Nursing Chapter 2: Health Care Delivery System

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Questions and Answers

Which of the following is NOT a level of health care?

Quaternary (correct)

Continuing health care

Preventative

Traditional

What is the primary focus of primary health care?

Providing intensive care to patients

Improving health outcomes for an entire population (correct)

Rehabilitating patients in extended care facilities

Reducing and controlling risk factors for disease

What is the main goal of health promotion programs?

Reducing the incidence of disease (correct)

Improving health outcomes for an individual

Providing palliative care to patients

Focusing on restorative care

What is a challenge facing nursing due to the aging population?

Increased demand for primary health care services Signup and view all the answers

What is the primary focus of tertiary care?

Providing specialized care to patients Signup and view all the answers

Which of the following is an example of restorative care?

Home care Signup and view all the answers

What is a primary concern in healthcare delivery?

Health care costs Signup and view all the answers

What is a challenge facing nursing due to the rate of nurses' retirements?

Workforce shortages and knowledge gaps Signup and view all the answers

What is the main goal of preventive care?

Reducing and controlling risk factors for disease Signup and view all the answers

Which of the following is a key aspect of patient-centered care?

Coordination and integration of care Signup and view all the answers

Which of the following is an example of continuing care?

Assisted living Signup and view all the answers

What is a challenge facing nursing due to the uncertainty of health care reform?

Changes in health care policy and funding Signup and view all the answers

What is the primary goal of the Magnet recognition program?

Recognizing excellence in nursing practice Signup and view all the answers

What is a potential consequence of health care disparities?

Worse health outcomes Signup and view all the answers

What is a predicted trend in the future of healthcare?

Increased use of telehealth and digital care Signup and view all the answers

What is a key aspect of competency in healthcare delivery?

Information and education Signup and view all the answers

What is a potential consequence of a nursing shortage?

Worse health outcomes Signup and view all the answers

What is a key aspect of patient-centered care?

Continuity and transition Signup and view all the answers

What is a potential solution to healthcare disparities?

Education and community engagement Signup and view all the answers

What is a key aspect of the future of healthcare?

Consumer-centered care Signup and view all the answers

What is the primary focus of health education?

To help people develop a greater understanding of their health and how to better manage their health risks Signup and view all the answers

What is the primary goal of tertiary prevention?

To manage and rehabilitate defects or disabilities Signup and view all the answers

What is an example of a nonmodifiable risk factor?

Age Signup and view all the answers

What is the purpose of a health risk appraisal form?

To assess the risk of illness or accident Signup and view all the answers

What is the Transtheoretical Model of Change used for?

To understand the stages of change Signup and view all the answers

What is an example of an environmental risk factor?

Air pollution Signup and view all the answers

What is the primary goal of health promotion?

To maintain or enhance present health Signup and view all the answers

What is the primary focus of primary prevention?

To reduce the incidence of disease Signup and view all the answers

What is the purpose of identifying risk factors?

To assess the risk of illness or accident Signup and view all the answers

What is the primary goal of illness prevention?

To protect people from actual or potential threats to health Signup and view all the answers

Which of the following types of illness is characterized by a short duration and severe symptoms?

Acute illness Signup and view all the answers

What is the term for how people monitor their bodies and define and interpret their symptoms?

Illness behavior Signup and view all the answers

Which of the following is an example of a variable that can influence illness and illness behavior?

All of the above Signup and view all the answers

What is the term for the impact of illness on a person's sense of self-worth?

Impact on self-concept Signup and view all the answers

Which of the following is a way to care for oneself as a healthcare professional?

All of the above Signup and view all the answers

What is the term for a type of illness that lasts longer than 6 months and affects functioning?

Chronic illness Signup and view all the answers

Which of the following is an example of an internal variable that can influence illness and illness behavior?

Genetics Signup and view all the answers

What is the term for the changes that occur in a person's behavior and emotions as a result of illness?

Behavioral changes Signup and view all the answers

Which of the following is a way that illness can affect a person's family?

Impact on family roles Signup and view all the answers

What is the term for the ways in which people perceive and respond to their symptoms?

Illness behavior Signup and view all the answers

What is the primary goal of Healthy People 2030?

To promote a society in which all people live long, healthy lives Signup and view all the answers

According to the World Health Organization (WHO), what is the definition of health?

A state of complete physical, mental, and social well-being Signup and view all the answers

What is the primary purpose of models of health and illness?

