Professional Capstone and Practicum Reflective 10 week Journal

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Students are required to maintain 10 week reflective narratives throughout the course to combine into one course-long reflective journal that integrates leadership and inquiry into current practice as it applies to the Professional Capstone and Practicum course.

In your journal, you will reflect on the personal knowledge and skills gained throughout this course. The journal should address a variable combination of the following, depending on your specific practice immersion clinical experiences:

  1. New practice approaches
  2. Intraprofessional collaboration
  3. Health care delivery and clinical systems
  4. Ethical considerations in health care
  5. Population health concerns
  6. The role of technology in improving health care outcomes
  7. Health policy
  8. Leadership and economic models
  9. Health disparities

Students will outline what they have discovered about their professional practice, personal strengths and weaknesses that surfaced, additional resources and abilities that could be introduced to a given situation to influence optimal outcomes, and finally, how the student met the competencies aligned to this course.

New practice approaches are present, complete, and incorporates additional relevant details and critical thinking to engage the reader.

Intraprofessional collaboration information is present, complete, and incorporates additional relevant details and critical thinking to engage the reader.

Health care delivery and clinical systems information is present, complete, and incorporates additional relevant details and critical thinking to engage the reader.

Ethical considerations in health care information is present, complete, and incorporates additional relevant details and critical thinking to engage the reader.

Population health concerns information is present, complete, and incorporates additional relevant details and critical thinking to engage the reader.

Information on the role of technology in improving health care outcomes is present, complete, and incorporates additional relevant details and critical thinking to engage the reader.

Health policy information content is present, complete, and incorporates additional relevant details and critical thinking to engage the reader.

Information on leadership and economic models is present, complete, and incorporates additional relevant details and critical thinking to engage the reader.

Information on health disparities is present, complete, and incorporates additional relevant details and critical thinking to engage the reader.

