Apprehension can be a great barrier to case management in nursing and this concern has to be addressed so that the autonomy of nursing practice and patient service is taken care of while the rule of law is observed. Several individual factors form a barrier and hence impede dedication and interest to begin treatment. There is often anticipation of not being able to comply with all the rules or manage complicated conditions that would result into apprehension when this commitment is made. Some personal characteristics can adversely affect case management and become serious barriers to treatment like the feeling that is related to past encounters and failure of treatment, guilty conscience and shame concerning some duties that did not work, fear of losing certificate of practice, feeling of helplessness or fear to change and uncertainty.
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Healthcare providers have often suffered serious problems and faced major obstacles when carrying out their duties. This often happens when dealing with unique patients like children drug abusers, the older people, and pregnant women among others (Harrison, Nolin & Suero, 2004, p. 64). A Case that is related to such patients requires greater understanding healthcare practice, competencies and quality skills from practitioners who are compassionate, professional and are committed, show reciprocity and professionalism and have superior ability to communicate (Cohen, & Cesta, 2005, p. 35). Nurses who witness these patients suffering serious pain or financial constraints could also suffer similar compassion and pain. Without adequate care programs for individual patients, nurses could be lacking the qualities, skill and knowledge or the relevant training the meets such challenges of such specialized care, quality of nursing is at stake (Cohen, & Cesta, 2005, p. 35). This way, the healthcare providers could suffer emotional instability like anger, anxiety, panic and helplessness. This can easily translate to nurse burnout or even serious turn over.
Nurses may face several crime charges when they commit nursing mistakes. Criminal negligence is a bigger offense than just mire carelessness. This recklessness can be a crime when nurses disregard their duties (Collier & Harrington, 2004, p. 671). Criminal neglect is omission of duty or an act that fails to offer adequate care to patients.
Accountability is a major factor in healthcare and often strikes fear to the practitioners. This is simply because it directly translates to mean who is to bear consequences, like who is to take that punishment. It’s however very critical that practitioners, especially the managers understand that accountability is not the same thing as blame (Collier & Harrington, 2004, p. 671). When people work in an environment that is characterized by blame games, they are likely to naturally start working in defensive circles, covering up critical mistakes and hiding the serious issues that require discussion. This is not appropriate of the goal of healthcare is to offer quality services to the people. Denying responsibility and finger pointing should be addressed by the management as a serious mistake as it can destroy trust.
Management must understand that mistakes can happen at anytime and aspects like fear for apprehension of punishment can affect accountability which in turn can compromise quality of service delivery. Flow of information should be established according to hierarchy of power, offer feedback and the strategies to offer solutions defined. Best practice calls for mutual understanding between caregivers and patients (Parish, 2005. P. 10). However, this needs a significant paradigm shift when it’s evident that current systems are deeply rooted in command-control model of leadership styles.
Cohen, E., & Cesta, T. (2005). Nursing Case Management: From Essentials to Advanced Practice Applications, 4th Ed. St Louis, MO: Elsevier Mosby.
Collier, E., & Harrington, C. (2004). Discharge Planning, Nursing Home Selection and the Internet. The Gerontologist, 44 (1), 671.
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Harrison, J., Nolin, J., & Suero, E. (2004). The Effect of Case Management on U.S. Hospitals. Nursing Economics, 22 (2), 64.
Parish, C. (2005). Case Management Cuts Hospital Admissions to Virtually Zero. Nursing Standard, 20 (3), 10.