Implementación de un modelo integrado de enfermería de enlace: un estudio descriptivo

Case management nurse in Spain: facing the challenge of chronicity through a comprehensive practice

A new type of nurse role was established in the Spanish health care system in the late 1990s, currently called case manager nurse, to ensure access to resources needed to cope with chronic conditions and comprehensive home care. This paper aims to present this figure and discuss aspects of its work. The methodology was based on the bibliographic review of papers and normative publications and interviews with primary health care nurses, nursing faculty, and case management nurses. We present a brief history of the implementation of the case manager nurse role and the conceptual and operational bases of her practice in three autonomous Spanish communities: Andalusia, Valencian Community, and Basque Country, discussing potentialities and issues concerning this practice. In the conclusions, we make some considerations on the possible implementation of the case manager nurse in the Brazilian health system.

[Strategies for improving care of oncologic patients: SHARE Project results]

Cancer treatment is a major burden for the patient and its family that requires an individualized management by healthcare professionals. Nurses are in charge of coordinating care and are the closest healthcare professionals to patient and family; however, in Spain, there are not standard protocols yet for the management of oncology patients. The Spanish Oncology Nursing Society developed between 2012 and 2014 the SHARE project, with the aim of establishing strategies to improve quality of life and nursing care in oncology patients. It was developed in 3 phases. First, a literature search and review was performed to identify nursing strategies, interventions and tools to improve cancer patients' care. At the second stage, these interventions were agreed within a group of oncology nursing experts; and at the third phase, a different group of experts in oncology care categorized the interventions to identify the ones with highest priority and most feasible to be implemented. As a result, 3 strategic actions were identified to improve nursing care during cancer treatment: To provide a named nurse to carry out the follow up process by attending to the clinic or telephonic consultation, develop therapeutic education with adapted protocols for each tumor type and treatment and ensure specific training for nurses on the management of the cancer patients. Strategic actions proposed in this paper aim to improve cancer patients' healthcare and quality of life through the development of advanced nursing roles based on a higher level of autonomy, situating nurses as care coordinators to assure an holistic care in oncology patients.

[Continuity of care from the acute care hospital: Results]

OBJECTIVE

To describe the profile of patients treated by a Continuity of Care Manager in an acute-care center during the first six months of its activity, as well as the profile of patients treated and the resource allocation.

METHOD

A prospective cross-sectional study was conducted on patients with complex care needs requiring continuity of care liaison, and who were attended by the Continuity of Care Nurse during the period from October 2013 to March 2014. Patient characteristics, their social environment and healthcare resource allocation were registered and analyzed.

RESULTS

A total of 1,034 cases of demand that corresponded to 907 patients (women 55.0%; age 80.57±10.1; chronic 47.8%) were analyzed, of whom 12.2% were readmitted. In the multivariate model, it was observed that the variables associated with readmission were polypharmacy (OR: 1.86; CI: 1.2-2.9) and fall history prior to admission (OR: 0.586; CI: 0.36-2-88).

CONCLUSIONS

Patients treated by a Continuity of Care Nurse are over 80 years, with comorbidities, geriatric syndromes, complex care, and of life needs, to whom an alternative solution to hospitalization is provided, thus preventing readmissions.

[Towards integrated care. Nursing assessment of a "complex" patient using intermed]

Nurses are confronted with an increasing number of patients with complex health care needs. INTERMED (INTERdisciplinary MEDicine) is described here as an action oriented method to document the potential «complexity» of patients, summarising information on biological, psychological, social and health care domains, plotted on a time-axis (history, current state and prognoses). A 73 year old patient assessed with this tool on admission to an internal medicine ward is described. INTERMED identified that besides age, mental health problems were interfering with somatic state and identified the patient as a complex case. From an integral health care perspective, coordinated care was needed to focus on the psychological vulnerability of the patient that made the somatic state more complex, including all the health care providers involved. Complex patients are an important and interesting issue for today's nurses, challenging their ability for management, organisation and coordination of care beyond standard care and the INTERMED tool can be crucial in this development.

[Descriptive study of the type of patient cared for in a link-nursing program]

OBJECTIVE

Determine the type of patients in a program of link nursing of the urban area.

METHODS

Descriptive observational study conducted at the Hospital Clinic de Barcelona (HCB). The study population were patients hospitalized in the Institute of Orthopedics, Internal Medicine, Cardiology, Vascular Surgery and Post Coronary Care. The data was obtained through the registration of patients enrolled in the program between November 2006 and April 2008. We analyzed sociodemographic variables (gender, age, reason for admission, the institution where hospitalized, hospital stay, primary care (PAC) reference destination of the patient on discharge from hospital) and physical variables (Barthel dependency score and recommendations of the link nurse to reference PAC).

RESULTS

Information was analysed from 2025 (99.26%) out of 2040 eligible patients. Fifteen were excluded because they did not have complete information for data analysis. The average age for men was 73.55 years and 66.53 years for women (P<0.01). There was sever dependence in 92 (9.10%) males and 61 (6.02%) women (P<0.01). The average number of hospital stays for men was 9.7 and 9.65 for women (P<0.01). Continuity of care at home was not required in 571 (56.48%) males and 605 (59.66%).

CONCLUSIONS

The majority of the population was elderly with an index of slight dependence, demonstrating that this population need continuous monitoring of their progress after discharge, although the Barthel index was not severe or total.

[The concept of "patient type": utility for the care of surgical patients]

OBJECTIVE

To describe a model of surgical "patient type" by identifying the needs and characteristics of surgical patients.

METHOD

We performed a cross-sectional study of surgical patients with one or more diseases and similar needs and/or characteristics admitted to the surgical wards of a general hospital over a 10-month period. The variables analyzed were sociodemographic and clinical data, degree of autonomy, and Virginia Henderson's needs, which were identified through an interview performed in the postoperative period. Univariate analysis, stratified descriptive statistics and multiple correspondence analysis were performed.

RESULTS

A total of 270 medium- or low-complexity patients from different surgical specialties took part in the analysis. During the surgical process (pre- and post-operative), almost a half of the patients suffered from hypotension, heart rate showed no significant changes and the risk of developing a pressure ulcer was unmodified according to Norton's scale. The first statistical analysis classified the surgical patients into five groups and showed the relationship between the degree of autonomy (measured through Barthel's index) and the number of personal problems (assessed according to the Henderson model). A subsequent statistical analysis classified the patients into four groups or types, explaining 70% of the total variance.

CONCLUSIONS

Through the use of Virginia Henderson's model, a surgical patient type composed of four different groups was identified. The results of this study may be useful in the care of low- and medium-complexity patients in distinct surgical specialties.