Nursing case management: relationships as a strategy to improve care

MULTIPLE TRANSFERS, MULTIPLE caregivers, and an unpredictable hospital course may result in ineffective communication among patients, families, and the healthcare team, and a fragmented plan of care for complex patients. To address these concerns, CNSs in a tertiary hospital developed a nursing case management model for patients in a medical-surgical-neurological intensive care unit. Long-term relationships between nursing case managers (NCMs), patients, and families grounded the model. The NCM crossed traditional unit boundaries with the patient, improving communication among patient, family, and the healthcare team. Evaluation of the NCM's experience suggested four types of interventions: (a) telling the story, (b) advancing the plan of care, (c) maintaining values and beliefs, and (d) assisting with options and decisions. Case studies illustrate these interventions and demonstrate cost savings.