Reflective practice: a framework for case manager development.

PURPOSE/OBJECTIVES: The role of a nurse case manager (NCM) incorporates practice that is built upon knowledge gained in other roles as well as components unique to case management. The concept of reflective practice was used in creating a framework to recognize the developmental stages that occur within community based case management practice. The formation of this framework and its uses are described in this article. PRIMARY PRACTICE SETTING: The practice setting is a community based case management department in a large midwestern metropolitan health care system with Magnet recognition. Advanced practice nurses provide care for clients with chronic health conditions. FINDINGS/CONCLUSIONS: Twenty-four narratives were used to identify behaviors of community based case managers and to distinguish stages of practice. The behaviors of advanced practice found within the narratives were labeled and analyzed for similarities. Related behaviors were grouped and descriptor statements were written. These statements grouped into 3 domains of practice: relationship/partnership, coordination/collaboration, and clinical knowledge/decision making. The statements in each domain showed practice variations from competent to expert, and 3 stages were determined. Reliability and validity of the framework involved analysis of additional narratives. The reflective practice process, used for monthly case review presentations, provides opportunity for professional development and group learning focused on improving case manager practice. The framework is also being used in orientation as new case managers acclimate to the role. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE: Reflective writing has unveiled the richness and depth of nurse case manager practice. The depth of knowledge and skills involved in community-based case management is captured within this reflective practice framework. This framework provides a format for describing community based case manager practice development over the course of time and has been used as a tool for orientation and peer review.

Evolution of information on women and heart disease 1957-2000: a review of archival records and secular literature.

This project explores the evolution of public information on cardiac disease in women, focusing on warning signs and symptoms. Historical documents available from the American Heart Association of Wisconsin and selected professional and secular literature were reviewed. Analysis revealed little information specific to women's symptoms until the 1980s. During the 1960s, articles and programs focused on how women could take care of their husbands' hearts. The 1980s brought a dramatic surge in literature on women's health, specifically on women's risk for heart disease. The evolution of information about women has mirrored the evolution of women's social roles. Despite the growing body of literature, more information and educational programs are needed to increase public awareness of cardiac warning signs and symptoms in women.