1. 8/21/2012
Nursing Fundamentals Focus I Objectives –Focus I
Health Care Delivery
Describe the current the U.S. health care
and Professional Nursing delivery system
Discuss the role of nursing as a provider of care
Judy Ontiveros, RN, PHN, MSN
within the health care delivery system
Assistant Professor
Explain Professional Nursing and the delegation
of nursing functions to the different levels of the
health care providers
Health Care Delivery System Health Care Delivery System
Mechanism for providing services that meets
Institutions the health-related needs of the individual
Service
Survival?
Consumer Diversity
Practitioner Increasing services
Current Trends and Social Justice
Public demanding greater accessibility to
Health Care Technology
affordable health care
Health Care Delivery System Health Delivery Systems
Institutions State
Government Sponsored
VA system
Rancho
County
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2. 8/21/2012
Institutions
Private Sector
Fee-for-Service Government Sponsored
VA System
r
State
County or City
Public Health Institutions—
funded by taxes
local planning to meet the needs of the people
of the area.
outbreak of diseases
cultural needs
Institutions Health Care Services
PUBLIC HEALTH SERVICE of the US
Historically
Nation Institute on Drug Abuse Medical Model
National Institute on Alcohol, Abuse, ID of Diseases and their Treatment
Alcoholism
National Institute of Mental Health
items not FDA approved can be
Centers for Disease Control and acquired in other places w/o FDA
Prevention (CDC) eg France/MX
Federal Drug Administration
Types of HealthCare Services
Medical Model
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3. 8/21/2012
Health Care Services Primary Care
(by level of disease
Primary Prevention prevention) Major purpose
Health Promotion and Illness Prevention Promote wellness
Health promotion is the process of enabling people to Prevent illness or disability
increase control over, and to improve, their health. It
moves beyond a focus on individual behavior towards Focus of care
a wide range of social and environmental Individual
interventions-WHO Family
Secondary Prevention Community
Diagnosis and Treatment Still function in the illness care mode
Lack major aspects of preventive care
Tertiary Prevention Healthy lifestyles
Rehabilitation (health restoration)
Supportive Care- Hospice/Palliative Care
Secondary Care
Diagnosis and Treatment
Tertiary
Most care is delivered here Restoring to the state that existed before
Physician offices illness.
Clinics Reach the optimal level of self-care
Emergency rooms Restorative = Holistic Care
Urgent care facilities Physiological
psychological
Social
spiritual
Diversity in Health Care
Health Care Disparities Diversity in Health Care
Healthy People 2010 Demographic Changes
Decrease mortallity rates for four disticnt age
Aging Population ...baby boomers!
groups
Family services declining
Infants, children, adolescents and young
adults. And over 65 Increasing Ethnicity
Access to Health Care Lifestyle
Changed from acute to chronic
Barriers perceived
1/6 deaths attributed to smoking
Not universally available or accessible 5/10 top causes of death due to dietary
Effective Health Care 3 of those being alcohol related.
Link between utilization of heath care and
health outcomes
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4. 8/21/2012
RN Populations in Various
Practioners Institutions
RN RN in Acute Care Setting
APN’s (Advanced Practice Nurse)
LVN, CNA, Home health aides Community Health, Home Health
Physicians Occupational Health or Student Health
PA
Ambulatory Care Setting
PT
RT Nursing Homes or Extended Care Facility
Pharmacists
Pastoral Care REMAINDER Educators, Prisons, Insurance Companies, State
BRN, Prisons, Films sets, Cruise ships, amusement
Alternative medicine practioners parks, Church communities
DHS study 2000
Health Care Delivery System
Health Care Delivery System
Trends
Multi focused health care services Health Care Institutions
Health care financing
Private insurance – PPO
Inpatient Care
Managed Care – HMO
Government Plans vs
Medicare Outpatient Care
Medicaid
PPS – Prospective payment System
DRG – Diagnosis related groups
Health Care Delivery
Health Care Delivery
System
System
Outpatient Care:
Inpatient Care: Any health care service provided to a patient who is
Examination Treatment not admitted to a facility
Diagnosis Nursing Care
Patient is residing in the Hospital
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5. 8/21/2012
Health Care Delivery System
Health Care Delivery System
Hospitals
Emergency and Rescue Care:
Primary -
Community Hospitals, Rural Hospital, General Hospital
Secondary – Ambulance service and first aid treatment to victims
Larger Urban Hospital with a full range of services
Illness
Technical services available
Accidents
Tertiary
Large Medical Centers Disasters
Research/Teaching Triage
Sophisticated, advanced care
Health Care Delivery System Health Care Delivery
System
Psychiatric Care:
Inpatient and outpatient care Rehabilitative Care:
All of levels of nursing practice Inpatient and outpatient specialized services
RN are utilized at all levels of services
Health Care Delivery Health Care Delivery System
System
Long Term Care or Extended Care:
Hospice:
RN at all levels work at these facilities
Traditional nursing home
Assisted living Can be organized in a myriad of ways!
Residential care facility New avenue Tele-hospice care over videophone
Retirement home
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6. 8/21/2012
Health Care Delivery System Health Care Delivery System
Physician Office:
Ambulatory Care:
Provide outpatient services to those who visit a
hospital or other facility after treatment the
Dominate provider of outpatient care! same day
Health Care Delivery System Health Care Delivery System
School Health
Respite Care
provides temporary relief to informal caregivers Occupational Health Services
family members
relieve stress and burden of 24/7
Others……..
