Course Paper


Variouscontributions and roles the nurse holds in health care

Nursingin healthcare embraces independent and collective care of persons ofall ages, backgrounds, and communities. It entails the promotion ofhealth prevention of illnesses, care for the ill, disabled and dyingpeople. The American Nurses Association (ANA) defines nursing as theprotection, advancement, and optimization of well-being andcapabilities, prevention of illnesses and alleviation of sufferingthrough diagnosis and treatment of diseases (Kemppainen,Tossavainen &amp Turunen, 2013).The role of nurses in health care is broad, especially given theglobal health challenges.

Inthe United States, nurses are the most in number among all healthcare professionals. Nursing roles and their contributions are crucialcomponents of any health care organization that is governed by theobjective to improve the quality of care to their patients. Healthcare organizations with above-average staffing ratios perform betterin enhancing positive patient outcomes compared those withbelow-average staffing ratios.

Mostpeople get to recognize and value the functions and responsibilitiesof nurses only when they are under nursing care. This is because, forexample, when a patient undergoes surgery subsequent nursing caremay be needed for several weeks or months. Therefore, the success orfailure of any health interventions largely depends on nursing roles.Another case relates to patients under intensive care, and nurses arethe primary care providers charged with the mandate to monitor andreport any changes on the patient (Kemppainen,Tossavainen &amp Turunen, 2013).

Assuch, nurses are central to the promotion of healthcare in ways suchas administration of drugs, counseling patients, conducting physicalexaminations and conducting research aimed at improving practice andpatient outcomes. In health care settings, nurses advocate for theutilization of appropriate treatment protocols, safe medicationpolicies, management of symptoms and consultations with specialtyservices. Again, nurses contribute to health care through carecoordination. They ensure the safe passage of patients and organizingcare coordination to optimize timeliness, value, and efficiency tominimize injuries, inconvenience, and errors. Moreover, nursescontribute to health care through coaching roles and leadership(Kemppainen,Tossavainen &amp Turunen, 2013).As coaches, they help patients attain health goals and other needssuch as dietary exercise recommendations. As leaders, they leadhealth care initiatives centered on patients to bring the desiredchange.

Comparisonof select health care policies

TheUnited States is fundamentally a capitalist economy, where theprovision of goods and services involves money. This capitalist modelhas been followed by the health care sector. This implies thatpatients pay doctors directly for the services provided. The U.Shealth sector is characterized by rising numbers of health insuranceproviders, partly because most people cannot afford the newhigh-technology health services. These insurance providers pay partor the total cost of medical care in the event of an illness.Approximately 85 percent of the American population is underinsurance plans, and insurance providers foot most of the medicalbills. Essentially, the United States health insurance providers payabout 90 percent of all healthcare bills and 74 percent on doctors’remuneration (Dye,Reeder &amp Terry, 2013).

Besidesprivate health insurance providers, some individuals purchase theirinsurance, while employers through employment benefits provide some.The third player is the United States government that offers healthinsurance through Medicare and Medicaid. The Department of Health andHuman Services (HHS) stipulated a disparities action plan that iscomparable to the Affordable Care Act (ACA) efforts to minimizedisparities in healthcare (Dye,Reeder &amp Terry, 2013).The HHS action plan outlines a series of priorities, strategies,actions and objectives to achieve a disparities-free health careenvironment. On the contrary, the ACA efforts aim at increasing thecoverage options for populations with low and moderate incomes. ThisAct includes other provisions to reduce health disparities andengages local communities, private bodies, and health care providers.The gaps present in health care coverage, accessibility, andunhealthy lifestyles contribute to poor health outcomes among thepopulation. The high cost and poor health outcomes that characterizethe U.S health system result from numerous factors such as poverty,accidents, and poor health behavior among others. Therefore, thenursing roles and contributions can come in to help in thealleviation of some of the challenges that characterize the healthcare system to increase coverage and accessibility to the people.

