Have your health administration/ management assignment completed by a professional healthcare academic writer
Health Administration Paper Writing Service
Health Administration Assignment Help Services
Struggling to complete your health care related assignment? Brainstorm Essays is a reliable source of high-quality health/ medical administration academic papers. With a dedicated team of professional health care writers, you are assured of quality, non-plagiarized papers delivered on time.
Health care systems management or health systems management refers to leadership and management at all levels of health care systems, hospitals, and hospital networks. In the United States, however, “health care management”, “health administration”, or “medical and health services management” describes the management of a single institution.
Handling class assignments can be challenging especially for medical students who apart from theory work, are busy with the practical aspect of the course. Moreover, some students study part-time or online hence; balancing school and work becomes a challenge. Brainstorm Essays takes some of the load off your shoulders by giving you a unique platform to hire some of the best writers you can find online with a background in healthcare management. If you need help with your healthcare management assignment, you have come to the right place.
We offer healthcare management assignment help services to medical students pursuing health administration degree programs and courses from the universities in the US, UK, Canada, Australia, Malaysia, New Zealand, etc. Indeed our writers have helped thousands of undergraduate, diploma, Masters, and Ph.D. students in tackling various healthcare related assignments with positive results. You too can have your healthcare management assignment completed by an experienced writer within a specified deadline. If you have pending health care homework, then please feel free to place your order, and one of a qualified homework help writers will be assigned to help you instantly.
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The internet is, without doubt, a great place to find cheap, efficient, and fast service. In fact, research shows that the number of students seeking assignment help online has grown over the past few years and is set to grow even higher in the coming years. Unfortunately, the online environment is not as safe as desired. Cons have found an easy way to swindle unsuspecting users out of their hard earned money and privacy is also compromised.
Therefore, health administration students seeking writing services online ought to be careful when choosing a paper writing service. At Brainstorm Essays, we are cognizant of the fact that many online writing services have tarnished the reputation of academic writing industry by exploiting innocent students. As such, we strive to restore confidence by rendering unmatched writing services online. For instance, we allow students to pay on delivery, which means customers get the chance to examine the quality of the paper before paying a single cent. What’s more, our online health administration writing services are safe to use because we don’t ask for personally identifiable information. All we require to complete your paper is a working email address and your paper instructions.
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Many health care students need paper writing services but cannot afford the exorbitant prices set by the majority of paper writing companies online. It may seem reasonable to charge highly for healthcare related projects because of the expertise needed and the intensity of research and amount of time taken to complete a paper, but the bottom line is that students have tight budgets. Brainstorm Essays is perhaps one of the most understanding health administration/ management paper writing services online. Our pricing strategy balances students’ budgets and fair compensation of our writers leaving the company with a decent profit, which is an accumulation of small profits made per order.
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Sometimes students search for a particular health care topic, and they come across ready papers or companies selling similar papers. While this may appear to be a shortcut, it is very dangerous especially for students who submit such papers as their own. To avoid plagiarism and to ensure papers submitted for grading are original, it is advisable to buy a custom paper as opposed to prewritten or one that has already been sold to many other students.
To get a custom health admin paper, it is advisable that you take time to discuss with your assigned writer how you want your paper to be written, submit unique content to be included, and generally, give detailed instructions to guide the writer in producing an outstanding paper. Brainstorm Essays is a custom health administration/ management essay writing service with a great reputation online for delivering quality custom papers. If you are a student struggling with your healthcare-related essay, then simply submit your paper instructions to us, and our writers will ensure you get a custom paper within the shortest time possible.
Duty of Care Assignment Help
Looking to hire a good writer to help you write your duty of care assignment? Look no further! We offer duty of care assignment help services at an affordable cost. Duty of care simply refers to a moral or legal obligation to preserve the safety or well-being of others. In health care, it involves acting within your competence and avoiding activities or taking on anything that you cannot do safely. Our competent writers will help you write an excellent paper that discusses in detail the various topics that fall under duty of care assignment. For instance, duty of care assignment help may touch on areas like the importance of duty of care in healthcare, healthcare provider's duty of care, duty of care responsibilities, elements of negligence, difference between duty of care and standard of care, duty of care in workplace health and safety etc.
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The Best Health Care Academic Writing Service
Considering an increase in the number of academic writing companies online, the best health care academic writing services are hard to come by. In fact, nearly every company claims to be the best, but the majority of such websites are a complete rip-off because of the shoddy work they deliver. Before you hit the keyboard searching for “the best health care academic writing service”, you need to, at least, have a list of qualities to compare against. Some of the qualities that ought to be a priority include timely delivery, affordability, quality, and more importantly, confidentiality. Brainstorm Essay has, on numerous occasions, been voted one of the best health care academic writing services online. The best thing about our service is transparency. We are not in the business to swindle you out of your hard-earned money. Therefore, we let you take charge of every order you place on our website. The fact that we allow customers to pay on delivery shows that indeed we are committed to quality.
Reliable Health Administration Essay Writing Services
Indeed there are many essay writing services online, but finding a reliable health administration/ management essay writing service is not a walk in the park. The majority of essay writing companies hire general academic writers who cannot be trusted to handle healthcare related essays/ assignments. Worst, some of the online companies are after money hence they do not monitor their writers to ensure they deliver quality consistently.
To avoid losing money to unreliable health administration essay writing companies online, consider hiring our professional writers. As trusted company online, we understand the importance of ensuring consistency in quality of papers submitted for grading. Therefore, we hire reliable writers who operate within strict guidelines to offer the much need academic assistance to health care students. What’s more, our services are open 24 hours a day 7 days a week, and we ensure timely delivery of all orders placed on our website.
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Confidentiality is an important aspect of academic writing help. In fact, the reason some students are reluctant to ask for academic writing help online is that they fear accusations of cheating and possible set up by fake writing companies. Brainstorm Essays is a company with a difference. We take your privacy seriously and will not trade your information for anything. In fact, not even our writers have access to your email. We also do not require personally identifiable information like name and the university/ college you are enrolled in to serve you. All we need is a valid email address we can use to deliver the finished product and your paper instructions.
