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Evidence-based best practice in community care.

In July 2002, the Australian Institute for Primary Care at La Trobe University released an interim report titled Evidence-based Best Practice in Community Care. The authors were

Wells, Nay, Hill, and Maher. The findings are of significance to Faith Community Nurses because they discuss best-practice initiatives that have an evidence base that FCNs can use in their health promotion. The summary of best practice re falls prevention, safe medication management and wound care are useful tools for FCNs.

The recommendations endorse the information AFCNA has been providing to members for some years, as a brief precis on the area of case management demonstrates.

The Commonwealth Department of Human Services (2008) requested health services to incorporate the following best-practice principles in their programs:

1. Emphasis on capacity building or restorative care to maintain or promote a client's capacity to live as independently as possible, the overall aim being to improve functional independence, quality of life and social participation.

2. An emphasis on a holistic, "person-centered" approach to care that promotes clients' wellness and active participation in the decisions about care.

3. An attempt to provide more timely, flexible, and targeted services that are capable of maximizing the client's independence.

These are congruent with the aims of health ministry promoted by AFCNA, again emphasizing the fact that Faith Community Nursing is a relevant and timely ministry in this country.

The report underscores national standards of practice in case management relevant to community care. While FNCs' case management is informal, AFCNA has been promoting these principles via their introductory modules at courses and conferences for some time. They include:

* Case Identification and Assessment: Eligible clients are identified and assessments are completed.

* Needs Identification: In conjunction with the client, the case manager documents identified client needs.

* Planning: Client goals are documented, reflecting the priorities and plan for action agreed upon by the client and case manager.

* Monitoring: Planned services, supports and resources are monitored against the goals documents in the client's individualized care plan.

* Evaluating: Periodic reassessment and evaluation of the client's outcomes are to be conducted against the expected outcomes and available evidence.

* Outcome: Case management actions are outcome oriented.

It is important for FCNs to remember that documenting and reporting outcomes of all programs and care plans is very important. It demonstrates to government policy makers and funders the impact of FCN services and provides a future evidence base for practice. It is useful to use WholeHealth [the newsletter of the AFCNA] to share these outcomes, whether they are single case studies or evaluations of programs you deliver. In documenting and publishing your outcomes and inputs, you are providing your FCN and health ministry colleagues with documented references they can use for future grant applications.

The report notes that case management is associated with improved client outcomes, including mental state, social function, and user satisfaction. Clients appreciate the emotional engagement and personal support they receive from their case managers. This is deemed more important than how qualified that person is (Rapp 1998), again emphasizing the fact that "who we are" with our clients is just as important as "what we know." Clients are more satisfied with services when their strengths and interests have been recognized and their independence promoted (Simpson et al, 2003), endorsing the personal empowerment strategies FCNs use in their practice.

Clients prefer contact in their own home whenever possible rather than in an office, or by phone, again reinforcing the rationale for the personal visits that FCNs and health ministry volunteers provide. It is important that the contact is responsive to the client needs. The frequency of that contact is a strong predictor of how engaged a client will be with their program. FCNs are in a position to ensure the frequency of their visits and the support provided to individuals and families. The report says mobilizing informal support that occurs naturally within the community is to be encouraged. Consequently, using the support of your faith community to supplement the FCNs activities is likely to be appreciated by the client.

Good case management includes ongoing monitoring with devolution of responsibility for services via referrals. In the case of health ministry volunteers and FCNs, the provision of continuity in support is likely to assist in building rapport and trust on which to base future interactions. It is important that the client maintain authority over their care plan choices. However, this needs to be assessed if a client's competency regarding decisionmaking is at risk. It is important to know how to access experienced professional staff for support and specialist information as needed. This is particularly important for families who may need to access support services out of normal work hours if they have a time of crisis.

When setting up your health ministry, structure your team to promote creative care planning, problem solving and sharing of knowledge. The model that AFCNA promotes facilitates the establishment of trusting and understanding relationships between clients and case manager/care coordinator and other health ministry volunteers.

Reprinted from the June 2009 issue (Vol. 14, No. 2) of WholeHealth, the newsletter of the Australian Faith Community Nursing Association. Used with permission.

More info on AFCNA at

By Anne van Loon, RN, MN

(Research), PhD

Former Chair, AFCNA
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Author:Loon, Anne van
Publication:Parish Nurse Perspectives
Date:Jun 22, 2009
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