Combs J A, Rusch S C
Carondelet St. Mary's Health Center, Tuscon, AZ.
Health Prog. 1990 May;71(4):38-41.
To regain some of the principles of personalized care that were part of the foundation of nursing, Carondelet St. Mary's Health Center in Tucson, AZ, instituted a nurse case manager program in 1985. The program assigns a nurse case manager to coordinate patient and family care from an array of nursing services. Its special characteristic is a focus on home care after discharge. The basis for the program is a belief in holistic care, beginning during the hospital stay and continuing after discharge. Because the psychosocial and spiritual impact of the illness might not be felt until the client returns home, the nurse case manager concentrates on preventing or alleviating distress through a program of care, education, and service. In 1988 the center was asked to apply its program to a high-risk adolescent obstetrical group enrolled in a local health maintenance organization. The challenges for the nurses included poor nutritional status, substance abuse, unemployment, low self-esteem, and other factors precipitated by the group's socioeconomic status. By direct intervention the nurses were able to set patterns for positive adult behavior, and by the end of the program most of the clients had made considerable changes toward more successful life-styles.
为了重拾作为护理基础一部分的个性化护理原则，亚利桑那州图森市的卡伦德莱特圣玛丽医疗中心于1985年设立了护士个案管理项目。该项目安排一名护士个案管理员，从一系列护理服务中协调患者及家庭护理。其特殊之处在于注重出院后的家庭护理。该项目的基础是相信整体护理，始于住院期间并持续至出院后。由于疾病的心理社会和精神影响可能直到患者回家后才会显现，护士个案管理员通过护理、教育和服务项目专注于预防或减轻痛苦。1988年，该中心被要求将其项目应用于当地健康维护组织中一个高危青少年产科群体。护士们面临的挑战包括营养状况差、药物滥用、失业、自卑以及该群体社会经济地位引发的其他因素。通过直接干预，护士们能够为积极的成人行为树立榜样，到项目结束时，大多数客户在更成功的生活方式方面有了很大改变。
