be dealt with when proper measures are put in place. This writing will evaluate and discuss a number of factors such as adverse selection, health insurance, and price change on health care insurance field.


Adverse selection is defined as the phenomenon that is in any type of insurance such as health insurance. Adverse selection happens when individuals make purchasing decisions on the insurance policies. It occurs in different ways such as an individual might have some information on a given risk which is not known by the insurer or the insurer might be in a position to access the patient’s information, but he is unable to use it in the process of price change. This might happen because of certain factors such as the limitations of the insurer’s rating system or antidiscrimination laws.

Study shows that health insurance may be susceptible to the aspect of adverse selection in a situation where its occurrence happens in a competitive and transparent pricing environment. In common, members of the public are the one who will and make decisions on what to purchase, whether, and when depending on the knowledge they have about their personal health. For instance, an individual may have an opportunity to get different insurance plans from a health insurer covering different aspects such as a catastrophic plan and the other with a comprehensive coverage plan. It is clear that the person who goes for a catastrophic plan is a healthier and younger person than a person who seeks a comprehensive insurance plan. Most consumer protection laws do limit the potential or the ability of insurers to make considerations on their health risk in underwriting and rating, (Buchmueller, 2009).

There are many ways under which insurers use in protecting their business from adverse selection. One of the methods used is by measuring the risk where they enter into an agreement on whether to cover the risk or not consider it. In the healthcare setting, medical insurers do exclude the pre-existing illness conditions when providing insurance services. Medical insurance companies don’t provide coverage services to clients who were not paying for the premiums before they got sick, (Knutson, 2011).


In the current health care industry, there is an issue of consideration which is the basis upon which individuals seek and get premium rates on their health care coverage. In the community rating, individuals are charged by the health insurer a similar health insurance policy. Premium paid by health insurance remains the same irrespective of the occupation, health status, gender, and age as well as other factors. When determining the level of premium to be paid, the insurer uses demographic, and health profile of the selected geographical place or the insurer can use the total population and puts it in a given cover. In the community rating, the groups made of sicker people or the old people (high cost groups) are averaged out with groups made of healthier or young people (lower cost groups). Expenses in this case of all the participants are spread out equally or pooled together across all the participants, (Leduc, 2008).

In community rating approach, people usually pay different rates in their premiums depending on the differences in the medical status, past health care utilization and on the demographics among others. In this case, the insurer uses experience in predicting the future medical costs based on a given group. In the experience rating approach, the insurer of the health care calculates the premium using the community’s experience. Study shows that a good number of states impose rating restrictions on the insurers based on the respect to the development of premiums on a given group. Study shows that community rating gives insurers an incentive to engage in preferred risk selection. The reason behind this is due to the fact that the pricing system is based on open principle where individuals covered may have different risks thus an insurer must ensure preferred risk selection is achieved, (Leduc, 2008).


As price goes up so do the demand of human needs and wants go up, and the opposite is true. Studies indicate that when the prices goes up, a good number of potential health care clients will decide not to get the insurance, but when the prices goes down, clients do afford the cost thus they purchase the insurance. When clients feel that the price is high, they don’t get the worth of taking care of their healthcare plans and as a result, they end up using substitute plans which are cheaper and affordable. It is clear that the demand for other typical products is complicated as compared to the demand of health and the estimation of elasticity demand is straightforward in this case.  Although consumers have demand for health, they don’t directly purchase it especially when prices go up. It is difficult to establish and determine the price schedule for health care services something that create challenges in individual users of care plans, (Knutson, 2011).

The price of health insurance services varies depending on the quantity of services that are offered or used by the client. This is a condition that creates a technical environment for the estimation of the price in the elasticity demand for any health care services. In this case, when estimating the true effects if price changes, one has to determine the effective price that a given person should cater for an additional unit of services in health care insurance offered. For instance, in a situation where a person has reached her out-of-pocket expenses for a given period faces a price of zero will have no impact on the purchase decision and a person who has not reached her deductible will face full price of the health care, (Buchmueller, 2009).


In summing up, health care setting has changed over the past few decades. Most people are going for health insurance services, to cover their health. Insurers face problems on the determination of proper insurance measures when serving individuals. 


Buchmueller, T. C. (2009). Consumer-Oriented Health Care Reform Strategies: A Review of the Evidence on Managed Competition and Consumer-Directed Health Insurance. Milbank Quarterly87(4), 820-841. doi:10.1111/j.1468-0009.2009.00580.x

Schansberg, D. (2014). The Economics of Health Care and Health Insurance. Independent Review18(3), 401-420

Knutson, D. J. (2011). Risk Adjustment of Insurance Premiums in the United States and Implications for People with Disabilities: The Future of Disability in America. Retrieved from,

Leduc, J. L. K. (2008). Community versus Experience Rating Health Insurance. Retrieved from,

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Demand is the behavior of the consumer (Carlsen & Grytten, 2000). In terms of health care, it is the quantities of health care products and services that the consumer has the ability and will to purchase at specified prices. This analytical paper has a purpose to describe factors which most affect the individual utilization of health care products or services. In this paper, I seek to identify factors that most influence how much health care services people are willing to purchase, using the demand dynamics for renal transplant services.

Health Care Service/Product

The incidence and prevalence of kidney disease is on the rise among Americans. Several factors affect this trend including lifestyle changes and an in the aging population. The most common management modality for renal disease is dialysis. This is because it is affordable and easily affordable. However, it is a short-term remedy. The ultimate treatment of renal disease is kidney transplantation. Hence, the demand for kidney transplant service is rising irrespective of the costs to the consumer.

Impact of Consumer Demand on Medical Services

For an economist, demand, cost, and supply are the three magic words. The price or cost can change for many reasons. In the case of kidney transplant, technology is a key factor for the high cost.  The relationship between the product demand and supply and changes in price is called elasticity. The demand for kidney transplant is inelastic.


