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WHO (1986) definition of health is:
“….a state of physical, mental, and social well-being and not merely absence of disease or infirmity”
What is Healthy People 2010?
1. Increase quality and years of healthy life.
2. Eliminate health disparities.
What are the leading health indicators?
- · 1.Physical Activity
- · 2.Overweight and Obesity
- · 3.Tobacco Use
- · 4.Substance Abuse-liver disease, homelessness
- · 5.Responsible Sexual Behavior-std for seniors highest
- · 6.Mental Health- lack of understanding
- · 7.Injury and Violence- increase in crime, guns
- · 8. Environmental Quality- pollution
- · 9. Immunization
- -10. Access to Health Care
What are the 28 focus areas of health?
- · Access to quality health services
- · Arthritis, Osteoporosis, Chronic Back Conditions
- · Cancer
- · Chronic kidney disease
- · Diabetes
- · Disability and Secondary Conditions
- · Educational and Community based programs
- Environmental health
- Family planning
- Food safety
- Health Communication
- Hearing Objectives
- Heart Disease and Stroke
- Immunizations and Infectious Diseases
- Injury and Violence Prevention
- Maternal, Infant, Child health
- Medical Product safety
- Mental Health and Mental Disorders
- Nutrition and Overweight
- Occupational Health
- Oral Health
- Physical Fitness
- Public Health Infrastructure
- Respiratory Diseases
- Sexually Transmitted Diseases
- Substance Abuse
- Tobacco Use
As a nation, what are our health strengths and weaknesses?
- · Strengths: screenings for mammograms, colorectal cancer, annual dental visits
- · Weaknesses: uninsured women, poverty, obesity, coronary heart disease, chronic diseases (asthma, diabetes, BP), reproductive health, life expectancy.
What is Healthy Delaware 2010 initiative?
- · A private-public initiative established to improve the health and quality of life for all Delawareans
- · The motto of Delaware’s plan is prevention
- · Leading State Indicators are similar to the National Leading Health Indicators
- · www.behealthydelaware.org
What are healthy DE goals?
- · Promote healthy behaviors
- · Promote healthy communities
- · Prevent and reduce diseases and disorders
- · Improve health systems
Delaware’s Report Card for health
- Strengths: screenings for cholesterol, mammograms and colorectal cancer
- coronary heart disease
- maternal and infant mortality
- binge drinking
- uninsured females
- access to fruits and vegetables in one’s daily diet
Health promotion activities:
- · Process of enabling people to increase control over, and to improve, their health through education and community based programs.
- · Focuses on facilitating the maintenance of a person’s current position on the continuum relative to age, with movement toward the positive end.
- · Environmental or regulatory measures that protect large groups of people.
- · “Laws” protect the community
Focuses on preventing different diseases that carry one to the negative end of the health spectrum.
- Activities directed at preventing a problem before it occurs.
- · General health promotion
- · good nutrition, adequate shelter, rest, exercise,
- · Specific protection
- · immunization, purification of water, use of car seats,seat belts, smoking cessation
- · Early detection and prompt intervention
- · Screening for disease:
- mammography, blood pressure screening, scoliosis screening, PAP smears, breast self-exams, hearing and vision screening, genetic screening (neonatal, breast cancer)
- · Limitation of disability and rehabilitation
- · teaching newly diagnosed diabetic to self-administer insulin
- · referral for head injured patient to physical therapy
- · support groups for grieving parents after loss of child
- · mental health counseling after rape
Excellent health care in any setting including the community:
- · Requires coordinated effort
- · Requires continuity of care
- · The nurse is usually the “coordinator” of care between patient and family, multiple physicians, and other providers
Continuity of care:
- · Continuity of Care is a bridge to quality care for all individuals of the community.
- · Coordination of activities involving clients, providers, and payers to promote the delivery of healthcare.
- · Healthcare is appropriate, uninterrupted, and coordinated between settings and levels of care
- · Without continuity-care is fragmented, patient and family needs often not met.
- · Requires that discharge planning occur at admission.
Community of Care includes:
- · A seamless admission into the health care system
- · Coordination of care when making
- - referrals
- 1. Discharge/transfer plans
- 2. care plans
- · Setting goals with health care team AND the client
Skills Needed by Nurses in Ensuring Continuity of Care:
- · Communication
- · Teaching
- · Management of care
- · Nursing Process
- · Documentation
What is the nursing process?
- . Assessment
- · Diagnosis
- · Planning
- · Implementation
- · Evaluation
- · A blue print or recipe for care
- · Key events related to a healthcare problem that must occur for the client to reach the outcomes set by the multidisciplinary team.
What is the purpose of referrals and how are they made effective?
- · Purpose-to ensure that appropriate and timely information is communicated in order for client’s needs to be met in optimal way.
- What Makes an Effective Referral?
- · Does it have merit?
- · Is it practical and timely?
- · Is it individualized?
- · Has family been involved?
Financing Healthcare: the history of reimbursement
- · Lillian Wald (1890) convinced the Metropolitan Insurance Company to pay Public Health Nurses to deliver care to immigrants in NYC
- · Post World War II: Retrospective payment system
- · Medicare and Medicaid (1965): Cost containment legislation
- · Healthcare Reform: DRG’s (1983) payment now Prospective
Frameworks for Health Care Delivery:
- · Case Management: method used by some managed care systems to coordinate a patients health care, maximize positive outcomes and contain costs
- · Managed Care: a system designed to control health care costs while maintaining the quality of care
Federally funded health care:
- · Medicare
- · Part A
- · Part B
- · Part D
- · Payment is prospective,
- · based on DRG
- Coverage depends on individual state regulations
Explain what an HMO is:
- no or minimal out of pocket cost
- no choice of providers outside of HMO
- gate keeper for referrals
- supports managed-care concept
- group health plan that allows enrollees to receive all medical services through a group of affiliated providers
Explain what a PPO is:
- allows third party payer (insurance companies) to contract with health care providers to provide services at a lower fee (fee for service)
- more choice of providers
- may seek care outside of PPO without referral
What is private insurance?
- members pay monthly premiums
- choice of physicians and services
- insurance companies pay major health care costs
Longterm care insurance:
- · Requires a premium separate from health care premium
- · Plans cover nursing home, home care, adult day care and respite care
- · Specialized Insurance coverage for patients requiring long term care
Reasons for Increasing Health Care Costs
- · High cost of entitlement programs such as Medicare and Medicaid
- · High cost of biomedical technology and sophisticated care
- · Increased salaries of health care workers
- · High malpractice awards
- · Unhealthy lifestyles such as obesity, lack of exercise, and addictions
- · More people are living longer
Trends in health care delivery:
- Changing demographics
- · Increasing diversity
- · Technology explosion
- · Educated consumer
- · Complexity of patient care
- · Cost of health care
- · Current nursing shortage
- · Health care reform
Primary Health Care:
- · Universally accessible
- · Affordable
- · Health care is based on practical, scientific, and socially acceptable methods and technology
Summary of lecture 2.
- · Community Health Care is meeting the needs of a large segment of the population who require care but are not being cared for in an inpatient setting.
- · Nurses are essential components in community health care.
- Community Health Nursing is a rapidly growing area of healthcare.