Discuss about the Quality and Accountability in Healthcare Delivery.
Back in 1980’s, the majority of care to patients was provided by registered nurses (RNs) and licensed practical nurses (LPNs) with supportive assistance being provided by unregulated care providers (UCPs) such as porters and orderlies. (Haugen, & Musser, 2012). The term unregulated care providers are used to define health care workers who are neither licensed nor regulated by any professional, regulatory or governmental body. (Hamilton, 2013) They may assist in providing care to clients in various hospital settings such as acute care, comprehensive rehabilitative, and community care. Here in Canada, some changes in the health care system have led to the emergence of new models of delivery of care. (Clarke, 2012) UCPs work has shifted from that of support models to that of assistive roles with a primary focus on patient care. This increased reliance on UCPs in health care areas is related to greater need to control costs in health, shortage in staff and the dynamic changes in the delivery of health care in the aging population.
An expanding body of research recommends that the collaborative framework within the health providers will assist in managing increased workloads, reducing waiting times and improving health outcomes for clients. However, most research has concentrated on the relationship among the health specialists with increased questions as to the effectiveness of UCPs within a team-based care approaches in health activities. This questions include, what may be the implications of units made up of both UCPs and regulated health providers? What strategies optimize and maintain the roles of both licensed and unregulated care providers? Are there concerns that commonly put across both disciples, jurisdictions, and settings? (Clarke, 2012)
Due to the rapid increase in aging of the world’s population, UCPs are emerging to be an important health care workforce in the care of older adults. There exist similarities in the ways nurses work here in Brazil and that of Canada concerning UCPs. Developed and developing nations are facing numerous challenges due to the increased aging health care workforce and population. Therefore, the increasing age of population and shortage of health providers has led to increasing demand for UCPs to provide care in both our countries. The major similarities are that both countries are ethnically diverse and large, consist of democratic governance, a multi-dynamic culture and a stable economy. They also consist of a universal system of health that meets the needs of their entire population. Regarding differences, Canada is developed and underpopulated while Brazil is populous and a middle-income country. (Veras et al., 2016)
Nurses have to understand the health care system of both their country of origin and that of Canada for effective planning and delivery of health care in these two countries. The cost of health services is growing fast, and also there is increased attention to the impact of the growing and aging population. The health care system in Canada is based on the five principles of the health act which include; comprehensiveness, portability, and universality of the system. Other factors are the accessibility of health services and public administration. (McIntosh, Forest, & Marchildon, 2014) On the other hand, the Brazilian health system is divided into sectors that include; private, public and unified public health system that are mainly financed by private funds. (Veras et al., 2016) Nurses understanding of these differences and similarities is vital as it enhances their knowledge on such shifts in their day to day care of patients both in the home and community settings.
It is in the nurse’s approach in the work environment to ensure that the various models support and sustain their roles and enhance safe client care. These models facilitate the enactment of legislation of nurse to patient ratios along with regulation of UCPs. The evolvement of nursing practice between one’s country of origin to Canada should be based on issues that are identified in the description and roles of unregulated health workers (UHWs). These issues include; lack of statistics on UCPs, inconsistent titles of UHWs, insufficient education/training and lack of employer standardization in regulation. (Storch, 2013) Therefore, as members of a regulated profession, nurses within a specified country need to understand their roles and responsibilities and be held accountable when working with UHWs. This is particularly when in close involvement of delegating nursing tasks and procedures.
This evolving approach is justifiable by the fact that UHWs do not possess certain characteristics, unlike licensed or registered professionals. UCPs lack attributes such as; a legislated scope of practice, set of professional standards for practice, titles, a mandatory requirement of equipment and a professional conduct review process. These attributes are intended to ensure the public receives the highest standard of individualized care which includes safe, competent and ethical care for the clients. (Storch, 2013) UCPs may be taught through either the instructional or vocational training to function in the assisting role or may possess no formal training and learn on the job. Nurses should be familiar with various regulatory approaches concerning the standards of nursing practice of the nursing profession in their country and that which they are working currently. This knowledge helps them address concerns in nursing practice and clarify accountability of UHWs and other strategies such as clarifying the responsibility of the employer and standardizing curriculum.
