THE PROBLEM: Caring for older adults with chronic conditions and complex health needs is becoming increasingly challenging.  Guided Care addresses the lack of an efficient, cost-effective way to respond to the needs of patients with either chronic illnesses or co-morbidities. Research shows that Guided Care reduces the use of expensive health services for chronically ill older adults.

THE SOLUTION: The Guided Care® model consists of a Guided Care nurse, based in a primary care office, working with 2 to 5 physicians and other care team members to provide coordinated, patient-centered, cost-effective health care to 50 to 60 of their chronically ill patients. Guided Care RNs are trained to coordinate care, monitor patients and teach patients and families self-management skills, including early identification of worsening symptoms that can be addressed before an emergency department or hospital admission becomes necessary. The RNs typically focus on Medicare beneficiaries in the top quartile of health risk.

Unlike most care/case management interventions, Guided Care focuses on the role of the Guided Care Nurse who is based in the primary care physician’s office, works with the patient long-term, provides intensive transitional care, and uses motivational interviewing to help patients manage their conditions. The Guided Care Nurse provides continuing education, resources, and support for family caregivers

OUTCOMES:

• Improves the quality of patient care
• Improves family caregivers’ perception of quality of care
• Produces high job satisfaction among Guided Care nurses
• Improves physicians’ satisfaction with chronic care
• May reduce the use of expensive services

This course is the only approved Guided Care Nurse training. 

GUIDED CARE NURSING CERTIFICATE: Nurses who complete this course will receive a Certificate in Guided Care Nursing from Johns Hopkins.

COURSE CONTENT: 20 core courses & 19 clinical courses- completely online! 

We have expert Guided Care nurses who can help you implement the Guided Care model.  Phone consultations or in-person education, follow up and support are available.  Contact us. 

"Like" our Guided Care Nurses Facebook page. Ask about group discounts.

The Guided Care Nursing course was developed in collaboration with the Johns Hopkins Bloomberg School of Public Health with support from the John A. Hartford Foundation.  It is endorsed by the National Gerontological Nursing Association and sponsored by SeniorBridge.

Learn how one organization saved 22 Million Dollars.  

For more information about Guided Care, see:

• Guided Care: A New Nurse-Physician Partnership in Chronic Care (book)
• Improving the Quality and Efficiency of Health Care for Older Americans,
  Dr. Chad Boult (video)​

Comments from past course participants:

• My department was developed around the Guided Care Model. I use the knowledge I gained in this class on a daily basis in my nursing practice.
• I am using the Motivation Interviewing techniques when I am coaching and monitoring my patients.
• The supplemental modules have helped tremendously when educating my patients and assessing their needs.
• My nursing team works directly with PCP, Internists and Pediatricians. I apply the GCN concepts when engaging with physicians and office staff, especially when primarily interacting telephonically with patients and physicians.
• I use the skills I learned every day. It helped me understand how to effectively communicate with patients when asking them questions.
• I am using a lot of motivational interviewing, the caregiver assessment, and have adapted the model to work with the population I manage.
• The idea of creating an action plan and care guide have been introduced to the providers here. We now have case conferences for our top complex cases and review as a team. From this meeting we solidify a plan of care that infuses the patients goals and priorities with the providers goals and priorities.
• The guided care course helped me to focus in on what I should be doing for my patients and how to direct them appropriately using motivational interviewing techniques. I have also run into situations where being aware of others' cultural differences has come into play.
• Loved the supplementals, and found them ALL very helpful, pertinent information.
• They [supplemental courses] were very helpful with educating my patients and the additional information that can be accessed through websites given.
• All the modules, were instrumental to give direction to my position, where it had none. We started this position with an ideal job description, putting it to practice would have been difficult without the GCN Course.
• This course was incredibly relevant to my work at that time. In fact I have since recommended it to care managers as a great training tool. It's a slightly different model, but the elements and components are still spot on to our work with patients in a PCMH.
• Motivation Interviewing will be helpful especially when coaching and monitoring my patients. Transitional care was very important to ensure our patients are receiving the care and resources they need.