Healthcare Policy Issues: Health Equity Essay Example

Issue Identified

One of the main healthcare policy issues that are currently in need of addressing is health equity (HE) (American Public Health Association [APHA], 2015). Alternatively, it can be identified as the presence of health and care disparities (Ubri & Artiga, 2016). In other words, HE is a challenge, and the present brief will provide its overview complete with potential solutions.

Background Information

Health and healthcare inequalities define the disparities in health and care that are determined by social factors (Ubri & Artiga, 2016). Such issues affect a very diverse population, but they are often concerned with marginalized groups, which can intersect (Ubri & Artiga, 2016; Voyles & Sell, 2015). The population of different countries, including the US, is becoming increasingly diverse (Ubri & Artiga, 2016). Therefore, the group that is affected by the challenge is very large and includes the people of varied socioeconomic statuses, racial and ethnic backgrounds, genders, orientations, and so on. Moreover, the problem exists at multiple levels. Nation-level interventions are significant, but state and local policies are also important. APHA (2015) notes that the considerations of HE need to be addressed by policy-makers of all levels when preparing and reviewing any kind of policy because HE is interconnected with a variety of other areas.

The evidence on the topic is sufficient because the challenge is long-standing. In the US, there is ample data to indicate that people of color are more likely to delay visits to doctors than White people, and low-income individuals report more barriers to care than people with less financial difficulties. For instance, Hispanic populations tend to avoid visiting doctors because of costs; American Indians and Alaskan Natives are very likely to do the same for non-financial reasons (Ubri & Artiga, 2016). Similarly, chronic conditions are more common among LGBT people than heterosexuals, but the research on the topic is underfunded (Ubri & Artiga, 2016; Voyles & Sell, 2015). The disparities affect specific conditions, substance use, mental health, and other areas. Similar issues can be found outside of the US (Fisher, Baum, Kay, & Friel, 2017). Thus, there is sufficient evidence to indicate that the issue is present and in need of solutions.

Problem Statement

Based on the above-presented information, the following problem statement can be drawn. There are disparities in health and care that are the result of social inequality. Disadvantaged groups are disproportionately affected by illnesses and have reduced access to care, which violates their right to the latter. Thus, it is necessary to address the issue and provide appropriate solutions to it.

Solution

The most common approach to health equity policies is concerned with specific care coverage options (Fisher et al., 2017; Ubri & Artiga, 2016). An example is the US Affordable Care Act (ACA), which was primarily developed to improve access to care and has succeeded in reducing disparities in this regard (Ubri & Artiga, 2016). However, coverage is not the only approach to relevant policies. Other important activities include the improvement of healthcare infrastructure, the training and empowerment of its workforce, and research on the topic (Purnell et al., 2016; Ubri & Artiga, 2016; Voyles & Sell, 2015). Also, the introduction of non-coverage approaches to equity (for instance, culturally appropriate care) are similarly important (Purnell et al., 2016). Furthermore, non-governmental efforts are also notable; they are typically funded by local or state institutions or private organizations and provide policies and interventions that consist of similar components (Ubri & Artiga, 2016). Therefore, the primary approach to HE comprises comprehensive policies that should include all the mentioned options and be coordinated by specific objectives and strategies.

Stakeholders and Funding Considerations

The stakeholders of HE are multiple. First, the populations which are affected by the issue should be empowered to participate in policy-making. Additionally, healthcare providers have the unique knowledge that can help them to provide useful commentary on the topic, which is why they are important stakeholders as well. Varied organizations, including private and public ones, can assist with resources. Finally, policymakers are major stakeholders (APHA, 2015; Purnell et al., 2016). The mentioned groups can contribute to the development of HE policies. As for funding, it is not possible to draw a budget for the identified solution within this brief, but it should be stated that one of the first issues to eliminate is funding disparities (Voyles & Sell, 2015). As a result, the process of funding the identified initiatives should require careful analysis of the existing state of events and the reasons behind it, which should lead to an improved distribution of finances.

