Review of Current Healthcare Issues

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Week 1 Discussion: Main Post

Dr. Donnelli and Classmates,

An ongoing national healthcare issue and stressor is the burnout and shortage of nurses. The burnout of nurses has been an issue even since the start of my career as a nurse. I have experienced the impact in the psychiatric inpatient setting. A study by Bekelepi and Martin (2022) in Cape Town, South Africa states that one in five patients in the psychiatric inpatient unit will have an incidence of violence. The exposure to high incidences of violence in the workplace is stressful for nurses who are trying to care for patients. It causes physical and psychological trauma which eventually leads to burnout. Social norms and community context may contribute to this issue because it has been said that the violence is just part of the job. This perspective does not help the fight for a safer workplace. This burnout in turn contributes to the shortage of nurses. As stated by Speroni (2024), nurses during the Covid-19 pandemic listed psychosocial support as a key factor in staying with their employer. When nurses are not provided adequate support, they seek employment elsewhere. I have experienced this personally, as well as seen it many times with coworkers. My workplace has addressed this issue by routinely sending surveys to staff in order to keep open communication and address the staff’s concerns. According to an article by Li et al. (2024), Congress passed legislation allocating $100 million of funding toward the promotion of mental health, fostering resilience, and reducing the stigma among healthcare professionals. This legislation along with changes in the workplace are needed to address the ongoing burnout and shortage of nurses in healthcare.

References

Bekelepi, N., & Martin, P. (2022). Experience of violence, coping and support for nurses working in acute psychiatric wards. South African Journal of Psychiatry, 28(0), e1–e7. https://doi.org/10.4102/sajpsychiatry.v28i0.1700

Li, L.Z., Yang, P., and Singer, S. (2024). Nurse burnout and patient safety, satisfaction, and quality of care: A Systematic review and meta-analysis. JAMA Network Open, 7(11). Retrieved from https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2825639′

Speroni, K. (2024). Overview and Summary: Today’s Nursing Shortage: Workforce Considerations. Online Journal of Issues in Nursing, 29(2). https://doi.org/10.3912/ojin.vol29no02manos

Main Post 

Healthcare issue: The High Cost of Healthcare 

For many decades, one of the greatest obstacles facing the US healthcare system has been the exorbitant expense of medical care. It is a major national problem that impacts the economy, families, and individuals (Steinreich, 2022).

Social determinants of health 

The high cost of healthcare has led to significant problems in terms of socioeconomic determinants. Social variables like socioeconomic level, education, insurance coverage, cultural views, and accessibility to medical services are contributing factors to the rising expense of healthcare (KFF, 2025). People in rural areas with little to no access to healthcare facilities, as well as individuals from lower-income families, frequently struggle to get the healthcare they need, which causes delays in treatment and, eventually, higher expenses. The high costs and high percentage of underinsured or uninsured individuals put many people at risk of becoming bankrupt in the event of a catastrophic illness, according to Harvard professor Dr. Shmerling, MD. He also emphasized that the United States does poorly on several key health measures, including life expectancy, preventable hospital admissions, suicide, and maternal mortality, while spending significantly more on healthcare than other high-income nations. In other words, the US healthcare system is not the greatest, despite its high cost. In addition, Americans are dissatisfied with the current state of the healthcare system despite all that investment (Shmerling, 2021).

How your health system work setting has responded to the healthcare issue 

The Division of Public Health in Delaware offers services to uninsured adults and children, as well as those on Medicaid, at minimal or no cost, contingent upon income. We offer cost-effective immunizations for children and treatments for infectious disease control, including tuberculosis for immigrants or anyone at risk of exposure, as well as sexual and reproductive health services. For individuals who lack access to healthcare due to prohibitive costs and limited availability of healthcare facilities, we offer a community mobile unit that operates from Monday to Saturday, providing services such as blood pressure and cholesterol monitoring, HIV and other sexually transmitted disease testing, lead screening, and immunizations.

 Conclusion, 

Debates on how to address the high cost of healthcare issues such as insurance reform, government-provided health coverage, drug price regulation, and the sustainability of the healthcare system have been ongoing for decades. Although the Affordable Care Act was introduced, it has had little to no effect on these issues. To guarantee that everyone has access to competent and reasonably priced healthcare without experiencing financial hardship, these issues necessitate comprehensive policy adjustments.

Telesford, I. Links to an external site.WingerLinks to an external site., A. & Rae, M. (2024). Beyond cost, what barriers do health care consumers  

face? (Peterson-KFF) https://www.healthsystemtracker.org/chart-collection/beyond-cost-what-barriers-toLinks to an external site.. (February 24, 2025). 

Steinreich, D. (2022). Big Med: Megaproviders and the High Cost of Health Care in 

America. Quarterly Journal of Austrian Economics, 25(2), 501–528. 

https://doi.org/10.35297/qjae.010135 

Shmerling, R. (2021). Is our healthcare system broken? Harvard Health publishing  

https://www.health.harvard.edu/blog/is-our-healthcare-system-broken-202107132542Links to an external site.  (February 24, 2025). 

Healthcare issue/stressor

The US is in such a dire healthcare worker shortage that subgroups of healthcare that deal with non-physical symptoms suffer in greater capacity. Less than one-third of the U.S. population (28%) lives in an area where there are enough mental health professionals available to meet the needs of the community; sadly, most states have fewer than 40% of the mental health professionals, such as psychiatrists and nurses, needed (Modi et al., 2022). The percentage of need met ranges from a shocking low of 5% in the District of Columbia to an insufficient high of 69% in New Jersey (Modi et al., 2022).

This great disparity in mental healthcare leads to a strain on psychiatric in-patient units due to persistent readmissions. Specifically in the hospital I work at in a metropolitan city in New Jersey, I care for adult patients with poor insight into their mental illness that causes them to be repeatedly readmitted for adequate care across their lifetime. We often see readmissions due to not receiving or having access to quality out-patient mental health services in the local community. This constant strain puts an immense amount of pressure on the scarce psychiatric facilities and the limited resources available to them; not only the strain on resources, but psychiatric readmission also reduces the patients’ quality of life and increases the years of life lost in care (Owusu et ai., 2022). While the number of aspiring psychiatrists matched to a medical residency program has grown over the past five years, it takes well over a decade to effectively educate and train psychiatrists; mental health professionals who can be trained more quickly than psychiatrists (such as psychologists, or nurse practitioners) play a vital role in expanding access to mental health care (Modi et al., 2022).

