Syllabus

Course Title: NURSING CASE MANAGEMENT: ROLE AND PROCESS

CREDITS: Three

COURSE DESCRIPTION:

This course focuses on innovative, integrated nursing case and care management models within the context of assessment, planning, implementation, collaboration, negotiation, and evaluation. The critical competencies and strategies in managing risk and legal liabilities, seeking and obtaining interdisciplinary support, coordination of services across placement settings, and client and caregiver education are discussed. An emphasis will be on the strategies effective in the management of care for diverse populations in urban settings. Students will discuss functions and issues in evolving role demands, opportunities, and responsibilities of the nurse case manager.

This course is designated as Hybrid.

This is an online course with weekly online assignments Students should check their New York City Tech email on a daily basis for announcements and course updates. (H) courses at City Tech are any course where online are 33-80% of scheduled class meetings.

Our online class will meet online each week from 01/29/2021 to 05/2021. The online classes will take place in Open lab (OER) and Blackboard.  The following is a brief overview of Blackboard 9.1 components:

TECHNOLOGY REQUIREMENTS

For this course, we are using this site on the OpenLab, which you can access on any computer or mobile device.

The college uses an online platform, Blackboard, which all students have an option to learn and use with support from the Information Technology Center. Many students have been using Blackboard for many years and are familiar with the system. Below are the suggested minimum prerequisites that students should know/have for taking part in an online course.

1. You should have access to and be able to use Internet Explorer, Mozilla Firefox, or Safari browsers. Blackboard does not fully support AOL.
2. You will need a City Tech e-mail account and should be comfortable using it. The college provides an e-mail account to all students. Personal email accounts are not to be used.
3. You need access to a computer with at least 256 MB RAM.
4. You should have the correct Java version downloaded/ installed – if necessary. The installation is automatic. You only need to do this the first time.

This course is designated as Online. 

Online (O) courses at City Tech are any course where 100% of scheduled class meetings are online activities.

Our online class will meet ONLINE each week from 01/29/21 to /5/19/2021. The on line or virtual classes will take place in Blackboard.  The following is a brief overview of Blackboard 9.1 components:

ANNOUNCEMENTS are the entry point. Notices, assignments, and updates are posted on a regular basis, so please check these announcements daily.

INFORMATION is where you’ll find the information that is given out on the first day of a course, such as course syllabus, grading policies, class schedule.

CONTENT is where you will submit your papers in Safe Assign.

TOOLS are where you can send emails to individuals or groups in the class as well as check your grades.

DISCUSSIONS are where you’ll be participating in on line discussions and replying to your classmates’ questions and comments.

ATTENDANCE AND PARTICIPATION IN THE ONLINE COMPONENT

• Visit the Discussion Board several times a week.
• Respond to the discussion questions with thoughtful responses that are grammatically correct.   The questions for each online class will be posted about a week before they are due.
• Check the Discussion Board area of our Blackboard several times each week and respond to the discussion questions with solid, thoughtful posts (not just “ok” or “I agree”).  Please see Grading Rubric for Discussion Board for specifics.
• Your discussion responses must be posted by 11:59pm on the day they are due.  LATE POSTS ARE COUNTED AS LATE ARRIVALS TO CLASS.  ABSENT POSTS ARE ABSENCES FROM CLASS.

The Help Desk number is 718 254-8565

TEACHING/ LEARNING METHODS

Discussion

Case Presentations

Written Assignments

Reading Assignments

Role Play

METHODS OF EVALUATION:

Assignments

Discussion Board  Participation

Exams

Final Paper

GRADING

Mid-term exam               20%

Discussion board Participation  35%

Final exam                    20%

Paper                               25%

Grading Policy for all courses designated with the prefix NUR

Grade              Definition                    Quality Points (Index)

A                     93–100%                                 4.0

A-                    90-92.9%                                 3.7

B+                   87-89.9%                                 3.3

B                     83-86.9%                                 3.0

B-                    80–82.9%                                2.7

C+                   77–79.9%                                2.3

C                     75–76.9%                                2.0

D                     60–74.9%                                1.0

F                      Below 60                                 0.0

STUDENT SUPPORT SERVICES

Any student with a documented disability or history of disability services seeking academic adjustments and/or reasonable accommodations will need to contact The Center for Student Accessibility and meet with staff to establish your adjustments and reasonable accommodations.

