Angel David Genera (ADG) is reported to suffer from Major depressive disorder (MDD), Generalize Anxiety Disorder (GAD), and alcohol dependency. He cannot access the healthcare services that are relevant to him. He also has a mental illness that poses a significant challenge to his quality of life. Upon reviewing ADG’s clinical case, the pertinent healthcare problems facing ADG include stigmas against mental health services, poor access to mental health providers and high cost and limited access to insurance coverage. The delves into developing effective interventions that would help address these challenges.
Part 1: Proposed Intervention
The proposed intervention to the problem is a community-based educational and clinical program comprising interdisciplinary teams. Components of the proposed intervention include community sensitization on mental health stigmatization, offering medical services at the grassroots level, and community education on high healthcare costs and limited access to health insurance coverage (World Health Organization, 2020). It aims to address the following issues: stigma and culture norms through education forums and family therapies; access to mental health providers by offering telepsychiatry care, increasing the number of healthcare providers, and addressing the cost of care by focusing on care coordination, prevention and early detection and providing community-based incentives to community members to see and accept more insurances coverages.
Apart from sensitizing the community about the culturally motivated stigma in mental health, the program rolls out community-based social and clinical workers to offer healthcare services to the residents. Apart from ADG, most people within our societies suffer the same challenges. It requires an effective and profound community-based intervention that offers health services from the grassroots level (World Health Organization, 2020). The decision for the intervention was prompted by the poor distribution and shortages of healthcare professionals, the need to review the leadership approaches to offer medical services at the grassroots level, the lack of quality care posing safety concerns to patients like ADG and the lack of effective collaboration and care coordination between interdisciplinary teams to optimize utilization of the available resources.
Part 2: Analysis of the Intervention
Angel David Genera (ADG) is a Cuban-born female patient who relocated to the U.S. in 2012. He has mental illness but cannot seek mental health services due to the cultural norms that stigmatize seeking mental health. He could only seek mental health services from a Latino provider, which is hard to find in the United States. ADG also cannot meet the financial burden of his treatments. That means ADG is facing three pertinent healthcare problems, which include stigmas against mental health, poor access to healthcare services, high healthcare costs and limited access to insurance coverage. This is also the problem that the intervention tries to solve.
The problem was chosen because there is profound evidence of its existence in the American healthcare system. For example, the Mordi et al. (2022) study revealed a significant shortage of healthcare providers in the United States and called for an urgent need to address the latter through policy intervention. The policy must address the challenges healthcare providers face, especially nurses, and offer adequate scholarships to increase the number of nursing professionals. The study further looked at the financial burden of the American healthcare system on patients like ADG and revealed that the vast majority of the minority communities in the United States cannot afford the cost of healthcare. Ghafoori and Knoo’s (2022) study revealed how cultural norms and beliefs significantly challenge a patient’s decision to seek medical care. This is reflected in ADG’s case, where he cannot seek mental health services due to cultural stigmatization. The problem is relevant to the nursing profession because it affects the quality of patient care. It also applies to the ADG and his family because it affects access to quality care and offers them a financial burden, impacting their quality of life.
Role of Leadership and Change Management
American healthcare system leaders need to refocus their leadership approaches to address the problem from the community level. In this case, nursing leadership needs to roll out community-based public health educators and social workers to educate people on how cultural norms and stigmatization challenge treatment outcomes and the ability to access quality care (Abbas et al., 2022). In the case of ADG, cultural stigma against mental health treatments would only worsen his condition, making it difficult to recover. Public health educators and social workers offering educational programs would sensitize ADG and other community members facing similar cultural barriers to prioritize their health over social norms. This will be facilitated through inclusive and participative family therapies that explore various cultural barriers to quality healthcare and how to overcome them.
The leadership must also provide the required resources for the interdisciplinary teams to enhance community-based care coordination and educate the communities on the potential risk factors for various health problems. Research shows that healthcare costs are always high because most chronic conditions are only detected in their advanced stages, requiring specialized clinical care using sophisticated medical equipment. Educational and counselling programs would help the communities adopt preventive and early detection measures to seek medical assistance before it reaches its advanced stages (Abbas et al., 2022). Lastly, nursing leadership must refocus on adopting telehealth technologies to offer medical services to the communities remotely. A good example is telepsychiatry care, which helps reach out to multiple clients remotely, eliminating the transport costs to the healthcare facility that contributes to the increased cost of care.
