Category: Health Care and Life Sciences : Nursing

For this assessment, you will evaluate the preliminary care coordination plan you developed in Assessment 1 using best practices found in the literature. Assessment 1 was Preliminary Care Coordination Plan!
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.
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: 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.
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.
dentify relevant health policy implications for the coordination and continuum of care.
Cite specific health policy provisions.
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.
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
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.
By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and 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.
Grading Rubric
1. Designs patient-centered health interventions and timelines for a selected health care problem that includes community resources.
2. Considers insightful ethical decisions in designing patient-centered health interventions. These decisions are supported by the literature.
3. Identifies relevant health policy implications for the coordination and continuum of care, based on precise and accurate interpretations of relevant policy provisions. Makes valid, insightful inferences.
4. 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 explains the need for changes to the plan.
5. Uses 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. Clearly explains the need for any revisions.
6. Exhibits strict and flawless adherence to APA formatting of headings, in-text citations, and references. Quotes and paraphrases correctly.
7. Organizes content with a clear purpose. Content flows logically with smooth transitions using coherent paragraphs, correct grammar/punctuation, word choice, and free of spelling errors.

Create a detailed narrative script for your presentation, approximately 4  pages in length. This is a video presentation.
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.
Scenario
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.
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 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.
The script should include a reference page.
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.
By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and 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.
1. 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.
2. 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.
3. 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.
4. 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.
5. 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  that includes a written script and an APA-formatted reference list.

Develop a 3 page preliminary care coordination plan for a selected health care problem. Include physical, psychosocial, and cultural considerations for this health care problem. Identify and list available community resources for a safe and effective continuum of care.
The first step in any effective project is planning. This assessment provides an opportunity for you to strengthen your understanding of how to plan and negotiate the coordination of care for a particular health care problem. Include physical, psychosocial, and cultural considerations for this health care problem. Identify and list available community resources for a safe and effective continuum of care.
As you begin to prepare this assessment, you are encouraged to complete the Care Coordination Planning activity. Completion of this will provide useful practice, particularly for those of you who do not have care coordination experience in community settings. The information gained from completing this activity will help you succeed with the assessment. Completing formatives is also a way to demonstrate engagement.
Scenario
Imagine that you are a staff nurse in a community care center. Your facility has always had a dedicated case management staff that coordinated the patient plan of care, but recently, there were budget cuts and the case management staff has been relocated to the inpatient setting. Care coordination is essential to the success of effectively managing patients in the community setting, so you have been asked by your nurse manager to take on the role of care coordination. You are a bit unsure of the process, but you know you will do a good job because, as a nurse, you are familiar with difficult tasks. As you take on this expanded role, you will need to plan effectively in addressing the specific health concerns of community residents.
To prepare for this assessment, you may wish to:
Review the assessment instructions and scoring guide to ensure that you understand the work you will be asked to complete.
Allow plenty of time to plan your chosen health care concern.
Assessment 01 – Preliminary Care Coordination Plan
For this assessment, you will develop a 3 page preliminary care coordination plan for a selected health care problem. Include physical, psychosocial, and cultural considerations for this health care problem. Identify and list available community resources for a safe and effective continuum of care.
Before you complete the instructions detailed in the courseroom, first select one of the following health care problems or issues:
• Domestic Violence
o Physicalconsiderations:Domesticviolencecancausephysicalinjuriessuchas
bruises, broken bones, and head injuries.
o Psychosocialconsiderations:Domesticviolencecancauseemotionaldistress,
anxiety, and depression.
o Culturalconsiderations:Culturalbeliefsandpracticesmayinfluenceanindividual’s
willingness to seek help for domestic violence.
o Communityresources:Domesticviolencehotlines,shelters,andsupportgroups
can provide resources and support for individuals experiencing domestic violence.
• Food Insecurity
o Physicalconsiderations:Foodinsecuritycancausemalnutrition,weightloss,and
other physical health problems.
o Psychosocialconsiderations:Foodinsecuritycancauseemotionaldistress,
anxiety, and depression.
o Culturalconsiderations:Culturalbeliefsandpracticesmayinfluenceanindividual’s
willingness to seek help for food insecurity.
o Communityresources:Foodbanks,mealdeliveryprograms,andnutrition
education programs can provide resources and support for individuals experiencing food insecurity.
After you have selected one of the problems/issues from the list above, return to the detailed instructions in the courseroom to complete your assessment.
Develop the Preliminary Care Coordination Plan
Complete the following:
Select one of the health concerns in the Assessment 01 Supplement: Preliminary Care Coordination Plan [PDF] Download Assessment 01 Supplement: Preliminary Care Coordination Plan [PDF]resource as the focus of your care coordination plan. In your plan, please include physical, psychosocial, and cultural needs.
Identify available community resources for a safe and effective continuum of care.
Document Format and Length
Your preliminary plan should be an APA scholarly paper, 3–4 pages in length.
Remember to use active voice, this means being direct and writing concisely; as opposed to passive voice, which means writing with a tendency to wordiness.
In your paper include possible community resources that can be used.
Be sure to review the scoring guide to make sure all criteria are addressed in your paper.
Study the subtle differences between basic, proficient, and distinguished.
Supporting Evidence
Cite at least two credible sources from peer-reviewed journals or professional industry publications that support your preliminary plan.
Grading Requirements
The requirements, outlined below, correspond to the grading criteria in the Preliminary 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.
Analyze your selected health concern and the associated best practices for health improvement.
Cite supporting evidence for best practices.
Consider underlying assumptions and points of uncertainty in your analysis.
Describe specific goals that should be established to address the health care problem.
Identify available community resources for a safe and effective continuum of care.
Organize content so ideas flow logically with smooth transitions; contains few errors in grammar/punctuation, word choice, and spelling.
Apply APA formatting to in-text citations and references, exhibiting nearly flawless adherence to APA format.
Write with a specific purpose with your patient in mind.
Adhere to scholarly and disciplinary writing standards and current APA formatting requirements.
Before submitting your assessment, proofread your preliminary care coordination plan and community resources list to minimize errors that could distract readers and make it more difficult for them to focus on the substance of your plan. Be sure to submit both documents.
By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and scoring guide criteria:
Competency 1: Adapt care based on patient-centered and person-focused factors.
Analyze a health concern and the associated best practices for health improvement.
Competency 2: Collaborate with patients and family to achieve desired outcomes.
Describe specific goals that should be established to address a selected health care problem.
Competency 3: Create a satisfying patient experience.
Identify available community resources for a safe and effective continuum of care.
Competency 6: Apply professional, scholarly communication strategies to lead patient-centered care.
Organize content so ideas flow logically with smooth transitions; contains few errors in grammar/punctuation, word choice, and spelling.
Apply APA formatting to in-text citations and references, exhibiting nearly flawless adherence to APA format.

