The Health Care Delivery System PDF

T H E H E A LT H C A R E DELIVERY SYSTEM D R. S E R P İ L TO P Ç U 1  Health care delivery system is a mechanism for providing services that meet the health-related needs of individuals Health care providers are seeking cost-effective ways to deliver a...

T H E H E A LT H C A R E DELIVERY SYSTEM D R. S E R P İ L TO P Ç U 1  Health care delivery system is a mechanism for providing services that meet the health-related needs of individuals Health care providers are seeking cost-effective ways to deliver an ever-increasing range of services to consumers. Consumers are demanding greater accessibility to quality health care services that are affordable Nursing is a major component of the world health care delivery system. 2  TYPES OF HEALTH CARE SERVICES Basically, health care services can be categorized into three levels: primary, secondary, and tertiary 3 1- PRIMARY: HEALTH PROMOTION AND ILLNESS PREVENTION The major purposes of health care are to promote wellness and prevent illness or disability. Illness prevention activities are directed at the individual, the family, and/or the community. 4 1- PRIMARY: HEALTH PROMOTION AND ILLNESS PREVENTION Unfortunately, our entire system of health care delivery is not a health promotion and illness preventin system but rather an illness care system. Services are directed to caring for an individual after disease or disability has developed rather than emphasizing preventive aspects of care Ideally, preventive care occurs in the community (e.g., homes, workplaces, schools) and emphasizes the development of healthy lifestyles. 5 2- SECONDARY: DIAGNOSIS AND TREATMENT Most services occur within this secondary type of health care. Acute treatment centers (hospitals) are still the predominant site of delivery of health care services. There is a growing movement to have diagnostic and therapeutic services provided in locations that are more easily accessed by individuals. 6  3- TERTIARY: REHABILITATION Restoring an individual to the state that existed before the development of an illness is the purpose of rehabilitative (or restorative) care. In situations in which the person is unable to regain previous functional abilities, the goal of rehabilitation is to help the client reach the optimal level of self-care. Restorative care is holistic, in that the entire person is cared for physiological, psychological, social, and spiritual aspects. 7 TYPES OF HEALTH CARE SERVICES 8 SECONDARY AND TERTIARY CARE CENTERS 1- Hospitals Hospital emergency departments, urgent care centers, critical care units, and inpatient medical-surgical units provide secondary and tertiary levels of care Quality safe care is the focus of most acute care organizations; satisfaction with health care services is important to them 9  SECONDARY AND TERTIARY CARE CENTERS 1- Hospitals Patients require the following instruction before they leave health care facilities: Safe and effective use of medications and medical equipment Instruction in potential food-drug interactions and counseling on nutrition and modified diets Rehabilitation techniques to support adaptation to and/or functional independence in the environment 10  SECONDARY AND TERTIARY CARE CENTERS 2- Intensive Care Unit (ICU) An ICU or critical care unit is a hospital unit in which patients receive close monitoring and intensive medical care. ICUs have advanced technologies such as computerized cardiac monitors and mechanical ventilators. Nursing and medical staff have special knowledge about critical care principles and techniques. ICU patients need special care and treatment 11  SECONDARY AND TERTIARY CARE CENTERS 3- Psychiatric Facilities/ Mental Health Hospitals Patients who suffer emotional and behavioral problems such as depression, violent behavior, and eating disorders often require special counseling and treatment in psychiatric facilities. These facilities locate in hospitals, independent outpatient clinics, or private mental health hospitals, 12 SECONDARY AND TERTIARY CARE CENTERS 4- Home Health Care (Home Care) Home care; patients and families in their homes for health maintenance, education, illness prevention, diagnosis and treatment of disease, palliation, and rehabilitation Home nursing care include monitoring vital signs; assessment; administering parenteral or enteral nutrition, medications, and IV or blood therapy; and wound or respiratory care, patient recovery and stabilization of illness in the home 13  SECONDARY AND TERTIARY CARE CENTERS 5- Rehabilitation Rehabilitation restores a person to the fullest physical, mental, social, vocational, and economic potential possible. Specialized rehabilitation services such as cardiovascular, neurological, musculoskeletal, pulmonary, and mental health rehabilitation programs help patients and families adjust to necessary changes in lifestyle and learn to function with the limitations of their disease. 14  SECONDARY AND TERTIARY CARE CENTERS 5- Rehabilitation Rehabilitation services include physical, occupational, and speech therapy and social services. Initially rehabilitation usually focuses on the prevention of complications related to the illness or injury. Rehabilitation occurs in many health care settings, including special rehabilitation agencies, outpatient settings, and the home. Frequently patients needing long-term rehabilitation (e.g., patients who have had strokes and spinal cord injuries) have severe disabilities affecting their ability to carry out the activities of daily living. 15 HEALTH CARE TEAM 20  HEALTH CARE TEAM NURSE Health care services are delivered by a multidisciplinary team. Because nurses work with other care providers on an ongoing basis, it is necessary to understand the role of each provider. Nurses coordinate the care provided by other personnel. Nurses fulfill a variety of roles while assisting clients to meet their needs. These roles are affected by changes in the health care environment. Nurses function in dependent, independent, and interdependent roles. 