Develop infographic of a preliminary care coordination plan for a selected healthcare problem. Include physical, psychosocial, and cultural considerations for this healthcare problem. Identify and list available community resources for a safe and effective continuum of care.
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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 healthcare problem. Include physical, psychosocial, and cultural considerations for this healthcare problem. Identify and list available community resources for a safe and effective continuum of care.
Note: You are required to complete this assessment before Assessment 5.
Overview
Please watch the following brief video message for an overview of what to keep in mind as you complete your Preliminary Coordination Plan Infographic.
· Preliminary Coordination Plan Infographic.
Scenario
Preparation
As you begin to prepare for this assessment, complete the virtual simulation from Sentinel U on Patient Management & Delegation. The goal of this activity is to help familiarize yourself with technology in healthcare, patient acuity, along with assigning and delegating patient care based on the acuity level and skillset of the registered nurse.
You are also 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.
Instructions
Note: You are required to complete this assessment before Assessment 5.
Choose a specific healthcare problem that aligns with your practicum site population and create an infographic that visually represents your care coordination plan.
1. Select one health concern and a patient population that aligns with your practicum setting. Examples include:
· Type 2 diabetes in pediatric patients in a community healthcare setting.
· Cognitive impairment in home health of elderly patients.
· Mental health in adult patients in an acute health setting.
· Pain management in adults in hospice care.
· Falls in long-term care adults.
2. Analyze your selected health concern and the associated best practices for health improvement.
· Address the following content elements in your analysis:
o Best practices: Summarize evidence-based best practices related to the chosen healthcare problem.
o Physical considerations: Address physical aspects of care (for example, medications, treatments, or monitoring).
o Psychosocial considerations: Consider mental health, emotional support, and patient coping strategies.
o Cultural considerations: Recognize cultural diversity and tailor care accordingly.
· Cite supporting evidence for best practices.
3. Describe two specific SMART (specific, measurable, achievable, relevant, time-bound) goals that should be established to address the healthcare problem and the evidence to support those goals.
· For example: “Reduce A1C levels by 10% within 6 months through lifestyle modifications.”
· Include physical, psychosocial, and cultural considerations of your specific patient population.
· Discuss your SMART goals with your preceptor. Document discussion of SMART goals in Capella Academic Portal.
4. Identify available community resources for a safe and effective continuum of care.
· Compile a list of community resources relevant to the healthcare problem.
· Include local clinics, support groups, educational programs, and social services.
· Include physical, psychosocial, and cultural considerations of your specific patient population.
5. Apply APA formatting to in-text citations and references, exhibiting nearly flawless adherence to APA format.
The requirements outlined above correspond to the grading criteria in the Preliminary Care Coordination Plan scoring guide, so be sure to address each point in your infographic. Read the performance-level descriptions for each criterion to see how your work will be assessed.
Format
· Create an infographic that visually represents your care coordination plan.
· Create the infographic using a PowerPoint infographic template.
· Use clear and concise language.
· Include relevant icons, graphics, and colors to enhance readability.
Example Infographic
This is an Example Infographic [PPTX]. Feel free to use a PowerPoint infographic template and be creative in your presentation.
Practicum Hours Submission
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Nursing Reflection Journal: Four Spheres of Care
Reflective Journaling
Reflective journaling serves as a powerful tool for self-reflection during your academic journey. Reflective journaling enables you to assess your performance and to develop the regular practice of self-reflection. During your practicum, you’ll complete four reflective journal entries, each aligned with one of the four spheres of care.
For your first entry, you can choose any of the four spheres, but you will need to complete all four by the end of the course. Remember that you’ll need to submit your completed nursing reflection as part of the final assessment for the course.
Instructions
Complete your first entry in 100–400 words in the Nursing Reflection Journal: Four Spheres of Care activity. You do not need to include scholarly resources or a reference list. Your reflections should be your own original thoughts. Please do not include patient or clinic identifying information.
As you complete your practicum hours (total of 40 hours required), it is good practice to complete a reflection journal entry every 10 hours. Take a moment to review the four spheres of care and the assigned readings for each assessment. This can help you focus your practicum time on specifics of learning and experiencing the courseroom content.
AACN Definition of the Four Spheres of Care
Wellness and disease prevention: This sphere emphasizes health promotion, as well as the treatment of minor uncomplicated diseases or injuries for those not experiencing chronic illness or life-limiting conditions. Prenatal care, screenings, immunizations, and health promotion are some examples of care in this sphere (AACN, 2021). Nursing knowledge and competency in disease prevention and addressing social determinants of health are vital to promoting wellness across populations.
Chronic disease management: This sphere encompasses caring for those with one or more chronic diseases and preventing adverse outcomes associated with them. Specialized nursing care is often needed for this population due to the complex needs, along with integrated interprofessional team-based care. Four in 10 Americans have two or more chronic diseases, and those diagnosed with multiple comorbidities are projected to increase.
Regenerative and restorative care: This sphere includes critical and trauma care, complex acute care, acute exacerbations of chronic disease, and care of unstable patients who are typically in acute care hospital settings (AACN, 2021). This sphere includes the acute management of illness, such as a stroke or mental health crisis, and progression through the rehabilitative phase. Nursing skills and management of these populations are resource-intensive and specialized.
