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Define system in relation to the U.S. healthcare system
The U.S. healthcare system is an interconnecting network with multi-layers of components to manage the health of U.S. citizens
Be able to explain various government-sponsored healthcare programs
The Affordable Care Act of 2010 (Obamacare) provided additional coverage from Medicaid to those of low income, and Medicare also expanded
Discuss factors influential to the development of the U.S. healthcare system
The sources do not directly discuss the factors influential to the development of the U.S. healthcare system.
Be able to state at least three historical events that influenced U.S. healthcare (do not need to know
exact dates)
The Emergency Medical Treatment and Labor Act (EMTALA) established in 1986 made it unlawful for hospitals to turn anyone away from the emergency department, regardless of insurance or means of payment [3].
Florence Nightingale's delivery of nursing services during the Crimea War in 1854 [4].
One of the earliest clinical trials was conducted in 1747 by James Lind
Define health
Health is defined as a state of complete physical, social, and mental well-being, and not merely the absence of disease or infirmity
Describe health determinants that affect the health of a person and a population
Biological determinants:
Hereditary components such as heart disease, cancer, diabetes, stroke, and Alzheimer’s [7].
Gender, such as osteoporosis being more common in women [8].
Race, such as sickle cell anemia occurring mostly in African Americans or those of Mediterranean descent and diabetes occurring more often in Black, Hispanic, and Native American populations
Socioeconomic determinants: Education, employment, income, family, social support, and community safety [8, 9].
Health behavior determinants: Cigarette smoking, poor diet, lack of exercise, alcohol consumption, and sexual health [9]. Stress is also a factor [10].
Physical environmental determinants: Secondhand smoke, lead-based paints, poor quality of drinking water, pests in the home, outdoor pollution, poor air quality, and "food deserts" [10]
Discuss measures used to assess the health status of the U.S.
Measures include morbidity, mortality, life expectancy at birth and at age 65, and infant mortality rate
Define chronic disease and understand behaviors contributing to the cause of a chronic condition
Chronic diseases are conditions that last one year or more and require ongoing medical attention or limit activities of daily living or both. Common chronic diseases in the U.S. are heart disease, stroke, cancer, diabetes, obesity, arthritis, Alzheimer’s disease, epilepsy, and tooth decay [13]. Behaviors such as cigarette smoking, poor diet, lack of exercise, and alcohol consumption contribute to chronic conditions
Identify personal behaviors and local/national initiatives to improve the health of Americans
Personal behaviors to improve health include avoiding cigarette smoking, maintaining a healthy diet, exercising regularly, and moderating alcohol consumption [9]. National initiatives include the Healthy People 2030 initiative
Contrast the many types of healthcare workers in the U.S.
Healthcare workers include:
Physicians (MDs and DOs) [15].
Advanced practice providers (APPs) like nurse practitioners (NPs) and physician assistants (PAs) [16].
Registered nurses (RNs) [17].
Licensed practical/vocational nurses (LPN/LVNs) [18].
Allied health professionals such as physical therapists (PTs), medical sonographers, occupational therapists (OTs), respiratory therapists (RTs), dentists, optometrists, pharmacists, and psychologists [19-26].
Identify the different work settings for healthcare providers
Healthcare providers work in various settings, including hospitals, private clinics, multi-provider clinics, surgical centers, public health departments, prisons, elderly care centers, academia, government, patient homes, nursing homes, schools, and occupational health settings
Understand the projections for future employment in healthcare professions
Healthcare employment opportunities are expected to grow 14% from 2018 to 2028 [30].
There are expected physician and RN shortages [31, 32].
Imaging professionals are expected to grow [32].
Nurse practitioner employment is expected to grow 28% and physician assistant employment is expected to grow 31% in the next ten years
Explain and understand how the rising numbers of seniors will impact the U.S. healthcare workforce
The growing elderly population and the numbers of healthcare providers entering retirement age will impact the U.S. healthcare workforce [30]. A major contribution to physician shortage is an increase in persons 65 and older, projected at 48% over the next twelve years [31]. The demand continues for RNs because of the increased burden for healthcare services for seniors [32].
