Term-Long Project Nursing Paper Example

Several statements, including the Millennium Development Goals and the Alma Ata Declaration, call for the global community to address health inequalities, especially in developing nations. Vietnam’s health system is an excellent example of a developing world that continues to encounter immense challenges ranging from inadequate human and financial resources, limited institutional infrastructure and capacity, poor health information systems, embedded inequity, and health services availability discrimination. While Vietnam has been making economic and social advancements toward becoming a high-income economy, the nation’s health state should be prioritized to address current and future health disparities as healthy people contribute one of the most vital development resources. Evidenced-based strategies such as adequate healthcare expenditure aim to improve a number of the healthcare workforce, building more health infrastructure, investing in new and modern medical technologies, and achieving universal health coverage may effectively improve the nation’s healthcare state. This evidence-based project aims to address health inequities among vulnerable populations (Pregnant women and children) using a clinical question to apply accurate evidence and analyze health outcomes in Vietnam.

Overview of the Country

Vietnam is a developing economy located in the Southeast Asia of the Peninsula’s Eastern edge called Indochina. The nation occupies around 331,211.6 square kilometers, neighboring China to the North, Cambodia and Laos in the West. Vietnam’s current population is about 98,885,115 and is expected to reach 100 million by the end of 2023 (Worldometer, 2023). Vietnamese is the official language spoken in the country, with English as the preferred second language. Catholicism and Buddhism are significant regions, although several folk traditionalists exist.

Vietnam is one of the most growing economies globally due to trade wars, global pandemics like COVID-19, and slow growth rates. The economic acceleration is attributed to a labor shift from agriculture to small-scale entrepreneurship, industrialization, and urbanization. For instance, industries contributed about 37.5% of the nation’s GDP and employed about 27% of the total labor workforce. The nation’s unemployment rate has reached its all-time lowest of 2.4% in 2022 and is expected to be 2.3% by the end of this year (International Monitory Fund, 2023). The nation’s GDP has continuously grown in the last three years. Vietnam’s GDP was 346.31 in 2020, 369.74 in 2021, and 406.45 USD billion in 2022. The GDP is expected to be 449.09 by the end of 2023 and 498.37 in 2024. (Lloyds Bank, 2023). Notably, Vietnam provides an ideal combination of lower living costs, good earning potential, and a high quality of life. Of 165 countries surveyed about the quality of life, Vietnam scored 78.49 points ranking in the 62nd position. CEOWORD conducted the survey based on categories such as costs of living, working environment, income equality, and health system (Vietnamplus, 2023)

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Description of the Healthcare System

Currently, plans are underway to establish a universal health system in Vietnam. The nation’s health system obtains revenue from pocket spending (Allianz Care, 2023). As such, most Vietnamese people pay for their health services out of their pocket to private and public hospitals. People with relatively good incomes prefer to seek healthcare from private healthcare services that are efficient and well-equipped. In Vietnam, public hospitals need to be more adequately equipped and funded. Most physicians and medical staff speak Vietnamese only, and the waiting times are long and frustrating. The availability of health services and quality of care is deteriorated in rural areas, while standard health care is almost nonexistent in remote areas. On the contrary, private hospitals’ standards and quality of care are higher than public ones. The private hospitals are adequately staffed and equipped. Most health personnel in the private sector are competent, receive training in the USA, France, or Canada, and can comfortably communicate in English.

Vietnam’s government health spending, including social health insurance financed through voluntary and mandatory contributions, accounts for about a quarter of the health spending, equivalent to about 1.2% of the GDP. However, recent improvements have made the government’s expenditure per capita expected to reach about USD 262, a 9% increase (International Trade Administration, 2023). The nation’s health system is currently average compared with most developing countries. In 2021, the mortality rate in Vietnam peaked at 7.32 deaths per 1000 people, although the COVID-19 pandemic significantly contributed to high cases experienced globally.

The nation’s life expectancy is 75.77 years and is expected to increase as the healthcare system develops. Subsequently, healthcare financing and delivery in Vietnam are also decentralized. As such, healthcare spending is based on local/provincial government spending leading to interregional inequalities. Thus, the government favours affluent regions at the expense of people with low incomes, who need more healthcare services. The tiered pyramid model organization of health organization from top to bottom also leads to undesirable habits where people bypass local low-level providers and overuse the high-level healthcare facilities.

