Chapter 4: Health and Illness

Carolyne Richardson-PhillipsPNU 145 Fall 2015

Pages 50-59

Learning Objectives

By the end of this session, the PN students will be able to:1.Describe how the World Health Organization (WHO) defines health2.Discuss the difference between values and beliefs and list health beliefs common among Americans3.Define Wellness and Holism and how they relate to the health of a person4.Identify Maslow’s five levels of human needs5.Define illness and the terms used to describe illness6.Differentiate primary, secondary, tertiary, and extended care 7.Discuss the health payment systems that help finance health care for the aged, disabled, and poor8.List four methods to control escalating health care costs.9.Identify “Healthy People 2020”, the goals and health indicators10.Discuss five patterns that nurses use to administer client care

Nursing

• Nurses need to be committed to helping people prevent illness & restore or improve their health

• These goals accomplished by:• Helping people live healthy lives• Encouraging early diagnosis of disease• Implementing measures to prevent complications of

disorders

Health• WHO (World Health Organization) defines health as a state of complete physical,

mental, & social well-being, not merely the absence of disease or infirmity: global commitment to “Health for All”

• Each person has their own opinion of what health means to them• Nurses to respect these differences

• Values: ideals that a person feels are important• Beliefs: concepts a person holds to be true• Person’s actions/behaviors-guided by values-beliefs• American health belief

• Limited Resource: no substitute; “as long as you have your health, you have everything”

• A Right: everyone is entitled to health care according to the principles of USA; not always true as health disparities exist among various groups

• A Personal Responsibility:• Requires continuous personal effort• Much potential for illness as there is for health• Nurses have a duty to protect and preserve health of those who may not be able

to assert this right for themselves

• Americans believe one or all of the following• Health is a resource, a right, a personal responsibility

Wellness and Holism• Wellness: Balance of all aspects of health involves:

• Physical health• Emotional health• Social health• Spiritual health

• Holism: sum of physical, emotional, social, and spiritual health• Determines how “whole” or well a person feels• Nurses-”holistic practitioners-committed to restoring balance in

each of the four spheres that affect health• Based on hierarchy of human needs

Maslow’s Hierarchy of Human Needs• Identified 5 levels of human needs that

motivate behavior• First level: Physiological

• Most important-necessary for life• Second: Safety and Security• Third: Love and Belonging• Fourth: Esteem and Self Esteem• Fifth: Self Actualization

• Believed that by satisfying needs at each level-people realize their potential for health & well-being

• Tools used by nurses for each settings• Priorities for client care

Illness• State of discomfort

• Highly subjective & individualized• May result from physical, emotional, intellectual, social or

spiritual deterioration, from disease, deterioration or injury which impairs the person’s health

• Morbidity: incidence of a specific disease, disorder or injury; refers to -Rate or number of people affected within population

• Mortality: incidence of deaths; number of people who died from a particular disease or condition

Types of Illnesses • Acute illness: symptoms develop suddenly

• Lasts a short period of time-usually curable• May lead to long-term problems b/c of their sequelae-ill effects

from permanent/progressive organ damage caused by disease or its treatment

• Chronic illness-comes on slowly • Lasts a long time - may last a lifetime• Increases as people age• May have periods of remission & exacerbation

• Terminal illness: no potential for cure; terminal stage of an illness- person is approaching death

• Primary illness: one that develops independently of any other disease• Secondary illness: a disorder that develops from a pre-existing

condition• Remission: s & s associated with a particular disease disappear;

resembles a cured state, but may be temporary• Exacerbation: s & s reappear - or one that reverts from a chronic to an

acute state; can occur periodically in clients w/ long-standing diseases

Illnesses (cont’d)• Hereditary condition - disorder acquired from the genetic codes of

one or both parents and symptoms may or may not be present at birth• Congenital disorders - present at birth but which are the result of

faulty embryonic development and cannot be genetically predicted• Idiopathic illness -an unexplained cause

• Treatment focuses on relieving signs/symptoms

Health Care System• Network of available health services

• Includes agencies- institutions where people seek treatment for health problems or assistance with maintaining or promoting their health

