Discussion question 1

Disparities in Vulnerable Populations

Step 1

• Identify a vulnerable population that you see in your caseload or that lives in your community.
• Describe the effect of disparities of health services to that population on health-promotion outcomes.

Step 2 Read other students’ posts and respond to at least two of them.

In your response to each of your peers, identify something you learned and agree with. Explain why you agree. Provide two examples from your peer’s post to support why you agree.

Your initial post should be 2-3 paragraphs long and follow the requirements outlined in the discussion rubric. Please add to the discussion in your peer responses with informative responses, instead of posts similar to “great idea! I really agree with you.” The initial post and the peer responses have different deadlines. Make sure that your discussion adheres to these deadlines. DSN Healthcare Promotion and Information Confidentiality Questions

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APA guidelines and plagiarism prevention matter in discussion posts just like with other scholarly assignments. Cite all references appropriately using APA format.

Discussion response 1 Philetha

Vulnerable population

Vulnerable populations include chronically ill and disabled persons, low income and/or homeless, the uninsured, LGBTQ+ population, people living with human immunodeficiency virus (HIV), the very young and the very old (World Health Organization, 2018). The vulnerability of these persons results from ethnicity, race, age, sex, and other factors such as insurance coverage and income. One of the vulnerable populations is within my workplace, these population of people have learning disabilities, described by activity limitation, impairment, and participation restrictions (Shivayogi, 2017). Although disability is extremely diverse and on the rise due to an increase in chronic health conditions, all people with disabilities suffer almost the same general health care needs thus need access to mainstream healthcare services (Shivayogi, 2017). Further, despite the goals and efforts the United States put forward to eliminate and reduce health care disparities by 2010, some such as access to healthcare, risk factors, mortality, and mobility continue to affect the vulnerable population health promotion outcomes.

A study by the world health organization showed that people living with disabilities seek more health care than people without disabilities but have more unmet needs (World Health Organization, 2018). This is due to prohibitive costs, limited availability of services, physical barriers, and inadequate skills and knowledge of health workers. Also, health promotion and prevention activities rarely target disabled persons. For example, adolescence and adults living with a disability are likely to be excluded from sex education programs. Also, disabled women receive less screening for breast and cervical cancer, and individuals with intellectual impairment and diabetes rarely get their weight checked (Shivayogi, 2017). As a result, this population may experience greater vulnerability to age-related conditions, co-morbid conditions, engage in health risk behaviors, secondary conditions such as pressure ulcers, osteoporosis, pain, and urinary tract infections. DSN Healthcare Promotion and Information Confidentiality Questions

References

Shivayogi P. (2017). Vulnerable population and methods for their safeguard. Perspectives in clinical research, 4(1), 53–57. https://doi.org/10.4103/2229-3485.106389

World Health Organization. (2018, January 16). Disability and health. WHO | World Health Organization. https://www.who.int/news-room/fact-sheets/detail/disability-and-health (Links to an external site.)

Discussion response 2 Lana

A vulnerable population I have seen in my profession are people with socioeconomic disparities. Most have lived with undiagnosed diabetes, and hypertension before their bodies began to suffer from its effects. Then they sought medical attention finding out that they were already in kidney failure. Most had no medical insurance and never saw a doctor. Other’s may have had a primary care doctor but had difficulty paying for insulin and other medications. To help this population through health promotion they first need affordable access to a health care provider. “High quality primary care therefore represents a key strategy through which disparities in the incidence and progression of CKD may be eliminated” (Greer & Boulware, 2015, par 1). Once adequate primary care is established the heath care provider could get a baseline of the persons health and work on physical and nutritional education strategies. Diet and exercise are important in controlling or decreasing the incident of disease that often leads to kidney failure. If those in these vulnerable populations do not receive the care they need especially those that have a predisposition to hypertension and diabetes, they will be at risk for developing CKD in the future.

Greer. R., & Boulware. E., (2015). Reducing CKD risks among vulnerable populations in primary care. Advanced Chronic Disease. 22 (1), 74-80.

Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4291538/ (Links to an external site.)

 

Discussion question 2

Confidentiality and the Protection of Patient Information

Respond to the following question based on this weeks lesson and, if it’s relevant, include your own personal experience.

• What is confidentiality? How is confidentiality impacted by HIPAA?
• Describe at least one incident when confidential information within an informatics system was improperly disclosed. If you have not had this experience, describe at least one opportunity for potential improper disclosure of confidential information within an informatics system. DSN Healthcare Promotion and Information Confidentiality Questions
• What additional security measures do you feel would further protect patient information in clinical practice?

Read other students’ posts and respond to at least two of them.

