Nursing Case Management – The Modern Trend in Health Care Provision

Introduction

Numerous and notable developments in the health care environment have been observed over the recent past. This has seen the health care providers enhance their service delivery. Nursing case management has come up as one of the modern trends in health care provision. In essence, nursing case management has proved to be among the ways through which health care delivery can offer high quality, effective resource utilization, and patient-centered care.

A case management nurse has an integral role to play in health care provision. The case manager is obliged to monitor the various aspects of care that a patient receives. The case manager makes sure that the healthcare objective and targeted results are achieved effectively (Fitzpatrick and Ea, 2012). Nursing case management ensures a range of health care services for certain categories of patients. Nursing case management involves a multidisciplinary approach that emphasizes clinical specialties, methods of case management, and the health care system (White and Hall, 2006).

This paper aims at discussing and analyzing the various ways in which the concept of case management can be applied by nurses. This is in respect to when they are caring for patients with high-risk complexions and within different contexts.

The contexts that will be considered include complex physiological needs, complex functional health status, a family in crisis, a plan of care that is slow to advance, multiple hospitals and community transfers, complex discharge planning, complex pre and post-hospitalization course and unexpected readmission within 30 days of discharge. The paper shall also look into the future of nursing case management in the provision of health care.

Background

The case management nurses are always in touch with other medical professionals and health-related service providers. This is meant to enhance service delivery to the patient. The physician orders treatment for the patient and the case manager takes the responsibility of developing an intricate plan of care for the patient.

The nurse case managers ensure that the plan is followed effectively. The case manager also establishes the quality of care and conducts an elaborate review to make sure that the patient receives high-quality and adequate health care. In essence, the case manager is critical to patients who are in hospital and out of the hospital setting like in the home care and rehabilitation centres (Brunner and Smeltzer, 2010). Case management has been under observation for its effectiveness in improving care given to patients. In most instances, case management involves telephone monitoring, home visits, as well as diagnostic screening among other aspects.

In this case, the case manager ensures that communication and interaction with the patients is constant. It has been noted that case management involves the integration of patient and provider satisfaction, bears in mind cost aspects, and offers a way of addressing the patient’s health concerns. Case management provides nurses with a chance to showcase their roles within the multidisciplinary health care teams. Case management thus ensures effective health care provision to patients in a comprehensive manner (Yamamoto and Lucey, 2005).

Complex physiological needs

Successful nursing case management depends on clear setting of targets. In this case, the case managers should engage in the identification of the clients who are at risk among the population. Properly defined criterion must be used during the screening period to identify the best management interventions by the case managers.

In nursing case management, risk identification is usually an important process that is continuous. This aspect enables the identification of health risks, which should be stopped or managed to stop or delay further deterioration that may arise from the illness. The initial step in addressing health challenges affecting patients with complex physiological needs through a comprehensive case management structure is the identification of these patients. In this case, nurses make use of case management concepts in ensuring that managed care is delivered for the welfare of the individual and society at large.

Data on complex cases and how to address them can be obtained from case management referrals such as emergency rooms and hospitalisation. From the information that is collected, the nurse case managers can be able to categorise patients basing on the seriousness of their condition.

This is critical for the case managers when determining the intensity of risk in an effort to develop an effective medical program for the patient. After the risk level has been evaluated, target interventions are established by the nurse case manager. An evaluation of the results of the targeted group then follows (Olbort, Mahler, Campbell, Reuschenbach, Müller-Tasch, Szecsenyi and Peters-Klimm, 2009).

A case in point is the program adopted by Kaiser Permanente Centre for health Research. The centre has an elaborate program for handling the frail elderly patients through a well-targeted case management plan. Most of Medicare members are categorised by the facility in groups according to frailty. In a one year span, a self-report describing the poor health of patients was analysed. Afterwards, the data guide the case manager in the determination of the appropriate management that can be recommended.

The patients are assessed based on frailty probability score, and a comprehensive in-home assessment may be done for the extreme cases. The provision of chronic care to patients with complex functional health statuses is not easy. Thus, the nurse case manager handling the patient should have enough knowledge in resource mobilisation (CMSA, 2010).

