CHAPTER 1

History and Evolution of The Nurse LifeCare Planning Specialty

Anne Sambucini, RN, CCM, CDMS, CNLCP, MSC-C

Nursing continues to evolve, expanding into new rolesand offering numerous opportunities for growth. Nursespioneering new and expanded roles make nursing roles evenmore dynamic. Nurse life care planning, planning care for thelifetime needs of an individual, is relatively new; projectingmedical needs and associated costs for a lifetime are new andexciting expansions of older concepts (Lance, 2012).

The American Nurses Association's Nursing Scope andStandards of Practice (ANA, 2010), builds on previous nursingdevelopment and provides the following definition of nursing:

Nursing is the protection, promotion, andoptimization of health and abilities, prevention ofillness and injury, alleviation of suffering throughthe diagnosis and treatment of human response,and advocacy in the care of individuals, families,communities, and populations (ANA, 2010).

Definition of Nurse Life Care Planning

Expanding on the ANA's Scope and Standards ofPractice, the American Association of Nurse Life Care Planners(AANLCP) defines nurse life care planning in this way:

The specialty practice in which the nurse life careplanner utilizes the nursing process for the collectionand analysis of comprehensive client-specific datain the preparation of a dynamic document. Thisdocument provides an organized, concise planthat estimates for reasonable and necessary (andreasonably certain to be necessary) current andfuture healthcare needs with the associated costsand frequencies of goods and services. The nurselife care plan is developed for individuals who haveexperienced an injury or have chronic healthcareissues. Nurse life care planners function withintheir individual professional scope of practice and,when applicable, incorporate opinions arrived uponcollaboratively with various health professionals. Thenurse life care plan is considered a flexible documentand is evaluated and updated as needed (AANLCP,2008).

NLCPs formulate life care plans by using the nursingprocess, collecting and analyzing comprehensive, client-specificdata, and coordinating care in a variety of healthcare settings.Nurse life care planners function within their individualprofessional scopes of practice, and, when applicable,incorporate opinions arrived at by collaboration with varioushealthcare providers.

Actual implementation of recommendedinterventions in the life care plan is delegated to thenurse case manager, who also helps identify whenthe life care plan needs to be updated. Updated needswill trigger a referral to a nurse life care planner forre-evaluation of the life care plan (AANLCP, 2012).

The National League of Nurses defines critical thinkingin nursing practice as "a discipline-specific, reflective reasoningprocess that guides a nurse in generating, implementing,and evaluating approaches for dealing with client care andprofessional concerns" (NLN, 2011). When critical thinking isused in nursing, it is called the nursing process. The practicerole of the NLCP uses the nursing process to develop a planof care for the injured or chronically ill person's lifetimethroughout the continuum of healthcare in multiple settings.

Professional nurses' extensive education and wealthof experience are excellent preparation for nurse life careplanning. Nurses complete a thorough assessment of anindividual's physical, functional, emotional, and spiritualneeds, and collaborate as members of the healthcare team.Nurses' extensive knowledge base includes pharmacology,rehabilitation, orthopedics, pediatrics, and medical-surgicalnursing, as well as coordination of care, utilization review ofcosts, and medical coding. Working knowledge of all theseareas is needed in nurse life care planning.

Evolution of Nurse Life Care Planning

The nurse's role in coordinating care and services beganin the early 1900s with the advent of privately funded homenursing for the poor. In the early 1900s, Lillian Wald promotedthe term "public health nurse," expanding nursing practiceto encompass employment, recreation, health education,and sanitation. Visiting nurses used community-basedcoordination, which was further developed by publicly fundedhealth nursing in the 1930s. By the 1940s, the insuranceindustry was using case management as a method of costcontainment (CMSA, 2008). During World War II, industry usedcase management nurses to help maintain a healthy workforcefor the war effort.

Care planning in nursing advanced further in 1961 withthe identification of the nursing process by Ida Jean Orlando.As care planning has evolved, so have its purpose and tools.Case management roles expanded as early as 1966, whennurses began adding budget planning to coordinating care andservices.

In the mid-1970s, Paul Deutsch first identified theterm "Life Care Planning," referring to future needs, todescribe a tool to project the costs of medical care in thelitigation environment. In Damage in Tort Action (1981),Deutsch referenced case management, catastrophic disabilitycase management, and catastrophic disability research asmeans to project future medical care (Deutsch, 2011). Thiswas introduced to the healthcare industry in 1985 in hisGuide to Rehabilitation in short seminars and, later, a definedcurriculum. Numerous professionals, including nurses,continue to learn and adapt this methodology.

In 1997, the discipline of nurse life care planning(NLCP) began when Kelly Lance, MSN, RN, CNLCP, LNCP-C,FNP-BC, recognized that a registered nurse's multidimensionalhealthcare education combined with...