Costa CPV da, Luz MHBA, Bezerra AKF, Rocha SS da. .docx

Costa CPV da, Luz MHBA, Bezerra AKF, Rocha SS da.
Application of the nursing theory of Callista Roy...
English/Portuguese
J Nurs UFPE on line., Recife, 10(Suppl. 1):352-60, Jan., 2016
352
ISSN: 1981-8963 ISSN: 1981-8963 DOI: 10.5205/reuol.7901-
80479-1-SP.1001sup201622
APPLICATION OF THE NURSING THEORY OF CALLISTA
ROY TO THE PATIENT
WITH CEREBRAL VASCULAR ACCIDENT
APLICAÇÃO DA TEORIA DE ENFERMAGEM DE CALLISTA
ROY AO PACIENTE COM ACIDENTE
VASCULAR CEREBRAL
APLICACIÓN DE LA TEORÍA DE ENFERMERÍA DE
CALLISTA ROY AL PACIENTE CON ACCIDENTE
VASCULAR CEREBRAL
Cecília Passos Vaz da Costa
1
, Maria Helena Barros Araújo Luz
2
, Alessandra Kelly Freire Bezerra

3
, Silvana
Santiago da Rocha
4
ABSTRACT
Objective: reporting the experience of application of the nursing
process implemented in the light of the
Theory of Adaptation of Callista Roy to a patient with stroke.
Method: a descriptive study of type experience
report, resulting from the application of the nursing process to a
patient admitted in a neurological clinic of
an emergency hospital in the city of Teresina, Piaui, in 2013.
Results: showed itself 15 nursing diagnoses
listed based on the taxonomy of the North American Nursing
Diagnosis Association International and to
establish interventions and nursing results there was used
respectively the Classification of Nursing
Interventions and the Classification and Nursing Outcomes.
Conclusion: facing the findings, Roy's theory
contributed to nursing care to patients affected by this
pathology by giving importance to the stimuli that
trigger responses which require the adaptation of the patient.
Descriptors: Stroke; Nursing Theory; Nursing
Care.
RESUMO
Objetivo: relatar a experiência da aplicação do processo de
enfermagem implementado à luz da Teoria da
Adaptação de Callista Roy a uma paciente com acidente

vascular cerebral. Método: estudo descritivo, tipo
relato de experiência, resultante da aplicação do processo de
enfermagem a uma paciente internada em uma
clínica neurológica de um hospital de urgência do município de
Teresina, Piauí no ano de 2013. Resultados:
evidenciaram-se 15 diagnósticos de enfermagem elencados com
base na taxonomia da North American Nursing
Diagnoses Association
International e para estabelecer as intervenções e resultados de
enfermagem utilizou-se
respectivamente a Classificação das Intervenções de
Enfermagem e a Classificação dos Resultados de
Enfermagem. Conclusão: diante dos achados, a teoria de Roy
contribuiu com o cuidado de enfermagem a
paciente acometida por tal patologia ao dar importância aos
estímulos que desencadeiam respostas, as quais
exigem a adaptação da paciente. Descritores: Acidente Vascular
Cerebral; Teoria de Enfermagem; Cuidados
de Enfermagem.
RESUMEN
Objetivo: presentar la experiencia de la aplicación del proceso
de enfermería aplicado a la luz de la Teoría
de Adaptación de Callista Roy a un paciente con ictus. Método:
un estudio descriptivo del tipo relato de
experiencia, resultante de la aplicación del proceso de
enfermería a una paciente ingresada en una clínica
neurológica de un hospital de emergencia en la ciudad de
Teresina, Piauí, en 2013. Resultados: se
presentaron 15 diagnósticos de enfermería enumerados basados
en la taxonomía de la North American Nursing

Diagnoses Association
International y para establecer las intervenciones y resultados
de enfermería se utilizan,
respectivamente, la Clasificación de Intervenciones de
Enfermería y la Clasificación de los Resultados de
Enfermería. Conclusión: en los resultados, la teoría de Roy
contribuyó a los cuidados de enfermería a los
pacientes afectados por esta patología, dando importancia a los
estímulos que desencadenan respuestas que
requieran la adaptación del paciente. Descriptores: Accidente
Cerebrovascular; Teoría de Enfermería;
Cuidados de Enfermería.
1
Nurse, Master’s Student, Nursing Postgraduate Program,
Federal University of Piaui/PPGENF/UFPI. Teresina (PI),
Brazil. Email:
[email protected];
2
Federal University of Piaui/PPGENF/UFPI.
Teresina (PI), Brazil. Email: [email protected];
3
Federal University of
Piaui. Teresina (PI), Brazil. Email: [email protected];
4
Nurse, Professor of Nursing, Nursing Postgraduate Program,
Federal

University of Piaui/PPGENF/UFPI. Teresina (PI), Brazil. Email:
[email protected]
CASE REPORT ARTICLE
mailto:[email protected]
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Through the view of the World Health
Organization the patient affected by a chronic
disease, such as stroke (CVA), needs planned

care able to meet his basic needs and provide
integrated care, in addition, this condition
requires that the same reorganize his daily
life, in order to find new ways of relating to
life.
1
As the base of nursing process, Nursing
offers theories or conceptual models
consisting of an organization of central
concepts of the profession in an orderly and
scientific way to direct data collection,
identification of changes in the clinical
condition of the patient, the nursing
interventions and evaluation of the results.
Among these, it emphasizes the conceptual
model of the proposed adaptation by Callista
Roy, which includes the notion of stimuli and
responses. The appearance of stimuli takes

the need for part of the individual responses
for coping mechanisms that are triggered
which are processed through two subsystems
defined as regulator and knowing. That may
be chemical, neural and endocrine, already
recognizing that the subsystem is related to
higher brain functions of perception, emotion
or judgment processing of information.
2-3
The resulting behaviors of these subsystems
are observed from four adaptive modes. In
physiological way the person responds like a
physical environmental incentives and involves
five basic needs of physiological integrity
(oxygenation, nutrition, elimination, activity
and rest, and protection) and four complex
processes (sensory, fluid and electrolytes,
neurological function and function endocrine).

