Questions on the Assignment 


Questionson the Assignment&nbsp


Describetwo practice settings for RN Case Management. Discuss the goals forcase management in that setting, and the key functions of the RN CaseManager in each of those settings.

RegisteredNurse plays essential role in case management for continuum care. RNcase management deals with various care aspects such as ambulatorycare, home care, long-term care, skilled nursing care, hospice, acuterehabilitation and sub-Acute care. In acute care practice, the goalof RN case managers is to optimize the care outcomes of patients toavert adverse consequences. The key function of RN in acute care isdischarging plans, managing outcomes, bedside and hands on care.

Otherfunctions of RN in acute care involve documentation and variancecollection and analysis. In long-term care practice, the goal of RNcase managers is to enhance the stabilization, service planning andimplementing healthcare to patients with long-term sufferings. RNfunctions in long-term care involve variance collection and analysis,bedside care, outcome management, service planning andimplementation.

Identifythe most important competencies and /skills for case management. Whyare these so important to successful role performance? How is thisskill important to staff nurses?

Casemanagers need to posses important competences and skills in order toserve effectively in their complex and challenging roles. In thiscase, case managers need to be creative, be change agency, illustratechange hardiness and risk competency. A case manager should befriendly, open and likes other people. In addition, case managersshould portray higher degree of tolerant, advocacy, embrace change,curios, clinically competent and self-directed.

However,the core competencies of RN are good interpersonal skills, goodknowledge of healthcare management, good understanding of law andregulations. Others include reliability in service delivery andcommunity resource mobilization. These skills are important inensuring competency in service delivery. Interpersonal skills help infacilitating good communication, relationship building, crisismanagement, tolerance to ambiguity and change. These skills areimportant in ensuring consistency, optimizing patient care, effectiveresource use and assessment.

Whatis the impact and magnitude of the health care needs of individualwith multiple chronic conditions on the health care system and oureconomy?

Individualswith multiple chronic conditions and elderly people require anextensive healthcare approach that adequately covers all aspects oftheir health needs. Specialized care is needed for these individualswith chronic illness. Chronic patients may be bedridden for severalyears’ thereby requirement constant day to day care. In particular,continuum care is required for individuals with chronic conditions.As such, individuals suffering from chronic conditions requirefinancial support to cover for basic needs, hospital bills and homecare.

Medicarecover has been effective in assisting individuals with chronicconditions. However, the Medicare program is insufficient and doesnot adequately cover long-term care, dental and mental health of apatient. However, with advanced healthcare policies, provision ofadequate care will depend on effective cooperation between caregivers and healthcare providers. The number of patients with chronicconditions continues to rise amid expensive Medicare program. Assuch, there is need for an improved and reduced cost health caresystem to address the needs of the chronic patients.

Whatdo the articles identify as the most critical changes that need to bemade in the management of multiple chronic conditions and trends forthe future? Why?

Themain argument in the articles is that, patients with chronicconditions are increasing while Medicare program expense continues tobecome expensive. The U.S News Heath article advocate for improvedhealthcare coordination from homes and hospitals in order to improvehealthcare. In particular, the articles express optimism that unlikein the past, health needs for people with chronic conditions willimprove. The argument posted is that, with increased development inhealth technology, improved health policies and governmentresponsiveness, chronic patients will have more specialized andaffordable care.

Thearticles identify data, financial resources and integrated care asthe main important aspects that need change in future. The articlesfurther adds that, with increased several cases of chronicconditions there is need for more integrated healthcare thatencompasses patient-centered care, cheap medical cover and effectivehealthcare coordination.

Knowingmore about the health care system, history and challenges in theUnited States (as you now do) what barriers exist to implementing thestrategies outlined in the articles?

Thereare several barriers that have inhibited the implementation ofeffective healthcare policies. In particular, bad politics are toblame for derailing implementation of effective healthcare policiessuch as the Affordablecare Act.Inadequate cooperation between health providers and the governmentleads to derailment in the implementation of health policies. Otherbarriers include limited resources that cover all individuals and lowadoption of technology in healthcares.

Whatstrategies can you implement as an RN and how? What condition/swould be your priority? How would you coordinate these across thecontinuum?

