1. Hospitals and Nursing Centers
Chapter 1
Hospitals and Nursing Centers

2. Hospitals Hospitals provide:
Emergency care, surgery, nursing care, x-ray procedures and treatments, and laboratory testing
Respiratory, physical, occupational, and speech therapies
Care to people of all ages
Care for people having babies, surgery, physical and mental health problems, and broken bones
Care to diagnose and treat medical problems
Care for persons who are dying

3. Hospital Patients Hospital patients have:
Acute illness (a sudden illness from which the person is expected to recover)
Chronic illness (an on-going illness that is slow or gradual in onset and has no known cure)
Terminal illness (an illness or injury from which the person will not likely recover)
Chronic illness can be controlled and complications prevented with proper treatment.
The person with a terminal illness will die.
Hospital stays can last:
Less than 24 hours
Days, weeks, or months

4. Long-Term Care Centers
Long-term care centers are designed to meet the needs of persons who cannot care for themselves but do not need hospital care.
Medical, nursing, dietary, recreational, rehabilitative, and social services are provided.
Persons in long-term care centers are residents.
The center is their temporary or permanent home.
Care needs range from simple to complex.
Residents include:
Persons who are older with chronic diseases, poor nutrition, or poor health
Persons who are disabled from birth defects, accidents, or diseases
Persons discharged from hospitals while still recovering from illness, surgery, or an injury
Some residents recover and return home.
Others need nursing care until death.

5. Long-Term Care Center Residents
Long-term care centers meet the needs of:
Alert, oriented persons
Confused and disoriented persons
Persons needing complete care
Short-term residents
Persons needing respite care
Life-long residents
Mentally ill persons
Terminally ill persons
Alert, oriented persons know who they are, where they are, and what year and time of day it is.
Disability level affects the amount of care required.
Confused and disoriented persons are mildly to severely confused and disoriented.
Some problems are temporary; others are permanent.
Persons needing complete care are very disabled, confused, or disoriented.
Short-term residents need to recover from acute illness, surgery, fractures, and other injuries.
Persons needing respite care go to nursing centers for short stays. The caregiver can go on a trip, tend to business, or simply rest.
Life-long residents may have a disability that occurred before 22 years of age (a developmental disability). Impairments may be physical, intellectual, or both.
With mentally ill persons, behavior and function are affected.
Terminally ill persons may need hospice care. Some are alert and oriented; others are comatose.

6. Long-Term Care Center Residents, cont'd.
Board and care homes provide a room, meals, laundry, and supervision.
A safe setting is provided but not 24-hour nursing care.
Assisted-living residences (ALRs) provide housing, personal care, support services, health care, and social activities in a home-like setting.
Mobility is often required.
Stable health is required.
ALRs must follow state laws and rules.
Residents can usually dress themselves and meet grooming and elimination needs with little help.
Some board and care homes are for older persons. Others are for people with certain problems.
ALR residents need help with some daily activities.
Many residents have problems with thinking, reasoning, and judgment.
The resident can leave the building in an emergency.
Residents have 24-hour supervision and three meals a day.
Services are added or reduced as the person’s needs change.

7. Long-Term Care Center Residents, cont'd.
Nursing centers (nursing facilities, nursing homes) provide health care services to persons who need regular or continuous care.
Licensed nurses are required.
Skilled nursing facilities (SNFs) provide complex care for severe health problems.
Some nursing centers and hospitals provide subacute care.
A hospice is an agency or program for persons who are dying.
The focus is on comfort, not cure.
Alzheimer’s units (dementia care units) are designed for persons with Alzheimer’s disease and other dementias.
In SNFs, medical, nursing, dietary, recreation, rehabilitation, and social services are provided.
Many people are admitted to SNFs from hospitals. Some stay for a short time to recover or for rehabilitation. Others never go home.
Subacute care is complex medical care or rehabilitation when hospital care is no longer needed.
Persons receiving subacute care are often called patients.
In a hospice, the physical, emotional, social, and spiritual needs of the person and family are met. Hospice care is provided by hospitals, nursing centers, and home care agencies.
Persons with Alzheimer’s disease suffer increasing memory loss and confusion.

8. Hospital and Nursing Center Organization
A hospital has a governing body called the board of trustees or board of directors.
An administrator manages the agency.
Directors or department heads manage certain areas.
Nursing centers are owned by an individual, a corporation, or a county health department.
Each center has an administrator.
Department directors report to the administrator.
The board makes policies.
Refer to Figure 1-1 on p. 3.
Hospitals and nursing centers must follow local, state, and federal laws and rules.

9. Hospital and Nursing Center Organization, cont'd.
The health team involves the many health care workers whose skills and knowledge focus on the person’s total care.
In nursing centers, it is called the interdisciplinary health care team.
The goal is to provide quality care.
The person is the focus of care.
An RN leads this team.
Review Table 1-1 on p. 4.
Review Focus on Communication: The Health Team on p. 4.

10. Hospital and Nursing Center Organization, cont'd.
Nursing service
The director of nursing (DON) is responsible for the entire nursing staff and the care given.
The DON is an RN.
Nurse supervisors and nurse managers oversee a work shift, a nursing area, or a certain function.
Nursing areas may have charge nurses for each shift.
Staff RNs report to the charge nurse.
LPNs/LVNs report to staff RNs or to the charge nurse.
You report to the nurse supervising your work.
Functions include staff development, restorative nursing, infection control, and continuous quality.
The charge nurse is responsible for all patient or resident care and for the actions of nursing staff during that shift.

