Implementation of Case Management to Increase Quality of Nursing
Services: A Systematic Review
Nuning Khurotul Af’ida
1
, Nursalam
1
and Ahsan
2
1
Faculty of Nursing Universitas Airlangga, Kampus C Mulyorejo, Surabaya, Indonesia
2
Head of Nursing Program, Medicine Faculty, Brawijaya University, Indonesia
Keywords: Case Management, Quality, Nursing Service, Systematic Review.
Abstract: Background: Case management becomes a global issue of health care in hospitals and requires special
attention in its implementation. The purpose of this study is to identify the various impacts of case
management implementation to increase the quality of nursing services. The Keywords that used are case
management, quality, nursing service, systematic review. Method: Journal had searched towards multiple
database: Proquest, Medline, Google Scholar, Science Direct. It used limited time in July 2012 to December
2017. From 1679 articles, only 15 articles that suitable with the inclusion criteria. Result: From 15
literatures have been obtained various impact of case management implementation to increase quality of
nursing service on various aspects such as, patient safety, pain management and comfort, patient satisfaction
level, self care, patient anxiety level, and patient’s behavior (knowledge and skills). The instruments used to
measure the implementation of case management include questionnaires, checklist observation form, and
interview form. The most commonly used instrument types are Nursing Case Manager (NCMs) and Target
Case Management (TCM). Discussion: Implementation of case management will give a positive impact in
the process of health services, especially to increase the quality of nursing services. Implementation of case
management can provide positive support in hospitals to implement excellent management and health care
systems to minimize complaints, lengthy ALOS, and expensive financial. In the process of case
management implementation is expected to have good cooperation and collaboration of all elements in the
hospital to run optimally and provide a positive impact to increase the quality of nursing services.
1 BACKGROUND
Case management is an intervention strategy used by
providers and healthcare systems to support patients,
coordinate health service, facilitate results, both in
price and quality (Huber, 2010). Case management
is a procedure for planning, searching, evaluating,
and monitoring services that patients get from
several health professions (Sunaringtyas & Sulisno,
2015; Rohmah N, 2011). Nursing service as an
integral part of the hospital also determines how the
quality of the hospital (Azwar, 2016). Quality of
nursing service consists of 6 (six) aspects. There are
patient safety, pain and comfort management,
patient satisfaction level of service, self care, level
of patient anxiety, and behavior (knowledge,
attitude, and skill) patient. One indicator the quality
of nursing service is dissatisfaction that not only
affects to the hospital clients but also to other
communities. The impact of this makes customers
choose to other hospital (Hartini, 2009).
The professional health workers that can do case
management is case manager. Case managers are
generally responsible for the coordination and
continuity of patient care or at a specific service
phase clearly identified very closely to the patient so
that case management model led by the case.
manager is able to realize health service based on
patient centered care (Aeni, 2014). Some accredited
hospitals are recommended to streamline the
implementation of case management models.
Based on research conducted by Mark, et all
2016, data were obtained from Amida Care, a
special medical services agency handling HIV
located in New York. The study found that 840,000
people in New York who were infected with HIV
infection had not been adequately handled due to
financing problems and patients' discomfort during
treatment. With the quasi experimental design of
Af’ida, N., Nursalam, . and Ahsan, .
Implementation of Case Management to Increase Quality of Nursing Services: A Systematic Review.
DOI: 10.5220/0008321501210131
In Proceedings of the 9th International Nursing Conference (INC 2018), pages 121-131
ISBN: 978-989-758-336-0
Copyright
c
 2018 by SCITEPRESS – Science and Technology Publications, Lda. All rights reserved
121

pre-existing group, from 2072 respondents in the
period January 2011-September 2012 by using
billing system, Standard Operational Procedure
(SOP) and clinical pathway of HIV. Based on the
research, it was found that Target Case Management
(TCM) can minimize the treatment financing and
and discomfort. It also increase the satisfaction of
HIV patients by 73%.
Experimental panel studies agreed on a case
management nursing model as an attempt to realize
the preference or the right of patients to determine
treatment options according to their needs and
expectations (Morales-Asencio et al, 2010). Case
management is led by a case manager who works
together to make care planning to fit the desired and
needed patient.
Based on the successful research of case
management, the author are interested to perform
further analysis on the impact of case management
implementation in improving the quality of nursing
service. With this analysis, it is expected to increase
the quality of health services and support the success
of monitoring and evaluation of the accreditation
process at the hospital.
