The topics that don’t belong to any assigned chapters…but are important to ATI/NCLEX

Case Management nursing

Collaborative process that assesses, plans, implements, coordinates, monitors, and evaluates options and services to meet an individual’s health needs through communication and available resources to promote quality, cost-effective outcomes

Coordinates care through an episode of illness

The focus is on individual clients, not populations of clients.

Managing Care with Case Management #1

Case managers often manage care using critical pathways and multidisciplinary action plans (MAPs) to plan patient care.

The care MAP is a combination of a critical pathway and a nursing care plan, which indicates times when nursing interventions should occur.

All health-care providers follow the care MAP to facilitate expected outcomes.

If a patient deviates from the normal plan, a variance is indicated.

PRINCIPLES OF CASE MANAGEMENT (ATI CHAP 2, P25)

Case management focuses on managed care of the client through collaboration of the health care team in acute and post acute settings

The goal of case management is to avoid fragmentation of care and control cost

A case manager collaborates with the interprofessional team during the assessment of a client’s needs and subsequent care planning, and follows up by monitoring the achievement of desired client outcomes within established time parameters

A case manager can be a nurse, social worker, or other designated healthcare professional. A case manager’s role and knowledge expectations are extensive

Principles of case management continued

Therefore case managers are required to have advanced practice degrees or advanced training in this area.

Case manager nurses do not usually provide direct client care

Case managers usually oversee a caseload of clients who have similar disorders or treatment regimens

Case managers in the community coordinate resources and services for clients whose care is based in a residential setting

Principles of case management continued

A critical or clinical pathway or care map can be used to support the implementation of clinical guidelines and protocols. These tools are usually based on cost and length of stay parameters mandated by prospective payment systems such as Medicare or insurance companies

Nursing role in case management (ATI p 25)

Coordinating care, particularly for clients who have complex health care needs

01

Facilitating continuity of care

02

Improving efficiency of care and utilization of resources

03

Enhancing quality of care provided

04

Limiting unnecessary costs and lengthy stays

05

Advocating for the client and family

06

Magnet recognition program (ATI Chap 2, p 24) (Text 314-16)

Well-qualified nurse executives in a decentralized environment, with organizational structures that emphasize open, participatory management

Autonomous, self-managing, self-governing climates that allow nurses to fully practice their clinical expertise, flexible staffing, adequate staffing ratios, and clinical career opportunities

Characteristics of magnet hospitals

A professional practice culture in all aspects of nursing care

Compliance with standards in the ANA’s Scope and Standards for Nurse Administrators

The 14 forces of magnetism for magnet hospital status # 1

Quality of nursing leadership

Organizational structure

Management style

Personnel policies and programs

Professional models of care

Quality of care

Quality improvement

the 14 forces of magnetism for magnet hospital status # 2

Consultation and resources

Autonomy

Community and the hospital

Nurses as teachers

Image of nursing

Interdisciplinary relationships

Professional development

Shared Governance

Nurses at every level play a role in the decisions that affect nursing activity throughout the system.

Nurse-managers move out of traditional industrial model roles into collegial models, becoming moderators of the service process.

Usually defined by a structure of rules or bylaws

Organizational culture

The values and behaviors that contribute to the unique social and psychological environment of an organization

A sum total of values, language, traditions, formal and informal communication networks, and the rituals of an organization

READ DISPLAY 12.3 (TEXT p 311):

“ASSESSING THE ORGANIZATIONAL CULTURE

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