Question

identify and describe the issues affecting standards of practice related to competency of medical care identified in the Lyckholm and Hackney article. Discuss the relevant points of the article, explain the relevance that standards of practice have (or will have) to you as a practitioner.

1. Ethics of Rural Health Care

Read "Ethics of Rural Health Care" by Lyckholm, Hackney, and Smith, from Critical Reviews in Oncology/Hematology (2001).

https://lopes.idm.oclc.org/login?url=http://dx.doi.org.lopes.idm.oclc.org/10.1016/S1040-8428(01)00139-1

Answer 1

Ethics in healthcare

Article summary

            It is stated in the article that about quarter of the population of the United States, live in areas considered rural. Delivery of health care in the rural areas can be challenging with peculiar problems such as limited access to health specialists (Lyckholm, Hackney, and Smith, 102). There is the Rural Cancer Outreach Program, which is an alliance between five rural hospitals and academic medical center. The presence of this program has made the appropriate narcotics for chronic pain to increase. This program has also doubled the number of breast conserving surgeries while accrual to clinic trials has similarly increased from zero to nine over the period of surgery. The other area that has been noted to having improved is adjuvant chemotherapy, which has also increased (Lyckholm, Hackney, and Smith, 102). The academic center and rural hospitals have therefore achieved a positive financial impact.

            The most prominent issues affecting standards of practice related to competency of medical care are ethical issues, which put focus on justice, especially privacy, access to healthcare, medical competency, confidentiality, and the blurring of professional and personal boundaries in small communities. Medical care and healthcare delivery has become more complex given the increasing number of intertwined ethical issues (Lyckholm, Hackney, and Smith, 98). The rural hospitals have started developing mechanisms aimed at providing help in challenging situations. In an effort to counter ethical dilemmas, the academic center has offered continued education for the staff and expertise, both for individuals and groups.

Justice issues

            The principle of justice proposes an equitable distribution of medical care resources. This implies that healthcare should be distributed based on people’s needs rather than their affordability. The challenges affecting this healthcare principle include financial and geographical barriers. This problem escalates when more independent community hospitals reach a point of closing their door because of lack of funds. Inequitable distribution of medical services makes elderly and poor people with no access to transportation receive minimal or no healthcare at all (Lyckholm, Hackney, and Smith, 122). The complexity and traffic of urban centers often intimidated those who live in the rural areas. Improved accessibility to oncology forms the major objective of rural cancer outreach. The other important goal of the program is to improve geographical and financial assistance to consultation and sub-specialty. Cancer outreach program aims at delivering healthcare close home to offer greater sense of security and comfort to patients who feel threatened by cancer diagnosis.

Competency of medical care

            A number of issues relating to competency of medical care prevail in the rural setup, particularly to the rural outreach oncology setting. Competency involves providing specialty care; many rural areas have no specialist and less primary care givers. It is believed that high volume produces high quality, but since rural hospitals have low volume, they will always produce low quality. The issues of competency in healthcare also concerns nurse practitioners, physician assistants, and other nursing personnel providing care that is beyond their expertise level, with little supervision, with the aim of meeting the heath care needs of rural population (Lyckholm, Hackney, and Smith, 88). This is likely to compromise expertise and the quality of healthcare in the rural hospitals. Communication and handling of patient information involves managing large volumes of information from a wide range of sites, which can prove to be extremely challenging. Elaborate systems should be put in place to ensure that the information is recorded and noted by the cancer center nurse practitioners and site nurses. Ongoing quality assessment has also been put in place to assure management of impeccable data, to avoid losing critical information.

Privacy and confidentiality

            The proximity in which healthcare workers and patients work and live in rural communities makes it possible for healthcare workers and physicians to know their patients socially and personally, thus creating significant challenges to ensuring respect for patient privacy and confidentiality. There have been several cases where patients have refused to be treated in the rural oncology clinics because of the fear of their privacy being jeopardized (Lyckholm, Hackney, and Smith, 97). In most instances, the waiting rooms for such clinics are crowded with relatives, friends, and neighbors of the patients. Given that this clinic is only for patients with oncologic or hematologic problems, it becomes possible for one to know the general diagnosis of another person. When diagnostic tests are done, they are often interpreted, and transcribed by relatives and acquaintances of the patients. In addition, chemotherapy is given to patients in one big room, and on one particular day, they are likely to find themselves sitting next to a distant cousin, the local florist, or a neighbor (Lyckholm, Hackney, and Smith, 64). In other instances, several nurses have at one time treated old friends, relatives, neighbors, and teachers. Some patients may be comfortable with such incidences but a large number of patients find this uncomfortable and embarrassing. Safeguarding confidentiality and privacy and confidentiality of patient information is important because it can potentially compromise physician’s integrity, patient care, or even legally endanger the physician.

            As a practitioner, the standards of practice are quite relevant in my area of practice because they define the ethical issues surrounding the job as well as the dos and don’ts that every health practitioner has to adhere to. This will ensure that the issues discussed above are implemented in the medical facilities.

Works Cited

            Lyckholm, Hackney, and Smith. Ethics of Rural Health Care Critical. Reviews in Oncology/Hematology (2001).