Health Management Paper Writing Service
Looking for a legit health management paper writing service? Look no further! Brainstorm Essays is a trusted source of quality, non-plagiarized health management papers. As you strive to gain the relevant healthcare management practical skills, our service will help you handle class assignments. Some of the health management topics our writers have encountered include hospital administration, universal health care, medical advancements, healthcare polices, illness treatment procedures, health laws, clinical issues, etc. The best thing about our paper writing service is that we are committed to the delivery of quality papers. We understand the need for in-depth research and use of scholarly sources to write excellent academic papers. Therefore, by placing your order on our website, you are assured of outstanding healthcare papers that guarantee excellent grades.
Healthcare Management Assignment Help
Struggling to complete your healthcare management assignment? We have a team of experienced healthcare writers ready to assist. As a trusted homework help service, our health management assignment help services are ranked highest online by thousands of satisfied medical students. Whether it's an undergraduate, masters, or PhD level healthcare management assignment, our reliable writers will deliver an outstanding paper.
Health Information Systems
Just like nursing informatics writing services, health informatics essay writing services are hard to find. This is because finding expert academic writers with a solid background in health informatics is not easy. At Brainstorm Essays, we employ competent writers who are well versed with health informatics concepts including expertise in writing health information systems (HIS) papers. Given that strong health systems are core to achieving better health outcomes, it is important that you hire a writer who will help you produce an outstanding paper that demonstrates your knowledge of health information systems.
Long Term Care Essay Writing Service
Struggling with an essay assignment on long term care? Brainstorm Essays has you covered. We have a dedicated team of healthcare writers who are competent enough to deliver outstanding papers on long term care. Whether your essay topic seeks to explore long term care insurance or long term care in an institutional setting, a community, or a home setting, our writers guarantee excellent essays.
Health/ Medical/ Administration Essay Writing Service
One of the most sought after writing services online is health administration essay writing service. Medical students are required to complete several academic essays to discuss various healthcare concepts, but they often struggle to strike a balance between school and work. To avoid failing a course or scoring bad grades, medical students have turned to professional writers for academic help. Brainstorm Essays is one such service that has helped thousands of medical students complete their health administration academic essays. Our service is not only affordable but also adheres to academic writing quality standards.
Related: Healthcare essay writing service
Health/ Medical/ Administration Term Paper Writing Service
A health care term paper is a detailed research paper required at the end of an academic term/ semester. The paper accounts for a larger part of the grade and aims to track and evaluate the knowledge of a student about a health care course. More Importantly, Health care Term Papers are intended to describe an argument, event or a concept. If you are having a difficult time completing your health administration or any healthcare related term paper, then Brainstorm Essays is the right place to seek help. We have a dedicated team of experienced term paper writers always on standby to help you tackle any healthcare related term paper.
Health/ Medical/ Administration Dissertation writing service
A health care dissertation is a long essay written by medical students on a particular subject for a university degree or diploma. Given the intensity or research and the time required to complete a dissertation, medical students often find themselves in last minute rush or even end up delivering poorly written dissertation way past the deadline. To help you beat the deadline and submit outstanding health administration/ health care management dissertation paper, our writers are available 24 hours a day 7 days a week armed with the necessary skills and expertise. Simply fill out the order form provided, and our thesis/ dissertation writers will follow your detailed instructions to produce a paper that guarantees excellent grades.
Health/ Medical/ Administration Research Writing Service
Do you have a medical/ health care research paper and wondering how to go about it? Make your work easier by engaging the services of our expert academic writers. Our company constantly hires professional medics with a passion for academic writing to offer academic assistance to health care students struggling with their research paper assignments. Given their experience both in practice and writing academic research papers, you are assured of quality, in-depth research papers that will undoubtedly impress your professor and in turn help you to score excellent grades. Today, thousands of medical students are engaging research writing services of professionals as they concentrate on revision and practical aspect of the course. You too can receive instant help. Our service is confidential and offered professionally. What’s more, our writers have access to medical databases, which gives them an edge over the others as regards evidence-based research.
Health Administration Writers
Looking to hire a professional health administration/ management writer with a vast background in health care? Look no further! Brainstorm Essays maintains a team of expert health care writers always ready to help students in need of academic writing services.
Experienced Health Admin Writers
Experience is a key factor every medical student ought to consider before settling on a particular writer for help with healthcare assignments. The reason is simply that experienced health admin writers have been in the industry long enough to experience various challenges and tackle different health care topics than armature writers. What’s more, experienced health administration/ management writers understand the importance of delivering quality papers as a way of maintaining and expanding a loyal customer base. As such, they accord every health care paper the seriousness it deserves. Lastly, experienced writers pay attention to detail. Considering the critical role health care assignments play, it is important to hire someone who is detail-oriented and one who is willing to take time to do detailed research in order to produce an outstanding paper.
Professional Health Administration/ management Writers
Although the internet is considered a great place to find assignment help services, it is also filled with mediocre writers claiming to offer health care writing service when in actual sense they’ve never set foot in a medical class. At Brainstorm Essays, we offer you a unique platform to hire professional writers screened by us. As professionals, they take academic writing seriously since it forms a significant part of their income generating activity.
Expert Health Administration Writers
An expert is defined as a person who is skillful or very knowledgeable in a particular area. Therefore, if you want an excellent paper that guarantees an “A” grade, hiring an expert writer is a must. An expert writer in health administration understands the various health care concepts and knows exactly what instructors/ tutors/ professors look out for when they issue assignments. Brainstorm Essays boasts of some of the best health administration/ management academic writing experts you can find online. Place your order now to enjoy quality services at competitive prices.
Native English Speakers
Hiring a native English speaker to write your assignments is very important. This is because the internet is full of both native and non-native English speakers hence increasing the risk of hiring someone who will mess your paper with poor grammar, style, and other language issues. Our company only hires native English speakers from English speaking countries such as the US, UK, Canada, Australia, Malaysia and New Zealand to offer health care academic assistance. What’s more, our writers use Grammarly to eliminate language related issues before submission as a way of improving the quality of your paper.
Health Care Writing Services in the US, UK, Canada, Australia, Malaysia and New Zealand
We understand that some health care papers adhere to country-specific guidelines and students will always strive to find writers in the said countries to complete their assignments. To ease your search, we have a pool of writers drawn from major countries such as the US, UK, Canada, Australia, Malaysia and New Zealand ready to assist. All you need to do is specify in your instructions whether you need a US, UK, Canada, Australia, Malaysia or New Zealand-based writer and our support team will match your specification with the writer to ensure you receive a quality paper that meets the country-specific guidelines.
Brainstorm Essays is your reliable source of high-quality essays, research papers, dissertations and all types of college/ university class assignments. 100% original content written by experienced writers
Examples of courses Under Bachelor of Science in Health Administration that our writers can comfortably assist.