11. Hospital and Nursing Center Organization, cont'd.
Nursing education staff:
Plan and present educational programs (in-service programs) that meet federal and state requirements
Provide new and changing information
Instruct on the use of new equipment
Review key policies and procedures on a regular basis
Teach and train nursing assistants
Conduct new employee orientation programs

12. The Nursing Team Registered nurses:
Assess, make nursing diagnoses, plan, implement, and evaluate nursing care
Develop care plans, provide care, and delegate nursing care and tasks to the nursing team
Evaluate how the care plans and nursing care affect each person
Teach persons how to improve health and independence
Teach the family
Carry out the doctor’s orders or delegate them to other nursing team members
Clinical nurse specialists or nurse practitioners:
Have limited diagnosing and prescribing functions
The nursing team involves RNs, LPNs/LVNs, and nursing assistants.
All focus on the physical, social, emotional, and spiritual needs of the person and family.
An RN has completed a 2-, 3-, or 4-year nursing program and has passed a licensing test.
RNs do not diagnose or prescribe treatments or drugs.
Some RNs become clinical nurse specialists or nurse practitioners.

13. The Nursing Team, cont'd.
Licensed practical nurses and licensed vocational nurses:
Are supervised by RNs, licensed doctors, and licensed dentists
Have fewer responsibilities and functions than RNs do
Need little supervision when the person’s condition is stable and care is simple
Assist RNs in caring for acutely ill persons and with complex procedures
An LPN has completed a 1-year nursing program and has passed a licensing test.
The title of licensed vocational nurse (LVN) is used in some states.

14. The Nursing Team, cont'd. Nursing assistants:
Have passed a nursing assistant training and competency evaluation program (NATCEP)
Perform delegated nursing tasks under the supervision of a licensed nurse
Nursing assistants are discussed further in Chapter 3.

15. Nursing Care Patterns
The pattern used depends on how many persons need care, the staff, and the cost.
Functional nursing focuses on tasks and jobs.
Team nursing involves a team of nursing staff led by an RN.
Primary nursing involves total care.
Case management is like primary nursing.
Patient-focused care involves moving services from departments to the bedside.
With functional nursing, each nursing team member has certain tasks and jobs to do.
In team nursing, the “team leader” delegates care, nursing tasks, and procedures to other nurses and to nursing assistants. Delegation is based on the person’s needs and team member abilities.
With primary nursing, an RN (primary nurse) is responsible for the person’s total care.
With case management, a case manager (an RN) coordinates a person’s care from admission through discharge and into the home setting.
Patient-focused care reduces the number of people caring for each person.

16. Paying for Health Care
Private insurance is bought by individuals and families.
Group insurance is bought by groups or organizations for individuals.
Medicare is a federal health insurance program for persons 65 years of age or older and some younger people with certain disabilities.
Part A pays for some hospital, SNF, hospice, and home care costs.
Part B helps pay for doctors’ services, out-patient hospital care, physical and occupational therapists, some home care, and many other services.
Health care is costly.
Medicare Part B is voluntary. The person pays a monthly premium.

17. Paying for Health Care, cont'd.
Medicaid is a health care payment program sponsored by the federal government and operated by the states.
Prospective payment systems limit the amount paid by insurers, Medicare, and Medicaid.
The amount paid for services is determined before giving care.
Medicare severity-adjusted diagnosis-related groups (MS-DRGs) are for hospital costs.
Resource utilization groups (RUGs) are for SNF payments.
Case mix groups (CMGs) are used for rehabilitation centers.
People with low incomes usually qualify for Medicaid. Some older, blind, and disabled persons also qualify.
With Medicaid, there is no insurance premium. The amount paid for covered services is limited.
With prospective payment systems, the amount paid for services is determined before giving care.
Review Promoting Safety and Comfort: Paying for Health Care on p. 6.

18. Paying for Health Care, cont'd.
Managed care deals with health care delivery and payment.
Insurers contract with doctors and hospitals for reduced rates or discounts.
Managed care limits:
The choice of where to go for health care
The care that doctors provide
Many states require managed care for Medicare and Medicaid coverage.
The insured person uses doctors and agencies providing the lower rates.
The person pays for costs not covered by insurance.
Review the contents of Box 1-1 on p. 6.

19. Meeting Standards
Standards are set by the federal and state governments and accrediting agencies.
A survey team will:
Review policies, procedures, and medical records
Interview staff, patients and residents, and families
Observe how care is given
Observe if dignity and privacy are promoted
Check for cleanliness and safety
Make sure the staff meets state requirements
Standards relate to agency policies and procedures, budget and finances, and quality of care.
The survey team decides if the agency meets the standards.

20. Meeting Standards, cont'd.
If problems (deficiencies) are found:
The agency is given time, usually 60 days at most, to correct the problem.
The agency can be fined for uncorrected or serious deficiencies.
The agency can lose its license, certification, or accreditation.

21. Meeting Standards, cont'd.
Your role involves:
Providing quality care
Protecting the person’s rights
Providing for the person’s and your own safety
Helping keep the agency clean and safe
Conducting yourself in a professional manner
Having good work ethics
Following agency policies and procedures
Answering questions honestly and completely
Review Focus on Surveys: Your Role on p. 7.
Review Focus on PRIDE: The Person, Family, and Yourself on p. 7.