To provide a framework for understanding complex concepts or ideas Signup and view all the answers

What is the Health Belief Model primarily used for?

To explain how people's health beliefs influence their health practices Signup and view all the answers

What is Maslow's Hierarchy of Needs primarily used for?

To understand the interrelationships of human needs Signup and view all the answers

What is the primary focus of the Holistic Health Model?

Emotional, spiritual, social, cultural, and physical aspects of wellness Signup and view all the answers

What influences health beliefs and practices?

Cultural, social, and environmental factors Signup and view all the answers

What is the primary goal of health promotion programs?

To prevent disease and promote health Signup and view all the answers

What is the primary focus of health promotion models?

Individual behavior and lifestyle changes Signup and view all the answers

What is the primary purpose of identifying leading health indicators?

To identify high-priority health issues in the United States Signup and view all the answers

In a person-to-person encounter, what is involved in providing presence?

Being both physically and emotionally present Signup and view all the answers

What is the primary goal of true listening in nursing?

To know what really matters to the patient and family Signup and view all the answers

What is spiritual health achieved when a person can find a balance between?

Their life values, goals, and belief systems Signup and view all the answers

What is the core of clinical decision making and patient-centered care?

Knowing the patient and their needs Signup and view all the answers

What is the primary benefit of continuity of care in knowing the patient?

It helps the nurse to understand the patient's needs and concerns Signup and view all the answers

What is the primary purpose of touch in nursing?

To create a sense of closeness and connection Signup and view all the answers

What is the primary goal of caring behaviors in nursing?

To reach out to colleagues and care for them Signup and view all the answers

What is the primary focus of providing presence in nursing?

To establish a connection with the patient and their family Signup and view all the answers

What is the primary benefit of self-care in nursing?

It helps nurses to prioritize their own needs and well-being Signup and view all the answers

What is the primary purpose of active listening in nursing?

To begin to truly know the patient and their needs Signup and view all the answers

What is a common theme among nursing caring theories?

Caring is highly relational Signup and view all the answers

What does an ethic of care concern itself with?

The relationship between the nurse and the patient Signup and view all the answers

What is a key aspect of caring in nursing practice?

Developing caring behaviors Signup and view all the answers

What does the Caring Assessment Tool measure?

Patient's perceptions of caring Signup and view all the answers

What is a benefit of building a nurse-patient relationship?

Patients become more active in their care Signup and view all the answers

What is a key aspect of Leininger's Transcultural Caring theory?

Cultural differences are respected Signup and view all the answers

What is a key aspect of Watson's Transpersonal Caring theory?

Caring is a spiritual experience Signup and view all the answers

What is a key aspect of Swanson's Theory of Caring?

Caring is a process of knowing, being, and doing Signup and view all the answers

What is a benefit of knowing the context of a patient's illness?

It helps choose and individualize interventions Signup and view all the answers

What is an aspect of enabling in the context of caring?

It is about empowering the patient Signup and view all the answers

What is essential for reducing symptoms and suffering in patients?

Providing a quiet, caring presence Signup and view all the answers

How can nurses support family caregivers?

By helping them to be active participants Signup and view all the answers

What is a challenge facing healthcare today?

The need for healthcare to become more compassionate Signup and view all the answers

What is necessary for a patient's comfort and dignity?

A nonjudgmental, caring presence Signup and view all the answers

Why is it important to understand the stress of a patient's illness on family members?

To help family caregivers be active participants Signup and view all the answers

What is the consequence of a lack of compassionate healthcare?

A negative impact on healthcare outcomes Signup and view all the answers

What is essential for providing comfort to patients?

A listening, nonjudgmental, caring presence Signup and view all the answers

Why is it important for nurses to care for patients' families?

To support the family's emotional well-being Signup and view all the answers

What is the primary goal of caring nursing actions?

To provide comfort, dignity, respect, and peace Signup and view all the answers

What is the consequence of not addressing the stress of a patient's illness on family members?

An increase in family caregiver stress Signup and view all the answers

What is the primary purpose of asking a clinical question in PICOT format?

To develop a research hypothesis Signup and view all the answers

Which of the following sources is NOT considered a reliable source of evidence for evidence-based practice?

Social media Signup and view all the answers

What is the primary goal of critically appraising the evidence?

To identify the best evidence for practice Signup and view all the answers

What is the primary purpose of integrating the evidence into practice?

To apply the research findings to patient care Signup and view all the answers

What is the primary goal of translation research?

Translating research findings into clinical practice Signup and view all the answers

What is the primary goal of a systematic approach to evidence-based practice?