Public and private sector expenditures on health are on the rise faster than any other sector in the United States. The demand for kidney transplant services is one of the factors that drive the increase in investment costs of health care services. The Center for Medicare and Medicaid had projected that the national health expenditures would reach $3.1 trillion (Nahata, Ostaszewski, & Sahoo, 2005). The growth is at an annual rate of 7.3%.  According to the estimates, the share of health spending in gross domestic product would be 17.7% in 2012.

Supply and Access

            The technology, expertise, and facilities required to offer kidney transplant services are available and accessible. Therefore, patients can obtain the service at proximal locations. However, the issue is the availability of kidneys for patients. The organs are not easily accessible. In addition, the organs are expensive to obtain from donors. The other issue is the donor-patient compatibility issues.

            The cost of kidney transplant services is likely to remain high for the long-term. This is because of the technology and availability of organs for transplant. The care required for patients undergoing a kidney transplant is specialized. The access of the service is not an issue particularly due to adoption of enhanced medical technology and improvement in treatment know-how. There has also been improvement in expansion of services in medical facilities across the country to include kidney transplant. Therefore, the main issue is the cost and supply of kidneys. Coupled with the fact that kidney transplantation is the absolute and only cure for kidney disease, it is predictable that the demand for kidney transplant services will remain inelastic, at least for the near future.

The implication on medical service provision is that health facilities will enhance their capacities to provide the service so as to benefit from the inelastic demand. For public health care facilities, the aim is to liaise with the financial sector organizations to partner in making the service accessible and affordable to the people that need it.

Rationale for Continued Provision of the Service

In health care systems, the demand for products and services may be influenced by factors determined by the provider, consumer, the supply, and location of services or products (Scandlen, 2005). Despite the high cost of kidney transplant services, the demand will continue to rise. This can be explained by the economic concept of elasticity of demand. Elasticity of demand relates the quantity of services or goods demand to the price. The cost to the consumer is a vital factor in choosing to purchase a service or good. Hence, elasticity of demand is the ratio of the relative change in a dependable variable to the relative change in the independent variable. In the ordinary situation, a change in the demand factors will cause a change in the quantity of items purchased per time period.

Elasticity of demand is influenced by price changes, availability and price of substitutes and complements, income change, nature of commodity, position of the product in consumer’s budget, and other factors. A combination of these considerations contributes to the level of consumer demand for a product. Keeping all other factors constant, price is deterring factor for the demand of any health care service or product, particularly when it involves out-of-pocket payment (Scandlen, 2005. Insurance payment for health care services distorts the natural influence of price on demand. The change in income is the other factor.

The demand for kidney transplant services is portrayed by a demand curve that is almost perpendicular. The implication is that a price change causes a negligible or no fall in the quantity of kidney transplant services. The primary reason is the absence of alternatives. The nature of kidney transplant is that it does not have an alternative. Dialysis is a short-term procedure that does not provide a cure for the disease. It is a medical procedure that helps the patient survive as the patient awaits kidney transplant. Kidney disease only ceases when a transplant is done or when the patient dies. In addition, dialysis is a costly treatment option for the disease. In terms of the position of service in the consumer’s budget, kidney transplant is a priority for any person suffering end-stage kidney disease. No other service can be more important than this service because the disease is a threat to life. 


            The expectations of patients are changing rapidly. Health care systems ought to be prepared to respond. Kidney transplant is a proven remedy for kidney disease. Therefore, health care providers must seek to improve health care outcomes of patients with kidney disease while controlling costs associated with kidney transplant services. It may be necessary for health care systems to take advantage of inter-sectoral collaboration so as to enhance their ability to provide services that patients need despite their financial limitations. Perhaps, collaboration with social insurance providers may be an ideal solution to the problem of affordability.


Carlsen, F. & Grytten, J. (2000). Consumer satisfaction and supplier induced demand. Journal of Health Economics, 19(5): 731-753

Nahata, B. Ostaszewski, K., & Sahoo, P. (2005). Rising Health Care Expenditures: A Demand-Side Analysis. Journal of Insurance Issues, 28(1): 88-102

Scandlen, G. (2005). Consumer-Driven Health Care. Health Affairs, 24(6): 1554-1558

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Friday, 08 December 2017 11:30

Administrative Costs of Insurance

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 The total health care expenditures in the U.S. take a greater share of the nation’s yearly budget. Part of the said expenditure is the administrative costs of insurance that individuals are required to cater through insurance health premiums they pay. In the current US health care insurance policy, consumers are required to part with a flat dollar amount that caters for their medical insurance administrative services. Both in the private and in public health sector, patients are required to pay the same amount of insurance administrative costs either in whole or spread over a given period. The country uses substantial ways of administrative costs something that makes up the estimate of nearly one third of the total spending, (Yong & Olsen, 2010).

            Taking the role of health care economist, I would counter argue this statement because the nation is in need of revenue, to cater for health care services offered to the society. Although most people feel and think that the administrative costs of insurance are a small part of the total health care expenditures, it should be noted that not all individuals who take insurance on their health don’t turn for medications. The administrative costs should remain in their current state because there is no much is needed in facilitating the insurance services for the administration purposes. These costs are enough to ensure that proper and right measures have been established and implemented towards improving services in the health insurance sector. It has been established that about sixty percent of the administrative insurance costs could be eliminated and still remain in a state where proper and timely health services are offered to relevant patients, (Yong & Olsen, 2010).


Yong, P. L. & Olsen, L. Y. (2010). The Healthcare Imperative: Lowering Costs and Improving Outcomes: Workshop Series Summary. Retrieved from, on 5th March 2014

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Friday, 08 December 2017 11:26

Health Insurance

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Health insurance spending is seen as a factor of hospital costs, provider prices, medical technology, waste, unhealthy lifestyles, aging populations, and taxes. The premiums that are paid to health insurance providers are aligned to these costs and directly relate to the costs that health insurance covers. The administrative costs and profits are also related to the above costs. This share a direct relation and the costs and profits that are for administrative purposes will have a direct relation in increase and decrease. The rates of premiums that are paid to health care providers are determined by various factors. Lifestyle and age are some of the determinants of premiums. Premiums for these groups of patients are higher due to the high or elevated cost of care that is accorded to this group of people. These groups of patients also require specialized medical care.