Proposed Communication and Collaboration Strategies
The proposed intervention requires healthcare providers to adopt effective communication and collaborative strategies to address the problem and improve the treatment outcome. The first strategy is the use of multiculturalism communication (Horváth & Molnár, 2022). ADG is a Latino and most likely faces a communication barrier while seeking healthcare services in American hospitals. The interdisciplinary teams would, therefore, involve Latinos who could interpret the communication to the client and eliminate the communication barrier. They must demonstrate cultural sensitivity and respect by showing mindfulness of the client’s cultural background. The second strategy uses collaborative and participative communication. Healthcare providers must build trust with the client to foster the free exchange of information to diagnose pertinent social issues effectively. The third strategy is active listening and respect for patient autonomy. Due to ADG’s cultural stigma, he will most likely reject healthcare providers proposed mental illness treatments. In this case, healthcare workers must respect and listen to their views and then address the differences professionally (Cynoteck Technology Solutions, 2023). The goal is to make clients see sense and drop their tough stances for appropriate treatments.
How State Board Nursing Practice Standards or Governmental Policies Guided the Development of a Proposed Intervention
State board nursing practices and federal policy guided the development of the proposed strategy. The intervention’s component that addresses the cost of care was driven by the Affordable Healthcare Act (ACA), which seeks to increase healthcare insurance coverage to cover most of the uninsured population and implement reforms in the health insurance market (Courtemanche et al., 2020). The intervention offers educational programs to sensitize the community to choose relevant insurance coverages to ease the burden of healthcare expenses. Similarly, the component that addresses the telehealth strategy, like telepsychiatric care, was guided by the U.S. telehealth policy that centres around the reimbursements for the services offered under Medicare on the federal level and private insurance and Medicaid services provided at the state level. The policy seeks to reduce the cost of care for patients, their families, and the facilities. Lastly, the overall intervention and its components were guided by the Health People 2030 policy that proposes the need to improve people’s health and well-being through community-based healthcare programs (Santana et al., 2021).
How Proposed Intervention Improve the Quality of Care, Enhance Patient Safety, and Reduce Costs to The System and Individual
The proposed intervention would improve the quality of care by providing profound and effective care coordination between the interdisciplinary teams, including the patient and his family, hence offering a client-centric treatment plan. Offering educational programs at community levels and sharing health information with community members improves early detection of health needs, avoiding late diagnosis (World Health Organization, 2020). This helps improve the treatment outcomes and lower the cost of care since the clients are offered home-based medical services. Interdisciplinary teams running the program would engage in teamwork and active collaboration, reducing the chances of medical errors and enhancing the patient’s safety. Offering online medical services through telehealth technologies like telepsychiatry care helps improve the quality of care, ease access to healthcare services and reduce the cost of care.
Application of Technology, Care Coordination, and the Utilization of Community Resources
The intervention proposes using telepsychiatry care that would offer home-based treatment to the client, reducing the cost of care. ADG revealed that he was facing financial challenges to cover his medical expenses. Implementing telepsychiatry care technology would relieve him from travelling to the facility, saving on cost. Through telepsychiatry care, there is no physical interaction between healthcare providers and the client, which could result in cultural bias in service delivery. Offering care coordination through interdisciplinary teams enhances the information flow, leading to accurate diagnosis and treatment. As a result, it helps improve the quality of care. Lastly, the community-based intervention will utilize community-level resources such as public social halls and playgrounds for educational programs, hence saving on cost. It eliminates the cost of hosting the client, which translates to a lower cost of care.
References
Santana, S., Brach, C., Harris, L., Ochiai, E., Blakey, C., Bevington, F., … & Pronk, N. (2021). Practice full report: Updating health literacy for healthy people 2030: Defining its importance for a new decade in public health. Journal of Public Health Management and Practice, 27(6), S258.https://doi.org/10.1097%2FPHH.0000000000001324
Courtemanche, C., Marton, J., Ukert, B., Yelowitz, A., & Zapata, D. (2020). The impact of the Affordable Care Act on healthcare access and self‐assessed health in the Trump Era (2017‐2018). Health services research, 55, 841–850.https://doi.org/10.1111/1475-6773.13549
Cynoteck Technology Solutions, (2023). 7 Communication Strategies to Increase Trust in Healthcare Providers. https://www.linkedin.com/pulse/7-communication-strategies-increase/
Horváth, Á., & Molnár, P. (2022). A review of patient safety communication in multicultural and multilingual healthcare settings with special attention to the U.S. and Canada. Developments in Health Sciences, 4(3), 49-57.https://doi.org/10.1556/2066.2021.00041
Abbas, S., Al-Abrrow, H., Abdullah, H. O., Alnoor, A., Khattak, Z. Z., & Khaw, K. W. (2022). Encountering COVID-19 and perceived stress and the role of a health climate among medical workers. Current Psychology, 41(12), 9109–9122.https://link.springer.com/article/10.1007/s12144-021-01381-8
World Health Organization. (2020). Health policy and system support to optimize community health worker programs for HIV, T.B. and malaria services: an evidence guide.https://iris.who.int/bitstream/handle/10665/340078/9789240018082-eng.pdf?sequence=1
Modi H, Orgera K, Grover A, (2022). Exploring Barriers to Mental Health Care in the U.S. Washington, DC: AAMC. doi:10.15766/rai_a3ewcf9p.
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