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Explain 5 Roles of The Case Manager
Explain 5 Roles of The Case Manager
Order ID# 45178248544XXTG457 Plagiarism Level: 0-0.5% Writer Classification: PhD competent Style: APA/MLA/Harvard/Chicago Delivery: Minimum 3 Hours Revision: Permitted Sources: 4-6 Course Level: Masters/University College Guarantee Status: 96-99% Instructions
Explain 5 Roles of The Case Manager
Chapter 25
Case Management
Copyright © 2020 by Elsevier Inc. All rights reserved.
1
Define continuity of care, care management, case management, care coordination, population health management, transitional care, integrated care, social determinants of health, and advocacy.
Describe the scope of practice, roles, and functions of a case manager.
Compare and contrast the nursing process with processes of case management and advocacy.
Objectives (1 of 2)
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2
2
Identify methods to manage conflict, as well as the process of achieving collaboration.
Define and explain the legal and ethical issues confronting case managers.
Objectives (2 of 2)
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3
3
Population management
Social mandate
Care management
Utilization management
Critical pathways
Disease management
Demand management
Definitions
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4
4
Case management and the nursing process
Characteristics and roles
Knowledge and skill requisites
Tools of case managers
Historical evidence
Contemporary evidence
Concepts of Case Management
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5
5
Assessment
Diagnosis
Planning for outcomes
Implementation
Evaluation
Case Management and the Nursing Process
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6
See Table 25.1, The Nursing Process and Case Management.
6
Case Management Roles
Broker
Consultant
Coordinator
Educator
Facilitator
Liaison
Mentor
Monitor/reporter
Negotiator
Client advocate
Researcher
Standardization monitor
Systems allocator
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7
See Box 25.1, Case Manager Roles, for descriptions of these roles.
7
Factors That Demand Case Management Attention
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8
Fig. 25.4: Factors that require the attention of the nurse and client in the case management process
8
Knowledge and Skill Requisites
Standards of practice for case management
Evidence-based practice guidelines
Knowledge of the health care financial environment
Clinical knowledge, skill, and maturity
Care resources
Transition planning
Management skills
Teaching, counseling, and education skills
Program evaluation and research
Performance improvement techniques
Peer consultation and evaluation
Requirements of eligibility and benefit parameters by third-party payers
Legal and ethical issues
Information management systems
Health care legislation/policy
Technical information skills
Outcomes management and applied research
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9
See Box 25.2 for an expanded list of knowledge and skill requisites.
9
Six “rights” of case management
Right care
Right time
Right provider
Right setting
Right price/value
Right outcomes
Tools of Case Managers (1 of 2)
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10
Three tools
Case management plans
Standards of client care and nursing practice
Clinical guidelines
Evidence-based practices
Critical path development gave way to care maps
Disease management
Focus: the natural progression of a disease in high-risk populations
Life care planning
Needs of a client for catastrophic or chronic disease over a life span
Technology driven
Tools of Case Managers (2 of 2)
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11
Technology supports the delivery of processes used by the case manager. The technology sector is refining software in the areas of documentation, decision support, dashboard tools, predictive modeling, workflow automation, reporting capabilities, electronic health records, patient engagement strategies and social media, and remote monitoring.
11
Historical evidence
Taylor’s three models
Client focused
System focused
Social service
Contemporary evidence
Model of intensive case management (ICM)
Kolbasovshy (2009)
Reduced readmissions
CARE ONE program: reduced emergency room (ER) visits
2012 Study: decreased acute outpatient and inpatient admissions
Evidence-Based Examples of Case Management
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12
Client-focused models are concerned with the relationship between case manager and client to support continuity of care and to access providers of care.
System-focused models, in contrast, address the structure and processes of using the population-based tools of disease management and case management plans to offer care for client populations.
The social service models provide services to clients to assist them in living independently in the community and in maintaining their health by eliminating or reducing the need for hospital admissions or long-term care.
These models offer a solution to unnecessary health care expenses by reducing costs and accessing appropriate health care services.
12
Which model demonstrated a consistent reduction in ER visits, readmissions, and acute outpatient and inpatient admissions in multiple studies?
Social service
Client-focused
System-focused
Intensive case management
Quick Recall (1 of 2)
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13
13
Answer is D.