The Center for Student Accessibility is located in room L-237 and the phone number is (718)260-5143.  Students may enroll with the program throughout the year and are responsible for alerting faculty to accommodations needed.

NEW YORK CITY COLLEGE OF TECHNOLOGY POLICY ON ACADEMIC INTEGRITY

Students and all others who work with information, ideas, texts, images, music, inventions, and other intellectual property owe their audience and sources accuracy and honesty in using, crediting, and citing sources. As a community of intellectual and professional workers, the College recognizes its responsibility for providing instruction in information literacy and academic integrity, offering models of good practice, and responding vigilantly and appropriately to infractions of academic integrity.  Accordingly, academic dishonesty is prohibited in The City University of New York and at New York City College of Technology and is punishable by penalties, including failing grades, suspension, and expulsion.

The Baccalaureate Program in Nursing adheres to this New York City College of Technology/CUNY Policy on Academic Integrity. This policy spells out in detail what constitutes Academic Dishonesty. All students are responsible for following this policy.

The detailed policy can be found in the NYCCT College Catalogue or on the college website www.citytech.cuny.edu. Two DVD’s on plagiarism are available in the Nursing department.

COURSE PARTICIPATION

You are expected to attend each class meeting. You may be absent without penalty for no more than 10% of the class instructional hours during the semester.

Active participation on discussion board will signify attendance.

All course assignments must be submitted on time or you will lose points.  If you have a personal emergency, please let faculty know via email ASAP and within 24 hours of an assignment which may not be submitted on time.

NUR 4030 – Participation in Discussion Board      

Grading:  Number of postings: 7 pts; Quality of postings: 21 pts; Literacy/Clarity of postings: 7 pts; Total:  35 points

Grading Rubric for Discussion Board

Student Participation	Excellent	Good	Adequate	Poor
Number of postings (7 points)	Student consistently posts 5 or more times each week (7)	Student consistently posts 3-4 times each week (6.5)	Student consistently posts 2 times each week (6)	Student consistently posts less than 2 times each week (5 or less)
Quality of postings (21 points) a)      Number of sentences b)      Knowledge of CM concepts c)      Knowledge of cultural competence in CM	Student consistently posts 5 or more sentences and demonstrates comprehensive knowledge of CM and cultural competence (21-19)	Student consistently posts 4 sentences and demonstrates accurate knowledge of CM and cultural competence (18-17)	Student consistently posts 3 sentences and demonstrates some knowledge of CM and cultural competence (16)	Student consistently posts less than 3 sentences and demonstrates minimal knowledge of CM and cultural competence (15 or less)
Literacy/clarity        (7 points) Spelling, punctuation, grammar, sentence structure (S, P,G,SS)	Student postings are always accurate for S, P, G, SS. (7)	Student postings have 1- 2 errors in S, P, G, SS. (6.5)	Student postings have 3-5 errors in S, P, G, SS. (6)	Student postings have 6 or more errors in S, P, G, SS. (5 or less)

NUR4030 Criteria for Paper

Your paper should be 5 to 7 pages (10 to 12 pages if working in pairs), double spaced, APA format, excluding Title and Reference Page. You must cite three to five references (5 to 7 if working in pairs) from peer reviewed journals within the past 7 years to explain the issue and support your position. Textbook and Internet sources may be used in addition to journal references.

Grading:  Concept: 3 pts; Cultural Competence: 7 pts; Case Management: 5 pts;