Describe the meaning of gender pay inequality
A gender pay gap exists between men and women in the health profession careers
Describe types of hospitals
Types of hospitals include acute care hospitals, rehabilitation hospitals, and mental hospitals
Have knowledge of overall statistics for hospital admissions, including number of admissions, length of
stay, readmissions, payer sources, community income distribution, and geographical usage (do not need
to know exact numbers)
The top two most common diagnoses for inpatient hospital stays are pregnancy with childbirth and newborns/neonates [36, 37]. Common diagnoses causing hospital admissions after the maternal/newborn admissions include septicemia, osteoarthritis, congestive heart failure, Pneumonia, mood disorders, cardiac dysrhythmias, and complication of a device/implant/graft [37]. There was an increase in patients who are insured by Medicare and Medicaid from 1998 to 2017 and admissions of patients with private health insurance and those with no insurance decreased
Differentiate types of long-term care facilities
Long-term care facilities include skilled nursing facilities, nursing homes, and assisted living facilities [38].
Nursing homes only provide basic custodial care, meals, and activities of daily living [39].
"Skilled" nursing facilities indicate a higher level of care that professionals provide such as wound care by registered nurses and speech, physical, and occupational therapy services [39].
Assisted living facilities provide housing and usually meals, and medications may or may not be provided [39]. The resident is aware and able to provide their own activities of daily living [40].
Explain the rise in outpatient healthcare resources
Many healthcare services that were once provided to a hospitalized (inpatient) individual are now provided on an outpatient basis [40]. Outpatient procedures are increasing, and outpatient surgeries and procedures can now be done in an ambulatory setting, thus decreasing healthcare costs
Discuss how emergency departments are used
The emergency department (ED) is a part of a hospital established for patients experiencing emergencies that could result in life alterations, such as an injury, an acute illness, or an exacerbation of a chronic disease process [42]. It is common for persons without health insurance to seek care in the ED rather than have a primary healthcare provider
Describe the role of public health and public health departments
Public health, as an entity, is population rather than individual focused [3].
Local health departments provide services for individuals and families such as immunizations and clinics such as Women, Infant, and Children (WIC) [43].
The purpose of public health is to prevent epidemics and spread of disease, protect against environmental hazards, prevent injuries, promote and encourage healthy behaviors, respond to disasters and assist communities in recovery, and assure the quality and accessibility of services
Professional Conduct: Why it exists, expectations of clinicians
Professionalism is important to promote patient safety [45]. Health care is delivered by teams of professionals who need to communicate well, respect the principles of honesty, demonstrate respect for others, and maintain confidentiality and responsibility for their actions
Main Principles of Ethical Conduct
Main ethical conduct principles include honesty, autonomy, beneficence, respect, justice, and non-maleficence
Define cultural competence
Cultural competence is defined as the ability of providers and organizations to effectively deliver health care services that meet the social, cultural, and linguistic needs of patients
Skills suggested for cultural competence
Skills such as communication, medical history-taking techniques, curiosity, empathy, respect, and humility can be applied to a wide diversity of clientele
Determining scholarly information
The sources describe evidence-based practice (EBP) which uses research evidence and clinical expertise [50]. There are four levels of evidence: A, B, C, and ML (multilevel) [51-53].
Understand Evidence based process
Evidence-based practice (EBP) integrates clinical expertise, patient values, and the best research evidence into the decision-making process for patient care [54].
Build an effective search strategy
Formulating a well-detailed, clearly worded question is the starting point [55]. The more detailed the question, the better because it makes it easier and more likely to be found in a medical database [56].
Techniques to evaluate info
Closer look at all of the evidence that’s been gathered [51]. Ensure it is good quality [51].
Difference between quantitative, qualitative, and mixed methods research
Quantitative research uses numerical data [57].
Qualitative research incorporates the recording, interpreting, and analyzing of non-numeric data [57].
