Introduction to Medical-Surgical Nursing, 6th ed.
1
Lesson Plans for
The Health Care System
CHAPTER LESSON PLANS & OBJECTIVES
Lesson 1.1:
2. Identify the health care issues addressed by the Patient Protection and Affordable Care Act.
4. Describe the financing of health care in the United States, including Medicare and Medicaid
programs.
6. Describe the impact of cost–containment measures on the delivery of care.
8. Explain the potential benefits of a national health information infrastructure.
10. Describe the QSEN quality and safety competencies for nurses.
CHAPTER TEACHING FOCUS
• In this chapter, students will be introduced to the organization of the health care system in the United
States, including public health services and prevention, the financing of health care (including Medicare
and Medicaid), and the impact of cost-containment measures on the delivery of care in inpatient and
outpatient settings.
CONCEPTS
The following conceptual themes and specific concepts match those presented in Giddens, J. R. (2013).
Concepts for nursing practice. St. Louis: Elsevier. The specific exemplars chosen and listed below for
each concept have been tailored specifically to correspond to the Linton textbook.
THEME: Health Care Infrastructures
• Concept: Health Care Economics
• Exemplar: Managed Care Organizations, p. 2
• Exemplar: Medicaid, p. 5
• Concept: Health Care Organizations
• Exemplar: Ambulatory Care Facilities, p. 7
• Exemplar: Hospitals, p. 10
• Figure 1-3: A large number of patients in the hospital setting are older adults, p. 10
THEME: Care Competencies
• Concept: Quality
• Exemplar: The Institute of Medicine (IOM), p. 12
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Introduction to Medical-Surgical Nursing, 6th ed.
CHAPTER PRETEST
Have the students answer these questions prior to covering this chapter to understand where they stand
in relation to the content.
1) The Department of Health and Human Services was formerly known as the ___________.
a) Office of Human Development Services
b) Social Security Administration
c) Department of Health, Education, and Welfare
d) Public Health Service
2) Teaching women to perform breast self-examination is an example of a(n) __________.
a) primary prevention activity
b) secondary prevention activity
c) tertiary prevention activity
d) adverse health activity
3) Which of the following people would qualify for Medicare?
a) A 35-year-old man receiving hemodialysis for chronic renal failure
b) A 64-year-old man who works part-time
c) A 25-year-old unemployed woman
d) The 13-year-old daughter of a disabled man
4) Which of the following is an example of an outpatient care setting?
a) A psychiatric hospital
b) A long-term care facility
c) An emergency department
d) A medical clinic
5) The main focus of public health service is __________.
a) to promote the treatment of illnesses in the acute care setting
b) improvement of the health of communities and people
c) to reduce health care spending
d) to provide care to dying patients in their homes
6) A home health care agency that is organized to make a profit is called a(n) __________.
a) official agency
b) proprietary agency
c) hospital agency
d) volunteer agency
7) To qualify for home care services, which of the following must be true?
a) The patient must have private
insurance.
b) The patient must live with someone.
c) The patient must have Medicare.
d) The patient must be homebound.
8) To qualify for hospice care, a patient must meet which of the following criteria?
a) Be homebound
b) Have cancer
c) Have a prognosis of living 6 months or
less
d) Be 65 years old or older
9) An inpatient unit that provides care to patients who require care but are no longer acute is a
__________.
a) transitional hospital
b) subacute unit
c) skilled nursing facility
d) rehabilitation hospital
10) Of the following, which would qualify a patient for care in a skilled nursing facility?
a) Assistance with bathing
b) An abdominal wound requiring dressing changes three times a day
c) A patient with a memory deficit
d) A patient who needs assistance with eating
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Introduction to Medical-Surgical Nursing, 6th ed.
Chapter Pretest Answers
1) c
6) b
CHAPTER BACKGROUND ASSESSMENT
Discuss these questions with your students prior to covering this chapter to understand where they stand
in relation to the content.
Question: What are the three levels of prevention? Define and provide an example for each level of
prevention.
Answer: The three levels of prevention are primary, secondary, and tertiary. Primary prevention is aimed
at improving health and preventing disease and injury. An example of primary prevention is a campaign
Question: What is the focus of home health care? Identify the three primary skilled services in home
care.
