The body of the research paper is 5, which of course will come with additional reference and title page as a standard format. An outline page is required which makes it 6 pages order placed. I should be receiving total of 8 pages. The research must be nursing related that is the requirement. Attached is the rubric to follow.

Paper Outline

1. Introduction
2. Statement of the problem
3. Population demographic affected
4. Delegation, supervision, conceptual framework
5. Literature review of research (evidence) into obstacles in accessing healthcare
6. Conclusion

Nursing Research Paper: Major Obstacles in Accessing Healthcare

Nursing research is concerned with finding solutions to practice problems that are seen in the course of providing professional nursing services. In carrying out nursing research, the aim is to come up with scholarly evidence that supports a particular solution or bundle of solutions to the particular practice problem. When these solutions derived from nursing research are implemented, they become art of evidence-based practice or EBP (Melnyk & Fineout-Overholt, 2019). One of the commonly encountered practice problems is inability of particular populations to access quality healthcare services. This is a problem that eventually leads to preventable morbidity and mortality because of systemic inequities. The purpose of this paper is to evaluate the nursing research related to major obstacles in accessing healthcare.  Major Obstacles in Accessing Healthcare Essay Paper

Statement of the Problem

Several factors determine the ability of a person or family to access quality healthcare. The most important of this is income. It is a known fact that healthcare in the United States is the costliest in the world (Sultz & Kroth, 2018). This is because in the US there is no Universal Health Care or UHC (WHO, 2019. What this means is that there is no single-payer system as is the case, for instance, with the UK’s National Health Service or NHS. In the US, healthcare services have been largely left at the mercy of market forces where the private sector dictates the price of healthcare. It is a capitalistic approach to an important aspect of human rights that has not yet found a lasting solution. A single-payer system in the US that would be likened to UHC would be Medicare-for-All, if that became a reality (Cai et al., 2020; PNHP, n.d.). Because the premiums charged by the private insurance companies and the fees charged by providers are beyond the reach of many, a large population of Americans were not been able to access quality healthcare. This only changed a bit when the Patient Protection and Affordable Care Act of 2010 (ACA 2010) was signed into law by President Obama.

The so-called Obamacare brought into coverage an additional 22 million poor Americans who could hitherto not access healthcare services (Kominski et al., 2017). Apart from making healthcare coverage affordable for the poor, Obamacare (as the ACA 2010 is so fondly referred to) also made a provision for healthcare to stop being volume-based but quality-based. Going forward, reimbursement for providers would be based on the doctrine of pay-for-performance only and not the volume of work done (Holmström, 2017). Lastly but not least; Obamacare also brought policy relief to the very many disadvantaged Americans who live with pre-existing conditions. It made it possible for this population of patients to get healthcare coverage under ACA 2010 by providing fiscal incentives to the payers that covered this special population. Previously, it would be impossible for any payer to accept to pay for pre-existing conditions and this led to many preventable deaths in vulnerable populations.

The Population Demographic Most Affected

The clinical problem of having obstacles in trying to access healthcare in the US is known to mostly affect minority marginalized communities such as African Americans and Hispanics. These are populations and communities that have been affected by decades of systemic racism and discrimination. These communities have low incomes and can therefore not always afford healthcare coverage or cash payment in the expensive US healthcare system. In addition to that, they are also the moist affected by pre-existing conditions because of the lifestyles that they lead. For instance, obesity disproportionately affects these communities and it is simply because they are poor and cannot afford to purchase fresh fruits and vegetables regularly (Ogden et al., 2018). They therefore resort to junk foods and cheap sugary beverages from childhood to adulthood. Obesity is associated with the development of many lifestyle diseases that include hypertension, type II diabetes, hypercholesterolemia, and cardiovascular disease (Hammer & McPhee, 2018). In other words, these marginalized communities find major obstacles in attempting to access healthcare services because of unfavorable social determinants of health or SDOH (Powell, 2016). As a matter of fact, access to quality healthcare is itself a social determinant of health.

