Category: Caring

INTRODUCTION

In my report I will be discussing HIPAA , why it’s important and what it means and how it protects patient information. Here’s a little background on HIPAA, The Congress as the Kennedy-Kassebaum Bill had introduced and passed HIPAA August 21, 1996. There have been a lot of add ons to the HIPAA policies over the last 20 years. The latest one was in April 2003 and April 2005. HIPAA has four rules and they are HIPAA privacy rules which protect what is communicated to others .HIPAA security rule will protect your information in a secure database HIPAA enforcement rule points out implementation procedures and penalties. HIPAA breach notification rule contacts patients if their information has been broken into and they can help them. All of these rules play a very important role in the medical and dental field.

HYPOTHESIS

HIPAA stands for Healthcare Insurance Portability and Accountability Act. HIPAA is very important because it helps protect the patient, healthcare insurance and health plans . It also helps others who have insurance through jobs and not on their own. Also HIPAA is very important in the medical field especially . HIPAA lets you choose who can speak on your behalf. If you were to get in an accident and were unable to communicate, it is important to choose someone you can trust, this matter because they will be representing you. You also have access to have copies of your health records if needed. The physical, technical, and administrative safeguards for HIPAA It protects you from fraudulent activities like identity theft, harm and embarrassment from others and stops people who aren’t allowed to see your records if they do not have permission. It protects your health information for example any of your treatments, diagnoses, test results and medications . HIPAA also protects patients personal information like your address, email address, dates, social security and account numbers and imaging.

CONCLUSION

Overall the Healthcare Insurance Portability and Accountability Act is important to have while going into any medical and dental office in order to protect from any harm. Always ask questions on information you don’t understand especially when it comes to the HIPAA policies at your doctor or dental office. . While I was doing this report I learned a lot about HIPAA and what it protects and when it was created was very intriguing to me. It not only protects our information but our identity and they also will contact us on anything that looks unfamiliar and they make sure we are aware that we can share information with someone we trust just in case we die or get into a terrible accident that cause not being able to communicate.

The experts in the wellbeing segment have a gigantic undertaking of ensuring the wellbeing information record is constantly protected. For instance, exchanges that exist between a specialist and a patient ought to be classified to a high degree and kept safely without getting to an outsider’s hand, it is profoundly conceivable that the patient wants to get approaches a landline telephone as opposed to utilizing a cell phone. Shut relatives with similar family names are not permitted to speak to their nearby ones.

HIPAA is an abbreviation that is spoken to as the Health Insurance Accountability Act. It realizes protection decides that is a prime theme in civil rights. There exist two different ways of deidentifying customers’ close to home information identifying with their wellbeing. They incorporate the factual strategy and the safe harbor method technique (Garfinkel, 2016). For the measurable strategy, the proper workforce would have been prepared to check the evacuation of identifiers and guarantees the danger of recognizing the person to be extraordinarily diminished, while in the safe harbor technique. Information is referred to as deidentified, at whatever point the secured individual expels 18 identifiers from the identifier information sent. During the procedure of deidentification, a way to reidentify the de-distinguished data is done which involves doling out a remarkable code to the de-recognized data to effectively re-recognize it, there is each likelihood that the code appointed won’t be produced from the de-identified data identified with the person. The substance secured may really not uncover the code to anybody to ensure their privacy (Garfinkel, 2016).

The HIPAA presented safe harbor supports disposing of a portion of the identifiers, some of them incorporate Names, all current geographic areas that a state is bigger than, all date component, phone, vehicle number, fax number, email address, government disability number, and others (Institute of Medicine, 2009). Some HIPAA guidelines exist, and this will enable different health experts to share data that is straightforwardly significant to the association of the life partner or relatives, companions or different people indicated by a patient. It is conceivable that the patient can settle on close to home choices about healthcare services, here the specialist can have one-on-one synchronization with the patient for them to choose on the off chance that they will share and does not protest at all or the other. A few circumstances do emerge when the patient is absent to give proceed before relatives (Health information privacy, 2019). Notwithstanding when the patient is absent to request approval before with relatives or companions.

HIPAA safe harbor de-distinguishing proof technique guarantees the individual has the privilege to the protection and accomplish a lot more advantages when utilizing advanced data. It can possibly wind up available over the globe. This strategy is promptly utilized for huge datasets. In the case of going for the underlying safe harbor or master assurance, different classifications of data have their separate de-identification proof difficulties (Health information privacy, 2019)

References

1. Garfinkel, S. (2016). De-identifying Government Datasets, National Institute of Standards and Technology 800- 188 (2d DRAFT) p. 8 Retrieved from https://www.ncvhs.hhs.gov/wp-content/uploads/2013/12/2017-Ltr-Privacy-DeIdentification-Feb-23-Final-w-sig.pdf
2. Health information privacy. (2019). U.S. Department of Health & Human Services Retrieved from https://www.hhs.gov/hipaa/for-professionals/privacy/special-topics/de-identification/index.html
3. Institute of Medicine (US). (2009). Committee on Health Research and the Privacy of Health Information: The HIPAA Privacy Rule; Nass SJ, Levit LA, Gostin LO, editors. Washington (DC): National Academies Press (US). Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK9573/

It’s hard to imagine a time in our health care that we weren’t protected. A time when everything was handwritten and had to be filed. This was a time in history when HER (electronic health records) and the protection of HIPAA (Health Insurance Potability and Accountability) wasn’t even thought of. I’m talking about back in the 1950’s and 1960’s when electronic health records would have boggled doctors or health care professional minds. Even the thought of a law such as HIPAA wasn’t even imaginable in those times.

POMR- (Problem Oriented Medical Records)

Our health records dates back in a time before the first computer system had internet service. One of the first to improve the keeping of patient’s medical records was POMR. Health records originated by paper records known as Problem-Oriented Medical Records in 1968. As of today, some facilities still use POMR, but not many. Through the years, our heath care medical records evolved so much that POMR is almost a thing of the past.

As years evolved with our technology, as did our health care. In the early 1990’s the computer-based patient records were written and came to be by Richard S. Dick, Elaine B. Steen and Don E. Detmer. Thanks to CPR being g created, it was now easier for users to have accurate data, alerts, reminders and clinical decision support. Along with CPR, the 90’s also brought to us HIPAA. Until 1996 there was nothing set to protect our health care privacy and records. In Aug. 1996, President Bill Clinton signed the ACT to implement health care protection whether it is paper records or electronic. So, in signing this ACT called HIPAA, President Bill Clinton provided us with the means to have our health care records protected and to stay private. (Rouse)

HIPPA and HIPAA Violations

HIPAA was designed to protect employees’ health records that may have lost their jobs, but HIPAA also has other objectives. Other objectives of this ACT are to combat waste, fraud, and abuse in health care and health insurance and improving health insurance for long term care. HIPAA does have an impact on EHR. HIPAA’s regulations require HIPAA to protect electronic health records in keeping patients records and information private and secure. All physicians or health care providers who have access to a patient record “must” follow and comply with all HIPAA regulations and rules. Many things are considered before a physician can be granted access to a patient file. One of the many things is a physicians’ relationship or affiliation with the facility, also the intentions behind the need to access the file. Another is the reason to why the physicians’ personal would need access, such as things like billing or procedures. HIPAA also protects the standards of EHR. EHR standards are important due to reduced medical mistakes, lower costs and correct medical records. There are many rules of the HIPAA Law and EHR is only one of the many.

When accessing a patients’ records for reasons other than those that follow the privacy law such as payment, treatments or billing, you will be in violation of HIPAA law. Accessing any patients file for any reason other than allowed is considered a violation. An employee who looks at a patients file that may be family or even a co-worker is considered “snooping. Snooping is a violation that is considered a crime and could result in a fine and/or jail time. It’s not common but it has happened.

