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Health Care Delivery and the Roles of the Nurse Delune & Ladner Chapter 4, Roy 429-39. Factors Influencing Healthcare. Longevity US population 90% of healthcare $ in last 6 months of life Increasing age of baby boomers Technological advances Educated consumers

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factors influencing healthcare
Factors Influencing Healthcare
  • Longevity US population
    • 90% of healthcare $ in last 6 months of life
  • Increasing age of baby boomers
  • Technological advances
  • Educated consumers
  • Politics of Health care industry
focus of care
Focus of Care
  • Type of service – philosophy (fig 4-1 pg. 58)
    • Promotion - prevention
      • Education, counseling
    • Nurture and support
      • Hospice, homecare
    • Diagnosis and treat
      • Hospital, clinic
    • Rehabilitation
      • Nursing homes, Senior centers
health care settings table 4 3 pg 61
Health Care Settings Table 4-3, pg 61
  • Private – investor owned
  • Public - Government
  • Hospitals
  • Clinics - ambulatory centers
    • Schools, health departments, private offices, churches,
  • Extended care facilities
slide5
Day care
    • Child, homeless, elderly
  • Home care Agencies
  • Hospice centers
  • Retirement communities
roles of the nurse pg 63
Roles of the Nurse – pg. 63
  • Caregiver, teacher, advocate, manager, team member
  • Related to settings of practice
  • Defined by
    • Level of education
    • Standards of care - practice
    • Oklahoma nurse practice act
healthcare issues 2010
Healthcare Issues 2010
  • Rising cost
  • Access - financial, geographic
  • Fragmentation of service
  • Quality/quantity of care
    • Shortage of personnel
  • Alternative therapies
  • Ethical considerations
healthcare cure care vs commodity
Healthcare Cure/care vs. Commodity

Product

Producers

Consumers

Quality / Quantity

Availability

Regulation

access political
Access - Political
  • Geographical - proximity
  • Financial - ability to pay
  • Cultural - language, treatment alternatives
  • Educational - awareness
economics of healthcare
Economics of Healthcare
  • Right Vs privilege
  • Technology
  • Demographics
    • Age, lifestyle, environment.
      • Acute Vs chronic
      • Urban Vs rural
healthcare economics
Healthcare Economics
  • One of the largest industries in the US.
    • 13.7% of GDP.
    • More Than any other industrialized nation.
    • Cost shifting.
      • Public Policy – Taxes.
      • With in a business - $8.00 aspirin.
philosophy of financing and utilization
Philosophy of Financing and Utilization
  • Pay for service - product
  • Fee for service
  • Prospective payment
  • DRG’s - Diagnostic related groups
    • definitions of service/reimbursement
funding
Funding
  • Financial Flow – Fig. 3-4 pg. 109
  • Sources
  • Insurance
    • business
    • government
  • Self pay
  • Charity
types of finance
Types of Finance
  • Private - self, insurance
  • Government
    • Medicare - federal
    • Medicaid - state
  • Managed care group
    • PPO, HMO,
    • Charity
healthcare issues 20101
Healthcare Issues 2010
  • Rising cost
  • Access - financial, geographic
  • Fragmentation of service
  • Quality/quantity of care
    • Shortage of personnel
  • Alternative therapies
  • Ethical considerations
oklahoma nurse practice act
Oklahoma Nurse Practice Act
  • State law that defines the practice of nursing with in that states boundaries
  • Legal document
  • www.ncsbn.org
definition of nursing
Definition of Nursing
  • Legal
  • RIGHTS/RESPONSIBILITIES
  • Standards of performance
    • Operational definition
oklahoma nurse practice act1
Oklahoma Nurse Practice Act
  • “The practice of Nursing means the performance of services provided for purposes of nursing diagnosis and treatment of human responses to actual or potential health problems consistent with educational preparation”

Pg..... 1, 1994

what are some practice issues
What are Some Practice Issues?
  • Knowledge - education
  • Skills - training, practice
  • Abilities - environment, tools
nursing standard of practice care pg 71
Nursing Standard of Practice – Care pg. 71
  • Guidelines to describe minimum nursing practice
  • General guidelines ANA
  • Specialty guidelines are developed by the specialty groups
  • Legal documents – Agency for Health Care Quality and Research (AHCPR)
examples of standards

