Care Coordination Presentation Paper

Care Coordination Presentation Paper

Care Coordination Presentation Paper

Hello colleagues. My name is Emily Nathan. I take this chance to welcome you to this presentation, where I will discuss care coordination. The objective of this presentation is that nurses understand the fundamental principles of effective care coordination. Effective care coordination is a fundamental part of interdisciplinary and inter-professional teams. Patients require holistic, evidence-based practice and patient-centric care to attain healthcare goals (Cleveland et al., 2017). Collaboration with their families and other providers is critical to ensuring that nurses offer evidence-based practice care to enhance quality outcomes. Nurses need to know factors that influence care coordination and continuum of care by deploying community resources efficiently. They must also adhere to recommended ethical frameworks that mirror their professionalism in care coordination.

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Effective Collaboration Strategies with Patients to Attain Desired Outcomes

Care coordination is a fundamental component of effective care delivery and quality patient outcomes as it entails taking action and sharing information with professional colleagues to provide better care. Coordination involves collaboration among different professionals in the healthcare system or setting. Coordination requires identifying patients, communicating health issues effectively and efficiently, and a common approach by all involved based on set goals and objectives (Tonnessen et al., 2017). The implication is that as nurses, you are obliged to understand effective strategies to enhance desired patient outcomes. The first strategy is effective planning among healthcare providers for the success of the care coordination model. Proper planning ensures that all key and critical care coordination features are identified. Planning includes identifying time issues, the contribution from the team members, better coordination, and formulation of a common objective among the providers to enhance patient outcomes.

Secondly, including patients and their families is a vital component of coordinated care. Patients are central to the care process, and their inclusion demonstrates the need for cultural competency and patient-centered care delivery. Inclusion ensures that nurses know cultural matters that may hinder or promote better care delivery (Kominski et al., 2017). The implication is that cultural competency strategy is a critical approach that allows providers to understand patients and their environment. Cultural competency ensures that nurses understand patients’ cultural backgrounds to appreciate their needs and have a good idea of care provision. For instance, individuals come from diverse backgrounds and cultures, and it is essential to appreciate their values and beliefs for better care provision. Therefore, healthcare workers must note these aspects as necessary in care provision to patients.

The third strategy is effective communication. Communication requires nurses and other professionals in the team to develop therapeutic interactions with patients to understand their needs. Effective communication ensures that an inter-professional team overcomes barriers to offer the best care. Communication allows providers in the team to nurture therapeutic interactions with patients and their families. Educational interventions can only enhance the attainment of desired outcomes through better communication. For instance, nurses need to possess practical communication skills to educate patients and their families about managing their conditions and how to promote recovery. For instance, to prevent blood clots in patients, nurses can educate the family about management strategies like blood thinners. However, ambulating the patient promotes better circulation. Therefore, a nurse can suggest and help patients ambulate while the family can reinforce the task by ambulating when they visit the patient. All these can happen through effective communication.

Aspects of Change Management

Change in healthcare impacts providers at various levels, from physicians dealing with reimbursement models to workflows and enhanced patient satisfaction. Managing change is essential to enhancing care coordination and quality patient outcomes. Aspects of change management like increased technology interoperability and new care models like value-based care affect patient satisfaction levels. The coordination team must know such changes. For instance, technology is a leading factor contributing to changes in the healthcare industry. The use of digital medical records through electronic health records (EHRs), deployment of telehealth and telemedicine aims to enhance care coordination, patient outcomes, and overall quality of care among providers and organizations. Electronic health records (EHRs) are a digital format of a patient’s medical history and allow physicians and nurses to offer better care since they can share information in different settings through a connected network to enhance interoperability (Salmond & Echevarria, 2017). Using EHRs allows physicians to get data on patients’ demographics, nurse assessment, medications and allergies, vital signs, and notes from other providers. The implication is that care coordination requires increased embracement of new models like value-based care that emphasizes quality and not quantity offered.

Changes in policy, especially in reimbursement as developed by Centers for Medicare and Medicaid Services (CMS), implore nurses and members of care coordination to align their plans of care to comply with legal frameworks. For instance, CMS reimburses organizations and providers based on quality care offered and measured outcomes. Patients need better care coordinated to offer positive feedback and allow organizations to enhance their care plans in the long term. Therefore, embracing change through frameworks like value-based care, cultural competency, digital technologies, and patient-centered care as advanced by evidence-based practice interventions is essential for better care coordination.

