The Importance of Health Care Risk Management Essay Example

social workers and community members, who are conveniently willing to assist doctors, patients, any healthcare providers and families in case they encounter difficulties in ethical decisions. The ethics committees differ in operation and mission, but most of them have three common roles, namely policy development, education, and consultation on cases. Ethics committees get involved in formulation of policies on ethical matters that affect patient care. Such policies include guardianship, informed consent, hydration, and artificial nutrition. Through such educational forums as seminars, resource centers and conferences, health care ethics committees feed hospital staff with resources and information on ethical decision-making.

Consultation on cases entails discussion of a situation/case by the committee as requested by a patient, surrogate, guardian or even a member of staff. The case consultation may take two forms, prospective form, where the members of the committee participate actively in decision making on the case presented or retrospective review where the participants in a particular case-discussion ask for feedback on a challenging decision already made. Organizational ethics and clinical ethics form the fourth role played by the ethics committees in health institutions. Here, the committee is concerned with the ethical matters that broadly arise in an institution on a system-wide basis.

In order to have sound resolution of ethical problems, the case managers ought to possess unique and outstanding skills, including particular communication skills. It is important that a case manager possess tactful communication skill. This would be necessary in ensuring sensitivity in the communication with different patients, and so the other health workers can imitate. A communication manner that fails to pay attention to the patients' sensitive issues will result in poor comprehension and adherence,

dissatisfaction of the patient and low-quality care. Unlike the other practitioners, case managers have general perspectives, such that they stand to be consultants for both the fellow professionals and themselves. This calls for clarity and concision in their communication to avoid rivalries when asking others to engage in the process, requesting for their cooperation and in preparation of performance report on their concerted effort.

Thirdly, a case manager ought to confident in their communication. As an advocate for and negotiator in upholding patient's rights and best interests, and ensuring that clinical pathway plan outlined in the institution is adhered to, the case manager need to have comprehensive knowledge of hospital services involved, ethical dimensions of any given situation and community services available. He/she should therefore be able to justify their views and air their dissidence once required. Lastly, a case manager's communication ability should entail convincing power. This would be good in convincing fellow professionals to trust and accept their leadership.

The principles that govern the practice of discharging patients has not changed much over time (Department of Health, 2013), the process and pace of discharge planning has changed greatly. For simple discharges carried out at ward level, the process should be standardized throughout an entire hospital. The key to making this or any process work consistently in an organization is to adapt it to fit existing systems and processes; it is helpful to involve patients and their families in this process.

There is great complexity in discharge planning activity, especially in the context of new services offered outside hospital, like intermediate care, and having a population with older people, mostly having extremely complex care needs. To ensure

timely discharge and continuity in care provision, however, effective discharge planning is very important. Healthcare providers have also been able to utilize limited resources in a more effective manner and essential readmissions avoided.

Applicable case study concerns nurse-client relational boundaries. A client may develop a stronger feeling towards a nurse, or a nurse towards the client in the event of health care provision. This would be treated unethical since it is "unprofessional behavior to engage in sexually intimate behavior with a client" according to Code of Professional Conduct for Case Managers (Butts & Rich, 2013)

Cultural Competence

Cultural competence is the capacity of nurses to give quality and safe healthcare to patients of varying cultural backgrounds. It is defined by cultural sensitivity, cultural awareness, cultural knowledge, skill and dynamic process (Berger et al., 2014). According to Dudas (2012), cultural competence is an ethical requirement and that specialized therapeutic skills ought to be placed at the same level with cross-cultural skills. Today, most of the known organizations of health care are in need of culturally competent health care and for professionals who are culturally competent (Herman et al., 2010).

