Northern Negros State College of Science and Technology Old Sagay, Sagay City, Negros Occidental MASTER IN NURSING

(as per BOT Res. No. 42, s. of 2005)

Roles and Challenges of the Nurse in Health Care Delivery System

Prepared By:

Clifford L. Estilo, RN

Submitted to:

Ma. Luisa S. Parrenas, RN, RM, MAN, EdD

Roles of the Professional Nurses to Healthcare Delivery System The health care system has begun a decade of transitions that, for the nursing profession, promise to change the practice of nurses, expand current nursing roles and create new ones, and provide many opportunities for nurses to participate in shaping the future delivery system. With the passage of the Affordable Care Act (ACA) in 2010, care delivery and financing systems are undergoing significant transformations that will accelerate in 2014, when major provisions of the legislation are implemented. Under the ACA, Accountable Care Organizations will be developed to align the goals of health care delivery reorganizations, enhance care coordination, and improve patient transitions across the care delivery continuum. Expansion of medical care homes, community health care centers, and enhanced coverage for preventative care services will help to shift the delivery system's current focus on acute care to a greater emphasis on prevention and treatment of chronic care conditions using health care teams and information technology. And, over the decade, changes that capitate provider payments and bundle payments for episodes of care will further increase pressures on efficiency. To be sure, these changes in health care delivery and financing, and many other initiatives contained in the ACA, will be tested when health insurance coverage is expanded to 32 million Americans in 2004 (16 million are expected to receive care in Medicaid programs alone). As health care delivery organizations react to the changes brought about by public and private sector reform initiatives, RNs can anticipate that, in addition to intended outcomes, there will be unpredictable pressures and unintended consequences arising from reform. Some of these unintended consequences are likely to impede nurses' capacity to assure quality of care and safe conditions for patients. With so many known and unknown changes unfolding, one might question how well the nursing workforce is positioned to contend with, and even thrive, during the decade. Despite so many initiatives that have supported nurses in recent years, should policymakers be concerned about whether the nursing profession is prepared to meet the known and unknown challenges as health reforms unfold? Different Roles of the Nurse 1. Caregiver The caregiver role has traditionally included those activities that assist the client physically and psychologically while preserving the clients dignity. Caregiving encompasses the physical, psychosocial, developmental, cultural and spiritual levels. As a caregiver, the nurse helps the client regain health through the healing process. Nurses play an important role either in hospitals, rest homes or homes in giving care to their patients. The nurse meets the holistic health care needs of the person, including measures to restore emotional, spiritual and social wellbeing. The caregiver helps the client and family set goals and meet those goals with minimum cost of time and energy (Crisp & Taylor, 2005).

2. Communicator Communication is an integral to all nursing roles. Nurses communicate with the client, support persons, other health professionals, and people in the community. In the role of communicator, nurses identify client problems and then communicate these verbally or in writing to other members of the health team. The quality of a nurses communication is an important factor in nursing care. Communication is very important in nursing roles. It is vital to establish nurse-client relationship. Nurses who communicate effectively get better information about the clients problem either from the client itself or from his family. With better information nurses will be able to identify and implement better interventions and or nursing care that promotes fast recovery, health and wellness. 3. Teacher As a teacher, the nurse helps clients learn about their health and the health care procedures they need to perform to restore or maintain their health. The nurse assesses the clients learning needs and readiness to learn, sets specific learning goals in conjunction with the client, enacts teaching strategies and measures learning. Being a teacher is an important role for a nurse. It is her duty to give health education to the clients, families and community. However, the nurse must be able to assess the knowledge level, learning needs and readiness of the clients, families and community to give appropriate and necessary health care education e.g. diseases, health, wellness, nursing care procedure, etc. They need to do to restore and maintain their health.

4. Client advocate Client advocate acts to protect the client. In this role the nurse may represent the clients needs and wishes to other health professionals, such as relaying the clients wishes for information to the physician. They also assist clients in exercising their rights and help them speak up for themselves. A nurse may act as an advocator. An advocator is the one who expresses and defends the cause of another or acts as representative. Some people who are ill maybe too weak to do on his own and or even to know his rights to health care. In this instance, the nurse may convey is clients wish like change of physician, change of food, upgrade his room or even to refuse a particular type of treatment.

