Complete an interactive simulation of the role of the nurse in health care coordination. Then, create a comprehensive patient needs assessment of 4-5 pages based on that simulation.

Note: Each assessment in this course builds on your work from preceding assessments; therefore, complete the assessments in the order in which they are presented.

Care coordination is an emerging and complex field in the health care system because of the growing number of providers, the various settings of care, and the numerous methods of delivering care. Hospitals are implementing several interventions to address gaps in care coordination, such as enhanced systems of communication, information technology, and personnel resourcing. This assessment provides an opportunity for you to complete a comprehensive needs assessment.

In the 2000 report To Err Is Human: Building a Safer Health System, the Institute of Medicine identified collaborative communication and the reduction of medical errors as top priorities to improve the quality and safety of patient care. In response to this, the National Quality Forum (NQF), a nonprofit organization that works to catalyze improvements in health care, identified care coordination as an important national strategy to improve patient safety and quality of care delivery.

Coordination of care supports patient safety and quality and is a recognized professional standard shared by registered nurses regardless of their practice settings. Whether educating a patient about his or her medication and plan of care or reviewing follow-up care, nurses are essential in facilitating the continuity of care for all patients. Historically, nurses have engaged in coordinating care for every one of their patients. As the landscape of health care evolves, so does care coordination.

REFERENCE

Institute of Medicine. (2000). To err is human: Building a safer health system. National Academies Press.

Note: Complete the assessments in this course in the order in which they are presented.

As you prepare to complete this assessment, you may want to think about other related issues to deepen your understanding or broaden your viewpoint. You are encouraged to consider the questions below and discuss them with a fellow learner, a work associate, an interested friend, or a member of your professional community. Note that these questions are for your own development and exploration and do not need to be completed or submitted as part of your assessment.

• What are the key reasons for completing a patient needs assessment?
• Which types of information are likely to be most valuable for improving patient outcomes?
• What are the benefits of a multidisciplinary approach to coordinated care?

To prepare for this assessment, complete the following simulation:

• Vila Health: The Nurse’s Role in Care Coordination.

This simulation explores the roles that case managers and other team members play in care coordination. Upon completion of the exercise, you should have a better understanding of care coordination trends and their historical contexts. Use the information available in this simulation to begin your assessment of the patient, Mr. Decker.

Note: As you revise your writing, check out the resources listed on the Writing Center’s Writing Support page.

Complete a comprehensive needs assessment for Mr. Decker, based on the information provided in the Vila Health simulation and your own research.

COMPREHENSIVE NEEDS ASSESSMENT FORMAT AND LENGTH

Format your comprehensive needs assessment using APA style:

• Use the APA Style Paper Tutorial [DOCX] provided. Be sure to include:
  • A title page and references page. An abstract is not required.
  • A running head on all pages.
  • Appropriate section headings.
• Your needs assessment should be 4–5 pages in length, not including the title page and references page.

SUPPORTING EVIDENCE

Cite 3–5 sources of scholarly or professional evidence to support your assessment.

CONDUCTING THE ASSESSMENT

The requirements outlined below correspond to the grading criteria in the scoring guide. Be sure that your needs assessment addresses each point, at a minimum. Read the Comprehensive Needs Assessment Scoring Guide to better understand how each criterion will be assessed.

• Identify current gaps in a patient’s care.
  • Use an appropriate needs assessment tool to identify gaps. This tool may be one in use at your place of employment, one you locate for yourself, or one provided by faculty.
  • Consider the types of patient information that will be most useful in assessing the current level of care.
• Develop a strategy for gathering additional necessary assessment data not readily available from an initial patient interview.
  • Consider the full range of interrelated needs that affect the patient’s health.
• Discuss 3–5 societal, economic, and interprofessional factors most likely to affect patient outcomes.
  • Consider the potential effects of these factors on outcomes.
  • Support your conclusions with evidence.
• Relate specific patient and care coordination outcome measures to professional standards.
  • Provide the rationale for measuring outcomes based on established agencies and organizations.
  • Describe the relationship between specific outcomes and the identified standards.
• Identify evidence-based practices for successful implementation of care coordination.
  • Use relevant and credible sources from the research literature.
  • Consider best practices for a population-health focus on patient outcomes.
• Advocate for the benefits of a multidisciplinary approach to patient care.
  • Provide the key points in your argument.
  • Support your assertions with evidence.
• Write clearly and concisely, using correct grammar and mechanics.
  • Express your main points and conclusions coherently.
  • Proofread your writing to minimize errors that could distract readers and make it more difficult to focus on the substance of your needs assessment.
• Support main points, claims, and conclusions with credible evidence, correctly formatting citations and references using APA style.
• By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria:
  • Competency 1: Develop patient assessments.
    • Identify current gaps in a patient’s care.
    • Develop a strategy for gathering additional necessary assessment data not readily available from an initial patient interview.
  • Competency 2: Explain the effect of societal, economic, and interprofessional factors on patient outcomes and the care coordinator’s role.
    • Discuss societal, economic, and interprofessional factors most likely to affect patient outcomes.
    • Advocate for the benefits of a multidisciplinary approach to patient care.
  • Competency 3: Evaluate care coordination plans and outcomes according to performance measures and professional standards.
    • Relate specific patient and care coordination outcome measures to professional standards.
  • Competency 4: Develop collaborative interventions that address the needs of diverse populations and varied settings.
    • Identify evidence-based practices for successful implementation of care coordination.
  • Competency 5: Communicate effectively with diverse audiences, in an appropriate form and style, consistent with applicable organizational, professional, and scholarly standards.
    • Write clearly and concisely, using correct grammar and mechanics.
    • Support main points, claims, and conclusions with credible evidence, correctly formatting citations and references using APA style