Transcript Chapter 4: Health and Illness

Chapter 4: Health and Illness
Carolyne Richardson-Phillips
PNU 145
Fall 2015
Pages 50-59
Learning Objectives
By the end of this session, the PN students will be able to:
1. Describe how the World Health Organization (WHO) defines
health
2. Discuss the difference between values and beliefs and list health
beliefs common among Americans
3. Define Wellness and Holism and how they relate to the health of a
person
4. Identify Maslow’s five levels of human needs
5. Define illness and the terms used to describe illness
6. Differentiate primary, secondary, tertiary, and extended care
7. Discuss the health payment systems that help finance health care
for the aged, disabled, and poor
8. List four methods to control escalating health care costs.
9. Identify “Healthy People 2020”, the goals and health indicators
10. Discuss five patterns that nurses use to administer client care
Nursing
• Nurses need to be committed to helping people prevent illness &
restore or improve their health
• These goals accomplished by:
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Helping people live healthy lives
Encouraging early diagnosis of disease
Implementing measures to prevent complications of disorders
Health
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WHO (World Health Organization) defines health as a state of complete
physical, mental, & social well-being, not merely the absence of disease or
infirmity: global commitment to “Health for All”
Each person has their own opinion of what health means to them
• Nurses to respect these differences
Values: ideals that a person feels are important
Beliefs: concepts a person holds to be true
Person’s actions/behaviors-guided by values-beliefs
American health belief
• Limited Resource: no substitute; “as long as you have your health, you
have everything”
• A Right: everyone is entitled to health care according to the principles
of USA; not always true as health disparities exist among various
groups
• A Personal Responsibility:
• Requires continuous personal effort
• Much potential for illness as there is for health
• Nurses have a duty to protect and preserve health of those who may
not be able to assert this right for themselves
Wellness and Holism
• Wellness: Balance of all aspects of health involves:
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Physical health
Emotional health
Social health
Spiritual health
• Holism: sum of physical, emotional, social, and spiritual health
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Determines how “whole” or well a person feels
Nurses-”holistic practitioners-committed to restoring balance in
each of the four spheres that affect health
Based on hierarchy of human needs
Maslow’s Hierarchy of Human Needs
• Identified 5 levels of human needs that
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motivate behavior
First level: Physiological
• Most important-necessary for life
Second: Safety and Security
Third: Love and Belonging
Fourth: Esteem and Self Esteem
Fifth: Self Actualization
• Believed that by satisfying needs at each
level-people realize their potential for health
& well-being
Tools used by nurses for each settings
Priorities for client care
Illness
• State of discomfort
Highly subjective & individualized
• May result from physical, emotional, intellectual, social or
spiritual deterioration, from disease, deterioration or injury
which impairs the person’s health
• Morbidity: incidence of a specific disease, disorder or injury; refers
to -Rate or number of people affected within population
• Mortality: incidence of deaths; number of people who died from a
particular disease or condition
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Types of Illnesses
• Acute illness: symptoms develop suddenly
Lasts a short period of time-usually curable
• May lead to long-term problems b/c of their sequelae-ill effects
from permanent/progressive organ damage caused by disease or its
treatment
Chronic illness-comes on slowly
• Lasts a long time - may last a lifetime
• Increases as people age
• May have periods of remission & exacerbation
Terminal illness: no potential for cure; terminal stage of an illnessperson is approaching death
Primary illness: one that develops independently of any other disease
Secondary illness: a disorder that develops from a pre-existing
condition
Remission: s & s associated with a particular disease disappear;
resembles a cured state, but may be temporary
Exacerbation: s & s reappear - or one that reverts from a chronic to an
acute state; can occur periodically in clients w/ long-standing diseases
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Illnesses (cont’d)
• Hereditary condition - disorder acquired from the genetic codes of
one or both parents and symptoms may or may not be present at birth
• Congenital disorders - present at birth but which are the result of
faulty embryonic development and cannot be genetically predicted
• Idiopathic illness -an unexplained cause
• Treatment focuses on relieving signs/symptoms
Health Care System
• Network of available health services
Includes agencies- institutions where people seek treatment for
health problems or assistance with maintaining or promoting
their health
• Changes on-going with system
• Advances in technology, & new discoveries
• More modern methods of diagnosing & treating diseasescreating a need for specialized care
• Now a complex system involving types of health care
• Primary
• Secondary
• Tertiary
• Extended care
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Primary Health Care
• Primary Health and Illness prevention-
Promotes health and preventing development of disease and
injury
• Health Services: provided by first health care professional or
agency a person contacts
• Family practice physician, nurse practitioner, physician’s
assistant in an office or clinic
• Focuses on health promotion
• Protection against specific
health problems
• Illness prevention
• Preventive care
• Health education
• Environmental protection
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Secondary Care
• Secondary Health and Illness Prevention-Focus on early
identification (screening) of health problems & prompt treatment
• Primary caregivers refer clients for consultation if needed or
additional testing- to help with diagnosis –recovery– (Ex: Blood
pressure, cholesterol, Cardiac Catheterization lab, X-rays,
oncologist, skin care, diabetes, HIV, skin cancer etc.)