2 METHODS
Literature search in major database such as
PROQUEST, SCIENCEDIRECT, MEDLINE, and
GOOGLE SCHOLAR with the key of case
management, quality, nursing service, systematic
review. The time limit used is July 2012 to
December 2017. From 1679 articles obtained, only
15 articles met the inclusion criteria. Inclusion
criteria of the article: RCT research design,
dependent variable of nursing service quality,
samples are health workers in the hospital, and the
parameters assessed are the intensity and quality of
case management implementation. We use the tools
CASP (Critical Appraisal Skills Programme) from
Public Health Resources Unit, UK to analyse the
article research and to select the articles that have
ethical approval.
From 15 literatures has been obtained various
impacts of case management implementation in
improving the quality of nursing service in various
aspects such as patient safety, pain and comfort
management, patient satisfaction level of service,
self care, patient anxiety, and behavior (knowledge,
attitude and skill) patients. Instruments used to
measure the implementation of case management
include questionnaires, checklist observation sheets,
and interview sheets. The most commonly used
instrument types are Nursing Case Manager (NCMs)
and Target Case Management (TCM).
3 RESULTS
Research conducted by Casey, et all 2016 on the
implementation of case management in emergency
cases. The study was conducted at 258 bed suburban
hospitals in California from February 2006 to
December 2014.
4 DISCUSSION
4.1 Patient Safety
The researchers identified 199 patients for 6 years or
more. The average patient visit repeated 16 times
during one year. After the implementation of case
management the patient visits repeatedly reduced
only 2 times in the 8th year. Case management can
effectively decrease repeated patient visits in
emergency cases. Implementation of case
management in this case aims to improve the
accuracy of patient identification which is the first
point of patient safety indicators.
4.2 Pain and Comfort Management
Research conducted by David, et all 2015 on the
implementation of case management in pediatric
cases in Ugandan hospitals. There were 30,351 data
analyzed and included in the inclusion criteria. From
the data obtained 92% included in the criteria
suspect malaria 81% have done by case
management, 32% using antibiotic treatment 89%
have done by case management, 30% included in the
criteria 38% have done by case management, 20%
included in the criteria suspect diarrhea have 18%
done by case management.
Significantly case management can effectively
manage the 4 cases of pediatrics by using distraction
techniques controlled by nurses in the child's room
to decrease pain and discomfort.
4.3 Patient Satisfaction Level of Service
A study conducted by Mark, et all 2016, data was
obtained from Amida Care, a special medical
services agency handling HIV located in New York.
The study found that 840,000 people in New York
who were infected with HIV had not been
INC 2018 - The 9th International Nursing Conference: Nurses at The Forefront Transforming Care, Science and Research
122

adequately handled due to financing problems and
patients' discomfort during treatment. With the quasi
experimental design of pre-existing group, from
2072 respondents in the period January 2011-
September 2012 by using billing system, Standard
Operational Procedure (SOP) and clinical pathway
HIV.
Based on the research, it was found that Target
Case Management (TCM) can decrease the
financing, discomfort and increase the satisfaction of
HIV patients by 73%.
4.4 Self Care
Research conducted by Francisco, et al 2014 on the
implementation of case management in handling
cases in patients with chronic diseases.
Observational and analytical cohort studies in
patients with multimorbidity. The instruments used
are Bartel Index and Caregiver Burden Index scores.
The results will be compared between nursing
service who done case management (62 patients)
and nurses who did not do it (193 patients).
Based on the research, it was found that there
were 255 patients (24.32% with management cohort
compared with 75.68% control cohort). The tools of
Hospital Case Manager can significantly increase
the level of patient satisfaction on health services
and decrease the level of dependence of patients so
that patients can gradually perform self-care
independently without the help of nurses.
4.5 Patient's Anxiety Level
Research has been done by Penelope, et all 2014 on
the implementation of case management in pediatric
patients with cases of pneumonia. A study of
perspective to determine the effect of Child Lung
Health Program (CHLP) on the severity of
pneumonia in infant and children. Implementation
was carried out during October, 1
st
, 2000 –
December, 31
th
, 2005 at 25 pediatric installations in
the Malawi region. Research data were compared in
the first 3 months of implementation and after
implementation.
During the implementation of data obtained
47.228 children in the hospital with the severity
level of heavy and very heavy in the range of 8-9%.