Therefore, the cost of care given to them is high. In the event that the data in the table reversed the downward trend, it would mean that all the costs that were due to medical care would experience a negative trajectory. This will relate to an increase in administrative costs and profits because of increased payment of premiums to health insurance providers. Insurance providers will adjust their rates depending on the prevailing health related cost so that they maintain their operational costs. Expenditure, by individuals, on healthcare, will relate to the need and additional spending will be realized, only, when the need arises. The profits that are realized by health insurance providers will keep rising when the premiums that are levied on the insurance recipients is not paid out to meet the costs of medical care.


Green, M. A., & Rowell, J. A. C. (2011). Understanding Health Insurance: A Guide to Billing and Reimbursement. Clifton Park, NY: Delmar Cengage Learning.

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Friday, 08 December 2017 10:55

Health Care Issues

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 Individuals in need of health services are increase due to the current increase in the population, in the community. There is too much unnecessary care that has increased the cost of healthcare in the society. Studies indicate that some patients are overusing care accounts something that contributes to the loss of disability and productivity. Avoid harm to patients is part of provider care issue affecting most professionals. Statistics show that one out of six admitted patients suffer from harm they get in hospital. Newborns and women are the most affected parties in the harm concept something that has raised a health care warning to care providers and the society at large, (Shi & Singh, 2004).

            There are variations in how health care services are offered to patients. Most patients are advised to take unnecessary health care tests and measures that make their health conditions worse and complicated. There exist perverse incentives in how patient pay for care. Medicaid, Medicare, health plans are not effective, and that has created a situation difficult to care for patients who are in need of health services. In most health care facilities, there is no transparency among health care providers and between the patient and care provider. It is clear that when selecting or comparing new car, there is enough information available as compared to the information that is available for making care decisions on lifesaving health care services. Consumers in the health care have been denied to know more about the reliable and available information that will aid them make decisions on taking the appropriate health saving insurance or care measures, (Shi & Singh, 2004).


Leiyu Shi & Douglas A. Singh (2004). Delivering Health Care in America: A Systems       Approach: Jones & Bartlett Learning

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Violent Death of a Child and Prolonged Bereavement among Parents


Homicides, suicides, and accidents are among the foremost causes of death among American children (Murphy et al, 2003). Death of children is such violent circumstance has a devastating impact on parents. This paper is set to probe the effect of violent death of a child on the reactions of bereaved parents.  The paper also scrutinizes factors that influence the length of bereavement among parents whose children die in unexpected and violent circumstances such as suicide, accidents, and homicides. A number of literatures are critically analyzed in order to answer these questions.  The analysis reveals that parents whose children die in violent circumstances are likely to exhibit prolonged grief. The severity of parents’ grief is also influenced by a number of factors including; marital status of bereaved parents; isolation; marital closeness of affected parents, level of social support; level of mental distress; interventions offered in early bereavement, and religious beliefs.   

Main Body

Song et al (2010) are among scholars who have studied the effects of child death on parents. Specifically, their study examined the long-term effect of death of a child on health-related quality of life (HRQoL) of the bereaved parents. The authors hypothesized that; bereaved parents have worse HRQoL than non-bereaved parents; bereaved mothers have worse HRQoL than fathers who are bereaved; Bereaved parents who have close marital relationship have better HRQoL than bereaved parents with least cohesive marital relationships, and Bereaved parents HRQoL varies according to the cause of the child’s death. The researchers used a longitudinal research design where 10,317 participants were selected from the list of students who graduated from Wisconsin high schools, in 1957, as well as, 5,823 of their siblings. The graduates were surveyed in 1957, 1975, 1992, and 2004 while their siblings were surveyed in 1977, 1994 and 2006. The study focused on analyzing data from participants who were married during the last survey. The married participants were divided into two groups; those who had experienced child bereavement and those whose children were all alive. The HRQoL of the two groups were compared, as well as, their HRQoL during the different surveys. The HRQoL of bereaved couple was also correlated with factors such as gender, closeness of family, and cause of death. The findings suggest that; believed parents have worse HRQoL than non-bereaved parents; bereaved parents with great marital closeness have better HRQoL than bereaved parents with least marital closeness, and parent who lost their child in violent circumstances have worse HRQoL. There was no considerable link between gender and HRQoL of bereaved parents. This research emphasizes on the need to consider marital cohesiveness and cause of death while administering psychological interventions to bereaved parents. The main advantage of this study is that the design involved the use of a control group which eliminated the effect of other variables on the wellbeing of parents.  The large sample size that comprised an experimental group of 301 couples (602 participants) and a control group of 301 couples (602 participants) enhanced the external validity of the study. The researcher also used the Health Utility Index (HUI), a proven tool for measuring HRQoL, thus enhancing the reliability and validity of the study. Song et al (2010) study relates to this paper because it demonstrates the effect of violent death on parents. It also identifies factors that affect parent’s reaction to child death.

