Introduction
NURS FPX 4050 Assessment 2 Ethical and Policy Factors in Care Coordination EN
Care Coordination is defined as,
“The deliberate organization of patient care activities between two or more participants involved in a patient’s care to facilitate the appropriate delivery of health care services”.
Care coordination is a function that ensures that a patient’s requirements and preferences for health care by facilitating efficient high-quality patient experience coordination improves the value of services supplied to patients (Karam et al 2021).
The purpose of this presentation is to examine how health-care legislation and government policies affect and change interprofessional collaboration. The lecture will also discuss how the integrity of nursing staff affects continuity and treatment interactions. The connection between personnel and the patients for whom they provide care is described by nursing ethics. Integrity is crucial in the administration and continuity of treatment of any medical union, particularly when it comes to exchanges between healthcare workers and patients. Through rules, money distribution, and how ways to handle public issues are devised, government initiatives have an impact on public group management and service integration .
Five Key Elements of Care Coordination
Numerous participants are typically involved in care coordination;
Coordination is necessary when participants are dependent upon each other to carry out different activities in a patient’s care;
In order to carry out these activities in a coordinated way, each participant needs adequate knowledge about their own and others’ roles, and available resources (Swan et al 2019).
Care Coordination is not a job of one person as said earlier. It involves group of people working together with an appropriate plan to achieve better health care outcomes. Care coordination’s purpose is to make it easier to deliver appropriate and efficient health care services both inside and across systems. Corrective measures will most likely be motivated by failures in coordination that harm the system’s financial performance.
A care coordinator (also known as a Patient Care Coordinator) is a qualified health worker who assists in the management of a patient’s care, such as the elderly or incapacitated. Patients’ treatment regimens are monitored and coordinated, and they are educated about their disease, connected with health care specialists, and evaluated. It has five key elements that are discussed in the current slide. Providing profound knowledge to the nurses and othe rmedical staff is extremely important for implementation of care-coordination.
Cont.
In order to manage all required patient care activities, participants rely on exchange of information; and
Integration of care activities has the goal of facilitating appropriate delivery of health care services.
Closing the Quality Gap: A Critical Analysis of Quality Improvement Strategies (Volume 7—Care Coordination) (www.ncbi.nlm.nih.gov/books/NBK44015)
The efficient operation of the company is contingent on excellent collaboration. Coordination ensures direction unity by arranging for spontaneous collaboration among several departments. It boosts the company’s and employees’ productivity. It boosts staff morale, improves job satisfaction, and reduces employee friction. It is a creative force, in the sense that it generates something new from the collective that is always superior to isolated or solo efforts. It fosters teamwork and creates a pleasant working environment. It prevents operations from being disrupted owing to omissions or incorrect assignment of responsibilities. It gets rid of contradictions in goals and policies. Therefore in any health sector, care cordination is extremely important in order to manage all the activities. In this respect the Quality improvement strategy was studied. A Critical Analysis of Quality Improvement Strategies for Closing the Quality Gap Quality issues and rising prices have sparked broad interest in measures to improve the health-care system’s efficacy and efficiency. The Institute of Medicine has suggested care coordination as one of the primary tools for potentially achieving these improvements. The goal of this project was to create a working definition of care coordination, apply it to a review of systematic reviews, and identify theoretical frameworks that could predict or explain how care coordination mechanisms are influenced by factors in the health care setting and how they relate to patient outcomes and costs. It was deduced that at the service delivery and system level, care coordination interventions cover a wide range of approaches. Their effectiveness is most likely contingent on the intervention and care coordination problem being properly matched, however further conceptual, empirical, and experimental research is needed to test this idea.
Affect of Government Policy on Coordination Care
The government must ensure that medical legislation and policies are implemented effectively.
The United States government’s healthcare program for those with chronic diseases or disabilities is known as nursing homes.
In the United States, more than one million individuals are served by nursing homes (National Center for Biotechnology Information, 2021).
The government must ensure that medical legislation and initiatives are effectively implemented in order to reduce the burden of diseases, illnesses, and accidents, among other things. Nursing Homes are a type of health-care facility run by the United States government for those who are disabled and unable to care for themselves. In the United States, roughly 1.5 million individuals are served by nursing homes, with the population expected to grow in the future (Zolotorofe et al., 2018). This policy, in conjunction with Health care Act, is critical in ensuring that people’ rights and lives are protected in the same way that other patients in hospital are protected (Rockwern et al., 2021).
Cont.