There was a significant association of CHLP effect
on children with the severity level of heavy in odd
ratio 0.70 (95% CI: 0.50-0.98); p = 0.036). There
was no significant correlation between CHLP effect
on children with very heavy in odd ratio 0.97 (95%
CI: 0.72-1.30); p = 0.8). The severity is affected by
the child's anxiety level during hospitalization. The
CHLP program implemented in the child's room can
decrease the anxiety of the child during
hospitalization so as can support the pediatric
treatment process with Pneumonia.
4.6 Patient's Behavior (Knowledge,
Attitude, and Skill)
Research conducted by Andjela, et all 2017 on the
implementation of case management in handling the
patient's repeated visits (readmission) Diabetes
Mellitus (DM). Researchers conducted a 30-day
restrospective analysis of readmission in DM
patients with the period July 2010 - December 2011.
After that in the period January 2012 - June 2013
have done the implementation of diabetes case
management. This data was obtained from 4472 RM
of patients returning at 18 months pre intervention
period and 32046 RM at 18 months post
intervention.
From the data in the level 30 days of DM
patient’s readmission significantly decreased from
20.1 (pre) to 17.6 (post), intervention (p<0.0001).
Patients who were followed up by the DM educator
had the lowest 30-day readmission rate (15% during
the study) approaching the non-DM patient
readmission level at the Nebrasca health center. The
DM nurse development program and the Diabetes
case manager effectively decrease the rate of
readmission. Patients monitored by DM educators
showed the lowest rates of readmission with
behavioral changes (knowledge, attitude, and skills)
to decrease the recurrence of symptoms in DM
patients.
5 CONCLUSION
Systematic reviews from 15 health journals show the
successful implementation of case management in
improving the quality of nursing services. Sixth
indicator quality of nursing service are patient
safety, pain and comfort management, patient
satisfaction level, self care, patient's anxiety, and
behavior (knowledge, attitude, and skill) of patient.
Implementation of case management can provide
positive support in hospitals to implement excellent
management and health care systems to minimize
complaints, lengthy ALOS, and expensive financing.
In the process of case management implementation
is expected to have good collaboration of all
elements in the hospital and provide a positive
impact on improving the quality of health services.
Implementation of Case Management to Increase Quality of Nursing Services: A Systematic Review
123

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Implementation of Case Management to Increase Quality of Nursing Services: A Systematic Review
125

APPENDIX
No Autho
r
Title Method Result
1 Glyn Elwyn
BA MB
BCh MSc
FRCGP
PhD, Meryl
Williams
BSc SRN
RM SP,
Catherine
Roberts BN
(Hons)
RGN,
Robert G
Newcombe
PhD CStat
FFPH,
Judith
Vincent BSc
Pharm
MRPharms
2008
Case
managemen
t by nurses
in primary
care:
analysis of
73 ‘success
stories’
Independent variable : Case
management
Dependent variable:
Primary health care system
This is a qualitative study,
undertaken as part of a wider
evaluation. The project was
designed by the Swansea
Local Health Board to
implement nurse case
management in primary care.
Case manager nurses were
allocated to five volunteer
practices and the work started
in April 2005. The aim of the
overall project was to reduce,
if possible, from an agreed
sample of practices, the
number of unplanned medical
admissions referred to the
Swansea NHS Trust’s group of
hospitals..
The total number of patients consented
and placed on case-management caseloads
was 121. This number represents the
overall caseload taken on by the five
nurses over the 12-month study.
From this overall caseload of 121
patients, 73 ‘success stories’ were
collected during the year, indicating that
the nurses felt they had made a significant
positive difference for over half the
patients on their caseloads.
1. Assessment and coordination of
care (35)
2. Diagnosis and coordination of care (29)
3. Admission to non-acute bed (5)
4. Terminal care facilitated (3)
Case management by nurses based in
primary care provides a type of care to
elderly patients. It is clear from these
accounts that the case-manager role is
regarded as enabling innovative nursing
practice to increase the satisfaction and
q
ualit
y
of health services..
2 Jee Young
Joo , PhD,
RN , and
Diane L.
Huber ,
PhD, RN,
NEA-BC,
FAAN
2014
Evidence-
Based Nurse
Case
Managemen
t Practice in
Community
Health
Independent variable : Nurse
Case Management
Dependent variable:
Community health
Nurse case management (CM)
practice with NCMs in
community-based settings.
