NURSING CASE NURSING CASE MANAGEMENTMANAGEMENT

By SYDORENKO OKSANA, MD, PhD

IntroductionIntroduction

Case Management model designed for use in: population approach community setting complex clients (disease management)

Nurse case management - a strategy Nurse case management - a strategy for care co-ordinationfor care co-ordination

“ “ A role and process that focuses on A role and process that focuses on

procuring, negotiating, and coordinating the procuring, negotiating, and coordinating the

care, services, and resources needed by care, services, and resources needed by

individuals with complex issues throughout individuals with complex issues throughout

an episode or continuum”an episode or continuum”

Bower, K. (1996)

Case managementCase management

strategy to coordinate care through a process strategy to coordinate care through a process

of managing quality, access, and cost to of managing quality, access, and cost to

manage the risks with vulnerable groups.manage the risks with vulnerable groups.

(Yoder-Wise, 1999)

It involves face-to-face relationships across a

variety of health care agencies and services

and their representatives.

Case managementCase management

is an area of practice within several healthcare is an area of practice within several healthcare professions. Most case managers are nurses or professions. Most case managers are nurses or social workers.social workers.

The term case management is also used to refer to The term case management is also used to refer to dispute resolution systems which provide court or dispute resolution systems which provide court or tribunal officials with closer administrative control tribunal officials with closer administrative control over the litigation process than is traditionally over the litigation process than is traditionally associated with common law litigation.associated with common law litigation.

Case managementCase management

The Case Management Society of America The Case Management Society of America defines case management as:defines case management as:

"a collaborative process of assessment, "a collaborative process of assessment, planning, facilitation and advocacy for planning, facilitation and advocacy for

options and services to meet an individual's options and services to meet an individual's health needs through communication and health needs through communication and

available resources to promote quality cost-available resources to promote quality cost-effective outcomes."effective outcomes."

Case Management goals:Case Management goals:

Enhance health status and functionality of clients;

Maximize client access to services; Use resources cost-effectively; Integrate & coordinate services provided by

multiple disciplines

Cohen (1996)

Five Principles of Five Principles of Nursing Case ManagementNursing Case Management

Focuses on clients and families with complex issues Involves negotiation, coordinating, and procuring

services and resources Entails using a clinical reasoning process Network development of multi-disciplinary relationships Is episode- or continuum-focused

Cohen, E (1996)

For community health nurses, this has been the method of caregiving for more than 100 years.

However, it was introduced in the acute care setting, with enthusiasm, in the 1990s as a “delivery innovation” and a panacea for harnessing escalating costs and insurance premium increases.

(Powell, 2000)

HospitalHospital

SanatoriumSanatorium

CommunityCommunity

Nurse case management in the Community Setting

Health promotion & disease prevention

Prevent escalation of client condition

Comprehensive & collaborative care

Efficient use of health care services

Practice guidelines, clinical pathways &

client/family outcomes improve effectivity

The Case Management Process

Case finding & risk appraisal Nursing interventions matched against

characteristics & needs of the risk group Co-ordination of services & continuum of

care Evaluation of individual & group outcomes

Bower, K. (1992) & Mullahy, C.M. (1995)

WIDER COMMUNITY

WORK & PLAY

WHANAU

CLIENT

HOSPITAL

MO’S/PHMS

OTHER PHN’S

SOCIAL AGENCIES

NURSE

NURSE

Strengths Strengths

Good collaboration –

nurse/client/doctors/services Focuses on prevention Highlights health promotion Treatment becomes an integral part of daily life

for our client

WeaknessesWeaknesses

Dependent upon individual nurses’ skills/perseverance/initiative

Educational requirements vs the demands of the role

Nurses often feel ill-prepared to offer basic instruction/support in health promotion & prevention

Optimum Example

Benefits & Outcomes

Question: Where on the continuum do the clients access

services? How do we measure prevention? How do we measure health promotion? What changes are needed to realise these

benefits?

Why measure outcomes?

