NOTRE DAME OF TACURONG COLLEGE COLLEGE

OF NURSING
Lapu-Lapu St., Tacurong City, Sultan Kudarat, Philippines Telephone
No.: (064) 200-3631 Fax No.: (064) 200-4131

Instructor: ANGELIE V. BATISLA-ONG, RN

Subject: NCM 103-FUNDAMENTALS OF NURSING PRACTICE
Schedule: Tuesday(1A), Friday(1B) 8:00-11:00 AM
Course Credit: 3 UNITS Lecture
Placement: First year, 2nd Sem

LESSON 10

CONTEMPORARY HEALTH CARE: HEALTHCARE DELIVERY SYSTEM

I. OBJECTIVES: At the end of the lesson, the students must have:

➢ Differentiated types of health care services;
➢ Presented providers of health care services
➢ Discussed frameworks for care
➢ Classified Levels of Prevention

II. COURSE CONTENT:

A. Definition:
o A health care system is the totality of services offered by all health disciplines. o
The services provided by a health care system are commonly categorized
according to type and level.

B. Types of Healthcare services (Levels of Prevention):

1. Primary Prevention: Health Promotion and Illness Prevention
- 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.

Category Health Promotion Illness Prevention

a. Patients WELL patients AT RISK patients

b. Goals - Wellness - Protect and
- Promote healthy preserve life
lifestyle
- Eliminate risk
factors
 c. Examples - Proper nutrition - Vaccination
- Exercises - Immunization
- Health education - Prophylaxis
activities
- Stress reduction

2. Secondary Prevention: Diagnosis and Treatment

- is trying to detect the disease early in order to prevent it from getting worse.

Category Diagnosis Treatment

Patients ASYMPTOMATIC SYMPTOMATIC

Examples - Regular dental exam - First aid

- Check-up - Surgery
- Screening / laboratory - Acute care
tests - Emergency care
- Operation “timbang”
- Case finding
- Physical assessment

3. Tertiary Prevention: Rehabilitation, Health Restoration, and Palliative Care -

Tertiary prevention focuses on people who are already affected by a disease.
- The goal is to improve quality of life by reducing disability, limiting or
delaying complications, and restoring function.

Category Rehabilitation / Health Palliative Care

Restoration
Patients Patients who are critically and chronically ill
Examples - Physical therapy - Hospice care
- Speech therapy - End-of-life care
- Self-monitoring - End-stage renal
- Maintenance care
medication - End-stage cancer
care

C. Types of Healthcare Agencies and Services

1. Public Health
▪ Government (official) agencies are established at the local, state, and federal
levels to provide public health services.
▪ Health agencies at the state, county, or city level vary according to the needs
of the area.
▪ Examples: municipal health offices, rural and urban local health clinics
2. Physician’s Offices
▪ Clients usually go to a physician’s office for routine health screening, illness
diagnosis, and treatment.
 ▪