Rationale for Coordinated Care Plans

Nurses face ethical dilemmas due to the fast-changing nature of healthcare provision. Ethical frameworks like biomedical principles implore nurses and other healthcare providers to develop a common approach to care to enhance adherence to existing codes of ethics and avoid potential legal consequences of their actions. Ethical principles create a set of practice standards that help nurses to make informed decisions and choices when evaluating the effects of their actions. Therefore, coordinated care plans are a fundamental aspect of addressing such issues (Salmond & Echevarria, 2017). Coordinated care plans ensure that patients enjoy its four elements: access to providers, effective communication, patient-centered individualized care, and a clear understanding of the importance of the plan. The implication is that coordinated care plans place patients at the center of all efforts and actions. Coordinated care plans ensure that all providers have a common goal and incorporate patients to deliver quality care services.

Underlying assumptions that may influence decision-making in coordinated care plans include the need for nurses to adhere to the code of conduct and ethics as developed by professional organizations like the American Nurses Association (ANA) (Golden et al., 2017). Therefore, care coordination assumes that patients and providers share information and apply principle models like transition and introduction to the healthcare team. Sharing information must be both ways for adequate care. The team should also be aware of the critical steps to enhance overall coordination. For instance, all parties involved should understand each step and the projected implementation when developing a plan. Again, in coordinated care plans, the team must identify the underlying values and a model that illustrates professional responsibility among the members.

Potential Impact of Specific Health Care Policy Provision

Health care policy provisions have critical effects on outcomes and patient experiences. Policies that mandate increased access, affordable and quality care enhance outcomes as they demonstrate the need for coordinated care plans among providers and organizations. For instance, the enactment of the Affordable Care Act in 2010 has had a significant impact on patient experiences and outcomes. The policy aims to improve the quality of care, lower the cost of care, and enhance accessibility. These provisions mean that organizations and providers can only enhance their ability to meet the policy requirements through coordinated care plans (Crowley et al., 2019). The expansion of Medicaid ensures that patients can have better outcomes and experiences since their medical insurance can cover their expenses. Secondly, the restructuring of Medicare plans and increased emphasis by CMS on value-based care imply that providers must embrace coordinated care plans to offer individualized patient-centered care for better outcomes and patient experience (Cleveland et al., 2019). Today, individuals with preexisting conditions and over 20 million Americans attained increased access to healthcare through policies like the ACA and value-based models.

Nurses’ Vital Role in Coordination and Care Continuum

Nurses are at the center of care provision for patients. Nurses also link patients and other healthcare providers like physicians because of their close interactions. Imperatively, effective coordination of the care continuum rests mainly with nurses (Shrank et al., 2021). As patient advocates, they ensure that other professionals like physicians address their needs. Nurses assess patients and recommend specific interventions to physicians to enhance care outcomes and experience. Therefore, their role in coordination cannot be overemphasized (Cleveland et al., 2019). As patient advocates, change agents, and transformational leaders, nurses, take the frontline role to develop care plans that are patient-centered, inter-professional in their outlook and focus on enhancing the overall patient experience.

Conclusion

Care coordination is essential to enhance overall satisfaction levels and ensure that patients get quality outcomes. Frameworks like ACA and value-based models implore nurses and other providers to coordinate care plans to enhance overall patient care quality outcomes and satisfaction. This presentation shows that nurses and other healthcare providers can offer better care, adhere to existing ethical and legal requirements by embracing coordinated care plans.

References

Cleveland, K.A., Motter, T., Smith, Y., (May 31, 2019) “Affordable Care: Harnessing the Power

of Nurses” OJIN: The Online Journal of Issues in Nursing Vol. 24, No. 2, Manuscript 2. DOI: 10.3912/OJIN.Vol24No02Man02

Crowley, R. A., Bornstein, S. S., & Health and Public Policy Committee of the American

College of Physicians. (2019). Improving the Patient Protection and Affordable Care Act’s insurance coverage provisions: a position paper from the American College of Physicians. Annals of internal medicine, 170(9), 651-653. https://doi.org/10.7326/M18-3401

Golden, R. L., Emery‐Tiburcio, E. E., Post, S., Ewald, B., & Newman, M. (2019). Connecting

social, clinical, and home care services for persons with serious illness in the community. Journal of the American Geriatrics Society, 67(S2), S412-S418. DOI: 10.1111/jgs.15900.