Need a discussion post on the following question..
Does Katz’ 3 skill model, i.e. explain leadership? Does it still “hold” in the Information Age? Is it true, for example, that top management must have a higher level of conceptual skills while managers “on the floor” do not? 
Please use the link below for the required reading.
https://pressbooks.usnh.edu/ld820/chapter/6/

It is necessary for the student to demonstrate an enhanced understanding of the pathophysiological processes of disease, the clinical manifestations and treatment protocols, and how they affect clients across the life span.
Evaluate the Health History and Medical Information for Mr. C., presented below.
Based on this information, formulate a conclusion based on your evaluation, and complete the Critical Thinking Essay assignment, as instructed below.
Health History and Medical Information
Health History
Mr. C., a 32-year-old single male, is seeking information at the outpatient center regarding possible bariatric surgery for his obesity. He currently works at a catalog telephone center. He reports that he has always been heavy, even as a small child, gaining approximately 100 pounds in the last 2-3 years. Previous medical evaluations have not indicated any metabolic diseases, but he says he has sleep apnea and high blood pressure, which he tries to control by restricting dietary sodium. Mr. C. reports increasing shortness of breath with activity, swollen ankles, and pruritus over the last 6 months.
Objective Data:
1.    Height: 68 inches; weight 134.5 kg
2.    BP: 172/98, HR 88, RR 26
3.    3+ pitting edema bilateral feet and ankles
4.    Fasting blood glucose: 146 mg/dL
5.    Total cholesterol: 250 mg/dL
6.    Triglycerides: 312 mg/dL
7.    HDL: 30 mg/dL
8.    Serum creatinine 1.8 mg/dL
9.    BUN 32 mg/dl
Critical Thinking Essay
In 750-1,000 words, critically evaluate Mr. C.’s potential diagnosis and intervention(s). Include the following:
1.    Describe the subjective and objective clinical manifestations present in Mr. C.
2.    Describe the potential health risks for obesity that are of concern for Mr. C. Explain whether bariatric surgery is an appropriate intervention.
3.    Assess each of Mr. C.’s functional health patterns using the information given. Discuss at least five actual or potential problems you can identify from the functional health patterns and provide the rationale for each. (Functional health patterns include health-perception, health-management, nutritional, metabolic, elimination, activity-exercise, sleep-rest, cognitive-perceptual, self-perception/self-concept, role-relationship, sexuality/reproductive, coping-stress tolerance.)
4.    Explain the stages of renal disease that leads to end-stage renal disease (ESRD). What factors contributed to Mr. C’s ESRD?
5.    Consider ESRD prevention and health promotion opportunities. Describe what type of patient education for ESRD should be provided to Mr. C. for prevention of future events, health restoration, and avoidance of deterioration of renal status.
6.    Explain the type of resources available for ESRD patients for nonacute care and the type of multidisciplinary approach that would be beneficial for these patients. Include aspects such as devices, transportation, living conditions, return-to-employment issues.
You are required to cite a minimum of three sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and relevant to nursing practice.
Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

