Rural Community Case Management Experience for Bachelor of Science in Nursing Students: A Focus Group Evaluation.

BACKGROUND: This presentation concerns the evaluation of an additional clinical experience in case management for senior baccalaureate students. During their final leadership course, nursing students can elect to do an additional 80-hour precepted clinical experience focusing on case management in primary care clinics. As part of that experience, they rotate through seven nurse-managed rural primary health clinics in Tennessee. METHOD: As part of the evaluation process, students and preceptors were asked to review the experiences that students had participating in the clinical. RESULTS: For the most part, students were highly satisfied with the case management experience and thought it provided an additional skill set for them as they were completing their final year in nursing school and preparing to enter the nursing workforce as graduates of the Bachelor of Science in Nursing program. CONCLUSION: A community case management clinical opportunity in primary care allows a community experience for students that provides them with an opportunity to witness an RN practicing to the full scope of the license. [J Nurs Educ. 2018;57(9):557-560.].

Intensive Care Unit-Acquired Weakness: Implications for Case Management.

PURPOSE: The purpose of this case study is to provide a specific example of the disease trajectory for one patient's experience with intensive care unit-acquired weakness (ICUAW). This case study provides those in case management with an overview of some of the common signs and symptoms of ICUAW, as well as the possible prognosis and recovery from ICUAW. PRIMARY PRACTICE SETTING: The events in this case study take place in the acute care setting including the intensive care unit of a mid-sized health center, a general medical-surgical (med-surg) unit, and a long-term acute care facility. CONCLUSIONS: ICUAW affects the clinical, functional, and financial outcomes of patients. If the patient survives, their quality of life and the quality of life of their family members could be severely impacted. Case management practice has a significant role in coordinating care for those diagnosed with ICUAW. Case managers can use knowledge about ICUAW to improve the patient's transition throughout the hospital stay, improve discharge recommendations, and improve the patient's short-term and long-term outcomes. This may reduce unnecessary utilization of health care resources.

Implementation of an Obstructive Sleep Apnea Screening Program at an Overseas Military Hospital.

Anesthesia providers and surgeons do poorly at consistently identifying patients with obstructive sleep apnea (OSA) without use of screening tools. Aims of this evidence-based-practice project were to determine whether educating nurses about OSA and incorporating the STOP-BANG Questionnaire into preoperative forms was associated with an increased identification of patients with suspected OSA and an increased frequency of nurse-generated anesthesia consultation for OSA. A retrospective chart review of 100 consecutive records over a 1-month period using the STOP-BANG Questionnaire criteria was completed before and after implementation of the education and screening program at US Naval Hospital Okinawa, Japan. A STOP-BANG Questionnaire score of 3 or higher indicated high risk of OSA. Descriptive and inferential statistics were used to analyze results. Two hundred charts were reviewed. The prevalence of a STOP-BANG score of 3 or more increased from 5% to 21% after program implementation (P = .001). The frequency of anesthesia consultation for known or suspected OSA by our nursing staff increased from 5% to 26% after implementation (P = .0001). After this educational intervention with preoperative nurses and redesign of preoperative forms to incorporate the STOP-BANG Questionnaire, an increased proportion of patients at high risk of OSA were identified.

Qualitative Analysis of the Lived Experience of First-Time Nurse Responders in Disaster.

The study purpose was to examine the reflections of the lived experiences of nurses in shelters or temporary community medical clinics responding for the first time to a civilian disaster. The disaster-nursing literature echoes the need for development of disaster content in the nursing curriculum. However, little thematic analysis-supporting curriculum from the lived experience of first-time responders exists in the literature. This study's purpose is to identify the essential thematic knowledge and skills necessary to provide care to disaster survivors in communities and for determining the themes necessary to formulate education in emergency preparedness curricula. A narrative inquiry, with a phenomenological analysis, to explore the lived experiences of nurses who responded once to a community disaster was the methodology used to identify themes. Thematic findings demonstrated a lack of prior knowledge about volunteering during a disaster response, that previous mass casualty exercises did not help with their actual responses, and that the participant RNs identified specific and assessment skills necessary for disasters.

Employer Satisfaction With an Injured Employee's Health Care: How Does It Affect the Selection of an Occupational Health Care Provider?

