Interagency coordination and cooperation focus in enhancing an effective and efficient service that promotes a positive implication to the economy. Agencies operating within international environments need cooperation for smooth operations. For instance, an agency dealing with international border requires coordination among land border, international airports, immigration, police and quarantine customs to enhance smooth travel of people across borders. However, there can exist hurdles among the international border agencies which may hinder effective operations. For instance, international agencies share different goals in regards to productivity. The variation in shared goals many results to the hurdle of interagency conflicts which may further slow the cooperation between the agencies. For instance, the customs department may have contradicting policies about migrations while the police may have law reviews that contradict the customs departments. This may cause delayed agreements regarding the best practice of policy to put into place to enhance efficiency and effectiveness among the agencies. The employees for these departments may have diverse skills and knowledge regarding the operations of international organizations, and this may cause inefficiency in the systems used to foster operations. For example, the employees at custom and immigration department have different knowledge to those of police. This may call for law reviews in the international environment and which may negatively affect the operating systems.
Lack of cooperation among the agencies may cause delays in shipments and clearance of travellers. This may further affect the interested people willing to engage in trading activities in the region. Also, the lack of cooperation may cause lack of harmonized tariff structures, an inadequate framework to secure trade and increase in trade transaction costs due to ineffective and inefficiency of systems that aid to better coordination.
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Develop a 20-minute presentation for nursing colleagues highlighting the fundamental principles of care coordination. Create a detailed narrative script for your presentation, approximately 4 pages in length, and record a video of your presentation.
Introduction
Nurses have a powerful role in the coordination and continuum of care. All nurses must be cognizant of the care coordination process and how safety, ethics, policy, physiological, and cultural needs affect care and patient outcomes. As a nurse, care coordination is something that should always be considered. Nurses must be aware of factors that impact care coordination and of a continuum of care that utilizes community resources effectively and is part of an ethical framework that represents the professionalism of nurses. Understanding policy elements helps nurses coordinate care effectively.
This assessment provides an opportunity for you to educate your peers on the care coordination process. The assessment also requires you to address change management issues. You are encouraged to complete the Managing Change activity.
Completing course activities before submitting your first attempt has been shown to make the difference between basic and proficient assessment.
Preparation
Your nurse manager has been observing your effectiveness as a care coordinator and recognizes the importance of educating other staff nurses in care coordination. Consequently, she has asked you to develop a presentation for your colleagues on care coordination basics. By providing them with basic information about the care coordination process, you will assist them in taking on an expanded role in helping to manage the care coordination process and improve patient outcomes in your community care center.
To prepare for this assessment, identify key factors nurses must consider to effectively participate in the care coordination process.
You may also wish to:
Review the assessment instructions and scoring guide to ensure you understand the work you will be asked to complete.
Allow plenty of time to rehearse your presentation.
Note: Remember that you can submit all, or a portion of, your draft presentation to Smarthinking Tutoring for feedback, before you submit the final version for this assessment. If you plan on using this free service, be mindful of the turnaround time of 24-48 hours for receiving feedback.
Recording Equipment Setup and Testing
Check that your recording equipment and software are working properly and that you know how to record and upload your presentation. You may use Kaltura (recommended) or similar software for your audio recording. A reference page is required. However, no PowerPoint presentation is required for this assessment.
If using Kaltura, refer to the Using Kaltura tutorial for directions on recording and uploading your video in the courseroom.
Note: If you require the use of assistive technology or alternative communication methods to participate in this activity, please contact DisabilityServices@capella.edu to request accommodations.
Instructions
Complete the following:
Develop a video presentation for nursing colleagues highlighting the fundamental principles of care coordination. Include community resources, ethical issues, and policy issues that affect the coordination of care. To prepare, develop a detailed narrative script. The script will be submitted along with the video.
Note: You are not required to deliver your presentation.
Presentation Format and Length
Create a detailed narrative script for your video presentation, approximately 4-5 pages in length. Include a reference list at the end of the script.
Supporting Evidence
Cite 3-5 credible sources from peer-reviewed journals or professional industry publications to support your video. Include your source citations on a references page appended to your narrative script. Explore the resources about effective presentations as you prepare your assessment.
Grading Requirements
The requirements outlined below correspond to the grading criteria in the Care Coordination Presentation to Colleagues 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.
Outline effective strategies for collaborating with patients and their families to achieve desired health outcomes.
Provide, for example, drug-specific educational interventions, cultural competence strategies.
