Trends and issues in
health care system
Najma Waqas
Nursing Instructor
SFINHS
Objectives
At the end of this session students will be able to:
Define issues and trends in healthcare system.
Identify specific issues related to nursing.
Describe ethical issues.
Describe legal issues.
Identify generational issues in nursing.
Determine current trends in healthcare system.
Understand the effect of currents trends on health and
development of nursing.
TREND
A general direction in which something is
developing or changing.
It is a change towards something new or
different. It is the direction over time.
Trend is something increased number of people
doing at same time.
For example advance technology in healthcare.
ISSUE
An important topic or problem for debate or
discussion.
An issue is a matter of concern or of interest.
Often people have different opinions about an
issue and will discuss or argue about it in order
to find a solution.
Issue is any diverse topic.
For example bioethical issues in healthcare.
Issues in
Healthcare
Nursing Shortage
Generational issues
Bio ethical issues
Patient Satisfaction
Managed Care
Trans cultural Nursing
National Patient Safety Initiatives
Evidence-Based Practice
Information Age
Genetics
Globalization of Health
Aging Population
Legal & Ethical Issues
Terrorism/Bioterrorism/Disaster Nursing
Nursing Shortage
National problem which is
growing
Critical shortage in
specialty areas because it
often requires special skills
and competence.
Average of nurse is 45.
Resurgence of enticements
for recruitment.
Reasons for Shortage
Work environment
Recruitment
Retention
Aging workforce
Compensation
Aging Baby Boomers
Shortage of nursing faculty
Generational
Issues
Traditional
Generation
Born in 1930-1940.
This group of nurses were hardworking, loyal,
family focused and work is important to them.
Served in military in World war 2.
Negative characteristics were emphasis on
bureaucratic structure and difficult to change
set standards and rules. Do not act as a change
agent.
Baby Boomers
Born 1960-1964.
This is currently largest in work era.
Grew at the time of women liberation
movement, civil rights movement and
Vietnam war.
They are independent loyal, workaholic
and has less experience with technology.
Generation X
Born 1965-1980.
They assume more nursing leadership roles as
Baby Boomers retire.
They are more accomplished in technology at
good communication and information power.
Have high levels of self-confidence and
empowerment.
They appreciate diversity more.
GENERATION Y
Born 1980- present.
They handle change better, take risk and want
to be challenged.
This generation is connected to cell phones,
iPods, digital assistant and are multi-tasking.
Bio ethical issues
The branch of ethics which studies moral
values in the field of medicine and biology.
Following are few bio ethical issues faced by the
health care system :
o Abortion
o End of life care
o Medical resource allocation
o Organ donation
o Euthanasia
Abortion
Abortion is the medical
termination of pregnancy
it is permissible only
when the life or health of
mother or fetus is
threatened.
Care givers have right to
refuse to perform an
abortion or to assist with
the procedure if it is
contrary to their moral
and ethical belief.
End of life care
End of life decisions:
o Patient have the right to refuse life sustaining
treatment.
o Respect this right and this decision.
With drawing life sustaining treatment:
o Withdrawing and withholding life sustaining
treatment are ethically and legally equivalent.
o Both are ethical and legal when the patient has
given informed consent.
Medical resource
allocation
The process of assigning or managing the
resources or assets to those most in need.
The un-even or un-just allocation is a burning
out issue because the resources of a society are
in limited supply, whereas human wants are
usually unlimited, and any given resource can
have many alternative uses.
Organ donation
The nurse should
carefully discuss the
situation in an ethical
committee or with the
supervisor before
communicating with the
donor and the recipient.
Ethical dilemmas arise
during equitable selection
and access.
Euthanasia
It is the termination of a very sick persons
life in order to relieve them from suffering.
Euthanasia can become a means of health
care cost containment.
It is a rejection of the importance and value
of human life.
Patient
Satisfaction
Press ganey surveys.
(survey without
biasness).
