Transcript Levels of Health Care in USA

Levels of Health
Care in USA
Levels of health care
• Preventive
• Primary
• Secondary
• Tertiary
• Restorative
• Continuing care
Six core attributes of
primary care
1. Excellent primary care is grounded in both
the bio-medical and social sciences.
2. Clinical decision making in primary care
differs from that in specialty care.
3. Primary care has as its core a sustained
relationship between clinical care and clients.
4. Primary care does not consider mental
health separately from physical health.
5. Important opportunities to promote health
and prevent disease are intrinsic to primary
care.
6. Primary care is information intensive.
Focus of health promotion
– to keep people healthy through
• personal hygiene,
• good nutrition,
• clean living environments,
• regular exercise,
• rest,
• adoption of positive health attitudes
Preventive and Primary
Care
• School Health Services
• Occupational Health Services
• Physicians' Offices
• Clinics
• Nursing Centers
• Primary Health Care in the
Community
School Health Services
• Approximately 50,000 licensed
professional school nurses provide
health services to children and youth
in the school setting
• Goal: supporting educational success
by enhancing health
A school nurse
• develops programs that foster
children's growth,
• positive life skills for successful
coping,
• acquisition of knowledge and skills
for self-care,
• reinforce positive health attitudes
Specific nursing
interventions
• Health education
• Parent programming and
counseling
• Communicable disease control
• Physical assessment
• Crisis intervention
• Environmental safety
• Nutrition planning
• Emergency care
Occupational Health
Services
Foundation of occupational health
nursing:
–epidemiology
–worker advocacy
–occupational health risk assessment
–critical thinking
–educational principles
Occupational health
nurses
• conduct environmental surveillance
• direct nursing care
• health education
• communicable disease control
• counseling
• administration
• research
Physicians' Offices
• Nurse practitioners:
– screen for possible health
problems
– identify clients' health promotion
practices
– make recommendations to
minimize or control risk factors
Physicians' Offices
• RNs - office or practice manager:
–supervision of secretarial and
medical assistant staff and medical
record personnel
–managing the flow of clients
through the office
–dealing with physician concerns
Clinics
(ambulatory health services)
• Assess and treat ambulatory
clients on an outpatient basis
• May be affiliated with a hospital,
medical school, group practice,
church, or community organization
Nursing Centers
• Provide high-quality nursing services
with a focus on
– health promotion and health education,
– disease prevention,
– chronic disease management,
– support for self-care and caregivers
Nursing Centers
• Serve vulnerable populations such as
minority and ethnic groups of lowincome status, older adults, and the
disabled
– Nurse practitioners
– Clinical nurse specialists
– Public health nurses
Criteria for nursing
centers
• direct access by the client to the
nurse,
• a nursing model of care,
• holistic reimbursed services.
Block and Parish Nursing
Block nursing
• happens where the nurse lives
• for older clients or those unable to leave the
home or who are underserved
• services might include running errands to
the grocery store or pharmacy, transporting
clients to a physician's office, providing
respite care to family members, and being
home-maker aides
Block and Parish Nursing
• Parish nursing is the same as block
– churches and synagogues offer the site
and support system for the program's
activities
– themes of clients' perceptions included
being available, helping clients to help
themselves, and integrating spirituality
and health
Primary Health Care in the
Community
• focuses on collaboration of health
professionals, community members, and
others working in multiple sectors,
emphasizing health promotion,
development of health policies, and
prevention of diseases for all individuals
• include health education, proper nutrition,
maternal/ child health care, family
planning, immunizations, and control of
locally endemic diseases
Secondary and Tertiary
Care
• hospital emergency departments
• urgent care centers
• critical care units
• inpatient medical-surgical units
nurses work closely with all members of
the health care team to plan,
coordinate, and deliver care for clients
who are seriously ill
Hospitals
• Case management model of care the case manager coordinates the
referral of clients to services
provided by other disciplines,
ensures that client education has
been implemented, and monitors the
client's progress through discharge
Hospitals
• Critical pathway - tool that staff may use to
coordinate care
• multidisciplinary treatment plan that sequences
clinical interventions over a projected length of
stay or a projected time frame for specific case
types
• typically outlines standard clinical assessments,
treatments and procedures, activity and exercise
therapies, client education, and referral activities
required to ensure a smooth and uneventful
discharge
Instruction before clients
leave health care facilities
• Safe and effective use of medications and medical
equipment
• Instruction in potential food-drug interactions and
counseling on nutrition and modified diets
• Rehabilitation techniques to support adaptation to
and/or functional independence in the environment
• Access to available community resources (as needed)
