DEISM: The religion of those believing in a God who rules the world by established laws but not believing in the divinity of Christ or the inspiration of the Bible; "natural" religion, based on reason and a study of nature, as opposed to "revealed" religion. The scientific movement which grew out of the new knowledge of the world and the universe following upon the discoveries and theories of Columbus, Copernicus, Galileo, Francis Bacon, and later the members of the Royal Society, furthered the development of a rationalistic point of view which more and more tended to rely upon reason instead of upon revelation in the consideration of humanity's relation to God and the Universe. The fact that the conceptions of the physical world found in the Old Testament seemed inconsistent with the newer knowledge shook the faith of many in the doctrine of the special inspiration of the Bible. DEISM was a product of this general point of view. 1. The Bible is not the inspired word of God; it is good so far as it reflects "natural" religion and bad so far as it contains "additions" made by superstitious or designing persons. 2. Certain Christian theological doctrines are the product of superstition or the invention of priests and must be rejected; e.g., the deity of Christ, the doctrine of the Trinity, and theory of the atonement for sins. 3. God is perfect, is the creator and governor of the Universe, and works not capriciously but through unchangeable laws (hence "miracles" are to be rejected as impossible). 4. Human beings are free agents, whose minds work as they themselves choose; even God cannot control human thought. 5. Since human beings are rational creatures, like God, they are capable of understanding the laws of the universe; and as God is perfect, so can humanity become perfect through a study of nature, which shows design and must therefore be an expression of God. 6. Practical religion for the individual consists in achieving virtue through the rational guidance of conduct (as exemplified in the scheme for developing the moral virtues recorded by Franklin in his Autobiography). (Thrall, Hibbard, Holman. A Handbook to Literature.) Chapter 8 Economics of Health Care Economic Approach to Health Care Competition in the market Healthcare market Demand Supply Competition Competition Versus Regulation Standards of participation Cost containment and value Market Failure in Health Care Free market competition Market failure Supplier-influenced demand Third-party payer Imperfect market Rising Costs and Today’s Healthcare System Social Security Act of 1935 1959 Federal Employees Health Benefit Act and Blue Cross 1960’s Medicaid (Title XIX) and Medicare (Title XVIII) Increased costs Gross domestic product (GDP) Rising Costs and Today’s Healthcare System (cont.) Decreased access Rising costs/inability to pay Increased number of people covered by Medicare.

1. DEISM: The religion of those believing in a God who rules the
world by
established laws but not believing in the divinity of Christ or
the
inspiration of the Bible; "natural" religion, based on reason and
a study
of nature, as opposed to "revealed" religion. The scientific
movement
which grew out of the new knowledge of the world and the
universe
following upon the discoveries and theories of Columbus,
Copernicus,
Galileo, Francis Bacon, and later the members of the Royal
Society,
furthered the development of a rationalistic point of view which
more and
more tended to rely upon reason instead of upon revelation in
the
consideration of humanity's relation to God and the Universe.
The fact
that the conceptions of the physical world found in the Old
Testament

2. seemed inconsistent with the newer knowledge shook the faith
of many in
the doctrine of the special inspiration of the Bible. DEISM was
a
product of this general point of view.
1. The Bible is not the inspired word of God; it is good so far
as it reflects "natural" religion and bad so far as it
contains "additions" made by superstitious or designing
persons.
2. Certain Christian theological doctrines are the product of
superstition or the invention of priests and must be
rejected; e.g., the deity of Christ, the doctrine of the
Trinity, and theory of the atonement for sins.
3. God is perfect, is the creator and governor of the Universe,
and works not capriciously but through unchangeable laws
(hence "miracles" are to be rejected as impossible).
4. Human beings are free agents, whose minds work as they