Onthis account, the existent gaps in health care delivery presentvarious ethical dilemmas for nurses that necessitate making the rightchoices. For example, given that a proportion of Americans are notinsured, nurses may face the issue of whether to provide care for anuninsured patient or not. An uninsured individual would have to footthe medical bill using his money. This situation may be delicate fornurses who are labeled as custodians of life. Just like the ethicaldilemma described by Dibben (2015), nurses would have to consulttheir colleagues, especially officers in charge to help find asolution that is ethical.

Ethicalissues and decisions faced in health care

Atthe center of the nursing profession is the ethical sense ofaccountability to people under the care of nurses. In return, thepatients express respect and confidence. In the annual Gallup`ssurvey, nurses top the list of honesty and ethics in variousprofessions. The nursing profession has been the highest publiclyrated since its first inclusion in the Gallup`s Honesty and IntegritySurvey in 1999 (Epstein &amp Turner, 2015). This implies that theconcept of morality is highly embedded in the nursing profession. Itis impossible to address the concepts morality and ethics separatewith nursing in health care. Quality has always topped the nursingpriority list. Historically, nurses carry a strong ethical obligationto provide necessary care without cheating to avoid causing harm tothe patients in their care.

Thenursing profession embodies the moral principle of doing good and thecorresponding principle of doing no harm, in conjunction withjustice, fidelity, and confidentiality. These obligations are alwaysintegral in the nursing practice. Seldom do nurses talk about theirpersonal problems. However, they often talk about the type of careneeded by patients, families and communities, and they regularly forcare delivery in communities that limit the availability oraccessibility of care (Epstein &amp Turner, 2015).

Therefore,the nursing practice is based on an analytical framework of criticalthinking constituting of examination, diagnosis, and identificationof outcomes, planning, execution and assessment. These steps make upthe nursing process, which forms the foundation of clinicaldecision-making and supports evidence-based practice. Nurses arerequired to apply the nursing process ethically to meet the needs ofthe patients of communities they serve, and use strategies thatsupport ideal results for the patients, while taking into accountresource constraints (Lo,2012).Nurses are required to use evidence to guide their practice andpolicy.

Furthermore,the nursing practice is founded on caring and respect for humandignity. A kindhearted approach to patient care embodies the duty toprovide that care in a competent manner. Competency in health care isfostered through independent practice and partnerships. Collaborationcan be between colleagues or individuals seeking assistance withhealthcare needs. The art of caring is critical to the nursingpractice, and it manifests itself through the bond that occursbetween the nurse and the patient (Lo,2012).This art goes beyond the emotional connectedness to the ability torespond to the health needs of individuals at the most desired momentto promote healing.

Nursingis responsive to the dynamic needs of the society and expandingknowledge of its theoretical and scientific foundations. Among thenursing objectives is the need to attain positive health careconsumer outcomes that improve one’s life throughout theirlifespan. Registered nurses facilitate the interprofessional andinclusive care provided by health care professionals and volunteers.In some situations, nurses engage in consultations with theircolleagues to make decisions and plan on the best ways to meetpatients` health needs.

Allnursing practice is independent practice despite a nurse’s role,setting, or area of expertise. Registered nursing personnel areresponsible for the nursing judgments they make and actions they takein the course of their practice. Therefore, they must develop andmaintain expertise and capabilities through formal and continuouslearning and obtain accreditation when it is available in their areasof specialty (Epstein &amp Turner, 2015). Moreover, nurses are boundby a professional code of ethics that regulates them as individualsthrough a process of peer assessment of practice. Peer reviewpromotes the improvement of knowledge, abilities and medicaldecision-making at all levels in their practice.

Evaluationof various global health care delivery systems


Allcitizens are required to have health insurance cover, and it isprovided by private insurers who do it for profit or non-profit butare highly regulated by the government. The government offerssubsidies to the insurers for patients with severe health conditionsor the aged. Patients can choose their desired insurer throughemployment group plans. The government spends approximately 80percent of the total expenditure on health (Dye,Reeder &amp Terry, 2013).Consumers are required to pay a flat-rate premium for the policy.People with identical policies pay equal premiums, while low-incomeindividuals receive an allowance from the government to help themmake payments. Netherlands has a strong health care delivery systemthat fosters quality, choices for consumers and accessibility to all.


