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INTRODUCTION TO BEING A HEALTH CARE WORKER History of Health Care Section 1.1 EARLY BEGINNINGS • Primitive humans focused on survival – protecting themselves against predators and finding food • Superstitious – believed illness & disease were caused by supernatural spirits • Tribal doctors performed ceremonies to exorcise evil spirits • Used herbs & plants as medicines, some of which are still used today…. Medicines from herbs and plants: • Digitalis – used to strengthen & slow heartbeat • Quinine – controls fever, relieves muscle spasms, and helps prevent malaria • Belladonna and atropine – relieve muscle spasm, especially in GI pain • Morphine – relieves severe pain, addicting MEDICINE IN ANCIENT TIMES • Egyptians first people to keep accurate health records • Still superstitious – called upon gods to heal them • Learned to identify certain diseases • Used medicines • Learned the art of splintering fractures • Treated disorders by bloodletting with use of leeches • Ancient Chinese were first to use primitive acupuncture therapies • Chinese acupuncture still commonly used today Ancient Greeks • First to study the causes of disease and to determine that illnesses may have natural, rather than spiritual causes • Kept records on what they observed and what they thought caused illness • Research about disease helped to eliminate superstition • Further developed the use of massage and herbal therapies • Dissection was not allowed due to religious custom • Hippocrates (“father of medicine”) based his knowledge of A & P on observation of the external body Hippocrates (469-377 B.C.): • Kept notes on signs and symptoms of many diseases • Found that disease was not caused by supernatural forces • Wrote the standard of ethics called the Oath of Hippocrates – still the basis for today’s medical ethics – physician’s still take this oath today ROMANS • Learned from the Greeks that some disease was caused by lack of sanitation • Introduced public health and sanitation • developed a sanitation system, using aqueducts to bring clean water into their cities • Built sewers to carry off waste • Public baths with filtering systems • The beginning of public health and sanitation ROMANS • First to organize medical care • Sent physicians & med equipment with armies • Introduced the concept of hospitals – kept room in their houses for the sick – established public buildings for the care of the sick • Physicians paid by Roman gov’t. • Wore a death mask with spice-filled beak, believed to protect them from infection & bad odors DARK AGES & MIDDLE AGES (A.D. 400-800) (A.D. 800-1400) • After the conquering of the Roman Empire, the study of medical science stopped • For 1,000 years, medicine was practiced only in convents and monasteries where they believed life and death were in god’s hands • Monks and priests had no interest in how the body functioned – primary treatment was prayer • All research in physiology ceased • Care was custodial DARK AGES & MIDDLE AGES • Epidemics caused millions of deaths • Bubonic plague (black death) killed 60 million • Other uncontrollable diseases - Smallpox, diphtheria, syphilis, and TB • Today, these illnesses are not always life threatening due to vaccines and medications RENAISSANCE (A.D. 1350-1650) • Rebirth of learning & new scientific progress began which influenced the future of medical science: – Building of universities and medical schools for research – New ideas about disease – Acceptance of dissection of the body for study – Printing press & publishing of books, allowing access to knowledge from research 16th & 17th CENTURIES • Leonardo da Vinci – studied & recorded anatomy of the body • William Harvey – used knowledge of anatomy to understand physiology – described the circulation of blood and pumping of the heart • Gabriele Fallopius discovered the fallopian tubes of the female anatomy • Bartolommeo Eustachio discovered the tube leading from the ear to the throat (Eustachian tube) 16th & 17th CENTURIES (cont’d) • Antonie van Leeuwenhoek invented the microscope – first to observe bacteria – established there is life smaller than the eye could see • Apothecaries (early pharmacies) started • Quackery, mass death from childbed fever, and disease continued • In the 16th & 17th centuries, the causes of infection and disease were still not understood. 18th Century • Medical teachings expanded • the study of physiology and disease processes continued through observation and dissection. • Wider range of students studied medicine 18th Century • Rene Laennec invented the stethoscope – **made of wood ** • Joseph Priestley discovered O2 – observed that plants refresh air that has lost O2 • Benjamin Franklin - many discoveries, including bifocals. Also found that colds could be passed from person to person • Edward Jenner – discovered a method of vaccination for smallpox. This led to immunization and to preventive medicine in public health 19th & 20th CENTURIES • The beginning of organized advancement of medical science • Ignaz Semmelweis identified the cause of childbed fever (puerperal fever) – Linked HANDWASHING & cleanliness to infection – This became an accepted practice – *** Today, handwashing