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Medicare has made tremendous steps in terms of its growth; it originated in the U.S in the twentieth century camouflaged as worker’s compensation. The worker’s compensation intended to protect employees who were injured while on duty. The great depression changed various aspects of Medicare. After the stock market crashed in the United States in 1929, the need for government protection from bankruptcy became inevitable.
This necessitated the signing of the social security act by President Roosevelt in the year 1935 (Aspen Health Law Center,1998). The social security started small, and it was mostly based on government’s collection of paychecks of workers. However, as time went by the funds taken in the form of taxes were used to create pensions schemes for workers. Many Americans thus felt that they were supported financial protection (Staman, 2010).
In the year 1952, President Kennedy envisioned reforms in the social security arena; it was specifically designed to ensure that all the elderly persons in the United States were entitled to Health insurance. However, this dream held by President John F. Kennedy was thwarted by the medical industry and the Congress. In the wake of the general President’s death, his successor Lyndon Johnson continued to push for the health care bill and the civil rights and economic opportunity act of 1964 was incorporated and in the year 1965 the health insurance for the elderly was passed. Ever since the birth of Medicare in the year 1965, there have been great milestones that have been made in this health care industry (Oliver, 2005).
Medicare was further overhauled in the year 1983 when diagnosis-related groups (DRGs) were included in the medical lexicon and by the year 1984, hospital payments were determined entirely on the basis of the patient’s diagnosis rather than the daily charges. For this reason, Medicare began paying for the average cost to treat a patient’s diagnosis rather than the daily charges that it used to pay for before (Oliver, 2005).
The first legislation that was aimed towards improvement of Medicare came in the year 1965, when the Congress created Medicare under the title XVIII of the social security act. The Act was established in an effort to ensure that all people aged above 65 years old regardless of the income or medical history had health insurance. In the year 1972, the Congress expanded the Medicare eligibility to younger persons who had permanent disabilities. The congress passed unanimously that these persons would receive social security disability insurance (SSDI).
In the year 1980, the Medicare secondary payer Act of 1980 came into effect (Dismone, 2000). This Act included the prescription of drugs into the insurance coverage and enabled people to get more medical attention as they were enjoying free government drug subscriptions. In the year 2001, Congress further expanded the Medicare Act and covered young people who had ALS (amyotrophic lateral sclerosis) (Marmor, 2000).
During its formation, Healthcare was mostly concerned with hospital and inpatient services; however, since the year 1997 it was broadened to include physician’s visits, outpatient’s care, and other necessary medical services. Under the equitable budget act of 1997, the Congress added Medicare benefits through private plans. 2003, the PL 108-173 Medicare as well as Prescription Drug development and Modernization Act was signed into law by the President. The act touted change in the introduction of the entitlement benefit for prescription drugs through subsidies and tax breaks (Oliver, 2005). In the year 2010, President Barack Obama signed into law the Health Insurance and Education Reconciliation act that included all United States citizens into federal sponsored health care (Staman, 2010).
Since the inception and inauguration of the prospective payment system, physician’s fee freeze, as well as other cost-cutting measures, many physicians have been in many cases approached with income generating opportunities that related to its practices. However, most of these opportunities present potential criminal and civil liability under the federal Medicare as well as anti-fraud abuse provisions (Staman, 2010).
The federal civil monetary penalties under the Section 1128A of the Social Security Act/42 USC 1320a-7aa), shows that health care professionals as well as entities are prohibited from the presentation or causing to present claims for the services of individuals which were not provided as claimed (Dismone, 2000). This provision often deals with the persons and entities that know that the claims are fraudulent and false and therefore, prohibits any person from providing misleading information that could reasonably be expected to influence the decisions regarded when discharging inpatient hospital services.
The anti-kickback law or better known as the criminal punishments for Acts involving federal health care programs (Section 1128B for the social security act/43 USC 1320a-7b). This act stipulates that the entities and individuals are prohibited from willfully and knowingly making false statements in the application of benefits or payments which are all under the federal and state health care programs (Aspen Health Law Center,1998). There is the prohibition against the knowingly soliciting or receiving any remuneration including kickbacks, rebates and bribes.
Self-Referral Law/Limitations on Certain Physician Referrals (Section 1877 of the Social Security Act/42 USC 1395nn) prevents physicians as well as their intermediate families having an ownership or even compensation relationship with a clinical lab from making referrals to it.
