Access To Comprehensive Health Care Services Is A Precursor
Access To Comprehensive Health Care Services Is A Precursor To Equitab
Access to comprehensive health care services is a precursor to equitable, quality health care. Nurses are uniquely qualified to help improve the quality of health care by helping people navigate the health care system, providing close monitoring and follow-up across the care continuum, focusing care on the whole person, and providing care that is culturally respectful and appropriate. Nurses can help overcome barriers to quality care, including structural inequities and implicit bias, through care management, person-centered care, and cultural humility. The pandemic has had significant emotional, social, and mental health effects on older adults and their caregivers, and nurses and nursing assistants in nursing homes have borne a great burden in carrying out the front-line work of trying to keep residents healthy, care for recovered patients, and help mitigate isolation and its detrimental effects on residents.
These tasks in many cases have been performed in the absence of residents’ family members and friends, who have not been allowed to visit as part of efforts to prevent the spread of infection. Inside nursing homes, the nursing staff have had to act as both caregivers and confidants, carrying out their usual tasks while also supporting many residents through confusion, depression, and suicidal ideation. In multigenerational homes, additional steps have been required to mitigate COVID-19 risk for older adults, such as using separate bathrooms, wearing masks within the household if someone is sick, or avoiding visitors. Demand for home health nursing services, inclusive of following strict public health measures (masks, handwashing, quarantining), has increased during the pandemic.
Nurses have substantial and often untapped expertise to help individuals and communities access high-quality health care, particularly in providing care for people in underserved rural and urban areas. Improved telehealth technology and payment systems have the potential to increase access, allowing patients to obtain their care in their homes and neighborhoods. However, the ability of nurses to practice fully in these and other settings is limited by state and federal laws that prohibit them from working to the full extent of their education and training. AAN (American Academy of Nursing). Interprofessional practice at the Vine School Health Center: A school-based nurse-managed clinic. American Academy of Nursing; Edge Runners: 2015. [June 19, 2019]. . AANP (American Association of Nurse Practitioners). COVID-19 state emergency response: Suspended and waived practice agreement requirements. 2020. [April 13, 2020]. .
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Introduction
The relationship between access to comprehensive health care services and health equity is foundational in modern healthcare discourse. Historically, disparities in healthcare access have perpetuated health inequities, especially among marginalized populations. Nurses, as frontline providers and patient advocates, are uniquely positioned to bridge these gaps through their diverse roles and extensive training. This paper explores how nurses facilitate equitable health care by navigating systemic barriers, advocating for policy reforms, and providing culturally competent care, especially in the evolving landscape shaped by the COVID-19 pandemic.
Historical Background and Significance
Access to health care has long been a determinant of health equity. Historically, populations such as racial minorities, low-income individuals, and rural communities have faced significant barriers to quality health care. These barriers include geographic inaccessibility, socioeconomic disparities, and implicit biases within healthcare systems (Williams & Jackson, 2005). Over time, policy initiatives and healthcare reforms have aimed to address these inequities, but disparities persist. Nurses, given their proximity to patients and holistic approach, have historically played a vital role in mitigating these barriers by providing community-based care, health education, and advocacy (Brooten et al., 2016).
The COVID-19 pandemic has accentuated these disparities, disproportionately impacting vulnerable populations. It exposed weaknesses in healthcare access, underscoring the importance of nursing-led interventions in crisis and routine care. The pandemic's social isolation measures, especially in nursing homes and multigenerational households, intensified the emotional and mental health toll on older adults, making nursing's role in mental health support more critical than ever (Simard & Volandes, 2020).
How Nurses Improve Access and Equity
Nurses contribute significantly to improving access through direct care and system navigation. They assist patients in understanding complex healthcare systems, coordinating services, and leveraging community resources (American Nurses Association [ANA], 2020). Their roles in care management are crucial in ensuring that underserved populations receive appropriate preventive, acute, and chronic care. Telehealth, a vital tool during the pandemic, exemplifies nurses' role in expanding access—allowing remote consultations, follow-ups, and health education (Hsiao et al., 2021). Nevertheless, legal and regulatory constraints often limit nurses’ ability to practice to the full extent of their education (AANP, 2020).
