The Healthcare Delivery System (The Nature of Nursing) Part 4

Impact of Changes in Third-Party Payment

The evolving system of healthcare financing in the United States has greatly affected the delivery of healthcare. Changes include:

•    Emphasis on wellness, disease prevention, and health promotion

•    Greatly decreased length of hospital stays

•    Use of hospitals for only the critically ill

•    Higher levels of client acuity in nursing homes

•    Fewer admissions for inpatient care

•    Sicker people discharged from hospitals, needing more care at home

•    Families taking more responsibility for care

•    Need for more outpatient care because procedures formerly done in the hospital are done on an outpatient basis

•    More community-based care and home care nursing

•    More specialized care

•    More diversified hospitals that rent medical equipment, provide home care, and have day-surgery centers and ECFs—in addition to providing inpatient care

•    Decentralized administration

•    Need for more cooperation among departments to maximize resources

•    Mergers of several hospitals or nursing homes to form a large corporation

•    More computers used for information processing

•    Advertising and marketing of hospital services as hospitals compete for clients

•    More concern for clients and their reactions to care

•    Many small hospitals closing or changing their emphasis because they can no longer compete (e.g., converting to nursing homes)


Many people believe that means other than traditional Western medicine can cure diseases and help them to achieve optimum health. These methods and beliefs are known as alternative healthcare or complementary healthcare. Several such modalities are discussed below. They may be used alone or in conjunction with other therapies. Only qualified practitioners should be used. Some practitioners must be licensed to practice legally.

Chiropractic, Physical, and Occupational Therapy

Chiropractic manipulates the spinal column and joints to treat pain and certain disorders. This therapy is based on the structure and function of the body. Chiropractors believe that the relationships between the spinal column and nervous system are important. Chiropractic adjustments seek to achieve a balance between these systems.

Physical therapy (PT) and occupational therapy (OT) are forms of rehabilitation after disease or injury. They use exercise, heat, cold, electrical muscle stimulation, splinting, ultraviolet radiation, and massage to improve circulation and to strengthen and retrain muscles. Physical therapy is also important in the management of chronic disorders such as arthritis. Occupational therapy is important in teaching skills that will enable people to return to work, manage their homes, or care for themselves again.

Holistic Healthcare

Holistic healthcare was at the center of many beliefs and practices of ancient civilizations. Holism became accepted in North American healthcare within the last half of the 20th century. Holism is a philosophy that considers the “whole person,” or the multidimensional aspects of the human being, to be in need of healthcare.

The person is seen as a complete and integrated unit. The individual is a physical, psychological, and spiritual being. However, each individual is more than the sum of these three concepts. The goal in integrated healthcare is to combine disciplines to meet the person’s overall needs.

Wellness not only means absence of disease and the meeting of one’s basic needs, but also includes avoidance of hazardous situations and the ability to cope with stress. Persons experiencing high-level wellness are better able to achieve personal growth and contentment, as well as the freedom to be creative.

Holistic healthcare refers to comprehensive and total care of a person by meeting his or her needs in all areas: physical, emotional, social, spiritual, and economic. Rather than defining health in terms of disease, holistic healthcare emphasizes wellness.

Holistic healthcare teaches that individuals can be in control of their own life and health, and that people can largely determine the quality of their life.

NCLEX Alert The concepts of Maslow’s Hierarchy are fundamental components of clinical nursing. They can determine the importance of a nursing care situation.Therefore, it is critical to know these concepts. Often these concepts may answer which action should be taken first (prioritization).

Clients have the right to be actively involved in their own care. Rather than passively following the physician’s orders, clients should consider the physician’s advice and make informed decisions about care they wish to receive. Clients also have the right to refuse care. Part of your nursing responsibility is to teach clients and to answer their questions. You will also teach clients ways to prevent disease and to improve their health.

Nurses and other healthcare professionals should provide holistic care in a supportive and positive fashion to help clients maintain a self-image as a worthy human being. By sincerely caring about your clients and respecting their ways of life, you can strengthen their feelings of self-respect and dignity.

Herbalists and Vibrational Remedies

Herbalists promote health through the use of herbs and other plants (botanicals). In many cases, the use of herbs is combined with a healthful diet, exercise, and other healthy practices. “Vibrational remedies” include flower essences and homeopathy.

Acupuncture and Acupressure

Acupuncture, a healing method originating from Chinese medicine, is based on Chi, which is believed to be the energy of life. Acupuncture views health and its functions as energy balance—and disease as imbalance—in the body. Acupuncture therapy includes the use of very fine needles inserted into specific energy points underneath the skin to balance the body’s flow of energy.

The use of this procedure is increasing in Western culture and is becoming more accepted by traditional allopathic medicine. It allows the body to heal naturally and does not involve the use of drugs, although herbal extracts and vitamins may be used. Acupuncture is often combined with meditation and exercise. It can be used for health promotion, such as weight control or smoking cessation, as well as for healing.

