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  1. How disability might affect people’s access, perceptions and experiences of healthcare services.


    1. Critically consider how disability might affect people’s access, perceptions and experiences of healthcare services. Referring to the evidence base and using examples from your own clinical practice identify how nurses can address issues which might arise. (25%)

      The NMC Code (2018) requires that nurses:

      “act as an advocate for the vulnerable, challenging poor practice and discriminatory attitudes and behaviour relating to their care”

      With reference to your own clinical experiences and with reference to relevant literature, critically consider how nurses can meet this requirement and what challenges exist professionally, and in society which might make this goal difficult to achieve. (25%)

    2. Critically consider how effective Inter-Professional Working might help to enhance partnership working between staff and patients/service-users leading to improved health outcomes? Give examples from practice of effective Inter-Professional Working, (this can include working with non-statutory services) making reference to literature on the subject and citing examples of key reports that have illustrated where poor practice was implicated in untoward events. (25%)


Subject Nursing Pages 14 Style APA


Effects of Disability and Inter-professional Working in Health Care

Part 1:

Question 1:

            It is estimated that over a billion persons live with certain form of disability worldwide. This figure corresponds to approximately 15 percent of the global populace (Rotarou & Sakellariou, 2017). The disability rate is significantly growing in part because of the elderly population as well as the acceleration of chronic health conditions; however, the disabled people face difficulties in accessing health care. Persons living with disabilities are principally susceptible to deficiency in healthcare services. Dependent on the group and setting, people with disability experience great vulnerability to higher rates of premature death, engaging in health risk behaviors, age-related conditions, co-morbid conditions, and secondary conditions. Transportation and affordability of health services are two major factors that hinder persons living with disability from accessing the needed health care. Research shows that in low income nations, approximately 32 percent of persons with no form of disability are not able to afford health care in comparison to 52-54% of persons with disability (Rotarou & Sakellariou, 2017). The disabled people mostly depend on other people, including relatives for medical costs, making it difficult to see doctors.

Most people with disability can also not commute to clinics or hospitals alone as they need the assistance of friends or family member, who may not be in a position to take them for medical care at the appropriate time. Moreover, lack of availability of healthcare facilities within the proximity of this critical population also hinders their accessibility to healthcare services. de Vries McClintock et al. (2016) found that after medical costs, lack of hospitals and clinics was the second most significant barrier to accessing healthcare by persons living with disability. The author also established that physical barriers including uneven accessibility to buildings (health centers, hospitals), inaccessible parking area, inadequate bathroom facilities, internal steps, narrow doorways, poor signage, and inaccessible medical equipment create obstacles to healthcare facilities. For instance, most women with difficulty in mobility are habitually unable to access cervical and breast cancer screening since mammography equipment can only accommodate women who are capable of standing and examinations tables are not height-adjustable.

Persons with disabilities have various experiences in regard to the delivery of healthcare services. Obtaining adequate interpreter services and effective physician-patient communication is perceived to be a big impediment in the delivery of healthcare services. Most persons living with disabilities cite that finding care providers who are knowledgeable about their conditions prove to be a major problem. In my healthcare organization, a patient living with disability described an experience of arriving at the hospital and unable to fit in the wheelchair that was availed in the waiting zone. Some patients also had difficulty in transportation from the ground floor to the third floor in hospitals without elevators (de Vries McClintock et al., 2016). Most patients living with disability cite feeling diminished and deflated, insufficient information provision, and short duration of visits with care providers in many of the public hospitals. They state that the physicians neither give them the attention needed nor provide them with the necessary. As such, persons living with disability perceive hospitals as institutions established for people without disabilities because due to their conditions and insufficient funds, they have never been able to receive holistic and patient-centered approach to health care. Some state that the nurses have never been able to establish a good rapport with them to allow access to critical health information required for diagnosis as well as treatment.