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Literature Evaluation Table Student Name: Binoy Joseph Change Topic (2-3 sentences): Care coordination is very important when it comes to heath care. It goes a long way to improve the overall health care and patient satisfaction. Criteria Article 1 Article 2 Author, Journal (PeerReviewed), and Permalink or Working Link to Access Article The authors of the study include Brown, Green, Desai, Weitzman, and Rosenthal. The working link is: The authors of the journal are Genna and Julia. The working link is http://pediatrics.aappublicati ons.org/content/133/3/e530 https://academic.oup.com /jamia/article/23/e1/e146 /2379872 Article 3 The authors are Daveson, Harding, Shipman, Mason, Epiphaniou, Higginson and Murray. The working link is https://doi.org/10.1371/j ournal.pone.0095523 Article Title and Year Published The name of the article is Need and unmet need for care coordination among children with mental health conditions it was published in the year 2014 The journal is titled Meaningful use care coordination criteria: Perceived barriers and benefits among primary care providers and was published in 2015 The journal is titled The Real-World Problem of Care Coordination: A Longitudinal Qualitative Study with Patients Living with Advanced Progressive Illness and Their Unpaid Caregivers. Article 4 The authors of the journal are Foster, Hart, Lindsell, Miller, and Lyons. The working link is https://doi.org/10.10 16/j.ajem.2018.04.0 05 The journal is titled Impact of a low intensity and broadly inclusive ED care coordination intervention on linkage to primary care and ED utilization published in 2018 It was published in 2014 Research Questions (Qualitative)/Hypothesi s (Quantitative), and Purposes/Aim of Study Design (Type of Quantitative, or Type of Qualitative) The study aimed to find out the importance of care coordination to children suffering from mental health conditions. The research questions included; what is the major difference between those where the care is met and those that aren’t? The study used the quantitative design The aim of the study was to find out the factors that hinder care coordination and the benefits of care coordination to primary care providers. What are the benefits of care coordination? The study sought to understand the concept of care coordination better and to come up with a model for patients who are living with a progressive illness to have care coordination. A qualitative study was carried out that involved the participants taking part in a survey It was a multiperspective qualitative study and involved case studies. © 2015. Grand Canyon University. All Rights Reserved. The purpose of the study was to find out how effective abroad, comparatively lowintensity intervention is when linking ED patients to a primary care home. A qualitative design was used. Setting/Sample Methods: Intervention/Instrumen ts Analysis Key Findings A sample of about 5 750 000 children was used. The stratified sampling method was used. A statewide survey was conducted. A random sample was selected. Logistic regression models were used. Surveys were done through paper, online, fax, phone and mail. The study showed that those with unmet care has an association with as anxiety, parent stress, and low income. The study found out that from the sample the 40% of the parents who had reported that they had a need for care coordination also reported that it was unmet. A descriptive statistics of barriers was created. The method of analysis used was open and axial coding. Many barriers were found but the main one was the lack of effective HIE capacities. The study found out that a lot of people are involved when it comes to caring coordination. That is, informed staff, unpaid caregivers and patients and they all have to work together. To in order to improve care coordination, effective systems and services have to be put in place and there has to be proper communication. The study is the first to examine the views that patients and caregivers had when it came to coordination Recommendations Ensuring there are familycentered care and family support will help to reduce the unmet need for care coordination. Explanation of How the Article Supports EBP/Capstone Project The study supports the importance of having care coordination The study concludes that there are many barriers to primary care, however, it is important to come up with policies that help in overcoming the barriers. The study gives suggestion on what can be done to improve care coordination Three cases were observed from contrasting primary, secondary and tertiary settings from Britain. Fifty-six patient and 27 cases of unpaid caregivers were used. Interviews were conducted © 2015. Grand Canyon University. All Rights Reserved. There were 2142 referrals that were made. Used a retrospective cohort study and interviews were also conducted. Data were removed from the program records as well as the electronic medical record. Out of all the referrals that were made, only 1688 accepted the help they were been offered. It was recommended that barriers that are hindering the linkage to the care have to be dealt with This supports EBP in that it looks at the ED patients and the relationship to care coordination Criteria Author, Journal (Peer-Reviewed), and Permalink or Working Link to Access Article Article Title and Year Published Research Questions (Qualitative)/Hypoth esis (Quantitative), and Purposes/Aim of Study Article 5 The authors of the article include Monika, Rachel, Rob ert, Lawrence and Lisa. The working link is http://pediatrics.aapp ublications.org/conte nt/141/5/e20173168 The name of the article is Perceptions of Health Care Transition Care Coordination in Patients With Chronic Illness published in 2018 The aim of the study was to assess the effectiveness of implementation of care coordination on chronic illness patients. Article 6 Article 7 Article 8 The authors of the article include The authors of the journal are The authors are McAllister, McNally, Rodgers, Mpofu, Monahan, and Lock. The working link is https://doi.org/10.1097/ DBP.00000000000005 76 Wu, Shortell, Rundall, and Bloom. The working link is Morton, Shih, Winther, Tinoco, Kessler, and Scholle. The https://journals.lw w.com/hcmrjourna working link is l/Abstract/2017/10 https://doi.org/ 10.1370/afm.1797 000/The_role_of_ health_informatio n_technology_in.2 .aspx The name of the article is The journal is titled The study aims at finding out the outcomes of families with children having How can healthcare information technology improve care coordination? The study sought to find out how healthcare IT tools could improve care coordination A qualitative design was used Health ITEffects of a Care Enabled Care Coordination Coordination: A Intervention with National Survey Children with of