Clients can learn acupressure (external pressure applied to the energy points) for pain and symptom control between acupuncture treatments. Physical therapy and chiropractic use many of the same energy and pressure points.

Relaxation and Imagery

Relaxation and imagery are becoming more common in many areas of healthcare. Therapeutic relaxation begins with the client sitting or lying in a comfortable position, with eyes gently closed and the body relaxed. The person breathes deeply and concentrates on systematically and progressively relaxing all the muscles in the body. The person may also visualize relaxing images, such as clouds or colors. Hypnosis and self-hypnosis make use of relaxation techniques.

Imagery involves calling up mental pictures or events, usually after the client completely relaxes. Although the person can use any of the senses, the most common is visual imagery. Imagery is often used in cancer therapy. For example, clients visualize their cells as being big and strong and the cancer as being small and weak, or clients picture the cancer cells being destroyed by their own white blood cells or visualize themselves as being well and whole. Other practitioners teach clients to “love the cancer out of existence.” Imagery is also used in pain and spasm control, weight reduction, and smoking cessation.


Many religious groups practice meditation, which consists of deep personal thought and breath control. The meditating person can keep his or her eyes open or closed. A word or phrase (mantra) may be repeated to aid concentration. Meditation strives to “clear or still the mind” through the art of “quiet thinking.” Those who meditate change their concentration from the external world to the internal world, bringing mindfulness to oneself. Meditation helps decrease anxiety and enables people to better cope with stress. People can meditate while doing any relaxing activity: sitting, gardening, knitting, or walking.

Therapeutic Touch

Therapeutic touch is a specific noninvasive modality that does not require entering the body or puncturing the skin. Therapeutic touch grew out of the holistic healthcare movement. It was developed by Dora Kunz and Dolores Krieger and is based on the ancient practice of “laying on of hands,” although the skilled practitioner never actually touches the client. Therapeutic touch teaches that each person is surrounded by an energy field. This electromagnetic field can be detected by magnetic resonance imaging.

The practitioner first “centers” himself or herself, achieving a sense of peace or wholeness and then assesses and maximizes the client’s energy with the goal of restoring harmony. Should the practitioner sense that the client’s energy flow is obstructed, depleted, or disordered, the practitioner tries to direct the client’s energy to unblock and balance the areas of disturbed flow. Therapeutic touch aids relaxation, lowers muscle tension, and may decrease the client’s need for medication. It is considered to be a healing meditation.


Unlike complementary healthcare methods, which are acceptable modalities used in place of or along with conventional Western methods, many fraudulent healthcare practices and treatments are on the market.

The public spends an estimated $25 billion per year on “sure cures” for every imaginable ailment. The result is that ill people run the risk of delaying vital treatment until it is too late. Cancer, obesity, and arthritis “cures” are the most common frauds. So-called cures for AIDS and chronic fatigue are also on the rise.

Misleading the public (consumer fraud) is illegal. A great deal of money is at stake, so new schemes continue to develop. Why are so many people taken in by claims for a drug or other magic cure? People who are experiencing pain may be willing to try anything at any cost. Also, the general public often cannot tell the difference between true and false claims. As a nurse, you may be asked for your opinion about a questionable medical practice. Although people must make their own decisions, encourage them to find out all the facts before starting any untested healthcare measure.



When teaching clients and families about consumer fraud, be sure to address the following concepts:

♦    Encourage people to develop their consumer awareness. Support groups are available for those who have been victims of fraud and for advocates of consumer rights. Help direct clients and families to such avenues, if appropriate.

♦    Warn clients and families to suspect products, treatments, or methods with the following advertising claims:

♦    "Special formula”

♦    Supported by unrecognized 1 ‘healthcare experts’ ‘ or celebrities

♦    Testimonials by those who have used the product ("It really works!!”)

♦    Attractive refund policy if not "completely satisfied”

♦    Discuss with clients their option to consult other qualified healthcare practitioners about their current treatment and prognosis (second opinion).

♦    Explain to clients that they have rights to information about their health and about any product or treatment measure that they use or are interested in pursuing.


•    Many changes in the healthcare system in the 21st century will bring new and unknown challenges for nurses.

•    Types of healthcare facilities include hospitals, which now primarily treat people with acute conditions; extended care facilities, where care is given for a longer time; and community services, which include outpatient care, walk-in care, home healthcare, and care in schools and industries. Employment opportunities for nurses exist in all these areas.

•    The Joint Commission for Accreditation of Healthcare Organizations establishes quality and appropriate care standards.

•    Many hospitals have established the position of client advocate (representative, ombudsperson) to help the client and family adapt to hospitalization.

•    Third-party payment has been the method of payment for healthcare in the United States for a number of years. A variety of organizations provide this service.

•    Complementary healthcare will play an increasing role in the healthcare delivery system in the United States in the future. Holism is a philosophy that views the “whole person.”

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