Chapter 1.pdf

Chapter 1 Primary care in the Twenty-first Century: A Circle of Caring  Affordable Care Act and payment Where We’ve reforms Been and Where We Are Evolving from fee-for-service payment system to payment for Going quality, cost, and sa...

Chapter 1 Primary care in the Twenty-first Century: A Circle of Caring  Affordable Care Act and payment Where We’ve reforms Been and Where We Are Evolving from fee-for-service payment system to payment for Going quality, cost, and satisfaction with care Idealistic goals of Healthy People 2020 Disciplinary and professional “turf battles”  Increasing health inequities Where We’ve Falling life expectancy Been and Rising burden of chronic Where We Are illness Going Need for identification of social determinants of health (continued) Need for A P R N care providers  The tip—the easily visible peak above the water—treating the symptom or underlying “disease” for a “fee” paid by reimbursement The Tip of the American health care has been driven by this Iceberg payment model Hidden “under-structure” is often invisible in health care  Hidden “under-structure” The Tip of the Iceberg composed of social (continued) determinants of health built of various lifestyle and health equity issues As nurses, you have been educated to see the whole of the iceberg Medical Model and Medical model Nursing Model: A Comparison Nursing model  Health promotion Nursing-Based Disease prevention Approach to Primary Care Chronic disease management All of these utilizing a view of the wholeness of persons, an understanding of human responses, and a repertoire of therapeutic options built on a contextual understanding Advanced Nursing Practice    Historical Perspectives of Advanced Practice Nursing    Historical Perspectives of Advanced Practice Nursing (continued_1)    Historical Perspectives of Advanced Practice Nursing (continued_2)    Historical Perspectives of Advanced Practice Nursing (continued_3)   Cody states that “only when nurses everywhere are guided by a theory base specific to nursing will nursing have achieved a parity with other Claiming Our scholarly disciplines” Future Barbara Bates and Joan Lynaugh on nursing’s invisibility  As nursing theory embraces the mode of midrange Claiming Our Future theory development and testing, with real-life clinical applications for practice, (continued) the applicability to A P R N practice will be more visible The utilization of theory-based practice should increase D N P programs include extensive clinical practice and have a strong focus on scholarly and evidence-based practice  In 1990, Benner’s work in Advanced Practice “From Novice to Expert” was utilized by the National Organization of Nurse Nursing: Models of Practitioner Faculties (N O N P F) to create five domains for a framework for primary- Practice care N P curricula 2006 1990 Revised in 2006, N O N P F identified 7 domains and 75 core competencies that N P’s must be able to demonstrate on graduation  Management of patient The N P-patient N O N P F’s health/illness relationship status Seven Practice Domains The teaching/coaching Professional role function Managing and Monitoring and negotiating health- ensuring the care delivery quality of health- systems care practice Culturally sensitive care  Independent practice N O N P F’s Scientific Ethics Competency Areas foundation for N P/D N P Graduates Health delivery Leadership system Policy Quality Technology and information Practice inquiry literacy  The core of every person, both patient and nurse, is the spirit, defined as an animating or vital principle held to Swanson’s (1995) give life to physical organisms “A Spirit-Focused Conceptual Model of Nursing for the Advanced Nursing is a goal-directed Practice Nurse” interpersonal relationship between the patient and nurse, based on traditional nursing process components such as assessing, planning, intervening, and evaluating  Swanson’s (1995) “A Spirit-Focused Conceptual Model of Nursing for the Advanced Practice Nurse” (continued)   Rooted in a holistic patient database that includes physical, psychological, social, cultural, The Shuler’s environmental, and spiritual dimensions (1993) Nurse Practitioner The patient’s physical and psychological ability to Practice Model participate in wellness activities is assessed; creative, uninhibited problem-solving and identification of appropriate wellness activities are pursued  Symptom Management (1994)   Snyder and Mirr (1995)   Snyder and Mirr (1995) (continued)  Ryan’s (2009) Integrated Theory of Health Behavior Change (I T H B C)     Cumbie, Conley, and Burman’s (2004) Model of Promoting Process Engagement   Nurse Coaching    Changing Models of Medical Practice and Research    Changing Models of Medical Practice and Research (continued)     A broadened and contextualized database A Transformative A labeling of the patient’s concern that Template: The incorporates the patient’s responses to the meaning of illness in his or her day-to-day life Circle of A holistic approach to an individualized, Caring therapeutic plan that includes nursing interventions based on evidence, including complementary therapies, incorporated with standardized surgical, pharmacologic, and nonpharmacologic interventions  A Transformative Template: The Circle of Caring (continued_1)    A Transformative Template: The Circle of Caring (continued_2)     Need to incorporate patients’ perceptions as measured Population- objectively and subjectively Based Approaches Importance of social determinants of health P C M H as a main driver in providing a more responsive and effective, and less expensive health-care delivery system Need for leaders to guide teams of health-care providers and support staff who work with specific patient populations  Caring is the central concept in nursing and is uniquely known and expressed in nursing The Circle of Nursing takes place within nursing situations Caring Nursing is a discipline of knowledge and a professional service that has as its goal nurturing persons living, caring, and growing in caring  Caring attributes: knowing, patience, authentic presence, commitment, courage, and advocacy The Circle of Characterize the nurse-patient relationship Caring (continued) Disparate partners in health care Productive tension between health- care professions benefits the care of all patients  The Circle of Caring Model Provides a way to Incorporates the Needed for patients, document and strengths of nursing, families, social describe the practice public health, and groups, and of primary-care medicine for a new communities provider model of care