is one of the most important and simplest ways to control the spread of infection*** 19th & 20th Centuries (cont’d) • Louis Pasteur (“Father of Microbiology”) proved that microorganisms cause disease; discovered pasteurization; vaccine for rabies • Joseph Lister discovered antiseptic to prevent infection in wounds and surgical incisions • Ernst von Bergmann developed asepsis to keep an area germ-free before and during surgery • Robert Koch discovered many disease-causing organisms; developed culture plate method to identify pathogens; isolated the bacterium that causes TB; introduced importance of cleanliness and sanitation in preventing the spread of disease • Wilhelm Roentgen discovered x-rays – allowed doctors to see inside the body for diagnostics • Paul Ehrlich discovered the effect of medicine on some disease-causing microorganisms - found a chemical to treat syphilis • Before the 19th century, pain was a serious problem; surgery was performed on patients without anesthesia • Early physicians used herbs, hashish, and alcohol to help relieve the pain of surgery • During the 19th and 20th centuries, anesthesia was discovered in the form of nitrous oxide (for dental care), ether, and chloroform • Knowledge of asepsis and the ability to prevent pain during surgery are the basis of safe, painless surgery today 19th & 20th Centuries (cont’d) • Gerhard Domagk discovered sulfonamide compounds – first medications effective in killing bacteria – used to treat deadly diseases • Dmitri Ivanovski realized some diseases were caused by some other microorganisms not seen under standard microscopes – viruses – eventually studied with electron microscope – found to cause: – Polio, rabies, measles, flu, chicken pox, German measles, herpes zoster, mumps 19th & 20th Centuries • Sigmund Freud discovered the conscious and unconscious parts of the mind – the mind and body work together – led to understanding of psychosomatic illness; founded the basis of psychology & psychiatry • Alexander Fleming discovered penicillin, one of the most important discoveries of the 20th century – pneumonia, gonorrhea, blood poisoning…. 19th & 20th Centuries • Jonas Salk discovered the polio vaccine using dead polio virus • Albert Sabin used a live polio virus vaccine – more effective – used today to immunize babies • Francis Crick and James Watson discovered the molecular structure of DNA - explained how DNA replicates and how hereditary information is coded on it • New approaches to medical care are being discovered every year • Wellness • Self-care Today • New approaches to medical care every year • Emphasis on wellness & self-care • Health – now refers to a person’s emotional, social, mental, and spiritual wellness – Holistic Health • Alternative medicine more widely accepted – acupuncture, chiropractic, homeopathy, naturopathy • Emphasis on home health care • Ambulatory care People live longer and healthier • • • • • • • • • Genetic research Organ transplants Reattachment of severed body parts Computers to aid in diagnosis, accurate record keeping, and research Noninvasive techniques for diagnosis Advanced procedures for caring of unborn fetus Greater acceptance of alternative medicine and complementary medical practice Geriatric research Facilities to better meet needs of senior citizens Future hopes in medical science • • • • • • Diabetes Cancer AIDS MS Arthritis MD ADVANCEMENT OF NURSING • Florence Nightingale (1820-1910) – founder of modern nursing – (1860) started a nursing school which raised the standards of nursing to become a “respectable” profession • Clara Barton (1821-1912) – established the American Red Cross • Lillian Wald (1867-1940) – established visiting nurse services for the poor. Today, visiting nurse services are found in most communities Patient Care Today • Patient caregiver team – includes licensed as well as unlicensed caregivers: – – – – – Clinical partner Service partner Nurse extender Health care assistant Patient care assistant • Extend the role of entry-level employees • The RN delegates patient care tasks according to training and expertise of the assistive personnel A Look Back to the 20th Century • • • • • • Antibiotics for bacterial diseases Improved life expectancy Organ transplants Healthier hearts (reduced smoking, better diets) Dentistry without pain Noninvasive diagnosis with computers (CAT, MRI) • • • • • • • • • End of smallpox Childhood immunizations New understanding of DNA & genetics Control of diabetes (insulin) Decline in polio Medical machines (kidney dialysis and heart-lung) Test tube babies HMOs Hospice Future of Medicine • Cure for AIDS • Decrease in malaria, flu, leprosy • Cure for genetically transferred diseases (Tay-Sachs, MD, MS, cerebral palsy, Alzheimer’s, Lupus) • Improved tx for arthritis & the common cold • Isolation of the gene that causes depression • Use of electronics to allow disabled to walk • Nutritional therapy for schizophrenia MEDICAL ETHICS • With medical advancement comes new issues – Organ recipients – Experimental drugs – Creation of in vitro embryos – AIDS confidentiality? – Assisted death (euthanasia) for terminally ill? UNDERSTANDING HEALTH CARE SYSTEMS Ch. 2 HEALTH CARE PROVIDERS Section 2.1 TYPES OF HEALTH