Social determinants

Largely at play for these lack of resources are two social determinants: economic stability and healthcare access/quality. Communities highly impacted by these determinants are often densely populated urban communities or sparsely populated rural communities. People often are driven to live in these places due to financial need, and often their overall well-being and health is something too costly to consider. When children grow up in socioeconomic disadvantage, they are up to 3 times more likely to experience mental health issues than their non-disadvantaged peers, with elevated risk associated with long duration exposure in addition to severity of exposure (Kirkbride et al., 2024). Financial stress among other socioeconomic disadvantages had more consistent effects on risk for common mental disorders than income and employment (Kirkbride et al., 2024). These financial strains not only affect children in their adolescence, but also prenatally. When families don’t have adequate financial resources, they are much less likely to have basic needs met, which can increase the risk of some psychiatric disorders, like schizophrenia, later in life (Kirkbride et al., 2024).

The second social determinant, healthcare access and quality, is the determinant I most consistently see in my unit of work. As discussed in the beginning, having access to adequate out-patient mental healthcare is a direct correlation to readmissions in our unit. Often patients will cite their inability to access ongoing care, and this lack of resources affects our ability to create an adequate discharge plan. In a qualitative study that looked at different strategies to reduce readmissions in psychiatric units, the study revealed that having discharge plans with quality care were vital in successful transitions from in-patient to out-patient care (Owusu et ai., 2022). The support services offered were not necessarily methods of care that are outside the scope of an inpatient unit, but did extend their abilities much further into the patient’s care. These support services often looked like follow-up calls, discharge services, bridge visits, and psychoeducation (Owusu et ai., 2022).

Addressing the issue

Much of the strain we see in inpatient care is in the lack of care continuity in outpatient care. Specifically, preventative and early intervention care is essential to providing quality and comprehensive mental health care throughout a person’s lifespan. A clearer understanding of the factors surrounding readmission can assist in improving the management of patients in inpatient care units and establishing measures of early intervention to reduce readmission (Owusu et ai., 2022). Traditionally, mental health illnesses have been isolated in their diagnosis and treatment from physically presenting illnesses and different healthcare disciplines work their scope of practice hindering collaboration (Modi et al., 2022). This is fostered through a combination of factors such as regulatory requirements, and a deficit of integrated technology and training (Modi et al., 2022). I believe that to address this issue with longevity, the health care system needs to create a new model of care that integrates mental health care into primary health. This new model of care can ensure that a person receives lifelong comprehensive and quality mental health care from prenatal care to geriatric care.

References

Kirkbride JB, Anglin DM, Colman I, Dykxhoorn J, Jones PB, Patalay P, Pitman A, Soneson E, Steare T, Wright T, Griffiths SL. (2024). The social determinants of mental health and disorder: evidence, prevention and recommendations. World Psychiatry. 2024. https://pmc.ncbi.nlm.nih.gov/articles/PMC10786006/Links to an external site.

Modi H, Orgera K, Grover A. (2024). Exploring Barriers to Mental Health Care in the U.S. Washington, DC: AAMC;. https://doi.org/10.15766/rai_a3ewcf9pLinks to an external site.

Owusu E, Oluwasina F, Nkire N, Lawal MA, Agyapong VIO. (2022). Readmission of Patients to Acute Psychiatric Hospitals: Influential Factors and Interventions to Reduce Psychiatric Readmission Rates. Healthcare (Basel). https://pmc.ncbi.nlm.nih.gov/articles/PMC9498532/Links to an external site.

Main Post:

The United States has been battling Nursing Staff Shortage for many decades. Being in the healthcare field for almost 10 years, I believe that it has gotten worse each year after the pandemic.  This healthcare issue has significant implications for the quality, accessibility, and cost of healthcare services. The nursing shortage impacts not only inpatient services but outpatient as well. According to the World Health Organization (WHO) report, it was estimated that there will be a shortage of 7.2 million health workers to deliver healthcare services worldwide, and by 2035, the demand of nursing will reach 12.9 million.

The impact of nursing staff shortage in a work setting is nurses’ experiencing burnout. Burnout syndrome has been characterized by emotional exhaustion, depersonalization, and a diminished sense of personal accomplishment and is typically observed to be the result of chronic workplace stress (Li et al,2024). Nurses can also experience significant physical, emotional, and mental stress due to the nature of their work. Nurses work long shifts with high patient to nurse ratios and physical demands that can contribute to burnout. I currently work in an outpatient service and the staff is overworked with the influx of patients. With the inadequate supply of nurses has notably created many negative impacts on the patient’s health-related outcome as well as challenges to fight diseases and improving health, which causes increased workload and stress levels on nurses and later results in decreasing the quality of nursing care (Tamata and Mohammed, 2022).

Social determinants that affect the nursing staff shortage is income and financial stability, often nurses are underpaid in comparison to the level of responsibility they bear. Another social determinant is lack of cultural competence and support in a healthcare environment can lead to discrimination or unequal treatment of nurses from diverse backgrounds. Work- life balance has become big in healthcare. Nurses, especially women may face pressure to balance professional demands with family responsibilities. The lack of flexible working hours, paid family leave, and affordable childcare can discourage nurses. Multiple national medical professional associations recommend social risk screening and documentation in healthcare settings because of the compelling evidence that social risks are associated with poorer adherence to treatment plans, worse health outcomes, and increased costs of care (Tiase et al, 2022).

The healthcare system that I work for has implemented mental health days and recruitment programs. I work in Outpatient so there is some flexibility for nurses that are mothers and have children to work 5×8 hour days or 4–10-hour days. The manager is very big on work life balance and takes the extra step by gifting us with treat, food, and celebratory parties to show her appreciation for our hard work.

Broome, M., & Marshall, E. S. (2021). Transformational leadership in nursing: From expert clinician to influential leader (3rd ed.). New York, NY: Springer. https://bookshelf.vitalsource.com/books/9780826135056Links to an external site.

Li, L. Z., Yang, P., Singer, S.J., Mathur, M. B., & Shanafelt, T. (2024). Nurse Burnout and Patient Safety, Satisfaction, and Quality of Care: A Systemic Review and Meta-Analysis. JAMA network open, 7 (11), e2443059. https://doi.org/10.1001/jamanetworkopen.2024.43059

Tiase, V., Crookston, C. D., Schoenbaum, A., & Valu, M. (2022). Nurses’ role in addressing social determinants of health. Nursing, 52(4), 32–37. https://doi.org/10.1097/01.nurse.0000823284.16666.96Links to an external site.

Tamata, A. T., & Mohammadnezhad, M. (2022). A systematic review study on the factors affecting the shortage of nursing workforce in the hospitals. Nursing Open, 10(3), 1247–1257. https://doi.org/10.1002/nop2.1434Links to an external site.

