Health Care Delivery and the Roles of the Nurse Delune & Ladner Chapter 4, Roy 429-39

1. Health Care Deliveryand the Roles of the NurseDelune & Ladner Chapter 4, Roy 429-39

2. 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

3. 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

4. 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

5. Day care • Child, homeless, elderly • Home care Agencies • Hospice centers • Retirement communities

6. 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

7. Healthcare Issues 2010 • Rising cost • Access - financial, geographic • Fragmentation of service • Quality/quantity of care • Shortage of personnel • Alternative therapies • Ethical considerations

8. Healthcare Cure/care vs. Commodity Product Producers Consumers Quality / Quantity Availability Regulation

9. Access - Political • Geographical - proximity • Financial - ability to pay • Cultural - language, treatment alternatives • Educational - awareness

10. Economics of Healthcare • Right Vs privilege • Technology • Demographics • Age, lifestyle, environment. • Acute Vs chronic • Urban Vs rural

11. 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.

12. Philosophy of Financing and Utilization • Pay for service - product • Fee for service • Prospective payment • DRG’s - Diagnostic related groups • definitions of service/reimbursement

13. Funding • Financial Flow – Fig. 3-4 pg. 109 • Sources • Insurance • business • government • Self pay • Charity

14. Types of Finance • Private - self, insurance • Government • Medicare - federal • Medicaid - state • Managed care group • PPO, HMO, • Charity

15. Healthcare Issues 2010 • Rising cost • Access - financial, geographic • Fragmentation of service • Quality/quantity of care • Shortage of personnel • Alternative therapies • Ethical considerations

16. Oklahoma Nurse Practice Act • State law that defines the practice of nursing with in that states boundaries • Legal document • www.ncsbn.org

17. Definition of Nursing • Legal • RIGHTS/RESPONSIBILITIES • Standards of performance • Operational definition

18. 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

19. What are Some Practice Issues? • Knowledge - education • Skills - training, practice • Abilities - environment, tools

20. 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)

21. Examples of Standards http://nursingworld.org/anp/pdescr.cfm?CNum=15.

22. Responsibilities • Provider of care (Role) • Manager • Communicator • Decision maker • Coordinator • Educator • Client advocate

23. 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

24. Example Nursing Leader • Florence Nightingale • Sister Calista Roy • Donna Wong • Susan Gaston

25. Nursing Managers • Use developed skill to accomplish the work of managing • Planning • Organizing • Directing • Controlling • All nurses are managers of patient care

26. Example Nursing Manager • Head Nurse • Director ANA • Case Manager

27. Professional Nurses are expected to an be both Leaders and Managers

28. Not all managers are leadersand not all leaders have management skill

29. 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

30. Advanced Practice • NP - Nurse practitioner, 1 - 2 years • CNM - Citified Nurse Midwife • CRNA - Citified Nurse Anesthetist • CNS - Clinical nurse specialist

31. Certification • Post license education and evaluation that results in a certificate stating you have participate and met minimum criteria. • May have renewal clause

32. Certification • Certificate in specialty • Pediatrics • Psychiatric Nursing • Home health • Perinatal • Womans’ health • Geriatrics • School nurse

33. Nursing Delivery Systems • Primary - 24 hour accountability, shared responsibility • Team - shared, accountability and responsibility • Organized around geographical arraignments, care functions, or job skills

34. Members of the Healthcare Team • Nurses - RN, LPN, UAP’s • Physicians - MD., DO., PA • Dentist • Opthamalogist • Pharmacists • Chiropractor

35. Therapists - BS., MS., pH.D. • Social worker, psychologists, nutritionists, respiratory, physical, recreational, rehabilitation, vocational, speech. • Technologists • radiology, laboratory, dietary, medical records.

36. 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

37. Teams • Interdependent group of people • Effectiveness/success requires • Respect • Commitment • Communication

38. Work Teams in Healthcare • Group of Differently Skilled Professionals • Share a body of knowledge/client • Utilize different approaches/ view point to same situation

39. Professional Teams • Every member is required to • Plan • Perform their share • Participate in problem solving • Attend meetings • Provide constructive feedback

40. 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.

41. Group Process • Forming - in or out • Storming - battle for power • Norming - rules of membership • Performing - work gets done • Adjourning - summarize and feedback

42. 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.

43. 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