Format/Structure: 5pts; Total – 20 points

Paper Requirements	Excellent	Good	Adequate	Poor
Concept (6 points) CM concept is chosen from items listed under Unit Objectives and is: a) identified b) defined          c) explained why it is of interest.	Student clearly incorporates a), b), c) in paper              (3 points)	Student incorporates two of the a), b), c) components in paper (2 points)	Student incorporates one of the a), b), c) components in paper (1 point)	Student doe not incorporate any of the a), b), c) components in paper (0 point)
Cultural Competence (7 points)   Describe how the CM concept is relevant to or influenced by cultural competence	Student discusses the relationship between the CM concept and cultural competence using real or simulated examples. (7 points)	Student discusses the relationship between the CM concept and cultural competence without examples. (6 points)	Student discusses cultural competence or CM concept (5 points)	Student minimally discusses cultural competence or CM concept (4 or less points)
Case Management  ( 7points) Discuss how the culturally competent CM concept can improve CM practice.	Student discusses how the culturally competent CM concept can improve CM practice using real or simulated examples. (5 points)	Student discusses how the culturally competent CM concept can improve CM practice without examples. (4  points)	Student discusses the culturally competent CM concept only. (3 points)	Student does not discuss the culturally competent CM concept. (2 or less points)
Structure/Format (5 points) APA style b) organization, c) clarity d) page limit e) spelling, punctuation, grammar.	Student has three or less errors in a) through e). (5 points)	Student has four to six errors in a) through e). (4 points)	Student has seven to ten errors in a) through e) (3 points)	Student has more than eleven errors in a) through e) (2 or less points)

UNIT OBJECTIVES

Unit I: Overview of Nursing Case Management

Describe changes in healthcare over the last 50 years

Identify case management essential skills.

Identify job responsibilities of the nursing case manager

Discuss credentials, organizations, guidelines, and standards for nursing case management.

Discuss Watson’s theory in relation to Case Management practice.

 

Unit II: Conceptual Frameworks and Managed Care Models

Discuss transcultural nursing in relation to Case Management.

Identify types of insurance models/systems.

Discuss reimbursement and protective strategies.

Identify insurance players.

Apply case studies to managed care models.

 

Unit III: Utilization Management (UM)

Discuss the basic concepts of utilization management in case management.

Identify the main types of UM services.

Describe the impact of regulatory agencies on utilization of services

Discuss the management of the utilization of resources in various stages of healthcare.

Describe the importance of utilization management documentation.

 

Unit IV: Quality Review and Risk Management

Discuss the role of case managers working in project teams.

Describe the process and outcomes of quality reviews

Discuss the cost of poor quality care

Describe the role of the nurse case manager and clinical nurse in maintaining quality.

Review quality indicators as applied to case management.

 

Unit V: Legal Issues in Case Management

Discuss confidentiality mandates and HIPPA.

Identify standards of care and practice.

Discuss informed consent and patient’s rights,

Describe theories of negligence.

Apply case studies in legal issues in nursing case management

 

Unit VI: Ethical Issues and Dilemmas

Define quality reviews and risk management.

Discuss the role of ethics committees.

Identify communication skills needed by case managers for resolution of ethical problems.

Explain discharge planning understanding levels of care and transfers.

Apply case studies in ethical issues in nursing case management.

 

Unit VII: The Case Management Process

Discuss the concept of discharge planning/ transitional planning

Describe the review process for discharge planning.

Identify levels of care

Describe the impact of Diagnosis Related Groups (DRGs) on transitional planning

Discuss insurance criteria.

 

Unit VIII: Types of Managed Care Organizations

Discuss integrated health care delivery systems.

Describe complementary and alternative medicine in nursing case management.

Examine common assertions about managed care.

Discuss the compensation of primary care providers.

Discuss contracting and reimbursement of specialty physicians.

 

Unit IX: Teaching and Learning Principles for Managed Care.

Identify nursing case management methods to assess learner needs.

Identify case management teaching methods and strategies.

Apply a developmental approach to the assessment of teaching/learning strategies.

Identify teaching/learning strategies for individuals with special managed care needs.

Discuss outcomes assessment of teaching/learner effectiveness.

 

Unit X: Overview of Disease Management

Describe the process of disease management in managed care settings.

Discuss disease management in diverse care settings.

Identify age related disease management concerns.

Present an overview of outcomes management.

Apply case studies for management/outcomes of the management program.

 

Unit XI: Job Stress vs. Stress Factors in Case Management

Identify stress factors in case management.

Discuss effective problem-solving techniques for nursing case managers.

Describe effective time management strategies for nursing case managers.

Discuss the significance of a professional network.

Present case management self-care strategies for nursing case managers.

Identify therapeutic case management techniques.