Impact on the Health Care Delivery System

As it was mentioned, health inequities affect health care delivery systems, as well as the rights of people to care. Some of the key consequences of the issue are reduced access to care, its lower quality, and adverse health outcomes for the affected populations (Purnell et al., 2016; Ubri & Artiga, 2016). Additionally, inequity tends to result in increased spending (Ubri & Artiga, 2016). Thus, multiple negative outcomes of health inequities can be found. In turn, HE should help to remove them, which would be beneficial for the society and ensure the protection of the right to care for all groups within it.

Conclusion

In summary, HE is challenging to achieve, but the adverse outcomes of inequality in the field, as well as its problematic nature from the perspective of human rights, imply that it is necessary to address the problem. The most appropriate approach to the task is a comprehensive effort. An example of such a policy is ACA, which has produced some positive outcomes. Still, in order to achieve HE, it is necessary to unite the efforts of multiple stakeholders and proceed to work on the issue.

References

American Public Health Association. (2015). Better health through equity. Web.

Fisher, M., Baum, F., Kay, A., & Friel, S. (2017). Are changes in Australian national primary healthcare policy likely to promote or impede equity of access? A narrative review. Australian Journal of Primary Health, 23(3), 209. Web.

Purnell, T., Calhoun, E., Golden, S., Halladay, J., Krok-Schoen, J., Appelhans, B., & Cooper, L. (2016). Achieving health equity: Closing the gaps in health care disparities, interventions, and research. Health Affairs, 35(8), 1410-1415. Web.

Ubri, P., & Artiga, S. (2016). Disparities in health and health care: Five key questions and answers. Web.

Voyles, C., & Sell, R. (2015). Continued disparities in lesbian, gay, and bisexual research funding at NIH. American Journal of Public Health, 105(S3), e1-e2. Web.

Activation Energy For Viscous Flow Of Water, Acetone, Toluene, And O-Xylene

Abstract

The knowledge of physiochemical properties of binary mixtures of solvents is of great importance for learning intermolecular interactions. The aim of the research was to investigate the hypothesis that the activation energy of a substance depends on intermolecular forces that arise in this substance. To test this hypothesis, activation energies of pure water, acetone, toluene, and xylene have been experimentally determined using the viscosity-temperature function. The viscosities have been investigated using the Cannon-Fenske viscometer and simplified version of Poiseuille equation for fluid flow for water-acetone and toluene -xylene mixtures over the entire range of mole fractions at 295.35-328.15K. These systems have been evaluated in terms of ideality using calculated fluidities. Activation energies of water, acetone, toluene, and o-xylene have been calculated from the experimental results of viscosity measurements. Based on the theoretical and experimental fluidities, interactions between water and acetone molecules and toluene and o-xylene molecules have been discussed. It has been reiterated that the stronger the intermolecular forces of interactions arising between the molecules, the higher is the activation energy.

Introduction

The question to be investigated in the given research is whether there is a correlation between the type of intermolecular forces found in solvents and physicochemical properties of these solvents, in particular, activation energy. Also, the research was aimed at evaluating the ideality of the binary liquid systems by comparing theoretical and experimental fluidities. It is considered that for systems in which intermolecular forces are stronger, values of activation energies will be greater (Adamson, 2012). This is because the amount of energy needed to begin a chemical reaction will be greater.

Major types of intermolecular forces found between molecules of liquids consist of van der Waals forces (which include dipole-dipole interactions and London dispersion forces) and hydrogen bonds. Dipole-dipole interactions arise between permanent diploes of polar molecules (Atkins and Paula, 2014). Hydrogen bonds arise between the hydrogen of one molecule and oxygen, nitrogen, or fluorine of another molecule. London dispersion forces arise between non-polar molecules because of temporary fluctuations in their electronic distributions. The solubility of polar solvents in other polar solvents is explained by dipole-dipole interactions which are attractive for two different polar molecules. In contrast, if one molecule is non-polar, dipole-dipole interactions become repulsive; that is why non-polar solvents are non-soluble in polar solvents.

