title: Reflective practice: a framework for case manager development.
abstract: OBJECTIVE
  The role of a nurse case manager (NCM) incorporates practice that is built upon knowledge gained in other roles as well as components unique to case management. The concept of reflective practice was used in creating a framework to recognize the developmental stages that occur within community based case management practice. The formation of this framework and its uses are described in this article.
  
  
  METHODS
  The practice setting is a community based case management department in a large midwestern metropolitan health care system with Magnet recognition. Advanced practice nurses provide care for clients with chronic health conditions.
  
  
  CONCLUSIONS
  Twenty-four narratives were used to identify behaviors of community based case managers and to distinguish stages of practice. The behaviors of advanced practice found within the narratives were labeled and analyzed for similarities. Related behaviors were grouped and descriptor statements were written. These statements grouped into 3 domains of practice: relationship/partnership, coordination/collaboration, and clinical knowledge/decision making. The statements in each domain showed practice variations from competent to expert, and 3 stages were determined. Reliability and validity of the framework involved analysis of additional narratives. The reflective practice process, used for monthly case review presentations, provides opportunity for professional development and group learning focused on improving case manager practice. The framework is also being used in orientation as new case managers acclimate to the role.
  
  
  CONCLUSIONS
  Reflective writing has unveiled the richness and depth of nurse case manager practice. The depth of knowledge and skills involved in community-based case management is captured within this reflective practice framework. This framework provides a format for describing community based case manager practice development over the course of time and has been used as a tool for orientation and peer review.
authors.affiliation: Aurora Health Care's Community Based Case Management Department, Milwaukee, WI, USA. karen.brubakken@aurora.org
authors.forename: Karen
authors.initials: K
authors.lastname: Brubakken
authors.forename: Sara
authors.initials: S
authors.lastname: Grant
authors.forename: Mary K
authors.initials: MK
authors.lastname: Johnson
authors.forename: Cynthia
authors.initials: C
authors.lastname: Kollauf
mesh_terms: D057179:Advanced Practice Nursing / Q000379:methods*; D019090:Case Management; D003152:Community Health Nursing / Q000379:methods*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D024802:Nurse's Role; D010379:Peer Group; D036301:Qualitative Research; D015203:Reproducibility of Results; D014922:Wisconsin; D014956:Writing