Hospice and palliative care: The final sphere relates to competencies surrounding palliative care in advanced illness and hospice care at the end of life. All registered nurses provide generalist palliative care in compassionate and patient-centered care while managing pain and other symptoms associated with advanced, progressive illness. The End-of-Life Nursing Education Consortium has mapped its Competencies and Recommendations for Educating Nursing Students competencies to the new AACN Essentials to assist educators in this endeavor.
Reflection Questions
By the end of your practicum, make sure that you have answered each of these questions.
· Wellness and disease prevention: Reflect on the health promotion disease prevention interventions you witnessed in your practicum site, as it relates to the social determinants of health most prevalent in your community. What did you see? What does this time mean to you as a professional nurse in your role?
· Chronic disease management: Reflect on the integration of interprofessional team-based care as it relates to chronic disease management in your practicum site. What did you see? What does this time mean to you as a professional nurse in your role?
· Regenerative and restorative care: Reflect on the acute management of illnesses such as stroke, mental illness, and falls in your practicum site. What did you see? What does this time mean to you as a professional nurse in your role?
· Hospice and palliative care: Reflect on end-of-life nursing and advanced illness and hospice care in your practicum site. What did you see? What does this time mean to you as a professional nurse in your role?
Reference
American Association of Colleges of Nursing. (2021). The essentials: Core competencies for professional nursing education. https://www.aacnnursing.org/Portals/0/PDFs/Essentials/Essentials-Executive-Summary.pdf
Completion Checklist
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Competencies Measured
By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and scoring guide criteria:
· Competency 1: Create a patient centered strategy to achieve desired health outcomes.
o Analyze a health concern and the associated best practices for health improvement.
o Describe specific goals that should be established to address a selected health care problem.
o Identify available community resources for a safe and effective continuum of care addressing a specific healthcare problem.
· Competency 5: Apply professional, scholarly communication strategies to lead patient-centered care.
o Organize content so ideas flow logically with smooth transitions; contains few errors in grammar/punctuation, word choice, and spelling.
o Apply APA formatting to in-text citations and references, exhibiting nearly flawless adherence to APA format.
Scoring Guide
Use the scoring guide to understand how your assessment will be evaluated.
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Criterion 1
Analyze a health concern and the associated best practices for health improvement.
Distinguished
Analyzes a health concern and the associated best practices for health improvement. Provides credible evidence for best practices and articulates underlying assumptions and points of uncertainty in the analysis.
Proficient
Analyzes a health concern and the associated best practices for health improvement.
Basic
Identifies a health concern and some best practices for health improvement without weighing appropriate physical, psychosocial and cultural considerations.
Non Performance
Does not analyze a health concern and the associated best practices for health improvement.
Criterion 2
Describe specific goals that should be established to address a selected health care problem.
Distinguished
Describes specific goals that should be established to address a selected healthcare problem. Goals are realistic, measurable, and attainable.
Proficient
Describes specific goals that should be established to address a selected health care problem.
Basic
Describes undefined goals that should be established to address a selected health care problem.
Non Performance
Does not describe specific goals that should be established to address a selected health care problem.
Criterion 3
Identify available community resources for a safe and effective continuum of care addressing a specific healthcare problem.
Distinguished
Identifies available community resources for a safe and effective continuum of care addressing a specific healthcare problem. Provides a comprehensive list of resources, with credible evidence of their contribution toward improving community health.
Proficient
Identifies available community resources for a safe and effective continuum of care addressing a specific healthcare problem.
Basic
Identifies available community resources.
Non Performance
Does not identify available community resources for a safe and effective continuum of care addressing a specific healthcare problem.
Criterion 4
Organize content so ideas flow logically with smooth transitions; contains few errors in grammar/punctuation, word choice, and spelling.
Distinguished
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.
Proficient
Organizes content so ideas flow logically with smooth transitions; contains few errors in grammar/punctuation, word choice, and spelling.
Basic
Organizes content with some logical flow and smooth transitions. Contains errors in grammar/punctuation, word choice, and spelling.
Non Performance
Does not organize content for ideas. Lacks logical flow and smooth transitions.
Criterion 5
Apply APA formatting to in-text citations and references, exhibiting nearly flawless adherence to APA format.
Distinguished
Exhibits strict and flawless adherence to APA formatting of headings, in-text citations, and references. Correctly uses quotes and paraphrasing.
Proficient
Applies APA formatting to in-text citations and references, exhibiting nearly flawless adherence to APA format.
Basic
Applies APA formatting to in-text citations, headings and references incorrectly and/or inconsistently, detracting noticeably from the content. Inconsistently uses headings, quotes, and/or paraphrasing.
Non Performance
Does not apply APA formatting to headings, in-text citations, and references. Does not use quotes or paraphrase correctly.
Criterion 6
Complete a minimum of 10 practicum hours, approved by your preceptor. Submit practicum hour documentation to Capella Academic Portal. Document discussion of SMART goals in Capella Academic Portal under “Activities.”
Distinguished
Completes a minimum of 10 practicum hours. Includes detailed description of activities and discussion of SMART goals with preceptor in Capella Academic Portal. Submits all to Capella Academic Portal.
Proficient
Completes a minimum of 10 practicum hours, approved by your preceptor. Submits practicum hour documentation to Capella Academic Portal. Documents discussion of SMART goals in Capella Academic Portal under “Activities.”
Basic
Completes less than 10 practicum hours, approved by your preceptor. Submits practicum hour documentation to Capella Academic Portal.
Non Performance
Does not complete any practicum hours, approved by your preceptor. Does not submit practicum hour documentation to Capella Academic Portal.
