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Being a Nursing Assistant, Ninth EditionFrancie Wolgin

Pearson EducationCopyright 2005

Being aNursing

AssistantNinth Edition

Francie Wolgin

Chapter One

The Health Care System

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Purpose and Functions of Health

Car e Delivery System

Definition: Involve the facilities designed for the delivery of health car e and the

health car e pr ovider s who deliver these ser vices.

Purpose Meet the health car e needs of all individuals

5 Basic Functions: Pr ovide car e for ill and/or injur ed people

Pr event disease

Pr omote individual and community health

Pr ovide facilities for the education of health worker s

Pr omote r esear ch in the sciences of medicine and nur sing

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Patient care is delivered in several ways:

Inpatient

Outpatient

Short-term/long-term

Patient¶s home



Health Car e Delivery System

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DRG¶s and Managed Car e

Influence Health Car e Systems

DRG¶s Diagnostically r elated gr oups of patients r elated by

body system or disease type Basis for payment for Medicar e patients

Method to assess pr ovision of quality car e

Set payment fees based on DRG assigned

CPT coding Curr ent Pr ocedur al Ter minology

Gr oups of five number s to classif y pr ocedur e or ser vices for billing purposes

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Managed Car e

Var iety of or ganizations with

Pr epayment agr eements,

Negotiated contr acts & discounts,

Agr eements for pr ior ser vice author ization or

appr oval,

Per for mance audits

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Managed Car e (continued)

Types

Health Maintenance or ganization

Pr eferr ed pr ovider or ganizations

Business str ategy wher eby health car e

financing and delivery ar e combined tobalance costs, quality of car e, and access.

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HIPP A²Health Insur ance Por tability and

Accountablity Act

Feder al r egulations that gover ns and pr otectsindividual¶s pr ivacy and the secur ity of health

infor mation (medical r ecor ds). It also standar dizes

electr onic tr ansactions and the use of unique

identifier s( ie. Employer's Tax ID)

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Privacy Standards

(HIPAA)

Protects the confidentiality of medical records and other

personal health information.

Limits the use and release of individually identifiable health

information. Gives patients the right to access their medical records.

Restricts most disclosure of health information to the

minimum needed for the intended purpose.

Improper uses or disclosures under the rule are subjectto criminal and civil sanctions prescribed in HIPAA.



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Or ganizing Patient Car e

Ser vices/Nur sing Health Car e Team

Method of deliver ing health car e ser vices

Functional nur sing(char ged nur se or nur se

manager )

Char ge Nur se assigns and dir ects patient car e

Duties ar e assigned for tasks such as passing

medications, tr eatment, etc. for all the patients.

Member s of the staff ther efor e only per for m the

task assigned on all patients

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Team nur sing (or nur se manager )

Resour ce Nur se divides staff into teams

Each team has a designated leader and gr oup of patients

Team member s per for m the tasks necessary to

take car e of that gr oup of patients based on

what they can do by job descr iption

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Pr imary nur sing

Pr ofessional nur se (RN) is r esponsible and

accountable for the entir e nur sing car e of apatient for 24 hour s

System is focused on the needs of the patient

Associate nur se will pr ovide car e for the patient

when the pr imary nur se is absent

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Figure 1±3 The nur sing car e health team

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Par tner s in pr actice

Car e is deliver ed with a Pr imary nur se or

combination of pr imary car e nur se with anur sing assistant as a team

Team takes car e of a gr oup of patients.

Other par tner ships may occur with an RN and

LPN or RN and Respir atory Ther apist

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Patient-focused car e

Involves small team of cr oss-tr ained car egiver s

to deliver patient car e in a specific unit or ar ea. Member s ar e cr oss tr ained with other

depar tments for example: dr awing blood

samples; running EKG or pr oviding other skilled

car e of the other disciplines in healthcar e

Multidisciplinary appr oach to health car e

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Figure 1±4 A multidisciplinary team pr ovides patient-focused/patient-

center ed car e; when possible the team includes the patient and the

patient¶s family

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Purpose and Function of

Multidisciplinary Team Appr oach

Multidisciplinary team consists of pr ofessionals and nonpr ofessionals

f r om differ ent disciplines that work together to plan, make decisions, andimplement car e focused on the patient.

Patient focuses vs. par ticular discipline¶sneeds

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Differ ence Between Qualifications of

the Differ ent Nur sing Team Member s

RN

Register ed Nur se has completed a tr aining

pr ogr am of either 2, 3, or 4 year s andpassed the state boar d licensing testing

Able to assess a patient for what ar e thepr oblems, concer ns, and needs of a patient

and per for m the duties as outline in the jobdescr iptions and state nur sing pr actice act.

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LPN Licensed Pr actical Nur se completes a tr aining

pr ogr am of 1 year and passed the state boar dlicensing testing.

They work under the dir ection of the r egister ed

nur se to pr ovide the car e to their patients

Able to obser ve the patient for pr oblems,concer ns, and needs of the patient along with

administr ating medications and specific tr eatments

accor ding to their state nur sing pr actice act.

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NA/PCA

Omnibus Budget Reconciliation Act of

1987 r equir es all nur sing assistantsworking in skilled and nur sing car e facilities

to complete an appr oved tr aining pr ogr am.

Work under super vision of pr ofessionalnur se and cooper atively with other

member s of the nur sing ser vice staff.

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