Care coordination is an action that falls within the category of a medical service operation.
The HIPPA Act allows healthcare providers to release any personal health information (PHI) contained in a patient’s medical record.
It’s exclusively for the purpose of transferring data for therapy (Qin. F, 2019)
HIPAA allows health care providers to share any protected health information (PHI) contained in a patient’s medical record with other health care providers for treatment, case management, and coordination of care, and it treats mental health information the same as other health information, with a few exceptions.The HIPAA Administrative Simplification Regulations include four standards covering transactions, identifiers, code sets, and operating rules. The Health Insurance Portability and Accountability Act (HIPAA) legislation implies that a nurse should share confidential information only with the direct care staff and those that the patient consents to inform.
Cont.
A violation of the ACA or HIPPA must be reported. Those who are responsible should always be held accountable.
Temporary housing residents have the right to get high-quality medical care.
Due to uncertain constraints, several HIPPA laws may prevent unified treatment
Some types of HIPAA violation are
Unauthorized Access.
Loss or Theft of Devices.
Sharing Information.
Accessing PHI from Unsecured Location Savage M. & Savage L, 2020)
The US Department of Health and Human Services Office for Civil Rights was informed in 2015 by media allegations that a health center in Florida had mismanaged protected health information (PHI), disclosing extensive personal and medical information about individuals.
The OCR probe unearthed some troubling information. The organization took four years to report that three boxes holding patient medical records had been misplaced. Its security was so lousy that one employee sold patient data for five years before being discovered.
The hospital system agreed to pay $2.15 million to settle HIPAA infractions, but restitution for medical ethics offences is more difficult.
The failure to conduct an organization-wide risk analysis to identify risks to the confidentiality, integrity, and availability of protected health information (PHI) and the failure to enter into a HIPAA-compliant business associate agreement are the most common HIPAA violations that have resulted in financial penalties.
Provisions at the Federal, State, and Local levels that Raise Ethical Concerns
Certain ethical issues connected to service administration pose difficulty for health practitioners.
Some efforts focus on finding care for underserved people.
Impovershied localites.
Integrated care involves a large number of organisations and
insurance schemes, all of which must be funded (Larkin et al 2019).
Case management is complicated by certain ethical issues for health practitioners linked to service administration (Twine et al, 2021). Some projects focus on finding care for underrepresented populations, such as homeless individuals and the poor, whose health-care costs have been a source of contention. Because delivering integrated care necessitates the funding of different organizations and insurance systems, this technique raises moral concerns. Supporting health-care expenditure is an issue that has to be addressed.
Cont.
Healthcare costs are rising despite the introduction of medications. Nursing Homes is a regional healthcare initiative. Home care facilities, according to Nursing Home, account for 20% of overall spending.
Organizations do not give adequate medical care to their employees. Professionals in the medical field should see the act of having access to significant therapy as ethical.
Living in a nursing home costs roughly $888 per week on average, compared to $704 per week in a residential home. The expenses vary depending on where you live in the United States, the type of care you require, and the provider you select.
Nursing homes charge extra because they provide a greater degree of care and can handle more complex conditions than a residential home.
Nursing home inhabitants require some form of nursing care, which necessitates additional personnel, facilities, equipment, and resources.
Cont.
The Patient Protection and Affordable Care Act (PPACA) has definitely raised ethical problems among collaborative care practitioners.
Its provisions are intended to limit the number of people who will be protected.
Certain homeless persons, especially those without health insurance, continue to be discriminated against when it comes to receiving quality care.
As a result, community centre care services and standards of care are questioned and compromised.
The Affordable Care Act (ACA), also known as the Patient Protection and Affordable Care Act, became law on March 23, 2010. President Barack Obama signed in the ACA. It is informally known as Obamacare. The ACA aimed to ensure that more people had more health insurance coverage in the United States. The groundbreaking Patient Protection and Affordable Care Act (ACA) compels nurses to continue innovation, transformational leadership, and care coordination as major stakeholders in provision of the next generation of cost containment, quality advances, and patient access improvements.
NURS FPX 4050 Assessment 2 Ethical and Policy Factors in Care Coordination EN
Code of Ethics of Nurses and the Coordination and Continuum of Care
The American Nurses Association formally adopted the Code of Ethics for Nurses in 1950. There are four principles of ethics:
autonomy in nursing,
beneficence in nursing,
justice in nursing and
nonmaleficence in nursing
The goal of the ANA Code of Ethics for Nurses is to: It is a concise description of every individual who enters the nursing profession’s ethical commitments and duties. It is a non-negotiable ethical norm for the profession. It is a reflection of nursing’s own sense of its social responsibilities.
