Transcript 02. Health Care Delivery System, Nursing Research as the Basis of

Health Care Delivery System
Nursing Research as the Basis of
Nursing
Health Care Delivery System?
• Mechanism for providing services that meet the health-related
needs of individuals.
• Nursing is a major component of the U.S. health care delivery
system.
Types of Health Care Services
• Primary:
Health promotion and illness prevention
• Secondary: Diagnosis and treatment
• Tertiary: Rehabilitation
Health Care Settings Public Sector
• Federal Level
– U.S. Department of Health and Human Services (DHHS)
• State Level
– Department of Health
• Local Level Health Units
– Communicable disease control
– Health records maintenance
– Individual health services
– Environmental health and safety
– Public health education
Health Care Settings Private Sector
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Hospitals
Extended care facilities
Home health agencies
Hospices
Outpatient settings
Schools
Industrial clinics
Managed care organizations
Community nursing centers
Rural primary care hospitals
Health Care Team
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Nurse (RN)
Physician (MD)
Physician Assistant (PA)
Pharmacist (RPh)
Dentist (DDS)
Dietitian (RD)
Social Worker (SW)
Respiratory Therapist (RT)
Physical therapist (PT)
Occupational Therapist (OT)
Chaplain
Unlicensed Assistive Personnel
(UAP)
• Dental Hygienist
Advanced Practice Registered Nurse
Diagnoses and manages common health problems.
Performs medical procedures (e.g., suturing, casting).
• Registered nurses (RNs) treat patients, advise patients and provide
emotional support to patients and their family members during difficult
times. RNs document patients' medical histories and symptoms, help
doctors perform diagnostic tests, administer treatment and medications,
and follow-up with patients during rehabilitation.
RNs instruct patients and their families about post-treatment illness or injury
management, making nutrition and exercise program recommendations. Some
RNs promote public health by educating the public about disease symptoms.
RNs often organize health screening or immunization clinics and blood drives.
When working with patients, RNs establish a care plan. Plans could include
the monitoring and administration of prescription drugs, setting up and
monitoring (IV) lines for fluid, coordinating treatments, patient observation,
record keeping, and discussing patient care with doctors. Some RNs instruct
licensed practical nurses and nursing aids about patient care. RNs with
advanced educational training may perform diagnostic tests and prescribe
some medication.
RNs can specialize in certain types of patient care. RNs can work in a certain
setting, such as perioperative nurses, found in operating rooms. RNs may
specialize in certain disease treatment, such as diabetes management nurses,
who help patients with diabetes. Some RNs specialize in particular organ
systems, such as dermatology nurses, who help with patients with skin
disorders. RNs also can choose to work with a specific type of people, such as
geriatric nurses, specializing in treating the elderly. RNs may combine
specialties, such as pediatric oncology nurses, who work with children cancer
patients.
Some RNs specialize in working with people from certain age groups or certain
settings. For example, some nurses specialize in working with newborns
(neonatology), children and adolescents (pediatrics), adults, and the elderly
(gerontology or geriatrics). Certain RNs work with people outside of hospital
settings such as in the military or a summer camp. Some RNs travel around the
country and the world providing care to patients in areas with health
professional shortages.
Nursing Roles
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Caregiver
Teacher
Advocate
Manager
Expert
Case Manager
Team Member
Economics of Health Care
• Private Insurance
• Managed Care
– Primary care providers
– Health Maintenance Organizations
(HMOs)
– Preferred Provider Organizations
(PPOs)
– Exclusive Provider Organizations
(EPOs)
• Federal Government Insurance Plans
– Social Security Act 1965
– Medicare and Medicaid
– Regulated by Centers for Medicare &
Medicaid Services (CMS)
What is Medicare / Medicaid?
• Medicaid and Medicare are two governmental programs that
provide medical and health-related services to specific groups
of people in the United States. Although the two programs are
very different, they are both managed by the Centers for
Medicare and Medicaid Services, a division of the U.S.
Department of Health and Human Services.
• Medicare is a social insurance program that serves more than
44 million enrollees (as of 2008). The program costs about
$432 billion, or 3.2% of GDP, in 2007. Medicaid is a social
welfare (or social protection) program that serves about 40
million people (as of 2007) and costs about $330 billion, or
2.4% of GDP, in 2007. Together, Medicare and Medicaid
represent 21% of the FY 2007 U.S. federal government.
