Chapters 11 & 12 - Healthcare Delivery System

‭Health Care‬ ‭●‬ ‭Safety and quality‬ ‭●‬ ‭Access to healthcare‬ ‭●‬ ‭Cost‬ ‭How the US Health Dollar is Spent‬ ‭Healthcare Reform‬ ‭●‬ ‭Expand coverage, control healthcare costs, and improve the healthcare delivery system‬ ‭●‬ ‭Provide Medicaid or subsidized coverage to qualifying people with incomes up to 400%‬ ‭of poverty (started in 2014)‬ ‭●‬ ‭Provide a new way to get health insurance: Health Insurance Marketplace‬ ‭●‬ ‭Issues with the Affordable Care Act:‬ ‭○‬ ‭High premiums‬ ‭○‬ ‭High deductibles‬ ‭○‬ ‭Difficulty in accessing the marketplace‬ ‭Organizing Healthcare‬ ‭●‬ ‭Primary:‬ ‭○‬ ‭Primary care‬ ‭○‬ ‭Employee health‬ ‭○‬ ‭Urgent‬‭care‬ ‭●‬ ‭Secondary:‬ ‭●‬ ‭‬ ● ‭●‬ ‭●‬ ‭●‬ ‭‬ ● ‭●‬ ‭ ‬ ‭Hospital-based clinics‬ ○ ‭○‬ ‭ED‬‭and same-day‬‭clinics‬ ‭Tertiary:‬ ‭○‬ ‭Specialty‬‭consultative care‬ ‭Healthcare providers and hospitals‬ ‭Multispecialty group practice‬ ‭Community health centers‬ ‭Prepaid group practice‬ ‭○‬ ‭Health maintenance organizations (HMO)‬ ‭○‬ ‭Preferred provider organizations (PPO)‬ ‭Accountable care organizations (ACO)‬ ‭Medical homes to medical neighborhoods‬ ‭Paying for Healthcare‬ ‭●‬ ‭Out-of-pocket payment‬ ‭●‬ ‭Individual private insurance‬ ‭●‬ ‭Employer-based private insurance‬ ‭●‬ ‭Government financing:‬ ‭○‬ ‭Medicare:‬‭> 65 y/o or disabilities‬ ‭○‬ ‭Medicaid:‬‭Low-income families‬ ‭○‬ ‭Children’s health insurance program (CHIP)‬ ‭○‬ ‭Veteran’s health administration (VHA)‬ ‭Healthcare Settings‬ ‭●‬ ‭Hospitals‬ ‭●‬ ‭Primary care centers‬ ‭●‬ ‭Ambulatory care centers and clinics‬ ‭●‬ ‭Home healthcare‬ ‭●‬ ‭Long-term care facilities‬ ‭●‬ ‭Specialized care centers/settings‬ ‭●‬ ‭End-of-life care/hospice‬ ‭●‬ ‭Healthcare agencies‬ ‭Question:‬‭The nurse’s role in hospitals includes managing‬‭others of the healthcare team.‬ ‭a.‬ ‭True‬ ‭b.‬ ‭False‬ ‭Roles of Nurses in Hospitals‬ ‭●‬ ‭Direct care‬ ‭●‬ ‭Manager of healthcare team‬ ‭‬ ● ‭●‬ ‭●‬ ‭●‬ ‭●‬ ‭●‬ ‭ dministrator‬ A ‭Nurse practitioner‬ ‭Clinical nurse specialist‬ ‭Patient educator‬ ‭Inservice educator‬ ‭Researcher‬ ‭Primary Care Centers‬ ‭●‬ ‭Community health centers:‬‭Federally-qualified health‬‭centers (FQHCs)‬ ‭Ambulatory Care Centers and Clinics‬ ‭●‬ ‭Urgent care center‬ ‭●‬ ‭Outpatient clinic‬ ‭●‬ ‭Ambulatory surgery center‬ ‭ uestion:‬‭In same-day surgery clinics, screening tests‬‭and teaching take place upon admission to‬ Q ‭the clinic.‬ ‭a.‬ ‭True‬ ‭b.‬ ‭False‬ ‭Home Healthcare Services‬ ‭●‬ ‭Rapidly growing and driven by payment system of reimbursement for‬‭early discharges‬ ‭●‬ ‭Growing population of‬‭older adults‬‭with‬‭chronic‬‭illness‬ ‭●‬ ‭Patients discharged “quicker and sicker”‬ ‭●‬ ‭Need for specialized care at home‬ ‭●‬ ‭Provided through:‬ ‭○‬ ‭Visiting nurse association‬ ‭○‬ ‭Public health department‬ ‭○‬ ‭Private agencies‬ ‭○‬ ‭Hospital-affiliated agencies‬ ‭●‬ ‭Nursing roles include:‬ ‭○‬ ‭Direct care‬ ‭○‬ ‭Assessment‬ ‭○‬ ‭Teaching‬ ‭○‬ ‭Support‬ ‭○‬ ‭Care coordination‬ ‭Long-Term Care Facilities‬ ‭●‬ ‭Transitional care units‬ ‭●‬ ‭Intermediate and long-term care‬ ‭‬ ● ‭●‬ ‭●‬ ‭●‬ ‭ ursing homes‬ N ‭Retirement centers‬ ‭Residential centers for people with mental or physical disabilities‬ ‭Aging in place - PACE programs‬ ‭○‬ ‭Program of all-inclusive care for the elderly‬ ‭○‬ ‭Support brought to the home‬ ‭Specialized Care Centers‬ ‭●‬ ‭Daycare centers‬ ‭●‬ ‭Senior centers‬ ‭●‬ ‭Mental health centers‬ ‭●‬ ‭Rural health centers‬ ‭●‬ ‭Schools‬ ‭●‬ ‭Industry‬ ‭●‬ ‭Homeless shelters‬ ‭●‬ ‭Rehabilitation centers‬ ‭ uestion:‬‭Which of the following is designed to provided‬‭palliative and supportive care services‬ Q ‭for dying people?