Chapter 1- 4

Chapter 1: Today's Health Care

  • Learning Objectives:

    • Identify trends in today's healthcare system.

    • Discuss implications of healthcare reform for delivery of patient care.

    • Identify the components of healthcare system.

    • Describe the complex factors involved in the delivery of patient care.

    • Identify the participants in the healthcare system.

Health

  • Health can be defined as one without illness or disease.

  • The nation strives for a state of health for every individual.

  • Healthy People goals and objectives:

    • Healthy People is reviewed and published every 10 years.

    • Main goal: to improve the health and well-being of people in the U.S.

Health History Continued..

  • Historically, care focused on those who were sick and injured.

  • Current focus includes health promotion (keeping people healthy) and injury prevention.

Affordable Care Act

  • Context: rising homelessness, undocumented workers, poverty, and healthcare costs.

  • ACA aims to provide healthcare coverage to those who cannot afford or access insurance.

  • Main goals/provisions include:

    • Opens Health Benefit Exchange (sales of coverage).

    • Prohibits denial of coverage to adults with preexisting conditions.

    • Requires large employers to provide coverage to those who work 30 hours/week.

    • Expands eligibility for Medi-Cal (California’s Medicaid).

    • Provides tax credits for small businesses that provide coverage.

    • Provides tax credits for individuals/families with income up to 94{,}200 who buy insurance through the Health Benefit Exchange.

Healthcare System Defined

  • The healthcare environment includes:

    • Patient

    • Patient's family

    • Community in which the system operates

    • Technology

    • Governmental and regulatory agencies

    • Medical profession

    • Third-party participants (e.g., insurance companies)

  • Overall goal: provide safe and appropriate healthcare services.

Health Promotion and Illness Prevention

  • Three levels of health promotion:

    • Primary Prevention: Seeks to avoid disease states through wellness activities (e.g., seatbelts, helmets, pre-sickness screening).

    • Secondary Prevention: Identifies disease and seeks to prevent the patient from becoming more ill (promote healthy behaviors).

    • Tertiary prevention: Reduces further complications from a disease or disorder.

  • Example: Dietary teaching to a patient with diabetes to reduce hyperglycemia occurrences.

Delivery of Patient Care

  • Care of the patient is a humanistic enterprise: focuses on the person at the center.

  • Focus includes treatment, prevention, restoring optimal wellness, caring for chronically ill, and educating patients and families.

  • A care plan is created using the nursing process to meet expressed patient needs.

  • Development involves the patient and all healthcare providers to meet total needs in a holistic caring manner.

Health History (Page 9)

  • In the 1900s, the healthcare team included:

    • Physician

    • Nurse

  • Additional members could include:

    • LPN

    • PCT

    • CNA

    • Medical office assistant (MOA)

Development of the Patient Care Technician

  • Increasing demand for qualified healthcare workers to assist nurses due to nursing shortages.

  • The PCT role was developed to provide higher-level care to patients (e.g., ECG and phlebotomy) as delegated by the nurse.

The Healthcare Team

  • Registered Nurse (RN): direct healthcare provider licensed after completing a nursing education program.

  • Licensed Practical Nurse (LPN): practices under supervision of the RN or physician; often direct caregiver alongside RN.

  • Nursing Assistants (NA): practice under supervision of LPN or RN; many states require NA certification.

  • PCT: often a CNA with further training to perform more advanced skills.

  • Other Caregivers: require registration/licensure and specialized education (e.g., social workers, physical therapists, respiratory therapists).

  • Technologists, Medical Technicians, and Personnel: assist in testing and support nursing care plans; work in labs, radiology, etc.

Economic Factors that Affect Health Illness

  • Major factors:

    • Rising healthcare costs

    • aging Americans, advances in technology, protecting patient privacy

    • Changes in delivery system

    • Social and environmental factors that affect health and illness

    • Health promotion

    • Patient’s rights

    • Healthcare providers’ rights

    • Interdisciplinary approach to healthcare

Chapter 2: The Role of the Patient Care Technician

  • Learning Objectives:

    • Discuss history of the PCT role

    • Discuss the PCT role in the healthcare environment

    • Understand current employment outlook for the PCT

    • Consider non-financial factors when choosing a PCT position

    • Describe PCT credentialing requirements, importance, and process

    • Discuss differences between a certified nursing assistant (CNA) and a PCT

The Difference Between the Certified Nursing Assistant and the Patient Care Technician

  • Similarities:

    • Care for patients in inpatient or outpatient settings

    • Accept responsibility delegated by the nurse or physician

  • Differences:

    • PCT has a wider skill set (e.g., phlebotomy and ECG)

Certifications for the Patient Care Technician

  • National Health Career Association (NHA) offers PCT certifications.