These laws about Medicare have been pivotal in changing the current Healthcare system. The pertinent terms of the Care Act aim to increase the sources of this Medicare insurance program funding. They also provide incentives for employers to adhere to the Act and stipulate the available penalties for defaulters.
To reduce Medicare expenses for the individuals and the government, some mechanisms were formulated which include subsidies, insurance exchanges, and mandates. The mechanisms are geared towards the provision of affordable and qualitative-insurance coverage for all the Americans despite color, race, creed or level of income. It tries to bridge the gap in regard to health care within all the population whether currently insured or not. It emphasized the health first rather than the economic status of the patient (Klein, 2006).
However, since being signed, the Act has faced criticism from all corners of the political fronts including some of those allied with the sitting president who advocated the bill. The reforms needed for successful implementation of the Act have not been spared. All matters of issues have been raised concerning its feasibility and legal authenticity.
The legal aspect has been the point of concern for the most of the critics. Whether genuine or just another loophole to be used to shoot down the enactment of the Act, the legal perspective has its merits as depicted by the suits presented to the courts in relation to the Act.
There have been a myriad of these all over the nation, but the most notable are the ones involving the independent business alliance and other petitioners versus the U-S-A Secretary of Health Branch and that of the human health services and other petitioners versus Florida. The first case had a lot of impacts and this is why it led to some changes in the original framing of the Act. The penalty provision has been since overhauled by the courts. The second case more or less affirms the same.
The cases have for this reason helped to restructure the provisions to some acceptable standards though more changes are still being called for from different platforms. They can, for this reason, be said to have streamlined and offered the much needed legal guidelines on more effective implementation of the well-intentioned Patients Protection and Affordable Care Act (Blatt, 2002). The resulting restructured act is more feasible and represents the views of all including those who oppose it. The equity in the applicability of the Act across the board was also ensured. Nevertheless, it led to the expansion of a better Act that will cater for all the affected parties currently and in the future.
Aspen Health Law Center. (1998). Health care fraud and abuse. Gaithersburg: Aspen Publishers
Dismone, R. (2000). Medicare: History of Provisions. New York.
Peterson, K. (2010). Medicare . CATO handbook for policy makers , 34-75.
Staman, J. (2010). Health Care Fraud and Abuse Laws Affecting Medicare and Medicaid: An Overview. Washington D.C.
Theodore Marmor, G. M. (2000). Medicare's Future: Fact, Fiction and Folly. American Journal of Law and Medicine Vol. 26 , 226-248.
Thomas Oliver, P. L. (2005). A Political History of Medicare and Prescription Drug Coverage. New York.
The failure to attend to hand hygiene often has very serious consequences, it contributes negatively to patient safety as well as the quality of the patients lives and consequently their confidence in healthcare delivery. It is of the essence to note that prevalence of hand hygiene omission is still high. The improvement of hand hygiene often has the potential to prevent infections as well as harm and consequently reducing the healthcare industry time and costs. This is particularly of importance with the current efficiency saving targets for the medical industry in order to increase their profits. Hand hygiene amongst medical professionals is a cost-effective intervention that can be able to save lives. Hand hygiene is an importance concept amongst nurses and nurses play a very pivotal role when it comes to the influencing of other professionals to observe with hand hygiene recommendations. The nurses should start by example and in turn create a culture amongst healthcare professionals of observing hand hygiene in order to ensure that there is sustenance of patient care practices that are of a high standard. A decrease in compliance with proper hand washing techniques used to ensure hand hygiene often leads to increasing in cross-infections amongst medical professionals. Therefore, this topic of hand hygiene is extremely important to the nursing practice, and the nurses should take into consideration the significance of hand cleanliness and conform to it.
Recently there has been an increase in cross-infections amongst nurses and other medical professionals. The cross-infections has largely been blamed on the medical professionals inability to conform to the existing procedures of ensuring hand hygiene. This increase has seen the death of various medical practitioners as a result of this cross infection. Research has shown that because of the mere fact that medical professionals wear gloves this does not mean that their hands are completely protected. It has been established that under the gloves often lies battle dry and irritated skin. After removing their gloves most nurses and health care, professionals do not completely understand the importance of proper hand-washing protocols.
It has been accepted amongst medical circles that indeed health care associated infection has come to be a major burden around the world, and it currently threatens the safety as well as care for patients. When dealing with patients, it is imperative that hand hygiene be performed at specified moments, for example, by washing one's hands with soap and water or by hand rubbing with an alcohol. It is against this backdrop of rising non-conformity of hand hygiene amongst medical practitioners that this literature review was performed.
