World Health Organization (WHO) defines health as the state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.

Health care consumers respond differently. They have initial, secondary, and experiential responses when asked about their definition of health.

Initial responses include (a) feeling of well being with no illness, (b) homeostasis, and (c) complete physical, mental, and social well being.

Secondary responses include (a) frame of mind, (b) psychosocial well being, and (c) the ability to performa activities of daily life.

Experiential responses include (a) shiny hair and teeth, (b) warm, smooth, glossy skin, (c) clear eyes, (d) being alert and happy, and (e) freedom from pain.

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WHO defines homeostasis as the maintenance or balance of condtions within a system. This definition originated in physiology with the concept of one body with many functions, all interdependent. This concept soon expanded beyond the physiological to include mental and social aspects.

An expanded definition includes the maintenance of body balance; psychological and emotional balances; cultural, social, and political balances; and spiritual and philosophical balance.

Illness is usually defined as the absence of health.

American Heritage Dictionary defines illness as sickness of body or mind evil, wickedness (obsolete definition). The definition of illness is just as elusive as the definition for health.

Comprised of four stages:

Onset - symptoms firstoccur
Diagnosis - illness or disease identified
Patient status - patient adjusts to social status of being ill & gives in to demands of illness
Recovery - patient assumes pre-illness roles & activities. Alterations in life style or unexpected or
                   undesirable changes may occur.

Health status is defined as the holistic well-being of an individual which may not necessarily mean total freedom from diseases. It varies between individuals and is dependent on several factors: vocation, environment, culture, lifestyle, genetic makeup, and access to health care.

Healthy People 2000 is the PEW Commission statement of national strategy for significantly improving the health of the American people in the decade preceding the year 2000. The report recognizes lifestyle & environment factors as major determinants in disease prevention and health promotion. Healthy People 2000 provides strategies for reducing preventable death and disability, enhancing the quality of life, and reducing disparities in health status between various population groups within our society. Three broad goals are defined: to increase the span of healthy life for all Americans, to reduce health disparities among Americans, and to achieve access to preventive services for all Americans.

A profession is an occupation which:
     (1) consists of a body of knowledge
     (2) requires recognized education and training composed of:
               (a) organized classes or courses and practical experiences
               (b) meets established standards of education, skill, and competencies
                     required of the graduate
     (3)delivers service to individuals and society

A professional is a person who engages in a pursuit requiring specialized knowledge and often long and intensive academic preparation.
The National Labor Relations Act (1988) defines a professional employee as one who engages in work that:
               (1) is predominantly intellectual and varied in character as opposed to routine mental, manual, mechanical, or physical work
               (2) involves the consistent exercise of discretion and judgment in performance
               (3) is of such a character that the output produced cannot be standardized in relation to a given period of time
               (4) requires knowledge of an advanced type in a field of science or learning customarily acquired by a prolonged course of                     specialized intellectual instruction and study in an institution of higher learning or hospital, as distinguished from a general                     academic education or from an apprenticeship or from training in the performance of routine mental, manual, or physical                     processes

Professionalism is a consistent set of values and beliefs that guide and motivate practice.
     In 1962, Eastman Kodak define the Concept of Professionalism.
                  Professionalism and chance have little in common.
                  Professionalism is created - built on purpose and devotion.
                  Professionalism is experience, the total of it. Like a bank account, it grows upon deposits.
                  Professionalism is competence to perform, regardless of convenience, fatigue - or luck.
                  For the true professional, the better he becomes, the higher the standard.
                  Each patient depends upon medical professionalism. Skill long practiced, experience long ready. Standards long honored.

1. Possession of a body of specialized knowledge, skills, and attitudes known and practiced by its members.
2. This body of specialized knowledge, skills, and attitudes is derived through scientific inquiry and scholarly learning.
3. This body of specialized knowledge, skills, and attitudes is acquired through preparation, preferably at the graduate level, in a college or university as well as through continuous in-service training and personal growth after completion of formal education.
4. This body of specialized knowledge, skills, and attitudes is constantly tested and extended through research.
5. A profession has a literature of its own, even though it may, and indeed must, draw portions of its contents from other areas of knowledge.
6. A profession exalts service to the individual and society above personal gain. It possesses a philosophy and a code of ethics.
7. A profession through the voluntary association of its members constantly examines and improves the quality of its professional preparation and services to the individual and society.
8. Membership in the professional organization and the practice of the profession must be limited to persons meeting stated standards or preparation and competencies.
9. The profession affords a life career and permanent membership as long as services meet professional standards.
10. The public recognizes, has confidence in, and is willing to compensate, the members of the profession for their service.