17 HEALTH CARE TEAM 21  HEALTH CARE TEAM IMAM 19 NURSING ROLE IN HEALTH CARE TEAM 20 NURSING ROLE IN HEALTH CARE TEAM 21  FACTORS INFLUENCING THE DELIVERY OF HEALTH CARE 1- Cost; The very existence of the health care system depends on fiscal issues Government spends money on health care for per person 22  FACTORS INFLUENCING THE DELIVERY OF HEALTH CARE 2- Access Access to health care services has a serious impact on the functioning of the health care system Poverty often adversely affects an individual's access to health care services. For example, limited transportation (lack of an automobile or funding for public transit) interferes with the ability to travel to health care facilities 23  FACTORS INFLUENCING THE DELIVERY OF HEALTH CARE 3- Quality It is estimated that 30% to 40% of diagnostic and medical procedures performed in many country are unnecessary For example, hospitals that are reducing the numbers of registered nurses (“downsizing”) risk endangering quality. 24 ISSUES IN HEALTH CARE DELIVERY 1- Nursing Shortage 25 01.01.2020 – Health Minister data 26 ISSUES IN HEALTH CARE DELIVERY 1- Nursing Shortage There are almost 200.000 nurses in Turkey Nurses generaly work in medical-surgical service/ hospitals, they are involved in delivering health care at all levels, including primary and preventive care It is expected that this shortage will worsen with increased need for health care services by the aging population 27  ISSUES IN HEALTH CARE DELIVERY 2- Competency Health care professionals must have competency in the twenty-first century The IOM (Institute of Medicine) identified five essential competencies; 1- Work in Interdisciplinary Teams II- Provide Patient-Centered Care III- Use Evidence-Based Practice IV- Use Informatics V- Apply Quality Improvement 28 Would you like to be a nurse like this? 29  ISSUES IN HEALTH CARE DELIVERY 3- Evidence-Based Practice Evidence-based practice is a problem- solving approach to clinical practice that involves the conscientious use of current best evidence, along with clinical expertise and patient preferences and values in making decisions about patient care 30  ISSUES IN HEALTH CARE DELIVERY 3- Evidence-Based Practice As professionals, nurses are challenged to stay familiar with new information to provide the highest quality of patient care. Nursing practice is dynamic and always changing because of new information coming from research studies, practice trends, technological development, and social issues affecting patients. 31  ISSUES IN HEALTH CARE DELIVERY 4- Quality and Safety in Health Care Nursing plays an important role in quality and safety in health care Some measures for patient safety; hand hygiene, teamwork, training, influenza prevention, catheter associated urinary tract infection prevention, fall prevention, and medication reconciliation 32  ISSUES IN HEALTH CARE DELIVERY 5- Magnet Recognition Program The American Nurses Credentialing Center (ANCC) established the Magnet Recognition Program to recognize health care organizations that achieve excellence in nursing practice Health care organizations that apply for Magnet status must demonstrate quality patient care, nursing excellence, and innovations in professional practice 33  ISSUES IN HEALTH CARE DELIVERY 6- Nursing Informatics and Technological Advancements Nursing informatics “uses information and technology to communicate, manage knowledge, mitigate error, and support decision-making” Examples; Artifical intelligance (AI) in nursing «Technology does not replace a nurse’s critical eye and clinical judgment» 34  ISSUES IN HEALTH CARE DELIVERY 7- Globalization of Health Care Advances in communication, primarily through the Internet, allow nurses, patients, and other health care providers to talk with others worldwide about health care issues. Although globalization of trade, travel, and culture improves the availability of health care services, the spread of communicable diseases such as Covid-19, tuberculosis and severe acute respiratory syndrome has become more common. 35 COMMUNITY-BASED NURSING PRACTICE 36  INTRODUCTION Community-based health care is a collaborative, evidence-based model designed to meet the health care needs of a community Community-based care focuses on health promotion, disease prevention, and restorative care. 37  INTRODUCTION A healthy community includes elements that maintain a high quality of life and productivity. Nurses are in a strategic position to play an important role in health care delivery and improve the health of the community 38  INTRODUCTION Community health nursing and community-based nursing are components of a health care delivery system that improve the health of the general public. Within community health settings, nurses are leaders in assessing, diagnosing, planning, implementing, and evaluating the types of public and community health services needed. Community-based health care occurs outside traditional health care institutions such as hospitals. It provides services to individuals and families within the community for acute and chronic conditions 39 COMMUNITY HEALTH NURSING Community health nurses goal is to preserve, protect, promote, or maintain health The emphasis of nursing care is to improve the quality of health and life within that community Community health nurse provides direct care services to subpopulations within a community 40  COMMUNITY-BASED NURSING Vulnerable Populations Vulnerable populations are groups of patients who are more likely to develop health problems as a result of excess health risks, who are limited in access to health care services, or who depend on others for care. Examples of vulnerable populations; living in poverty, older adults, people who are homeless, immigrant populations, individuals in abusive relationships, substance abusers, people with severe mental illnesses eg. 41  COMMUNITY-BASED NURSING Vulnerable Populations- Immigrant populations