Abstract
BackgroundThe 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.MethodsA 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.ResultsThe 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.ConclusionsCare 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.
Highlights
The number of people with complex nursing and care needs living in their own homes is increasing
People are increasingly living with complex care needs, characterized by multimorbidity, polypharmacy, issues with mental health and chronic illnesses, and social challenges [1, 2]
Population aging poses a significant challenge to healthcare systems as it relates to increased prevalence of multiple chronic illnesses and questions of long-term care [3, 4]
Summary
The number of people with complex nursing and care needs living in their own homes is increasing. The healthcare systems in Europe are currently highly fragmented and mostly focused on single diseases [5] This type of care often does not meet the needs of those affected, as multiple diseases and complex socio-legal and socioinstitutional problem situations require patient-centered holistic care [5]. The problems addressed by our study are threefold and elaborated on in the coming paragraphs: a) limited research exists on the interdisciplinary care needs of people living and receiving nursing care in their own homes, b) limited research exists on the increasingly complex realities faced by nurses and the additional skills necessary to work in mobile nursing, and c) to evaluate the need for and potentials of a complex intervention ( Case Management). Schmidt and Kraehmer [8] propose the implementation of a monitoring system for a network of regional providers as a means to provide needs-based coordination of care and to strengthen the support mechanisms for those with care needs living in their own homes
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