CASE MANAGEMENT in NURSING

By J. P. Bradley
three registered nurses writing on patients chartsCase Management in nursing is an evolving practice specialty. The role of nurses in case management is to supervise and coordinate healthcare for patients with long-term illnesses. Such patients require long-term therapy and careful planning of all aspects of treatment. For instance if there is a patient suffering from cancer , the nurse who is assigned the role of the nurse case manager must arrange for doctor’s appointment, drugs, radiation, surgery or chemotherapy. A nurse case manager usually works in a specific practice specialty such as cancer, pediatric or cardiovascular disease.
Among the goals of case management nursing is to coordinate the care of patients. Since there are other specialists involved such as therapists, surgeons and other doctors, a nurse in case management will coordinate and keep the records of all their activity while updating the patient accordingly on the progress. According to the health problem at hand, the nurse can also decide what the other specialists should examine the patient so that there is collaboration of efforts by all. The nurse also ensures that all the procedures performed on a patient are at the highest level, increasing the chances of the expected outcome. In so doing, all the resources are used efficiently without any wasted or over usage of care resources.

Case Management in Nursing

The role of the nurse in case management can be defined in 3 basic ways, or a combination of any, according to the individual hospital setting as follows:

Quality Management

In larger hospitals, this aspect of quality management may be separated from the normal case management. The nurse is assigned the role of ensuring that all the services provided are of high standards. In smaller hospitals though, the finances may not allow for separation of duties and the case management nurse does all the work involved. The nurse is responsible for the general quality of health care being delivered, and can also assist in the risk management office when legal matters arise during a patient’s treatment.

Utilization Review

This type of case managers review different elements of the various hospital systems, guided by the terms of the hospital or the insurance company that is in charge. Prompt service delivery as well as adequate and safe utilization of the service is also a responsibility under this docket. The nurse is specially of essence in relation to insurance, because he/she approves and certifies acute and non-acute admissions. This information is then passed on to the insurance company under which the patient is covered. The nurse uses what is known as ‘InterQual Criteria’ which is a standardized method of identifying diagnoses, probable complications, procedures required and the timelines during which to account for a shifting diagnoses.
The Utilization Review nurse coordinates with the quality manager physician to administer high quality services to the patient. For instance if the patient has improved and no longer needs acute care, the nurse can consult the QM physician to see if the patient can be transferred to outpatient care or other suitable services. Before making a decision, the physician will review the patient’s chart, current situation and discharge plan. If in agreement the recovering patient can be moved to a lower level of care. To qualify for a post of Utilization Review Manager nurse, a three-year experience in  an acute hospital setting is advisable.
 

Discharge Planning

The role of this nurse in case management is to coordinates all the elements of admission or discharge of a patient. According to the InterQual Criteria, this nurse deals with the high risk patients with chronic diagnoses such as complicated pneumonia or stroke. The nurse combines all the available social and financial services to come up with a viable and safe discharge plan. A discharge planning nurse can cover up to forty patients at a time depending on the individual hospital policy. It is ideal however to have no more than twenty patients. Past experience together with assessment abilities are used to review the patients current situation, medical history and family support before formulating a discharge plan. A discharge planner should be familiar with Medicare guidelines, InterQual Criteria as well as fees for service items that enable a patient to be given a different level of care. These are some of the important things that should be known.
Nursing case management is a growing practice specialty. Many registered nurses are taking advanced case and care management programs to increase their knowledge and skills to practice in this area. As health care continues to reform, we will see this nursing specialty increase in demand and in importance.

Forensic Nursing: A Rewarding Practice Specialty

collecting criminal evidence, a forensic nurseThe practice of nursing in the intersection where medical and legal/criminal systems overlap is known as forensic nursing. The basic premise of forensic nursing is that a nurse in this specialty will care for patients who are injured as a result of violence. This can include either the perpetrator or the victim of the violent act, but it is usually the victim who is the patient. Patients who are the victims of abuse, assault or other  physically aggressive violence often suffer from deeply-inflicted trauma in the psychological, physical, and even social senses. A forensic nurse is educated and trained to be an expert in the needs and requirements of the law as it relates to victims and perpetrators of violent crimes, and can play an important role in a legal action. They may provide evidence they have collected, may testify in court regarding the patient and the injuries inflicted, and may play a consulting role for the authorities involved in the legal proceedings.
Just as with any other nurse, the primary responsibility of a forensic nurse is to provide the best possible medical and health care for patients. The difference is that the patients in forensic nursing have been assaulted, abused or otherwise injured, and the nurse is an expert in the optimum treatment for all injuries, whether they are physical or mental. Most often the nature of these injuries is sexual, and rape victims and victims of other types of sexual abuse and aggression are the first patients assigned to a forensic nurse.
Skills in many areas uncommon for a regular nurse come into play in this case. A forensic nurse can identify injuries, professionally evaluate the type and extent of the injuries, document the details and results of the abusive incident, and properly collect and store evidence of the crime, both physical and biological. A forensic nurse must also be able to communicate effectively with legal representatives and law enforcement authorities, and testify as an expert witness in courtroom proceedings regarding the case at hand.
There are different types of forensic nurses, who can specialize even within their specialty, so to speak. Victims of sex crimes will be the majority of the patients in forensic nursing, especially in the US, but there are other areas of specialization possible as well. One track for a forensic nurse to take is to be a death investigator, sometimes even acting as a coroner in local government. These nurses specialize in investigating and documenting the causes and circumstances of death, and in dealing with the legal authorities and families involved as a result of the death.
Having these types of nurses on staff is increasingly important for corrections facilities, psychiatric and mental hospitals, and rehabilitation centers. Specialization is also possible for forensic nurses who are interested in helping victims of domestic violence, and elder and child abuse and neglect, in emergency services facilities and staff training, and in public health clinics and agencies. In all of these cases, the nurse provides care to the patient and interfaces with the legal authorities as needed, but each one requires an extensive knowledge of law and law enforcement in small areas of practice.
Forensic nursing is important in the effort to reduce violent crime because these medical experts can be highly visible members of a team that provides care to victims of violent crimes. Their testimony and the documentation and evidence they can provide may be crucial in obtaining a satisfactory legal outcome for a victim and patient. By fulfilling the role they have chosen, forensic nurses become an important part of the overall effort to administer justice in a community, and will have a very rewarding career.

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