The self-mode focuses on the psychological
and spiritual aspects of a person and includes
self-physical (includes sensation and body
image) and self-personnel (includes self-
consistency, self-ideal and self-ethical-moral-
spiritual).
2-4
But the function mode/role performance
focuses on the social aspects related to the
roles that one occupies in society and finally
the interdependence so that is related to
emotional fitness as well as to holders of
systems, receptive behavior and contribution
of behavior identified the patterns of human
value, affection, love and affirmation.
2-4
The nursing process should not be seized or
held for a mere fulfillment of tasks, as this

methodological tool scientifically underpins
the profession knowledge, allows to develop
effective assistance focused on patient safety
and provides the identification of individual
and collective needs under a holistic and
critical view.
5-6
The nursing process comprises phases
which vary according to nursing theory
adopted. The elements of Roy nursing process
include: research behavior, research stimuli,
nursing diagnosis, goal setting, intervention
and evaluation. The first element consists of
collecting answers or the person's behavior in
relation to each of the adaptive modes. The
second involves the identification of focal,
contextual and residual stimuli that are
influencing behaviors. The third element of

the process is the identification of nursing
diagnoses, which reflects the nurse's judgment
on the level of adaptation of the person.
4, 7
The fourth element includes goal setting,
time the nurse lists the resulting behaviors of
nursing care. The fifth is for the planning of
interventions that should be selected
according to pre-established goals, aiming to
promote adaptation by stimulating change.
Finally, evaluation, it is believed that the
effectiveness of nursing intervention is related
to human behavior adaptation.
4,7
By analysis of Callista Roy adaptation
nursing theory, sees it a theoretical
framework for the development of care for
people with chronic diseases which need to go

through a process of adaptation to the new
conditions of health and disease, among these
the affected by stroke, as this condition
creates stimuli that the patient requires an
adaptive response.
Given the above, the objective of this
study is to reporting the experience of the
application of the nursing process
implemented in the light of the Theory of
Adaptation of Callista Roy to a patient
affected by stroke.
This is a descriptive study of type
experience report, resulting from the
application of the nursing process mediated by
the Nursing Theory of Adaptation of Callista
Roy to a hospitalized patient in June, 2013, in
a neurological clinic of an emergency hospital

in the city of Teresina, Piaui.
To implement the first phase of the nursing
process there was drawn up an interview
script with the intention of guiding the
research and behavioral stimuli (Appendix A).
After behavioral and stimulation research
nursing diagnoses were established, using as
basis the taxonomy of the North American
Nursing Diagnosis Association International
(NANDA-I).8 The process of preparing and
inference of nursing diagnoses followed the
steps recommended by the reasoning of
METHOD
INTRODUCTION
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80479-1-SP.1001sup201622
Risner, namely: categorization of data,
identification of data gaps, clusters of
relevant data, comparison between the groups
with normal patterns, inferences and
propositions of etiological relations.
9
Then it set up goals and interventions
needed to promote better adaptive response.
The nursing interventions were defined
according to the Nursing Interventions
Classification (NIC)
10
and are shown in Table 1
with its specific code for each intervention
with four digits. For the results we used the
taxonomy Nursing Outcomes Classification

(NOC)
11
identifying the result with their
respective specific code, and finally there was
the evaluation of the implemented actions.
The application of the Roy Adaptation
Model allowed identify commitment in the
following components of the physiological
mode: oxygenation, protection, nutrition,
activity and rest, senses and neurological
function.
In the oxygen component it showed up the
following nursing diagnoses according to
NANDA-I: ineffective breathing pattern
manifested by tachypnea defining
characteristics and dyspnea, ineffective
airway clearance manifested by ineffective
cough, tachypnea, and dyspnea and risk of

ineffective cardiac tissue perfusion.
For the diagnosis of ineffective breathing
pattern nursing interventions were:
respiratory monitoring, monitoring of vital
signs and respiratory control with the
following activities: monitoring frequency,
pace, depth and effort of breaths, listen
breath sounds, monitor diaphragmatic muscle
fatigue, monitor and record temperature,
pulse, blood pressure and breathing pattern.
Interventions facing the diagnosis of
ineffective airway clearance were: listen
breath sounds, vacuum when necessary, place
the patient in order to maximize breathing,
encourage slow, deep breathing and guide and
encourage the patient to cough after inhaling
and exhaling deeply. For the diagnosis of
cardiac tissue perfusion ineffective risk

interventions were listen heart sounds and
administering antihypertensive medication,
according to prescription.
As adaptive problems of the protection
component, there are the nursing diagnoses,
namely: impaired tissue integrity, impaired
skin integrity, which were listed by the
patient develops pressure ulcers (UPP) Grade
III sacral area and UPP grade II calcaneus
region and the diagnosis of impaired oral
mucosa, and infection risk.
Interventions for the care of UPP were to
describe the ulcer features, monitor the
color, temperature, edema moisture and
appearance of the skin around, monitor
wound infection signs, perform changing
positions of 2 in 2 hours, advise mattress use
appropriate, guide staff and conduct healing

of the wound.
The activities for the intervention of oral
health maintenance guide were doing oral
hygiene after meals and whenever necessary
and guide brush of their teeth, gums and
tongue. For the restoration of intervention of
oral health activities consisted of guiding the
use of brush with soft bristles and monitor
lesions on the lips and mucous membranes.
For the diagnosis of infection risk
interventions were: monitor site of
venipuncture, exchange peripheral access
where necessary and monitor systemic signs
and symptoms and infection sites.
In the nutrition component there was
detected the nursing diagnosis of impaired
dentition related to ineffective oral hygiene
evidenced by loss of teeth and halitosis.

Interventions for these diagnoses were the
same as diagnosis of impaired oral mucosa.
The physical mobility nursing diagnoses
related to impaired neuromuscular
impairment evidenced by hemiplegia and
disturbed sleep pattern related to
environmental changes evidenced by reports
of trouble sleeping and staying asleep were
listed as adaptive problems of the
physiological mode on their activity
component and rest.
Nursing interventions prescribed for the
diagnosis of impaired physical mobility were
neurological positioning and therapy exercises
with the following activities: avoid applying
pressure on the affected side of the body,
supporting the affected body part, hold
stimuli and passive exercises on the affected

side, guide family to monitor the realization
of exercise and physical therapy forward.
For intervention improves sleep has
prescribed the following activities: monitor
sleep patterns and the amount of hours slept,
discouraging daytime sleep and provide
comfort measures while sleeping.
As the adaptive problem senses component
found that the impaired verbal communication
and diagnostics risk of falls.
The activities for communication
improvement intervention were listening,
encouraging the patient to repeat words,
offer positive reinforcement and support,
when necessary, to maintain dialogue with the
patient, encourage the patient to talk slowly
and observe nonverbal clues. For diagnosing
EXPERIENCE REPORTS

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80479-1-SP.1001sup201622
risk of falls, interventions were guiding on the
use of assistive devices and guide the patient
to call help when jogging.
The last mode of the physiological adaptive
problem was identified in neurological
function component with the nursing diagnosis
risk of inefficient brain tissue perfusion.
Although the patient be affected by a
condition in the neurological system, found
only a nursing diagnosis in the component
neurological function, this fact can be
explained because the neurological function is

configured as a component of the hardest
physiological mode analysis due to the
condition of relationship between this
complex process and the other components of
the physiological mode.
3
Interventions for diagnosis of neurological
function component were: monitor the size,
shape, symmetry and reactivity of pupils,
monitor level of awareness and guidance,
applying the Glasgow coma scale, observe
headache complaints, monitor speaks
characteristics and monitor the presence of
signs and symptoms of increased intracranial
pressure.
In so self-evident that the adaptive
problem in self-staff component formed by
anxiety as nursing diagnosis. The interventions

were outlined using a calm and safe approach,
explain the procedures to be performed and
encourage the patient to verbalize feelings.
The last way in which it showed an
adaptive problem was the role of performance
mode which nursing diagnosis raised was
ineffective control of the therapeutic
regimen. The activities for the nutrition
counseling intervention were to identify the
behaviors to be changed, provide information
to diet modification and discuss preferences
and food which the patient does not like. For
behavior modification intervention activities
were encouraging the replacement of
undesirable habits by desirable habits,
discussing the process of change with the
patient and caregiver and promote family
involvement in the change process.