Main Post: Healthcare Issue/stressor

National healthcare issue/stressor

There are many issues and stressors that impact healthcare, one is the lack of adequate healthcare providers. The healthcare industry is facing a shortage of multiple disciplines, impacting the number of patients receiving treatment. By the year 2033 there is an expected shortage of 124,000 physicians, and hospitals are having to replace 200,000 nurses each year to keep up with care demands (American Hospital Association, 2021).  The population is increasing due to people living longer, however the number of providers to render treatment is diminishing. The population expectancy is 2 billion people by the year 2050 with most of the population having at least one chronic health condition (Amalberti et al., 2019). The number of healthcare providers needs to increase to meet the demands of the growing population.

Impact on work setting

The shortage of healthcare providers impacts on the work environment by not allowing patients to receive adequate treatment for illnesses. Patients are forced to go without treatment or receive less than treatment because there are not enough providers to render care. Patients are having to wait long periods of time to visit with providers and are having the least informed healthcare works decide on whether the patient should see a physician (Slonim, 2023). The number of patients a healthcare worker is having to care for is increasing, adding stress to providers and decreasing the quality-of-care patients are receiving. Healthcare providers are having to render treatment as tasks, such as needing to give medications and drawing labs, rather than being able to listen to patients, spend time with them, while still performing tasks. Physicians often spend very little time with patients due to their workload, leaving patients feeling unheard and uncared for (Slonim, 2023).

Social determinant affected  

Healthcare and quality are the social determinants that are affected by the lack of health care providers. People already do not seek healthcare treatment for many reasons, one being the lack proximity to provider, some people do not seek specialized screenings because the provider who do the screens are not nearby (Healthy People 2030, 2018). If people are currently finding it difficult to find providers in close proximity with a even greater shortage of providers expected, then the number of people not choosing to seek treatment could increase. This leaves people at a disadvantage and an increased risk for many illnesses.

Responded to the healthcare issue/stressor

The changes I have witnessed in healthcare facilities are hiring providers that are from outside of the country to help with the staffing shortages. For example, one facility I worked with employed nurses that were from the Philippines and Africa, to help with nursing shortages. This phenomenon is not new and help physicians and nurses alike from other countries receive an expedited Visa authorization process in order to have these healthcare workers help with staff shortages (American Hospital Association, 2021).  While it may not be a new concept it seems that with healthcare provider shortages more facilities are using this method to help with increasing staff needs.

References

Amalberti, R., Vincent, C., Nicklin, W., & Braithwaite, J. (2019). Coping with more people with more illness. Part 1: The nature of the challenge and the implications for safety and quality. International Journal for Quality in Health Care, 31(2), 154–158. https://doi.org/10.1093/intqhc/mzy235Links to an external site.

American Hospital Association. (2021). Fact Sheet: Strengthening the Health Care Workforce | AHA. Www.aha.org; American Hospital Association. https://www.aha.org/fact-sheets/2021-05-26-fact-sheet-strengthening-health-care-workforceLinks to an external site.

Healthy People 2030. (2018). Health Care Access and Quality – Healthy People 2030 | health.gov. Health.gov. https://odphp.health.gov/healthypeople/objectives-and-data/browse-objectives/health-care-access-and-qualityLinks to an external site.

Slonim, Anthony (2023). Top Challenges Facing Healthcare: Back to Basics. Physician Leadership Journal, 10(2), 12-14. https://www.proquest.com/scholarly-journals/top-challenges-facing-healthcare-back-basics/docview/2788462727/se-2Links to an external site.

Discussion 1 initial post:

Healthcare Issue 

The rise in healthcare costs makes it very difficult for anyone to afford basic medical care. The gaps in health insurance coverage along with high deductibles leave people without insurance or underinsured. I work in a rural healthcare setting that resides in an underserved community. Most individuals that seek healthcare don’t do so until they’re very sick due to them having no insurance or not being able to afford the cost of what their health insurance doesn’t cover. Many of the individuals we see have to be transferred to other facilities for further care or evaluation, which costs them even more in healthcare bills. 40% of U.S. adults have delayed or refused medical care because of the cost (NHCC, 2024).  

Social Determinants Affected 

Geographic location, income, and social support are the main social determinants that affect this health issue and influence how individuals determine their health outcomes. Unfortunately, individuals with poor social determinants are at an increased risk of experiencing chronic health problems, leading to increased hospital or clinic visits, and increased costs (McCarthy et al., 2022). Addressing the above social determinants can improve patient outcomes.  

Working to Solve the Issue 

To address this issue, our facility has focused on what we can do to prevent chronic illnesses, such as early and preventative screening. Depending on the patient and their situation, these screenings can be free of charge. Providing preventive care services at low to no cost has shown to improve vaccination rates, increase screening for chronic conditions and cancers, and improve the overall health for individuals (CMS, 2024).  

References 

CMS. (2024). Background: The affordable care act’s new rules on Preventive Care. CMS.gov. https://www.cms.gov/cciio/resources/fact-sheets-and-faqs/preventive-care-backgroundLinks to an external site. 

McCarthy, M. L., Li, Y., Elmi, A., Wilder, M. E., Zheng, Z., & Zeger, S. L. (2022, September). Social Determinants of health influence future health care costs in the Medicaid cohort of the District of Columbia study. The Milbank quarterly. https://pmc.ncbi.nlm.nih.gov/articles/PMC9576227/#:~:text=economically%20stressed%20neighborhood.-,5,and%20beyond%20past%20comorbidity%20burdensLinks to an external site.. 

NHCC (2024, May 3). Identifying challenges facing the U.S. Healthcare System . NHCC. https://healthcarecouncil.com/identifying-challenges-facing-the-u-s-healthcare-system/#:~:text=According%20to%20the%20Kaiser%20Family%20Foundation%2C%20half,seeing%20costs%20increase%2C%20primarily%20brought%20about%20byLinks to an external site.: 

Healthcare issue

Access to healthcare is a significant national challenge, as many individuals encounter obstacles that prevent them from obtaining the care they need. These obstacles can include financial difficulties, lack of insurance, and limited healthcare options, especially in rural or underserved regions (Franco et al., 2021). In healthcare settings, this issue often results in delayed treatments, increased emergency room visits, and pressure on healthcare resources. Patients may also experience heightened stress, which negatively impacts their health and recovery.

Social Determinants

Key social determinants that influence this issue are income, education, geographic location, and social support, all of which affect a person’s ability to access and navigate healthcare services (Pratt et al., 2023). These factors play a strong role in a person’s ability to access and navigate healthcare services, making it crucial to address them for better patient outcomes. Overall, addressing these factors is essential for improving health outcomes.