Identification of Healthcare Disparity (Interprofessional)

Vietnam prioritizes achieving universal coverage for about 80% of the nation’s population per the Sustainable Development Goals. Universal health coverage will target everyone regardless of socioeconomic status and residence. However, potential health inequities have challenged policymakers and health healthcare planners. Health inequities pose significant differences in the health status and health resources distribution among different groups that emanate from the social conditions in which people are born, grow, live, and work. In Vietnam, the inaccessibility of health facilities, understaffing, and lack of medical equipment pose health inequities during maternal and child healthcare, especially among women among ethnic minority groups (McKinn et al., 2019). Other factors, such as education, income, and occupation, contribute to health inequities. UNICEF (2023) asserts that health inequities in pregnancy, childbirth, and early childhood lead to about 600 maternal deaths and more than 10000 neonatal deaths yearly in Vietnam. Additionally, approximately 100 children under five years also succumb to preventable causes. More deaths are experienced in ethnic minorities, especially in rural deaths. Thus, there is a need to devise evidence-based strategies to eliminate health inequities to promote maternal and child healthcare in Vietnam.

PICOT Question

Among pregnant women and children (under five years) in Vietnam (P), do those with access to adequately staffed health facilities (I) experience lower maternal and children (Under five years) mortality rates (O) compared to those with limited access (C) within one year (T)?

The ‘P’ stands for the patient population in this evidence-based project. Pregnant women and children under five years are the patient population in this project. Secondly, ‘I’ is the intervention for access to adequately staffed healthcare facilities. Access pertains to timely access to health services to achieve the best health outcomes. At the same time, adequate staffing ensures that available healthcare providers in the health facilities are enough to meet patient needs. Thirdly, ‘O’ stands for the expected outcome after the implementation of the intervention. The expected outcome will be lower maternal and child mortality, compared (C) to a high mortality rate for infants that will not access staffed health facilities within a timeframe (T) of one year.

Evidence Review

Maternal-child health care access and utilization lead to disparities in health outcomes of women and children. Although Vietnam continues to increase access to all healthcare services, maternal neonatal and child health (MNCH) remains a constant problem, especially for ethnic and minority populations. Women who manage to access the MNCH services still encounter understaffing problems as many frontline healthcare facilities, especially public hospitals, have inadequate workforce to meet the immense healthcare needs of the people. Heo et al. (2020) assert that primary MNCH services remain underutilized from failure to meet the desired quality standards that may emanate from understaffing issues. The services are underutilized due to limited access, as women and children in remote areas may not access most of the public health facilities in Vietnam’s urban areas.

In a study conducted at Thai Binh Paediatric Hospital, Pham et al. (2021) assert that the under-five children mortality rate was about 1.94 pre-live births. The study further portrays that a survey conducted by the Institute of Health Metrics and Evaluation found that the major causes of Vietnam’s child mortality rate in 2017 were maternal and neonatal disorders (31.3%), lower respiratory tract infections (13%), congenital disabilities (26.6%), meningitis (1.3%) diarrhea (0.7%), whooping cough (3%), encephalitis (2.3%) and HIV (0.3%). As of 2019, Thai Binh Paediatric Hospital had 86 physicians and 171 nurses providing healthcare services in 15 departments across the 566-bed capacity facility (Pham et al., 2021). Based on the information provided, the healthcare facility could have been facing an understaffing problem that limits care accessibility, attributed to a high number of infant mortality experienced. Adequate staffing may have been instrumental in addressing the risks that may have led to deaths related to lower tract infections and diarrhea. Thus, improved provider-to-patient ratios would have led to effective hygiene standards and infection surveillance.

Nguyen et al. (2020) assert that Vietnam encounters problems delivering an equitable and adequate workforce. Traditional methods, such as staffing based on the patient population and institution size, have led to adverse health outcomes for the selected patient population and the nation’s overall health system. In a study on ethnic women’s maternal care, McKinn et al. (2019) claim that access to adequate antenatal care and skilled personnel during delivery will be vital to preventing future mortality, infant and potential child mortality rates.