In the water-acetone system, there are three types of intermolecular forces. There are hydrogen bonds that are formed by the partial negative charge of oxygen of the one molecule and the partial positive charge of hydrogen of another molecule (Wypych, 2019). There are also strong dipole-dipole interactions between permanent dipoles of acetone molecules. Lastly, the oxygen atom of acetone interacts with the OH-group of water. So, there is a hydrogen bond between the partial negative charge of oxygen of acetone and the partial positive charge of hydrogen of water. In the system toluene-o-xylene, only weak van der Waals forces arise (Kuhn et al., 2009). It can be expected that the viscosities of these two systems will be different due to the different intermolecular forces, and so will be the activation energies. The strength of intermolecular forces increases in the following sequence: dispersion < dipole-dipole interaction < hydrogen bonding. Thus, activation energies are also going to increase in the same manner.

To determine activation energies of pure solvents, their viscosities need to be calculated. A Cannon-Fenske viscometer will be used for measuring the time required for the meniscus of a liquid to pass from point a to point b. The design of the viscometer fits the equation experimentally derived and formulated by the French physician and physiologist Poiseuille (1847):

the French physician and physiologist Poiseuille

Poiseuille (1843) determined the relative viscosity of the sample tested by comparing it with the reference:

the relative viscosity of the sample

The relative viscosity of the sample tested can be calculated as:

The relative viscosity of the sample

Theoretical fluidities of the systems and pure solvents will be calculated assuming that fluidities of ideal solutions are additive:

Theoretical fluidities of the systems and pure solvents,

where Xand Xare molar fractions of components A and B of the mixture.

Experimental fluidities will be calculated using the formula:

Experimental fluidities

It can be expected that for ideal solutions, experimental and theoretical fluidities will be practically identical. The relationship between the temperature and viscosity was expressed by Arrhenius:

The relationship between the temperature and viscosity

Methods

The experiment has been performed using the Cannon-Fenske viscometer that should be clean and dry. The solutions of water-acetone and toluene-o-xylene at different percent compositions by volume at 0, 20, 40, 60, 80, and 100% have been prepared. There have been the four parts of the experiment, each one performed at a different temperature (220C, 350C, 450C, and 550C). The temperature has been regulated by submerging the viscometer in the water bath. 8,00 mL of the liquid has been injected directly into the larger tube of the viscometer (Abbott-Lyon, 2019). During the experiment, the volume of liquid used and the flow times for the liquid solutions passing from point a to point b have been recorded to an accuracy of 0.001 s. Three sets of readings for the flow times have been taken, and their average has been used. It is necessary to be accurate at keeping the volume of a liquid constant and keep the pipette clean and dry. In the given experiment, water (t=250C) has been considered as a reference for all parts of the experiment.

Results

Based on the data obtained, the relative coefficients of viscosity for all pure solvents and mixtures have been calculated. Plots of the coefficients of viscosity versus mole fraction have been made (see Figures 1-8). It can be seen that it is possible to have a homogeneous binary liquid solution with a higher viscosity coefficient than that of both pure fluids making the solution (see Figures 1, 3, 5, 7).

Coefficients of viscosity for water-acetone versus mole fractions at 22 C.
Figure 1. Coefficients of viscosity for water-acetone versus mole fractions at 22 C.

Coefficients of viscosity for toluene-xylene versus mole fractions at 22 C.
Figure 2. Coefficients of viscosity for toluene-xylene versus mole fractions at 22 C.

Coefficients of viscosity for water-acetone versus mole fractions at 35 C.
Figure 3. Coefficients of viscosity for water-acetone versus mole fractions at 35 C.

Coefficients of viscosity for toluene-xylene versus mole fractions at 35 C.
Figure 4. Coefficients of viscosity for toluene-xylene versus mole fractions at 35 C.

Coefficients of viscosity for water-acetone versus mole fractions at 45 C.
Figure 5. Coefficients of viscosity for water-acetone versus mole fractions at 45 C.

Coefficients of viscosity for toluene-xylene versus mole fractions at 45 C.
Figure 6. Coefficients of viscosity for toluene-xylene versus mole fractions at 45 C.

