A nurse is discussing with another nurse how health outcomes for underinsured clients can be improved by returning to school to achieve a higher level of education. Which of the following rationales should the nurse include in the discussion?

Choice A: Implementing the Teach Back Method When Prescribing Medication
The Teach Back Method is an effective communication strategy where healthcare providers ask clients to repeat back the information given to ensure understanding. While this method can improve medication adherence and health literacy, it does not directly address the broader systemic issues related to poverty. It is a useful tool but not the most impactful intervention for breaking the cycle of poverty.

Choice B: Replacing Medicare Programs with Medigap Policies
Medigap policies are supplemental insurance plans that cover costs not included in traditional Medicare. However, replacing Medicare programs with Medigap policies would not necessarily improve outcomes for clients impacted by poverty. Medigap policies can be expensive and may not be affordable for low-income individuals. This intervention does not address the root causes of poverty or improve access to essential health services.

Choice C: Eliminating the Use of Client Portals or Virtual Visits
Eliminating client portals or virtual visits would likely have a negative impact on client outcomes, especially for those in poverty who may have limited access to transportation. Virtual visits and client portals provide convenient access to healthcare services, allowing clients to communicate with providers, access medical records, and receive care without the need for in-person visits. Removing these options would reduce access to care for many individuals.

Choice D: Opening a Community Health Center in an Underserved Area
This is the correct choice. Opening a community health center in an underserved area directly addresses the lack of access to healthcare services, which is a significant barrier for individuals living in poverty. Community health centers provide comprehensive primary care, preventive services, and support for managing chronic conditions. They often offer sliding scale fees based on income, making healthcare more affordable and accessible for low-income populations. By improving access to healthcare, community health centers can help break the cycle of poverty and improve overall health outcomes.

Choice A Reason:
Autonomy refers to respecting an individual's right to make their own decisions. In the context of healthcare, it means allowing patients to make informed choices about their own care. While autonomy is an important ethical principle, it is not the primary focus when considering the balance of benefits and harms in a community-wide intervention.

Choice B Reason:
Beneficence is the ethical principle that involves acting in the best interest of others by promoting good and preventing harm. In this scenario, the nurse demonstrates beneficence by ensuring that the benefits of the physical activity program substantially outweigh any potential harms. This principle is central to public health initiatives, where the goal is to enhance the well-being of the community.

Choice C Reason:
Nonmaleficence is the principle of "do no harm." It emphasizes the importance of not causing harm to others. While nonmaleficence is closely related to beneficence, the focus in this scenario is on the positive impact of the intervention (beneficence) rather than solely avoiding harm (nonmaleficence).

Choice D Reason:
Justice refers to fairness and equality in the distribution of resources and treatment. It ensures that all individuals have equal access to healthcare and that no group is unfairly disadvantaged. Although justice is a crucial ethical principle, the scenario specifically highlights the balance of benefits and harms, which aligns more closely with beneficence.