Academic journal article Scholarly Inquiry for Nursing Practice

What Is Access and What Does It Mean for Nursing?

Academic journal article Scholarly Inquiry for Nursing Practice

What Is Access and What Does It Mean for Nursing?

Article excerpt

Stevens' paper discusses the role of nursing in an inequitable market-driven health care system and offers a conceptualization of access to care. Nurses provide the bulk of primary care and are thus witness to the deleterious effects of limited accessibility to health care. Despite their firsthand knowledge of the health care system's inequities, the profession has largely ignored the social, economic and political conditions that obstruct access to care. If nursing does not transcend its individualistic focus, Stevens cautions, the discipline will be left in a state of theoretical and practical standstill.

While nurses are in a unique position to gather data for informing public policy on access to health care, this is not often done. In today's world, budget sheets dictate policy, and numbers are political bullets. It is therefore critical for nurses? and all health care practitioners?to systematically document the nature and frequency of barriers to their clients' receipt of health services. Initiatives supported by quantitative data will be more effective in influencing policy than positions based on subjective or anecdotal reports.

Nursing practice and research can illustrate that clinical impacts of delayed treatment ultimately have economic repercussions. As nurses well know, when people are deterred from seeking timely care, existing problems are exacerbated and new ones invariably develop. Delayed care has been associated with longer hospitalizations over a broad spectrum of conditions (Weissman, Stern, Fielding, & Epstein, 1991). Costly use of emergency rooms for primary care among the poor and in areas with few primary care providers is common. A survey of nine lowincome communities in New York found the number of primary care visits occurring in emergency rooms was two to four times higher than in other city areas (Community Service Society, 1989). The literature on access to health care has most recently examined how access to specific services affects health outcomes. The incidence of illness, the likelihood of receiving specialized services while hospitalized, and mortality have all been associated with insurance coverage and income (Davis, 1991).

To integrate equitable access to health care into nursing's agenda, research efforts such as those indicated above are imperative. Although Stevens lays the theoretical groundwork for further action to ensure equitable access, the broad actions outlined at the end of the article need to be concretized. Nursing education is a critical avenue for reform. It is during the educational process that professionals undergo what the French term 'deformation professionnelle'?literally a deformation of the professional self. Davis (1968), for example, has documented how a recruit's view of the job changes during nurses' professional education. During this socialization, new recruits should be sensitized to systemic issues obstructing patients' achievement of optimal health. The curriculum could be modified to incorporate more information on the sociopolitical context in which practice occurs. Further, practica or projects in which nursing students isolate barriers to health care in their practice and suggest strategies for reform would be useful exercises. Stevens is concerned with the geographical accessibility of services. For example, students may observe elderly patients not attending clinic because the bus schedules are inconvenient for them. Students could gather data on the problem and devise a strategy for attempting to modify either the bus route or clinic hours.

Nursing education must incorporate the realities in which nurses practice and do research. The gap between nursing theory and practice noted by Stevens is evidence that such integration has not yet occurred. Politics play a critical role in shaping this country's response to health care issues. Access, in fact, has been termed a political rather than an operational idea (Aday & Anderson, 1974). …

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