To determine the value of the evidence Signup and view all the answers

Which of the following is a key step in the evidence-based practice process?

Searching for the best evidence Signup and view all the answers

What is the primary goal of outcomes research?

Helping patients and healthcare providers make informed decisions Signup and view all the answers

What is the primary goal of evidence-based practice in clinical decision-making?

To integrate the best evidence with clinician expertise and patient values Signup and view all the answers

What is the primary focus of phase 1 clinical trials?

Testing safety and efficacy in a small group of subjects Signup and view all the answers

What is the first step in the evidence-based practice process?

Cultivate a spirit of inquiry Signup and view all the answers

What type of research studies are considered the best evidence for evidence-based practice?

Well-designed, systematically conducted research studies Signup and view all the answers

What is the primary focus of nursing research?

Identifying new knowledge and improving professional education Signup and view all the answers

What is the primary focus of quantitative research?

Conducting experimental and non-experimental studies Signup and view all the answers

What is the purpose of critically appraising the evidence in evidence-based practice?

To evaluate the quality and relevance of the evidence Signup and view all the answers

What is the role of a clinician's expertise in evidence-based practice?

To provide a critical perspective on the evidence Signup and view all the answers

What is the primary focus of phase 5 clinical trials?

Translating research findings into community practice Signup and view all the answers

What is the ultimate goal of evidence-based practice in healthcare delivery?

To improve patient outcomes and quality of care Signup and view all the answers

What is the primary purpose of evaluating the outcomes of an evidence-based practice decision?

To determine the effectiveness of the practice change Signup and view all the answers

Who should be involved in communicating the outcomes of an evidence-based practice decision?

All of the above Signup and view all the answers

What is the primary goal of sustaining knowledge use in evidence-based practice?

To incorporate the change into the culture and practice environment Signup and view all the answers

What should be considered when evaluating an evidence-based practice change?

Whether modifications are needed and if the change should be discontinued Signup and view all the answers

Why is it important to evaluate the outcomes of an evidence-based practice decision?

To determine whether the change is effective and to identify areas for improvement Signup and view all the answers

What is the purpose of incorporating an evidence-based practice change into the culture and practice environment?

To sustain knowledge use and make the change a part of the organization's culture and practice environment Signup and view all the answers

What is the primary focus of performance improvement programs?

Improving local work processes to enhance patient care and outcomes Signup and view all the answers

What is the primary difference between research and quality improvement (QI)?

Research contributes to generalizable knowledge, while QI does not Signup and view all the answers

What is the relationship between evidence-based practice (EBP), research, and performance improvement (PI)?

EBP uses research evidence, research generates new knowledge, and PI improves local work processes Signup and view all the answers

What is the primary goal of nursing research?

To contribute to the generalizable knowledge base of nursing Signup and view all the answers

What is the primary focus of evidence-based practice (EBP)?

Determining safe and effective nursing care based on research evidence Signup and view all the answers

What is the primary purpose of combining performance improvement (PI) with evidence-based practice (EBP)?

To improve local work processes and patient care simultaneously Signup and view all the answers

Study Notes

Health Care Delivery System

Four challenges facing nursing: aging baby boomer generation, shortage and uneven distribution of physicians, rate of nurses' retirements, and uncertainty of health care reform

Traditional Levels of Health Care

Preventative care
Primary care
Secondary care
Tertiary care
Restorative care
Continuing health care

Integrated Health Care Delivery

Primary and preventive health care services: focus on improved health outcomes for an entire population, requires collaboration among health professionals, health care leaders, and community members
Health promotion programs: designed to reduce the incidence of disease
Preventive care: focused on reducing and controlling risk factors for disease
Secondary and tertiary care: hospitals, intensive care, mental health facilities, rural hospitals, and discharge planning
Restorative care: home care, rehabilitation, and extended care facilities
Continuing care: nursing centers or facilities, assisted living, respite care, adult day care centers, and palliative and hospice care

Issues in Health Care Delivery for Nurses

Health care costs and quality: patient satisfaction
Nursing shortage: competency
Patient-centered care: respect for patient's values, preferences, and expressed needs, coordination and integration of care, information and education, physical comfort, emotional support and alleviation of fear and anxiety, involvement of family and friends, continuity and transition, and access to care
Magnet recognition program: nursing-sensitive outcomes
Technology in health care: robotics, telemedicine
Health care disparities: economic stability, education, health and health care, neighborhood and built environment, and social and community context

