• For this assessment, you will evaluate the preliminary care coordination plan you developed in Assessment 1 using best practices found in the literature.
NOTE: You are required to complete this assessment after Assessment 1 is successfully completed.
Care coordination is the process of providing a smooth and seamless transition of care as part of the health continuum. Nurses must be aware of community resources, ethical considerations, policy issues, cultural norms, safety, and the physiological needs of patients. Nurses play a key role in providing the necessary knowledge and communication to ensure seamless transitions of care. They draw upon evidence-based practices to promote health and disease prevention to create a safe environment conducive to improving and maintaining the health of individuals, families, or aggregates within a community. When provided with a plan and the resources to achieve and maintain optimal health, patients benefit from a safe environment conducive to healing and a better quality of life.
This assessment provides an opportunity to research the literature and apply evidence to support what communication, teaching, and learning best practices are needed for a hypothetical patient with a selected health care problem.
You are encouraged to complete the Vila Health: Cultural Competence activity prior to completing this assessment. Completing course activities before submitting your first attempt has been shown to make the difference between basic and proficient assessment.
Demonstration of Proficiency
By successfully completing this assessment, you will demonstrate your proficiency in the course competencies through the following assessment scoring guide criteria:
• Competency 1: Adapt care based on patient-centered and person-focused factors.
• Design patient-centered health interventions and timelines for a selected health care problem.
• Competency 2: Collaborate with patients and family to achieve desired outcomes.
• Describe priorities that a care coordinator would establish when discussing the plan with a patient and family member, making changes based upon evidence-based practice.
• Competency 3: Create a satisfying patient experience.
• Use the literature on evaluation as a guide to compare learning session content with best practices, including how to align teaching sessions to the Healthy People 2030 document.
• Competency 4: Defend decisions based on the code of ethics for nursing.
• Consider ethical decisions in designing patient-centered health interventions.
• Competency 5: Explain how health care policies affect patient-centered care.
• Identify relevant health policy implications for the coordination and continuum of care.
• Competency 6: Apply professional, scholarly communication strategies to lead patient-centered care.
• Apply APA formatting to in-text citations and references, exhibiting nearly flawless adherence to APA format.
• Organize content so ideas flow logically with smooth transitions; contains few errors in grammar/punctuation, word choice, and spelling.
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Preparation
In this assessment, you will evaluate the preliminary care coordination plan you developed in Assessment 1 using best practices found in the literature.
To prepare for your assessment, you will research the literature on your selected health care problem. You will describe the priorities that a care coordinator would establish when discussing the plan with a patient and family members. You will identify changes to the plan based upon EBP and discuss how the plan includes elements of Healthy People 2030.
Note: Remember that you can submit all, or a portion of, your plan to Smarthinking Tutoring for 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.
Instructions
Note: You are required to complete Assessment 1 before this assessment.
For this assessment:
• Build on the preliminary plan, developed in Assessment 1, to complete a comprehensive care coordination plan.
Document Format and Length
Build on the preliminary plan document you created in Assessment 1. Your final plan should be a scholarly APA-formatted paper, 5–7 pages in length, not including title page and reference list.
Supporting Evidence
Support your care coordination plan with peer-reviewed articles, course study resources, and Healthy People 2030 resources. Cite at least three credible sources.
Grading Requirements
The requirements, outlined below, correspond to the grading criteria in the Final Care Coordination Plan 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.
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• Design patient-centered health interventions and timelines for a selected health care problem.
• Address three health care issues.
• Design an intervention for each health issue.
• Identify three community resources for each health intervention.
• Consider ethical decisions in designing patient-centered health interventions.
• Consider the practical effects of specific decisions.
• Include the ethical questions that generate uncertainty about the decisions you have made.
• Identify relevant health policy implications for the coordination and continuum of care.
• Cite specific health policy provisions. | PLACE YOUR ORDER NOW AT writtask.com |
• Describe priorities that a care coordinator would establish when discussing the plan with a patient and family member, making changes based upon evidence-based practice.
• Clearly explain the need for changes to the plan.
• Use the literature on evaluation as a guide to compare learning session content with best practices, including how to align teaching sessions to the Healthy People 2030 document.
• Use the literature on evaluation as guide to compare learning session content with best practices.
• Align teaching sessions to the Healthy People 2030 document.
• Apply APA formatting to in-text citations and references, exhibiting nearly flawless adherence to APA format.
• Organize content so ideas flow logically with smooth transitions; contains few errors in grammar/punctuation, word choice, and spelling.
Additional Requirements
Before submitting your assessment, proofread your final care coordination plan to minimize errors that could distract readers and make it more difficult for them to focus on the substance of your plan.
MODEL ANSWER
Care coordination involves organizing patient care across multiple healthcare providers to facilitate effective care delivery to the patients. Coordinated care is designed by integrating the care services needed by the patient that helps to avoid unnecessary tests and procedures (Swan et al., 2019). This is important to the chronic patient since it helps the early diagnostic of the patient’s condition and in designing | PLACE YOUR ORDER NOW AT writtask.com | calls upon the participation of various healthcare professionals such as clinicians, nurses, physicians, and dietitians to ensure every aspect of the patient is addressed. This is done through collaboration in the healthcare team in what is known as inter-disciplinary care. Engaging in care coordination helps to eliminate the fragment of care and ensures all the aspects of care are addressed through including members of the healthcare team, family, and | PLACE YOUR ORDER NOW AT writtask.com | final care coordination focuses on delivering care to the hypothetical stroke patient aged 55 years through presenting the patient-centered health intervention | PLACE YOUR ORDER NOW AT writtask.com | the ethical decisions that should be taken into account when designing patient-centered health intervention and the relevant health policy and their implications, priorities of care coordinators, and the best practices that align with healthy people 2020.
Patient-Centered Health Interventions and timeline
A stroke occurs when the flow of blood to certain sections of the brain is interfered with due to blood clots or the fragmentation of the | PLACE YOUR ORDER NOW AT writtask.com | Centers for Disease Control and Prevention (CDC), reports note that in the United States, 795000 people have a stroke each | PLACE YOUR ORDER NOW AT writtask.com | issue that requires patient-centered intervention for the stroke patient is the rehabilitation of language speech and | PLACE YOUR ORDER NOW AT writtask.com | stroke, the patient may face communication | PLACE YOUR ORDER NOW AT writtask.com | the inability to find the right words and the challenge in coming up with complete sentences or putting up words together to come up with statements that | PLACE YOUR ORDER NOW AT writtask.com | patient may have problems with memory retention and the ability to | PLACE YOUR ORDER NOW AT writtask.com | are always frustrating. The best intervention to these challenges is to organize a medical session with speech and language therapists to help the patient learn how…