Transcript 19 th & 20 th CENTURIES

INTRODUCTION TO BEING A
HEALTH CARE WORKER
History of Health Care
Section 1.1
EARLY BEGINNINGS
• Primitive humans focused on survival – protecting
themselves against predators and finding food
• Superstitious – believed illness & disease were
caused by supernatural spirits
• Tribal doctors performed ceremonies to exorcise evil
spirits
• Used herbs & plants as medicines, some of which
are still used today….
Medicines from herbs and plants:
• Digitalis – used to strengthen & slow
heartbeat
• Quinine – controls fever, relieves muscle
spasms, and helps prevent malaria
• Belladonna and atropine – relieve muscle
spasm, especially in GI pain
• Morphine – relieves severe pain, addicting
MEDICINE IN ANCIENT TIMES
• Egyptians first people to keep accurate health
records
• Still superstitious – called upon gods to heal them
• Learned to identify certain diseases
• Used medicines
• Learned the art of splintering fractures
• Treated disorders by bloodletting with use of leeches
• Ancient Chinese were first to use primitive
acupuncture therapies
• Chinese acupuncture still commonly used
today
Ancient Greeks
• First to study the causes of disease and to determine
that illnesses may have natural, rather than spiritual
causes
• Kept records on what they observed and what they
thought caused illness
• Research about disease helped to eliminate
superstition
• Further developed the use of massage and herbal
therapies
• Dissection was not allowed due to religious
custom
• Hippocrates (“father of medicine”) based his
knowledge of A & P on observation of the
external body
Hippocrates (469-377 B.C.):
• Kept notes on signs and symptoms of many
diseases
• Found that disease was not caused by
supernatural forces
• Wrote the standard of ethics called the Oath
of Hippocrates
– still the basis for today’s medical ethics
– physician’s still take this oath today
ROMANS
• Learned from the Greeks that some disease
was caused by lack of sanitation
• Introduced public health and sanitation
• developed a sanitation system, using
aqueducts to bring clean water into their cities
• Built sewers to carry off waste
• Public baths with filtering systems
• The beginning of public health and sanitation
ROMANS
• First to organize medical care
• Sent physicians & med equipment with armies
• Introduced the concept of hospitals – kept
room in their houses for the sick – established
public buildings for the care of the sick
• Physicians paid by Roman gov’t.
• Wore a death mask with spice-filled beak,
believed to protect them from infection & bad
odors
DARK AGES & MIDDLE AGES
(A.D. 400-800) (A.D. 800-1400)
• After the conquering of the Roman Empire, the study
of medical science stopped
• For 1,000 years, medicine was practiced only in
convents and monasteries where they believed life
and death were in god’s hands
• Monks and priests had no interest in how the body
functioned – primary treatment was prayer
• All research in physiology ceased
• Care was custodial
DARK AGES & MIDDLE AGES
• Epidemics caused millions of deaths
• Bubonic plague (black death) killed 60 million
• Other uncontrollable diseases - Smallpox,
diphtheria, syphilis, and TB
• Today, these illnesses are not always life
threatening due to vaccines and medications
RENAISSANCE
(A.D. 1350-1650)
• Rebirth of learning & new scientific progress
began which influenced the future of medical
science:
– Building of universities and medical schools for
research
– New ideas about disease
– Acceptance of dissection of the body for study
– Printing press & publishing of books, allowing
access to knowledge from research
16th & 17th CENTURIES
• Leonardo da Vinci – studied & recorded anatomy of
the body
• William Harvey – used knowledge of anatomy to
understand physiology – described the circulation of
blood and pumping of the heart
• Gabriele Fallopius discovered the fallopian tubes of
the female anatomy
• Bartolommeo Eustachio discovered the tube leading
from the ear to the throat (Eustachian tube)
16th & 17th CENTURIES (cont’d)
• Antonie van Leeuwenhoek invented the microscope
– first to observe bacteria – established there is life
smaller than the eye could see
• Apothecaries (early pharmacies) started
• Quackery, mass death from childbed fever, and
disease continued
• In the 16th & 17th centuries, the causes of infection
and disease were still not understood.
18th Century
• Medical teachings expanded
• the study of physiology and disease processes
continued through observation and dissection.