PURPOSE/OBJECTIVES: The purpose of this article is to explore the most important factors that an employer utilizes in selecting an occupational health care provider for their employees injured on the job. PRIMARY PRACTICE SETTING(S): The primary practice setting is the attending physician's office who is an occupational health care provider. FINDINGS/CONCLUSIONS: The responding employers deemed "work restrictions given after each office visit" as their most important factor in selecting an occupational health care provider, with a score of 43. This was followed in order in the "very important" category by communication, appointment availability, employee return to work within nationally recognized guidelines, tied were medical provider professionalism and courtesy with diagnostics ordered timely, next was staff professionalism and courtesy, and tied with 20 responses in the "very important" category were wait time and accurate billing by the provider.The selection of an occupational health care provider in the realm of workers' compensation plays a monumental role in the life of a claim for the employer. Safe and timely return to work is in the best interest of the employer and their injured employee. For the employer, it can represent hard dollars saved in indemnity payments and insurance premiums when the employee can return to some form of work. For the injured employee, it can have a positive impact on their attitude of going back to work as they will feel they are a valued asset to their employer. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE: The case managers, who are the "eyes and ears" for the employer in the field of workers' compensation, have a valuable role in a successful outcome of dollars saved and appropriate care rendered for the employees' on the job injury. The employers in the study were looking for case managers who could ensure their employees received quality care but that this care is cost-effective. The case manager can be instrumental in assisting the employer in developing and monitoring a "stay-at-work" program, thereby reducing the financial exposure for the employer.

Hypnic Jerks: A Scoping Literature Review.

A scoping review is an approach to identify or map the extent of key concepts and main sources and types of evidence available on a topic. Hypnic jerks are considered a parasomnia categorized as a sleep-wake transition disorder. Although hypnic jerks are considered a benign sleep/movement disorder, some of the latest research indicates that they may be a clinical characteristic for other sleep disorders that affect health care outcomes. This article conducts a scoping review of the literature to determine the extent, range, and nature of the research activity related to hypnic jerks and identifies research gaps in the existing literature.

Psychiatric Case Management in the Emergency Department.

PURPOSE: The care of the mentally ill has reached a real crisis in the United States. There were more than 6.4 million visits to emergency departments (EDs) in 2010, or about 5% of total visits, involved patients whose primary diagnosis was a mental health condition or substance abuse (). That is up 28% from just 4 years earlier, according to the latest figures available from the Agency for Healthcare Research and Quality in Rockville, MD. Using a method called scoping, the purpose of this article is to examine the range, extent, and evidence available regarding case management as an intervention in the ED to manage mental health patients, to determine whether there is sufficient quantity and quality of evidence on this topic to conduct a meta-analysis, and to identify relevant studies that balance comprehensiveness with reasonable limitations. PRIMARY PRACTICE SETTINGS: One solution for ensuring that the costs are contained, efficiency is maintained, and quality outcomes are achieved is the placement of a case manager in the ED. According to , because the majority of hospital admissions come through the ED, it makes sense to have case managers located there to act as gatekeepers and ensure that patients who are admitted meet criteria and are placed in the proper bed with the proper status. FINDINGS/CONCLUSIONS: From the scoping techniques implemented in this study, the authors came to the conclusion that case management has been and can be used to effectively treat mental health patients in the emergency room. A good number of patients with psych mental health issues are frequent visitors and repeat visitors. Case management has not been used very often as a strategy for managing patients through the ED or for follow-up after the visit. Hospitals that have developed a protocol for managing these patients outside the main patient flow have had successful results. Staff training and development on psych mental health issues have been helpful in the ED. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE: While there are not a large number of studies available on this topic, there is sufficient evidence to warrant further examination of this research topic. The findings in this scoping study have broader implications for research, policy, and practice. The framework of this study involved an outcomes-based approach. Clinical outcomes that positively enhance patient care and save the hospital money are necessary in the current health care environment.

The Effect of Transcranial Direct Current Stimulation (tDCS) on Resilience, Compassion Fatigue, Stress and Empathy in Professional Nurses.

The purpose of the study is to determine the effect of Transcranial Direct Current Stimulation (tDCS) on measured levels of resilience and empathy in professional nurses with evidence of compassion fatigue and other stress related problems. Lowered levels of resilience, compassion fatigue and decreased empathy are significant predictors of burnout in nurses. Enhanced levels of resilience are associated with improved empathic responses and overall emotional well-being. Nurses who work in high stress environments often exhibit compassion fatigue and post-traumatic stress disorders that may reduce their ability to function effectively. Because tDCS has been used successfully in a number of chronic disease conditions, it would seem that there is potential for it to be useful in a broader context. The treatment with tDCS may be a potential strategy for improving resilience and eliminating chronic stress responses. A timed series counterbalanced research design was used for the study. Participants completed 18 sessions of tDCS over a six week period. They also completed a resilience, compassion fatigue, stress and empathy scale before and after each tDCS administration. A repeated measure analysis was used to determine if tDCS had an impact on scale scores. The analysis showed that tDCS amperage had significant positive effects on empathy. On the outcomes of resilience, compassion fatigue and stress, tDCS did not produce any significant changes. This research provides a new approach to compassion fatigue, an old problem with caregivers. Notably, when implemented with individuals experiencing problems that involve apathy or indifference, tDCS is a non-effortful intervention that offers a pathway that may improve symptoms and does not require extensive outlays of physical or mental energy.