▪ Examples: physician’s clinics

3. Ambulatory Care Centers
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.
▪ Examples: out-patient laboratories, out-patient pharmacies, out-patient
diagnostics, chemotherapy, minor surgeries
4. Occupational Health Clinics
▪ Occupational health services keep employees healthy and safe whilst in work
and manage any risks in the workplace that are likely to give rise to
workrelated ill health.
▪ Examples: company clinics, organizational clinics
5. Hospitals
▪ A hospital is a health care institution providing patient treatment with
specialized medical and nursing staff and medical equipment.
▪ Examples: Private or government
6. Subacute Care Facilities
▪ Subacute care is a variation of inpatient care designed for someone who has
an acute illness, injury, or exacerbation of a disease process.
▪ Subacute care is health care for people who are not severely ill but need
support to regain their ability to carry out activities of daily life after an
episode of illness, help to manage new or changing health conditions.
assistance to live as independently as possible.
▪ Examples: physical therapy clinics, wound care clinics, orthopedic clinics,
dialysis centers
7. Extended (Long-Term) Care Facilities
▪ Long term care facilities provide a variety of services, both medical and
personal care, to people who are unable to live independently.
▪ Examples: independent living apartments, adult homes, enriched housing,
nursing homes.
8. Retirement and Assisted living centers
▪ Retirement or assisted living centers consist of separate houses,
condominiums, or apartments for residents.
▪ Retirement communities and independent living facilities are residential or
shared housing communities that are usually age-restricted (e.g., aged 55
and older) with residents who are partially or fully retired and can generally
care for themselves without regular nursing or other routine medical
assistance.
▪ Examples: assisted living programs, adult homes, retirement communities
9. Rehabilitation Centers
▪ Rehabilitation is a treatment or treatments designed to facilitate the process
of recovery from injury, illness, or disease to as normal a condition as
possible.
▪ Examples: drug rehabilitation, mental rehabilitation, alcohol rehabilitation
10. Home Health Care Agencies
▪ home health agency - a public agency or private organization that is
primarily engaged in providing skilled or paraprofessional home health
care to individuals in out-of-hospital settings, such as private homes,
boarding homes, hospices, shelters, etc.
▪ Examples: health care agencies assigning healthcare at home 11. Day
Care Centers.
 ▪
The primary function of a daycare center is to provide a safe and secure
environment with quality caregivers, so that parents have the peace of mind
of knowing their children are safe while they work.
12. Rural Care
▪ Rural hospitals increase local access and allow patients to focus on “getting
better” rather than “getting to appointments.”
▪ Examples: rural health unit (RHU)
13. Hospice Services
▪ Hospice care is a special kind of care that focuses on the quality of life for
people and their caregivers who are experiencing an advanced, life-limiting
illness.
▪ Hospice care provides compassionate care for people in the last phases of
incurable disease so that they may live as fully and comfortably as possible.
▪ Examples: spiritual services, 24-hour care, on-call care, etc.
14. Crisis Centers
▪ Crisis centers provide emergency services to clients experiencing life crises.
▪ A crisis center is a resource for individuals going through mental health
crises. They provide mental health services and emotional support for their
state or local communities.
▪ Examples: 911 emergencies centers, mental crisis centers, etc.
15. Mutual Support and Self-Help Groups
▪ Self-help groups, also sometimes referred to as mutual-help groups, are
groups in which members share the same issue, condition, or situation and
thus are in a position to provide help and support to each other.
▪ Examples: anger management groups, stress management groups, alcohol
management groups, etc.

D. Providers of health care services

1. Nurse ▪ An RN assesses a client’s health status, identifies health problems, and
develops and coordinates care.
2. Alternative (Complementary) Care Provider
▪ Alternative or complementary health care refers to those practices not
commonly considered part of Western medicine.
▪ Examples: Chiropractors, herbalists, acupuncturists, massage therapists,
reflexologists, holistic health healers, etc.
3. Case Manager
▪ The case manager’s role is to ensure that clients receive fiscally sound,
appropriate care in the best setting.
▪ Depending on the nature of the client’s concerns, the case manager may be
a nurse, a social worker, an occupational therapist, a physical therapist, or
any other member of the health care team.
4. Dentist
▪ Dentists diagnose and treat mouth, jaw, and dental problems.
 ▪
▪ Dentists (and their dental hygienists) are also actively involved in preventive
measures to maintain healthy oral structures (e.g., teeth and gums).
5. Dietitian or Nutritionist
▪ A dietitian has special knowledge about the diets required to maintain health
and to treat disease.
Dietitians in hospitals generally are concerned with therapeutic diets,
supervise the preparation of meals to ensure that clients receive the proper
diet, and may design special diets to meet the nutritional needs of individual
clients.
6. Emergency Medical Personnel
▪ These personnel are trained to assess, treat, and transport clients
experiencing a medical emergency, accident, or trauma.
▪ Examples: paramedics, emergency medical technicians, fire response team,
etc.
7. Occupational Therapist
▪ An occupational therapist (OT) assists clients with impaired function to gain
the skills to perform activities of daily living (ADLs).
▪ For example, an OT might teach a man with severe arthritis in his arms and
hands how to adjust his kitchen utensils so that he can continue to cook.
8. Paramedical Technologist
▪ Laboratory technologists, radiologic technologists, and nuclear medicine
technologists are just three kinds of paramedical technologists.
9. Pharmacist
▪ A pharmacist prepares and dispenses pharmaceuticals in hospital and
community settings.
10. Physician Assistant
▪ Physician assistants (PAs) perform certain tasks under the direction of a
physician and are increasingly positioned to provide primary care.
11. Podiatrist
▪ Doctors of podiatric medicine (DPM) diagnose and treat foot and ankle
conditions. They are licensed to perform surgery and prescribe medications.
12. Respiratory Therapist
▪ A respiratory therapist is skilled in therapeutic measures used in the care of
clients with respiratory problems.
13. Social Worker
▪ A social worker gives counseling to clients and their support persons
regarding problems such as finances, marital difficulties, and adoption of
children
14. Spiritual Support Personnel
▪ Chaplains, pastors, rabbis, priests, and other religious or spiritual advisers
serve as part of the health care team by attending to the spiritual needs of
clients.
 ▪
15. Unlicensed Assistive Personnel
▪ Unlicensed assistive personnel (UAPs) are health care staff who assume
delegated aspects of basic client care.