• Wider range of students studied medicine
18th Century
• Rene Laennec invented the stethoscope – **made of
wood **
• Joseph Priestley discovered O2 – observed that plants
refresh air that has lost O2
• Benjamin Franklin - many discoveries, including
bifocals. Also found that colds could be passed from
person to person
• Edward Jenner – discovered a method of vaccination for
smallpox. This led to immunization and to preventive
medicine in public health
19th & 20th CENTURIES
• The beginning of organized advancement of
medical science
• Ignaz Semmelweis identified the cause of
childbed fever (puerperal fever)
– Linked HANDWASHING & cleanliness to infection
– This became an accepted practice
– *** Today, handwashing is one of the most
important and simplest ways to control the
spread of infection***
19th & 20th Centuries
(cont’d)
• Louis Pasteur (“Father of Microbiology”) proved that
microorganisms cause disease; discovered
pasteurization; vaccine for rabies
• Joseph Lister discovered antiseptic to prevent infection
in wounds and surgical incisions
• Ernst von Bergmann developed asepsis to keep an area
germ-free before and during surgery
• Robert Koch discovered many disease-causing
organisms; developed culture plate method to identify
pathogens; isolated the bacterium that causes TB;
introduced importance of cleanliness and sanitation in
preventing the spread of disease
• Wilhelm Roentgen discovered x-rays – allowed
doctors to see inside the body for diagnostics
• Paul Ehrlich discovered the effect of medicine on
some disease-causing microorganisms - found a
chemical to treat syphilis
• Before the 19th century, pain was a serious problem;
surgery was performed on patients without
anesthesia
• Early physicians used herbs, hashish, and alcohol to
help relieve the pain of surgery
• During the 19th and 20th centuries, anesthesia was
discovered in the form of nitrous oxide (for dental
care), ether, and chloroform
• Knowledge of asepsis and the ability to prevent pain
during surgery are the basis of safe, painless surgery
today
19th & 20th Centuries (cont’d)
• Gerhard Domagk discovered sulfonamide
compounds – first medications effective in
killing bacteria – used to treat deadly diseases
• Dmitri Ivanovski realized some diseases were
caused by some other microorganisms not
seen under standard microscopes – viruses –
eventually studied with electron microscope –
found to cause:
– Polio, rabies, measles, flu, chicken pox, German
measles, herpes zoster, mumps
19th & 20th Centuries
• Sigmund Freud discovered the conscious and
unconscious parts of the mind – the mind and
body work together – led to understanding of
psychosomatic illness; founded the basis of
psychology & psychiatry
• Alexander Fleming discovered penicillin, one
of the most important discoveries of the 20th
century – pneumonia, gonorrhea, blood
poisoning….
19th & 20th Centuries
• Jonas Salk discovered the polio vaccine using dead
polio virus
• Albert Sabin used a live polio virus vaccine – more
effective – used today to immunize babies
• Francis Crick and James Watson discovered the
molecular structure of DNA - explained how DNA
replicates and how hereditary information is coded
on it
• New approaches to medical care are being
discovered every year
• Wellness
• Self-care
Today
• New approaches to medical care every year
• Emphasis on wellness & self-care
• Health – now refers to a person’s emotional, social,
mental, and spiritual wellness – Holistic Health
• Alternative medicine more widely accepted –
acupuncture, chiropractic, homeopathy, naturopathy
• Emphasis on home health care
• Ambulatory care
People live longer and healthier
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Genetic research
Organ transplants
Reattachment of severed body parts
Computers to aid in diagnosis, accurate record keeping, and
research
Noninvasive techniques for diagnosis
Advanced procedures for caring of unborn fetus
Greater acceptance of alternative medicine and complementary
medical practice
Geriatric research
Facilities to better meet needs of senior citizens
Future hopes in medical science
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Diabetes
Cancer
AIDS
MS
Arthritis
MD
ADVANCEMENT OF NURSING
• Florence Nightingale (1820-1910) – founder of
modern nursing – (1860) started a nursing school
which raised the standards of nursing to become a
“respectable” profession
• Clara Barton (1821-1912) – established the
American Red Cross
• Lillian Wald (1867-1940) – established visiting nurse
services for the poor. Today, visiting nurse services
are found in most communities
Patient Care Today
• Patient caregiver team – includes licensed as well as
unlicensed caregivers:
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Clinical partner
Service partner
Nurse extender
Health care assistant
Patient care assistant
• Extend the role of entry-level employees
• The RN delegates patient care tasks according to
training and expertise of the assistive personnel
A Look Back to the 20th Century
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Antibiotics for bacterial diseases
Improved life expectancy
Organ transplants
Healthier hearts (reduced smoking, better diets)
Dentistry without pain
Noninvasive diagnosis with computers (CAT, MRI)
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End of smallpox
Childhood immunizations
New understanding of DNA & genetics
Control of diabetes (insulin)
Decline in polio
Medical machines (kidney dialysis and heart-lung)
Test tube babies
HMOs
Hospice
Future of Medicine
• Cure for AIDS
• Decrease in malaria, flu,
leprosy
• Cure for genetically
transferred diseases
(Tay-Sachs, MD, MS,
cerebral palsy,
Alzheimer’s, Lupus)
• Improved tx for arthritis
& the common cold
• Isolation of the gene
that causes depression
• Use of electronics to
allow disabled to walk
• Nutritional therapy for
schizophrenia
MEDICAL ETHICS
• With medical advancement comes new issues
– Organ recipients
– Experimental drugs
– Creation of in vitro embryos
– AIDS confidentiality?
– Assisted death (euthanasia) for terminally ill?
