Reference no: EM133500864

Assignment: Care Coordination for Ischemic Stroke

Course Competencies

By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies:

I. Competency I: Adapt care based on patient-centered and person-focused factors.

• Analyze a health concern and the associated best practices for health improvement.

II. Competency II: Collaborate with patients and family to achieve desired outcomes.

• Describe specific goals that should be established to address a selected health care problem.

III. Competency III: Create a satisfying patient experience.

• Identify available community resources for a safe and effective continuum of care.

IV. Competency IV: 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.

Develop a 3 to 4 pages 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.

Introduction

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.

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.

Instructions

Develop the Preliminary Care Coordination Plan

Complete the following:

Question 1. Identify a health concern as the focus of your care coordination plan. In your plan, please include physical, psychosocial, and cultural needs. Possible health concerns may include, but are not limited to:

a. Stroke.
b. Heart disease (high blood pressure, stroke, or heart failure).
c. Home safety.
d. Pulmonary disease (COPD or fibrotic lung disease).
e. Orthopedic concerns (hip replacement or knee replacement).
f. Cognitive impairment (Alzheimer's disease or dementia).
g. Pain management.
h. Mental health.
i. Trauma.

Question 2. Identify available community resources for a safe and effective continuum of care.