5. Counselor Counseling is a process of helping a client to recognize and cope with stressful psychologic or social problems, to developed improved interpersonal relationships, and to promote personal growth. It involves providing emotional, intellectual, and psychologic support. A nurse may act as a Counselor. She provides emotional. Intellectual and psychological support. She helps a client to recognize with stressful psychological or social problems, to develop and improved interpersonal relationship and to promote personal growth. 6. Change agent The nurse acts as a change agent when assisting others, that is, clients, to make modifications in their own behavior. Nurses also often act to make changes in a system such as clinical care, if it is not helping a client return to health. As a change agent, oftentimes a nurse change or modify nursing care plan based on her assessment on the clients health condition. This change and modification will only happen when the intervention/s does not help and improve a clients health e.g. caring of the pressure ulcer, change in medication, change of food, etc. 7. Leader A leader influences others to work together to accomplish a specific goal. The leader role can be employed at different levels; individual client, family, groups of clients, colleagues, or the community. Effective leadership is a learned process requiring an understanding of the needs and goals that motivate people, the knowledge to apply the leadership skills, and the interpersonal skills to influence others. Nurse often assumes the role of leader. Not all nurses have the ability and capacity to become a leader. It takes confidence, initiative and ability to innovate change, motivate, facilitate and mentor others. As a leader it allows you to participate in and guide teams that assess the effectiveness of care, implement-based practices, and construct process improvement strategies. You may hold a variety of positions like shift team leader, chairperson of a professional organization, ward in-charge, board of directors, sister, matron, etc. 8. Manager The nurse manages the nursing care of individuals, families, and communities. The nursemanager also delegates nursing activities to ancillary workers and other nurses, and supervises and evaluates their performance.

As a Manager, a nurse has the authority, power, and responsibility for planning, organizing, coordinating and directing work of others. She is responsible for setting goals, make decisions, and solve problems that the organization may encounter. It is also her responsibility to supervise and evaluate the performance of her subordinates. The manager always ensures that nursing care for individuals, families and communities are met. 9. Case manager Nurse case managers work with the multidisciplinary health care team to measure the effectiveness of the case management plan and to monitor outcomes. In some hospitals, a case manager is a primary nurse who provides direct care to the client or family. For example a case manager for diabetic client. She has the responsibility to give health education, measure the effectiveness of the nursing care plan and monitor the outcomes of intervention whether effective or not. 10. Research consumer nurses often use research to improve client care. In a clinical area nurses need to:

Have some awareness of the process and language of research Be sensitive to issues related to protecting the rights of human subjects Participate in identification of significant researchable problems Be a discriminating consumer of research findings

Challenges in the healthcare delivery system The Philippines is a third world country in Asia where poverty and corruption is very rampant. It encompasses poor health care facilities, infrastructures, government, employment, and majority of the people cant afford to go to school. According SWS survey as of 2006, 52% of Filipinos said that they belong to the poor sector and according to Feud Art as of 2006 in Philippines by income class, low class (poor) represents 26.9% of the total population. This sector is usually deprived of their basic needs and necessities in life especially in health care. In fact majority of them suffer from different diseases and die of unknown reasons without having seen by a health care provider. In addition, most of them are uneducated and misinformed as they are the common victims of violence, social discrimination, immorality, and devious acts. As health care professionals, we must act as an advocate for them through disseminating essential information and providing proper knowledge in order for them to become aware, correct misconceptions, to learn and practice health promotion towards independence to promote quality life. These interventions would help in truly making health in the hands of the people.

II. Issues Community involvement is an integral part in making a program designed for the community a success. A community health nurse would perform ocular visitation, he or she would visit some areas in the community, conduct interviews and maybe even hand out surveys or ask for the masses opinions regarding the needs of the district. Upon collecting the data the community health care workers identify issues, prioritize and develop a plan to get the program started. A dilemma that the group has noticed while still in their college days is that when a community is being engaged to attend seminars, lectures and embody the program they lack the enthusiast and they fail to realize the utility of the plan and its benefit in their lives. What else can be done to entice the people to take more action? With all the different plans and programs nursing schools and even the local government have for the community they become very dependent and just wait for the provisions that will be coming from these groups of health care facilitators. The goal of these groups is to help the community realize what they need and then together with the community health care team assigned in their area act upon those need. But in most cases the community lack the initiative to act on their own and that they have to be prodded and periodically checked to make sure that the program is being carried out. Another problem with this is that there are only a handful of people to supervise the community periodically, it is possible that because of this the people lose interest in the project there is no one to motivate them. To make a plan spring into action there would be a need for some funding. It would be difficult for a project to start running without the budget. In the Philippine setting, sometimes it takes too long for a budget to be approved and it seems like health issues is not high on the governments list of priority. Although lawmakers do make up programs for the poor however those programs are not enough and it is not reaching the people in far and hard to reach rural areas, with a budget that is minimal and manpower that is lacking, what can be done to address this issue? What else can the government do for the health of its people?