Levels of Health Care in USA

Levels of health care Preventive Primary Secondary Tertiary Restorative Continuing care

Six core attributes of primary care 1. Excellent primary care is grounded in both the bio-medical and social sciences. 2. Clinical decision making in primary care differs from that in specialty care. 3. Primary care has as its core a sustained relationship between clinical care and clients. 4. Primary care does not consider mental health separately from physical health. 5. Important opportunities to promote health and prevent disease are intrinsic to primary care. 6. Primary care is information intensive.

Focus of health promotion personal hygiene, good nutrition, clean living environments, regular exercise, rest, adoption of positive health attitudes – to keep people healthy through

Preventive and Primary Care School Health Services Occupational Health Services Physicians' Offices Clinics Nursing Centers Primary Health Care in the Community

School Health Services Approximately 50,000 licensed professional school nurses provide health services to children and youth in the school setting Goal: supporting educational success by enhancing health

A school nurse develops programs that foster children's growth, positive life skills for successful coping, acquisition of knowledge and skills for self-care, reinforce positive health attitudes

Specific nursing interventions Health education Parent programming and counseling Communicable disease control Physical assessment Crisis intervention Environmental safety Nutrition planning Emergency care

Occupational Health Services Foundation of occupational health nursing : –epidemiology –worker advocacy –occupational health risk assessment –critical thinking –educational principles

Occupational health nurses conduct environmental surveillance direct nursing care health education communicable disease control counseling administration research

Physicians' Offices Nurse practitionersNurse practitioners: – screen for possible health problems – identify clients' health promotion practices – make recommendations to minimize or control risk factors

RNs - office or practice manager:RNs - office or practice manager: –supervision of secretarial and medical assistant staff and medical record personnel –managing the flow of clients through the office –dealing with physician concerns Physicians' Offices

Clinics (ambulatory health services) Assess and treat ambulatory clients on an outpatient basis May be affiliated with a hospital, medical school, group practice, church, or community organization

Nursing Centers Provide high-quality nursing services with a focus on –health promotion and health education, –disease prevention, –chronic disease management, –support for self-care and caregivers

Nursing Centers Serve vulnerable populations such as minority and ethnic groups of low- income status, older adults, and the disabled –Nurse practitioners –Clinical nurse specialists –Public health nurses

Criteria for nursing centers direct access by the client to the nurse, a nursing model of care, holistic reimbursed services.

Block and Parish Nursing Block nursing happens where the nurse lives for older clients or those unable to leave the home or who are underserved services might include running errands to the grocery store or pharmacy, transporting clients to a physician's office, providing respite care to family members, and being home-maker aides

Block and Parish Nursing Parish nursing is the same as block –churches and synagogues offer the site and support system for the program's activities –themes of clients' perceptions included being available, helping clients to help themselves, and integrating spirituality and health

Primary Health Care in the Community focuses on collaboration of health professionals, community members, and others working in multiple sectors, emphasizing health promotion, development of health policies, and prevention of diseases for all individuals include health education, proper nutrition, maternal/ child health care, family planning, immunizations, and control of locally endemic diseases

Secondary and Tertiary Care hospital emergency departments urgent care centers critical care units inpatient medical-surgical units nurses work closely with all members of the health care team to plan, coordinate, and deliver care for clients who are seriously ill

Hospitals Case management model of care - the case manager coordinates the referral of clients to services provided by other disciplines, ensures that client education has been implemented, and monitors the client's progress through discharge

Hospitals Critical pathway - tool that staff may use to coordinate care multidisciplinary treatment plan that sequences clinical interventions over a projected length of stay or a projected time frame for specific case types typically outlines standard clinical assessments, treatments and procedures, activity and exercise therapies, client education, and referral activities required to ensure a smooth and uneventful discharge

