VALVERDE JIMENEZ, María del Rosario et al. Nurse Case Manager Murcia Health Service: a year of program implementation. []. , 13, 36, pp.57-69. ISSN 1695-6141.

The objectives: of this paper are to describe the fundamental processes of the nurse case manager in a year of the program, to know the sociodemographic and clinical profile of the target population and the strain on the caregiver. Methodology: This observational, descriptive and transversal study has been made in the health area of Murcia IX from 1 June 2010 to 31 May 2011. It describes the process maps of the nurse case manager; patients are identified through OMI-AP software and CIVITAS. Home visits are conducted to measure the social and demographic patterns, to perform evaluation through M. Gordon functional patterns and to apply validated questionnaires. The number of people who enter into the program is 258 patients and 115 caregivers. The population with chronic obstructive pulmonary disease represents 22.9%; 63.9% of patients have made full assessment. Results: The functional pattern that measures activity and exercise is the most altered. Patients have a mean age of 74 ± 15 years. Women predominate in the overall target population 54.7%; 87.2% have some degree of dependence, there are a higher percentage of patients with severe dependence. The average age of caregivers is 59 ± 13 years, of which, 40 % of family caregivers are not overloaded. The target population represented 5.3% of the population more vulnerable. Since the introduction of case manager, registration of functional patterns in medical records of patients and caregivers has increased. The aging population is high, fragile, with a severe dependence level, preferably female, with family caregivers (women) without overloading conclusions.

: health manager; research; nursing care.

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