Include evidence that you have to support your selected strategies.
Identify the aspects of change management that directly affect elements of the patient experience essential to the provision of high-quality, patient-centered care.
Explain the rationale for coordinated care plans based on ethical decision making.
Consider the reasonable implications and consequences of an ethical approach to care and any underlying assumptions that may influence decision making.
Identify the potential impact of specific health care policy provisions on outcomes and patient experiences.
What are the logical implications and consequences of relevant policy provisions?
What evidence do you have to support your conclusions?
Raise awareness of the nurse’s vital role in the coordination and continuum of care in a video-recorded presentation.
Fine tune the presentation to your audience.
Stay focused on key issues of import with respect to the effects of resources, ethics, and policy on the provision of high-quality, patient-centered care.
Adhere to presentation best practices.
Additional Requirements
Submit both your presentation video and script. The script should include a reference page. See Using Kaltura for more information about uploading multimedia files. You may submit the assessment only once, so be sure that both assessment deliverables are included.
Portfolio Prompt: Save your presentation to your ePortfolio. Submissions to the ePortfolio will be part of your final Capstone course.
Competencies Measured
By successfully completing this assessment, you will demonstrate your proficiency in the course competencies through the following assessment scoring guide criteria:
Competency 2: Collaborate with patients and family to achieve desired outcomes.
Outline effective strategies for collaborating with patients and their families to achieve desired health outcomes.
Competency 3: Create a satisfying patient experience.
Identify the aspects of change management that directly affect elements of the patient experience essential to the provision of high-quality, patient-centered care.
Competency 4: Defend decisions based on the code of ethics for nursing.
Explain the rationale for coordinated care plans based on ethical decision making.
Competency 5: Explain how health care policies affect patient-centered care.
Identify the potential impact of specific health care policy provisions on outcomes and patient experiences.
Competency 6: Apply professional, scholarly communication strategies to lead patient-centered care.
Raise awareness of the nurse’s vital role in the coordination and continuum of care in a video-recorded presentation.
SCORING GUIDE
Use the scoring guide to understand how your assessment will be evaluated.
healthcare team coordination and the oversight and accountability for care delivery.
Nursing and Medical
Health and Medical
Discussion Posts
Community Health Assessments Nursing
CRITERIA
Meets Expectations3
Approaching Expectations2
Not Meeting Expectations0-1
1. Reflects on current theory and clinical class with concepts and theories using the Program Learning Outcomes and BSN Essentials listed in the syllabus.
1. Reflects on current theory class and clinical and how courses support each other (transfer of knowledge to apply to clinical)- Focused to Current Term.2. Synthesizes theories and concepts from liberal education to build an understanding of the human experience.
3. Uses skills of inquiry and analysis to address practice issues
4. Applies knowledge of social and cultural factors in the care of populations encountered in this course.
1. Limited reflection on current theory class and clinical and how courses support each other (transfer of knowledge to apply to clinical)- Focused to Current Term.
2. Limited synthesis of theories and concepts from liberal education to build an understanding of the human experience
3. Use limited skills of inquiry and analysis to address practice issues
4. Applies limited knowledge of social and cultural factors in the care of populations encountered in this course.
1.No reflection on current theory class and clinical and how courses support each other
2. Does not synthesize theories and concepts from liberal education to build an understanding of the human experience
3. Does not use skills of inquiry and analysis to address practice issues
4. Does not apply knowledge of social and cultural factors in the care of populations encountered in this course.
2. Develops an effective communication style for interacting with current patients, families, and the interdisciplinary health team when providing holistic, patient centered nursing care to populations encountered in this course.
1. Reflects on providing holistic patient care to populations encountered in this course.
2. Describes inter-collaborative involvement (i.e. Interprofessional rounds; consultations and interaction with PT/OT; Respiratory Therapy, Pharmacist consultation—describe their role/ contribution.)
1. A limited reflection on providing holistic patient care to populations encountered in this course.
1. No reflection on providing holistic patient care to populations encountered in this course.
2. Does not describes inter-collaborative involvement
3. Models leadership when providing safe, quality nursing care; coordinating the healthcare team; and when tasked with oversight and accountability for care delivery.
