Care Coordination Presentation to Colleagues

Introduction

The basic essence of care coordination is attained by the integration of patient activities among different relevant parties. Care coordination involves the integration of activities as well as information sharing. According to Powell et al. (2017), to ensure positive patient outcomes, different healthcare entities work together sharing patient information to come up with measures that will ensure the best care is afforded to the patient. However, it is paramount to note that in sharing patient information, patients' autonomy is respected, and therefore only relevant parties are allowed access to the patient's information. Parties involved in providing care for the patient ensure that the patient is in the right kind of environment, the patient engages in healthy behavior, and has enough and the required resource to meet their needs.

Importance Of Care Coordination

Limited healthcare personnel places great burdens on nursing in providing the best care for patients. Additionally, considering the different social determinants of health, and according to the future of nursing report, to ensure quality healthcare for patients, nurses have to work with different teams and agencies across the healthcare industry. Therefore, care coordination plays a great role in reducing the burden associated with chronic and healthcare issues. According to Choi (2017), care coordination plays an effective role in promoting patient safety and efficiency in the healthcare sector. Additionally, patients with chronic diseases face diverse challenges that can hinder them from fully recovering, especially after being released from the hospital or between treatment sessions. Therefore, care coordination ensures that the different issues a patient faces beyond the medical arena are fully catered for. Consequently, care coordination reduces the burden on the patient and their family in handling the different needs and issues that arise in ensuring positive patient outcomes.

Care Coordination Process

According to Mohta et al. (2020), the care coordination process entails a multidisciplinary approach, and the more people and resources are involved in the process, the better the positive patient outcomes. The care coordination process involves integrating physicians, caregivers, nutritionists, social workers, nurses, therapists, and family members. In implementing the care coordination plan, all the people involved have to work in harmony. However, firstly, there needs to be an assessment that will determine the different needs and issues in providing care for the patient. This will help determine the team needed for a particular patient (Rizzo et al., 2016). Secondly, the nurse, together with the team, needs to determine the patient's desired health outcomes. This is to help them strategize and plan the needed resources in meeting the goals. Additionally, according to Rizzo et al. (2016), the next step is to formulate interventions that align with the available resources, patient needs, and desired health outcomes. Interventions formulated need to be evidence-based. Lastly, the nurse must collect data and evaluate to see the patient health outcomes against the set goals.

Factors Affecting Care Coordination

The main factors affecting care coordination are the availability of community resources, ethical and policy issues. In offering care coordination to chronic and acute patients, community resources are required to compromise part of the care coordination team. Community resources are the basic elements, including hospitals, non-profit organizations, clinics, community programs, and healthcare professionals. According to Powell (2017), integrating these resources ensures the best health outcome for the patient. Patients must be linked with the community resources to facilitate referrals that will respond to patient social service needs.

The ANA Code of ethics is the guide in nursing practices in the care coordination process. The code highlights the need to respect human dignity, maintain patient privacy and confidentiality, uphold patient interest ad primary motive for all processes to be carried out, ensure no harm to the patient, and ensure no bias in attending to a patient (Olson& Stokes, 2016). In respecting human dignity, the nurses have to ensure that the care coordination process is carried out to uphold the patients' rights as human beings. However, there arises interest in conflict when a nurse is obligated to provide care to a patient. Hospital policies do not allow them to provide care to a patient without financial payment. Additionally, healthcare professionals are faced with a conflict of interest when it comes to upholding patients' autonomy or following ethical guidelines that dictate a patient should not be harmed (Tønnessen, Ursin & Brinchmann, 2017). A nurse is required to uphold patient autonomy. However, what happens when the patient's autonomy interferes with the provision of care and in ensuring positive health outcomes for the patient?

The government is responsible for enacting policies that are aimed at ensuring better healthcare results for citizens. However, some policies present challenges in upholding the care coordination process. One of the policies enacted by the government is the affordable care act (ACA), which was aimed at increasing the number of insured people. According to Edmonds et al. (2017), ACA has enacted preventive health measures and reduced medication costs. Additionally, it has enhanced the number of people who have access to quality healthcare. However, the policy presents payment issues caused by delays brought about by government involvement and insurance agency issues in releasing and processing payments. These delays have led to ineffective service delivery as care coordination processes are delayed either due to a lack of resources since hospitals lack finances or due to delay in processes as healthcare personnel is awaiting payment processing.

Nurses Role in Care Coordination

A nurse plays a major role in care coordination. According to the National academy of medicine (NAM), care coordination is a major responsibility of nurses in providing care to people. Nurses have problem-solving skills, communication skills, and innovation skills to run the care coordination process in its full efficiency. Additionally, regarding the changes in education structure and training held for nurses, nurses hold interdisciplinary knowledge that allows them to engage and coordinate different participations and levels in the healthcare setting (NASEM, 2021). In the care coordination process, nurses are responsible for enacting communication and relationship between the different team members. Additionally, they are tasked with assessing the patient to evaluate their progress. The nurse educated the patients and their families on medication and treatments appointment for the patient. Lastly, they conduct home visits and ensure a smooth transition from the hospital setting to home care.

Involvement Of Family

The family of a patient plays a critical part in ensuring that the care coordination process runs smoothly and that in the patient's transition from hospital care to home care, they are fully comfortable and are in a safe environment. Having that the family spends the most time with the family and that they have personal involvement in the patient's life, it is paramount that they are trained and informed of the care coordination process (Choi, 2017). This ensures that they know the role they ought to play while also providing the nurse and the multidisciplinary team involved in the care coordination process with the right information about the patient progress needs and health state. This helps the nurse know the patient's progress and identify whether there are changes that need to be carried out. Additionally, when the patient is not in a position to make healthcare decisions for themselves, the family takes up the role of informing the medical team of the decision to be made.

Conclusion

Positive healthcare outcomes go beyond the nursing scope. Therefore, nurses have to work with other healthcare professionals, patients, and patient's family members to ensure the best care for patients. Care coordination is fundamental in ensuring quality health outcomes. Care coordination ensures the utilization of different resources and evidenced-based interventions to meet patient's needs. The nursing code of ethics should guide nurses to ensure ethical standards are upheld in delivering care to patients.

Care Coordination Presentation to Colleagues

Introduction

1. The basic essence of care coordination is attained by the integration of patient activities among different relevant parties.
2. Care coordination involves the integration of activities as well as information sharing.
3. According to Powell et al. (2017), to ensure positive patient outcomes, different healthcare entities work together sharing patient information to come up with measures that will ensure the best care is afforded to the patient.
4. However, it is paramount to note that in sharing patient information, patients' autonomy is respected, and therefore only relevant parties are allowed access to the patient's information.
5. Parties involved in providing care for the patient ensure that the patient is in the right kind of environment, the patient engages in healthy behavior, and has enough and the required resource to meet their needs.

Importance of Care Coordination

1. Limited healthcare personnel places great burdens on nursing in providing the best care for patients.
2. Additionally, considering the different social determinants of health, and according to the future of nursing report, to ensure quality healthcare for patients, nurses have to work with different teams and agencies across the healthcare industry.
3. Therefore, care coordination plays a great role in reducing the burden associated with chronic and healthcare issues.
4. According to Choi (2017), care coordination plays an effective role in promoting patient safety and efficiency in the healthcare sector.
5. Additionally, patients with chronic diseases face diverse challenges that can hinder them from fully recovering, especially after being released from the hospital or between treatment sessions.