The design of this study was
an exploratory, descriptive
secondary analysis of 4 types
of service by 11 NCMs,
delivered to selected Medicare
benefi ciaries in community
settings. Descriptive
statistics and ANOVA tests
were calculated.
The majority of CM services were
delivered in home care services in the
community. Most of the 4 types of
services are home, telephone, clinic, and
mixed care that positively changed
patients’ quality measure outcomes such
as self-care activities of daily life, quality
of life, and well-being. The results
contribute to understanding how
community health nurses may choose to
select home care interventions for
effectiveness.
3 Dwi
Kartikasari,
Aryo
Dewanto,
Fatchur
Rochman
2016
The Effect
of Health
Service
Quality to
Satisfaction
and Trust in
Bunda
Kandangan
Hospital,
Surabaya.
Independent variable : quality
of health service
Dependent variable:
Satisfaction and trust of
patients
Data were collected using
questionnaires. Questionnaires
were
given to patients in the
hospitalization unit of RSBK.
The sample of this study is 121
people. Data were analyzed by
Structural Equation Modeling
(SEM) with SPSS AMOS
software.
The study shows that service quality has a
direct and indirect effect on patients’ trust.
Service quality has indirect effects on
patient’s trust through patient satisfaction
as interviening variable. There is a
significant direct effect of service quality
on patients’ satisfaction, but there is no
significant indirect effect of service
quality on patients’satisfaction through
patients’ trust.
INC 2018 - The 9th International Nursing Conference: Nurses at The Forefront Transforming Care, Science and Research
126

4 Mark
Brennan-
Ing, Liz
Seidel,
Leslie
Rodgers,
Jerome
Ernst, Doug
Wirth,
Daniel
Tietz,
Antonio
Morretti,
Stephen E.
Karpiak
2016
The Impact
of
Comprehens
ive Case
Manageme
nt on HIV
Client
Outcomes
Independent variable :
Comprehensive Case
management
Dependent variable:
HIV client outcomes
Data were obtained from
Amida Care. Amida Care
operates not-for-profit
Medicaid and Medicare HIV
Special Needs Plans (SNPs),
providing managed care to
HIV-positive people in New
York City.
The Amida Care database
provides a consolidated source
of member and claims
information
which is permanently
maintained.
Data on all members receiving
TCM as determined by billing
and procedure codes were
extracted from the Amida Care
database to provide the
information for the analyses
described below (N = 2072),
from the start of the study
period (January 2011) to the
end of
the study period
(September, 2012).
The average age of the TCM sample was
48.0 years, 33% were women and 67%
were men.
Based on the research, TCM can reduce
cost of medicine, increase the patient’s
comfort and the satisfaction of HIV
patient in the range 73%.
5 David
Sears,
Arthur
Mpimbaza,
Ruth
Kigozi,
Asadu
Sserwanga,
Michelle A.
Chang,
Bryan K.
Kapella,
Steven
Yoon,
Moses R.
Kamya,
Grant
Dorsey,
Theodore
Ruel
2015
Quality of
Inpatient
Pediatric
Case
Manageme
nt for Four
Leading
Causes of
Child
Mortality at
Six
Government
-Run
Ugandan
Hospitals
Independent variable:
Pediatric Case magement
Dependent variable :
Four case management
categories were defined for
analysis: suspected malaria,
selected illnesses requiring
antibiotics, suspected anemia,
and diarrhea.
All children up to the age of
14 years admitted to six
district or regional hospitals
over 15 months were included
in the study.
A total of 30,351 admissions were
screened for inclusion in the analysis.
Ninety-two percent of children met
criteria for suspected malaria and 81%
received appropriate case management.
Thirty-two percent of children had
selected illnesses requiring antibiotics and
89% received
appropriate antibiotics. Thirty percent of
children met criteria for suspected anemia
and 38% received appropriate case
management. Twelve percent of children
had diarrhea
and 18% received appropriate case
management. Multivariable logistic
regression revealed
large differences in the quality of care
between health facilities. There was also a
strong association between a positive
malaria diagnostic test result and the odds
of receiving appropriate case management
for comorbid non-malarial illnesses-
children with a positive malaria test were
more likely to receive appropriate care for
anemia and less likely for illnesses
re
q
uirin
g
antibiotics and diarrhea.