Evaluation of HIPAA Over Time

Since the beginning of 1990, EHR has had much improvement. We now have greater continuity car, improved efficiency and better emergency readiness and response. Having greater continuity care allows for receiving high quality care. Improved efficiency allows for quicker access to patients and saves time accessing patient records with ease. It is important that we have quick response time and better prepared for an emergency.

Over time, thanks to technology, our EHR, with the help from Apple, Google and Amazon has improved even more. Apple, Google and Amazon have introduced health information and health record apps. We can now access our PMR (Personal Medical Records) via our smart phones or other electronical devices. It can make it much easier for patients to keep track of any upcoming appointment, medication refills, and allergy history. As the generations evolve, our health care evolves making it easier to stay on top of being heathy.

Conclusion

From the conception of POMR in the 60’s to HIPAA in the 90’s, our medical care and privacy has taken a huge leap forward, allowing for the best care and protection possible. In having HIPAA implemented into rules and law, we as patients can feel confident in knowing we are protected. When President Clinton signed the ACT into law it also protected our privacy even if we had lost our jobs. Our health care, whether paper records or electronical records, and/or our private information stays that way. Private. Thanks to President Clinton and HIPAA, if there happens to be a breach in our health care records or personal information it is punishable by law. Under HIPAA rules it can cost as much as $50,000.00 and/or one year in prison.

6 Key dates that HIPAA laws were enforced in History

• August 1996—HIPAA signed into law by President Bill Clinton
• April 2003—Effective date of HIPAA Privacy Rule
• April 2005—Effective date of Security Rule
• March 2006—Effective date of Breach Enforcement Rule
• September 2009—Effective date of HITECH and the Breach Notification Rule
• March 2013—Effective date of Final OMNIBUS Rule. The closing paragraph is designed to bring the reader to your way of thinking if you are writing a persuasive essay, to understand relationships if you are writing a comparison/contrast essay, or simply to value the information you provide in an informational essay. The closing paragraph summarizes the key points from the supporting paragraphs without introducing any new information.

References

1. HIPAA history. (2020, May 19). HIPAA Journal. https://www.hipaajournal.com/hipaa-history/
2. EHRIntelligence. (2015, November 12). Why is establishing standards of EHR use important? https://ehrintelligence.com/news/why-is-establishing-standards-of-ehr-use-important
3. Rouse, Margaret. (2019, February 13). What is HIPAA (Health Insurance Portability and Accountability Act) ? – Definition from WhatIs.com. SearchHealthIT. https://searchhealthit.techtarget.com/definition/HIPAA
4. Ferran, Tod. (2015, March 11). Don’t confuse EHR HIPAA compliance with total HIPAA compliance. Healthcare IT News. https://www.healthcareitnews.com/blog/don%E2%80%99t-confuse-ehr-hipaa-compliance-total-hipaa-compliance
5. Sandy. (2019, April 16). History of electronic health records | EHR | ICANotes. ICANotes. https://www.icanotes.com/2019/04/16/a-history-of-ehr-through-the-years/
6. The most common HIPAA violations you should be aware of. (2020, May 19). HIPAA Journal. https://www.hipaajournal.com/common-hipaa-violations/
7. https://www.hipaajournal.com/hipaa-compliance-checklist

Communication is a key skill that we learn at a very young age. It involves the exchange of information between two or more parties. It helps us express our feelings and emotions and enhances comprehension about a person’s overall health state. Although communication is used by everyone, it is crucial to health care field. Doctor’s, nurses’, surgeons, and other health care professionals need to communicate important patient information in order to enhance quality of care. With that being said, they cannot simply send a text message or an email as we would in our everyday lives. There must be rules and regulations that monitor and protect a patients’ personal data, including how, when and what kind of information can be shared among different platforms.

What is HIPPA?

As defined by Gale Encyclopedia of Nursing and Allied Health, “The Health Insurance Accountability and Portability Act (HIPAA) helps to protect the privacy of patients by giving them certain rights over the use of their medical information, and providing limitations on who may have access to this information.” (Cataldo & Granger, 2013) HIPAA also has regulations in effect that make sure confidential records stay secure. The Health Insurance Portability and Accountability Act of 1996 was signed by President Bill Clinton and intended to help workers who could not change their jobs because their family members had serious pre-existing health problems. HIPAA requires employer-sponsored insurance plans to accept workers from other plans without denying coverage based on preexisting condition clauses. (Stebnicki, 2015) It also allows patients to view their medical records online, giving them control to view how their personal health information is used.

How it affects Nursing?

According to Gallup’s December 3-12 polls, Nurses were the most trusted profession for 17 years in a row, outranking Doctors by 17% (Brenan, 2018.) It is no doubt that patient privacy is key to this professions’ success. Subjective data is essential for developing nursing diagnoses and establishing rapport with a patient. However, if a nurse does not guarantee confidentiality, the patient may not disclose all of the information needed to continue his or her care. Nurses are held at an all-time high standard to protect the privacy of their patients, and only disclose information relevant and necessary to their care. Doing so builds trust in the nurse-patient relationship.

What happens if it is violated?

A breach in the privacy of a patient can have very serious consequences including monetary penalties, loss of a nursing license, employment termination, prison time, and now, the exposure of a new cause of action a lawsuit. (De Simone, 2019) Nursing students are also held accountable for protecting patient health information. There are many factors that surround a HIPAA violation by a nursing student, such as the case of a senior nursing student who was assigned during clinical to a hospital where she worked for as a Certified Nurse’s Assistant. She was instructed to prepare a presentation on how the patient’s family dynamics affect the nursing students’ ability to care for the patient. She had only 2 weeks to prepare her material, meanwhile she was working night shifts as a CNA. During her working shifts, a covering preceptor advised her that there was a patient whom would be perfect for her needs since the patient had “complicated family dynamics, complex medical history, prolonged length of stay, and high profile nature of the case.” (Caldwell, H. Cannon, A. 2016) The student and preceptor also came to an agreement that the student had limited options since she was working night shifts. The student gave the report on the chosen patient in front of other senior nursing students, and representatives from the facility’s education department. That same day, the Director of Clinical Education from the facility called the Clinical Placement Coordinator from the school to inform that the senior student had been terminated from the practicum experience due to a HIPAA violation. It was also said by the Director of Education, who attended the student presentation, that the student was unprofessional in her approach on speaking about the patient’s situation, that she had shared Protected Health Information about the patient, and made comments regarding the care that the nurses had given the patient, often blaming them on the complications of the case. The Director said she was “offended” by the manner in which the material was presented. It was also argued that before the nursing student was given the assignment, the student and other employees were instructed to not share any of this patient’s information due to current litigations with the hospital. Even though the student did not include the patients name, medical record number or room number, her report contained enough identifiable ques to connect the patient to the case. The student argued that her report was given in the same fashion as her CNA hand-off reports are given and did not understand why she was being accused. Nursing students are held at the standard as licensed nurses to protect patient privacy, therefore, it is imperative that the nursing educator be competent in HIPAA compliance in order to prevent these preventable mistakes. After careful review of nursing education policy for the school, the student was disciplined by written or verbal reprimand, she received a failing grade for all her senior practicum course and was suspended for one term. After returning from suspension and without instruction, wrote a letter of apology to the Director of Education and Human Resources Department. Within 30 days of the incident the hospital allowed her to return as a CNA and she did continue her career and eventually passed her NCLEX-RN.