Addressing the issue

To address the issue of access to healthcare, my health system has made several changes. One of the main changes is the expansion of telehealth services, which allows patients, especially those in rural areas, to see healthcare providers remotely, reducing the need for travel. The system has also introduced sliding-scale payment options for patients with financial difficulties, making healthcare more affordable for those with lower incomes. Additionally, the health system works with community organizations to provide education and resources, such as health fairs and workshops, to help patients understand affordable healthcare options and how to enroll in insurance (Maganty et al.,2023). These changes have improved access to care, reduced emergency room visits, and helped more people receive timely treatment, especially those who might have otherwise gone without. By focusing on factors like income, education, and location, these efforts aim to improve health outcomes for all patients.

Sources

Franco, C. M., Lima, J. G., & Giovanella, L. (2021). Primary healthcare in rural areas: access, organization, and health workforce in an integrative literature review. Atenção primária à saúde em áreas rurais: acesso, organização e força de trabalho em saúde em revisão integrativa de literatura. Cadernos de saude publica, 37(7), e00310520. https://doi.org/10.1590/0102-311X00310520Links to an external site.

Maganty, A., Byrnes, M. E., Hamm, M., Wasilko, R., Sabik, L. M., Davies, B. J., & Jacobs, B. L. (2023). Barriers to rural health care from the provider perspective. Rural and remote health, 23(2), 7769. https://doi.org/10.22605/RRH7769

Pratt, C., Taylor, R., & Smith, S. D. (2023). Health Equity and Access to Health Care as a Social Determinant of Health: The Role of the Primary Care Provider. Primary care, 50(4), 549–559. https://doi.org/10.1016/j.pop.2023.04.006

MAIN POST. 

Mental Health – A National Health Issue.  

One of the most pressing issues facing healthcare today is mental health disorders that has swept across multiple demographic groups in the country. Ongoing concerns like the COVID –19 pandemic, economic instability and social isolation have worsened mental health issues leading to a heightened demand for mental health services (Reform of the national institute of mental health, 2025). The surge has highlighted the existing gaps in mental health provision, accessibility as well as stigma, making it a critical situation that calls for immediate attention. 

The impact on work setting. 

The rising demand for mental health services has placed a significant burden on healthcare systems, impacting healthcare operation costs, provider workload and patient outcomes (James, 2020). The limited resources in rural and underserved areas, including shortages of qualified mental health professionals and high patient loads has led to an increase in the complexity of the healthcare issue resulting in delayed care, overcrowding in the E.D., unmet needs for many individuals suffering from mental health conditions. As a bedside nurse working in the hospital, I have seen first-hand how discharges are delayed because of limited psychiatrists and how work sometimes gets more stressful, which leads to staff burnout and healthcare outcomes for the patients. 

Social Determinants Affecting Mental Health. 

Research by Satcher and Shim (2024) supports the fact that several social determinants of health (SDOH) play a significant role in mental health outcomes, the most important ones being economic stability, access to healthcare, lower levels of education and support networks. Economic stability can lead to increased stress, anxiety, and depression yet limited access to mental health services further worsens the condition (Fisher et al., 2023).  

Trinity Health’s Response to the Mental Health crisis. 

In response to the rising mental health crisis, Trinity Health has applied a comprehensive strategy that has taken steps to improve their mental health services and some of the changes include hiring more mental health specialists like psychologists, social workers and psychiatrists, it has initiated programs to integrate mental health screenings within primary care settings, has increased its community outreach efforts, has increased support for healthcare workers and has expanded their Telehealth services, all in an effort to improve access, reduce stigma and to foster community wellness. By addressing the root causes, they are contributing to improved mental health outcomes in their patient population. 

References.  

Fisher, M., Newton, C., & Sainsbury, E. (2023). Mental health social work observed (national institute social services library) (1st ed.). Routledge.  

James, J. M. (2020). Mental health & mental illness. Joan M. James. 

Reform of the national institute of mental health: A proposal. (2025). Journal of Neurology and Neurocritical Care, 8(1). https://doi.org/10.31038/jnnc.2025811Links to an external site. 

Satcher, D., & Shim, R. S. (2024). Chapter 11. a call to action: Addressing the social determinants of mental health. In The social determinants of mental health (pp. 235–254). American Psychiatric Association Publishing. https://doi.org/10.1176/appi.books.9781615378470.lg11Links to an external site. 

National Health Care Issue:

Working in the pediatric and pediatric intensive care units, I noticed a gap in care regarding pediatric mental health. This is one of the reasons I decided to become a psychiatric mental health nurse practitioner. In a 2018 national health survey of over 1,400 practices that care for children, 85% said they found it challenging to obtain mental health services for children in their practice.  (Chien et al., 2022) 15% of children in America have a behavioral, mental, or developmental disorder that the MBDD diagnoses. There is a national shortage of mental health providers. These shortages affect children in rural areas and living in poverty at higher rates. (CDC, 2024) Inadequate treatment for children with mental health disorders can negatively impact their ability to learn and develop healthy relationships with others.  (Factors Associated with Not Receiving Mental Health Services among Children with a Mental Disorder in Early Childhood in the United States, 2021–2022, 2024)

Impact On Pediatric Units

The lack of mental health support leads to longer lengths of stay, increased complications during treatment, and higher risks for readmission. These children often experience higher rates of anxiety, feelings of distress, and inability to cooperate with medical staff. (Why Children Are Stranded in the Hospital, 2023) In my hospital, I have had children as young as seven attempt suicide. Taking care of children after a suicide attempt is challenging, and these patients often experience complex family dynamics. Taking care of these patients can put intense emotional distress on practitioners. (Wei et al., 2020) My hospital does not provide psychiatric treatment for children. In some cases, children are stuck at our hospital for days to weeks while we find placement. Younger children and children with severe cases are some of the most difficult to place. I feel defeated at times seeing children struggle in an unfamiliar environment without adequate treatment.

Implementations

One way we overcome the challenges of treating children with mental health disorders is by relying on our child life specialists. Child life specialists can reduce fear and anxiety and teach positive coping mechanisms. (Mayo Clinic College of Medicine & Science, 2016) When we have children with behavioral problems, we can provide therapeutic play and reward them with prizes for good behavior. Child life specialists work with nurses and support staff to provide education on how to create a positive and nurturing environment for children with mental health disorders. We are taught to acknowledge and validate children’s feelings and develop routines to make a more comfortable environment where children know what to expect from staff.

Factors Associated With Not Receiving Mental Health Services Among Children With A Mental Disorder in Early Childhood in the United States, 2021–2022. (2024). https://www.cdc.gov/pcd/issues/2024/24_0126.htm

‌Chien, A. T., Leyenaar, J., Tomaino, M., Woloshin, S., Leininger, L., Barnett, E. R., McLaren, J. L., & Meara, E. (2022). Difficulty Obtaining Behavioral Health Services for Children: A National Survey of Multiphysician Practices. The Annals of Family Medicine, 20(1), 42–50. https://doi.org/10.1370/afm.2759

‌CDC. (2024). Child Mental Health: Rural Policy Brief. Rural Health. https://www.cdc.gov/rural-health/php/policy-briefs/child-mental-health-policy-brief.htmlLinks to an external site.

