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NURS FPX 4050 Assessment 3 Care Coordination Presentation to Colleagues JJ

NURS FPX 4050 Assessment 3 Care Coordination Presentation to Colleagues JJ

Care Coordination

Hello All, My name is Julian and today I am going to explain about the Care Coordination Process.

The policies and goals of the health care system keep on changing with the advent of new technologies and practical theoretical applications. People living with chronic disease often face the challenges of poor care coordination leading to morbidity and mortality. Health care organizations are the providers of coordinated care practices with the expertise of health care professionals. 

I will describe the basic rationale of care coordination and the strategies that can be used to implement the coordinated measures. The ethical implications for the nurses also entitle them to practice care coordination management for patient-centred outcomes. The main goal of care coordination is patient satisfactory health care measures.

NURS FPX 4050 Assessment 3 Care Coordination Presentation to Colleagues JJ

The National Quality Forum provides a concise description of the care coordination as the deliberate measures to provide safe, efficient and quality care to the patients according to the needs and preferences of the patients and their families with fulfilment of the community and health care services in time (Bower, 2016). Interprofessional collaboration is a major part of care coordination. The American Academy of Nursing (ANA) also emphasizes care coordination in the health care department (ANA). The care coordination emerges into sub themes of integrated care, patient/ family centred, organization, outcome-oriented and synchronization of the care (Gray et al., 2020). The model of care coordination also engages the communication across the health care settings, and interprofessional collaboration (Bruvik et al., 2017). The Affordable Care Act implemented by the U.S. Government also ensures care coordination services and provides insurance and reduced costs of the health care provisions (Cleveland et al., 2019). This affordable care act enables the nurses to provide innovative, transformational and coordinated care to the patients and also aims to reduce the expenses of the medication. The failure of care coordination causes high medical expenses with improper diagnosis, high rehospitalization rate, duplication of the medical tests and consumption of the hospital resources (Bower, 2016). 

Factors Influencing the Care Coordination

Now I will explain the factors influencing the care coordination. The multisectoral nature of the diseases requires multiple organs of the health to work together for patient-centred outcomes. The nurses are responsible for providing the health care measures. There are numerous factors, environmental, individual and organizational that affect the care coordination practice in the health care settings. Most common of them are the resource availability, willingness to participate, policy implementation, work overload, working environment and mistrust among the professionals. Other than these the individual motivation, knowledge and skill also affect the implementation of care coordination practices (Vargas et al., 2020). 

Effective Strategies for Collaborating 

I will now discuss effective strategies for collaborating with colleagues. The goal of care coordination is to provide patient-centred health outcomes with satisfactory care provisions. Numerous evidence-based strategies can be adapted at the health care setup to enhance the patient care continuum. Multiple health care coordination strategies are being sued to enhance patient satisfaction and outcomes. 

The provision of value-based invectives to nurses in the health care setting is a beneficial investment in terms of care coordination outcomes. The budgetary allocation and policies are perceived as initiatives of targeted patient-centred care (Galarraga et al., 2021). Affiliation of the health care organizations with the Accountable Care Organization (ACOs) poses a great capacity for collaboration for providing care continuum. It also extends its benefits to the payment arrangement (Anderson and Chen, 2019). The transitions of the care coordination measures should be safe and efficient for the patient. The medication reconciliation strategy can enhance the patient centred mediation safety. Specifically, patients with chronic diseases benefit from medication reconciliation and it also enhances medication adherence among them (Rangachari et al., 2019). 

NURS FPX 4050 Assessment 3 Care Coordination Presentation to Colleagues JJ

With the advancement of technology, using telemedicine is also a strategy that can be adapted for care coordination. It keeps the patient and the family in the loop with remote consultation and communication resources. It ensures the access of the patients to care practices and also enhances the confidence of the nurses or care providers in safe and efficient care practices (Cheng et al., 2019). The use of telemedicine can provide wide-scale interventions and care practices because of its easy access. The involvement of the nurses and the physicians and social workers in the health care programs improves the integration of the care services and continuum of care in older adults (Donelan et al., 2019). 

The implementation of the home-based telehealth programs for increasing monitoring, education, incorporating multidisciplinary professional coordination and enhancing self-management measures have been found to increase the functional status of the health with increased patient satisfaction. It also reduces the rate of rehospitalization (Somsiri et al., 2021). Medication errors because of the poor medication administration, prescription, calculation and reporting have been attributed as causing damage to care coordination. The Pharmacist led medication administration and dose calculation will reduce medication errors (Jaam et al., 2021). The post-discharge monitoring of the patients of the surgery and chronic diseases enhance patient safety, optimized recovery, medication adherence and reduce the rate of rehospitalization. The telemedicine-based post-discharge monitoring of knee and hip injury patients have been found to reduce rehospitalization and continuity of the care continuum (Mehta et al., 2020). 

