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Gonçalves I, Mendes DA, Caldeira S, Jesus E, Nunes E. Nurse‐led care management models for patients with multimorbidity in hospital settings: a scoping review. J Nurs Manag 2022; 30:1960-1973. [DOI: 10.1111/jonm.13621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 01/13/2022] [Accepted: 04/05/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Isabel Gonçalves
- Universidade Católica Portuguesa Institute of Health Sciences, Centre for Interdisciplinary Research in Health Portugal
| | | | - Sílvia Caldeira
- Universidade Católica Portuguesa Institute of Health Sciences, Centre for Interdisciplinary Research in Health Portugal
| | - Elvio Jesus
- Universidade Católica Portuguesa Institute of Health Sciences, Centre for Interdisciplinary Research in Health Portugal
| | - Elisabete Nunes
- Universidade Católica Portuguesa Institute of Health Sciences, Centre for Interdisciplinary Research in Health Portugal
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The Evolving Roles of Nurses Providing Care at Home: A Qualitative Case Study Research of a Transitional Care Team. Int J Integr Care 2022; 22:3. [PMID: 35087352 PMCID: PMC8782082 DOI: 10.5334/ijic.5838] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 01/06/2022] [Indexed: 01/01/2023] Open
Abstract
Purpose: To examine the roles of transitional care nurses in an integrated healthcare system and how the integrated healthcare system influences their evolving roles. Background: Transitional care teams have been introduced to enable the seamless transfer of patients from acute-care to the home settings. A qualitative case study of the transitional care team was conducted to understand the changing roles of these nurses in an integrated Regional Health System (RHS) in Singapore. Methods: A hospital transitional team of an integrated RHS was studied. Purposive sampling was used. Non-participant observations and follow-up interviews were conducted with four nurses. Data were triangulated with the interviews of two managers and three healthcare professionals, and the analysis of documents. Within-case thematic analysis was carried out. Results: Three themes were identified: ‘Coming together to meet the needs of all’; ‘Standing strong amidst the stormy waves’; and ‘Searching for the right formula in handling complexity’. These themes have explained on the atypical roles taken on by nurses in their attempts to close the gaps and meet the patients’ needs. Various factors influencing the evolving roles were revealed. Conclusion: The roles of nurses have ‘emerged differently’ from their traditional counterparts. Various nursing roles have been undertaken to facilitate care integration. The findings emphasised the important balance between formal structural practices and informal processes in facilitating and supporting the nurses in their role development.
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Evidências sobre modelos de gestão em enfermagem nos serviços hospitalares: revisão integrativa. ACTA PAUL ENFERM 2021. [DOI: 10.37689/acta-ape/2021ar02095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Rayment J, Sidhu M, Wright P, Brown P, Greenfield S, Jeffreys S, Gale N. Collaboration for Impact: Co-creating a Workforce Development Toolkit Using an Arts-based Approach. Int J Integr Care 2020; 20:11. [PMID: 32565761 PMCID: PMC7292144 DOI: 10.5334/ijic.5377] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 05/13/2020] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION The identification, communication and management of health risk is a core task of Community Health Workers who operate at the boundaries of community and primary care, often through not-for-profit community interest companies. However, there are few opportunities or resources for workforce development. Publicly funded researchers have an obligation to be useful to the public and furthermore, university funding is increasingly contingent on demonstrating the social impact of academic research. Collaborative work with participants and other stakeholders can have reciprocal benefits to all but may be daunting to some researchers, unused to such approaches. METHODS This case study is an account of the co-creation of a (freely accessible) workforce development toolkit, as part of a collaboration between academics, community interest companies, patients and services users and arts practitioners. RESULTS Our collaborative group produced three short films, fictionalising encounters between Community Health Workers and their clients. These were used within a series of five discussion-led workshops with facilitator guidance to explore issues generated by the films. Two collaborating community-based, not-for-profit organisations piloted the toolkit before its launch. CONCLUSION We aim to encourage other academics to maximise the impact of their own research through collaborative projects with those outside of academia, including research participants and to consider the potential value of arts-based approaches to explore and facilitate reflection on complex tasks and tensions that make up daily work practices. Whilst publication of findings from such projects may be commonplace, accounts of the process are unusual. This detailed account highlights some of the benefits and challenges involved.