Why Children Are Stranded in the Hospital. (2023, May 9). Penn LDI. https://ldi.upenn.edu/our-work/research-updates/why-children-are-stranded-in-the-hospital-and-how-to-get-them-out/Links to an external site.

Wei, H., Kifner, H., Dawes, M. E., Wei, T. L., & Boyd, J. M. (2020). Self-care Strategies to Combat Burnout Among Pediatric Critical Care Nurses and Physicians. Critical Care Nurse, 40(2), 44–53. https://doi.org/10.4037/ccn2020621

‌Mayo Clinic College of Medicine & Science. (2016). Child Life Specialist. Mayo.edu. https://college.mayo.edu/academics/explore-health-care-careers/careers-a-z/child-life-specialist/

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                             Nursing and Clinician Shortage: A National Healthcare Issue  

Nursing is a highly demanding and stressful profession. Many nurses are experiencing burnout, fatigue, and dissatisfaction with their working conditions at the bedside. According to a study by Petterson et al. (2015), cited in Broome and Marshall (2020), by the year 2035, there is expected to be a shortage of 33,000 primary care physicians. Additionally, it is estimated that 20% of nurses leave their jobs within the first year of employment.  

Impact on the Work Setting 

Due to nursing shortages, hospitalized patients are at an increased risk of unsafe events, such as falls, reduced quality of care, poor health outcomes, and decreased patient satisfaction ratings (Quaranta, 2024). According to Lasater et al. (2021, cited in Quaranta, 2024), “The lack of nurses in hospital settings increases errors, morbidity, and mortality, and decreases patient satisfaction.” As healthcare evolves and patient demographics change, with patients living longer, there is a strong push to enhance the quality of care. Hospital reimbursement models are increasingly focusing on quality of care rather than volume of services. Furthermore, there is a growing demand for patient care outside of hospital settings, leading to a shift towards more home care and telemedicine. However, the shortage of nurses and clinicians can negatively impact the quality of care delivered through these alternatives as well. 

Social Determinants Affecting Shortage 

Some argue that the COVID-19 pandemic significantly contributed to the trend of nurses leaving the profession, while I contend that COVID may have merely been the last straw. Nurses are facing burnout, fatigue, and dissatisfaction with their working conditions at the bedside. Sixty percent of the 3.2 million nurses in the United States are employed in hospital settings (Quaranta, 2024). In 2021, over 100,000 nurses exited the profession (Auerbach et al., 2022, as cited in Quaranta, 2024). According to Quaranta (2024), nurses leave bedside positions due to unfavorable working conditions, including unsafe patient ratios, low pay, long shifts, and poor management.  

Furthermore, financial concerns contribute to the shortages of nursing staff. Hospitals spend substantial amounts of money on hiring, training, paying salaries, covering insurance, and providing benefits such as retirement plans. These expenses may hinder hospitals from hiring additional nurses. Hospital CEOs, policymakers, and legislators may not fully grasp the importance of adequate nurse staffing for ensuring the safety of both patients and nurses, improving patient outcomes, and reducing nurse burnout. Additionally, the personal experiences of those in positions of power can significantly influence these decisions, making them less empathetic to the actual needs of nurses and patients. 

Healthcare System Response  

There is a growing population of aging individuals with health problems. In brief, people are living longer due to advancements in medicine and technology. According to Amalberti et al. (2019), “By the 2050s, over 50% of the global population will be living with a chronic illness.” 

In response to the shortage of clinicians, some states are granting Advanced Practice Registered Nurses (APRNs) greater autonomy and flexibility. While this may help alleviate the shortage of clinicians, it does not address the ongoing shortage of nurses or the trend of nurses leaving the bedside profession. Many states in the United States do not have mandated nurse-to-patient ratios. There are currently bills pending that aim to address nursing ratios, but they have not made progress or received approval. 

Conclusion  

The nursing and clinician shortage remains a pressing national healthcare issue with far-reaching consequences for patient care and safety. The challenges faced by nurses, including burnout, inadequate working conditions, and insufficient staffing ratios, contribute to high turnover rates and diminished quality of care. As the healthcare landscape evolves, it is crucial to address these underlying issues to cultivate a sustainable workforce. While initiatives to enhance the autonomy of Advanced Practice Registered Nurses (APRNs) may provide some relief, a comprehensive strategy that also focuses on improving the workplace environment for all nurses is necessary. This includes advocating for mandated nurse-to-patient ratios, addressing financial constraints for hospitals, and fostering supportive management practices. By prioritizing these changes, we can ensure a healthier future for both healthcare professionals and the patients they serve. 

References  

Amalberti, R., Vincent, C., Nicklin, W., Braithwaite, J. (2019).  Coping with more people with more illness part 1: The nature of the challenge and the implications for safety and quality. International Journal for Quality in Health Care, vol 31 (2), pages 154–158. https://doi.org/10.1093/intqhc/mzy235Links to an external site. 

Broome, M., & Marshall, E. (2020). Transformational Leadership in Nursing (3rd ed.). Springer Publishing LLC. https://mbsdirect.vitalsource.com/books/9780826135056Links to an external site. 

Quaranta, N. (2024). Team nursing: An innovative approach to address the nursing shortage. MEDSURG Nursing, 33(2), 79–84. https://doi.org/10.62116/MSJ.2024.33.2.79Links to an external site. 

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National Healthcare Issue

One of the most pressing national healthcare issues today is the accessibility of mental health services. Despite the growing awareness of the importance of mental health, many individuals still face significant barriers to obtaining the care that they need. These barriers can include a lack of available providers, financial constraints, stigma surrounding mental health issues, and limited insurance coverage for mental health services(Coombs et al.,2021). Moreover, the COVID-19 pandemic has only exacerbated these challenges, leading to increased demand for mental health care while simultaneously straining the resources available(American Psychiatric Association,n.d) Review of Current Healthcare Issues.

Impact on My Work Setting

I currently work in a community health hospital serving a diverse population; the issue of mental health access profoundly impacts our healthcare delivery operations and the overall health outcomes of our patients. Many of our patients face socioeconomic challenges, such as low income and lack of transportation, which can hinder their ability to seek timely mental health care(WHO,n.d). Furthermore, the stigma associated with mental illness can prevent individuals from reaching out for help, leading to worsening conditions that strain healthcare organizations’ emergency services and other healthcare services, healthcare resources (Corrigan,2004).

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Social Determinants  of Health Affecting Mental Health Access

The social determinants of health (SDOH) that most significantly affect mental health access include economic stability, social and community context, and access to healthcare. Moreover, lower-income individuals may lack insurance coverage or the financial means to afford out-of-pocket costs. At the same time, those in marginalized communities may experience a lack of culturally competent care or face discrimination, further encouraging them to seek help (Kirkbride et al.,2024).

