Nurse case managers enhance care for service members, families

16 Aug 2007 | Ms. Heather Owens

Like a drum major for change, time marches on, often bringing with it new advances and ways of doing business.

Take for example, a plausible snap shot of the medical treatment of a service member wounded in theater during World War II. After possibly being away from his family for an extended amount of time fighting the war, a wounded service member would often spend his convalescence in Veteran’s Administration care far from home. Thus, as old movies sometimes showed, the first time a wounded service member saw his family might be showing up in a taxi cab with an amputated limb.

In contrast today, according to Capt. Mark C. Olesen, commanding officer of Naval Hospital Camp Lejeune, families are notified literally within hours of the injury by service notification channels and in many instances, they’re there to meet that injured service member at a tertiary care center, the National Naval Medical Center at Bethesda or at the Walter Reed Army Medical Center. The service member wakes up for the first time after his or her injury seeing their family surrounding the bedside, and the family is intimately involved in not only his or her acute care, but in the convalescence.

“That to me cements the value of having case management involved at all levels of the military system to help not only the injured service member, but the family dealing with this situation and, in many cases, life-threatening injuries,” said Olesen. “I really believe that the case management approach that the Department of Defense is using will serve as a model for case management for significant illnesses and injuries in the civilian sector just as the advances in trauma care that were developed on the battlefield have translated into advances in civilian medical practice.”

So what is case management?

Case management is performed by registered nurses who help the injured and ill and their families navigate the medical system. They serve as a patient’s advocate, family supporter, confidant, translator of medical information and a friendly voice at the end of the telephone. Sometimes more …

“Especially for the younger Marines who are away from their families, we sometimes become like a mother figure to them,” said Tammie Styer, nurse case manager.

Right now at NHCL there are 12 nurse case managers billeted to help right around 400 people through their treatment. The hospital is also planning to add four additional part-time case managers in the fall.

“As registered nurses, we can teach patients about their medications, side effects and things that they’re going to have to do the rest of their lives to manage their care so that when they leave Camp Lejeune, they can be independent,” said Kathy Buffell, case management division officer. “Maybe [because of our care] they will go have that annual check up or go get blood work done for medication.”

A typical day for a case manager can be fast and furious in taking care of wounded or ill service members or dependents and their families. “You come in and sometimes you have a few Marines waiting for you, or the phones are ringing. Whatever the need is, we try to take care of it as soon as possible, whether it’s helping someone with their medication or someone who may have gone to a specialist and the specialist wants some information, such as an [magnetic resonance imaging] or wants them to see another specialist,” said Styer. “So you coordinate that referral and the authorization and contact different primary care managers. Whatever the need might be, you just take it and run with it. Pretty soon, it’s 4:30 and it’s time to go home.”

When an injured service member first comes into the NHCL system, they may have a great many needs that require coordination and assistance. The case managers might have to set up their physical therapy appointments, referrals to specialists and then maybe plan for the patient to go home for a 30 day convalescent leave. When the service member comes back from leave, there may be further appointments and follow ups to schedule.

Later, the service member may become able to return to active duty or they may go on to medically retire.

“So it’s run, run, run, run and then just slowly the interaction comes to an end,” said Styer in characterizing a typical case management situation.

No matter the duration of the assistance the case managers provide to patients, the feedback for their services has been uniformly positive.

“I just got a letter from a Marine Corps mom talking about one of our case managers and how thankful she was [for her help]. This 22-year-old son was injured in theater and needed some follow-up care. His mom was so appreciative of the support and assistance that Lynn [the case manager] had offered them,” said Olesen. “I get this kind of feedback verbally all the time that people recognize and appreciate how a case manager can help them. When I say people, I’m talking about how injured service members, unit commanders, regimental and battalion commanders are all very appreciative of how the case managers help the Marines.”