Therefore, to address limited access to adequately staffed health facilities, Vietnam should adopt a rigorous process to determine the number of health personnel in the facilities. Gialama et al. (2019) suggest that the Workload Indicators of Staffing Need (WISN) method is a suitable strategy that can be used to determine the optimal number and health workforce distribution for local and national health systems globally. Introduced by the WHO, the method is based on the healthcare workers’ workload with time or activity standard for each work component to rationally determined the number and type of healthcare staff required in a given healthcare facility. Nguyen et al. (2020) also support the method and claim that it will be effective for health managers to determine different health professionals’ responsibilities, thus improving access to adequate maternal and child health care in Vietnam.

Interprofessional Approach to Improve the Healthcare Disparity

The project will use the best available evidence to address the problem. Shortage of the healthcare workforce is one of the main contributors to understaffing, leading to limited access to care. The shortage emanates from potential healthcare staff recruitment and retention problems. Therefore, this project proposes effective healthcare staff recruitment and retention strategies as a suitable interprofessional approach that will help address understaffing problems in Vietnam. In this case, health management and administration disciplines will be effective towards staff recruitment and retention through strategies such as improved working conditions, motivation, and provision of required resources for health professionals (Khalil & Alameddine, 2020). As such, women and children will have access to adequately staffed healthcare facilities and improved quality of care, linked to lower mortality rates among children.

Secondly, the human resource discipline will be vital to improve medical education and training to address Vietnam’s understaffing issues. Human resource departments can call for the government to collaborate with health-education curriculum developers to ensure more opportunities for graduates from medical training institutions to be absorbed in the health market and address potential understaffing problems (Frenk et al., 2022). For instance, lowering the entry points for medical and health-related courses will ensure that more people are absorbed in the medical training institutions solving the health workforce shortage and understaffing problems.

Thirdly, the health research discipline will be vital to address staffing problems in Vietnam’s healthcare facilities. This project will research to determine some potential causes of staffing problems in Vietnam and devise appropriate interventions backed by evidence to ensure that women and children have access to adequately staffed healthcare facilities. After evidence review, the project has proposed that health managers and leaders adopt the Workload Indicators of Staffing Need (WISN) method for staff health department based on the patient’s needs.

Stakeholders & Overcoming Barriers

Stakeholders’ support will be vital for this evidence-based project to achieve success. One of the main stakeholders for this project is the government. The government plays a significant role in regulating the healthcare workforce, eventually influencing healthcare staffing. First, the government is responsible for regulating the number of medical and health training institutions in the country. As such, the government sets rules and regulations for an institution to offer medical and healthcare-related courses. The government also collaborates with curriculum developers to set the cluster points and requires that requires one qualify in medical schools. It also regulates the certification and accreditation of various healthcare providers, thus affecting the overall workforce in the country.

The government will play a significant role in implementing my project by increasing the healthcare expenditure to employ adequate staff to meet the current and future healthcare needs of the people, especially women and children. The government will also support the proposed Workload Indicators of Staffing Need (WISN) method to determine the type and number of healthcare staff in different departments in Vietnam’s health facilities. Creating a strategic plan and budget required to implement my project will be vital to obtain the government’s support. While politics may be a significant barrier affecting the government’s support, creating awareness about the project and implementation strategies will promote trust.

Healthcare facilities in Vietnam are also instrumental stakeholders required to implement this EBP. Specifically, healthcare leaders and managers will be mandated to staff the various health departments. In this case, the healthcare leaders and managers will be vital to adopt the proposed Workload Indicators of Staffing Need (WISN) method in staffing the different health departs to promote access to adequately staffed health facilities by women and children. While a lack the knowledge to utilize the WISN method in staffing may be a barrier, education and training will be vital to obtain their support. As such, maternal and child health departs staffed based on the patients’ need to improve the quality of care. Other stakeholders may be policymakers that formulate policies of staffing ratio and medical and health training institutions responsible for training more health personnel. The community members, especially pregnant women and children, are also stakeholders since limited access to adequately staffed health facilities affects health outcomes. Creating awareness about the project will be vital to obtain their support.

Funding and Sustainability

Adequate funding will guarantee project success and sustainability. Different costs are associated with this EBP project. First, the project will incur costs related to researching staffing problems in Vietnam and potential interventions to remedy the problem. For instance, the project requires finances to purchase the internet required in the research process. Secondly, the project will incur costs related to creating awareness about the project. In this case, the project will require educational materials such as pamphlets distributed to the various stakeholders informing them about the project. Transport costs may also be incurred to conduct campaigns aimed at creating awareness among community members. Nonetheless, the project will incur costs associated with training programs for health managers about the Workload Indicators of Staffing Need (WISN) method. Implementing the project may also require hiring and recruiting a health workforce that requires finances.