Bachelor of Science in health administration deals with programs that focus on equipping students with communication skills and knowledge on ethics, finance and technological developments in the healthcare industry. It involves the collaboration of case studies, use of updated software and simulations that are utilized in learning. It ensures the involved students acquire the necessary foundational skills needed in helping others that face health-related problems through the alignment and attachment in institutions such as the “American College of Healthcare Executives” (ACHE). The approval of this degree by the “Health Information and Management System’s Society” (HIMSS) enable it to deliver healthcare information technology (IT) courses that include learning and understanding technological advancements in the healthcare industry like electronic medical records (EMRs). It also offers career and networking opportunities for students to explore through HIMSS membership. Below are some of the core courses that are provided under the Bachelor of Science in Health Administration.
Fundamental of electronic health records
This course purposes to provide students with the knowledge and skills required in the comprehensive understanding of electronic health records including the functions, features and skills needed to operate them effectively. Additionally, it also explores the software used, access to information provided by EHRs like patient records, workflows and information systems. The billing features if EHRs is also explored under this course. Therefore, in this course, students learn all aspects of the EHR use and implementation in healthcare centers.
Medical terminologies for healthcare professionals
Healthcare professionals use terminologies that are different from other professions to have a better understanding of their working environments. The study of these terms in the healthcare industry is referred to as medical terminology. In this course, students are equipped with knowledge on terminologies used in the healthcare industry to enable them to communicate effectively with others. These terminologies range from diseases and their symptoms among others. Therefore, students learn the pre-and suffixes of words, abbreviations used in healthcare and pronunciations. For instance, gastric in healthcare industry refers to the stomach in nonprofessional’s language.
Business communication skills for healthcare professionals
This course focuses on equipping students with the necessary business skills needed to ensure proper physician-patient and colleagues’ relations, rapport creating and provision of efficient client service. Moreover, they learn the verbal and nonverbal ways of interacting with patients and distinguish the wrong from the necessary ones. Hospital setting examples are set up during classes to understand the communication between colleagues and patients. Through these examples, students learn alternative ways to deal with various issues that arise in the healthcare industry without ruining the rapport with patients and client service.
Healthcare delivery in the United States
This course offers a summary of the U. S healthcare systems, the historical background, institutional service models and service provision systems like mental and ambulatory care in private and public medical centers. It also outlines the trends that influence the healthcare systems like technological advancements and government policies. It also looks at the impact funding has on the provision of medical services to patients in the United States. Moreover, it looks at the health and treatment outcomes for various providers and measures incorporated in the healthcare centers.
Healthcare professional development
This course focuses on the various ways healthcare professionals can improve their skills and careers. It looks at the various career opportunities in the healthcare sector, which gives students various departments to choose from and venture in from doctors, opticians, cardiologists and dermatologists among others. It also gives a summary of the expected leaning outcomes of the course and the bachelor degree and organizations that present these opportunities.
This course equips students with the needed administration skills. It also focuses on examining the various types of organizational structures in the healthcare institutions. It expounds on the administrative roles like control, organizing, planning and directing among others utilized by healthcare administrators. It also looks at the several problems faced by the administration of healthcare centers. Therefore, it ensures that students that become administrators can effectively run healthcare institutions.
Healthcare ethics and social responsibility
Ethical practices in the healthcare industry are essential as failure to comply with the set laws leads to loss of medical licenses. Therefore, this course identifies the various unethical practices in the healthcare industry and looks at ways that healthcare professionals can avoid them to ensure their licenses are safe. Moreover, it offers students with the knowledge needed in the controlling and handling of various types of patients and populations.
Human resources in healthcare
Human resource involves the control and handling of healthcare personnel in medical centers. This course offers students with sufficient knowledge on ways to handle various personnel and their posts in the healthcare industry. It also looks at the various issues faced by the human resource department in most healthcare institutions. These issues are mostly faced in the recruitment, training and development of employees in the healthcare industry. The course investigates healthcare personnel and organizations performance and expounds on the various federal laws governing operations in the healthcare industry.
This course focuses on the conduct of various employees, departments and their impact on the organization. It also looks at the decision-making models and processes utilized by managers and employees in making organizational decisions. Further, it looks at the organizational leadership, its culture and means of solving the different forms of conflicts that arise in the healthcare institutions.
This course provides students with knowledge of the accounting practices in the healthcare industry. It equips them with knowledge on the accountability, responsibility and management of accounts books in the medical centers. Accounting basics are also studied.
This course outlines the various financial expenditures and revenues for healthcare institutions. It discusses the various budgets, income sources and their expenses to ensure accountability of available finances. It also outlines the various effects of financial issues like shortage of funding to the delivery of healthcare services in the institutions.
Healthcare quality management and outcome analysis
Healthcare services are standardized by various quality assurance organizations. The students under this course study the various regulatory bodies, their rules regarding healthcare and the punishments faced by organizations that do not comply. It also evaluates organizational performance and the quality of care provided by medical institutions. It also reviews the various healthcare quality issues, trends that influence the quality and costs as well as the recognition of involved parties in healthcare quality management.
Public and community health
This course equips students with knowledge on the various aspects of community health. It also looks at the various ecological influences on disease outbreaks and measures to prevent these illnesses from having damaging impacts on the community. Moreover, it discusses the developments on research done on community health and the impact of execution and rectification of errors from research findings to the communities.
Healthcare research utilization
Research in the healthcare industry is important as it leads to the development of vaccines, cures and identification of causative agents for diseases. Therefore, this course provides students with information on the various research techniques and the utilization of findings obtained from the different studies. For instance, the development of vaccines enables healthcare professionals to curb illnesses early before infection and also lead to the reduction of the affected individuals relieving pressure in the healthcare institutions.
Healthcare information systems
The use of technology in the healthcare industry is evident from the use and adoption of electronic health records and radiology equipment among others. This course equips students with knowledge on the use, adoption, impact and execution of technological advancements in the healthcare industry. It also looks at the various types of software that can be utilized in the healthcare institutions to have better outcomes.
Healthcare consumer trends
Consumers are the most important persons in the service industry as they offer first hand feedback on the satisfaction of products and services offered to them. In this course, students look at the various client preferences and means through which they can improve the provision of healthcare services to ensure client satisfaction.