Allthe people are obliged to have health insurance through eitheremployment or national health care program. Insurers do not operatefor profit hence, there is no competition because they coveridentical services at same prices. The health ministry monitors theseprices and negotiates rates with the insurance sector every twoyears. The coverage includes inpatient, outpatient, home care,elderly home nursing, dental, home care prescription and long-termcare. The premiums for the policy are shared between the employer andthe employee, while in national health insurance, consumers co-payfor care and prescription drugs and pay 30 percent of the costs untila certain point beyond which, they are awarded full coverage. TheJapanese government spends approximately 81 percent of the totalhealth care spending (Dye,Reeder &amp Terry, 2013).As such, Japan`s health care delivery system ranks as one of the bestperforming in the world.


Canadahas a universal health care system that is publicly funded,administered and dominated by private insurers. The government,however, prevent private insurance from covering the same benefits aspublic plans. They only exist to seal coverage gaps. The governmentsets standards and provides support where necessary. Health insurancein Canada is funded through taxes and public expenditure accounts for70% while private expenditure accounts for 30 percent (Dye,Reeder &amp Terry, 2013).This system is the closes to that of the United States because theMedicare program is compulsory for every individual. Canada spendsless on health care compared to the U.S and other countries, possiblybecause of the strict government regulation.

Inall the countries examined, ethical dilemmas in care delivery existin various forms. No country whose care delivery system is devoid ofcritical nursing issues. These issues range from resource management,beliefs, minor dilemmas involving minors and information disclosure.Just as the nurse in the case presented by Dibben (2015) handled thesituation, nurses from the above countries use the right approachesto find solutions to similar cases. The nurses use evidence-basedpractice to direct their efforts to care delivery for the patients asit is aligned with their nursing mandate.

ProgramLevel Student Learning Outcomes

Thehealthcare sector is an expansive one, and healthcare professionalsface a myriad of ethical dilemmas that necessitate criticaldecision-making. The case presented by Dibben (2015) presents anideal ethical dilemma in the nursing practice. The student-learningoutcome involved entails expressing ways in which evidence-basedpractice can be used to deliver the best care amidst ethicaldecision-making. This is because nurses will always face ethicaldilemmas in their practice despite their expertise or geographicallocation. Therefore, there is the need to understand the bestmechanisms to address such cases to avoid conflicts of interests andensure superior quality of care.


Nursesare important personnel in the health care domain because theycontribute in many ways that are paramount for patient healing. Thereare numerous ways through which they can contribute to healthcare forthe good of patients. There are significant variations in healthcarepolices, particularly in health insurance because people fall intodifferent categories based on their age, socioeconomic status, andnotions regarding health insurance. There are also significantdifferences in the health care delivery systems in differentcountries. This paper looked at Netherlands, Canada, and Japan.Healthcare insurance is compulsory in these three countries, andtheir governments spend a significant proportion of its budget onhealthcare, unlike in the United States, where health insurance isprovided by private insurance with little accessibility to nationalinsurance programs. Therefore, despite the location of nurses,ethical dilemmas are bound to occur, and at such times, it is up tothe to use their nursing knowledge to make sound decisions, andconsult if necessary to establish the best way to handle thesituations as they arise.


Dibben,K. (2015). Jehovah`sWitness Parents refuse consent for son`s life-saving bloodtransfusion.The Courier Mail. Retrieved September 12, 2016, from

Dye,C., Reeder, J. C., &amp Terry, R. F. (2013). Research for universalhealth coverage.&nbspSciencetranslational medicine,&nbsp5(199),199ed13-199ed13.

Epstein,B., Turner, M., (May 31, 2015) &quotThe Nursing Code of Ethics: ItsValue, Its History&quot OJIN:The Online Journal of Issues in NursingVol. 20, No. 2, Manuscript 4. DOI:10.3912/OJIN.Vol20No02Man04

Kemppainen,V., Tossavainen, K., &amp Turunen, H. (2013). Nurses` roles inhealth promotion practice: an integrative review.&nbspHealthPromotion International,&nbsp28(4),490-501.

Lo,B. (2012). Resolvingethical dilemmas: A guide for clinicians.Lippincott Williams &amp Wilkins.