health care dilevery and nursing practic

Chapter 1

Health Care Delivery
and Nursing Practice

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Nursing 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


Health
• 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


Wellness
• 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 Promotion
• Increased emphasis on
– Health
– Wellness
– Self-care
– Health promotion


Question
• 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.


Answer
• 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 Delivery
• Population demographics
– Aging population
– Cultural diversity
– Changing patterns of disease
• Advances in technology, genetics
• Economic changes


Ensuring 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 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 Nurse
• Practitioner
• Leadership
• Research


Question
• 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


Answer
• 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 Delivery
• Primary nursing
• Community nursing, community-oriented/public health
nursing


Expanded 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


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