The last step of the nursing process, as
Callista Roy, is the evaluation in which the
nurse questions and weaves judgment about
the achievement of objectives in the process
of adaptation by which the individual passes.
After 3 days of use of the nursing process
based on Roy's theory in patient care it will
found that interventions have allowed changes
in decreased anxiety with positive patient
discourse and planning for execution of daily
life activities after hospital discharge
configurating itself change in strategy
planning indicator is inserted into the nursing
outcome "self-anxiety." To the result of level
of anxiety became evident change in the
indicator improved in the pattern of sleep and
rest of patients with nocturnal sleep
improvement report allowing adaptation of

the patient to self-concept mode and activity
and rest.
The physiological mode results achieved for
the diagnosis of oral hygiene with an
improvement in halitosis indicator and the
inefficient respiratory pattern diagnosis and
ineffective airway clearance with changes in
respiratory rate indicators and dyspnea at rest
and the result of vital signs there was change
in respiratory rate indicator.
The mode of performance was a result of
knowledge and control of hypertension with
changes in control benefits indicators of the
disease and strategies to improve adherence
to diet and result of family support during
treatment with change in the collaboration
window with family sick in determining the
care and information request indicator.

The other results listed in Figure 1
represent the expected results compared to
the listed diagnoses and nursing interventions.
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Component
Mode of
Adaptation
Nursing diagnosis (NANDA-I) Nursing intervention
(NIC)-Code of NIC
Nursing results (NOC)

Physiological
Oxygenation
Ineffective breathing pattern related to hyperventilation
manifested by tachypnea and dyspnea
Respiratory monitoring (3350).
Monitoring of vital signs (6680).
Airway control (3140).
Respiratory status (0415).
Vital signs (0802).
Oxygenation
Ineffective airway clearance related to neuromuscular
dysfunction and smoking shown by ineffective cough,
tachypnea and dyspnea.
Respiratory monitoring (3350).
Airway control (3140).
Stimulus to cough (3250)
Respiratory status: airway permeability (0410).
Respiratory status: ventilation (0403).

Oxygenation
Risk of cardiac tissue perfusion related to decreased
hypertension and hyperlipidemia.
Tissue: cardiac perfusion (0405).
Vital signs (0802).
Protection
Impaired tissue integrity related to impaired mobility,
decreased dermal vascularization secondary to ageing
and moisture evidenced by grade III pressure ulcer on
sacral region.
Caring for pressure ulcers (3520). Wound healing: second
intention (1103).
Tissue integrity: skin and mucous membranes (1101).
Physiological

Protection
Impaired skin integrity related to motor deficit, impaired
mobility and decreased Vascularity secondary dermal
aging evidenced by grade II pressure ulcer in calcaneal
region.
Caring for pressure ulcers (3520). Wound healing: second
intention (1103). Tissue
integrity: skin and mucous membranes (1101).
Protection
The oral mucosa impaired related to ineffective oral
hygiene evidenced by tongue coated, oral lesion and
halitosis.
Maintenance of oral health (1710).
Restoration of oral health (1730)
Oral hygiene (1100).
Protection Risk of infection related to invasive procedures.
Protection against infection (6550) Risk control: infectious
process (1924).
Nutrition Impaired dentition related to ineffective oral hygiene
evidenced by loss of teeth and halitosis.
Maintenance of oral health (1710).
Restoration of oral health (1730).
Oral hygiene (1100).

Activity and
rest
Impaired physical mobility related to neuromuscular
impairment evidenced by hemiplegia.
Neurological positioning (0844).
Exercise therapy: joint mobility (0224).
Body mechanics performance (1616).
Mobility (0208).
Physiological
Activity and
rest
Disturbed sleep pattern related to environmental
changes, evidenced by reports of difficulty to sleep and
stay asleep.
Sleep improvement (1850). Sleep (0004).
Senses
Impaired verbal communication related to changes in the

central nervous system, manifested by dysarthria.
Improvement of communication: speech
deficit (4976).
Listen actively (4920).
Communication (0902).
Communication: expression (0903).
Senses Risk of falls related to impaired physical mobility.
Prevention of falls (6490). Risk control (1902).
Care with the affected side (0918).
Neurological
Function
Risk of cerebral tissue perfusion ineffective related to
cerebral aneurysm and hypertension.
Neurological monitoring (2620).
Tissue perfusion: cerebral (0406). Neurological State
(0909).
Self-concept Self-personal Disease-related anxiety manifested
by crying and
insomnia.
Anxiety reduction (5820). Level of anxiety (1211).
Anxiety self-control (1402).
Role
performance
Ineffective therapeutic regimen related control the

complexity of the treatment regimen indicated for failure
to take action to reduce risk factors.
Nutritional counseling (5246).
Behavior modification (4360).
Knowledge: control of hypertension (1837).
Family support during treatment (2609).
Figure 1. Diagnoses, interventions and outcomes of nursing for
a patient with STROKE according to the Adaptive Model of
Roy. Teresina-PI, 2014.
Santos FS, Arruda AJCG de, Vasconcelos JMB.
Aplicabilidade do código de ética nas ações...
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The grounded nursing process in Roy's
theory contributed to effective nursing care to
patients affected by stroke to give importance
to the stimuli that trigger responses which
require the adaptation of the patient.

Before long the patient has demonstrated
adaptive behaviors with regard to diagnosis of
oral hygiene, ineffective breathing pattern,
and ineffective airway pattern of sleep and
rest, anxiety and ineffective control of the
therapeutic regimen.
In view of this is salutary that care
implemented resulting from the nursing
process based on the theoretical model of Roy
and the use of NANDA-I taxonomy, NIC and
NOC allowed direct the activities to adaptive
problems contributing to the adaptation of
the patient, and provide scientific nature to
care practice with consequent empowering
care by nurses. Therefore, the experience
raises the need to use a conceptual
framework in nursing care.

