Assessment 4 instructions: final care coordination plan content

For this evaluation, you'll implement the preliminary care coordination plan you developed in Evaluation 1. Current the plan to the affected person in a face-to-face scientific studying session and collaborate with the affected person in evaluating session outcomes and addressing doable revisions to the plan.

NOTE: You're required to finish this evaluation after Evaluation 1 is efficiently accomplished.

Care coordination is the method of offering a easy and seamless transition of care as a part of the well being continuum. Nurses should concentrate on group assets, moral concerns, coverage points, cultural norms, security, and the physiological wants of sufferers. Nurses play a key function in offering the required information and communication to make sure seamless transitions of care. They draw upon evidence-based practices to advertise well being and illness prevention to create a secure surroundings conducive to enhancing and sustaining the well being of people, households, or aggregates inside a group. When supplied with a plan and the assets to attain and keep optimum well being, sufferers profit from a secure surroundings conducive to therapeutic and a greater high quality of life.

This evaluation gives a chance so that you can apply communication, educating, and studying finest practices to the presentation of a care coordination plan to the affected person.

You're inspired to finish the Vila Well being: Cultural Competence exercise previous to finishing this evaluation. Finishing course actions earlier than submitting your first try has been proven to make the distinction between fundamental and proficient evaluation.

Demonstration of Proficiency

By efficiently finishing this evaluation, you'll show your proficiency within the course competencies by way of the next evaluation scoring information standards:

  • Competency 1: Adapt care primarily based on patient-centered and person-focused elements.     
    • Design patient-centered well being interventions and timelines for care delivered by way of direct scientific interplay that's logged within the CORE ELMS system.
  • Competency 2: Collaborate with sufferers and household to attain desired outcomes.     
    • Consider studying session outcomes and the attainment of mutually agreed-upon well being objectives, in collaboration with a affected person.
  • Competency three: Create a satisfying affected person expertise.     
    • Consider affected person satisfaction with the care coordination plan and progress made towards Wholesome Individuals 2020 objectives and main well being indicators.
  • Competency four: Defend choices primarily based on the code of ethics for nursing.     
    • Make moral choices in designing patient-centered well being interventions.
  • Competency 5: Clarify how well being care insurance policies have an effect on patient-centered care.     
    • Establish related well being coverage implications for the coordination and continuum of care.

Preparation

On this evaluation, you'll implement the preliminary care coordination plan you developed in Evaluation 1 and talk the plan to the affected person in knowledgeable, culturally delicate, and moral method.

To arrange for the evaluation, contemplate the affected person expertise and the way you'll current the plan. Be sure to schedule time accordingly.

Word: Bear in mind that you may submit all, or a portion of, your plan to Smarthinking Tutoring for suggestions, earlier than you submit the ultimate model for this evaluation. When you plan on utilizing this free service, be aware of the turnaround time of 24–48 hours for receiving suggestions.

Directions

Word: You're required to finish Evaluation 1 earlier than this evaluation.

For this evaluation:

  • Full the preliminary care coordination plan you developed in Evaluation 1.
  • Current the plan to the affected person in a face-to-face scientific studying session. Talk in knowledgeable, culturally delicate, and moral method.
  • Collaborate with the affected person in evaluating session outcomes and addressing doable revisions to the plan.

Reminder: The time you spend presenting your remaining care coordination plan have to be logged within the CORE ELMS system. The overall time spent in securing particular person participation on this exercise in Evaluation 1 and presenting your plan on this evaluation have to be at the least three hours. The CORE ELMS hyperlink is positioned within the courseroom navigation menu.

Please be suggested that the Volunteer Expertise type requires that you just present the identify and call data for at the least one particular person with whom you labored as a part of your direct scientific exercise. Your school might attain out to this particular person to confirm that you've precisely documented and accomplished your scientific hours.

Doc Format and Size

Construct on the preliminary plan doc you created in Evaluation 1. Your remaining plan must be 5–7 pages in size.

Supporting Proof

Help your care coordination plan with peer-reviewed articles, course examine assets, and Wholesome Individuals 2020 assets. Cite at the least three credible sources.

Grading Necessities

The necessities, outlined beneath, correspond to the grading standards within the Last Care Coordination Plan Scoring Information, so make sure you tackle every level. Learn the performance-level descriptions for every criterion to see how your work will likely be assessed.

  • Design patient-centered well being interventions and timelines for care delivered by way of direct scientific interplay that's logged within the CORE ELMS system.     
    • Tackle three affected person well being points.
    • Design an intervention for every well being challenge.
    • Establish three group assets for every well being intervention, so the affected person might make an knowledgeable resolution about what assets to make use of.
  • Make moral choices in designing patient-centered well being interventions.     
    • Think about the sensible results of particular choices.
    • Embrace the moral questions that generate uncertainty in regards to the choices you have got made.
  • Establish related well being coverage implications for the coordination and continuum of care.     
    • Cite particular well being coverage provisions.
  • Consider studying session outcomes and the attainment of mutually agreed-upon well being objectives, in collaboration with the affected person.     
    • What facets of the session would you modify?
    • How may revisions to the plan enhance future outcomes?
  • Consider affected person satisfaction with the care coordination plan and progress made towards Wholesome Individuals 2020 objectives and main well being indicators.     
    • What adjustments would you suggest to enhance affected person satisfaction and higher align the session with Wholesome Individuals 2020 objectives and main well being indicators?
Further Necessities

Earlier than submitting your evaluation, proofread your remaining care coordination plan to reduce errors that would distract readers and make it tougher for them to concentrate on the substance of your plan.

You need to submit your hours to the CORE ELMS system earlier than you may full this evaluation and course.

Portfolio Immediate: Save your presentation to your ePortfolio. Submissions to the ePortfolio will likely be a part of your remaining Capstone course.