Delegation, Supervision, and Conceptual Framework

Before ACA 2010, volume-based care allowed providers to have as their main objective to treat as many patents as possible without particular policy reference to quality. This meant that some of the patients did not receive the required level of healthcare quality needed. After ACA 2010 came into force, however, the concept and requirement of quality and pay-for-performance meant that providers needed to start practicing better and delegation and closer supervision. These two are managerial functions that must be present in any work environment in which quality is required. From a nursing perspective, it is the responsibility of registered nurses as clinical nurse leaders to ensure that expected patient outcomes are achieved. They achieve this task by delegating responsibilities and then supervising the tasks being completed. This way, the goal of quality-based care as required by ACA 2010 is achieved.

With regard to the obstacles in accessing healthcare services, a number of theoretical concepts apply in trying to find a solution. This is from a nursing perspective. The population demographics that cannot access quality healthcare invariably suffer from a deficit of self care as addressed by Dorothea Elizabeth Orem’s Self-Care Deficit Theory or SCDT (Alharbi & Baker, 2020). This then calls for the application of the concepts in Watson’s Theory of Human Caring that uses 10 caritas principles (Pajnkihar et al., 2017). Applying the concepts in these two mid-range nursing theories will provide the necessary conceptual framework to find and implement the evidence-based interventions to remove the obstacles in accessing healthcare.

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Nursing Research Into the Major Obstacles in Accessing Healthcare

There is enough evidence from peer-reviewed scholarly literature in support of the assertion that major obstacles exist in the access to healthcare services. A closer look at the evidence indicates that there are only two factors involved in the ease of access or otherwise of healthcare services. These are cost and nonfinancial factors. Kullgren et al. (2012) acknowledge that cost is an important obstacle to access to healthcare. This is especially true for families with low-income earners as the bread winners. They are not able to afford healthcare coverage and when a family member gets sick they are left poor after using the little money they have to treat them. Zagaria (2013) agrees that income (as related to cost) is a very important obstacle to access to quality healthcare. The author forcefully makes the case for marginalization and racial discrimination as being the root cause of this disparity. They mention that socio-demographic factors such as older age, female gender, and race all have a part to play in the difficulty to access healthcare in the United States.  Major Obstacles in Accessing Healthcare Essay Paper

But as Huot et al. (2019) opine, it is the unique social determinants of health (SDOH) for a population demographic that ultimately decides whether community members will experience obstacles to healthcare access. SDOH are conditions in which a person is born, lives in, works in, and dies in (Powell, 2016). These conditions closely determine the health status of the individual and can explain their wellbeing or otherwise since it is the factors that determine this wellbeing or illness. The SDOH include socio-economic status (income), educational achievement, access to quality healthcare, environmental sanitation, and living conditions at home. As stated above already, it is the marginalized African American and Hispanic communities that are disproportionately affected by obstacles to healthcare access. These communities have endured decades of systemic racism and do not enjoy equality of income with their White compatriots. For this reason, they are more often than not unable to purchase premiums for healthcare coverage or even to pay for healthcare services in the capitalistic healthcare atmosphere that is in the US. Low educational achievement is the other consequence of marginalization and systemic racism. This SDOH becomes a barrier to healthcare access in that an ignorant population will not know that they require to seek medical attention for some problems. For instance, colorectal cancer is rampant among the Hispanic community. The reason for this is that they do not want or are not aware of the importance of screening for the same (Martinsen et al., 2016). This is a direct consequence of low educational achievement. Likewise, the living conditions at home and poor environmental sanitation also contribute to the fact that marginalized communities suffer disproportionate obstacles when it comes to accessing quality healthcare. It is however acknowledged that the ACA 2010 has done a lot to try and mitigate the effects of these SDOH.