Inorder to enhance continuity of healthcare, I would improve myknowledge on all aspects of healthcare demands. This means possessingadditional skills in such areas as case management and resourcemanagement. In particular, I would implement plans for the continuityof care, enhance collaboration among healthcare givers and ensureadequate resource utilization. In order to coordinate theseconditions across the healthcare continuum, I would serve as an agentof change and enhance a collaborative spirit among all healthcarestakeholders.

Whatis the role of palliative care and hospice in chronic conditionscare?

Palliativecare is provided when a team of doctors collaborate in providingextra support to patients suffering from serious illness. Palliativecare is focused on providing patients with specialized treatment fromvarious care givers such as therapists, dieticians, pharmacists andsocial workers. In a chronic condition, the goal of palliative careis to offer relieve of symptoms, offer medical, spiritual andemotional support while offering concerted care to the patient.

Whatis the care implication for hospital care during the first admission?

Patientfirst hospital visit marks the beginning of healthcare depending onthe nature of illness. In the wake of increased hospitalreadmissions, the government has been concerned with high readmissionrates. The first admission to hospital is supposed to assess anddetermine the patient future care requirement. In this firstadmission, adequate care should be given to the patient and futureneeds for care assessed. This helps in home based or mobile casemanagement rather than readmission.

Therole of nursing and nurse case managers in preventing readmission andcoordinating care along the continuum?

Nursesplay an integral role in preventing hospital readmission and ensuringcontinuum care. In particular, nurses helps in educating patients onimportant health matters and facilitate in transition planning.Nurses advocate, communicate and provide clear knowledge on importanthealth practices required by patients to enhance their recovery. Aspart of continuum care, nurses provide ambulatory care, home care,skilled nursing care and long-term care.

Exampleof quality standards that gurantee Medicare payments to hospitals

Oneof the most important quality standards that are required forhospitals to receive Medicare payment is quality care andperformance. Healthcare providers are assessed based on the level ofsatisfaction that patients derive from the hospitals.

Whatis the role of RN case manager and staffs in meeting qualitystandards?

Registerednurses and managers play an integral role in providing continuum carethereby enhancing patient quality of life. Hospitals with qualityhealthcare meet the desired quality standards. Another role of RN isfacilitating effective use of patient care resources and costcontainment. Optimal utilization of available resources and reducingoperation costs is another component of quality standard inhospitals.

Howare checklists used in achieving quality outcomes?

Checklistsare used in achieving quality outcome in assessing patient’ssatisfaction with healthcare treatment. In particular, checklistsrecords and evaluates service delivery to patients in areas such asICU mortality, hospital mortality, ICU length of stay and the generalsustainability of quality health programs.

Patientsatisfaction measures

Inhospitals patient satisfaction is assessed on the basis of reducedpatient readmission, patients’ feedback on positive experience andeffective treatments. Patients are satisfied when good quality careis given, there is reduced mortality rate, and good home based careservices and effective communication.

Whatis the role of nursing in achieving these?

Nursesplay an essential role in facilitating patient satisfaction. Inparticular, nurses provide after care services such as educationpatients on important matters that concerns health, advocacy,empowering patients and providing empathy to the sick. In addition,nurses’ help in conflict resolution, problem solving and assistingpatients adapt to life after treatment. These aspects help inachieving patient satisfaction.

Whatis Utilization or Resource Management?

Resourceutilization management refers to the aspect of gathering statistic onhow resources are used in order to assess the best practice ofresource usage. In the health sector, Utilization management refersto the appropriate and efficiency use of healthcare services thatenhance health care.

Whydo hospitals or other care settings utilize RNs in a Utilization orResource Management role?

Hospitalsutilize RN in their resource management because RN possesses relevantskills in resource use, cost containment and resource mobilization.In particular, RN determines appropriate care for patients, evaluatescare plans, helps in documentation and identifies patients’ needs.In these aspects, the goal of RN is to assess the most efficient wayof providing quality health care to patients at minimum cost andoptimal resource use.

Decisionsupport tools utilized by Utilization Management or ResourceManagement RN’s

RegisteredNurses utilize numerous tools to support them in decision making. Inparticular, RN uses various aspects of patient assessment todetermine how resources are to be used in provision of healthservices. RN conducts physiologic, psychological, spiritual, social,resources and cultural assessment of patients before care plan isdeveloped. In addition, RN communicate, plan and share informationacross as part of ensuring efficiency in resources use.