FUNDAMENTALS WEEK 3 CH 8 & 10

Case management

* An interdisciplinary process of assessing, planning, facilitating, and advocating for options to meet the healthcare needs of an individual. * Nursing case management is an important method of coordinating care, controlling costs, and improving access to healthcare. The nurse case manager is responsible for these goals and may follow the patient from diagnosis of an illness to hospitalization and then back to home care.

Primary healthcare

* Is defined as essential healthcare based on practical, scientifically sound, and socially acceptable methods and technology, made universally accessible to individuals and families in the community through their full participation and at a cost the community can afford. * Both physicians and nurse practitioners provide primary care, which focuses on the individual patient and is directed by the provider. In contrast, primary healthcare emphasizes universal access and afford- ability of healthcare, health of the whole population, and consumer involvement.

Nurses Role in Primary Health Care Centers

* Makes Health assessments * Performs technical procedures *Assists the physician and/or APRN * Provide health care education

Preferred provider organizations (PPOs)

Allow a third-party payer (agencies that pay healthcare providers for services provided to individuals, such as a health insurance company) to contract with a group of healthcare providers to provide services at a lower fee in return for prompt payment and a guaranteed volume of patients and services. Although patients are encouraged to use specific providers, they may also seek care outside the panel without referral by paying additional out-of- pocket expenses.

Non-Profit

Are financed and operated by local, state, or national agencies and services are provided at little or no cost to the patient. Tax revenue or public funds cover the cost.

Public hospitals

Are nonprofit institutions, are financed and operated by local, state, or national agencies. Patients admitted to a public hospital may not have health insurance, and services are provided at little or no cost to the patient. Tax revenue or public funds cover the cost.

Ambulatory care centers

Are often located in convenient areas such as shopping malls or other community agencies. They offer walk-in services so that appointments are unnecessary, and they are also open at times other than traditional office hours.

Rural health centers

Are often located in geographically remote areas that have few healthcare providers.

Health maintenance organizations (HMOs)

Are prepaid, group-managed care plans that allow subscribers to receive all the medical services they require through a GROUP OF AFFILIATED PROVIDERS. There may be no additional out-of-pocket costs, or subscribers may pay only a small fee, called a copayment. May employ all its providers (including physicians) or may be a group of physicians in alliance who provide care as independent practitioners. THE PATIENT DOES NOT HAVE A CHOICE about healthcare providers but receives all services from physicians who are associated with or are part of the group. Are popular with large employers who support the concept of managed care, and they are also associated with Medicare in some states.

Homeless Shelters

Are usually living units, such as an apart- ment building or home, that provide housing for people who do not have regular shelter. The homeless are at increased risk for illness or injury because of factors such as exposure to the elements, exposure to violence, drug and alcohol addiction, poor nutrition, poor hygiene, and overcrowding.

Occupational therapist (OT)

Assists physically challenged patients to adapt to limitations. Use a variety of adaptive devices and strategies to aid patients in carrying out the activities of daily living.

Social worker

Counsels patients and family members and also informs them of and refers them to various community resources.

Daycare centers

Daycare centers have a variety of purposes. Some centers care for healthy infants and children whose parents work; some also care for children with minor illnesses. Eldercare centers and senior citizen centers provide a place for older adults to socialize and to receive care while family members work.

Physician Assistant (PA)

Has completed a specific course of study and a licensing examination in preparation for providing support to the physician. The ___ responsibilities usually depend on the supervising physician and might include conducting physical examinations and suturing lacerations.

Unlicensed assistive personnel (UAPs)

Help nurses provide direct care to patients. As defined by individual state boards of nursing, may have the title of certified nursing assistants, orderlies, attendants, or technicians.

Custodial services

Homemaking and housekeeping Hourly or shift coverage Live-in services Companionship

"High-technology pharmacy services

Intravenous therapy Home uterine monitoring Ventilator management Chemotherapy

Referrals

Is a person who recommends home care services and supplies the home healthcare agency with details about the patient's needs.

Hospice

Is a program of palliative and supportive care services providing physical, psychological, social, and spiritual care for dying persons, their families, and other loved ones." services are provided by nurses, social workers, therapists, counselors, volunteers, and chaplains working together as an interdisciplinary team.

Palliative care

Is a related area of care that has evolved out of the hospice experience but is used earlier in the dis- ease process. The goal of palliative care is to improve quality of life at the end of life by preventing and relieving suffering through early assessment and treatment of pain and other physical, psychosocial, and spiritual needs.

