Health Care Delivery and Nursing Practice

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Health Care Delivery and Nursing Practice

• Dr. Belal M. Hijji, RN, PhD
• 29.08.2010

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Learning Outcomes

• At the end of this lecture, students will be able
  to
• Define nursing and identify phenomena that are
  the focus of nursing care and research
• Distinguish between the terms patient and
  client
• Discuss Maslows hierarchy of human needs
• Define health, wellness, and health promotion
• Identify the factors that influence health care
  delivery

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The Health Care Industry And The Nursing
Profession Definition of Nursing

• Nightingale (1858) noted that the goal of nursing
  was to put the patient in the best condition for
  nature to act upon him.
• Nursing leaders said that nursing is both an art
  and a science.
• The American Nurses Association (ANA, 1995)
  defined nursing as the diagnosis and treatment
  of human responses to health and illness. The
  following is list of phenomena that are the focus
  for nursing care and research
• Self-care processes
• Physiologic and pathophysiologic processes
• Comfort, pain, and discomfort
• Emotions related to experiences of health and
  illness
• Meanings ascribed to health and illnesses
• Decision making and ability to make choices
• Perceptual orientations such as self-image and
  control over ones body and environments
• Transitions across the life span
• Affiliative relationships, including freedom from
  oppression and abuse

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The Patient/ Client Consumer of Nursing and
Health Care Health Care in Transition

• The patient is a central figure in health care
  services.
• The term patient means to suffer is used to
  describe those who are recipients of care and
  dependent.
• The term client means to lean connoting
  alliance and interdependence.
• The patient who seeks care for a health problem
  is also an individual, a member of a family, and
  a citizen of the community.
• Patients needs vary depending on their problem,
  associated circumstances, and past experiences.
  One of the nurses important functions in health
  care delivery is to identify the patients
  immediate needs and take measures to address them.

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The Patients Basic Needs

• Certain needs are basic to all people and require
  satisfaction.Such needs are addressed on the
  basis of priority. Once anessential need is met,
  the person experiences a need on a higherlevel.
  Approaching needs according to priority reflects
  Maslowshierarchy of needs (Next slide).
• Maslows Hierarchy
• Maslow ranked human needs as follows physiologic
  needs safety and security belongingness and
  affection esteem and self-respect and
  self-actualization, which includes
  self-fulfillment, desire to know and understand,
  and aesthetic needs.
• Lower-level needs always remain, but a persons
  ability to pursue higher-level needs indicates
  that he or she is moving toward psychological
  health and well-being.

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Health, Wellness, And Health Promotion

• The US health care system is currently placing
  greater emphasis on health and its promotion.
  Similarly, a growing portion of nurses is
  directing its efforts toward health promotion and
  disease prevention.

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HEALTH

• The World Health Organization (WHO) defines
  health as a state of complete physical, mental,
  and social well-being and not merely the absence
  of disease and infirmity (Hood Leddy, 2002).
  Such a definition does not allow for any
  variation in degrees of wellness or illness.
• On the other hand, the concept of a
  healthillness continuum allows for a greater
  range in describing a persons health status.
• The limitations of the WHO definition of health
  are clear in relation to chronic illness and
  disability. A chronically ill person cannot meet
  the standards of health as established by the WHO
  definition. However, when viewed from the
  perspective of the healthillness continuum,
  people with chronic illness or disability can be
  understood as having the potential to attain a
  high level of wellness, if they are successful in
  meeting their health potential within the limits
  of their chronic illness or disability.

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WELLNESS

• Wellness has been defined as being equivalent to
  health.
• Cookfair (1996) indicated that wellness includes
  a conscious and deliberate approach to an
  advanced state of physical, psychological, and
  spiritual health and is a dynamic, fluctuating
  state of being.
• Leddy and Pepper (1998) contended that wellness
  is indicated by the capacity of the person to
  perform to the best of his or her ability, the
  ability to adjust and adapt to varying
  situations, a reported feeling of well-being, and
  a feeling that everything is together and
  harmonious.

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Health Promotion

• Great emphasis is placed on health, health
  promotion, wellness, and self-care. Health is
  seen as resulting from a lifestyle that is
  oriented toward wellness. The result has been the
  evolution of a wide range of health promotion
  strategies, including screening, genetic testing,
  lifetime health monitoring programs,
  environmental and mental health programs, risk
  reduction, and nutrition and health education.
• A growing interest in self-care skills is
  evidenced by the large number of health related
  publications, conferences, and workshops designed
  for the lay public.
• Individuals are increasingly knowledgeable about
  their health and are encouraged to take more
  interest in and responsibility for their health
  and well-being. Self-care education programs
  emphasize health promotion, disease prevention,
  management of illness, self-medication, and
  judicious use of the professional health care
  system.
• Special efforts are being made by health care
  professionals concerning lifestyle and health
  practices. Stress, improper diet, lack of
  exercise, smoking, drugs, high-risk behaviors and
  poor hygiene are all lifestyle behaviors known to
  have a negative effect on health.