TOPICAL OUTLINE

Week 1 

Case Management Defined

1. Managed care defined
2. Job responsibilities of case managers
3. Essential skills of case managers
4. Credentials of Case Managers
   1. Educational preparation
   2. Types of programs
5. Code of professional conduct
6. Opportunities in nursing case management

Watson’s Theory and Case Management           Internet sites/select handouts

Week 2 

Transcultural Nursing and Case Management       Internet sites/select handouts

Reimbursement and Protective Strategies

1. Cost sharing strategies for insurance companies
   1. Protective strategies for insurance companies
   2. Types of reimbursement
   3. Enrollment terms and qualifications for special insurance
2. Types of Insurance Models
3. Coordination of benefits
4. Billing terms

Week 3

Utilization management and case management

1. Utilization management defined
2. The relationship between UM and case management
3. Utilization management services
4. Utilization management documentation

Week 4

Quality Improvements (QI) and Risk management (RM) terminology

1. Quality review
2. Risk management
3. Defining and comparing/ contrasting the terms
4. Outcomes
   1. Adverse patient occurrence
   2. Potentially compensable event
   3. Incident report
5. Quality reviews
6. Quality indicators
7. The role of the nurse in maintaining Quality

Week 5

Legal Issues in Case Management

                        Negligence and other claims

1. Documentation
2. The importance of hospital policy and a compliance program
3. Discharge planning
4. Confidentiality/HIPPA
5. Grievances

Week 6

Ethical Issues and Dilemmas in Case Management

1. Ethics Committees
2. Ethical decision-making
3. Code of Conduct for Nurse Case Managers
4. ANA Statement of Ethical Case Management Practice/Code of Professional Conduct for Case Managers
5. Conflict resolution
6. Consumer Bill of Rights and Responsibilities/Patient Bill of Rights

Week 7                                   

Models of Case Management

1. Primary Care
2. Medical/ social models
3. Nursing Case Management models
4. Milliman and Robertson Guidelines and InterQual

Week 8                   MID TERM EXAM     

Discharge Planning (Transitional Planning)

Discharge planning defined

1. The review processes
2. Levels of care
   1. Custodial care
   2. Intermediate care
   3. Skilled nursing
   4. Long-term care (LTC)
   5. Acute care
   6. Rehabilitation services/inpatient rehabilitation centers
   7. Transitional hospitals

Week 9                                                                              

Discharge Planning (Transitional Planning) Continued

1.Post acute care

1. Sub acute care defined
2. Categories of sub acute care

2.Hospice

3.Insurance Criteria

Week 10

Readings to be Assigned

Overview of Teaching/Learning Principles for Managed Care

2. Teaching methods
3. The role of planning in teaching
   1. Institutional objectives
   2. Behavioral objectives
4. Lesson Plans

Week 11                                                                                           Readings to be assigned

Disease Management                         

1. Disease management in diverse care settings
   1. Assessment
   2. Planning
   3. Service planning and resource allocation
   4. Establishing goals
   5. Prioritizing needs and goals
   6. Intervention of the plan
   7. Negotiation
   8. Coordination of the case plan
   9. Evaluation and follow-up
2. Age related needs
3. Vulnerable populations

Week 12

Stress Factors in Case Management

1. Problem solving techniques for nursing case managers
2. Time management strategies for nursing case managers
3. Personal and professional networking support
4. Life-long learning and educational growth

Week  12 & 13     Class Assignments     FINAL PAPERS DUE

Week 14 Class Assignments

Week 15          FINAL EXAM

REFERENCES

American Psychological Association. (2010). Publication Manual of the American Psychological Association (6^th Edition). Washington, D.C.: author. (Available in the City Tech Library, in the Reference section. Call number: BF76.7 .P83 2010).

Anderson, D. R., St. Hilaire, D., & Flinter, M. (2012). Primary Care Nursing Role and Care Coordination: An Observational Study of Nursing Work in a Community Health Center.

Online Journal of Issues in Nursing, 17(2), Arnold, A (2017) Utilization of the health care system of community case management patients. Professional Case Management Wolters Kluwer Health Inc. 22 (4) 155-162.

Baldwin, S. M., Zook, S. & Sanford, J. (2018) Implementing post hospital Interprofessional care team visits to improve care Transitions and decrease hospital readmission rates. Professional Case Management 23, (5) 264-271.