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Affiliation(s)
- Juliet Rayment
- Centre for Maternal and Child Health Research, City, University of London, GB
| | - Manbinder Sidhu
- Health Services Management Centre, University of Birmingham, GB
| | | | | | - Sheila Greenfield
- Medical Sociology, Institute of Applied Health Research, University of Birmingham, GB
| | | | - Nicola Gale
- Health Sociology and Policy, Health Services Management Centre, University of Birmingham, GB
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Hernández-Zambrano SM, Mesa-Melgarejo L, Carrillo-Algarra AJ, Castiblanco-Montañez RA, Chaparro-Diaz L, Carreño-Moreno SP, Rico-Salas RG, Marles-Salazar MA, Diaztagle-Fernández JJ, Ardila-Rodriguez HM. Effectiveness of a case management model for the comprehensive provision of health services to multi-pathological people. J Adv Nurs 2018; 75:665-675. [PMID: 30375026 DOI: 10.1111/jan.13892] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 08/19/2018] [Accepted: 09/12/2018] [Indexed: 11/27/2022]
Abstract
AIM To determine the effectiveness of a case management model for approaching multi-pathological people in a health promoting entity of the contributory healthcare scheme in Bogotá, Colombia between 2018 - . DESIGN Mixed methods research. METHOD The study contemplates two components: a quantitative component using a quasi-experimental analytical design before and after longitudinal intervention to determine the effectiveness of the case management model and a qualitative descriptive design to understand the experience of the participants about the model. The Administrative Department of Science, Technology and Innovation of Colombia (Colciencias) funded this project by means of call 777-November 2017, under the financing agreement No. 848-December 2017. DISCUSSION Addressing problems deriving from the structure of the Colombian healthcare system is crucial for implementing case management models. Furthermore, the effectiveness of such models may be affected by power relations and market failures, but the proved potential of a model may represent a generalized benefit for the Colombian health system. IMPACT In Colombia, considering complications and management of chronic non-communicable diseases as isolated cases is considered as the highest cost events in healthcare provision, since an average of 12.8 million pesos is invested in each patient. This has led to rethink the management in these patients by means of a comprehensive model that guarantees the effectiveness of healthcare delivery, in the framework of a healthcare system heavily affected by payment capacity, where the market has a strong predominance, such as the case of Colombia. TRIAL REGISTRATION NUMBER RPCEC00000293.
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Affiliation(s)
| | | | | | | | - Lorena Chaparro-Diaz
- Nursing Care for Chronic Patients Research Group, Faculty of Nursing, Universidad Nacional de Colombia, Bogotá, Colombia
| | | | | | | | - Juan José Diaztagle-Fernández
- Faculty of Medicine, Universidad Nacional de Colombia, Bogotá, Colombia.,Faculty of Medicine, Fundación Universitaria de Ciencias de la Salud, Bogotá, Colombia
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Home Care Case Managers' Integrated Care of Older Adults With Multiple Chronic Conditions. Prof Case Manag 2018; 23:165-189. [DOI: 10.1097/ncm.0000000000000286] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Lees C, Hutchison T, O'Brien S. Introducing community integrated nursing teams: How one Clinical Commissioning Group applied an evidence-based approach. Br J Community Nurs 2017; 22:289-294. [PMID: 28570114 DOI: 10.12968/bjcn.2017.22.6.289] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The present day collection of financial and demographic challenges confronted by health and social care mean that integrated services are undoubtedly essential to sustain adequate care. However, the impact of integrated care upon healthcare staff and patients as well as new ways of working will need to be demonstrated, with collaboration and engagement throughout any transition. This paper provides an overview of the evidence relating to the delivery of effective, integrated out-of-hospital care, with a discussion of the literature. It also considers how one Clinical Commissioning Group has begun the process of integration with the focus on community nursing services for the provision of better care for patients with an evidence-based approach.
