UMKC Health Sciences 101

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

1. 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