NRG 106

• Critical thinking


  The process of intentional higher-level thinking to define a client's problem, examine the evidence-based practice in caring for the client, and make choices in the delivery of care
• Critical thinking


  • The ability to think in a systematic and logical manner with openness to question and reflect on the reasoning process
  • Recognizing that an issue exists, analyzing information, evaluating information, and drawing conclusions
• A healthcare system is the totality of services offered by all health disciplines. It is one of the largest industries in the United States.
• Previously, the major purpose of a healthcare system was to provide care to individuals who were ill or injured. However, with increasing awareness of health promotion, illness prevention, and levels of wellness, healthcare systems are changing, as are the roles of nurses in these areas.
• Healthcare services are often described in terms of how they are correlated with levels of disease prevention: (a) primary prevention, which consists of health promotion and illness prevention; (b) secondary prevention, which consists of diagnosis and treatment; and (c) tertiary prevention, which consists of rehabilitation, health restoration, and palliative care.
• Healthy People 2030 has five overarching goals: (1) Attain healthy, thriving lives and well-being, free of preventable disease, disability, injury, and premature death. (2) Eliminate health disparities, achieve health equity, and attain health literacy to improve the health and well-being of all. (3) Create social, physical, and economic environments that promote attaining full potential for health and well-being for all. (4) Promote healthy development, healthy behaviors, and well-being across all life stages. (5) Engage leadership, key constituents, and the public across multiple sectors to take action and design policies that improve the health and well-being of all.
• Health promotion was slow to develop until the 1980s. Since that time, more and more people have recognized the advantages of staying healthy and avoiding illness.
• Primary prevention programs address areas such as adequate and proper nutrition, weight control and exercise, and stress reduction. Health promotion activities emphasize the important role clients play in maintaining their own health and encourage them to maintain the highest level of wellness they can achieve.
• Illness prevention programs may be directed at the client or the community and involve such practices as providing immunizations, identifying risk factors for illnesses, and helping individuals take measures to prevent these illnesses from occurring.
• In the past, the largest segment of healthcare services was dedicated to the diagnosis and treatment of illness. Hospitals and physicians' offices have been the major agencies offering these complex secondary prevention services.
• Freestanding diagnostic and treatment facilities have evolved and serve ever-growing numbers of clients. For example, MRI and related radiologic diagnostic procedures are commonly performed at physician- or corporate-owned centers. Similar structures exist in outpatient surgical units (surgi-centers). Urgent care centers and independent emergency rooms are also more common than in previous years.
• The goal of tertiary prevention is to help individuals move to their previous level of health (i.e., to their previous capabilities) or to the highest level they are capable of given their current health status.
• Rehabilitative care emphasizes the importance of assisting clients to function adequately in the physical, mental, social, economic, and vocational areas of their lives.
• Palliative care is a growing field of nursing and tertiary prevention services, providing comfort and treatment for symptoms. End-of-life care may be conducted in many settings, including the home.
• Government (official) agencies are established at the local, state, and federal levels to provide public health services.
• The Public Health Service of the U.S. Department of Health and Human Services is an official agency at the federal level. Its functions include conducting research and providing training in the health field, assisting communities in planning and developing health facilities, and assisting states and local communities through financing and provision of trained personnel.
• In North America, the physician's office is a significant care setting. The majority of physicians either have their own offices or work with several other physicians in a group practice.
• Ambulatory care centers, one type of outpatient setting, are used in many communities. Most ambulatory care centers have diagnostic and treatment facilities that provide medical, nursing, laboratory, and radiologic services, and they may or may not be associated with an acute care hospital.
• The industrial (occupational) clinic is gaining importance as a setting for employee healthcare. The importance of employee health to productivity has long been recognized.
• Hospitals vary in size from the 12-bed rural hospital to the 1500-bed metropolitan hospital. Hospitals can be classified according to their ownership or control as governmental (public) or nongovernmental (private).
• Subacute care is a variation of inpatient care designed for someone who has an acute illness, injury, or exacerbation of a disease process. Clients may be admitted after, or instead of, acute hospitalization or to administer one or more technically complex treatments.
• Hospitals

  • Have undergone organizational changes to contain costs or attract clients
  • Some have merged with other hospitals or been purchased by large corporations
  • Some are providing innovative outpatient services like fitness classes, day care, nutrition classes, and alternative birth centers
  • Hospitals that provide significant care to low-income, uninsured, and vulnerable populations are referred to as safety-net hospitals
• Subacute care

  • A variation of inpatient care designed for someone who has an acute illness, injury, or exacerbation of a disease process
  • Clients may be admitted after, or instead of, acute hospitalization or to administer one or more technically complex treatments
  • The individual's condition is such that the care does not depend heavily on high-technology monitoring or complex diagnostic procedures
  • Requires the coordinated services of an interprofessional team including physicians, nurses, and other relevant professional disciplines
  • May be delivered in a long-term care facility, skilled nursing facility, or long-term care hospital and often lasts 20–90 days
• Extended (long-term) care facilities

  • Formerly called nursing homes, now often multilevel campuses that include independent living quarters, assisted living facilities, skilled nursing facilities, and extended care (long-term care) facilities
  • Provide levels of personal care for those who are chronically ill or unable to care for themselves without assistance
  • Traditionally provided care only for older adult clients, but now provide care to clients of all ages who require rehabilitation or custodial care
  • Clients may still require supplemental care in a skilled nursing or extended care facility before they return home after being discharged earlier from acute care hospitals
• Retirement and assisted living centers