PatientNeurodevelopmental Centered Medical Disabilities and Their Home Clinicians Families published in Published in 2015 2018 Neurodevelopmental Disabilities when care coordination intervention is implemented Design (Type of Quantitative, or Type of Qualitative) A qualitative approach was used A single-group, repeated-measures design was used Setting/Sample A sample of adolescents and young adults with chronic illness were enrolled in the intervention. A total A sample of 70 families was used. A sample of 350 participants was used. © 2015. Grand Canyon University. All Rights Reserved. The title of the journal is “The role of health information technology in advancing care management and coordination in accountable care organizations” published in 2017 The journal looks at the role that healthcare technology plays when it comes to caring coordination as well as management. A study used a qualitative design The study was carried out in accountable care organizations. Methods: Intervention/Instrum ents of 209 participants were enrolled. A healthcare transition care coordination intervention was used. A randomized methodology was used. Pre-visits assessments intervention, 6-month care coordination, planned care visits and SPoc developments A survey was carried out in a physician-owned and hospital/health system–affiliated primary care practices A survey of accountable care organizations was carried out 2012 data retrieved from the National Survey of Accountable Care Organizations was used to carry out a Retrospective cross-sectional analysis The study showed the coordination roles that may play when it comes to care coordination. Healthcare IT was found to be very vital when it comes to care coordination. Analysis A patient Assessment of Chronic Illness Care score at 12 months of 3.6 was used versus the 3.3 compared with participants in the control group The feasibility of the care coordination model was evaluated as well as the effects of care coordination on the families. An analysis to find out the association of use of health IT and appropriate factors to find out the care coordination was carried out Key Findings The intervention showed that the participants odds had increased of seeking the services they thought they needed had increased by 2.5 times and their likelihood of talking to their provider regarding their care in the future had increased by 2.4 times There is need to improve the HCT coordination. There was an improvement when it came to caring coordination access, the families were empowered and they worried less. The use of healthcare IT systems to support the care coordination was not consistent. It is advised to use a care coordination model that is familycentered when it comes to children with Healthcare IT has to be used consistently for it to be effective. Recommendations neurodevelopmental disabilities Explanation of How the Article Supports EBP/Capstone With this, the nurses will know the chronic illness want when it comes to care coordination. The article supports EBP since it shows how useful a familycentered approach is. The article is important to EBP since it shows a link between care coordination and technology © 2015. Grand Canyon University. All Rights Reserved. Accountable care organizations were advised to embrace healthcare IT since it will improve the existing care coordination Technology is one of the important aspects when it comes to healthcare, the article, therefore, supports EBP by showing how it can be used. Running head: CHANGE PROPOSAL 1 Change Proposal Binoy Joseph Grand Canyon University: Professional Capstone and Practicum June 17, 2018 Background CHANGE PROPOSAL 2 Over the years healthcare organizations have been at the forefront in trying to ensure that patient care is provided in the most efficient and convenient ways while at the same time ensuring a reduction in health care costs. To address issues of efficiency, healthcare organizations have developed care coordination approaches. These approaches are aimed at organizing patient care activities between several participants engaged in caring for the patient to facilitate the delivery of care. The issue of care coordination can be observed in a variety of healthcare settings involved in the delivery of care to the patients. Care coordination requires active collaboration between the healthcare staff involved in caring for the patient, and it is an essential practice that conserves the resources of the health care provider and also the patients’ time. Care coordination also facilitates accurate diagnosis and treatment since all the participants in the provision of patient care receive the relevant information about diagnosis and treatment from all the providers involved in caring for the patient (Cohen & Adler-Milstein, 2015). The primary objective of care coordination in any health care setting is meeting the needs and preferences of the patients in the delivery of high-value and high-quality health care. This implies the health care providers know the needs and preferences of the patient and thus communicated to the right providers at the right time so this information can be utilized in guiding the delivery of appropriate, safe, and effective care. Problem Statement In the practice of delivering patient care, health providers are faced with some challenging illness which if not handled well, their treatment would be a daunting challenge. Illness involving the brain requires close attention. Children with special health care needs have not fully met the requirements for care coordination. Coordination among the nurses for mental health patients has been the concern for various stakeholders including the federal government. CHANGE PROPOSAL 3 With an efficient care coordination system, the resources of the healthcare provider as well as the patient's time are preserved. Efficient and accurate sharing of patient data facilitates diagnosis and treatment from all the providers involved. Incentives to the primary care practices are offered to encourage all efforts required to improve patient care coordination. Children diagnosed with depression are mainly victims of unmet need for care coordination (Huffman et al. 2015). Following this, patient care of this vulnerable population will be adequately addressed if an intervention which embarks on collaborative care coordination rather than the communitybased management approach is utilized in a healthcare organization. The result of the uncoordinated care is poor patient outcomes. Concerns are also raised on the use of technology in healthcare as a focus on the effectiveness of care coordination. Purpose of the Change Proposal The change proposal seeks to determine the approach to care coordination which fits best in the prevention and treatment of depression among young people of age 12 to 18 years. The first approach, collaborative