Health care delivery - Essay Example

Nursing- Discuss how technology impacts on the nursing care of the highly dependent patient. Introduction Numerous trends influence all areas of health care, including care by nursing. The rising cost of health care has generated numerous outcomes that have had a broad impact on health care delivery. The potential compensation system for hospital Medicare patients, introduced in 1983, and current managed care competition need cost containment measures and a redefinition of least standards of care for hospitalized patients. The patient care plan should reflect a strategy that best congregates the patient's needs within time limitations and limited resources. The goal of efficiency inflicts shorter hospital stays for patients, reformation of hospitals for economic survival, and efforts to enumerate nursing care costs (Sinclair Vaughn 1988). Patients in hospitals are sicker, are being treated more appropriately, and are being expulsioned before they are completely recovered from their illnesses. Home health care and ambulatory services are growing in retort to the need and the economic inducement ( Freeman et al., 1987, Slemenda Mary Beth, 1983). Set the scene A subsequent trend in health care relates to the greatly technical hospital environment ( Moorhouse, Geissler, and Doenges, 1987: 1-3). Quickly changing technology imposes both knowledge requirements and a rising concern about the impersonality of the critical care environment. Nursing has reacted to these issues by attempts at association and communication in education and perform, innovative attempts at care planning all the way through computerization, organized training and education plans for staff, and new roles and constitutions in nursing practice ( Simpson and Brown, 1985). Main Discussion Nursing as a discipline is becoming inextricably bounced to technology ( DeVisser, 1981: 127). Specialization in medical practice as the sixties has imposed a national standard of medical and nursing care ( Garlo, 1984). Proceeding to that time, a physician might determine proper care for a heart attack patient. This care might be prejudiced by the region, the personal philosophy of the physician, as well as the resources of the community and hospital. The universal practitioner in a small town might have a diverse standard than would the teaching hospital in a big city. This is less the case now than ever before. National medical board qualifications now determines obstetric or cardiac care in both urban and rural areas, and these standards are upheld officially for physicians, nurses, and hospitals. Hospitals in small towns might have equipment and offer services once simply seen in a medical center. Regional trauma and neonatal ICU networks exemplify this phenomenon. Third-party payers, including Medicare, inflict a further standard for hospital care. Official approval standards set by the Joint Commission on Accreditation of Healthcare Organizations also encourage similarities somewhat than differences among hospitals. Critical care units have emerged as a general feature of hospitals in the 1990s (Elpern Ellen H., Suzanne B. Yellen, and Laural A. Burton 1998). The consequences of technology for nursing practice comprise demands for education and training, the materialization of specialized clinical roles, artistic and often expensive staffing patterns, salary incentive programs, distresses about abrasion of expert staff, stress and job tension, and the stresses of ethical predicaments arising in critical care settings. Critical care nursing, at present an anticipated part of hospital care in the 1990s, seems rooted in two discrete features (Campbell Margaret L. and Richard W. Carlson 2002). First, the enormity of patient needs calls for twenty-four-hour nursing surveillance. The temperament of this nurse-patient relationship has social, structural, institutional, and economic roots in the development of nursing in the United States. Private duty nursing and hospital staff nursing both restrain elements of this model of nursing care. Subsequent, the critical care unit has emerged as a geographic entity in hospitals, structuring patients and nurses together in retort to medical and surgical specialization and growing technology. Critical care nursing might reflect other evolutionary changes in twentieth-century nursing. Nursing education has gradually more moved to collegiate settings, and changes in nursing practice comprise performance of comprehensive physical and psychosocial patient assessments. The rising trend toward theoretically grounded practice and research has been stable. The practice of critical care nursing is more and more complex and sophisticated. Further, the consequences of feminist philosophy and labor practices in medicine and nursing practice in hospital settings are but two of the social drifts that have influenced the larger society as well as nursing as a discipline. Questions concerning the individuality of critical care nursing practice seem rooted both in past practice settings and in the sole interpersonal and technological environment of the modern critical care unit. Rising specialization, knowledge, and technology impulsive a need for bringing together nurses who had specialized knowledge with patients. The private duty nurse-patient relationship appeared to be the model for this ICU planning, somewhat than the subsistence of equipment or technology. Numerous of the earlier ICUs opened even without cardiac monitors, now measured one of the most primary elements of ICU care. The nurse was the monitor in the early units, using conventional hands-on nursing skills, such as taking the pulse and temperature and offering constant surveillance and observation of patient condition and status. Both medicine and nursing were less composite then and often involved more touch and personal, hands-on ministrations and care, such as alcohol baths for importunate high fevers (Spicer Joan G. and Mary Anne Robinson, eds., 1990, Stehle Joan L. 1991). As technology and specialized equipment appeared rapidly, the rapidity of change accelerated. This