Positive implications have been identified in the health care system about the evolving work approaches among UCPs and regulated health providers. First, there is an evident increase in the role of UHCWs in the care of the clients in the health population. This care is evidenced by their scope of practice which includes; health promotion, light keeping and individualized care, integrated care, mental health and physical rehabilitation. Collaborative care is enhanced by the active participation of the various disciplines in the provision of patient and client care. There is an increase in effective communication as an implication in the various approaches by the nurse when working with UCPs. This approaches such as the awareness of other members’ communication style and thought processes are essential in the development of a collaborative relationship among health care workers. (Kortes-Miller, Jones-Bonofiglio, Hendrickson, & Kelley, 2015)
A team approach should aim in maximizing the skills of all the involved members and deter a repetition of service delivery thus enhancing the productivity of the health workforce. The various health approaches have therefore lead to increased cooperation and coordination among the care providers. Lastly, there is increased responsibility and accountability for the health professionals. Defined guidelines and protocols help reduce uncertainties and outline a supportive structure which is specific to the various health settings. The roles of UHWs must be well known by the regulated professionals for effective and safe care. This will ensure concern of the licensed and regulated health providers concerning their accountability and responsibility in such cases as the delegation of tasks or procedures to the UCPs. Various regulatory bodies have developed tools and protocols that provide guidance on the roles and scope of UHWs. A good example of such a protocol is the practical guideline on the utilization of unregulated care providers which is provided by the College of Nurses of Ontario. (Das, 2015)
Conclusion
The inter-relationships of various factors are specific to determine where a certain clinical responsibility falls for a specific category of a health care provider. A quality client outcome is outlined by the ability to assign, supervise and delegate appropriately and also by realizing when and how to follow up patients. RNs and LPNs should, therefore, be aware of their roles, responsibilities and related accountability when dealing with unregulated workers. Following the key issues outlined in this essay, it is true to say that, registered and UCPs should work together to advance the health for all individuals for positive health outcomes. Today, UCPs work in various settings that include traditional and modern health care surroundings with a wide variety of clients. Nurses are also obliged to work together to improve practice and policy settings for the creation of professional environments for collaborative client-centered care.
References
Clarke, J. (2012). Health, illness, and medicine in Canada. Don Mills, Ont.: Oxford University Press.
Das, J. (2015). Quality and accountability in healthcare delivery (1st ed.). [Washington, D.C.]: World Bank.
Hamilton, H. (2013). Unregulated care workers … the thin edge of the wedge. Collegian, 4(2), 3. doi.org/10.1016/s1322-7696(08)60213-9
Haugen, D., & Musser, S. (2012). Health care (1st ed.). Farmington Hills, MI: Greenhaven Press.
Janes, N., Sidani, S., Cott, C., & Rappolt, S. (2014). Figuring it Out in the Moment: A Theory of Unregulated Care Providers’ Knowledge Utilization in Dementia Care Settings. Worldviews On Evidence-Based Nursing, 5(1), 13-24.doi.org/10.1111/j.1741-6787.2008.00114.x
Kortes-Miller, K., Jones-Bonofiglio, K., Hendrickson, S., & Kelley, M. (2015). Dying With Carolyn: Using Simulation to Improve Communication Skills of Unregulated Care Providers Working in Long-Term Care. Journal Of Applied Gerontology, 35(12), 1259-1278.doi.org/10.1177/0733464815577139
McIntosh, T., Forest, P., & Marchildon, G. (2014). Changing health care in Canada (1st ed.). Toronto [Ont.]: University of Toronto Press.
McIntosh, T., Forest, P., & Marchildon, G. (2014). The governance of health care in Canada (1st ed.). Toronto [Ont.]: University of Toronto Press.
Storch, J. (2013). Casualization of nurses and unregulated workers impair ethical practice. International Nursing Review, 45(5), 140-141.doi.org/10.1046/j.1466-7657.45.no.5issue341.4.x
Veras, M., Paquet, N., Oliveira, E., Zakus, D., Deonandan, R., & Pottie, K. (2016). Unregulated health care workers in the care of aging populations: Similarities and differences between Brazil and Canada. Family Medicine And Community Health, 4(1), 3-14. doi.org/10.15212/fmch.2015.0113
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