Lohan and Murphy (2007) conducted a similar study that focused on examine the effect of the marital status on mothers’ long-term adaptability to violent death of a child and family functioning. The authors noted that few studies had examined the adjustments single bereaved parents as compared to married parents. The study is a significant because the American society is exhibiting an increase in single parent families. The authors also used a longitudinal design where a sample of 86 parents was recruited in two states using death certificate data. All participants were female who provided data about family functioning. A baseline assessment was conducted using the Family Adaptability and Cohesion Evaluation Scales (FACE III) at 2-7 months after child’s death. Subsequent surveys were conducted six months and 18 months after the baseline assessments. The outcomes suggest that there was no statistical deference between married and single mothers in terms of long-term adaptability to violent death of a child and family functioning. This finding implies that the marital status of the bereaved parent is not a good predictor of family functioning and adaptability of mothers after the loss of a child in violent circumstances. The most significant advantage of this study is that the sample was drawn from death certificates and not a clinical population hence minimizing sample bias. The longitudinal design of the study also supported the validity of results. The use of FACE III, a proven tool for measuring adaptability and family functioning, also enhanced the reliability of the results. The main limitation is that only mothers were assessed thus family functioning was interpreted from the perspective of the mother and not other members of the family such as children. Another limitation is that there was no data indicate family functioning before the death of the child hence the impact of death on family functioning cannot be determined with certainty. The study with Lohan and Murphy (2007) is relevant to this paper because it demonstrates that the marital status of the parent is not a significant factor that determines the severity of grieving among bereaved parents.    

Another study by Murphy et al (2003) focused on investing the prevalence of post-traumatic stress disorder (PSTD) among parents who lose their children in violent circumstances, as well as, the predictors of change five years after the child’s death. The researchers also used a longitudinal design where participants were selected from official death records from six counties in Oregon and Washington states. The Traumatic Experiences Scale (TES) was used to measure PTSD among participants at the time of recruitment and five years after recruitment. A total of 173 parents participated in both assessments. PTSD events were correlated against several factors including; parents’ gender; cause of death; self-esteem; coping strategies; social support, and concurrent mental distress.  The participants were also divided into two groups using random assignment methods four months after recruitment. A psychological intervention was administered to one group while the other acted as a control group. Findings revealed that repressive and affective coping, self-esteem, gender, cause of death, and concurrent mental condition had a noteworthy influence on PTSD in the short-term, four months after child death. However, only gender had a long-term effect on PTSD. The intervention has a positive effect on PTSD up to 1 year after the death and no further effects. These findings imply that psychologists need to focus on helping bereaved parents to develop coping mechanisms, positive self-esteem, and deal with mental condition in order to minimize PTSD. It also implies the need to focus on female parents though this finding contradicts the finding by Song et al. The study also demonstrates the effect of interventions in relieving PTSD in the short-term. The main advantage of this study is that it used a longitudinal design which enabled the research to observe changes in PTSD events among parents. Selection of sample using official death records also minimized sampling bias. The use of the TES, which is a proven tool for measuring PTSD, enhanced the reliability and validity of the study.       

Murphy, Johson, and Lohan (2003) sought to investigate how finding meaning of child’s death affected the parents’ health and adjustment. Specifically, the researchers invested; the time taken to find meaning; predictors of finding meaning, and effects of finding meaning on health and adjustment outcomes. The study also utilized a longitudinal design where 204 participants were recruited from official death records. Data was collected after 4, 12, 24, and 60 months after the violent death of the child. Several predictor variables were considered including; cause of death; perception of preventability of death; religious coping, and support group attendance. These variables were correlated against five health and adjustment outcomes; mental distress; PTSD; Acceptance; marital satisfaction, and physical health status. Findings revealed that 12% of the parents found meaning 12 months after death of the child and 57% of parents found meaning five years after the death. Significant predictors of finding meaning were support group attendance and religious coping. The findings also suggest that finding meaning has a momentous impact on three of the five health and adjustment outcomes; physical health status; marital satisfaction, and mental distress. This implies those psychologists need to focus on helping bereaved parents to find meaning in order to enhance physical health status; marital satisfaction, and reduce mental distress. It also implies that parents should be encouraged to join a support group and turn to religion order to find meaning. Selecting the sample from official death records minimized sampling bias while longitudinal design supported the validity of results. The chief drawback is that the study only focused on a few outcomes related to finding meaning. Other indicators such as perceptions on quality of life and social functioning need to be considered. The study is relevant to this paper as it identifies factors that can help bereaved parents to overcome their grief.

Dyregrov, Nordanger, and Dyregrov (2003) examined factors that affect the level of psychological distress among parents after violent death of children. This is also a cohort study that involved 140 families with a total of 232 parents. Data was collected using the Inventory Traumatic Grief, the General Health Questionnaire, and the Impact Event Scale. Qualitative aspects of bereavement were also assessed using in-depth interview. Previous predictor variables were examined including; whether survivors had any children left; age of deceased; gender of the deceased; age and gender of the parent; time since death; place of residence, whether parent was working outside home, and education. Findings identified self-isolation as the most significant predictor of psychosocial distress among parents. The findings also revealed that survivors of accident and suicide had greater psychosocial distress than survivors of infant death syndrome. This study has a significant advantage the other studies as it used triangulation in collection and analysis of data. Various quantitative and qualitative instruments of collecting data are used. This study identifies factors that affect grieving parents, as well as, causes of deaths that have a significant impact on the severity of parents’ grief thus contributed to this paper.

Discussion/ Conclusion

Child’s death has a significant impact on parents. The impacts are highly prolonged when the death occurs under violent circumstances. Violent death of children often results in prolonged grief among parents. It was hypothesized that the severity of parents’ grief is affected by various factors including; marital status of bereaved parents; isolation; marital closeness of affected parents, level of social support; level of mental distress; interventions offered in early bereavement, and religious beliefs. Several literatures were critically analyzed and findings support the view that child deaths that occur in violent circumstances cause prolonged grief among parents. The findings also supported the view that; isolation; marital closeness of affected parents, level of social support; level of mental distress; interventions offered in early bereavement, and religious beliefs affected the severity of parents grief. This implies that psychologists need to focus on addressing these factors when helping bereaved parents to overcome grief. There were conflicting views concerning the effect of marital status of bereaved parents on severity of grief. Future researchers should make inquiries into this factor.