Dramatic shifts in health care delivery is being driven by changes in reimbursement

It is more cost effective to treat populations by using epidemiological and public health models rather than treating individuals or families/whanau

Challenges in Measuring Outcomes

Client confidentiality I.T. development of user friendly software Nurse’s need to adapt health care practice

to modern-day technology Population-based care requires healthcare

providers work together

Examples of Outcomes Measurement

Quality Outcomes

Cost Outcomes

Comparison studies to show contrast

Measuring the complexity of needs

Lessons Learned

Central to this model are:

Collaboration Networking Keeping the client & family/whanau at the centre of care Public health nurses have become pro-active in the

development of strategies that are core to the health care management of high-risk populations eg. Case management

Multi-disciplinary team approaches National and International planning

BibliographyBibliography

Bower, K. and C. Falk (1996). Case Management as a Response to Quality, Cost, and Access Imperatives. Nurse Case Management in the 21st Century. E. Cohen. St. Louis, Mosby: 161-166.

Cohen, E. (1996). Nurse Case Management in the 21st Century. St Louis, Mosby.

Cohen, E. and T. Cesta (1997). Nursing Case Management; from concept to evaluation. St Louis, Mosby.

Donabedian, A. (1990). “The Seven Pillars of Quality.” Arch Pathol Lab Med 114: 1115 - 8.

Etheredge, M. L. (1989). Collaborative Care Nursing Case Management. (American Hospital Association), American Hospital Publishing, Inc.

Kersbergen, A. L. (1996). “Case Management: a rich history of coordinating care to control costs.” Nursing Outlook 44(4): 169-72.

Zander, K. (1990). Patient Care Delivery Models. Rockville, MD: Aspen Publishers.

External linksExternal links

Case Management Software Solution http://www.handelit.com/

Commission for Case Manager Certification Case Management Society of America American Case Management Association

http://www.acmaweb.org/ Case Management resources On the Case from minoritynurse.com

He aha te mea nui ki te He aha te mea nui ki te Ao?Ao?

He tangata,

he tangata, he tangata

What is the mostWhat is the most

important treasure onimportant treasure on

earth?earth?

It is people

It is people

It is people

Roles and Functions Roles and Functions of the Community of the Community and Public Health and Public Health

NurseNurse

Upon mastery of this chapter, you should be able to:• ● Identify the three core public health functions basic

to communityhealth nursing.• ● Describe and differentiate among seven different

roles of the community health nurse.• ● Discuss the seven roles within the framework of

public health nursing functions.• ● Explain the importance of each role for influencing

people’s health.• ● Identify and discuss factors that affect a nurse’s

selection and practice of each role.• ● Describe seven settings in which community health

nurses practice.• ● Discuss the nature of community health nursing,

and the common threads basic to its practice, woven throughout all roles and settings.

• ● Identify principles of sound nursing practice in the community.

Three primary functions of public health

• The various roles and settings for practice hinge on three primary functions of public health: – assessment, – policy development, – and assurance.

• They are foundational to all roles assumed by the community health nurse and are applied at three levels of service: – to individuals, – to families, – and to communities

Assessment

• An essential first function in public health

• the community health nurse must gather and analyze information that will affect the health of the people to be serve:– health needs, – health risks, – environmental conditions,– political agendas, – and financial and other resources

Policy Development

• is enhanced by the synthesis and analysis of information obtained during assessment.

• At the community level, the nurse provides leadership in convening and facilitating community groups to evaluate health concerns and develop a plan to address the concerns.

• Typically, the nurse recommends specific training and programs to meet identified health needs of target populations.

Assurance

• Assurance activities—activities that make certain that services are provided—often consume most of the community health nurse’s time.

• Community health nurses perform the assurance function at the community level when they– provide service to target populations, – improve quality assurance activities, – and maintain safe levels of communicable

disease surveillance and outbreak control.

Standards for Community Nursing

• Individuals should receive nursing services based on standards developed by the American Nurses Association (ANA), such as:• the Code for Nurses With Interpretive

Statements (1985), • Nursing’s Social Policy Statement (1995),

• Standards of Clinical Nursing Practice (2nd edition) (1998a),

• The Scope and Standards of Public Health Nursing Practice (1999).

Clinician Role

• The most familiar role of the community health nurse is that of clinician or care provider;

• means that the nurse ensures that health services are provided not just to individuals and families, but also to groups and populations.

• Three clinician emphases, in particular, are useful to consider here: – holism, – health promotion, – and skill expansion.