Conclusion

Protecting a patients’ privacy is extremely important because it helps establish rapport between patient and provider. A requirement by HIPAA is that a patient must receive a Notice of Privacy Practices in which “Individuals must be informed through a written notice of the privacy practices that are used by their health care providers and health plans, as well as their privacy rights regarding their protected health information.” (Stebnicki (2015.) When a patient knows that their health information will be kept private, they feel safer in discussing valuable symptoms, diseases and past medical history without fear that their PHI (Protected Health Information) will be wrongfully exposed. Nurses, nursing students, nursing faculty, nursing coordinators also have a legal and ethical oath to protect patient information that is use for educational purposes. Protecting the patient’s health information aids in having more personalized care during treatment.

References

1. Brenan, M. / Gallup, Inc. (2018) Nurses Again Outpace Other Professions for Honesty, Ethics. Retrieved from https://news.gallup.com/poll/245597/nurses-again-outpace-professions-honesty-ethics.aspx
2. Caldwell, H., & Cannon, A. (July 20, 2016). HIPAA violations among nursing students: Teachable moment or terminal mistake-A case study. Journal of Nursing Education and Practice, volume 6 (issue number 12), pp 1-8. Doi: https://doi.org/10.5430/jnep.v6n12p41
3. De Simone, D. M. (2019). Data Breaches Are Not Just Information Technology Worries! Pediatric Nursing, 45(2), 59–62. Retrieved from http://search.ebscohost.com.lscsproxy2.lonestar.edu/login.aspx?direct=true&AuthType=ip,cpid&custid=s1088435&db=a9h&AN=136004039&site=ehost-list
4. Granger, J. I., & Cataldo, L. J. (2013). HIPAA. In Gale (Ed.), The Gale encyclopedia of nursing and allied health (3rd ed.). Farmington, MI: Gale. Retrieved from http://lscsproxy.lonestar.edu/login?url=https://search.credoreference.com/content/entry/galegnaah/hipaa/0?institutionId=5037
5. Stebnicki, M. (2015.) A synopsis of the health insurance portability and accountability act and the affordable care act. The professional counselor’s desk reference (2nd ed.) Retrieved from http://lscsproxy.lonestar.edu/login?url=https://search.credoreference.com/content/entry/sppcd/a_synopsis_of_the_health_insurance_portability_and_accountability_act_and_the_affordable_care_act/0?institutionId=5037

Health care is essential for all individuals regardless of where the person may reside. Every country has their own health care system set up differently from others. Mexico has experienced a great deal of progress over the past couple of decades. Although the health system has tried to improve through different health insurance and attempting to improve the quality of care it’s safe to say that they still face many challenges (OECD,2016).

The World Health Organization had defined universal health coverage as a program for individuals to assess high quality services needed such as preventative care, treatments, and palliative care without facing financial hardships (Shawn Radcliffe, 2007). Mexico’s healthcare system encompasses private and public, employer-funded health coverage and military ( InterNations n.d). The public sector is composed of the Mexican Social Security Institute (IMSS), the Institute of Security and Social Services for State Workers (ISSSTE), and the Popular Health Insurance also known as Seguro Popular (Roberto Castro, 2014). All Mexican citizens receive insurance and have availability for basic healthcare. Before 2003, approximately 40 % of population was covered by the IMSS and 7% by the ISSSTE, and no more than 2-3% had private insurance (Mexico’s Healthcare System,2016). During this time this left 50 % of the population lacking adequate access to public health insurance. This meant that out of pocket expenses had to be made when visiting healthcare facilities and many individuals could not afford these expenses. It was then that the government passed the health care system of Seguro Popular (2016). Poor families that are unable to qualify for social security are able to receive insurance through Seguro Popular which is open for the public and intended to help the less fortunate (Julio Frenk, e.g at, 2009). Since this has been issued as an option 50 million people who were uninsured are benefitted ( InterNation, n.d). This had a purpose for the public to reduce out-of-pocket expenses while trying to provide quality health care (Mexican healthcare system challenges and opportunities, 2015).Each health care sector have their own physicians, pharmacies, and health care centers and each individual needs to be attended in those locations (2016). For individuals who are covered through the IMSS, are responsible for a monthly premium which is calculated based on their wages. In 2003, systems of social protection in health was established to increase public funding to guarantee universal health care coverage (Julio Frenk, et at., 2009).

Like any health insurance, there are advantages and disadvantages. For example, Seguro popular is affordable but services can be slow and hospitals tend to be overcrowded. If a patient needs to consult with a specialist, they may have to be on a waitlist due to the overpopulation of individuals enlisted under this insurance. In addition, IMSS provides universal healthcare to Mexican families, although they’ll be assigned to local clinics they can go for regular checkup and obtain prescriptions for free. However, not all pharmaceutical drugs are available at their local pharmacies, which then have to be prescribed to a private pharmacy where they would need to pay out of pocket. IMSS insurance does not include eye care, dental visits, or infertility treatments. If an individual with this insurance is admitted to an inpatient hospital, families and friends are expected to bring all the necessary amenities, such as prescription drugs (Mexperience, 2019). This also proves that Mexico’s healthcare system is still lacking resources and quality healthcare. Of course, Mexican residents would prefer private insurance, as this gives them the accessibility to visit private doctors, hospital, and clinics where it is not overcrowded. Private insurance coverage also depends on the individuals age, term of coverage, and deductible one Is paying (2019). Mexico roughly spends 6.3 percent of its budget on health care which is one of the lowest rates in the OECD. This means that about 45% out of pockets expenses are made Castro 2014). Major source of funding comes from federal taxes with contributions made from states. The IMSS funding’s come from employers, workers, and the government. As for Seguro popular funding’s come from the federal government, state health services, and individuals. In addition, 20 percent from the poor are spared from payments and still be able to receive services (2014).

According to OECD reviews of health system, preventative care is a concern in the country of Mexico. It was stated that 32% of the adult population was obese, ranking Mexico to be the second most obese in the OECD nation. In addition, almost 1 in 6 adults are diabetic, this information demonstrates that there have been serious inefficiencies in their health care system starting with preventative care (2016). This has brought the attention to most citizens and have resulted them in visiting private clinics although having insurance. In results, the health system has failed to improve quality health care. Nurses play a vital role in health promotion, disease prevention, and care. In many countries nurses may have different accessibility to what they can do. For example, Mexico recently passed a law to allow nurses to prescribe medications in the absence of a doctor in emergency situations (PAHO,2018). Mexico is providing opportunity and potential for development of the Advanced Practice Nursing role (Pérez-Cuevas, Muñoz Hernández, & Gutiérrez Trujillo, 2010). Advanced practice nurses is beneficial for Mexico because this can potentially remove lacking quality care in vulnerable areas.

Mexico approached the universal coverage Seguro Popular (Popular Health Insurance) which had the purpose to improve access to those families that were poor and couldn’t afford health services. Many people have their opinion on Seguro Polpular, they either feel that this insurance provides healthcare equality and others believe it is still lacking quality in services provided (InterNations, n.d). One positive outcome of the health care system is that due to the new availability of vaccinations and preventative drugs malaria rate and tuberculosis mortality has declined significantly. Although the conditions are greatly improved in the western world, Mexico still present a great health risk (InterNations, n.d).

The US health care system and Mexico have made an investment in their healthcare. According to NHE fact sheet, the US spent 17 percent of its gross domestic product and Mexico spent 3.3 percent of its gross domestic product. In addition, the US spends more money per person on healthcare than in any other country and still have lower life expectancy (2017). Even though Seguro Popular was introduced, the OECD has reported that out of pocket expenses remain at a 45 % which is still very high because this is equal to 4 percent of their household expenses (2017). Undeniably, Seguro Popular has reduced deleterious spending on health service. For example, inpatient and outpatient medical care for both poor families and the overall populations out of pocket was reduced (2017). Unfortunately, medical devices and medication were not reduced in out of pocket spending (2017).