Dyregrov, K. Nordanger, D. and Dyregrov, A. (2003). Predictors of Psychosocial Distress after Suicide, SIDS and Accidents. Death Studies. 27: 143- 165

Lohan, J. & Murphy, S. (2007). Bereaved Mother’s Martial Status and Family Functioning After a Child’s Sudden, Violent Death. Loss and Trauma Journal. 12: 333- 347

Murphy, S. & Johnson, C. (2003). Finding Meaning in a Child’s Violent Death. Death Studies. 27: 381- 204

Murphy, S. et al (2003). The Prevalence of PTSD following the Violent Death of a Child and Predictors of Change 5 Years Later. Traumatic Stress Journal. 16 (1); 17- 25

Song, J. et al (2010). Long-Term Effects of Child Death on Parents’ Health-Related Quality of Life. Family Relations Journal. 59 (3): 269- 282

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It has been discovered that VAP (Ventilator Associated Pneumonia) is a recurring health care infection that leads to a high mortality rate. A good number of health care facilities have been in the move of implementing programs for reduction of rates in the ICUs. Care bundles are used for VAP prevention which has been one of the key evidence based practice initiated in most health care facilities. A major challenge has been low compliance and noncompliance with the VAP care bundles in the University of Miami Hospital in its intensive care unit. This has increased the risk of morbidity and healthcare costs although the situation can be prevented. Non compliance has resulted to patient contracting VAP every year something that causes health care hospital loses the great deal of funds. Solution to the above problem has been proposed to be the creation and implementation of VAP bundle checklist. The management of health facility will monitor the compliance of the tool that will assure that every ventilator checklist element is followed by nurses. Care bundle checklist will help collect measures of compliance where the ICU nurses will have to complete the checklist in ensuring all the elements of the care bundles are followed.

Research Support

The creation and implementation of VAP bundle checklist have been validated for compliance measurement. These care bundles are used for VAP prevention something that reduces the risk of morbidity and reduce healthcare costs.

In a study by Saber et al. (2013), this research provided an examination on the implementation of the ventilator bundle in prevention of ventilator associated pneumonia. The investigation carried out was to examine whether ventilator associated pneumonia increases the mortality and morbidity rates in the health care setting. 100 intubated mechanically ventilated patients were used in this study. In a period of six months, patients were admitted and administered in the Geriatric ICU in the Ain Shams University Hospital. In the 100 patients admitted 50 patients were treated before the implementation of VAP care bundle in the first three mnths and the other bunches was treated after the implementation of the VAP care bundle in the last three months. Findings of this study were associated with a decrease in the density of colonization from 80 percent in the first group to forty percent in the second group.

In the analysis of the study data, a statistical package for social science was used. Results indicated that there was a significance decrease from 71.4 in group one to 49.1 in group two. It is a clear indication that care bundles assisted nurses in reducing VAP, as well as establishment of proper monitoring and implementation of the bundle care checklists. Since data for this study was collected from the car facility there is a possibility that there was biasness because the management knew they were studied. Patient participants were randomly selected facilitating the external validity of the study. The internal validity may be affected because nurses and the management knew that they were studied. Suggestions on further studies about the topic allow room for not generalizing on the results of the study.

Westwell (2008) performed a study seeking the implementation of a ventilator care bundle in an adult ICU so as to appraise the implementation of a series of high impact care bundle intervention components. Implementation in this study introduced the management of patients within a healthcare facility in the first twenty four hours. The focus was to ensure there was standard treatment and care given to patients who required mechanical ventilation irrespective of their place in the hospital. The high impact intervention clinical procedure that was used consisted of four elements that are gastric ulcer prophylaxis, deep vein thrombosis prophylaxis, daily sedation hold, and the elevation of the head of the bed to 20-45 degrees. Its implementation demonstrated a significant reduction in the incidence of VAP. Limitation of this study was in the achievement of all the elements of the bundle for every patient something that affected the internal validity of the study.

Results of this study give an opinion that the implementation of a ventilator care bundle in a health care facility can reduce the risk of VAP in adult intensive care unit. A fixed procedure on the use and implementation of a ventilator was not given in this study and this affected the external validity of the entire research. Critical analysis on how the implementation of the care bundle components has influenced the practice was discussed and this gave the reason for the use and implementation of the tool for preventing VAP. Daily audit of the care bundle in the study had positive compliance effect on the act of the promoted staff and collected data.

A study performed by Khorfan (2008) examined the daily goals checklist which focused on eliminating nonsocomial infection in the ICUs. Elimination of infection of VAP in the ICU is important because patients are usually sick and have complicated and multisystem dysfunctions that are life threatening when undergoing healthcare treatment. Literature material of the study supported that daily goals checklist offer quality aspects that incorporate several evidence based quality parameters which reduce the cost of the health care VAP administering. The study established a goal directed checklist to implement and achieve objectives of its project. The checklist contained various aspects based on the evidence based best practices in respect to VAP, line sepsis, and other multiple ICU patients care. A proper procedure for the use and implementation of the checklist was examined and evaluated in this study something that supported the internal validity of the study.

A limitation of the study is based on a collection of data because on the use of health care facility as the primary source of information. Nurses may be biased in a situation where they think they are studied and monitored. Summarizing on the study data, it is true that application and use of a checklist is a suitable evidence-based practice. It is used in prevention and control of VAP hence supported on the external validity of the study.

The study of Sabrina et al., (2012) reports on the qualitative convergent care research on the use of a bundle checklist care on the prevention of VAP by professionals and nurses at ICU in public teaching hospital in Santa Catarina. It hypothesized that risk factors resulting from VAP are diverse and they occur differently from various health care facilities and ICU settings. There is a need for the continual local surveillance as well as specific conducts to control and prevent adverse events. Nurses were empowered to monitor the implementation of the strategy which has been adopted by other health facilities for success prevention of VAP. Reliability of another hospital performance had an effect on the internal validity of the study. Not all facilities use the same procedure thus their results and outcomes might vary.

