Nurse-led case management in the National Health Service: bridging clinical and social worlds

Manthorpe, Jill; Goodman, Claire; Drennan, Vari; Davies, Sue; Masey, Helen; Gage, Heather; Scott, Cheryll; Brearley, Sally; Iliffe, Steve

doi:10.1017/s1463423611000533

Cited by 9 publications

(9 citation statements)

References 20 publications

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“…The role of nurses as coordinators of complex care remains the subject of debate and contemporary research. For example, Manthorpe and colleagues (2012) identified that it is both the clinical expertise and the social support that nurses provide, which allows them to coordinate effective care. This analysis of nurse navigator vignettes has supported this view, identifying what Parker et al (2013, p. 38) term ‘understandings of nurses, link[ing] to perceptions of the kinds of “tacit knowledge” they have that can be brought to their nursing role’.…”

Section: Discussionmentioning

confidence: 99%

Exploring the nurse navigator role: A thematic analysis

et al. 2020

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Background: Patients with complex chronic conditions experience fragmentation of care, unnecessary hospitalization and reduced quality of life, with an increased incidence of poor health outcomes. Aim(s):The aim of this paper was to explore how nurse navigators manage client care. This was achieved through an examination of narratives provided by the nurse navigator that evaluated their scope of practice. Method(s):All nurse navigators employed by Queensland Health were invited to participate in a study evaluating the effectiveness of the service. Eighty-four selfreported vignettes were thematically analysed to understand the work from the nurses' perspectives.Results: Two themes emerged from the vignettes. Theme 1, the layers of complexity, is comprised of three sub-themes: the complex patient, the complex system and patient outcomes. Theme 2, professional attributes, has two sub-themes: personcentred care and clinical excellence.Conclusion: Navigators innovatively integrate services and address the fragmented nature of the health system. They apply expert clinical and social skills, through consistent and robust communication, to meet the needs of those with multiple chronic conditions. Implications for nursing management: Results provide insight into the new role, illuminating the work they achieve, despite system complexities. K E Y W O R D S integrated health care systems care, multiple chronic conditions, nurse navigator, nurses' role, patient navigation, quality of life | 815 BYRNE Et al.

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Section: Discussionmentioning

confidence: 99%

Exploring the nurse navigator role: A thematic analysis

et al. 2020

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“…A comparative case study design (Yin 2003) was used to investigate different nurse case manager delivery models: community matrons, district nurses, nurse specialists, nurse practitioner. Patients reported that case management provided significant psycho-social support (Manthorpe et al 2012), but interviews with local stakeholders found scepticism about the ability of nurse case managers to reduce hospital admissions and concerns about the disruption to local services that accompanied the introduction of community matrons (Iliffe et al 2011). Commissioners now thinking about the reconfiguration of community nursing (to optimize efficiency and effectiveness) need evidence about the impact of community matrons, when compared with other nurses carrying out case management (Drennan et al 2010).…”

Section: Introductionmentioning

confidence: 99%

Nurse-led case management for community dwelling older people: an explorative study of models and costs

Gage

Ting²,

Williams

et al. 2012

J Nurs Manag

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“…99 Other literature concentrates on methods of service delivery such as integrated case management (as promoted in recent Best Practice Guidance, 'Delivering Care Closer to Home'). 100 An integrated case management approach might be beneficial to patients 101,102 and reduce costs. 103 However, potential benefits are likely to be contingent on, for instance, the context, leadership, management and previous methods of service delivery (e.g.…”

Section: Defining and Organising Intermediate Carementioning

confidence: 99%

Secondary analysis and literature review of community rehabilitation and intermediate care: an information resource

