health care & professional nursing
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Nursing Fundamentals Focus I
Health Care Deliveryand Professional Nursing
Judy Ontiveros, RN, PHN, MSNAssistant Professor
Objectives –Focus I
Describe the current the U.S. health care delivery systemDiscuss the role of nursing as a provider of care within the health care delivery systemExplain Professional Nursing and the delegation of nursing functions to the different levels of the health care providers
Health Care Delivery System
Institutions
Service
Consumer Diversity
Practitioner
Current Trends and Social Justice
Health Care Technology
Health Care Delivery SystemMechanism for providing services that meets the health-related needs of the individual
Survival?
Increasing services
Public demanding greater accessibility to affordable health care
Health Care Delivery System
InstitutionsGovernment Sponsored
VA system
Health Delivery SystemsState
County
Rancho
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Private SectorFee-for-Service
r
Institutions
Government SponsoredVA SystemStateCounty or City
Public Health Institutions—funded by taxeslocal planning to meet the needs of the peopleof the area. outbreak of diseasescultural needs
Institutions
PUBLIC HEALTH SERVICE of the US Nation Institute on Drug AbuseNational Institute on Alcohol, Abuse, AlcoholismNational Institute of Mental HealthCenters for Disease Control and Prevention (CDC)Federal Drug Administration
Health Care ServicesHistorically
Medical Model ID of Diseases and their Treatment
Types of HealthCare ServicesMedical Model
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Health Care ServicesPrimary Prevention
Health Promotion and Illness PreventionHealth promotion is the process of enabling people to increase control over, and to improve, their health. It moves beyond a focus on individual behavior towards a wide range of social and environmental interventions-WHO
Secondary PreventionDiagnosis and Treatment
Tertiary PreventionRehabilitationSupportive Care- Hospice/Palliative Care
Primary CareMajor purpose
Promote wellnessPrevent illness or disability
Focus of careIndividual FamilyCommunity
Still function in the illness care modeLack major aspects of preventive careHealthy lifestyles
Secondary CareDiagnosis and Treatment
Most care is delivered herePhysician officesClinicsEmergency roomsUrgent care facilities
TertiaryRestoring to the state that existed before illness. Reach the optimal level of self-careRestorative = Holistic Care
PhysiologicalpsychologicalSocialspiritual
Diversity in Health CareHealth Care Disparities
Healthy People 2010Decrease mortallity rates for four disticnt age groups Infants, children, adolescents and young adults. And over 65
Access to Health CareBarriers perceivedNot universally available or accessibleEffective Health CareLink between utilization of heath care and health outcomes
Diversity in Health CareDemographic Changes
Aging PopulationFamily services decliningIncreasing Ethnicity
LifestyleChanged from acute to chronic
1/6 deaths attributed to smoking5/10 top causes of death due to dietary3 of those being alcohol related.
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PractionersRNAPN’s (Advanced Practice Nurse)LVN, CNA, Home health aidesPhysiciansPAPTRTPharmacistsPastoral CareAlternative medicine practioners
RN Populations in Various Institutions
RN in Acute Care Setting
Community Health, Home HealthOccupational Health or Student Health
Ambulatory Care Setting
Nursing Homes or Extended Care Facility
REMAINDER Educators, Prisons, Insurance Companies, State BRN, Prisons, Films sets, Cruise ships, amusement parks, Church communities
DHS study 2000
Health Care Delivery SystemTrends
Multi focused health care servicesHealth care financing
Private insurance – PPOManaged Care – HMOGovernment Plans
MedicareMedicaidPPS – Prospective payment SystemDRG – Diagnosis related groups
Health Care Delivery System
Health Care Institutions
Inpatient Care vs
Outpatient Care
Health Care Delivery System
Inpatient Care: Examination TreatmentDiagnosis Nursing Care
Patient is residing in the Hospital
Health Care Delivery System
Outpatient Care:Any health care service provided to a patient who is not admitted to a facility
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Health Care Delivery System
Hospitals
Primary -Community Hospitals, Rural Hospital, General Hospital
Secondary –Larger Urban Hospital with a full range of servicesTechnical services available
TertiaryLarge Medical CentersResearch/TeachingSophisticated, advanced care
Health Care Delivery System
Emergency and Rescue Care:
Ambulance service and first aid treatment to victims
Illness
Accidents
Disasters
Triage
Health Care Delivery System
Psychiatric Care:Inpatient and outpatient care
All of levels of nursing practice
Health Care Delivery System
Rehabilitative Care:
Inpatient and outpatient specialized services
RN are utilized at all levels of services
Health Care Delivery System
Long Term Care or Extended Care:
Traditional nursing home
Assisted living
Residential care facility
Retirement home
Health Care Delivery System
Hospice:RN at all levels work at these facilities
Can be organized in a myriad of ways!
New avenue Tele-hospice care over videophone
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Health Care Delivery System
Physician Office:
Dominate provider of outpatient care!
Health Care Delivery System
Ambulatory Care:
Provide outpatient services to those who visit a hospital or other facility after treatment the same day
Health Care Delivery System
Respite Careprovides temporary relief to informal caregivers
family membersrelieve stress and burden of 24/7
Health Care Delivery System
School Health
Occupational Health Services
Others……..