If you are looking for professional help with assignments in any of these courses or any topic under health administration, then Brainstorm Essays is the right place. Our services are affordable and we guarantee quality, non-plagiarized papers delivered in a timely manner.
Sample Healthcare Management Paper #1
Electronic Health Record Implementation
Acquisition through vendors is a great way of implementing the electronic health record, especially where in-house development is not feasible. One of the advantages of outsourcing is that it allows access to vendor expertise and can sometimes be cheaper than in-house development especially where infrastructural costs are involved. Therefore, this paper will examine the steps that I would follow to implement the EHR as a project manager in one year time.
The first step is Assessment. Implementing EHR follows a genuine business need, a concrete value proposition, and justifiable gain after implementing the software. In the scenario described, The reason for wanting to transition to electronic health record is to not only claim the financial incentives under the meaningful use program of the government, but also to improve the charting functions to facilitate accuracy and accessibility. With business justification in place, it’s important to involve the top management in decision making before proceeding with the Acquisition process. Assuming the process is approved, the next step would be vendor selection.
This step is about finding the right company to supply the desired system. To ensure success in this process, it would be important to create an evaluation team that comprises functional experts, top management, and end-users. Specifically, the team would be tasked with the responsibility of evaluating the software vendors to determine their credibility and quality of services and systems they sell. Comparing vendors is also important to ensure the best vendor is picked (HealthIT.gov, 2018). It is also important to assess the current state of the healthcare facility by looking at the critical processes and noting down the benefits the new system can deliver for the said processes.
Under vendor selection, another important step would be to consider the EHR specifications that meet the meaningful use criteria. According to Appari, Johnson, and Anthony (2013), meaningful use, in a health information technology context, refers to the U.S government’s minimum standards for using EHR. It also covers issues such as the exchange of patient data between healthcare providers, between health care providers and patients, and between healthcare providers and insurers.
The step involves assembling the project team. There's a need to set up a governance structure, which may be a governance board or steering committee. The purpose of this committee would be to assist the managers in assessing the current state of the project as well as adjusting content and direction when and if necessary. Typically, the committee would comprise the project sponsor, project management office, project manager, and business unit managers that have a vested interest in the success of the project. Indeed it is a time-consuming process, but a crucial step in the implementation process.
The process involves sending out the functional leads to interact with the business process experts from the vendor side with the intention of identifying the important processes that ought to be included in the EHR. Once the processes have been fully identified and reengineered, the next activity would be to document, while keeping it simple.
First Software Build Out
The next step would be the first software build out. The functional leads would be required to transfer the EHR requirements to the technical team for programming and configuration based on the healthcare facility’s need. At this stage, the software is usually 85 to 90% built. Without a doubt, this step is important because it allows the project team to validate whether the technical team is on track or not and what needs to be adjusted before the end product is delivered. This process may be repeated at least twice in what is known as rinse and repeat to ensure the EHR system is functional, free of software bugs, and usability issues are fully addressed.
User acceptance testing
At this stage, the EHR system should be ready for the users. It’s important to conduct in-depth user testing of the EHR software with every business process from every function of the healthcare facility. The selected vendor must be available to collect responses and should there be any issues during the user acceptance step, the vendor will have to complete another final round of software configuration before going live. It is important, at this stage, to offer final user training to ensure the end-users use the EHR system as intended
Once the system has been accepted, it’s time to begin the transitioning process from the paper system to the electronic health record system. This involves proper planning, preparation and ultimate execution of the changeover. Considering the importance of the patient data that needs to be transferred to the new system, it's important to have a contingency plan in place (HealthIT.gov, 2013). Therefore, I propose parallel changeover for a period of two months. While this method is considered costly, it is more costly to mess with patient data.
The go-live Event is important because it is the actual day the new system will be opened for the users to transact. On this day, one of the important activities is to ensure functional resources are efficiently deployed to key locations to provide adequate support.
The last step is the post mortem which involves project closure and documentation of the lessons learned. As the project manager, my duty would be to compile a final checklist to ensure anything that ought to have been done is fully completed. Responses regarding lessons learned can be collected from the project team through a questionnaire.
Appari, A., Eric Johnson, M., & Anthony, D. L. (2013). Meaningful use of electronic health record systems and process quality of care: evidence from a panel data analysis of US acute‐care hospitals. Health services research, 48(2pt1), 354-375.
HealthIT.gov. (2013, Feb 27). What are the key steps of the electronic health record (EHR) implementation planning phase? Retrieved from HealthIT.gov: https://www.healthit.gov/faq/what-are-key-steps-electronic-health-record-ehr-implementation-planning-phase
HealthIT.gov. (2018, Aug 3). How do I select a vendor? Retrieved from HealthIT.gov: https://www.healthit.gov/faq/how-do-i-select-vendor
Sample Healthcare Management Paper #2
Benefits and Challenges of Patient Portal Implementation
Electronic health records have been in existence for more than a decade. Over the years, they have been used as tools to enhance patient outcomes in conditions that demand consistent patient follow up. Recent advancements have increased the applications of electronic health data to provide online access to data for patients and doctors. For instance, patient portals have the ability to complete the circle of care by linking patients to their caregivers directly. A number of studies have been done to support the impact of patient portals in diabetes care. This literature review aims to analyze data from various researches to determine the impact of patient portals on patients suffering from diabetes.
Most research papers on the impact of patient portal systems have managed to highlight several advantages of using the systems. For instance, the research by Lau, Campbell, Tang, Thompson, and Elliott (2014) undertook a retrospective observational study with a hospital set up in British Columbia. The research used an electronic health recording system supported by a patient portal that was coupled with staff support. Access to the patient portal was free and was aimed at providing a question and answer system for doctors and patients; updated laboratory data and a journal. The results of the study revealed that the management of diabetes has significantly improved once the patients were provided with medical information support through the patient portals. Moreover, better health outcomes were also identified in patients who made more use of the patient portal systems to seek knowledge on diabetes and self-care capabilities. Lau et al. (2014) also managed to show how the results on patient outcome were independent of the type of diabetes since both type one and type two showcased similar results in the value of patient care.
Additionally, Or, Calvin and Da Tao (2014) also undertook a study that sought out to evaluate the impact of consumer health information on the outcomes of self-managed diabetes care. The main hypothesis of the study was that CHITs have the potential to significantly improve the patient outcomes in diabetes patients. In comparison to EHR, CHITs are tailored to the general public rather than to individual patients. They represent information that is available for all to view and utilizes. Patients who made a self-concerted effort to seek CHITs showed changes in their behaviors and self-monitoring frequencies. Consequently, the use of the CHITs showed a positive increased in the medical outcomes. The results indicated a 64 % increase in diabetes outcomes measures. In this way, it also supports the ability of patient portals in increasing patient outcomes.
