Nursing care management is a multidimensional term, which allows its approach from a
theoretical, legal, ethical, methodological orientation, etc.
Although there is a lot of literature regarding Care Management (CG), few works address its definition. For example, KM is understood as “the professional practice of the nurse, based on her discipline, the science of caring, and is defined as the application of professional judgment in the planning, organisation, motivation and control of the provision of timely, safe, comprehensive, that ensure the continuity of care and are based on the policies and strategic guidelines of the institution” or “an exercise of personal, professional and instrumental skills to organise, coordinate and articulate care at the different levels of care, ensuring with this, the continuity and effectiveness of the same”.
In the health sector, three levels of management are distinguished: macro-management, referring to health policies, meso-management, that is, the management of health centres and institutions; and micro-management, which nurses carry out in their care work.
Going down to the micromanagement of care is defined as “the professional care provided by the nurse in health service benefits, where a helping relationship is established with the person or persons dependent on care and whose objective is focused on developing the self-care capacity of the person and their environment, with the empowerment of natural resources regarding the knowledge, motivation and capacity for self-care” or “the continuous decision-making process by nurses, which allows guiding professional practice regarding the care required by a person or a group and the best way to organise available resources, always considering the best available evidence”.
However, any definition is complex given the complexity of the nursing practice, understanding that care management focuses on a practical aspect of the occupational field of nurses, including the management of resources, information, patients and the action of caring as a whole.
Care management as part of clinical management
Care management is considered a part of clinical management, and its objective is to adapt the supply of nursing care to the needs and demands of patients. It involves producing effective, quality nursing care at a reasonable cost.
The care management model of each institution is based on the professional values set by the Nursing Department, positioning itself in a theoretical nursing model that guides the organisation and operation of nursing units and services and allows the optimisation of resources.
The principles of nursing care management are constituted by the elements of nursing management and the field of care management.
The framework of the nursing discipline delimits the elements of nursing management. Nursing discipline is about nursing knowledge from the nature of care. These elements of nursing management include planning care aimed at the needs of the person and managing the person’s environment as a conditioning factor for health. It also consists of the values of respect, considering the person for their human dignity and being defined as a unique and global being. And other elements of nursing management are the methods for analysing care needs based on the registration of the variables that collect the perception of the person and her environment about her care.
The care management field is determined by the structure, process, and outcomes of health care provided by nurses. The system of care is based on nursing knowledge and the values of health care; the process is defined by nursing, that is, by the nursing method and the context in which nursing care is provided. Finally, the results are the measure of health that has been achieved with the person’s capacity for autonomy and their environment to meet their care needs.
Areas of development of care management
The areas of nursing care are in all life and health situations of people and in the contexts of human development where health care requires professional help, including Primary Care, Specialized Care and Social and Health Care.
In the hospital setting, a nursing unit is defined as a work team that provides nursing care to patients. When patients are admitted, it is an inpatient unit or intensive care unit. When care is provided on an outpatient basis, it can be a home hospitalisation unit, a palliative care unit, a home care unit, etc. Maintenance can also be provided in the surgical block, outpatient clinics or central services.
All of them are directed by a unit manager or a supervisor and have a portfolio of intermediate product services.
The proper management of nursing care is guaranteed when those responsible, the supervisors, are nurse managers who are not only focused on being effective as organisers and supervisors of human and material resources according to the goals of the organisation but also include the management of care for the person and their needs, consolidating their leadership and promoting the participation of the teams.