3. themselves choose; even God cannot control human thought.
5. Since human beings are rational creatures, like God, they are
capable of understanding the laws of the universe; and as God
is perfect, so can humanity become perfect through a study of
nature, which shows design and must therefore be an
expression of God.
6. Practical religion for the individual consists in achieving
virtue through the rational guidance of conduct (as
exemplified in the scheme for developing the moral virtues
recorded by Franklin in his Autobiography).
(Thrall, Hibbard, Holman. A Handbook to Literature.)
Chapter 8
Economics of Health Care

4. Economic Approach to Health Care
Competition in the market
Healthcare market
Demand
Supply
Competition
Competition Versus Regulation
Standards of participation
Cost containment and value
Market Failure in Health Care
Free market competition
Market failure
Supplier-influenced demand
Third-party payer
Imperfect market
Rising Costs and Today’s Healthcare System
Social Security Act of 1935
1959 Federal Employees Health Benefit Act and Blue Cross
1960’s Medicaid (Title XIX) and Medicare (Title XVIII)
Increased costs
Gross domestic product (GDP)
Rising Costs and Today’s Healthcare System (cont.)
Decreased access
Rising costs/inability to pay
Increased number of people covered by Medicare and Medicaid;
decreased number covered by private insurance
More employers offering insurance; fewer employees are

5. purchasing it
Private insurance does not guarantee financial access to care
Public programs offer inadequate prenatal and mental health
care programs
Negative outcomes for the uninsured/underinsured
Rising Costs and Today’s Healthcare System (cont.)
Influences on costs and access
Increased sources of funds from governments
Inflation
Drug cost increase
Advanced technology is expensive
Higher personnel wages and benefits costs
Change in population demographics
Excess
Medical excess
Administrative excess
Emphasis on cure instead of prevention
Paying for Health Care
Out-of-pocket payments and charity
Cost sharing
Health insurance
Private insurance
Employment-based insurance
Experience rating
Community rating
Health insurance purchasing cooperatives
Self-insurance
Paying for Health Care (cont.)
Publicly funded insurance and direct care programs

6. Medicare
Part A
Inpatient hospital care
Benefit period
Skilled nursing facility
Home health agency
Hospice
Part B and Part D
Medicare Advantage
“Medigap” insurance
Paying for Health Care (cont.)
Medicaid
Entitlement/welfare program
Based on income and assets
Categorically needy
Medically needy
Personal Responsibility and Work Opportunity Act
Temporary Assistance for Needy Families (TANF)
Paying for Health Care (cont.)
Children’s Health Insurance Program (CHIP)
Federally funded
CHAMPUS
Other public direct care programs:
Public Health Service Act of 1994
Affordable Care Act (ACA) of 2010
Cost Containment, Cost Analysis, and Quality
Cost-containment strategies
Controlling quantity of supply
Controlling price

7. Controlling quantity of demand
Competition
Prioritizing through cost analysis
Cost Containment, Cost Analysis, and Quality (cont.)
Cost analysis
Cost-of-illness analysis
Cost–benefit analysis
Cost-effectiveness analysis
Technology assessment
Public Health, Managed Care, and the Economics of Prevention
Opportunities for collaboration
Cost-containment efforts
Shift from acute services to preventive
Counterforces to collaboration
Safety net
Dumping of services
Coordination of state reporting
Nature of for-profit firms
Economics of alternative therapies
Significance of Economics for Community Health Nursing
Practice
Disease prevention/health promotion
Consumer-driven health care
Nurses can help consumers understand price and quality issues
Gaining third-party reimbursement—an important labor market
change for nurses
Coalition building, research, lobbying, negotiating with
insurers, influencing policymaking

8. Economics and Nightingale’s Legacy
Market justice
Social justice
Chapter 9
Politics and the Law
Government Authority
Protection of the public’s health
U.S. Constitution
Bill of Rights
State power
Power, Authority, and the
Health of the Public
Concepts of power
Coercive
Reward
Expert
Legitimate
Referent
Information
Connection
Evolution of the Government’s
Role in Health Care