6 Fransisco P
Garcia-
Fernandez,
Effect of
hospital
case-
Independent variable: hospital
case manager nurses
De
p
endent variable:
The study included 255 patients with
complex chronic disease (24·32% in
mana
g
ement cohort vs. 75·68% in control
Implementation of Case Management to Increase Quality of Nursing Services: A Systematic Review
127

Maria J
Arrabal-
Orpez,
Maria del
Carmen
Rodrigues-
Torres,
Carmen
Gila-Selas,
Issabel
Carrascosa-
Garcia, Juan
M Laguna-
Parras
Journal of
Clinical
Nursing,
2014
manager
nurses on
the level of
dependence,
satisfaction
and
caregiver
burden in
patients
with
complex
chronic
disease
Level of dependence,
satisfaction, and caregiver
An observational and
analytical cohort study was
undertaken in multimorbid
patients. Data were gathered
on Barthel Index and
Caregiver Burden Index
scores, primary care resource
consumption, readmission and
mortality rates, and patient
satisfaction with care and care
continuity. Results were
compared between nurse case-
managed (n = 62) and control
(n = 193) multimorbid patients
using univariate and bivariate
analyses.
cohort). The nurse case-managed group
had significantly lower Barthel Index and
higher Caregiver Burden Index scores and
a significantly longer hospital stay. At 90
days postdischarge, no significant
intergroup differences were observed in
Barthel Index or Caregiver Burden Index
scores, primary care resource
consumption, readmission rate or
mortality rate; the case-managed patients
showed a significantly higher satisfaction
level with their care and its continuity.
Nurse case management prevents a post
discharge increase in the dependence of
multimorbid patients and the burden of
their caregivers.
7 Andjela
Drincic,
Elisabeth
Pfeffer,
Jiangtao
Luo ,
Whitney S.
Goldner
2017
The effect
of diabetes
case
managemen
t and
Diabetes
Resource
Nurse
program on
readmission
s of patients
with
diabetes
mellitus
Independent variable: Diabetes
case management and
Diabetes Resource Nurse
Program
Dependent variable:
Readmission pasien DM
We performed retrospective
analysis of 30-day readmission
rates of patients with diabetes
before (July 2010–December
2011), and after (January
2012–June 2013) starting the
implementation
of this tiered inpatient diabetes
care delivery model.
We analyzed 34,472 discharged patient
records from the 18-month pre-
intervention period, and 32,046 records
from the 18-month post-intervention
period. The overall 30-day readmission
rate for patients with diabetes decreased
significantly from 20.1% (pre) to 17.6%
(post) intervention
(p < 0.0001). Patients seen by
diabetes educators had the lowest 30-day
readmission rates (15% during the whole
study), a rate approaching the overall
hospital readmission rates in those
without diabetes in our institution. The
Diabetes Resource Nurse program is
effective in decreasing readmission rates.
Patients seen by the diabetes educators
have the lowest rates of readmission.
8 Wiwin Nur
Aeni
Nursing
Department,
Health
Education
Institute,
Indramayu,
West Java,
Indonesia
2016
Pengemban
gan Case
Manager
dalam
Patient
Centered
Care
Independent variable: Case
Manager
Dependent variable:
Patient Centered Care
Systematic review to analysis
the development of case
manager towards the
fulfillment of the rights of
patients. This study used
critical appraisal method by
leveling the evidence based
nursing from proceeding,
thesis, dissertation, national as
well as international journals.
Case manager can meet patients' rights
through effective communication. Case
manager works closely with the patient so
that the maintenance time nurse to the
patient lasts a long time since the patient
came to the patient's home. Case manager
through its role in collecting and
organizing various data related to the
patient and treatment process which traces
the disease, needs, and the potential that
exists in the patient so that reconcile the
needs/expectations and patient
compliance.
9 Penelope M.
Enarson,
Robert P.
Gie3,
Charles C.
Mwansamb
o, Ellubey
R.
Reducing
Deaths from
Severe
Pneumonia
in Children
in Malawi
by
Improving
Independent variable:
Pneumonia case management
Dependent variable:
Rating of deaths from severe
pneumonia in children
A prospective, nationwide
public health intervention was
studied to evaluate the impact
Following implementation, 47,228
children were admitted to hospital for
severe/very severe pneumonia with an
overall CFR of 9,8%. In both analyses,
the highest CFR was in the children 2 to
11 months, and those with very severe
pneumonia. The majority (64%) of cases,
2
–
59 months, had severe pneumonia. In
INC 2018 - The 9th International Nursing Conference: Nurses at The Forefront Transforming Care, Science and Research
128

Maganga5,
Carl J.
