Practice nurses and older people: a case management approach to care.
ABSTRACT This paper reports on aspects of a study designed to answer the research questions: (i) To what extent do practice nurses use the five cyclical elements of a case management approach when caring for people aged over 75 years? (ii) What determines or deters practice nurses' use of the cyclical elements of a case management approach in caring for older people?
Case management is an approach that uses a cyclical process of assessment, planning, implementation, monitoring and evaluation to provide systematic proactive care to people with complex health and social care needs. In England, specialist practice nurse case managers for older people have been piloted in ten primary care trusts and the posts are to be implemented nationally by 2008. No baseline work has, however, considered the applicability of developing the existing generalist practice nurse workforce.
A 26-item structured postal questionnaire was used to explore both practice nurses' use of a case management approach when working with older people, and what factors influenced the care provided. A random sample of 500 practice nurses was selected from the Royal College of Nursing Practice Nurse Association member database.
A 45% response rate was achieved. Practice nurses assessed, planned and implemented care, but reviewing medication opportunistically and evaluating the care were uncommon. A case management approach was significantly (P = 0.005) more likely to be used in on-going management activities than in one-off treatment room care. Practice nurses with postregistration education in district nursing were significantly (P = 0.016) more likely to refer patients to social care services. Lack of time and the central role of the general practitioner were the main reasons for not incorporating case management into practice. CONCLUSIONS. The extent to which practice nurses used elements of a case management approach was highly variable and influenced by individual professional expertise, the nature of the consultation and the practice nurse's position in the general practice.
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ABSTRACT: Background Population ageing fosters new models of care delivery for older people that are increasingly integrated into existing care systems. In the Netherlands, a primary-care based preventive home visitation programme has been developed for potentially frail community-dwelling older people (aged ¿75 years), consisting of a comprehensive geriatric assessment during a home visit by a practice nurse followed by targeted interdisciplinary care and follow-up over time. A theory-based process evaluation was designed to examine (1) the extent to which the home visitation programme was implemented as planned and (2) the extent to which general practices successfully redesigned their care delivery.Methods Using a mixed-methods approach, the focus was on fidelity (quality of implementation), dose delivered (completeness), dose received (exposure and satisfaction), reach (participation rate), recruitment, and context. Twenty-four general practices participated, of which 13 implemented the home visitation programme and 11 delivered usual care to older people. Data collection consisted of semi-structured interviews with practice nurses (PNs), general practitioners (GPs), and older people; feedback meetings with PNs; structured registration forms filled-out by PNs; and narrative descriptions of the recruitment procedures and registration of inclusion and drop-outs by members of the research team.ResultsFidelity of implementation was acceptable, but time constraints and inadequate reach (i.e., the relatively healthy older people participated) negatively influenced complete delivery of protocol elements, such as interdisciplinary cooperation and follow-up of older people over time. The home visitation programme was judged positively by PNs, GPs, and older people. Useful tools were offered to general practices for organising proactive geriatric care.Conclusions The home visitation programme did not have major shortcomings in itself, but the delivery offered room for improvement. General practices received useful tools to redesign their care delivery from reactive towards proactive care, but perceived barriers require attention to allow for sustainability of the home visitation programme over time.BMC Family Practice 10/2014; 15(1):173. · 1.74 Impact Factor
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ABSTRACT: Introduction. Current demographic trends show that the process of aging in Europe and Poland is still going on. This cause a growing demand for medical services and social services. The older people are the main beneficiaries of health care, especially of the nursing and care system, which entails the reorganizing the system of care for the seniors in their households. Aim of the study. The aim of this study is to define new tasks for the community nurse drawing from the needs and expectations of the older people. Material and methods. The two focused groups interviews conducted in the framework of the project „Improving access to community based services for older people in their households” consisted of 6 older people and 11 representatives of various community care providers. Results. Older people’s expectations focused on various community institutions are mostly addressed to community nurses. Participants of two focus groups emphasize the important role of community nurse in the process of informing senior citizens about the possibilities of obtaining care and the tasks of nurses in transmitting information to other community professionals of geriatric team. In community nurse’s work apart from performing instrumental tasks it is particularly important to provide informational and emotional support for older people and their families. Conclusions. It is necessary to define the new tasks of nurse in caring for the older peopleJournal Problems of Nursing. 02/2011;
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ABSTRACT: The significant role of case managers in improving the health status of clients and in achieving cost-containment has been increasingly recognized. However, very few studies have touched on the emerging group of case managers who work exclusively with frail older adults. The purpose of this study was to determine the level of overall job satisfaction and some of its determinants among case managers of the Visiting Nurse Health System, Atlanta, Georgia, working primarily with older adults in two community-based programs. The objectives were to learn: (1) the level of overall job satisfaction among these case managers; (2) how these case managers perceive their role; and (3) what factors facilitate their work, what factors present barriers to their job performance, and what policy or procedural changes they feel would improve their performance. An established job satisfaction scale was employed to assess job satisfaction among the case managers. The overall job satisfaction scores ranged from 109 to 198 (out of a maximum possible score of 216), with a mean of 158.2, which is considerably higher than the theoretical mid-point of the scale (126). Nine subscales of job satisfaction, ordered by the satisfaction level from highest to lowest were, Coworkers, Supervision, Nature of Work, Communication, Contingent Rewards, Fringe Benefits, Operating Conditions, Pay, and Promotion.