E. Frameworks of Care
1. Managed Care
▪ Managed care describes a health care system whose goals are to provide
cost-effective, quality care that focuses on decreased costs and improved
outcomes for groups of clients.
▪ In managed care, health care providers and agencies collaborate to render
the most appropriate, fiscally responsible care possible.
2. Case Management
Case management describes a range of models for integrating health care
services for individuals or groups.
▪ A case manager, however, may be a nurse, social worker, or other appropriate
professional.
3. Differentiated Practice
▪ Differentiated practice is a system in which the best possible use of nursing
personnel is based on their educational preparation and resultant skill sets.
▪ Differentiated practice models consist of specific job descriptions for nurses
according to their education or training, for example RN, BSN RN, MSN, etc.
4. Case Method
▪ The case method, also referred to as total care, is one of the earliest nursing
models developed.
▪ In this client-centered method, one nurse is assigned to and is responsible for
the comprehensive care of a group of clients during an 8- or 12-hour shift.
6. Functional Method
▪ The functional nursing method focuses on the jobs to be completed (e.g., bed
making, temperature measurement).
▪ In this task-oriented approach, personnel with less preparation than the
professional nurse perform less complex care requirements.
▪ Clearly defined job descriptions, procedures, policies, and lines of
communication are required.
7. Team Nursing
▪ Team nursing is the delivery of nursing care to individual clients by a group of
providers led by a professional nurse.
▪ The team is consisting of: registered nurse (RN), licensed practical nurse
(LPN), unlicensed assistive personnel (UAP). This team is responsible for
providing coordinated nursing care to a set of clients for a specific period of
time, for example, one shift.
 ▪
8. Primary Nursing
▪ Primary nursing is a system in which one nurse is responsible for overseeing
the total care of a number of hospitalized clients 24 hours a day, 7 days a
week, even if he or she does not deliver all of the care personally.
▪ It is a method of providing comprehensive, individualized, and consistent
care.

III. INTERACTIVE LINKS

1. United States Health Care: Providers and Professionals -
https://www.youtube.com/watch?v=j4ZDSuNaMmg

IV. RESEARCH STUDIES / ADDITIONAL READINGS

1. Work methods for nursing care delivery - https://www.mdpi.com/16604601/18/4/2088/htm

V. EVALUATION
To pass the subject, you must:
1. Read all subject readings and answer the pre-assessment quizzes, activities, expected
output and assignments.
2. Submit the expected output on time.
3. Pass the midterm and final exam.
4. Grading System:
Quizzes/assignment 40%
Participation/attendance 10%
Portfolio/project 10%
Examination 40%
Total: 100%
VI. REFERENCES:
1. Berman, A., Snyder, S., & Frandzen, G. (2016). Kozier and Erb's Fundamental of
Nursing, Concepts, Process and Practice (10th ed.). New Jersey: Pearson 2.
Potter, P. A., & Perry, A. G. (2017). Fundamentals of nursing (9th ed.).Philippines:
Elsevier, Inc. pp 786-1275
3. Udan, J. (2009). Mastering fundamentals of nursing: Concept and clinical application (3rd
ed.). Malabon, Philippines: Educational Publishing House. pp 165-196, 333-464,
509522, 1-78