  • Consist of separate houses, condominiums, or apartments for residents
  • Residents live relatively independently, but many offer meals, laundry services, nursing care, transportation, and social activities
  • Some have an affiliated hospital to care for residents with short-term or long-term illnesses
  • Nurses provide limited care to residents, usually related to the administration of medications and minor treatments, but conduct significant care coordination and health promotion activities
• Rehabilitation centers

  • Usually independent community centers or special units
  • Rehabilitation ideally starts the moment the client enters the healthcare system, so nurses employed on various hospital units also help to rehabilitate clients
  • Play an important role in assisting clients to restore their health and recuperate
  • Nurses coordinate client activities and ensure compliance with treatments, often requiring specialized skills and knowledge
• Home healthcare agencies

  • Provide education to clients and families and comprehensive care to clients who are acutely, chronically, or terminally ill
  • Use of the home as a care delivery site has increased due to concerns about the cost of healthcare and earlier hospital discharges
• Day care centers

  • Serve many functions and age groups, providing care and services for infants, children, and adults who cannot be left at home alone but do not need institutional care
  • Nurses may provide medications, treatments, and counseling, facilitating continuity between day care and home care
• Rural care

  • Rural primary care hospitals and critical access hospitals provide emergency care and primary care access for rural residents
  • Nurses in rural settings must be generalists able to manage a wide variety of clients and healthcare problems
  • Nurse practitioners are particularly suited to these roles due to their training in comprehensive primary care across the lifespan
• Hospice services

  • Interprofessional healthcare service for the dying, provided in the home or another healthcare setting
  • Central concept is improving or maintaining the quality of life until death
  • Hospice nurses serve primarily as case managers and supervise the delivery of direct care by other team members
  • Clients may be cared for at home, in hospitals, in freestanding hospice facilities, or in skilled nursing facilities
• Crisis centers

  • Provide emergency services to clients experiencing life crises, operating out of a hospital or in the community and often providing 24-hour telephone service
  • Nurses need well-developed communication and counseling skills to immediately identify the individual's problem, offer assistance, and direct them to long-term support
• Mutual support and self-help groups

  • Focus on nearly every major health problem or life crisis, providing education, guidance, and support for clients and their friends/family
  • Nurses' role is to provide information and guidance to these groups
• Healthcare providers

  • Nurses
  • Physicians
  • Dentists
  • Dietitians/Nutritionists
  • Emergency medical personnel
  • Assistive personnel
  • Case managers
  • Therapists (physical, occupational, speech, etc.)
  • Holistic health providers
• Nurses

  • Roles vary with client needs, nurse's credentials, and employment setting
  • RNs assess, identify problems, and coordinate care
  • LVNs/LPNs provide direct care under direction of RN, physician, or other practitioner
  • Advanced practice registered nurses (APRNs) provide direct care as nurse practitioners, nurse midwives, nurse anesthetists, and clinical nurse specialists
• Nurse

  The role of the nurse varies with the needs of the client, the nurse's credentials, and the type of employment setting. An RN assesses a client's health status, identifies health problems, and develops and coordinates care. A licensed vocational nurse (LVN), in some states known as a licensed practical nurse (LPN), provides direct client care under the direction of an RN, physician, or other licensed practitioner. As nursing roles have expanded, new dimensions for nursing practice have been established. Nurses can pursue a variety of practice specialties (e.g., critical care, mental health, oncology). Advanced practice registered nurses (APRNs) provide direct client care as NPs, nurse midwives, certified registered nurse anesthetists, and clinical nurse specialists. These nurses have education and certifications that—depending on state regulations—may allow them to provide primary care, prescribe medications, and receive third-party (insurance) reimbursement directly for their services.
• Alternative (Complementary) Care Provider

  Alternative or complementary healthcare refers to those practices not commonly considered part of Western medicine. Chiropractors, herbalists, acupuncturists, massage therapists are examples.
• Physical Therapist

  The physical therapist (PT) assists clients with musculoskeletal problems. Physical therapists treat movement dysfunctions by means of heat, water, exercise, massage, and electric current. The functions of a PT include assessing client mobility and strength, providing therapeutic measures (e.g., exercises and heat applications to improve mobility and strength), and teaching new skills (e.g., how to walk with an artificial leg). Some PTs provide their services in hospitals; however, independent practitioners establish offices in communities and serve clients either at the office or in the home.
• Physician

  The physician is responsible for medical diagnosis and for determining the therapy required by an individual who has a disease or injury. The physician's role has traditionally been the treatment of disease and trauma (injury); however, many physicians include health promotion and disease prevention in their practice. Some physicians are primary care practitioners (also known as general or family practitioners); others are specialists such as dermatologists, neurologists, oncologists, orthopedists, pediatricians, psychiatrists, radiologists, or surgeons—to name a few. Physicians who specialize in the care of clients in hospitals are referred to as hospitalists, and hospitalists who specialize in critical care are called intensivists. Primary care physicians are those who provide the first point of contact for most clients and can include allopathic (Western) medical doctors (MDs) trained in areas such as internal medicine, gynecology, and geriatrics, and doctors of osteopathy (DOs), a branch of medicine traditionally focused on primary care. Differences between allopathic and osteopathic physicians are becoming fewer.
• A healthcare system is the totality of services offered by all health disciplines. It is one of the largest industries in the United States.
• Previously, the major purpose of a healthcare system was to provide care to individuals who were ill or injured. However, with increasing awareness of health promotion, illness prevention, and levels of wellness, healthcare systems are changing, as are the roles of nurses in these areas.