The Future of Health Care

Current system is in a constant state of change
Predictions: consumer-centered health care system, increased use of telehealth and digital care, decreased office visits, and increased use of artificial intelligence to assist in early detection and better understanding of disease progression

Healthy People

Provides evidence-based, 10-year national objectives for promoting health and preventing disease
Healthy People 2030 aims to promote a society in which all people live long, healthy lives and identifies leading health indicators

Definition of Health

A state of complete physical, mental, and social well-being, not merely the absence of disease or infirmity (WHO, 1947, 2018)
A state of being that people define in relation to their own values, personality, and lifestyle

Models of Health and Illness

Models help explain complex concepts or ideas, such as health and illness
Health beliefs are a person's ideas, convictions, and attitudes about health and illness
Health Belief Model and Health Promotion Model are examples of models of health and illness
Maslow's Hierarchy of Needs is used to understand the interrelationships of human needs
Holistic Health Model considers emotional, spiritual, social, cultural, and physical aspects of wellness

Variables Influencing Health and Health Beliefs and Practices

Internal variables: developmental stage, intellectual background, perception of functioning, emotional factors, and spiritual factors
External variables: family role and practices, social determinants of health, and culture

Health Promotion, Wellness, and Illness Prevention

Health promotion: helps individuals maintain or enhance their present health
Health education: helps people develop a greater understanding of their health and how to better manage their health risks
Illness prevention: protects people from actual or potential threats to health

Three Levels of Prevention

Primary prevention: true prevention that reduces the incidence of disease
Secondary prevention: focuses on preventing the spread of disease, illness, or infection once it occurs
Tertiary prevention: occurs when a defect or disability is permanent or irreversible

Risk Factors

Any attribute, quality, environmental situation, or trait that increases the vulnerability of an individual or group to an illness or accident
Risk factors include: nonmodifiable risk factors, modifiable risk factors, and environment

Risk Factor Identification and Changing Health Behaviors

Identify risk factors: assessment, health risk appraisal forms
Implement education and counseling: wellness strategies, Transtheoretical Model of Change

Illness

A state in which a person's physical, emotional, intellectual, social, developmental, or spiritual functioning is diminished or impaired
Acute illness: short duration and severe
Chronic illness: lasts longer than 6 months and affects functioning
Illness behavior: involves how people monitor their bodies and define and interpret their symptoms
Variables influencing illness and illness behavior: internal variables and external variables
Impact of illness on the patient and family: behavioral and emotional changes, impact on body image, impact on self-concept, impact on family roles, and impact on family dynamics

Caring for Yourself

Eat a nutritious diet
Get adequate sleep
Engage in exercise and relaxation activities
Establish a good work-family balance
Engage in regular nonwork activities

Theoretical Views on Caring

Caring is primary in nursing practice
Leininger's Transcultural Caring theory emphasizes cultural sensitivity
Watson's Transpersonal Caring theory focuses on the humanistic and spiritual aspects of caring
Swanson's Theory of Caring emphasizes the nurse's role in enabling patients to achieve their goals

Summary of Theoretical Views

Nursing caring theories share common themes
Caring is highly relational and context-dependent
The absence of caring is evident
Enabling is an essential aspect of caring
Knowing the patient's context helps in individualizing interventions

Patient's Perspective of Caring

Patients value the affective dimension of nursing care
The Caring Assessment Tool measures patients' perceptions of caring
Patients become active partners in care when they sense sensitivity, sympathy, and compassion from healthcare providers
Assessing patient expectations and building a nurse-patient relationship is crucial

Ethic of Care

Caring involves mutual respect and trust between nurse and patient
The ethic of care focuses on relationships and the nurse's character and attitude towards others
An ethic of care is concerned with right and wrong behavior

Caring in Nursing Practice

Caring is a developing skill that grows with practice
Caring is a human behavior that can be given and received
Recognizing the importance of self-care is essential
Caring behaviors should be extended to colleagues as well

Providing Presence

Providing presence is a person-to-person encounter that conveys closeness and caring
Presence involves "being there" and "being with"
Nursing presence is the connectedness between nurse and patient
Establishing presence strengthens patient-centered care

Touch

Touch provides comfort and creates a connection
There are different types of touch: non-contact, contact, task-oriented, caring, protective, and therapeutic touch
Touch should be used with discretion, as it conveys many messages