1. Organização Mundial de Saúde. Cuidados
inovadores para condições crônicas:
componentes estruturais de ação. Relatório
mundial. Organização Mundial da Saúde.
Brasília, 2003 [Internet]. [cited 2013 July 5].
Available from:
http://www.who.int/chp/knowledge/publicat
ions/icccportuguese.pdf
2. Roy C, Andrews HA. The Roy adaptation
model. Stamford: Appleton e Lange; 1999.
3. Lopes MVO, Araújo TL, Rodrigues DP. A
relação entre os modos adaptativos de ROY e
a taxonomia de diagnósticos de enfermagem
da NANDA. Rev Latino-Am Enfermagem
[Internet]. 1999; [cited 2013 July 12];7(4):97-
104. Available from:
http://www.scielo.br/scielo.php?script=sci_ar
ttext&pid=S0104-

11691999000400013&lng=en&nrm=iso
4. George JB. Teorias de enfermagem: os
fundamentos à prática profissional. Porto
Alegre: Artes Médicas; 2000.
5. Pereira CFD, Tourinho FSV, Miranda FAN,
Medeiros SM. Ensino do processo de
enfermagem: análise contextual. J Nurs UFPE
on line [Internet]. 2014 [cited 2014 Mar
15];8(3):757-64. Available from:
http://www.revista.ufpe.br/revistaenfermage
m/index.php/revista/article/view/5473
6. Freitas NF, Tannure MC, Chianca TCM.
Implementation of nursing process in a
neonatal intensive care unit of Belo
Horizonte. J Nurs UFPE on line [Internet].
2010 [cited 2014 Jan 10];4(esp):1287-293.
Available from:
http://www.revista.ufpe.br/revistaenfermage

m/index.php/revista/article/view/1053/pdf_
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7. Coelho SMS, Mendes IMDM. Da pesquisa à
prática de enfermagem aplicando o modelo de
adaptação de Roy. Esc Anna Nery [Internet].
2011 Dec [cited 2013 July 11];15(4):845-50.
Available from:
http://www.scielo.br/scielo.php?script=sci_ar
ttext&pid=S1414-
81452011000400026&lng=en&nrm=iso
8. North American Nursing Diagnosis
Association International (NANDA-I).
Diagnóstico de enfermagem da NANDA:
definições e classificação - 2012-2014. Porto
Alegre: Artmed; 2013.
9. Risner PB. Diagnosis: analysis and
synthesis of data. In: Griffith-Kenney JW,
Christensen PJ. Nursing Process application of

theories, frameworks, and models. 2nd ed. St.
Louis Mosby; 1986
10. Buthcher H, Bulechek GM. Classificação
das Intervenções de Enfermagem (NIC). 3 ed.
Porto Alegre: Artmed; 2004.
11. Moorhead S, Johnson M, Maas M.
Classificação dos resultados de enfermagem
(NOC). 4th ed. Rio de Janeiro: Elsevier; 2010.

REFERENCES
FINAL REMARKS
http://www.who.int/chp/knowledge/publications/icccportuguese.
pdf
http://www.who.int/chp/knowledge/publications/icccportuguese.
pdf
http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0104-
11691999000400013&lng=en&nrm=iso
11691999000400013&lng=en&nrm=iso
11691999000400013&lng=en&nrm=iso
http://www.revista.ufpe.br/revistaenfermagem/index.php/revista
/article/view/5473
/article/view/5473
/article/view/1053/pdf_94
81452011000400026&lng=en&nrm=iso
81452011000400026&lng=en&nrm=iso
81452011000400026&lng=en&nrm=iso

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GUIDE FOR BEHAVIORAL AND STIMULUS RESEARCH
Name:
___________________________________________________
Birthdate: ________________ Age:
_____________________
Gender: ( ) Male ( ) Female
Skin color: ( ) White ( ) Black ( ) Yellow ( ) Maroon
Marital status: ( ) Married ( ) Single ( )
Widower/Widow ( ) Separated
( ) Stable union
Schooling: ( ) Illiterate ( ) Incomplete elementary school (
) Complete elementary school ( )
Incomplete high school ( ) Complete high school ( )

Incomplete higher education ( ) Complete
higher education
Occupation:
_____________________________________________________
_
Address:
_____________________________________________________
__
City: ________________________ State:
_________________________
Date of admission: ___________________
Origin: Home Hospital Other:
________________
Nursing: ________________ Bed: _________________
2 PHYSIOLOGICAL MODES
2.1 OXIGENATION
2.1.1 Breath
Breath: ( ) Spontaneous ( ) Nasal catheter ( ) Mask
Chest: ( ) Flat ( ) Cask or Barrel ( ) Funnel-shaped ( )
Carinate

Other: ___________________________
Respiratory frequency: __________ respiratory movements per
minute
Respiratory auscultation: ( ) Adventitious noise absent
( ) Adventitious noises present: ( ) Snoring ( ) Ping ( ) Rattle
Other: _________
Cough: ( ) No ( ) Yes: ( ) Nonproductive ( )
Productive
2.2.2 Circulation
Blood pressure: ___________mmHg Heart frequency:
______bpm
Pulse: ( ) Regular ( ) Irregular ( ) Thready ( ) Full ( )
Impalpable
Capillary filling time: ________seconds
The presence of edema: ( ) No ( ) Yes: ( ) MMSS ( )
MMII Other: ____________
2.2 NUTRITION AND ELIMINATION
Diet: ( ) Oral ( ) SNG ( ) SNE ( ) Parenteral
Dentition: ( ) Absence of teeth ( ) Loss of teeth ( )

Presence of teeth
Oral mucosa: ( ) Full ( ) With lesions
Oral hygiene: ( ) Unsatisfactory ( ) Satisfactory
Abdomen: ( ) Flat ( ) Globulous ( ) Distended ( )
Flaccid ( ) Painful on palpation
Fluid intake per day: ( ) less than 5 glasses ( ) 5-10
glasses
( ) more than 10 glasses
Number of meals a day: ( ) less than 3 meals ( ) between 3-
5 meals
( ) more than 5 meals
Weight: ______kg Height: _____m BMI: _________
Bowel sounds: ( ) Absent ( ) Present ( ) Increased ( )
Diminished
Nausea: ( ) No ( ) Yes Vomiting: ( )
No ( ) Yes
Dyspepsia: ( ) No ( ) Yes Diarrhea: ( )
No ( ) Yes
Frequency of defecation: __________times per week
APPENDIX

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Date of the last defecation: _______________
Urinary elimination: ( ) Spontaneous ( ) SVD ( )
Urinary device
( ) Urinary retention ( ) Urinary incontinence ( ) Dysuria ( )
Hematuria ( ) Anuria ( ) Oliguria
Urinary volume: __________
2.3 Activity/rest and protection, and four complex processes
(sensitive, liquid and electrolytes,
neurological function and endocrine function).
Sleep: ( ) Increased ( ) Diminished ( ) Without
complaints
Sleep on the day shift: ( ) No ( ) Yes: _________hours
Mobility: ( ) Not changed ( ) Changed:
__________________________
Mucous membranes: ( ) Normochromic ( ) Hypochromic
_____/4+ ( ) Icteric

Eyes: ( ) Jaundice ( ) Eyelid edema Other: ______________
Skin: ( ) Normal ( ) Cyanosis ( ) Jaundice ( ) Pallor
Wound: ( ) No ( ) Yes Local:
________________________________
Dimensions:
_____________________________________________________
_
CLASSIFICATION:
The wound: ( ) Closed ( ) Open ( ) Chronic
( ) Acute
The tissue: ( ) Necrosis ( ) Mortification of tissues
( ) Granulation ( )
Epithelialization
The exudate: ( ) Serous ( ) Sanguineous ( ) Purulent ( )
Fibrinous exudation
Quantity of the exudate: ( ) Small ( ) Moderate ( )
Intense ( ) Abundant
Odor: ( ) Odorless ( ) Fetid
Recommended therapy for wound treatment:
_____________________________________________________
__________