Coefficients of viscosity for water-acetone versus mole fractions at 55 C.
Figure 7. Coefficients of viscosity for water-acetone versus mole fractions at 55 C.

Coefficients of viscosity for toluene-xylene versus mole fractions at 55 C.
Figure 8. Coefficients of viscosity for toluene-xylene versus mole fractions at 55 C.

Theoretical and experimental fluidities have been calculated in order to determine the ideality of the water-acetone and toluene-xylene systems. For theoretical fluidities, inverse measures of theoretical viscosities of pure solvents have been used. Conclusions regarding the ideality of the systems studied have been made based on the differences between theoretical and experimental fluidities (see Figures 9-14). In the report, these differences will be further discussed and explained.

Fluidities of water-acetone at 22 C.
Figure 9. Fluidities of water-acetone at 22 C.

Fluidities of toluene-xylene at 22 C.
Figure 10. Fluidities of toluene-xylene at 22 C.

Fluidities of water-acetone at 35 C.
Figure 11. Fluidities of water-acetone at 35 C.

Fluidities of toluene-xylene at 35 C.
Figure 12. Fluidities of toluene-xylene at 35 C.

Fluidities of water-acetone at 45 C.
Figure 13. Fluidities of water-acetone at 45 C.

Fluidities of toluene-xylene at 45 C.
Figure 14. Fluidities of toluene-xylene at 45 C.

To determine the activation energy of pure solvents, the Arrhenius equation has been rearranged to the equation for a straight line:

To determine the activation energy of pure solvents

Graphs of ln η against 1/T have been created, and activation energy has been determined as a slope of a straight line.

a slope of a straight line

However, some of the data points have been rejected to keep the linear form of the plot (see Figures 15-18). Values of viscosities and so the values of ln η should decrease with an increase in temperature, though some data points do not fit the given tendency (see Table 1). This may be attributed to time measurement errors and the impossibility of measuring accurate results at high temperature.

Determination of the EA of water.
Figure 15. Determination of the EA of water.

Determination of the EA of acetone.
Figure 16. Determination of the EA of acetone.

Determination of the EA of toluene.
Figure 17. Determination of the EA of toluene.

Determination of the EA of xylene.
Figure 18. Determination of the EA of xylene.

Solvents Slope R (J/mole/K) EA (J/mole)
Water 946,65 8,314 7870
Acetone 448,64 8,314 3730
Toluene 814,27 8,314 6770
O-xylene 842,54 8,314 7005

Table 1. Calculation of activation energies of pure solvents.

Discussion

It can be seen that the relative coefficient of viscosity of pure water is higher than that of acetone. This is due to strong hydrogen bonds that arise between water molecules and do not arise between molecules of acetone. High coefficients of the viscosity of water-acetone mixtures can be explained by strong dipole-dipole interaction between molecules of water and molecules of acetone. It can be observed that the higher the temperature, the lower is the relative coefficient of viscosity. As have been mentioned before, in the toluene-xylene system, only weak van der Waals forces arise. This is reiterated by comparatively low coefficients of viscosities. Based on viscosity coefficients, intermolecular forces between xylene molecules are stronger than those between toluene molecules.

There is a significant variation between theoretical and experimental fluidities of the water-acetone system, yet theoretical and experimental fluidities of the toluene-xylene system are almost the same. It may be assumed that the toluene-xylene system is close to the ideal solution. This means that intermolecular interactions that arise between molecules of toluene and xylene are almost the same as those intermolecular interactions that arise in the mixture of these solvents. In contrast, intermolecular interactions that arise in pure water and pure acetone differ from those that arise in the water-acetone system.

It has been stated that of all the four solvents, water is the one to have hydrogen bonds. Dipole-dipole interactions can be found both in water and acetone. Dispersion forces arise between molecules of all solutions, yet dispersion forces are stronger for xylene that has one extra carbon compared to toluene. Activation energy is directly related to the intermolecular forces of interactions that exist between the molecules. As was expected, the strength of experimentally determined activation energy increases in the following manner: toluene < xylene < water. The activation energy of acetone was expected to be higher than that of xylene and lower than that of water. However, the calculated activation energy of the acetone does not support the trend. This may be explained by experimental errors in measuring time flow.

