tiating the often intimidating healthcare delivery system, particularly for those patients with complex needs: "Nurses are adopting case management across community and hospital settings in an attempt to decrease service fragmentation and improve the quality of care for people who require numerous or long-term health services."
Expansion of the case management function in the nursing profession has resulted in changes in nurse-client relationships and nurse-colleague relationships, as revealed by interviews with 17 Canadian nurses who practiced case management in community-based agencies. Although all the nurses interviewed were responsible for case management coordination, more than half were not officially designated as case managers. The interviews for this study lasted from 30 to 90 minutes and the results were summarized and integrated with research findings from published and unpublished sources.
Studies examining the nurse-client relationship conclude that interaction is initially superficial, develops according to the situation and circumstance, and is agreed on covertly by both parties. The study of Canadian nurses found the relationship between nurse and client to be more formal than the therapeutic relationship between primary care nurse and client. Nurse case managers benefit their clients, but in ways that are different from their primary care nursing counterparts: "Given the nature of case managers' coordination responsibilities, the development of a therapeutic relationship with clients may be more difficult to achieve."
Likewise, case management duties affect the nurse's relationship with his or her colleagues. Case management shifts the traditional lines of authority between nurses and physicians. It expands the nursing power base by giving the nurse authority for coordination and monitoring of patient care. Nurses in the Canadian study reported initial resistance and skepticism by physicians rega...