Memory performance and affect: are there gender differences in community-residing older adults?

After age 65, the incidence of episodic memory decline in males is greater than in females. We explored the influence of anxiety and depression on objective and subjective memory performance in a diverse sample of community-residing older adults. The study was a secondary analysis of data on three samples of adults from two states, Ohio and Texas: a community sample (n = 177); a retirement community sample (n = 97); and the SeniorWISE Study (n = 265). The sample of 529 adults was 74% female, the average age was 76.58 years (range = 59-100 years), and educational attainment was 13.12 years (±3.68); 68% were Caucasian, and 17% had depressive symptoms. We found no memory performance differences by gender. Males and females were similarly classified into the four memory performance groups, with almost half of each gender in the poor memory category. Even though males had greater years of education, they used fewer compensatory memory strategies. The observed gender differences in memory were subjective evaluations, specifically metamemory. Age was not a significant predictor of cognition or memory performance, nor did males have greater memory impairment than females.

Alabama Veterans Rural Health Initiative: a pilot study of enhanced community outreach in rural areas.

PURPOSE: Access, enrollment, and engagement with primary and specialty health care services present significant challenges for rural populations worldwide. The Alabama Veterans Rural Health Initiative evaluated an innovative outreach intervention combining motivational interviewing, patient navigation, and health services education to promote utilization of the United States Veterans Administration Healthcare System (VA) by veterans who live in rural locations. METHODS: Community outreach workers completed the intervention and assessment, enrolling veterans from 31 counties in a southern state. A total 203 participants were randomized to either an enhanced enrollment and engagement outreach condition (EEE, n = 101) or an administrative outreach (AO, n = 102) condition. FINDINGS: EEE participants enrolled and attended VA appointments at higher rates and within fewer days than those who received AO. Eighty-seven percent of EEE veterans attended an appointment within 6 months, compared to 58% of AO veterans (P < .0001). The median time to first appointment was 12 days for the EEE group and 98 days for the AO group (P < .0001). Additionally, a race by outreach group interaction emerged: black and white individuals benefited equally from the EEE intervention; however, black individuals who received AO took significantly longer to attend appointments than their white counterparts. CONCLUSIONS: Results provide needed empirical support for a specific outreach intervention that speeds enrollment and engagement for rural individuals in VA services. Planned interventions to improve service utilization should ameliorate ambivalence about accessing health care in addition to addressing traditional systems or environmental-level barriers.

Chief nursing officers' perceptions of the Doctorate of Nursing Practice degree.

PROBLEM: Nurse executives practice in a business environment, which requires a skill set that has traditionally not been included in advanced nursing curriculum. The Doctorate of Nursing Practice (DNP) essentials are designed to address this gap in education while maintaining the focus on advanced nursing practice and executive management competency. Current literature supports the appropriateness of the DNP with practice focus areas of advanced practice specialties and nursing leadership. Although certification and educational bodies, and some professional nursing organizations, have embraced the DNP as the terminal degree for non-research-focused nurses, there remains a gap in the literature in regards to the perceptions of validity of the DNP for nurse executives. METHOD: The purpose of this capstone project was to investigate the perceptions of practicing chief nursing officers (CNOs) in the acute care setting regarding the application of the DNP degree for nurse leaders. Utilizing an online survey, specific perceptions investigated included application and appropriateness of the DNP in a business-based practice model and managing daily nursing operations. FINDINGS: CNOs practicing in the acute care setting differed on their responses regarding whether the DNP should be the recommended or the required degree in CNO development programs. CNOs with tenure responded more positively to the perception that the DNP curricula contains advanced nursing knowledge content appropriate to nurse executive practice. CONCLUSIONS: Practicing CNOs in the acute care setting do perceive the DNP as an appropriate degree option for nurse executive roles at aggregate, system, and organizational levels.

The clinical nurse leader: a comparative study of the American Association of Colleges of Nursing vision to role implementation.

