For this assessment, you will implement the preliminary care coordination plan you developed in Assessment 1. Present the plan to the patient in a face-to-face clinical learning session and collaborate with the patient in evaluating session outcomes and addressing possible revisions to the plan.

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

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.

This assessment provides an opportunity for you to apply communication, teaching, and learning best practices to the presentation of a care coordination plan to the patient.

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.

Demonstration of Proficiency

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

• Competency 1: Adapt care based on patient-centered and person-focused factors. 
  • Design patient-centered health interventions and timelines for care delivered through direct clinical interaction that is logged in the CORE ELMS system.
• Competency 2: Collaborate with patients and family to achieve desired outcomes. 
  • Evaluate learning session outcomes and the attainment of mutually agreed-upon health goals, in collaboration with a patient.
• Competency 3: Create a satisfying patient experience. 
  • Evaluate patient satisfaction with the care coordination plan and progress made toward Healthy People 2020 goals and leading health indicators.
• Competency 4: Defend decisions based on the code of ethics for nursing. 
  • Make ethical decisions in designing patient-centered health interventions.
• Competency 5: Explain how health care policies affect patient-centered care. 
  • Identify relevant health policy implications for the coordination and continuum of care.

Preparation

In this assessment, you will implement the preliminary care coordination plan you developed in Assessment 1 and communicate the plan to the patient in a professional, culturally sensitive, and ethical manner.

To prepare for the assessment, consider the patient experience and how you will present the plan. Make sure you schedule time accordingly.

Instructions

Note: You are required to complete Assessment 1 before this assessment.

For this assessment:

• Complete the preliminary care coordination plan you developed in Assessment 1.
• Present the plan to the patient in a face-to-face clinical learning session. Communicate in a professional, culturally sensitive, and ethical manner.
• Collaborate with the patient in evaluating session outcomes and addressing possible revisions to the plan.

Reminder: The time you spend presenting your final care coordination plan must be logged in the CORE ELMS system. The total time spent in securing individual participation in this activity in Assessment 1 and presenting your plan in this assessment must be at least three hours. The CORE ELMS link is located in the courseroom navigation menu.

Please be advised that the Volunteer Experience form requires that you provide the name and contact information for at least one individual with whom you worked as part of your direct clinical activity. Your faculty may reach out to this individual to verify that you have accurately documented and completed your clinical hours.

Document Format and Length

Build on the preliminary plan document you created in Assessment 1. Your final plan should be 5–7 pages in length.

Supporting Evidence

Support your care coordination plan with peer-reviewed articles, course study resources, and Healthy People 2020 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 care delivered through direct clinical interaction that is logged in the CORE ELMS system. 
  • Address three patient health issues.
  • Design an intervention for each health issue.
  • Identify three community resources for each health intervention, so the patient may make an informed decision about what resources to use.
• Make 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.
• Evaluate learning session outcomes and the attainment of mutually agreed-upon health goals, in collaboration with the patient. 
  • What aspects of the session would you change?
  • How might revisions to the plan improve future outcomes?
• Evaluate patient satisfaction with the care coordination plan and progress made toward Healthy People 2020 goals and leading health indicators. 
  • What changes would you recommend to improve patient satisfaction and better align the session with Healthy People 2020 goals and leading health indicators?

  

In this assignment you will be required to write a Focused SOAP note, please do not submit a Complete SOAP note, you must learn to differentiate the two. If you do not have enough information to make a scholarly Focused note, you may make up information. For example, if the Family History is missing make up a history.

The Lab Assignment

Using evidence-based resources from your search, answer the following questions and support your answers using current evidence from the literature.

· Analyze the subjective portion of the note. List additional information that should be included in the documentation.

· Analyze the objective portion of the note. List additional information that should be included in the documentation.

· Is the assessment supported by the subjective and objective information? Why or why not?

· Would diagnostics be appropriate for this case, and how would the results be used to make a diagnosis?

· Would you reject/accept the current diagnosis? Why or why not?

 Identify three possible conditions that may be considered as a differential diagnosis for this patient.

·  Explain your reasoning using at least three different references from current evidence-based literature.

Week 10: Special Examinations—Breast, Genital,

Prostate, and Rectal

GENITALIA ASSESSMENT

Subjective:

• CC: “I have bumps on my bottom that I want to have checked out.”

• HPI: AB, a 21-year-old WF college student reports to your clinic with external

bumps on her genital area. She states the bumps are painless and feel rough.

She states she is sexually active and has had more than one partner during the

past year. Her initial sexual contact occurred at age 18. She reports no abnormal

vaginal discharge. She is unsure how long the bumps have been there but

noticed them about a week ago. Her last Pap smear exam was 3 years ago, and

no dysplasia was found; the exam results were normal. She reports one sexually

transmitted infection (chlamydia) about 2 years ago. She completed the

treatment for chlamydia as prescribed.

