1. Chapter 4: Health and Illness Carolyne Richardson-Phillips PNU 145 Fall 2015 Pages 50-59

2. Learning Objectives By the end of this session, the PN students will be able to: 1. Describe how the World Health Organization (WHO) defines health 2. Discuss the difference between values and beliefs and list health beliefs common among Americans 3. Define Wellness and Holism and how they relate to the health of a person 4. Identify Maslow’s five levels of human needs 5. Define illness and the terms used to describe illness 6. Differentiate primary, secondary, tertiary, and extended care 7. Discuss the health payment systems that help finance health care for the aged, disabled, and poor 8. List four methods to control escalating health care costs. 9. Identify “Healthy People 2020”, the goals and health indicators 10. Discuss five patterns that nurses use to administer client care

3. Nursing Nurses need to be committed to helping people prevent illness & restore or improve their health These goals accomplished by: Helping people live healthy lives Encouraging early diagnosis of disease Implementing measures to prevent complications of disorders

4. Health WHO (World Health Organization) defines health as a state of complete physical, mental, & social well-being, not merely the absence of disease or infirmity: global commitment to “Health for All” Each person has their own opinion of what health means to them Nurses to respect these differences Values: ideals that a person feels are important Beliefs: concepts a person holds to be true Person’s actions/behaviors-guided by values-beliefs American health belief Limited Resource: no substitute; “as long as you have your health, you have everything” A Right: everyone is entitled to health care according to the principles of USA; not always true as health disparities exist among various groups A Personal Responsibility: Requires continuous personal effort Much potential for illness as there is for health Nurses have a duty to protect and preserve health of those who may not be able to assert this right for themselves Americans believe one or all of the following Health is a resource, a right, a personal responsibility

5. Wellness and Holism Wellness: Balance of all aspects of health involves: Physical health Emotional health Social health Spiritual health Holism: sum of physical, emotional, social, and spiritual health Determines how “whole” or well a person feels Nurses-”holistic practitioners-committed to restoring balance in each of the four spheres that affect health Based on hierarchy of human needs

6. Maslow’s Hierarchy of Human Needs Identified 5 levels of human needs that motivate behavior First level: Physiological Most important-necessary for life Second: Safety and Security Third: Love and Belonging Fourth: Esteem and Self Esteem Fifth: Self Actualization Believed that by satisfying needs at each level-people realize their potential for health & well-being Tools used by nurses for each settings Priorities for client care

7. Illness State of discomfort Highly subjective & individualized May result from physical, emotional, intellectual, social or spiritual deterioration, from disease, deterioration or injury which impairs the person’s health Morbidity: incidence of a specific disease, disorder or injury; refers to -Rate or number of people affected within population Mortality: incidence of deaths; number of people who died from a particular disease or condition

8. Types of Illnesses Acute illness: symptoms develop suddenly Lasts a short period of time-usually curable May lead to long-term problems b/c of their sequelae-ill effects from permanent/progressive organ damage caused by disease or its treatment Chronic illness-comes on slowly Lasts a long time - may last a lifetime Increases as people age May have periods of remission & exacerbation Terminal illness: no potential for cure; terminal stage of an illness- person is approaching death Primary illness: one that develops independently of any other disease Secondary illness: a disorder that develops from a pre-existing condition Remission: s & s associated with a particular disease disappear; resembles a cured state, but may be temporary Exacerbation: s & s reappear - or one that reverts from a chronic to an acute state; can occur periodically in clients w/ long-standing diseases

9. Illnesses (cont’d) Hereditary condition - disorder acquired from the genetic codes of one or both parents and symptoms may or may not be present at birth Congenital disorders - present at birth but which are the result of faulty embryonic development and cannot be genetically predicted Idiopathic illness -an unexplained cause Treatment focuses on relieving signs/symptoms

10. Health Care System Network of available health services Includes agencies- institutions where people seek treatment for health problems or assistance with maintaining or promoting their health Changes on-going with system Advances in technology, & new discoveries More modern methods of diagnosing & treating diseases- creating a need for specialized care Now a complex system involving types of health care Primary Secondary Tertiary Extended care

