NURSES IN CARE COORDINATION

[Audio] Welcome . Gerardo Velasco Capella University NHS-FPX4050: Assessment 3 Dr. Shari Redden 19, December, 2023

[Audio] Hello everyone, and welcome to my presentation of several key themes in care coordination that mark out the fundamentals of care coordination. I would like to start by inviting you all to remember that care coordination is a deliberate process, and all decisions made for the continuity or discontinuity of care have to be owned, justified and accounted for. This is the reason that medical professionals must always stick within the limits of their educational competence to ensure that they only offer what they consider quality and safe healthcare practice. I hope you have heard of the term reverse quackery. If you have not heard of the term reverse quackery, it simply means that some care providers offer low-quality care because they tend to tend to matters outside their competence or entirely non-medical concerns (Hansson, & Fröding, 2020)..

[Audio] If everyone sticks to their area of competence, then roles can be clearly defined to ensure a coherent flow of activities that ensure patients and families receive the full range of services they require. Consequently, I will state that nurses must always practice within their competence, be accountable for their decisions, and be ready to defend their actions. During the COVID-19 crisis, care coordination was challenging because of the limited resources caused by the above-normal incidence of emergency cases requiring high-dependency resources that are never enough. Ethical decision-making is critical in such circumstances, and remembering some universal principles such as beneficence, non-maleficence, and justice can help rationalize difficult choices during care coordination in times of crisis (Rawlings et al., 2021)..

[Audio] Remember that working with families is not easy, and there can be complications when consumers cause overlapping care, role confusion, and invoke administrative intervention when they think or feel that care coordination for the patient is not reassuring. When decisions become overruled for some reason, the prudent thing to do is to reconsider the ethical nuances of the scenario and adapt for future challenges. Nurses have a duty to both the organization and the community, which creates ethical dilemmas whenever fiduciary duty and patient-centeredness come into conflict over loyalties (Tønnessen, Ursin & Brinchmann, 2017)..

[Audio] As always, the most informed and ethically defensible position should be taken when such situations arise. Remember that making ethical decisions does not have a definitive guideline and only requires that the most morally defensible position be taken. Therefore, critical thinking in nursing decision-making is an essential competence to make sure all decisions are made considering all the stakeholders collaborating in healthcare services. In the pursuit of patient-centeredness, the nurse has to always remember that care coordination is about meeting the healthcare needs of the patient in the broad description of a person as a biopsychosocial entity. Therefore, care coordination has to entail comprehensive planning for the elicitation of patient needs through evidence-based and best practices. These should be the hallmarks of the patient narrative that are most relatable to anyone managing care and the basis for setting up goals and aligning the preferences of the patient and family with conventional, alternative, and complementary health services..

[Audio] With goals in place and preferences known, the nurses come in with nursing-led interventions such as condition-specific patient education and self-management training. These are often interventions that run concurrently with other interventions led by the interdisciplinary team. It is mandatory to participate in collaborative care as a nurse involved in care coordination or otherwise, as one of the fundamental principles of nursing competence. At this juncture, communication emerges as a critical element of care coordination. Nurses are bound by several rules of communication within their professional context and when collaborating with other professionals. HIPAA provides privacy rules that all nurses should be aware of to ensure only relevant identifiers are used to share information during care coordination efforts (Alder, 2023). Communicating openly and limiting unnecessary disclosure during therapeutic relationships is a good way to prevent ethical issues of privacy and confidentiality over protected health information. The golden rule of thumb I would propose is to recall that the nature of the relationships within the community allows the patients to disclose anything necessary to get their narrative across and communicate their illness to get the best guidance on navigating the systems while getting the care they need. However, it is not your privilege to share these stories without informed consent and full awareness of the patient and how their information is used during the process of care coordination. If you remember correctly, nursing is an evidence-based practice that requires updates from research. Therefore, researchers can borrow or collect information from your patients or patient records. You must protect your patients' privacy and the confidentiality of their narratives from anyone outside of direct care coordination efforts..

