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Today: most Americans are ___, aged ___ or older, live in ___ areas, and ___ their own homes
female, 35, metro, own
Five ways to demonstrate ethical behavior
Promote wellness
Preserve life
Provide adequate and continuous care for all patients/clients
Know and do not exceed the limits of practice
Maintain competence by continuing education
Ethics
the principles and values that determine appropriate behavior (more based on following the rules)
Respect for cultural, social, and ethical differences of the clients and other workers
Practicing within the guidelines of laws, policies, and regulations established for each type of employment
Morals
based on the experience, religion, and philosophy of the individual and the society. (more about behavior, how you treat people)
Being a good spouse, friend, or parent is an example of:
morals
Codes of conduct
first code of conduct was created by physicians
lawyers established the second code of conduct
pharmacists
veterinarians
UMKC school of nursing code of conduct
students are held to a code of conduct in the school of nursing
ex. honesty
Professional Codes of Conduct
Health professionals must stay within a scope of practice
Illegal and unethical to perform skills or tasks that are outside scope of practice
For some licensed professions, limits of practice may be established by each state
ex. Exercise specialist is not a physical therapist, A Nutritionist is not a Registered Dietician, A Nursing Assistant is not a Registered Nurse
Massage therapists in Kansas
Currently there are no state requirements for licensure in state of Kansas
Massage therapists in Missouri
Missouri State Board of Therapeutic Massage - Division of Professional Registration
500 hours from a board approved school
Pass exam - NCETMB
Maintenance status: 12 hours biennially
*scope of practice is probably more defined
An individual may perform only those procedures for which they are educated, certified, licensed, AND credentialed
trained to do
certified as competent
authorized by medical director
state licensed to practice
jurisprudent
aware of laws that influence their industry
Negligence
failure to perform duties in a reasonable and customary way.
Malpractice
bad or harmful practice that harms another person. neglecting to do something that is considered to be common practice, such as leaving the client in an unsafe situation
It is considered _______ when the health care worker is performing skills that are beyond the level of the health care worker's education and training
malpractice
A client's or patient's health care is ALWAYS considered ______
confidential
The care provider is ______ responsible to maintain the patient's ______
ethically, privacy
confidentiality
allows the client to tell the professional personal information related to their health without fear of it being shared with someone who is not involved in the client's health care
HIPAA was passed by Congress in 1996.
established to reduce administrative overhead
ensure the ability of the patient with preexisting conditions to change insurance plans
HIPAA privacy rules were issued in 2000.
Protect patient info by standardizing rules that protect electronic health information
Protected Health Information (PHI) - any individually identified health info that's transmitted or maintained in any way.
HIPAA is enforced by the __________
HHS Office for Civil Rights (OCR)
Patient's Bill of Rights.
In 1973, the American Hospital Association (AHA)
right to confidentiality and personal privacy.
right to quality care without mistreatment, neglect, or abuse.
right to voice grievances without fear of retaliation.
personal possessions must be cared for and kept secure while care is being given.
rights and responsibilities for the patient:
1998, the Advisory Commission on Consumer Protection and Quality in the Health Care Industry
designed to protect consumers
Right and responsibility to participate or have a representative in making treatment decisions
Responsibility to communicate honestly and show respect for health care providers
Responsibility for making a good-faith effort to pay for care
Responsibility for following the procedures of the health care plan
Informed Consent
Risks and medical information must be fully explained to patient
Elements of Informed Consent
Description of treatment or procedure - what and why
Description of alternatives, regardless of cost or insurance coverage
Risks, benefits & unknown factors of each alternative
Risks, benefits & unknown factors of no treatment at all
Patient questions
Assessment of patient understanding
Agreement by the patient for the treatment/procedure
Legal directives
documents that allow patients to express their wishes about their health care and treatment
Care provider's responsibility to know about and respect the patient's directives
Advance Directives
Living will (document) Durable power of attorney (person)
Living will
document
Allows a person to state in advance whether to receive life support and what life support procedures to withhold if the person is terminally ill and permanently unconscious
Durable power of attorney
person
Allows a second person or agent to make decisions if the first person is unable to make them
Elements of Advanced Directives
Health Care Agent
Treatment Preference: Living Will
Organ Donation
Autopsy
Signatures
Health Care Agent
Someone else makes decisions if patient unable to do so - power of attorney
Treatment Preference: Living Will
what type of care is important to patient
DNR?
life support?