care coordination entails some primary care physicians, and at least one other health professional to provide integrated care to patients through a structured patient management plan. The other approach, community-based management is an intensive teambased approach for service delivery which provides supportive care and aid to patients to access resources and skills needed for living a healthy life within the community. The objective of the change proposal is, therefore, to determine between, community-based approach and collaborative care coordination approach which fits in the treatment of depression in children. PICOT CHANGE PROPOSAL 4 Picot Question: In children patients with mental illness such as depression how effective is collaborative care coordination compared to community-based case management in controlling the occurrence of bipolar disorder during the treatment, diagnosis perioperative and the patient recovery. The population under consideration is children from the age of 12 to age 18 suffering from depression. The intervention strategy is the collaborative care coordination model while the alternative interventions under consideration are the community-based management coordination model. The collaborative care coordination model involves working as a team that entails nurses, social workers, a psychiatrist as well as all the necessary tools and equipment need to ensure the patient efficient and effective care. They all combine in providing case management and decision support. Concerning the treatment of childhood depression, collaborative care coordination cones handy in improving screening and diagnosis, and help in improving patient engagement in the treatment of depression. Community-based management coordination model is an intensive team-based approach for service delivery which provides supportive care and aid patients to access resources and skills needed for living a healthy life within the community. When collaborative care coordination model is used, children respond well to treatment of depressing thereby reducing chances of having bipolar disorder later on in life. The time frame is the period during which the patient is receiving treatment as well as the perioperative and recovery period. Literature Review Strategy Employed Having in mind that the issues of health are susceptible and require much precision in analysis and synthesis, the study employed a positivist model of reviewing literature. This model aims to synthesize, summarize, and present an interpretation of the published literary texts on the CHANGE PROPOSAL 5 topic of care coordination. In this regard, this model provides conceptual or theoretical insights into the topic of childhood depression as well as insight into the different and the best care coordination approach h for depression treatment in children. Literary texts written within a time frame of ten years and involving treatment models of depression were reviewed. Ten years was deemed a salient period since it relates to the view of many scholars on the current technological advancement. The texts used provides a systematical analysis of the structure, content, design, methodology, theoretical approach, and conclusions of the topic. Evaluation of the Literature According to Brown et al. (2014), there is a clear distinction between children with mental health conditions who receive collaborative, coordinated care and those who do not. The further focus on research is not whether coordination is essential but rather on how to implement it effectively. With an approximate of 40 percent of the children who express the need for care coordination not receiving it an alternative to reinforce the care coordination such as extensive family support and its effects become paramount to the children (Brown et al. 2014). Where collaborative care coordination is employed, children suffering from depression respond to treatment quickly as compared to those under an alternative approach. Difficulties in sending and receiving information electronically is a barrier for the effective coordination among the healthcare practitioners (Cohen & Adler-Milstein, 2015). Care coordination effectiveness is dependent on the investment that is affected in the whole process. The entire process requires highly informed health practitioners with other unpaid caregivers who must integrate efficiently to provide high-quality healthcare. This defines the need to have efficient systems as coordinated care almost demand the practitioners and the unpaid caregivers to make personal costs toward its effectiveness. CHANGE PROPOSAL 6 Nursing theory Theory of Interpersonal Relations which was developed by Hildegard Peplau in 1952 finds its application in this change proposal (Huffman et al. 2014). The theory provides holistic nurse and patient partnership. Peplau suggests that patient care can only be made effective only if the nurses of the health care providers crest a collaborative partnership with the patient (Huffman et al. 2014). The objective of the theory is to ensure that patients receive a health care package that fits their condition. The package cannot be availed if there is no coordination between the health providers and the patient or the patient's family (Huffman et al. 2014). Theory of interpersonal relations provides the utilization of four phases which include, orientation phase, identification phase, exploitation phase, and resolution phase. Implementation plan The implementation plan involves nine factors which are significant for the success of the collaborative care model for depression. These factors include the following; strong leadership support, well-defined and -implemented care representative roles, a strong primary care physician champion, and an on-site and accessible care representative. These factors put together to provide a success rate that can never be compared to any other approach (Huffman et al. 2014). Strong leadership ensures the patient is well integrated into the treatment program with ease. Well defined health provider roles ensure patients receive the right package of health care while an accessible health care representative makes it possible for the patient or the patient family to have an easy time to engage with healthcare providers on issues relating to the treatment of their condition (McAllister et al. 2018). Potential Barriers to Plan Implementation CHANGE PROPOSAL 7 Difficulties in sending and receiving information electronically is a barrier for the effective implementation of coordination among the healthcare practitioners. Competing priorities in health care is another barrier. Concentrating on collaborative care coordination has not been an excellent option for many. This is due to the technicality and the complexity of the approach. Health care providers seek to use other simpler