Respite care

Is a type of care provided for caregivers of homebound ill, disabled, or elderly patients. The main purpose is to give the primary caregiver some time away from the responsibilities of day-to-day care. Professionals or volunteers may provide care in an adult daycare center or in the patient's home.

Palliative care

Is an area of care that has evolved out of the hospice experience, but also exists outside of hospice programs. It is not restricted to the end of life and can be used the initial diagnoses of an incurable illness. Palliative care, which can be used in conjunction with medical treat- ment and in all types of healthcare settings, is focused on the relief of physical, mental, and spiritual distress.

The physician

Is primarily responsible for the diagnosis of illness and the medical or surgical treatment of that illness.

Respiratory therapist (RT)

Is trained in techniques that improve pulmonary function and oxygenation. May also be responsible for administering a variety of tests that measure lung function and for educating the patient about the use of various devices and machines prescribed by the physician.

Speech therapist

Is trained to help hearing-impaired patients speak more clearly, to assist patients who have had a stroke to relearn how to speak, and to correct or modify a variety of speech disturbances in children and adults. Speech therapists also diagnose and treat swallowing problems in patients who have had a head injury or a stroke.

Profit

Make a profit for their services and expect payment for their services.

Registered dietitian (RD)

Manages and plans for the dietary needs of patients, based on knowledge about all aspects of nutrition. Can adapt specialized diets for the individual needs of patients, counsel and educate individual patients, and supervise the dietary services of an entire facility.

Large Industry's

Many ______ _________ have their own ambulatory care clinic, staffed primarily by nurses.

Mental health centers

May be associated with a hospital or may provide services as an independent agency. The services provided may be crisis centered or may involve long-term counseling.

Private hospitals

May be for-profit or nonprofit and are operated by communities, churches, corporations, and charitable organizations. Many patients cared for in private hospitals have some type of personal health insurance or healthcare insurance.

Concepts of home health care

May be provided through community health departments, visiting nurses' associations, hospital-based case managers, and home health agencies. These agencies provide many different health-related services, * including skilled nursing assessment, * teaching and support of patients and family members * direct care for patients

Home healthcare

May be provided through community health departments, visiting nurses' associations, hospital-based case managers, and home health agencies. These agencies provide many different health-related services, including skilled nursing assessment, teaching and support of patients and family members, and direct care for patients.

Community support services

Meals on Wheels services Transportation Friendly visitor Delivery services Emergency answering services

Private, proprietary agencies

Most private, proprietary agencies are for-profit organizations governed by individual owners or national corporations. Their services are paid for through healthcare insurance or individual self-pay.

Skilled professional/ paraprofessional services

Nursing care (provided by a licensed practical nurse, a registered nurse, a clinical nurse specialist, or a nurse practitioner) Care by home health aides Personal care Physical therapy Occupational therapy Speech therapy Medical social work Respiratory therapy

Hospice care

Pain management Physician services Spiritual support Respite care Bereavement counseling

Hospitals

Patients who require complex surgery, who are acutely ill or seriously injured, or who are having babies are hospitalized—and then only for a minimum period of time.

Reimbursement source

Pays for home healthcare services. Although Medicare is the largest single source of reimburse- ment, services are also reimbursed by Medicaid, private insurance, patients or their families, and other public funding.

Private Insurance

Personal healthcare can be financed by private insurance through large, nonprofit, tax-exempt organizations or through smaller, private, for-profit insurance companies. To be insured, members pay monthly premiums either by them- selves or in combination with employer payments.

Primary Health Care Centers

Physicians and advanced practice nurses provide ______ ____________ services in offices and clinics. Services include the diagnosis and treatment of minor illnesses; performing minor surgical procedures; and providing obstetrical care, well-child care, counseling, and referrals.

Pharmacist

Prepared at the doctoral level, is licensed to formulate and dispense medications.Is also responsible for keeping a file of all patient medications and for informing the physician when a potential or actual medication error in prescribing has occurred, or when prescribed drugs may interact adversely. Is an excellent resource for information related to medications for both patients and nurses.

Physical therapist (PT)

Seeks to restore function or to prevent further disability in a patient after an injury or illness. Use various techniques to treat patients, including massage, heat, cold, water, sonar waves, exercises, and electrical stimulation.