Organ Donation
patient may wish to donate or not
Autopsy
patient may refuse or allow
Signatures
must be signed by patient and witnesses
Health and the Internet: Patients can:
Access health care information
Purchase drugs and other medical items
Consult a health care practitioner online
Telehealth
Health and the Internet: Providers must:
be aware of ethics and legal responsibilities when providing online or telehealth programming
Being aware of patient or client wishes shows ______ ______
professional responsibility
Liable
Legally Responsible
Permits
license
certification
The health care or health service provider is ______ ______ for his or her behavior and the care given
legally responsible (liable)
The employer may be liable for the actions of a health care or health service provider that are not ______ ______ or that reflect ______ ______
reasonably prudent (negligent) bad practice (malpractice)
Hippocrates (460-377 B.C.)
One of the first to separate medicine from religion
Believed illness was caused by environmental factors, diet, and living habits
Believed there were 4 "humors" that needed balance
Hippocrates' four humors
yellow bile
black bile
phlegm
blood
late 1500 - early 1600's
Zacharis Janssen invents microscope
Late 1770's
Edward Jenner — small pox vaccine is widely created
"Father of Immunology"
Edward Jenner
1800
Gregor Mendel — determined traits were inherited
"Father of Genetics"
Gregor Mendel
1813 - 1858
John Snow's "Grand Experiment" of 1854
"Father of Modern Epidemiology"
John Snow
Marine Hospital Service (1798)
treated ill merchant seamen - offered assistance on epidemics and quarantine
formed the foundation of public health in the US
was renamed US Public Health Service in 1912
Marine Hospital Service was renamed the ___ ___ ___ ___ in 1912
US Public Health Service
US Public Health Service responsibility:
health investigation and environmental health
6 initiatives focused on by early public health
communicable and infectious diseases
crowded living conditions
improved sanitation
separating toilet from public water supply
clean drinking water
immunizations
communicable
contagious
___ ___ vaccine arrived in US in ___ but didn't become required until ___, and then enforcement began in ___
small pox 1800 1855 1872
Incidence
the probability of occurrence of a given medical condition in a population within a specified period of time. Although sometimes loosely expressed simply as the number of new cases during some time period, it is better expressed as a proportion or a rate
Prevalence
the proportion of cases in the population at a given time
Endemic
normal prevalence of disease in a population (e.g. malaria in Africa)
Epidemic
outbreak of disease that affects many people at the same time and is spread through multiple communities (epi = 'above')
Pandemic
disease spreading across many parts of the world (pan = 'all')
Dem
people or district
Spanish flu
1918
Highly infectious illness
Pandemic
More than 20 million people died
Asian flu
1957
Fewer died than Spanish flu, lessons learned
2 waves
69,800 died in the US
Avian flu
"bird flu"
1997
18 died of a few hundred affected
recent occurrence of epidemic/pandemic
Swine flu
2009
43,000 cases with 302 deaths
Jonas Salk
Polio vaccine (1955)
largest outbreak in history took place in 1952
current problems for public health in the present:
Diseases that result from lifestyle - Cancer
Heart disease
Drug abuse Continued focus on communicable diseases - flu, HIV, TB
natural disasters
bioterrorism
food borne illness
What was the old definition of "healthy"
Absence of illness or injury
What does it mean to be "healthy" now?