Answer: Home health care services are provided to patients and families in their own homes or assisted
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Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 1.1
Instructor Preparation
Textbook Objectives Covered
1. Describe the organization of the health care system in the United States.
3. Describe the focus of public health services.
5. Describe the components of the health care system that provide both inpatient and outpatient
care and the types of services each system provides.
7. Discuss the contribution nurses can make to cost containment.
9. Describe the six aims of health care.
10. Describe the QSEN quality and safety competencies for nurses.
Lesson Preparation Checklist
• Prepare lecture from TEACH lecture slides available on Evolve.
• Guest speaker: representative from the local public health department
• Student performance evaluation of all entry-level skills required for student comprehension of
principles underlying the health care system, including:
• Public health services
• Costs
• The impact of cost-containment measures
• Assemble materials and supplies needed for each lesson as indicated below.
Materials and Supplies
• computer and PowerPoint
projector
Key Terms
• health maintenance
organization (HMO) (p. 2)
• skilled nursing facility (p. 9)
• diagnosis-related group
(DRG) (p. 11)
• Older Americans Act (p. 7)
• preferred provider
Student Preparation
Assignments 2 hours
1
READ – Textbook (pp. 1-2)
REVIEW
• Figure 1-1: Outpatient clinics serve many people in the community (p. 3)
ANSWER – Study Guide
• Part IIC: 7, 8 (p. 2)
2
READ – Textbook (p. 2)
ANSWER – Study Guide
• Part IA: 1 (p. 1)
• Part IIC: 15 (p. 3)
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Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 1.1
3
• Part IIC: 1, 11, 14 (pp. 2-3)
• Part IIID: 16 (p. 5)
READ – Textbook (pp. 2-3)
REVIEW
• Figure 1-2: A nurse takes the blood pressure of a resident in an extended care facility (p. 5)
ANSWER – Study Guide
4
READ – Textbook (pp. 10–11)
REVIEW
• Table 1-1: Comparisons of Medicare and Medicaid (p. 10)
ANSWER- Text
• Review Questions for the NCLEX Examination: 2 (p. 14)
ANSWER – Study Guide
• Part IA: 2, 5, 7, 8 (p. 1)
• Part IIC: 3, 6, 12 (pp. 2-3)
• Part IIID: 6, 8, 9 (p. 4)
5
READ – Textbook (pp. 3-9)
ANSWER – Study Guide
• Part IIC: 4, 5, 9, 10, 13 (pp. 2-3)
• Part IIID: 3, 4, 5, 7, 10, 11 (p. 4)
6
READ – Textbook (pp. 11–12)
ANSWER – Study Guide
7
READ – Textbook (pp. 11–12)
REVIEW
• Figure 1-4: A patient is assisted with ambulation in rehabilitation center (p. 9)
ANSWER – Text
• Review Questions for the NCLEX Examination: 9 (p. 15)
8
READ – Textbook (p. 12)
ANSWER – Text
• Review Questions for the NCLEX Examination: 10 (p. 15)
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Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 1.1
9
READ – Textbook (pp. 13)
REVIEW
• Box 1-1: Aims for the twenty-first century health care system (p. 13)
ANSWER_ Text
ANSWER – Study Guide
• Part IIC: 18 (p. 3)
10
READ – Textbook (pp. 12–13)
REVIEW
• Box 1-2: QSEN Quality and Safety Competencies and Definitions (p. 13)
ANSWER- Text
• Review Questions for the NCLEX Examination: 6, 8 (pp. 14-15)
ANSWER – Study Guide
• Part IA: 4 (p. 1)
50-Minute Lesson Plan
Lecture Outline 20 minutes
Slide 1
Chapter 1
The Health Care System
1
Slide 2
Organization
• Health care system consists of patient, patient’s family, community, governmental
agencies, health care providers, insurance companies
• Many health services funded by government or private agencies
• Not all U.S. citizens eligible for government funds; some unable or unwilling to obtain
private insurance
TALKING POINTS:
• Are all the costs of health care covered by government funding and insurance?
