Introductory Medical-Surgical Nursing

1. Introductory Medical-Surgical Nursing Concepts and Trends in Healthcare

2. Roles of Nurses in the Healthcare Delivery System • Collect data; plan, provide, and evaluate outcomes of care • Work in various settings; adhere to facility policies and state nurse practice acts • Educate clients, families, and staff • Manage resources • Participate in disease prevention and health promotion • Practice from the perspective of holism

3. Health and Wellness • Introduction • WHO definition of health • State of physical, mental, social well-being; holistic definition of health • Wellness: A state of being; individual; components of wellness • Illness and Disease • Illness: State of being sick • Disease: Pathologic condition of the body • Difference between illness and disease

4. Question Is the following statement true or false? Health is a constant and intentional effort to stay healthy and achieve the highest potential for total well-being.

5. Answer False. Health is a state of complete physical, mental, and social well-being and not merely the absence of disease and infirmity. Wellness is a constant and intentional effort to stay healthy and achieve the highest potential for total well-being.

6. Health and Wellness • The Health–Illness Continuum Figure 1-1 The health–illness continuum

7. Health and Wellness • The Health–Illness Continuum • Considers levels of health • Varies from person to person • Determines a client’s health status • Client with chronic illness can achieve a high level of wellness

8. Question Is the following statement true or false? Clients with chronic illness can be considered healthy.

9. Answer True. Clients with chronic illness can be considered healthy if they are physiologically stable and engaged in personal and social activities they find meaningful.

10. Health and Wellness • Health Maintenance and Promotion • Health maintenance • Preventing illness or deterioration • Being screened for diseases or practicing safe sex • Health promotion • Engaging in strategies to enhance health • Eating a diet high in fiber and complex carbohydrates and exercising regularly • Balancing work with leisure activities

11. Health and Wellness • Health Maintenance and Promotion • Health promotion (cont’d) • Practicing stress reduction techniques • Client • Active partner in nursing care • Takes great responsibility for meeting health maintenance and promotion needs • Actively participates in treatment decisions regarding health restoration

12. Healthcare • Introduction • Development of highly sophisticated methods for diagnosing and treating disease • Increasing costs; advances in science and technology • Healthcare system: Multiple outpatient, short-term, and long-term care facilities with care given by various providers

13. Question Is the following statement true or false? Rapid advances in science and technology have increased disparity in access to healthcare.

14. Answer False. Escalating healthcare costs have created difficult economic conditions, disparity in access to healthcare, and shorter stays in hospitals.

15. Healthcare Figure 1-2 Members of the healthcare team

16. Individual student activity • List and identify the function of all the various members of the healthcare team. • Allow 5 minutes. Submit to instructor.

17. Healthcare • Healthcare Providers • Specially trained personnel work together to help clients meet their healthcare needs • Team: Physicians, nurses, psychologists, pharmacists, dietitians, social workers, respiratory and physical therapists, occupational therapists, nursing assistants, technicians, and insurance company staff

18. Healthcare • The Healthcare Delivery System • Full range of services: Prevention, identification, treatment, or rehabilitation of health problems • Primary care: First resource; family practitioner, internist, or nurse practitioner • Secondary care: Referrals to facilities for additional testing • Tertiary care: Provided in hospitals; skilled nursing care; rehabilitative services; home care; hospices and home hospice

19. Question Is the following statement true or false? Groups most likely to be underserved by healthcare include children, older adults, ethnic minorities, and the poor.

20. Answer True. Groups most likely to be underserved by healthcare include children, older adults, ethnic minorities, and the poor.

21. Healthcare • The Healthcare Delivery System • Access to care • Clients who do not have access to healthcare or inadequate healthcare • Unaffordable luxuries • Underserved: Children, older adults, ethnic minorities, and the poor • Local hospital emergency department: Long waits and no follow-up care

22. Healthcare • The Healthcare Delivery System • Financing the costs of healthcare • Payment for healthcare: Private insurance, self-insurance, and Medicare • Higher charges: More revenues for healthcare facilities; no incentives to control costs; escalated charges, abuse, and fraudulent billing • 1990s: Streamlined government payment systems and innovative approaches from private insurers

23. Healthcare • The Healthcare Delivery System • Financing the costs of healthcare • Government-funded healthcare: Medicare • Federally run program financed primarily through employee payroll taxes • Covers: People 65 years of age or older, permanently disabled workers of any age with specific disabilities and their dependents, and people with end-stage renal disease

24. Healthcare • The Healthcare Delivery System • Financing the costs of healthcare • Government-funded healthcare: Medicare (cont’d) • Several parts: A, B, C, D • Part A: Hospital, skilled care; hospice; home health services • Part B: Physician services; outpatient care; other selected services • Part C: Combines Parts A, B, and sometimes D

