The purpose of the review of literature presented here is to determine, on the basis of pertinent work in the existing knowledge base, the role requirements of the Transcultural Nurse Specialist (TNS) in the managed care system. To this end, the paper presents a brief overview of the managed care system. This is followed by a definition of transcultural nursing and a discussion of its general function in managed care.
The next section of the review describes and discusses the roles of the transcultural nurse specialist, using Role Theory as a conceptual framework. To place the roles of the TNS in context, the delineated roles of the TNS will be compared and contrasted to those of the Clinical Nurse Specialist (CNS). The review ends with a delineation of conclusions formulated on the basis of the reviewed research as well as implications and recommendations for future research in the field.
Managed care is a broad category of health care delivery that encompasses 23 different types of organizations...In general, they are means of coordinating and presumably streamlining health care. (p. 8)
Although there is a good deal of variation, Landers (1995) reports that the two major models of managed care in the United States are The Health Maintenance Organization (HMO) and the Individual Practice Association (IPA). The structure of these models differ somewhat.
HMOs provide medical services to clients (e.g., individual clients, groups of business employees or other groups of insured clients, government-related collectives such as people on welfare or medicare, etc.) for a set monthly fee (the capitation rate). In order to see a profit, HMOs must provide their medical services at a cost that is below the total amount paid by their diverse types of clients.
The IPA consists of a collective of health care providers (e.g. doctors, doctors and nurses, etc.) which: a) provide lower than market value services to individu...