1. Describe an event that demonstrates:• application of leadership concepts, skills and decision making in theprovision of high quality nursing care,
• healthcare team coordination
• the oversight and accountability for care delivery
2. Describe an event that demonstrates leadership, appropriate teambuilding and collaborative strategies to effectively implement patient safety and quality improvement initiatives within the context of the interprofessional team
1. Describes limited• leadership concepts, skills and decision making in the provision of high quality nursing care,
• healthcare team coordination and the oversight and accountability for care delivery
2. Limited description of an event that demonstrates leadership, appropriate teambuilding and collaborative strategies to effectively implement patient safety and quality improvement initiatives within the context of the interprofessional team
Gives no examples of leadership concepts, skills and decision making in the provision of high quality nursing care, healthcare team coordination and the oversight and accountability for care delivery in a variety of settings
2. Does not describe an event that demonstrates leadership, appropriate teambuilding and collaborative strategies to effectively implement patient safety and quality improvement initiatives within the context of the interprofessional team
Nursing practice: Outline the relevant care coordination skills you as the Registered Nurses require to effectively manage Liam’s shared care plan..
Written Assignment
Weight: 60%
Word Length: 2000 words
Notes: Written assignment
Liam is a 15-year-old male patient who has recently joined the program. You have not met Liam previously and he and his mother, Erica, are due to attend the surgery later today. In preparation for Liam’s appointment you review his patient’s notes and shared care plan. On review you note that the shared care plan has been started however is not yet complete.
Task
Review the attached case study of Liam and his shared care plan then answer the following questions:
Part one
Complete the missing information on Liam’s care plan and provide the relevant information;
Patient Care Team: Identify all of the facilities, organisations and professionals Liam and his parents will have to access/interact with to achieve his treatment goals. Separate these into primary secondary or other (if relevant) and document the referral process and their role in Liams’ care.
Patient’s barriers to care goals: Review the patient care goals identified on the care plan. Identify barriers for achieving the care goals (note: may be: medical, situational system. Consider self-management strategies, health literacy and the team goals, this is not exhaustive).
Part two
Role of the RN as the complex care coordinator to deliver the shared Care Plan
Nursing practice: Outline the relevant care coordination skills you as the Registered Nurses require to effectively manage Liam’s shared care plan.
Identify Strategies: As the complex care coordinator you have to effectively implement Liam’s shared care plan. Identify any/all projects, programs, technology, organisations, innovations etc. that would assist with delivering the goals identified in Liam’s shared care plan.
HSNS363 Assessment 2 case study: Liam
Meet Liam
Introduction
Liam is a 15-year-old male who lives in Westtown with his mother, Erica. Liam is a patient of Dr Jones and moved to the clinic when her practice merged with another local practice to form the Youbeaut clinic late last year.
Liam has a history of Juvenile Idiopathic Arthritis (JIA) and Asthma. Liam attended the Accident and Emergency department at the Westtown Hospital four times last summer, including one overnight admission, due to acute exacerbation of Asthma. The Westtown region has been drought declared for the last two years and is experiencing large dust storms which triggered Liam condition. Liam fractured his right hand three years ago when he fell of his bike.
In addition to his recent asthma exacerbations Liam has also been experiencing pain related to his JIA, particularly in his right wrist and right knee. Dr Jones has referred him for review with his regular paediatric rheumatologist in Sydney which is located 500km away. Liam is to have an MRI prior to attending the appointment. In light of his recent Asthma exacerbations Liam is also due to visit his regular paediatrician to review his Asthma Action Plan. His paediatrician is located in a rural service centre 250km from Westtown.
Background
Medical History
JIA – diagnosed at the age of 8, four joints involved
Asthma – diagnosed at the age of 10
Right carpel/scaphoid fracture 3 years ago (cycling accident).
Medications
NSAIDS – BD naproxen 250mg
Paracetamol PRN for pain.
Inhaled corticosteroid preventer (daily)
Salbutamol PRN
Family
Liam lives with his mother Erica (37), step father John (39) step-brother Sam (7) and step-sister Molly (4). Liam has a god relationship with Erica, John and his younger siblings however, this is a busy household with both parents working and all children attending different school/childcare facilities. John is a supervisor at the local mine. He is a shift worker and his hours include evening and weekend work. Erica works full time at the local bank.
Liam spends alternative weekends and half his school holidays with this father, Michael (45), his step mother Annie (44) and twin step-sisters Charlotte and Grace (18 months). Michael and Annie live on a mixed farming property 25km from Westtown. Annie and Michael tried unsuccessfully to have children for several years prior to the arrival of their daughters. Charlotte and grace are very welcome additions to the family however Michael and Annie are finding the demands of caring for two young children (largely unassisted) and running the farm incredibly tiring with little-to-no spare time.
