Healthcare Ethics Exam 2 Slides PDF

Healthcare CHAPTER 12 Ethics Copyright © 2022 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com.  Introduction (1 of 2) ▪Legal standards are the minimal standard of action established for individuals in a society....

Healthcare CHAPTER 12 Ethics Copyright © 2022 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com.  Introduction (1 of 2) ▪Legal standards are the minimal standard of action established for individuals in a society. Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪Ethical standards are considered one level above a legal action because individuals make a choice based on what is the “right thing to do,” not what is required by law. ▪Actions may be considered legal but not ethical. ▪There are many definitions of ethics but, basically, ethics is concerned with what are right and wrong choices as perceived by society and its individuals. Medical Ethics and Bioethics ▪Medical ethics focuses on the decisions Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com healthcare providers make on the patient’s medical treatment. ▪Euthanasia and physician-assisted death would be examples of medical ethics. ▪Bioethics focuses on the field of study concerned with the ethical implications of certain biologic and medical procedures and technologies. ▪Organ transplants and genetic engineering are examples of bioethics. Workplace Bullying (3 of 9) ▪2021 Workplace Bullying Awareness survey results: Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪49 million Americans are bullied at work. ▪Remote workers are bullied at a higher rate than nonremote workers. ▪Same-gender bullying accounts for 61% of all bullying. ▪90% of Americans support new legislation against bullying. ▪50% of bullying occurs in meetings and 9% occurs in emails.  Workplace Bullying (5 of 9) ▪Verbal bullying, which consists of threats, name calling, and insults Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪Social bullying, which consists of exclusionary behavior, such as exclusion from meetings and accusing the victim not being part of the team ▪Cyberbullying, which uses electronic methods to inflict emotional stress on the target ▪Retaliation, in which the bully blames the victim because the bully did not get a job ▪Employees have also reported less aggressive behavior, such as demeaning comments about the victim’s work. Workplace Bullying (6 of 9) ▪Institutional bullying occurs when the Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com workplace accepts this type of behavior and may even encourage bullying. This type of bullying is the worst type because it is implicit in the environment. ▪Employees have also reported less aggressive behavior, such as demeaning comments about the victim’s work. Workplace Bullying (7 of 9) ▪Lateral violence also occurs in health Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com care, which is defined as “nurse to nurse” aggression, demonstrated by both verbal and nonverbal behavior. ▪No federal legislation in the United States forbids workplace bullying. New York is the only state that has enacted legislation that forbids this type of behavior in the workplace.  Workplace Bullying (9 of 9) ▪Two federal laws can be applied in workplace bullying: the Occupational Safety and Health Act Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com of 1970 (OSH Act) and Title VII of the Civil Rights Act of 1964. ▪The OSH Act of 1970 states that employers must provide a safe and healthful working environment for their employees. ▪Under Title VII of the Civil Rights Act, if a protected class employee (gender, religion, ethnicity, etc.) is bullied by another employee, the action can be illegal based on the concept of a hostile work environment. Recommendations to Eliminate Workplace Bullying 1. Adopt a policy of zero tolerance for workplace Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com bullying and develop measures to discipline bullies in the workplace. 2. Create an organizational culture that focuses on a positive work environment, enabling all individuals to pursue their careers. 3. Reward behaviors that encourage teamwork and collaboration among employees and their supervisors. 4. Develop an educational program for all employees.  Ethics and the Doctor–Patient Relationship ▪Four models apply to the doctor–patient relationship: Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪Engineering model: The provider empowers the patient with knowledge to make a decision. ▪Priestly model: Assumes the doctor will make the best decisions for the patient’s health ▪Contractual model: Based on a legal foundation, assumes there is an agreement between the two parties, assuming mutual goals ▪Collegial model: Assumes trust between the patient and doctor and that decision-making is an equal effort  Suggested Ethical Values of the Doctor–Patient Relationship ▪Autonomy: Decision making may be different and healthcare providers must respect their Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com patients’ decisions even if they differ. ▪Beneficence: Patient’s best interests when making a decision are primary. ▪Nonmalfeasance: The healthcare provider will cause no harm when taking action. ▪Justice: Healthcare providers will make fair decisions. ▪Dignity: Patients should be treated with respect and dignity. Decision-Making Model for Healthcare Dilemmas 1. Identification of the dilemma Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com 2. Identification of the conflicting ethics of each party 3. Identification of alternatives to a solution 4. Identification of the impact of each alternative 5. Selection of the solution Ethics and Public Health ▪Issues in public health include: ▪Inaccessibility to health care for certain Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com populations ▪Responding to bioterrorism ▪Research in developing countries ▪Health promotion and its infringement on individual’s lifestyle choices ▪Public health’s response to emergencies Paternalism ▪The concept of paternalism and public health is the concern that individual Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com freedom will be restricted for the sake of public health activities because the government infringes on individual choices for the sake of protecting the community. Stewardship Model ▪This model addresses the issues of paternalism in public health. Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪The stewardship model states that public health officials should achieve the stated health outcomes for the population while minimizing restrictions on people’s freedom of choice. ▪While promoting a healthy lifestyle, it is also important that public health programs should not force people into programs without their consent or introduce interventions that may invade people’s privacy. Justifying Public Health Interventions (1 of 2) ▪Effectiveness is essential to demonstrating that the public health efforts Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com were successful and, therefore, it was necessary to limit individual freedom of choice. ▪The need for a public health intervention must be demonstrated to limit individual freedom. ▪If the proportionality of the public health intervention outweighs freedom of choice, then the intervention must be warranted. Justifying Public Health Interventions (2 of 2) ▪If the public health intervention satisfies effectiveness, need, and proportionality, the Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com least restrictive intervention or minimal infringement on individual freedoms should be considered first. ▪Public health must provide public education to explain their interventions and why the infringement on individual choices is warranted. Duty to Treat ▪If there is a natural disaster, what is the “duty to treat” during a time of crisis? Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪During Hurricane Katrina, several healthcare professionals volunteered to stay behind in the local hospital. Unfortunately, several patients in the hospital died and the providers were accused of negligence. ▪As a result of this incident, many professionals are now wary of volunteering during a crisis. From their perspective, they commit to an ethical reaction and they may be rewarded with a criminal liability. Ethical Discussion (1 of 2) Healthcare providers who support euthanasia Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com believe that: ▪It is an opportunity to relieve the pain a patient is experiencing at the end of their life. ▪It is an example of autonomy in life by allowing a person to choose when they are dying. ▪It allows an opportunity to be released from a life that no longer has quality. Ethical Discussion (2 of 2) Healthcare providers who believe that Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com euthanasia is unethical feel that: ▪It devalues the concept of life. ▪It may merely be an opportunity to contain medical costs for both the families and health insurance companies. ▪Most importantly, a provider should not be directly involved in killing a patient. Bioethical Issues (1 of 23) ▪Alternative reproductive methods are Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com methods of conception that parents use to have children, such as in vitro fertilization, which means that the embryo is fertilized in a clinic using the sperm from the father. ▪Preimplantation genetic diagnosis (PGD) can be used to test the embryo for tissue compatibility with their siblings prior to being transplanted into the mother. Bioethical Issues (3 of 23) ▪All human beings possess stem cells, Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com which are “starter” cells for the development of body tissue that have yet to be formed into specialized tissues for certain parts of the body. ▪The term cloning applies to any procedure that creates a genetic replica of a cell or organism. Bioethical Issues (4 of 23) ▪Two major types of cloning: reproductive Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com cloning, which creates cloned babies, and therapeutic or research cloning, which uses the same process but the focus is replicating sources for stem cells to replace damaged tissues ▪There are several ethical issues regarding cloning. Researchers worldwide have attempted human cloning with no success. Some feel that cloning humans is unnatural and “playing God” rather than allowing procreation to progress naturally.  Bioethical Issues (5 of 23) ▪Genetic testing is carried out on populations based on age, sex, or other risk factors to Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com determine if they are at risk for a serious genetic disease or if they have a carrier gene that they may pass on to their children. ▪If employers were aware of this information, would they use it to discriminate against employees? ▪Would parents decide against having a child because of a result of a genetic test? How accurate are the genetic tests? There are no regulations regarding genetic tests, so individuals and families may make decisions based on faulty laboratory tests.  Bioethical Issues (6 of 23) ▪End-of-life issues of a patient can be an ethical challenge. Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪Healthcare providers may find this difficult to understand because they have been trained to save lives. ▪The term euthanasia is the term most often associated with end-of-life issues. There are two major types of euthanasia: voluntary and nonvoluntary. ▪Voluntary euthanasia is assisting a patient with ending their life at the patient’s request. Bioethical Issues (7 of 23) ▪Nonvoluntary euthanasia means ending the Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com life of an incompetent patient, usually at the request of a family member. ▪Confusion over difference between euthanasia and physician-assisted suicide, now referred as physician assisted death ▪Physician-assisted death (PAD) refers to the physician providing the means for death, most often with a prescription. ▪The patient, not the physician, will ultimately administer the lethal medication.  Bioethical Issues (10 of 23) ▪A survey of terminal patients showed they requested the prescriptions because they felt they were Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com becoming a burden on their families, they were losing their independence, and they were losing the ability to enjoy life. ▪In Washington and Oregon, the patient needs to be deemed terminal by two physicians. ▪If physicians have doubts about a patient’s mental state, a mental health professional will be consulted. ▪The patient must make an oral request and a witnessed written request and another request 15 days later. The physicians must inform the patient about hospice and palliative care options. Bioethical Issues (11 of 23) ▪Advance directives are legal documents that patients give to providers to ensure that if they Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com are terminally ill and incompetent to make a decision, certain measures will not be taken to prolong the patient’s life. ▪The patient may also include a document of durable power of attorney for health care that designates an individual authorized to make health decisions for the patient. ▪Examples: Resuscitation if the patient stops breathing, being placed on breathing machines or feeding tubes, organ or tissue donation Bioethical Issues (12 of 23) ▪Transplantation is the general procedure of Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com implanting a functional organ from one person to another. ▪Two major ethical and legal issues associated with organ transplants between humans: 1. The decision-making process for who receives the organ 2. Financial remuneration from selling organs, which has resulted in a black market for buying organs Bioethical Issues (15 of 23) ▪Under the current United Network for Organ Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Sharing (UNOS), patients awaiting a transplant are assigned a priority based on medical need. ▪If a patient is waiting for a heart transplant, the patient who is on life support or is in intensive care has first priority. ▪Kidneys are allocated based on a point system maintained by UNOS. Liver transplants also include guidelines on alcohol abuse, which often destroys livers.  Bioethical Issues (18 of 23) ▪In other parts of the world, countries use Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com “presumed consent” which means that if a parent does not actively oppose the transplantation, the procedure automatically occurs. ▪In the United States, the consent must be actively received from the family first. ▪Is it an ethical policy to assume the family will consent to organ donations? Oftentimes, a family is frozen with grief and cannot make a coherent decision. Is this policy ethical to them? Bioethical Issues (19 of 23) ▪Organ transplants may occur between two family members because it has been determined that the Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com compatibility is very high, which would result in less risk for an organ to be rejected. ▪An ethical issue with this situation is the pressure a family member feels from other family members to agree to give one of their organs to another family member. ▪ Living donor organ transplantation is the only field in medicine in which two individuals are ultimately involved—the person donating the organ and the person receiving the organ. Bioethical Issues (22 of 23) ▪Procurement of body parts from poor people is Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com illegal in most countries in the world, and is certainly unethical, but nothing has been done because many of the organ recipients need these organs to live and those individuals that sell the organs are