For an enhanced intervention by the nurse case managers, the healthcare should adopt the use of high-tech tools to help in the identification of the risks. The world is moving very fast, and technology has been incorporated in various sectors of life. In this respect, nursing case management should adopt the use of modern technologies in delivering case management plan.

Complex functional health status

In most instances, nurses or social workers serving as case managers have had to be highly skilled in performing this role. Dealing with identified cases of chronic care involves conducting interviews with patients who are at risk. This includes home assessment for patients with extremely complex needs. The case manager then develops an appropriate structure to provide information and coordinate with relevant individuals involved in the case.

The nursing case manager has the skills to identify present and future needs of the individual patients under his or her care. The case manager also determines the patients to be addressed by the community and those that fall under the physician’s authority. The case manager makes the necessary connection through communication with the patients, clinical staff, and family. This communication is based on the information that the case manager has on the community resources.

In this respect, the case manager advises the interested parties on the role they can play in assisting the client recover (Koutoukidis, Lawrence and Tabbner, 2008). For the future success of nursing case management in complex functional health status, the case managers should be equipped with various skills that would be essential in the identification of the high risk patients. This will ensure that case managers are able to deliver healthcare services promptly and effectively.

Family in crisis

Case management is also critical in helping a family in crisis. The family of the patient requiring comprehensive care is vital in the healing process of the patient. Among patients suffering from addiction, the case manager has to advocate for the appropriate services to be availed to the family. This may include resources to help the family to engage in the rehabilitation process of their members in an effective manner. A case manager should help the family to understand the context of the patient condition in a simplified manner.

Helping the family understand the role it is supposed to play in the patient’s recovery process may be a difficult endeavour. Nonetheless, this can be achieved when the nursing case manager avails convincing facts regarding the patient’s condition (Wayman, 1999). This is because some medical cases may appear hopeless to a family in the nonprofessional context. They may be called in to offer their contribution in terms of time and resources towards the healing process of the patient.

This may appear to be an uphill task to the family members. Therefore, the case manager must learn how to lay emphasis on the need for persistent offer of social support and encouragement. This is encouraged as the patient continues to come to terms with their previous behaviour, which may be a painful experience in the case of addiction.

The case manager offers support to the family and the patient while acting like a cheer leader. The case manager must take this as their role since other stakeholders such as the physicians may not have the time and commitment to offer family support. This is necessitated by their participation in the patient’s healing process that majorly focusses on the provision of treatment only (Covey, 2007).

In this respect, it can be observed that nursing case management is critical in offering support to a family in crisis. It can be noted that the nursing case manager will continue offering their essential services to patients by engaging the family into the healing process. This is a critical aspect associated with the healing process. Therefore, for successful engagement, the case managers should be equipped with counselling skills, as well as convincing power to be able to bring on board the families of the patients in the recovery process.

Plan of care that is slow to advance

The case manager is required to play a role in improving a plan of care that is slow to advance. At all times, the case manager’s first priority is the plight of the patient. In this case, the case manager must ensure that all required components of the organisation address the patient’s problems.

The case manager makes recommendations for the patient with high risk complex needs. Most nurses serving in such situations have at times been at logger heads with the organisations as part of their role is patient welfare advocacy. Nurses have applied case management concepts to care for patients with high-risk complex needs inside the hospitals. They have done this by advocating for patient’s right to access the necessary care within the appropriate setting and time without unnecessary delays.

By virtue of their skills, nurses serving as case managers have a professional understanding that when patients overstay in the hospital, they are exposed to nosocomial infections. When patients stay long in hospital, their hospital bills or utilisation of the hospital benefit schemes is set to increase. In other programs, such as the U.S. Medicare program, hospitals would continue incurring expenses since the program pays a prospective amount that has no regard for the length of stay or the cost of care to be provided while at the facility.

Therefore, the case manager is an ideal candidate to advance change within the healthcare system (Fero, Herric and Hu, 2011). The nursing case managers have the responsibility to advance their obligation in ensuring that the patients under their care receive the most appropriate care. Initially, the plight of the patient was not put into consideration. However, this has changed over the years, and the patient’s rights and welfare have been incorporated in the healing process. In this case, it can be noted that case managers have and will continue playing a critical role in advancing the welfare of the patients.