Instruction before clients leave health care facilities Safe and effective use of medications and medical equipment Instruction in potential food-drug interactions and counseling on nutrition and modified diets Rehabilitation techniques to support adaptation to and/or functional independence in the environment Access to available community resources (as needed) When and how to obtain further treatment The client's and family's responsibilities in the client's ongoing health care needs and the knowledge and skills needed to carry out those responsibilities Maintenance of good standards for personal hygiene and grooming

Intensive care unit (ICU) clients receive close monitoring and intensive medical care equipped with the most advanced technologies the most expensive delivery site for medical care

Psychiatric Facilities For clients who suffer emotional and behavioral problems such as depression, violent behavior, and eating disorders located in hospitals, independent outpatient clinics, or private mental health hospitals offer inpatient and outpatient services

Rural Hospitals In 1989 the Department of Health and Human Services to create a new health care entity, the rural primary care hospital (RPCH) provides 24-hour emergency care no more than six inpatient beds for providing temporary care for 72 hours or less to clients needing stabilization before transfer to a larger hospital

Restorative Care goal of restorative care is to assist an individual in regaining maximal functional status The restorative health care team is an interdisciplinary group of health professionals that includes the client and family or significant others

Home care health services are provided to individuals and families in their home to promote, maintain, or restore health, or to maximize the level of independence while minimizing the effects of disability and illness

Home care infusion therapy home dialysis home birthing wound care respiratory care ostomy management

Rehabilitation the restoration of a person to the fullest physical, mental, social, vocational, and economic usefulness possible rehabilitation services include –physical, –occupational, –speech therapy –social services.

Extended Care Facilities provides intermediate medical, nursing, or custodial care for clients recovering from acute or chronic illnesses or disabilities include intermediate care and skilled nursing facilities (SNF) may include: –administration of intravenous (IV) fluids, –wound care, –long-term ventilator management, –and physical rehabilitation Medicare covers stays at SNFs for 100 days but at a decreasing dollar amount after the first 20 days

Continuing Care describes a collection of health, personal, and social services provided over a prolonged period to persons who disabled, who never were functionally independent, or who suffer a terminal disease is available within institutional settings –nursing centers or nursing homes –group homes –retirement communities communities – adult day care and senior centers the home –home care –home-delivered meals –hospice

Area Agencies on Aging Older Americans Act (OAA) of 1965 Each AAA must designate community "focal points" (multipurpose senior citizen centers, churches, community centers, hospitals, and town halls) Types of services: –information and referral for medical and legal advice –psychological counseling –preretirement and postretirement planning –programs to prevent abuse, neglect, and exploitation –programs to enrich life through educational and social activities –health screening and wellness promotion –nutrition services.

Nursing Centers or Facilities provides 24-hour intermediate and custodial care such as nursing, rehabilitation, dietary, recreational, social, and religious services for residents of any age with chronic or debilitating illnesses philosophy of care is to provide a planned, systematic, and interdisciplinary approach that helps residents reach and maintain their highest level of function, taking into account their feelings, thoughts, lifestyle, and physical condition

Resident bill of rights the right to select a personal attending physician to receive complete information about one's care to have privacy with regard to accommodations, treatment, and communication, to participate in resident and family groups and social, religious, and community activities

Assisted living offers an attractive long-term care setting with a homier environment and greater resident autonomy Services include –meals –social and recreational programs –personal laundry and housekeeping –transportation –24-hour oversight –an emergency call system –health checks

Respite Care service that provides short-term relief or time off for persons providing home care to the ill or disabled

Adult day care centers provide a variety of health and social services to specific client populations who live alone or with family in the community may be associated with a hospital or nursing facility services include transportation, assistance with personal care, nursing and therapeutic services (e.g., counseling and rehabilitation), meals, and recreational activities

Hospice a system of family-centered care designed to allow clients to live and remain at home with comfort, independence, and dignity while alleviating the strains caused by terminal illness focus of hospice care is palliative care, not curative treatments

Hospice the terminal phase of illness (generally, the final 6 months or less) no further treatment could reverse the disease process providing pain control and comfort measures bereavement counseling to the family following the client's death