Eighty two professionals including 59 nurse technicians, six physiotherapists, and 17 nurses were used in this study. The reference framework by Morse and Field was used in the interpretation and analysis of the research data. Results of the study gave an argument that use and implantation of bundle support health care evidence based practice that contributes reduction of ventilator associated pneumonia rates. The external validity of the study is facilitated by the methods and variables in the study and the stand that its literature provides for the checklist bundle. In summarizing the entire study, it is clear that there exist simplicity of the care actions in the use of bundle that reduces additional costs of the ICU and low demand for increased workload.

In the research activity by Virginia (2009) is not different from the findings that have been presented by the above studies. The focus in this study was the reduction of VAP using a two hospital approach that engaged a multidisciplinary concept of regular staff education and oral care. Based on the past literature of this study, VAP develops in about nine percent of patients admitted in ICU something that leads to longer duration of ventilation. This results to a longer stay in ICU plus increase in the medical care cost that goes beyond $40, 000 in a single patient situation. The internal validity of the study can be authenticated based on the accurate data provided by the two hospitals. With the help of a multidisciplinary approach, health care facilities can reduce the risk of VAP in their healthcare setting.

In this study, a protocol check sheet plus oral care protocol were used and assisted in the benefits requirement of the staff commitment. Elevating the head of the bed at thirty degrees played a role in reducing the risk of VAP in the health care environment. Results in the study support the external validity of the study and in the initial education offered to ICU nurses in their respective shifts. Implementation of the program and regular schedule staff education plays a significant role in the reduction of VAP rates that are sustainable over time.


It’s true that VAP is a recurring health care infection that leads to a high mortality rate. A good number of health care facilities have been in the move of implementing programs for reduction of rates in the ICUs. The above studies have proved that creation and implementation of VAP bundle checklist help reduce the risk of morbidity and health care cost for patients with VAP.


Khorfan, F. (2008). Daily goals checklist--a goal-directed method to eliminate nosocomial infection in the intensive care unit. Journal for Healthcare Quality: Official Publication ofthe National Association for Healthcare Quality, 30(6), 13-17.

Saber, S. M., Aly, W. W., Bassim, H. H., & Said, A. S. (2013). Implementation of ventilator bundle in prevention of ventilator associated pneumonia. Middle East Journal of Age & Ageing, 10(4), 29-34. Doi: 10.1186/cc6877

Sabrina, Eliane Regina, N., & Raquel. (2012). BUNDLE TO PREVENT VENTILATOR-ASSOCIATED PNEUMONIA: A COLLECTIVE CONSTRUCTION. Texto&ContextoEnfermagem, 21(4), 837-844.

Virginia Lipke. (2009). Sustained Reduction in Ventilator Associated Pneumonia (VAP) Using a Two-Hospital, Multidisciplinary Approach that Includes Oral Care and Regular Staff Education. American Journal of Infection Control, 36 (5), E40-E41.

Westwell, S. (2008). Implementing a ventilator care bundle in an adult intensive care unit. Nursing In Critical Care, 13(4), 203-207

Nancy Simon is the Managing Director of WritingCapital.Com a globally competitive custom essay writing company  which is the premiere provider of Essay Writing Services, Research Paper Writing Services at Term Paper Writing Services at very affordable cost. For 9 years, she has helped a number of students in different academic subjects.

Thursday, 07 December 2017 13:16

The Future of Nursing

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Recommendation 4 aims to increase the proportion of nurses with a baccalaureate degree to 80% by 2020. Currently, I am part of the nursing students on the way to meeting this target. I am undertaking a baccalaureate degree in nursing, and upon graduation, I will be part if the nurse proportion with a baccalaureate degree. Recommendation 5 aims to double the number of nurses with a doctorate by 2020. I anticipate furthering my schooling by undertaking a master degree and later a doctorate. I know I will have completed my doctorate by 2020 thus contributing to the rise in the number of nurses with a doctorate. I also fit in recommendation 6 in as I will engage in life-long learning. Nursing has evolved beyond the basic tasks of providing patient care. Nurses are now taking leadership and managerial roles in different healthcare settings. Leadership and managerial roles can be acquired if nurses engage in lifelong learning processes.  I intend to study beyond the baccalaureate degree I am currently taking. I intend to take a managerial nursing profession in future and to achieve this career goal I have to keep studying.  When I finish my baccalaureate degree and get a job, I will ensure I get on-the job training.  Nursing is a profession that requires training that goes beyond the books. I intend to work, with other experienced nurses to improve my skills. I also intend to get further hands-on training throughout my studies to doctorate level. 

Currently, with my Baccalaureate degree, I become a qualified nurse. However, I will be a general nurse. I will, however, have the opportunity to specialize in nursing careers such as midwifery, or paramedics. Alternatively, I will have the chance to specialize in teaching if I desire to become a teacher. I will be involved in teaching students nurses. Alternatively, I can divert from the nursing specialties and become a counselor or a social worker. The baccalaureate degree will prepare me for my interest of specialization.

Increasing my level of education will boost my ability to compete in the job market.  For instance, I can specialize in a specific field of nursing e.g. pediatric or surgical unit.  Specialization is vital in nursing as it gives a general nurse an opportunity to venture to an area that she loves. Specialization opens additional job opportunities. It also reduces competition in the selected career path.  Additionally, additional education will guarantee my ability to provide patients with quality healthcare services.  This is because increased education also increases experience and knowledge. Alternatively, I can opt for a nursing course that focuses on nursing management.  With qualification in nursing management, I will get a job that involves supervision and management of my nurse colleagues. I will also be involved in policy making concerning improving the working environment of nurses. I will have the necessary qualifications to pursue other job professions. Additionally, during a selection process, I will be given special consideration over my peers with RN and bachelor of nursing qualifications.

Nancy Simon is an academic writer and an editor and she offers custom writing service. Thus, people that doubt their own writing abilities can use the best custom paper writing service and forget about their fears and unconfidence by visiting WritingCapital.Com.