  • Eligibility:

    • Possess a high school diploma or GED

    • Successfully complete a training program within the past 5 years or have 1 year of supervised healthcare work experience within the last 3 years

  • Exam: 100 questions in 2 hours

  • Exam content categories:

    • Patient Care

    • Compliance, Safety, and Professional Responsibility

    • Infection Control

    • Phlebotomy

    • EKG Monitoring

Certifications Continued..

  • Cost: 90 to 149 on average.

  • Preparation: a test blueprint outlines categories/content areas.

  • Passing: results sent to candidate within 48 hours.

  • Retake policy:

    • If you do not pass, you have a second opportunity to retake.

    • After the second attempt, you must wait 30 days before reapplying.

    • After the third attempt, you must wait 12 months before taking the exam again.

Continuing Education

  • Practicing PCTs must stay current with rapid changes in healthcare.

  • Continuing education (CE) classes may be required to maintain certification.

  • NHA requirement: 10 credits of continuing education before renewing certification every 2 years.

  • NCCT certification requirement: 14 hours of CE annually.

The Scope of Practice of a PCT

  • PCTs work under direct supervision of a nurse and perform delegated tasks.

  • Clinical duties vary by healthcare institution and state.

  • PCTs are trained in first aid and CPR.

  • They collect and prepare laboratory specimens, perform ECGs, and prepare patients for x-ray evaluations.

  • In certain settings, they can assist in minor surgical procedures, prepare sterile trays, and perform autoclave sterilization of instruments.

  • Other duties include obtaining and recording vital signs.

Professional Appearance

  • A well-groomed PCT in appropriate attire has a positive psychological effect on patients.

  • Essentials of professional appearance:

    • Good health: sleep, balanced meals, exercise

    • Good grooming: daily bathing, deodorant, oral hygiene; avoid strong perfume; conservative nail polish; long nails discouraged

    • Suitable dress: scrubs cleaned and wrinkle-free; daily laundering; closed-toe shoes; limited jewelry; comply with workplace regulations

Chapter 3: Professionalism and Work Ethics

  • Learning Objectives:

    • Explain why professionalism is important in the medical field

    • Discuss characteristics of professionalism

    • Explain why confidentiality is critical in medicine

    • Identify hazards of using social media in healthcare

    • Discuss importance of attitude in caring for patients

    • Discuss workplace politics

    • Discuss meaning of insubordination and grounds for dismissal

    • Discuss how substance abuse affects employment

The Meaning of Professionalism

  • Definition: having a courteous, conscientious, and generally businesslike manner in the workplace.

  • Professionalism is essential for a successful PCT.

  • Evidence suggests patients are less likely to sue those they like or feel connected to; building rapport makes patients feel their concerns are valid.

Work Ethics

  • Definition: sets of values based on moral virtues of hard work and diligence.

  • PCT should display initiative and reliability: arriving on time, rarely absent, using best abilities.

Characteristics of Professionalism

  • Loyalty

  • Courtesy

  • Initiative

  • Flexibility

  • Credibility

  • Confidentiality

  • Social media awareness

  • Attitude

Obstructions to Professionalism

  • Personal problems and “baggage”

  • Rumors and the “grapevine”

  • Personal phone calls and business

  • Workplace politics

Professional Attributes: Teamwork

  • Time management basics:

    • Take about 10 minutes to write down daily tasks to ensure completion

    • Stay on schedule

    • Prioritize tasks to manage time effectively

    • Time management principles: decide which tasks are most important and in what order to perform them

    • Practice prioritizing to create an organized workflow

Professional Attributes: Documentation

  • Complete, accurate electronic medical record entries are critical; knowledge of the computer system enhances care

  • Note taking:

    • Carry a small notebook for notes/instructions

    • Use it to prevent forgetting tasks

    • Destroy any notes containing patient information in confidential recycling or a shredder

  • Hygiene and Interpersonal Skills:

    • Communicate clearly and courteously; explain instructions

    • Maintain a professional attitude of concern and helpfulness

  • Substance Abuse: avoid drug and alcohol abuse

Chapter 4: Communicating with the Healthcare Team

  • Learning Objectives:

    • Discuss verbal and nonverbal communication

    • Recognize assertive communication as the most appropriate style

    • Identify factors that affect communication

    • Discuss barriers to communication

    • Recognize trust as the foundation for effective interaction

    • Describe the electronic health record (EHR) and personal health record (PHR)

    • Determine when SBAR is beneficial

    • Note legal aspects of chart ownership, access, confidentiality, and documentation

    • Describe guidelines for charting and mechanics of charting

    • Discuss issues related to computerization in documentation

Overview of Communication

  • For communication to occur, a sender and a receiver are necessary:

    • Sender: the person conveying the message

    • Receiver: the person(s) to whom the message is conveyed

  • Two-way communication requires active participation by both parties and aims to meet the needs of both technician and patient, building a trusting relationship.

Verbal Communication

  • Involves spoken or written words or symbols.

  • Potential for miscommunication if the patient does not understand the words used by the PCT.

  • Ensure shared vocabulary with the patient; avoid jargon that the patient may not understand.

Nonverbal Communication

  • Messages transmitted without words (spoken or written).

  • Nonverbal cues are powerful and include:

    • Tone

    • Rate of voice

    • Volume of speech

    • Eye contact

    • Physical appearance

    • Use of touch

Styles of Communication

  • Assertive Communication: interactions that consider the patient’s feelings and needs while respecting the technician’s rights.

  • Aggressive Communication: typically overpowering and forceful, meeting one’s own needs at the expense of others.

Establishing a Therapeutic Relationship

  • A therapeutic caregiver-patient interaction demonstrates caring, sincerity, empathy, and trustworthiness. Trust is essential.

  • Focus on the patient, not just tasks.

  • Actively listen to patient thoughts, feelings, and concerns.

  • Use techniques that invite expression and convey acceptance and respect.

  • Use open-ended questions to encourage sharing.

  • Maintain professional boundaries and avoid sharing personal information.

Documentation

  • The chart is a legal record used to meet health, accreditation, medical insurance, and legal demands.

  • If it isn’t documented, it is as if it wasn’t done.

  • The process of adding information to the chart is called charting, recording, or documenting.

  • Always document exactly what was done; do not document tasks you plan to perform until they are completed.

Purpose of Patient Records

  • Five basic purposes:

    • Documented communication

    • Permanent record for accountability

    • Legal record for care

    • Teaching

    • Research and data collection

  • The patient record provides a concise, accurate, and permanent record of past and current medical/nursing problems, care plans, care given, and patient responses.

  • It is a legal record and can be used in court if there is liability.

SBAR

  • SBAR stands for Situation, Background, Assessment, and Recommendation.

  • It is a method of communication used among healthcare workers and is part of documentation.

  • SBAR is a safety measure to prevent errors during handoff interactions.

Methods of Recording

  • Traditional chart sections typically include:

    • Admission information

    • Physician’s orders

    • Progress notes

    • History and physical examination data

    • Nurse’s admission information

    • Care plan and nursing notes

    • Graphics

    • Laboratory and x-ray reports

Nursing Care Plan

  • A nursing care plan outlines proposed nursing care based on the nursing assessment and nursing diagnoses to provide continuity of care.

  • Developed to meet the nursing care needs of a patient.

Incident Reports

  • A form used to document events not consistent with routine operation or care.

  • Used to track unusual events (injuries to patient, visitor, or staff).

  • Helps track trends and prevent future problems through education and corrective measures.

  • Typically completed by the nurse for patient events; the injured staff member completes for staff injuries.

Record Ownership and Access

  • Patients generally have access rights to their records in most states.

  • A written request for chart access may be required.

  • Institutions can specify a review period and may require a staff presence to answer questions and protect record integrity.

Confidentiality

  • Healthcare personnel are mandated to respect patient confidentiality.

  • HIPAA (Health Insurance Portability and Accountability Act):

    • Passed in 1996

    • Sets protections for individuals covered by health plans, standards for electronic transactions, and safeguards for privacy of identifiable patient information.

  • Violating confidentiality can lead to job termination, lawsuits, or both.

Electronic Documentation Safeguards

  • Access requires login with a secure password; data entries are linked to the user who signed in.

  • Always log out before leaving the terminal.

  • Passwords should not be shared or written down, unless stored securely.

Questions?

  • End of content for review and clarification.