Listening

Listening is necessary for meaningful interactions with patients
True listening leads to knowing and responding to what matters to patients and their families
Effective listening requires silencing oneself and listening with an open mind
Active listening helps in truly knowing patients and what is important to them

Knowing the Patient

Knowing the patient is the core of clinical decision making and patient-centered care
Continuity of care and clinical expertise facilitate knowing
Factors that facilitate knowing include time, continuity of care, teamwork, trust, and experience

Spiritual Caring

Spiritual health involves balancing life values, goals, and beliefs with those of others
Spirituality offers a sense of intrapersonal, interpersonal, and transpersonal connectedness

Relieving Symptoms and Suffering

Relieving symptoms and suffering requires caring nursing actions that provide comfort, dignity, respect, and peace
Conveying a quiet, caring presence, touching, or listening helps in assessing and understanding patient discomfort
Providing comfort through a listening, non-judgmental, caring presence is essential

Family Care

Caring for an individual includes caring for their family
Nurses should help family caregivers be active participants in care
Understanding the stress that a patient's illness places on family members is crucial

The Challenge of Caring

Challenges to caring include the task-oriented biomedical model, institutional demands, time constraints, reliance on technology, cost-effective strategies, and standardized work processes
Health care must become more compassionate to make a positive difference

Evidence-Based Practice (EBP)

EBP is a problem-solving approach to clinical practice that combines the best evidence with a clinician's expertise, patient preferences and values, and health care resources in making decisions about patient care.
The best scientific evidence comes from well-designed, systematically conducted research studies found in scientific, peer-reviewed journals.

Steps of Evidence-Based Practice

Cultivate a spirit of inquiry: constantly questioning current practices leads to consistent use of EBP.
Ask a clinical question in PICOT format:
- P = Patient population of interest
- I = Intervention of interest
- C = Comparison of interest
- O = Outcome
- T = Time
Search for the best evidence:
- Sources include agency policy, procedure manuals, quality improvement data, existing clinical practice guidelines, and journal articles.
- Ask experts for help, such as nurses, educators, and librarians.
Critically appraise the evidence:
- After critiquing all articles for a PICOT question, synthesize or combine the findings.
- Consider the scientific rigor of the evidence and whether it has application in practice.
Integrate the evidence:
- Apply the research in your plan of care for a patient; use evidence as rationale.
- Education about the change must occur, and large-scale change requires planning.
Evaluate the outcomes of the practice decision or change:
- Determine whether the change was effective, if modifications are needed, or if the change should be discontinued.
- Unexpected events or results may occur.
Communicate the outcomes of the evidence-based practice decision:
- Share with clinical staff, nursing practice council, EBP council, research council, clinicians, and professional conferences.

Scientific Method

Make an observation
Ask questions and gather information
Analyze the literature and form a research question or hypothesis
Conduct a study using scientific rigor
Analyze the data and draw conclusions
Types of research studies:
- Quantitative research: experimental research, nonexperimental research, surveys
- Qualitative research: inductive reasoning

Nursing Research

A way to identify new knowledge, improve professional education and practice, and use resources effectively
Many professional and specialty nursing organizations support the conduct of research for advancing nursing science
Translation research phases:
- Preclinical and animal studies—basic science research
- Phase 1 clinical trials—testing safety and efficacy in a small group of human subjects
- Phase 2 and 3 clinical trials—testing safety and efficacy in a larger group of human subjects and testing for comparison to standard treatment
- Phase 4 clinical trials and outcomes research—translation to practice
- Phase 5 population-level outcomes research—translation to community
Outcomes research:
- Helps patients, health care providers, and those in health care policy make informed decisions based on current evidence.
- Focuses on the benefits, risks, costs, and holistic effects of a treatment on patients.

Performance Improvement

A formal approach for the analysis of health care–related processes
Reviews how existing interventions within a process function
PI combined with EBP is the foundation for excellent patient care and outcomes
Performance improvement programs focus on processes or systems that significantly contribute to outcomes

The Relationship Among EBP, Research, and PI

Although EBP, research, and PI are closely related, they are separate processes.
EBP: Use of information from research and other sources to determine safe and effective nursing care with the goal of improving patient care and outcomes.
Research: Systematic inquiry answers questions, solves problems, and contributes to the generalizable knowledge base of nursing; may or may not improve patient care.
QI: Improves local work processes to improve patient outcomes and health system efficiency; results usually not generalizable.

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Description

This quiz covers the fundamentals of nursing, focusing on the challenges facing the health care delivery system, including the aging population, physician shortage, and nurse retirements.