11

Coordinating Health Coordinating Health Care DeliveryCare Delivery

Sandie Freeman, RNC, Sandie Freeman, RNC, MSNMSN

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Definition of HealthDefinition of Health

WHO – “WHO – “State of complete physical, State of complete physical, mental and social well being – not merely mental and social well being – not merely the absence of disease or infirmity.”the absence of disease or infirmity.”

Good health is often synonymous with Good health is often synonymous with “Wellness”“Wellness”

Health or wellness are defined on Health or wellness are defined on individual termsindividual terms

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Health / Illness Continuum ModelHealth / Illness Continuum Model

Dr. John Travis, 1972

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High level wellness High level wellness modelmodel

Dr. Halbert Dunn, 1950’s

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Health Belief ModelHealth Belief Model

Rosenstock, Becker and Maiman, 1974

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Health Promotion Model

Nola Pender, PhD, RN, 1996

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Basic Human Needs Basic Human Needs ModelModel

Dr. Abraham Maslow, 1970

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Health Care Delivery Health Care Delivery SystemSystem

Access to servicesAccess to services Continuity of health careContinuity of health care Changes in acute care facilitiesChanges in acute care facilities The Dilemma-The Dilemma- How can health How can health

care in the U.S. be financed so that care in the U.S. be financed so that services are produced efficiently, services are produced efficiently, costs are effectively controlled, costs are effectively controlled, and quality is maintained or and quality is maintained or improved?improved?

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Health Care RegulationHealth Care Regulation

Utilization Review (UR)Utilization Review (UR) Prospective payment systemProspective payment system

-DRG’s (diagnosis-related -DRG’s (diagnosis-related groups)groups)

CapitationCapitation Managed CareManaged Care

How is health care paid for?

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Emphasis on Population Emphasis on Population WellnessWellness

Health care industry emphasis is shifting from Health care industry emphasis is shifting from managing illness to managing health.managing illness to managing health.– Dietary habitsDietary habits– ImmunizationsImmunizations– ↓ ↓ in tobacco usein tobacco use– Injury prevention programs (seat belts, child safety Injury prevention programs (seat belts, child safety

seats, helmet laws)seats, helmet laws)– Screening (mammograms, fecal occult blood test, Screening (mammograms, fecal occult blood test,

eye exams, pap smears)eye exams, pap smears)

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Levels of Health Care

-Preventative -Primary-Secondary -Tertiary -Restorative -Continuing

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Preventive and Primary Preventive and Primary Care SettingsCare Settings School health servicesSchool health services Occupational health servicesOccupational health services Physicians’ officesPhysicians’ offices ClinicsClinics Nursing centersNursing centers Block and parish nursingBlock and parish nursing

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3 Levels of Prevention3 Levels of Prevention

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LEVELS OF PREVENTION CHART

Level of Prevention Focus Role of the Nurse Examples

Primary

Secondary

Tertiary

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A client has a history of a gastrointestinal A client has a history of a gastrointestinal (GI) disease with eight hospitalizations (GI) disease with eight hospitalizations over the past 21-year period. He tries to over the past 21-year period. He tries to eat a well-balanced diet that usually keeps eat a well-balanced diet that usually keeps his GI symptoms suppressed. Which level his GI symptoms suppressed. Which level of prevention corresponds to his dietary of prevention corresponds to his dietary management?management?

a. Primary preventiona. Primary prevention b. Secondary preventionb. Secondary prevention c. Tertiary preventionc. Tertiary prevention d. Health promotiond. Health promotion

Think!Think!

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Secondary and Tertiary Secondary and Tertiary Care SettingsCare Settings Hospitals/medical centersHospitals/medical centers

– Emergency departmentsEmergency departments– Medical unitsMedical units– Intensive care Intensive care

Psychiatric facilitiesPsychiatric facilities

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Restorative Care SettingsRestorative Care Settings

Home health careHome health care Rehabilitation centersRehabilitation centers Extended care facilitiesExtended care facilities

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Home Health Nursing

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HospiceHospice

Hospice is not a place, but Hospice is not a place, but a concept of care that a concept of care that provides compassion, provides compassion, concern and support for concern and support for the dying.the dying.

DignityDignity No heroic measuresNo heroic measures Comfort of friends, family Comfort of friends, family

and their own homeand their own home

2020

Continuing Care SettingsContinuing Care Settings

Agencies on agingAgencies on aging Nursing Facilities/CentersNursing Facilities/Centers Assisted livingAssisted living Adult day care centersAdult day care centers

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Community Health Community Health NursingNursing

Merges Public Health Sciences with Merges Public Health Sciences with professional nursing theories to professional nursing theories to safeguard and improve the health of safeguard and improve the health of populations in the community populations in the community

Includes care in:Includes care in: the Homethe Home clinicsclinics workplaceworkplace churchchurch

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Shift from hospital to Shift from hospital to

communitycommunity Patient care is shifting from acute care to Patient care is shifting from acute care to

community-based and home care community-based and home care settings.settings.

Factors influencing changeFactors influencing change -more cost effective-more cost effective -changing demographics-changing demographics -nature and prevalence of illness-nature and prevalence of illness -technology-technology -increasing consumerism-increasing consumerism

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Think one more time!Think one more time!

The nurse recognizes that a greater need The nurse recognizes that a greater need exists for comprehensive community health exists for comprehensive community health care. Which of the following is the care. Which of the following is the largestlargest contributing factor for the increase in the contributing factor for the increase in the need for and use of home care?need for and use of home care?

a. Government funding of the home care a. Government funding of the home care setting has increased greatly.setting has increased greatly.

b. The existence of more single-income b. The existence of more single-income families has increased the need for their families has increased the need for their elderly relatives to receive care in the home.elderly relatives to receive care in the home.

c. Clients are more acutely ill when discharged c. Clients are more acutely ill when discharged from the acute care facility.from the acute care facility.

d. Seven-days-per-week services are available d. Seven-days-per-week services are available for the elderly in home care agencies.for the elderly in home care agencies.

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The future of Health The future of Health CareCare Evidenced-Based PracticeEvidenced-Based Practice Electronic Health Records (EHR)Electronic Health Records (EHR) HIMSS (Healthcare Information and HIMSS (Healthcare Information and

Management Systems Society)Management Systems Society) Increased use of “Alternative” therapiesIncreased use of “Alternative” therapies ““e” health care (Cyber-Docs, Web MD)e” health care (Cyber-Docs, Web MD) eMedicine World Medical Library: eMedicine World Medical Library:

Allergy-ImmunologyAllergy-Immunology Welcome to the e-health nurses networkWelcome to the e-health nurses network

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What will Nursing’s What will Nursing’s contribution be to the future contribution be to the future of healthcare?of healthcare? Nurses number 2.7 million and Nurses number 2.7 million and

rank as the nation’s largest rank as the nation’s largest healthcare profession.healthcare profession.

http://nursing.advanceweb.com/http://nursing.advanceweb.com/Editorial/Content/Editorial.aspx?Editorial/Content/Editorial.aspx?CC=205970CC=205970