9. Preamble of the U.S Constitution
“Promote the general welfare” of the people
Marine Hospital Service
The Shattuck Report
Hill-Burton Act
Evolution of the Government’s
Role in Health Care (cont.)
Medicare & Medicaid
The Civil Rights Act of 1964
National Environmental Policy Act
Americans with Disabilities Act (ADA)
Affordable Care Act (ACA) of 2010
Federal Government
Executive
Office of the President
Legislative
Congress
Judicial
Federal Court System
U.S. Public Health Agencies
National Institutes of Health
Food and Drug Administration
Centers for Disease Control and Prevention
Indian Health Service
Health Resources and Services Administration
Substance Abuse and Mental Health Services Administration
Agency for Healthcare Research and Quality
U.S. Public Health Service Corps

10. Human Services Agencies
Centers for Medicare and Medicaid Services
Administration for Children and Families
Administration on Aging
Department of Education
Department of Labor
Legislative Branch
U.S. Congress
Has two houses with equal power:
Senate
House of Representatives
Judicial Branch
94 federal districts courts
12 circuit courts of appeals
U.S. Supreme Court
Several specialized courts
State Government
Executive
Legislative
Judicial

11. Local Government
Public health
Public education
Drinking water
Sewage disposal
Police protection
Solid waste management
Different Types of Law
Constitutional law
Statutory law
Judicial or common law
Civil or criminal
Regulation of Nursing Practice
Nurse practice acts of each state control:
Requirements for entry into practice
Standards for acceptable practice
Standards for continuing competence
Disciplinary actions
Board of Nursing
Licensure of Nursing Practice
National Council Licensing Examination for Registered Nurses
(NCLEX-RN)

12. Nursing Practice and Law
Negligence and malpractice
Correctional settings
Forensic nursing
Chapter 13
Environmental Health
Trends in Exposure and Disease
World view
Health risks from environmental toxicants
Rapid increase in the world’s population
Changes in urbanization and agricultural production
Recent ecological changes
Population movement
Deforestation
Irrigation
Expanding urbanization
Change in agricultural practices
Environmental Health
Definition: freedom from illness or injury related to toxic
agents and other environmental conditions
Applications range from hospital rooms to international and
global perspectives on health of the planet
Environmental Health Policy: Historical Perspectives
Early environmental health focused on sanitation, water quality,

13. and housing
Mortality rates decreased
Influential publication:
Carson, R. (1962). Silent spring. Boston: Houghton Mifflin
Legislation and commissions
Clean air and water acts
Occupational health
Safety acts
Pollution Prevention Act of 1990
Toxic Substances Control Act
Environmental Protection Agency
Occupational Safety and Health Administration Nuclear
Regulation Commission
Recent Health Issues & Trends
Issues
Damage to the environment
Population growth
Urban spread
Advanced technology
Industrialization
Modern agricultural methods
Trends
Focus on the built environment
Children’s environmental health
Chemicals, pesticides, mercury, smoke
Environmental justice movement
Historical Perspectives on Environment and Health
Epidemiology
Time
Person

14. Place
Chronic disease epidemiology
Asbestos and mesothelioma
Prenatal exposure to diethylstilbestrol (DES)
Occupational exposure
Origins of Environmental Health Policy
Industrial Revolution—1800s
Focus on modernization and rapid production of goods and
services
Growing concern for working conditions and safety of workers
1900s
Environmental health and safety
Passages of laws to protect the public
Pure Food and Drug Law
Food and Drug Administration
1960s–1970s
Post-war industrial rebuilding
Consumer-driven environmental movement
Environmental Policy: Governmental Roles
Protect and safeguard
Pass laws and enact rules and regulations
Identify and monitor risks and hazards
Healthy People 2020
Monitor compliance with rules
Gather data to inform policymakers
Nursing and the Environment
Nightingale
Pure, fresh air

