Effective Responding In Nursing Care

Fields related to healthcare often utilize this model to address patient’s needs. St. Luke approach to team case management is effective in positive outcomes for their patients and families from a holistic point of view. In palliative care or nurse-led care, case managers with specific expertise to help individual care needs (Joo & Huber,20123). By regular case review, care plan meetings, evaluation of care, and constant direct contact with patient and families. Case management in hospice and palliative care agencies are very comprehensive in nature. Coordinating direct care services is the key component to positive outcomes (Spettell et al., 2009).

Standard 16 of the American Nurses Association (ANA) Scope and Standards Practice, directs nurse leaders to advocate not only for patients but for all members of our healthcare community. As a discharge planner, I am in a unique position to advocate not only for patients but for caregivers as well. As part of my responsibilities, I participate in daily multi-disciplinary team rounds. The meetings take place so that all disciplines can openly discuss patient care needs. They provide the perfect opportunity for anyone to bring to light problems or concerns.

The focus of this paper is case management. Case management has evolved into a diverse profession which includes many disciplines and is exercised in many settings. Case management involves the process of coordinating multiple services on behalf of clients and has been practiced now for several decades. Many disciplines have engaged in case management and identify themselves as case managers. Case managers work with many populations and settings and play an important role in today’s society. The following analysis explores how case management developed, how it is defined, its components, and how it relates to other nursing care delivery models. All these aspects are reviewed with the purpose to show the importance of case management

These provisions have a huge effect on nurses. Hospitals are encouraging nurses and social workers to provide their patients with self-care education regarding medication management, follow-up care, and signs and symptoms of expected/unexpected conditions that could develop after discharge (Burton, 2012). Some hospitals are requiring their nurses to follow up with patients through weekly home-visits and phone calls (Coleman, n.d.). Hospitals using the care transitions model experienced a 30% reduction in 30-day readmission and were able to reduce patient care costs by 20% (Coleman, n.d.).

To support excellence in nursing practice, Roy’s Adaptation Model (RAM) guides nurses in developing effective care through the use of reasoning, critical thinking, and decision-making. With a focus on adaptation, RAM can be utilized as a framework to conceptualize and plan individualized patient care or may be applied in a limited context to develop interventions for distinct clinical populations (Senesac, 2013).

Transitioning patients from one care setting to another has to potential to cause chaos, confusion and even harm for the patient. Case management plays an integral role in reducing that potential

Preparing our nurses to assist in changing our healthcare system is a crucial step to provide more efficient, affordable and accessible care to all patients. Nursing is one of the fastest growing careers in the healthcare field, by utilizing the opportunities to improve education, undertaking leadership positions, and providing patient centered healthcare the undertaking of changing the healthcare system will be a positive change. Redefining the role and responsibilities of the nurse towards primary patient care in this remodeling process is crucial in implementing an effective and efficient health care system.

Nursing Practice continues to evolve in order to adapt to perpetual revamping and reshaping of the healthcare system. The Patient Protection and Affordable Care Act (PPACA) calls for a dramatic and rapid metamorphosis of patient care delivery models in order to provide cost effective, safe, efficient, and high quality care to every American (Cherry & Jacob, 2016).

This, in turn, means that the patients that are in the hospital are more acute and require intensive nursing care. The role of the registered nurse must now include greater professional judgment, management of complex systems, and greater clinical autonomy (Lippincott, 2003). The pressure to contain costs and meet the needs of the rising levels of severe illnesses of inpatients make it imperative for hospitals to seek out ways to redesign delivery of care without compromising quality of care (Tappen, 2004). The structure, organization and financing of health care are rapidly changing. Patients previously hospitalized are now treated on an outpatient basis, relying on care through different delivery systems. Hospital communities are trying to increase health care services while raising prices as little as possible.

A nurse is expertised in assessing patients by collecting and analyzing information about their patients’ physical and mental conditions along with their responses to evaluated conditions while simultaneously acknowledging the extraneous factors the patients’ experience such as physiological, social, spiritual, lifestyle, and psychological. Also, they are found responsible for making making clinical judgments—identifying their patients' symptoms and responses as well as their ongoing needs based on potential problems or complications. Additionally, nurses contribute to the crucial planning involved which means Creating detailed and accessible care plans (that include assessment information and clinical judgments) by setting achievable goals and outcomes that can be measured and charted over a span of time. Lastly, implementing care plans for their patients while ensuring that those plans are not disrupted by evaluating care plans continuously monitoring the status of patients and determining whether or not their care is effective or needs to be

Through experience, it is recognizable that the focus of nursing is shifting as a result of cost-efficient care approach, increased workload, and time consumed by performing technical skills. As a consequence, research has shown poor patient outcomes as nurses are faced with decreased amount time to connect with their patients (Canadian Federation of Nurses Union [CFNU], 2012). Despite the tasks at hand, the nursing scope of practice (College of Registered Nurse British Columbia[CRNBC], 2016) is to support patients through all aspects of their health challenges. This means that nurses need to attend to any aspects such as

This shift in the setting for health care is moving health care back into the patient’s environment and also requiring people to take a greater role in their individual health management. Nurses can offer professional guidance in this trend as well. Proper diagnosis and treatment will be of paramount importance in the future so that health care funds can be better applied and the nursing experience and knowledge gleaned can be more widely disseminated in the field. (Saver, 2006)

When nurses demonstrate certain values such as dignity, integrity, and respect in his/her personal life those qualities will be reflected in the professional life as well (Burkhart & Nathaniel, 2013). An empowered nurse will use his/her self-awareness to respect the choices and decisions a patient will make. By doing so, the patient becomes an equal and active participant in their personal health care. The goal of today’s healthcare is to provide personalized care for each patient. In order to be successful and provide the best care possible, the patient must have an active role in those care decisions. By taking responsibility for his/her care, the patient becomes empowered. In turn, the healthcare team respects the decisions made by the patient and uses those choices to craft an individualized care plan (Paget et al., 2011). When the preferences of a patient are combined with the unique education and experiences of the interdisciplinary team, every party involved is

Fragmentation of care increases the vulnerability of the frail elderly patients, which contributes to increased readmissions to the hospital. To overcome this problem all health care providers need to work as a team. Teamwork starts from the day of admission to the hospital until the patient is discharged to the SNF and is followed by the advanced practice nurse (APN) or is discharged to home and is followed by the primary care provider in the community. To reduce fragmentation and improve the transition of care, coordinated care between the healthcare providers in the hospital or acute care facility, the SNF, and the community is required, as well as coordination with the informal, family caregivers (Coleman, 2003; Coleman, 2009; Coleman & Boult,

The nurse still relies heavy on general guidelines and are only beginning to see recurring patterns in their clinical practice. The competent nurse is stage three in this model. The nurse at this stage has more confidence in their clinical judgment as a practitioner. There able to formulate a plan that will help to achieve efficiency and organization in their practice. The proficient nurse is the four stage in this model. In this stage the nurse is able to connect the pieces together to develop a whole concept of the situation. Nurses at this stage are also able to formulate a long-term treatment plan based on past experiences. These treatment goals can be modified in response to changes in patient condition. The expert nurse is stage five in this model. The expert nurse has a large amount of clinical experience upon which to draw a quick conclusion from. Nurses at this stage are able to focus in on the problem without delaying with flawed diagnoses. The nurse’s intuitively is also a factor at this stage of the model with the use of their experience or