Abstract
Professional nurses’ experiences are affected by a lack of facilities and resources, heavy workloads and unsafe working environments. These contributory factors prompt professional nurses’ decisions to leave the bedside setting for alternative employment opportunities. Case management is a nursing resource employed by managed health care organisations to ensure patients receive appropriate care which is cost effective and beneficial to the patient’s health within available funding structures. Traditional nursing practices, however, take place in a physical face-to-face context, allowing compassion and care transference. Nursing care in the managed health organisation is office-based; contact between the professional registered nurse and patient is only through electronic, digital systems. It is best described as ‘faceless’. The nursing care that a case manager renders is unexamined and unknown, and this detached structure introduces a different facet of nursing and nursing care. The purpose of this study was to gain an understanding of the lived experiences of case managers in caring for patients in a managed health care organisation, in order to make recommendations for quality nursing care by case managers in a managed health care organisation. A qualitative research approach was used by implementing an explorative, descriptive and contextual phenomenological research design. Non-probability purposive sampling was used. The research population consisted of 10 registered professional nurses employed as case managers for one year or longer. Data collection was done through one-on-one, in-depth, unstructured phenomenological interviews, which focused on the central question: What are the experiences of case managers in caring for patients in a managed health care organisation? Ten participants out of a total of 80 case managers who formed part of the total accessible population were interviewed and data saturation was reached. Data was analysed using Giorgi’s five-step method, with the help of an independent coder. From the research findings two themes emerged from the data. Communication was found in theme one: The case manager’s role includes coordinating all aspects of care in a financial framework and they rely on receiving sufficient, timely information. Caring was found in theme two this was determined vi to be that case managers experience great satisfaction in caring for patients, even if they do not see the patients; they view it as a professional benefit. However, the case managers are subjected to frustrating barriers in their efforts to obtain sufficient, appropriate clinical information from the hospitals. Measures to ensure trustworthiness and ethical principles were applied throughout this study. The findings reveal that case managers experienced a great sense of ultimate satisfaction from caring for patients in a managed health care organisation. Although the case managers did express that they communicate and care for a patient from behind a computer screen and never get to see or touch their patient, as they did at the clinical bedside setting, this forces them to seek new and alternative ways to communicate with their patient to show and share care. The caring that a case manager renders to a patient is through technological, digital means; mainly by email or telephone. Patient care rendered by a case manager from the managed health care organisation is thus distant and detached. But there is still care that is shared; it is just a different way of caring. General recommendations to facilitate case managers in caring for patients in a managed health care organisation were made as follows: To develop an effective, efficient means of coordination of all aspects of nursing care for patients by case managers, and management should monitor and collaborate communication and relationship building between in-hospital case managers and managed health care case managers.
M.Cur. (Nursing)