One of the potential financiers for the project is the government. Submitting a grant proposal with the project’s expected budget will be vital to obtain the required funding. Charitable organizations and well-wishers educated to improve access to quality care may also provide the required funding for the project. Subsequently, gaining full stakeholder support is one way to improve this project’s sustainability. Quality improvement on strategies to improve staff recruitment, retention, and staffing strategies will improve the outcomes. Health managers’ continuous training on the Workload Indicators of Staffing Need (WISN) method will promote sustainability.

Evaluation and Analysis Plan

Project evaluation and analysis will be instrumental in determining whether the EBP project effectively addresses limited access to adequate healthcare facilities among pregnant women and children in Vietnam (Chan et al., 2020). First, quantitative data on the children’s mortality rates will be adequate to determine whether the project addressed the problem. In the analysis, a decrease in the maternal and children mortality rates will imply the project was successful as the selected patient will have access to adequately staffed facilities. Secondly, qualitative data on health managers’ perspectives, attitudes, and experiences on using the proposed Workload Indicators of Staffing Need (WISN) method to staff departments will improve care accessibility. In this case, positive experiences, attitudes, and perspectives on using WISN models to staff healthcare departments based on the needs will imply success. Qualitative data will also be collected from the pregnant women and mothers about the quality of care measured through metrics such as patient waiting times and availability of care providers to address emergencies among pregnant mothers or children. Reduced patient waiting times and adequate availability of healthcare professionals during emergencies will imply success.

Lessons Learned

One of the major takeaways I have learned is that health and well-being influence human resources positively. As such, Vietnam is an excellent example of how good health and well-being can lead to the development of a self-sustainable economy. As a developing country, Vietnam requires adequate human resources to invest in fast-growing small-scale enterprises to promote growth and development. Therefore, improving the nation’s healthcare system will be vital to achieving the desired outcome of becoming a high-income economy. Although Vietnam lacks a universal healthcare system, strategies such as government policies and creating a national health insurance system based on a single-payer system will ensure all citizens have equal access to affordable and quality care. I also learned that the current out-of-pocket spending people to healthcare disparities caused by the social determinants of health. Vulnerable populations such as pregnant women and children, especially those from minority and ethnic rural communities, are highly affected by these health care disparities.

One of the significant problems I noted in Vietnam’s healthcare system is inadequate healthcare expenditure, leading to healthcare gaps related to inadequate health infrastructure or capacity, understaffing, and unavailability of medical equipment. The healthcare gaps are linked to poor healthcare quality, patient outcomes, and patient satisfaction. However, I learned that carefully designed and implemented financing policies are instrumental in addressing health-spending problems. For instance, payment and contracting arrangements incentivize care coordination and improve care quality through time and sufficient fund disbursement to promote adequate staffing, supplies, and equipment for care provision.

Of importance, I learned that evidence-based interventions are critical in addressing modern-day healthcare problems. Evidence-based information allows the government, healthcare providers, and policymakers to prioritize quality care and patient safety. I will use the acquired information to become an evidence-based practitioner. In this case, I will use evidence-based interventions to meet patient needs. While patients have diverse health needs, healthcare professionals have different responsibilities to provide required healthcare services. In this case, I will become an interprofessional team member to collaborate with other healthcare professionals to ensure that patients receive the best available healthcare services for improved healthcare outcomes.

Conclusion

While Vietnam continues to make economic and social advancements toward becoming a high-income economy, the nation’s health state should be prioritized to address current and future health disparities as healthy people contribute one of the most vital development resources. The current plan to establish a universal health system will be vital to improving healthcare in Vietnam. Disparities such as health inequity continue to limit access to quality and affordable care. For instance, limited access to adequately staffed health facilities has been linked with increased maternal and child mortality rates. However, evidence-based interventions such as using WISN will address staffing problems, while staff recruitment and retention strategies are critical to remedy the problem. Seeking stakeholders’ support and required financing will promote the implementation and sustenance of the project. Lastly, the evaluation and analysis plan will determine whether the project has achieved the desired purpose.

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References

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