Case Management in the Community Psychiatric Nursing Service in Hong Kong: Describing the Process

Article excerpt

PURPOSE. To explore the roles, functions, and work practices of case managers and their perceptions on the implementation of case management in the Community Psychiatric Nursing Services.

METHODS. A qualitative descriptive approach was used. Data were collected from daily reports, field observations, reflective diaries, and small group interviews.

FINDINGS. The study showed the work practices of case managers were more intensive compared to the conventional community psychiatric nursing practice, and there was more involvement of clients and their family in the treatment process Case managers identified liaison, coordination, supportive and family counseling, and teaching practical living skills as their important roles.

CONCLUSIONS. This study provides valuable information in understanding the process of case management and contributed to the development of case management as a care delivery model in Hong Kong.

Key words: Case management, community psychiatric nursing services, Hong Kong

Following the establishment of the Hospital Authority in Hong Kong in 1990, all public hospital services were provided with a new strategic direction. The goal was to create a seamless healthcare system, which would be outcome focused and cost-effective (Hospital Authority, 1995a). The implementation of case management in nursing was suggested as one of the ways to achieve those aims (Hospital Authority, 1995b).

This article describes a case study that is part of a larger funded study (Chan, Mackenzie, & Ng, 1998) to evaluate the implementation of case management for chronic schizophrenic clients in the Community Psychiatric Nursing Service in Hong Kong. In this study, a specific case management model has been developed to care for the schizophrenic clients in the community. The term case management is widely used by healthcare professionals, such as nurses, doctors, and social workers. Although there is a diversity in the definitions of the term, Lee, Mackenzie, Dudley-Brown, and Chin (1998) argue that the different cultural and healthcare contexts in which case management is practiced should determine the practice and definition of case management in that particular context. In Hong Kong, the Hospital Authority (1995b) defines case management as a "systematic process of assessment, service coordination, referral monitoring, and evaluation through which the unique needs of clients are met" (p. 3). It aims at providing high-quality, comprehensive service for clients in their home environment.

The Community Psychiatric Nursing Service (CPNS) in Hong Kong was established in 1977. CPNS's mission has been to strengthen clients' coping capabilities and prevent a relapse of their mental illness. The scope of service included planning and implementing nursing intervention, health education, rehabilitation, early detection of illness, and crisis intervention. At present, about 80% of clients who are cared for by the CPNS have a diagnosis of schizophrenia. Most clients have a long duration of illness, poor social support, and difficulties in daily functioning. Their difficulties are sometimes influenced by the inability to use available community resources, as well as lack of coordination of existing service components. As a result, readmissions are frequent and clients may have a poor quality of life (Mak & Gow, 1996). Improving care outcomes for chronic schizophrenic clients, therefore, is a priority for the CPNS team, and there is a need to consider ways in which care can be provided more effectively.

Given the complexity of problems in mentally ill clients, Carpenter (1992) suggests the most effective way to cope with such difficulties is to have a specific individual act as the case manager to whom the client can relate. Worley, Drago, and Hadley (1990) argue that community psychiatric nurses (CPNs) are in a good position to be case managers, as they have knowledge about community resources available to clients and provide direct care in clients' homes. …