Nurse case managers influence the disease process through the sharing of their knowledge, providing community based resources, and the relationships that are formed with the patient (Cohen & Cesta, 2005). The purpose of this paper is to describe how the nurse and healthcare organizations can provide supportive and preventative patient care to educate the patient with diabetes mellitus. Diabetes mellitus is a chronic illness that affects over 25 million American children and adults (American Diabetes Association [ADA], 2011).
There are many complications that accompany this disease such as, heart disease, stroke, hypertension, kidney failure, hearing loss, blindness, neuropathy, skin conditions, and amputation (ADA, 2011). Diabetes is a chronic illness that has a substantial impact on the cost of healthcare. It is estimated that in 2007, 174 billion dollars was spent on patients with the diagnosis of diabetes (ADA, 2011). Two out of three individuals with diabetes will die from heart disease or a stroke (ADA, 2011).
The path that diabetes takes is different in each individual but the education and preventative measures for the disease should be available to all patients in order to prevent the progression and debilitation that it can cause. Nurse case- managers help the chronically ill patient to move along the healthcare system and in the process provide education, quality healthcare, and cost effective healthcare management (Cohen & Cesta, 2005).
Changes Needed from Supportive Care to Preventative Care and Education Diabetes care has shifted from the hospital setting to the outpatient clinic setting, with the primary care physician leading the plan of care (Greisiner et al. , 2004). This setting often includes the registered nurse, the dietitian, the pharmacist, or a certified diabetes educator (Greisiner et al. , 2004). Preventative healthcare should be initiated with the patient’s encounter with the primary care physician and support staff.
The primary care physician and the nurse have the opportunity to educate, encourage, and perform preventative health screening tests on a regular basis. The Healthcare Effectiveness Data and Information Set (HEDIS) measures are used to improve patient outcomes, lower healthcare costs, and provide education to the consumers of healthcare plans (National Committee for Quality Assurance [NCQA], 2011).
Comprehensive diabetes care is a preventative measure that includes hemoglobin A1C monitoring twice a year, an annual lipid panel, urine screening for micro-albumin, podiatry care, an eye exam, and blood pressure monitoring (NCQA, 2011). Many patients are given the diagnosis of diabetes but need guidance and education as to what encompasses the disease process. The nurse case manager has the opportunity to assess the patient’s knowledge on the disease process and also the life style behaviors that affect the progression and path of the disease.
The nurse can then set up the educational format to meet the patient and care giver needs (Boehler, Hardesty, Gonzales, & Kasnetz, 2009). Patient education should focus on medication knowledge and compliance, dietary modifications, interventions that can be done at home when signs and symptoms of hypo and hyperglycemia are present, the importance of skin monitoring, specifically the feet, why the annual eye exam is recommended, the purpose of testing the urine for micro-albumin, and the annual lipid panel (NCQA, 2011).
The nurse case manager can educate the patient on blood pressure management and the importance of not only compliance with diabetes medication, but also with anti-hypertensive medication. Blood pressure control in the diabetic patient is important for decreasing the risk of developing other risk factors such as heart disease and stroke. Providing education on each component of diabetic preventative care is an effective way to treat the patient and keeps the patient involved in the plan of care (Greisinger et al. , 2004).
The Benefits to Supportive Care The HEDIS measures are a great starting point for nurses to educate, plan, and develop relationships with patients and families to promote health maintenance and supportive nursing care. The nurse case manager coordinates the plan of care to ensure education, support, the opportunity for community resources, and works to increase outcomes in a resourceful and cost effective manner (Cohen & Cesta, 2005).
The benefits to care management in the diabetic patient include better glycemic control, goals to achieve a healthy weight status, a decrease in hospital utilization, a decrease in associated illnesses, an increase in diabetic education attendance, and a better understanding of the disease process (Greisinger et al. , 2004). Providing continuity in the care of the diabetic patient with nurse care management provides the patient with a contact to confide in and a resource in the path to managing their disease. The Case Management Theories, Concepts and Strategies.
An interdisciplinary system of case management is essential when coordinating the care for a patient with diabetes. Managing the care of a diabetic patient requires the skill and knowledge of various disciplines. The interdisciplinary team can work together to maximize resources that are available to the patient and family (Cohen & Cesta, 2005). The clinicians can coordinate their efforts to build a plan of care that unites all necessary resources to support the patient and their journey through the healthcare system (Cohen & Cesta, 2005).
The Sierra Health Services plan is a care management program that began with the philosophy of encouraging the healthcare providers, the patients, and the insurers to work together to achieve positive patient outcomes (Hillegass, Smith, & Phillips, 2002). The philosophy also included that care management is imperative to provide quality healthcare in a cost efficient manner (Hillegass et al. , 2002). The goal of the Sierra Health Services plan consisted of providing continuity of care in a safe and cost effective manner in order to move the patient through the healthcare continuum (Hillegass et al., 2002).
This organization was successful in building a care management system for the population with a chronic illness. The organization looked at the population with a chronic illness in regards to their medical needs, their socio-economic status, their functional status, and how they viewed their disease process (Hillegass et al. , 2002). This was needed to determine the type of care management program that was needed with in their organization. The Sierra Health System refined the program and began to assess the chronically ill for home care services.
This process included screening the patient for knowledge of their disease, medication knowledge and compliance, physical signs and symptoms of the disease, nutritional status, social support, home safety, functional mobility, and if community resources were involved (Hillegass et al. , 2002). This healthcare system allowed nurses to manage patient care in a collaborative effort that promoted patient independence and compliance with health care prevention as a leading step in providing quality cost effective care.
Knowledge and Insights to Provide Diabetic Prevention and Education Providing community care management for the patient with diabetes requires the efforts of many disciplines within the healthcare community. The nurse case manager can provide education and resources but it is a community effort to streamline services for a chronically ill patient with diabetes. The most helpful intervention for the diabetic patient is the establishment of the therapeutic relationship with the nurse case manager.
This relationship can serve as the access point in and out of the healthcare environment with the opportunity for the patient to receive education, community services, psychosocial support, nutritional education, and routine medical care. An important aspect of diabetic case management is the ability to engage the patient in their plan of care to promote compliance, improve health status outcomes, and decrease healthcare costs (Cohen & Cesta, 2004). Summary Nurse case managers are crucial members of the healthcare team in the assessment, planning, and implementation of a patient education and a preventative health maintenance program.
Nurse case managers serve as the gate keepers in the process of teaching, seeking out available resources, and coordinating the interdisciplinary approach to community case management. The patient with diabetes requires multiple community resources to maintain their optimal level of well- being, to decrease the risk of disease related complications and to decrease the incidence of hospitalization. The goals set forth for the diabetic patient and a healthcare organization are to improve quality of life with cost saving processes (MacKinnon-Schifalacqua, O’Hearn, & Schmidt, 2004).