Despelder8_ppt_ch05

Despelder8_ppt_ch05 - a Chapter FiveC H Chapter H Health...

Info iconThis preview shows page 1. Sign up to view the full content.

View Full Document Right Arrow Icon
This is the end of the preview. Sign up to access the rest of the document.

Unformatted text preview: a Chapter FiveC H Chapter H Health Care Patients, Staff, and Institutions Patients, Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland Modern Health Care s s s Health care triangle Health care financing Rationing scarce resources Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland Copyright The Health Care Triangle s s s Patients Staff Institutions/Administration Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland Copyright Institutional Medical Care s s s Hospitals Nursing Homes Hospice programs Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland Copyright Hospitals s In the past, hospitals were devoted In past hospitals mainly to acute intensive care of a acute limited duration. Now they offer an integrated system of health care services providing education, outpatient therapy, and (in some cases) palliative care. cases) Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland Copyright Nursing Homes s Also called convalescent and Also extended-care facilities, these institutions are designed to provide long-term residential care for the chronically ill. chronically Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland Copyright Hospice Care s Unlike hospitals and nursing homes, Unlike hospice is not necessarily a place, but a program of caring that is oriented toward the needs of dying patients and their families. The focus is on comfort rather than cure. comfort Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland Copyright The Rising Cost of Health Care s s s Medical coverage extended to cover Medical more people more The “technological imperative” Rationing scarce resources Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland Copyright Dimensions of Managed Care s s s Attempts to control when, where, and Attempts from whom medical services can be obtained obtained Diagnosis-related groups (DRGs) Diagnosis-related involve a predetermined schedule of fees for reimbursement to care providers providers May be restrictive, requiring bedside May rationing of services rationing Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland Copyright The Caregiver-Patient Relationship s s s s Paternalism Disclosing a life-threatening diagnosis Achieving clear communication Providing total care Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland Copyright Medical Paternalism s The assumption of parent-like The authority by medical practitioners, potentially infringing on a patient’s autonomy or freedom to make medical decisions medical Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland Copyright Disclosing Information s s s Present diagnosis and prognosis in a Present manner that best meets the needs of the patient the Advise about options for treatment Evaluate patient’s personality, Evaluate emotional constitution, and capacity for continued function under stress for Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland Copyright Disclosing Information (continued) s s Consider cultural factors Set aside time to explore patient’s Set questions and concerns questions Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland Copyright Strategies in Response to a Patient’s Desire to Talk About Death s s s Reassurance (“You’re doing so well.”) Denial (“Oh, you’ll live to be 100.”) Changing the subject (“Let’s talk about something more cheerful.”) something Fatalism (“Well, we all have to die sometime.”) sometime.”) Discussion (“What happened to make you feel that way?”) you s s Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland Copyright Care of the Dying s s s s Hospice and palliative care Home care Social support Trauma and emergency care Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland Copyright Palliative Care s Active total care of patients whose Active disease is unresponsive to curative treatment. Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland Copyright Aims of Palliative Care s s s s Control pain Relieve suffering Provide care for physical, Provide psychological, spiritual, and existential needs existential Help patients achieve a good or Help peaceful death peaceful Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland Copyright Features and Goals of Hospice Care s s s Provide relief from pain and suffering Promote an aura of peacefulness and Promote acceptance of dying acceptance Treat patient and family as the unit of Treat care care Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland Copyright Features and Goals of Hospice Care (continued) s s Provide access to comprehensive Provide services services Designed for those in the final stages Designed of a terminal illness who agree to forgo medical interventions intended to extend life to Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland Copyright Challenges to Hospice s s s The presence of a primary caregiver The who is available 24/7 who Adequate funding The six-month rule (i.e., life The expectancy six months or less) expectancy Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland Copyright Challenges to Hospice (continued) s s Expanding access to underserved Expanding populations populations Excessive bureaucracy leading to Excessive routinization of care routinization Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland Copyright Elder Care s s Institutional neurosis Institutional care options Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland Copyright Trauma and Emergency Care s s Triage system dates from Civil War Priority given to patients whose Priority injuries are serious but survivable injuries Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland Copyright Trauma and Emergency Care (continued) s s Many procedures adapted from Many techniques used by military in combat situations situations “Time is the enemy” / The “golden Time hour” hour” Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland Copyright Sources of Caregivers’ Stress s s s s s Feelings of inadequacy Non-reciprocal giving Too many demands Feelings of being devalued Inability to cure a disease or save a Inability life life Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland Copyright Burnout s A reaction to stress in which a reaction caregiver moves beyond exhaustion and depression to being “past caring.” and Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland Copyright Burnout Relief s s s s Social support Communication with other caregivers Sharing experiences and feelings Time off from the job Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland Copyright Being with Someone Who Is Dying s s s Leave your own agenda at the door Be present to what the person needs Life review can be empowering Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland Copyright Being with Someone Who Is Dying (continued) s s s Sit and listen “Stay close and do nothing” Moments of intimacy that Moments acknowledge both life and death acknowledge Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland Copyright ...
View Full Document

Ask a homework question - tutors are online