2.4 NEUROLOGICAL FUNCTION
Glasgow Coma Scale: Eye Opening: ______
Verbal answer: __________ Motor answer: ________
Pupils: ( ) Equal ( ) Anisocoric ( ) Miosis on the
right ( ) Miosis on the left ( ) Mydriasis
on the right ( ) Mydriasis on the left
Conscious: ( ) Yes ( ) No
Guided: ( ) Yes ( ) No
3. What do you know about your present illness?
_____________________________________________________
__________
4. Important complaints:
_____________________________________________________
_________________________________
_____________________________________________________
_________________________________
_________________
VITAL SIGNS:

T: _______ P: _________ R: _________ PA:
_______
IMPORTANT LABORATORY DATA:
_____________________________________________________
_________________________________
_____________________________________________________
_________________________________
________________
________________________________________________
SIGNATURE
English/Portuguese
360
73529-1-RV1001201601
Submission: 04/07/2015
Accepted: 25/07/2015

Published: 01/01/2016
Correspondence Address
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Running head: ACA
1
ACA
10
Changes resulting from the Affordable Health Care for America
Act (ACA)
Weltee Wolo
Rasmussen College

Author Note
This paper is being submitted on May 28, 2017, Kristi Downs’s
Healthcare Planning and Policy Management H360/HSA4150
course
The Affordable health care act was a series of changes and
reforms that were directed towards the health sector. The bill
got signed into law in March 2010. The reforms aimed at
improving the quality of health care for the American
population (Protection & Act, 2010). They are a set of rules for
health care facilities, insurance companies and other businesses
on matters to do with the provision of health care to people.
Much as there are changes the overall perception is that there
has had a tremendously positive effect on the people of America
as they can now comfortably rely on the act to have their
medical issues taken care of without worrying too much about
paying. According to Huntington et al. (2011), the bill has
substantially made health care affordable and attainable by most
of the people in the US. Ever since it’s passing the bill has had
tremendous changes in some primary health care providers such
as insurance companies, health care providers, and the facilities.
The changes range from those that are negative and those that
are positive, from the long term to the short term goals. One of
the providers that have been affected the most by the law is the
insurance companies and the way that they operate.
Possible causes of change to the insurance unit
The changes have had to take place so as to accommodate the
titles of the ACA of 2010. The biggest and most recognizable
cause of the changes is the fact that the law calls for the
increase in the number of people who get health care in the
country. More people of all classes and social standing
automatically request the adjustment of operation and systems

within insurance companies (Cantor et al., 2012). There is the
need to reduce the amount of money being spent by individuals
in health care without having to compromise the quality of care.
What this implies is that companies and businesses that take
care of issues of insurance substantially need to check their
systems so as to be viable and up to the task of meeting the
needs of the people and fulfilling the law of ACA.
According to Blumenthal & Collins (2014), most of these
changes are not temporary as they are static unless there is a
reversal of the law they are for the long term. Naturally, the
insurance companies are the ones that are most affected by the
act. This is because most of the components of the law deal with
issues of money as well as health care quality. As a result of
this, it is critical that the effects of the changes be evaluated by
what takes on a temporary standing and those that are for the
long term. The short term effects are those that are quickly
forgotten based on the minimal impact that they have. On the
other hand, the long-term effects are more permanent and affect
the company the greatest.
Effects of the Affordable Care Act on insurance companies
Education of consumers – more power to consumers
The ACA is one document that has brought about enlightenment
to the consumer when it comes to matters of health care. People
can conveniently take control of their lives and what facilities
that they would want to have the care in (Huntington et al.,
2011). With more private insurance firms coming up to fill the
gap which is used to fulfill the needs of the people, there is the
emergence of the need to conduct consumer education. Berwick
& Hackbarth (2012), state that consumer education ensures that
people make choices that are informed and with adequate
knowledge on the issue. There is a possibility that people could
under buy or over buy the policies and harm them financially in
the long run. The ACA has mandated the insurance companies
to offer very valid and more information on their policies and
has even made it simpler for more understanding. In the
beginning, these companies would quickly hide facts and

figures in very complicated insurance terminology that was not
understandable upfront. This could easily mislead people into
buying things that they did not understand or be deceived into
buying policies that did not meet their needs entirely
(Blumenthal & Collins, 2014). Deception and poor
understanding are a thing of the past according to the new act.
People now have a choice among many options, and they do so
after accessing the relevant information.
Accommodation of more people
Some of the ways through which insurance companies
accommodate more people is by increasing the coverage limits,
mandating private business owners with fifty additional
employees to offer medical insurance to its employees, not
using medical conditions to provide medical cover and stopping
the idea of people losing protection based on the seriousness of
their diseases (Rosenbaum, 2011). All these are strategies
employed by the ACA to increase the number of people being
covered by the medical health plans under the act. For the
insurance companies, this translates once again to fiscal
adjustments.
As of 2009, there were fewer businesses that could not facilitate
accommodation for every individual that needed to be covered.
For instance, with this act, there has been accommodation of
younger people as compared to previous years where older
people were included (Cantor et al., 2012). Insurance companies
have had to establish safeguards so as to ensure that the
premiums offered were enough to cover the extra costs that
would accommodate all the additional people that have had to
be covered. Safeguards are meant to reduce consumer spending,
increase insurance companies spending and eventually ensure
that costs of all the medical care for individuals that deserve
and have covered are catered to properly.
Financial
The ACA has significant financial implication for the insurance
companies all around the state. The cat called for the coverage

of people and therefore more planning and the need to establish
more sources of funds emerged. The private firms also saw a
chance to get a place in the market. The act also increases the
amount of money that the government allocates for the
companies. Much as the government assists the companies in
their funding, the amount used to cover the cost official care is
far more than they can get from the government. Retaining a
for-profit healthcare system has economic benefits this mostly
applies to the private insurance companies who are set to cater
to the needs of the people as well as make profits to remain in
the market and relevant (Sommers et al., 2015). This also means
that the system’s aspects also need to gain benefit so as to stay
relevant. While the ACA aims at reducing the cost of health
care Americans are still among the people paying the most for
basic health care. These are some of the adjustments that
companies have to take care of.
The other financial implication of the Affordable Care Act is
that of reduction of annual revenue of insurance companies.
According to Blumenthal & Collins (2014), while the insurers
had to make adjustments to suit the demands of the ACA, the
clients to these insurers were not affected as they were not
expected to make adjusted contributions to also adjust to the
ACA marketplace. This had them making assumed projection,
and these assumptions did not work as projected since this was
a first time experience. The result of this was that insurers did
worse in their performance unlike in previous years. Many of
the insurers underestimated the claims by over thirty-five
percent for the high claimants. On the other hand, the lower
providers underestimated their own by over four percent. Both
of these were equivalent to a six percent deviation from the
global market share of claims. In the preceding years, there
have been evidence of more accurate projections, but the losses
have been permanent as most of the newer and smaller insurers
have had difficulty in gaining their financial round with many
of them closing shop due to bankruptcy.