Kruse, Clemens Scott, Katy Bolton, and Greg Freriks (2015) add to the discussion by evaluating the concept of meaning full use and how it impacts the applications of patient portals. The health and information technology for economic and clinical health compels health organizations to be aware of the meaning full use qualification. The requirement is seen to increase the participation of the patients in medical decision making but the implications on the patient outcomes had not been evaluated. Kruse et al. (2015) purposed to review the results from other patient portal quality use and evaluate how meaningful use has impacted the patient outcomes. They used data-driven research papers and related them back to the criteria of meaning full use. The results indicated that the use of patient portals resulted in improvements in awareness of the disease improved medical treatment adherence, and decreased hospital visits, increased self-management capabilities. Additionally, the study also showed an increase in satisfaction and quality of health care provided. Consequently, more organizations are making use of the patient portal to increase patient outcomes.
Challenges of implementing patient portals identified in various research papers revolve around various factors associated with the patient side. Ketterer, West, Sanders, Hossain, Kondo, Sharif (2013) identified the socio-economic barriers that exist in the success of patient portal enrollments. The study assessed predictors of enrollments such as demographics and clinical perspectives in pediatric primary care population. It used a cross-sectional analysis of a children’s hospital database composing of 84,015 children over a duration of 4 years. The results indicated that only 38% of the children enrolled and even a lower percentage managed to activate their accounts. The statistics indicated lower levels for low-income families, adolescents, recipients of Medicaid and patients of minority ethnicity. The results of this study are significant as they evaluate the sociodemographic disparities that are available in patient portal outcomes. The impact of patient portals can be decreased in cases where there exist such socio-economic disparities.
Irizarry, DeVito, and Curran (2015) also supported the potential for patient portals to improve care by promoting engagement between patients and their health providers. The research aimed at reporting the findings from literature reviews on diabetes patients making use of a patient portal. Through an electronic literature search, the researchers were able to identify controlled practices that had defined outcomes. The results indicated that patients had registered for accounts and had a record of using their portals had improved outcomes when compared to their peers.
Another key issue that affects the impact of patient portals in diabetes patient outcomes is the motivational factors. There are various factors that affect the motivation of patients in feeling self-empowered to follow the guidelines provided either through EHR or CHITs. These factors have been argued out to have significant impacts on the value of patient portals in institutions. For patients who make voluntary use of the systems, have greater potential to witness improved outcomes. Additionally, the patient outcomes are also affected by the literacy levels and the ability to make appropriate use of technology provided. Using an online portal and the level of improvement witnessed are factors of the literacy and motivation of the individual patients.
In light of the need for patient motivation and adequate literacy, the importance of Internet-based patient portals have been underscored by a number of researches. Kruse, C.S, Bolton, K. &, Freriks G. (2015) argue out that the ineffectiveness of the patient portal systems is visible in the way self-management is not always a sufficient mechanism of improving care. Other factors identified were such as the knowledge of diabetes versus the information given, the choice of technology, the need for confidentiality together with social concerns associated with the surrounding community. These factors are poised to decrease the significance of patient portals in instigating significant change in diabetes patient care outcomes.
Sun, Korytkowski, Sereika, Saul, Li, and Burke (2018) highlight the various uses of patient portals in managing diabetes patient care. For instance, patients can comfortably perform medical tasks such as look at their summaries, view their lab results, communicate with their care providers and manage future appointments. The portals are advancing to be capable of recording patient symptoms and self-care results such as the blood pressure and glucose readings. The increased effectiveness of care delivery is the main reason for the adoption of the patient portals by organizations.
The impact of portal systems has also been evaluated by considering the perceptions of patients. For instance, the research by Irizarry et al (2015) outlined the way in which patients were more satisfied with the portal features offered. The results of the study indicated that the patients were more aware of their health status and more willing to make deliberate attempts at improvement. However, while patients made extensive use of features such as the recording blood pressure Irizarry et al (2015) noted that they made limited use of other features. It was also noted that different patients had a varied frequency of use that declined for all patients over time. Patients highlighted issues such as the difficulties in navigating the portal together with the lack of user-friendly design that is simple and captivating. These issues raise the concern of the need for focus on the design aspect in the impact of patient portals.
In light of the literature analysis, it is evident that patient care is enhanced through the application of patient portals. Various research papers have indicated an increase in the positive outcomes for patients suffering from diabetes and other conditions. However, the patient perspectives raise significant concerns about the application of patient portals. The decrease in the use of EHR over time by patients and the barriers are potential limiting factors that affect the long-term viability of patient portals. The question raised is what the resulting patient outcomes are in the long run. How do patient portals influence the long-term outcomes of patients suffering from diabetes? This paper seeks to answer these questions and add on to the research provided by other researchers.
Lau, M., Campbell, H., Tang, T., Thompson, D., & Elliott, T. (2014). Impact of Patient Use of an Online Patient Portal on Diabetes Outcomes. Canadian Journal of Diabetes, 38(1), 17-21. Doi: 10.1016/j.jcjd.2013.10.005
Irizarry T., DeVito D.A., & Curran C.R. (2015) Patient portals and patient engagement: a state of the science review. J Med Internet Res; 17(6):e148 [doi: 10.2196/jmir.4255] [Medline: 26104044]
Or, Calvin, K.L., & Da, T. (2014). Does the use of consumer health information technology improve outcomes in the patient self-management of diabetes? A meta-analysis and narrative review of randomized controlled trials." International Journal of Medical Informatics 83.5: 320-329.
Ketterer T., West D.W., Sanders V.P., Hossain J., Kondo M.C, Sharif I.K., Clemens S., Katy B., and Greg, F. (2013) "Correlates of patient portal enrollment and activation in primary care pediatrics." Academic Pediatrics 13.3 264-271. 10.1016/j.acap.2013.02.002
Kruse, C.S, Bolton, K. &, Freriks G. (2015) "The effect of patient portals on quality outcomes and its implications to meaningful use: a systematic review." Journal of Medical Internet Research 17.2 e44.
