Social Insurance and Public Assistance Discussion

Isabella is a 4-year-old girl who showed signs of a viral illness that did not seem to get better for 2 days. Her mother, Sonia Ramirez, took her to a local walk-in clinic, where she was reassured that Isabella had a bad cold but would recover within a few days. She was given a teaching sheet about viral illnesses that, after getting home, she realized she could not understand. The next day, however, Isabella was barely responsive and had numerous dark purple spots. Her mother rushed her to a local emergency room. Isabella was intubated and airlifted via helicopter to a major medical center, where she was diagnosed with meningococcemia, a life-threatening infection.

undefinedIsabella subsequently had bilateral amputations of her legs for gangrene secondary to poor perfusion. After a long hospitalization, she was transferred to a rehabilitation facility where she was fitted with prosthetic legs. Sonia quit her job to stay with Isabella throughout her illness and recovery. When Sonia quit her job, her insurance benefits ended, and she could not afford to pay for continuing insurance coverage.

undefinedDiscuss all of the questions below:
Isabella’s health care bills were enormous.

• What is the role of private insurance in paying these bills?
• What is the role of public assistance?
• What is the role of the nurse in containing these costs?
• Do you feel that health literacy played a role in the patient’s outcome?
• If so, how?
• Do you think Sonia should have continued working through Isabella’s illness in order to continue insurance coverage?
• Would you feel differently about who is accountable for paying the bills for caring for this patient if the patient had been a morbidly obese adult who lived with unhealthy eating and exercise habits?
• Is this a display of incivility?
• If so, what are some possible destructive consequences of this incivility, including the financial implications for the patient and rehabilitation facility?
• How could each of the following nursing roles advocate for Isabella: educator, manager, researcher, activist?
• How could the contemporary care delivery model of patient-centered care, used by an interdisciplinary team, effect the care and outcomes for Isabella?
• What is the RN’s role on that team?

Discuss these questions as well:

You are a nurse working in this rehabilitation facility. You have a peer in this facility who disagrees with your feelings about Isabella’s current employment decisions. This peers make derogatory, demeaning statements about your feelings for this situation.