‬ ‭a.‬ ‭Respite care‬ ‭b.‬ ‭Parish nursing‬ ‭c.‬ ‭Palliative care‬ ‭d.‬ ‭Hospice services‬ ‭End-of-Life Care‬ ‭●‬ ‭Respite:‬‭Caregivers‬ ‭●‬ ‭Hospice care:‬ ‭○‬ ‭Interdisciplinary, supportive care for people and families at end of life‬ ‭○‬ ‭No curative intent‬ ‭○‬ ‭Funded by Medicare‬ ‭●‬ ‭Bereavement care:‬‭Grief from loss‬ ‭●‬ ‭Palliative care:‬‭Provide physical, mental, and spiritual‬‭care from initial diagnosis of‬ ‭incurable illness; curative intent‬ ‭Healthcare Agencies‬ ‭●‬ ‭Voluntary agencies‬ ‭●‬ ‭Parish nursing (Faith community nursing)‬ ‭●‬ ‭Government agencies‬ ‭●‬ ‭Veterans administration and military agencies‬ ‭●‬ ‭Public health services:‬‭CDC and NIH‬ ‭●‬ ‭Public health facilities:‬‭Local, country, state, and federal‬ ‭Multidisciplinary Team‬ ‭●‬ ‭Physician‬ ‭●‬ ‭Physician’s assistant‬ ‭●‬ ‭Dietician‬ ‭●‬ ‭Pharmacist‬ ‭●‬ ‭Social worker‬ ‭●‬ ‭Unlicensed assistive personnel‬ ‭●‬ ‭Therapists:‬ ‭○‬ ‭Respiratory (RT)‬ ‭○‬ ‭Physical (PT)‬ ‭○‬ ‭Occupational therapist (OT)‬ ‭■‬ ‭Helps people develop, recover, or maintain the skills they need to live‬ ‭○‬ ‭Speech therapist‬ ‭Fragmentation in Care‬ ‭●‬ ‭Occurs when a patient’s care is spread across multiple providers‬ ‭●‬ ‭No single provider sees the patient for a large portion of their visits‬ ‭Role of the Nurse in Community-Based Care‬ ‭●‬ ‭Provide care coordination‬ ‭●‬ ‭Provide collaborative practice‬ ‭●‬ ‭Provide continuity of care‬ ‭●‬ ‭Promote self-care‬ ‭●‬ ‭Provide interventions to promote health‬ ‭●‬ ‭Manage acute/chronic illness‬ ‭Qualities of the Community-Based Nurse‬ ‭●‬ ‭Knowledgeable and skilled‬ ‭●‬ ‭Independent in making decisions‬ ‭●‬ ‭Accountable‬ ‭Establishing an Effective Nurse-Patient Relationship‬ ‭●‬ ‭Communicate with the patient as an individual‬ ‭●‬ ‭Remember that the patient has concerns and needs other than medical ones‬ ‭●‬ ‭Take time to learn about the patient‬ ‭●‬ ‭Reduce anxiety through therapeutic communciation, teaching, and acceptance‬ ‭●‬ ‭Provide for family participation in all aspects of care‬ ‭ uestion:‬‭When a patient leaves a hospital against medical advice, the hospital is legally‬ Q ‭responsible for the patient’s health outcome.‬ ‭a.‬ ‭True‬ ‭b.‬ ‭False‬ ‭Leaving Against Medical Advice (AMA)‬ ‭●‬ ‭Patients are legally free to leave‬ ‭●‬ ‭Patient must sign a release form‬ ‭●‬ ‭Patient’s signature must be witnessed‬ ‭●‬ ‭Form becomes part of medical record‬ ‭●‬ ‭Patient is informed of risks prior to signing form‬ ‭●‬ ‭Choice carries a risk for increased illness/complications‬ ‭Trends and Issues in Healthcare‬ ‭●‬ ‭Changing demographics‬ ‭●‬ ‭Globalization of economy and society‬ ‭●‬ ‭Increasing diversity‬ ‭●‬ ‭Educated and engaged consumers‬ ‭●‬ ‭Technology explosion‬ ‭●‬ ‭Increasing complexity of patient care‬ ‭●‬ ‭Costs of healthcare‬ ‭●‬ ‭Shortages of key healthcare professionals/educators‬ ‭●‬ ‭Effect of health policy and regulation‬ ‭Nurses’ Role in Healthcare Reform‬ ‭●‬ ‭Nurses in greater numbers are increasing their education and becoming APRNs‬ ‭(advanced practice RN)‬ ‭●‬ ‭Nurses are becoming a stronger voice in addressing health-related problems in our nation‬ ‭and proposing solutions‬ ‭●‬ ‭The focus of nursing care provided by all nurses is holistic care essential to promoting‬ ‭health and preventing illness‬ ‭●‬ ‭Changes taking place in healthcare give nurses the opportunity to shape healthcare for the‬ ‭future‬