making an informed choice. Bioethical Issues (23 of 23) ▪Another type of transplantation is Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com xenotransplantation, which is the transfer of organs from one species to another. This has evolved as a result of the shortage of human organs available for donation. ▪Although xenotransplantation is promising, the ethical dilemma is that we are killing animals for these procedures, which are considered experimental. ▪Is there a difference between killing animals for food and killing them for organ transplants? Unequal Access to Health Care ▪Healthcare statistics indicate that 30% of Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com medical costs of blacks, Hispanics, and Asian Americans are tied to health inequities because of unequal access to health care. ▪Research indicates there is a systemic bias of discrimination in health care towards people of color. The bias can be intentional or unintentional due to ignorance. Racial Bias ▪The term racial bias indicates that there are Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com stereotypical attitudes and judgments towards people of color. ▪Racial bias in health care is exemplified by lack of multilingual staff in a healthcare facility, poor access to healthcare services, and unequal treatment of direct care. ▪Healthcare statistics show that black women giving birth have a disproportionate mortality rate than nonminority mothers because of the bias of their healthcare providers. Implicit Bias ▪Implicit bias occurs when healthcare Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com professionals make treatment decisions based on their own unconscious stereotypes about race. ▪This is a systemic problem that needs to be rectified through education and training. Training clinicians to become culturally competent should help clinicians and staff in recognizing their implicit bias. Algorithm Bias ▪Algorithm bias occurs when data that already Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com are analyzed are based on previous inequities. ▪For example, a study examining algorithmic biases examined one used by UnitedHealth to determine which patients would require more medical care. The result favored white patients over black patients, prioritizing white patients over black patients for care. CHAPTER 13 Mental Health Issues Copyright © 2022 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com. Categories of Mental Illness ▪Two broad categories of mental illness: Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪Any Mental Illness (AMI), which is a mental, behavioral, or emotional disorder ▪Serious Mental Illness (SMI), which is also a mental, behavioral, or emotional disorder but it impacts how patients function in daily life  U.S. Mental Illness ▪In 2020, there were 53 million people 18 years or older that have AMI. This number represents 21% of Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com adults. ▪The prevalence of AMI was more common in females (25.8%) than males (15.8%) and higher in multiracial adults (35.8%), followed by white adults (22%). Nearly 6% of adults were diagnosed with an SMI, higher among females (7%) than males (4%) and highest among multiracial adults. ▪ In 2022, there are nearly 43 million adults diagnosed with anxiety disorders. The global pandemic had a major impact on mental health wellness worldwide. Mental Health Care ▪Mental Health Parity Act of 1996 and its Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com 2008 amendment were attempts to establish a fair system of treatment between mental health disorders and traditional healthcare conditions by mandating annual and lifetime limits to be equal. ▪Mental health is treated with both traditional and alternative medicine. History of U.S. Mental Health Care (5 of 5) ▪Over the past three centuries, the mental Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com health system has consisted of a patchwork of services that has become very fragmented. ▪Mental health problems impact not only the individual, but family members and friends as well. ▪As a result of the vast impact of mental health disabilities, behavioral services are provided by psychiatrists, psychologists, social workers, nurses, counselors, and therapists.  Mental Health Disorders ▪The 1999 Surgeon General’s report on mental health defines mental disorders as conditions Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com that alter thinking processes, moods, or behavior and result in dysfunction or stress. The condition can be psychological or biological in nature. ▪The most common conditions include phobias, which are excessive fear of objects or activities; substance abuse; and affective disorders, which are emotional states such as depression.  Mental Health Legislation ▪Mental Health Parity Act was passed in 1996 to Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ensure adequate coverage for mental health illnesses and mandate that annual lifetime reimbursement limits on mental health services were similar to other medical benefits. ▪Mental Health Parity and Addiction Equity Act of 2008 further supported mental health care by requiring insurance plans to offer mental health benefits and cost sharing similar to those of traditional medical benefits. Who Provides Mental Health Services? (1 of 2) ▪De facto mental health system (Figure 13-1). ▪Families often provide support to their mentally Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ill family members. ▪Primary care providers often detect mental health issues and refer patients to specialists. ▪Psychiatrists are specialty physicians who can prescribe medication and admit patients to hospitals. ▪Psychologists, who also participate in the treatment of mental health, cannot prescribe drugs but provide different types of therapy. Who Provides Mental Health Services? (2 of 2) ▪Social workers focus on mental health Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com counseling. ▪Nurses may specialize in psychiatric care. ▪Additional counselors/therapists participate in treatment of the mentally disabled. ▪National Alliance on Mental Illness (NAMI) and Mental Health America are nonprofit organizations that provide education and support for the mentally ill.  Mental Health Commitment Laws (1 of 2) ▪Voluntary commitment occurs when people commit Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com themselves willingly to receive care. ▪If a person voluntarily commits for treatment, that person can leave of their own free will. ▪Involuntary commitment occurs when people are being forced to receive treatment or are committed to a facility against their wishes. Private and Public Funding ▪Medicare and Medicaid are large sources Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com of mental health funding, particularly for those individuals with serious mental disabilities who often cannot work. ▪Medicaid is the single largest payer for state-financed mental health care. PCP Behavioral Care Training ▪Because many PCPs report they are not able Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com to access behavioral health treatment for their patients, and 30% to 50% of referrals do not go to their first appointment, co-locating behavioral health services with PCP locations is also being explored.  DSM ▪The Diagnostic and Statistical Manual of Mental Disorders (DSM) is a guide published by the Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com American Psychiatric Association that explains the signs and symptoms that mark more than 300 types of mental health conditions. ▪Traditionally, mental health providers use the DSM to diagnose everything from anorexia to voyeurism and, if necessary, determine appropriate treatment. ▪ Health insurance companies also use the DSM to determine coverage and benefits and to reimburse mental health providers.  