rapid change had numerous outcomes. Nurses were eager to learn new skills, but did not give up older methods. Nursing incorporated technical proficiency into the usual constant caretaking considered essential to nursing practice. Both medicine and nursing often skilled an over-reliance on technology that at times resulted in a diminished capability for manual assessment. Certainly, technology resulted in more data being obtainable for both medicine and nursing. The nurse rapidly became the expert in critical care. Since change was steady, there were few experts to educate and set up acceptable standards of practice. Nurses assumed new roles as clinical educators of nurses, patients, and often physicians, and as clinical experts who used clinical judgment to establish appropriate patient care. Nurses frequently set limits on patients, visitors, other nurses, and physicians in order to look after patients in the critical care unit. In truth, nurses always exercised judgment in hospitals to protect patients from harm or to give better care. As the nurses, in the days before the ICU the sickest patients were moved contiguous to the nurses' station so that the nurses could offer them more incessant nursing care. The physical space for the early ICUs was almost always adapted from areas not designed purposely for ICU care, often from space no longer desired because of technological advances. For instance, steam rooms used for babies with croup or patients with pneumonia, which were made superseded by the advent of antibiotics and the accessibility of humidified oxygen, were often converted to ICUs. The changes in technology and the new nursing roles were constantly a surprise to nurses. Defibrillation of the heart, for instance, was portrayed as almost unbelievable. Execution of new technology was similarly indistinct and uncharted. Nurses and physicians had good collaborative, working relations in these specialized units. Both learned together that the technology and the care would amplify patient survival (Daly Barbara J., Barbara Newlon, Hugo D. Montenegro, and Terry Langdon 1993, 217-223). The skill attainment in adapting to new technology was additive. Nurses integrated the new skills into customary roles. Nurses in critical care have compound knowledge and skills, and they mediate based on that expertise. For example, nurses give drugs or defibrillate the heart based on their appraisal of cardiac arrhythmias. Nurses as well diagnose cardiac ischemia (low tissue oxygen level) from an electrocardiogram and warn the physicians, so that instant intervention can prevent a heart attack or death. The combination of caring, skill, and persistent presence was improved by a new ferociousness in nursing practice in the critical care nurse. This aggression in assessing and intervening with patients based on specialized knowledge was a new notion. It surprised and perplexed numerous nurses and physicians. Thus, medical technology today is a propensity to think in terms of those technologies which are the most extravagant, such as transplantation, genetic engineering and in vitro fertilization (E. Tenner, 1996, 43). Yet, though we normally think of technology in a fairly narrow sense, any human-made invention or innovation can be stared as technological. therefore, health care technology refers not simply to high-tech devices such as ventilators, but also to drugs and medical and surgical procedures, and still things as basic as surgical gloves or developments in hand-washing techniques. It expands to devices which ease communication from patient to nurse, nurse to doctor and doctor to doctor, from the elementary hand-held patient call bell to the more multifaceted telemedicine devices which transmit electrocardiographic (ECG) traces. Moreover, the introduction of intravenous (IV) drips into a ward was observed as quite advanced, with simply the most senior nurse being permissible to interrelate with the IVs. The patients attached to the IVs were recognized as more composite cases requiring special observations. The capability to access the vascular system and feed fluids and blood products directly into patients' bodies was a main get through for both trauma victims and surgical patients. There were chambers joined to the IV lines, which not simply detected air in the line but mechanically measured and monitored the correctness of the device. By then IV fluid therapy was a typical intervention and remains so. Though, these days' ambulance officers routinely insert IV lines before transferring a patient from an accident, and cannulas for urgent access are placing in all patients admitted for surgery (D.W. Bates, 1999, pp. 13-17, ). Ventilators became rapidly classier as their potential became evident. Another noteworthy breakthrough was the invention of instruments such as the ophthalmoscope and microscope, and later X-rays, ultrasounds, computerized axial tomography (CAT) and magnetic resonance imaging (MRI), all of which facilitated the doctor to visualize as well as to feel and listen, adding a new aspect to the art of diagnosis. One of the major health technological innovations in the last century was the capability to obtain access to the interior of the body through catheters, scopes and radiological systems and to insert devices which conquest the function of failed or diseased parts. The cardiac pacesetter was one such innovation permitting individuals to live normal lives again subsequent to the uncertainty of living daily with life-threatening heart indiscretions. Inserting catheters such as the Swan-Ganz into main arteries and veins for diagnosis or monitoring of assorted physical parameters, such as major and venous pressures and cardiac function, has turn out to be an established practice. Monitoring devices have become more and more sophisticated, enabling a more accurate and instant diagnosis and assisting in the deterrence of emergencies. Eventually, technology permitted us to save those not only with acute illnesses and injuries, but also those with fatal illnesses such as renal failure. In the renal unit, large haemodialysis machines