alternative instead of the collaborative care model. Lastly, financial costs involved in the implementation of the collaborative care coordination model makes many healthcare providers shy off from the approach. To address the above barriers healthcare organization need to employee training to the health workers within the organization. Such training will ensure they become sensitized to the benefits of using an approach in their practice of providing care to children suffering from mental illnesses. CHANGE PROPOSAL 8 References Brown, N. M., Green, J. C., Desai, M. M., Weitzman, C. C., & Rosenthal, M. S. (2014). Need an unmet need for care coordination among children with mental health conditions. Pediatrics, 133(3), e530-e537. Cohen, G. R., & Adler-Milstein, J. (2015). Meaningful use care coordination criteria: Perceived barriers and benefits among primary care providers. Journal of the American Medical Informatics Association, 23(e1), e146-e151. Huffman, J. C., Mastromauro, C. A., Beach, S. R., Celano, C. M., DuBois, C. M., Healy, B. C., & Januzzi, J. L. (2014). Collaborative care for depression and anxiety disorders in patients with recent cardiac events: the Management of Sadness and Anxiety in Cardiology (MOSAIC) randomized clinical trial. JAMA internal medicine, 174(6), 927935. McAllister, J. W., McNally, R. K., Rodgers, R., Mpofu, P. B., Monahan, P. O., & Lock, T. M. (2018). Effects of a Care Coordination Intervention with Children with Neurodevelopmental Disabilities and Their Families. Journal of developmental and behavioral pediatrics: JDBP. Running head: NURSING LITERATURE REVIEW Nursing Literature Review Binoy Joseph Grand Canyon University: Professional Capstone and Practicum May 27, 2018 1 2 NURSING LITERATURE REVIEW Introduction Children with special health care needs have not fully met the requirements for care coordination. Coordination among the nurses for mental health patients has been the concern for various stakeholders including the federal government. A need to have a system in which patients’ data can be transferred from one healthcare delivery setting to another electronically in an efficient way to ensure relevant and accurate clinical decisions. With an efficient care coordination system, the resources of the healthcare provider as well as the patient's time are preserved. Efficient and accurate sharing of patient data facilitates diagnosis and treatment from all the providers involved. Incentives to the primary care practices are offered to encourage all efforts required towards the improvement of the patient care coordination (Foster et al., 2018). Children diagnosed with anxiety are mainly victims of unmet need for care coordination. This vulnerable population will best be if an intervention embarks on the identification and enhancement of the family-based supported in addition to a coordinated care system of the healthcare practitioners. The result of the uncoordinated care is poor patient outcomes. Concerns are also raised on the use of technology in healthcare as a focus on the effectiveness of care coordination (McAllister et al., 2018). The focus of the literature review is on the comparison of the various research questions raised and the limitations established for the effective implementation of policies for coordinated care. Comparison of Research Questions There is a clear distinction between children with mental health conditions who receive a coordinated care and those who don't. The further focus on research is not whether coordination is essential but rather on how to implement it effectively. With an approximate of 40% of the children who express the need for care coordination not receiving it an alternative to reinforce NURSING LITERATURE REVIEW 3 the care coordination such as extensive family support and its effectiveness become paramount to the children (Brown et al., 2014). What factors hinder the care coordination? Many efforts made by the various stakeholders including incentives to the practitioner's care coordination remain a phenomenon in policy development. Difficulties sending and receiving information electronically is a barrier for the effective coordination among the health practitioners (Cohen, & Adler-Milstein, 2015). Other such as competing priorities and the financial costs involved significantly hinder the coordination. Care coordination effectiveness is dependent on the investment that is affected in the whole process. The entire process requires highly informed health practitioners with other unpaid caregivers who must integrate efficiently to provide highquality healthcare. This defines the need to have efficient systems as coordinated care almost demand the practitioners and the unpaid caregivers to make personal costs toward its effectiveness (Daveson et al., 2014). Comparison of Sample Population To determine the need for care coordination the population choice was on the children aged between 2 to 17 was chosen. This represents the population that would extensively seek medical attention on every mental issue that the parents identified. Using a population of 57500000 children the outcome measures are reliable. It represents what is best for a diversified community seeking coordinated care. 43.2% of the people with a need for care coordination providing an outcome of 41.2 % as unmet need mean then that 1 million of the population within that year did not efficiently meet the care coordination needs even when they prevalently sought for them. To determine the barriers that the health practitioners encounter in focus for care coordination (Cohen, & Adler-Milstein, 2015) use 328 primary care practices and the outcome between October 2013 and March 2014. One of the focuses to the practitioners was the use of 4 NURSING LITERATURE REVIEW electronic measures to transfer information to other practitioners. Using the practitioners to conduct the survey reinforce the research done earlier by Brown et al., 2014 on the patients. To determine the factors that would enhance care coordination the population integrated 56patients to 27 unpaid caregivers. Through this population, coordination must be deliberate, and the stakeholders must show full commitment and sacrifice to achieve the desired results. Comparison of the Limitations of the Study According to the research conducted by Brown et al., (2014) on the need for care coordination the research fails to identify what is the alternative approach and its outcome to the population that has no prevalence for care coordination. This research focuses on the population in which care coordination is prevalence and not the one to which it's available and inefficient. The outcome of the results in general and has no specific platform for further research and the factors that hinder care coordination. (Cohen, & Adler-Milstein, 2015) emphasizes the need for