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Fundamentals of Nursing Taylor Ch 8
Terms in this set (56)
A way of providing care that is designed to control the cost while still maintaining the quality of that care. Limits the choice of care providers, may require approval for specialty care.
A method used to coordinate a patient's healthcare to achieve patient wellness and optimum functions through advocacy, communication and education.
An interdisciplinary process of assessing, planning, facilitating, and advocating for options to meet the healthcare needs of the individual.
Essential healthcare based on practical, scientifically sound, and socially acceptable methods and technology, made universally accessible to individuals and families in the community through their full participation and at a cost the community can afford.
Examples of Healthcare Settings
Clinics, Homes, Schools, prisons, and Daycare centers for children and older adults. Crisis intervention centers, mental health centers, drug and alcohol rehabilitation programs, storefront clinics and churches.
Examples of what Healthcare Settings Provide
-Immunizations for infants and children
-Screenings for STI's or TB
-Verification of need and voucher distribution for milk and food for women and children with low incomes through the Women, Infants and Children (WIC) program
-Focus on patients with special needs, such as older adults or terminally ill patients.
short-term general,non-federal, and special (ex orthopedic, cancer, academic medical center) hospitals.
How are hospitals classified?
Public or Private, and For-Profit or Non-Profit.
Non-profit hospital institute that is financed or operated by local, state, or national agencies. Patients may not have health insurance, and services are provided at little or no cost to the patient. Tax revenue or public funds cover the cost.
May be for-profit hospital or non-profit and are operated by communities, churches, corporations, or charitable organizations. Many patients cared in this facility have some type of personal health insurance or healthcare plan.
A person who enters a hospital and stays overnight for an indeterminate time
Those who are not hospitalized overnight, but who require diagnosis or treatment. Examples:
Nursing Role in a Hospitals
Serves as administrator or manager, assesses and monitors patients health status, provides direct care, coordinates the care provided by others, teaches patients and families, plans, implements and evaluates the plan of care, provides staff information, coordinates discharge planning to ensure continuity of care, provides specialized care, make referrals.
Primary care centers
Physicians and advanced practice nurses provide primary healthcare services in offices and clinics. RN's in this setting make health assessments, perform technical procedures, assist the physician, and provide health education.
Services in Primary Care Centers
-Diagnose and treat minor illnesses
-Minor surgical procedures
-Well child care
Advanced Practice Registered Nurse
APRNs, nurse practioners, midwives or clinical nurse specialists work independently or collaboratively with physicians to make assessments and care for patients who require health maintenance or health promotion activities. Depending on the state, some may have their own offices and clinics.
Ambulatory care centers and clinics
Agencies that deliver medical care on an outpatient basis, may be located in hospitals, may be a free-standing service provided by a group of healthcare providers who work together, or may be managed by an APRN. Usually located in conveinent areas. Usually offer walk-in services and have different office hours.
Services in Ambulatory Care Centers or Clinics
-Technical services (e.g., administer medication)
-Determine the priority of care needs
-Provide teaching about all aspects of care.
One of the most rapid growing areas of the healthcare system. Maybe provided through community health departments, visiting nurses associations, hospital based care managers, and home health agencies.
Services in Home Healthcare
-Skilled nursing assessments
-Teaching and support of patients and family members
-Direct care for patients
Provides medical and non-medical care for people with chronic illnesses or disabilities; facilities assist with activities of daily living for people of any age who are physically or mentally unable to independently care for themselves (assisted living and nursing homes, retirement centers, etc.).
Aging In Place
Patients move to a living space, such as an apartment, while they are still physically able to care for themselves, and then have access to services that are part of the healthcare community as needed as long as they live.
Omnibus Budget Reconciliation Act 1987. It produced many improvements in in long-term care.
Have a variety of purposes. Some centers care for healthy infants and children whose parents work; some also have minor illnesses. Eldercare centers and senior citizen centers provide a place for older adults to socialize and to receive care while family members work. Some daycare centers provide health-related services to those who do not require to be in a healthcare institution but cannot be at home alone.