• Prompt intervention to alleviate health problems
• Diagnosis & treatment
• Emergency care
• Acute care
Tertiary Care
• Tertiary-Care given to minimize the effects of a condition – Helps
to prevent long-term complications if possible
• Begins after an illness
• Health services provided at hospitals or medical centers
with Clinics-complex technology and specialists
• May be Outpatient care
• May need to travel from Home to facilities to receive Care
Ex: Chemotherapy, Wound care, Diabetes
Extended Care
• Services that meet the health needs of clients who no longer require
acute hospital care
• Rehabilitation, skilled nursing in person’s home or a nursing home,
and hospice care for dying clients
Assisted Living
Rehabilitation
Nursing Facility
Access to Care
• There are still millions of uninsured people in the USA because of
economic burden
• Groups with inadequate health care include: Children, Older adults,
Ethnic minorities, Poor
• Many delay seeking treatment-can not afford to pay or insurance
may not pay
• Facilities – physicians –pharmacies - not close for care
• May go to emergency room when needing care
• Inappropriate use of emergency departments –expensive-long
waits & no follow-up
Financial Health Care System Payments
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Financing Health Care
• Payment Sources in USA
- Private insurance
- Self-insurance systems
- Medicare
- Medicaid
Financing Health Care (cont’d)
• Medicare-Federal program- finances health care costs of persons 65
years and older, permanently disabled workers of any age and their
dependents, and those with end-stage renal disease; funded
primarily through withholdings from employed person’s income
• Part A covers-acute hospital care, rehab care, hospice & home
care services
• Part B- purchased for an additional fee-covers MD services,
outpatient, labs, medical equipment
• Part D: 2006-additional fee – covers a portion of medications
• Medicaid-A state administered program designed to meet the needs
of low-income residents
• Funded from federal, state and local sources
• Each state determines how funds are to be used
• Covers-hospitalization, diagnostic tests, MD visits, rehab &
outpatient care
• Long-term care- when he/she runs out of their own money
Financing Health Care (cont’d)
• Prospective Payment Systems- for people enrolled in Medicare –
Hospitals Reimbursed at a predetermined set rate regardless of
length of stay, acuity or complexity of client’s care
• Payments based on Diagnostic-related group (DRG)-a classification
system used to group clients with similar diagnoses
• If costs are less-hospital keeps difference
• If costs exceed reimbursed amount-hospital has deficit
• Limits amount paid to hospitals that receive Medicare payments
• Hospitals try to treat & discharge as early as possible for
decreased hospital days
• In Nursing facilities/Rehabilitation units-Form used to determine
documentation & reimbursement to the State-called MDS
(Minimum Data Set)
Financing Health Care (cont’d)
• Managed Care Organizations - Private insurers carefully plan-
supervise distribution of client’s health care services
• Control costs-use resources efficiently- & focus more on
prevention (ex. Screening, education, health promoting
activities)
• Types of Managed Care:
• Health Maintenance Organizations (HMO): corporations that
charge preset, fixed, yearly fees in exchange for providing
health care for their members - fee does not change regardless of
health issues
• Emphasize client wellness-Offer preventive services, periodic
screenings, health education
Types: Managed Care Organizations (cont’d)
• Preferred Provider Organizations (PPOs)
Agents for insurance companies-control costs on basis of
competition
• Create a network of a community’s physicians- willing to discount
fees for exchange of referred clients
• Capitation
• Different from HMOs & PPOs
• Payment system with a preset fee per member is paid to healthcare
provider-regardless of whether or not member requires services
• Incentive to providers to control tests- services to make a profit
• If members do not receive costly care, provider receives money
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National Health Goals: Healthy People 2020
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Healthy People 2020 tracks approximately 1,200 objectives organized into 42
topic areas, each of which represents an important public health area
Four overarching goals:
• Attain high-quality, longer lives free of preventable disease, disability, injury,
and premature death
• Achieve health equity, eliminate disparities, and improve the health of all
groups
• Create social & physical environments that promote good health for all
• Promote quality of life, healthy development, and healthy behaviors across all
life stages.