• PMH: Asthma

• Medications: Symbicort 160/4.5mcg

• Allergies: NKDA

• FH: No hx of breast or cervical cancer, Father hx HTN, Mother hx HTN, GERD

• Social: Denies tobacco use; occasional etoh, married, 3 children (1 girl, 2 boys)

Objective:

• VS: Temp 98.6; BP 120/86; RR 16; P 92; HT 5’10”; WT 169lbs

• Heart: RRR, no murmurs

• Lungs: CTA, chest wall symmetrical

• Genital: Normal female hair pattern distribution; no masses or swelling. Urethral

meatus intact without erythema or discharge. Perineum intact. Vaginal mucosa

pink and moist with rugae present, pos for firm, round, small, painless ulcer noted

on external labia

• Abd: soft, normoactive bowel sounds, neg rebound, neg murphy’s, negMcBurney

• Diagnostics: HSV specimen obtained

Assessment:

• Chancre

PLAN: 

 

We are still exploring section III which involves Conceptual Models/Grand Theories in the Integrative-Interactive Paradigm

Our text readings will include concepts from:

Chapter 12: Helen Erickson, Evelyn Tomlin, and Mary Ann Swain’s Theory or Modeling and Role Modeling

Chapter 13: Barbara Dossey’s Theory of Integral Nursing

As healthcare professionals, we need to be aware of nursing theory, as you heard it many times that it applies to our practice as nurses. When you think about it, how many practicing nurses are aware of the nursing theories and how they use in their careers. If you have a chance this week, go and ask a colleague about what they know regarding nursing theorist and who may be their favorite theorist in the profession.

You will see an overlap in the three nursing theorist listed below (Erickson, Tomlin, and Swain).

As your read and explore the following website resources, think about how their works contribute to our current practices today in nursing.

We will investigate Modeling and Role Modeling in nursing; these concepts will build upon the four metaparadigms of nursing: Person, Environment, Health, and Nursing.

When using the modeling and role-modeling theory, the nurse attempts to understand the “client’s personal model of his or her world and to appreciate its value an significance for the client from the client’s perspective.” (Masters, 2015).  

Reference:

Masters, K. (2015). Nursing Theories: A Framework for Professional Practice. (2nd ed.). Burlington, Massachusetts. Jones & Bartlett Learning.

Who is Helen Erickson?

https://www.nursing-theory.org/theories-and-models/erickson-modeling-and-role-modeling-theory.php

Who is Evelyn Tomlin?

http://currentnursing.com/theory/modeling_and_role-modeling_theory.html

Who is Mary Ann Swain?

https://nursology.net/nurse-theorists-and-their-work/modeling-and-role-modeling/

Video: Modeling and Role Modeling

https://www.youtube.com/watch?v=MNRkJlzYp6I

Article: Modeling and Role Modeling

http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.841.9640&rep=rep1&type=pdf

Who is Barbara Dossey? What is her Theory of Integral Nursing?

An integral process is defined as a comprehensive way to organize multiple phenomenon of human experience and reality from four perspectives:

(1) the individual interior (personal/intentional);

(2) individual exterior (physiology/behavioral);

(3) collective interior (shared/cultural); and

(4) collective exterior (systems/structures) (Dossey, n.d.).

Consciousness & Holistic nursing – Barbara Dossey part 1 out of 2

Part One

https://www.youtube.com/watch?v=HD5pxzc9q0U&t=94s

Part Two

https://www.youtube.com/watch?v=mRAoD0-loWM

Website: Dossey Theory of Integral Nursing

http://www.dosseydossey.com/barbara/tin.html

PowerPoint: Barbara Dossey

http://www.dosseydossey.com/barbara/pdf/Dossey_Theory_of_Integral_Nursing_powerpoint.pdf

 

DISCUSSION A

Robert and Jenna Smith’s 2nd child has Down Syndrome. Philip is 14 years old. He has a sibling that is older and one younger. 15 year old sister, Lucy and a little brother Danny who is 10 years old. As all 14 year olds he is becoming more interested in his sexuality and expressing that with curiosity. He has been known to have some overt aggression toward his sister and some classmates in his public school.
Discuss how you could help this family cope and guide Philip to learn appropriate behavior.Group B Response
Will this behavior interfere with his interest in being in the local Boy Scout troop? His troop leader is his father.

DISCUSSION B

Toddlers have some very unique behavioral characteristics as they move from infancy to childhood. Identify these behavioral changes. Include the challenges that parents may face with these characteristics including identifying temperament, nutritional barriers, hygiene, activity, and sleep.Group A Response
Can you help parents learn to deal with these behaviors and provide them some insight and guidance that will ease this transition for the child and parent?
You work in the pediatrician’s office.
Assessments and education are the focus of your work. Please only do Group B. Include In text citation and 3-4 references

Health promotion has and remains to be significant to patient care outcomes through its roles that include; management of diseases and provision of tools and resources that enable patients to take personal action and achieve accountability for their own wellness. On this same road to health promotion, health education has been essential in ensuring wellness. By definition, health education is “any combination of learning experiences designed to help individuals and communities improve their health, by increasing their knowledge or influencing their attitudes” (WHO, 2018a, para 1). Therefore, health education plays a paramount role when nurses use it to provide patients with necessary tools and information that empowers them to make informed choices and decisions that enhance health promotion. One way of achieving health education is through the nursing process. This component, which has been the backbone of nursing uses various aspects to include; assessment, diagnosis, planning, implementation and evaluation to help patients achieve desirable health outcomes. Through assessment, the nurse is able to identify a need from which he/she can formulate a diagnosis. Thereafter, by involving the patient, they come up with a plan that is practical and the patient then move to implementing it with the support of the nurse. Finally, through evaluation, the nurse is able to compare the expected outcomes to the actual outcomes done by the patients from which they can work on making necessary improvements to improve health promotion.

