Gessl Alessandra Schirin, Flörl Angela, Schulc Eva
LMU Munich School of Management, Ludwig-Maximilians-Universität (LMU) München, Geschwister-Scholl-Platz 1, 80539, Munich, Germany.
Division of Integrated Care, Institute of Nursing Science, Department of Nursing Science & Gerontology, UMIT - Private University for Health Sciences, Medical Informatics and Technology, Hall in Tyrol, Austria.
BMC Nurs. 2022 Jan 4;21(1):5. doi: 10.1186/s12912-021-00775-0.
The number of people with complex nursing and care needs living in their own homes is increasing. The implementation of Case and Care Management has shown to have a positive effect on unmet care needs. Research on and implementation of Case and Care Management in the community setting in Austria is limited. This study aimed to understand the changes and challenges of changing care needs by mobile nurses and to evaluate the need for Case Management in mobile care organizations by investigating the evolution of mobile care nurses'task profiles and the challenges in working in a dynamic field with changing target groups and complexifying care needs.
A qualitative study with reductive-interpretative data analysis consisting of semi-structured focus groups was conducted. Community care nurses, head nurses, and managers of community mobile care units as well as discharge managers of a community hospital (n = 24) participated in nine qualitative, semi-structured focus groups. The recorded focus groups were transcribed and analyzed using qualitative content analysis.
The analysis revealed three main categories: the complexity of the case, innerinstitutional frameworks, and interinstitutional collaboration, which influence the perception of need for further development in the direction of Case and Care Management. Feelings of overwhelmedness among nurses were predominantly tied to cases that presented with issues beyond healthcare such as legal, financial, or social that necessitated communication and collaboration across multiple care providers.
Care institutions need to adapt to changing and increasingly complex care needs that necessitate cooperation between organizations within and across the health and social sectors. A key facilitator for care coordination and the adequate service provision for complex care needs are multidisciplinary institutional networks, which often remain informal, leaving nurses in the role of petitioner without equal footing. Embedding Case and Care Management in the community has the potential to fill this gap and facilitate flexible, timely, and coordinated care across multiple care providers.
居家生活且有复杂护理需求的人数正在增加。案例与护理管理的实施已显示出对未满足的护理需求有积极影响。奥地利社区环境中案例与护理管理的研究及实施较为有限。本研究旨在通过调查移动护理护士任务概况的演变以及在目标群体不断变化且护理需求日益复杂的动态领域工作的挑战，了解移动护士对不断变化的护理需求的认识变化和挑战，并评估移动护理机构中案例管理的必要性。
进行了一项采用简化解释性数据分析的定性研究，包括半结构化焦点小组。社区护理护士、护士长、社区移动护理单元经理以及一家社区医院的出院经理（n = 24）参加了9个定性、半结构化焦点小组。对记录的焦点小组进行转录，并使用定性内容分析法进行分析。
分析揭示了三个主要类别：案例的复杂性、机构内部框架和机构间协作，这些因素影响了在案例与护理管理方向上进一步发展的需求认知。护士的不堪重负感主要与那些呈现出医疗保健之外问题（如法律、财务或社会问题）的案例相关，这些问题需要多个护理提供者之间进行沟通与协作。
护理机构需要适应不断变化且日益复杂的护理需求，这需要卫生和社会部门内部及跨部门组织之间的合作。护理协调和为复杂护理需求提供适当服务的关键促进因素是多学科机构网络，而这些网络往往是非正式的，使得护士处于请愿者的角色且没有平等地位。将案例与护理管理嵌入社区有可能填补这一空白，并促进多个护理提供者之间灵活、及时和协调的护理。