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Affiliation(s)
- Carolyn Lees
- Senior Lecturer, Liverpool John Moores University
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Abstract
Aims To identify education priorities for practice nursing across eight London Clinical Commissioning Groups (CCGs); to identify the education, training, development and support needs of practice nurses in undertaking current and future roles. BACKGROUND The education needs of practice nurses have long been recognised but their employment status means that accessing education requires the support of their GP employer. This study scopes the educational requirements of the practice nurse workforce and working with educational providers and commissioners describes a coherent educational pathway for practice nurses. METHOD A survey of practice nurses to scope their educational attainment needs was undertaken. Focus groups were carried out which identified the education, training, development and support needs of practice nurses to fulfil current and future roles. Findings A total of 272 respondents completed the survey. Practice nurses took part in three focus groups (n=34) and one workshop (n=39). Findings from this research indicate a practice nurse workforce which lacked career progression, role autonomy or a coherent educational framework. Practice nurses recognised the strength of their role in building relationship-centred care with patients over an extended period of time. They valued this aspect of their role and would welcome opportunities to develop this to benefit patients. CONCLUSION This paper demonstrates an appetite for more advanced education among practice nurses, a leadership role by the CCGs in working across the whole system to address the education needs of practice nurses, and a willingness on the part of National Health Service education commissioners to commission education which meets the education needs of the practice nurse workforce. Evidence is still required, however, to inform the scope of the practice nurse role within an integrated system of care and to identify the impact of practice nursing on improving health outcomes and care of local populations.
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Roberson C. Caseload management methods for use within district nursing teams: a literature review. Br J Community Nurs 2016; 21:248-255. [PMID: 27170409 DOI: 10.12968/bjcn.2016.21.5.248] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Effective and efficient caseload management requires extensive skills to ensure that patients receive the right care by the right person at the right time. District nursing caseloads are continually increasing in size and complexity, which requires specialist district nursing knowledge and skills. This article reviews the literature related to caseload management with the aim of identifying the most effective method for district nursing teams. The findings from this review are that there are different styles and methods of caseload management. The literature review was unable to identify a single validated tool or method, but identified themes for implementing effective caseload management, specifically caseload analysis; workload measurement; work allocation; service and practice development and workforce planning. This review also identified some areas for further research.
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Affiliation(s)
- Carole Roberson
- Queen's Nurse and Lead for Corporate Nursing (Community services), Worcestershire Health and Care NHS Trust
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Carolan CM, Forbat L, Smith A. Developing the DESCARTE Model: The Design of Case Study Research in Health Care. QUALITATIVE HEALTH RESEARCH 2016; 26:626-39. [PMID: 26336896 DOI: 10.1177/1049732315602488] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Case study is a long-established research tradition which predates the recent surge in mixed-methods research. Although a myriad of nuanced definitions of case study exist, seminal case study authors agree that the use of multiple data sources typify this research approach. The expansive case study literature demonstrates a lack of clarity and guidance in designing and reporting this approach to research. Informed by two reviews of the current health care literature, we posit that methodological description in case studies principally focuses on description of case study typology, which impedes the construction of methodologically clear and rigorous case studies. We draw from the case study and mixed-methods literature to develop the DESCARTE model as an innovative approach to the design, conduct, and reporting of case studies in health care. We examine how case study fits within the overall enterprise of qualitatively driven mixed-methods research, and the potential strengths of the model are considered.