• Changes on-going with system• Advances in technology, & new discoveries• More modern methods of diagnosing & treating diseases-

creating a need for specialized care• Now a complex system involving types of health care

• Primary• Secondary• Tertiary• Extended care

Primary Health Care• Primary Health and Illness prevention-

• Promotes health and preventing development of disease and injury

• Health Services: provided by first health care professional or agency a person contacts• Family practice physician, nurse practitioner, physician’s

assistant in an office or clinic• Focuses on health promotion

• Protection against specific health problems• Illness prevention• Preventive care• Health education• Environmental protection

Secondary Care

• Secondary Health and Illness Prevention-Focus on early identification (screening) of health problems & prompt treatment • Primary caregivers refer clients for consultation if needed or

additional testing- to help with diagnosis –recovery– (Ex: Blood pressure, cholesterol, Cardiac Catheterization lab, X-rays, oncologist, skin care, diabetes, HIV, skin cancer etc.)• Prompt intervention to alleviate health problems• Diagnosis & treatment• Emergency care• Acute care

Tertiary Care • Tertiary-Care given to minimize the effects of a condition – Helps

to prevent long-term complications if possible• Begins after an illness

• Health services provided at hospitals or medical centers with Clinics-complex technology and specialists

• May be Outpatient care• May need to travel from Home to facilities to receive Care Ex: Chemotherapy, Wound care, Diabetes

Extended Care

• Services that meet the health needs of clients who no longer require acute hospital care

• Rehabilitation, skilled nursing in person’s home or a nursing home, and hospice care for dying clients

Assisted Living Nursing FacilityRehabilitation

Access to Care• There are still millions of uninsured people in the USA because of

economic burden• Groups with inadequate health care include: Children, Older adults,

Ethnic minorities, Poor• Many delay seeking treatment-can not afford to pay or insurance

may not pay• Facilities – physicians –pharmacies - not close for care• May go to emergency room when needing care• Inappropriate use of emergency departments –expensive-long

waits & no follow-up

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Financial Health Care System Payments

Financing Health Care• Payment Sources in USA

- Private insurance

- Self-insurance systems

- Medicare

- Medicaid

Financing Health Care (cont’d) • Medicare-Federal program- finances health care costs of persons 65

years and older, permanently disabled workers of any age and their dependents, and those with end-stage renal disease; funded primarily through withholdings from employed person’s income• Part A covers-acute hospital care, rehab care, hospice & home

care services• Part B- purchased for an additional fee-covers MD services,

outpatient, labs, medical equipment• Part D: 2006-additional fee – covers a portion of medications

• Medicaid-A state administered program designed to meet the needs of low-income residents• Funded from federal, state and local sources• Each state determines how funds are to be used• Covers-hospitalization, diagnostic tests, MD visits, rehab &

outpatient care• Long-term care- when he/she runs out of their own money

Financing Health Care (cont’d)• Prospective Payment Systems- for people enrolled in Medicare –

Hospitals Reimbursed at a predetermined set rate regardless of length of stay, acuity or complexity of client’s care

• Payments based on Diagnostic-related group (DRG)-a classification system used to group clients with similar diagnoses• If costs are less-hospital keeps difference• If costs exceed reimbursed amount-hospital has deficit• Limits amount paid to hospitals that receive Medicare payments• Hospitals try to treat & discharge as early as possible for

decreased hospital days• In Nursing facilities/Rehabilitation units-Form used to determine

documentation & reimbursement to the State-called MDS (Minimum Data Set)

Financing Health Care (cont’d)• Managed Care Organizations - Private insurers carefully plan-

supervise distribution of client’s health care services• Control costs-use resources efficiently- & focus more on

prevention (ex. Screening, education, health promoting activities)

• Types of Managed Care: • Health Maintenance Organizations (HMO): corporations that

charge preset, fixed, yearly fees in exchange for providing health care for their members - fee does not change regardless of health issues

• Emphasize client wellness-Offer preventive services, periodic screenings, health education

