health care dilevery and nursing practic

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Chapter 1

Health Care Delivery and Nursing Practice

Chapter 1

Health Care Delivery and Nursing Practice


Nursing DefinedNursing Defined

• Florence Nightingale (1858): goal of nursing is “to put patient in best condition for nature to act upon him”

• American Nurses Association Social Policy statement (2003): defines nursing as diagnosis, treatment of human responses to health, illness

• Role of nurse expanding

– Nurse’s functions include identification of health care needs, taking measures to address these needs


HealthHealth

• World Health Organization (WHO) defines health in preamble to constitution: “state of complete physical, mental, and social well-being and not merely the absence of disease and infirmity” (2006)

• Health: ever-changing, best viewed as continuum


WellnessWellness

• Wellness: has been defined as equivalent to health

• Hood and Leddy (2007): wellness has four components:

– Capacity to perform to best of ability

– Ability to adjust, adapt to varying situations

– Reported feeling of well-being

– Feeling that “everything is together,” harmonious


Health PromotionHealth Promotion

• Increased emphasis on

– Health

– Wellness

– Self-care

– Health promotion


QuestionQuestion

• Tell whether the following statement is true or false:

• The health care system in the United States, which traditionally has been disease-oriented, is placing increasing emphasis on health and its promotion.


AnswerAnswer

• True.

• Rationale: The health care system in the United States, which traditionally has been disease-oriented, is placing increasing emphasis on health and its promotion. Today, increasing emphasis is placed on health, health promotion, wellness, and self-care. Health is seen as resulting from a lifestyle oriented toward wellness.


Factors Affecting Health Care DeliveryFactors Affecting Health Care Delivery

• Population demographics

– Aging population

– Cultural diversity

– Changing patterns of disease

• Advances in technology, genetics

• Economic changes


Ensuring Quality Health CareEnsuring Quality Health Care

• Public demand for quality care

• Joint Commission (2007) specifies that patients have right to health care

– Considerate, preserves dignity

– Respects cultural, psychosocial, spiritual values

– Age specific

• Continuous quality improvement

• Evidence-based practice

• Clinical pathways, care mapping


Alternative Health Care Delivery SystemsAlternative Health Care Delivery Systems

• Managed care

– Prenegotiated payment rates

– Mandatory precertification

– Utilization review

– Limited choice of providers

– Fixed-price reimbursement

• Case management: system of coordinating health care services to ensure cost-effectiveness, accountability, quality care


Roles of the NurseRoles of the Nurse

• Practitioner

• Leadership

• Research


QuestionQuestion

• Which role involves actions taken by nurses to meet the health care and nursing needs of individual patients, families, and significant others?

A.Practitioner

B.Leadership

C.Research


AnswerAnswer

• A. Practitioner

• Rationale: The practitioner role involves those actions taken by nurses to meet the health care and nursing needs of individual patients, their families, and significant others. Nursing leadership role involves four components: decision making, relating, influencing, and facilitating. The primary task of nursing research is to contribute to the scientific base of nursing practice. The research role is considered to be a responsibility of all nurses in clinical practice.


Models of Care DeliveryModels of Care Delivery

• Primary nursing

• Community nursing, community-oriented/public health nursing


Expanded Roles of the NurseExpanded Roles of the Nurse

• Nursing roles changing to meet changing health care needs

• Advanced practice roles

– Nurse practitioner

– Clinical nurse specialist

– Certified nurse-midwives

– Certified registered nurse anesthetists

• Collaborative practice


Collaborative Practice Model Collaborative Practice Model

Education

health care dilevery and nursing practic