Kominski, G. F., Nonzee, N. J., & Sorensen, A. (2017). The Affordable Care Act’s impacts on

access to insurance and health care for low-income populations. Annual review of public health, 38, 489-505. DOI: 10.1146/annurev-publhealth-031816-044555

Salmond, S. W., & Echevarria, M. (2017). Healthcare transformation and changing roles for

nursing. Orthopedic nursing, 36(1), 12-25. DOI: 10.1097/NOR.0000000000000308

Shrank, W. H., DeParle, N. A., Gottlieb, S., Jain, S. H., Orszag, P., Powers, B. W., & Wilensky,

242. R. (2021). Health Costs and Financing: Challenges and Strategies for A New Administration: Commentary recommends health cost, financing, and other priorities for a new US administration. Health Affairs, 40(2), 235-242. https://doi.org/10.1377/hlthaff.2020.01560

Tonnessen, S., Ursin, G. & Brinchmann, B. S. (2017). Care managers professional choices:

ethical dilemmas and conflicting expectations. BMC Health Services Research, 17(630). DOI: 10.1186/s12913-017-2578-4.

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Assessment 3 Instructions: Care Coordination Presentation to Colleagues

Top of Form

Bottom of Form

• Develop a 20-minute presentation for nursing colleagues highlighting the fundamental principles of care coordination. Create a detailed narrative script for your presentation, approximately 4-5 pages in length, and record a video of your presentation.

Introduction

Nurses have a powerful role in the coordination and continuum of care. All nurses must be cognizant of the care coordination process and how safety, ethics, policy, physiological, and cultural needs affect care and patient outcomes. As a nurse, care coordination is something that should always be considered. Nurses must be aware of factors that impact care coordination and of a continuum of care that utilizes community resources effectively and is part of an ethical framework that represents the professionalism of nurses. Understanding policy elements helps nurses coordinate care effectively.

This assessment provides an opportunity for you to educate your peers on the care coordination process. The assessment also requires you to address change management issues. You are encouraged to complete the Managing Change activity.

Completing course activities before submitting your first attempt has been shown to make the difference between basic and proficient assessment.

Preparation

Your nurse manager has been observing your effectiveness as a care coordinator and recognizes the importance of educating other staff nurses in care coordination. Consequently, she has asked you to develop a presentation for your colleagues on care coordination basics. By providing them with basic information about the care coordination process, you will assist them in taking on an expanded role in helping to manage the care coordination process and improve patient outcomes in your community care center.

To prepare for this assessment, identify key factors nurses must consider to effectively participate in the care coordination process.

You may also wish to:

• • Review the assessment instructions and scoring guide to ensure you understand the work you will be asked to complete.
  • Allow plenty of time to rehearse your presentation.

Note: Remember that you can submit all, or a portion of, your draft presentation to Smarthinking Tutoringfor feedback, before you submit the final version for this assessment. If you plan on using this free service, be mindful of the turnaround time of 24-48 hours for receiving feedback.

Recording Equipment Setup and Testing

Check that your recording equipment and software are working properly and that you know how to record and upload your presentation. You may use Kaltura (recommended) or similar software for your audio recording. A reference page is required. However, no PowerPoint presentation is required for this assessment.

Instructions

Complete the following:

• • Develop a video presentation for nursing colleagues highlighting the fundamental principles of care coordination. Include community resources, ethical issues, and policy issues that affect the coordination of care. To prepare, develop a detailed narrative script. The script will be submitted along with the video.

Note: You are not required to deliver your presentation.

Presentation Format and Length

Create a detailed narrative script for your video presentation, approximately 4-5 pages in length. Include a reference list at the end of the script.

Supporting Evidence

Cite 3-5 credible sources from peer-reviewed journals or professional industry publications to support your video. Include your source citations on a references page appended to your narrative script. Explore the resources about effective presentations as you prepare your assessment.

Grading Requirements

The requirements outlined below correspond to the grading criteria in the Care Coordination Presentation to Colleagues Scoring Guide, so be sure to address each point. Read the performance-level descriptions for each criterion to see how your work will be assessed.

• • Outline effective strategies for collaborating with patients and their families to achieve desired health outcomes.
    • Provide, for example, drug-specific educational interventions, cultural competence strategies.
    • Include evidence that you have to support your selected strategies.
  • Identify the aspects of change management that directly affect elements of the patient experience essential to the provision of high-quality, patient-centered care.
  • Explain the rationale for coordinated care plans based on ethical decision making.
    • Consider the reasonable implications and consequences of an ethical approach to care and any underlying assumptions that may influence decision making.
  • Identify the potential impact of specific health care policy provisions on outcomes and patient experiences.
    • What are the logical implications and consequences of relevant policy provisions?
    • What evidence do you have to support your conclusions?
  • Raise awareness of the nurse’s vital role in the coordination and continuum of care in a video-recorded presentation.
    • Fine tune the presentation to your audience.
    • Stay focused on key issues of import with respect to the effects of resources, ethics, and policy on the provision of high-quality, patient-centered care.
    • Adhere to presentation best practices.