Breysse, J., Wendt, J., Dixon, S., Murphy, A., Wilson, J., Meurer, J., & … Jacobs, D. E. (2011). Nurse Case Management and Housing Interventions Reduce Allergen Exposures: The Milwaukee Randomized Controlled Trial. Public Health Reports, 12 (6), 89-99.

Browne, G., Cashin, A., & Graham, I. (2012). Models of case management for working with young children: Implications for mental health nurses. International Journal of Mental Health Nursing, 21(2), 123-130.

Chouinard, M., Gagnon, C., & Mathieu, J. (2010). Nursing case manager in neuromuscular diseases: outcomes of a community-integrated care pathway implementation… Canadian Association of Neuroscience Nurses: 41st annual scientific sessions, Quebec City, QC, June 8-11, 2010: “Oui” CANN: Communicating and Networking Nationally: Réseau de Communication National. Canadian Journal of Neuroscience Nursing, 32(1), 17.

Chow, S., & Wong, F. (2010). Health-related quality of life in patients undergoing peritoneal dialysis: effects of a nurse-led case management program. Journal of Advanced Nursing, 66(8), 1780-1792.

Chuang, C., Levine, S. H., & Rich, J. (2011). Enhancing Cost-Effective Care with a Patient-Centric Coronary Obstructive Pulmonary Disease Program. Population Health Management, 14(3), 133-136.

Dellasega, C., Gabbay, R., Durdock, K., & Martinez-King, N. (2010). Motivational interviewing to change type 2 diabetes self-care behaviours. Journal of Diabetes Nursing, 14(3), 112-118.

Drennan, V., & Goodman, C. (2010). Nurse case management in England: a study of different models for community dwelling older people… Fourth European Nursing Congress. Journal of Clinical Nursing, 19(17).

Fischer, H. H., Eisert, S. L., Everhart, R. M., Durfee, M. J., Moore, S. L., Soria, S., & … Estacio, R. O. (2012). Nurse-Run, Telephone-Based Outreach to Improve Lipids in People With Diabetes. American Journal of Managed Care, 18(2), 77-84.

Gage, H., Ting, S., Williams, P., Drennan, V., Goodman, C., Iliffe, S., & … Masey, H. (2013). Nurse-led case management for community dwelling older people: an explorative study of models and costs. Journal of Nursing Management, 21(1), 191-201.

Golden, A. G., Martin, S., da Silva, M., & Roos, B. A. (2011). Care Management and the Transition of Older Adults from a Skilled Nursing Facility Back Into the Community. Care Management Journals, 12(2), 54-59.

Gray, F. C., & White, A. (2012). Concept Analysis: Case Management Role Confusion. Nursing Forum, 47(1), 3-8.

Gustafson, D., Wise, M., Bhattacharya, A., Pulvermacher, A., Shanovich, K., Phillips, B., & … Kim, J. (2012). The Effects of Combining Web-Based eHealth With Telephone Nurse Case Management for Pediatric Asthma Control: A Randomized Controlled Trial. Journal of Medical Internet Research, 14(4).

Happell, B., Hoey, W., & J. Gaskin, C. (2012). The Characteristics of Consumers Receiving Case Management in the Community: A Review of Literature. Issues in Mental Health Nursing, 33(3), 145-148.

Hinkle, J. (2010). Case management consent: a requirement. Journal of Legal Nurse Consulting, 21(3), 8-10.

Horton, S., & Johnson, R. (2010). Improving access to health care for uninsured elderly patients. Public Health Nursing, 27(4), 362-370.

How Do Case Managers and Navigators Interface? (2012). Journal of Oncology Navigation & Survivorship, 3(6), 13. Initiation of case-management in patient-centered care. (2011). CANNT Journal, 21(2), 32.

Ireland, S., MacKenzie, M., Gould, L., Dassinger, D., Koper, A., & LeBlanc, K. (2010). Nurse case management to improve risk reduction outcomes in a stroke prevention clinic. Canadian Journal of Neuroscience Nursing, 32(4), 7-13.

