Lecture 10

Question 1

Other Health Workers: History

Early America

Answer 1

Families relied on female members to provide health care

Question 2

Other Health Workers: History

Early Nursing

Answer 2

As medicine became controlled by physicians and health care left the home, nursing became a viable occupation for many women

Question 3

Nursing History: Post Civil War to 1920

Growth of health care institutions

Answer 3

Growth of HC Institutions due to urbanization, industrialization and the spreading out of families which created a need for formal health care

Question 4

Nursing History: Post Civil War to 1920

Advent Nursing Education

Answer 4

Formal training began in 1873 in NY, Boston, and New Haven: followed the philosophy of Florence Nightingale

Question 5

Nursing History: Post Civil War to 1920

Maternity Care

Answer 5

by late 1800s the AMA deemed that obstetrics was one of the four major areas of medicine

Question 6

Nursing History: Post Civil War to 1920

Home Nursing Care

Answer 6

Important source of employment around 1900

Question 7

Nursing History: 1920 - 1950s

Midwifery

Answer 7

1921 Federal Act on Midwifery Care: set up education and registration for the occupation

Question 8

Nursing History: 1920 - 1950s

Emergence of Staff Nursing

Answer 8

Shift back from private to hospital nursing

Question 9

Nursing History: 1920 - 1950s

Some nurses then did what…

Answer 9

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.

Question 10

Nurses and The Field of Nursing

Regulation of nurses

Answer 10

Regulation of Nursing is a State responsibility:

Question 11

Nurses and The Field of Nursing

Types of Nurses

Answer 11

– 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….)

Question 12

Nurses: Two Key Social Roles

Answer 12

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

Question 13

Nurses: Work Setting and Status

Answer 13

• Work Settings
– 80% of all qualified nurses are employed, not contractors

• Occupational Status
– Lack professional autonomy: direct control by doctors

Question 14

Nurses: Emerging Issues

Two issues

Answer 14

• 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

Question 15

Mid-Level Health Care Practitioners

Answer 15

– Advanced Practice Nurses
• Nurse Practitioner (NPs)
• Certified Nurse Mid-Wife (CNMWs)
• Certified Registered Nurse Anesthetist (CRNAs)

– Physician Assistant (PAs)

Question 16

Advanced Practice Nurses

Nurse Practitioners: RN + additional training

Answer 16

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

Question 17

Advanced Practice Nurses

Certified Nurse Midwives

Answer 17

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

Question 18

Advanced Practice Nurses

Certified Nurse Anesthetists

Answer 18

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

Question 19

Physician Assistants

Under direct or indirect supervision of a physician

Answer 19

– Perform most of the basic care of a doctor: even prescribe medications
– Role created to handle routine patient care

Question 20

Allied Health Workers

Answer 20

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

Question 21

Health Care Team: Defined

Answer 21

• Group of highly competent, technical specialists and supporting personnel who execute dramatic, intense, and short-term activities

Question 22

Physicians and Nurses

Past

Answer 22

Doctor-Nurse Game: Relationship is hierarchical, doctor is super-ordinate, nurses agree and this structure is maintained

Question 23

Physicians and Nurses

Today

Answer 23

Decline in public’s esteem for doctors and increase in female doctors: stereotypical roles are played out less often

Question 24

Physicians and Nurses

Nurse now have greater training, specialization and are in under supply

Answer 24

helped nurses received greater respect and status on HC Team. Training has increased their power and prestige.

Question 25

Physicians and Mid-Level Practitioners

Physicians most comfortable

Answer 25

with mid-level practitioners that supplement their work only and who fall under their direct supervision (PAs, CRNAs)

Question 26

Physicians and Mid-Level Practitioners

More tension with nurse practitioners

Answer 26

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.

Question 27

National Health Expenditures [NHE]

Answer 27

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.

Question 28

Financing Health Care

Answer 28

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

Question 29

Health Care Funding Channels

Answer 29

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

Question 30

Medicare: Defined

Three aspects

Answer 30

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

Question 31

Medicaid

How is it funded?

Answer 31

Jointly funded federal-state-local program to make HC more available to the poor and eligibility varies from state to state

Question 32

CHIP: Defined

Answer 32

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.

Question 33

Entitlement Programs [EP]

Answer 33

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…