Review of databases
Biomed Central is the largest scientific and medical publisher with open access science publisher and database. The Database is based in London in the United Kingdom and since it was founded in the year 2000, grown tremendously in terms of the journals that it holds as well as the quality of information that is published and stored on the database. Biomed Central hosts some of the biggest journals in the scientific community such as Journal of Biology and Genome Biology. The database has been accredited by many universities worldwide as it is known to publish and stock only peer reviewed articles that have the minimum publication threshold on their database. Therefore, it is in order to state that this is a trusted database which is known to churn out quality publications that are not only peer reviewed, but also which have been published in reputable journals. The database is professionally handled and, therefore, an assurance can be given that the information gotten from this database is extremely accurate and reliable.
Elsevier is an academic publishing company and database which publishes medical and scientific literature. The company is based in Amsterdam, but it has been able to permeate different parts of the world. It produces quality journals such as the Lancet, Science Direct, and Current opinion which are extremely respected in the scientific community. The database currently archives around seven million publications The site is known to produce high-quality publications, and if the publication is not peer reviewed, the database does not accept the publication. Many Universities around the world pay subscription fees to Elsevier in order for its students to use the renowned medical and scientific database. In fact, over time the three leading universities in the world, Harvard University, California University, and Duke University have paid 10-year subscriptions to the database because its high reliability and credibility.
When one mentions medical databases one cannot forget to mention PubMed. PubMed is a search engine which accesses the MEDLINE database in order to get articles relating to medicine. The database is highly rated as it is known to provide quality control when it comes to scientific publishing. In fact, it is only journals that meet the scientific standards that are put up by PubMed are indexed. The database has over 24 million records of publications that go back to the year 1809. The database library is, in fact, the biggest medical databases that exist in the world today and its growth has been over the roof over the past few years. The database is credible, and the publications that are retrieved from the site are peer reviewed and of high quality. They have undergone the rigorous process of evaluation in order to fit the famous database, and this is a proof their validity and reliability.
EBSCO information services based in Massachusetts offers library resources to customers in different areas of specialization. The database has an access to around 375 full-text databases and is planning to increase that to 400 in the next few years. The database is often subscribed to by many credible universities because of its high-quality publications as well as its rigorous process that is used to include an article in the database. The database only holds peer reviewed articles in the sphere of medicine, and it recently raised its bar in regards to the publication of scientific publications. This was performed to ensure that quality was increased dramatically in the database, and the criteria for entry was also increased in order to deter plagiarized articles, as well as inaccurate data. EBSCO has been able to build a reputable brand amongst scholars and, therefore, the publications that have been retrieved from the site are credible and reliable. They can be used in any scholarly session as the site is known to produce only high-quality publications.
Scholar's research is one of the largest libraries that has access to different publications related to medicine. The scholars research explores research data, different findings and also looks at journals in order to provide proven and peer reviewed information regarding current events. The scholars Research library journals offer scientifically sound research articles which contain information that is both accurate as well as reliable. The Scholars research just like other big databases has subscriptions in reputable institutions of higher learning such as Harvard, Yale, Oxford and Cambridge. The library is known to have an extensive system that authors have to undergo through in order for their work to be put up in the database. This is one of the various issues that makes the database be one of the highest ranked databases in the world. In this regard, the publications that come from this database are extremely credible and accurate and can be relied on as original research.
Therefore, it can be seen that the five databases above are credible and come offer publications that are of high quality and peer reviewed. Further, before an article is accepted by the databases, the publication must go through a rigorous process which determines its authenticity, its accuracy levels, as well as its reliability. Therefore, these databases have provided this research with vital information that is credible, reliable as well as efficient. There is no mentioned database that was used that has credibility issues.
Ahmed Mahfouza, M. N. (2013). Hand hygiene non-compliance among intensive care unit health care workers in Aseer Central Hospital, south-western Saudi Arabia. International Journal of Infectious Diseases, 729-732.
