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Community-based healthcare delivery has recently become the most popular approach among American medical institutions because it is crucial for the prevention of diseases, improvement of sanitary conditions, and successful recovery. It is usually mentioned with regard to low-income people who cannot afford insurance. Nurses are supposed to play an important role in this process because they can act as case managers who assess patients needs, plan and implement the treatment, make regular reviews of the patients health (Cohen & Cesta, 2005). However, the implementation of this model is slowed down by many obstacles. The most difficult one is the lack of facilities, personnel and funding. This is a widespread situation in community hospitals. Medical workers cannot cover all out-patients due to time and resource limitations. Many institutions are so understaffed, that they can hardly address the needs of their resident patients and they frequently employ student nurses. One of the key problems is that there is an acute shortage of highly qualified nurses, who would be able to alleviate the burden of case managers (Winsome & Keheler, 2006). Overall, this problem cannot be effectively solved without close cooperation of medical institutions and the government. I work in Plastic and Reconstructive Surgery Center and these problems are not so pressing. However, even this institution cannot fully integrate community-based approach.
It seems that the underlying causes of some problems are connected with the education of nurses. First, to become a case manager a nurse has to pass several exams and obtain a certificate (Bluhm, 27). Many of them are not able to do it due to lack of time or desire. It should be pointed out that a case manager performs several functions: he/she assesses patients condition, plans care, provides patient education, arranges follow-up visit etc., and nurses are not always sufficiently qualified for this task (Cohen & Cesta 2005). One of the best ways to overcome this obstacle is to make several changes in nurse training. They have to be prepared for the role of a case manager, who acts as a physician, administrator, or even a psychologist (Powell, 2000). It has to be admitted that the government has already taken several steps in an attempt to improve nursing education. In particular, in 2009, Obama administration increased funding of educational institutions, which train nurses, at fifty percent (The Center to Champion Nursing in America, 2009). Nevertheless, policy was adopted only a year ago, and significant improvements can be expected only in the near future. Besides, educators must develop new strategies for the training of nurses, namely they should pay more attention to the functions and responsibilities of a case manager.
In addition to that, we need to speak about the lack of motivation. Case managers are frequently overworked and underpaid and this is why some nurses are reluctant to take their duties and responsibilities. Therefore, it is necessary to provide a stimulus to them, for example, increased salary. In 2009, the government provided more than $ 1 billion to support nursing, it is also necessary to make sure that this money will be distributed in an appropriate way. Nurses must see that the government is genuinely concerned about their financial needs. Without adequate payment and good work conditions, they will not contribute to the effective healthcare delivery, and people will not receive all the benefits of community-based medicine and case management.
Therefore, we can argue that the key challenges to integrating case management approach are as follows: insufficient financial resources and lack of appropriate training. Nonetheless, one should not presume that these challenges could not be overcome. There are several strategies for coping with these problems, one of them is a reform in the education and training of nurses, they need to acquire proper skills to act in the capacity of a case manager. Furthermore, medical institutions should provide a good compensation to nurses, who act as case managers to motivate them; otherwise, this model will never be fully integrated. Finally, these barriers to the integration of case management cannot be broken without close cooperation of medical institutions, government and educators.
Reference List
Bluhm W, Group Insurance: Fourth Edition, Actex Publications, Inc., 2003
Cohen. E.L. & Cesta T.G. (2005). Nursing case management: from essentials to advanced practice applications. NY: Elsevier Health Sciences.
Powell S.K. (2000). Case management: a practical guide to success in managed care. New Jersey: Lippincott Williams & Wilkins.
The Center to Champion Nursing in America. President Obamas 2010 Budget Includes Major Increase for Nursing Education . 2009. Web.
Winsome J. & Keleher. H. (2006) Community Nursing Practice: Theory, Skills and Issues. NY: Allen & Unwin.
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