The importance of caring in an extended care facility, means more to me than just being t physically present. It means caring for my patient with the same respect and dignity, you would want someone to care for your elderly loved one. After reading the journal article and learning more about the interprofessional clinical experience, I recognize how important it is to introduce trainees to the roles of different healthcare professionals, it provides them with the chance to participate in an a teamwork environment, and familiarize trainees with how caring for older adults in the nursing home setting is. ICE was designed so that trainees representing at least three healthcare professions would individually interview a patient in a skilled nursing facility and later participate in a care-plan discussion. The collaboration of team work that they displayed, helped me to see that I too have experienced this in my previous work environment. They implemented team work, and ways they could improve a positive, and healthy work environment.

Evaluation was based on Kirkpatrick and Kirkpatrick’s (2006) model focused on changes in attitudes toward interprofessional teams and older adults. This included both quantative and qualitative assessments. To evaluate the impact of ICE on trainee attitude toward interprofessional teams and attitudes toward older adults, assessments were given pre- and post- experience. I found this to be an interesting presentation on how to improve care at an extended care facility, and also how to experience interprofessional team work in the nursing home setting.

I have worked with older adults in an extended care facility and I like the way that ICE involves the entire team as one and no staff member will feel left out. Everyone plays an important role in the care plan for the patients, whether it be the secretary, housekeeper or dietary. In my personal experience, I think that when collaborative work is done as a team such as this, it gives everyone not only a chance to interact, but also, a chance to get different views and opinions from your coworkers that may or may not be doing some of the same work as you. It also allows for questions to be asked and feedback received on somethings that could be changed to help with the improvement of patient care. Other interprofessional programs have shown that trainees had a positive attitude toward interprofessional care in a hospital setting following a participation in a training exercise (Anderson, Manek, & Davidson. 2006).

In conclusion, some of the strengths of ICE included using actual patients and having trainees from multiple professions interact directly at each session, resulting in gaining a better understanding of other profession’s roles and responsibilities. Given the importance of interprofessional teams in the delivery of quality, patient-centered health care ICE is a potential strategy to teach these concepts to trainees from multiple professions. I feel this was a good opportunity for ICE to provide a professional view, on how the trainees felt after being able to engage with other healthcare professionals in the care-plan of the patient. The end result in caring for the elderly patients would be to put the patients first and provide quality care to each and every patient.

Robots can assist in medical-related situations, for example, supplying and handling medication, reminding them to take medicine, or monitoring medicine usage. Additionally, they can act as a bridge for communication to doctors or nurses, and regularly inform and observe their health. Robots can provide physical assistance as well, such as household tasks including lifting, moving from one place to another, dressing, cooking, or cleaning. For instance, there is a robot developed by Riken called the Riba robot: “…it has a teddy bear face, and can pick up and carry humans from a bed to a wheelchair” (Sharkey & Sharkey, 2010, p. 32). Lastly, service robots may provide companionship and social interactions for elderly as a way to ease anxious feelings or isolation and loneliness. They may provide company, entertainment, or serve as a distraction. They can help them connect or communicate with family or friends who are distant or promote engagement in social activities such as conversations and companionship.

While robotic care may benefit the elderly in numerous ways, there also many downsides to their usage in elderly care. For instance, it has a number of weaknesses in comparison to human caregivers. Robots cannot provide the same level of interaction and care that a human carer would. Even with certain capabilities, such as simulated emotions or verbal interactions, they are extremely limited. Robot carers would not be able to provide a genuine human relationship in which a human can express love, attention, and emotion. Unlike humans, robots can only do what they are designed and programmed to do. Humans can provide reliable support because they can think for themselves and act accordingly to any situation that may occur. Furthermore, elderly people often find themselves deprived of a social life and lack daily human interactions as they age. Implementation of robots as a replacement of human carers will further reduce the amount of social interactions that an elderly person may face. For instance, some robots may allow virtual communication, which could lessen the amount of real visitations taking place. This could result in various mental health problems, such as depression or loneliness, and could make them feel as if they no longer have control over their lives. Depriving them from human contact could further diminish their health. This leads us to the many ethical concerns that are raised from the use of robot care.

Not only could robots negatively impact the social aspects of an elderly person, it could also result in a violation of human rights and values. Privacy and security may be threatened as a result of implementing robots into their daily lives. Liability and safety issues are also a concern that arise from robot care. Failures or malfunctions in a robot carer could potentially pose risks of physical harm towards an elderly person. A lack of accountability for the robot could make it hard to identify who would be at fault if any accidents were to occur. Overall, the main ethical issues pertaining to robot care for the elderly include loss of social interaction, the violation of their rights, trust, and values, privacy and security risks, safety issues towards their health and well-being, and liability issues regarding who is responsible for the robots. These issues must be addressed to determine whether or not robotic care should truly be implemented into the livelihoods of elderly people.

The role of a service robot is to provide manual, repetitive tasks and assistance so that human caregivers can focus on other tasks. However, the capabilities of a robot to produce anything more than what they are designed to do is very limited. According to the article by Amanda Sharkley, elderly people have “…the right to a standard of living adequate for health and well-being; to private and family life; to freedom from torture and inhuman or degrading treatment…” (Sharkey & Sharkey, 2010, p. 27-28). Replacing robotic carers in place of human carers might diminish the human rights that an elderly person holds. The absence of human contact and having extensive presence of a non-human, robotic carer might negatively affect an elderly person’s well-being and mental health. A robot might be able to help assist an elderly person with simple tasks, like lifting or moving, but it lacks many characteristics that only a human can provide. According to Sharkey, “…a person’s psychological welfare is going to be affected by their physical needs failing to be met in this way” (Sharkey & Sharkey, 2010, p. 30). In other words, an elderly person who is cared for by a robot might not receive the same amount of benefits he or she might receive from a human caregiver. The capabilities of a robot carer might mislead people into believing that if a robot can take care of a person’s physical needs, then all other needs are also met. Just because there is a wide availability in the services a robotic carer may provide, it does not mean that the robot alone can provide sufficient enough care for an adequate standard of living. While robot carers may be used to help lessen the workload that must be done in elderly care, human caregivers are still a necessity to fully meet all the needs that an elderly person requires. If a robot carer cannot provide all the necessary care that an elderly person would need, then it would be a violation of their human rights to strip them from a human carer who could give them the standard of living that is suited for their health and well-being.

Additionally, to ensure the health and well-being of the elderly, their values and beliefs must be taken into account. Another ethical concern that comes with robot care is the fact that elderly people might not accept them. To implement robots without their approval would be ethically unjust and they could feel as if they have lost control over making their own decisions in their lives. Elderly people might not accept them due to fears or worries, or simply just rejecting the use of robots over an actual human. Introducing a robotic carer might easily cause distraught, stress, or fears that could result in unintended consequences to their mental well-being. Another significant concern is that they might feel objectified, or view themselves as just another mere object rather than an actual human. According to Parvianinen and Pirhonen, they define objectification as “…treating people as mere physical objects to be pushed, lifted, pumped or drained without proper reference to their lived bodies” (Parviainen & Pirhonen, 2017, p. 109). If robot carers were used in place of humans to carry out routine, manual tasks such as feeding, lifting, or cleaning, it could make an elderly person feel as if he is an object. It could diminish their own value, happiness, and dignity, and it could even be dehumanizing to the elderly person.

