Lecture 10 Flashcards
Other Health Workers: History
Early America
Families relied on female members to provide health care
Other Health Workers: History
Early Nursing
As medicine became controlled by physicians and health care left the home, nursing became a viable occupation for many women
Nursing History: Post Civil War to 1920
Growth of health care institutions
Growth of HC Institutions due to urbanization, industrialization and the spreading out of families which created a need for formal health care
Nursing History: Post Civil War to 1920
Advent Nursing Education
Formal training began in 1873 in NY, Boston, and New Haven: followed the philosophy of Florence Nightingale
Nursing History: Post Civil War to 1920
Maternity Care
by late 1800s the AMA deemed that obstetrics was one of the four major areas of medicine
Nursing History: Post Civil War to 1920
Home Nursing Care
Important source of employment around 1900
Nursing History: 1920 - 1950s
Midwifery
1921 Federal Act on Midwifery Care: set up education and registration for the occupation
Nursing History: 1920 - 1950s
Emergence of Staff Nursing
Shift back from private to hospital nursing
Nursing History: 1920 - 1950s
Some nurses then did what…
Some nurses move away from Direct patient care: During the war years, they became administrators making the space for many levels of nursing to develop.
Nurses and The Field of Nursing
Regulation of nurses
Regulation of Nursing is a State responsibility:
Nurses and The Field of Nursing
Types of Nurses
– Licensed Practical Nurses (LPNs): HS grad, short vocational training
– Diploma Nurses: Three year program in hospital based school
– Associate Degree: Two year nursing education at a community college
– RNs or Baccalaureate Nurses: Under grad curriculum, earned BSN, 1/3 of all nursing graduates
– Advanced Practicing Nurses (APN): Degreed nurses who have additional certifications. Many have Master’s Degrees (give more detail later….)
Nurses: Two Key Social Roles
Caregiver
– Meet patient needs
• Dependency (hygiene, nutrition, safety)
• Comfort (physical and psychological)
• Therapy (medications, other treatments)
– Monitoring (gatherer and recorder of data)
Integrator
– Coordinates several units to provide integrative care
Nurses: Work Setting and Status
• Work Settings
– 80% of all qualified nurses are employed, not contractors
• Occupational Status
– Lack professional autonomy: direct control by doctors
Nurses: Emerging Issues
Two issues
• Education and Image
– Internal strife of caregiver vs. technical professional jobs
• Job Responsibilities and Strains
– Recent years taken on additional responsibilities due to managed care, regulations and certifications
Mid-Level Health Care Practitioners
– Advanced Practice Nurses
• Nurse Practitioner (NPs)
• Certified Nurse Mid-Wife (CNMWs)
• Certified Registered Nurse Anesthetist (CRNAs)
– Physician Assistant (PAs)
Advanced Practice Nurses
Nurse Practitioners: RN + additional training
90% complete Master’s degree
– can do 70-80% of basic primary and preventive care of doctors (medical histories, physical exams, screenings, etc.)
– 248,000 in US today with 80% doing primary care
– regulated by the state
– can work unsupervised from a physician
– Office of Technology Assessment: Reported NPs gave care especially well to chronically ill patients, better taking family into account, know community better for help
Advanced Practice Nurses
Certified Nurse Midwives
RN with additional accredited training in midwifery (make $104k average, per year)
- 11,300 certified in US with 25% in hospitals
– More likely to be in the inner-city
Advanced Practice Nurses
Certified Nurse Anesthetists
RN with additional 1-2yrs training in anesthesiology
– Administer 65% of all anesthetics in the US
– 50,000 in the US; make $160K per year
Physician Assistants
Under direct or indirect supervision of a physician
– Perform most of the basic care of a doctor: even prescribe medications
– Role created to handle routine patient care
Allied Health Workers
New Allied Health Workers Developed: PT and Med Techs due to new diagnostic techniques and treatments
Developed around particular technologies and techniques
– Perform diagnostic tests which physicians then read
Health Care Team: Defined
• Group of highly competent, technical specialists and supporting personnel who execute dramatic, intense, and short-term activities
Physicians and Nurses
Past
Doctor-Nurse Game: Relationship is hierarchical, doctor is super-ordinate, nurses agree and this structure is maintained
Physicians and Nurses
Today
Decline in public’s esteem for doctors and increase in female doctors: stereotypical roles are played out less often
Physicians and Nurses
Nurse now have greater training, specialization and are in under supply
helped nurses received greater respect and status on HC Team. Training has increased their power and prestige.
Physicians and Mid-Level Practitioners
Physicians most comfortable
with mid-level practitioners that supplement their work only and who fall under their direct supervision (PAs, CRNAs)
Physicians and Mid-Level Practitioners
More tension with nurse practitioners
who have additional training and specialized skills
– Independence to provide care: Contentious point b/c ANA calling for APNs to receive direct reimbursement for providing care.
National Health Expenditures [NHE]
Dating back to 1960, the NHEA measures annual U.S. expenditures for health care goods and services, public health activities, government administration, the net cost of health insurance, and investment related to
health care.
Financing Health Care
Financed by a mix of private (employers, individuals and families) and public (federal, state and local governments) purchasers who pay health care providers directly for services and products
Health Care Funding Channels
Blue Cross and Blue Shield (started in 1929): not profit health insurance company: Blues today cover 30% of US with health insurance and are the dominant private insurer in the nation
Medicare: Defined
Three aspects
Federal insurance program: created by Title XVIII of the Social Security Act of 1965
Designed protect people 65 and older rising HC costs
1972: Disabled, their dependents and people with end stage renal disease (kidney) were added
Medicaid
How is it funded?
Jointly funded federal-state-local program to make HC more available to the poor and eligibility varies from state to state
CHIP: Defined
Created in 1997, federal government gives grants to states to pay 2/3rds of the costs for children to have health insurance, who do not have health insurance through their parents and who’s income is above Medicaid law. States pick up the rest.
Entitlement Programs [EP]
Medicare, Medicaid and CHIP are EPs
– Defined as people receive benefits automatically when they qualify for the programs
– Number covered has to do with number >=65 for medicare and number of people who fall below income/asset levels for Medicaid or children not covered by their parents plans…