In this article Mahfouza, Tahqrik, et al. (2013) argue that hand hygiene has been known to reduce health care associated infections. The purpose of their study is to study the degree of compliance in relation to hand sanitation practices among nurses in I.C.U at Asser Central hospital in Saudi Arabia. The authors utilize observation methods of health care workers in intensive care units that were delivering routine care and observed whether or not the nurses conformed to the required standards for the maintenance of hand hygiene. The non-compliance rate that was observed stood at 41% and the study made a conclusion that showed that that there were significant risks for the people that had non compliance in the hospital (Mahfouza, 2013). In fact, the high figures of hand hygiene non compliance show that indeed that there is a need to intensify education to promote local hand hygiene as well training programs in order to embed efficient and effective hygiene into different elements of care deliver in the intensive care unit. The article makes an emphasis on the growing health problem that increased morbidity; increased hospital stays as well as increased cross infection and relates it to lack of proper hand hygiene by nurses and medical professionals (Mahfouza, 2013).
AD, Akyol. (2012). Hand hygiene among nurses in Turkey: opinions and practices. US National Library of Medicine National Institutes of Health, 431-417.
The authors argue that the transmission of microorganisms from the hands of healthcare workers as the main source of the ever increasing cross-infection in hospitals. They continue by stating that this cross-infection hospitals can be substantially reduced by hand washing and observing proper hand hygiene. Their study aimed at identifying nurse's practices, as well as their opinions regarding hand washing during their common routine patient care. The authors showed that nurses have a meager echelon of knowledge regarding the quality of hand washing. In fact, all nursing actions that related to unsoiled and filthy activities was evaluated by the authors using the Fulkerson scale (Akyol, 2012). The authors made a finding that a majority of nurses did need to clean their hands frequently but they were not able to do it because of intense operational conditions as well as insufficient materials for drying hands after frequent washing. The authors made a conclusion that there was a need to advance hand sanitation and quality of hand washing compliance, and additional factors should be considered. Some of these important factors that need to be taken into consideration include the improvement of health care workers conditions and increase in information about hand hygiene techniques as well as disinfection.
Han K, D. F. (2011). [Compliance on hand-hygiene among healthcare providers working at secondary and tertiary general hospitals in Chengdu]. US National Library of Medicine National Institutes of Health, 1139-1142.
The authors in this article evaluate the compliance of nurses and other health care providers on hand hygiene that are working at secondary as well as tertiary hospitals in Chengdu China. The authors use on-site observations regarding hand hygiene compliance and they conducted that in 6 hospitals in Chengdu. The style used by the authors was to ask a swell as record their knowledge regarding hand hygiene. 92.8% of the healthcare providers understood the six-step method that is used in hand washing. However, the high-level knowledge that existed on hand hygiene did not translate into good practices. In fact, most of the hospitals that were involved in the research in this article were seen to have poor hand hygiene equipment. 2.2% of the treating rooms in the hospital had foot operated or automatic facets and in fact, only 24.5% of the faucet had alcohol based sanitize or even soap (Han, 2011). The authors of the article recommend that must training as well as periodic monitoring in the area in order for the hygiene to be improved. Further, proper hand hygiene equipment should be improved to ensure the facilitation of hand hygiene practices among the health care providers.
Sharon Salmon, X. B. (2011). A novel approach to improve hand hygiene compliance of student nurses. Antimicrobial Resistance and Infection Control, 2-16.
The authors noted with great concern that the consistently low compliance that was shown by nursing students that prompted them to discover novel approaches to educating nurses in order to help them improve good hand hygiene practice. The authors decided to introduce experiential learning assignment to the final year nurses which involved hand hygiene auditor training. The findings showed that nursing students that were taught and were monitored had higher chances of complying with hand hygiene practices. In fact, 97.5% of nursing students after the training felt that the understanding would come and improve their hand sanitation practice, and this would help them greatly in their nursing career (Salmon, 2011). The authors made a conclusion that there was a need for people concerned to sit down and create a flexible program which when implemented would increase the hand hygiene compliance amongst student nurses. The experiential learning regarding hand washing and hand hygiene can be reported to be like a highly educational tool and, therefore, it should be practiced in other nursing schools and later extend to hospitals. While the training does not in any way guarantee long term behavioral change it is imperative as it creates an intuition that instills habits (good), as well as messages at the premature stages of the student's career. This method would potentially have a lot of significance and a long term impact in terms of proper hand hygiene (Salmon, 2011).
Jeannie P. Cimiotti, L. H. (2012). Nurse stafﬁng, burnout, and health careeassociated infection. American Journal of Infection Control, 486-490.