In addition, elderly people may feel as if they have loss their freedom and independence. While robot carers are aimed to allow elderly people to be more mobile and independent for themselves, they might just have the opposite effect. Many robots within an elderly environment would be designed to monitor and ensure safety for the elderly. For instance, a robot could detect and warn an older person about potential dangerous situations like leaving the stove on or preventing an elderly person from climbing up on a chair. These approaches seem like appropriate steps to take in order to protect elderly people from harming themselves. However, it may also introduce ethical issues about the loss of their freedom. A robot might restrain an individual from certain activities in which it believes is unsafe, for example, leaving his room at night, and therefore would automatically lock the door. How can we trust the robot to make the correct decisions on what is actually a dangerous situation or not? These restrictions may make an elderly person feel like his or her freedom has been taken away, and they could feel as if they were imprisoned within their own home. While the physical needs might be met by using a robot, their social and emotional needs would be neglected. This could have a negative impact on their well-being because it will directly affect their emotional needs and reduce their quality of life.

With the progression in robotic advancements, along with it comes many technological risks. One of the responsibilities that a robotic caregiver may provide is the capability of surveillance or monitoring of the elderly person. A robot carer may be used to monitor and record information regarding an individual’s health, safety, and behavior. Also, robot carers may be assigned to physical tasks, such as household work like cleaning, cooking, or lifting and moving objects. To perform tasks, robot carers might be remote-controlled or designed to function using detectors. For example, a robot known as uBot5 is designed for several tasks, such as, “…used for social telepresence, since it can be remotely controlled by authorised users over the internet, allowing a virtual visit and two way conversation…” (Sharkey & Sharkey, 2010, p. 31). As with all robots, security threats are an evident problem. A robot carer may be able to traverse throughout the house and virtually relay all of its surrounding information. They are equipped with hardware such as cameras, sensors, microphones, and so on. This ability to monitor and collect data is at risk of cyber-related attacks, such as hackers who could potentially gain unauthorized access to retrieve that private data. This leads to many ethical concerns within privacy and security. The risk that comes with surveillance of the elderly may be infringing their rights in privacy. The use of robots within elderly care may lead to exposure to sensitive, private data that the elderly would not want shared. For instance, video and audio data of the elderly person may be leaked or viewed by unauthorized individuals. Information about their lifestyle and position, personal property or belongings, health status, and other details in which elderly person might not want shared could be disclosed. An elderly person may not consent to having their information being collected for supervision. Also, an ethical dilemma regarding the collection of data would be who would have access to that information, and the length in which it would be stored. Would family members be allowed to access the information? What level of authorization would an employee at a care center need in order to retrieve the information? The right to privacy is a fundamental human right, and the usage of robotic carers may potentially put that right at risk.

In addition to risks of privacy, threats to safety and security in robot care may also lead to potential physical and psychological harm on the elderly. Robots in elder care may be utilized to perform physical interactions like lifting or moving a person or following a person around. They might be able to operate autonomously in certain tasks, and therefore, would not need to be administered by other human beings. These activities could place the elderly person in unpredictable and dangerous situations. Similar to privacy risks, the robots are prone to cyber-threats in which a hacker may obtain unauthorized access to the robot’s features. These features could potentially be exploited or re-programmed and configured, which could put the elderly person at risk of physical harm. Likewise, robots are susceptible to unexpected failure or malfunctions, which could lead to serious incidents as well. For example, a robot used to lift an elderly person may malfunction and lift the person up too fast, bump them into a wall, or drop them unknowingly which could result in injury. A robot that is responsible for monitoring an elderly person may fail to notify doctors or nurses about changing health statuses. Overall, the robots may fail in its ability to effectively provide proper care for the elderly because of the safety and security issues that come with it. Therefore, it would not be as reliable or safe to associate it with an elderly person who is vulnerable or in poor health as compared to a human caregiver. These issues on safety are an ethical concern because it poses the question of whether or not robot care should even be utilized in an elderly care environment. These issues also bring up concerns with whether or not a robot caregiver should be left alone with an elderly person without any human supervision. While service robots may introduce a variety of benefits, they may also present numerous potential safety and security vulnerabilities to the elderly. Knowing these risks, robot care would be a challenge to implement because of the many ethical issues that are introduced.

Similar to issues with the safety and security pertaining to robot care, many ethical concerns of liability and accountability are introduced. A goal of robot care would be to provide assistance for the elderly so that they can be more independent for themselves. It allows them to be more mobile and do daily tasks on their own without the constant need for human caregivers. However, many ethical questions are brought up in this situation. For instance, if an elderly person is given control over the robot, how much control should he or she be given? Giving the elderly more control over the robot carer would empower them to be more independent and rely less on another human caregiver. This could be beneficial for their mental health and protecting their independence. On the other hand, if an elderly person is given too much control, what would happen if he or she commanded the robot to cause physical harm? Likewise, it brings up the question of liability. Who would be held responsible if an incident occurs in which an elderly person is in control of the robot? That same question can be brought up if the robot carer was provided by a care center or operated by a human caregiver. Who would be liable for the unintended consequences made by the robot’s actions that might inflict damage or harm? Furthermore, if autonomous robots were implemented, it would bring up similar issues of accountability. Autonomous robots that make decisions based on their predictions of the situation could be defective or make wrong decisions resulting in dangerous outcomes. Overall, there would be a lack of accountability when using robotics in a care environment, and that poses an ethical dilemma on how deeply robot care should be integrated into an elderly care environment.

While the implementation of robot care for the elderly comes with many clear and distinct ethical concerns, it does not mean that these ethical questions can not be answered. In order to gain the most out of robot care, there must be a balance between utilizing the robot for it’s convenience, assistance, and usefulness while also securing the safety and security of the elderly people and protecting their physical, mental, and social health and well-being. The ethical theory of deontology could be taken into consideration to evaluate the ethical questions posed by robotic care. In duty-based deontology, it views the morals within actions rather than the outcome produced. It argues that it is a person’s duty to carry out what is morally right for another human being. In robot care, replacing humans entirely with robot carers would lessen the burden on human caregivers. However, it would not be entirely beneficial for the elderly people. For instance, it could negatively impact their physical, social, or mental health. Ethical concerns about privacy, safety, security, and liability also comes forth. Additionally, human caregivers may lose their employment. It would be an immoral course of action to take because it would deprive the elderly from certain human values and it could cause unintended pain and suffering, either physically or psychologically. It is a moral obligation to protect the fundamental rights of another human being. If using robots in such a way might deprive an elderly person of their rights, safety, or quality of life, it would not be morally just. Therefore, it would make sense to use robot care alongside human caregivers rather than entirely replacing them. This would reduce the burden on human caregivers so they can focus more on other important responsibilities, while also providing the proper care for the elderly to maintain an adequate quality of life.

Ultimately, the use of robot care for the elderly has presented many advantages and disadvantages. Robots in elder care promise positive contributions for human caregivers and the elderly. They could provide assistance and support to further improve the physical and mental health of the elderly. It could increase their mobility and independence, and allow for better communication with doctors and nurses and family and friends. While it may bring forth a variety of benefits, it would be wrong not to take into consideration the ethical concerns that come with it. Ethical issues within robot care include technological risks, such as privacy and security may be threatened. Safety and liability issues pertaining to elderly are also introduced. Their social and emotional needs might not be entirely met, and many of their human rights, such as freedom and liberty, might be violated. To find the answer to the ethical dilemma of whether or not robots should be used and how they should be used in a care environment, one could look at the ethical theory of deontology. Overall, in order to reach the full potential of robot care, and ensure that all the essential needs for the elderly are met, it would be reasonable to divide the responsibilities between robotics and humans, and not use robotic care as a complete substitute for human interaction. Using robots will provide greater benefits in elder care, but humans are still needed as the backbone in order for it to succeed. Additionally, regulations or guidelines could be implemented to identify and address the ethical issues that come with robots. Once these ethical concerns of robots are properly handled and considered, only then would robotic care be used to effectively improve the livelihoods of the elderly.

