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Health Care Delivery and the Roles of the Nurse Delune

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Title: Health Care Delivery and the Roles of the Nurse Delune


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
  • DRGs - 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?CNum15.

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, UAPs
  • 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 - whos 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
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