NURS FPX 4050 Assessment 4 Final Care Coordination Plan
With the situation involving chronic disease management being highly complex, the
patient-centred care approach is the most vital model. It is characterized by tailored-to-a
person’s needs and preferences-centered intervention that addresses each patient’s concerns.
In this paper, a multi-dimensional approach toward the residents of patient-centred care will be
discussed, which incorporates aspects such as disease control, growth of self-management
skills, and quality of life overall. To add to that point, it also deals with the ethical issues and
health policy implications as well as those of how it aligns with the Healthy People 2030
objectives, thus putting forth the need for some revisions and adaptations to boost the
improvements in patient outcomes (Pronk et al., 2020).
Patient-Centered Health Interventions for Chronic
Disease Management
Chronic diseases are a matter of great concern for people and medical professionals alike, as
they have an indefinite duration of management, which demands intricate modalities of
management (Reynolds et al., 2022). To win this fight adequately, the patient-centered care
model that is comprehensive and individualized can be used. As such, developing interventions
that regard a whole-system perspective, comprehensively integrating health, psychological, and
lifestyle issues, is imperative.
Optimizing Disease Control
Patient-centered care is instrumental in managing chronic disease. Part of that process is
ensuring disease control at its best. It means precisely that personalized treatment, such as
compatible prescription courses, nutritional modification, and exercise regimens, must be made
possible considering the patient’s disease and preferences (Alowais et al., 2023). The best way
to accomplish this is for patients to be part of decision-making together with the provider and
the patient to become knowledgeable about their disease management, and adherence to
treatment regimens can be improved. Commitment resources such as disease education
programs and health courses are other support mechanisms that patients can rely on regarding
their treatment plans.
Enhancing Self-Management Skills
The following vital element is to make patients adequately autonomous in the assistance
process. This may involve teaching the patient how to take medications correctly, monitor the
range of their symptoms, and make healthy lifestyle choices. Through healthcare
professionals-led sessions aimed at teaching patients practical ideas for controlling their
disorder as well as group-based interactions that will help them put their knowledge into
practice, patients can improve the management of their condition (Kristjansdottir et al., 2021).
Community resources, including support groups and health care centers, are among the most
significant ones in helping patients not only to address their concerns but also to stay
motivated, hence guaranteeing their self-management success.
Improving Quality of Life
Alongside the disease management of chronic conditions and self-care, dealing with the
psycho-social aspects of chronic diseases is an integral part of helping with the quality of life of
patients. Interventions like counseling, art therapy, and support groups can offer patients the
necessary social and emotional reinforcement to tackle the setbacks involved with the state of
their health (Shukla et al., 2022). These implementations allow patients to express themselves
openly in a safe, nurturing environment. As they connect with others who have been on the
same journey, their psychological well-being is improved by many different community-based
resources (Baxter et al., 2022). Particularly useful to patients, art therapy courses and support
groups can help the patients engage in art activities and associate with their fellows, and
therefore, increase their quality of life.
Ethical Considerations in Patient-Centered Health
Interventions
Ethical considerations in the design of patient-oriented health interventions place a great
emphasis on the principle of patient autonomy and their right to benefit and justice. In chronic
disease management, strategists make adequate ethical decisions so that interventions are
designed and implemented to promote good health conditions and function ethically.
Respect for Autonomy
Respect for autonomy, it can be said, is one of the ethical principles that govern patient
self-determination, where patients` rights to decide for themselves about their health are taken
into account. While physicians are designing interventions, patients should be included in every
single aspect of the decision-making process, including all treatment options and distributed
work plans (Oprea et al., 2023). This means giving patients detailed info about their health
issues, treatment options, and possible risks and benefits, which, in turn, they will choose the
type of treatment based on their values and preferences (Ness, 2020). Through the
acknowledgment and care of the patient’s autonomy, the healthcare providers will endorse the
empowerment of patients and bolster the trust in the relationship between the patient and the
caregiver.
Beneficence and Non-Maleficence
The moral judgment made in patient-oriented interventions also consists of weighing principled
disclaimers, namely” beneficence (doing good)” and “non-maleficence (not harm). Providers in
healthcare should give a thought to the pros and cons of interventions they use, ensuring that
the outcome is beneficial to patients, leading to doing less harm to them. This could be doing a
targeted treatment aimed at different patients, who they are, and what they like, making sure to
remember age, comorbidities, and cultural background (Rayman et al., 2022). The providers
should be able to monitor and evaluate the outcome of intervention on the one hand and, on the
other, if needed, to provide alternative therapy or palliative care (depending on the goals and
side effects of treatment).
Relevant Health Policy Implications for Coordination
and Continuum of Care
Understanding appropriate health policy implications is appreciated since these are crucial for
achieving effective coordination and a continuum of care. Through the correct interpretation
and enforcement of policy provisions, healthcare providers can channel the dilemma of
caregiving properly and simultaneously meet patient expectations and regulation requirements.
Interpretation of Policy Provisions
Exact comprehension of related supervisory provisions becomes a prerequisite for adequately
studying their consequences concerning the delivery of coordinated services and evidence of
uninterrupted treatment (Haferkamp & Smelser, 2020). Policies about health insurance
coverage, quality care guidelines, and patient care access affect how care is offered and
distributed throughout the continuum.