Long-Term Care

Provides medical and nonmedical care for people with chronic illnesses or disabilities. Through a variety of services, family, and other caregivers, it assists with activities of daily living for people of any age who are physically or mentally unable to care for themselves independently.

Home medical services

Providing durable medical equipment such as beds, braces, canes, crutches, wheelchairs, commodes, and oxygen

Rehabilitation centers

Specialize in services for patients requiring physical or emotional rehabilitation and for treatment of chemical dependency.

The five core competencies necessary for healthcare professionals to meet the needs of the 21st-century healthcare system

The competencies are based on communication, knowledge, technical skills, critical thinking, and values in clinical practice. These competencies are (1) to provide patient-centered care (2) to work in interdisciplinary teams (3) to use evidence-based practice (4) to apply quality improvement (5) to use informatics

Bereavement care

The continuation of care for the family 1 year after the death of the patient. is called ____________ _______.

family

The patient in home healthcare is both the person receiving care and the person's __________, who often are also the care- givers.

Official or public

These agencies are operated by state agencies or local governments and primarily financed by tax funds. Most offer home care and disease-prevention programs in the community

Voluntary or private not-for-profit agencies

These agencies are supported by donations, endowments, charities (such as the United Way), and insurance reimbursements. They are governed by a board of directors, usually representing the community they serve.

Institution-based agencies

These agencies operate under a parent organization, such as a hospital. The home care agency is governed by the institution, and most referrals for care come from within the institution.

Hospice

_______ services usually begin when the patient has 6 months or less to live.

Legal considerations

________ ____________ in home care involve a variety of factors, including issues of privacy and confidentiality, the patient's access to health information, the patient's freedom from reasonable restraint, informed consent, and matters of negligence and malpractice.

Medicare

________ amendments to the Social Security Act established national and state health insurance programs for the elderly under Title 18. Within a decade, almost all citizens older than 65 years of age held Medicare insurance for hospital care, extended care, and home healthcare.

Medicaid

________ was established in 1965 under Title 19 of the Social Security Act. Is a federally funded public assistance program for people of any age who have low incomes; for the blind, elderly, and disabled covered by sup- plemental security benefits; and for beneficiaries of Aid to Families With Dependent Children. The coverage depends on individual state regulations.

School

__________ nurses are often the major source of health assessment, health education, and emergency care for the nation's children. The role of the school nurse reflects changes in society itself: Children in schools today are from many different racial and ethnic groups, have varying socioeconomic backgrounds, and have more complex disabilities that require expert knowledge and skills for management during school hours.

Managed care systems

are a way of providing care that is designed to control the cost while still maintaining the quality of that care. The care of the individual is carefully planned and monitored by the primary care provider, sometimes referred to as the case manager or "gatekeeper," from the initial contact to discharge from a healthcare episode. A managed care system limits the choice of care providers and may require approval for specialty care.

Nurses Role in Home Health Care

• Assesses the home environment and the patient • Develops the relationship based on mutual trust • Plans, implements, and evaluates the plan of care • Provides direct care • Coordinates care of others • Teaches patient and family • Provides support for family members • Makes referrals

"ELIGIBILITYREQUIREMENTSFOR MEDICARE REIMBURSEMENT FOR HOME HEALTH SERVICES"

• Be confined to the home. • Under the care of a physician. • Receiving services under a plan of care established and periodically reviewed by a physician • Be in need of skilled nursing care on an intermittent basis (provided or needed on fewer than 7 days a week or less than 8 hours of each day for periods of 21 days or less, although extensions may be possible). • Have an intermittent need for physical therapy, speech-language therapy, or to continue occupational therapy.

Nurses Role in Ambulatory care centers

• Makes assessments of health status of patients • Assists (or is) the primary care provider • Provides direct patient care • Coordinates care provided by others • Teaches patients and families • Plans, implements, and evaluates the plan of care • Serves as patient advocate

Nurses Role in Long-Term Care

• Serves as administrator • Coordinates the care provided by others • Provides direct care • Teaches patients and families • Plans, implements, and evaluates the plan of care • Makes referrals

Nurses role in hospital

• Serves as administrator or manager • Assesses and monitors patient's health status • Provides direct care • Coordinates the care provided by others • Teaches patients and families • Plans, implements, and evaluates the plan of care • Provides staff information • Coordinates discharge planning to ensure continuity of care