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- 1. 8/21/2012 Nursing Fundamentals FocusI Objectives –Focus I Health Care Delivery Describe the current the U.S. health care and Professional Nursing delivery system Discuss the role of nursing as a provider of care Judy Ontiveros, RN, PHN, MSN within the health care delivery system Assistant Professor Explain Professional Nursing and the delegation of nursing functions to the different levels of the health care providers Health Care Delivery System Health Care Delivery System Mechanism for providing services that meets Institutions the health-related needs of the individual Service Survival? Consumer Diversity Practitioner Increasing services Current Trends and Social Justice Public demanding greater accessibility to Health Care Technology affordable health care Health Care Delivery System Health Delivery Systems Institutions State Government Sponsored VA system Rancho County 1
- 2. 8/21/2012 Institutions Private Sector Fee-for-Service Government Sponsored VA System r State County or City Public Health Institutions— funded by taxes local planning to meet the needs of the people of the area. outbreak of diseases cultural needs Institutions Health Care Services PUBLIC HEALTH SERVICE of the US Historically Nation Institute on Drug Abuse Medical Model National Institute on Alcohol, Abuse, ID of Diseases and their Treatment Alcoholism National Institute of Mental Health items not FDA approved can be Centers for Disease Control and acquired in other places w/o FDA Prevention (CDC) eg France/MX Federal Drug Administration Types of HealthCare Services Medical Model 2
- 3. 8/21/2012 Health Care Services Primary Care (by level of disease Primary Prevention prevention) Major purpose Health Promotion and Illness Prevention Promote wellness Health promotion is the process of enabling people to Prevent illness or disability increase control over, and to improve, their health. It moves beyond a focus on individual behavior towards Focus of care a wide range of social and environmental Individual interventions-WHO Family Secondary Prevention Community Diagnosis and Treatment Still function in the illness care mode Lack major aspects of preventive care Tertiary Prevention Healthy lifestyles Rehabilitation (health restoration) Supportive Care- Hospice/Palliative Care Secondary Care Diagnosis and Treatment Tertiary Most care is delivered here Restoring to the state that existed before Physician offices illness. Clinics Reach the optimal level of self-care Emergency rooms Restorative = Holistic Care Urgent care facilities Physiological psychological Social spiritual Diversity in Health Care Health Care Disparities Diversity in Health Care Healthy People 2010 Demographic Changes Decrease mortallity rates for four disticnt age Aging Population ...baby boomers! groups Family services declining Infants, children, adolescents and young adults. And over 65 Increasing Ethnicity Access to Health Care Lifestyle Changed from acute to chronic Barriers perceived 1/6 deaths attributed to smoking Not universally available or accessible 5/10 top causes of death due to dietary Effective Health Care 3 of those being alcohol related. Link between utilization of heath care and health outcomes 3
- 4. 8/21/2012 RN Populations in Various Practioners Institutions RN RN in Acute Care Setting APN’s (Advanced Practice Nurse) LVN, CNA, Home health aides Community Health, Home Health Physicians Occupational Health or Student Health PA Ambulatory Care Setting PT RT Nursing Homes or Extended Care Facility Pharmacists Pastoral Care REMAINDER Educators, Prisons, Insurance Companies, State BRN, Prisons, Films sets, Cruise ships, amusement Alternative medicine practioners parks, Church communities DHS study 2000 Health Care Delivery System Health Care Delivery System Trends Multi focused health care services Health Care Institutions Health care financing Private insurance – PPO Inpatient Care Managed Care – HMO Government Plans vs Medicare Outpatient Care Medicaid PPS – Prospective payment System DRG – Diagnosis related groups Health Care Delivery Health Care Delivery System System Outpatient Care: Inpatient Care: Any health care service provided to a patient who is Examination Treatment not admitted to a facility Diagnosis Nursing Care Patient is residing in the Hospital 4
- 5. 8/21/2012 Health CareDelivery System Health Care Delivery System Hospitals Emergency and Rescue Care: Primary - Community Hospitals, Rural Hospital, General Hospital Secondary – Ambulance service and first aid treatment to victims Larger Urban Hospital with a full range of services Illness Technical services available Accidents Tertiary Large Medical Centers Disasters Research/Teaching Triage Sophisticated, advanced care Health Care Delivery System Health Care Delivery System Psychiatric Care: Inpatient and outpatient care Rehabilitative Care: All of levels of nursing practice Inpatient and outpatient specialized services RN are utilized at all levels of services Health Care Delivery Health Care Delivery System System Long Term Care or Extended Care: Hospice: RN at all levels work at these facilities Traditional nursing home Assisted living Can be organized in a myriad of ways! Residential care facility New avenue Tele-hospice care over videophone Retirement home 5
