Being a

Nursing
Assistant
Ninth Edition

Francie Wolgin

Chapter One
The Health Care System

Pearson Education Being a Nursing Assistant, Ninth Edition

Copyright 2005 Francie Wolgin
 Purpose and Functions of Health
Care Delivery System
Definition:
• Involve the facilities designed for the delivery of health care and the
health care providers who deliver these services.
Purpose
• Meet the health care needs of all individuals
5 Basic Functions:
• Provide care for ill and/or injured people
• Prevent disease
• Promote individual and community health
• Provide facilities for the education of health workers
• Promote research in the sciences of medicine and nursing

Pearson Education Being a Nursing Assistant, Ninth Edition

Copyright 2005 Francie Wolgin
 Health Care Delivery System

Patient care is delivered in several ways:

• Inpatient
• Outpatient
• Short-term/long-term
• Patient’s home

Pearson Education Being a Nursing Assistant, Ninth Edition

Copyright 2005 Francie Wolgin
 DRG’s and Managed Care
Influence Health Care Systems
DRG’s
• Diagnostically related groups of patients related by
body system or disease type
• Basis for payment for Medicare patients
• Method to assess provision of quality care
• Set payment fees based on DRG assigned
CPT coding
• Current Procedural Terminology
• Groups of five numbers to classify procedure or
services for billing purposes
Pearson Education Being a Nursing Assistant, Ninth Edition
Copyright 2005 Francie Wolgin
 DRG’s and Managed Care
Influence Health Care Systems
Managed Care
• Variety of organizations with
Prepayment agreements,
Negotiated contracts & discounts,
Agreements for prior service authorization or
approval,
 Performance audits

Pearson Education Being a Nursing Assistant, Ninth Edition

Copyright 2005 Francie Wolgin
 DRG’s and Managed Care
Influence Health Care Systems
Managed Care (continued)
• Types
 Health Maintenance organization
 Preferred provider organizations
• Business strategy whereby health care
financing and delivery are combined to
balance costs, quality of care, and access.

Pearson Education Being a Nursing Assistant, Ninth Edition

Copyright 2005 Francie Wolgin
 DRG’s and Managed Care
Influence Health Care Systems
HIPPA—Health Insurance Portability and
Accountablity Act
• Federal regulations that governs and protects
individual’s privacy and the security of health
information (medical records). It also standardizes
electronic transactions and the use of unique
identifiers( ie. Employer's Tax ID)

Pearson Education Being a Nursing Assistant, Ninth Edition

Copyright 2005 Francie Wolgin
 Privacy Standards
(HIPAA)
• Protects the confidentiality of medical records and other
personal health information.
• Limits the use and release of individually identifiable health
information.
• Gives patients the right to access their medical records.
• Restricts most disclosure of health information to the
minimum needed for the intended purpose.
Improper uses or disclosures under the rule are subject
to criminal and civil sanctions prescribed in HIPAA.

Pearson Education Being a Nursing Assistant, Ninth Edition

Copyright 2005 Francie Wolgin
 Organizing Patient Care
Services/Nursing Health Care Team
Method of delivering health care services
• Functional nursing(charged nurse or nurse
manager)
Charge Nurse assigns and directs patient care
Duties are assigned for tasks such as passing
medications, treatment, etc. for all the patients.
 Members of the staff therefore only perform the
task assigned on all patients

Pearson Education Being a Nursing Assistant, Ninth Edition

Copyright 2005 Francie Wolgin
 Organizing Patient Care
Services/Nursing Health Care Team
• Team nursing (or nurse manager)
Resource Nurse divides staff into teams
Each team has a designated leader and group
of patients
 Team members perform the tasks necessary to
take care of that group of patients based on
what they can do by job description

Pearson Education Being a Nursing Assistant, Ninth Edition

Copyright 2005 Francie Wolgin
 Organizing Patient Care
Services/Nursing Health Care Team
• Primary nursing
 Professional nurse (RN) is responsible and
accountable for the entire nursing care of a
patient for 24 hours
 System is focused on the needs of the patient
 Associate nurse will provide care for the patient
when the primary nurse is absent

Pearson Education Being a Nursing Assistant, Ninth Edition

Copyright 2005 Francie Wolgin
 Figure 1–3 The nursing care health team
Pearson Education Being a Nursing Assistant, Ninth Edition
Copyright 2005 Francie Wolgin
 Organizing Patient Care
Services/Nursing Health Care Team
• Partners in practice
 Care is delivered with a Primary nurse or
combination of primary care nurse with a
nursing assistant as a team
 Team takes care of a group of patients.
 Other partnerships may occur with an RN and
LPN or RN and Respiratory Therapist

Pearson Education Being a Nursing Assistant, Ninth Edition

Copyright 2005 Francie Wolgin
 Organizing Patient Care
Services/Nursing Health Care Team
• Patient-focused care
 Involves small team of cross-trained caregivers
to deliver patient care in a specific unit or area.
 Members are cross trained with other
departments for example: drawing blood
samples; running EKG or providing other skilled
care of the other disciplines in healthcare
 Multidisciplinary approach to health care

Pearson Education Being a Nursing Assistant, Ninth Edition

Copyright 2005 Francie Wolgin
 Figure 1–4 A multidisciplinary team provides patient-focused/patient-
centered care; when possible the team includes the patient and the
patient’s family
Pearson Education Being a Nursing Assistant, Ninth Edition
Copyright 2005 Francie Wolgin
 Purpose and Function of
Multidisciplinary Team Approach
Multidisciplinary team consists of
professionals and nonprofessionals
from different disciplines that work
together to plan, make decisions, and
implement care focused on the patient.

Patient focuses vs. particular discipline’s

needs

Pearson Education Being a Nursing Assistant, Ninth Edition

Copyright 2005 Francie Wolgin
 Difference Between Qualifications of
the Different Nursing Team Members

RN
• Registered Nurse has completed a training
program of either 2, 3, or 4 years and
passed the state board licensing testing
• Able to assess a patient for what are the
problems, concerns, and needs of a patient
and perform the duties as outline in the job
descriptions and state nursing practice act.

Pearson Education Being a Nursing Assistant, Ninth Edition

Copyright 2005 Francie Wolgin
 Difference Between Qualifications of
the Different Nursing Team Members

LPN
• Licensed Practical Nurse completes a training
program of 1 year and passed the state board
licensing testing.
• They work under the direction of the registered
nurse to provide the care to their patients
• Able to observe the patient for problems,
concerns, and needs of the patient along with
administrating medications and specific treatments
according to their state nursing practice act.
Pearson Education Being a Nursing Assistant, Ninth Edition
Copyright 2005 Francie Wolgin
 Difference Between Qualifications of
the Different Nursing Team Members

NA/PCA
• Omnibus Budget Reconciliation Act of 1987
requires all nursing assistants working in
skilled and nursing care facilities to
complete an approved training program.
• Work under supervision of professional
nurse and cooperatively with other
members of the nursing service staff.

Pearson Education Being a Nursing Assistant, Ninth Edition

Copyright 2005 Francie Wolgin