Conclusions

Intermolecular forces condition a number of physicochemical properties of chemical substances. The viscosity of a mixture of solvents depends on intermolecular forces between the molecules of these solvents. Since viscosity is a thermally activated process, activation energy can be experimentally determined using experimental values of viscosity at the chosen range of temperatures. The stronger the intermolecular forces, the higher is the activation energy of a solvent. However, the accuracy of the given research is limited due to the measurement errors, which is why the activation energy of acetone did not fit the tendency.

References

Abbott-Lyon, H. Viscosity Lab Manual. Kennesaw State University: Georgia, 2019.

Adamson, A. A Textbook of Physical Chemistry, 2nd ed.; Elsevier: New York, 2012; pp. 280-294.

Atkins, P.; Paula, J. Atkins’ Physical Chemistry, 10th ed.; Oxford University Press: Oxford, 2014; pp. 838-840.

Kuhn, H.; Forsterling, H.; Waldeck, D. H. Principles of Physical Chemistry, 2nd ed.; John Wiley & Sons: Hoboken, 2009; pp. 835-845.

Poiseuille, J. L. M. The Flow of Liquids of Different Nature in Glass Tubes of Small Diameters. C. R. Acad. Sci. 1843, 16, 61-63.

Poiseuille, J. L. M. The Movement of Liquids of Different Nature in Tubes of Small Diameters. Ann. Chem. Phys. 1847, 21, 76-110.

Wypych, G. Handbook of Solvents: Use, Health, and Environment, 3rd ed.; Elsevier: Toronto, 2019; Vol. 2, pp. 1518-1530.

Workplace Interpersonal Conflicts Among The Healthcare Workers

The work in a healthcare setting is rather demanding and may sometimes require much more than a thorough preparation and the knowledge of one’s job. Since medical workers and patients communicate on a daily basis and since different people have various opinions and approaches to situations, conflicts are inevitable. Disagreements may appear due to insufficient experience, unsatisfactory working conditions, or unjustified demands from customers. Whereas some individuals tend to keep their feelings to themselves, others prefer to share their emotions either in a polite or in an unfriendly way. Whatever the type of conflict is, it is vital to find the most suitable method of resolving it so that neither a healthcare employee nor a patient should suffer from the misunderstanding that took place. The present paper depicts an unresolved conflict that occurred in a healthcare setting, outlines the four stages of the conflict and relates them to delegation, and offers strategies for conflict resolution.

Description of the Unresolved Conflict

Since all employees in our hospital are trained to prevent or avoid conflicts with patients and their families, the rare cases of misunderstanding that occur usually happen among the staff. Scholars remark that interpersonal conflicts in a healthcare setting are a rather common phenomenon (Jerng et al., 2017). Recently, I witnessed one of such disputes between two nurses in the elderly services department. The head nurse told one of the nurses, L. C., to take the vital signs of the patient who had been admitted that morning. While L. C. was measuring the patient’s pulse, another nurse, R. N., entered the ward. R. N. observed the work of L. C. and said, “You are doing it wrong! Let me show you how it is performed!” The patient, O. W., was a seventy-five-year-old lady who became shocked both by the tone of R. N. and her words. O. W. immediately asked for the nurse manager to come and complained about L. C.’s unprofessionalism. When the nurse manager listened to the patient’s explanations, she apologized for her subordinates’ misconduct but assured O. W. that every employee of the department was highly-skilled.

The conflict was unresolved since, despite the nurse manager’s explanations, the patient demanded not to have L. C. as her nurse for the whole stay. The type of conflict was interpersonal because it involved two healthcare employees, one of whom prevented the other from performing her professional duties by interrupting her work. The outcome of the situation was the dissatisfaction of the customer and the tense relationship between the colleagues.

