Now, at century's close, Hawkins and Veeder say the advent of managed care has placed a major portion of modern health care squarely back in the community. The reliance on HMOs, satellite clinics and preventive medicine regimens echoes the approaches and professional challenges of the Progressive Era, they say.
In a forthcoming book, Nurse-Social Worker Collaboration in Managed Care: A Model of Community Case Management , Veeder, Hawkins and University of Massachusetts at Lowell Associate Professor of Nursing Carole Wieland Pearce, a 1993 SON doctoral degree recipient, examine innovative ways in which nurses and social workers can blend their skills effectively in this new era of community-based care. The three interviewed nurses and social workers in the field, as well as executives of hospitals and home health care agencies.
Veeder and Hawkins have teamed in the past to research the nurse-social worker collaboration in turn-of-the-century settlement houses like Hull House, founded in Chicago by Addams to serve the moral and physical health of the city's immigrant workers. The authors see similar challenges facing nurses and social workers today who are increasingly called to practice in the community, and to combine in non-traditional ways to treat both the physical and emotional needs of patients.
Authors Carole W. Pearce, Assoc. Prof. Nancy Veeder (GSSW) and Prof. Joellen Hawkins (SON), from left.
By the year 2000, according to Veeder, an estimated 98 percent of Americans with health insurance will be involved in some sort of managed care program, which offer walk-in treatment at health centers and promote healthy lifestyles and fitness club memberships as ways to avoid illness. Lengthy hospital stays are reserved for the most extensive, and expensive, treatment.
"Here we are at the turn of another century and health care is returning to the community," said Veeder. "People are staying in the hospital for shorter periods. More surgery is on an outpatient basis. So both nursing and social work have returned to the community as the place where their practice will be most needed."
Although nurses and social workers often found themselves as competitors in traditional institutional settings, said Veeder and Hawkins, now they are joining forces to care for "the whole person."
"The combination of the nurse-social worker should not be competitive, but collaborative," said Hawkins. "Some exciting new models of practice in the community are being developed between the social work and nursing professions."
As an example, the authors cited a case of a diabetic woman suffering from debilitating depression who had not been keeping her medical appointments, and whose case was referred to a nurse and social worker at a home health care agency. Working together, the two were able to address the patient's needs in a more comprehensive way than if either had tried to handle the case alone.
"The case of a patient with depression who can't get out of bed in the morning has physical and psychological aspects," said Veeder. "While the social worker assesses the psycho-social situation in the family, the nurse on the team will manage the health aspect, taking care of the woman's diabetes and urging her not to eat foods that are potentially harmful."
Beyond their individual skills, Hawkins points out, nurses and social workers also have access to services which can provide a broader range of care. A nurse might be able to help treat a depressed mother of a pre-school child, she said, but "nurses don't have the connections social workers do to get the kid into Head Start."
These collaborations can bring forth more innovative st service to the community, efficiently," said Veeder, and interdisciplinary cooperation to that end "is the hot topic in health care."
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