Registered nurses’ contributions to care coordination have long been regarded as a professional requirement. It’s what nurses are trained to do. It’s something we’ve always done. RNs make coordinated care feasible by making care plans based on patients’ needs and choices, educating patients and their families at discharge, and doing their utmost to support continuity of care for patients across venues and providers. Nursing: Scope and Standards of Practice, Third Edition, assists nurses in the application of their professional knowledge, skills, and duties, while state law, rules, and regulations govern the practise of nursing.
Cont.
Make every effort to provide for those entrusted to his or her care.
In accordance with the legislation, manage, direct, and administer the institution.
In accordance with the law and professional norms
All long-term health care administrators must maintain the highest standards of integrity and ethical principles in order to successfully fulfil their professional responsibilities. The American College of Health Care Administrators (ACHCA) has issued this Code of Ethics in an effort to highlight the core standards that are regarded necessary to this basic aim. Members must strive to avoid not only conduct that is expressly prohibited by the code, but also behavior that is inconsistent with its spirit and purpose.
The absence of any specific obligation or activity from this Code of Ethics should not be interpreted as a denial of other responsibilities or practises. Recognizing that the ultimate duty for upholding and enforcing norms and ethics remains with the individual.
NURS FPX 4050 Assessment 2 Ethical and Policy Factors in Care Coordination EN
Cont.
Maintain the privacy of information about specific recipients of care.
Carry out administrative responsibilities with personal integrity, earning the public’s confidence, trust, and respect.
Take the necessary precautions to avoid racism-based prejudice (MacCarthy 2020).
Raising general public awareness of racial and ethnic inequities in health care. In publicly sponsored health plans, strengthen patient-provider interactions. Apply the same managed care safeguards to public-sector HMO members as they do to private-sector HMO members.
Genetics, access to care, poor quality of care, community characteristics (e.g., inadequate access to healthy foods, poverty, limited personal support systems, and violence), environmental conditions (e.g., poor air quality), language barriers, and health behaviours are all factors that contribute to health disparities.
Health-Care Racism Prevention Strategies
Examining institutional policies through the viewpoint of equity.
Establishing accountability frameworks such as equity scorecards.
Examining medical school curricula for inaccuracies on race.
Examining clinical algorithms that erroneously use race as a factor.
NURS FPX 4050 Assessment 2 Ethical and Policy Factors in Care Coordination EN
Conclusion
Different communities’ activities are directed by national policies.
The approach allows insurance to pay healthcare expenses, allowing for better coordination.
Nursing staff are expected to be accountable for their actions, according to the ANA ethics code.
National policy initiatives have a significant impact on care management in health system.
Concluding, ethical issues are increasingly being reported by care-providers; however, little is known about the nature of these issues within the nursing home. Ethical issues are unavoidable in healthcare and can result in opportunities for improving work and care conditions; however, they are also associated with detrimental outcomes including staff burnout and moral distress.
References
Karam, M., Chouinard, M. C., Poitras, M. E., Couturier, Y., Vedel, I., Grgurevic, N., & Hudon, C. (2021). Nursing care coordination for patients with complex needs in primary healthcare: A scoping review. International journal of integrated care, 21(1).
Swan, B. A., Haas, S., & Jessie, A. T. (2019). Care coordination: Roles of registered nurses across the care continuum. Nursing Economics, 37(6), 317-323.
Qin, F. (2019). The Debilitating Scope of Care Coordination Under HIPAA. NCL Rev., 98, 1395.
References
Savage, M., & Savage, L. C. (2020). Doctors routinely share health data electronically under HIPAA, and sharing with patients and patients’ third-party health apps is consistent: interoperability and privacy analysis. Journal of medical Internet research, 22(9), e19818.
Larkin, M. E., Beardslee, B., Cagliero, E., Griffith, C. A., Milaszewski, K., Mugford, M. T., … & Witte, E. R. (2019). Ethical challenges experienced by clinical research nurses:: A qualitative study. Nursing Ethics, 26(1), 172-184.
McCarthy, E. P., Ogarek, J. A., Loomer, L., Gozalo, P. L., Mor, V., Hamel, M. B., & Mitchell, S. L. (2020). Hospital transfer rates among US nursing home residents with advanced illness before and after initiatives to reduce hospitalizations. JAMA internal medicine, 180(3), 385-394.
