NURSING CASE

MANAGEMENT







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