Competition in business – insurance market place
The ACA makes room for the establishment of an insurance
marketplace. This is where people get to make informed choices
based on the type of insurance that they want and the amount of
money available (Berwick & Hackbarth, 2012). Unlike in the
past, the insurance companies have been mandated with the duty
of making known and transparent all the information about it as
much as possible so as to facilitate in decision making. As a
result of this companies may have to make adjustments to their
services and premiums so as to attract more clients to its
companies. The competition for customers increases and this
calls for the need for changes.
According to Protection & Act (2010), many insurance
companies have had to take on extreme measures so as to attract
more customers. Those with difficulty in adjusting may have
had to take adverse measures such that they have run out of
business. Lack of clients or their reduction in number equally
results into the making of losses for the company. This means
that these companies have had to run out of business and close
shop. Business is threatened by the need to adjust premiums and
rates. People have the power to choose the policies and
companies that they feel serve their needs without feeling
oppressed by them. The failure to comply with the policies of
the Act will bring about the tight competition that makes the
other companies better their offers so as to attract more clients.
Competition in this business has had extreme effects that work
to the advantage of the patients by regulation of costs and
quality (Rosenbaum, 2011).
Medical conditions covered – preexisting conditions
With the signing in of the ACA, insurance companies have had
to change the type of conditions that they cover. Before the law
was implemented, people were limited to insurance cover based
on their present health conditions. There was an increased
chance that people with chronic illnesses before their
application would be left out of coverage based on these

circumstances. With the inception of the Affordable health care
act into law, insurance companies have had formulated policies
that accommodate children and adults even if they had
preexisting conditions that initially barred them from getting
covered (Rosenbaum, 2011). This was a measure that the
insurers made the most of their revenue by reducing associated
risks which were to be borne by the individual as opposed to the
company. For this reason, the insurer has had to deal with extra
costs incurred by the people who are suffering from chronic
diseases other conditions that may have had to be addressed at a
cheaper cost. Due to the fact that a person only pays a limited
amount of money for their cover, the insurance company is the
one that cushions the extra fees.
In addition to the medical conditions covered insurance
companies have had to deal with the limitation of the conditions
that could lead to one losing their cover. These have been
reduced to accommodate those people who may have made an
honest mistake while making their application or may have
developed a complication that was beyond their control or
previous awareness (Sommers et al., 2015). Initially, insurance
companies had the power to dismiss a cover for mistakes made
and complications developed even after providing the person
with medical cover. This implies that once again the insurer has
to part with more money to provide essential services without
charging the client more to get the same services.
Increase in coverage limit
The act has changed the age limit for coverage. It is flexible
enough, and the insurance policies have been mandated with the
task of covering children under their parents for up to twenty-
six years of age. These have deep fiscal implications that have
the long-term impact on the companies. These have further
long-term financial consequences to these enterprises. There is
a need for flexibility, and without proper planning, most of
these businesses may quickly run out of business based on the

fact that they are not financially prepared for these changes. As
of 2016 many of the newly established insurers have had to go
into financial distress to the extent of failing and going out of
business. The effect has also been seen in the larger companies
such as United Healthcare which have so far withdrawn from
the ACA’s exchange market due to the important financial
losses that it had been facing. The insurers as of 2016 only
managed to make only two percent of profits higher than the
projected profits in 2010 even after the account reinsurance
payment done. This is evidence of the deep financial plunges
that insurance companies have had to deal with as a result of
actions such as increasing the insurance cover limit.
In conclusion, the new health care act has had a very great
impact on the insurance companies. This range from fiscal
implications to having to accommodate more people at a smaller
cost than it was before. Many adjustments have therefore been
made to accommodate these changes. The greatest impact of all
time is that these companies have shifted focus from making
more money from claims to ensuring that everybody gets an
insurance policy or treated at a lower cost. These companies
have often focused on making money for themselves at times
compromising the health of the patients. These include
situations such as dropping of patients due to complications
developed so as to cut the costs of money discharged by the
insurance companies. Much as there seem to be more negative
impacts as opposed to the positive ones, the insurance
companies may have ultimately been favored as they have more
people to cover thereby accumulating more money while
offering better services to the people. Finally, the ACA has
enabled more companies to crop into the market thus creating
equilibrium as more money has been allocated by the federal
government to support the provision of better health care for
people.
References
Berwick, D. M., & Hackbarth, A. D. (2012). Eliminating waste
in US health

care. Jama, 307(14), 1513-1516.
Blumenthal, D., & Collins, S. R. (2014). Health care coverage
under the Affordable Care Act—a
progress report.
Cantor, J. C., Monheit, A. C., DeLia, D., & Lloyd, K. (2012).
Early impact of the Affordable
Care Act on health insurance coverage of young adults. Health
services research, 47(5), 1773-1790.
Protection, P., & Act, A. C. (2010). Patient protection and
affordable care act. Pu
Huntington, W. V., Covington, L. A., Center, P. P., Covington,
L. A., & Manchikanti, L. (2011).
Patient Protection and Affordable Care Act of 2010: reforming
the health care reform for the new decade. Pain
Physician, 14(1), E35-E67.blic Law, 111, 48.
Rosenbaum, S. (2011). The Patient Protection and Affordable
Care Act: implications for public
health policy and practice. Public health reports, 126(1), 130-
135.
Sommers, B. D., Gunja, M. Z., Finegold, K., & Musco, T.
(2015). Changes in self-reported
insurance coverage, access to care, and health under the
Affordable Care Act. Jama, 314(4), 366-374.
HEALTH CARE PROVIDER
1

Health care provider
Weltee Wolo
Rasmussen College
Author Note
This paper is being submitted on April 20, 2017, Kristi Downs’s
course
Health care provider is a term that is used to describe a business
or an individual who is authorized by the state to perform to
consumer’s health care services. An example of such a health
care provider is a doctor office. It is considered as medical
premises where one or more patients are provided with
treatment by one or more doctors. With the implementation of
the health care act, it was noted that time spent between
physicians and patients reduced. This was due to the mounting
duties that are non-clinical and reimbursement decline, thus
leading to minimal patient-doctor contact. With this, it means
the patient would not have a consistent follow-up care due to
the use of patient extenders by doctors in office (U.S.
Department of Health & Human Services, n.d).

References
U.S. Department of Health & Human Services. (n.d). About
Affordable Care. Retrieved from
https://www.healthcare.gov/get-coverage/
HEALTH CARE PROVIDER
3
Weltee Wolo
Rasmussen College
Author Note
This paper is being submitted on April 20, 2017, Kristi Downs’s
course
A hospital is an example of a health care provider. It is
responsible for the provision of short-term care to individuals
with serious health issues which might be an outcome of a
disease, injury or abnormality. With the implementation of the
health care act, the hospital was one place that was affected. It
is considered that most of these impacts were positive. There
was an increase of the community fund. Which provided
recognized health centers the right to provide medical services
to populations that are considered underserved and are often
shut down from departments of emergency. With the health act

