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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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Being a Nursing Assistant, Ninth EditionFrancie Wolgin
Pearson EducationCopyright 2005
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
Being a Nursing Assistant, Ninth EditionFrancie Wolgin
Pearson EducationCopyright 2005
Health Car e Delivery System
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Being a Nursing Assistant, Ninth EditionFrancie Wolgin
Pearson EducationCopyright 2005
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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Being a Nursing Assistant, Ninth EditionFrancie Wolgin
Pearson EducationCopyright 2005
DRG¶s and Managed Car e
Influence Health Car e Systems
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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Being a Nursing Assistant, Ninth EditionFrancie Wolgin
Pearson EducationCopyright 2005
DRG¶s and Managed Car e
Influence Health Car e Systems
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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Being a Nursing Assistant, Ninth EditionFrancie Wolgin
Pearson EducationCopyright 2005
DRG¶s and Managed Car e
Influence Health Car e Systems
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.
Being a Nursing Assistant, Ninth EditionFrancie Wolgin
Pearson EducationCopyright 2005
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Being a Nursing Assistant, Ninth EditionFrancie Wolgin
Pearson EducationCopyright 2005
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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Being a Nursing Assistant, Ninth EditionFrancie Wolgin
Pearson EducationCopyright 2005
Or ganizing Patient Car e
Ser vices/Nur sing Health Car e Team
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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Being a Nursing Assistant, Ninth EditionFrancie Wolgin
Pearson EducationCopyright 2005
Or ganizing Patient Car e
Ser vices/Nur sing Health Car e Team
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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Being a Nursing Assistant, Ninth EditionFrancie Wolgin
Pearson EducationCopyright 2005
Figure 1±3 The nur sing car e health team
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Being a Nursing Assistant, Ninth EditionFrancie Wolgin
Pearson EducationCopyright 2005
Or ganizing Patient Car e
Ser vices/Nur sing Health Car e Team
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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Being a Nursing Assistant, Ninth EditionFrancie Wolgin
Pearson EducationCopyright 2005
Or ganizing Patient Car e
Ser vices/Nur sing Health Car e Team
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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Being a Nursing Assistant, Ninth EditionFrancie Wolgin
Pearson EducationCopyright 2005
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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Being a Nursing Assistant, Ninth EditionFrancie Wolgin
Pearson EducationCopyright 2005
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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Being a Nursing Assistant, Ninth EditionFrancie Wolgin
Pearson EducationCopyright 2005
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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Being a Nursing Assistant, Ninth EditionFrancie Wolgin
Pearson EducationCopyright 2005
Differ ence Between Qualifications of
the Differ ent Nur sing Team Member s
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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Being a Nursing Assistant, Ninth EditionFrancie Wolgin
Pearson EducationCopyright 2005
Differ ence Between Qualifications of
the Differ ent Nur sing Team Member s
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.