Introduction

Caring can be defined as having compassion, empathy or a feeling of concern for others. According to Jean Watson Caring is “the model ideal of Nursing whereby the end is protection, enhancement, and preservation of human dignity. Human caring involves values, a will and a commitment to care, knowledge, caring actions, and consequences”. Caring goes beyond human to human person-centred care as it involves the act of caring, action and upholding values of caring.

Section 1

In the nursing literature, caring behaviours can be described as actions concerned with the well-being of a patient, such as sensitivity, comforting, attentive listening, honesty, and nonjudgmental acceptance Journal of Caring Sciences 2014. In the case study video of Mrs Palmer, a number of behaviours relate to providing comfort. As one example, it was observed in Mrs Palmers video that the nursing student gave Mrs Palmer a heat pack to relieve pain, for her to rest comfortably without a lot of pain and putting a pillow for her under her head and pulling the blanket for her to ensure she is warm.

We also see in the case study video one of the nursing student attentively listening to Mrs Palmer when he saw her crying by talking to her with an open body, eye contact and lowered himself to the same level with her. Attentive listening gives the patient a sense of comfort that, they are being heard and it also gives an opportunity for caring nurses to know the patient more. The nursing students consistently addressed Mrs Palmer by name, as we see them referring to her by her name when they administered medication and as they were getting her out of bed to go and have a shower.

The nursing students gave Mrs Palmer vital information to enable her to make informed decisions, as one of the nursing student suggested for her to talk to a social worker for an ideas that might help her with her children and a dietician to help with a diet plan. The nursing students exhibited therapeutic communication as they talk to Mrs Palmer, asking her how she is feeling? How is the pain in the rating scale of 1-10? In the case study we also observed nursing students administering Medication to Mrs Palmer at the exact time they communicated to her indicating that they can be trusted as they were honesty in providing care as required by the nursing code of conduct.

The nursing students exercises personal hygiene by sanitizing their hands before they could touch the patient and asking for permission from the patient before they could touch them as a form of respect, as one example we observed the students asking the patient so they can have a look at her leg. The nursing students made Mrs Palmer their responsibility by checking on her and positioning the bed and patient to reduce exertion required by nursing staff and making sure she has an access to the patient buzzer. As Mrs Palmer was crying one of the students managed to talk to her showing empathy and asking why she was crying. By showing empathy to her, it made Mrs Palmer to tell him some of the sensitive issues in her life and even opened up about her weight and that she is looking after her children by herself. The nursing student was Patient as he was talking to Mrs Palmer allowing her to express herself and allowing her time to respond on some of the suggestions he had regarding her weight and caring of the children.

Section 2

According to Secure Health Care Solutions on 11 July 2016 “nurses operate on six core values which are commonly known as the 6 c’s. Nurses who operate on these values ensure that the job gets done in an effective and efficient manner and that patients are safe and treated well”. The six C’s as described by Jean Watson are compassion, competence, confidence, conscience, commitment and comportment.

Providing comfort is considered a key caring behaviour of nurses. Comfort is a broad term which can have many meanings, for example the Porto Biomedical Journal Volume 2 January to February 2017 views comfort as characterized by the satisfaction of one’s needs, by the person feeling strong, safe, supported and cared for. Within the 6C’s of caring, providing comfort is seen as a component of compassionate care. In the nursing literature there are many examples of the importance of providing comfort to ensure quality care and enhance the patient experience. For example, patients often perceive nurses as caring when they engage them in the necessary steps to take for them to get well quickly.

Compassionate goes beyond comfort and empathizing with patients. Providing kind and considerate treatment all times. As a result of this nurses may receive an inspirational sense of human connection and confirmation of the meaning of their work. For example, as observed in the case study video we saw students nurses being compassionate towards Mrs Palmer when one of the nurses saw her crying, the student nurse took time to seat down and talk to Mrs Palmer that she does not have to worry about her children or her being obese as they are professionals who can help her.

Responsibility by the nursing staff towards patients is seen as an act of conscience which is to put yourself in the patient’s shoes and continued focus on empathy. According to Sister Simone Roach 2002 views conscience as “working consistently on another’s behalf and representing the concerns of the patient”. Respect is a component of comportment as nurses are to treat patients with respect and being non-judgemental, thus respecting their beliefs and dignity. This enables the patients to trust nurses to provide a high level of personal caring. As observed in the case study video we saw student nurses asking Mrs Palmer before they can touch her or before administering medication to her if they can touch her.

As observed in the case study we saw Mrs Palmer confident to share her personal problems with the student nurse. The student nurse was attentively listening to Mrs Palmer as she was talking which made her to have confidence in sharing the personal challenges that she was facing. As nurses exhibits high levels of commitment to their work, requires them to possess higher levels of patience, as they may be over-stretched with little financial growth for their efforts. Patients have a wide range of needs and treatments requirements and come from different sphere of life hence nurses should possess high levels of commitment and patience in order to make sure that their patient needs are met.

Section 3

A number of nursing theories include the core concept of caring. One such theory, the Theory of Human Caring and according to Jean Watson is that, “humans cannot be treated as objects and that humans cannot be separated from self, other, nature, and the larger workforce.” This theory describes caring as “the centrality of human caring and on the caring-to-caring transpersonal relationship and its healing potential for both the one who is caring and the one who is being cared for” (Watson 1996).

In this theory there are 4 major concepts that Watson outlined which are human being, health, environment or society and nursing. One key idea that is of interest is the Theory of Transpersonal Caring. According to Watson’s theory of Transpersonal Caring “Nursing is concerned with promoting health, preventing illness, caring for the sick, and restoring health.” This idea could be incorporated into nursing care by ensuring that information such as preventing illness is provided to patients after they are discharged.

As observed in the case study video we saw one of the nursing students encouraging Mrs Palmer to talk to a dietician for a healthy diet to manage her body weight thereby promoting health for the patient. Promoting health of patients should not be a once of thing, personal care centre facilities should have different professionals on site to help in some of the cases. For example, having a dietician on site to talk to Mrs Palmer to provide her with a diet plan. We also observed in the case study video the nursing students making sure that Mrs Palmer is well taken care of by providing the information so that the patient make an informed decision in the care that she is receiving. Such information is important to nurses for caring for the sick in helping them to restoring their health.

Conclusion

Caring is broad and it goes beyond having compassion, empathy or human to human person – centred care. It also involves behaviours which define how we offer person-centred care to our patients. Behaviours such as touch, respect and addressing the patient by name helps the patient to recover quickly. The 6C’s which include among them compassion, confidence and conscience gives a clear picture of quality care to our patient and enhancing their experience. Jean Watson gave us an insight that Theory of Human Caring, humans cannot be treated as objects and cannot be separated either from self or nature.

