Long-term disease management needs of southern African Americans with diabetes.

PURPOSE: This qualitative study explored the issues, concerns, and needs of low-income, southern African Americans in managing type 2 diabetes over time. METHODS: Two focus groups (N = 22) were conducted with the target population to collect data. Group sessions were audiotaped and transcribed verbatim. Content analysis was used to analyze the data. RESULTS: The data revealed an overall theme of learning to live with diabetes, which consisted of 3 processes: (1) symptom management, (2) making healthy choice, and (3) emotional adjustment. This article focuses on the processes of symptom management and making healthy choices. Findings suggest that the sequential processes of symptom management and making healthy choices occurred over time primarily through experiential learning in this population and were influenced by social support, caring and collaborative provider-client relationships, and access to resources and culturally sensitive supportive services. CONCLUSIONS: Experiential educational methods that incorporate social support and access to resources may be more appropriate than the traditional didactic method of teaching diabetes self-care.

Nurse case managers in rural hospitals.

Many rural hospitals are struggling to survive the capitated care environment by implementing nursing case management. However, little is known about what rural nurse case managers (NCMs) do to achieve outcomes or what their qualifications should be. This national survey of NCMs (N = 302) in rural hospitals suggests that individual advocacy, teaching, and clinical practice play key roles in the practice of rural NCMs and that the education and experience of NCMs does affect their practice.

Developing and testing a case manager impact profile.

The purpose of this study was to develop and test an instrument to measure the activities and perceived outcomes of rural nurse case managers in hospital settings. The Nurse Case Manager Impact Profile (NCMIP) is a 69-item, Likert-type questionnaire organized into two scales, the Activity Scale and the Outcome Scale. Content validity of the NCMIP was endorsed by four experts in nursing case management and rural nursing. Its validity and reliability were assessed in a survey of nurse case managers (N = 302) in nonfederal, rural, U.S. hospitals. Internal consistency was high for the five Activity subscales and for the Activity and Outcome scale: Individual Advocacy (alpha = .85), Clinical Practice (alpha = .85), Teaching (alpha = .89), Research (alpha = .86), System Advocacy (alpha = .85), Activity (alpha = .93), and Outcome (alpha = .92). Factor analysis with orthogonal varimax rotation resulted in clear confirmation of a five-dimensional Activity scale and of two of the five subscales. Factor solutions, however, suggested a reconceptualization of three subscales into three new factors with unifying themes. Although factor solutions confirmed two of the four dimensions of the Outcome Scale, items for the remaining two dimensions reconfigured to suggest overlapping domains. Psychometric testing suggests that the NCMIP warrants further development and testing and, like any new instrument, should be used with discretion and caution.

A nursing case management model for rural hospitals.

Providing health care to vulnerable rural populations presents many challenges and limitations that urban models may not address. The model of nursing case management presented here focuses on improving quality, reducing costs, and increasing access for people in rural areas through a professional case management role. The manager's role includes individual advocacy, clinical practice, education, research, and system advocacy. Empowerment of nurse case managers influences achievement of goals and job satisfaction and is based on a new view of power. The model is applicable to hospital, home, and community settings.

A case study of nursing case management in a rural hospital.

This article describes the process of implementing a New England model of case management in a rural hospital and the modifications necessary in adapting an urban model to a rural setting. Nursing case management at this institution has been associated with a decrease in the length of stay by 1.7 days at an estimated cost savings of $65,932 for the 16-month study period. Case management has also been instrumental in improving quality of care through a program of continuous quality improvement and in redesigning the RN role. The vision for the future is to extend the nurse case manager role outside the hospital walls to the community in a collaborative plan that would bill nursing services through physicians' offices.

In search of a nursing case management model for rural hospitals.

Research has provided increasing evidence that nursing case management is a cost-effective way to maximize health outcomes for high-risk, high-cost, high-volume patients (Ely, Walker, & Berger, 1993: Etheridge & Lamb, 1989; Krieger, Connell, & LoGerfo, 1992; Green, Lovely, Miller, & Ondrich, 1989; Schull, Tosch, & Wood, 1992; Zander, 1988). However, models of nursing case management developed in urban settings and tested primarily on urban populations do not address the needs of rural people and areas. This article proposes a definition of nursing case management for rural hospitals that is grounded in the reality of rural practice and offers a meaningful approach to the provision of care to underserved populations, cost containment, and recruitment and retention of registered nurses.