The Four Stages of Conflict

The diversity of conflicts and the problem of resolving them led specialists to identifying several stages of disagreements. Finkelman (2018) distinguishes between such conflict phases as latent, perceived, felt, and manifest. At the latent stage, the factors that might induce the conflict are identified (Champoux, 2017). The most probable precondition of this situation was a series of small misunderstandings between the two nurses prior to the described conflict. R. N. had worked at the hospital for five years whereas L. C. had only a few months of experience. Thus, R. N. thought that she was more competent without the actual ground for such an opinion. A common reason for latent conflicts is the incompatibility of goals (Finkelman, 2018). However, it is not possible to say that the two nurses had different purposes. It is more likely that R. N. was trying to demonstrate that she was a more experienced and, thus, valuable employee than L. C. Delegation was not the issue since L. C. was performing her professional duties.

The perceived conflict occurs when the parties involved in the case admit that there is a problem between them. In the situation that happened between R. N. and L. C., such realization occurred. After R. N.’s intrusion in the work of L. C., it became clear that the former wanted to spoil the reputation of the latter. Even if L. C. did something wrong, R. N. should have asked her out to explain what her mistake had been without getting the patient involved in the situation. However, the behavior of R. N. made it clear that she wanted to create an unpleasant situation and show L. C. in a bad light.

The next stage is the felt conflict that presupposes the recognition of the issue by both parties. In the situation described, at this stage, not only the two nurses but also the patient was involved. O. W. tended to believe R. N.’s resolution about L. C.’s professional skills (or, rather, unprofessionalism) and demanded to have another nurse. At that point, it became obvious that the conflict was felt by all parties.

The last phase is the manifest conflict, and it involves the response from the participants of the situation. The most typical manifestation is aggression (Champoux, 2017). L. C. did not make a scene in front of the patient, but she burst into crying in the nurse ward later and shouted at R. N., saying unpleasant things and complaining on her conduct. There was no violence in L. C.’s reaction, but some mild aggression was present.

Strategies for Conflict Resolution

The next thing to do upon acknowledging a conflict situation is finding ways of resolving it. Leadership, as well as the participation of team members, can help mitigate the problem and prevent the occurrence of similar cases in the future (Finkelman, 2018). One of the most important aspects of conflict resolution is the regulation of emotions (Halperin, 2013). The nurse leader should have explained to the patient that L. C. had done everything correctly and that R. N.’s statement had been wrong. By doing so, the leader would have mitigated the dispute, and no further development of the problem would have occurred. The best of possible approaches to conflict management is the win-win method of conflict reduction (Champoux, 2017). When applying this approach, all parties receive what they want. However, it is impossible to implement this method in the current situation since by satisfying R. N.’s interests, the nurse leader would diminish L. C.’s role. Thus, the best strategies to solve the issue would have been the authoritative command (Champoux, 2017). The leader should have explained to R. N. what she had done wrong and should have warned her that the repetition of such a demeanor would lead to negative consequences for R. N.

Summary

The observed situation gives several important lessons for the future practice. First of all, it seems that for the effective management of such conflicts, it is necessary to take preventive measures. In particular, the head nurse needs to explain the subordinates their duties not only to patients but also to one another. Also, in such a situation, the nurse leader could have approached the patient to mitigate the conflict. Finally, it is crucial to cultivate the positive environment in the workplace in order to avoid such incidents.

References

Champoux, J. E. (2017). Organizational behavior: Integrating individuals, groups, and organizations (5th ed.). New York, NY: Routledge.

Finkelman, A. (2018). Professional nursing concepts: Competencies for quality leadership (4th ed.). Burlington, MA: Jones and Bartlett Learning.

Halperin, E. (2013). Emotion, emotion regulation, and conflict resolution. Emotion Review, 6(1), 68-76.

Jerng, J.-S., Huang, S.-F., Liang, H.-W., Chen, L.-C., Lin, C.-K., … Sun, J.-S. (2017). Workplace interpersonal conflicts among the healthcare workers: Retrospective exploration from the institutional incident reporting system of a university-affiliated medical center. PLoS One, 12(2), e0171696.

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