As stated before, the aim in case management is to meet the patients’ and family's health needs in health care institutions or units. This implies that, for case management to be realized, the nurses and other health professionals need to fit themselves into the 'shoes' of the patients to show compassion and meet their demands. People come from different regions, and so varying cultural settings that health professionals have to bag. In this way then, cultural competence becomes influencing factor in case management through five ways, which are the attributes of

cultural competence: cultural awareness, cultural sensitivity, cultural knowledge, cultural skill, and dynamic process.
Cultural awareness involves development of the nurse's consciousness of the varying norms, beliefs, and values of the patients. In provision of nursing care, nurses need to recognize the similarities and differences in cultures and value put resulting influence of culture on health. There has to be exploration on the personal and cultural biases, assumptions and/or stereotypes by health professionals as it could be, towards other cultures seen to be different. This therefore calls upon the nurses to first know their own cultures, so that they can easily/better understand the practices, values and beliefs of others patients) (Purnell, 2012).

Cultural sensitivity is the nurse's respect, comfort, and appreciation of client's cultural diversity. As cultural diversity stand to be inevitable, the culture of every person cannot be taken to be the same. Then, case management should entail recognition of this diversity in order to attain mutual learning for common progress. Additionally, the bigotry should be avoided in health care organizations (Dudas, 2012). To offer genuine and satisfactory care to patients, respect to differences in cultures is always necessary (Starr & Wallace, 2011).
Being the attainment of sound educational ground on several cultural groups by nurses, cultural knowledge calls for better and wider understanding of the different behaviors, beliefs and values of the clients. In order to identify appropriate nursing options and health care needs, (Matteliano & Street, 2012) suggests that nurses become familiar with the models, concepts, and theories relating to provision of services to culturally diverse groups.

Cultural skill allows nurses to carry out assessment on cultures, collect cultural data on the current health condition of a

client and correctly in-build related information into care planning and provision in a culturally sensitive manner (Smith, 2013). For case management to be of relevance then, effective communication, both verbal and non-verbal, and which can be understood by the other cultures is mandatory (Giger, 2014).

Dynamic process, as an influencing factor in case management, emphasizes that as nurses encounter clients of diverse cultures consistently and overtime, they become culturally competent (Purnell, 2012). Since culture is influenced by many different factors, it has a dynamic nature; and so, cultural competence is not a static situation. It is due to cultural differences that people express their concerns, sufferings and interpret their symptoms differently. According to Zander (2009), no nurse should be assumed to possess sufficient skills and knowledge to give services that are culturally consistent with each patient. Gradual development of cultural competence is possible continued efforts to provide healthcare according to each client's cultural context. To be culturally proficient healthcare, therefore, nurses can learn from diverse cultural groups.

Case Management

A culturally competent case manager can use several relevant ways to improve the case management practice, such as;

a) Advocacy- case managers are instrumental in facilitation of access to appropriate and necessary services when educating patient and support systems about resource availability within practice settings and the community. It is the role of the case managers to promote patient's self-determination, self-advocacy, and autonomy, have them informed, and facilitate shared decision-making (Truong, 2014). The case manager identifies the goals, strengths, needs of a client, and incorporates this information into the plan of care. Such disparities may be related to race, ethnicity, national origin, sex, sexual orientation, age, religion, and political beliefs,

physical, mental, or cognitive disability. The case manager therefore should advocate for the patient at the service-delivery, benefits-administration, and policy-making levels.

b) Patient and cultural assessment- here, the case manager is expected to complete a psychological and health assessment, while noting the linguistic and cultural needs of every individual.

c) Development of a case management plan which accommodates every individual's linguistic and cultural needs and preferences of service (Case Management Society of America, CMSA, 2016).

d) Advocate for cross-cultural leadership- in this form of leadership, the case manager will put efforts to understand the differences in cultures, and so be well versed with each individual's ability to fit into another culture. That will allow understanding, and compassion on patients.

References

1. Brusin J.H. (2012). How cultural competency can help reduce health disparities. Radiol Technol, volume 84, issue 2. Pp. 129-152
2. Butts, J. B., & Rich,K.L (2013). "Nursing Ethics: Across the Curriculum and into Practice." Jones & Bartlett Publishers
3. Purnell L. (2012). Transcultural health care: a culturally competent approach, 4th ed., FA Davis, Philadelphia.
4. Shen Z. (2014). Cultural competence models and cultural competence assessment instruments in nursing: literature review. J Transcult Nurs, Volume 26,pp. 308-321