Additional Requirements

Submit both your presentation video and script. The script should include a reference page. See Using Kaltura for more information about uploading multimedia files. You may submit the assessment only once, so be sure that both assessment deliverables are included.

Portfolio Prompt: Save your presentation to your ePortfolio. Submissions to the ePortfolio will be part of your final Capstone course.

Competencies Measured

By successfully completing this assessment, you will demonstrate your proficiency in the course competencies through the following assessment scoring guide criteria:

• • Competency 2: Collaborate with patients and family to achieve desired outcomes.
    • Outline effective strategies for collaborating with patients and their families to achieve desired health outcomes.
  • Competency 3: Create a satisfying patient experience.
    • Identify the aspects of change management that directly affect elements of the patient experience essential to the provision of high-quality, patient-centered care.
  • Competency 4: Defend decisions based on the code of ethics for nursing.
    • Explain the rationale for coordinated care plans based on ethical decision making.
  • Competency 5: Explain how health care policies affect patient-centered care.
    • Identify the potential impact of specific health care policy provisions on outcomes and patient experiences.
  • Competency 6: Apply professional, scholarly communication strategies to lead patient-centered care.
    • Raise awareness of the nurse’s vital role in the coordination and continuum of care in a video-recorded presentation.

 

Care Coordination Presentation to Colleagues Scoring Guide

CRITERIA	NON-PERFORMANCE	BASIC	PROFICIENT	DISTINGUISHED
Outline effective strategies for collaborating with patients and their families to achieve desired health outcomes.	Does not outline strategies for collaborating with patients and their families to achieve desired health outcomes.	Attempts to outline strategies for collaborating with patients and their families to achieve desired health outcomes.	Outlines effective strategies for collaborating with patients and their families to achieve desired health outcomes.	Outlines effective, evidence-based, and culturally sensitive strategies for collaborating with patients and their families to achieve desired health outcomes. Ensures the strategies are well-supported by credible evidence.
Identify the aspects of change management that directly affect elements of the patient experience essential to the provision of high-quality, patient-centered care.	Does not identify the aspects of change management that directly affect elements of the patient experience essential to the provision of high-quality, patient-centered care.	Attempts to identify aspects of change management not relevant to the patient experience, emphasizes patient expectations, or identifies aspects of the patient experience with minor impact on the quality of care.	Identifies the aspects of change management that directly affect elements of the patient experience essential to the provision of high-quality, patient-centered care.	Identifies the aspects of change management that directly affect elements of the patient experience essential to the provision of high-quality, patient-centered care. Focuses on aspects of care highly valued by patients, and distinguishes between patient experience and patient satisfaction.
Explain the rationale for coordinated care plans based on ethical decision making.	Does not explain the rationale for coordinated care plans based on ethical decision making.	Attempts to explain the rationale for coordinated care plans based on ethical decision making, but reaches conclusions based on a simplistic, biased, or cursory examination of the issue.	Explains the rationale for coordinated care plans based on ethical decision making.	Explains the rationale for coordinated care plans based on ethical decision making. Identifies the logical implications and consequences of an ethical approach to care, and articulates underlying assumptions that guide decision making.
Identify the potential impact of specific health care policy provisions on outcomes and patient experiences.	Does not identify policies affecting the provision of health care.	Attempts to identify policies affecting the provision of health care.	Identifies the potential impact of specific health care policy provisions on outcomes and patient experiences.	Identifies the potential impact of specific health care policy provisions on outcomes and patient experiences. Draws logical, evidence-based conclusions from an insightful interpretation of relevant and significant policy provisions.
Raise awareness of the nurse’s vital role in the coordination and continuum of care in a video-recorded presentation.	Does not raise awareness the nurse’s role in the coordination and continuum of care. Does not include a video presentation.	Attempts to raise awareness of the nurse’s role in the coordination and continuum of care. Does not include a video presentation.	Raises awareness of the nurse’s vital role in the coordination and continuum of care in a video-recorded presentation.	Raises awareness of the nurse’s vital role in the coordination and continuum of care. Clearly establishes the importance and relevance of the nurse’s role in an engaging and memorable presentation that is appropriate for the audience and well supported by an error-free video presentation that includes a written script and an APA-formatted reference list.