Thursday, 07 December 2017 12:55

Community health

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The complex relationship of mental health and alcohol, tobacco and other drug abuse

  • Introduction

Among the various goals of government public health in New Jersey, there is the goal to improve public health via strengthening community and government partnership. The governmental public health departments of New Jersey in the past five years have led city-based and country strategic planning processes around the state through engaging more than 1200 community partners. The departments with the community partners have performed a comprehensive analysis of the communities and come up with health improvement plans for New Jersey regions. The top health priority issue for New Jersey was identified, which are Tobacco, alcohol and other drugs that have an impact on mental health, nutrition, obesity and fitness; case; access to care, and cardiovascular diseases. This paper will provide an in-depth discussion on the health problem of tobacco, alcohol and other drug abuse which have a complex relationship with mental health.

Berlin New Jersey

Berlin New Jersey is among the eleven forms and five types of municipal government (borough) located in Camden country, New Jersey, U.S/. The population of Berlin according to the 2010 Census of the United States was 7,588 showing an increase of 1,439 of the 2000 Census (23.4%). Camden Country Human Services and the Department of Health have hundreds of services and programs for the public. The services include a range of specialized health programs such as cancer screening referrals, for men and woman, adult health services, school health, family planning services, Child Health Clinics and other specialized health services targeting families with Children with developmental delays and special needs.

The cost of living according to March 2012 Index was at 101.6. The land areas cover 13.7 square miles while water is covers 0.2 square miles. The population density is 915 people per square miles. Female population is 6467 (51.7%) and males population is 6,053 (48.3%). 90% of the population has attained a high school and college education. 26.0% has a bachelor’s degree and higher. 7.6% has professional and graduate degree. 7.3% are unemployed.

  • Demographic and epidemiological data:

Teen depression and alcohol abuse and senior, prescription drugs misuse, and the negative results of mixing alcohol with prescription drugs are attributed to be a significant factor leading mental health challenge in Berlin, New Jersey. CDC undertook behavioral risk factor surveillance to residents of Camden County between 2003 and 2009. The reports from this surveillance system showed that 46.3% had smoked more than 100 cigarettes in their lives. Also in the past month 77% of adult residents had drunk alcohol. People living in group quarters including Berlin showed that 35 people in halfway houses and homes are involved in alcohol and drug abuse. Camden County from the surveillance was number 86 of the top 101 counties having the highest percentage of drunken people. It was number 64 of the top counties with most wine, beer and liquor stores for 1000, 000 populations in 2010. The county was number 75 of the top counties with the highest number of residents who have smoked over100 cigarettes in their lives (CDC, 2009).

  • Windshield survey:

Alcohol and drug abuse are a risky behavior that causes other health problems such as heart diseases stroke, cancer and mental problems. Drug and alcohol addictions, crime, low educational level, poverty and crime are among the most challenging risks that impact on Berlin community. This means that the community should consider setting up stop alcohol and smoking programs, counseling services and mental health counseling programs to assist community members.

  • Problem

Based on the reports given by Healthy People 2020, tobacco addiction and use and alcohol abuse can be addressed through community-based and educational programs. These programs should be provided to senior high schools, middle and elementary students as part of comprehensive school health programs that will help students understand alcohol and drug abuse dangers. Other strategies to reduce tobacco and alcohol use in communities and families is through increasing their price, funding programs for alcohol and tobacco control, access control, enacting smoke-free policies, media campaign for anti-tobacco use, and assisting and encouraging alcohol and tobacco users to quit (Fiore, Jaen, Baker, et al 2008).

  • Summary:

Substance abuse is closely linked to behavioral and mental health. This calls for the need to establish addiction services and mental health counseling services since there is a major gap in Berlin’s, New Jersey health care system. These areas are lacking especially for the most at risk population who are teenagers and the elderly population. This makes many people reluctant to seek help due to the stigma related to mental health problems. Substance abuse is a major challenge in Berlin since there is a growing problem with abuse of prescription drugs even pain killers and other drugs abuse. All these problems have a major contributing factor to the mental health problem currently experienced in Berlin, New Jersey.


Centers for Disease Control and Prevention (2009) Cigarette smoking in adults and smoking cessation—United States, MMWR. 58(44):1227-32

Fiore M, Jaen C, Baker T, et al (2008) Clinical practice guideline: Treating tobacco use and dependence. Rockville, Health and Human Services Department

Janet Peter is the Managing Director of FastCustomWriting.Com a globally competitive custom essay writing company  which is the premiere provider of Essay Writing Services, Research Paper Writing Services at Term Paper Writing Services at very affordable cost. For 9 years, she has helped a number of students in different academic subjects.

Thursday, 07 December 2017 12:35

Changes in the Practice of Nursing

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The nursing profession has evolved over time. Traditionally, nurses were tasked with duty of taking care of patients.  However, changes in nursing practice, as well as the restructuring of the US healthcare delivery system have seen the role of nurses become pronounced. Nurses are now exposed to non-traditional experienced of practicing. These practices include exposure to direct and indirect care experiences. Nurses get to learn, within the healthcare environment they are expected to work. Nurses will keep playing a vital role as their jobs become increasingly available in communities. Nurses will widen the continuum of care. Nurses will also be active players in Accountable Care Organization, medical homes and nurse-managed health clinics. Nursing practice is thus bound to become an increasingly valuable profession.


The role of nurses has changed dramatically with the nurse’s role evolving to cover a wider range of healthcare responsibilities. The society is grappling with a diversity of health complications such as diabetes and obesity. These complications have increased due to the changing lifestyle of individuals, as well as increasing numbers of the aging population. According to Tiffin (2012) nurses are no longer confined to taking care of the sick. They are becoming involved in research; there are also active players in the progress of mobile medical applications. Additionally, nurses are engage in active collaboration with professionals in social services, administrations, as well as physicians, in determining the ideal strategies to enhance the delivery of quality healthcare services. The nursing profession is becoming increasingly broad and deep as nurses have the opportunity to specialize in their preferred nursing fields e.g. oncology, pediatrics, or pharmacology. Nurses will also be involved in analyzing the health of surrounding communities. Nurses will conduct research and analysis of surrounding communities. The data collected will be utilized to establish ideal health strategies to prevent diseases and ascertain a healthy population. The role of nurses is expected to keep evolving over the years, with the practicing nurse performing tasks that go beyond the traditional role of taking care of the sick.