One study in the American Journal of Public Health estimated in 2009 that as many as 45,000 people died every year because of the lack of health insurance. “Uninsured, working-age Americans have 40 percent higher death risk than privately insured counterparts”(The Harvard Gazette). With universal healthcare, this number would decrease significantly because everyone would be insured without financial stress on individuals. Take this story from The Huffington Post to validate these claims; “Georgeanne Koehler has devoted dozens of hours to telling anyone who would listen about how her brother died. Billy Koehler’s died from cardiac arrest after his implanted defibrillator ran out of batteries, is a testament to how someone can perish from lack of access to health care”. Some countries have been proactive and have created universal healthcare policies such as Norway who was the first country to enact universal healthcare as a single-payer system in 1912. 16 years later, Japan and New Zealand created a universal healthcare policy leading a new wave of people establishing new healthcare policies. Belgium, Sweden, and North Korea all established some form of a universal healthcare policy from 1945-1955. Universal healthcare has improved the wellbeing of populations and has created more organized society. Right now, 31 out of the 32 developed countries have universal healthcare, the United States being the only one without universal healthcare. From there, once there are enough models of what this healthcare policy could look like, getting the rest of the world on board might be a challenge, but it could help less developed countries develop more, and have more sustainable populations. Some countries have already enacted a universal healthcare movement, but with the rest of the world on board, public health would improve, healthcare spending would decrease, and good health habits could be instilled in children at a young age.

Although universal healthcare has mostly positive outcomes, there are some potential issues to address and how they can be avoided. One is the issue of government spending and where the money would come from to fund a universal healthcare system without increasing tax payers spending too much. The way this issue could be avoided is by establishing an efficient and effective system to use taxpayer’s money, but not overly tax people. Unfortunately, in most cases taxes must be raised to provide universal coverage. In this case, yes, taxes would be more, but if everything is put in perspective, people wouldn’t be spending money directly on healthcare, instead they would put money towards taxes and save money overall in the long run. It would be a big change, but it’s important to look beyond the present and see how enforcing these policies now can really benefit the population in the long run. A specific example is in the United States, the government is currently paying an annual $7.65 trillion, but with a certain universal healthcare plan put in place, $2.1 trillion could be deducted from that and saved over time.

To set a basis of knowledge for this paper, the definition of universal healthcare according to The Balance, is, “a system that provides quality medical services to all citizens. The federal government offers it to everyone regardless of their ability to pay”. A major goal of universal healthcare is that is it truly universal, and is equal for every person so no one experiences financial burden because of the need for healthcare. Some common misconceptions of universal healthcare are that it is absolutely free, it is easy to create a universal system, and that it is the same everywhere in the world. It is important to understand that universal healthcare is only the necessities. It is also important to note that, ‘Countries are using a bottom-up approach by working to prioritize poor and vulnerable populations, as they usually have the highest need for healthcare but the least access’ (The Balance). The name universal healthcare can be misleading because it sounds like it is uniform and identical everywhere, but that is not the case. Depending on the location the policy is enforced, it can vary in terms of systems. Healthcare systems are organized differently around the world to best suit the population and have the most efficient organization. According to Stratfor and Forbes, the organization of a healthcare system can be influenced by demographics, economics, history and, of course, politics all help determine the shape of a country’s health care system, from who pays for medical services to what services are available and what training is required to perform them. Though maintaining a robust health care system is a universal problem, it lacks a universal solution. Creating a universal healthcare system isn’t something you can just flip a switch and it will be enforced. It is a system that needs to be well engineered and organized in order for it to function and benefit the population. Afterall, the point of universal healthcare is to create an accessible and equal system to sustain a population medically.

Another basis of knowledge to set is the difference between universal and non-universal healthcare systems. In the research I have done, the main systems that appear to be in place are single-payer, two-tier, and universal. First off, single-payer healthcare is a system also called; ‘Medicare for all’. The system entails that everyone in the given country or place is provided with the necessary healthcare including doctors, hospital care, dental care, eye care, and medications by one single paying source-hence the name ‘single-payer’. According to VerywellHealth, there are currently 17 countries who use and single-payer healthcare system. Two-tier healthcare is a system in which the government provides a basis of healthcare, but also offers a secondary coverage tier of care for those able and willing to pay for a higher standard of care. In this case, single-payer healthcare and universal coverage work hand in hand. Some countries have found this to work including Denmark, France, Australia, Ireland, Hong Kong, Singapore, and Israel (VerywellHealth). Finally, universal coverage is a system in which everyone has access to healthcare. Universal health coverage comes in many different forms, but nonetheless, there are currently 32 countries with some universal coverage policy. Within these 32 countries, there are some exceptions where 98% of their population is covered, so it isn’t considered truly universal coverage. On the other hand, 18 out of those 32 countries have entirely universal coverage with 100% of the population covered. Those countries are Australia, Canada, Finland, France, Germany, Hungary, Iceland, Ireland, Israel, the Netherlands, New Zealand, Norway, Portugal, the Slovak Republic, Slovenia, Sweden, Switzerland, and the United Kingdom. Something to note is that, ‘They [single-payer system and universal coverage] are not the same thing, despite the fact that people sometimes use them interchangeably. And while single-payer systems generally include universal coverage, many countries have achieved universal coverage without using a single-payer system’ (VerywellHealth).

Now that there’s a basis to this topic, it’s time to discuss the main reasons why universal coverage is a better option than what some countries have today. The main one is that with universal coverage, every registered citizen has access to the healthcare they need. This means that people who couldn’t afford to be insured before would be given the care they need at no cost. This would create a stronger and more sustainable population. Also, universal coverage lowers the overall healthcare costs of an economy because the government controls the price of medication and medical services (The Balance). Government costs also go down because there is only one system and insurer for the population, so there are no administrative costs as there are with private insurers. Overall, universal coverage creates a more efficient, uniform and sustainable system for the population. A final pro to universal coverage is that if children have health coverage and are educated about their health at a young age, healthy habits can be instilled in them as they grow up, and can be set up for a better, healthier life.

In talking about the pros to universal health coverage, it’s important to look at countries with universal coverage policies in place and see how their healthcare runs. Aaron Carroll and Austin Frakt from The New York Times did an interesting interactive article on several healthcare systems around the world-some of which are universal, some that are not-and had healthcare professors, physicians, and economists vote for which country they thought had the best healthcare system to ultimately come out with the “best” healthcare system in the world. Additionally, within the article, there was a poll that readers could take after each comparison to input their opinion as well. The countries compared in this article were Canada (single-payer universal), Britain (single-payer universal), Singapore (partly universal), United States (a mixture of everything), France (universal), Australia (universal), Switzerland (universal with required insurance), and Germany (universal multi-payer). To start off, Britain won vs. Canada. The “judges” reasoning was that the British system was more efficient and had the same quality as Canada with less spending. Britain also won the public vote with 76% of the 106,4899 that voted. The next pairing was the United States vs. Singapore. The US has a mix of everything for healthcare. There is Medicare for select groups of people, private insurance through employment, private hospitals, and several million people without healthcare. Singapore has inexpensive basic care, and Singapore’s workers contribute around 37 percent of their wages to mandated savings accounts that may be spent on health care, housing, insurance, investment or education, with part of that being an employer contribution. The government, which helps control costs, is involved in decisions about investing in new technology. It also uses bulk purchasing power to spend less on drugs, controls the number of medical students and physicians in the country, and helps decide how much they can earn (NY Times). The United States won this faceoff with the judges (4-1) and the public with 53% out of the 89,943 people that voted. One of the judges said, “The lack of data in Singapore is a problem, and it had higher rates of unnecessary hospitalizations and far higher heart attack and stroke mortality rates than the United States. Plus, the U.S. has a highly dynamic and innovative health care system. It is the engine for new diagnostics and treatments from which Singapore and other nations benefit”. The next faceoff was with France and Australia. Australia provides free inpatient care in public hospitals, access to most medical services and prescription drugs. There is also voluntary private health insurance, giving access to private hospitals and to some services the public system does not cover (NY Times). In France, everyone must buy health insurance, or insurance is provided through an employer or by voluntary health insurance (95% of the population). 75% of doctors provide free healthcare to patients. France won this battle 4-1 with the judges, and with the public (80% of the 85,306 voted France). Some of the judges said, “It provides almost everything you’d want, and it’s expensive only compared with countries other than the United States. (Compared with the U.S., it’s a bargain,” and “It has seemingly done a better job of using markets to create competition across public and private hospitals — which provides incentives for quality provision and innovation”.