in place, there was a reduction of uncompensated care in
hospitals. That meant there was an improvement of access to
coverage care of patients due to the creation of patient and state
stability fund. There is the restoration of DHS which hospitals
stand to benefit from (American Hospital Association, 2016).
It is also considered that all is not well since, with the
legislation on the proposal, the levels of insured would reduce.
And in the process, no Medicare rates would be restored to the
higher levels of ACA-level. Also, there is the issue of greater
flexibility concerning requirements of coverage, which has
implications for hospitals (American Hospital Association,
2016).
References
American Hospital Association. (2016). Hospitals are economic
anchors of community. Retrieved from http://www.aha.org.
Running head: HEALTH CARE PROVIDERS
1
HEALTH CARE PROVIDERS
3
Annotated bibliography for health care providers
Weltee Wolo
Rasmussen College
Author Note

course
Eichenwald, S., Petterson, B. J., & Wapola, J. (2014). Using the
electronic health record in the health care provider practice.
Clifton Park, NY: Delmar.
This book is a practical guide that discusses all the aspects of
electronic health record (EHR) at health facilities. The book
addresses the various types and functions of EHR use namely
administrative functioning EHRs and Clinical functioning
EHRs. This book is a resourceful tool for the purpose of
understanding just what the categories of EHRs are and how
they apply to the healthcare facilities. It further emphasizes the
fact that EHR is an essential part of modern health care
operation today. This book will contribute to my project as it
highlights the various aspects of EHR and I will utilize this
information to conclude the relevance of modernity in the health
care organization.
In Shirazian, T., & In Gertz, E. (2013). Around the Globe for
Women's Health: A Practical Guide for the Health Care
Provider.
The book gives an in-depth account of the value of culture by
communication and cultural knowledge for health care providers
dealing with women's health. This is a basic need when it comes
to this century's type of care which targets equity, sensibility
and improved care for health care for the women. There are
specific chapters that touch on the specific health conditions
that mainly affect the women population. This is a resourceful
book as it gives insight to health provision for this particular
health population. I will use this book as a source for my
project as it has information that contributes positively to my
project. Health care is all rounded and focuses on a different
population. For this specific project, I will highlight on the

women population.
U.S. Department of Health & Human Services. (n.d). About
Affordable Care. Retrieved from
https://www.healthcare.gov/get-coverage/
Medical health insurance cover is a very important thing to have
in these times. This is the best way through which an individual
can have their medication paid for. It is paperless form of
payment. This website gives a variety of options that
individuals can use to pay for the medical care including which
conditions necessitate the use of insurance such as having a new
baby and cushioning expensive emergency procedures. The
government website is the ultimate compilation of justifications
and workable data thus the information provided is highly
reliable. I will use this information from this website to justify
the use and advantages of adopting health insurance among
households at health care facilities.
American Hospital Association. (2016). Hospitals are economic
anchors of community. Retrieved from http://www.aha.org.
This website is a critical one as it gives detailed information on
the uses and application of health care facilities in America.
These vary from the type of hospitals in America to the specific
type of resources that they deal with. Once again the
information in this website facilitates the understanding of the
role of a hospital in a community. In my project this will
facilitate in the distinction between the different types of
facilities and the role that they play in the community as well.
Running head: ACA
1
ACA
10
Changes resulting from the Affordable Health Care for America
Act (ACA)

Weltee Wolo
Rasmussen College
Author Note
course
The Affordable health care act was a series of changes and
reforms that were directed towards the health sector. The bill
got signed into law in March 2010. The reforms aimed at
improving the quality of health care for the American
population (Protection & Act, 2010). They are a set of rules for
health care facilities, insurance companies and other businesses
on matters to do with the provision of health care to people.
Much as there are changes the overall perception is that there
has had a tremendously positive effect on the people of America
as they can now comfortably rely on the act to have their
medical issues taken care of without worrying too much about
paying. According to Huntington et al. (2011), the bill has
substantially made health care affordable and attainable by most
of the people in the US. Ever since it’s passing the bill has had
tremendous changes in some primary health care providers such
as insurance companies, health care providers, and the facilities.
The changes range from those that are negative and those that
are positive, from the long term to the short term goals. One of
the providers that have been affected the most by the law is the
insurance companies and the way that they operate.
Possible causes of change to the insurance unit
The changes have had to take place so as to accommodate the

titles of the ACA of 2010. The biggest and most recognizable
cause of the changes is the fact that the law calls for the
increase in the number of people who get health care in the
country. More people of all classes and social standing
automatically request the adjustment of operation and systems
within insurance companies (Cantor et al., 2012). There is the
need to reduce the amount of money being spent by individuals
in health care without having to compromise the quality of care.
What this implies is that companies and businesses that take
care of issues of insurance substantially need to check their
systems so as to be viable and up to the task of meeting the
needs of the people and fulfilling the law of ACA.
According to Blumenthal & Collins (2014), most of these
changes are not temporary as they are static unless there is a
reversal of the law they are for the long term. Naturally, the
insurance companies are the ones that are most affected by the
act. This is because most of the components of the law deal with
issues of money as well as health care quality. As a result of
this, it is critical that the effects of the changes be evaluated by
what takes on a temporary standing and those that are for the
long term. The short term effects are those that are quickly
forgotten based on the minimal impact that they have. On the
other hand, the long-term effects are more permanent and affect
the company the greatest.
Effects of the Affordable Care Act on insurance companies
Education of consumers – more power to consumers
The ACA is one document that has brought about enlightenment
to the consumer when it comes to matters of health care. People
can conveniently take control of their lives and what facilities
that they would want to have the care in (Huntington et al.,
2011). With more private insurance firms coming up to fill the
gap which is used to fulfill the needs of the people, there is the
emergence of the need to conduct consumer education. Berwick
& Hackbarth (2012), state that consumer education ensures that
people make choices that are informed and with adequate
knowledge on the issue. There is a possibility that people could

under buy or over buy the policies and harm them financially in
the long run. The ACA has mandated the insurance companies
to offer very valid and more information on their policies and
has even made it simpler for more understanding. In the
beginning, these companies would quickly hide facts and
figures in very complicated insurance terminology that was not
understandable upfront. This could easily mislead people into
buying things that they did not understand or be deceived into
buying policies that did not meet their needs entirely
(Blumenthal & Collins, 2014). Deception and poor
understanding are a thing of the past according to the new act.
People now have a choice among many options, and they do so
after accessing the relevant information.
Accommodation of more people
Some of the ways through which insurance companies
accommodate more people is by increasing the coverage limits,
mandating private business owners with fifty additional
employees to offer medical insurance to its employees, not
using medical conditions to provide medical cover and stopping
the idea of people losing protection based on the seriousness of
their diseases (Rosenbaum, 2011). All these are strategies
employed by the ACA to increase the number of people being
covered by the medical health plans under the act. For the
insurance companies, this translates once again to fiscal
adjustments.
As of 2009, there were fewer businesses that could not facilitate
accommodation for every individual that needed to be covered.
For instance, with this act, there has been accommodation of
younger people as compared to previous years where older
people were included (Cantor et al., 2012). Insurance companies
have had to establish safeguards so as to ensure that the
premiums offered were enough to cover the extra costs that
would accommodate all the additional people that have had to
be covered. Safeguards are meant to reduce consumer spending,
increase insurance companies spending and eventually ensure