information and not the actual commitment by the health practitioners to give efficient healthcare to the patients. The population choice was limited to a single state while the different state has different mechanisms of coordination. Davison et al., 2014 research is limited to the observational data that would enhance the trustworthiness of the findings. The study would have been enhanced more with a more significant contribution by the unpaid caregivers. The research outcome has limitations on the actual investment required for a given population that would provide adequate information. Conclusion The care coordination of healthcare services dramatically improves the patient's outcome and help save time and other resources. It's even more useful when dealing with a large NURSING LITERATURE REVIEW population of patients such as children who must significantly seek care (Wu et al., 2017). One of the solutions established in the previous research is the electronic health records systems. Having up to date patient data as well as the outcome of discoveries will improve the efficiency of the services by the caregivers. From the research outcome care coordination would require a voluntary commitment by the caregivers. Policy makers need to standardize the operations to incorporate care coordination as the primary approach to health care providing the resources required. I recommend research to correctly identify the current efforts to care coordination and the quantifiable results. The basis for further research is to improve the efficiency of the care coordination practices. 5 NURSING LITERATURE REVIEW 6 References Brown, N. M., Green, J. C., Desai, M. M., Weitzman, C. C., & Rosenthal, M. S. (2014). Need an unmet need for care coordination among children with mental health conditions. Pediatrics, 133(3), e530-e537. Cohen, G. R., & Adler-Milstein, J. (2015). Meaningful use care coordination criteria: Perceived barriers and benefits among primary care providers. Journal of the American Medical Informatics Association, 23(e1), e146-e151. Daveson, B. A., Harding, R., Shipman, C., Mason, B. L., Epiphaniou, E., Higginson, I. J., & Dale, J. R. (2014). The real-world problem of care coordination: a longitudinal qualitative study with patients living with advanced progressive illness and their unpaid caregivers. PloS one, 9(5), e95523. Foster, S. D., Hart, K., Lindsell, C. J., Miller, C. N., & Lyons, M. S. (2018). Impact of a low intensity and broadly inclusive ED care-coordination intervention on linkage to primary care and ED utilization. The American Journal of Emergency Medicine. McAllister, J. W., McNally, R. K., Rodgers, R., Mpofu, P. B., Monahan, P. O., & Lock, T. M. (2018). Effects of a Care Coordination Intervention with Children with Neurodevelopmental Disabilities and Their Families. Journal of developmental and behavioral pediatrics: JDBP. Wu, F. M., Shortell, S. M., Rundall, T. G., & Bloom, J. R. (2017). The role of health information technology in advancing care management and coordination in accountable care organizations. Health care management review, 42(4), 282-291. Running head: PICOT STATEMENT 1 PICOT Statement Binoy Joseph Grand Canyon University: Professional Capstone and Practicum May 6, 2018 PICOT STATEMENT 2 PICOT statement: One of the main challenges in healthcare has been lack of coordination. Nurses are one of the main professionals when it comes to healthcare, they, therefore, have a huge role to play since they are in charge of taking significant care of patients. Care coordination refers to having better communication as well as the interaction of care across all the professionals in healthcare. All the patient needs have to be addressed and every medical condition attended to. when patients get to the hospitals they end up spending a lot of time while others leave even without being attended to because the providers do not know what exactly they are supposed to be doing. However, if there is better coordination this is likely to change. The PICOT question, in this case, is: Will improving coordination of health care result in better patient care? How will it improve the mental health and lead to healthier people by the year 2020? Population- the population for the study are the patients suffering from mental health. Using these patients will be good because mentally ill patients require a lot of care and attention. It will then be possible to identify where the professionals are falling short. Intervention- this is the coordination of care. The hospital will have to come up with ways in which the health professionals can be better organized. Comparison- this is the unattended patients and the long hours spent in the waiting areas or in the hospitals in general. Outcome- the outcome here will be improved care. If the nurses and the other healthcare providers are able to work together and communicate well then, the patients will be well taken care of. Time- the period for this intervention is 2020. If there is proper coordination of care will there be healthier people come 2020? This period is enough to know if the intervention and other programs put in place really work. PICOT STATEMENT 3 There are quite many reasons why the coordination should be improved. To start with, the healthcare facility can get sued after the Patient Protection and Affordable Care Act was passed. This is going to assist in improving the care that the patients get and also ensure the satisfaction of the patient as well. The time in which they spend in the hospitals will also be reduced since there will be someone to attend to them immediately they get to the facilities (Hofmarcher et al., 2007). Many things have changed in health care, for instance, the medical practices have advanced, there is the use of technology, and the delivery is now sophisticated there is no reason as to why healthcare should be lagging behind when it comes to coordination. One of the things that can be done is to use electronic health record. This will help in a great way in reducing the fragmentation of care. The patient’s information will be well organized and it can be retrieved easily upon the patient’s arrival to the hospital. This will also ensure that all the providers have the same information about the patient. With care coordination, there will be no misdiagnosis. The patients are also going to receive all the information that they need for their treatment (O'Malley et al., 2009). The healthcare providers are able to know the needs of the patients and they are communicating with the others in good time leading to the patient receiving the best care they need. 4 PICOT STATEMENT References Hofmarcher, M. M., Oxley, H., & Rusticelli, E. (2007). Improved health system performance through better care coordination. OECD Health Working Papers, (30), 