Services in Daycare Centers
-Administer medications and treatment
-Conduct health screenings
Mental health centers
May be associated with a hospital or may provide services as an independent agency. May be crisis centered or may involve long-term counseling.
Patients receive outpatient care through a variety of interventions including individual and group counseling, medications, and assistance with independent living
Crisis intervention centers are also mental health centers that are typically provide 24 hour services and hotline for people who are suicidal, abusing drugs and alcohol or in abusive situations and rape.
Rural health centers
Often located in geographically remote areas and have few healthcare providers. Many rural health centers are run by APRNs who serve as the patients primary health provider for care and of minor acute illnesses as well as chronic illnesses.
Those who are seriously ill are given emergency care and then transferred to the nearest large hospital.
Major source of health assessment, health education, and emergency care for the nations children. The role of the nurse reflects changes in society itself. Nurses in this setting are often the major source of health assessment, health education, and emergency care for the nation's children.
Services in Schools
-Maintaining immunization records
-Providing emergency care for physical and mental illnesses -Administering prescribed medications
-Conducting routine health screenings (e.g., vision, hearing, scoliosis)
-Providing health information and education.
Many have their own ambulatory care clinic staffed primarily by nurses. Occupational health nurses' focus is on preventing work-related injury and illness by conducting health assessments, teaching for health promotion (e.g., stopping smoking, eating sensibly, using safe equipment, exercising regularly), caring for minor accidents and illnesses, and making referrals for serious problems.Many of these have their own care clinic, staffed primarily by nurses.
Usually living units, such as an apartment or home, that provide housing for people who do not have regular shelter. Homeless are at an incredible risk for illness or injury because of factors such as exposure to the elements, exposure to violence, drug and alcohol addiction, poor nutrition, poor hygiene, and overcrowding.
Services in Homeless Shelters
-Educating pregnant women
-Treating infections and illnesses
-Referring for diagnosis and treatment of STIs
-Providing information about maintaining health
Specialize in services for patients requiring physical or emotional rehabilitation and for treatment of chemical dependency.
Care provided for primary caregivers of homebound ill, disabled, or elderly patients. The main purpose is to give the primary caregiver some time away from the responsibilities of day-to-day care.
Program of palliative and supportive care services providing physical, psychological, social, and spiritual care for dying persons, their families, and other loved ones. Generally begins when the patient has 6 months or less to live and ends with the family 1 year after the death of the patient.
Hospice Care Services
(1) patients are kept as free of pain as possible so that they may die comfortably and with dignity
(2) patients receive continuity of care, are not abandoned, and do not lose personal identity
(3) patients retain as much control as possible over decisions regarding their care and are allowed to refuse further life-prolonging technologic interventions
(4) patients are viewed as individuals with personal fears, thoughts, feelings, values and hopes
Last portion of hospice care; a continuation of care, usually up to 1 year, for the family, after loss of a loved one
An area of care that has evolved out of the hospice experience, but also exists outside of hospice programs. It is not restricted to the end of life and can be used from the initial diagnoses of an incurable illness. Focused on the relief of physical, mental, and spiritual distress. Goal is to prevent and relieve suffering by early assessment and treatment of pain and other physical problems .
Community agencies, often nonprofit voluntary agencies. Financed through private donations, grants or fundraisers. Ex Meals on Wheels, American Heart Association, American Lung Association
Voluntary agencies may also provide a setting for support groups; Provide an education and support system for patients who are adjusting to their health problems. Ex Alcoholics anonymous, Cancer support groups, Reach to recovery
An expanded area of nursing practice that emphasizes holistic healthcare, health promotion, and disease-prevention activities; combines professional nursing practice with health ministry , emphasizing health and healing within a faith community.
Nurses function as health educators, resource and referral aids, and facilitators of volunteer and support groups; reach out to the most vulnerable such as the elderly, those who have suffered loss or change, single parents and children.
Hospitals and public health clinics that are supported by national, state, or local tax finances. Ex State tax: State mental health hospitals, National tax: National health and welfare programs
Veterans Administration and Military Agencies
VA hospitals and Military hospitals all come under the umbrella of government supported and government operated healthcare. VA hospitals provider healthcare services to veterans, and military hospitals provide care to active members of the armed forces and their immediate families.