Advice for Caregivers ▪Support groups: Caregivers may feel guilty if they resent their role as a caregiver. Do not judge your Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com thoughts as bad, which will increase your stress; instead, recognize that other people may have the same feelings. ▪Do not ignore personal relationships: Caregivers may unintentionally lose contact with friends. Set up times, even if only once per month, to see friends for a short period of time. ▪It is very difficult to take care of someone else if the caregiver does not take care of themselves first.  Special Populations: Children and Teens (1 of 3) ▪Children and teens ▪According to the NIMH, just over 20% (or 1 in 5) of Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com children, either currently or at some point during their life, suffer from depression. Suicide is a major concern among children and adolescents. In 2021 alone, nearly 5,000 youths in the United States younger than 25 years died by suicide. ▪It is particularly difficult to assess teen mental disorders because of their stage in life. ▪It is important that there is open communication with both children and teens either with their parents, counselors, or friends to ensure that, if there is a mental disorder, it will be addressed.  Special Populations: Children and Teens (2 of 3) ▪According to the American Psychological Association (APA), it is important that parents recognize problems in Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com their children, so that they can be treated appropriately. Home and school changes can create stress and anxiety in young children and adolescents. ▪The pandemic pushed stress to high levels in children and adolescents. ▪Between 2016 and 2020, anxiety and depression diagnoses increased by 29 and 27%, respectively. Signs of stress can manifest in different behaviors such as anger issues, poor sleeping patterns, eating changes, a drop in school performance, or having physical ailments. Special Populations: Veterans (1 of 3) ▪In 1989, the National Center for Posttraumatic Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Stress Disorder was created within the VA to address the needs of military-related PTSD. ▪The suicide rate for male veterans 18–29 years of age rose 26% from 2005 to 2007, with record rates in 2009. ▪Mental health issues are the leading cause of hospitalizations for active-duty military. Special Populations: Veterans (2 of 3) ▪Military personnel can experience several Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com types of mental health conditions, including PTSD, traumatic brain injury, and major depressive disorders (MDDs). ▪Compared to the civilian population, MDDs are 5 times more prevalent in the military, and PTSD is 15 times more prevalent. ▪The National Council for Mental Wellbeing (NCMW) statistics indicate that reserve and active military in Iraq and Afghanistan require treatment.  Special Populations: Veterans (3 of 3) ▪Approximately 30% of military in combat situations struggled with MDDs and PTSD. As many as 50% Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com of veterans do not receive mental health care despite the fact there are 755 VA-operated outpatient clinics, 380 sites and mobile units, and 170 medical centers in the United States. ▪Between 2016 and 2019, the number of veterans receiving mental health treatment increased by 90% ▪The VA indicates that veterans are 1.5 times more likely to commit suicide. Telehealth visits increased by 200% during the first 8 months of the pandemic.  Special Populations: Elderly (1 of 6) ▪As we age, we will experience loss of family Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com members and friends, which is a major trigger of depression and possibly suicide. ▪Many elderly are not treated for mental illness for several reasons. ▪The elderly are focused on seeing their primary care provider for their main ailments, so both the patient and the provider may ignore the symptoms.  Special Populations: Elderly (2 of 6) ▪Primary care providers may not be comfortable addressing mental health issues. Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪If the elderly patient is referred to a psychologist, a recent APA survey indicated that fewer than 30% of psychologists have had graduate coursework in geropsychology, which deals with mental health issues in the elderly. ▪APA has provided guidelines, Guideline 20, for psychologists for older adults.  Special Populations: Elderly (3 of 6) ▪Depression may strike more than 10% of the elderly population. It can imitate dementia because its Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com victims withdraw, cannot focus, and appear confused. ▪Only 15% of the elderly population suffers from dementia.  Special Populations: Elderly (4 of 6) ▪Of that percentage, over 60% suffer from Alzheimer’s disease, for which there is no cure as Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com of this writing. ▪Approximately 40% of dementias are caused by conditions such as high blood pressure or a stroke or other diseases, such as Parkinson’s disease and Huntington’s disease, which are disorders that, in their advanced stages, can cause dementia.  Special Populations: Elderly (5 of 6) ▪Pseudo dementias (also known as false dementias) may develop as a result of medications, drug Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com interactions, poor diet, or heart and gland diseases. ▪These dementias may occur accidentally because of these conditions. Many elderly patients have multiple prescriptions, so it is important to note any potential interactions that could result in dementia. ▪Seniors 65 years and older are the fastest growing segment of the U.S. population because our life expectancy has increased over the decades, although there was a recent life expectancy decline due to the pandemic.  Mental Health and Culture (1 of 2) ▪Mental health disorders occur across race and culture; however, according to the NIMH, diverse Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com communities are often underserved. ▪The following is mental health information related to the lesbian, gay, bisexual, transgender, questioning, and intersex (LGBTQI) community; African Americans; Latinos; Asian Americans; and American Indians and Alaskan Natives.  Mental Health and Culture (2 of 2) ▪Too often culture may negatively impact what we learn about mental health. Messages of “stay Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com tough” cause people to ignore their mental health issues. ▪In general, people of color have been marginalized in the United States because they experience racism, which often leads to mental health issues.  Special Populations: LGBTQI (1 of 5) ▪The LGBTQI populations are at higher risk of depression or an anxiety disorder. LGB individuals Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com are twice as likely as heterosexuals to experience a mental health condition. ▪The fear of coming out or being discriminated against for sexual orientation can lead to mental health disorders.  Special Populations: LGBTQI (2 of 5) ▪ Thoughts of suicide and substance abuse can be issues with this community. Some LGBTQI Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com individuals also hide their orientation from the mental health system because of fear of being ridiculed. ▪ The term minority stress stems from the social stigma, prejudice, denial of civil rights, victimization, and family rejection that can occur. With any population that experiences mental health distress, it is important that people feel comfortable reaching out for assistance.  