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Affiliation(s)
- Clare M Carolan
- University of Stirling (Western Isles Campus), Stornoway, Scotland
| | - Liz Forbat
- Australian Catholic University, Canberra, Australia
| | - Annetta Smith
- University of Stirling (Western Isles Campus), Stornoway, Scotland
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Morales-Asencio JM, Martin-Santos FJ, Kaknani S, Morilla-Herrera JC, Cuevas Fernández-Gallego M, García-Mayor S, León-Campos Á, Morales-Gil IM. Living with chronicity and complexity: Lessons for redesigning case management from patients' life stories - A qualitative study. J Eval Clin Pract 2016; 22:122-132. [PMID: 25546074 DOI: 10.1111/jep.12300] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/11/2014] [Indexed: 11/29/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Case management is commonly used to provide health care for patients with multiple chronic conditions. However, the most effective form of team organization and the necessary support structures need to be identified. In this respect, patients' views could provide a valuable contribution to improving the design of these services. To analyse the experiences of patients with chronic diseases and of caregivers, in relation to health care services and mechanisms, and to identify means of modelling case management services. METHODS The method used was a qualitative study based on life stories, and semi-structured interviews with 18 patients with complex chronic diseases and with their family caregivers, selected by purposeful sampling in primary health care centres in Andalusia (southern Spain) from 2009 to 2011. RESULTS Three transition points were clearly identified: the onset and initial adaptation, the beginning of quality-of-life changes, and the final stage, in which the patients' lives are governed by the complexity of their condition. Health care providers have a low level of proactivity with respect to undertaking early measures for health promotion and self-care education. Care is fragmented into a multitude of providers and services, with treatments aimed at specific problems. CONCLUSIONS Many potentially valuable interventions in case management, such as information provision, self-care education and coordination between services and providers, are still not provided.
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Affiliation(s)
| | - Francisco Javier Martin-Santos
- Faculty of Health Sciences, University of Málaga, Málaga, Spain.,District of Primary Health Care, Andalusian Healthcare Service, Málaga, Spain
| | - Shakira Kaknani
- Faculty of Health Sciences, University of Málaga, Málaga, Spain
| | - Juan Carlos Morilla-Herrera
- Faculty of Health Sciences, University of Málaga, Málaga, Spain.,District of Primary Health Care, Andalusian Healthcare Service, Málaga, Spain
| | - Magdalena Cuevas Fernández-Gallego
- Faculty of Health Sciences, University of Málaga, Málaga, Spain.,District of Primary Health Care, Andalusian Healthcare Service, Málaga, Spain
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Trust and decision-making: How nurses in Australian general practice negotiate role limitations. Collegian 2015; 22:225-32. [PMID: 26281411 DOI: 10.1016/j.colegn.2015.03.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIM To explore the importance of role recognition and relationships between the opportunities for decision-making, social support, and skill development, in a sample of nurses working in general practice in New South Wales, Australia. BACKGROUND Understanding how nurses make decisions about patients and their care in general practice will benefit organisations and public policy. This understanding is important as the role changes and opportunities for further role development emerge. DESIGN A sequential mixed methods design was used. Study 1 utilised the internationally validated Job Content Questionnaire to collect data about decision making, social support, skill development, and identity derived from the role. In 2008 a purposive sample of nurses working in general practice (n = 160) completed and submitted an online Job Content Questionnaire. Study 2 used a set of open-ended questions informed by Study 1 to guide semi-structured interviews. In 2010 fifteen interviews were undertaken with nurses in general practice. Demographic characteristics of both samples were compared, and the findings of both studies were integrated. RESULTS The integration of findings of Study 1 and 2 suggests that nurses defined their expertise as being able to identify patient need and communicate this to the general practitioner, the ability to do so led to the development of trusting relationships. Trusting relationships led to greater support from the general practitioner and this support allowed the nurse greater freedom to make decisions about patient care. CONCLUSIONS Nurses gained influence in clinical decision-making by building trusting relationships with patients and medical colleagues. They actively collaborated in and made decisions about patient care. These results suggest that there is a need to consider how nursing can more effectively contribute to care in general practice settings.