The authors start by stating staggering statistics regarding new infections. They state that each year over 7 million hospitalized patients acquire new infections while they are being treated in the hospital for other conditions. Nurse Staffing has often been blamed for the spread of infection within hospitals; however, little evidence is available in regards to explaining the association that exists between the two. The authors collected survey data from several hospitals regarding cross infections. The authors examined the urinary tract as well as surgical infections that are described as the most prevalent infections. Hand washing and improper hand hygiene in general was also blamed as the understaffed nurses had no time to take precaution. Most of the nurses complained that they did not have enough time to study the proper hand washing technique despite having information about how they were supposed to be done (Cimiotti, 2012). They argued that they often went for the basic hand washing techniques, and this might be contributed to the extremely high rate of new infections. A research paper by the authors provides the explanation for the possible association between nurse staffing, hand washing and health care associated infections. They concluded and recommended that the reduction of burnout in registered nurses would be a great way to improve the strategy to control infections in acute care facilities.
Mahmoud Al-Hussami, M. D. (2011). Predictors of compliance handwashing practice among health care professionals. Healthcare Infection, 79-84.
Hand washing compliance amongst the health care workers is the best practice to use in combating associated infections. The authors argue that despite many health care professionals understanding this perfectly, the compliance rates with hand washing practices still remain low. The authors decided to determine the application status of the information about hand washing in the context of infection control measures in the practice areas. The target population included a cross-sectional survey of health care professionals including nurses, technicians and physicians who were working in large acute hospitals in Amman Jordan. The results from the study show little compliance in the hospital regarding their hand washing compliance. The results of the study are imperative because it helps in the improvement of healthcare in regards to compliance with hand washing through education, as well as reinforcement of education (Al-Hussami, 2012). There is a requirement to have a wholesome monitoring plan according to the authors in order to effectively monitor hand washing hygiene in order to trim the infections related with improper hand washing techniques. This study will go a long way in ensuring that compliance in regards to hand hygiene is improved in the medical industry.
Maria Malliarou, P. S. (2013). The Importance of Nurses Hand Hygiene. International Journal of Caring Sciences, 327-331.
Nurses represent an extremely large working group that performs a lot of direct patient care in health services. Hand hygiene has been described by many authors as one of the effective steps that are used in the prevention of hospital acquired information. The nurses are often aware of the rationale that exists for the hand hygiene procedures. However, the compliance rate amongst many hospitals is still low, and there is a need to ensure that this rate is increased in order to offer better services to the relevant patients. The authors in their research concluded that infectious diseases are particularly a risk to the old and children as well as people that have a compromised immune system (Malliarou, 2013). The authors argue that the washing of hands by the nurses in the proper way not only prevents them from getting sick, it also reduces dramatically the risk of infecting patients by transporting the pathogens from one patient to the other. The authors argue that must more training as well as education to the relevant quarters in order to improve general hand washing in the industry.
Khaled M. Abd Elaziz, I. M. (2010). Assessment of knowledge, attitude and practice of hand washing among health care workers in Ain Shams University hospitals in Cairo. Assessment of knowledge, Attitude Journal, 45-67.
The authors of this article prescribe to the school of thought that most of the nosocomial infections are transmitted through the hands of different health workers. They, therefore, assessed the knowledge, attitude as well as the general practice of hand washing among health care workers in Ain-Shams University hospitals. The authors used a cross sectional descriptive as well as an observational study. From the results, the doctors showed a higher compliance of around 37.5% as compared to other groups. However, it is of the essence to note that only 11.6% had done the hand washing procedure correctly (Khaled, 2010). This showed that indeed there was an inborn need for education in the hospital in order to increase the compliance rates as well as show the health workers the proper procedure on how one should wash hands. The compliance to hand washing is extremely low and the implementation of multifaceted behavior and hygiene program with monitoring and performance feedback is the only way in which hand washing and general hand hygiene can be increased in the health care industry. The authors stress that there is a need to have a strong institutional support in order to improve the compliance of the hand hygiene guidelines that are set up. Without proper monitoring, cross-infection will still be a problem and, therefore, the implementation of these recommendations by the authors will go a long way in ensuring that the cross infections in the hospitals and clinics are prevented (Khaled, 2010).
Ummu Yildiz Findik, M. ¸. (2011). Evaluation of Handwashing Behaviors and Analysis of Hand Flora of Intensive Care Unit Nurses. Asian Nursing Research, 99-106.