What is Medicaid?
Required services include:
• Inpatient hospital services
• Outpatient hospital services
• Prenatal care
• Vaccines for children
• Physician services
• Nursing facility services for persons aged 21 or older
• Family planning services and supplies
• Rural health clinic services
• Home health care for persons eligible for skilled-nursing services
• Laboratory and x-ray services
• Pediatric and family nurse practitioner services
• Nurse-midwife services
• Federally qualified health-center (FQHC) services and ambulatory services
• Early and periodic screening, diagnostic, and treatment (EPSDT) services
for children under age 21
What is Medicare?
Medicare is a Federal health insurance program that pays for
hospital and medical care for elderly and certain disabled
Americans.
The program consists of two main parts for hospital and medical
insurance (Part A and Part B) and two additional parts that
provide flexibility and prescription drugs (Part C and Part D).
Medicare
Part A, or Hospital Insurance (HI), helps pay for hospital stays,
which includes meals, supplies, testing, and a semi-private
room. This part also pays for home health care such as
physical, occupational, and speech therapy that is provided on
a part-time basis and deemed medically necessary. Care in a
skilled nursing facility as well as certain medical equipment
for the aged and disabled such as walkers and wheelchairs are
also covered by Part A. Part A is generally available without
having to pay a monthly premium since payroll taxes are used
to cover these costs.
Medicare Part B is also called Supplementary Medical
Insurance (SMI). It helps pay for medically necessary
physician visits, outpatient hospital visits, home health
care costs, and other services for the aged and disabled.
For example.
Part B covers:
Durable medical equipment (canes, walkers, scooters,
wheelchairs, etc.), Physician and nursing services, Xrays, laboratory and diagnostic tests, Certain
vaccinations, Blood transfusions, Renal dialysis,
Outpatient hospital procedures, Some ambulance
transportation, Immunosuppressive drugs after organ
transplants, Chemotherapy, Certain hormonal
treatments, Prosthetic devices and eyeglasses.
Medicare Part C
• Medicare Advantage Plans (sometimes known as Medicare
Part C, or Medicare + Choice) allow users to design a custom
plan that can be more closely aligned with their medical needs.
These plans enlist private insurance companies to provide
some of the coverage, but details vary based on the program
and eligibility of the patient. Some Advantage Plans team up
with health maintenance organizations (HMOs) or preferred
provider organizations (PPOs) to provide preventive health
care or specialist services. Others focus on patients with
special needs such as diabetes.
Medicare Part D
Medicare Part D. Part D is administered by one of several
private insurance companies, each offering a plan with
different costs and lists of drugs that are covered. Participation
in Part D requires payment of a premium and a deductible.
Pricing is designed so that 75% of prescription drug costs are
covered by Medicare if you spend between $250 and $2,250 in
a year. The next $2,850 spent on drugs is not covered, but then
Medicare covers 95% of what is spent past $3,600.
Who is eligible for Medicare?
To be eligible for Medicare, an individual must either be at least
65 years old, under 65 and disabled, or any age with EndStage Renal Disease (permanent kidney failure that requires
dialysis or a transplant.)
In addition, eligibility for Medicare requires that an individual is
a U.S. citizen or permanent legal resident for 5 continuous
years and is eligible for Social Security benefits with at least
ten years of payments contributed into the system.
NURSING RESEARCH
Nursing research provides the scientific basis for the practice of
the profession.
Nursing research focuses on the understanding and easement of
the symptoms of acute and chronic illness; prevention or
delayed onset of disease or disability, or slowing the
progression thereof; finding effective approaches to achieve
and sustain optimal health; and improvement of the clinical
settings in which care is provided
GOALS
The two overarching goals are:
1) helping individuals of all ages to increase life expectancy
and improve their quality of life,
2) 2) eliminating health disparities among different segments of
the population in the United States.
Scope of Nursing
Nursing research encompasses a wide scope of scientific inquiry
including clinical research, health systems and outcomes
research, and nursing education research. Clinical research,
based on biological, behavioral, and other types of
investigations, provides the scientific basis for the care of
individuals across the life span and occurs in any setting where
nursing care is provided. Health systems and outcomes
research examine the availability, quality, and costs of health
care services as well as ways to improve the effectiveness and
appropriateness of clinical practice. Finally, nursing education
research focuses on how students learn the professional
practice and discipline of nursing as well as how to improve
educational strategies to prepare clinicians and scientists.