Sun, R., Korytkowski, M., Sereika, S., Saul, M., Li, D., & Burke, L. (2018). Patient Portal Use in Diabetes Management: Literature Review. JMIR Diabetes, 3(4), e11199. doi: 10.2196/11199
Sample Health Administration #3
Minors and their Right to Consent/ Privacy
Minors have a right to privacy just like adults do. This privacy cuts across all aspects of a minor’s life, but is at times difficult to grasp or define because minors are generally under the care of parents or guardians. Jackson, Burns and Richter (2014) observe that there are no clear, direct or comprehensive policies and legislation on minors’ rights and privacy in health care provision. In the first place, there is no universal definition of a minor; its meaning changes from one jurisdiction to another. In this paper, the concept refers to a young person of the ages 3 to 19 years. The common assumption is that parents and guardians understand all the rights of minors and know the limits of consent they can give. In most cases, this assumption is not true. The human society keeps changing, and laws evolve with time. Therefore, human rights have undergone constant reinterpretation in response to emerging issues and contexts. The aim of this paper is to discuss the current issues on the minors’ rights, informed consent, and confidentiality in health care treatment. The paper concludes by providing a summary of issues discussed and suggestions to improve minors’ privacy.
Understanding of consent and privacy
Consent refers to a voluntary agreement for treatment. Informed consent implies that the patient understands their condition, the nature of the proposed treatment and related alternative interventions, and fully knows the risks and benefits of the proposed treatments and interventions (Feierman, Lieberman, Schissel, Diller, Kim & Chu, 2015). Informed consent recognizes the inherent dignity of human beings as individuals. It also provides a framework to promote professionalism in medical practice. Both consent and privacy are issues of ethics as opposed to the law. However, as ethical principles, they receive reinforcement from the law and evolving policies.
Consent in the medical profession takes many forms. It can be verbal or written agreements as well as gestures such as nodding or giving out one’s arm for injection. The act of a patient visiting the hospital to seek specific treatment often implies consent. Failing to obtain informed consent is a type of malpractice which is punishable by law. Privacy or confidentiality mandates that a doctor, or anyone with legal access to patients and health information, should not disclose the medical information of a patient without the permission of the person who consented to treatment. In paediatrics, the responsibility for giving informed consent falls completely on the parents (Pascut & Aluas, 2016). However, the physician defines the content and extent of consent based on the nature of treatment sought and about existing federal and state laws. It also entails implied consent which is obtained automatically because the parent has brought their child for treatment.
Informed consent in the treatment of minors is majorly concerned with three aspects of health care. First, it defines those health services that a minor can seek without the consent of the parent or guardian as opposed to those that parental consent is mandatory. Second, it explores areas in which a parent or guardian seeks access to medical information of a minor. Third, it is concerned with aspects in which a doctor must seek the minor’s consent before sharing the minor’s medical information. Ethical dimensions in health care are constantly updated based on evolving laws, policies and practices.
Legislations on minors’ right to consent and privacy
The aim of all laws is to safeguard the rights and privileges of every individual irrespective of age or other demographic characteristics. Therefore, laws try to define right and wrong in all aspects of human life, including health care. There are laws that define how health care practitioners must administer services to minors. The American Academy of Paediatrics (AAP) (2003) observes that in the United States, the federal and state laws on minors’ right to medical confidentiality are often vague. Nevertheless, the governments in both levels have increasingly apportioned minors with the rights to make decisions about their health care. Some of these laws have received criticism for seeking to undermine the authority of parents. Some parents still feel the need to maintain authority over their children. Sometimes such strict authoritarianism in parenting acts as a barrier to health care seeking among young people. However, the legislations have come in response to the increasing recognition that not all families encourage free communication.
In some cases, seeking parental consent may, in fact, act as a barrier to reception of health care service by minors. Parents may feel the need to keep family secrets. Therefore, they may not allow their children to seek care on their own, lest they should be found to have crossed some moral grounds. In such situations, privacy as part of ethical practice entails barring the parent from the medical information of the minor. Some examples of these unique cases identified by AAP (2003) are abortion, birth control, screening for HIV and treatment for AIDS and other STIs. They also include cases of mental health, substance abuse, rape, incest and other forms of sexual abuse. The caveat in the above scenarios is that the minor must be old enough to understand their health condition and the implications of consent. The basis of this provision is the Mature Minor Doctrine legislation which defines the terms for relying solely on the minor’s consent in medical treatments (AAP, 2003). Such laws regard the minor as an adult capable of making responsible decisions.
Despite numerous legislations, health care professionals still hold great discretion over the disclosure of minors’ medical information. The fact that health care professionals have a greater role to play than, say, parents in matters of children’s informed consent and privacy, is a good thing in itself. These professionals are better able to elicit cooperation among minors because they (professionals) are impassioned and objective in their work; they do not harbour any vested interests, and they are trained to tackle problems affecting young people. In most cases, the doctor, the minor and the parent or guardian enter into a verbal agreement on confidentiality. In this agreement, the three parties involved affirm that the information that the minor will share with the doctor will remain confidential unless the physician deems from such information that the minor runs the risk of self-harm or bringing harm to others (AAP, 2003). There are specific provisions on the limitations of such an agreement.
Under the Health Insurance Portability and Accountability Act (HIPAA), adolescents who have attained the legal age, as well as emancipated minors, are eligible to give consent individually (US Congress, 1996). On the other hand, parents and guardians are responsible for giving consent on behalf of minors who are non-emancipated and those who have not attained the legal age. Under this provision of representation, these adults can have full access to protected medical information of minors. HIPAA also recognizes the unique cases in which minors have a right to consent to treatment. An additional provision allows a minor to give consent if the treatment can be administered legally without parental consent. Moreover, in emergency cases where delayed parental consent may threaten the life of a minor, doctors can waive consent to treatment (McNary, 2014). In such a scenario, if able, the minor’s consent is valid.
Minors’ treatment and confidentiality in health care
The privacy of medical information of every patient, irrespective of age or other differences, is guaranteed in law (Hickey, 2007). In most cases, when a minor has individually consented to treatment, they also have a right to make decisions on the disclosure of their medical information. In general, minors have limited privacy on sensitive medical procedures such as family planning, abortion, the treatment of infections transmitted through sexual activities, and the effects of substance abuse. However, the application of these laws varies across states.
