1. In order to provide the care to indigent patients, Sue should be aware of the nurse practice acts, which specify the things expected from the nurse while providing the health care (Murray, McKinney, 2014, p. 37). She should understand her inner traits in order to cope with all her responsibilities. Carrying for the indigent individuals is truly difficult, because this task presupposes not only the provision of the necessary medical treatment, but also considering how these people might get the lower price for their treatment. It means that Sue should know not only the essentials of her profession, but also the programs and affordable insurances for patients. Researchers Saltzman, Furman and Ohman (2015) have mentioned one really significant thing in their work, which presupposes that medical treatment is beyond the means of poor people, as they simply cannot afford it (p. 424). For them, getting the necessary medical treatment becomes a challenge. Sue performs the role of an altruistic individual, able not only to assist the patients to improve their health, but also considering the ways to make it affordable for the ill and their families. In order to determine the way of taking decisions, Sue is obliged to know all the legal aspects of her profession, consider the policies’ changes, which might turn out to be effective for the indigent patients, and understand the domains of nursing practice.
2. Researchers Patton, Zalon, and Ludwick (2014) discuss the issue of policy-making process in nursing and emphasize that it is a cyclical process for nurses, and its first phase is understanding of the context of the issue (p. 11). Sue needs to start from this stage, as it assists to view the problem of health care from the viewpoint of people, who have no finances to afford it. Comprehending the context from their side helps in making the policy maximally efficient. Whenthe policy alteration is conducted starting from this first stages, there is a chance to make it maximally efficient. If Sue obtained the possibility to initiate certain changes on this particular phase, she could control the policy making process and direct it in the necessary direction. Jean Nagelkerk (2006) calls this stage the policy formulation phase, which is the most suitable for the changes implementation. He emphasizes that during the policy formulation “much debate and input is generated with special interest groups and other influential leaders to encourage legislation or to prevent a bill” (p. 34). It should be added, that the third stage, which presupposes the policy modification, might be also applied by Sue. It is a good way to make changes in already existing policies in order to conduct the necessary alterations to assists the patients.
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3. Sue should apply the five-step decision making process in order to determine which patient will be delegated. It includes the following steps:
- Identification of the needs for a decision;
- Determination of the goal or outcome;
- Identification of alternatives or actions;
- Choosing an alternative;
- Evaluating the alternative chosen (Kelly and Marthaler, 2010, p. 27).
At first, Sue should understand what needs she wants to follow, and what is her final objective. After it, she has to consider the possible actions, which could lead her to the final goal. Usually, there exists a variety of ways. Taking into account that Sue is the nurse, she may take the health state of the individuals as priority. The most ill patients should be assisted first. In general, after determining the course of actions, it would be wise to choose one alternative and follow it. In order to understand, whether this alternative suits to the issue, Sue shoulld thoroughly consider and analyze it. In practice, it will look as follows. At first, Sue will choose that her final goal is assisting a number of poor people. After it, she could select the actions, which might turn out to be helpful. Out of the wide variety of different strategies, Sue will be obliged to choose the most efficient one, and finally, she will have to consider, why this particular strategy is effective.
4. To start with, it should be stated that the evidence-based practice (EBP) of this case study requires the complex plan of actions, which the nurse Sue should facilitate. These actions include the high-level management commitment and innovation of skills. Researchers Gerrish and Lacey (2010) emphasized that there exist three factors affecting the evidence-based practice. They are a) the nature of evidence; b) structures and mechanisms, which are required; and c) consideration of the importance of patient centeredness (p. 497). In general, the main difficulties that could be anticipated are related to the structures and mechanisms, which facilitate the change. It would be quite difficult to consider what steps will be really efficient and will lead to positive outcome. Theoretically, everything is understandable, but in practice, the situation is totally different. This case presupposes introducing certain changes to the existing policies, and it will be definitely quite problematic. The changes proposed should be implemented in such a way in order to add certain things to the existing regulation without destroying their legal unity. Another difficulty which might occur concerns the resources available. Sue alone will be unable to cope with the wide range of duties, and she will definitely lack resources. The evidence-based practice assumes availability of access to finances which are necessary to support new approach to treatment of poor patients and adequate number of assistants.
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