Chapter 03 - The U.S. Health and Public Health Care Systems
Parents can expect their children to be immunized for communicable diseases before entering kindergarten in the local school system because:
the public health system has mandates for immunization. Rationale: Although the goal of the public health system is to ensure that the health of the community is protected, promoted, and ensured, overlap exists between this system and the primary care system. The overlap comes from the primary care system, which provides health promotion and disease prevention, and through the public health system, which provides personal primary care services for those who cannot afford to receive care elsewhere. The public health system is mandated through laws that are developed at the national, state, and local levels. Examples of public health laws instituted to protect the community are laws mandating immunization for all children entering kindergarten or laws requiring the constant monitoring of the local water supply to make sure that it meets set standards.
What are some of the benefits of an electronic medical record in the public health setting? (Select all that apply.)
- Coordination of referrals and facilitation of chronic disease management. - Improvement of quality measurement and monitoring. - Incorporation of protocol reminders for prevention, screening, and management of chronic disease. Rationale: The electronic medical record (EMR), a form of electronic health record, helps with ensuring patient safety and quality care. The availability of an EMR system allows the embedding of reminders so that the clinician can have access to practice guidelines at the very point of care for patients. Some additional benefits in public health, and these are some of the uses health centers make of such records, include the following: · 24-hour availability of records with downloaded laboratory results and up-to-date assessments · Coordination of referrals and facilitation of interprofessional care in chronic disease management · Incorporation of protocol reminders for prevention, screening, and management of chronic disease · Improvement of quality measurement and monitoring · Increased client safety and decline in medication errors
What are some of the effects of technology in the area of home health care? (Select all that apply.)
- High technology equipment increases expense. - Technology quickly becomes outdated when newer developments occur. - There is inconsistent quality of resources available on the Internet. Rationale: Cost is the most significant negative aspect of advanced health care technology. The more high-technology equipment and computer programs become available, the more they are used. High-technology equipment is expensive, quickly becomes outdated when newer developments occur, and often requires highly trained personnel. There are other drawbacks to new technology, particularly in the area of home health care. These include increased legal liability, the potential for decreased privacy, too much reliance on technological advances, and the inconsistent quality of resources available on the Internet and other places.
What are some examples of programs which may be provided at the local health department level? (Select all that apply.)
- Immunization clinics. - Health education. - Family planning services. Rationale: Some examples of programs that may be offered by local health departments include immunization clinics, health education, and family planning. The range of services varies considerably depending on the size of the area served and the resources available to fund programs. Licensing of health care professionals is conducted at the state level and quality and safety data is typically provided by federal entities.
Primary care refers to personal health care for the most common needs of members of a community. Which of the following statements also differentiates primary care from primary health care? (Select all that apply.)
- Primary care is provided within the context of family and community. - Primary care provides first-contact, continuous, comprehensive, and coordinated care. Rationale: Primary care refers to personal health care that provides first-contact and continuous, comprehensive, and coordinated care. The providing of integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with clients, and practicing in the context of family and community. Primary health care is defined more broadly than is primary care. Primary health care is "essential care" made universally accessible to individuals and families in a community with the full participation of the community and provided at a cost that the community/county can afford. The primary health care workforce is a multidisciplinary team that includes providers from multiple disciplines, community outreach workers, allied health professionals, translators, and community members themselves.
A nurse in community health that administers a local WIC program for women, infants, and children is participating in a federal-state collaborative program that receives oversight from the:
Department of Agriculture (DOA). Rationale: The Department of Agriculture is involved in health care primarily through administering the Food and Nutrition Service, which oversees a variety of food assistance activities in collaboration with state and local government welfare agencies to provide food stamps to needy persons to increase their food purchasing power, as well as school breakfast and lunch programs, grants to states for nutrition education training, and WIC, a supplemental food program for women, infants, and children. The Department of Defense provides health care for members of the military and their dependents. The Department of Health and Human Services maintains primary responsibility for the health of the American people. Agencies within the Department of Labor develop safety and health standards and ensure compliance.
Implementing a community-level program, such as walking for exercise, to assist citizens in improving health behaviors is an example of which level of prevention?
Primary prevention. Rationale: Implementation of a community level program like walking for exercise to assist citizens in improving health behaviors related to lifestyle is an example of primary prevention at the public health level. Implementation of a family-planning program to prevent unintended pregnancies for young couples who attend the local community health center is a secondary prevention activity. An example of tertiary prevention at the public health level is the self-management asthma program for children with chronic asthma to reduce their need for hospitalization. These examples are not disease promotion measures.
A nurse works in a free clinic for uninsured low-wage employees in the community. The free clinic setting operates in a primary health care (PHC) strategy. The nurse would most likely focus on:
Self-care/management. Rationale: Primary health care (PHC) is generally defined more broadly than is primary care. It includes a comprehensive range of services including public health; prevention; and diagnostic, therapeutic, and rehabilitative services. PHC is essential care made universally accessible to individuals and families in a community. Health care is made available to them with their full participation and is provided at a cost that the community and county can afford. PHC encourages self-care and self-management in health and the social welfare of daily life. PHC does not provide a focus on incidence of disease, pathophysiology of disease, or individual orders for care.
A nurse who questions whether a particular activity in her job description is within her scope of practice would look to which government jurisdiction or agency to seek the clarification?
State system. Rationale: Every state has a board of examiners of nurses. The board may be in the department of licensing board of the health department or in an administrative agency of the governor's office. Created by legislation known as a state practice act, the examiners' board is made up of nurses and consumers and, in a few states, other providers and/or administrators. The functions of the board are described in the practice act of each state and generally include licensing and examination of registered nurses and licensed practical nurses; approval of schools of nursing in the state; revocation, suspension, and denial of licenses; and writing of regulations about nursing practice and education. The Department of Labor, the Department of Health and Human Services, and other federal agencies are not responsible for licensure at the state level.
The federal agency most responsible for improving the health status of the American people is the:
U.S. Department of Health and Human Services. Rationale: The U.S. Department of Health and Human Services (USDHHS) is the federal agency most heavily involved with the health and welfare concerns of U.S. citizens. The department includes the Office of the Secretary, 11 agencies, and a program support center. It is charged with regulating health care and overseeing the health status of America. Newer areas in the HHS are the Office of Public Health Preparedness, the Center for Faith-Based and Community Initiatives, and the Office of Global Affairs. The Office of Public Health Preparedness was added to assist the nation and states to prepare for bioterrorism after September 11, 2001.