Special Populations: LGBTQI (3 of 5) ▪For LGBTQI people ranging in age between 10 and 24 years, suicide is one of the leading causes Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com of death. ▪An estimated 20% to 30% of LGBTQI individuals report substance abuse problems, compared to 9% of the general population. ▪LGBTQI youth of color have a greater risk of suicide, especially if they have experienced discrimination. ▪ A 2021 survey of 35,000 respondents between the ages of 13 and 14 in the United States included data on suicide risk. The data reveal disparities in suicide risk for LGBTQI youth of color.  Special Populations: African Americans (1 of 3) ▪Over 13% of the U.S. population identify themselves as black or African American. This Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com percentage represents 7 million individuals. ▪Over 16% reported having a mental illness episode in the past year. ▪Some African Americans are hesitant to access mental health care due to prior misdiagnoses, inadequate treatment, and cultural misunderstandings.  Special Populations: African Americans (3 of 3) ▪There are 5 million Black individuals who suffer from a mental health issues; however, only 1 out of 3 Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com seek treatment. ▪Unfortunately, there is a higher percentage of African Americans in the foster home system, homeless population, and prison. Those environments have a higher level of mental health disorders than other environments.  Special Populations: Latinos (2 of 2) ▪Like the African American population, Latinos may seek treatment from the clergy rather than Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com specialists. ▪There is a small percentage of Latinos who are mental health professionals, so the comfort level is lower between the patient and provider. ▪This is also tied to language barriers.  Special Populations: Asian Americans (1 of 2) ▪Asian Americans have the highest life expectancy of any ethnic group in the United States. Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪Mental health disorders are lower among Asians than Whites. They are much less likely to report mental health disorders to friends or medical professionals because they feel it is shameful and consider it a personal weakness. ▪They will seek help for mental health disorders from alternative medicine providers. ▪Possible barriers with language  Special Populations: American Indians/Alaskan Natives ▪Over 28% of American Indian or Alaskan Native adults live with a mental health condition. They report high Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com rates of depression, suicide, and substance use. They report PTSD at rates more than twice the population reports. Statistics indicates that American Indian and Alaskan Native youths use alcohol by 14 years old. They use marijuana and prescription medications at twice the rate of the national average. ▪IHS uses telebehavioral health, a method of service delivery that broadens availability and quality of care across all behavioral health program areas.  Special Populations: Women (1 of 3) ▪Depression affects nearly twice as many women than men. Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪Women they tend to experience it earlier, longer, and more severely. ▪Women who are depressed experience episodes nearly twice as often as men who are depressed. ▪Women may also feel depressed as a result of infertility, miscarriage, and menopause. ▪Married women suffer depression more than married men. The more children a woman has, the more likely she may suffer from depression.  Special Populations: Women (2 of 3) ▪Women who have been victims of sexual abuse or Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com domestic violence may also suffer from depression. ▪Women in nursing homes do not often receive mental health care. Throughout their lives, women have been traditional caregivers. ▪Women may provide up to 13 hours of care a day for more than 20 years for both physical and emotional illnesses.  Special Populations: Women (3 of 3) ▪Research indicates that healthcare providers do Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com not provide appropriate mental health care to a large majority of older women. ▪Depression in women is misdiagnosed between 30% and 50% of the time.  B4Stage4 (1 of 2) Mental Health America has developed a proactive philosophy, B4Stage4, to treat mental Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com health like other diseases such as cancer and diabetes: Stage 1: Mild Symptoms and Warning Signs Stage 2: Symptoms Increase in Frequency and Severity and Interfere with Life Activities and Roles Stage 3: Symptoms Worsen with Relapsing and Recurring Episodes Accompanied by Serious Disruption in Life Activities and Roles Stage 4: Symptoms Are Persistent and Severe and Have Jeopardized One’s Life  B4Stage4 (2 of 2) With cancer and other chronic diseases, medical community recognizes early symptoms and Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com hopes to treat them before they progress to stage 4, which is typically the end state of a disease. Mental Health America is proposing to apply the same philosophy to recognize early signs of mental illness and treat them before it progresses to a more serious mental health illness. Focus is on early identification and intervention. ADA and Mental Health ▪The ADA defines mental impairment as: Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪Mental or psychological disorder ▪Organic brain syndrome ▪Emotional or mental illness ▪Specific learning disabilities ▪ADA accommodates individuals with these issues.  Alternative Approaches to Mental Health (1 of 4) ▪Emphasize the relationship between the body, Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com mind, and spirituality. ▪Self-help organizations: Many mentally ill individuals seek comfort in self-help organizations. ▪Nutrition: Some research has demonstrated that certain types of diets may assist with certain mental disorders. ▪Pastoral counseling: Mental health counselors have recognized that incorporating spiritual guidance may help alleviate some symptoms of mental illness.  Alternative Approaches to Mental Health (2 of 4) ▪Animal-assisted therapies: Animals are often used Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com to increase socialization skills and encourage communication among the mentally ill. ▪Art therapy: Activities such as drawing, painting, and sculpting may help people express their emotions and may help treat disorders such as depression. ▪Dance therapy: Moving a body to music may help with those individuals recovering from physical abuse.  Alternative Approaches to Mental Health (3 of 4) ▪Music therapy: Research supports that music elevates a person’s emotional moods. It has been Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com used to treat depression, stress, and grief. ▪Acupuncture: Chinese practice of insertion of needles in specific points of the body to balance the system has been used to treat stress, anxiety, and depression. ▪Ayurveda medicine: Incorporates diet, meditation, herbal medicine, and nutrition to treat depression and to release stress ▪Yoga: Indian system that uses breathing techniques, stretching, and meditation to balance the body. CHAPTER 7 Long-Term Care Services Copyright © 2022 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com. Introduction (2 of 3) ▪Most long-term care is not medical care but Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com rather assistance with the basic personal tasks of everyday life. ▪These tasks are sometimes called activities of daily living (ADLs); they include bathing, dressing, eating, and going to the bathroom. Introduction (3 of 3) ▪Long-term care services also provide Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com assistance for instrumental activities of daily living (IADLs). ▪IADLs include housework, money management, taking medications, grocery or clothes shopping, pet care, and using the telephone. Long-Term Care Legislation (1 of 7) ▪1965: A Social Security Act amendment Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com established the Medicare and Medicaid programs. ▪Medicaid programs provided assistance for long-term institutional care, which fostered the start of a nursing home industry. Long-Term Care Legislation (6 of 7) ▪2010: The Affordable Care Act provided Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com states with the opportunity under the Medicaid program to improve their long- term care infrastructure. ▪2013: The American Taxpayer Relief Act established a Commission on Long-Term Care. Long-Term Care Legislation (7 of 7) ▪2014: The Centers for Medicare and Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Medicaid Services provided new standards that community-based services must meet to be considered home and community based. ▪2015: The CMS improved its Five Star Quality rating system for nursing homes.  