Impact of Free Healthcare in Colombia Free Essay Example

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Scope of Professional Practice and Standards of Performance

Nursing is defined as “the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations” (American Nurses Association [ANA], 2015, p. 1). Throughout the capstone experience the definition of nursing, as given by the ANA was seen every day. Health care professionals from America came together in Colombia to aid those in need. Over the course of four days, the clinics that were opened served over three thousand people by providing diagnosis, treatment, education, and support for all those that came through the doors. In the clinics, there were two physicians, two dentists, three registered nurses, and nine nursing students. Any type of nurse including LPNs and RNs were welcome to work in the clinic and use their skills. The specific practice setting included clinics set up in schools and community centers located near Venezuelan refugee camps located on the edge of Cartagena, Colombia. The clinic treated all types of cases ranging from dermatology, OB/GYN, med-surg, pediatrics, optometry, dental and physical therapy. In terms of numbers, the clinic saw three thousand one hundred and forty patients. While some days were more busy than others, this divides out to about seven hundred and eighty five patients per day. The role of the nurse during these clinic days changes depending on the area they were stationed. A typical day included splitting the nursing students into groups of five in triage, two with the physicians, and the last two in the dentist’s office. The nurses rotated so that everyone got at least one experience in a different area of the clinic. The nurse’s role changed in order to practice basic skills in triage that a nurse utilizes often in every healthcare setting. The nurses who assisted the doctors were there to make the process go quickly so the doctor could see as many people as possible in a day. After the doctor diagnosed the patient, prescribed medicine if needed, and did some education, the nurse took the time to continue to educate and answer any questions the patient had. The focus of practice is to give every patient efficient quality care while seeing as many patients as physically possible. The nurse’s shift started at eight in the morning with half an hour of travel. Upon arriving at the clinic site for that day, triage was set up by putting student desks from classrooms together and the equipment needed for the day was separated among the desks. Equipment for triage included a thermometer, scale, blood pressure cuff, stethoscope, and glucometer. All staff took a break for lunch and returned half an hour later. The shift ended when the clinic closed doors around five in the afternoon. While the doors closed, there were still patients waiting to be seen in the building after they were checked in. Once all patients were seen and left the building, the equipment was packed up and the group traveled back to their place of residence around six at night.

Ethics in Nursing

The Code of Ethics for Nurses is a set of ethical standards for nurse and can be a guide for decision making. Provision 2 addresses the nurses primary commitment to the patient whether an individual, family, group, community, or population (ANA, 2014, pp. 5 ). One code stated in this section is that the nurse must provide the patient with opportunities to participate in planning and have an honest discussion about available resources for treatment options and their ability to care for themselves. In the free clinics in Colombia this was seen in action with every patient. While the clinic had a variety of meds and recourses, it did not have everything a patient could possibly need. When suggesting a medication or interventions that could not be provided at the clinic, the nurses and doctors had to talk to the patient about available recourses around them that could be utilized to carry out the plan of care. Another code is about collaboration. This section states that collaboration requires open communication among all who share concern and responsibility for health outcomes. This provision is very relevant in a clinic treating the underserved population in the refugee camps in Colombia. Nurses needed to collaborate with the patient to educate them and help them make informed decisions.

Other additional standards there were seen in the capstone experience include the culturally congruent practice. The nurse demonstrates respect, equity, and empathy with all healthcare customers (ANA, 2014, p. 69). The nurse must also communicates with appropriate language and behaviors. This was utilized in the clinic with translators who are native Spanish speakers. The nurses also understood the importance of prayer after concluding the healthcare visit as well as the custom to touch cheeks as a sign of thanks and affection. Another standard of practice seen in the clinic was leadership. This is seen when a nurse contributes to the establishment of an environment that supports and maintains respect, trust, and dignity (p. 75). Every nurse in the clinic had a leadership quality to them and encouraged others to practice in a professional role and enhanced the quality and safety of care. Being a leader also means taking responsibility so nurses were able to work independently as well as alongside each other and enhance the effectiveness of the team. Recourse utilization is a standard that was used in the clinic to assist the patient in factoring the risks and benefits in decisions about care (p. 82). Risks and benefits had to commonly be explained in the dentist’s office. There were situation in which taking a tooth out had a higher chance to cause pain or infection. The risks were explained and the physician advocated for the best choice and ultimately the patient had the final say in the matter. Recourse utilization is also used when community recourses are used to implement interprofessional plans (p. 82). This was utilized when the team from Bridges of Hope worked alongside Colombian doctors, pharmacists, and dentists in the same clinic in order to provide the best care we could for the patients. The last example of a standard seen in the capstone experience is environmental health. This may be the most used and educated on in the clinic. Environmental health is promising a safe and health workplace, assessing environmental risk factors, communicating health risks and reduction strategies, and promoting health communities (p. 84). Environmental risks were assessed before setting up a clinic for the safety of the health care professionals as well as the patients. Education on environmental factors that contributed to health concerns were also largely expanded on when talking to patients. In the cases of parasites, rashes, and bed bugs, the nurses had to educate on safe household practices, safe sources of water and food, and way to prevent obtaining the disease again. The guide to the code of ethics as well as the scope and stands of practice were seen every day in the clinic setting.