The issues cited by people with disability are critical, therefore, require action. First, it is important to address the above issues through policy and legislation. The nurses should petition the legislature to conduct an assessment of existing services and policies, and identify priorities that would help in reducing health disparities and plan improvement for inclusion and access. It is important for the ministry of health and every hospital to establish healthcare standards related to care of people living with disabilities with execution mechanisms (Sakellariou & Rotarou, 2017). The nurses should also employ self-advocacy and undergo training on how to provide care to persons living with disability. The nurses should advocate for changes in the physical layout of hospitals to provide access for persons with mobility difficulties.  More importantly, the nurses ought to establish a good rapport with patient living with disability and treat them with the necessary respect, empathy, dignity, and compassion so that they can feel valued like other people in the society. They should also know the needs and preferences of persons with disability to enable effective delivery of care services.

Question 3:

            Inter-professional working plays a critical role in enhancing the partnership working between care providers and patients and service-users resulting in improved health outcomes. In providing care, for example, collaboration and effective teamwork promptly and positively impact patient safety and health outcomes. An effective teamwork which involves proper coordination and collaboration is accredited as a significant tool for building patient-centered care approach; which plays an integral role in ensuring patient satisfaction (Thomas et al., 2017). Teamwork and collaboration essentially aids effective communication and consultation, therefore, leading to optimal health care decisions. Inter-professional collaboration and teamwork also comes with other benefits including improved relationship with other disciplines, reduced healthcare costs, and improved patient outcomes. It enables the care providers to provide coordinated and compassionate care which is based on respect for patients’ needs, values, and preferences and allows minimization risks of harm to the patients thus ensuring patient safety.

Teamwork and collaboration, additionally, ensures quality improvement through using data in monitoring the care processes’ outcomes and utilizing improvement approaches to design and test changes to help in improving safety and quality of healthcare systems. Studies show that teamwork lessens the volume of medical and enhances patient safety (Stiggelbout, Pieterse & De Haes, 2015). Working together as well reduces the problems associated with burnout because one individual is no longer responsible for taking care of a patient but a multidisciplinary team. The effective communication exhibited by teamwork leads to development of good rapport and relationships with the patient and family members making them to feel at ease with the delivery of care thus increasing customer satisfaction. Health team also breaks down centralized and hierarchy of healthcare facilities providing more leverage to the workforce.

There are various examples that can show how developing inter-professional working helps in reducing the risks in the clinical practice set-up. For instance, Hospital Z had been experiencing medical errors associated with ineffective discharge medication plans that encompassed poor medical prescriptions. This resulted in poor health outcomes, high rates of hospital readmissions, and high cost of providing care. Many of clients raised complaints and to poor customer satisfaction most of the loyal customers began seeking medical attention in other healthcare facilities. The organization’s revenue significantly decreased and had fire some of the staff. To counter this problem, the healthcare facility proposed a strategy of inter-professional team which would help in delivering patient-centered care to ensure safety of the patients. The team comprises nurses, physicians, doctors, and clinicians. Due to this strategy, the hospital began to experience few complaints from the patients and after two months, the customer reported higher satisfaction. The inter-professional team warranted effective communication even with the patients and developed good rapports which enhanced care delivery.

Remarkably, inter-professional plays a great role in the provision of compassionate care to the patients. Compassionate care involves not only the care providers but also the patient as well as his or her family members. This kind of involvement creates therapeutic relationship, establishes good rapport, enables active listening, and offers effective solutions patients’ issues and concerns (Findyartini et al., 2019). It is important to note that involving patients their health care helps them to make their health care experiences safer through becoming active, providing critical health information, and taking part in decision-making. Patient involvement in care also enables them to voice their concerns and allows the care providers to deliver health services that correspond to the patients’ beliefs, values, preferences, and need, thus resulting in patient satisfaction. In the same vein, an enhanced relationship between care providers and a patient’s family is very vital for all parties involved in the care process. The care providers, including nurses or physicians can utilize the family members’ knowledge in regard to the condition of the presented patient. The involvement of care providers and patient family members can make a patient receive better health care due to the fact that both the informal and formal care are better aligned to one another.