NURS FPX 4050 Assessment 3 Care Coordination Presentation to Colleagues JJ

 The interprofessional collaboration of the physicians, pharmacists and nurses enhances medication adherence in diabetes care (Lakin et al., 2019). The pharmacist can enhance the nurses and physicians’ decision-making confidence related to the medication prescription. The errors of medication administration and prescription can be prevented. The pharmacist can provide a manual to the nurses which can serve as a standard to provide medication administration guidelines. 

The care coordination builds a trustworthy relationship with the patients enhances the patient’s safety and feeling of being respected (Peart et al., 2020). It builds a relationship with the professionals providing security and trust in the treatment measures. Person-centred care has been found promising in enhancing the care practices by the patients. 

The use of autophagy inducing drugs has been approved by the Federal Drug Authority (FDA) to autophagy the impaired nicotine exposed proteinesis in COPD patients. These autophagy drugs reduce the alveolar damage and decline of lung functions. In return, the drug has been ascribed to reduce COPD associated emphysema (Bodas and Vij, 2017).

Impact of Potential Health Policy on Outcomes 

Next is the Impact of Potential Health Policy on Outcome.I will use the example of smoking cessation for this purpose. Smoking cessation is the most important policy of reducing the lung function decline in COPD patients. Primary and secondary smoke both causes breathing problems among patients with respiratory diseases (Levin et al., 2021). Smoking cessation can reduce the costs and expenses on nonessential commodities because of the high governmental taxes on cigarette use. The use of electronic cigarettes has also been suggested for smoking cessation (Grundy et al., 2020). The policy has been implied to reduce the costs, provide better public health measures and increase the patient’s experience through the health care provisions. 

NURS FPX 4050 Assessment 3 Care Coordination Presentation to Colleagues JJ

The implementation of smoking cessation among COPD smoker patients improved lung functions in long-term management. It improves the breathing rate and prevents the frequency of exacerbation hospitalization among the patients (Cheong et al., 2018). The conversion of the patients to electronic cigarettes prevented some of the risks of COPD but complete cessation can improve the patient experience and quality of life (Polosa et al., 2020).

The logical implications of the smoking cessation policy are related to the increased amount of tobacco and nicotine in the body and atmosphere. Non-smoker COPD patients might have a high risk of inflammation response of the respiratory system to the triggers of cigarette smoke. Smoking has an impact on the phenotypic expressions of COPD as well as lead to the severity of the disease. It also reduces the quality of life of patients with different graded dyspnea and disease severity (Riesco et al., 2017).

The evidence-based literature entitles that the airways of the respiration are irritated by the smoke causing an increased cough and exacerbation of COPD (Gompertz et al., 2001). The blood of the patients having COPD exacerbation has increased biomarkers of the inflammation andIL-6 indicating a predictive value of triggered COPD (Oh et al., 2018).

Role of Nurses

Now I will explain the role of nurses in the whole scenario. Nurses are the stakeholder of change in the healthcare settings. They have diverse roles with diverse care coordination responsibilities. The sustainability of health care requires the resilience of health care professionals. The behavioural implications of a collaborative approach towards patient care and understanding the complex factors with coping capacity along with the community influences enhances the resilience of the healthcare professionals (Barratt, 2018). 

Nurses are also concerned with leading the coordinated care practices with the patients and other reactions. The integrated management of the disease reduces the risk of progression and enhances patient-centred outcomes (Bower, 2016). Nurses are also responsible for the medication administration so it enables them to play a key role in patient safety in the health care setting (Rohde and Domm, 2018). The role of nurses in ambulatory care with direct interaction with patients enhances the patient’s coordination and integration educational skills as well (Saunders et al., 2019). 

NURS FPX 4050 Assessment 3 Care Coordination Presentation to Colleagues JJ

The role of nurses in the coordination continuum of patients is very crucial. Nurses are directly responsible for providing the medication, care coordination, addressing the physiological and psychological issues of health. The American Nursing Association code of ethics implies that nurses have the moral duty to provide the multiple dimensions of the care continuum in primary care set up and post-discharge. 