Lombard6,
Donald A.
Enarson,
Stephen M.
Graham
2014
Delivery of
Pneumonia
Case
Manage
ment
on pneumonia specific case
fatality rate (CFR) in infants
and young children (0 to 59
months of age) following the
implementation of the CLHP.
The implementation was step-
wise from October 1st 2000
until 31st December 2005
within paediatric inpatient
wards in 24 of 25 district
hospitals in Malawi. Data
analysis compared recorded
outcomes in the first three
months of the intervention (the
control period) to the period
after that, looking at trend over
time and variation by calendar
month, age group, severity of
disease and region of the
country. The analysis was
repeated standardizing the
follow-up period by using only
the first 15 months after
implementation at each district
hospital.
this group there was a significant effect of
the intervention Odds Ratio (OR) 0,70
(95%CI: 0,50–0,98); p = 0,036), while in
the same age group children treated for
very severe pneumonia there was no
interventional benefit (OR 0,97 (95%CI:
0,72–1,30); p = 0,8). The nationwide
implementation of the CLHP significantly
reduced CFR in Malawian infants and
children (2–59 months) treated for severe
pneumonia.
10 Casey A.
Grover,
MD,
Elizabeth
Crawford,
BS, and Reb
J. H. Close,
MD
2016
The
Efficacy Of
Case
Managemen
t On
Emergency
Department
Frequent
Users: An
Eight-Year
Observation
al Study
Independent variable: case
management
Dependent variable:
emergency department case
This was an observational
study of ED usage conducted
at
a community hospital that has
an ED case management
program
in which frequent users of the
ED are enrolled and provided
with intensive care
management to reduce ED use.
The study was conducted at a
258-bed suburban hospital on
the West Coast, with an annual
ED census of approximately
50,000 patients per year. The
study was granted institutional
review board exemption by the
hospital committee
on research.
We identified 199 patients that were
enrolled for 6 or more years. Patients
averaged 16 visits per person per year in
the year prior to enrollment. Patients
averaged the following number of visits
per person per year after enrollment: year
1 (7.1), year 2 (4.1), year 3 (3.1), year 4
(3.3), year 5 (3.1), year 6 (2.0), year 7
(2.1), and year 8 (1.9), all statistically
significant compared to the year prior to
enrollment. Twenty-nine patients, despite
case management, continued their
frequent use, and required a revision to
their plan of care. Five patients required a
second revision to their plan of care
secondary to recurrent ED usage.
Persistent use despite case management
was primarily due to prescription
medication misuse and chronic pain.
Case management of ED frequent users
seems to be an effective means to reduce
ED usage in both the short and long term.
Patients with prescription drug misuse or
chronic pain may continue to demonstrate
frequent use despite case management,
and may require revisions to their plan of
care.
11 Wilson
Abreu,
Cristina
Barroso,
Maria de
Fátima
Segadães,
and Silvia
Promotion
of Self-Care
in Clinical
Practice:
Implications
for Clinical
Supervision
in Nursin
g
Independent variable: Clinical
supervision
Dependent variable:
Self care
This quantitative study was
developed in a hospital in the
North of Portugal. Participants
were 110
p
atients hos
p
italized
The test of hypothesis found significant
statistical differences (p<0.05) between
the interventions chosen by specialist
nurses and those of the medical records;
the hypothesis was, therefore, generally
confirmed. the quality of healthcare
provided by nurses
de
p
ends on their abilit
y
to have an im
p
act
Implementation of Case Management to Increase Quality of Nursing Services: A Systematic Review
129

Teixeira
2015
in a ward of the above-
mentioned hospital.
Two instruments were
used to collect data. The first
was a questionnaire focused on
self-care and was filled out by
rehabilitation nurses. The
second instrument evaluated
self-care as recorded in nurses’
electronic records filled during
the caring process.
on self-care.
12 Fery
Agusman
Mendrofa
1
,
Chatarina
U.
Wahyuni
3
,
Nursalam
2
,
Hasan
Machfoed
4
,
Kuntoro
3
,
Hari
Basuki
Notobroto
3
,
Rachmad
Hargono
3
,
Bagus
Widjonarko
5
2015
Independen
cy Models
of Nursing
Self-Care
for Ischemic
Stroke
Patient
Independent variable :
Independency models of self
care (self care and family
support)
Dependent variable :
Selfcare of ischemic stroke
patient
A cross-sectional survey
research design was used. Data
was collected with interviews
by home visited method. Data
were analyzed with
confirmatory analysis for
determined of validity and
reliability indicator, models
analyzed by SEM (Structural
Equation Model)
The study was conducted on
65 patients with stroke who
perform hospital clinical
visited at Panti Wilasa dr.