Conclusion

Healthcare services in the US are some of the most expensive in the world. This is in comparison to similar wealthy developed countries such as the UK. In the US unlike in the UK, there is no Universal Healthcare Coverage (UHC) just as yet. If it worked, it is the often cited ‘Medicare for All’ that would have been closer to what UHC coverage is. The UK has the NHS that caters for all its citizens equally whether low-income earners or high-income earners. The capitalistic approach to healthcare in the US has meant that those who are poor are unable to access quality healthcare. This is a direct consequence of the cost factor. Private health insurance is beyond the reach of marginalized communities such as African Americans and Hispanics. Furthermore, many of the community members from these minority communities also have pre-existing conditions that make the private payers reject them. Major obstacles in accessing healthcare therefore exist but mainly for poor fringe marginalized minority communities such as AA and Hispanics. Since the coming into force of the ACA 2010 health legislative policy, however; a lot of ground has been covered in trying to level the playing field for access to healthcare between the rich and the poor.

References

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Barrow, J.M., & Sharma, S. (2019). Nursing five rights of delegation. https://www.ncbi.nlm.nih.gov/books/NBK519519/

Cai, C., Runte, J., Ostrer, I., Berry, K., Ponce, N., Rodriguez, M., Bertozzi, S., White, J.S., & Kahn, J.G. (2020). Projected costs of single-payer healthcare financing in the United States: A systematic review of economic analyses. PLOS Medicine, 17(1), 1-18. https://doi.og/10.1371/journal.pmed.1003013

Hammer, D.G., & McPhee, S.J. (Eds). (2018). Pathophysiology of disease: An introduction to clinical medicine, 8^th ed. McGraw-Hill Education.

Holmström, B. (2017). Pay for performance and beyond. American Economic Review, 107(7), 1753–1777. https://doi.org/10.1257/aer.107.7.1753

Huot, S., Ho, H., Ko, A., Lam, S., Tactay, P., MacLachlan, J., & Raanaas, R.K. (2019). Identifying barriers to healthcare delivery and access in the Circumpolar North: important insights for health professionals. International Journal of Circumpolar North, 78(1), 1-8. https://doi.org/10.1080/22423982.2019.1571385

Kominski, G.F., Nonzee, N.J. & Sorensen, A. (2017). The Affordable Care Act’s impacts on access to insurance and health care for low-income populations. Annual Review of Public Health, 38. https://doi.org/10.1146/annurev-publhealth-031816-044555

Kullgren, J.T., McLaughlin, C.G., Mitra, N., & Armstrong, K. (2012). Nonfinancial barriers and access to care for U.S. adults. Health Services Research, 47(1 Pt. 2), 462-481. https://doi.org/10.1111/j.1475-6773.2011.01308.x

Martinsen, R.P., Morris, C.R., Pinheiro, P.S., Parikh-Patel, A., & Kizer, K.W. (2016). Colorectal cancer trends in California and the need for greater screening of Hispanic men. American Journal of Preventive Medicine, 51(6), e155-e163. Doi: 10.1016/j.amepre.2016.05.019

Melnyk, B.M., & Fineout-Overholt, E. (2019). Evidence-based practice in nursing & healthcare: A guide to best practice, 4^th ed. Wolters Kluwer.

Ogden, C.L., Carroll, M.D., Fakhouri, T.H., Hales, C.M., Fryer, C.D., Li, X., & Freedman, D.S. (2018). Prevalence of obesity among youths by household income and education level of head of household – United States 2011-2014. MMWR Morbidity and Mortality Report, 67(6), 186-189. Doi: http://dx.doi.org/10.15585/mmwr.mm6706a3

Pajnkihar, M., McKenna, H.P., Stiglic, G., & Vrbnjak, D. (2017). Fit for practice: Analysis and evaluation of Watson’s theory of human caring. Nursing Science Quarterly, 30(3). https://doi.org/10.1177/0894318417708409

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Powell, D.L. (2016). Social determinants of health: Cultural competence is not enough. Creative Nursing, 24(1), 5-10. http://dx.doi.org/10.1891/1078-4535.22.1.5

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Zagaria, M.A.E. (2013). Access to health care: Influential factors and cultural competence. US Pharmacist, 38(9), 20-22. https://www.uspharmacist.com/article/access-to-health-care-influential-factors-and-cultural-competence-43073  .Major Obstacles in Accessing Healthcare Essay Paper