Response from My Healthcare Organization

In response to the mental health access issue,  my healthcare organization has implemented several strategic changes to improve mental health service delivery and reduce barriers to care. For example, my organization has expanded its mental service team by hiring additional licensed counselors, social workers, and mental health providers to reduce appointment wait times. Furthermore, my organization has initiated a telehealth program, allowing patients to access mental health services from the comfort of their homes, which is particularly beneficial for individuals facing transportation issues (Bashshur et al.,2016).

Additionally, my healthcare organization has partnered with local organizations to provide outreach and education programs about mental health services available in our community. This includes workshops to reduce mental health stigma and increase awareness of mental health issues; overall, my organization has witnessed positive engagement from members of the community (Ahad et al.,2023). My organization also provides sliding scale fees based on income, ensuring that our services are accessible to individuals who may not be able to afford the services they need.

In conclusion, addressing the issue of mental health access requires a multifaceted approach that considers the various social determinants of health affecting our patients. My healthcare organization’s proactive measures are a step in the right direction. Moreover, ongoing collaboration and innovation will ensure that all individuals in our community and beyond receive the mental health support they need.

References

Ahad, A. A., Sanchez-Gonzalez, M., & Junquera, P. (2023). Understanding and addressing mental health stigma across cultures for improving psychiatric care: A narrative review. Cureus. https://doi.org/10.7759/cureus.39549

American Psychological Association. (n.d.). Monitor on psychology. https://www.apa.org/monitor/2021/01/trends-national-crisis

Bashshur, R. L., Shannon, G. W., Bashshur, N., & Yellowlees, P. M. (2016). The empirical evidence for telemedicine interventions in mental disorders. Telemedicine and E-Health, 22(2), 87–113. https://doi.org/10.1089/tmj.2015.0206

Coombs, N. C., Meriwether, W. E., Caringi, J., & Newcomer, S. R. (2021). Barriers to healthcare access among U.S. adults with mental health challenges: A population-based study. SSM – Population Health, 15, 100847. https://doi.org/10.1016/j.ssmph.2021.100847

Corrigan, P. (2004). How stigma interferes with mental health care. American Psychologist, 59(7), 614–625. https://doi.org/10.1037/0003-066x.59.7.614

Kirkbride, J. B., Anglin, D. M., Colman, I., Dykxhoorn, J., Jones, P. B., Patalay, P., Pitman, A., Soneson, E., Steare, T., Wright, T., & Griffiths, S. L. (2024). The social determinants of mental health and disorder: Evidence, prevention and recommendations. World Psychiatry, 23(1), 58–90. https://doi.org/10.1002/wps.21160

World Health Organization. (n.d.-d). Social Determinants of Mental Health. World Health Organization. https://www.who.int/publications/i/item/9789241506809

The national healthcare issue I chose for this discussion is the shortage of nurses in healthcare. There are many factors to consider when discussing the nursing shortage. Burnout, pandemic challenges, unhealthy working environments, pay rate variances, staffing constraints, management issues, nurses retiring, nurses leaving the profession early, and not enough nursing educators all contribute to the current nursing shortage (Speroni, 2024).

Nurse executives suggest the following to combat the nursing shortage: listening to nurses’ concerns, prioritizing workplace culture, adjusting protocols, increasing diversity and representation in nursing, addressing the need for nurse educators, and supporting nurses leading healthcare innovation (Jean, 2023).

I no longer work in bedside nursing, but my background is in the emergency department and the nursing shortage affects the emergency department. Short staffed emergency departments can lead to longer wait times, overcrowded waiting rooms, patient dissatisfaction, medication errors, poor patient outcomes, nurse burnout, and hostility from patients or coworkers.

Nurses play a huge part in addressing health and social inequities by promoting quality healthcare for all (Tiase et al., 2022). So, social determinants of health are affected with the shortage of nurses. Longer wait times can prevent access to care. The quality of care decreases with the shortage, which can lead to poor outcomes among patients, especially vulnerable patients.

In my experience, I have seen very little done to fix the nursing shortage. The facility I used to work for did offer sign on bonuses and recently created a shared governance. At times, they would offer incentive pay if staffing was critical, but that rarely happened. The manager would be open to suggestions on improvement, but the environment stayed the same.

References

Jean, J. (2023, November 10). Proven strategies from nurse execs to combat the nursing shortage in 2022. NurseJournal. https://nursejournal.org/articles/proven-strategies-to-survive-the-nursing-shortage-2022/

Speroni, K. (2024). Overview and Summary: Today’s Nursing Shortage: Workforce Considerations. Online Journal of Issues in Nursing, 29(2). https://doi.org/10.3912/ojin.vol29no02manosLinks to an external site.

Tiase, V., Crookston, C. D., Schoenbaum, A., & Valu, M. (2022). Nurses’ role in addressing social determinants of health. Nursing, 52(4), 32–37. https://doi.org/10.1097/01.nurse.0000823284.16666.96

Module 1: Main Post

Culturally Competent Care in Home Health Care

Culturally competent care is essential in-home health care, where patients come from diverse backgrounds. It ensures respectful and effective care, improving communication and patient trust (Shepherd et al., 2019). Without cultural competence, misunderstandings can occur, leading to poor health outcomes.

Impact on Home Health Care

Home health providers work with patients from different cultures, languages, and beliefs. If caregivers lack cultural awareness, patients may struggle to follow treatment plans. For example, a Muslim patient may need dietary accommodations, while a Spanish-speaking patient may require a translator (Purnell & Fenkl, 2019). Often, our nurses encounter multiple challenges when patients struggle to follow doctors’ orders after hospitalization. This issue is most evident in patients for whom English is a second language or those with low literacy skills.

Key Social Factors Affecting Culturally Competent Care

• Language barriers: Patients with limited English may misunderstand instructions.
• Economic status: Low-income patients may have trouble accessing culturally appropriate care.
• Education and health literacy: Different cultural beliefs affect how patients understand health conditions.
• Bias and discrimination: Implicit bias can lead to unequal treatment.

How Home Health Care Agencies Are Responding

To address these challenges, home health organizations are:

1. Providing Cultural Competency Training: Staff receive education on cultural awareness and communication.
2. Offering Language Support: Agencies use bilingual staff, interpreters, and translation apps.
3. Tailoring Care to Patient Needs: Care plans respect cultural and religious preferences.
4. Updating Policies: Agencies follow national standards for culturally appropriate care.

For example, some agencies such as my workplace match Spanish-speaking patients with bilingual caregivers or adjust meal plans to fit religious diets.