Confidentiality of health care information for minors finds support in some federal and state-based health care organizations. For instance, according to Loxterman (1997), the American Medical Association confidentiality is crucial in the treatment of minors. AMA urges physicians to engage parents when dealing with health cases involving minors. However, the basis of parental involvement must be on the need to protect the health interests of the young patient. If the physician deems that parental notification may hinder a minor’s care, then he or she is legally bound to forego parental involvement. Parents may have othe agendas or interests when it comes to minors’ health care, such as the need to protect the family image. They may also be interested in consent situations to rein in more authority on their children.
Similarly, The American Academy of Paediatrics recommends that the physician must explain the policy on confidentiality to the parent right from the start of the professional relationship. Advisable, the physician can make this explanation both verbally and in writing. On its part, the American College of Physicians argues that physicians must remain abreast on all state and federal laws that pursue protection of the rights of minors as patients. The ACP also cautions that a physician must never disclose information regarding a minor’s health without the parent’s consent. The only exception, in this case, is where a court order requires the physician to release the information, and when the release of the said information is in the interest of protecting others. Moreover, The American Public Health Association posit that the privacy of health care information should be driven by the need to protect the needs of minors. In this case, physicians must protect the privacy of minors, including those who are sexually active and those who seek treatment for STIs and substance abuse related conditions.
Abortion and minors’ privacy
Abortion is a controversial issue the world over. It carries both social and political consequences. In the midst of all the politics around abortion, there are the real health challenges involved for especially women and girls. Pregnant women or minors may seek an abortion for several reasons. However, irrespective of the justification, abortion continues to attract controversial responses from different sections of society. The situation is worse if a minor is seeking to get an abortion. Kost and Henshaw (2014) estimate that there were over 600,000 documented cases of teenage (15-19 years) pregnancies in the United States in 2010. Of these pregnancies, 30% ended in abortion (Kost & Henshaw, 2014). These figures show there is a relatively high rate of abortion among teens in the US. What are the ethical implications involved in abortion among minors?
According to Planned Parenthood (n.d), most states in the United States require that a minor notifies parents before getting an abortion. For instance, in states like Arkansas, Arizona, Alaska, Colorado, Florida, and Georgia, among others, at least one parent must be notified and must give consent before an abortion. The only exception, in this case, is if court grants that the minor does not notify the parents either before or after abortion. This legal provision is known as a judicial bypass. Others simply mandate parental notification after a minor has had an abortion. However, in Hawaii, Washington DC, Maine, Nevada, New Jersey, New Mexico and New York, among others, no parental involvement is required in abortion by minors. These states do not require parental consent for abortion; they only require the minor’s consent. The American Public Health Association (APHA) (2011) argues that laws that mandate parental involvement put pregnant minors at risk by delaying treatment. Therefore, APHA recommends that federal, state and local policymakers and courts should stop enforcing parental involvement as a requirement for getting an abortion by minors.
Birth control and minors’ privacy
Sexual activity among teens in the United States is relatively high. In 2013 alone, over 46% of high school students reported that they had engaged in sexual intercourse within a period of twelve months (Hamilton, Martin, Osterman & Curtin, 2014). Of these, over 33% had had sex in the last three months. These figures indicate a high level of sexual activity among minors in America. The good news is that since the 1990s, there has been a decrease in teen pregnancy, and this is mainly attributable to increased use of contraceptives among girls (Kann et al., 2014).
There are many ethical debates when it comes to minors engaging in birth control. Parents get worried when there is a rise in the trends of birth control seeking behaviour among minors. Most of these debates often take the trajectory of gender parity. For instance, while no one would question a teenage boy for buying condoms, most people would most likely raise eyebrows when they see a teenage girl buying contraceptives. Social attitudes still shape most of the ethical views on issues of sex and sexuality.
The Guttmacher Institute (2017a) states that recent court rulings in the US have extended minors’ constitutional right to privacy in their decisions to obtain contraceptives. Accordingly, at least 21 states in America explicitly allow minors to consent to contraceptive services. Another 25 states require minors’ consent only in some circumstances involved in obtaining of contraceptives. One of these circumstances is when the doctor believes that there may be a potential health hazard. It also applies when the minor is married and if the minor is a parent. Another circumstance is if the minor is pregnant, a high school graduate, of minimum age, demonstrates maturity or when a specialized professional has referred the minor (Guttmacher Institute, 2017a). Nogales (2012) reports that based on research there is evidence to show that requiring parental consent for minors’ access to contraception results in the overall delay in seeking of reproductive health services. According to her, such laws do not play any role in reducing sexual activity among minors. As a result, there is a general opposition among health organizations in the United States against mandatory parental involvement as a precondition for minors’ seeking contraception.
Screening for HIV/AIDS, STIs and minors’ privacy
The Centres for Disease Control and Prevention (CDC) (2015) estimates that at least 4% of those who are HIV-positive in America fall in the age of between 13 and 19 years. CDC (2015) attributes the prevalence of HIV and other STIs among the youth to inadequate sex education, risk behaviours, high rates of STDs in general, the stigma around HIV and feelings of social isolation. These factors also play a role in health-seeking behaviour among minors. Young people are more prone to stigma and isolation when they suspect they have infections of such ailments than older people.
According to the Guttmacher Institute (2017b), all the US states require minors to consent to screen for STIs. Of these states, at least thirty-two include HIV screening in this requirement. The other eighteen states require that doctors inform parents about a minor’s seeking of STI services. This requirement includes informing the parent especially if the minor tests positive for HIV. Culp and Caucci (2013) have found that HIV pre-exposure prophylaxis without parental consent is unclear. They recommend that there need to evaluate state laws that support the provision of clinical interventions for HIV prevention. In most cases, minors would rather forego reproductive health check than endure holding an uncomfortable conversation with parents and physicians about their active sex life.
Mental health and minors’ privacy
Mental health problems among minors range from severe mental disorders to psycho-social distresses. Stagman and Cooper (2010) aver that at least one in every five children in the United States suffers from a diagnosable mental disorder. Moreover, teens of ages 12 to 17 suffer from severe emotional problems that tend to result in psychological abnormalities. Based on the nature of the mental health issue, many factors influence decisions on consent and privacy of patient records. Psychologists, doctors, and social workers must be aware of the specific challenges and requirements for the different mental health cases. Like most of the other laws regarding minors, decisions on mental health also vary across states. Where the law grants a minor the right to give consent, the physician must still gauge whether or not the minor is mentally capable to properly understand the details of consent and the implications on confidentiality.