lined the walls attached to fragile, yellowed women who looked ninety but were really thirty. These were the days before renal transplantation so haemodialysis was their life line. Today, not simply would transplantation be a possibility, but peritoneal dialysis is a daily event for many individuals with failed kidneys, permitted them to lead comparatively normal lives. Innovations in pharmacological technology have complemented innovations in equipment. There has been an exponential increase in the variety of drugs obtainable to fight infections, sedate, and offer pain relief. More significant, however, was a greater considerate of how drugs worked and at what doses. The detection of the 'miracle' drugs sulpha, penicillin and streptomycin between 1930 and 1940 made a main difference in the care of those with severe infections. And extended surgical procedures were difficult as they relied very much on the penetratation in muscle relaxants which enabled patients to survive for extended periods under anaesthesia. Later, the capacity to keep the circulation functioning unnaturally outside the body meant that operations on the heart can be undertaken, from valve replacements, mend of congenital abnormalities and coronary artery bypass to heart and lung transplantation. In the case of technologies requisite to facilitate transplant surgery, improved immunosuppressant drug therapy has been one of the most significant, since devoid of such drugs patients would be incapable to survive for long devoid of rejecting their new organs. Indeed, the manufacture of the immunosuppressant drug Cyclosporin enabled liver transplantation to move from a few faltering cases to the institution of the National Liver Transplant Unit. Transplantation of organs from one person to another symbolizes for numerous scientists the triumph of humans over nature (E.E. Roughhead, 1999, pp. 19-22). The mainly recent technological developments centre on rising surgical interventions which lessen time spent in hospital. Keyhole surgery has offered the breach here. This has enabled surgery formerly done by cutting through the abdominal wall (laparotomy) to be assumed using several small incisions through which a tiny scope can be passed. Types of surgery comprise hernia repair (herniorrhaphy) and gall bladder removal (cholecystectomy) but investigations, biopsies and diagnosis can also be carried out in this way, thus avoiding major surgical techniques, long anaesthetics and longer stays in hospital. Currently such surgery is under search due to some proof of poor outcomes in a small percentage of patients (R. Moynihan, 1998, p. 35). The outcomes, perchance due to the refining of procedures, include unfavorable events such as damage to other internal organs due to poor vision through the extent, and extreme pain and fatigue following discharge. So regardless of the cost savings of 'day only' surgery, the outcomes for patients might be no better and might even be worse. This will not essentially be clear to surgeons and hospitals, though, because the patient will be meeting the costs of staying off work longer. Technological developments have changed the way patient care is organized and delivered. Possibly the mainly striking change has been the shift in focus from the body of the patient to the technology itself. The overture of technological devices such as the IV drip required the attention of health care professionals, at times at the expense of attention to the patients. In the case of the drip, nurses had to stand alongside the IV line each hour and observe the flow in drops per minute which then permitted a calculation to be made concerning the amount of time it would take for the patient to obtain the whole bag of fluid. Interestingly, although numerous technological devices when first set up were presented as time-saving, in realism the nurse has been left to make certain that, for example, the tracing leads are placed appropriately on the patient, the monitor is correct, readouts are recorded at a range of intervals for documentation for the doctor, and the patient is educated concerning the actual technology. Unlike other workplaces where it appears that the introduction of technology has cut staffing and transformed the level of staff required, in health the contradictory has occurred. We desired better trained staff and more of them as of the diagnostic and management potential and the growth of medical specialization. As technological devices in hospitals offer more accurate data, they need skilled insertion, management and understanding of results if the data are to be believed. Devoid of such reassurance, the usefulness and safety of new technology is doubtful (J. Lumby, 1997, pp. 231-8). Further significant transform brought about by increased technology in health care was the birth of extensive specialization as we know it today. The rise in specialized machines required a rise in specialist units. Technology begat specialists and speciality areas, educational programs as well as research units and in turn they begot more complicated technologies. What began as one acute unit in any teaching hospital where strictly ill patients were admitted, rapidly spread into a plethora of highly specialized units focusing on specific body parts such as hands or kidneys, on dysfunctions such as incontinence or asthma, or on disorders which need specialized technology such as sleep apnoea or renal dialysis. The impact of technology on work practices, organization of health care, and the culture of hospitals has been huge. Today communities seem to subsist within the specialties themselves somewhat than all through the organization, except in the case of a relatively small tangential hospital. And specialist colleges and associations have led to further fragmentation of disciplines, which in several ways has eroded any hope of united voice in general health care matters. Vested interests understandably stand in the specialist groups rather than in the wider discipline, whether that bemedicine, nursing, pharmacy or physiotherapy. Working in specialist environments with complex