- 6. 8/21/2012 HealthCare Delivery System Health Care Delivery System Physician Office: Ambulatory Care: Provide outpatient services to those who visit a hospital or other facility after treatment the Dominate provider of outpatient care! same day Health Care Delivery System Health Care Delivery System School Health Respite Care provides temporary relief to informal caregivers Occupational Health Services family members relieve stress and burden of 24/7 Others…….. Health Care Delivery Health Care Delivery System System Practitioners: Allied Health Practitioners Service Excellence in Nursing: RN Pharmacists 5 descriptors Social Workers APN tangibles Spiritual and Religious Physicians Personnel reliability PA Alternative Practitioners responsiveness assurance empathy 6
- 7. 8/21/2012 Health CareDelivery System Current Trends Health Care Delivery System OBAMA CARE Social Justice The Patient Protection and Affordable Care Act (PPACA) Effective March 23, 2010 Acting in accordance with fair treatment Major provisions phased in by January 2014 regardless of economic status, race, ethnicity, Supplemental Provisions by 2020 age, citizenship, disability, or sexual orientation. What will it do Ethnic disparities Decrease the number of uninsured Affluence and Poverty Reduce the overall costs of health care Improving 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 System Nurse as a Provider Health Care Technology: Requires: Intellectual achievement New Health Care Information Technology Ethical standards Genetic Engineering Scientific knowledge Ambulatory Monitoring Devices Technological skills New Imaging Techniques Personal standards New Nursing Care Devices Scope of practice RN, LVN, CNA Nurse as a Provider The Nursing Process Data Assessment Nursing Goal Plan and Evaluation Collection Diagnosis Setting Implement Care Major aspects of of nursing function: Gather data Makes Makes Establish Target and Use based on judgments judgments care describe objective competency based on based on priorities intervention data to Autonomous and skills of assessment assessmen set goals with s and carry assess caregiver t data outcome out plan outcome criteria Interdependent Shared function of all Professional Profession Professio Shared function of all members Professional responsible al nal responsible members of of the health the health responsible responsibl care team care team e based on Coordinative based on individual individual competency competency RN, LVN, RN ONLY RN ONLY RN RN, LVN, RN ONLY CNA ONLY CNA 7
- 8. 8/21/2012 Nurse as aProvider Nurse as a Provider Nursing Roles: Caregiver Nursing: Advocate responds to illness by providing care Critical thinker- habits of the mind + cognitive skills Teacher VS Communicator Manager Research Medicine: Rehabilitator diagnoses and treats illness Profession of Nursing Profession of Nursing Education Education Advanced Practice Education - Masters Degree Programs Diploma programs - Doctoral Degree Programs Associate Degree programs Continuing Education Baccalaureate Degree programs Graduate degree programs In-service Education Nurse as a Provider Profession of Nursing The Five Rights of Delegation: Delivery of Nursing Service 1. RIGHT TASK 2. RIGHT CIRCUMSTANCES Team Nursing 3. RIGHT PERSON Delegation/Assignment 4. RIGHT DIRECTION/COMMUNICATION see BRN statement 5. RIGHT SUPERVISION See syllabus 8
- 9. 8/21/2012 Profession of Nursing Profession of Nursing Delivery of Nursing Service Factors affecting conduct Primary Care Nursing The Nurse Practice Act BRN (Title 16) 1. The goal of providing patients with Marie ANA Clinical practice Standards continuity in their care Manthey ANA Code Ethics (Integrity) 2. Promote nursing authority for care planning and accountability for patient outcomes. Sense of Altruism Concern for the welfare and well-being of others Profession of Nursing Profession of Nursing Professional Misconduct Professional Misconduct Failing to maintain a record reflecting evaluation Exercising undue influence on the client and treatment of a client Moral unfitness Failing to exercise appropriate supervision over persons who need supervision Revealing personal info with client prior consent Not guaranteeing satisfaction or cure from the Practicing beyond scope of permitted by law performance of professional services Abandoning or neglecting a client Failing to wear and identification badge Harassing, abusing, or intimidating a client Failing to use scientifically accepted infection physically or verbally control techniques Profession of Nursing Profession of Nursing Nursing is a true profession because: -Vital service to human kind Role of research - Special body of knowledge - Services provided involved intellectual activity, individual responsibility, and activity - Education in institutions of higher learning Development of nursing models - 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 9
- 10. 8/21/2012 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. 10