Clinical Research
The scope of clinical research ranges from acute to chronic care
experiences across the entire life span; health promotion and
preventive care to end-of-life care; and care for individuals,
families, and communities in diverse settings. It is imperative
for nursing research to take a farsighted approach in order to
have greater impact in the future. For example, recent
discoveries in the genetic basis of disease and behavior may
help nurse scientists to develop more effective strategies to
manage symptoms and tailor interventions.
Nursing Education Research
• Nursing education research centers on developing and testing more
efficient educational processes, identifying new ways to incorporate
technology in order to enhance learning, and discovering more
effective approaches to promoting lifelong learning and
commitment to leadership. To achieve these goals, the use of
rigorous research strategies in the assessment of the teachinglearning process and outcomes at all levels of nursing education is
essential from baccalaureate and graduate education through. The
continuous supply of well-educated nurses is critical to maintain and
enhance our nation's health, especially in light of the changes in the
demographics of the population. To this end, new strategies for
recruiting and retaining bright young men and women from diverse
educational and cultural backgrounds into nursing must be developed and
tested.
Creating a Culture and Workforce for Nursing
Research
Cultures supportive of research and scholarship generally develop within
academic institutions where knowledge development, discourse, and debate
are expected and encouraged. Given the broad scope of nursing research,
this also means that nurse researchers require environments that support
integration of various approaches to inquiry. Collaborative research among
nurse scientists that brings together a range of perspectives on a particular
question will result not only in a better understanding of and coherence in
the entire discipline, but also in an understanding of how knowledge from
one field complements and extends learning in another. Further,
contemporary research problems demand that nurse scientists move into
more interprofessional collaboration, team-based work, and increase
attention to the rapid progression to safe and appropriate practical
application of findings The ultimate goal of research training in nursing at
all levels is to strengthen the profession's contribution to enhancing the
health and healthcare of individuals and populations. The expectations and
competencies of graduates at each level of nursing education in regard to
research are described below:
• Baccalaureate programs
prepare nurses with a basic
understanding of the
processes of research.
Graduates can understand
and apply research findings
from nursing and other
disciplines in their clinical
practice. They understand
the basic elements of
evidence-based practice, can
work with others to identify
potential research problems,
and can collaborate on
research teams.
• Master's programs prepare
nurses to evaluate research
findings and to develop and
implement evidence-based
practice guidelines. Their
leadership skills enable
them to form and lead teams
within their agencies and
professional groups. They
identify practice and
systems problems that
require study, and they
collaborate with scientists to
initiate research.
Practice-focused doctoral
programs
prepare graduates for the highest level of
nursing practice beyond the initial
preparation in the discipline.
Graduates obtain the highest level of
practice expertise integrated with the
ability to translate scientific
knowledge into complex clinical
interventions tailored to meet
individual, family and community
health and illness needs. In addition,
these professionals use advanced
leadership knowledge and skills to
evaluate the translation of research
into practice and collaborate with
scientists on new health policy
research opportunities that evolve
from the translation and evaluation
processes. They are prepared to focus
on the evaluation and use of research
rather than the conduct of research
(AACN, 2004a)
• Research-focused doctoral programs prepare graduates
to pursue intellectual inquiry and conduct independent
research for the purpose of extending knowledge (AACN,
2001). Graduates are expected to plan and launch an
independent program of research, seek needed support for
initial phases of the research program, and begin to
involve others (i.e., students, clinicians, and other
researchers) in that.
• Postdoctoral programs provide graduates from researchfocused doctoral programs not only with a period of time
devoted fully to further developing research skills, but the
opportunity to establish their research program with the
formal mentorship of senior investigators. Formal
postdoctoral study generally ensures that an individual's
research program is firmly launched before facing the
multiple demands of any academic, clinical, or
administrative position.
Nursing research faces a number of challenges and opportunities
stemming from rapid growth and limited resources. In the past
two decades, with the rapid expansion of resources for
research, nursing's contribution to evidence-based practice and
health policy has increased exponentially. Even so, a number
of challenges are preventing the discipline of nursing from
achieving its full scientific potential.