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Influences on Health Care Delivery

• The health care delivery system is rapidly
  changing as the population and its health care
  needs and expectations change.
• The shifting demographics of the population, the
  increase in chronic illnesses and disability, the
  greater emphasis on economics, and technological
  advances have resulted in changing emphases in
  health care delivery and in nursing.

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Population Demographics

• The population expansion is attributed in part to
  improved public health services and improved
  nutrition.
• Not only is the population increasing, but the
  composition of the population is also changing.
  The decline in birth rate in the US, for example,
  and the increase in life span attributed to
  improved health care have resulted in fewer
  school-age children and more senior citizens,
  most of whom are women.
• The number of homeless people increased
  significantly.
• The population has become more culturally diverse
  as increasing numbers of people from different
  national backgrounds

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Changing Patterns of Disease

• During the past 50 years, the health problems
  have changed significantly. Many infectious
  diseases have been controlled or eradicated
  others, such as tuberculosis, acquired
  immunodeficiency syndrome (AIDS), and sexually
  transmitted diseases, are on the rise.
• An increasing number of infectious agents are
  becoming resistant to antibiotic therapy as a
  result of widespread inappropriate use of
  antibiotics.
• The chronicity of illnesses is increasing because
  of the lengthening life span of patients and the
  expansion of successful treatment options for
  conditions such as cancer and HIV infection
• Because of chronicity, many people are learning
  to protect and maximize their health within the
  constraints of chronic illness and disability.
• As chronic conditions increase, health care
  broadens from a focus on cure and eradication of
  disease to include the prevention or rapid
  treatment of exacerbations of chronic conditions.
  
• Nursing plays a prominent role in the current
  focus on management of chronic illness and
  disability.

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Advances in Technology and Genetics

• Advances in technology and genetics have occurred
  with great frequency during the past several
  decades.
• Sophisticated techniques and devices have
  revolutionized surgery and diagnostic testing,
  making it possible to perform many procedures on
  an outpatient basis.
• This is also an era of sophisticated
  communication systems that connect most parts of
  the world, with the capability of rapid storage,
  retrieval, and dissemination of information.
• Such scientific and technological advances are
  themselves stimulating brisk change in health
  care delivery strategies.

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Economic Changes

• The provision of comprehensive and quality health
  care for all citizens prompted governmental
  concern about increasing health care costs and
  wide variations in charges among providers.
• Nurses, in hospitals, care for patients who are
  older and sicker and require more nursing
  services community nurses care for patients who
  have been discharged earlier and need acute care
  services with high-technology and long-term care.
  
• Nurses in hospitals must assume responsibility
  with other health care providers for maintaining
  quality care while facing pressures to discharge
  patients and decrease staffing costs. These
  nurses must also work with nurses in community
  settings to ensure continuity of care.

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Demand for Quality Care

• The general public, in the US, has become
  increasingly interested in and knowledgeable
  about health care and health promotion.
• The general public has begun to subscribe
  strongly to the belief that quality health care
  constitute a basic right, rather than a
  privilege. In 1977, the National League for
  Nursing (NLN) said that nurses are responsibility
  to uphold patients rights to privacy,
  con?dentiality, informed participation,
  self-determination, and access to health records.
• The ANA promotes the delivery of quality health
  and nursing care. The ANA assesses the quality of
  health care provided and lobbies legislators to
  pass bills related to health insurance or length
  of hospital stay for new mothers.
• Efforts to provide full health care coverage for
  citizens, particularly children, represent
  measures by state governments to promote access
  to health care. Legislative support of advanced
  practice nurses in individual practice is a
  recognition of the contribution of nursing to the
  health of consumers, particularly underserved
  populations.

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Quality Improvement and Evidence-Based Practice

• In the 1980s, health care institutions
  implemented ongoing quality assurance (QA)
  programs which were required for reimbursement
  for services and for accreditation by the Joint
  Commission on Accreditation of Healthcare
  Organizations (JCAHO).
• QA programs sought to establish accountability
  on the part of the health professions to society
  for the quality, appropriateness, and cost of
  health services provided.
• Objective and measurable indicators were used to
  monitor, evaluate, and communicate the quality
  and appropriateness of care delivered.
• QA criteria were identi?ed as measures to ensure
  minimal expectations only they did not provide
  mechanisms for identifying causes of problems or
  for determining systems or processes that need
  improvement.

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• Continuous quality improvement (CQI) was
  identi?ed as a more effective mechanism for
  improving the quality of health care.
• Quality improvement efforts have focused on
  ensuring that the care provided meets or exceeds
  JCAHO standards.
• QA focuses on individual incidents or errors and
  minimal expectations, while CQI focuses on the
  processes used to provide care, with the aim of
  improving quality by assessing and improving
  those interrelated processes that most affect
  patient care outcomes and patient satisfaction.
• In health care agencies, nurses have many
  opportunities to be involved in quality
  improvement. One such opportunity is through
  facilitation of evidence-based practice.
• Evidence-based practiceidentifying and
  evaluating current literature and research and
  incorporating the ?ndings into care
  guidelineshas been designated as a means of
  ensuring quality care.