NURSING CASE MANAGEMENT

1. NURSING CASE MANAGEMENT

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

3. Nurse case management - a strategy for care co-ordination “ A role and process that focuses on procuring, negotiating, and coordinating the care, services, and resources needed by individuals with complex issues throughout an episode or continuum” Bower, K. (1996)

4. Case management strategy to coordinate care through a process of managing quality, access, and cost to 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.

5. Case management • is an area of practice within several healthcare professions. Most case managers are nurses or social workers. • The term case management is also used to refer to dispute resolution systems which provide court or tribunal officials with closer administrative control over the litigation process than is traditionally associated with common law litigation.

6. Case management The Case Management Society of America defines case management as: "a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individual's health needs through communication and available resources to promote quality cost-effective outcomes."

7. 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)

8. Five Principles of Nursing 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)

9. 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)

10. Hospital

11. Sanatorium

12. Community

13. 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

14. 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)

15. WIDER COMMUNITY NURSE WORK & PLAY WHANAU CLIENT HOSPITAL MO’S/PHMS OTHER PHN’S SOCIAL AGENCIES NURSE

16. Strengths • Good collaboration – nurse/client/doctors/services • Focuses on prevention • Highlights health promotion • Treatment becomes an integral part of daily life for our client

17. Weaknesses • 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

18. Optimum Example

19. 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?

20. 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

21. 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

22. Examples of Outcomes Measurement • Quality Outcomes • Cost Outcomes • Comparison studies to show contrast • Measuring the complexity of needs

23. 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

24. Bibliography • 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.

25. External 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

26. He aha te mea nui ki te Ao? He tangata, he tangata, he tangata What is the most important treasure on earth? It is people It is people It is people

27. Roles and Functions of the Community and Public Health Nurse

28. 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 thecommunity health nurse. • ● Discuss the seven roles within the framework of public healthnursing functions. • ● Explain the importance of each role for influencing people’s health. • ● Identify and discuss factors that affect a nurse’s selection andpractice of each role. • ● Describe seven settings in which community health nursespractice. • ● Discuss the nature of community health nursing, and the commonthreads basic to its practice, woven throughout all roles andsettings. • ● Identify principles of sound nursing practice in the community.

29. Threeprimary functions of public health • The various roles and settings for practice hinge onthree primary functions of public health: • assessment, • policydevelopment, • and assurance. • They are foundational to allroles assumed by the community health nurse and are appliedat three levels of service: • to individuals, • to families, • and tocommunities

31. Assessment • An essential first function in public health • the community health nurse must gather and analyzeinformation that will affect the health of the people tobe serve: • health needs, • health risks, • environmental conditions, • political agendas, • and financial and other resources

32. Policy Development • is enhanced bythe synthesis and analysis of information obtained during assessment. • At the community level, the nurse provides leadershipin convening and facilitating community groups toevaluate health concerns and develop a plan to address theconcerns. • Typically, the nurse recommends specific trainingand programs to meet identified health needs of target populations.

33. Assurance • Assurance activities—activities that make certain that servicesare provided—often consume most of the communityhealth nurse’s time. • Communityhealth nurses perform the assurance function at the communitylevel when they • provide service to target populations, • improve quality assurance activities, • and maintain safe levelsof communicable disease surveillance and outbreak control.

34. Standards for Community Nursing • Individuals should receive nursing services based onstandards 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 NursingPractice (1999).

35. Clinician Role • The most familiar role of the community health nurse is that ofclinician or care provider; • means that the nurseensures that health services are provided not just to individualsand families, but also to groups and populations. • Three clinician emphases, in particular, are useful toconsider here: • holism, • health promotion, • and skill expansion.

36. Holistic Practice • In communityhealth a holistic approach means consideringthe broad range of interacting needs that affect the collectivehealth of the “client” as a larger system • Holistic nursing care encompassesthe comprehensive and total care of the client in allareas, such as physical, emotional, social, spiritual, and economic.

37. Healthpromotion • The clinician role in community health also is characterizedby its focus on promoting wellness. • Examples include immunization ofpreschoolers, family planning programs, cholesterol screening,and prevention of behavioral problems in adolescents. • Protecting and promoting the health of vulnerable populationsis an important component of the clinician role

38. Expanded Skills • With time,skills in observation, listening, communication, and counselingbecame integral to the clinician role as it grew to encompassan increased emphasis on psychological and socioculturalfactors. • Recently, environmental and community-wide considerations, such as problems caused by: • pollution, • Violenceand crime, • drug abuse, • unemployment, poverty, homelessness, • and limited funding for health programs • have createda need for stronger skills in assessing the needs of groups andpopulations and intervening at the community level.

39. Role of the Public Health Nurse • To: Provide input to interdisciplinary programs that monitor, anticipate and respond to health problems in population groups for all diseases or public health threats including bioterrorism • To: Evaluate health trends and risk factors of population groups to help determine priorities forming targeted interventions

40. Role of the Public Health Nurse • To: • Work with the community or specific population groups to develop targeted health promotion and disease prevention activities • To: Evaluate health care services • To: Provide health education, care, management and primary care to individuals and families who are members of vulnerable populations and high risk groups

41. Public health nurses integrate community involvement and knowledge of the entire population with the personal clinical understandings of health and illness gleaned from the experiences of individuals and families within the population.

42. The nurse working in public health should be a voice for members of the community to voice problems and desires

43. The public health nurse can apply her knowledge of strategies to choose the intervention(s) that meets the needs of a particular community, family or individual

44. The nurse is the agent who translates and applies the knowledge of health and social sciences to individuals and population groups through specific interventions, programs and advocacy

45. He or she also articulates and translates health and illness experiences of diverse, often vulnerable, individuals and families to the health planners and policy makers

46. Standards of practice have been established by the American Nurses Association

47. The Quad Council, made up of four public health nursing organizations, has established core competencies

48. These competencies reflect an agreement by the Quad Council that the public health nurse requires preparation at the baccalaureate level.

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

50. Even early on, the shortage of nurses affected the hiring of BSN or MSN prepared nurses. Public health departments could not compete with hospital systems.