1. Nursing and the Health Care System
Chapter 1
Nursing and the Health Care System

2. Learning Objectives
Identify 10sites of employment for licensed practical/vocational nurse (LPN/LVN) in medical surgical nursing.
Describe each of the roles of the LPN/LVN.
Explain how a health maintenance organization (HMO)and a preferred provider organization (PPO) differ.
Differentiate between Medicare and Medicaid in areas of eligibility and services provided.
Describe how hospitals are reimbursed under the diagnosis-related group (DRG) system of Medicare.
Discuss four factors that contribute to rising health care costs.

3. Learning Objectives
Define and explain the importance of holistic care.
Discuss how psychological, social, cultural, and spiritual needs are incorporated.
List four practice settings in which LPNs may find employment.
Identify segments within various levels of health care.
Discuss how the standards of practice for the LPN/LVN are applied in the clinical setting.
List practice areas in the community in which you could be employed as a vocational nurse.

4. Common Goals of the LPN/LVN
Uphold clinical standards
Provide safe patient care
Teach patients
Communicate effectively
Work as a collaborative member of the health care team
Advocate for the patient
To accomplish these goals, the practical nurse takes on the role of caregiver, educator, collaborator, and manager.
The nurse's goal is to encourage growth toward wellness so that the patient can once again be self-reliant.
What are interventions?

5. Roles of the Practical Nurse
Caregiver
Implement interventions to improve, maintain, or restore health
Educator
Heath teaching and counseling to promote wellness, prevent illness
Collaborator
Work with RN and health care team to provide continuity of care
Manager
Assign minor tasks to nurse assistant or other ancillary personnel

6. Current Nursing Practice
Nurse Practice Acts
Established in each U.S. state and Canadian province
Defines the role and scope of practice of LPN/LVNs
Regulate the practice of nursing
Designed to protect the public and define legal scope of practice
The practice acts generally define activities in which nurses may engage, state the legal requirements and titles for nursing licensure, and establish the education needed for licensure.
What are the Standards of Nursing Practice?

7. Practice Settings Hospitals Extended care facilities
Outpatient surgery
Intermediate care units (step down units)
IV therapy teams
Emergency rooms
Extended care facilities
Intermediate or long-term care for rehabilitation or custodial care
Physicians’ offices
Ambulatory patients receive preventive care or treatment of illness or injury

8. Practice Settings Ambulatory clinics
Ambulatory patients come for preventive care or treatment of an illness or injury
Rehabilitation Services
Group Homes
Assisted living facilities
Hospices
Supportive treatment for patients who are terminally ill
Home health care
Military
Prisons

9. Practice Settings: Expanded Role of the LPN/LVN
The most common site of employment for the LPN/LVN is the nursing home or long-term care unit.
Charge nurse/manager of care
Delegation and assignment

10. Delegation and Assigning
Delegating:
Transferring to competent unlicensed assistive personnel (UAP’s) the authority to perform a selected nursing task/activity in a selected patient situation within the job description of the LPN/LVN.
Voluntary function
Not all states allow LPN/LVN’s to delegate
Assignment:
Describes the distribution of work that each staff member is to accomplish on a given shift or work period.

11. Delegation: 5 Rights of Delegation
Right task
Right circumstances
Right Person
Right Direction/Communication
Right Supervision

12. Delegation
What should the nurse consider before delegating a specific task?

13. Delegation: Answer Know the scope of practice
Be aware of the staff competency and experience.
Provide adequate explanation and oversight of the task..

14. Health Care Financing: Definitions of Terms
Fee for service
Provider
Deductible
Copayment
Co-insurance
Capitataion
Appeared in the late 1960s and 1970s.
Because research is showing better patient outcomes with more of the care being delivered by nurses, there is a trend back to total patient care.
How is the productivity level increased with primary nursing?

15. Health Care Financing: Definition of Terms
Group Health Insurance
Managed Care-Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs)
Government sponsored health insurance- Medicare and Medicaid
Retrospective payment system
Diagnosis Related Groups (DRG)
Prospective Payment System (PPS)

16. Goals For Health Care
Cost containment- the US spend more money on health care than any other industrialized nation, yet have pooper heath outcomes than other countries (infant mortality, life expectancy)
Health promotion and Healthy People 2020
Holistic care

17. References
deWit, S. (2013). Medical-surgical nursing: Concepts & practice. 2nd ed. St Louis: Saunders Elsevier.

18. Question?
What actions can you take as a nurse to help with cost containment?

19. Today’s Health Care System: Preferred Provider Organizations (PPOs)
Offer discount on fees in return for large pool of potential patients
Allows insurance companies to keep premium rates lower and makes insurance coverage of employees less expensive for employers
There are usually a larger number of physicians to choose from in a PPO than in an HMO.
Who may contract with PPOs?

20. Today’s Health Care System: Health Maintenance Organizations (HMOs)
Enroll patients for a set fee per month
Provide limited network of physicians, hospitals, and other providers from which to choose
One goal is to keep patients healthy and out of the hospital
What are the names of two national HMOs?
Patients must be referred by their primary physician for diagnostic tests, hospitalization (including emergency room visits), and consultation with a specialist.

21. Today’s Health Care System: The Managed Care Environment
Considerable controversy about effectiveness of this approach
Nurses must constantly think about cost containment while trying to give optimal care to patients
Documentation is exacting because every treatment and each use of equipment must be documented with evidence showing it is needed.
Why is vigilant assessment with documentation more important than ever?

22. Medicare and Medicaid Medicare:
Federal program that partially finances health care for all persons over 65 years old age.
Have at least a 10 year record in Medicare-covered employment and are citizens or permanent resident of US.
Given to patients who have end-stage renal disease and permanent and total disability.
Medicaid:
Joint funding state and federal program provides medical assistance for families and individuals with low incomes and poor resources

23. Healthy People 2020
Attain high quality, longer lives free of preventable disease, disability, and the opportunities for progress.
Achieve health equality, eliminate disparities, and improve the health of all groups.
Create social and physical environments that promote good health for all.
Promote quality of life, healthy development, and healthy behaviors across all life stages.

24. Holistic care
Involves being aware of and attending to the following needs of the patient:
Psychological
Physiologic
Social
Cultural
Spiritual

25. Meeting Psychological Needs
Use of empathy
Promote therapeutic nurse patient relationships
Establish trust
Use of therapeutic communication
Maintain patient self-esteem
Display competence
Ensure pain control
Use therapeutic touch

26. Meeting Social Needs
Inability to assume personal responsibilities can be a source of worry for patients and may interfere with positive outcomes after illness or surgery
Financial needs
Home situations-responsibilities, family role

27. Meeting Cultural Needs
Nurses must be open-minded, nonjudgmental
Cultural differences- social class, religion, ethnicity, or sexual preference

28. Meeting Spiritual Needs
Spirituality is an essential part of being human. The spirit is the inner most part of an individual, the spirit encompasses the beliefs and values that provide strength and hope, awareness of self, and understanding of life's meaning and purpose.

29. References
deWit, S. (2013). Medical-surgical nursing: Concepts & practice. 2nd ed. St Louis: Saunders Elsevier.