HealthCare Delivery Flashcards
**How does the WHO describe health?
state of complete physical, mental, and social well-being,
- Not merely the absence of disease and infirmity
Healthcare
management of the resources for healing
- work together
Delivery of Healthcare
action or activities of supplying or providing services to maintain health, detect illness, and cure those who are ill or injured
American Nursing Association
Healthcare reform agenda
universal access to essential healthcare services
outcomes on research to improve quality
shift priority to health promotion
single-payer system to finance
Health care in the US is moving toward practices that emphasize managing ________ rather than managing illness.
health
Challenges of Healthcare
Uninsured - more likely to skip/delay tx and die prematurely
Cost - lower cost but high quality
Access
Health (edu. behaviors)
Services
New Millenium - tension btw caring and business and cost-saving
Earlier discharges result in more patients needing
nursing homes or home care
What financial information would be beneficial for a nurse to be a better pt advocate?
finances and reimbursements
-Documentation carries a vital role
1 tsp = _____ mL
5
1 Tbsp = _____ mL
15
1 Tbsp = 1tsp
1 oz = ______ mL
30
1 C = ______ oz.
8
1 C = _____ mL
240
1 C = 8 oz / 1 oz = 30 mL / 8 oz = 240 mL
1 kg = ______ lbs
2.2
lbs divided by 2.2 = lbs
- round up if to tenths
- round down if to hundreths
Formula for Dosage
Desired / Have x Quantity
Documentation is used to determine
severity of illness
the intensity of received services
quality of care
Documentation is used to determine what for the insurance companies?
determine payment and reimbursements
DRGs are based on the pts
primary and secondary dx
- the basis for Medicare reimbursements
-advocate for your pt
DRGs mean
Diagnostic Related Group
Is the US the only industrialized country without a national policy?
yes
Individual private insurance
pays a premium to the company
prearranged rates
Out of pocket expenses
Employment-based private insurance
the employer pays all or portion of premiums
both pay
extend to intimate family
-employer tries to reduce coverage they provide so gov. subsidizes by not taxing health insurance with tax benefit
Medicare
over 65
disabled parts A-D
Madigap
Medicaid
mothers children
nursing home care
What are the 3 charitable organizations that Covenant helps?
United Way
Salvation Army
Red Cross
- provide direct support to poor, elderly, children, and vulnerable groups
What are the 6 levels of Healthcare?
Preventative
Primary
Secondary
Tertiary
Restorative
Continuing
Preventative Care
Physician offices, nurse-managed clinics, schools, community, parish, and block nursing
health promotion and prevention of diseases
-Vaccines-nutrition-occupation-
Secondary Care
hospitals, outpatient surgical, specialists (referral)
Early dx, tx, prevention of worsening of disease, illness, injury
Tertiary Care
ICU, oncology, burn, psych, rural hospitals
specialized pt populations
-quaternary care - transplant
Discharge Planning starts when
at time of admission
Discharge Planning consists of
pt hospital needs (edu of health and meds) - learning level
Social workers and Case Mgrs
Home situation and supplies
Post-discharge needs/resources
Instructions
Discharge Planning Benefits
fewer complications
fewer admins
improved outcomes
Discharge Planning Barriers
ineffective communications (to pt and teams)
lack of role therapy
lack of follow-ups
lack of resources (rehab or nursing homes)
If a pt comes back before 24 hours after discharge with a complication, will insurance pay for it?
no
Restorative Care
skilled-nursing rehab, home health
recover from illness/disability
helps max function and enhance the quality of life
Continuing Care
nursing centers (prolonged care for dependents) and assisted living (long-term at home with greater autonomy)
respite care, day care, and palliative care
Respite Care
short term relief for caregivers
Adult Day Care
retain independence by living at home and continuity of care at the center
Hospice Care
home, inpatient, freestanding
*symptoms, not cure
Team Members
- just reference-
Practitioners - physicians and NPs, CRNAs
Assistive - CNAs, Unit secretaries
Nursing - RN, LVN
Supportive - pharmacists and therapists
Specialty - social workers, case mgmt, dieticians, spiritual
Ancillary - EVS, nutrition, security
Social Workers
find assistance for meds, housing, transport, and financial needs
Case Mgmt
helps with plans for pt recovery and home care resources
Direct Care
interaction with nurse and pt
Indirect Care
work on behalf of pts
Why is there such a big critical nursing shortage?
burnout