• When and how to obtain further treatment
• The client's and family's responsibilities in the client's
ongoing health care needs and the knowledge and
skills needed to carry out those responsibilities
• Maintenance of good standards for personal hygiene
and grooming
Intensive care unit (ICU)
• clients receive close monitoring and
intensive medical care
• equipped with the most advanced
technologies
• the most expensive delivery site for
medical care
Psychiatric Facilities
• For clients who suffer emotional and
behavioral problems such as
depression, violent behavior, and
eating disorders
• located in hospitals, independent
outpatient clinics, or private mental
health hospitals
• offer inpatient and outpatient
services
Rural Hospitals
• In 1989 the Department of Health and
Human Services to create a new
health care entity, the rural primary
care hospital (RPCH)
• provides 24-hour emergency care
• no more than six inpatient beds
• for providing temporary care for 72 hours
or less to clients needing stabilization
before transfer to a larger hospital
Restorative Care
• goal of restorative care is to assist
an individual in regaining maximal
functional status
• The restorative health care team is
an interdisciplinary group of health
professionals that includes the client
and family or significant others
Home care
• health services are provided to
individuals and families in their home
to promote, maintain, or restore
health, or to maximize the level of
independence while minimizing the
effects of disability and illness
Home care
• infusion therapy
• home dialysis
• home birthing
• wound care
• respiratory care
• ostomy management
Rehabilitation
• the restoration of a person to the
fullest physical, mental, social,
vocational, and economic usefulness
possible
• rehabilitation services include
– physical,
– occupational,
– speech therapy
– social services.
Extended Care Facilities
• provides intermediate medical, nursing, or
custodial care for clients recovering from acute or
chronic illnesses or disabilities
• include intermediate care and skilled nursing
facilities (SNF)
• may include:
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administration of intravenous (IV) fluids,
wound care,
long-term ventilator management,
and physical rehabilitation
• Medicare covers stays at SNFs for 100 days but
at a decreasing dollar amount after the first 20
days
Continuing Care
• describes a collection of health, personal, and
social services provided over a prolonged period
to persons who disabled, who never were
functionally independent, or who suffer a
terminal disease
• is available within institutional settings
– nursing centers or nursing homes
– group homes
– retirement communities
• communities
– adult day care and senior centers
• the home
– home care
– home-delivered meals
– hospice
Area Agencies on Aging
• Older Americans Act (OAA) of 1965
• Each AAA must designate community "focal
points" (multipurpose senior citizen centers,
churches, community centers, hospitals, and
town halls)
• Types of services:
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information and referral for medical and legal advice
psychological counseling
preretirement and postretirement planning
programs to prevent abuse, neglect, and exploitation
programs to enrich life through educational and social
activities
– health screening and wellness promotion
– nutrition services.
Nursing Centers or
Facilities
• provides 24-hour intermediate and
custodial care such as nursing,
rehabilitation, dietary, recreational, social,
and religious services for residents of any
age with chronic or debilitating illnesses
• philosophy of care is to provide a
planned, systematic, and interdisciplinary
approach that helps residents reach and
maintain their highest level of function,
taking into account their feelings,
thoughts, lifestyle, and physical condition
Resident bill of rights
 the right to select a personal attending
physician
 to receive complete information about
one's care
 to have privacy with regard to
accommodations, treatment, and
communication,
 to participate in resident and family
groups and social, religious, and
community activities
Assisted living
• offers an attractive long-term care setting
with a homier environment and greater
resident autonomy
• Services include
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meals
social and recreational programs
personal laundry and housekeeping
transportation
24-hour oversight
an emergency call system
health checks
Respite Care
• service that provides short-term
relief or time off for persons
providing home care to the ill or
disabled
Adult day care centers
• provide a variety of health and social
services to specific client populations who
live alone or with family in the community
• may be associated with a hospital or
nursing facility
• services include transportation, assistance
with personal care, nursing and
therapeutic services (e.g., counseling and
rehabilitation), meals, and recreational
activities
Hospice
• a system of family-centered care
designed to allow clients to live and
remain at home with comfort,
independence, and dignity while
alleviating the strains caused by
terminal illness
• focus of hospice care is palliative
care, not curative treatments
Hospice
• the terminal phase of illness
(generally, the final 6 months or less)
• no further treatment could reverse
the disease process
• providing pain control and comfort
measures
• bereavement counseling to the family
following the client's death