State of optimal well-being
Achieved through PREVENTION of illness and injury
holistic health
Holistic health includes:
Physical, emotional, social, intellectual, spiritual, environmental, occupational
Primary Prevention /Care
Primary care provider - well visits, dental visits
Federal, state, local, privately funded, grant funded
Key word for primary care:
prevention
Secondary Prevention /Care
Care after being referred for further treatment
Inpatient care for specific body system or disease (Cardiologists, Oncologist)
Health screenings - colorectal cancer, mammograms
Key words for secondary care:
diagnose and treat
Tertiary Care
Complex coordinated care in hospital setting you may not receive in local care centers
Bypass surgery, hemodialysis, etc.
key word for tertiary care:
rehab
Quaternary Care
Even more specialized and highly unusual care than tertiary
Who was the Department of Health and Human Services Secretary?
Sylvia Mathews Burwell
Who is the current Department of Health and Human Services Secretary?
Tom Price
Department of Health and Human Services
• Publish Healthy People 2020 goals • Office of Disease Prevention and Health Promotion
US Health Care system one of the most costly but not delivering the best care
U.S. ranked 17th out of 19 developed countries on number of years of healthy life before disease. • Institute for Health Metrics and Evaluations
Medicaid
Combined state and fed health care program for those with low income and limited resources
Medicaid varies from state to state
Medicare
Fed. health care program for those 65 and older, certain younger people with disabilities, and people with end-stage renal disease
Characteristics of healthcare of the future
• STRONG focus on wellness and prevention • Most cost effective • Childhood obesity • Care for elderly • Hospitals provide care for the severely ill - reduce the number of beds • Advanced treatment and surgical methods • Complementary and alternative care • Diabetes care (by 2050, estimated 1 in 3 people will have diabetes) • Technology-based care • Patient-centered care • Encouraging patient to be an advocate, educated, and informed • Health care teams
May address more than just illness: health education and prevention, emergency response and bioterrorism • Continued health care reform • Flexibility, problem-solving and critical thinking are all valuable tools needed for the health care worker of the future • Unconventional therapy (Quackery) • Data driven
Health behavior surveys - Hospital admission data - Research studies
etc. Healthy People 2020
Unconventional therapy (Quackery)
Bee pollen, shark cartilage, hypnosis, acai berry, multi-level marketing, anti-aging, rapid weight loss, quick, easy, painless
What is the leading cause of death for all races and genders age 25-34 years
Accidents
What is the leading cause of death for hispanic females age 15-19 years?
Accidents
Healthy People 2020
vision: a society in which all people live long, healthy lives
can establish benchmarks and monitor progress
Health and Human Services initiative
Science-based, 10 year national objectives for improving the health of Americans
Health Disparities
vary by sociodemographic factors - Social Determinants of Health (zip code, age, sex, etc.)
Healthy People 1990
• Decrease mortality: infants-adults • Increase independence among older adults *15 topic areas
Healthy People 2000
• Increase span of healthy life • Reduce health disparities • Achieve access to preventive services for all *22 topic areas
Healthy People 2010
• Increase quality and years of healthy life • Eliminate health disparities *28 topic areas
Healthy People 2020
• Attain high-quality, longer lives free of preventable disease • Achieve health equity; eliminate disparities • Create social and physical environments that promote good health • Promote quality of life, healthy development, healthy behaviors across life stages *29 topic areas
Childhood Obesity: Georgia
• Nearly 1 million kids in Georgia are overweight or obese • Georgia has the second worst rate of childhood obesity in the United States • 75% of parents in Georgia who have overweight or obese children do not recognize the problem • Campaign developed by hospital from Atlanta that owns a group of hospitals across the state
Co-sleeping deaths in Milwaukee
• • • • • • Health Disparities: Co-sleeping deaths in Milwaukee In 2009 there were 122 infant deaths in the City of Milwaukee most were preventable 2007 Big Cities Health Inventory, the City of Milwaukee ranks 7th worst for infant mortality among the 53 largest cities in the US Difference between Milwaukee's infant mortality rates for African Americans and whites is one of the worst in the nation Reducing infant mortality, and racial disparities in infant mortality - MAJOR goal of the City of Milwaukee Health Department Some preventable infant deaths were caused by co-sleeping
Examples of health disparities
Childhood Obesity rates in Georgia Co-sleeping deaths in Milwaukee
Note
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