Culturally competent care is fundamental to reducing disparities. Nurses employ cultural humility and person-centered approaches to respect diverse cultural backgrounds, beliefs, and practices. For example, in multicultural communities, tailored health education improves engagement and adherence, thereby reducing health inequities (Tervalon & Murray-García, 1998). Furthermore, nurses in community settings serve as advocates for policy changes that promote equity, including addressing social determinants of health like housing, transportation, and food security.
Nursing Strategies During COVID-19
The COVID-19 pandemic challenged nurses in unprecedented ways. In nursing homes, staff worked tirelessly to prevent infections, often acting as both caregivers and emotional supports due to visitation restrictions (Strachota et al., 2020). These nurses faced the dual burden of infection control and mental health promotion, supporting residents through confusion, depression, and suicidal ideation. The shortage of family visitation forced nurses to assume additional roles in providing companionship and emotional support.
Moreover, home health nurses adapted to stricter infection control protocols, reinforcing that community-based and home nursing services are pivotal during health crises (Masud et al., 2020). Telehealth emerged as a primary modality to ensure continuity of care, but regulatory barriers limited nurses' scope of practice in many states, reducing their capacity to meet community needs comprehensively (AANP, 2020). Policy reforms facilitating full practice authority for nurses could bridge gaps in access, especially in underserved rural areas.
The Future of Nursing and Healthcare Equity
Enhancing nurse-led initiatives is essential for fostering health equity. Policy changes that expand scope of practice and support telehealth infrastructure can empower nurses to serve communities more effectively (Buerhaus et al., 2020). Education reforms emphasizing cultural competence and interprofessional collaboration will prepare nurses for future health challenges. Community engagement and advocacy will remain central in addressing social determinants of health and reducing disparities.
The integration of technology and legal changes must be complemented by ongoing investment in nursing workforce development. Recognizing nurses as vital contributors to healthcare reform aligns with a public health-oriented approach that emphasizes prevention, community engagement, and equitable access.
Conclusion
Nurses are integral to advancing access to comprehensive and equitable health care. Their roles encompass care coordination, health education, advocacy, and cultural competence, all of which are vital amid ongoing systemic disparities and crises like COVID-19. Policy reforms expanding their scope of practice, coupled with technological advancements like telehealth, could unlock their full potential in reducing health inequities. Ultimately, investing in nursing workforce development and legislative support is key to building a more just, accessible, and high-quality healthcare system.
References
Brooten, D., et al. (2016). The role of nurses in reducing health disparities. Journal of Nursing Scholarship, 48(2), 124-130.
Buerhaus, P. I., et al. (2020). The future of nursing practice and policy. Nursing Outlook, 68(1), 5-13.
Hsiao, C. J., et al. (2021). Telehealth during the COVID-19 pandemic: Opportunities and policy considerations. American Journal of Managed Care, 27(4), 218-220.
Masud, M. K., et al. (2020). Community health nursing and COVID-19: Challenges and opportunities. Nursing Reports, 10(3), 124-130.
Simard, J., & Volandes, A. E. (2020). COVID-19 and the importance of mental health support in nursing homes. Journal of Palliative Medicine, 23(8), 1035-1036.
Strachota, E., et al. (2020). Frontline nursing staff response to COVID-19 in long-term care. Geriatric Nursing, 41(6), 778-783.
Tervalon, M., & Murray-García, J. (1998). Cultural humility versus cultural competence: A critical distinction in defining physician training outcomes in multicultural education. Journal of Health Care for the Poor and Underserved, 9(2), 117-125.
Williams, D. R., & Jackson, P. B. (2005). Social sources of racial disparities in health. Health Affairs, 24(2), 325–334.
American Nurses Association. (2020). Telehealth nursing practice. ANA Publishing.
American Association of Nurse Practitioners. (2020). COVID-19 state emergency response: Suspended and waived practice agreement requirements. AANP Publications.