The clinical nurse leader (CNL) is a new nursing role developed from a series of discussions held by the American Association of Colleges of Nursing (AACN) about revisions in nursing education that would prepare nurses with the competencies needed to work in the current and future health care system. The CNL is supposed to have a direct impact on clinical, functional, satisfaction, and cost outcomes. A number of health care organizations have adapted the role and integrated it into their unique clinical environment, but it remains unclear if the implementation is in line with the AACN's vision. This study investigated this question using the first cohort of graduates at a major university in the Southern United States. Of the 11 graduates, 8 responded to a questionnaire. Results support the idea that these new CNLs function largely in accord with the nine components of the CNL role outlined by the AACN. However, these results also show that different CNL role components are emphasized in different clinical settings. The results suggest that the CNL role as an advanced generalist role is a genuine innovation, rebutting some critiques. Implications and directions for future research are discussed.

Innovative partnerships: the clinical nurse leader role in diverse clinical settings.

The American Association of Colleges of Nursing in collaboration with leaders in the health care arena has developed a new role in nursing, the clinical nurse leader (CNL). The CNL is a master's-prepared advanced nurse generalist, accountable for providing high-quality, cost-effective care for a cohort of patients in a specific microsystem. Although initial implementation of the CNL has been predominantly in urban acute care settings, the skill set of the CNL role is equally applicable to diverse clinical settings, such as smaller rural hospitals, home-based home care providers, long-term care facilities, schools, Veteran's Administration facilities, and public health settings. This article reports the strategies used and the progress made at The University of Alabama Capstone College of Nursing in the development of innovative partnerships to develop the role of the CNL in diverse clinical settings. With academia and practice working in partnership, the goal of transforming health care and improving patient outcomes can be achieved.

The "wins" of change: evaluating the impact of predicted changes on case management practice.

PURPOSE/OBJECTIVES: A variety of strategies were employed to identify current and future trends that would impact the practice of case management. Historical review, consultation with case management experts, literature review, and environmental scanning by practicing case managers were strategies employed to determine the impact of current and future trends on case management. PRIMARY PRACTICE SETTING(S): The trends identified in this article have implications for case managers in a variety of settings. Case managers participating in the environmental scanning process to evaluate the impact of the identified trends on their organization included representation from acute care, home care, behavioral health, workers' compensation, and private insurance settings. FINDINGS/CONCLUSIONS: The top 7 trends identified by experts in the field of case management included pay for performance, recovery audit contractors, Medicare demonstration projects, transitions of care, informatics in healthcare and case management, metrics for case management, and the impact of an aging population in case management. Practicing case managers were asked to react to these trends in terms of likelihood of occurrence in their organization and impact of these trends on their case management practice. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE: Case management will ultimately have a higher degree of accountability for its practice if metrics to evaluate and reimbursement for case management become a reality. A multitude of performance measures exist that will be monitored and be tied to reimbursement. To ensure that agencies are accomplishing these performance measures, case management will potentially have a growing importance. Case managers perceive that these trends have a predominantly positive impact on case management.

Designing a system of case management for a rural nursing clinic for elderly patients with depression.

This article provides an overview of the process and procedures used to develop and implement a system of case management for middle-aged and older depressed adults in a rural health nursing clinic. This system included on-site case management for elderly clients and telephonic follow-up by case managers on an ongoing basis.

Case management evolution: from basic to advanced practice role.

This article provides an overview of nursing case management as an advanced practice role from a theoretical and practice basis. Not all case managers will, or need to, perform case management duties at the advanced level. However, it has become abundantly clear over the past several years that nurse case managers are performing more complex duties that appear to match the competencies of other advanced practice roles. In this article, the authors will explore the issue in depth and demonstrate the differences between basic and advanced practice nursing case management on the basis of clinical practice, educational level, and research responsibilities for both the basic and advanced levels of case management practice; advanced practice competencies; and examples of advanced practice case management from current practice. Just as there are differences between basic and advanced professional and clinical nursing practice, there is a difference between basic and advanced levels of case management practice.

Case management process improvement protocol: transcribing an initial summary for the oncology geriatric patient in a rural satellite office.

This case management improvement project involved the provision of a transcribed summary of an initial clinic visit for elderly oncology patients at a rural satellite clinic. The aim of this project was to provide elderly patients at a rural satellite oncology clinic with a transcription of their encounter with the doctor and case manager when their diagnosis and treatment options were discussed. This project was introduced to improve communication and enhance satisfaction of the patients with their case management services. This low-cost intervention was implemented with 25 patients. Results demonstrated that the patient did express a high degree of satisfaction with this intervention.

Development of a military competency checklist for case management.

This presentation will discuss the design, implementation, and evaluation of a competency-based checklist in military nursing network. The checklist was initiated to help assess case manager competency where background and preparation for the case manager role were quite diverse. The checklist assisted initially with the assessment of learning needs; later, it served as a self-assessment for case managers to determine their areas for improvement. Finally, the assessment was used not only to verify competency by the case management supervisor, but also to establish systemwide quality in case management.