CH 1: Health Care Delivery System and Nursing Concepts

Vocabulary flashcards based on the provided lecture notes covering health care systems, financing, prevention levels, health care levels, and QSEN competencies.

Health Care Delivery System

The organized system through which health care services are provided to clients, including providers, settings, regulatory agencies, financing, and levels of care.

Client/Consumer

A person who receives health care services.

Licensed Health Care Provider

A health care professional who has met legal requirements and is licensed to practice a specific profession.

Unlicensed Assistive Personnel (UAP)

A health care worker who provides delegated care but does not hold a professional nursing license.

Regulatory Agency

An organization that establishes or enforces rules, standards, or requirements for health care providers and facilities.

State Licensing Board

A state agency that regulates health care providers and ensures they comply with state laws and regulations.

Joint Commission

An organization that accredits health care facilities and establishes quality and safety standards for health care organizations.

Food and Drug Administration (FDA)

A federal agency that regulates medications, medical products, and other products to help ensure their safety and effectiveness.

Utilization Review

The evaluation of whether hospitalized clients are receiving appropriate diagnoses and treatments.

Health Care Financing

The methods and programs used to pay for health care services.

Medicare

A federally funded health insurance program primarily for people age 65 and older and certain people with permanent disabilities.

Medicare Part A

Medicare hospital insurance that covers services such as hospital care, skilled nursing care, home health care, and hospice.

Medicare Part B

Medicare medical insurance that covers outpatient services and provider services and requires a monthly premium.

Medicare Part C

Medicare Advantage; a Medicare plan that includes Part A and Part B coverage and may include Part D.

Medicare Part D

Medicare prescription drug coverage that helps pay for medications and requires a monthly premium.

Medicaid

A health insurance program for eligible low-income individuals that is funded by both the federal government and state governments.

State Children's Health Insurance Program (SCHIP)

A program that provides health insurance for eligible uninsured children whose families earn too much to qualify for Medicaid but cannot afford private insurance.

Preferred Provider Organization (PPO)

A health insurance plan that uses a network of preferred providers but allows clients to receive care from out-of-network providers, usually at a higher cost.

Exclusive Provider Organization (EPO)

A health insurance plan that generally requires clients to use providers within the contracted network and does not provide out-of-network coverage.

Long-Term Care Insurance

Insurance that helps cover expenses for long-term care that may not be covered by Medicare.

Social Determinants of Health (SDOH)

Conditions in the environments where people live, work, learn, and receive care that affect their health, functioning, and quality of life.

Neighborhood and Built Environment

The physical environment in which a person lives, including housing, crime, air and water quality, and access to safe outdoor spaces.

Social and Community Context

The relationships, social interactions, and community conditions that influence a person's health and well-being.

Economic Stability

A person's ability to meet basic needs through financial resources, employment, and other economic resources.

Health Care Access and Quality

A person's ability to obtain available, appropriate, and quality health care services, including insurance, providers, and screening services.

Education Access and Quality

A person's access to education and the quality of education available, which can influence health and opportunities.

Access to Health Care

The ability of individuals to obtain needed health care services when they need them.

Barrier to Health Care

A factor that makes it difficult or prevents a person from obtaining needed health care.

Geographic Isolation

Being physically separated from health care services because of location or distance.

Language Barrier

Difficulty communicating because the client and health care provider do not share the same language or have adequate language support.

Cultural Barrier

A difference in cultural beliefs, values, or practices that may interfere with receiving or providing appropriate health care.

Primary Prevention

Actions taken to prevent disease or injury before it occurs. Examples: immunizations, exercise education, nutrition education, hygiene education.

Secondary Prevention

Actions used to detect disease or health problems early, often through screening. Examples: mammograms, blood pressure screening, hearing screening.

Tertiary Prevention

Actions used to reduce complications and effects of an existing disease or condition and help the client manage it.

Preventive Health Care

Health care focused on preventing disease and reducing or controlling risk factors.

Primary Health Care

Health care focused on health promotion and disease prevention, often provided through routine/community-based services. Examples: prenatal care, well-baby care, family planning, nutrition counseling.

Secondary Health Care

Health care involving the diagnosis and treatment of acute illness or injury. Examples: emergency departments, hospitals, urgent care, diagnostic centers.

Tertiary Health Care

Specialized and highly technical health care for complex conditions. Examples: intensive care units, oncology centers, burn centers.

Restorative Health Care

Health care focused on restoring health or function and promoting self-care. Examples: rehabilitation, home health, skilled nursing facilities.

Continuing Health Care

Long-term or ongoing health care provided for chronic or end-of-life needs. Examples: hospice, palliative care, assisted living, adult day care, in-home respite care.

QSEN

Quality and Safety Education for Nurses; an initiative that prepares nurses to provide safe and high-quality care.

Safety

The QSEN competency focused on minimizing risks and preventing harm to clients, nurses, and others.

Patient-Centered Care

Care that respects and incorporates the client's needs, values, preferences, beliefs, and culture while involving the client in decisions about care.

Evidence-Based Practice

Using current research and other credible evidence to guide clinical judgment and client care.

Informatics

Using information technology and health information systems to support communication, clinical decision-making, and nursing practice.

Quality Improvement

Using data and systematic processes to improve health care services, processes, and client outcomes.

Teamwork and Collaboration

Working with members of the interprofessional health care team to coordinate care and achieve positive client outcomes.