Nurses will also be involved in the continuity of care. The concept of continuity of care refers to the provision of healthcare services over time. Additionally, it refers to focus on a client’s health needs. There are three main types of continuity: informational continuity focuses on effective sharing of information so as to enhance healthcare delivery. The second type is management continuity that ascertains multiple providers remain connected (Scudder, 2011). The third type is interpersonal continuity, which focuses on the formation of a therapeutic relationship between the client and provider. The ability to provide continuity of care will be possible through the provision of holistic nursing practice. Holistic nursing care focuses on the patient, his family, community and populations.

The nursing profession is also expected to grow with the emergence of Accountable Care Organization (ACO). ACO will focus on bring the services of doctors, hospitals and other ancillary providers together, to take responsibility in the provision of healthcare services, to patients. ACO will provide expanded opportunities for nurses who will become managers of care, rather than mere providers. The overall purpose of ACO is to improve the standard of patient care given to patients (Maslen, 2011). With ACO, nurses will enjoy care coordination as they will access a broad continuum of information. ACO will also minimize the risk of medical and medication errors, which may jeopardize the patient’s health. Nurses will also be exposed to broad options of preventive health. Nurses will also have the capability to investigate and determine at-risk populations and assist them with healthcare provisions (Graham, 2011).

Nurses are also expected to establish medical homes in an effort to extend the provision of healthcare services to the public. A medical home is a model to care that uses primary care providers to ascertain the provision of coordinated and comprehensive care. Nurses and nurse mid-wives are expected to take the role of primary care providers.  Traditionally, pediatricians and family physicians were considered as the ideal primary care providers. Nurses are receiving advanced education, which is gradually preparing them to provide initial, continuous and comprehensive care. In future, nurses in medical homes will be involved in the process of gathering patient’s medical histories, performing physician’s examinations, ordering and interpreting laboratory tests, as well as prescribing medication. This is a nursing role that will be highly appreciated considering there are hardly adequate physicians to handle all patients.

The inclusion of qualified nurses in the medical homes model will ascertain that patients receive prompt and quality services. Nurses will be assigned to healthcare communities. These are healthcare facilities that are situated within the locality of certain communities.  Traditionally, nurses have been the most dominant body in these community centers (Tiffin, 2012).  The inclusion of nurses in the medical home concept will ascertain that nurse’s take a leadership role, and that participate in the delivery of healthcare services. The restrictions on the scope of practice that undermined nursing profession will be eliminated, with the establishment of medical homes. Nurses will undertake active roles in the medical homes. Their participation in the provision of quality care will be based on the extent of their education and training. Currently, the government is engaging in efforts to improve the training and educational standards of nurses. Nurses will be trained to be caregivers, managers, leaders and researchers.  With this training, nurses, in the future, will take leadership positions with regard to the provision of quality care (Scudder, 2011).

 Advancement in education and training of nurses will also increase the number of nurse managed clinics. Nurse managed health clinics (NMHCs) is a model which could enhance access to quality healthcare services. NMHC is a community based healthcare services that operate under the leadership of advanced practice nurse. The establishments of these clinics would boost the provision of healthcare services. Additionally, the strain of physicians due to overcrowding in major hospitals will be minimized. The clinics will emphasize on health education. Nurses will be involved in the education and creation of awareness on disease prevention and methods of leading a healthy lifestyle. These clinics will be located at the vicinity of the local community hence ease of access to vital information related to healthcare management (Tiffin, 2012). My nurse colleagues agree that the NMCH that exists today are providing patients with exceptional healthcare services. In the future, expectations are that the number of NMCH will increase from the current 200. Currently there are 200 clinics across 37 states across America. These clinics serve approximately 2 million patients every year.  It is anticipated that clinics will increased. The clinics will be available in all states. The ease of use and access of the clinics will ascertain that many patients will access quality healthcare services. Currently, most people never visit healthcare facilities unless they are unwell. The presence of NMCH will ascertain that the public get informed on the need for regular testing and wellness check-ups. Some of the services that nurses will provide at the clinic will include physical examinations, cardiovascular analysis, smoking cessation program and immunization.  The clinics will provide treatment, as well as preventive measures that will ascertain a healthy community.


My sentiments on health reform tally with my nurse colleagues.  Nursing practice is becoming a valuable profession in the healthcare sectors. With adequate training and experience, nurses are becoming managers who are taking the leadership role in the management of medical homes and nurse-managed health clinics.   These health facilities are largely located around communities and strive to provide patients with prompt and easy to access treatment and preventive services. Nurse-managed health clinics will be essential providers of primary care, as mainstream health facilities grapple with a large number of patients. The increasing role of nurses is likely to lead to a rise in job opportunities for nurses, especially at the community level.


Graham, M. (2011). Accountable care organizations: the future of healthcare? The nurse practitioner. Vol. 36(8)

Maslen, L. (2011). Accountable Care organization: the future of quality healthcare. Washington healthcare news

Scudder, L. (2011). Nurse-led medical homes: Current status and Future plans. Medscape nurses

Tiffin, C. 2012). Beyond the bedside: changing role of today’s nurses. Huffington post

Nancy Simon is the Managing Director of WritingCapital.Com a globally competitive custom essay writing company  which is the premiere provider of Essay Writing Services, Research Paper Writing Services at Term Paper Writing Services at very affordable cost. For 9 years, she has helped a number of students in different academic subjects.

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