0_1. O'Malley, A. S., Tynan, A., Cohen, G. R., Kemper, N., & Davis, M. M. (2009). Coordination of care by primary care practices: strategies, lessons, and implications. Research briefs: center for studying health system change, (12), 1-16. Running head: MENTAL HEALTH FOR HEALTHY PEOPLE 2020 Mental Health for Healthy People 2020 Binoy Joseph Grand Canyon University: Professional Capstone and Practicum April 29, 2018 1 MENTAL HEALTH FOR HEALTHY PEOPLE 2020 2 The issue that is the focus of this project is improving the coordination of care for the purpose of improving patient outcomes. Care coordination can be defined as the practice of organizing patient care activities between several participants engaged in caring for the patient for the purpose of facilitating the delivery of care. The issue of care coordination can be observed in a variety of healthcare settings involved in the delivery of care to the patients. Care coordination requires effective collaboration between the healthcare staff involved in caring for the patient and it is an important practice that conserves the resources of the health care provider and also the patient’s time. Care coordination also facilitates accurate diagnosis and treatment since all the participants in the provision of patient care receive the relevant information about diagnosis and treatment from all the providers involved in caring for the patient (Cohen and Adler-Milstein, 2015). The main objective of care coordination in any health care setting is meeting the needs and preferences of the patients in the delivery of high-value and high-quality health care. This implies that the health care providers know the needs and preferences of the patient and thus communicated to the right providers at the right time so that this information can be utilized in guiding the delivery of appropriate, safe, and effective care. Care coordination has a significant impact on the quality of care provided by healthcare staff, work environment, and also on the patient outcomes. Effective care coordination improves the work environment in the provision of care by facilitating efficient and appropriate delivery of health care services both across and within systems. Care coordination also has a significant impact on improving the quality of care provided by healthcare staff because the absence of coordinated care can result in unsafe practices and also increases the risk of poor patient outcomes.an improvement in patient outcome is a major impact of care coordination whereby various studies have indicated that the clinical outcomes and satisfaction of patients are reported MENTAL HEALTH FOR HEALTHY PEOPLE 2020 3 to increase when there is an effective coordination between all the providers involved caring for the patient (McAllister, et al 2018). Care coordination also facilitates addressing the potential gaps in realizing the patients’ interrelated developmental, medical, behavioral, social, and financial needs for the purpose of achieving the best health care outcomes according to the preferences of the patient. The significance of the issue of care coordination includes helping to address some challenges that health care facilities are facing today. This is because care coordination helps to reduce the high rates of readmission which are caused by the lack of education in patients regarding their treatment plan or medication. Care coordination also has significance in addressing the problems faced by referral staffs since the disjointed nature of today’s health care systems pose a challenge to the referral staff in terms of dealing with lost information which may result to a less efficient care (Daveson, et al., 2014). The healthcare problem whereby specialists are not provided with adequate information on the patient’s test performed before can also be addressed by effective care coordination. The practical implication of care coordination to nursing include that the role of nurses in the process of care coordination is not clear. Therefore, their role and goals of each clinician should be clarified in order to avoid role conflict and confusion in care coordination. The solution to effective care coordination that can improve the patients’ outcome is implementing electronic health record (EHR) systems. EHRs can reduce fragmentation in the provision of care by integrating and organizing the health information of the patient and facilitating its quick distribution to all the care providers participating in patient’s care (Wu, et al. 2017). Accurate EHRs can facilitate all the providers involved in patient’s care to have up-to- MENTAL HEALTH FOR HEALTHY PEOPLE 2020 4 date and accurate medical information about a patient and thus improving quality care and patient outcomes. MENTAL HEALTH FOR HEALTHY PEOPLE 2020 5 References Brown, N. M., Green, J. C., Desai, M. M., Weitzman, C. C., & Rosenthal, M. S. (2014). Need and unmet need for care coordination among children with mental health conditions. Pediatrics, 133(3), e530-e537. Cohen, G. R., & Adler-Milstein, J. (2015). Meaningful use care coordination criteria: Perceived barriers and benefits among primary care providers. Journal of the American Medical Informatics Association, 23(e1), e146-e151. Daveson, B. A., Harding, R., Shipman, C., Mason, B. L., Epiphaniou, E., Higginson, I. J., … Murray, S. (2014). The Real-World Problem of Care Coordination: A Longitudinal Qualitative Study with Patients Living with Advanced Progressive Illness and Their Unpaid Caregivers. PLoS ONE, 9(5), e95523. http://doi.org/10.1371/journal.pone.0095523 Foster, S. D., Hart, K., Lindsell, C. J., Miller, C. N., & Lyons, M. S. (2018). Impact of a low intensity and broadly inclusive ED care-coordination intervention on linkage to primary care and ED utilization. The American Journal of Emergency Medicine. Lemke, M., Kappel, R., McCarter, R., D’Angelo, L., & Tuchman, L. K. (2018). Perceptions of Health Care Transition Care Coordination in Patients with Chronic Illness. Pediatrics, e20173168. McAllister, J. W., McNally, R. K., Rodgers, R., Mpofu, P. B., Monahan, P. O., & Lock, T. M. (2018). Effects of a Care Coordination Intervention with Children with Neurodevelopmental Disabilities and Their Families. Journal of developmental and behavioral pediatrics: JDBP. MENTAL HEALTH FOR HEALTHY PEOPLE 2020 6 Morton, S., Shih, S. C., Winther, C. H., Tinoco, A., Kessler, R. S., & Scholle, S. H. (2015). Health IT-enabled care coordination: a national survey of patient-centered medical home clinicians. The Annals of Family Medicine, 13(3), 250-256. Wu, F. M., Shortell, S. M., Rundall, T. G., & Bloom, J. R. (2017). The role of health information technology in advancing care management and coordination in accountable care organizations. Health care management review, 42(4), 282-291.
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Running head: WEEKLY REFLECTIVE JOURNAL