UNDERSTANDING HEALTH CARE
SYSTEMS
Ch. 2
HEALTH CARE PROVIDERS
Section 2.1
TYPES OF HEALTH CARE PROVIDERS
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General Hospitals
Specialty Hospitals
Convalescent care
Ambulatory care
Physician & Dental
Rehab Centers
Industrial Health Care
Centers
• School Health Services
• HMOs
• Home Health Care
Agencies
• Senior Day Care
• WHO
• Hospices
General Hospitals
• Patients are hospitalized for a short time
• Few days to few weeks
• Provide a wide range of diagnostic, medical,
surgical, and emergency care services
Specialty Hospitals
• Long-term stays (often over a month)
• Acute care environment
• Persistent recurring diseases or complex
medical conditions
• May include chronic diseases, pulmonary or
physical rehabilitation, wound care, and
psychiatric problems
Convalescent Care
• E.g., nursing homes, long-term care facilities
• Facilities that are generally for geriatric care – care for elderly
people needing nursing services and assistance with personal
care and daily living activities
• Also care for physically ill or injured people of all ages who
require an extended convalescence for recovery
• Focus is on rehabilitation, or optimizing the functional status
of the patient so they may return to the community.
• Staff: nurses, aides and assistants, physical, occupational, and
speech therapists, recreational assistants, and social workers
Nursing Homes
• Can differ from extended care facilities
• Places of residence for people who require
constant nursing care and have significant
problems with activities of daily living
Extended Care Facilities
• Care for those who need assistance with
activities of daily living or with medical needs
• For conditions that are likely to last for a long
time or for the rest of the patient’s life
(Alzheimer’s)
Independent Living and Assisted Living
Facilities
• For elderly with active lifestyles
• Offers older people the opportunity to remain
independent in a home of their own, close to health
care professionals and facilities
• Patients need some assistance, but want to live as
independently as possible for as long as possible
• Bridges the gap between independent living and
extended care or nursing homes
Ambulatory Care
• Facilities where several physicians with different
specialties combine their practices
• Allows patient immediate care for many different
illnesse
– Physician’s office
– Designated area in hospital
– Urgent care centers
• Patients do not spend the night
• These are outpatient services
Physician and Dental Facilities
• Provide care that promotes wellness and
diagnosis of illness.
– Simple surgeries
– Bone setting
– Counseling
– Administration of drugs
– Possible Diagnostic services – lab tests, x-rays
Rehabilitation Centers
• Provide outpatient care for clients who require
physical or occupational therapy, recreational
therapy, hydrotherapy, and other therapies (speech,
hearing) for loss of function in mobility or the
activities of daily living
• Patients may receive prosthetics and learn how to
use adaptive devices
• Services enable patients to return to the community
after therapy
Industrial Health Care Centers
GOVERNMENT AGENCIES
• VA HOSPITALS
• U.S. PUBLIC HEALTH
DEPT.
• STATE PSYCHIATRIC
HOSPITALS
• STATE UNIV. MED CTRS
• STATE PUBLIC
HEALTHSERVICES
• COUNTY HOSPITALS
• LOCAL PUBLIC HEALTH
DEPARTMENTS
• SENIOR CENTERS
VOLUNTEER AGENCIES
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Amer. Cancer Soc.
March of Dimes
American Red Cross
Amer. Heart Assoc.
Amer. Diabetes Assoc.
Nat’l. Assoc. of Mental Health
MANAGED CARE
• describes a variety of techniques intended to
reduce the cost of providing health benefits
and improve the quality of care
• Organizations that use those techniques or
provide them as services to other
organizations
• Systems of financing and delivering health
care to enrollees organized around managed
care techniques
Managed Care
• Preventive Care
– Routine physicals, well-baby care, immunizations,
and wellness education to keep patients healthy
– Wellness education stresses the importance of
good nutrition, weight control, exercise and
healthy living practices
– Being healthy helps prevent serious illness and
lowers medical costs
• Primary Care
– Family and general practice, internists, nurse
practitioners, and physician’s assistants
– All routine medical problems
– Refer patients to specialists
• Specialty Care
– Provider who is trained in one special area
– Specializes and has a broad knowledge of that
area
– Surgery, podiatry, obstetrics, orthopedics,
chiropractic, urology
• Emergency Care & Urgent Care
– Emergency care – for life-threatening conditions
that require hospitalization - expensive
– Urgent care – for non-emergencies that require
prompt treatment – Outpatient care - costs are
lower; patients prefer being at home
• Managed care has attracted controversy
because it has largely failed in the overall goal
of controlling medical costs.
• Proponents an critics are also sharply divided
on managed care’s overall impact on the
quality of U.S. health care delivery.
AMBULATORY CARE
• medical care delivered on an outpatient basis
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Rehab. Centers
Outpatient surgery
Outpatient medical centers/clinics
Physician’s offices
Day care
QUALITY HEALTH CARE COSTS & PAYMENTS
• Health Plan Emp. Data
Info Set
• Diagnostic-Related
Groupings
• Health Ins: 3rd party
Payers
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HMOs
PPOs
Medicaid
Medicare