(9.2%) are uninsured.
Slide 3
Managed Care
• Provides comprehensive health care at a reasonable cost
• Health maintenance organization (HMO)
• Preferred provider organization (PPO)
• Managed care has stimulated increased interest in wellness and prevention, increased
outpatient and home health care, and increased cost-sharing
__________________________________________________________ Chapter 1 The Health Care System 7
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 1.1
Slide 4
Administration
• 1953: Department of Health, Education, and Welfare was established to organize the
health and welfare agencies of the U.S. government
• 1980: Department of Health and Human Services (DHHS) was created when education
became a separate department
• Today: DHHS programs are administered by the Public Health Service and Centers for
Medicare and Medicaid Services, Administration for Children and Families, and the
Administration on Aging
TALKING POINTS:
• What is the role of the DHHS?
• The major activities of the Public Health Service Agencies are to:
• Support medical research
• Support research on health care systems, health care quality and cost issues,
access to health care, and effectiveness of medical treatments
• Ensure the safety of foods and cosmetics
• The Centers for Medicare and Medicaid Services (CMS) administer the services that
provide health insurance and prescription drugs for older and disabled Americans.
2
Slide 5
The Patient Protection and Affordable Care Act
• Has the potential to decrease health care costs
• Intent is to expand coverage to those previously not covered by health insurance
TALKING POINTS:
• What effects has the Affordable Care Act had on any of you?
3
Slide 6
Public Health
• Improvement of the health of communities and aggregates (collections of people) rather
than the individual
TALKING POINTS:
• How are the levels of prevention traditionally classified?
Primary Prevention
• To improve health; prevent disease and injury
Slide 8
Secondary Prevention
• Focuses on early detection and treatment of disease to improve patient outcomes
• Papanicolaou (Pap) smears and screening mammograms
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Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 1.1
Tertiary Prevention
• To prevent disease recurrence or complications
4
Financing
• U.S. health care most expensive in the world
• In 2002, $2.1 trillion—equal to 16% of gross domestic product (GDP)—spent on health
TALKING POINTS:
• The health care system of the United States is the most expensive in the world.
• What measures can be taken to control what is spent on health care?
Slide 11
Financing (cont.)
• Many approaches to health care financing: HMOs, PPOs, and governmental agencies
affect how health care is delivered
• Capitation: designed to control costs
TALKING POINTS:
• For the most part, health care systems have operated on a fee-for-service basis.
• What are third-party reimbursements?
Medicare
• Medicare: health insurance program offered by the U.S. government as part of the Social
Security Act
TALKING POINTS:
• Medicare insures more than 42 million older and disabled Americans.
• What is the difference between Medicare Part A and Medicare Part B?
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Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 1.1
Slide 13
Medicare (cont.)
• Diagnosis-related groups (DRGs)
• Hospitals reimbursed a flat fee for specified number of days based on predetermined
diagnosis fee schedule
• If the patient gets better faster, hospital makes money; if longer stay, hospital loses
money
TALKING POINTS:
• Historically, hospitals billed Medicare for their costs after they were incurred, a process
referred to as retrospective payment.
• The system changed in 1983, and since that time hospitals have been advised in
advance how much they would be reimbursed for treatment of a patient with a certain
condition; this is referred to as prospective payment.
• What if the patient does not stay the number of days specified by the DRGs?
Slide 14
Medicaid
• Government insurance program for people with very low income
• Funded by federal, state, and local taxes; administered by federal and state governments
on a partnership basis
TALKING POINTS:
• Medicaid was established in 1965 as part of the Social Security Act.
• Who is eligible for Medicaid?
Medicaid (cont.)
• Benefits provided for needy, low-income disabled individuals younger than age 65 and
their dependent children
TALKING POINTS:
• What services are covered by Medicaid?
• Medicaid is more likely than Medicare to cover long-term care.
• Medicaid provides health coverage for nearly 45 million persons.
5
Slide 16
Physicians’ Offices
• Physicians may practice in individual or group settings
• Many group practices are made up of various medical specialties so that patients can
have all of their health care needs dealt with in one location
TALKING POINTS:
• Many people, especially older adults, receive their primary medical care in physicians’
offices.
• How is the cost of visits to physicians’ offices covered?
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Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 1.1
Slide 17
Clinics
• Outpatient clinics are associated with community hospitals, teaching hospitals, or public
health departments
• Focus on individuals with chronic illnesses (diabetes or heart disease) but also treat
those with acute illnesses
TALKING POINTS:
• How are clinics in large hospitals usually organized?
• For many people, especially older adults, specialty clinics can be a problem because
older adults have many chronic illnesses and are seen in many different clinics.
Slide 18
Health Maintenance Organizations
• Group practice with prepayment, voluntary enrollment, combination of hospital and
outpatient facilities, emphasis on health promotion and illness prevention, and physician
TALKING POINTS:
• Because HMOs collect only a set fee from patients, they have an interest in promoting
health and maintaining wellness.
• HMOs employ physicians, nurses, and other health care providers and also have a broad
group of specialists available for referral.
• Patients are required to use only the services of the health care providers and hospitals
associated with the HMO.
• Who was the original HMO in the United States?
Ambulatory Care Centers
• Alternative to inpatient surgery
• Located in hospitals, freestanding clinics, health care centers, and physicians’ offices
TALKING POINTS:
• Many procedures such as cataract extraction, hernia repair, tonsillectomy, and the
removal of foreign objects that once required hospitalization are now often performed in
outpatient facilities.
• What is the primary criticism of outpatient surgery?
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Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 1.1
Slide 20
Home Health Agencies
• History of home health care
• 1617: St. Vincent de Paul organized Daughters of Charity
• Members went from house to house to provide food, education, and health care
to the sick
• Mid 1800s: William Rathbone organized first district nursing organization; he opened
TALKING POINTS:
• Who was one of the first organized groups to provide health education to the poor and to
help people help themselves?
• Rathbone often is called the “Father of the Visiting Nurse Association” because he was
the first to put the district nursing concept into use.
• The Henry Street Settlement was a place where the poor could come for care and was
supported by funds from the wealthy.
Focus of Home Health Care
• Services for patients in their homes or assisted living centers: promote, maintain, or
restore health or minimize the effects of illness and disability
TALKING POINTS:
• Fewer people are being admitted to hospitals, and they are being discharged sooner with
more needs for special care.
• Who provides home health care?
Slide 22
Funding of Home Care Services
• Paid for by individuals, private insurance, Medicare, and Medicaid
• Most nursing services paid for by Medicare must be skilled care; strict governmental
TALKING POINTS:
• Regulations vary from state to state but are generally patterned after federal government
regulations.
• What discipline fills the case manager position for services provided in the home?
12 Chapter 1 The Health Care System __________________________________________________________
LESSON 1.1
Slide 23
Voluntary Agencies
• First to deliver nursing care in the home
• Financed by wealthy philanthropists in the community; mission was to care for the sick
TALKING POINTS:
• Because board members are drawn from different areas and social strata within the
community, services often reflect community needs.
• Where does funding usually come from for voluntary agencies?
Slide 24
Official Agencies
• Supported by tax dollars; authorized by law to deliver services to a defined area or
community
• State, regional, and local health departments are responsible for health promotion and
Slide 25
Proprietary Agencies
• Organized to make a profit on their operation
• May or may not participate in Medicare; most do
• May be owned by individuals or corporate chains
• Because limitations imposed by the Balanced Budget Act (1997) decreased profitability,
many have closed
TALKING POINTS:
• What are the sources of revenue for proprietary agencies?
• The prospective payment system contributed substantially to the growth of home health
care.
Hospital-Based Agencies
• Usually governed by hospital’s board of directors
• Most referrals from the hospital itself
TALKING POINTS:
• Hospitals that were losing money under the prospective payment system saw the
opportunity to recoup lost profits by opening home health agencies.
• Who usually governs the hospital-based agencies?
Slide 27
Home Health Care Services
• Physical therapy
• For patients recovering from health problems affecting mobility, such as hip fractures
and strokes
TALKING POINTS:
• What are the requirements for a patient to receive services in the home?