Weekly Reflective Journal
Student Name
Institution
Course
Due Date

1

WEEKLY REFLECTIVE JOURNAL

2
Weekly Reflective Journal

The first achievement of the week was about ethical considerations in the healthcare
sector. When it comes to ethical concerns, a lot of thinking goes to the process. Even though the
process prepared me for such situations, the only right solution remains accomplished during the
job. Therefore, ethical considerations require practice from my end in such cases. Differences in
opinion and initiative are set to occur among the nurses which are why the nurses decide on
ethics collectively rather than individually. If every nurse followed their perspective of ethical
considerations, the direction of movement would not remain aligned. Maintaining a united front
among the nurses is vital in incorporating the ethical considerations in healthcare (Mahieu,
Anckaert, & Gastmans, 2017).Also, through experience, ethical concerns can use the previous
reference to know what and how to act.
The second achievement of the week was concerned with the population health concerns.
As a nurse, it is inevitable to pay attention to the population and its health concerns. A nurse
serves the population whether in hospital or in the real world. Some of the most vital population
health concerns include over dosage on prescriptions, alcohol-related issues, food safety,
epidemics like HIV/AIDS, obesity, and heart related diseases. The practicum process focused on
paying close attention to ailments that largely affected the population and finding solutions or
ways that nurses could contribute to solving them as they ensured continuous increased health
statistics regarding the entire population. The health of the population in general addresses the
level of fitness and health among the population. If there exists a lot of health concerns in the
population, then the population is prone to additional cases of illnesses or deterioration. If the
population is realized to possess lesser concerns, then nurses and the healthcare sector put
measure to establish continuous growth in due time.

WEEKLY REFLECTIVE JOURNAL

3
Reference

Mahieu, L., Anckaert, L., & Gastmans, C. (2017). Intimacy and sexuality in institutionalized
dementia care: clinical-ethical considerations. Health Care Analysis, 25(1), 52-71.


Running head: WEEKLY REFLECTIVE JOURNAL

Weekly Reflective Journal
Student Name
Institution
Course
Due Dat...


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