NUR 142#2lecture

“….a state of physical, mental, and social well-being and not merely absence of disease or infirmity”

2. Eliminate health disparities.

• · 1.Physical Activity
• · 2.Overweight and Obesity
• · 3.Tobacco Use
• · 4.Substance Abuse-liver disease, homelessness
• · 5.Responsible Sexual Behavior-std for seniors highest
• · 6.Mental Health- lack of understanding
• · 7.Injury and Violence- increase in crime, guns
• · 8. Environmental Quality- pollution
• · 9. Immunization
• -10. Access to Health Care

• · Access to quality health services
• · Arthritis, Osteoporosis, Chronic Back Conditions
• · Cancer
• · Chronic kidney disease
• · Diabetes
• · Disability and Secondary Conditions
• · Educational and Community based programs
• — Environmental health
• — Family planning
• — Food safety
• — Health Communication
• — Hearing Objectives
• — Heart Disease and Stroke
• — HIV
• — Immunizations and Infectious Diseases
• — Injury and Violence Prevention
• — Maternal, Infant, Child health
• — Medical Product safety
• — Mental Health and Mental Disorders
• — Nutrition and Overweight
• — Occupational Health
• — Oral Health
• — Physical Fitness
• — Public Health Infrastructure
• — Respiratory Diseases
• — Sexually Transmitted Diseases
• — Substance Abuse
• — Tobacco Use
• — Vision

• · Strengths: screenings for mammograms, colorectal cancer, annual dental visits
• · Weaknesses: uninsured women, poverty, obesity, coronary heart disease, chronic diseases (asthma, diabetes, BP), reproductive health, life expectancy.

• · A private-public initiative established to improve the health and quality of life for all Delawareans
• · The motto of Delaware’s plan is prevention
• · Leading State Indicators are similar to the National Leading Health Indicators
• · www.behealthydelaware.org

• · Promote healthy behaviors
• · Promote healthy communities
• · Prevent and reduce diseases and disorders
• · Improve health systems

• Strengths: screenings for cholesterol, mammograms and colorectal cancer
• Weaknesses:
• coronary heart disease
• maternal and infant mortality
• binge drinking
• uninsured females
• obesity
• smoking
• access to fruits and vegetables in one’s daily diet

• · Process of enabling people to increase control over, and to improve, their health through education and community based programs.
• · Focuses on facilitating the maintenance of a person’s current position on the continuum relative to age, with movement toward the positive end.

• · Environmental or regulatory measures that protect large groups of people.
• · “Laws” protect the community

Focuses on preventing different diseases that carry one to the negative end of the health spectrum.

• Activities directed at preventing a problem before it occurs.
• · General health promotion
• · good nutrition, adequate shelter, rest, exercise,
• · Specific protection
• · immunization, purification of water, use of car seats,seat belts, smoking cessation

• · Early detection and prompt intervention
• · Screening for disease:
• mammography, blood pressure screening, scoliosis screening, PAP smears, breast self-exams, hearing and vision screening, genetic screening (neonatal, breast cancer)

• · Limitation of disability and rehabilitation
• · teaching newly diagnosed diabetic to self-administer insulin
• · referral for head injured patient to physical therapy
• · support groups for grieving parents after loss of child
• · mental health counseling after rape

• · Requires coordinated effort
• · Requires continuity of care
• · The nurse is usually the “coordinator” of care between patient and family, multiple physicians, and other providers

• · Continuity of Care is a bridge to quality care for all individuals of the community.
• · Coordination of activities involving clients, providers, and payers to promote the delivery of healthcare.
• · Healthcare is appropriate, uninterrupted, and coordinated between settings and levels of care
• · Without continuity-care is fragmented, patient and family needs often not met.
• · Requires that discharge planning occur at admission.

• · A seamless admission into the health care system
• · Coordination of care when making
• - referrals
• 1. Discharge/transfer plans
• 2. care plans
• · Setting goals with health care team AND the client

• · Communication
• · Teaching
• · Management of care
• · Nursing Process
• · Documentation

• . Assessment
• · Diagnosis
• · Planning
• · Implementation
• · Evaluation
• "ADPIE"

• · A blue print or recipe for care
• · Key events related to a healthcare problem that must occur for the client to reach the outcomes set by the multidisciplinary team.

• · Purpose-to ensure that appropriate and timely information is communicated in order for client’s needs to be met in optimal way.
• What Makes an Effective Referral?
• · Does it have merit?
• · Is it practical and timely?
• · Is it individualized?
• · Has family been involved?

• · Lillian Wald (1890) convinced the Metropolitan Insurance Company to pay Public Health Nurses to deliver care to immigrants in NYC
• · Post World War II: Retrospective payment system
• · Medicare and Medicaid (1965): Cost containment legislation
• · Healthcare Reform: DRG’s (1983) payment now Prospective

• · Case Management: method used by some managed care systems to coordinate a patients health care, maximize positive outcomes and contain costs
• · Managed Care: a system designed to control health care costs while maintaining the quality of care

• · Medicare
• · Part A
• · Part B
• · Part D
• · Payment is prospective,
• · based on DRG

• Medicaid
• Coverage depends on individual state regulations

• — no or minimal out of pocket cost
• — no choice of providers outside of HMO
• — gate keeper for referrals
• — supports managed-care concept
• — group health plan that allows enrollees to receive all medical services through a group of affiliated providers

• — allows third party payer (insurance companies) to contract with health care providers to provide services at a lower fee (fee for service)
• — more choice of providers
• — may seek care outside of PPO without referral

• — members pay monthly premiums
• — choice of physicians and services
• — insurance companies pay major health care costs

• · Requires a premium separate from health care premium
• · Plans cover nursing home, home care, adult day care and respite care
• · Specialized Insurance coverage for patients requiring long term care

• · High cost of entitlement programs such as Medicare and Medicaid
• · High cost of biomedical technology and sophisticated care
• · Increased salaries of health care workers
• · High malpractice awards
• · Unhealthy lifestyles such as obesity, lack of exercise, and addictions
• · More people are living longer

• Changing demographics
• · Increasing diversity
• · Technology explosion
• · Educated consumer
• · Complexity of patient care
• · Cost of health care
• · Current nursing shortage
• · Health care reform

• · Universally accessible
• · Affordable
• · Health care is based on practical, scientific, and socially acceptable methods and technology

• · Community Health Care is meeting the needs of a large segment of the population who require care but are not being cared for in an inpatient setting.
• · Nurses are essential components in community health care.
• Community Health Nursing is a rapidly growing area of healthcare.