HEALTH CARE

DELIVERY SYSTEM

GALANG, JAMES LORD CABALDE

FUNDAMENTALS OF NURSING PRACTICE
 NURSING PRELIMS
REVIEWER | FIRST SEMESTER FUNDAMENTALS OF NURSING PRACTICE

CHALLENGE TO HEALTH CARE TODAY: MAJOR GOALS:

1. Increasing access to health care services
QUALITY OF PATIENT CARE for all
2. Reducing health care costs
3. Improving health care quality
HEALTH CARE COST HEALTH SYSTEM
SIX BUILDING BLOCKS (WHO, 2007)
INSTITUTE OF MEDICINE (IOM)
1. Service Delivery
• Calls for a HCDS that is safe, effective, 2. Health Workforce
patient-centered, timely, efficient, and 3. Information
equitable. 4. Medical Products, Vaccines and
Technologies
VISION 5. Financing
• The HCDS of the future makes quality 6. Leadership & Governance or Stewardship
care accessible to ALL populations, PHILIPPINE HEALTH CARE DELIVERY SYSTEM
focuses on wellness and disease
prevention, improves health outcomes, Government: DOH and Local Government
& provides compassionate care across Units
life span.
Local Government Code (R.A. 7160)
NURSES’ TRANFORMATION REQUIRES:
Devolution: LGUs should meet the priority
1. Full extent education & training needs of their communities by providing
2. Higher levels of education & training through basic health services
improved education system
Private: For-profit and non-profit agencies
3. Full partnership with health care providers
4. Improving data collection and information • provides all levels of services and
infrastructure for effective workforce accounts for a large segment of health
planning & policy making service providers in the country
HEALTH CARE REGULATION AND REFORM HEALTH SECTOR REFORM: UNIVERSAL HEALTH CARE
(UHC)
PROFESSIONAL STANDRADS REVIEW
ORGANIZATION (PSROs) Kalusugan Pangkalahatan / Aquino Health
Agenda (Administrative Order 2010-0036)
• Created by Medicare & Medicaid to
review the quality, quantity, and cost of OBJECTIVES:
hospital care to be able to eliminate any
unnecessary diagnostic and treatment 1. Better health outcomes
services ordered by the physician. 2. Sustained health financing
3. A responsive health system by
PATIENT PROTECTION AND AFFORDABLE CARE ACT ensuring equitable access to
(PPACA) affordable health care
Public Law No. 111-148; major health care
reform signed on 2010

BACHELOR
ST
OF SCIENCE IN NURSING 1
1 YEAR COLLEGE
 NURSING PRELIMS
REVIEWER | FIRST SEMESTER FUNDAMENTALS OF NURSING PRACTICE

NATIONAL HEALTH INSURANCE ACT OF 1995 (R.A. PREVENTIVE CARE

7875)
• Preventive care is more disease-
• created the Philippine Health Insurance oriented and focused on reducing and
Corporation (PhilHealth) controlling risk factors for disease
• aims for universal health coverage of all through activities (immunizations).
Filipino citizens (Congress of the
Philippines, 1995) SECONDARY AND TERTIARY CARE
• Amended to R.A. 10606 (NHIA of 2013) HOSPITAL
REPUBLIC ACT 11223 OF 2019 DISCHARGE PLANNING
• Senate Bill No. 1896, signed by Pres. Duterte • Begins from the moment a patient is
into a law that automatically enrolls ALL admitted to a health care facility.
Filipino citizens in the National Health • Centralized, coordinated,
Insurance Program and prescribes interdisciplinary process that ensures
complementary reforms in the health that a patient has a plan for continuing
system. care after leaving a health care
• ALL Filipinos can use promotive, agency.
preventive, curative, rehabilitative, & • Effective planning often requires
palliative health services needed. referrals to various health care
HEALTH CARE SETTING AND SERVICES disciplines and depends on
comprehensive patient & family
LEVELS OF CARE: education.
INTENSIVE CARE UNIT
• Patients receive close monitoring and
intensive medical care.
• Nurses and medical staff have special
knowledge about critical care principles
and techniques.
• Most expensive health care delivery site
because each nurse usually care only for
PRIMARY HEALTH CARE one or two patients at a time and
because of all treatments and
• Focuses on improved health outcomes for
procedures the patients require.
an entire population
PSYCHIATRIC/MENTAL HEALTH FACILITIES
HEALTH PROMOTION
• Offer inpatient & outpatient services,
• Health promotion programs lower the
depending on seriousness of the
overall health care costs by reducing
problem; voluntary or involuntary.
the incidence of diseases and
• Patients with emotional & behavioral
minimizing complications.
problems receive a comprehensive
interdisciplinary treatment plan that also
involves their families.