The authors in the study aimed at evaluating the hand hygiene behaviors of I.C.U nurses and the evaluations are based on the nurse's personal statements. The research goes ahead and identifies the micro-organisms that were represented in the hand flora pre shift as well as post shift. From the study, around 65% of the nurses preferred the use of alcohol based antiseptic solutions whereas 95% used paper towels for their hands. From the research, the authors show that the pathogen Escherichia Coli, as well as the negative staphylococcus, were found in higher levels amongst the post shift nurses as compared to the pre shift nurses (Findik, 2011). This in essence shows that the hand washing techniques of the post shift nurses was poor and was not up to par, and consequently, it contributed to the incidence of pathogens. The hand washing rate of different nurses in intensive care has been found to have low studies in intensive care, and it has been established to have low studies in conducted in turkey. The authors of the publication concluded that number of colonies in the micro-organisms in the hand flora of the post shift increased. The hand cleaning behaviors of the nurses should be improved especially in the intensive care nurses as they nurse the critical patients.
Idang N. Ojong, M. I. (2014). The practice of hand washing for the prevention of nosocomial infections among nurses in general hospital Ikot Ekpene, Akwa Ibom State, Nigeria. Archives of Applied Science Research, 97-101.
Many researchers have identified hospital acquired infections as presenting a critical problem which affects patient care. In fact, factors such as lack of adequate knowledge, long nails, the wearing of rings are some of the things that the writers identify as presenting problems during hand washing. The study examines the practice of hand washing amongst several nurses in the General hospital of Ikot Ekpene in Nigeria. The research is comprehensive as it examines all the nurses that rendered care directly to the patients in the medical surgery maternity as well as an intensive care unit. Out of the sample, 84% of the nurses had good knowledge of hand washing whereas around 17.6 had very poor knowledge regarding how to properly wash their hands after directly attending to a patient. The observations showed that the practice of hand washing stood at 43% while the noncompliance stood at 35 for those that practiced it occasionally and 24 for those that never practiced hand hygiene (Ojong, 2014). The study concluded that the nurses indeed had good knowledge regarding hand washing, but they did not practice it. The authors argue that must the hospital management to increase the hand washing facilities. After increasing the hand washing facilities, there is also a need to create an educational program such as a seminar/workshop which will help in the improvement of hand washing practice.
The search strategy used in the finding of the publications to be peer reviewed was methodological. I started with the known databases where I keyed in the topic and started perusing the articles in order to get the relevant article that completely covered my scope of the study. I had to filter the secondary publications as I required publications that had primary data. This process was not easy to execute as I had to move from one medical database to another while at the same time avoiding sites that were not verified and which did not provide in depth credible and reliable data. However, with patience I was able to go through five famous and credible databases where I was able to locate the relevant articles that I have done a review of the literature on. The keywords that I used to search for the publications included nursing, hand washing, compliance and sample. This ensured that the articles that came up in the search engine were mostly to do with hand washing of nurses and other medical practitioners. The key word sample ensured that most of the articles that I searched for were primary articles as compared to secondary articles. Eventually, this system bore fruits, and I was able to identify ten reliable and current publications that I used to carry out a literature review. If I were to carry the research again, I would involve in the keywords the year 2010, 2011,2008 and 2014. This would bring recent articles; I had a hard time as I need recent articles that were five years old, and the databases kept on bringing relevant articles that were older than five years. This, therefore is one of the aspects of my search strategy that I would change if I were given a chance.
Summary of Literature
Every author accepted and acknowledged the fact that hospital acquired infections are number one cause that are affect patient care in the 21st century. Further, they all agreed that there is a need to tackle this issue in order to ensure that cross-infections are reduced dramatically. However, despite sharing the same school of thought there were discrepancies that existed in terms of the education that the nurses had in relation to hand washing techniques. AD, (2012), Ummu Yildiz Findik, (2011), Idang N. Ojong, ( 2014) in their studies argued that the nurses that they had interviewed and observed had low education. This was in contrast to the rest of the authors that reported high education levels in terms of hand hygiene. This can be effectively explained in terms of development; the areas that had low knowledge are developing countries as compared to the areas that had high education that are developed countries. The compliance rate stood at approximately 40 to 45 percent in all the studies, and this shows consistency in the studies despite the geographical location. There were several places such as Nigeria and China in the studies by Idang N. Ojong, ( 2014) and Han K, ( 2011) respectively that complained of the lack of enough equipment to wash hands. The lack of sanitizers and lack of relevant equipment were blamed on the higher rate of infection that was experienced in the two areas. The authors argued that the introduction of the relevant equipment would greatly enhance the nurse's compliance.