that costs of all the medical care for individuals that deserve
and have covered are catered to properly.
Financial
The ACA has significant financial implication for the insurance
companies all around the state. The cat called for the coverage
of people and therefore more planning and the need to establish
more sources of funds emerged. The private firms also saw a
chance to get a place in the market. The act also increases the
amount of money that the government allocates for the
companies. Much as the government assists the companies in
their funding, the amount used to cover the cost official care is
far more than they can get from the government. Retaining a
for-profit healthcare system has economic benefits this mostly
applies to the private insurance companies who are set to cater
to the needs of the people as well as make profits to remain in
the market and relevant (Sommers et al., 2015). This also means
that the system’s aspects also need to gain benefit so as to stay
relevant. While the ACA aims at reducing the cost of health
care Americans are still among the people paying the most for
basic health care. These are some of the adjustments that
companies have to take care of.
The other financial implication of the Affordable Care Act is
that of reduction of annual revenue of insurance companies.
According to Blumenthal & Collins (2014), while the insurers
had to make adjustments to suit the demands of the ACA, the
clients to these insurers were not affected as they were not
expected to make adjusted contributions to also adjust to the
ACA marketplace. This had them making assumed projection,
and these assumptions did not work as projected since this was
a first time experience. The result of this was that insurers did
worse in their performance unlike in previous years. Many of
the insurers underestimated the claims by over thirty-five
percent for the high claimants. On the other hand, the lower
providers underestimated their own by over four percent. Both
of these were equivalent to a six percent deviation from the

global market share of claims. In the preceding years, there
have been evidence of more accurate projections, but the losses
have been permanent as most of the newer and smaller insurers
have had difficulty in gaining their financial round with many
of them closing shop due to bankruptcy.
Competition in business – insurance market place
The ACA makes room for the establishment of an insurance
marketplace. This is where people get to make informed choices
based on the type of insurance that they want and the amount of
money available (Berwick & Hackbarth, 2012). Unlike in the
past, the insurance companies have been mandated with the duty
of making known and transparent all the information about it as
much as possible so as to facilitate in decision making. As a
result of this companies may have to make adjustments to their
services and premiums so as to attract more clients to its
companies. The competition for customers increases and this
calls for the need for changes.
According to Protection & Act (2010), many insurance
companies have had to take on extreme measures so as to attract
more customers. Those with difficulty in adjusting may have
had to take adverse measures such that they have run out of
business. Lack of clients or their reduction in number equally
results into the making of losses for the company. This means
that these companies have had to run out of business and close
shop. Business is threatened by the need to adjust premiums and
rates. People have the power to choose the policies and
companies that they feel serve their needs without feeling
oppressed by them. The failure to comply with the policies of
the Act will bring about the tight competition that makes the
other companies better their offers so as to attract more clients.
Competition in this business has had extreme effects that work
to the advantage of the patients by regulation of costs and
quality (Rosenbaum, 2011).
Medical conditions covered – preexisting conditions
With the signing in of the ACA, insurance companies have had

to change the type of conditions that they cover. Before the law
was implemented, people were limited to insurance cover based
on their present health conditions. There was an increased
chance that people with chronic illnesses before their
application would be left out of coverage based on these
circumstances. With the inception of the Affordable health care
act into law, insurance companies have had formulated policies
that accommodate children and adults even if they had
preexisting conditions that initially barred them from getting
covered (Rosenbaum, 2011). This was a measure that the
insurers made the most of their revenue by reducing associated
risks which were to be borne by the individual as opposed to the
company. For this reason, the insurer has had to deal with extra
costs incurred by the people who are suffering from chronic
diseases other conditions that may have had to be addressed at a
cheaper cost. Due to the fact that a person only pays a limited
amount of money for their cover, the insurance company is the
one that cushions the extra fees.
In addition to the medical conditions covered insurance
companies have had to deal with the limitation of the conditions
that could lead to one losing their cover. These have been
reduced to accommodate those people who may have made an
honest mistake while making their application or may have
developed a complication that was beyond their control or
previous awareness (Sommers et al., 2015). Initially, insurance
companies had the power to dismiss a cover for mistakes made
and complications developed even after providing the person
with medical cover. This implies that once again the insurer has
to part with more money to provide essential services without
charging the client more to get the same services.
Increase in coverage limit
The act has changed the age limit for coverage. It is flexible
enough, and the insurance policies have been mandated with the
task of covering children under their parents for up to twenty-

six years of age. These have deep fiscal implications that have
the long-term impact on the companies. These have further
long-term financial consequences to these enterprises. There is
a need for flexibility, and without proper planning, most of
these businesses may quickly run out of business based on the
fact that they are not financially prepared for these changes. As
of 2016 many of the newly established insurers have had to go
into financial distress to the extent of failing and going out of
business. The effect has also been seen in the larger companies
such as United Healthcare which have so far withdrawn from
the ACA’s exchange market due to the important financial
losses that it had been facing. The insurers as of 2016 only
managed to make only two percent of profits higher than the
projected profits in 2010 even after the account reinsurance
payment done. This is evidence of the deep financial plunges
that insurance companies have had to deal with as a result of
actions such as increasing the insurance cover limit.
In conclusion, the new health care act has had a very great
impact on the insurance companies. This range from fiscal
implications to having to accommodate more people at a smaller
cost than it was before. Many adjustments have therefore been
made to accommodate these changes. The greatest impact of all
time is that these companies have shifted focus from making
more money from claims to ensuring that everybody gets an
insurance policy or treated at a lower cost. These companies
have often focused on making money for themselves at times
compromising the health of the patients. These include
situations such as dropping of patients due to complications
developed so as to cut the costs of money discharged by the
insurance companies. Much as there seem to be more negative
impacts as opposed to the positive ones, the insurance
companies may have ultimately been favored as they have more
people to cover thereby accumulating more money while
offering better services to the people. Finally, the ACA has
enabled more companies to crop into the market thus creating
equilibrium as more money has been allocated by the federal

government to support the provision of better health care for
people.
References
Berwick, D. M., & Hackbarth, A. D. (2012). Eliminating waste
in US health
care. Jama, 307(14), 1513-1516.
Blumenthal, D., & Collins, S. R. (2014). Health care coverage
under the Affordable Care Act—a
progress report.
Cantor, J. C., Monheit, A. C., DeLia, D., & Lloyd, K. (2012).
Early impact of the Affordable
Care Act on health insurance coverage of young adults. Health
services research, 47(5), 1773-1790.
Protection, P., & Act, A. C. (2010). Patient protection and
affordable care act. Pu
Huntington, W. V., Covington, L. A., Center, P. P., Covington,
L. A., & Manchikanti, L. (2011).
Patient Protection and Affordable Care Act of 2010: reforming
the health care reform for the new decade. Pain
Physician, 14(1), E35-E67.blic Law, 111, 48.
Rosenbaum, S. (2011). The Patient Protection and Affordable
Care Act: implications for public
health policy and practice. Public health reports, 126(1), 130-
135.
Sommers, B. D., Gunja, M. Z., Finegold, K., & Musco, T.
(2015). Changes in self-reported
insurance coverage, access to care, and health under the
Affordable Care Act. Jama, 314(4), 366-374.

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