In four of the five patient groups case management was the third most frequent category of
APN intervention. In the VLBW group, in which infants often received care in five or more
specialty clinics, case management was the second most frequent category of intervention.
The need for case management also shows the complexity of care needed by these high-risk
vulnerable patient groups. These patients often find management of their complex regimens
difficult and confusing, so the services of APNs help patients to make better use of the
available resources. APN skills in collaboration and in negotiating systems were critical. In
all groups, communication was the paramount intervention within the case management
category. This finding combined with the recognition that communication is basic to
assessment, surveillance, and health teaching underscores the critical nature of
communication skills in nursing.