Introduction

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.

NOTE: You are required to complete this assessment after Assessment 1 is successfully completed.

Preparation

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
.

Instructions

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.

· Identify 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.

Additional Requirements

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.

Portfolio Prompt: Save your presentation to your 
ePortfolio. Submissions to the ePortfolio will be part of your final Capstone course.

Context

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.

Step 1. Critical:  all else depends on your finding a Randomized Controlled (Clinical) Trial Peer-Reviewed Journal Article (Level II Evidence)  Review Figure 1.1,~ p. 13 of your textbook for the Level of Evidence Pyramid, which shows an RCT is at Level II. When you communicate with physicians about an article, they respect the article more when it is at least on the Level II evidence pyramid, which suggests more credibility and possibly better input regarding outcomes of care.  Find your peer-reviewed Randomized Controlled Trial (RCT) article related to your area of interest.  If you are not sure of how to find articles using our DCN Databases,do the following:

1. Go to the DCN Home Page
2. Notice that there are 3 columns and 3 rows, each with a green heading category.  Go to the second row, first column, and click on Databases. Once your see the top heading, Database Access, look below and see “For DCN Students: Database Use Tutorial (MP4 Recording). Study the tutorial, and it will assist you in finding a Randomized Controlled (Clinical) Trial article
3. If you need further assistance with finding an article after you review the tutorial, email Mr. Madsen, Director of the LRC. He has a Masters of Library Services degree, and can assist you in finding articles that you may not be able to access. If you find an article that charges a fee, e-mail Mr. Madsen the article you need, and he can usually get the full text article for you at no charge. His email address is [email protected].

Step 2.  Once you have your article, read it, and then look at the CONSORT Checklist, and write the page number in the article that has the information the checklist requires. (FYI, researchers who publish their research use this checklist to be sure they have everything in their article, or it is often not accepted by premier scholarly publishers). The checklist is worth 25 points, as it takes time and discernment to do it correctly.

Step 3:  Once your fill out the CONSORT CHECKLIST (25 points), you must then write a formal summary of the Analysis of Strengths and Weaknesses (worth 8 points) that you will notice is on the CONSORT checklist. The following steps are to assist you in distilling the specifics for what is required in the Analysis of Strengths and Weaknesses for the CONSORT checklist. .

Step 4  Specifics of the ANALYSIS OF STRENGTHS AND WEAKNESSES.  Review ~p. 9 of your research textbook, and then note how to write
 

1. Introduction  (1 point)

                   + Purpose of the RCT (discuss)

1. Overall Strengths and Weaknesses  (1 point) 

                  +  Research Design (Discuss)

                  +  Important Findings

1. Reliability and Validity  (2 points) (Check the

     methods, instruments, measurements or

     procedures sections of article); statistics; Level of Evidence and

     implications; cause-effect measurement; any threats to internal

     or external validity

1. Ethics (1 point)

                  +  IRB? +Conflict of Interest +Informed Consent Signed

1. Topic/Summary  (2 points)

                 + Implications

                 + Limitations

                 + Recommendation(s)

Instructions

In small groups, students will develop a visual communication project—an infographic—in which they use an image(s) to create a message that meaningfully informs or persuades an audience. The infographic should be like a poster you might see on the wall in a doctor’s office, containing a variety of types of information on a topic.  The topic does not need to be restricted to healthcare.  Be sure to follow APA throughout, treat all copyrighted images as research sources, and cite appropriately. Be sure to address all rubric criteria.

Required Format and Process

This assignment has two parts: 1) in groups, students will create an infographic (an image or a collection of images combined with text for the purpose of making a statement, illustrating a concept, or describing a process); students should decide early if they are aiming to inform or persuade, and research must inform the project; 2) the group will incorporate appropriate language to support the message to complete their infographic.

Example: To complete this assignment, each group  will: 1) choose a focus and goal (to either inform or persuade); 2) decide on the approach (illustrate process or make an impact); 3) select or create appropriate image(s); 4) conduct relevant research; 5) incorporate appropriate text to support the overall message in a well-designed infographic. Note: any online image must be cited just as text would (groups are free to create their own images for the infographic by using their own creative means, such as photography, drawing, etc.).

Assignment Support

Be sure to check out the Visual Communication Assignment Support documentOpen this document with ReadSpeaker docReaderLinks to an external site., as it provides samples and tips for creating infographics for you to consider.

(USLO 8.2)

 Post a response to your Blog in which you describe at least two of the most important needs/challenges/issues in your community or organization. Why are these needs/challenges/issues important? Be specific. Then, recommend at least two practice changes or interventions you would suggest to address these needs/challenges/issues in your community or organization. Be sure to align your role as the DNP-prepared nurse to the competencies identified in the AACN Essentials.

 

• American Association of Colleges of Nursing. (2006). The essentials of doctoral education for advanced nursing practice. https://www.aacnnursing.org/Portals/42/Publications/DNPEssentials.pdfDownload DNPEssentials.pdf
• Andrew, N., Tolson, D., & Ferguson, D. (2008). Building on Wenger: Communities of practice in nursing.Links to an external site.Nurse Education Today, 28(2), 246–252. https://doi.org/10.1016/j.nedt.2007.05.002
• Cook, D. A., Pencille, L. J., Dupras, D. M., Linderbaum, J. A., Pankratz, V. S., & Wilkinson, J. M. (2018). Practice variation and practice guidelines: Attitudes of generalist and specialist physicians, nurse practitioners, and physician assistants.Links to an external site. PLOS ONE, 13(1), e0191943. https://doi.org/10.1371/journal.pone.0191943
• Fukuda, T., Sakurai, H., & Kashiwagi, M. (2020). Efforts to reduce the length of stay in a low-intensity ICU: Changes in the ICU brought about by collaboration between Certified Nurse Specialists as head nurses and intensivists.Links to an external site. PLOS ONE, 15(6), e0234879. https://doi.org/10.1371/journal.pone.0234879
• Kislov, R., Walshe, K., & Harvey, G. (2012). Managing boundaries in primary care service improvement: A developmental approach to communities of practice.Links to an external site.Implementation Science, 7(97), 97–110. https://doi.org/10.1186/1748-5908-7-97

 

SDOH:  https://health.gov/healthypeople/priority-areas/social-determinants-health