Health Care Delivery System Nursing Research as the Basis of Nursing

1. Health Care Delivery System Nursing Research as the Basis of Nursing

2. Health Care Delivery System? • Mechanism for providing services that meet the health-related needs of individuals. • Nursing is a major component of the U.S. health care delivery system.

3. Types of Health Care Services • Primary: Health promotion and illness prevention • Secondary: Diagnosis and treatment • Tertiary: Rehabilitation

5. Health Care SettingsPublic Sector • Federal Level • U.S. Department of Health and Human Services (DHHS) • State Level • Department of Health • Local Level Health Units • Communicable disease control • Health records maintenance • Individual health services • Environmental health and safety • Public health education

6. Health Care SettingsPrivate Sector • Hospitals • Extended care facilities • Home health agencies • Hospices • Outpatient settings • Schools • Industrial clinics • Managed care organizations • Community nursing centers • Rural primary care hospitals

7. Health Care Team • Nurse (RN) • Physician (MD) • Physician Assistant (PA) • Pharmacist (RPh) • Dentist (DDS) • Dietitian (RD) • Social Worker (SW) • Respiratory Therapist (RT) • Physical therapist (PT) • Occupational Therapist (OT) • Chaplain • Unlicensed Assistive Personnel (UAP) • Dental Hygienist

8. Advanced Practice Registered Nurse Diagnoses and manages common health problems. Performs medical procedures (e.g., suturing, casting). • Registered nurses (RNs) treat patients, advise patients and provide emotional support to patients and their family members during difficult times. RNs document patients' medical histories and symptoms, help doctors perform diagnostic tests, administer treatment and medications, and follow-up with patients during rehabilitation.

9. RNs instruct patients and their families about post-treatment illness or injury management, making nutrition and exercise program recommendations. Some RNs promote public health by educating the public about disease symptoms. RNs often organize health screening or immunization clinics and blood drives. When working with patients, RNs establish a care plan. Plans could include the monitoring and administration of prescription drugs, setting up and monitoring (IV) lines for fluid, coordinating treatments, patient observation, record keeping, and discussing patient care with doctors. Some RNs instruct licensed practical nurses and nursing aids about patient care. RNs with advanced educational training may perform diagnostic tests and prescribe some medication. RNs can specialize in certain types of patient care. RNs can work in a certain setting, such as perioperative nurses, found in operating rooms. RNs may specialize in certain disease treatment, such as diabetes management nurses, who help patients with diabetes. Some RNs specialize in particular organ systems, such as dermatology nurses, who help with patients with skin disorders. RNs also can choose to work with a specific type of people, such as geriatric nurses, specializing in treating the elderly. RNs may combine specialties, such as pediatric oncology nurses, who work with children cancer patients.

10. Some RNs specialize in working with people from certain age groups or certain settings. For example, some nurses specialize in working with newborns (neonatology), children and adolescents (pediatrics), adults, and the elderly (gerontology or geriatrics). Certain RNs work with people outside of hospital settings such as in the military or a summer camp. Some RNs travel around the country and the world providing care to patients in areas with health professional shortages.

11. Nursing Roles • Caregiver • Teacher • Advocate • Manager • Expert • Case Manager • Team Member

12. Economics of Health Care • Private Insurance • Managed Care • Primary care providers • Health Maintenance Organizations (HMOs) • Preferred Provider Organizations (PPOs) • Exclusive Provider Organizations (EPOs) • Federal Government Insurance Plans • Social Security Act 1965 • Medicare and Medicaid • Regulated by Centers for Medicare & Medicaid Services (CMS)

13. What is Medicare / Medicaid? • Medicaid and Medicare are two governmental programs that provide medical and health-related services to specific groups of people in the United States. Although the two programs are very different, they are both managed by the Centers for Medicare and Medicaid Services, a division of the U.S. Department of Health and Human Services. • Medicare is a social insurance program that serves more than 44 million enrollees (as of 2008). The program costs about $432 billion, or 3.2% of GDP, in 2007. Medicaid is a social welfare (or social protection) program that serves about 40 million people (as of 2007) and costs about $330 billion, or 2.4% of GDP, in 2007. Together, Medicare and Medicaid represent 21% of the FY 2007 U.S. federal government.