Types of Long-Term Care Services (1 of 5) ▪There are home care, community care, and housing programs for long-term care. Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪Home care can be typically provided by family, friends, volunteers, or professionals. ▪Professionals called personal care assistants or home health aides (HHAs) assist with ADLs. They do not perform medical care but may take a patient’s vital signs. ▪Short-term, skilled care is covered by Medicare. Hospice care often is given at home for terminally ill individuals.  Types of Long-Term Care Services (2 of 5) ▪Community care are support services that include adult day care centers, meal programs such as Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Meals on Wheels, senior centers, and transportation. Adult day care centers offer a break for caregivers who provide ongoing care for loved ones with chronic diseases. Types of Long-Term Care Services (3 of 5) ▪Four general categories of long-term care Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com institutional services: independent living, assisted-living facilities, skilled nursing facilities, and memory care facilities, which are often part of a skilled nursing facility. ▪Independent living covers a broad range of settings for individuals who typically do not need regular healthcare services. The target market is 75 years or younger. Types of Long-Term Care Services (4 of 5) ▪Assisted-living facilities provide 24-hour Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com supervision and assistance with IADLs. ▪Recreational activities are provided. ▪Depending on state regulations, there may be some medical care assistance. Types of Long-Term Care Services (5 of 5) ▪Skilled nursing facilities provide care to residents who cannot live independently. Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪These facilities typically have age restrictions, increased security, and offer a range of social activities. There are 15,500 Medicare- and Medicaid-certified nursing facilities nationwide. ▪Memory care facilities focus on patients with dementia, Alzheimer's disease, and other cognitive issues. They have more supervision and staff for these patients with alarmed security and tracking devices to protect the patients.  Payment for Long-Term Care (1 of 10) ▪Personal funds, Medicare and Medicaid, and Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com long-term care insurance are ways to pay for long-term care services. ▪Medicare does not cover most long-term care costs. ▪Individuals pay out of pocket for long-term care services until their personal funds are depleted, and then they access Medicaid to pay for them. Payment for Long-Term Care (2 of 10) ▪Most continuing-care retirement Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com communities and assisted-living facilities are paid for by the individual, although Medicaid may pay for the costs in some states. ▪The Veteran’s Administration may help with paying for long-term care costs incurred by disabled veterans. Payment for Long-Term Care (3 of 10) ▪Medicare covers medically necessary Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com short-term or acute care such as doctor visits, prescription drugs, and hospital stays. ▪Physical therapy also is covered by Medicare for conditions that will be improved. Payment for Long-Term Care (4 of 10) ▪Medicare does not pay for the largest part Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com of long-term care services, such as help with ADLs. ▪It will pay for a short-term stay in a skilled nursing facility or home health care if certain conditions are met.  Payment for Long-Term Care (6 of 10) ▪These programs are targeted to low-income, Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com frail or disabled, minority older adults and older adults living in rural areas. ▪An annuity is a series of payments over a specified period of time. Entering a contract with an insurance company for an annuity may help pay for long-term care services. Payment for Long-Term Care (7 of 10) ▪An immediate long-term care annuity Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com consists of a specified monthly income in return for a single premium payment. ▪Deferred long-term annuities consist of a specified monthly income for a specified time period. These annuities are available to individuals up to age 85.  Payment for Long-Term Care (8 of 10) ▪Life insurance policies are purchased to Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com financially protect a beneficiary in the event of the death of the insured. They typically provide a lump sum to the beneficiary. ▪Some life insurance policies with an accelerated death benefit provide cash advances while the policyholder is still alive. ▪Amount taken from the life insurance policy is subtracted from the amount due to the beneficiaries. Payment for Long-Term Care (9 of 10) ▪Accelerated death benefits are available if Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com the policy holder lives permanently in a nursing home, is terminally ill, needs long- term care for an extended period of time, or has a life-threatening diagnosis such as AIDS. Payment for Long-Term Care (10 of 10) ▪Selling an insurance policy back to the Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com insurance company for its current value is an option to raise cash. ▪This is known as a life settlement and is available to people 70 and older. ▪The proceeds are taxable and can be used for any purpose, including long-term care services.  Current Trends in Long-Term Care (1 of 8) ▪Continuing care retirement communities Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com (CCRCs) combine independent living, assisted living, and nursing care on one campus. ▪This “aging in place” model offers the opportunity to reside in a single-family home, and as residents age, they can transfer to an assisted-living facility, and eventually to a skilled nursing facility. ▪Seniors must move into a CCRC when they are healthy and can live independently.  Current Trends in Long-Term Care (2 of 8) ▪Four different categories of “life care” contracts Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com within a CCRC: ▪Extensive contracts include housing, residential services, amenities, and unlimited access to health care at budgeted monthly rates. ▪A modified contract includes housing, residential services, and amenities but only limited healthcare access.  Current Trends in Long-Term Care (3 of 8) ▪CCRC contracts (cont.) Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪A fee-for-service contract includes housing, residential services, and amenities but no healthcare services. ▪A rental agreement contract on a monthly or annual basis does not give the resident access to healthcare services. Current Trends in Long-Term Care (4 of 8) ▪In 2001, the Robert Wood Johnson Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Foundation funded a pilot project developed by Dr. Bill Thomas called the Green House Project. ▪This unique type of nursing home focuses on creating a residence that not only provides services but is also a home to the residents, not an institution where they receive care. Current Trends in Long-Term Care (5 of 8) ▪The Green House home is managed by a Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com team of workers who share the care of the residents, including the cooking and housekeeping. ▪The daily staff members are certified nursing assistants (CNAs). ▪All mandated professional personnel, such as physicians, nurses, social workers, and dieticians, form visiting clinical support teams that assess the residents and supervise their care. Long-Term Care Financial Issues (1 of 3) ▪As the population lives longer, more people Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com will need long-term care services; however, the majority of Americans do not plan for long- term care. ▪Government programs account for 63% of long-term care funding, with Medicaid providing for 40% of that amount and Medicare 23%. Long-Term Care Financial Issues (3 of 3) ▪Consumers who have been concerned about Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com the cost of their premiums going to waste if they do not need long-term care can purchase a premium return rider on the policy, although it is expensive. ▪A more grassroots opportunity for the elderly is community networks that the elderly can join so they can access long-term care support services. Long-Term Care Insurance (1 of 2) ▪Long-term care insurance was developed to Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com cover services such as assistance with activities of daily living as well as care in an organizational setting. ▪The cost of long-term care insurance can vary based on the type and amount of services selected, as well as the age at time of purchase and healthcare status. Long-Term Care Insurance (2 of 2) ▪Most long-term care insurance policies are Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com comprehensive, which means they will cover expenses from home health care, hospice, respite care, assisted living and nursing homes, Alzheimer’s special care, and adult day services centers. CHAPTER 8 Careers in the Health Industry Copyright © 2022 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com.  Introduction (1 of 3) ▪Because of the aging of our population, the Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Bureau of Labor Statistics (BLS) indicates that the health industry will generate nearly 2.5 million new jobs by 2026. ▪When one thinks of healthcare providers, one automatically thinks of physicians and nurses. ▪However, allied health professionals, who represent nearly 60% of the healthcare workforce, provide a range of essential healthcare services that complement the services provided by physicians and nurses. Introduction (2 of 3) ▪In most states, only physicians, dentists, and a Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com few other practitioners may serve patients directly without the authorization of another licensed independent health professional. ▪Those categories authorized include chiropractic, optometry, psychotherapy, and podiatry. ▪Some states authorize midwifery and physical therapy. Physician Education ▪Doctor of Medicine (MD) or a Doctor of Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Osteopathic Medicine (DO) ▪MDs use an allopathic approach, which means MDs actively intervene in attacking and eradicating disease and focus their efforts on the disease. ▪DOs tend to stress preventive treatments and use a holistic approach to treating a patient, which means they do not focus only on the disease, but on the entire person. Most DOs are generalists.  Physician Compensation ▪In 2021, there were 727,000 physicians with growth expected to be 3%, which is slower than Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com average. The Association of American Medical Colleges (2021) projects a physician shortage between 40,000 and 100,000 by 2030. These figures have been exacerbated by the pandemic. ▪Wages for physicians and surgeons are among the highest of all occupations. ▪Differences in salaries are a reason for shortages of generalists, resulting in specialty maldistribution, which means there are less specialists in rural areas because they prefer to practice in urban and suburban areas.  Generalists and Specialists (1 of 2) ▪Generalists are also called primary care Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com physicians. ▪Family care practitioners are also called generalists, as are general internal medicine physicians and general pediatricians. ▪Their focus is preventive services such as immunizations and health examinations. ▪They often serve as gatekeepers for patients, which means they coordinate patient care if a patient needs to see a specialist. Generalists and Specialists (2 of 2) ▪Specialists are required to be certified in their Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com area of specialization. ▪This may require additional years of training and require a board certifying or credentialing examination. ▪The most common specialties are dermatology, cardiology, pediatrics, pathology, psychiatry, obstetrics, anesthesiology, specialized internal medicine, gynecology, ophthalmology, radiology, and surgery.  Hospitalists (1 of 2) ▪A hospitalist is a physician who provides care to hospitalized patients. Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪The hospitalist replaces a patient’s primary care physician while the patient is hospitalized. A hospitalist monitors the patient from admission to discharge and usually does not have a professional relationship with the patient before hospital admission. ▪This new type of physician, which evolved in the 1990s, is usually a general practitioner and is becoming more popular. Because the hospitalist spends so much time in the hospital setting, they can provide care that is more efficient.  Nonphysician Practitioners (1 of 2) ▪The general term nonphysician practitioners Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com (NPPs) includes nonphysician clinicians (NPCs) and midlevel practitioners (MLPs). ▪They are called physician extenders because they often are used as a substitute for physicians. ▪They are not involved in total care of a patient, so they collaborate closely with physicians. ▪Categories of NPPs include physician assistants (PAs), nurse practitioners (NPs), and certified nurse-midwives (CNMs).  Nonphysician Practitioners (2 of 2) ▪NPPs play an important role in areas that are Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com underserved by physicians, such as rural and underserved urban areas; in community health centers; and the managed care environment. ▪NPPs can be used with repetitive technical tasks such as screening tools for diseases. ▪May take care of non-life-threatening cases in emergency departments and perform physicals, drug testing, and other routine activities. ▪Salaries are nearly 50% less than physician salaries, so they are cost-effective caregivers.  Physician Assistants (1 of 2) ▪Physician assistants (PAs), a category of NPPs, provide a range of diagnostic and therapeutic Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com services to patients. ▪They take medical histories, conduct patient examinations, analyze tests, make diagnoses, and perform basic medical procedures. ▪They are able to prescribe medicines in all but three states. ▪They must be associated and supervised by a physician but the supervision does not need to be direct. Nurses ▪Nurses constitute the largest group of Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com healthcare professionals. ▪Provide the majority of care to patients ▪They are the patients’ advocate. ▪Several different types of nurses provide patient care. ▪Different levels of nursing care based on education and training  Licensed Practical Nurses (LPNs) ▪There are approximately 688,000 LPNs in the Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com United States. They are the largest group of nurses and provide basic nursing care. ▪Education is offered by community colleges or technical schools. Training takes approximately 12–14 months and includes both education and supervised clinical practice. ▪Work primarily in hospitals, home health agencies, and nursing homes ▪The 2021 median salary is approximately $41,000.  