Jeannie P. Cimiotti, (2012) presented a diverse view arguing that indeed the burnout and understaffing contributed to decreased compliance to handwashing as the nurses were extremely busy in their dealings. They were taking care of the patients and they at times forgot about the requirements that are required in regards to hand hygiene and ended up contributing immensely to the seven million infections that are gotten in the hospital. There was consensus in regards to the need for more training as well as monitoring in order to increase hand hygiene compliance amongst nurses. The training would help in ensuring that the nurses had enough information regarding the basic procedures that are used and are required when washing hands. This training was important as it would ensure that the nurses and other medical professionals understood clearly the need for washing their hands and the effects of not doing the same. Monitoring would also substantially increase the compliance rate as nurses, and other medical professional would feel the pressure of being monitored.
There is a need to increase training and monitoring activities in hospitals in regards to hand washing, The training would be important as it would ensure that the nurses understand the basic fabric of hand washing and learn the steps that are required to gain the different hand hygiene techniques (Salmon, 2011). The monitoring activities in the hospitals will increase the compliance rate as many nurses, and another medical staff will feel that there is a need and pressure to wash their hands. This eventually will be important in ensuring that the compliance rate of the medical staff increases and reduce infections. The areas that do not have an equipment should be well equipped in order to increase the compliance rate. The compliance rate amongst areas that have equipment is often extremely high as compared to areas that have scarcity of material. Therefore, the provision of equipment will go a well in ensuring that there is compliance amongst medical staff.
There is still a need to look at the effects of overworking as this area has not yet been explored. Overworked medical staff are often known to be careless in terms of their behavior and therefore; there is a need to further research into this sphere in bid to determine exactly the validity of this phenomenon. This gap has not yet been explored and therefore an increase in research in this area will show whether overworking and understaffing has a profound effect on hand washing compliance. As a leader in the nursing industry, I would strive on education and inform my nurses on the importance of hand hygiene. This would well in ensuring that the nurses understood completely the risks that come with not observing proper hand hygiene.
AD, A. (2012). Hand hygiene among nurses in Turkey: opinions and practices. US National Library of Medicine National Institutes of Health , 431-417.(Revised publication)
Ahmed Mahfouza, M. N. (2013). Hand hygiene non-compliance among intensive care unit health care workers in Aseer Central Hospital, south-western Saudi Arabia. International Journal of Infectious Diseases , 729-732.
Han K, D. F. (2011). [Compliance on hand-hygiene among healthcare providers working at secondary and tertiary general hospitals in Chengdu]. US National Library of Medicine National Institutes of Health , 1139-1142.
Idang N. Ojong, M. I. (2014). The practice of hand washing for the prevention of nosocomial infections among nurses in general hospital Ikot Ekpene, Akwa Ibom State, Nigeria. Archives of Applied Science Research , 97-101.
Jeannie P. Cimiotti, L. H. (2012). Nurse stafﬁng, burnout, and health careeassociated infection . American Journal of Infection Control , 486-490.
Khaled M. Abd Elaziz, I. M. (2010). Assessment of knowledge, attitude and practice of hand washing among health care workers in Ain Shams University hospitals in Cairo. Assessment of knowledge, Attitude Journal , 45-67. (Revised Publication)
Mahmoud Al-Hussami, M. D. (2011). Predictors of compliance handwashing practice among health care professionals . Healthcare Infection , 79-84.
Maria Malliarou, P. S. (2013). The Importance of Nurses Hand Hygiene . International Journal of Caring Sciences , 327-331.
Sharon Salmon, X. B. (2011). A novel approach to improve hand hygiene compliance of student nurses. Antimicrobial Resistance and Infection Control , 2-16.
Ummu Yildiz Findik, M. ¸. (2011). Evaluation of Handwashing Behaviors and Analysis of Hand Flora of Intensive Care Unit Nurses. Asian Nursing Research , 99-106.
Public health is very essential for every government. This is because it determines the well-being of a nation’s citizens and it improves the productivity of the country. The United States began constructing its public health sector in the 1850’s. The move towards achieving a common public health system was boosted by the discovery of a link between filth and diseases in the mid 19th century. In 1920, European countries discovered the germ theory and this was a major breakthrough in the invention of public hospitals. However, the use of hospitals was limited to a certain class of wealthy people who could pay for the hospital charges. This left out some people in the community who were poor. The wealthy citizens could even afford home care, while the poor citizens received little access to healthcare services.