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Morilla Herrera JC, Morales Asencio JM, Kaknani S, García Mayor S. [Complex chronic care situations and socio-health coordination]. ENFERMERIA CLINICA 2015; 26:55-60. [PMID: 26363991 DOI: 10.1016/j.enfcli.2015.08.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 08/02/2015] [Indexed: 10/23/2022]
Abstract
Patient-centered healthcare is currently one of the most pursued goals in health services. It is necessary to ensure a sufficient level of cooperative and coordinated work between different providers and settings, including family and social and community resources. Clinical integration occurs when the care provided by health professionals and providers is integrated into a single coherent process through different professions using shared guidelines and protocols. Such coordination can be developed at three levels: macro, which involves the integration of one or more of the three basic elements that support health care (the health plan, primary care and specialty care), with the aim of reducing fragmentation of care; meso, where health and social services are coordinated to provide comprehensive care to elderly and chronic patients; and micro, aimed to improve coordination in individual patients and caregivers. The implementation of new roles, such as Advanced Practice Nursing, along with improvements in family physicians' problem-solving capacity in certain processes, or modifying the place of provision of certain services are key to ensure services adapted to the requirements of chronic patients.
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Affiliation(s)
- Juan Carlos Morilla Herrera
- Unidad de Residencias, Distrito Sanitario de Atención Primaria de Málaga-Valle del Guadalhorce, Espana; Grupo de investigación CTS 970 «Cronicidad, Dependencia, Cuidados y Servicios de Salud», España.
| | - José Miguel Morales Asencio
- Grupo de investigación CTS 970 «Cronicidad, Dependencia, Cuidados y Servicios de Salud», España; Facultad de Ciencias de la Salud, Universidad de Málaga, España
| | - Shakira Kaknani
- Grupo de investigación CTS 970 «Cronicidad, Dependencia, Cuidados y Servicios de Salud», España; Unidad de Investigación del Distrito Sanitario de Atención Primaria de Málaga-Valle del Guadalhorce, España
| | - Silvia García Mayor
- Grupo de investigación CTS 970 «Cronicidad, Dependencia, Cuidados y Servicios de Salud», España; Unidad de Investigación del Distrito Sanitario de Atención Primaria de Málaga-Valle del Guadalhorce, España
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Mendes A. Ten years on from the national service framework for long-term conditions: how far have we come? Br J Community Nurs 2015; 20:150-1. [PMID: 25754784 DOI: 10.12968/bjcn.2015.20.3.150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Aysha Mendes investigates whether the Department of Health's blueprint for improving care of long-term conditions in the UK has been successful amid the large-scale changes occurring in the NHS over recent years.
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Affiliation(s)
- Aysha Mendes
- Freelance journalist specialising in health, psychology and nursing
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Procter S, Brooks F, Wilson P, Crouchman C, Kendall S. A case study of asthma care in school age children using nurse-coordinated multidisciplinary collaborative practices. J Multidiscip Healthc 2015; 8:181-8. [PMID: 25914542 PMCID: PMC4399592 DOI: 10.2147/jmdh.s71030] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aim To describe the role of school nursing in leading and coordinating a multidisciplinary networked system of support for children with asthma, and to analyze the strengths and challenges of undertaking and supporting multiagency interprofessional practice. Background The growth of networked and interprofessional collaborations arises from the recognition that a number of the most pressing public health problems cannot be addressed by single-discipline or -agency interventions. This paper identifies the potential of school nursing to provide the vision and multiagency leadership required to coordinate multidisciplinary collaboration. Method A mixed-method single-case study design using Yin’s approach, including focus groups, interviews, and analysis of policy documents and public health reports. Results A model that explains the integrated population approach to managing school-age asthma is described; the role of the lead school nurse coordinator was seen as critical to the development and sustainability of the model. Conclusion School nurses can provide strategic multidisciplinary leadership to address pressing public health issues. Health service managers and commissioners need to understand how to support clinicians working across multiagency boundaries and to identify how to develop leadership skills for collaborative interprofessional practice so that the capacity for nursing and other health care professionals to address public health issues does not rely on individual motivation. In England, this will be of particular importance to the commissioning of public health services by local authorities from 2015.