15. What is Medicaid? Required services include: • Inpatient hospital services • Outpatient hospital services • Prenatal care • Vaccines for children • Physician services • Nursing facility services for persons aged 21 or older • Family planning services and supplies • Rural health clinic services • Home health care for persons eligible for skilled-nursing services • Laboratory and x-ray services • Pediatric and family nurse practitioner services • Nurse-midwife services • Federally qualified health-center (FQHC) services and ambulatory services • Early and periodic screening, diagnostic, and treatment (EPSDT) services for children under age 21

16. What is Medicare? Medicare is a Federal health insurance program that pays for hospital and medical care for elderly and certain disabled Americans. The program consists of two main parts for hospital and medical insurance (Part A and Part B) and two additional parts that provide flexibility and prescription drugs (Part C and Part D).

17. Medicare Part A, or Hospital Insurance (HI), helps pay for hospital stays, which includes meals, supplies, testing, and a semi-private room. This part also pays for home health care such as physical, occupational, and speech therapy that is provided on a part-time basis and deemed medically necessary. Care in a skilled nursing facility as well as certain medical equipment for the aged and disabled such as walkers and wheelchairs are also covered by Part A. Part A is generally available without having to pay a monthly premium since payroll taxes are used to cover these costs.

18. Medicare Part B is also called Supplementary Medical Insurance (SMI). It helps pay for medically necessary physician visits, outpatient hospital visits, home health care costs, and other services for the aged and disabled. For example. Part B covers: Durable medical equipment (canes, walkers, scooters, wheelchairs, etc.), Physician and nursing services, X-rays, laboratory and diagnostic tests, Certain vaccinations, Blood transfusions, Renal dialysis, Outpatient hospital procedures, Some ambulance transportation, Immunosuppressive drugs after organ transplants, Chemotherapy, Certain hormonal treatments, Prosthetic devices and eyeglasses.

20. Medicare Part C • Medicare Advantage Plans (sometimes known as Medicare Part C, or Medicare + Choice) allow users to design a custom plan that can be more closely aligned with their medical needs. These plans enlist private insurance companies to provide some of the coverage, but details vary based on the program and eligibility of the patient. Some Advantage Plans team up with health maintenance organizations (HMOs) or preferred provider organizations (PPOs) to provide preventive health care or specialist services. Others focus on patients with special needs such as diabetes.

21. Medicare Part D Medicare Part D. Part D is administered by one of several private insurance companies, each offering a plan with different costs and lists of drugs that are covered. Participation in Part D requires payment of a premium and a deductible. Pricing is designed so that 75% of prescription drug costs are covered by Medicare if you spend between $250 and $2,250 in a year. The next $2,850 spent on drugs is not covered, but then Medicare covers 95% of what is spent past $3,600.

22. Who is eligible for Medicare? To be eligible for Medicare, an individual must either be at least 65 years old, under 65 and disabled, or any age with End-Stage Renal Disease (permanent kidney failure that requires dialysis or a transplant.) In addition, eligibility for Medicare requires that an individual is a U.S. citizen or permanent legal resident for 5 continuous years and is eligible for Social Security benefits with at least ten years of payments contributed into the system.

23. NURSING RESEARCH Nursing research provides the scientific basis for the practice of the profession. Nursing research focuses on the understanding and easement of the symptoms of acute and chronic illness; prevention or delayed onset of disease or disability, or slowing the progression thereof; finding effective approaches to achieve and sustain optimal health; and improvement of the clinical settings in which care is provided

24. GOALS The two overarching goals are: • helping individuals of all ages to increase life expectancy and improve their quality of life, • 2) eliminating health disparities among different segments of the population in the United States.

25. Scope of Nursing Nursing research encompasses a wide scope of scientific inquiry including clinical research, health systems and outcomes research, and nursing education research. Clinical research, based on biological, behavioral, and other types of investigations, provides the scientific basis for the care of individuals across the life span and occurs in any setting where nursing care is provided. Health systems and outcomes research examine the availability, quality, and costs of health care services as well as ways to improve the effectiveness and appropriateness of clinical practice. Finally, nursing education research focuses on how students learn the professional practice and discipline of nursing as well as how to improve educational strategies to prepare clinicians and scientists.