Health Care Delivery Health Care Delivery System
System
Practitioners: Allied Health Practitioners
Service Excellence in Nursing: RN Pharmacists
5 descriptors Social Workers
APN
tangibles Spiritual and Religious
Physicians Personnel
reliability
PA Alternative Practitioners
responsiveness
assurance
empathy
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Health Care Delivery System
Current Trends Health Care Delivery System
OBAMA CARE
Social Justice
The Patient Protection and Affordable Care Act (PPACA)
Effective March 23, 2010 Acting in accordance with fair treatment
Major provisions phased in by January 2014 regardless of economic status, race, ethnicity,
Supplemental Provisions by 2020 age, citizenship, disability, or sexual orientation.
What will it do Ethnic disparities
Decrease the number of uninsured Affluence and Poverty
Reduce the overall costs of health care
Improving health care outcomes
Update and streamline health care
delivery
Benefits – Cover all applicant, offer same rates despite pre-
existing conditions or gender
Health Care Delivery System Nurse as a Provider
Health Care Technology:
Requires:
Intellectual achievement
New Health Care Information Technology
Ethical standards
Genetic Engineering
Scientific knowledge
Ambulatory Monitoring Devices
Technological skills
New Imaging Techniques
Personal standards
New Nursing Care Devices
Scope of practice RN, LVN, CNA
Nurse as a Provider
The Nursing Process
Data Assessment Nursing Goal Plan and Evaluation
Collection Diagnosis Setting Implement
Care
Major aspects of of nursing function:
Gather data Makes Makes Establish Target and Use
based on judgments judgments care describe objective
competency based on based on priorities intervention data to
Autonomous and skills of assessment assessmen
set goals
with
s and carry assess
caregiver
t data outcome out plan outcome
criteria
Interdependent Shared
function of all
Professional Profession Professio Shared function
of all members
Professional
responsible al nal responsible
members of of the health
the health responsible responsibl care team
care team e based on
Coordinative based on individual
individual competency
competency
RN, LVN, RN ONLY RN ONLY RN RN, LVN, RN ONLY
CNA ONLY CNA
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8. 8/21/2012
Nurse as a Provider Nurse as a Provider
Nursing Roles:
Caregiver Nursing:
Advocate responds to illness by providing care
Critical thinker- habits of the mind + cognitive skills
Teacher
VS
Communicator
Manager
Research Medicine:
Rehabilitator diagnoses and treats illness
Profession of Nursing
Profession of Nursing Education
Education Advanced Practice Education
- Masters Degree Programs
Diploma programs - Doctoral Degree Programs
Associate Degree programs
Continuing Education
Baccalaureate Degree programs
Graduate degree programs In-service Education
Nurse as a Provider
Profession of Nursing The Five Rights of Delegation:
Delivery of Nursing Service
1. RIGHT TASK
2. RIGHT CIRCUMSTANCES
Team Nursing
3. RIGHT PERSON
Delegation/Assignment
4. RIGHT DIRECTION/COMMUNICATION
see BRN statement
5. RIGHT SUPERVISION
See syllabus
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9. 8/21/2012
Profession of Nursing Profession of Nursing
Delivery of Nursing Service Factors affecting conduct
Primary Care Nursing
The Nurse Practice Act
BRN (Title 16)
1. The goal of providing patients with Marie ANA Clinical practice Standards
continuity in their care Manthey
ANA Code Ethics (Integrity)
2. Promote nursing authority for care planning
and accountability for patient outcomes. Sense of Altruism
Concern for the welfare and well-being of
others
Profession of Nursing
Profession of Nursing
Professional Misconduct Professional Misconduct
Failing to maintain a record reflecting evaluation
Exercising undue influence on the client and treatment of a client
Moral unfitness Failing to exercise appropriate supervision over
persons who need supervision
Revealing personal info with client prior consent
Not guaranteeing satisfaction or cure from the
Practicing beyond scope of permitted by law performance of professional services
Abandoning or neglecting a client Failing to wear and identification badge
Harassing, abusing, or intimidating a client Failing to use scientifically accepted infection
physically or verbally control techniques
Profession of Nursing
Profession of Nursing Nursing is a true profession because:
-Vital service to human kind
Role of research - Special body of knowledge
- Services provided involved intellectual activity, individual
responsibility, and activity
- Education in institutions of higher learning
Development of nursing models - Practitioners have autonomy
- Practitioners are motivated by altruism
- Decisions and conduct are guided by a code of ethics
- High standards of practices are supported by an organization
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10. 8/21/2012
Bibliography
Berman, A., Synder , S., and Kozier, B, Erb, G. (2012). Fundamentals of Nursing: Concepts,
Process, and Practice., Prentice Hall, NJ.
Harkreader H.& Hogan.M. (2007) The Fundamentals of Nursing Caring and Clinical Judgment
(3rd ed.) St. Louis MO:Saunders
Andrews M. & Boyle J. (2003) Transcultural Concepts In Nursing Care (4th ed.) Philadelphia
PN: Lippincott Williams& Wilkins
Satterly, F. (2004) Where Have The Nurses Gone? Impact of The Nursing Shortage on
American Healthcare. Amherst NY: Prometheus Books
Spratley, E. (March 2000) The Registered Nurse Population, Findings from the National Sample
Survey of Registered Nurses, U.S. Department of Health & Human Services, Bureau of
Health Professions, Division of Nursing, Health Resources and Services Administration.
American Nurses Association. (1995). The ANA Basic Guide to Safe Delegation. American
Nurses Publishing Company. Washington, DC.
National Council of State Boards of Nursing. (1997). Delegation: Concepts and Decision-
Making Process Page
Ehrhart P.M., Furlong B. (1993) The renaissance nurse: permeating clinical competence with
the humanities. Nurse Educ. 1993 May-Jun;18(3):22-4.
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