This essay aims at creating a health care hall of fame museum proposal. The museum proposal considers the key icons in the American history who led to discovery and development of the healthcare sector. Further, the main goal of this essay is to explain the key fundamental changes that led to development of a more efficient healthcare system in the United States.
Vaccine Preventable Diseases
The germ theory explained the cause of infectious diseases, which were disastrous at the time because of few health care services. The practical applications of the germ theory became applicable and integrated in the American healthcare system in the 20th century (Boychuck, 2008). This led to development of disease preventable measures such as sanitation and hygiene measures. The United States government initiated an immunization policy. The policy provided the American citizens with vaccines against vaccine-preventable diseases such as tetanus and diphtheria.
In 1964, the United States government commissioned a surgeon to investigate the effects of tobacco in the human body. Evidence-based policies were implemented using the federal, state and public health systems. The newly implemented policies have reduced tobacco smoking significantly. For instance, there was a 14.5% decrease in the use of tobacco from 1997 to 2003 (Boychuk, 2008).
The Medicare and Medicaid Programs
This has led to implementation of various healthcare policies that were meant to improve the access to healthcare services by American citizens. The economical conditions experienced by the country have limited the financial incentives to the health sector in order to avoid causing an economic burden. The implementation of the Medicaid and medicare program by President Lyndon B. Johnson was meant to improve the access to healthcare services for the low-income earners. The two programs were initiated under the social security act, which was signed in July, 30, 1965. Medicaid and Medicare programs are different programs that are managed by the U.S Department of Health.
Medicaid is a health and medical services program that offers a variety of hospital services that differ depending on state health regulatory laws. Some of the health services provided by the Medicaid program include children vaccines, prenatal care, and inpatient and outpatient services. Different states have different regulatory laws that govern the funds allocated to the Medicaid program. The Medicaid program is offered for the low-income earners or people with little resources. Membership to the program is monitored and regulated by the Centre for Medicaid services (Shi & Singh, 2012).
On the other hand, Medicare is a government instituted health insurance program that caters for the elderly and disabled American citizens. The program has two main parts; the hospital insurance and the supplementary medical insurance. The hospital insurance helps patients pay for their hospital stay bills such as testing, meals and hospital supplies. The supplementary Medicaid insurance helps patients pay for necessary physician visits, home-health care costs and outpatient hospital visits (Shi & Singh, 2012).
Affordable Care Act
The Medicare and Medicaid programs have achieved significant changes in the healthcare sector. However, there was still need for a better and more efficient public health program for the middle and low-income earners in the United States. This led to the implementation of the Affordable Care Act (ACA) on March, 23/2010 (Shi & Singh, 2012). The law passed by President Obama was intended to lower the cost of healthcare by insuring all American citizens. The Affordable Care Act considers Affordable Health care for America Act, Patient Protection Act, Student Aid & Fiscal Responsibility and Health Care and Education Reconciliation Act. The Affordable Care Act provides American citizens with affordable quality health insurance. Further, it reduces the growth of healthcare spending by insurance companies by issuing them with certain rights and protections such as tax breaks and government funding.
The Affordable Care Act is privately owned under the supervision of the government. The government ensures that the health insurance companies offer coverage to low-income households and small business owners (Shi & Singh, 2012). The law has improved the efficiency of health insurance companies as they can now offer health insurance with low premiums to low-income households with government incentives. This has increased the number of American citizens eligible for insurance covers. Further, it has reduced the chances of discrimination in the health insurance process. Citizens who are enrolled in a health insurance cover are expected to pay a minimum essential coverage fee, and those who cannot afford the minimum fee receive cost assistance by the government.
After the implementation of the Affordable Care Act, the number of insured citizens has increased significantly. Consequently, health insurance is now affordable for many American citizens, although not all. Moreover, the act reduces the huge loss of government revenue that was initially used to fund the public healthcare sector. Thus, the new act will help improve the country’s economic situation.
Boychuk, G. W. (2008). National Health Insurance in the United States and Canada: Race, Territory, and the Roots of Difference. Washington: Georgetown University Press.
Shi, L., & Singh, D. A. (2012). Delivering health care in America: A systems approach. Sudbury, Mass: Jones & Bartlett Learning.
Haddad, S., Baris, E., & Narayana, D. (2008). Safeguarding the health sector in times of macroeconomic instability: Policy lessons for low- and middle-income countries. Trenton, N.J: Africa World Press.
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