26. Clinical Research The scope of clinical research ranges from acute to chronic care experiences across the entire life span; health promotion and preventive care to end-of-life care; and care for individuals, families, and communities in diverse settings. It is imperative for nursing research to take a farsighted approach in order to have greater impact in the future. For example, recent discoveries in the genetic basis of disease and behavior may help nurse scientists to develop more effective strategies to manage symptoms and tailor interventions.

28. NursingEducationResearch • Nursing education research centers on developing and testing more efficient educational processes, identifying new ways to incorporate technology in order to enhance learning, and discovering more effective approaches to promoting lifelong learning and commitment to leadership. To achieve these goals, the use of rigorous research strategies in the assessment of the teaching-learning process and outcomes at all levels of nursing education is essential from baccalaureate and graduate education through. The continuous supply of well-educated nurses is critical to maintain and enhance our nation's health, especially in light of the changes in the demographics of the population. To this end, new strategies for recruiting and retaining bright young men and women from diverse educational and cultural backgrounds into nursing must be developed and tested.

29. Creating a Culture and Workforce for Nursing Research Cultures supportive of research and scholarship generally develop within academic institutions where knowledge development, discourse, and debate are expected and encouraged. Given the broad scope of nursing research, this also means that nurse researchers require environments that support integration of various approaches to inquiry. Collaborative research among nurse scientists that brings together a range of perspectives on a particular question will result not only in a better understanding of and coherence in the entire discipline, but also in an understanding of how knowledge from one field complements and extends learning in another. Further, contemporary research problems demand that nurse scientists move into more interprofessional collaboration, team-based work, and increase attention to the rapid progression to safe and appropriate practical application of findings The ultimate goal of research training in nursing at all levels is to strengthen the profession's contribution to enhancing the health and healthcare of individuals and populations. The expectations and competencies of graduates at each level of nursing education in regard to research are described below:

30. Baccalaureate programs prepare nurses with a basic understanding of the processes of research. Graduates can understand and apply research findings from nursing and other disciplines in their clinical practice. They understand the basic elements of evidence-based practice, can work with others to identify potential research problems, and can collaborate on research teams. Master's programs prepare nurses to evaluate research findings and to develop and implement evidence-based practice guidelines. Their leadership skills enable them to form and lead teams within their agencies and professional groups. They identify practice and systems problems that require study, and they collaborate with scientists to initiate research.

31. Practice-focused doctoral programs prepare graduates for the highest level of nursing practice beyond the initial preparation in the discipline. Graduates obtain the highest level of practice expertise integrated with the ability to translate scientific knowledge into complex clinical interventions tailored to meet individual, family and community health and illness needs. In addition, these professionals use advanced leadership knowledge and skills to evaluate the translation of research into practice and collaborate with scientists on new health policy research opportunities that evolve from the translation and evaluation processes. They are prepared to focus on the evaluation and use of research rather than the conduct of research (AACN, 2004a)

32. Research-focused doctoral programs prepare graduates to pursue intellectual inquiry and conduct independent research for the purpose of extending knowledge (AACN, 2001). Graduates are expected to plan and launch an independent program of research, seek needed support for initial phases of the research program, and begin to involve others (i.e., students, clinicians, and other researchers) in that. • Postdoctoral programs provide graduates from research-focused doctoral programs not only with a period of time devoted fully to further developing research skills, but the opportunity to establish their research program with the formal mentorship of senior investigators. Formal postdoctoral study generally ensures that an individual's research program is firmly launched before facing the multiple demands of any academic, clinical, or administrative position. .

33. Nursing research faces a number of challenges and opportunities stemming from rapid growth and limited resources. In the past two decades, with the rapid expansion of resources for research, nursing's contribution to evidence-based practice and health policy has increased exponentially. Even so, a number of challenges are preventing the discipline of nursing from achieving its full scientific potential.