25. Healthcare • The Healthcare Delivery System • Financing the costs of healthcare • Government-funded healthcare: Medicare (cont’d) • Part D: Prescription drug coverage • Government-funded healthcare: Medicaid • State-administered entitlement program; funded from federal, state, and local sources • Covers: Hospitalization, diagnostic tests, physician visits, rehabilitation, outpatient care, and long-term care

26. Healthcare • The Healthcare Delivery System • Financing the costs of healthcare • Prospective payment system (PPS) • Financial incentives: Decrease total charges by reimbursement • Diagnosis-related group (DRG): Method of grouping clients with similar diagnoses • Reimburses predetermined amounts to hospitals; premature discharge • Private insurance companies; Medicare revenue

27. Healthcare • The Healthcare Delivery System • Financing the costs of healthcare • Managed care organizations (MCOs) • Insurers carefully plan and closely supervise the distribution of healthcare services; focus on prevention to manage healthcare costs

28. Healthcare • The Healthcare Delivery System • Financing the costs of healthcare • Managed care organizations (MCOs) • Capitation: Preset fee paid per month to healthcare provider • Covers: All medical costs incurred • Use of high-cost resources by client • Provides strongest incentives: Limiting use of expensive services

29. Healthcare • The Healthcare Delivery System • Financing the costs of healthcare • Managed care organizations (MCOs): 1. Health maintenance organizations • Group insurance plans; fixed fee • Financial stability; provide ambulatory, hospitalization, and home care; own facilities and community agencies; authorized and unauthorized secondary care; gatekeepers for healthcare services

30. Healthcare • The Healthcare Delivery System • Financing the costs of healthcare • Managed care organizations (MCOs): 2. Preferred provider organizations • Operate on the principle that competition can control costs • Agents for health insurance companies: Create a community network of providers willing to discount their fees

31. Healthcare • The Healthcare Delivery System • Financing the costs of healthcare • Managed care organizations (MCOs): 3. Point-of-service plans • Involve network of providers • Clients select primary care provider (PCP) to act as gatekeeper for services • Using providers outside group may increase deductible or copayment unless PCP approves

32. Healthcare • The Healthcare Delivery System • Financing the costs of healthcare • Managed care organizations (MCOs): 4. Physician hospital organizations • Corporate structure created between physician groups and hospitals • Contract with MCO to negotiate fees for self-insured employees • Goals: Maintain high service quality; contain costs; foster group contracts, collaboration, and capitation

33. Groups of 4-5 students activity • Describe and explain the purpose of HMOs; describe the positive and negative effects of DRGs • Allow 10 minutes. Present result of discussion in class.

34. Healthcare • The Healthcare Delivery System • Effects of cost-driven changes • Providers and consumers unable to provide or obtain care free from the insurer’s economic pressure • Influence of managed care on hospitals • Downsizing, restructuring, closing • Fewer hospitals; higher nurse/client ratios; higher client acuity levels • Insurance company profit at the expense of quality, jobs

35. Healthcare • The Healthcare Delivery System • Effects of cost-driven changes • Integrated delivery systems • Networks: Hospitals and healthcare facilities • Provide full range of healthcare services: result in highly coordinated and cost-effective care • Shorter hospital stays • Nurses: Take an active role in advocating for high quality

36. Healthcare The Healthcare Delivery System Sources of standards of care Nurse Practice Act, NCLEX (National Council Licensure Exam), ANA (American Nurses Association, Joint Commission, Hospitals Nurse Practice Act-laws established in each state NCLEX-nurses’ educational preparation and licensure ANA-an example of a professional organization with established code of ethics guiding Nursing practice JCAHO-Joint Commission Association of Hospital Organization

37. Healthcare The Healthcare Delivery System Measures of quality of care Government and private sector demands of: Evidence that high-quality, cost-effective care is provided; Medicare guidelines, JCAHO surveys, surprise visits from federal and state regulators Performance improvement committees Factors assessed by such committees Insurers: Set up quality improvement departments Practitioners: Ensure total care, teaching, and preparation before discharge

38. Healthcare • The Healthcare Delivery System Figure 1-3  Emergency department critical pathway for pneumonia-an example of hospital standard of quality

39. Healthcare • The Healthcare Delivery System • Measures of quality of care (cont’d) • Guidelines for managing care • Critical pathways • Analyzing variances from the pathway • Measures assessed when examining quality

40. Role of vocational nursing student • Nursing students prepare themselves to become excellent care providers to promote quality of care • How? • Learn and practice Time management • Develop organizational skills • Practice excellent study techniques • Incorporate stress management in daily practice