Cipto and general government
hos
p
ital of Semaran
g
.
Family support such as information,
instrumental, reward and emotion were
valid indicator for family support. Self
care indicators such as eat, bath, titivate,
dress, defecating, urination and transfer to
building of self-care. Indicators of eating,
bathing, titivate, dress, defecate, urination,
and transfer is an indicator for self care. It
could be concluded that eating, bathing,
ornate, dress, and the transfer is valid and
reliable. Model showed that self-care
needs were improved of self-carepatients
with through family support.
13 Ilkay
Culha
1
,
Nedime
Kosgeroglu
2
, Ozge
Bolluk
3
2016
Effectivenes
s of Self-
care
Education
on Patients
with Stomas
Independent variable: Self care
education
Dependent variable:
Patients with stoma
This intervention study was
carried out with 64 stoma
patients 32 of whom were
intervention group and 32 of
whom were control group at
one university research
hospital and two state hospitals
at Eskisehir in Turkey. After
stoma surgery, planned self-
care education was given to
intervention group, and control
group had routine service care.
After surgery, personal data
collection form and Self-Care
Agency Scale (SCAS) were
filled by both intervention and
control groups at 1 and 3
weeks later.
It was found that self-care agency scores
increased in both intervention and control
groups 3 weeks later and the increasing
extent in the intervention group was
higher than the control group (p<0.001).
Also there was found a positive
correlation between self-care agency and
stoma knowledge scores (r=0.466,
p<0.01) of intervention group. Education
may assist on self-care agency and stoma
knowledge of patients with stoma.
14 Esa Kurnia,
Dept.
Epidemiolo
gi FKM
Association
Between
Family
Support and
Independent variables in this
study were age, gender,
occupation, and family
support.
The study showed the majority of
respondent had a stroke aged 43–61 years,
male, and didn’t work. Most of
respondents got a good family support, so
INC 2018 - The 9th International Nursing Conference: Nurses at The Forefront Transforming Care, Science and Research
130

UNAIR
2016
Post-Stroke
Activity of
Daily Living
Autonomy
Dependent variable was ADL
independent of post-stroke.
This research included
observational studies, the
design of the study was cross-
sectional design. Fourty seven
respondents were involve
taken using simple random
sampling. Research was
conducted at the medical
rehabilitation of RSU Haji
Surabaya in June-
July 2015.
that respondents can be more autonomous
in activities. Based on analysis using Chi-
quare, there was an association between
family support and ADL independent of
post-stroke, p-value = 0.018 with α =
0.05, but there was no association
between age, sex and occupation with
ADL autonomy of post-stroke. It was
hoped that family create a calm situation,
and create activities that are beneficial to
the independence of the post-stroke.
15 Jonathan
Stokes,
Maria
Panagioti,
Rahul
Alam, Kath
Checkland,
Sudeh
Cheraghi-
Sohi1, Peter
Bower
2015
Effectivenes
s of Case
Managemen
t for 'At
Risk'
Patients in
Primary
Care: A
Systematic
Review and
Meta-
Analysis
Independent variable: Case
management
Dependent variable:
At Risk patients in Primary
Care We carried out a
systematic review and meta-
analysis of the effectiveness of
case management for ‘at-risk’
patients in primary care. Six
bibliographic databases were
searched using terms for ‘case
management’, ‘primary care’,
and a methodology filter
(Cochrane EPOC
group).
A total of 15,327 titles and abstracts were
screened, 36 unique studies were
included. Meta-analyses showed no
significant differences in total cost,
mortality, utilisation of primary or
secondary care. A very small significant
effect favouring case management was
found for self-reported health status in the
short-term (0.07, 95% CI 0.00 to 0.14). A
small significant effect favouring case
management was found for patient
satisfaction in the short- (0.26, 0.16 to
0.36) and long-term (0.35, 0.04 to 0.66).
Secondary subgroup analyses suggested
the effectiveness of case management
may be increased when delivered by a
multidisciplinary team, when a social
worker was involved, and when delivered
in a setting rated as low in initial
‘strength’ of primary care.
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131