Elements of Change Management 

Next is the elements of change management. The elements of change management that can provide efficient and quality care are integrated professional coordination, professional lead therapeutic measures and education and training of the nurses. Nurses are transformational leaders that bring change to health care organizations (Krepia et al., 2018). This requires the education, skill enhancement training of the nurses to provide the basic change in the organizational culture. The organizational practice of professional integration of care provides the int time diagnosis of the disease (Franck and O’Brien, 2019). An interprofessional post-discharge health care plan provides better care management and reduces the rehospitalization rate (Nguyen et al., 2018).  The pharmacist-led nurses training on medication administration and calculation reduces the medication errors and reduces costs for the hospital expenses (Abuzour et al., 2020).

The rationale for Coordinated Care Based on Ethical Decision Making

At the last I will explain about the rationale for Coordinated Care Based on Ethical Decision Making.  The health care providers are the stakeholder of change management at the health care department. The Nursing Code of ethics entitles the nurses to provide the care coordinated measures based on the safety, patient-centred and quality care standards (ANA, 2001). The 

The dilemmas of the ethical concerns of malpractice require the nurses to maintain the balance between accountability and responsibility. Patients are entitled to the confidentiality of the medical information provided to the nurses and the hospital organization (Shenoy and Appel, 2020). The nurses are under the ethical obligation to provide patient-centred care and make efforts to learn advanced care practices to provide better health care practices.

References

Abuzour, A.S., Lewis, P.J. and Tully, M.P. (2018). A qualitative study exploring how pharmacist and nurse independent prescribers make clinical decisions. Journal of advanced nursing74(1), pp.65-74.

Anderson, A.C. and Chen, J. (2019). ACO affiliated hospitals increase implementation of care coordination strategies. Medical care57(4), p.300.

Barratt, C., 2018. Developing resilience: the role of nurses, healthcare teams and organisations. Nursing Standard33(7), pp.43-49.

Bodas, M. and Vij, N. (2017). Augmenting autophagy for prognosis based intervention of COPD-pathophysiology. Respiratory research18(1), pp.1-8.

Bower, K.A. (2016). Nursing leadership and care coordination: creating excellence in coordinating care across the continuum. Nursing administration quarterly40(2), pp.98-102.

Bruvik, F., Drageset, J. and Abrahamsen, J.F. (2017). From hospitals to nursing homes–the consequences of the Care Coordination Reform. Sykepleien forskning12, p.60613.

Cheng, A., Guzman, C.E.V., Duffield, T.C. and Hofkamp, H. (2021). Advancing Telemedicine Within Family Medicine’s Core Values. Telemedicine and e-Health27(2), pp.121-123.

Cheong, C., Lee, T., Jang, S., Lee, B., Lee, Y. and Choi, N. (2018). PRS8-EFFECTS OF SMOKIMG CESSATION ON HEALTH OUTCOMES AMONG COPD PATIENTS IN SOUTH KOREA: 12 YEARS FOLLOW-UP. Value in Health21, p.S405.

Cleveland, K., Motter, T. and Smith, Y. (2019). Affordable care: harnessing the power of nurses. Online Journal of Issues in Nursing24(2).

NURS FPX 4050 Assessment 3 Care Coordination Presentation to Colleagues JJ

Donelan, K., Chang, Y., Berrett-Abebe, J., Spetz, J., Auerbach, D.I., Norman, L. and Buerhaus, P.I. (2019). Care management for older adults: The roles of nurses, social workers, and physicians. Health Affairs38(6), pp.941-949.

Franck, L.S. and O’Brien, K. (2019). The evolution of family‐centered care: From supporting parent‐delivered interventions to a model of family integrated care. Birth defects research111(15), pp.1044-1059.

Galarraga, J.E., DeLia, D., Wilhite, D., Romero-Barrientos, R., O’Sullivan, K., Noccolino, D., Pimentel, L., Woodcock, C., Fairbanks, R.J. and Pines, J.M. (2021). Emergency department care coordination strategies and perceived impact under Maryland’s hospital payment reforms. The American Journal of Emergency Medicine45, pp.578-589.

Gompertz, S., Bayley, D.L., Hill, S.L. and Stockley, R. (2001). Relationship between airway inflammation and the frequency of exacerbations in patients with smoking related COPD. Thorax, 56(1), pp.36-41.

Gray, L., Klein, N., Meuret, C., Nelson, L. and Stahlnecker, L. (2020). Care coordination: A principle of 21st century school nursing practice with a focus on case management. NASN School Nurse35(4), pp.219-223.

Grundy, E.J., Suddek, T., Filippidis, F.T., Majeed, A. and Coronini-Cronberg, S. (2020). Smoking, SARS-CoV-2 and COVID-19: A review of reviews considering implications for public health policy and practice. Tobacco induced diseases18.