The final faceoff was between Switzerland and Germany. Switzerland has a universal system, but requires everyone to buy insurance. Their system is sometimes compared to the Affordable Care Act (ACA) but is said to be a better version of it. In Germany, the amount individuals pay for healthcare is based on their income. Patients have a lot of choice among doctors and hospitals, and cost sharing is quite low. It’s capped for low-income people, reduced for care of those with chronic illnesses, and nonexistent for services to children (NY Times).

Caring in nursing practice is highly important and has a detrimental impact to a patient’s overall health outcome. This essay will critically discuss three aspects of caring in nursing practice and the importance they have, these topics include, caring behaviours, the 6 C’s of caring and Watson’s theory of caring. Each of these will be justified by relating them to the patient experience of Denise Palmer in Scenario 1.

In the nursing literature, caring behaviours can be described as actions concerned with the well-being of a patient, such as sensitivity, comforting, attentive listening, honesty, and nonjudgmental acceptance. Caring behaviours might be affected by the perceptions of nurses and patients. (Saleh Salimi, 2013) Nursing care is often confused to be synonymous with caring behaviours, which is incorrect. Nursing care covers the tasks that are standard with the job and provide physical comfort such as, taking vitals and giving medication whereas caring behaviours are positive interactions with the patient that provide emotional comfort, such as smiling, attentive listening and respect. In the case study of Denise Palmer, several behaviours related to providing comfort were observed. One example in Mr’s Palmer’s video, the student nurse attentively listens as she cries and explains her stress, he then shows another behaviour by comforting her afterwards. By showing empathy and reassuring body language such as nodding and being seated at her level. He provides information about services available to Mrs Palmer for support so she can make an informed decision in regard to the dietician and social workers he suggested. The student nurses exhibit responsibility during handover by double checking documentation of medication and vitals, checking oxygen tubes in case of emergency and performing hand hygiene effectively to protect her health. Respect is shown when the nurses are about to perform a task, they let Mrs Palmer know what is about to happen, so she is aware. They address Mrs Palmer by her name in all activities out of respect.

Providing comfort is considered a key caring behaviour of nurses. Comfort is a broad term which can have many meanings, for example, comfort may be defined as a state of physical ease and freedom from pain or constraint (‘Comfort | Definition of Comfort by Lexico’, 2020). Another definition is a feeling of freedom from worry or disappointment. (‘What does comfort mean?’, 2020) The 6C’s of caring are compassion, competence, confidence, conscience, commitment and comportment, the purpose of the 6C’s are to ensure workers who have courage, are competent and communicate well, treat patients with care and compassion. Compassion is the awareness of one’s relationship to others, sharing their joys, sorrows, pain and accomplishments. Participation in the experience of another. In the case of Denise Palmer, Blake shows compassion by sitting with her whilst she cries and letting her air out her emotions and concerns. Competence is having the knowledge, judgment, skills, energy, experience and motivation to respond adequately to others within the demands of professional responsibilities. (Berman et al., 2018, Chapter 26, p. 473). One of the student nurses, Liz, shows competence while caring for Mrs Palmer’s wound, making sure to not contaminate any equipment and to perform the task to the standards it requires, as well as administering pain relief during the painful procedure. Commitment is the ability to treat every task, every moment and every interaction with the highest level of care…We have an overall commitment and responsibility ‘to ensure the delivery of safe and quality care.’ (Brooke, 2018) Commitment is evident when Handover is occurring, Blake and Liz check over the documentation of vitals and medication, as sometimes medication gets missed and sometimes negative trends in vitals aren’t detected. Their commitment to their job and to Mr’s Palmers health ensures that safe and quality care is being delivered. Conscience directs moral, ethical and legal decision-making. It motivates us to increase the knowledge and skills needed to respond appropriately to moral, ethical and legal issues faced by one and others. It directs us to adhere to the standards of professional nursing practice. (‘S. Roach’, 2020) Blake shows having a conscience when he walks in the room to see Mr’s Palmer crying, instead of leaving the room and coming back later, his morals tell him, he should be there for her and support her. Confidence is trust in one’s ability to care for others. It is the belief that our skilled professional presence can make a difference. Confidence in our own ability to create caring environments serves as a catalyst for change. Shahn’s confidence can be displayed when she says what she can do to ease the pain for Mr’s Palmer in a confident manner she explains that she can give her patient pain relief and a heat pack to ease the pain and then if pain doesn’t ease she can escalate to a harder pain relief. This confidence that she will make her patient feel better will make Mr’s Palmer feel reassured that her pain will ease, and that Shahn will make sure of it. Comportment mean the nurse must look, sound, and act as the professional that he/she is and be truthful to oneself, to the patient, and to the family, showing “respect for patient first and the disease second.” (‘S. Roach’, 2020) All of the student nurses in the referenced video show comportment in every scenario. They carry themselves professionally in all interactions, always greeting the patient by her name, introducing themselves at handover, talking to Mrs Palmer respectfully and as an equal, avoiding slang and informal language and correct tone and body language. In person centred care, patients are partners with their health care providers, all individuals working towards care specified around the patient’s health needs and desired health outcome, in regard to mental, spiritual, social and physical health. (Coalescing the Theory of Roach and Other Truth-Seekers, 2020) The right type of care needs to be provided to a patient depending on their needs and desired outcome, a generalised type of care might not work for some patients and might make their outcome worse from that approach. For example, Mr’s Palmer recent weight gain was a topic that upset her, if we were to provide Person centred care, in handover where it was said she is overweight, instead we would leave a note to check BMI so it is not hurtful to Mrs Palmer. It is important we incorporate the 6c’s of caring into our nursing practice to ensure we are leaving our patient with a positive experience that will shape a positive outlook on nurses and result in a positive health outcome for the patient.

A number of nursing theories include the core concepts of caring. One such theory is Watson’s theory of caring. Pamela Van Der Riet states that the theory specifies that “caring as not just an emotion, concern, attitude or benevolent desire. Caring is the moral idea of nursing whereby the end is protection, enhancement and preservation of human dignity” ( Berman et al., 2018, Chapter 26, p. 474). This theory focuses on how nurses express care on their patients. In this theory, the disease might be cured, but illness would remain because, without caring, health is not attained. (‘Jean Watson: Theory of Human Caring’, 2020) Jean Watson believes that caring promotes health better than a simple medicinal cure and that people won’t heal when they are viewed as objects such as an illness rather than a person. The core principles and practices of the theory are the practice of loving-kindness and equanimity, having an authentic presence, the cultivation of one’s own spiritual practice toward wholeness of mind/body/spirit, “Being” the caring-healing environment and allowing miracles (openness to the unexpected and inexplicable life events). (Core concepts of Jean Watson’s Theory of Human Caring/Caring science, 2020) One principle that is of interest is the practice of loving-kindness and equanimity, meaning to have tenderness and consideration towards others and being calm when they are unhealthy and stressed is essential in being a calming factor in that patient’s care. This idea could be incorporated into nursing by making sure to always have a kind and calm approach to all news and to be a voice of support and love, your kindness means more to people than you know. We should try to maintain a positive and caring outlook, so our patients seek comfort and healing in us.

This essay has examined how caring in nursing practice is highly important and has a detrimental impact to a patient’s overall health outcome. Caring behaviours, the 6C’s of caring and Watson’s theory of caring are paramount in ensuring quality of care for patient in the parameters of nursing practice.