Implications for Care Coordination
Health policies commonly relate to care coordination among diverse providers and placements
of support services. These necessities include digital health record interchangeability, care
transition protocols, and joint care model implementation. By adhering to all these requirements,
healthcare providers will facilitate smooth continuity of care and ensure that the service is
continuous for the patients across the different healthcare facilities.
Implications for Continuum of Care
Through raising awareness, promoting responsible practices, pushing for more accountable
plans, and encouraging people and businesses to integrate sustainable practices into their daily
lives, we can all contribute to protecting our planet.
Final Care Coordination Plan
Not only policy components but the care continuum as well are in dire need of altering
preventive, primary, acute, and long-term care services. The measures to be undertaken will
include payment reform initiatives to encourage value-based care payment models, which
reimburse providers based on the effectiveness they bring in reducing emergency room visits
and preventing diseases (Cattel & Eijkenaar, 2019). Alongside, policies that deal with telehealth
and remote monitoring devices offer a more comprehensive coverage of healthcare, particularly
in areas with low access to care, thus increasing continuity of care for patients.
Establishing Priorities for Care Coordination
Discussions
When deciding on a care plan together with a patient and an anxiety member, a care coordinator
needs to decide on priorities that protect the patient today but are also based on
evidence-based practice. By concentrating on the part of the care plan, the coordinator can
provide interventions aimed at a particular patient’s requirements and give examples using
updated knowledge.
Identifying Priority Areas
One mission a care coordinator must complete is the initial assessment and identifying the
most urgent health issues or symptoms. So, the nurse’s primary duty is to address these issues
and direct intervention methods to help the patient bring relief and stabilization. The coordinator
may decide to prioritize interventions that relate to the treatment goals and agreement of the
patient, thereby making the care plan a patient-centered one that is personalized to the patient’s
likes and dislikes (Kuipers et al., 2019).
Making Changes Based on Evidence-Based Practice
The production of digital multimedia content is an extensive process that requires meticulous
work and immense attention to detail. This is essential for the effectiveness of the narrative and
the overall engagement of the audience.
Utilization of evidence-based practice in the care plan may entail the alteration of treatment
methods, the introduction of interventions that have been verified according to research
standards, or the optimization of the modules that have previously been used (Hasson et al.,
2020). Take, for instance, the case where recent findings show that a new one is better
compared to old ones prescribed previously; the care coordinator may then request to change to
the latest treatment to facilitate good results. With data being connected to the fact of a specific
lifestyle change being effective in the management of the disease, the care coordinator could
look into this recommendation to incorporate it into the care plan to improve the health outlook
for the patient (Idris Zubairu Sadiq, 2023).
Comparing Learning Session Content with Best
Practices
Evaluation of Learning Session Content
Renewable energy and energy efficiency measures can help mitigate climate change and reduce
greenhouse gas emissions worldwide, thus contributing to a more sustainable and resilient
future for all humanity. Employing the literature on evaluation as guidance, it is necessary to
compare the content of the learning sessions to the guides on best practices. This is to ensure
that the amount and depth of knowledge transferred and acquired skills among participants are
sufficient and effective (Anwer, 2019). Appraisal instruments that can be employed are, for
example, pre-and post-tests, questionnaires for evaluation of the seminar attendees, and
observations that can provide valuable information concerning the success of a course and
areas that require revision.
Alignment with Best Practices
Classroom teaching methodologies include interactive activities, providing definitive learning
objectives and materials, and providing an active learning environment, among others. With the
adjunction of teaching sessions to these good practices, educators can create a lot of positive
effects by reducing the loss of knowledge among the participants. Along with this, the provision
of teaching material based on scientific evidence and the application of different teaching
approaches that will fit into various students’ learning styles and personalities will also make a
mark on the effectiveness of teaching sessions’ success (Magulod, 2019).
Aligning with Healthy People 2030
The on-site tasks covered various areas such as data entry, inventory management, and
customer service, which enabled me to gain a comprehensive understanding of the company’s
functioning. Healthy People 2030 outlines a vision that health should prevail for all Americans
and that fewer individuals should suffer from chronic conditions (Pronk et al., 2020). It includes
aims and goals that are to be met by various participants. Implementing the Healthy People
2030 approach requires the delivery of messages that are related to health promotion, relevant
health priorities, and practices associated with healthy living to be incorporated into the
teaching sessions. The two ways by which educators can ensure teaching material is up-to-date,
relevant, and in line with national public health goals is to incorporate Healthy People 2030
objectives into teaching sessions.
Conclusion
Implementation of a patient-oriented is a crucial element of healthcare provision when tackling
the complex spectrum of chronic disease management. Through caregivers supporting patient
autonomy, increasing patients’ self-esteem, and considering how the conditions affect the
patient’s psychological state, healthcare providers’ job in improving patient care delivery and joy
in receiving services is defined highly. Accordingly, ethical principles, health policies, and
medical objectives of the county should concurrently tie in the interventions to enhance the
continuum of care. Using ongoing assessment and adaptation, healthcare systems may seek
the goals of maximum effectiveness and favorable outcomes related to the overall well-being of
populations.
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