Kilic, S., P. & Sevinc, S. The relationship between cultural sensitivity and assertiveness in nursing students from Turkey. (2018) Journal of Transcultural Nursing 29 (4) 379-386 Doi: 10.1177/1043659617716518

Marek, K., Adams, S., Stetzer, F., Popejoy, L., & Rantz, M. (2010). The relationship of community-based nurse care coordination to costs in the Medicare and Medicaid programs. Research in Nursing & Health, 33(3), 235-242.

Martin, E., French, L., & Janos, A. (2010). Home/community monitoring using telephonic follow-up. Neurorehabilitation, 26(3), 279-283.

McEvoy, P., Escott, D., & Bee, P. (2011). Case management for high-intensity service users: towards a relational approach to care co-ordination. Health & Social Care in the Community, 19(1), 60-69.

Metzelthin, S. F., Daniels, R., Rossum, E., Cox, K., Habets, H., de Witte, L. P., & Kempen, G. M. (2013). A nurse-led interdisciplinary primary care approach to prevent disability among community-dwelling frail older people: A large-scale process evaluation. International Journal of Nursing Studies, 50(9), 1184-1196.

Miles, J., Anderson, D. P., Engelke, M., Kirkpatrick, M. K., Pories, M., Waters, W. G., & … Rose, M. (2012). Barriers to Transition of Obese Patients from Hospital to Community. American Journal of Managed Care, 18(6), e234-7.

Nutt, M., & Hungerford, C. (2010). Nurse care coordinators: Definitions and scope of practice. Contemporary Nurse: A Journal for the Australian Nursing Profession, 36(1/2), 71-81.

Peter, S., Chaney, G., Zappia, T., Van Veldhuisen, C., Pereira, S., & Santamaria, N. (2011). Care coordination for children with complex care needs significantly reduces hospital utilization. Journal for Specialists in Pediatric Nursing, 16(4), 305-312.

Poitras, M. E., Chouinard, M. C. Gallagher, F., & Fortin, M. (2018) Nursing activities for patients with chronic

disease in primary care Settings a practice analysis. Nursing Research, 2018, Vol 67 (1) 35–42

Robison, J., Shugrue, N., Porter, M., Fortinsky, R. H., & Curry, L. A. (2012). Transition from Home Care to Nursing Home: Unmet Needs in a Home- and Community-Based Program for Older Adults. Journal of Aging & Social Policy, 24(3), 251-270.

Rosenberger, P. (2013). Balancing Work and Caregiving. Journal of Nurse Life Care Planning, 13(1), 7-12.

Smith, A., MacKay, S., & McCulloch, K. (2013). Case management: developing practice through action research. British Journal of Community Nursing, 18(9), 452-458.

Smith, C. K. (2011). Nurse case management specialty practice for a new and improved healthcare system. Arizona Nurse, 64(3), 4.

Span-Sluyter, C, A., M. F. H. Lavrijsen, J. C., M. Leeuwen, E., V., & Koopmans,  R.T.  C.M. (2018). Moral dilemmas and conflicts concerning patients in a vegetative state/unresponsive

wakefulness syndrome: shared or non- shared decision making? A qualitative study of the professional perspective in two moral case deliberations.

BMC Medical Ethics (2018) 19:10 https://doi.org/10.1186/s12910-018-0247-8

Taylor, C. (2012). The Impact of Nursing Case Management on Women with Diabetes in Pregnancy. JOGNN: Journal of Obstetric, Gynecologic & Neonatal Nursing, 41S131-2.

Thoma, J. E., & Waite, A. M. (2017) Experiences of nurse case managers within a central discharge planning role of collaboration between physicians, patients and other healthcare professionals: A sociocultural qualitative study. Wily Journal of Clinical Nursing. DOI: 101111/jocn.14166

Vermillion, C. (2010). Life care planning and case management for the elderly: introduction to geriatric medicine and geriatric specialists. Journal of Nurse Life Care Planning, 10(2), 236-242.

Watts, S. A., Lawrence, R. H., & Kern, E. (2011). Diabetes Nurse Case Management Training Program: Enhancing Care Consistent with the Chronic Care and Patient-Centered Medical Home Models. Clinical Diabetes, 29(1), 25-33.

Wolber, T., & Ward, D. (2010). Implementation of a diabetes nurse case management program in a primary care clinic: a process evaluation. Journal of Nursing & Healthcare of Chronic Illnesses, 2(2), 122-134.