Conclusion

Culturally competent care is vital for quality home health care. Addressing language barriers, training staff, and respecting cultural preferences improve patient outcomes and satisfaction.

References

Broome, M., & Marshall, E. S. (2021). Transformational leadership in nursing: From expert clinician to influential leader (3rd ed.). Springer.

Purnell, L. D., & Fenkl, E. A. (2019). Transcultural diversity and health care. In L. D. Purnell & E. A. Fenkl (Eds.), Handbook for culturally competent care(pp. 1–15).

Springer. https://doi.org/10.1007/978-3-030-21946-8_1

Shepherd, S. M., Willis-Esqueda, C., Newton, D., Sivasubramaniam, D., Paradies, Y., & Dunn, K. (2019). The challenge of cultural competence in the workplace: Perspectives

of healthcare providers. BMC Health Services Research, 19(1), 135. https://doi.org/10.1186/s12913-019-3959-7

National Healthcare Issue: Heart Disease

Cardiovascular disease is a significant national health concern that continues to impact millions of people across the United States. Cardiovascular diseases (CVD), being the leading cause of death, account for about one in four deaths each year (Tsao et al., 2022). The occurrence of conditions such as coronary artery disease, heart failure, and arrhythmias imposes a significant strain on the healthcare system. However, the impact of heart disease extends beyond the healthcare system. It affects society’s social and economic structure, leading to decreased productivity due to illness and increased healthcare costs. Heart disease burdens healthcare providers, facilities, and resources, from initial diagnosis and prevention to efficient management and prolonged care.

Impact on the Work Setting

Heart disease significantly impacts daily operations in healthcare settings, particularly in telemetry departments. Telemetry units, which monitor patients with acute cardiac conditions, are experiencing increased patient volumes due to the rising rates of cardiovascular disease. The continuous monitoring of patients’ vital signs, such as heart rate and rhythm, blood pressure, and oxygen levels, is essential in managing those with heart disease. Nonetheless, as the need for this type of care rises, telemetry units encounter difficulties sustaining adequate staffing and handling a patient surge. This may result in extended wait times for admission, a higher patient-to-nurse ratio, and increased pressure on healthcare professionals to deliver prompt interventions. Furthermore, managing patients with multiple comorbidities common in individuals with heart disease adds complexity to their care, requiring multidisciplinary teams to collaborate effectively (Batchelor et al., 2023).

Social Determinants Affecting Heart Disease

Several social determinants of health (SDOH) significantly influence the onset and advancement of heart disease. Socioeconomic status (SES) is one of the most significant factors, as individuals with lower SES are more likely to experience poor cardiovascular health due to limited access to healthcare, lower-quality diets, and increased stress levels (Yong et al., 2023). Additionally, individuals residing in low-income areas may lack access to healthcare facilities or preventive care, leading to delayed diagnoses and inadequate management of heart conditions. Access to healthcare is another key determinant, as individuals without insurance or with insufficient coverage may not have regular check-ups or timely interventions, leading to a deterioration of their health (Kris-Etherton et al., 2020). Health habits also impact heart disease, with poor lifestyle choices such as smoking, physical inactivity, and an unhealthy diet contributing significantly to cardiovascular risks. Environments that limit access to healthy foods or safe spaces for exercise exacerbate these factors, increasing the overall burden of heart disease, especially in disadvantaged communities.

Healthcare System Response and Changes Implemented

Healthcare systems have made several adjustments in response to the growing burden of heart disease. One significant change has been integrating advanced monitoring technologies in care settings. These technologies, such as continuous ECG monitors and remote patient monitoring systems, allow for real-time monitoring of patients, enabling healthcare providers to identify early signs of deterioration, such as arrhythmias before they become life-threatening. This proactive approach has improved patient outcomes by enabling timely interventions (Kuan et al., 2022).

Expanding telehealth services is another response to the increased demand for heart disease management. Telehealth allows healthcare providers to monitor patients remotely, which has been particularly beneficial for individuals with chronic heart conditions who may not require hospitalization but still need frequent monitoring. By utilizing telehealth platforms, healthcare systems can extend care beyond the hospital setting, offering greater patient convenience and reducing the burden on in-person resources (Kuan et al., 2022).

Additionally, healthcare systems have emphasized the importance of multidisciplinary care teams in managing heart disease. In these teams, cardiologists, nurses, dietitians, physical therapists, and pharmacists collaborate to provide comprehensive care that addresses the multiple aspects of heart disease management, from medication adherence to lifestyle modifications and rehabilitation. This approach has been particularly effective in improving long-term outcomes for patients with heart disease, as it ensures holistic care and fosters patient education and empowerment. The effectiveness of these teams in providing comprehensive care reassures patients and their families that they are receiving the best possible treatment, enhancing their confidence in the healthcare system (Batchelor et al., 2023).

In response to socioeconomic barriers to heart disease management, many healthcare organizations have worked to improve access to care through programs such as community health initiatives, mobile clinics, and expanded insurance coverage. These initiatives aim to bridge gaps in healthcare access, ensuring that individuals from underserved communities can receive timely interventions and preventive care. In addition, hospitals have implemented patient education programs to raise awareness about heart disease prevention, focusing on healthy lifestyle choices such as improved diet, regular exercise, and smoking cessation. These programs provide valuable information and empower individuals to take control of their health, fostering a sense of responsibility and encouraging proactive health behaviors. These programs also empower individuals to make informed decisions and take an active role in their well-being by equipping them with the knowledge and tools to manage their health (Kris-Etherton et al., 2020).

Heart disease remains a significant healthcare issue in the United States, with far-reaching consequences for individuals, healthcare providers, and systems. The increasing demand for care has highlighted the need for advanced technologies, expanded access to care, and interdisciplinary treatment approaches. While social determinants such as socioeconomic status and access to healthcare significantly affect the prevalence and outcomes of heart disease, healthcare systems have implemented strategies aimed at improving care and reducing disparities. These efforts are essential in addressing the ongoing challenges of heart disease and improving the quality of life for individuals affected by this condition (Tsao et al., 2022).

References

Batchelor, W. B., Anwaruddin, S., Wang, D. D., Perpetua, E. M., Krishnaswami, A., Velagapudi, P., Wyman, J. F., Fullerton, D., Keegan, P., Phillips, A., Ross, L., Maini, B., Bernacki, G., Panjrath, G. S., Lee, J., Geske, J. B., Welt, F., Thakker, P. D., Deswal, A., … Holmes, D. (2023). The multidisciplinary heart team in cardiovascular medicine: Current role and future challenges. JACC: Advances, 2(1). https://doi.org/10.1016/j.jacadv.2022.100160Links to an external site.

