Beyond the sick role: situating community health nursing practice

Whole of Client Health Care in a Gridlocked System: An Insider Dialogue Between the Theory and Practice of Community Case Management

This article blends theory with empirical qualitative research to investigate the present practices of Community Case Management and develop a new and informed model driven by a whole of client approach rather than agency ownership. The Case Management Society of Australia presents an idealistic model that has never been fully implemented. Our exploration of the gap between this theory and the actual real-world practice demonstrates that a whole of client focus has been marginalized and frustrates full implementation. Recent Australian government policy changes to the Home and Community Care program have encouraged competitive, market-oriented delivery in an attempt to reempower the client, but it has come at the expense of collaboration. Introducing competition has added another dimension to impediments to client-centered care that include funding pressures, turf wars, territorialism, and organizationally induced gridlocked systems, all of which shift the focus from the client to the organization. In the face of this, it is paramount that case managers remain client focused and be willing to collaborate/communicate with all parties involved in the cares of the client. Failure to do so may lead to the eventual failure of the Home and Community Care program.

Hospital and home

This paper addresses the hospital/community interface as an emerging context of health care practice. As a consequence of industry reforms health service managers are looking to the community space as a location for delivery of acute health care. This focus on the community is sharpened by the promise of cost savings and enhanced by the seemingly limitless potential of biomedical technology. The paper argues that the interface of hospital and community is a conceptual space where two different types of health services meet, bringing with them different cultural practices and expectations. The 'hospital in the home' programs that structure health care at this interface provide the delivery of acute nursing and medical care and the accoutrements of this care in the community, the neighbourhood, the home. Consequently, the home is becoming the new site for high technology 'hospital' care. This domestication of illness technology is contrasted with the notion of home as a place of sanctuary, familiarity and belonging.