In addition, inter-professional working provides patients with much information about their health conditions and gives them with reassurance and hope of recovery. It is important to note that reassurance plays a critical role in easing a patient at the time of treatment and help in improving their health outcomes due to medication or treatment compliance (De Sutter et al., 2019). Inter-professional working also enables diversity, thus bringing people from different culture. As such, most of the patients may find a person from their culture who understands their cultural beliefs and values, resulting in effective delivery of health care.

P2 Q1

To identify care priorities, nurses must develop skills in interviewing patients, and in interpreting their verbal and non-verbal cues, to take histories and undertake patient assessments appropriately. Genuine conversation builds relationship, solves problems, ensures understanding, resolves conflicts, and improve accuracy, which are important factors during patient interview for correct diagnosis. In this particular scenario, there are missing nursing cues from both the nurse and patient that have interfered with the interaction (Amoah et al., 2019). The first one is continuous interruption. The nurse continued to interrupt Mr. Dhes, the patient in this case, in several occasions where he needed to get certain important information about his treatment. It is important to note that an effective type of care is that which involves the participation of the patient by being part of the treatment method (Norouzinia et al., 2016). It is in this context that the patient should be made aware of every procedure that occurs. However, in this case, the attempt of the patient to know what was going on was not achieved by continuous interruption from the nurse. Secondly, Mr. Dhes, on the other hand, did not keep an open mind. He kept on talking as if he is the doctor or a healthcare professional. In any case he had something that he did not understand he kept on seeking clarification by asking the doctor another question. Mr. Dhes can be termed as a talkative patient whose speech at times may lack focus and contains irrelevant information. According to Irwan and Hassan (2016), collecting or gathering information from such patients may be challenging for healthcare providers. It is in this context that nurse calls him an Expert patient. Lastly, the use of strange but unexplained words during patient interview also interfered with interaction. The nurse was not willing to clearly explain to the patients some of the medical terms she was using. This created anxiety to the patient who thought some of the terms meant critical conditions that could severely affect his life.

P2 Q2

Healthcare discrimination which is differentiating treatment to certain individuals based on their perceived or actual characteristic such as race, age, gender, ethnicity, and income status manifests in the beliefs, status, attitudes, and opinions of clinicians that significantly affect certain populations or group of people (Rivenbark & Ichou, 2020). In this particular scenario, there are examples of discriminatory attitudes that have got potential effects during treatments. The first one is discrimination based on age. While studies reveal that most aged individuals may suffer from diabetes, not all of them are diabetic as some are very active and free from diseases that are perceived as those of the old people. The nurse believes that at Dhes’ age, he must be suffering from certain diseases that might interfere with normal operation. While the patient says that he is fit and runs five miles comfortably, the nurse does not believe. Such kind of beliefs have got negative impact during treatment as the nurse or care provider may omit certain important procedure because she/he believes that there are certain conditions that are permanent to certain age (Nguyen et al., 2019). The nurse’s attitude, when describing the use of DNAR to Mr. Dhes, reflect the intensity of age discrimination in the healthcare system. The nurse seems to suggest that the patient, due to his old age, would not require resuscitation if something goes wrong in the surgery, a clear indication of discrimination based on age. The nurse sentiments on the patient’s comments about his blood pressure measurement further portray discrimination based on age.

Another discriminatory attitude that has been clearly demonstrated in this case is religion. The nurse in this case, after looking at patient believes that he is a Muslim and when they patient says he is Shikh then she says that she prefers Sikh to Muslims. Based on that description, the nurse would attend to the Sikh more than a Muslim hence this would affect the outcome of any Muslim individual she takes care for. According to the study conducted by Rivenbark and Ichou (2020, health-compromising outcomes associated with social discrimination include heightened physical stress responses, poor compliance with medical treatment, patient disengagement, and healthcare avoidance behaviors, which all contribute to the higher morbidity and mortality rates. On the same note, the nurse believes that most people from Sikh religion eat a lot of sugary foods hence are diabetic. She, therefore, advices the patient not eat foods that have high sugar content 24 hours to the operation. A study conducted by Krause (2019) reveals that such kind perceptions may affect the judgment of the nurse hence may omit to perform certain important health procedures by believing that a certain groups must possess a particular condition. Additionally, according to (), discrimination has made certain individuals not access healthcare citing negative treatment a factor that increase mortality rate of particular groups.

