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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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Health care delivery and the roles of the nurse delune ladner chapter 4 roy 429 39
Health Care Deliveryand the Roles of the NurseDelune & Ladner Chapter 4, Roy 429-39


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


  • 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



Not all managers are leaders and not all leaders have management skill
Not all managers are leaders Managersand not all leaders have management skill


Level and type of education
Level and Type of Education Managers

  • RN - basic license, 2 years

  • BSN - baccalaureate, 4 years

  • MS, MSN - Masters, 2 years

  • pH.D..... - Doctorate, 2 - 3 years


Advanced practice
Advanced Practice Managers

  • NP - Nurse practitioner, 1 - 2 years

  • CNM - Citified Nurse Midwife

  • CRNA - Citified Nurse Anesthetist

  • CNS - Clinical nurse specialist


Certification
Certification Managers

  • Post license education and evaluation that results in a certificate stating you have participate and met minimum criteria.

  • May have renewal clause


Certification1
Certification Managers

  • Certificate in specialty

    • Pediatrics

    • Psychiatric Nursing

    • Home health

    • Perinatal

    • Womans’ health

    • Geriatrics

    • School nurse


Nursing delivery systems
Nursing Delivery Systems Managers

  • 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 Managers

  • Nurses - RN, LPN, UAP’s

  • Physicians - MD., DO., PA

  • Dentist

  • Opthamalogist

  • Pharmacists

  • Chiropractor


  • Therapists - BS., MS., pH.D. Managers

    • Social worker, psychologists, nutritionists, respiratory, physical, recreational, rehabilitation, vocational, speech.

  • Technologists

    • radiology, laboratory, dietary, medical records.


Healthcare teams
Healthcare Teams Managers

  • 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 Managers

  • Interdependent group of people

  • Effectiveness/success requires

    • Respect

    • Commitment

    • Communication


Work teams in healthcare
Work Teams in Healthcare Managers

  • Group of Differently Skilled Professionals

  • Share a body of knowledge/client

  • Utilize different approaches/ view point to same situation


Professional teams
Professional Teams Managers

  • 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 Managers

  • 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 Managers

  • 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 Managers

  • 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 Managers

  • 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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