Examples of Standards

http://nursingworld.org/anp/pdescr.cfm?CNum=15.

responsibilities
Responsibilities
  • Provider of care (Role)
    • Manager
    • Communicator
    • Decision maker
    • Coordinator
    • Educator
    • Client advocate
nursing leaders
Nursing Leaders
  • Develop the ability to influence people
  • Develop a style or combination of styles that best suits the situation

Page 64

Figure 4 - 1

example nursing leader
Example Nursing Leader
  • Florence Nightingale
  • Sister Calista Roy
  • Donna Wong
  • Susan Gaston
nursing managers
Nursing Managers
  • Use developed skill to accomplish the work of managing
    • Planning
    • Organizing
    • Directing
    • Controlling
  • All nurses are managers of patient care
example nursing manager
Example Nursing Manager
  • Head Nurse
  • Director ANA
  • Case Manager
level and type of education
Level and Type of Education
  • RN - basic license, 2 years
  • BSN - baccalaureate, 4 years
  • MS, MSN - Masters, 2 years
  • pH.D..... - Doctorate, 2 - 3 years
advanced practice
Advanced Practice
  • NP - Nurse practitioner, 1 - 2 years
  • CNM - Citified Nurse Midwife
  • CRNA - Citified Nurse Anesthetist
  • CNS - Clinical nurse specialist
certification
Certification
  • Post license education and evaluation that results in a certificate stating you have participate and met minimum criteria.
  • May have renewal clause
certification1
Certification
  • Certificate in specialty
    • Pediatrics
    • Psychiatric Nursing
    • Home health
    • Perinatal
    • Womans’ health
    • Geriatrics
    • School nurse
nursing delivery systems
Nursing Delivery Systems
  • Primary - 24 hour accountability, shared responsibility
  • Team - shared, accountability and responsibility
    • Organized around geographical arraignments, care functions, or job skills
members of the healthcare team
Members of the Healthcare Team
  • Nurses - RN, LPN, UAP’s
  • Physicians - MD., DO., PA
  • Dentist
  • Opthamalogist
  • Pharmacists
  • Chiropractor
slide35
Therapists - BS., MS., pH.D.
    • Social worker, psychologists, nutritionists, respiratory, physical, recreational, rehabilitation, vocational, speech.
  • Technologists
    • radiology, laboratory, dietary, medical records.
healthcare teams
Healthcare Teams
  • Two or more people working collaboratively on an issue
  • Teams are necessary because
    • Increased complexity of care
    • Increased technology
    • Increased specialization of team members
teams
Teams
  • Interdependent group of people
  • Effectiveness/success requires
    • Respect
    • Commitment
    • Communication
work teams in healthcare
Work Teams in Healthcare
  • Group of Differently Skilled Professionals
  • Share a body of knowledge/client
  • Utilize different approaches/ view point to same situation
professional teams
Professional Teams
  • Every member is required to
    • Plan
    • Perform their share
    • Participate in problem solving
    • Attend meetings
    • Provide constructive feedback
examples of healthcare team
Examples of Healthcare Team
  • Operating room - members
    • Patient, Physician, Anesthesiologists Circulating nurse, Scrub tech, Surgical assistant.
  • Psychiatric Team - members
    • Psychiatrist, Social Worker, Nurse, Nutritionist, Recreational therapist.
group process
Group Process
  • Forming - in or out
  • Storming - battle for power
  • Norming - rules of membership
  • Performing - work gets done
  • Adjourning - summarize and feedback
most frequent reasons for team failure
Most Frequent reasons for Team Failure
  • The team had allowed some other issue to replace the work focus of the group.
    • Control - who’s in charge
    • Socialization
    • Personal success
    • Incompetent team members - technical skill and membership ability.
methods to increase team effectiveness
Methods to increase Team Effectiveness
  • Clear definition of roles and goals
  • Access to each other - Location, time
  • Limit number of members
    • 5 - 7 most efficient
  • Rotate team manager
  • Keep social function of team to a minimum
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