Within these issues- also focus areas that need to be worked on: health insurance,
education of health, wellness, and facilities, reduce number of cases of cancer &
deaths, illness, disability, reduce infections from food-borne pathogens, improve
vision & hearing
Because objectives are national, not solely federal, achievement is dependent in
part on the ability of health agencies at all levels of the government and on nongovernmental organizations to assess objective progress.
Nurses Roles: prevention and patient education
HealthyPeople.Gov 2020-updated 8/28/2013,
http://www.healthypeople.gov/2020/about/default.aspx .
Nursing Team
• Nursing Team: Personnel who care for client’s directly
Goal: to help clients attain, maintain, or regain health
• May include several types of professionals, allied health care
workers with special training
• Nurses – have unique skills to work in various settings in health field
• Use several common management patterns
• Five common ones used: Functional nursing, Case method, Team
nursing, Primary nursing, Nurse-managed care
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Functional Nursing, Case Method & Team Leader
• Functional Nursing
Each nurse is assigned specific tasks
• Used less often-D/T more task oriented & less focused on the
individuality of care
• Case Method: one nurse manages all the care a client or group of
clients needs for a designated period of time
• Used in home health, public health nursing, & community mental
health nursing
• Nurses known as case managers
• Team Leader: clients are divided into groups & complete their care
together which is organized & directed by a nurse
• May assist but usually assigns or supervises the care the team
members provide
• Members report the outcomes of their care to the team leader
• Responsible for evaluating whether the goals of client care are met
• Daily conferences are important to discuss client’s progress towards
recovery & discharge
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Primary Nursing
• Admitting nurse assumes responsibility for planning client care and
evaluating the progress of client
• May delegate client’s care to someone else in his or her absence
• BUT Is consulted when new problems develop or plan of care
required modifications
• Remains responsible, accountable for client until discharge
Nurse-Managed Care & Continuity of Health Care
• Nurse-Managed Care: a nurse manager plans nursing care of
clients based on their type of case or medical diagnosis
• A clinical pathway is used to manage the care
• Nurse acts as case manager to evaluate whether predictable
outcomes are met on a daily basis
• Meeting the outcomes in a timely manner allows for a timely
discharge
• Approach ensures standards of care are met with efficiency and
cost savings
• System developed d/t nursing shortage & need to balance costs
with limited reimbursement systems
• Continuity of Health Care: maintenance of health care from one
level of health to another and from one agency to another
• Ensures that client navigates the complicated health care system
with maximum of efficiency & minimum of frustration
• Goal: avoid causing client-ill or healthy,
to feel isolated, fragmented, or abandoned
References
• Healthy People 2020 (2013); Retrieved on 5/8/14 from web site:
www.HealthyPeople.Gov2020.com
• Images retrieved from web site: www.http:// googleimages.com on
June 14, 2015
• Lippincott Williams & Wilkins, (2013) (10th ed.) Lippincott Manual
of Nursing Practice-Online Electronic Medical Library, retrieved on
4/29/2014 from web
site:http://online.statref.com/Document.aspx?fxId=485&docId=10
• Timby, B. K. (2013). (10th ed.). Fundamental Nursing Skills and
Concepts. Philadelphia: PA. Lippincott Williams & Wilkins