1. Health Care Delivery Systems Dr. Belal Hijji, RN, PhD November 21, 2010

2. 2 Learning Outcomes At the end of this lecture, students will be able to: Discuss the various types of health care services. Describe the roles of some common health care providers. Identify selected frameworks for the delivery of nursing care.

3. 3 Types of Health Care Services Health care services are often described according to the levels of disease prevention. These levels are: –Primary prevention: Health promotion and illness prevention. The World Health Organisation (WHO) developed the “Healthy People” project to emphasise the importance of maintaining an optimum level of wellness. Primary prevention programmes address areas such appropriate nutrition, weight control and exercise, and stress reduction. Illness prevention programmes may be directed at individual or community and involve such practices like immunisation, identifying risk factors for illness, and helping people take measures to prevent the occurrence of these illnesses.

4. 4 –Secondary prevention: Diagnosis and treatment. Health care institutions offer diagnostic and therapeutic services. Hospitals allocate significant resources on patients in need of emergency, intensive, and around-the-clock acute care. Early detection of disease as a health promotion service is also existing. This is accomplished through routine screening of the population and focused screening of individuals at risk of developing certain conditions. Examples include regular dental exams from childhood throughout life and bone density studies for women at menopause to evaluate for early osteoporosis.

5. 5 –Tertiary prevention: Rehabilitation, health restoration and palliative [تلطيفية] care. The goal of tertiary prevention is to help people move to their previous level of health or to the highest level they are capable of. Through rehabilitation, clients are assisted to function adequately in the physical, mental, social, economic, and vocational areas of their life. For example, a client with restrictions in the ability to perform daily activities, due to a temporary injury of back, may benefit from rehabilitation to return to the former function. If return to health is not possible, palliative care is possible through providing comfort and treatment of symptoms.

6. 6 Providers of Health Care Health professionals are health care providers include nurses and health personnel from different disciplines who coordinate their skills to assist clients and their carers. The mutual goal of care providers is to restore the client ’ s health and promote wellness (Next slide). A description of common health care providers is given on slide 8.

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8. 8 Nurse A registered nurse (RN) assesses the client ’ s health status, identifies health problems, and develops and coordinates care. A licensed practical nurse (LPN) provides care under direct supervision of a registered nurse, physician, or other licensed practitioner. Advanced practice nurses (APNs) provide direct client care as nurse practitioners, nurse midwives, certified registered nurses anesthetists, and clinical nurse specialists. These nurses may be allowed to provide primary care and prescribe medications.

9. 9 Alternative Care Providers Alternative health care refers to services offered by chiropractors, herbalists, accupuncturists, massage therapists, refloxologists, and healers. These providers may work alongside Western health personnel.

10. 10 Dentists Dentists diagnose and treat dental problems. They are also involved in preventive measures to maintain healthy oral structures.

11. 11 Dietitians Dietitians have knowledge about diets that maintain health and treat disease. They may design special diets to meet nutritional needs of clients and supervise the preparation of meals to ensure that clients receive proper diet. The community dietitian often function at the preventive level. They promote health and prevent disease, for example, by advising families about balanced diet for growing children and pregnant women.

12. 12 Occupational Therapists An occupational therapist (OT) assists clients with impaired function to gain the skills to perform the ADL. For example, an OT may teach a client with severe arthritis affecting arms and hands how to adjust his kitchen utensils so that he can continue to cook.

13. 13 Pharmacists A pharmacist prepares and dispenses pharmaceuticals. S(h)e monitors and evaluates the actions and effects of medications on clients. A clinical pharmacist is a specialist who guides physicians in prescribing medications.

14. 14 Physical Therapists A physical therapist (PT) assists clients with musculoskeletal problems, and treats movement dysfunction by means of heat, water, exercise, and massage. A PT assesses client mobility and strength, provides therapeutic measures, and teaching new skills (walking with an artificial leg).

15. 15 Physicians The physician is responsible for medical diagnosis and for determining the therapeutic plan for an ill client. Physicians nowadays include health promotion and disease prevention in their practice. Physicians could be general practitioners, dermatologists, neurologists, oncologists, or surgeons.

16. 16 Podiatrists A podiatrist is a doctor who diagnoses and treats foot conditions. He can perform surgery and prescribe drugs.

17. 17 Spiritual Support Personnel Chaplains [ قساوسة ], pastors [ قس، راعي الأبرشية ], priests, and other religious advisors attend to the spiritual needs of clients, and offer religious services. Nurses can identify the client ’ s spiritual needs and notify the appropriate person.

18. 18 Unlicensed Assistive Personnel (UAP) An UAPs are health care staff who assume delegated aspects of basic client care, such as bathing, assisting with feeding, and collecting specimens.

19. 19 Frameworks For Nursing Care There is a number of frameworks for the delivery of nursing care. These include case method, functional method, team nursing, and primary nursing. –Case method: This is referred to as total care. In this method, one nurse is assigned to and is responsible for the comprehensive care of a group of clients during a shift. For each client, the nurse assesses needs, formulates nursing diagnoses, plans care and implements interventions, and evaluates the effectiveness of care.

20. 20 –Functional method: This method focuses on the jobs that need to be completed (e.g., bed making, vital signs recording, dressings). In this task- oriented approach, personnel with less preparation than the professional nurse perform less complex care requirements. It is based on a production and efficiency model that gives authority and responsibility to the person assigning the work. This approach to nursing care is economical and efficient and allows centralised direction and control. Its disadvantages are fragmentation of care and nonquantifiable aspects of care may be overlooked.

21. 21 –Team nursing: Team nursing is the delivery of individualised nursing care by a team led by a professional nurse. A nursing team consists of registered nurses, LPNs, and UAP. This team is responsible for providing coordinated nursing care to a group of clients. The registered nurse retains responsibility and authority for client care but delegates appropriate tasks to the other team members.

22. 22 –Primary nursing: Primary nursing is a system in which one nurse is responsible for overseeing the total care of a number of clients 24 hours a day, 7 days a week, even if he does not deliver all the care personally. Primary nursing uses the nurses ’ technical knowledge and management skills. The primary nurse assesses and priortises each client ’ s needs, identifies nursing diagnoses, develops a plan of care, and evaluates the effectiveness of care. Associates provide some care, but the primary nurse coordinates it and communicates information about the client ’ s health to other nurses and other health care providers. The primary nurse is a teacher, advocate, decision-maker, and first-line manager of the client ’ s care.