need to read the paper make sure it follows the outline
needs to redo PRISMA AND GRANTT chart to match the fellow of thr project

Academic clinical SOAP notes provide a unique opportunity to practice and demonstrate advanced practice documentation skills, develop and demonstrate critical thinking and clinical reasoning skills, and practice identifying acute and chronic problems and formulating evidence-based plans of care
Develop a hospital follow-up progress SOAP note based on a clinical patient from your clinical/practicum setting. In your assessment, provide the following:
A one-sentence description of the primary working diagnosis, pending differential diagnoses, and the context or service in which the patient is being seen.
A one- or two-paragraph description of the current illness or hospital stay, including pertinent diagnostic findings or procedures. Include how many days the patient has been hospitalized, if applicable.
List of at least five systems affected by the working diagnosis. Provide two positive or negative effects that the working diagnosis has on each system.
List of at least five systems examined within the past 24 hours. Provide at least two pertinent positive or negative findings relevant to each system examined and include a full set of vital signs.
List of all admission diagnostics conducted for this visit or conducted within the past 24 hours.
List of all pertinent acute and chronic diagnoses in order of priority using ICD-10. Identify any differential diagnoses being eliminated.
Treatment plan that corresponds with the diagnosis. Provide information on admission type, types of diagnostics, any prescribed medications and dosages, and any relevant consults or follow-up procedures needed.
Discussion of any relevant ethical, legal, or geriatric-specific considerations.
Incorporate at least three peer-reviewed articles in the assessment or plan.
While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center.

This assignment involves identifying and describing different elements of the research method used in the Tobiano, Ting, Ryan, Jenkinson, Scott, & Marshall (2019) article.
Focus on the research design, sample selection, data collection methods, and plan for data analysis as discussed in the Tobiano, Ting, Ryan, Jenkinson, Scott, & Marshall (2019) article.
Identify at least two strengths and two weaknesses of the article’s research method based on trustworthiness. You must provide support for your explanation with citations from additional sources.
Use the Journal Club Template for Qualitative Research located in this week’s resources. Note: This will not be accepted unless the required template is used.
The template includes an area for each element discussed in the study.
Be brief, paraphrase and summarize each of the elements clearly on the form.

need to read the paper make sure it follows the outline
needs to redo PRISMA AND GRANTT chart to match the fellow of thr project

Academic clinical SOAP notes provide a unique opportunity to practice and demonstrate advanced practice documentation skills, develop and demonstrate critical thinking and clinical reasoning skills, and practice identifying acute and chronic problems and formulating evidence-based plans of care
Develop a hospital follow-up progress SOAP note based on a clinical patient from your clinical/practicum setting. In your assessment, provide the following:
A one-sentence description of the primary working diagnosis, pending differential diagnoses, and the context or service in which the patient is being seen.
A one- or two-paragraph description of the current illness or hospital stay, including pertinent diagnostic findings or procedures. Include how many days the patient has been hospitalized, if applicable.
List of at least five systems affected by the working diagnosis. Provide two positive or negative effects that the working diagnosis has on each system.
List of at least five systems examined within the past 24 hours. Provide at least two pertinent positive or negative findings relevant to each system examined and include a full set of vital signs.
List of all admission diagnostics conducted for this visit or conducted within the past 24 hours.
List of all pertinent acute and chronic diagnoses in order of priority using ICD-10. Identify any differential diagnoses being eliminated.
Treatment plan that corresponds with the diagnosis. Provide information on admission type, types of diagnostics, any prescribed medications and dosages, and any relevant consults or follow-up procedures needed.
Discussion of any relevant ethical, legal, or geriatric-specific considerations.
Incorporate at least three peer-reviewed articles in the assessment or plan.
While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center.