Good customer service
Patient Bill of Rights
Treat patients like family
Healthcare is a business.
Inspite of quality of care,
making money is imp.
Managed Care
Goal is to keep length of stay (LOS) down
Capitation
Patients are discharged sooner
Patient acuity higher
Health Care Plans
Case manager work closely with
physicians and insurance companies
Transcultural
nursing
Nursing has become
a melting pot
Nurses are
challenged to be
more culturally aware
Cultural sensitivity
National Patient Safety
Initiatives
Joint Commission National Patient
Safety Goals
Institute for Healthcare Improvement
“5 Million
Lives” Campaign
The Leapfrog Group
Joint Commission National Patient
Safety Goals
Improve the accuracy of patient identification
Improve the effectiveness of communication among
caregivers
Improve the safety of using medications
Reduce the risk of health care-associated infections
Accurately and completely reconcile medications
Reduce the risk of patient harm from falls
Encourage patients’ active involvement in their own
care as a patient safety strategy
The organization identifies safety risks inherent in its
population
Improve recognition and responses to changes in a
patient’s condition
The Leapfrog Group
Reduce preventable medical mistakes and
improve the quality and affordability of
health care.
Encourage health providers to publicly report
their quality outcomes so consumers can
make informed choices.
IHI “5 Million” Lives
Campaign
Deploy rapid response teams
Deliver reliable evidence-based care for acute MI
Prevent adverse drug events
Prevent central line infections
Prevent surgical-site infections
Prevent ventilator-associated pneumonia
IHI (Institute for health care improvement)
Evidence Based
Practice
Goal is to achieve cost-effective, high quality
patient care based on scientific inquiry
Nurses need to understand research process
involved
Nursing care should not be based on
opinions, past practices, but on the results of
scientific research
Clinical journals
Practice guidelines
Nursing research
Information Age
Consumers today are
more computer savvy
regarding healthcare
More info on internet
Consumers could
possibly be more
informed than health
care worker
Joint Commission 2014
all medical records have
to be EMR
Genetics
Many major
developments in the field
of genetic research
Stem Cell
Human Genome Project
Cloning
Legal & Ethical issues
Globalization of
Health
Healthcare has become
a global issue
People are mobile,
diseases can travel
Nurses need to have an
understanding of the
issues pertaining to
global health
Legal Issues in
Nursing
Do Not Resuscitate (DNR)
Confidentiality
Informed Consent
Negligence
Malpractice
Assault & Battery
False Imprisonment
DO NOT RESUSCITATE
Do Not Resuscitate (DNR), also known as no
code or allow natural death, is a legal order
written either in the hospital or on a legal form
to withhold cardiopulmonary resuscitation
(CPR) or advanced cardiac life support (ACLS).
It is the patient or family choice whether to sign
it or not. In case of DNR orders healthcare
provider is not allowed to do CPR. It sometimes
evoke an ethical dilemma and legal
consequences can be faced.
Confidentiality
The law requires to keep the information of the
patient confidential. This is an ethical issue.
Until patient tells you something that is harmful
to patient and others.
It helps to build trust with the patient but it is
difficult to maintain in today's health care system.
Informed Consent
It is a process for getting permission before
conducting a healthcare intervention on a
person, or for disclosing personal information.
It is an issue to talk upon as patients do not
have proper information and the consent
procedure is not efficiently followed.
Negligence
Negligence occurs when a person fails to
perform according to the set standards.
Common errors that can lead to negligence are
wrong identification of patient, Not following
proper anti-septic technique while performing
procedures, Surgical errors.
It is the responsibility of nurse to ensure that no
negligence will occur in care of patient.
Assault & Battery
Assault is a threat to a person, the willful
attempt to harm someone. It is a verbal
threatening.
Battery is the un lawful touching of someone
without consent and justification.
In medico-legal cases it occurs when procedures
are performed without consent of patient.