Health Care Delivery System
Service Excellence in Nursing:5 descriptors
tangiblesreliabilityresponsivenessassuranceempathy
Health Care Delivery System
Practitioners:RNAPNPhysiciansPA
Allied Health PractitionersPharmacistsSocial WorkersSpiritual and Religious PersonnelAlternative Practitioners
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Health Care Delivery SystemCurrent Trends
OBAMA CAREThe Patient Protection and Affordable Care Act (PPACA)
Effective March 23, 2010Major provisions phased in by January 2014Supplemental Provisions by 2020
What will it doDecrease the number of uninsuredReduce the overall costs of health careImproving health care outcomes Update and streamline health care delivery
Benefits – Cover all applicant, offer same rates despite pre-existing conditions or gender
Health Care Delivery SystemSocial Justice
Acting in accordance with fair treatment regardless of economic status, race, ethnicity, age, citizenship, disability, or sexual orientation.
Ethnic disparitiesAffluence and Poverty
Health Care Delivery System
Health Care Technology:
New Health Care Information Technology
Genetic Engineering
Ambulatory Monitoring Devices
New Imaging Techniques
New Nursing Care Devices
Nurse as a Provider
Requires:
Intellectual achievement
Ethical standards
Scientific knowledge
Technological skills
Personal standards
Nurse as a Provider
Major aspects of of nursing function:
Autonomous
Interdependent
Coordinative
Scope of practice RN, LVN, CNAThe Nursing Process
Data Collection
Assessment Nursing Diagnosis
Goal Setting
Plan and Implement Care
Evaluation
Gather data based on competency and skills ofcaregiver
Makes judgments based on assessment
Makes judgments based on assessment data
Establish care priorities set goals with outcome criteria
Target and describe interventions and carry out plan
Use objective data to assess outcome
Shared function of all members of the health care team based on individual competency
Professional responsible
Professional responsible
Professional responsible
Shared function of all members of the health care team based on individual competency
Professional responsible
RN, LVN, CNA
RN ONLY RN ONLY RN ONLY
RN, LVN, CNA
RN ONLY
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Nurse as a Provider
Nursing Roles:CaregiverAdvocateCritical thinker- habits of the mind + cognitive skills
TeacherCommunicatorManager ResearchRehabilitator
Nurse as a Provider
Nursing: responds to illness by providing care
VS
Medicine: diagnoses and treats illness
Profession of Nursing
Education
Diploma programs
Associate Degree programs
Baccalaureate Degree programs
Graduate degree programs
Profession of NursingEducation
Advanced Practice Education- Masters Degree Programs- Doctoral Degree Programs
Continuing Education
In-service Education
Profession of Nursing
Delivery of Nursing Service
Team Nursing
Delegation/Assignmentsee BRN statement
Nurse as a ProviderThe Five Rights of Delegation:
1. RIGHT TASK2. RIGHT CIRCUMSTANCES3. RIGHT PERSON 4. RIGHT DIRECTION/COMMUNICATION5. RIGHT SUPERVISION
See syllabus
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Profession of NursingDelivery of Nursing ServicePrimary Care Nursing
1. The goal of providing patients with Marie
continuity in their care Manthey
2. Promote nursing authority for care planning and accountability for patient outcomes.
Profession of NursingFactors affecting conduct
The Nurse Practice Act
BRN (Title 16)
ANA Clinical practice Standards
ANA Code Ethics (Integrity)
Sense of AltruismConcern for the welfare and well-being of
others
Profession of Nursing
Professional Misconduct
Exercising undue influence on the clientMoral unfitnessRevealing personal info with client prior consentPracticing beyond scope of permitted by lawAbandoning or neglecting a clientHarassing, abusing, or intimidating a client physically or verbally
Profession of NursingProfessional Misconduct
Failing to maintain a record reflecting evaluation and treatment of a clientFailing to exercise appropriate supervision over persons who need supervisionNot guaranteeing satisfaction or cure from the performance of professional servicesFailing to wear and identification badgeFailing to use scientifically accepted infection control techniques
Profession of Nursing
Role of research
Development of nursing models
Profession of NursingNursing is a true profession because:
-Vital service to human kind
- Special body of knowledge
- Services provided involved intellectual activity, individual
responsibility, and activity
- Education in institutions of higher learning
- Practitioners have autonomy
- Practitioners are motivated by altruism
- Decisions and conduct are guided by a code of ethics
- High standards of practices are supported by an organization
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Bibliography
Berman, A., Synder , S., and Kozier, B, Erb, G. (2012). Fundamentals of Nursing: Concepts, Process, and Practice., Prentice Hall, NJ.
Harkreader H.& Hogan.M. (2007) The Fundamentals of Nursing Caring and Clinical Judgment (3rd ed.) St. Louis MO:Saunders
Andrews M. & Boyle J. (2003) Transcultural Concepts In Nursing Care (4th ed.) Philadelphia PN: Lippincott Williams& Wilkins
Satterly, F. (2004) Where Have The Nurses Gone? Impact of The Nursing Shortage on American Healthcare. Amherst NY: Prometheus Books
Spratley, E. (March 2000) The Registered Nurse Population, Findings from the National Sample Survey of Registered Nurses, U.S. Department of Health & Human Services, Bureau of Health Professions, Division of Nursing, Health Resources and Services Administration.
American Nurses Association. (1995). The ANA Basic Guide to Safe Delegation. American Nurses Publishing Company. Washington, DC.
National Council of State Boards of Nursing. (1997). Delegation: Concepts and Decision-Making Process Page
Ehrhart P.M., Furlong B. (1993) The renaissance nurse: permeating clinical competence with the humanities. Nurse Educ. 1993 May-Jun;18(3):22-4.