Holistic Practice

• In community health a holistic approach means considering the broad range of interacting needs that affect the collective health of the “client” as a larger system

• Holistic nursing care encompasses the comprehensive and total care of the client in all areas, such as physical, emotional, social, spiritual, and economic.

Health promotion

• The clinician role in community health also is characterized by its focus on promoting wellness.

• Examples include immunization of preschoolers, family planning programs, cholesterol screening, and prevention of behavioral problems in adolescents.

• Protecting and promoting the health of vulnerable populations is an important component of the clinician role

Expanded Skills• With time, skills in observation, listening,

communication, and counseling became integral to the clinician role as it grew to encompass an increased emphasis on psychological and sociocultural factors.

• Recently, environmental and community-wide considerations, such as problems caused by:– pollution, – Violence and crime, – drug abuse, – unemployment, poverty, homelessness,– and limited funding for health programs

• have created a need for stronger skills in assessing the needs of groups and populations and intervening at the community level.

Role of the Public Health Role of the Public Health NurseNurse

• To: Provide input to interdisciplinary To: Provide input to interdisciplinary programs that monitor, anticipate and programs that monitor, anticipate and respond to health problems in respond to health problems in population groups for all diseases or population groups for all diseases or public health threats including public health threats including bioterrorismbioterrorism

• To: Evaluate health trends and risk To: Evaluate health trends and risk factors of population groups to help factors of population groups to help determine priorities forming targeted determine priorities forming targeted interventionsinterventions

Role of the Public Health Role of the Public Health NurseNurse

• To:To:• Work with the community or specific Work with the community or specific

population groups to develop targeted population groups to develop targeted health promotion and disease prevention health promotion and disease prevention activitiesactivities

• To: Evaluate health care servicesTo: Evaluate health care services• To: Provide health education, care, To: Provide health education, care,

management and primary care to management and primary care to individuals and families who are individuals and families who are members of vulnerable populations and members of vulnerable populations and high risk groupshigh risk groups

Public health nurses Public health nurses integrate community integrate community

involvement and knowledge involvement and knowledge of the entire population of the entire population

with the personal clinical with the personal clinical understandings of health understandings of health and illness gleaned from and illness gleaned from

the experiences of the experiences of individuals and families individuals and families within the population.within the population.

The nurse working in The nurse working in public health should be a public health should be a voice for members of the voice for members of the

community to voice community to voice problems and desiresproblems and desires

The public health nurse can The public health nurse can apply her knowledge of apply her knowledge of strategies to choose the strategies to choose the

intervention(s) that meets intervention(s) that meets the needs of a particular the needs of a particular

community, family or community, family or individualindividual

The nurse is the agent who The nurse is the agent who translates and applies the translates and applies the knowledge of health and knowledge of health and

social sciences to social sciences to individuals and population individuals and population

groups through specific groups through specific interventions, programs interventions, programs

and advocacyand advocacy

He or she also articulates He or she also articulates and translates health and and translates health and

illness experiences of illness experiences of diverse, often vulnerable, diverse, often vulnerable, individuals and families to individuals and families to

the health planners and the health planners and policy makerspolicy makers

Standards of practice have Standards of practice have been established by the been established by the

American Nurses American Nurses AssociationAssociation

The Quad Council, made up The Quad Council, made up of four public health of four public health

nursing organizations, has nursing organizations, has established core established core

competenciescompetencies

These competencies reflect These competencies reflect an agreement by the Quad an agreement by the Quad

Council that the public Council that the public health nurse requires health nurse requires

preparation at the preparation at the baccalaureate level.baccalaureate level.

However, in many states However, in many states nurses doing public health nurses doing public health work are not baccalaureate work are not baccalaureate

graduates.graduates.

Even early on, the shortage Even early on, the shortage of nurses affected the of nurses affected the hiring of BSN or MSN hiring of BSN or MSN

prepared nurses. Public prepared nurses. Public health departments could health departments could not compete with hospital not compete with hospital

systems.systems.

The specialist level The specialist level competencies require competencies require

preparation at the Master’s preparation at the Master’s level in community and /or level in community and /or

public health nursing.public health nursing.

THANK YOU!!!THANK YOU!!!