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Affiliation(s)
- Susan Procter
- Faculty of Society and Health, Buckinghamshire New University, High Wycombe, UK
| | - Fiona Brooks
- Centre for Research in Primary and Community Care (CRIPACC), University of Hertfordshire, Hatfield, UK
| | - Patricia Wilson
- Centre for Health Services Studies, University of Kent, Canterbury, UK
| | - Carolyn Crouchman
- Faculty of Society and Health, Buckinghamshire New University, High Wycombe, UK
| | - Sally Kendall
- Centre for Research in Primary and Community Care (CRIPACC), University of Hertfordshire, Hatfield, UK
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Roberts D, Hibberd P, Lewis CA, Turley J. The unique contribution of community clinical nurse specialists in rural Wales. Br J Community Nurs 2014; 19:601-7. [PMID: 25475675 DOI: 10.12968/bjcn.2014.19.12.601] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
To date, quality indicators that have been developed for nursing tend to focus on acute, secondary care settings. It remains unclear whether such quality indicators are applicable to community settings, particularly in rural environments. This research aims to identify the consensus view among specialist nurses regarding their unique nursing contribution within their rural community. Identifying agreed aspects of the unique role within the rural community area will enable quality care metrics to be developed, allowing specialist nurses to measure their unique contribution to rural health care in the future. The research used the Delphi technique to identify a consensus view among a population of specialist community nurses working in a designated rural area in Wales. The strongest area of consensus related to clinical and teaching expertise, where participants perceive educational expertise as being at the forefront of their role. In terms of care for individuals, consensus was focused on four main areas: developing appropriate criteria for referral in to the service, collaborative working, education, and advocacy roles. The findings highlight similarities to models of care provision elsewhere. Specific quality indicators are required for clinical nurse specialists working in rural areas. Current quality indicators may not be applicable across all clinical settings. Further work is required to explore the nature of rural nursing practice.
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Affiliation(s)
- Debbie Roberts
- Reader in Nursing, Academic Division of Psychology, Sport Science and Health, Glyndwr University, Wrexham, Wales
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Bentley A. Case management and long-term conditions: the evolution of community matrons. Br J Community Nurs 2014; 19:340, 342-5. [PMID: 25039343 DOI: 10.12968/bjcn.2014.19.7.340] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
It is now 10 years since the NHS Improvement Plan described a new clinical role for nurses and introduced the concept of community matrons for long-term conditions. This included conditions such as chronic obstructive pulmonary disease, diabetes, dementia, neurological conditions, heart failure, stroke and people with long and enduring mental illness. Despite initial concerns and scepticism about the role, community matrons continue to work with people to provide advanced clinical nursing care, often within a case-management model. Community matrons have continued to shape and develop this role around the main aims of preventing unnecessary emergency admissions, improving quality of life and outcomes for patients, and coordinating all elements of care. This article reviews the evidence, implementation and evolvement of case management within the role of the community matron.
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Affiliation(s)
- Allison Bentley
- Community Clinical Nurse Specialist, St Nicholas Hospice Care, Bury St Edmunds
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Burt J, Rick J, Blakeman T, Protheroe J, Roland M, Bower P. Care plans and care planning in long-term conditions: a conceptual model. Prim Health Care Res Dev 2014; 15:342-54. [PMID: 23883621 PMCID: PMC3976966 DOI: 10.1017/s1463423613000327] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The prevalence and impact of long-term conditions continues to rise. Care planning for people with long-term conditions has been a policy priority for chronic disease management in a number of health-care systems. However, patients and providers appear unclear about the formulation and implementation of care planning. Further work in this area is therefore required to inform the development, implementation and evaluation of future care planning initiatives. We distinguish between 'care planning' (the process by which health-care professionals and patients discuss, agree and review an action plan to achieve the goals or behaviour change of most relevance and concern to the patient) and a 'care plan' (a written document recording the outcome of a care planning process). We propose a typology of care planning and care plans with three core dimensions: perspective (patient or professional), scope (a focus on goals or on behaviours) and networks (confined to the professional-patient dyad or extending to the entire care network). In addition, we draw on psychological models of mediation and moderation to outline potential mechanisms through which care planning and care plans may lead to improved outcomes for both patients and the wider health-care system. The proposed typology of care planning and care plans offered here, along with the model of the process by which care planning may influence outcomes, provide a useful framework for future policy developments and evaluations. Empirical work is required to explore the degree to which current care planning approaches and care plans can be described according to these dimensions, and the factors that determine which types of patients and professionals use which type of care plans.