11. Primary Health Care Primary Health and Illness prevention- Promotes health and preventing development of disease and injury Health Services: provided by first health care professional or agency a person contacts Family practice physician, nurse practitioner, physician’s assistant in an office or clinic Focuses on health promotion Protection against specific health problems Illness prevention Preventive care Health education Environmental protection

12. Secondary Care Secondary Health and Illness Prevention-Focus on early identification (screening) of health problems & prompt treatment Primary caregivers refer clients for consultation if needed or additional testing- to help with diagnosis –recovery– (Ex: Blood pressure, cholesterol, Cardiac Catheterization lab, X-rays, oncologist, skin care, diabetes, HIV, skin cancer etc.) Prompt intervention to alleviate health problems Diagnosis & treatment Emergency care Acute care

13. Tertiary Care Tertiary-Care given to minimize the effects of a condition – Helps to prevent long-term complications if possible Begins after an illness Health services provided at hospitals or medical centers with Clinics-complex technology and specialists May be Outpatient care May need to travel from Home to facilities to receive Care Ex: Chemotherapy, Wound care, Diabetes

14. Extended Care Services that meet the health needs of clients who no longer require acute hospital care Rehabilitation, skilled nursing in person’s home or a nursing home, and hospice care for dying clients Assisted LivingNursing Facility Rehabilitation

15. Access to Care There are still millions of uninsured people in the USA because of economic burden Groups with inadequate health care include: Children, Older adults, Ethnic minorities, Poor Many delay seeking treatment-can not afford to pay or insurance may not pay Facilities – physicians –pharmacies - not close for care May go to emergency room when needing care Inappropriate use of emergency departments –expensive-long waits & no follow-up

16. 16 Financial Health Care System Payments

17. Financing Health Care Payment Sources in USA - Private insurance - Self-insurance systems - Medicare - Medicaid

18. Financing Health Care (cont’d) Medicare-Federal program- finances health care costs of persons 65 years and older, permanently disabled workers of any age and their dependents, and those with end-stage renal disease; funded primarily through withholdings from employed person’s income Part A covers-acute hospital care, rehab care, hospice & home care services Part B- purchased for an additional fee-covers MD services, outpatient, labs, medical equipment Part D: 2006-additional fee – covers a portion of medications Medicaid-A state administered program designed to meet the needs of low-income residents Funded from federal, state and local sources Each state determines how funds are to be used Covers-hospitalization, diagnostic tests, MD visits, rehab & outpatient care Long-term care- when he/she runs out of their own money

19. Financing Health Care (cont’d) Prospective Payment Systems- for people enrolled in Medicare – Hospitals Reimbursed at a predetermined set rate regardless of length of stay, acuity or complexity of client’s care Payments based on Diagnostic-related group (DRG)-a classification system used to group clients with similar diagnoses If costs are less-hospital keeps difference If costs exceed reimbursed amount-hospital has deficit Limits amount paid to hospitals that receive Medicare payments Hospitals try to treat & discharge as early as possible for decreased hospital days In Nursing facilities/Rehabilitation units-Form used to determine documentation & reimbursement to the State-called MDS (Minimum Data Set)

20. Financing Health Care (cont’d) Managed Care Organizations - Private insurers carefully plan- supervise distribution of client’s health care services Control costs-use resources efficiently- & focus more on prevention (ex. Screening, education, health promoting activities) Types of Managed Care: Health Maintenance Organizations (HMO): corporations that charge preset, fixed, yearly fees in exchange for providing health care for their members - fee does not change regardless of health issues Emphasize client wellness-Offer preventive services, periodic screenings, health education

21. Types: Managed Care Organizations (cont’d) Preferred Provider Organizations (PPOs) Agents for insurance companies-control costs on basis of competition Create a network of a community’s physicians- willing to discount fees for exchange of referred clients Capitation Different from HMOs & PPOs Payment system with a preset fee per member is paid to healthcare provider-regardless of whether or not member requires services Incentive to providers to control tests- services to make a profit If members do not receive costly care, provider receives money