Intensive case management
Quick Recall (2 of 2)
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14
Model of intensive case management (ICM)
Reduced readmissions
Reduced ER visits
Reduced acute outpatient and inpatient admissions
How’d You Do?
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15
Advocacy
Conflict management
Collaboration
Essential Skills for Case Managers
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16
16
The advocacy role aims to achieve patient engagement.
By helping patients become invested in their health and care through programs that provide information and tools to empower them to take control and evaluate their care
Advocacy (1 of 2)
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17
The definition of nursing includes advocacy: “Nursing is the protection, promotion and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities and populations” (ANA, 2010).
17
Process of advocacy
Promoting self-determination in clients
Informing:
Amplifying
Clarifying
Verifying
Supporting
Affirming
Illuminating values
Advocacy (2 of 2)
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18
Amplifying occurs between the nurse and the client to assess the needs and demands that will eventually frame the client’s decision. Information is exchanged from both viewpoints.
Clarifying is a process in which the nurse and client strive to understand meanings in a common way.
Verifying is the process used by the nurse advocate to establish accuracy and reality.
The second major process, supporting, involves upholding a client’s right to make a choice and to act on it.
The third process in the advocacy role is affirming. It is based on an advocate’s belief that a client’s decision is consistent with the client’s values and goals.
18
Allocation roles in nursing
Triage
Gatekeeping
Rationing
Systems-level demands
Budget decisions
Staffing assignments
Clinical level demands
Implementing treatment protocols
Advocacy can conflict with allocation.
Limited resources contribute to this conflict.
Allocation and Advocacy
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19
19
Negotiation outcomes
Distributive outcomes
One party gains
Integrative outcomes
Mutual advantages override individual gains
Negotiation stages
Prenegotiating
Negotiating
Aftermath
Conflict Management
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20
Negotiating is a strategic process used to move conflicting parties toward an outcome. The outcome can vary from one in which one party gains benefit at the other’s expense (distributive outcomes) or in which mutual advantages override individual gains (integrative outcomes).
20
Establish issues and agenda.
Advance demands and uncover interests.
Bargain and discover new options.
Work out an agreement.
Negotiation Phases
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21
Communication is essential but not sufficient.
Joint decision making valued
However, one member should be accountable.
Handling competing expectations
Collaboration (1 of 2)
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22
Collaboration (2 of 2)
Goal: to amplify, clarify, and verify all team members’ points of view
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23
23
Legal issues
Ethical issues
Issues in Case Management
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24
24
Liability for managing care
Negligent referrals
Experimental treatment and technology
Confidentiality/security
Fraud and abuse
Legal Issues
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25
25
Autonomy
Beneficence
Fidelity
Justice
Nonmaleficence
Veracity
Ethical Issues
RUBRIC
Excellent Quality 95-100%
Introduction 45-41 points
The background and significance of the problem and a clear statement of the research purpose is provided. The search history is mentioned.
Literature Support 91-84 points
The background and significance of the problem and a clear statement of the research purpose is provided. The search history is mentioned.
Methodology 58-53 points
Content is well-organized with headings for each slide and bulleted lists to group related material as needed. Use of font, color, graphics, effects, etc. to enhance readability and presentation content is excellent. Length requirements of 10 slides/pages or less is met.
Average Score 50-85%
40-38 points More depth/detail for the background and significance is needed, or the research detail is not clear. No search history information is provided.
83-76 points Review of relevant theoretical literature is evident, but there is little integration of studies into concepts related to problem. Review is partially focused and organized. Supporting and opposing research are included. Summary of information presented is included. Conclusion may not contain a biblical integration.
52-49 points Content is somewhat organized, but no structure is apparent. The use of font, color, graphics, effects, etc. is occasionally detracting to the presentation content. Length requirements may not be met.
Poor Quality 0-45%
37-1 points The background and/or significance are missing. No search history information is provided.
75-1 points Review of relevant theoretical literature is evident, but there is no integration of studies into concepts related to problem. Review is partially focused and organized. Supporting and opposing research are not included in the summary of information presented. Conclusion does not contain a biblical integration.
48-1 points There is no clear or logical organizational structure. No logical sequence is apparent. The use of font, color, graphics, effects etc. is often detracting to the presentation content. Length requirements may not be met
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Explain 5 Roles of The Case Manager