machinery we soon became specialists to endure. High-tech equipment led to the requirement for continual surveillance, detection and maintenance, which sequentially produced a network of new industries. In the each day routine of health care the nursing role has been most pretentious by such innovations. At the commencement of the twenty-first century, health care practitioners have tended to turn out to be experts in ever more specific areas of practice and less focused on generalist care. Thus, technological innovation has certainly added greatly to the cost of health care, not just because of the improvement itself but because it adds yet another level of practitioner and practice to a crowded field. The inconsistency of high-tech innovation is that at the similar time that we are prepared to fund high-tech 'miracle' interventions we are told there is inadequate funding for very fundamental health care which could improve the primary health of deprived groups in the community. With all new technological breakthroughs, together with new drugs, specialists emerge, educational courses are commenced, and research centers are funded. As institutions and practices turn out to be well-established, so do investments in them. High-tech interventionist practices are taken for granted, both within the health care system and outside by patients whose prospect are inexorably raised. As new drugs are developed and new procedures become offered, patients demand the newest interventions and practitioners make certain they are delivered. But with this comes the linked costs to individuals and to the health care system, costs which the public either are rude of or choose, often for very good reasons, to ignore. A further problem with innovations is that numerous practices are introduced devoid of evaluation and remain without evidence of their efficiency in terms of patient outcomes (Fairman Julie 1992. 56-59). Once large organ transplantation became probable it quickly became a typical option on the medical treatment list. As centers were set up in an experimental capability, they very rapidly became well-known centers supported by ongoing public funding. Long-term outcomes, of course, may not be optimistic but are hardly ever assessed once an individual becomes a successful statistic a 'survivor' measured by the reality that they were discharged from hospital. Despite the lack of public debate, there is substantiation that the public is not completely satisfied with what high-tech scientific medicine has to proffer them. Conclusion and Summary Technological innovations have amplified but so too has the interest in alternative therapies. One elucidation of this trend could be that people are looking for alternatives to the technological model of health care which 'dehumanizes' the patient and centers on illness rather than health and well-being. It is probable that rather than seen as opposed to conventional medicine, alternative therapies will come to balance it by fulfilling patients' needs for being cared for holistically as at the similar time having admittance to high-tech intervention in acute situation. The move away from generalist proficiency has left patients inadequate a good clinician who is capable to look at them as a whole person and not just as an assemblage of parts. Patients complain that doctors lean to focus on one or two features of their health problem somewhat than exercising tangential thinking and using good clinical judgment. General practitioners are criticized for relying on high-tech solutions such as drugs and referrals to specialists. Even in nursing, generic practitioners are much required today in the acute system where competence requires that nurses move between speciality areas according to need. This is hard for the nurse who has worked in one particular speciality for several years. Of course, generalists are found in the distant and some rural areas as of the lack of practitioners in these areas. There is the further problem of the lack of specialist facilities, often due to the lack of an adequate population to support them. The collision of technology within the area of health has been huge. It has distorted the way in which we think about health, illness, death and life. It has demanded new disciplines, disciplinarians, practices and practitioners and changed the distribution of funding in a way which has had lasting implications for certain groups in our society. It has raised our prospect and our sense of where we stand in the scheme of things. Some are omnipotent, some have lost power. Mortal infections have been cured through antibiotics, we can avert disease through vaccination, and now not simply do we remove diseased parts, we replace them. As a consequence, social expectations have increased and in turn have further driven the push for high-tech health care solutions. But such solutions might only be short term since enabling people to live longer lives means leaving them bared to illnesses they would not have encountered had their lives been shorter. When women died in childbirth, they were not left to face breast and uterine cancer, osteoarthritis, osteoporosis and dementia. When men died of heart attacks at a younger age and in larger numbers than is presently so, they were not left to face cancer of the prostate and dementia. Consequently, health problems are becoming more and more much complex and the range of demands on the health care system more competitive and costly, leading to health being reconceptualised as a business. References: E. Tenner, Why Things Bite Back: New Technology and the Revenge Effect, Fourth Estate, London, 1996. D.W. Bates, 'Frequency, consequences and prevention of adverse drug events', Journal of Quality in Clinical Practice, vol. 19, no. 1, 1999, pp. 13-17. E.E. Roughhead, 'The nature and extent of drug related hospitalizations in Australia', Journal of Quality in Clinical Practice, vol. 19, no. 1, 1999, pp. 19-22. R. Moynihan, Too Much Medicine The Business of Health and its Risks for You, ABC Books, Sydney, 1998, p. 35. J. 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