22. National Health Goals: Healthy People 2020 Healthy People 2020 tracks approximately 1,200 objectives organized into 42 topic areas, each of which represents an important public health area Four overarching goals: Attain high-quality, longer lives free of preventable disease, disability, injury, and premature death Achieve health equity, eliminate disparities, and improve the health of all groups Create social & physical environments that promote good health for all Promote quality of life, healthy development, and healthy behaviors across all life stages. Within these issues- also focus areas that need to be worked on: health insurance, education of health, wellness, and facilities, reduce number of cases of cancer & deaths, illness, disability, reduce infections from food-borne pathogens, improve vision & hearing Because objectives are national, not solely federal, achievement is dependent in part on the ability of health agencies at all levels of the government and on non- governmental organizations to assess objective progress. Nurses Roles: prevention and patient education HealthyPeople.Gov 2020-updated 8/28/2013, http://www.healthypeople.gov/2020/about/default.aspx. http://www.healthypeople.gov/2020/about/default.aspx

23. Nursing Team Nursing Team: Personnel who care for client’s directly Goal: to help clients attain, maintain, or regain health May include several types of professionals, allied health care workers with special training Nurses – have unique skills to work in various settings in health field Use several common management patterns Five common ones used: Functional nursing, Case method, Team nursing, Primary nursing, Nurse-managed care

24. Functional Nursing, Case Method & Team Leader Functional Nursing Each nurse is assigned specific tasks Used less often-D/T more task oriented & less focused on the individuality of care Case Method: one nurse manages all the care a client or group of clients needs for a designated period of time Used in home health, public health nursing, & community mental health nursing Nurses known as case managers Team Leader: clients are divided into groups & complete their care together which is organized & directed by a nurse May assist but usually assigns or supervises the care the team members provide Members report the outcomes of their care to the team leader Responsible for evaluating whether the goals of client care are met Daily conferences are important to discuss client’s progress towards recovery & discharge

25. Primary Nursing Admitting nurse assumes responsibility for planning client care and evaluating the progress of client May delegate client’s care to someone else in his or her absence BUT Is consulted when new problems develop or plan of care required modifications Remains responsible, accountable for client until discharge

26. Nurse-Managed Care & Continuity of Health Care Nurse-Managed Care: a nurse manager plans nursing care of clients based on their type of case or medical diagnosis A clinical pathway is used to manage the care Nurse acts as case manager to evaluate whether predictable outcomes are met on a daily basis Meeting the outcomes in a timely manner allows for a timely discharge Approach ensures standards of care are met with efficiency and cost savings System developed d/t nursing shortage & need to balance costs with limited reimbursement systems Continuity of Health Care: maintenance of health care from one level of health to another and from one agency to another Ensures that client navigates the complicated health care system with maximum of efficiency & minimum of frustration Goal: avoid causing client-ill or healthy, to feel isolated, fragmented, or abandoned

27. Patient Protection & Affordable Care Act (ACA) New system will create new payment systems and conditions for reimbursement, moving away from the traditional fee for service in favor of putting doctors & others into “capitated” or salaried payment systems with new reporting requirements The reimbursement reforms under ACA are designed to contain cost with implementation of public health and prevention programs in avoiding the costly health consequences of chronic diseases, such as heart diseases and diabetes Preventive care also includes screening program for cancer, immunizations, healthy eating and exercises, tobacco cessation, and substance abuse.

28. References Healthy People 2020 (2013); Retrieved on 5/8/14 from web site: www.HealthyPeople.Gov2020.com www.HealthyPeople.Gov2020.com Images retrieved from web site: www.http:// googleimages.com on June 14, 2015 Lippincott Williams & Wilkins, (2013) (10 th ed.) Lippincott Manual of Nursing Practice-Online Electronic Medical Library, retrieved on 4/29/2014 from web site:http://online.statref.com/Document.aspx?fxId=485&docId=10 Timby, B. K. (2013). (10 th ed.). Fundamental Nursing Skills and Concepts. Philadelphia: PA. Lippincott Williams & Wilkins