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


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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items not FDA approved can be acquired in other places w/o FDA eg France/MX

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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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...baby boomers!

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(by level of disease prevention)

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(health restoration)

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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 Institutions

Inpatient Care vs

Outpatient Care


Inpatient Care: Examination TreatmentDiagnosis Nursing Care

Patient is residing in the Hospital


Outpatient Care:Any health care service provided to a patient who is not admitted to a facility

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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


Emergency and Rescue Care:

Ambulance service and first aid treatment to victims

Illness

Accidents

Disasters

Triage


Psychiatric Care:Inpatient and outpatient care

All of levels of nursing practice


Rehabilitative Care:

Inpatient and outpatient specialized services

RN are utilized at all levels of services


Long Term Care or Extended Care:

Traditional nursing home

Assisted living

Residential care facility

Retirement home


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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Physician Office:

Dominate provider of outpatient care!


Ambulatory Care:

Provide outpatient services to those who visit a hospital or other facility after treatment the same day


Respite Careprovides temporary relief to informal caregivers

family membersrelieve stress and burden of 24/7


School Health

Occupational Health Services

Others……..


Service Excellence in Nursing:5 descriptors

tangiblesreliabilityresponsivenessassuranceempathy


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 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



Shared function of all members of the health care team based on individual competency


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


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


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


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.

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