Mixed methods involves collection and analysis of both qualitative and quantitative information [58].
Types of quantitative data
Categorical and continuous [59, 60]
Advantages and disadvantages of quantitative and qualitative research
Quantitative: Common types are relatively quick and easy, answers the “what” and “how many” questions, and findings are concrete with minimal possibility for reviewer bias [60, 61]. Data collection can be time-consuming, may not answer the “why” of the evaluation, and for more advanced data analysis, software and training needed for analysis can be costly [61].
Qualitative: Understanding the richness and complexity of human behavior is the root of qualitative research [62].
Types of data
The sources identify categorical and continuous data
Use of placebos in research
: A placebo is a treatment that seems real to the patient but doesn’t actually have any therapeutic effect [63]. They have become a powerful tool in healthcare research, making it easier to assess the genuine impact of a treatment
Define evidence-based practice
Evidence-based practice (EBP) integrates the best evidence from well-designed research studies and evidence-based theories
How to use/practice evidence-based practice
Review and assess the latest research [64]. Knowledge gained from evidence-based research may indicate changing a standard policy in your practice [65]. Should always discuss findings with leadership and the team before implementation
Steps in evidence-based practice for making patient-care decisions- Know the components of each step
Use of oxygen to help with hypoxia and organ failure in patients with COPD, management of angina (chest pain), recognition of a family member's influence on a patient's presentation of symptoms, and noninvasive measurement of blood pressure in children
Steps in evidence-based practice for making patient-care decisions- Know the components of each step
Pose a question [55].
Gather the best evidence [56].
Analyze the evidence [51].
Apply the evidence to clinical practice [66].
Assess the result [66].
Levels of evidence and examples
Level A: The most reliable level of evidence because evidence is acquired from randomized control trials [51]. Example: administering plasma or placebo to determine the plasma’s effectiveness on COVID-19 patients with severe pneumonia [51, 52].
Level B: Evidence is acquired from quality-designed control trials without randomization, clinical cohort studies, case-controlled studies, uncontrolled studies, epidemiological studies, and qualitative/quantitative studies [52]. Example: studying the development of heart disease after exposure or non-exposure to 10 years of secondhand smoke [52].
Level C: Evidence is acquired from consensus viewpoint, expert opinion, and meta-synthesis [52]. Example: determining treatment for an exceptionally rare condition [53].
Level ML (multilevel): Evidence is acquired from more than one level of evidence as defined in the rating system [53]. Example: concluding that invasive surgery to remove a malignant mass from an elderly patient’s pancreas would be extremely high risk not only due to the patient’s age but also because of the unusual position of the mass [53].
Implications of evidence-based practice
EBP is a crucial component of safe, high-quality patient care [67]. Utilizing the EBP approach helps clinicians provide the highest-quality and most cost-efficient patient care possible [67].
Define and understand the elements of patient-centered care
Characteristics: Specific to each episode, calibrated to practical realities and pressing problems, focused on one’s own experiences, frustrations, sources of knowledge, and resources at hand [68].
Questions: What caused my sickness? Why did I become sick at this particular time? How does the illness work inside my body? What will happen to me? What will this illness do to me? How should it be treated [68, 69]?
Define and understand the elements of patient-centered care
Invites patients to be active participants in their care [70].
Emphasizes the patient’s experience with their illness [71].
Effective incorporation of patient-centered care
Assess patient and family explanatory models of symptoms and illness [72]. Validate patient and family concerns [73]. Check understanding by asking patients to explain or “teach back” to you, in their own words, what you have just explained
Impact of family on patient-centered care and outcomes
Patients were also highly influenced by the preferences of family caregivers, although the mechanism of influence was sometimes conflicting [74]. Family members attend clinical encounters, offer opinions, and participate in treatment-related decision making [75].
How to approach situations employing the method of patient-centered care
To avoid a return to biological reductionism, it is recommended clinicians take the following steps as they evaluate and work with patients (and their families) to establish treatment plans [72]
