KOZIER & ERB’S
Fundamentals of NURSING
NINTH EDITION Concepts, Process, and Practice
CHAPTER
Health Care
Delivery Systems
Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Copyright ©2012 by Pearson Education, Inc.
Audrey Berman • Shirlee Snyder All rights reserved.
Health Care Delivery
• Health care system – totality of services
provided by all health disciplines
• Categorized by type and level:
– Primary prevention (health promotion, illness
prevention)
– Secondary prevention (diagnosis, treatment)
– Tertiary prevention (rehabilitation, health
restoration, palliative care)
Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Copyright ©2012 by Pearson Education, Inc.
Audrey Berman • Shirlee Snyder All rights reserved.
Primary Prevention
• Healthy People 2030 goals:
1. Attain healthy, thriving lives and well-being, free of preventable
disease, disability, injury, and premature death
2. Eliminate health disparities, achieve health equity, and attain
health literacy to improve the health and well-being of all.
3. Create social, physical, and economic environments that promote
attaining full potential for health and well-being for all
4. Promote healthy development, healthy behaviors, and well-being
across all life stages.
5. Engage leadership, key constituents, and the public across
multiple sectors to take action and design policies that improve the
health and well-being of all.
Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Copyright ©2012 by Pearson Education, Inc.
Audrey Berman • Shirlee Snyder All rights reserved.
Primary Prevention (cont’d)
• Address adequate and proper nutrition,
weight control and exercise, and stress
reduction
• Emphasize the important role clients play
in maintaining their own health and
encourage them to maintain the highest
level of wellness they can achieve
Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Copyright ©2012 by Pearson Education, Inc.
Audrey Berman • Shirlee Snyder All rights reserved.
Secondary Prevention
• Hospitals
– Emergency care
– Intensive care
– Around-the-clock care
• Health promotion services
– Early detection
– Routine screening
Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Copyright ©2012 by Pearson Education, Inc.
Audrey Berman • Shirlee Snyder All rights reserved.
Tertiary Prevention
• Restoration to previous level of health or
highest level possible, given current health
status
• Rehabilitation to function adequately in the
physical, mental, social, economic, and
vocational areas of their lives
Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Copyright ©2012 by Pearson Education, Inc.
Audrey Berman • Shirlee Snyder All rights reserved.
Figure 6-5 Physical therapy services are an integral service in rehabilitation centers. Mark Thomas/Science Photo
Library/Photo Researchers, Inc.
Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Copyright ©2012 by Pearson Education, Inc.
Audrey Berman • Shirlee Snyder All rights reserved.
Health Care Agencies
• Government agencies
– Public health services
– Local health departments develop programs
to meet the health needs of the people,
providing necessary nursing and staff to carry
out these programs, continue evaluating the
effectiveness of the program, and monitoring
changing needs
Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Copyright ©2012 by Pearson Education, Inc.
Audrey Berman • Shirlee Snyder All rights reserved.
Health Care Agencies (cont’d)
• Ambulatory care centers
– Diagnostic treatment facilities
– Minor surgery
• Occupational health clinics
– Run by companies for employees
– Health promotion activities
Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Copyright ©2012 by Pearson Education, Inc.
Audrey Berman • Shirlee Snyder All rights reserved.
Health Care Agencies (cont’d)
• Hospitals
– Acute inpatient services
– Outpatient and ambulatory care
– Emergency department
– Hospice care
• Subacute care
– Variation of inpatient care
– Technically complex treatments
Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Copyright ©2012 by Pearson Education, Inc.
Audrey Berman • Shirlee Snyder All rights reserved.
Health Care Agencies (cont’d)
• Extended (long-term) care facilities
(formerly called nursing homes)
– Independent living
– Assisted, skilled, extended care facilities
– Rehabilitation
– Custodial (protective) care
• Retirement and assisted-living centers
– For clients unable to stay at home, but do not
require hospital or nursing home
Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Copyright ©2012 by Pearson Education, Inc.
Audrey Berman • Shirlee Snyder All rights reserved.
Health Care Agencies (cont’d)
• Rehabilitation centers
– Restore or recuperate health
– Drug and alcohol
• Home health care agencies
– Education to clients and families
– Care to acute, chronic, or terminally ill
Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Copyright ©2012 by Pearson Education, Inc.
Audrey Berman • Shirlee Snyder All rights reserved.
Health Care Agencies (cont’d)
• Day-care centers
– Infants or children (parents who are working)
– Adults who cannot be left at home
• Rural care hospitals
– Federal funding
– Services for rural residents
Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Copyright ©2012 by Pearson Education, Inc.
Audrey Berman • Shirlee Snyder All rights reserved.
Health Care Agencies (cont’d)
• Hospice services
– Care for dying in home or facility
– Improve or maintain quality of life until death
– Ongoing assessment of needs of client and
family
– Help in finding resources and services
Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Copyright ©2012 by Pearson Education, Inc.
Audrey Berman • Shirlee Snyder All rights reserved.
Health Care Agencies (cont'd)
• Crisis centers
– Emergency services for life crises
– Counseling and support
• Mutual support or self-help groups
– Health problems
– Life crises
Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Copyright ©2012 by Pearson Education, Inc.
Audrey Berman • Shirlee Snyder All rights reserved.
Health Care Providers
• Nurses
• Alternative (complementary) care
providers
• Case manager
• Dentists
• Dietitians/Nutritionists
Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Copyright ©2012 by Pearson Education, Inc.
Audrey Berman • Shirlee Snyder All rights reserved.
Figure 6-6 Although all members of the health care team individualize care for the client based on the expertise of
their own discipline, there are areas of overlap facilitated through teamwork.
Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Copyright ©2012 by Pearson Education, Inc.
Audrey Berman • Shirlee Snyder All rights reserved.
Health Care Providers (cont'd)
• Emergency medical personnel
• Occupational therapists
• Paramedical Technologists
• Pharmacists
• Physical therapists
• Physicians
Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Copyright ©2012 by Pearson Education, Inc.
Audrey Berman • Shirlee Snyder All rights reserved.
Health Care Providers (cont'd)
• Physician assistants
• Podiatrists
• Respiratory therapists
• Social workers
• Spiritual support personnel
• Unlicensed assistive personnel (UAP)
Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Copyright ©2012 by Pearson Education, Inc.
Audrey Berman • Shirlee Snyder All rights reserved.
Factors that Affect Health Care
Delivery
• Increasing number of elderly
• Advances in technology
• Economics: medical insurance
• Women’s health issues: women equally to
men
• Uneven distribution of services &
increased specialization
Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Copyright ©2012 by Pearson Education, Inc.
Audrey Berman • Shirlee Snyder All rights reserved.
Factors that Affect Health Care
Delivery (cont'd)
• Access to health insurance
• Homelessness and poverty
• Health Insurance Portability and
Accountability Act (HIPAA): security of
medical information act
• Demographic changes
Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Copyright ©2012 by Pearson Education, Inc.
Audrey Berman • Shirlee Snyder All rights reserved.
Financing Health Care
• Cost containment efforts include health
promotion/illness prevention activities,
managed care, alternative insurance
systems
Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Copyright ©2012 by Pearson Education, Inc.
Audrey Berman • Shirlee Snyder All rights reserved.