Types: Managed Care Organizations (cont’d)

• Preferred Provider Organizations (PPOs)• Agents for insurance companies-control costs on basis of

competition• Create a network of a community’s physicians- willing to discount

fees for exchange of referred clients• Capitation

• Different from HMOs & PPOs• Payment system with a preset fee per member is paid to healthcare

provider-regardless of whether or not member requires services• Incentive to providers to control tests- services to make a profit• If members do not receive costly care, provider receives money

National Health Goals: Healthy People 2020• Healthy People 2020 tracks approximately 1,200 objectives organized into 42

topic areas, each of which represents an important public health area• Four overarching goals:

• Attain high-quality, longer lives free of preventable disease, disability, injury, and premature death

• Achieve health equity, eliminate disparities, and improve the health of all groups

• Create social & physical environments that promote good health for all• Promote quality of life, healthy development, and healthy behaviors across

all life stages.• Within these issues- also focus areas that need to be worked on: health insurance,

education of health, wellness, and facilities, reduce number of cases of cancer & deaths, illness, disability, reduce infections from food-borne pathogens, improve vision & hearing

• Because objectives are national, not solely federal, achievement is dependent in part on the ability of health agencies at all levels of the government and on non-governmental organizations to assess objective progress. 

• Nurses Roles: prevention and patient education• HealthyPeople.Gov 2020-updated 8/28/2013,

http://www.healthypeople.gov/2020/about/default.aspx .

Nursing Team• Nursing Team: Personnel who care for client’s directly

• Goal: to help clients attain, maintain, or regain health• May include several types of professionals, allied health care

workers with special training • Nurses – have unique skills to work in various settings in health

field• Use several common management patterns

• Five common ones used: Functional nursing, Case method, Team nursing, Primary nursing, Nurse-managed care

Functional Nursing, Case Method & Team Leader• Functional Nursing

• Each nurse is assigned specific tasks• Used less often-D/T more task oriented & less focused on the

individuality of care• Case Method: one nurse manages all the care a client or group of

clients needs for a designated period of time• Used in home health, public health nursing, & community mental

health nursing• Nurses known as case managers

• Team Leader: clients are divided into groups & complete their care together which is organized & directed by a nurse• May assist but usually assigns or supervises the care the team

members provide• Members report the outcomes of their care to the team leader• Responsible for evaluating whether the goals of client care are met• Daily conferences are important to discuss client’s progress towards

recovery & discharge

Primary Nursing• Admitting nurse assumes responsibility for planning client care and

evaluating the progress of client• May delegate client’s care to someone else in his or her absence• BUT Is consulted when new problems develop or plan of care

required modifications• Remains responsible, accountable for client until discharge

Nurse-Managed Care & Continuity of Health Care• Nurse-Managed Care: a nurse manager plans nursing care of

clients based on their type of case or medical diagnosis• A clinical pathway is used to manage the care• Nurse acts as case manager to evaluate whether predictable

outcomes are met on a daily basis• Meeting the outcomes in a timely manner allows for a timely

discharge• Approach ensures standards of care are met with efficiency and

cost savings• System developed d/t nursing shortage & need to balance costs

with limited reimbursement systems• Continuity of Health Care: maintenance of health care from one

level of health to another and from one agency to another• Ensures that client navigates the complicated health care system

with maximum of efficiency & minimum of frustration• Goal: avoid causing client-ill or healthy, to feel isolated, fragmented, or abandoned

References• Healthy People 2020 (2013); Retrieved on 5/8/14 from web site:

www.HealthyPeople.Gov2020.com• Images retrieved from web site: www.http:// googleimages.com on

June 14, 2015• Lippincott Williams & Wilkins, (2013) (10th ed.) Lippincott Manual

of Nursing Practice-Online Electronic Medical Library, retrieved on 4/29/2014 from web site:http://online.statref.com/Document.aspx?fxId=485&docId=10

• Timby, B. K. (2013). (10th ed.). Fundamental Nursing Skills and Concepts. Philadelphia: PA. Lippincott Williams & Wilkins