Public Health Service
PHS is a federal health agency under the direction of the U.S. department of health and human services. The PHS is a multifaceted program with a wide range of services. It is the medical brand of the U.S. coast guard and the principal source of Native American healthcare through the Indian Health Services. It supplies funds to health centers that provide care to migrant workers and to community agencies that supply healthcare to the poor and uninsured. Also provides healthcare professionals to U.S. Dept of Justice.
Center for Disease Control and Prevention and National Institutes of Health
CDC in both Atlanta and the NIH are both part of the PHS. The CDC focuses on the epidemiology, prevention, control and treatment of communicable diseases, such as STIs. The NIH is engaged in both funding and conducting various health research activities.
Public Health Agencies
Local, state, and federal agencies that provide public health services at the local, county, state, or federal level. They are usually funded by taxes and run by elected or appointed admins. Promote health and prevent illness such as providing immunizations and screening for TB and STIs. Ensure public health by inspecting restaurants and water supplies.
Unlicensed Assistive Personnel; help nurses provide direct care to patients. As defined by individual state boards of nursing, UAPs may have the title of certified nursing assistants (Cna), orderlies, attendants, or technicians.
Payment for healthcare
Federally Funded: Medicare, medicaid
Group Plans: HMOs and PPOs
Private insurance, and long-term care insurance
National and state health insurance programs for the elderly under Title 18 est in 1965 to the Social Security Act. In 1972, permanently disabled workers and their dependents also qualified for SSA benefits.
Diagnosis-related groups (DRGs)
Medicare converted to this prospective payment plan in 1983; classification categories of patients by major medical diagnosis for the purpose of standardizing healthcare costs .
Established in 1965 under Title 19 of the Social security Act. Federally funded public assistance program for people of any age who have low incomes; for the blind, elderly, and disabled covered by supplemental security benefits; for beneficiaries of Aid to Families with Dependent Children. Coverage depends on individual state regulations.
Managed care plans (Health Maint. Organizations [HMO]), Preferred Provider Organizations [PPO])
Enrollment is voluntary. Individual pays a fixed rate on a monthly or annual basis and in turn receives coverage for most healthcare services to maintain health and treat illness. Preventative health care is encouraged to avoid the higher costs of hospitalization.
Health Maintenance Organizations (HMO)
Prepaid, group-managed care plans that allow subscribers to receive all the medical services they require through a group of affiliated providers.
There may be no additional out-of-pocket costs or a small fee called a co-payment.
In most HMOs, the patient does not have a choice about healthcare providers but receives all services from physicians who are associated with or are part of the HMO.
Preferred Provider Organizations (PPO)
Allow a third-party payer to contract with a group of healthcare providers to provide services at a lower fee in return for prompt payment and a guaranteed volume of patients and services.
Personal healthcare can be financed by private insurance through large, nonprofit, tax-exempt organizations or through smaller, private, for-profit insurance companies.
Members pay monthly premiums either themselves or in combination with employer payments
Premiums tend to be higher than those for managed care plans, but members can choose their own physician and services desired.
Long-Term care insurance
Offered by some commercial insurance companies, most LTC insurance (about 90%) is paid for by medicaid and out-of-pocket spending. Medicare only pays for a minimal amount of LTC insurance.
Promoters of LTC insurance have developed plans that cover a variety of services:
-Nursing home care
-Adult daycare centers
-Prevention of institutionalization of older, debilitated and chronically ill people.
Focus on Preventative Care
Health awareness and practicing healthy habits to prevent illness. Ex Stress management programs, nutritional awareness, exercise and fitness programs, anti-smoking and anti-drug campaigns; the use of seat belts, promoting automobile and airplane safety, controlling smog, controlling handguns, and eliminating hazardous wastes.
Someone who use a commodity or service ; healthcare consumers (patients) are increasingly knowledgeable about health, prefer to control and make decisions about their own health, and want to be active participants in planning and implementing their healthcare. The internet is the main source of consumers becoming so much more informed about health services.
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