Civil & Common Law
Issues in
Nursing Practice
Intentional Tort
Unintentional Tort
Negligence
Malpractice
Consent
Informed Consent
Malpractice Insurance
Abandonment & Assignment Issues
Aging
Population
Population is aging
Growing concerns
regarding the unique needs
of the elderly
Gerontological nursing
Terrorism/
Bioterrorism/
Disaster Nursing
The 9-11 terrorist
attacks have
heightened attention to
the growing threats of
terrorism
Nurses need to be
aware to the health
consequences of
terrorism and use of
biological agents
Trends In healthcare
system:
Increased cost of health care
Change in federal and state regulations
Interdisciplinary skills
Nurses working beyond retirement age
Education changes due to change in
demographics
Increase complexity of patient care
Embracing of technology
Advancement in communication and
technology
Advances in nursing and science research
Increased Cost of Health Care :
As the cost of healthcare increases, patients are unable
to get the level of care needed to prevent chronic
illnesses and diseases from developing. This leads to
an increase in severely ill patients and higher hospital
bills as well as increased health care costs.
Changes in Federal and State Regulations:
Changes to healthcare in the latest healthcare act,
has brought up an issue surrounding patient care.
Patients are worried that if they don’t have a
managed care cover, they won’t get the same level
of treatment that a person with traditional insurance
would.
Nurses must be aware of how these changes affect
patients in order to adequately treat them and give
them the level of care they deserve.
Interdisciplinary Skills:
Since the healthcare needs of the population are
increasingly complex, nurses are beginning to
learn interdisciplinary skills.
As a result, nurses are able to deal with a wide
variety of disciplines including dental as well as
social issues.
Nurses Working Beyond Retirement Age:
The recent nursing shortage his lead to a discovery
which is, nurses are working beyond retirement age.
Some studies speculate that this is caused by the
latest recession which laid off numerous people.
As a result, nurses are either feeling more secure in
their jobs or are working beyond retirement age.
Working with More Educated Consumers:
Consumers are more educated than ever about their
health.
They understand how nutrition and exercise plays a
huge role in retaining longevity and preventing
diseases.
Pharmaceutical commercials also inform
consumers about which medications might work
for their particular medical conditions.
Nurses must be able to take in this information to
communicate with more educated consumers.
Education Changes Due to Changes in
Demographics:
Nurses nowadays have a whole new set of things
to learn due to changes in patient demographics.
People are now beginning to live longer and the
international community.
This means that nurses must understand the needs
of a diverse and aging population.
Increasing Complexity of Patient Care:
An increase in the life expectancy of patients have
lead to a shift in how patients are cared for.
Nurses must have a certain level of management,
administrative and medical skills in order to deal
with the new changes that healthcare reform and an
aging population have caused.
The latest trend has revealed that as the population
lives beyond their average life-expectancy, chronic
diseases are also on the increase.
The majority of these patients are inpatients that are
suffering from acute illnesses that require special
care.
Embracing of Technology:
In the age of increasing technology such as smart
phones, connected cars, TVs and tablets, nurses across
the world have had to educate themselves to use these
technologies to improve patient care.
The majority of medical facilities are starting to embrace
these technologies in order to reduce administration time
and to increase accuracy in treatment and medical
records keeping.
Nurses are now expected to use computer technology to
obtain patient information, save patient information and
even look up treatment options when necessary
Advancements in Communication and
Technology:
Advancements in communication and technology together
have helped the medical community immensely.
One way is an ability to reach out to those who were
unable to commute to a hospital or other care facility.
Nurses are able to communicate with these individuals in
order to provide them with medical information or even
prescriptions.
People are also using toll free numbers to contact nurses
through their insurance companies to ask medical
questions, which reduces the amount of emergency room
visits each day.
Advances in Nursing and Science Research:
An increase in nursing scholarships in research has
lead to better patient care as well as an improvement
with the way that patients experience treatment.