CARE PROVIDERS • • • • • • • General Hospitals Specialty Hospitals Convalescent care Ambulatory care Physician & Dental Rehab Centers Industrial Health Care Centers • School Health Services • HMOs • Home Health Care Agencies • Senior Day Care • WHO • Hospices General Hospitals • Patients are hospitalized for a short time • Few days to few weeks • Provide a wide range of diagnostic, medical, surgical, and emergency care services Specialty Hospitals • Long-term stays (often over a month) • Acute care environment • Persistent recurring diseases or complex medical conditions • May include chronic diseases, pulmonary or physical rehabilitation, wound care, and psychiatric problems Convalescent Care • E.g., nursing homes, long-term care facilities • Facilities that are generally for geriatric care – care for elderly people needing nursing services and assistance with personal care and daily living activities • Also care for physically ill or injured people of all ages who require an extended convalescence for recovery • Focus is on rehabilitation, or optimizing the functional status of the patient so they may return to the community. • Staff: nurses, aides and assistants, physical, occupational, and speech therapists, recreational assistants, and social workers Nursing Homes • Can differ from extended care facilities • Places of residence for people who require constant nursing care and have significant problems with activities of daily living Extended Care Facilities • Care for those who need assistance with activities of daily living or with medical needs • For conditions that are likely to last for a long time or for the rest of the patient’s life (Alzheimer’s) Independent Living and Assisted Living Facilities • For elderly with active lifestyles • Offers older people the opportunity to remain independent in a home of their own, close to health care professionals and facilities • Patients need some assistance, but want to live as independently as possible for as long as possible • Bridges the gap between independent living and extended care or nursing homes Ambulatory Care • Facilities where several physicians with different specialties combine their practices • Allows patient immediate care for many different illnesse – Physician’s office – Designated area in hospital – Urgent care centers • Patients do not spend the night • These are outpatient services Physician and Dental Facilities • Provide care that promotes wellness and diagnosis of illness. – Simple surgeries – Bone setting – Counseling – Administration of drugs – Possible Diagnostic services – lab tests, x-rays Rehabilitation Centers • Provide outpatient care for clients who require physical or occupational therapy, recreational therapy, hydrotherapy, and other therapies (speech, hearing) for loss of function in mobility or the activities of daily living • Patients may receive prosthetics and learn how to use adaptive devices • Services enable patients to return to the community after therapy Industrial Health Care Centers GOVERNMENT AGENCIES • VA HOSPITALS • U.S. PUBLIC HEALTH DEPT. • STATE PSYCHIATRIC HOSPITALS • STATE UNIV. MED CTRS • STATE PUBLIC HEALTHSERVICES • COUNTY HOSPITALS • LOCAL PUBLIC HEALTH DEPARTMENTS • SENIOR CENTERS VOLUNTEER AGENCIES • • • • • • Amer. Cancer Soc. March of Dimes American Red Cross Amer. Heart Assoc. Amer. Diabetes Assoc. Nat’l. Assoc. of Mental Health MANAGED CARE • describes a variety of techniques intended to reduce the cost of providing health benefits and improve the quality of care • Organizations that use those techniques or provide them as services to other organizations • Systems of financing and delivering health care to enrollees organized around managed care techniques Managed Care • Preventive Care – Routine physicals, well-baby care, immunizations, and wellness education to keep patients healthy – Wellness education stresses the importance of good nutrition, weight control, exercise and healthy living practices – Being healthy helps prevent serious illness and lowers medical costs • Primary Care – Family and general practice, internists, nurse practitioners, and physician’s assistants – All routine medical problems – Refer patients to specialists • Specialty Care – Provider who is trained in one special area – Specializes and has a broad knowledge of that area – Surgery, podiatry, obstetrics, orthopedics, chiropractic, urology • Emergency Care & Urgent Care – Emergency care – for life-threatening conditions that require hospitalization - expensive – Urgent care – for non-emergencies that require prompt treatment – Outpatient care - costs are lower; patients prefer being at home • Managed care has attracted controversy because it has largely failed in the overall goal of controlling medical costs. • Proponents an critics are also sharply divided on managed care’s overall impact on the quality of U.S. health care delivery. AMBULATORY CARE • medical care delivered on an outpatient basis • • • • • Rehab. Centers Outpatient surgery Outpatient medical centers/clinics Physician’s offices Day care QUALITY HEALTH CARE COSTS & PAYMENTS • Health Plan Emp. Data Info Set • Diagnostic-Related Groupings • Health Ins: 3rd party Payers • • • • HMOs PPOs Medicaid Medicare