15. Pure water
Efficient drainage
Cleanliness
Light
Emerging Role
Intervene directly in environmental factors
Role of the Community Health Nurse
Identify risks
Assess exposures
Communicate risks
Assess and refer clients
“Upstream Thinking”
Ethical Principles
Social justice
Environmental justice
Benjamin Franklin
Be sure to read the introduction in the textbook. Access the
notes on the Age of Reason
(Eighteenth Century) posted on the Background Study Notes.
Your textbook has an essay
“Reason and Revolution 1725-1800.” The page numbers are in
the Table of Contents and

16. also on your syllabus of Works to Read.
Franklin is a major representative of the Age of Reason, which
is also called the
Enlightenment. This era dates roughly from 1700-1800, the 18
th
century.
Franklin was born in Boston and died in Philadelphia. He lived
for the majority of the
18
th
century through exciting times in American history. He was a
crucial influence on
the development of this country.
Franklin was apprenticed as a printer when he was 12 years old.
He was basically self-
educated. As a teenager he became the editor of a newspaper.
He moved to Philadelphia
when he was 17 and began to make his fortune in that city.
He retired when he was 42. He made wise investments, worked
hard, and saved his

17. money. You can see some of the achievements in the
introduction. He was a scientist, a
diplomat, a businessman, a writer, a politician, an inventor. He
had many interests and
talents.
Franklin spent many years in France and England, working on
the American cause. He
worked on the Declaration of Independence and served the
Constitutional Convention.
Look at the footnote to the beginning of “The Autobiography.”
The work was written
when he was 65 years old and his son was an adult. I have asked
you to look at only a
small section. Look at the list of Works to Read for the pages.
He first listed 12 virtues but was told by a Quaker friend that he
needed another one, so
he added #13. He tells the reader that he wants to arrive at
moral perfection. He develops
a list of moral virtues, which he wants to possess. They are
listed in the pages you are to
read. He stresses that he intends to acquire the habit of these
virtues and that trying to do

18. them all at once would be difficult. He decides to try them one
at a time. He also
organizes his schedule so that nothing is wasted. You can see
that schedule. Notice
especially the questions he asks himself each morning and each
evening.
He says that he did not acquire the reality of humility but did
work on the appearance of
virtue.
In “The Way to Wealth,” Franklin uses a pen name to write.
Richard Saunders is the
author, but it is actually Franklin. Almanacs were popular
reading material. The sayings
were used for filler in the almanac and have been the part that is
important. The sayings
were not original for the most part, but Franklin gave them new
emphasis for the
American experience. The most famous collection of these
sayings was “The Way to
Wealth.”
You can read this section to get the idea of the sayings. You

19. will recognize many of
them. They are common sense approaches to life. They deal
with subjects like laziness,
time management, money management. The advice is practical.
Franklin spent many years in France as a diplomat. He had
married Deborah Read when
he arrived in Philadelphia. She was not educated, but the two
seemed to have a respectful
marriage. He was often away from home on diplomatic
missions.
In the “Letter to Ezra Stiles,” Franklin responds to questions
regarding his personal
beliefs. In a time when there was no instant communication,
letters were crucial in
sharing with others. Letters were used for more than factual
news—they also contained
philosophical, religious, political, and other insights. Stiles had
asked Franklin about his
religion in a previous letter. In paragraph 3 Franklin addresses
this.
Be sure you access the posted notes in Background Study Notes
that discuss Deism.