BACHELOR
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OF SCIENCE IN NURSING 2
1 YEAR COLLEGE
 NURSING
REVIEWER | FIRST SEMESTER
RESTORATIVE CARE
• Patients recovering from an acute or
chronic illness or disability often require
services to return to their previous level of
function or reach a new level of function
limited by their illness or disability.
GOAL: to help individuals regain maximal
functional status & enhance quality of life
through promotion of independence & self-
care.
HOME CARE
• The provision of medically related
professional and paraprofessional services
and equipment to patients and families in
their homes for health maintenance,
education, illness prevention, diagnosis,
and treatment of disease, palliation, and
rehabilitation.
FOCUS: patient & family independence
• Nurses address the recovery & stabilization
of illness in home.
Requires a strong knowledge base on:
✓ Family dynamics
✓ Cultural practices
✓ Spiritual values
✓ Communication principles
REHABILITATION
• This restores a person to the fullest physical,
mental, social, vocational, and economic
potential possible.
• Ideally, this begins at the moment a patient
enters a health care setting for treatment.
EXTENDED CARE FACILITIES
• Includes intermediate care & skilled
nursing facility
• Provide intermediate medical, nursing, or
custodial care for patients recovering from
acute illness or those with chronic illnesses
or disabilities.
BACHELOR
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OF SCIENCE IN NURSING
1 YEAR COLLEGE
PRELIMS
FUNDAMENTALS OF NURSING PRACTICE
• Intended for all ages due to sooner
hospital patient discharge
CONTINUING CARE
• Describes a variety of health, personal, and
social services provided over a prolonged
period of time to:
1. Disabled
2. One who never functionally
independent
3. One who suffer a terminal disease
NURSING CENTERS/FACILITIES
• Typically provides 24-hour intermediate &
custodial care such as nursing,
rehabilitation, dietary, recreational, social,
& religious services for residents of any age
with chronic or debilitating illness.
• A resident’s temporary or permanent
home, with surroundings made as
homelike as possible.
Philosophy of Care: to provide a planned,
systematic, & interdisciplinary approach to
nursing care to help residents reach & maintain
their highest level of function.
Cornerstone of Clinical Practice: interdisciplinary
functional assessment of residents
FOCUS:
1. Resident’s Functional Ability
2. Long-Term Physical & Psychosocial Well-
Being
ASSISTED LIVING
• Offers an attractive long-term setting with
an environment more like home & greater
resident autonomy.
• Provides independence, security, &
privacy at all times.
• Promote physical & psychosocial health.
• Not always an option for individuals with
limited financial resources.
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 NURSING PRELIMS
REVIEWER | FIRST SEMESTER FUNDAMENTALS OF NURSING PRACTICE

RESPITE CARE communities, & developing ethnically

responsible behaviors.
• A service that provides short-term relief or
“time-off” for people providing home care NURSES’ RESPONSIBILITIES:
to an individual who is ill, disabled, or frail.
• Offered in the home, a day care setting, or 1. Obtaining necessary continuing education
a health care institution that provides 2. Following an established code of ethics
overnight care. 3. Earning certifications in specialty areas

