Barriers to access
Steps to accessing health care:-Gaining entry into healthcare
system-Getting access to sites of care where client can receive
needed services-Finding providers with whom client can
communicate, develop trusting relationship and have individual needs met
Case management
A collaborative process of assessment, planning, facilitation, and
advocacy for options and services to meet an individual's and family's
comprehensive health needs through communication & available
resources to promote quality, cost effective outcomes
Essential for collaborative processes with multidisciplinary teams
Enables continuity of client care
Changing Demographics
Older adults
Racial, Ethnic Diversity
Client Focused Care
Delivery model that organizes health care around the expressed
physical and emotional needs of the client
Primary Prevention (examples of trying to prevent disease)
Provide education
Teach about
Sending a mailer
Posters about an event
Educating new parents
Secondary Prevention (examples of screening & education for
detecting illnesses in the early stage & prevent further worsening)
To detect
Screening
Providing a kit
Asking if a patient smokes
Counseling a patient
Screening for fall risk
Tertiary Prevention (examples focused on rehabilitation &
stopping the disease from progressing)
Providing lead resources to family with a lead poisoning
Monitor a TB patient
Refer for hearing loss
Provide info to parents about birth defects
Refer client to pain specialist
Following up with family
Factors Affecting Delivery of Healthcare
Changing demographics
Advances in technology
Healthcare literacy
Functional Nursing
Task-oriented approach to care delivery
Efficient-approach because it enables the nursing team to complete
many tasks in a short time
Cost effective
Unlicensed Assistive Personnel (UAP)
Critical component of functional nursing
Unlicensed paraprofessionals but may become certified (acts under
RN's, provides basic care to clients)
Risks becoming depersonalized and fragmented
Healthcare Settings
Primary Care
Secondary Care
Tertiary Care
Health Literacy
The degree to which individuals can obtain, act on and understand the
basic health info and services needed to make appropriate decisions
- Lower health literacy- Older adults- Lower
socioeconomic status- Lower education attainment
Lack of Health Insurance
Unable to afford
Individuals unable to negotiate better rates with providers
Seek less care so they end up getting care later into the disease process
Critical for Children:- Needs to be healthy to do well in
school- Well-child visits required for sports & school
Affordable Care Act (ACA) favorable toward children
Lack of Usual Source of Care
Medical or healthcare home: A client who receives regular care from a
facility- Trust and communication improved- Likely will
experience appropriate, high quality care
Children & Families- Better served with usual care-
Seek ongoing relationship & there's a high comfort level with provider
Legal Issues
Tort Law
Strategies to prevent incidents of professional negligence
Nurse Practice Acts (NPA)
Despite good intentions of nurse volunteer's, they must understand
that state and federal laws may not provide legal protection if the
nurse if practicing outside of the jurisdiction where the nurse is licensed
Managed Care
Method of delivering cost effective and high quality care
Designed to improve the outcomes for groups of clients
Managing Care
Care coordination
Delegation
Care coordination will be required to ensure the needs of disaster
victims are met
Nursing Care Delivery Systems
Functional
Team
Primary
Perception of Needs
Clients not always able to assess own need for care
When need arises with inability to obtain care, care is perceived as
difficult to access
Results in delays in care
Primary Care
Delivered in- Physicians Office- Hospital-Based
Clinics- Community Health Centers- Public Health Service Organizations
Covers services such as- Routine physicals-
Immunizations- Treatment of Common Illness- Support for
Psychosocial Needs
Primary Nursing
One nurse (PN) had 24/7 authority
Responsible for an assigned group of clients
Primary Prevention
Focus on health promotion and illness prevention
Healthy People updated every 10 years- Childhood obesity &
nutrition- Physical activity across lifespan- Dental &
oral health- Tobacco use and smoking cessation- Health
screening recommendations
Secondary Care
Delivered in- Hospital- Outpatient Surgical Center-
Specialists Office
Secondary Prevention
Secondary/Screening
Focuses on early disease detection, treatment and prevent
progression of disease
Early detection provided through screening
Solutions
Affordable Care Act (ACA)
Local Health Departments- Federal/State Funding- Grants
from private foundations
CHIP - kids who can get health coverage with families who make too
much but not enough for private insurance
Community Health Centers- Federally funded- Some states
are privately funded- Treat medically underserved in
communities- Take Medicare, Medicaid, sliding scale fees
Change client perception of needs
Promote appropriate, timely health care
Manage client care
Teach adults about self-care, care of children
When and how to access appropriate care
Physician shortages expected to worsen
Funding to improve recruitment, training of health professionals
Implementation of team approach
Team Nursing
Most frequently used today
Providing individualized care to clients
Tertiary Care
Delivered in:- Hospital- Rehab Center- Extended
Care Facility
Tertiary Prevention
Focus on restoring function, decreasing disease-related complications
of already established disease
Includes rehabilitation and palliative careEx: Someone has a
stroke and you try to help them & do rehab to help not get another stroke
Types of Healthcare Services
Primary Prevention
Secondary Prevention
Tertiary Prevention
Uneven Distribution of Services
Geographic populations underserved- Rural-
Impoverished- Shortage on primary care professionals: Increasing
number of specializing healthcare providers- Fragmentation of
care & costs- Need for care management