NURSING CASE MANAGEMENT Introduction Case Management model designed

  • Slides: 51
Download presentation
NURSING CASE MANAGEMENT

NURSING CASE MANAGEMENT

Introduction Case Management model designed for use in: population approach community setting complex clients

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

Nurse case management - a strategy for care co-ordination “ A role and process

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)

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

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) l It involves face-to-face relationships across a variety of health care agencies and services and their representatives.

Case management l is an area of practice within several healthcare professions. Most case

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

Case management The Case Management Society of America defines case management as: "a collaborative

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. "

Case Management goals: Enhance health status and functionality of clients; Maximize client access to

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 Nursing Case Management Focuses on clients and families with complex issues

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)

l l For community health nurses, this has been the method of caregiving for

l l 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 1990 s as a “delivery innovation” and a panacea for harnessing escalating costs and insurance premium increases. (Powell, 2000)

Hospital

Hospital

Sanatorium

Sanatorium

Community

Community

Nurse case management in the Community Setting Health promotion & disease prevention Prevent escalation

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

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

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

Strengths Good collaboration – nurse/client/doctors/services Focuses on prevention Highlights health promotion Treatment becomes an

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

Weaknesses Dependent upon individual nurses’ skills/perseverance/initiative Educational requirements vs the demands of the role

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

Optimum Example

Optimum Example

Benefits & Outcomes Question: Where on the continuum do the clients access services? How

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

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

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

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

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

Bibliography Bower, K. and C. Falk (1996). Case Management as a Response to Quality,

Bibliography Bower, K. and C. Falk (1996). Case Management as a Response to Quality, Cost, and Access Imperatives. Nurse Case Management in the 21 st Century. E. Cohen. St. Louis, Mosby: 161 -166. Cohen, E. (1996). Nurse Case Management in the 21 st 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 links l l l Case Management Software Solution http: //www. handelit. com/ Commission

External links l l l Case Management Software Solution http: //www. handelit. com/ Commission for Case Manager Certification Case Management Society of American Case Management Association http: //www. acmaweb. org/ Case Management resources On the Case from minoritynurse. com

He aha te mea nui ki te Ao? What is the most important treasure

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

Roles and Functions of the Community and Public Health Nurse

Roles and Functions of the Community and Public Health Nurse

 • • Upon mastery of this chapter, you should be able to: ●

• • 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.

Three primary functions of public health • The various roles and settings for practice

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

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

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

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

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 (2 nd edition) (1998 a), • The Scope and Standards of Public Health Nursing Practice (1999).

Clinician Role • The most familiar role of the community health nurse is that

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

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

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

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 Nurse • To: Provide input to interdisciplinary programs that

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

Role of the Public Health Nurse • To: • Work with the community or

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

Public health nurses integrate community involvement and knowledge of the entire population with the

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.

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

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

The public health nurse can apply her knowledge of strategies to choose the intervention(s)

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

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

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

He or she also articulates and translates health and illness experiences of diverse, often

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

Standards of practice have been established by the American Nurses Association

Standards of practice have been established by the American Nurses Association

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

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

These competencies reflect an agreement by the Quad Council that the public health nurse

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

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

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

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

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.

The specialist level competencies require preparation at the Master’s level in community and /or

The specialist level competencies require preparation at the Master’s level in community and /or public health nursing.