Complex Health Care Environments
- Complex Health Care Environments
Expanding Knowledge and Technology
Rapidly changing technology and dramatically expanding knowledge are adding to the complexity of health care environments. Advanced communication technologies have created a more global environment that affects the delivery of health care worldwide. The number and complexity of patient care technologies are transforming how care is delivered. The human genome project and advances in genetics affect the prevention, diagnosis, and treatment of health problems.
With advances in knowledge, ethical dilemmas and controversy arise regarding the use of new scientific knowledge and the disparities that exist in patients’ access to more technologically advanced health care. Throughout this book, expanding knowledge and technology’s impact on nursing practice are highlighted in genetics, informatics, and ethical/legal boxes.
Diverse Populations
Patient populations are more diverse than ever. Americans are living longer, in part due to advances in medical science, technology, and health care delivery. As the population ages, the number of patients with chronic conditions increases. Unlike those who receive acute, episodic care, patients with chronic conditions have a multitude of needs. They see a variety of health care providers in various settings over an extended period.
Nurses are also caring for a more culturally and ethnically diverse population. Immigrants, particularly undocumented immigrants and refugees, often lack the resources necessary to access health care. Inability to pay for health care is associated with a tendency to delay seeking care, resulting in illnesses that are more serious. Boxes throughout this book emphasize the influence of such factors as gender, culture, and ethnicity on nursing practice.
Consumerism
Health care is a consumer-focused business. Patients today are active participants in their health care and expect high-quality, coordinated, and financially reasonable care. Health information is readily available. Many patients eagerly seek information about their health problems and health care from media and Internet sources. They gather information so that they can have a voice in making decisions about their health care.
Question: The nurse reads on the care plan that a patient is at risk for developing an infection.
Question: A nurse is providing care to a patient after right hip surgery. Within a pay-for-performance system, what is a critical role of the nurse?
- Influences on Health Care Systems
Health Care Financing
Many changes in health care systems that influence nursing care delivery were initiated by the government, employers, insurance companies, and regulating agencies in an effort to provide more cost-effective health care. Historically, the most notable event related to changing reimbursement patterns was the institution of prospective payment systems in the Medicare program. With these changes, hospitals were no longer reimbursed for all costs. Instead, payment for hospital services for Medicare patients was based on flat fees determined by the diseases and problems treated during the admission.
Private and other public health care systems followed suit by introducing managed care systems that use prospective payment as a means of offering cost-effective health care delivery. In health maintenance organizations (HMOs) and preferred provider organizations (PPOs), charges are negotiated in advance of the delivery of care using predetermined reimbursement rates or capitation fees for medical care, hospitalization, and other health care services.
These same third-party payers demand outcome-based quality care that is provided at a price affordable for both individuals and society. Payment for health care services or pay-for-performance programs reimburse hospitals for their performance on quality-of-care measures. These measures include clinical outcomes, patient safety, patient satisfaction, adherence to evidence-based practice, and adoption of information technology. Payment for care can be withheld if a patient develops certain health care conditions during a hospital stay (e.g., pressure ulcer) or if something happens to the patient that is considered preventable (e.g., acquiring a catheter-related urinary tract infection).
Healthy People Initiative
For the past 30 years, the U.S. government has been active in establishing goals and objectives for promoting health and health care delivery for the nation through an initiative known as Healthy People. The vision of Healthy People is a society in which all people live long, healthy lives. Healthy People is a broad-based program that involves government, private, public, and nonprofit organizations. Individuals, groups, and organizations are encouraged to integrate Healthy People goals and focus areas into current programs, special events, publications, and meetings. These activities can further the health of all members of a community. The overarching goals of the Healthy People 2020 initiative are presented below.
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 and physical environments that promote good health for all.
- Promote quality of life, healthy development, and healthy behaviors across all life stages.
The Healthy People boxes related to these goals are integrated throughout this book.
The Healthy People initiative is a significant challenge for nursing. Both nursing education programs and clinical nursing practice must respond to major trends in health care. Educational programs for entry-level nurses now place a greater emphasis on health promotion; maintenance; and cost-effective care that responds to the needs of older adults, culturally diverse groups, and underserved populations. Today’s nurses must address the identified health problems, developments in health care delivery, research outcomes, and new technologies in order to meet Healthy People goals.
As a reflection of nursing’s contract with society, you are responsible for improving the health status of the public and reducing health disparities.
- Supporting Professional Practice
Professional Nursing Organizations
The American Nurses Association is the primary professional nursing organization. There are numerous professional specialty organizations, such as the American Association of Critical-Care Nurses (AACN), Association of periOperative Registered Nurses (AORN), and Oncology Nursing Society (ONS). Professional organizations have numerous roles in promoting quality patient care and professional nursing practice. These include developing standards of practice and codes of ethics, supporting research, and lobbying for legislation and regulations.
Major nursing organizations also promote research into the causes of errors, develop strategies to prevent future errors, and address nursing issues that affect the nurse’s ability to deliver patient care safely. Many nurses join a professional organization to keep current in their practice and network with others who are interested in a particular practice area.
QSEN
In 2003, the Institute of Medicine (IOM) commissioned an interdisciplinary task force to study the educational preparation of health care professionals to see whether new graduates were prepared for today’s reality of practice. What they found was that all health professions, including nursing, needed to review and revise their curricula and focus on developing specific competencies that serve as a basis for practice.
In nursing, this is done through a project known as Quality and Safety Education for Nurses (QSEN) (www.qsen.org). QSEN consists of six core competencies:
- Patient-centered care
- Informatics and technology
- Evidence-based practice
- Quality improvement
- Safety
- Teamwork and collaboration