Discussion response 1 Rebecca S

The term confidentiality is described in this week’s lesson as, “Confidentiality in health care is the idea that once a patient gives private information to a provider, the provider will not disclose that information without the patient’s consent” (Enhancing, n.d., Topic 1). HIPPA impacts patient confidentiality as it is a comprehensive law to protect the information patients share with their providers. “Patient confidentiality has been a standard of medical ethics for hundreds of years, but laws that ensure it were once patchy and incomplete. The federal law called HIPAA was passed in 1996 to make sure that there would be one nationwide law to protect patient privacy. The law includes other provisions, including continuity of care, but for many individuals, the right to confidentiality is most important. There are certain rights that the law provides for that all people should be aware of so that they can advocate for privacy and for the best possible care” (Confidentiality, 2018, para. 1-2). I for one have not experienced confidential information being exposed to my knowledge, either my own or one of my patients. I found some great examples online, here are two;

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• A hospital employee did not observe minimum necessary requirements when she left a telephone message with the daughter of a patient that detailed both her medical condition and treatment plan. An OCR investigation also indicated that the confidential communications requirements were not followed, as the employee left the message at the patient’s home telephone number, despite the patient’s instructions to contact her through her work number. To resolve the issues in this case, the hospital developed and implemented several new procedures (US, 2017, para. 1).
• After treating a patient injured in a rather unusual sporting accident, the hospital released to the local media, without the patient’s authorization, copies of the patient’s skull x-ray as well as a description of the complainant’s medical condition. The local newspaper then featured on its front page the individual’s x-ray and an article that included the date of the accident, the location of the accident, the patient’s gender, a description of patient’s medical condition, and numerous quotes from the hospital about such unusual sporting accidents (US, 2017, para. 5). DSN Healthcare Promotion and Information Confidentiality Questions

The security measures that are taken in the hospital setting where I work include audits, integrity, and access control, “the facility has to effectively control access to confidential patient information by utilizing unique identification procedures and an emergency access procedure” (Enhancing, n.d., Topic 2). It is important that everyone with access is properly trained in policy and procedure for the preceding to work. Part of our ongoing training is the IT team will send out e-mails that look real except it is .com, if one opens the e-mail a message appears that you were just phished! It really makes one pay attention after opening just one.

References

Confidentiality and HIPAA. Standards of Care. (2018, May 29). https://www.standardsofcare.org/understanding-care/confidentiality-and-hipaa/.

Enhancing the Privacy and Security of Patient Information. https://dcn.instructure.com/courses/32725/pages/week-9-lesson-enhancing-the-privacy-and-security-of-patient-information?module_item_id=773318.

US Department of Health and Human Services. (2017, June 7). All Case Examples. HHS.gov. https://www.hhs.gov/hipaa/for-professionals/compliance-enforcement/examples/all-cases/index.html.

Discussion response 2 Donna

Confidentiality in health care is the idea that once a patient gives private information to a provider, they will not disclose that information without the patient’s consent (Hebda, et al., 2019). Without a confidentiality agreement, a provider’s ability to gather the necessary information to assess, diagnose, and treat patients properly can be compromised. Health Insurance Portability Accountability Act of 1996 (HIPAA) is the legal foundation for all subsequent confidentiality considerations. HIPAA states that providers, insurers, and facilities must keep all patient information confidential (Hebda, et al., 2019).

A potentially serious threat to patient information is the staff itself. Either through carelessness or neglect, staff can violate patient confidentiality (Hebda, et al., 2019). Staff can also work to protect patient privacy. If staff members are constantly vigilant about the confidential information they acquire, they can help maintain patient confidentiality better than any electronic measure (Hebda, et al., 2019). This is why institutions should maintain strong privacy and confidentiality training programs to remind staff of their importance in maintaining confidentiality and privacy.

There are numerous examples of staff making mistakes or being neglectful. If a nurse leaves his or her workstation open and visible for any passerby to view, that would be a case of negligence (Hebda, et al., 2019). If a physician writes a prescription and leaves it out on top of the nurses’ station for anyone to see, that isn’t very responsible (Hebda, et al., 2019). However, if a nurse closes down his or her workstation and is careful never to discuss patients with anyone other than the other practitioners involved in the patients’ care, that nurse can help the facility maintain patient confidentiality immeasurably (Hebda, et al., 2019).

Facilities need to ensure that adequate safeguards are in place, like using personalized ID badges, which only grant you certain access to parts of the building. You need to have user names and passwords on computers so that way not just anyone can log in to your computer and get patient information.

Reference

Hebda, T.L., Hunter, K., & Czar, P. (2019). Handbook of infromatics for nurses & healthcare professionals (6th ed.). Upper Saddle River, NJ: Pearson.

Discussion question 3

Care Transitions

Step 1 Post a response to the discussion board.