Ariss

Enderby

Smith

et al. 2015

Health Services and Delivery Research

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Background and designThis research was based on a reanalysis of a merged data set from two intermediate care (IC) projects in order to identify patient characteristics associated with outcomes [Nancarrow SA, Enderby PM, Moran AM, Dixon S, Parker SG, Bradburn MJ,et al.The Relationship Between Workforce Flexibility and the Costs and Outcomes of Older Peoples’ Services (COOP). Southampton: National Institute for Health Research (NIHR) Service Delivery and Organisation (SDO); 2010 and Nancarrow SA, Enderby PM, Ariss SM, Smith T, Booth A, Campbell MJ,et al.The Impact of Enhancing the Effectiveness of Interdisciplinary Working (EEICC). Southampton: NIHR SDO; 2012]. Additionally, the impact of different team and staffing structures on patient outcomes and service costs was examined, when possible given the data sets, to enable identification of the most cost-effective service configurations and change over time with service provision. This secondary analysis was placed within updated literature reviews focused on the separate questions.Research objectives(1) To identify those patients most likely to benefit from IC and those who would be best placed to receive care elsewhere; (2) to examine the effectiveness of different models of IC; (3) to explore the differences between IC service configurations and how they have changed over time; and (4) to use the findings above to develop accessible evidence to guide service commissioning and monitoring.SettingCommunity-based services for older people are described in many different ways, among which are IC services and community rehabilitation. For the purposes of this report we call the services IC services and include all community-based provision for supporting older people who would otherwise be admitted to hospital or who would require increased length of stay in hospital (e.g. hospital at home schemes, post-acute care, step-up and step-down services).ParticipantsThe combined data set contained data on 8070 patient admissions from 32 IC teams across England and included details of the service context, costs, staffing/skill mix (800 staff), patient health status and outcomes.InterventionsThe interventions associated with the study cover the range of services and therapies available in IC settings. These are provided by a wide range of professionals and care staff, including nursing, allied health and social care.Outcome measures(1) Service data – each team provided information relating to the size, nature, staffing and resourcing of the services. Data were collected on a service pro forma. (2) Team data – all staff members of the teams participating in both studies provided individual information using the Workforce Dynamics Questionnaire. (3) Patient data – patient data were collected on admission and discharge using a client record pack. The client record pack recorded a range of data utilising a number of validated tools, such as demographic data, level of care (LoC) data, therapy outcome measure (TOM) scale, European Quality of Life-5 Dimensions (EQ-5D) questionnaire and patient satisfaction survey.Results(1) The provision of IC across England is highly variable with different referral routes, team structures, skill mix and cost-effectiveness; (2) in more recent years, patients referred to IC have more complex needs associated with more severe impairments; (3) patients most likely to improve were those requiring rehabilitation as determined by levels 3, 4 and 5 on the LoC (> 40% for impairment, activity and participation, and > 30% for well-being as determined on the TOM scale); (4) half of all patients with outcome data improved on at least one of the domains of the TOM scale; (5) for every 10-year increase in age there was a 6% decrease in the odds of returning home. The chance of remaining or returning home was greater for females than males; (6) a high percentage of patients referred to IC do not require the service; and (7) teams including clinical support staff and domiciliary staff were associated with a small relative improvement in TOM impairment scores when compared with other teams.ConclusionsThis study provides additional evidence that interdisciplinary teamworking in IC may be associated with better outcomes for patients, but care should be taken with overinterpretation. The measures that were used within the studies were found to be reliable, valid and practical and could be used for benchmarking. This study highlights the need for funding high-quality studies that attempt to examine what specific team-level factors are associated with better outcomes for patients. It is therefore important that studies in the future attempt empirically to examine what process-level team variables are associated with these outcomes.FundingThe NIHR Health Services and Delivery Research programme.

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Nurse-led case management in the National Health Service: bridging clinical and social worlds

Cited by 9 publications

References 20 publications

Exploring the nurse navigator role: A thematic analysis

Exploring the nurse navigator role: A thematic analysis

Nurse-led case management for community dwelling older people: an explorative study of models and costs

Secondary analysis and literature review of community rehabilitation and intermediate care: an information resource

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