Practice is defined as "to be professionally engaged in; to pursue a profession actively."

Practitioner is one who practices, especially in a profession.

Types of Health Care Practice
          Discipline specific
          Specialization
          Interdisciplinary
          Multidisciplinary

The Early Period (500 BC - 1800 AD) - few recognized professions

The Middle Modern Period (1800-1980) - reasonable number of new professions emerged and were accepted by the public

The Post-Modern Period (1980-2000+) - host of new occupations and “professions”came about.
Some of the new fields are legitimate. Some fields are still developing and it is still too early to fairly or accurately judge their eventual roles as health professions practices. Other positions seem to be crated with little or no education, professional, or ethical justification.

Reasons for Increase in Health Care Professions

1. Tremendous growth in demand for health care services
2. Huge expansion of knowledge related to biological, social, and behavioral problems and conditions
3. Development of a vast array of new clinical therapies, equipment, and procedures
4. Changing role of physicians
5. Doubling up, or overlapping of two or more traditional professions
6. Fractionation of many traditional professions into sub-specialties or other variations derived from ‘parent’ profession
7. Emergence of new fields of informonics, computers, and high-tech/high-speed communications
8. Tremendous power of large, high-profile managed care systems (corporations)
9. Fiscal imperative of continued progress toward greater cost-effectiveness of health care services

Statements that answer the question "What does a worker need to know and be able to do to contribute to the safe and effective delivery of health care?" It informs current and future health care workers, employers, and educators about needed skills and knowledge for success and provides the foundation for better work preparation and performance.

The National Health Care Skill Standards provide a common language, common goals, and a common reference point for employers, workers, students, labor union representatives, educators, and consumers.

     Employers - recruit, screen, & place potential employees more efficiently
     Workers - better prepared for jobs, career development, mobility, and advancement
     Labor organizations - maximize member employment security
     Students - clear goals in training
     Educators - design quality and focused instruction consistent with needs of industry
     Consumers - enjoy high quality, efficient health care delivery by well-trained workers

Currently there are over 250 health care occupations which are continually changing. Professional associations and labor organizations already have established standards for a number of occupations. Well-articulated standards are key to the national strategy to upgrade worker skills and increase economic competitiveness. The Standards are not directed at specific occupations but address major categories of related occupations and functions. They target career-entry and technical levels. Their implementation will hopefully avoid duplication of efforts among professions.

Therapeutic Functions - professions which maintain or change the health status of the client over time. Includes health care management, dental assisting, dietetics, home health, medical assisting, nursing, pharmacy, rehabilitation, respiratory care, social work, and others.

Diagnostic Functions - professions which create a picture of client health status at a single point in time. Includes cardiology, imagaing, medical laboratory, radiography, and others.

Information Services Functions - professions which document client care. Includes medical records management, risk management, unit coordination, utilization review, and others.

Environmental Services Functions - occupations which provide a therapeutic environment for the delivery of care.  Includes central supply, facility maintenance, food services, housekeeping, and others.

Return to Syllabus

References:

French, Ruth M. (1979). Dynamics of Health Care. New York, NY: McGraw-Hill, Inc.

Spector, Rachel. (1996). Cultural Diversity in Health and Illness. Stamford, CT: Appleton & Lange.

Parks, David G., Altman, Jeffrey P., & Lavelle, Lisa A. (1995). Who Are Professional Employees? Laboratory Medicine, 26(8), 503.

PEW Commission. Healthy People 2000: National Health Promotion and Disease Prevention Objectives. (DHHS Publication No. PHS 91-50213). Washington, DC: U.S. Government Printing Office.