Multiple hospital and community transfers

The case managers require different information due to their numerous roles and interactions with different participants in the medical and social setting. The case manager can use the information to institute change by reviewing the competing demands of the patient, family, and the organisation or health workers (Cohen and Cesta, 2005).

The case manager is also involved in cases of multiple hospital and community transfers. The transfer of the patient into the community or hospital without walls requires the case manager to consult with the physicians, family, and if necessary, social workers. Patients with complex health needs may require varied services and environments. Such a patient may require assistance in undertaking their daily activities and in their own preferred settings. Therefore, the case manager organises and coordinates the different participants involved in the healing process. This ensures that the client achieves maximum recovery.

If the patient has a history of severe mental or other deleterious health conditions, the case manager would have to coordinate the multiple transfers between the two areas based on the prevailing condition (Cox, 2010). In this respect, it can be argued that the case manager is critical in ensuring comprehensive health care is provided to the patient. Therefore, this forms a critical aspect in the health care provision. In this respect, nursing case management should be embraced for the benefit of the patient and ensuring comprehensive health care provision.

Complex pre and post hospitalisation course and discharge planning

Complex discharge planning and complex pre and post hospitalisation course are the other roles of the nursing case manager. An effective and efficient planning in the discharge process must be adopted in an effort to regulate the length of stay in hospitals. The case manager plays a vital role in both the discharge planning and post-hospital care provision.

In discharging of patients with complex needs, an assessment should be carried out to determine the appropriate transfer of the patient. The case manager determines whether to refer the patient to a nursing home on a short or long-term basis or send the patient home directly (Finn, 2011). The task calls for a consultation with other participants in the patient’s case such as the family and physicians. The case leader offers both personal and professional opinion concerning numerous factors surrounding the discharge.

These factors include financial implications, health status consideration, and the health insurance component. The case manager has to be decisive and avail the necessary information especially on post-acute care services owing to the weight of the discharge matter to all participants.

This is guided by the availability of the services, cost, location, and quality of care among other factors (Nosbusch, 2010). From this analysis, there is no doubt that nursing case management is critical in the provision of health care. Essentially, nursing case management has a great future in the recovery process of patients. In this respect, it is expected that nursing case management shall continue to play a critical role health care aspect.

Unexpected readmission within 30 days of discharge

When a patient with complex needs is discharged, an unanticipated readmission within 30 days of discharge may occur. The case manager is critical in ensuring post discharge follow-up of the patient. Notably, the case manager can develop an informed strategy regarding the model of the discharge plan. This can be done through the collection of information on patient readmission rates. If the patient is readmitted within 30 days for a similar medical condition that he or she was discharged for, the case manager has to implement a total overhaul of the complex discharge plan and adopt a new one (Scott, 2010).

Incidences of readmission for the same illness that one was discharged for are quite common. Therefore, the case manager’s intervention by overhauling the established plan becomes necessary to arrive at an effective plan that will ensure patient recovery. It can be observed that case management is critical in this aspect and thus will continue with their services in the foreseeable future.

Conclusion

The manner in which nurses apply case management concepts while caring for patients with high-risk complex needs within and without the hospital setting is influenced by numerous factors. There is no doubt that the case manager’s role is complicated. Particularly, this is evidenced when the case manager handles patients with complex needs.

The case managers get involved in the coordination of activities within and outside the hospital environment. The role played by the case manager is critical to both patients and nurses. This is because case management provides an elaborate guideline on how to address the various situations and participation as brought out in different settings.

The various settings include application of nursing case management for complex physiological needs, complex functional health status, a family crisis, a plan of care that is slow to advance, multiple hospital and community transfers, complex discharge planning, complex pre and post hospitalisation course and an unexpected readmission within thirty days of discharge.

It has been observed that nursing case management in these settings is critical in ensuring effective provision of health care. Therefore, it can be asserted that the future of nursing case management looks bright as it has been recognised as an important aspect of health care provision.

References

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