[Audio] I would like to highlight one key area in which nurses have an integral role to contribute, which is ensuring healthcare services are acceptable to the community. As Dawkins and others found in a research article in 2021, at the end of the day, care coordination may not work because some services are culturally unacceptable to the community. A religiously sectarian community, for instance, could respond poorly to an abortion clinic and any services related to that clinical pathway. Assessing the cultural orientation of the community, understanding their cultural predispositions, increasing knowledge of culture-sensitive care, and respecting the differences are good foundations for promoting acceptable healthcare services and getting the community to collaborate with healthcare systems. Research shows that there is greater uptake and acceptability of medical services when clinical pathways are designed with a culture-sensitive mindset (Kaihlanen et al., 2019). Issues such as institutional racism can be deleterious in care coordination, and they can create healthcare gaps despite the existence of sufficient medical systems to address those gaps. As a nurse, you have to be proactive as a cultural liaison between the patients and other providers and healthcare systems to ensure that resources are aligned with broad and inclusive community healthcare needs. You are well aware that culture is a major cause of health disparity as a mediating factor for the way people interact with their environment and lifestyle choices. Therefore, you must employ all your cultural awareness during care coordination efforts to be an asset to your patient, your team, your organization, and the community..

[Audio] Your clinical setting will integrate with services from other settings, such as nursing homes, hospices, mental health agencies, counseling programs, and other rehabilitation services within the community. There will be multidisciplinary interaction at different points, and nurses will often be a liaison somewhere, facilitating the transition of care across units, departments, and organizations. You must know the extent of resources available to extend the scope of services available in the community by integrating them into alignment with specific clinical pathways. At this juncture, I must mention the importance of making healthcare systems navigable. Skär and Söderberg (2018) found that patients often complain that they have difficulty navigating health systems and may forfeit appointments and specialized attention when trying to get an appointment. You, therefore, must guide patients along their care continuum, ensuring they understand why they have to move along the clinical pathways in different care environments..

[Audio] In conclusion nurses are called upon to use their humanity and professionalism to ensure continuity of care and in the same instance assure patients, families and the community that there is no compromise to quality and safety of care when coordinating care. Nurse should rely on the interdisciplinary team to provide collaborative care that is in line with policies on patient-centered care..

[Audio] Thank you. . References. Alder, S. (2023). HIPAA Continuity of Care. The HIPAA Journal. https://www.hipaajournal.com/hipaa-continuity-of-care/#:~:text=HIPAA%20continuity%20of%20care%20is,guidance%20on%20minimum%20necessary%20disclosures. Dawkins, B., Renwick, C., Ensor, T., Shinkins, B., Jayne, D., & Meads, D. (2021). What factors affect patients’ ability to access healthcare? An overview of systematic reviews. Tropical Medicine & International Health, 26(10), 1177–1188. https://doi.org/10.1111/tmi.13651 Hansson, O., & Fröding, B. (2020). Ethical conflicts in patient-centred care. Clinical Ethics, 147775092096235. https://doi.org/10.1177/1477750920962356 Kaihlanen, A., Hietapakka, L., & Heponiemi, T. (2019). Increasing cultural awareness: qualitative study of nurses’ perceptions about cultural competence training. BMC Nursing, 18(1). https://doi.org/10.1186/s12912-019-0363-x Rawlings, A., Brandt, L., Ferreres, A. R., Asbun, H. J., & Shadduck, P. P. (2020). Ethical considerations for allocation of scarce resources and alterations in surgical care during a pandemic. Surgical Endoscopy and Other Interventional Techniques, 35(5), 2217–2222. https://doi.org/10.1007/s00464-020-07629-x Skär, L., & Söderberg, S. (2018). Patients’ complaints regarding healthcare encounters and communication. Nursing Open, 5(2), 224–232. https://doi.org/10.1002/nop2.132 Tønnessen, S., Ursin, G., & Brinchmann, B. S. (2017). Care-managers’ professional choices: ethical dilemmas and conflicting expectations. BMC Health Services Research, 17(1). https://doi.org/10.1186/s12913-017-2578-4.