Respond to the following prompts and, if it’s relevant, include your own personal experience:

• What are some barriers and challenges to the transition of care from one level to another? Describe at least two. Examples: transition from hospital to primary care follow-up or long-term care to home care.
• Give an example from your experience or the literature of a procedure aimed at improving the process of care transitions. What impact do you suppose it will have on patient safety?

Step 2 Read and respond to two other students’ posts

Read other students’ posts and respond to at least two of them. Use your personal experience, if it’s relevant, to help support or debate other students’ posts. If differences of opinion occur, debate the issues professionally and provide examples to support your opinions.

In addition to your original post, be sure to provide a meaningful response to at least two of your peer’s posts by Friday night at 11:59pm Mountain Time. Cite any sources in APA format.

Discussion response 1 Lexina

Although, one of the most promising opportunities to improve care and lower costs is the move of care delivery to the home, there are barriers and challenges to the transition of care from one level to another. (Shi & Singh, 2019). An evaluation of the extent of functional impairment often determines which services are best suited to the individual, but personal preferences, and often the availability of financing, also play a significant role. Home health care is consistent with the philosophy of maintaining people in the least restrictive environment possible (Shi & Singh, 2019). There are several challenges that can deter clinicians from participating in home-based care. Compared to the hospital physicians, caring for patients at home requires longer visits to coordinate and manage care with limited resources and a limited number of patients to care for (Pooja et al., 2019). Another determinant is patient’s ability to self-care management along with health literacy. Physical or mental deficits that limit a person’s ability to do daily tasks. Patients who are older with chronic conditions and limited knowledge about their medical condition are associated with poorer health outcomes and face challenges to transition of care.

Ineffective care transitions can lead to adverse events and a hospital readmission. Elements that must be in place for a safe transition to occur from one health setting to another include: leadership support; multidisciplinary collaboration; early identification of patients/clients at risk; transitional planning; medication management; patient and family action/engagement; and the transfer of information (DelBoccio et al., 2015). From personal experience transitioning a patient to a skilled nursing facility, we have to assess and document the patient’s physical, mental, and emotional condition and past medical and social history, former occupation, leisure activities, and cultural factors which are used to determine which services would be most suitable for the individual (Shi & Singh, 2019). Monitoring compliance can be used to improve safe care transitions for patients, clinicians and family members.

DelBoccio, S., Smith, D., Hicks, M., Lowe, P., Graves-Rust, J., Volland, J., Fryda, S., (2015) Successes and Challenges in Patient Care Transition Programming: One Hospital’s Journey. OJIN: The Online Journal of Issues in Nursing Vol. 20 No. 3. Manuscript 2. DSN Healthcare Promotion and Information Confidentiality Questions

Pooja Chandrashekar, Sashi Moodley and Sachin H. Jain (2019). 5 Obstacles to home-based health care, and how to overcome them. Harvard Business Review. https://hbr.org/2019/10/5-obstacles-to-home-based-…

Shi, L., Singh, D. A. (2019). Essentials of the U.S. healthcare system(5thed.). Jones &Bartlett Learning

Discussion response 2 Elizabeth

Although we try to make transition of care as easy as possible sometimes it not that easy. Transitional care encompasses a broad range of services and environments designed to promote the safe and timely passage of patients between levels of health care and across care settings (Naylor & Keating, 2009). High-quality transitional care is very important for the elderly and other patients with multiple chronic conditions and complex regimens, as well as for their family caregivers. With patients that have multiple condition may receive care from multiple providers and a good hand off would be essential. Transitions within a hospital, such as from the ED to an ICU to a step-down unit to a general medical–surgical unit, can have devastating effects on the health of older adults and the well-being of family caregivers (Naylor & Keating, 2009). Such as serious medication errors are common during transition periods. When transition from a hospital stay back home can be tricky if all information is not given. If there are large gaps within care that exist with patient and caregivers during the transition period can lead to adverse events like readmission to the hospital. Case manager play an important role when it comes to patient transitioning out of the hospital. Case managers can play a pivotal role to ensure high-quality transitions by assessing patients and identifying those who are at high risk; coordinating care and services among providers and settings; reconciling medications; and facilitating education of patients and their support systems to improve self-management ( (Campagna, Nelson, & Krsnak, 2019). Having all the correct information and education the patient need to transition will impact the patient safety significantly. Having all information regarding medication follow-up appointment etc. is needed when transition and that is a key point and patients not being readmitted to hospitals.

References

Campagna, V., Nelson, S., & Krsnak, J. (2019). Improving Care Transitions to Drive Patient Outcomes: The Triple Aim Meets the Four Pillars. Lippincott®Nursing Center.

Naylor, M., & Keating, S. (2009). Transitional Care: Moving patients from one care setting to another.