Since 'Kos' is allowing non-political or at least vaguely tangential postings, I'm going to write today about the only sort of healthcare many people around the nation can afford - DIY (Do it yourself) Healthcare. While there are many definitions of 'health', I tend to prefer the rather mechanistic idea of health being existing in a disease-free state - health is, therefore, the absence of disease or the precursor conditions that set the stage for disease. This essay will be a general introduction to health and healthcare as viewed from a nurse's perspective.
There are three main stages to health and healthcare. Primary, or preventative care, secondary, screening care, and tertiary or treatment care. In primary care, one attempts to prevent a healthy behavior or body system from changing into an unhealthy one. Proper nutrition, exercise, and providing information regarding healthy mental and social skills fall into this category. Secondary care deals with attempting to identify as yet unnoticed health problems that have arisen. Mammograms, prostate exams, colonoscopies, or bloodwork falls into this category. Although such screenings can be negative, and the person healthy, one is now actively looking for existing disease processes, rather than attempting to prevent them from starting up in the first place. Once identified, existing diseases, syndromes, or illnesses require treatment. As you can guess, the farther along the chain you are, the more expensive things get.
From a nursing perspective, we usually wind up dealing with individuals who have already graduated into the third stage, and require various forms of treatment to either return them to health, or to stabilize people who have developed chronic conditions for which there is no cure. The explosion of health-care costs in the US in large part reflects a health-care system that spends very little on primary care, slightly more on secondary care, but the vast bulk of its energy and money on tertiary care, which is the most expensive and labor-intensive care possible.
One of the main reasons countries with socialized healthcare (and/or healthcare insurance) systems get so much 'bang for their buck' compared to the United States is that the low upfront costs to the users of the systems encourage them to seek healthcare earlier in the chain, rather than waiting until their situation is dire. Treating precursors or catching diseases in the early stage is far less expensive than catching them late, just as it's far less costly to put out a kitchen fire as soon as you see it, rather than waiting for the entire house to be aflame.
Until such time as the US starts pouring more money into community health fairs and facilities to teach people how best to keep themselves healthy (or seriously upgrading the 'health' requirements in the educational system) and then subsidizes proactive healthy behaviors, it is incumbent on each of us to take what steps we can to attain and maintain a healthy lifestyle. We have to take up the challenge of taking over our own primary care. Doing so will not only save us money as individuals in the long term, but allow us to enjoy longer, fuller, more active (and more politically active) lives.
There are certainly class and race issues that will make this more difficult to achieve for many. Poorer urban areas, frequently those populated by minorities, for instance, are notorious for being 'food deserts' - areas where the vast majority of food sold is of poor nutritional quality. While chips and quarter waters may provide high calories, they are essentially useless at providing any of the many other nutrients the body requires for optimal health. In such areas, a concept from decades ago, that of the 'co-op' might be helpful, with communities banding together to get corporations to deliver wholesale level shipments at wholesale level prices to a distribution point where they can be split up into the individual orders.
Since nurses most frequently deal with tertiary care in the US, most nursing diagnoses likewise deal with identifying the resulting behaviors of the body, mind, or spirit in response to disease processes. Still, there are a number of recognized 'risk' diagnoses that are used to attempt to head off unhealthy behaviors. Risks for activity intolerance, suicide, self or other-directed violence, nutritional imbalances and the like are all conditions recognized to require 'interventions', which are nursing interactions such as teaching, medicating, positioning, or assisting patients in some other fashion.
Nursing typically follows a framework frequently abbreviated as 'ADOPIE'. Assessment, Diagnosis, Outcome Identification, Planning, Intervention, and Evaluation.
In assessment, you look for 'signs' - things that can be objectively seen or measured (blood pressure, dilated pupils), or 'symptoms' - things that the person subjectively reports ('My pain is a 5 on a scale of 1 to 10' or 'I feel really nauseous') but cannot be directly measured from the outside.
Nurses are typically trained with a background in anatomy, physiology, and various disease processes, so in the diagnosis step, they cluster the collected signs and symptoms to come up with a nursing diagnosis. (Nursing diagnoses differ from medical diagnoses in that nurses don't identify specific illnesses or traumas, they deal with the distinct ways in which one responds to a variety of illnesses or traumas. Thus 'hyperthermia', or high bodily temperatures, is a nursing diagnosis that might be common to a number of disease processes such as infection.)
Once the diagnosis is in hand, one can identify the desired outcome, which is typically a return to a 'normal' state from an abnormal state. Is your heart beating too quickly? We want to slow it down, until it reaches a normal sinus rhythm. Is your temperature too high? We want to reduce it to a normal range. (Note that baseline data is always helpful here, as certain individuals might normally have very slow heartrates to begin with, or be abnormally 'hot'. So returning them to what is 'normal' for everyone else might not really be returning them to their own 'normal' health.)
So with the diagnosis and the desired outcome, we've got 'A' and 'B', and now we need to plan out the path that leads from A to B as directly as possible, using 'evidence-based practice'. Evidence based practice means using interventions (actions, procedures, medicines, etc) that have the best possible evidence that they actually work. So we comb through peer-reviewed studies in journals about people who have various problems, and see what particular treatments have been shown to work best. And what's 'best' might change based on the population studied. Women might respond to certain treatments better or worse than men, young children might respond differently than the elderly, and so on.
Finally, we 'do' something, by performing the identified 'best' interventions to treat the specific condition. This might be as simple as giving ibuprofen for a headache, positioning a person so that they're least likely to aspirate their meal (wind up with food going into the lungs), or something more involved.
Then we evaluate the effectiveness of what we've done, and start all over again, deciding what else may need done.
That same approach, obviously, can be used by the general public to provide their own primary care, or indeed, deal with any other non-health problem in life. Assess your situation, decide what problems you need to address, decide where you want to end up, search for information on how best to deal with the problems, do what needs to be done, and then see how well it worked to decide if more needs to be done. This does not mean cutting professionals out of the loop entirely - you'll still want all of the same screenings you are recommended to get, and still want professional treatment when you identify trauma or disease that needs treated.
But it does mean you can, and should be working to control the basics of primary healthcare - nutrition, exercise, social and spiritual health. I've already seen that the search function shows a variety of resources even on this very site for primary healthcare, and I hope to write a bit more about aspects of such in future diaries.
Perhaps the most insidious and rapidly spreading failure of primary care currently in the US is what nurses would diagnose as 'Nutrition imbalance: Greater than body requirements', which is, of course, strongly linked to the obesity epidemic in the country. Obesity creates great stresses on multiple bodily systems, and is thus a precursor to all sorts of disease processes from the heart and vascular system to endocrine issues and nerve damage. In addition, societal norms are such that it creates social stresses that often lead to maladaptive coping behaviors and social isolation. Thus, I think my next essay will deal with nutritional balance.
Questions, comments, or suggestions?