Registered Nurses (RNs) ▪A registered nurse (RN) is a trained nurse who has been licensed by a state board after passing the Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com national nursing examination. ▪In 2020, there were 3.1 million RNs. ▪Can be registered in more than one state ▪Different levels of registered nursing based on education: an associate degree or a 4-year degree. ▪The 2020 BS (BSN-RN) nurses’ median annual salary is $78,000. The BSN is the most rigorous of the nursing programs. These programs offered by colleges and universities usually take 4–5 years to complete. Advanced Practice Nurses (APNs) ▪Advanced practice nurses (APNs), or Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com midlevel practitioners, are nurses who have experience and education beyond the requirements of an RN. ▪They operate between the RN and MD, which is why they are called midlevel practitioners. ▪They normally obtain a Master of Science in Nursing (MSN) with a specialty in the field of practice.  Nurse Practitioners (NPs) ▪Nurse practitioners (NPs) are the largest category of advanced practice nurses. Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪They are required to obtain an RN and a master’s degree or doctoral degree. They may receive a certificate program and complete direct patient care clinical training. ▪NPs emphasize health education and promotion as well as disease treatment—referred to as care and cure. ▪NPs can write prescriptions in all states. ▪In 2020, there are 220,000 NPs in the United States with an annual average salary of $121,000.  Certified Nurse Midwives (CNMs) ▪Certified nurse–midwives (CNMs) are RNs Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com who have graduated from a nurse midwifery education program that has been accredited by the American College of Nurse–Midwives’ Division of Accreditation. ▪They must be recertified every 8 years as a CNM. ▪Nurse–midwives have been practicing in the United States for nearly 90 years. ▪The 2020 average annual salary is $105,000. Certified Midwives (CMs) ▪Certified midwives (CMs) are individuals Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com who do not have a nursing degree, but have a related health background. ▪They must take the midwifery education program, which is accredited by the same organization. ▪In 2023, the average annual salary for a CM is $96,377. ▪CMs are only recognized in 10 states.  Certified Nursing Assistants (CNAs) ▪Certified nursing assistants (CNAs) are unlicensed patient attendants who work under Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com the supervision of physicians and nurses. ▪They answer patient call bells and assist patients with personal hygiene, changing beds, ordering their meals. ▪Assist patients with their ADLs ▪Most CNAs are employed by nursing care facilities. ▪In 2022, there were 1.4 million CNAs. ▪The 2022 annual median salary is $31,000.  Other Healthcare Professionals ▪Dentists prevent, diagnose, and treat teeth, gum, and mouth diseases. Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪They are required to complete 4 years of dental school from an accredited dental school once a bachelor’s degree is completed. ▪They are awarded a Doctor of Dental Surgery (DDS) or Doctor of Dental Medicine (DDM). ▪In 2022, there are nearly 139,000 dentists in the United States—more than 90% are in private practice and are primarily general practitioners. ▪Average annual income for dentists is $163,000.  Dental Hygienists ▪Dental hygienists clean teeth, examine patients for oral diseases, and provide other preventative dental Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com care. ▪They educate patients on ways to improve and maintain oral health. ▪Dental hygienists typically need an associate’s degree in dental hygiene. ▪They must pass a national and state licensing exams. ▪This occupation is expected grow by 20% by 2026. ▪In 2021, the average median salary for dental hygienists is $77,000.  Pharmacists ▪Pharmacists are responsible for dispensing medication that has been prescribed by physicians. Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Advise patients and healthcare providers on side effects of medications ▪Doctor of Pharmacy programs require applicants to have taken postsecondary courses such as chemistry, biology, and anatomy. ▪Applicants need at least 2–3 years of undergraduate study; for some programs, applicants must have a bachelor’s degree. ▪Approximately 25% of pharmacists work in hospitals. ▪The 2021 median annual salary is $128,570. Chiropractors ▪Chiropractors take a holistic approach to Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com treating their patients, which means they focus on the entire body with an emphasis on the spine. ▪In 2021, there were 53,000 chiropractors. ▪Requires a Doctor of Chiropractic (DC) degree and a state license ▪The 2020 median annual salary for a chiropractor is $75,000.  Psychologists ▪Psychologists study the human mind and Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com human behavior. ▪Some work independently, doing research or working only with patients. Others work as part of a healthcare team, collaborating with physicians, social workers, and others. ▪Psychologists can complete a PhD in psychology or a Doctor of Psychology (PsyD) degree. ▪The 2021 median salary is $81,000.  Allied Health Professionals (1 of 2) ▪Four main categories: laboratory technologists Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com and technicians, therapeutic science practitioners, behavioral scientists, and support services ▪Provide support to physicians and nurses ▪Commission on Accreditation of Allied Health Education Programs (CAAHEP) accredits 2,000 U.S. programs that offer allied health specialties.  Allied Health Professionals (2 of 2) ▪This term was coined as the result of the passage of the Allied Health Professions Personnel Training Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Act of 1967. ▪ Allied health professionals provide both direct and indirect patient care. ▪There are 5 million allied health professionals in the United States who work in 80 different professions and represent nearly 60% of the healthcare workforce. ▪The Commission on Accreditation of Allied Health Education Programs (CAAHEP) accredits U.S. education programs that offer 32 allied health specialties. Medical and Health Services Managers ▪Medical and health services managers can be found at all levels of a healthcare organization. Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪They manage hospitals, clinics, nursing homes, community health centers, and other healthcare facilities. ▪ Mid-level administrators also play a leadership role in departments and are responsible for managing their areas of responsibility. ▪ They may manage departments or individual programs. ▪Undergraduate degree for entry-level positions ▪Master’s degree for management positions. ▪The 2021 median salary is $101,000, which varies depending on organization. Physical Therapists ▪Physical therapists help injured or ill people improve movement and manage pain. They Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com are often an important part of preventive care, rehabilitation, and treatment for patients with chronic conditions, illnesses, or injuries. ▪Physical therapists need a Doctor of Physical Therapy (DPT). ▪The 2021 median annual salary was $95,000.