Immigrant populations often have higher rates of hypertension, diabetes mellitus, and infectious diseases; decreased outcomes of care; and shorter life expectancies Frequently the immigrant population practices nontraditional healing practices 42  COMMUNITY-BASED NURSING Vulnerable Populations-Effects of Poverty and Homelessness People who live in poverty are more likely to live in hazardous environments, work at high-risk jobs, eat less nutritious diets, have multiple stressors in their lives, and be at risk for homelessness Homeless patients are often jobless and do not have the advantage of shelter and must continually cope with finding a place to sleep at night and finding food Chronic health problems tend to worsen because of poor nutrition and the inability to store nutritional foods 43  COMMUNITY-BASED NURSING Vulnerable Populations- Patients Who Are Abused Physical, emotional, and sexual abuse and neglect are major public health problems affecting older adults, women, and children. Risk factors for abusive relationships include mental health problems, substance abuse, socioeconomic stressors, and dysfunctional family relationships 44 COMMUNITY-BASED NURSING Vulnerable Populations- Patients Who Abuse Substances Substance abuse is a term that describes more than the use of illegal drugs, alcohol and prescribed medications (such as antianxiety agents and opioid analgesics) A patient with substance abuse often has health and socioeconomic problems 45  COMMUNITY-BASED NURSING Vulnerable Populations-Patients with Mental Illnesses. Many patients with severe mental illnesses are homeless or live in poverty When a patient has a severe mental illness such as schizophrenia or bipolar disorder, multiple health and socioeconomic problems need to be explored. Patients with mental illnesses are no longer routinely hospitalized in long-term psychiatric institutions, instead resources are offered within the community. 46  COMMUNITY-BASED NURSING Vulnerable Populations- Older Adults With the increasing older-adult population, simultaneous increases in the number of patients suffering from chronic diseases and they need health care services Thorough assessment and appropriate community-based interventions provide an opportunity to improve the lifestyle and quality of life of older adults 47 COMPETENCY IN COMMUNITY-BASED NURSING 1- Caregiver First and foremost is the role of caregiver Nurses apply the nursing process in a critical thinking approach to ensure appropriate, individualized nursing care for specific patients and their families 48  COMPETENCY IN COMMUNITY-BASED NURSING 2- Case Manager It is the ability to establish an appropriate plan of care based on assessment of patients and families and to coordinate needed resources and services for the patient’s well-being across a continuum of care. An effective case manager eventually learns the obstacles, limits, and even the opportunities that exist within the community that influence the ability to find solutions for patients’ health care needs 49  COMPETENCY IN COMMUNITY-BASED NURSING 3- Change Agent A community-based nurse is also a change agent Nurses identify any number of problems (e.g., quality of community child care services, availability of older-adult day care services, or the status of neighborhood violence) As a change agent nurses empower individuals and their families to creatively solve problems or become instrumental in creating change within a health care agency (For example, if your patient has difficulty keeping regular health care visits, you determine why) 50 COMPETENCY IN COMMUNITY-BASED NURSING 4- Patient Advocate Patient advocacy is more important today in community-based practice because of the confusion surrounding access to health care services Patients often need someone help for; - walk through the system - identify where to go for services - how to reach individuals with the appropriate authority - what services to request - how to follow through with the information they receive 51  COMPETENCY IN COMMUNITY-BASED NURSING 5- Collaborator In a community-based nursing practice you need to be competent in working with other related health are disciplines For example, when your patient is discharged home with terminal cancer, you collaborate with hospice staff and social workers to initiate a plan to support end-of-life care for the patient and support the family. 52  COMPETENCY IN COMMUNITY-BASED NURSING 6- Counselor A counselor helps patients identify and clarify health problems and choose appropriate courses of action to solve those problems As a counselor you are responsible for providing information, listening objectively, and being supportive, caring, and trustworthy «You do not make decisions but rather help your patients reach decisions that are best for them» 53  COMPETENCY IN COMMUNITY-BASED NURSING 6- Counselor Patients and families often require assistance in first identifying and clarifying health problem For example, a patient who repeatedly reports a problem in following a prescribed diet is actually unable to afford nutritious foods or has family members who do not support good eating habits 54 COMPETENCY IN COMMUNITY-BASED NURSING 7- Epidemiologist You focus on identifying the patterns, causes, and effects of health conditions within populations, especially in healthcare settings like hospitals or community health environments. Infection Control, Health Education, Outbreak Investigation, Policy Development are include COVID-19 Pandemic, vaccination, increased fetal and infant mortality rates, increases in adolescent pregnancy, presence of infectious and communicable diseases and outbreaks of head lice 55 COMMUNITY ASSESSMENT Community assessment is the systematic data collection on the population, monitoring the health status of the population and making information available about the health of the community The community has three components: structure or locale, the people, and the social systems 56