P2 Q3

The World Health Organization (WHO) defines patient empowerment as the process through which individuals or patients gain greater control and fully participate over the decisions and actions that affect their health.  According to the study conducted by Burkoski et al. (2019), there ae several ways through which a healthcare provider can empower the patient that may include sharing patient education materials and engaging patient in an interactive communication where all the processes of treatment are explained to the patient. However, in this particular scenario, there ae several patient disempowerment that have been caused by the nurse. The first example of how the nurse disempowered Mr. Dhes is inability to access important quality information.  Notably, the nurse kept on using medical terms that were not well understood by the patient, and in an attempt to seek clarification from the nurse, she did not provide clear information that was needed by the patient. In fact, the nurse at one point told the patient to learn better English. Inability to provide quality information during treatment has got several impacts that include making wrong decision by the patient during treatment. According to Amoah et al. (2016), the patient must consent to medication procedures; however, the correct decision can be reached only when the patient is given correct information.

Secondly, the nurse disempowered the patient by being sarcastic instead of appreciating the patient for having known certain basic medical procedures such as correct blood pressure level. A study conducted by Irwan and Hassan (2016) reveals that nurses or any care provider should have an effective communication skills that enable them to interact freely with their subjects. However, sarcasm is a hostility concealed as humor that makes people feel bad. Sarcasm is unsettling. In this case, the nurse calls Mr. Dhes an expert patient just because he understands certain medical procedures. It has a negative impact during interview and patient engagement since the patient is likely to feel indignant and stops talking, a factor that interferes with diagnostic and other medical procedures.

Lastly, the nurse got involved in continuous interruption that did not give the patient an opportunity not only to learn but also to express certain information that would have been important during preparation for the operation. Repetitive and continuous interruption to some extent annoys hence the patient may opt not only to keep quiet but also to provide wrong information (McSherry & Pearce, 2007).  As indicated by (), during operation preparation, certain critical information are required that include the past medical history of the patient as well as the recent social life of the patient. However, the patient remains at risks during operation when such important information are not put under consideration just because the patient decided not to talk or provide wrong information. 

P3 Q4

Informed consent is the process of communication between the patient and healthcare provider that always leads to permission or agreement for care, service or treatment. According to McSherry and Pearce (2007), every patient has the right to have treatment information that include all medical procedures and treatments. Whenever any adult patient is mentally able to make decisions, medical care should not begin before their consent is sought. In this particular scenario, there are certain cases of where consent was not sought as well as inability to provide important information. For example, the nurse pricks the patient’s finger for blood collection without informing him (Nursing and Midwifery Council (NMC), 2019). This is did not only hurt the patient but also made him upset why he was not informed. On the same, the patient tells the nurse to use a specific hand while checking blood pressure since the other hand hurts. Even after informing the patient, the nurse does not obey the wishes of the patient. In this case, the nurse should have provided detailed information about the possible effects of operation. The nurse ought to have obeyed the patients request during blood pressure checkup. There are several consequences of not obeying the consent of the patient. According to Findyartini et al. (2019), if the doctor performs procedure B after the patient has given informed consent for procedure A, the patient can sue the doctor based on lack of informed consent. This is true even if the procedure was successful. In some countries, disobeying the consent of the patient can lead to jail as well as revocation of the license depending on the charges and the extent of the damage.



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Appendix A:

Communication Plan for an Inpatient Unit to Evaluate the Impact of Transformational Leadership Style Compared to Other Leader Styles such as Bureaucratic and Laissez-Faire Leadership in Nurse Engagement, Retention, and Team Member Satisfaction Over the Course of One Year

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