Substance abuse and minors’ privacy
Most people who use drugs begin as teens. The National Institute on Drug Abuse (2015) opines that at the highest percentage of those who abuse substances in America are young people aged 18 to 20 years. However, NIDA (2015) reports that underage drinking and smoking is on a sharp decline. Some of the contributors to a reduction in substance use and abuse include health education, counselling, and treatment for minors. However, these interventions are fraught with ethical dilemmas that professionals who provide care to minors have to navigate carefully.
Physicians may learn about minors’ substance abuse directly from the minors who come to seek treatment. If a physician comes across such information while screening for some other condition, he or she may have to find a way to broach the subject with the minor. The physician must then seek the minor’s consent to screening for substances in the system. There are also cases where parents suspect their children of abusing substances. However, when a young person visits a hospital or clinic for treatment related to substance abuse, the clinician must abide by state and federal laws in the handling of their medical information. The doctor should seek the minor’s consent before sharing the information with the parent. If the law does not mandate parental consent, the physician must share the parent’s concerns with the minor. However, the health professional may be forced to disclose the minor’s information to the parent if such disclosure serves the best interest of the young patient. For example, if the condition of the minor requires mandatory admission into a detoxification programme, the parent will have to know about it. In some cases, substance abuse could be as a result of other factors which pose a risk of suicide for a minor. In such a case, the doctor must involve the parent in the treatment of the minor.
Rape, sexual abuse, and minors’ privacy
Sexual abuse presents a more delicate issue in the treatment of minors. Minors often fall victim to sexual exploitation and rape out of curiosity they have sex. In the absence of proper sex education before and at the onset of puberty, this danger tends to get worse. Sexual experimentation among minors often brings about other emotional and psychological problems such as guilt and shame, identity crisis and the need for affection. Minors who are victims of rape may be shy or afraid to report their predicament for fear of shame or blame by parents. Therefore, it is important first to educate minors to report any suspicion of sexual abuse they may have. Secondly, physicians must create an environment in which young people feel safe to share all the details of their sexual experiences. Consequently, the minors’ consent to interventions on sexual abuse is crucial. Once the minor has given consent, the physician goes ahead to provide counselling and treatment. It is after care that the physician can then decide if the issue demands disclosure. In a case of rape, the disclosure of a minor’s health information may be demanded to support court proceedings. Whatever the circumstance, minors who are rape victims or victims of sexual abuse can be treated immediately without parental consent. In such cases, the minor’s consent is sufficient.
Minors with divorced parents and step-parents
Children are often the unintended victims of the negative outcomes of the break-up in the family unit in the context of divorce or parental separation. Obviously, there are many valid reasons why married couples will choose to divorce, but minors always tend to root for family unity. In cases where parents are divorced, and there is a requirement for parental consent, the parent with the legal custody of the minor is the one to provide representational consent. If each of the parents has equal shared custody, then either of them can give consent. If both parents refuse to take part in giving consent, the physician must try and convince them separately and fairly. If they still disagree, the physician can seek court intervention to provide consent for a minor’s treatment. In most states, step-parents do not have legal right to provide consent for a minor’s treatment. The caveat for this law is when the step-parent has formally adopted the child. The natural parent of the child may also provide written authorization of consent to the step-parent.
An emancipated minor is one who by law has is not under any form of parental care, custody, and control. The key defining aspect in emancipation is the fact that the minor is not likely to return to the parents. In a court-ordered emancipation, the emancipated minor enjoys the same rights as an adult (McNary, 2014). In a treatment scenario, the minor is supposed to inform the doctor about their emancipation status. The doctor then proceeds to verify by obtaining legal documentation for emancipation. After verification, the physician proceeds with the process of obtaining informed consent from the minor before giving treatment.
Challenges with informed consent
Some situations may make it difficult to obtain informed consent before administering treatment to a minor. A good example is when the patient is in pain and cannot take the time to listen or read the details of a consent form. Consent forms have numerous details that require a patient to read exhaustively before signing. A patient under duress from their health condition may have no option but to consent to treatment. Doctors must be wary of the potential liabilities that could arise if they do not find legal grounds to treat patients without informed consent. On the one hand, withholding treatment as the physician awaits parental consent could lead to adverse effects such as paralysis and death. Similarly, rushing to provide treatment could result in an invasion of privacy and lawsuits.
Another challenge stems from the fact that minors are mostly dependent on parents for payment of medical treatments. Therefore, even when minors are the only ones who give consent, there may be a need to inform the parent for the sake of payments. There is also the challenge of minors’ rights to refuse treatment. In most cases when one talks about informed consent, the key concern is to prescribe care that is in the best interest of the minor. This is a prescribed type of care from outside the world of children themselves. Adults (parents and physicians) feel responsible towards minors. While this is a good way to view children, it is also important to realize that minors, especially teenagers, also have the capacity to make decisions alone.
Lastly, consent, as applied in health care interventions, can be confusing at times. Informed consent purports to give people a choice. However, this choice is an illusion because sometimes people do not have a choice on whether or not to accept or reject treatment. Sickness is itself an imposition on the body; one cannot simply opt out from an illness. Therefore, informed consent only applies to those types of treatments in which a person does indeed have a choice. These include cases where there are more than one types of treatment for the same illness. In such situations, a patient can make choices based on their sense of preference and need.
Informed consent assumes that a patient fully understands their health condition, the proposed treatment and the potential risks and benefits of that treatment. On the other hand, privacy concerns ethical principles of the management and disclosure of patient information. Privacy should not be confused with secrecy. Secrecy implies withholding information from those who are entitled to know. However, privacy has to do with the protection of the dignity and individuality of the patient. State and federal laws regarding informed consent and privacy of medical information for minors are still evolving. The changes in the health care environment drive this evolution. There are new diseases are emerging. Human understanding of science has also increased the capacity to respond to both old and new health care challenges. These changes constantly require a review of existing policy and legal frameworks. In the midst of all these, there is a greater emphasis on ethics in health care service and practice. Ethics in health care are concerned with the preservation of life and the promotion of human dignity and professionalism. Legislations are being tailored to support ethics in health care practice as well. All medical professionals must constantly update themselves on emerging issues, rules and regulations in health care. Of course, minors may not be well equipped to weigh options and distinguish real from perceived benefits in health care decisions. However, children must feel that their voice is heard and respected in the treatment context. They must feel safe confiding in the health care professional. Above all, they must receive care based solely on their primary needs.
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