One issue that poses as a threat to the wellbeing of a family is the incidents of falls. Despite its prevalence among pediatrics and geriatrics, falls may also occur in any age group. According to (CDC, 2017e), falls are a leading cause of death and disability among geriatrics and are nearly always a preventable cause. CDC also gives statistics of more than 27000 deaths of older adults resulting from falls which is almost 74 elderlies per day. Additionally, of all the reported cases of falls, approximately more than 7 million require medical treatment or restricted activity for at least a day. Through the nursing process, a nurse is able to perform a thorough assessment and employ effective strategies to help prevent this epidemic among susceptible populations (Falkner, 2018)

Some of the ways that can help address prevention of the risk to falls for children are: ensuring Play safety; through safe playground equipment and environment, Home safety; through safe home devices like guardrails, door locks et cetera, Sport safety; through appropriate gear like helmets and sunscreens and lastly Supervision; through guidance from a responsible adult. On the other hand, ensuring safety among the older adults can be through the following; installation of grab bars in the bathroom, decluttering the home environment, strength and balance exercises to improve their balance, removal of small throw rugs, adequate lighting and the use of assistive medical equipment such as walkers. This is helpful to achieving a fall-free environment for both groups. Additionally, collaboration with the case management worker to coordinate with the patient’s insurance company is essential for the acquisition of medical equipment especially for the older adults (Falkner, 2018)

References.

Centers for Disease Control and Prevention. (2017e). STEADI – Older adult fall prevention. Retrieved from https://www.cdc.gov/steadi

Falkner, A. (2018). In GCU’s Health Promotion: Health and Wellness Across the Continuum. Retrieved from

https://www.gcumedia.com/digital-resources/grand-canyon-university/2018/health-promotion_health-and-wellness-across-the-continuum_1e.php

 World Health Organization, (2018a). Health education. Retrieved from http://www.who.int/topics/health_education/en

Gaining health education as providers give educators a chance to help individuals and communities on how to enhance their health. Through teaching, hands-on and practicing, patients will feel better about themselves which will make room for healing faster. Proper education will minimize frequent hospital visits from providing a list of proper food, the proper way to store potential hazardous objects around the house to make an available list of organizations that can further assist with continued education. individuals and communities will also benefit from safe transportation and housing.

To develop a health education plan, the individual or the communities must be assessed. Assessment will give the educators ideas of what the patient needs. It will also assist in knowing the strengths and weaknesses of the individual. From the assessment, a diagnosis will be made, whether it is a knowledge deficit or ineffective. From there, a plan is made with the patient being the center of that plan. If the patient is not involved in creating that plan, the plan will not be effective. After a plan is made, education be implemented in the plan. By having the individual demonstrate what was learned is a great way to evaluate whether the plan was effective or not. Cultural competency plays a major role when developing a health education plan.

The active mass shooting has become a major global issue. According to a report from FBI’s Office of Partner Engagement along with FBI’s Criminal Investigation Division and the Advanced Law Enforcement Rapid Response training center at Texas State University, in 2018 alone, “ 27 incidents resulted in 213 casualties (85 people killed and 128 people wounded, excluding the shooters). The highest number of casualties (17 killed and 17 wounded) occurred at Marjory Stoneman Douglas High School in Parkland, Florida.” (FBI’s Office of Partner Engagement, FBI’s Criminal Investigation Division and ALERRT, 2018). Because of these frequent casualties, nurses require more education on the preparedness for those incidents. Parents and families will also require education on gun safety.

Planning comprises creating a kit with essentials in case a tragedy arises. This includes items such as water, flashlights, batteries, first-aid kit, and canned or dried edible food items that should be included. Educators should teach individuals or communities on communicating in meeting areas in case of a disaster. Per Angel Falkner, “Families should also take the time to discuss types of disasters with members of the family, including small children.” (Falkner, 2018). It is normal for families to panic at the time of a disaster but with good education and planning, it will alleviate some of the stress that may arise.

Reference

Falkner, A. (2018). Health Promotion in Nursing Care. Grand Canyon University. Retrieved from https://lc.gcumedia.com/nrs429vn/health-promotion-health-and-wellness-across-the-continuum/v1.1/#/chapter/4

FBI’s Office of Partner Engagement, FBI’s Criminal Investigation Division, and ALERRT. (2018). Active shooting incident in the United States in 2018. Washington D.C. Retrieved from https://www.fbi.gov/file-repository/active-shooter-incidents-in-the-us-2018-041019.pdf/view