Through the capstone experience the Quality and Safety in Nursing (QSEN) standards (2014) were implemented. QSEN has defined quality and safety competencies for nursing and target goals of knowledge, skills, and attitudes (QSEN, 2014). These qualities include patient centered care, teamwork and collaborations, evidence based practice, quality improvement, safety, and informatics. Every aspect of the QSEN was observed in clinical practice. While the QSEN was a part of everyday practice in the clinics, the Joint Commission patient Safety Goals were not called for in the clinic as they might be in a hospital or long term setting. Goals of the Joint Commission include improving patient identification, improve the safety of using medications, reducing health care associated infections, reducing risk of falls, and preventing health care associated pressure ulcers (The Joint Commission, 2014). While all of these are very important aspects to taking care of patients, the patients seen in the clinic were not at risk for any of these hospital acquired illnesses, injuries, or risks.

A nursing theory that represent the work done in Colombia is the Modeling and Role Modeling Theory. The Modeling and Role Modeling Theory was developed by Helen Erickson M. Tomli and Mary Anne P. Swain in 1983 enables nurses to care for and nurture each patient with an awareness of respect for individual patient’s uniqueness (Peptrin, 2016) The modeling and Role Modeling theory gives the nurse three main roles which include facilitation, nurturance, and unconditional acceptance. According to the theory “as a facilitator, the nurse helps the patient take steps toward health, including providing necessary resources and information. As a nurturer, the nurse provides care and comfort to the patient. In unconditional acceptance, the nurse accepts each patient just as he or she is without any conditions” (Peptrin, 2016). This theory summarizes a holistic approach to health care and is an accurate representation of what the nurses at the clinic did with the patients. Nurses developed an understanding of the patients point of view and assisted them as they could in mind, body, and spirit.

Case Study

The population served in this clinical experience was largely made up of Venezuelan refugees living in poverty and age ranging from one year old to ninety years old. This population is in a geologic area that is humid and living in close, unsanitary conditions. Health care has not been readily available in their home country for an estimated five years and they have now made the journey to another country seeking a better life, but still landing on hard times. A commonly seen diagnosis was parasites. Parasites were seen to heavily effect the pediatric population. Due to the high incidence, the case study will focus on the general population effected by parasitic diseases.

Physical assessment finding of children that came to the clinic include malnourished, dry skin and hair, and poor dental hyenine. The child would be brought in by their parent that is concerned about an itchy rash on their child’s body or presenting cold symptoms like a cough, low grade fever, diarrhea, and loss of appetite. The kids checked all the boxed for risk factors: walking with bare feet, lack of access to clean water, overcrowded living conditions, poor personal hygiene, and weak nutritional status. Due to the lack of recourses that the clinic had, any type of testing to confirm the diagnosis was unable to be completed. When the doctor strongly believed it to be a parasite, they would prescribe Albendazole for the parasite, sometimes clotrimazole for the itching and to cover all the bases in case it is a fungal infection, and Tylenol to help the fever and cold symptoms. The prevalence of parasites is very high in this tropical climate, it was commonly seen it the whole households of siblings to come in with symptoms of a parasite and all need to be treated.. According to the CDC (2013) this type of parasite that is found in warm climates where sanitation and hygiene are poor may be soil transmitted Helminths. Soil transmitted Helminths (STHs) are types soil transmitted parasite that infect humans intestinal tract. Some common examples of this parasite are hookworm, whipworm, and strongyloidiasis (CDC, 2018). The health needs of children are not being met in this area nor is environmental safety. Children need effective footwear, a nutritional diet, and a safe living environment. All which is not readily available in the situation these families are in.

Priority nursing diagnoses for this population were made using Medical-surgical nursing: patient-centered collaborative care by Blair, Ignatavicius, Rebar, Winkelman, & Workman (2016, pp. 224-226). Nursing diagnosis number one is “deficient community health related to lack of recourses, poverty and geographic location as evidence by high prevalence of communicable diseases.” The second diagnosis would be “imbalance nutrition: less than body requirements related to situational crisis as evidence by malnutrition among population. Lastly, a relevant diagnosis could include “caregiver role strain related to immigration as evidence by anxiety about child’s diagnosis.” Nursing diagnosis for this population should be focused on environment, community health, and the psychosocial aspects that come with living in a refugee camp.

Planning and Outcomes

Planning and outcomes is hard to follow in a population like this. Follow up appointment to check on the status of the patient to see if the assigned treatment is making progress is nearly impossible. The clinic staff had to work with what was available by prescribing appropriate medications, providing education, and suggesting signs of progress in an illness treatment plan. A goal for nursing diagnosis number one mentioned previously is an increased in health knowledge after the clinic visit, this goal can be shown to make progress by measuring the incidence of parasites in the area before the clinic visit and measuring again at a later time to calculate if the prevalence has dropped. The second diagnosis goal would be to increase child nourishment with vitamins and a balanced diet, evidence of progress is shown by increase in child weight. The last diagnosis would be decrease in anxiety by treating the child’s condition.