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Affiliation(s)
- J Burt
- Corresponding author: Jenni Burt, Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge, Forvie Site, Robinson Way, Cambridge CB2 0SR. Phone 01223 330596. Fax 01223 762515.
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Ansah JP, Eberlein RL, Love SR, Bautista MA, Thompson JP, Malhotra R, Matchar DB. Implications of long-term care capacity response policies for an aging population: A simulation analysis. Health Policy 2014; 116:105-13. [DOI: 10.1016/j.healthpol.2014.01.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Revised: 12/04/2013] [Accepted: 01/07/2014] [Indexed: 10/25/2022]
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Diagnoses, problems and healthcare interventions amongst older people with an unscheduled hospital admission who have concurrent mental health problems: a prevalence study. BMC Geriatr 2014; 14:43. [PMID: 24694034 PMCID: PMC3992161 DOI: 10.1186/1471-2318-14-43] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Accepted: 03/26/2014] [Indexed: 11/16/2022] Open
Abstract
Background Frail older people with mental health problems including delirium, dementia and depression are often admitted to general hospitals. However, hospital admission may cause distress, and can be associated with complications. Some commentators suggest that their healthcare needs could be better met elsewhere. Methods We studied consecutive patients aged 70 or older admitted for emergency medical or trauma care to an 1800 bed general hospital which provided sole emergency medical and trauma services for its local population. Patients were screened for mental health problems, and those screening positive were invited to take part. 250 participants were recruited and a sub-sample of 53 patients was assessed by a geriatrician for diagnoses, impairments and disabilities, healthcare interventions and outstanding needs. Results Median age was 86 years, median Mini-Mental State Examination score at admission was 16/30, and 45% had delirium. 19% lived in a care home prior to admission. All the patients were complex. A wide range of main admission diagnoses was recorded, and these were usually complicated by falls, immobility, pain, delirium, dehydration or incontinence. There was a median of six active diagnoses, and eight active problems. One quarter of problems was unexplained. A median of 13 interventions was recorded, and a median of a further four interventions suggested by the geriatrician. Those with more severe cognitive impairment had no less medical need. Conclusions This patient group, admitted to hospital in the United Kingdom, had numerous healthcare problems, and by implication, extensive healthcare needs. Patients with simpler conditions were not identified, but may have already been rapidly discharged or redirected to non-hospital services by the time assessments were made. To meet the needs of this group outside the hospital would need considerable investment in medical, nursing, therapy and diagnostic facilities. In the meantime, acute hospitals should adapt to deliver comprehensive geriatric assessment, and provide for their mental health needs.
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Morales-Asencio JM. [Case management and complex chronic diseases: concepts, models, evidence and uncertainties]. ENFERMERIA CLINICA 2013; 24:23-34. [PMID: 24314797 DOI: 10.1016/j.enfcli.2013.10.002] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Revised: 10/14/2013] [Accepted: 10/15/2013] [Indexed: 11/19/2022]
Abstract
Chronic diseases are the greatest challenge for Health Care, but the conventional health care models have failed noticeably. Nurses are one of the main providers of the services developed to tackle this challenge, with special emphasis on case management, as one of the most common forms. But, one of the key problems is that case management is poorly conceptualized, and with the diversity of experience available, make its development and comparative evaluation difficult. An in-depth review on case management definition and concepts is presented in this article, with a description of the models, ingredients and the effectiveness reported in various studies. The remaining uncertainties in case management, such as the heterogeneity of designs and target populations, the weak description of the components, and the scarce use of research models for complex interventions, are also discussed. Finally, some key factors for a successful implementation of case management are detailed, such as a clear definition of accountability and roles, the existence of support to guarantee the competence of case managers, the use of valid mechanisms for case finding, adjusted caseload, accessible and team-shared record systems, or the integration of health and social services.
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