Kris-Etherton, P. M., Petersen, K. S., Velarde, G., Barnard, N. D., Miller, M., Ros, E., O’Keefe, J. H., Williams, K., Sr, Horn, L. V., Na, M., Shay, C., Douglass, P., Katz, D. L., & Freeman, A. M. (2020). Barriers, opportunities, and challenges in addressing disparities in diet-related cardiovascular disease in the United States. Journal of the American Heart Association, 9(7), e014433. https://doi.org/10.1161/JAHA.119.014433Links to an external site.

Kuan, P. X., Chan, W. K., Fern Ying, D. K., Rahman, M. A. A., Peariasamy, K. M., Lai, N. M., Mills, N. L., & Anand, A. (2022). Efficacy of telemedicine for the management of cardiovascular disease: A systematic review and meta-analysis. The Lancet Digital Health, 4(9), e676–e691. https://doi.org/10.1016/S2589-7500(22)00124-8Links to an external site.

Tsao, C. W., Aday, A. W., Almarzooq, Z. I., Alonso, A., Beaton, A. Z., Bittencourt, M. S., Boehme, A. K., Buxton, A. E., Carson, A. P., Commodore-Mensah, Y., Elkind, M. S. V., Evenson, K. R., Eze-Nliam, C., Ferguson, J. F., Generoso, G., Ho, J. E., Kalani, R., Khan, S. S., Kissela, B. M., … Martin, S. S. (2022). Heart disease and stroke statistics-2022 update: A report from the American Heart Association. Circulation, 145(8), e153–e639. https://doi.org/10.1161/CIR.0000000000001052Links to an external site.

Yong, C., Palaniappan, L., Ibebuogu, U., Tran, A., Bacong, A. M., Lundberg, G., & Watson, K. (2023). Assessing and addressing social determinants of cardiovascular health: JACC state-of-the-art review. Journal of the American College of Cardiology, 81(14), 1368–1385. https://doi.org/10.1016/j.jacc.2023.01.042Links to an external site.

The Impact of Vascular Access Disparities on Dialysis Care

One of the biggest challenges in healthcare today, especially for patients with kidney disease, is vascular access for dialysis. For patients who require hemodialysis, their access type can make a significant difference in their overall health. Ideally, an arteriovenous fistula (AVF) or graft (AVG) should be placed before starting dialysis, but many patients, particularly those from underserved communities, begin treatment with a central venous catheter (CVC) instead. Unfortunately, catheters come with serious risks, including a higher chance of infection, blood clots, and hospitalizations (Allon et al., 2018).

Social Determinants of Health and Vascular Access

It’s easy to assume that vascular access issues are just a medical problem, but in reality, social determinants of health (SDOH) play a major role. Many patients don’t receive early kidney care because of financial barriers, transportation issues, or a lack of awareness about their condition. Research shows that individuals from lower-income backgrounds are significantly more likely to start dialysis with a catheter rather than a fistula or graft, which increases their risk for complications (Pisoni et al., 2018). Additionally, education is a key factor—patients who don’t fully understand their condition and the importance of vascular access may not seek care in time, leading to last-minute catheter placements Review of Current Healthcare Issues.

How does this issue affect my work?

As a Clinical Educator RN, I see the consequences of vascular access disparities every day. When a patient starts dialysis with a catheter instead of a fistula or graft, it often leads to frequent hospitalizations due to infections or clotting. I’ve worked with patients who return to the clinic multiple times with bloodstream infections, requiring antibiotics, hospital stays, and sometimes even surgical interventions. This not only impacts patient quality of life but also strains healthcare resources, increasing costs and workload for providers (Ravani et al., 2013).

How is my organization addressing the issue?

Recognizing the serious impact of vascular access complications, my organization has taken several steps to improve outcomes:

• Early Patient Education: We’ve expanded pre-dialysis education efforts, ensuring that patients and families understand why AVF placement is important.
• Vascular Access Coordinators: Specialists now work closely with nephrologists and surgeons to schedule access procedures before dialysis starts.
• Telehealth and Mobile Clinics: To address transportation barriers, we’ve increased telehealth options and set up mobile clinics for patients who struggle to reach appointments (Crews & Novick., 2018).
• Community Partnerships: We collaborate with local health programs to identify at-risk patients early and connect them to the right care before they reach kidney failure.

These efforts have already made a difference—more patients are receiving timely AVF placements, and fewer are starting dialysis with a catheter. However, there’s still work to be done. Reducing health disparities requires continued advocacy, policy changes, and additional resources to ensure every patient has access to optimal vascular care.

Addressing social determinants of health isn’t just about improving clinical outcomes—it’s about improving lives. By tackling these barriers head-on, we can create a healthcare system that gives every patient the best chance for a healthier future.

References

Allon, M., Imrey, P. B., Cheung, A. K., Radeva, M., Alpers, C. E., Beck, G. J., Dember, L. M., Farber, A., Greene, T., Himmelfarb, J., Huber, T. S., Kaufman, J. S., Kusek, J. W., Roy-Chaudhury, P., Robbin, M. L., Vazquez, M. A., Feldman, H. I., & Hemodialysis Fistula Maturation (HFM) Study Group (2018). Relationships Between Clinical Processes and Arteriovenous Fistula Cannulation and Maturation: A Multicenter Prospective Cohort Study. American journal of kidney diseases: the official journal of the National Kidney Foundation, 71(5), 677–689. https://doi.org/10.1053/j.ajkd.2017.10.027Links to an external site.

Crews, D. C., & Novick, T. K. (2019). Social Determinants of CKD Hotspots. Seminars in nephrology, 39(3), 256–262. https://doi.org/10.1016/j.semnephrol.2019.02.003Links to an external site.

Pisoni, R. L., Zepel, L., Fluck, R., Lok, C. E., Kawanishi, H., Süleymanlar, G., Wasse, H., Tentori, F., Zee, J., Li, Y., Schaubel, D., Burke, S., & Robinson, B. (2018). International Differences in the Location and Use of Arteriovenous Accesses Created for Hemodialysis: Results from the Dialysis Outcomes and Practice Patterns Study (DOPPS). American journal of kidney diseases: the official journal of the National Kidney Foundation, 71(4), 469–478. https://doi.org/10.1053/j.ajkd.2017.09.012Links to an external site.

Ravani, P., Palmer, S. C., Oliver, M. J., Quinn, R. R., MacRae, J. M., Tai, D. J., Pannu, N. I., Thomas, C., Hemmelgarn, B. R., Craig, J. C., Manns, B., Tonelli, M., Strippoli, G. F., & James, M. T. (2013). Associations between hemodialysis access type and clinical outcomes: a systematic review. Journal of the American Society of Nephrology: JASN, 24(3), 465–473. https://doi.org/10.1681/ASN.2012070643Links to an external site. Review of Current Healthcare Issues