Jaam, M., Naseralallah, L.M., Hussain, T.A. and Pawluk, S.A. (2021). Pharmacist-led educational interventions provided to healthcare providers to reduce medication errors: A systematic review and meta-analysis. PLOS ONE16(6), p.e0253588.

Krepia, V., Katsaragakis, S., Kaitelidou, D. and Prezerakos, P. (2018). Transformational leadership and its evolution in nursing. Progress in Health Sciences8, pp.185-190.

NURS FPX 4050 Assessment 3 Care Coordination Presentation to Colleagues JJ

Lakin, J.R., Benotti, E., Paladino, J., Henrich, N. and Sanders, J. (2019). Interprofessional work in serious illness communication in primary care: A qualitative study. Journal of palliative medicine22(7), pp.751-763.

Levin, S.R., Hawkins, S.S., Farber, A., Goodney, P.P., Osborne, N.H., Tan, T.W., Malas, M.B., Patel, V.I. and Siracuse, J.J. (2021). Association of state tobacco control policies with active smoking at the time of intervention for intermittent claudication. Journal of Vascular Surgery73(5), pp.1759-1768.

Mehta, S.J., Hume, E., Troxel, A.B., Reitz, C., Norton, L., Lacko, H., McDonald, C., Freeman, J., Marcus, N., Volpp, K.G. and Asch, D.A. (2020). Effect of Remote Monitoring on Discharge to Home, Return to Activity, and Rehospitalization After Hip and Knee Arthroplasty: A Randomized Clinical Trial. JAMA network open3(12), pp.e2028328-e2028328.

Nguyen, V., Sarik, D.A., Dejos, M.C. and Hilmas, E. (2018). Development of an interprofessional pharmacist-nurse navigation pediatric discharge program. The Journal of Pediatric Pharmacology and Therapeutics23(4), pp.320-328.

Oh, J.Y., Lee, Y.S., Min, K.H., Hur, G.Y., Lee, S.Y., Kang, K.H., Rhee, C.K., Park, S.J. and Shim, J.J., 2018. Difference in systemic inflammation and predictors of acute exacerbation between smoking-associated COPD and tuberculosis-associated COPD. International journal of chronic obstructive pulmonary disease13, p.3381.

Peart, A., Barton, C., Lewis, V. and Russell, G. (2020). A state‐of‐the‐art review of the experience of care coordination interventions for people living with multimorbidity. Journal of clinical nursing29(9-10), pp.1445-1456.

Polosa, R., Morjaria, J.B., Prosperini, U., Busà, B., Pennisi, A., Malerba, M., Maglia, M. and Caponnetto, P. (2020). COPD smokers who switched to e-cigarettes: health outcomes at 5-year follow up. Therapeutic Advances in Chronic Disease11, p.2040622320961617.

Rangachari, P., Dellsperger, K.C., Fallaw, D., Davis, I., Sumner, M., Ray, W., Fiedler, S., Nguyen, T. and Rethemeyer, R. (2019). A mixed-method study of practitioners’ perspectives on issues related to EHR medication reconciliation at a health system. Quality management in health care28(2), p.84.

Riesco, J.A., Alcázar, B., Trigueros, J.A., Campuzano, A., Pérez, J. and Lorenzo, J.L. (2017). Active smoking and COPD phenotype: distribution and impact on prognostic factors. International journal of chronic obstructive pulmonary disease12, p.1989.

NURS FPX 4050 Assessment 3 Care Coordination Presentation to Colleagues JJ

Rohde, E. and Domm, E. (2018). Nurses’ clinical reasoning practices that support safe medication administration: An integrative review of the literature. Journal of clinical nursing27(3-4), pp.e402-e411.

Saunders, R., Dugmore, H., Seaman, K., Singer, R. and Lake, F., 2019. Interprofessional learning in ambulatory care. The clinical teacher16(1), pp.41-46.

Shenoy, A. and Appel, J.M. (2017). Safeguarding confidentiality in electronic health records. Cambridge Quarterly of Healthcare Ethics26(2), pp.337-341.

Somsiri, V., Asdornwised, U., O’Connor, M., Suwanugsorn, S. and Chansatitporn, N. (2021). Effects of a transitional telehealth program on functional status, rehospitalization, and satisfaction with care in Thai patients with heart failure. Home Health Care Management & Practice33(2), pp.72-80.

Vargas, I., Eguiguren, P., Mogollón-Pérez, A.S., Bertolotto, F., Samico, I., López, J., De Paepe, P. and Vázquez, M.L. (2020). Understanding the factors influencing the implementation of participatory interventions to improve care coordination. An analytical framework based on an evaluation in Latin America. Health policy and planning35(8), pp.962-972.

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