20. Deism is a philosophical attitude that was prominent in the 18
th
Century Age of Reason.
The notes give you a definition and discussion. You need to
have that information.
Franklin, like most of the founders of the nation (including
Jefferson and Paine), was
Deist. Paragraph 4 of the letter begins Franklin’s account of his
own beliefs. He also
responds to the question about the nature of Jesus. Franklin says
that Jesus left the best
system of morals if people would only follow it. However,
corrupting changes have
occurred.
Franklin says the issue of divinity is not something he will have
to expend much energy
on because at his elderly state, he will have the opportunity of
knowing firsthand the truth
of the situation. Since he has prospered in this life, he has no
reason to doubt its
continuation in the next. Franklin died five weeks after he wrote
this letter as you see in

21. the footnote.
The “Speech in the Constitutional Convention” was delivered on
September 17, 1787,
when the Constitution was signed. It is important to notice that
he says he does not
entirely approve of the document, but that does not mean he
will never approve. He does
agree to the Constitution even with its faults because
government is necessary. It is
powerful that Franklin says he has found with his long life that
he has been wrong about
things he once thought were true.
ENG 251 THE AGE OF REASON
Eighteenth Century
MAJOR LITERARY FORMS
essays, autobiography, satire, pamphlets, documents, poetry,

22. sketches
THEMATIC CHARACTERISTICS
1. Influenced by European philosophers:
Sir Isaac Newton
Isaac Newton was the greatest English mathematician of his
generation. He laid the foundation for
differential and integral calculus. His work on optics and
gravitation make him one of the greatest scientists
the world has known.
John Locke
Much of John Locke's work is characterized by opposition to
authoritarianism. This opposition is both on
the level of the individual person and on the level of institutions
such as government and church. For the
individual, Locke wants each of us to use reason to search after
truth rather than simply accept the opinion
of authorities or be subject to superstition. On the level of
institutions, it becomes important to distinguish
the legitimate from the illegitimate functions of institutions and
to make the corresponding distinction for
the uses of force by these institutions. The positive side of
Locke's anti-authoritarianism is that he believes

23. that using reason to try to grasp the truth and determining the
legitimate functions of institutions will
optimize human flourishing for the individual and society both
in respect to its material and spiritual
welfare. http://plato.stanford.edu/entries/locke/
Rene Descartes
After an expanded statement of the method of doubt, he argued
that even the most dire skepticism is
overcome by the certainty of one's own existence as a thinking
thing. From this beginning, he believed it
possible to use our clear and distinct ideas to demonstrate the
existence of god, to establish the reliability of
our reason generally despite the possibility of error, to deduce
the essence of body, and to prove that
material things do exist. On these grounds, Descartes defended
a strict dualism, according to which the
mind and body are wholly distinct, even though it seems evident
that they interact.
http://www.philosophypages.com/ph/desc.htm

24. 2. Interest in Deism—God governing through natural laws (see
handout on Deism)
3. God humanity and nature existing in harmony
4. Reason , reflection, investigation, prudence, common sense
as guides to understanding divine design
5. Emphasis on the present world and conditions here
6. The natural rights of human beings
7. Political rights of the colonies, arguments for separation from
England
8. Defining an "American"
9. Contrast and comparisons of Europeans and Americans

25. STYLISTIC CHARACTERISTICS
English form and style—American sensibility
Many pamphlets and manifestos, highly rhetorical rather than
lyrical
Practical, political, and persuasive
Clarity and precision in prose
Poetry emphasizing form and meter
Importance of wit
Propaganda for the American Revolution
Evocation of a national sense
Topical subject matter
GENERAL CHARACTERISTICS OF NEOCLASSIC WRITING
Used heroic couplet (two rhyming lines in iambic pentameter
expressing a thought)
Cultivated poetic diction
Generalized about the situation and abstract in philosophy
Strove for perfection of form—regularity, clarity, standard

26. Conformed to law and order—Pope's "Whatever is, is right."
Stressed intellect, reason, common sense
Emphasized satire and criticism
Emphasized society and its institutions
Interested in city life
Interested in the contemporary world but also interested in the
Greek and Roman
classical works
Examples of classical architecture from Rome and Greece:
The Colesseum in Rome
The Parthenon in Athens
Examples of neoclassical architecture in the United States:
The Jefferson Memorial in Washington, D. C.
Mount Vernon, home of George Washington

27. The White House in Washington, D. C.
The Capitol in Washington, D. C.
Example of neoclassical gardens: