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Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 1.1
Slide 28
Home Health Care Services (cont.)
• Speech therapy
• Speech therapists work with patients who have speech or swallowing disorders
• A common indication for speech therapy is aphasia
TALKING POINTS:
• To receive speech therapy in the home that is reimbursed by Medicare, it is necessary to
meet all of the criteria for Medicare.
Slide 29
independent in the home
Home Health Care Services (cont.)
• Occupational therapy
• For conditions that impair upper-extremity movement
• People with arthritis or stroke may benefit from assistive devices for dressing and
other daily personal care and household activities
Slide 30
Home Health Care Services (cont.)
• Social workers
• Provide valuable assistance to families trying to manage chronic illness in the home
• Work with families to identify problems that arise in managing illness at home and
recommend referrals to community resources
Slide 31
Home Health Care Services (cont.)
• Home health aide services
• Provide personal care, such as bathing, ambulating, transferring, skin care, and oral
hygiene for the patient in the home
• Measure and record vital signs and do other basic, nonskilled tasks
• Homemaking tasks, such as making the bed and straightening the patient’s room,
are also common home health aide services
TALKING POINTS:
• What services are inappropriate for home health aides?
Slide 32
Home Health Care Services (cont.)
• Homemaker services
• Usually provided by families or state and local assistance programs
• Duties include common household chores, such as cooking, light housekeeping,
laundry, shopping, and picking up medications
Slide 33
Home Health Care Services (cont.)
• Enterostomal and wound care therapy
• Specialized care of all types of wounds, such as pressure ulcers, surgical wounds,
14 Chapter 1 The Health Care System __________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 1.1
Slide 34
Home Health Care Services (cont.)
• Other home health care service providers
• Dietitians
• Nurse practitioners
• Psychologists
Slide 35
Home Health Care Services (cont.)
• Specialty home care services
• Pediatric: small, compact pumps, ventilators, and monitors have enabled children
with cancer, respiratory disease, and cerebral palsy to live more normal lives at
home
TALKING POINTS:
• Prospective payment systems and the use of DRGs have provided a stimulus for the
• Why are insurance companies becoming more interested in funding pediatric home
care?
Slide 36
Hospice
• May be delivered in the home, acute care hospital, or extended care facility
• Provides care for terminally ill patients in the home and other specified facilities
• Purpose: enable terminally ill patients to live as full a life as possible, with skilled
personnel managing pain, discomfort, and other symptoms associated with the illness
TALKING POINTS:
• Later this concept was extended to the dying in both hospitals and home settings.
• What are the requirements for admission to hospice care?
Slide 37
Adult Day Centers
• Services and activities
• Promote health and socialization
• Benefit the elderly and mentally ill
• May be associated with hospitals or nursing homes, or they may function
independently
• Allow older people to live supervised in the community during the day while the
TALKING POINTS:
• Many of the services provided at day care centers are funded through the Older
Americans Act, which was originally passed in 1965.
• People who need counseling, follow-up care after hospitalization, and rehabilitation
related to chemical dependence may benefit from day care programs.
• What is the Older Americans Act of 1965?
__________________________________________________________ Chapter 1 The Health Care System 15
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 1.1
Slide 38
Hospitals
• Vary greatly in size, shape, and organization
• Some hospitals are public and financed by the local, state, or federal government; others
are private and owned by churches, businesses, corporations, or charitable
organizations
• Most frequent reasons for hospitalization are infant delivery, cardiovascular disease,
TALKING POINTS:
• Hospital care accounts for about 40% of personal health care expenditures in the United
States.
• The predominant sources of payment for hospital services are Medicare (34%), Medicaid
(22%), and private insurance (36%).
• What are subacute care units?
Slide 39
Psychiatric Hospitals
• Inpatient and outpatient treatment for acute psychiatric illnesses; the focus is on helping
patients control their behavior or restore their behavior to what it was before entering the
hospital
• May be private, nonprofit organizations that are sponsored by organized churches or
run by local, state, or federal governments
TALKING POINTS:
• How long will private insurance companies cover services in a psychiatric hospital?
Rehabilitation Centers
• Restore individuals to former level of functioning or maintain or maximize remaining
function
TALKING POINTS:
• Rehabilitation can and should be carried out in all health care settings by a variety of
health care professionals with the active involvement of patients and their families.
• Who makes up the rehabilitation team?
16 Chapter 1 The Health Care System __________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 1.1
Long-Term Care Facilities
• Originally described institutions attached to hospitals for recovery from acute illness
• Now comprised of several different kinds of institutions—nursing homes, convalescent
TALKING POINTS:
• Modern long-term care for the elderly and disabled had its beginnings in nursing home
care, which dates back at least to the turn of the twentieth century.
• What type of standards did long-term care have when it first began?
Slide 42
Long-Term Care Facilities (cont.)
• Independent living retirement centers
• Offer services that permit residents to access the level of care needed at a given
time
Slide 43
Long-Term Care Facilities (cont.)
• Assisted living facilities
• Permit a high degree of independence, but usually have limited access to nursing
Slide 44
Long-Term Care Facilities (cont.)
• Intermediate-care skilled nursing facility
• Provides care from a licensed nursing staff, including rehabilitation for people who
can regain function
• Services: medical and nursing care; physical rehabilitation; long-term ventilator care;
TALKING POINTS:
• This level of care is also referred to as extended care.
• What type of nursing care is provided at an intermediate-care facility?
__________________________________________________________ Chapter 1 The Health Care System 17
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 1.1
Slide 45
Skilled Nursing Facility
• Residents must be in need of care that consists of observation during an acute or
unstable phase of an illness, administration of enteral (tube) feedings or IV fluids, bowel
and bladder retraining (for a limited period), administration of intramuscular or
intravenous medications, or changing of sterile dressings
TALKING POINTS:
• Can residents in need of custodial care receive benefits at a skilled nursing facility under
Medicare?
• A skilled nursing facility must have skilled health professionals available around the
clock.
6
&
7
Slide 46
Cost Containment
• Nurses often feel cost-containment measures more than any other discipline
• However, nurses play a critical role in cost containment
• Effective utilization of resources
• Decrease waste
• Maximize quality
10
Quality and Safety in Health Care
• One major aspect of safety is medication use
• The potential for medication errors exists when the drug is obtained, prescribed,
TALKING POINTS:
• The following recommendations by the Institute of Medicine (2006) are intended to help
prevent medication errors:
• Medication prescribers should educate and work with patients to enable the patients
to take more responsibility for monitoring their medications and recognizing and
reporting adverse effects.
18 Chapter 1 The Health Care System __________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 1.1
Slide 48
Question 1
• Many people in the United States cannot afford health care and may not receive the
services they need. What percent of the U.S. population is uninsured?
A. 5%
B. 10%
C. 15%
D. 20%
TALKING POINTS:
Slide 49
Question 2
• Which age group is least likely to be covered by health insurance?
A. School-age children
B. Young adults
C. Middle-age adults
D. Elderly
TALKING POINTS:
Slide 50
Question 3
• Which of the following is a requirement for admission to hospice?
A. A diagnosis of a chronic illness
B. A prognosis of less than 12 months to live
C. Informed consent by the family to elect home health care
D. A physician’s order
TALKING POINTS:
__________________________________________________________ Chapter 1 The Health Care System 19
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 1.1
Activities
Classroom Choose from below to make 30 minutes
1
ASSESS BASELINE
• Have the class complete the Pretest.
Collect their work and use the results to
guide how you teach the class.
DISCUSS
• Discuss and outline the managed care
system in the United States.
• Divide the class into small groups. Have
2
DISCUSS
• Discuss the goals of public health
intervention.
3
DISCUSS
• Discuss eligibility requirements for Medicaid
and Medicare.
• Divide the class into small groups. Have
each group discuss and differentiate
• Ask students to research your state’s
Medicaid program. What are some details
of the program? What is the name of the
program in your state? How does a person
qualify for the program? What is the
application process? Obtain the appropriate
form and share it with the class. Have the
students be prepared to discuss the
information with the rest of the class.
20 Chapter 1 The Health Care System __________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 1.1
4
DISCUSS
• Discuss the different types of outpatient
care. Compare and contrast the settings
and services.
• Discuss the different types of inpatient care.
Compare and contrast the settings and
services.
• Divide the class into small groups and have
each group choose an outpatient or
5
DISCUSS
• Discuss the drivers behind the shift from
inpatient to more outpatient care.
• Divide the class into small groups. Have
each group discuss the effects of cost–
6
DISCUSS
• Discuss the current climate in health care
related to cost containment.
7
DISCUSS
• Elicit ideas from students about ways
nurses can work to decrease the costs
associated with health care.
__________________________________________________________ Chapter 1 The Health Care System 21
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 1.1
8
DISCUSS
• Ask students to discuss various information
infrastructure programs they have been
9
DISCUSS
• Review the six aims of health care. Lead a
discussion of ways students believe these
10
REVIEW
• Review safe medication administration with
students.
• Review drug medication labels with
Critical Thinking Question
A daughter is caring for her 75-year-old mother with Alzheimer’s disease at home. The
daughter is having difficulty caring for her mother and is considering placing her in a skilled
nursing facility. In a discussion with the nurse, the daughter asks how much the insurance
will pay toward the nursing home placement. What information can the nurse provide to the
daughter regarding insurance coverage for a skilled nursing facility placement?
Discussion Guidelines: For Medicare or other insurance to pay for care in a skilled nursing
facility, the patient needs to meet one of the following criteria: the patient must be in need of
Instructor Notes/Student Feedback
22 Chapter 1 The Health Care System __________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
1
Assessments for
The Health Care System
CHAPTER 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.
Assessments by Lesson & Objective
Lesson 1.1
1
Study Guide
• Part IIC: 7, 8 (p. 2)
Evolve Instructor Resources
• Test Bank: 11
Evolve Student Resources
• NCLEX Review: 1
2
Study Guide
• Part IA: 1 (p. 1)
• Part IIC: 15 (p. 3)
Evolve Instructor Resources
• Open Book Quiz: 2
3
Study Guide
• Part IA: 3, 6, 9 (p. 1)
• Part IB: 1 (p. 2)
Evolve Instructor Resources
• Test Bank: 24
• Open Book Quiz: 3, 4
Introduction to Medical-Surgical Nursing, 6th ed.
4
• Part IA: 2, 5, 7, 8 (p. 1)
• Part IIC: 3, 6, 12 (pp. 2–3)
• Part IIID: 6, 8, 9 (p. 4)
Evolve Student Resources
• NCLEX Review: 2, 4, 5, 6, 7, 8
• Prioritization: 1
• Multiple Response: 1
5
Study Guide
• Part IIC: 4, 5, 9, 10, 13 (pp. 2-3)
• Part IIID: 3, 4, 5, 7, 10, 11 (p. 4)
Evolve Instructor Resources
Evolve Student Resources
• Prioritization: 3
6
Study Guide
• Part IA: 3, 6, 9 (p. 1)
• Part IB: 1 (p. 2)
• Part IIC: 1, 11, 14 (pp. 2-3)
• Part IIID: 16 (p. 5)
Evolve Instructor Resources
7
Evolve Student Resources
• Prioritization: 2
Study Guide
24 Chapter 1 The Health Care System __________________________________________________________
Assessments by Lesson & Objective
10
Study Guide
Evolve Student Resources
• Prioritization: 4
Instructor’s Notes/Student Feedback