ADULT DAY CARE CENTERS 5 INTERRELATED COMPETENCIES

• Provide a variety of health & social services 1. Patient-Centered Care

to specific patient populations who live 2. Interdisciplinary Teams
alone or with family in community. 3. Evidence-Based Practice
• Usually operate 5 days a week during 4. Quality Improvement
typical business hours & usually charge on 5. Informatics
a daily basis. 10 RULES OF PERFORMANCE
HOSPICE 1. Care is based on continuous healing
relationship.
• A system of family-centered care that
2. Care is individualized based on patient
allows patients to live with comfort,
needs & values.
independence, & dignity while easing the
pains of terminal illness. 3. The patient is the source of control,
participating in shared decision making.
FOCUS: Palliative care, not curative treatment 4. Knowledge is shared, and information
flows freely.
CARE COORDINATION
5. Decision making is evidence-based, with
• Models used to focus on coordinating care based on the best available
medical care: scientific knowledge.
6. Safety is a system property & focused on
1. ACCOUNTABLE CARE ORGANIZATIONS reducing errors.
(ACOs) 7. Transparency is necessary through sharing
• ensures that patients receive the right information with patients & families.
care at right time, without duplication of 8. Patient needs are anticipated through
services or incidence of medical errors. planning.
9. Waste is continuously decreased.
2. PATIENT-CENTERED MEDICAL HOME (PCMH) 10. Cooperation & communication among
clinicians are priorities.
• goal is to make care for patients more
efficient, effective, continuous, QUALITY & SAFETY IN HEALTH CARE
comprehensive, patient-centered &
coordinated. QUALITY HEALTH CARE

ISSUES & CHANGES IN HEALTH CARE DELIVERY
COMPETENCY
• Emphasizes the importance of public
service, caring for the health of
• the degree to which health services for
individuals & populations increase the
likelihood of desired health outcomes &
are consistent with current professional
knowledge.

BACHELOR
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OF SCIENCE IN NURSING 4
1 YEAR COLLEGE
 NURSING
REVIEWER | FIRST SEMESTER
PATIENT SATISFACTION
HOSPITAL CONSUMER OF ASSESSMENT OF
HEALTHCARE PROVIDERS AND SYSTEMS (HCAHPS)
• A standardized survey developed to
measure patient perceptions of their
hospital experience.
CONCEPTS OF PATIENT-CENTERED CARE:
1. Respect & Dignity
2. Sharing of Information
3. Participation in care & Care decisions
4. Collaboration
NURSING-SENSITIVE OUTCOMES
• These are patient outcomes & nursing
workforce characteristics that are directly
related to nursing care such as changes in
patients’ symptom experiences, functional
status, safety, psychological distress,
registered nurse job satisfaction, total
nursing hours per patient day, and costs.
NURSING INFORMATICS & TECHNOLOGICAL
ADVANCEMENTS
NURSING INFORMATICS
• uses information & technology to
communicate, manage knowledge,
mitigate error, & support decision-making.
• knowledge & skills also provides the ability
to access quality electronic sources of
health care information to plan &
coordinate patient care.
• Focus on organization, analysis, &
dissemination of information.
TELEMEDICINE/TELEHEALTH
• emerging technology: electronic medical
records & video teleconferencing are used
by health care providers & nurses to
provide care from a remote location.
BACHELOR
ST
OF SCIENCE IN NURSING
1 YEAR COLLEGE
PRELIMS
FUNDAMENTALS OF NURSING PRACTICE
GLOBALIZATION
HEALTH TOURISM
• the travel to other nations to seek out
health care.
As a result of globalization, health care
providers have to make services more
accessible.
INTERNATIONAL COUNCIL OF NURSES (ICN)
MISSION: To represent nursing worldwide,
advancing the professions & influencing health
policy.
GOALS: To bring nursing together, advance the
nursing profession, and influence health policy
worldwide.
QUALITY & PERFORMANCE IMPROVEMENT
QUALITY IMPROVEMENT (QI)
• an approach to the continuous study and
improvement of processes of providing
health care services to meet the needs of
patients and others and informs health
care policy.
• programs are focused on improvement of
health-care related processes.
PERFORMANCE IMPROVEMENT (PI)
• an organization analyzes and evaluates
current performance and uses the results to
develop focused improvement actions
QI DATA
• informs about how processes work within
an organization and offer information
about how to make EBP changes
QI
QUALITY
DATA
PI
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 NURSING PRELIMS
REVIEWER | FIRST SEMESTER FUNDAMENTALS OF NURSING PRACTICE

PROCESSES OF QI DATA:
1. EBP & QI inform opportunities for research.
2. QI identifies gaps in evidence; EBP
literature reviews often identify gaps in
scientific evidence.
3. Implementing a QI project based from
information from research & EBP that aims
to improve or better understand practice.
PDSA CYCLE
PLAN – review available data
DO – select an intervention & implement
change
STUDY – evaluate the results of change
ACT – incorporating changes into daily unit
performance

PADAYON NURSING!!!

BACHELOR
ST
OF SCIENCE IN NURSING 6
1 YEAR COLLEGE