Liam has a good relationship with his father and Annie however, when he is at the farm he feels as though there is a ‘burden’ and is largely left to himself due to the time and attention required to care for the twins and run the farm.
Michael and Erica often struggle to balance the responsibilities of transporting Liam the multiple medical appointments and therapy sessions including:
Monthly medical appointment in Sydney
Local fortnightly physiotherapy
GP appointments as required
Paedtrician appointment quarterly.
Academic & Social
Liam enjoys school however, he is socially introverted and is sometimes bullied. He finds it difficult to complete school work when his hand is painful due to JIA particularly at the fracture site (Liam is right handed). Liam has one very close friend, Jack, who he has attended school with since kindergarten. Jacks and his parents recently relocated to Sydney for work.
Erica is concerned that Liam is becoming increasingly socially withdrawn. These days he mainly stays in his room and plays video games. Erica is concerned that he is becoming depressed. She has to constantly remind him to take his medication (he was previously independent) feels like she is ‘nagging’ concerned about what is happening with his medication when he is at the farm.
Erica is hopeful that participating in the Healthcare Homes program will assist in better managing Liams’ care, particularly given his current physical and mental health status.
Develop a 20-minute presentation, supported by 10-12-slides, for nursing colleagues highlighting the fundamental principles of care coordination.
Develop a 20-minute presentation, supported by 10-12-slides, for nursing colleagues highlighting the fundamental principles of care coordination. Create a detailed narrative script for your presentation, approximately 4-5 pages in length, and record a video of your presentation.
Nurses have a powerful role in the coordination and continuum of care. All nurses must be cognizant of the care coordination process and how safety, ethics, policy, physiological, and cultural needs affect care and patient outcomes. As a nurse, care coordination is something that should always be considered. Nurses must be aware of factors that impact care coordination and of a continuum of care that utilizes community resources effectively and is part of an ethical framework that represents the professionalism of nurses. Understanding policy elements helps nurses coordinate care effectively.
This assessment provides an opportunity for you to educate your peers on the care coordination process.
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 2: Collaborate with patients and family to achieve desired outcomes.
Outline effective strategies for collaborating with patients and their families to achieve desired health outcomes.
Competency 3: Create a satisfying patient experience.
Identify the aspects of change management that directly affect elements of the patient experience essential to the provision of high-quality, patient-centered care.
Competency 4: Defend decisions based on the code of ethics for nursing.
Explain the rationale for coordinated care plans based on ethical decision making.
Competency 5: Explain how health care policies affect patient-centered care.
Identify the potential impact of specific health care policy provisions on outcomes and patient experiences.
Competency 6: Apply professional, scholarly communication strategies to lead patient-centered care.
Raise awareness of the nurse’s vital role in the coordination and continuum of care.
Preparation
Your nurse manager has been observing your effectiveness as a care coordinator and recognizes the importance of educating other staff nurses in care coordination. Consequently, she has asked you to develop a presentation for your colleagues on care coordination basics. By providing them with basic information about the care coordination process, you will assist them in taking on an expanded role in helping to manage the care coordination process and improve patient outcomes in your community care center.
To prepare for this assessment, identify key factors nurses must consider to effectively participate in the care coordination process.
You may also wish to:
Review the assessment instructions and scoring guide to ensure you understand the work you will be asked to complete.
Allow plenty of time to rehearse your presentation.
Note: Remember that you can submit all, or a portion of, your draft presentation to Smarthinking Tutoringfor feedback, before you submit the final version for this assessment. If you plan on using this free service, be mindful of the turnaround time of 24–48 hours for receiving feedback.
Recording Equipment Setup and Testing
Check that your recording equipment and software are working properly and that you know how to record and upload your presentation. You may use Kaltura, Adobe Connect, or similar software for your audio recording. You may also add audio directly to your slides, using PowerPoint or other presentation software.
If using Kaltura, refer to the Using Kaltura [PDF] tutorial for directions on recording and uploading your video in the courseroom.
If using Adobe Connect, refer to the instructions and tutorials available from the Using Adobe Connect support page.
Note: If you require the use of assistive technology or alternative communication methods to participate in this activity, please contact DisabilityServices@capella.edu to request accommodations.
Instructions
Complete the following:
Develop a presentation for nursing colleagues highlighting the fundamental principles of care coordination. Include community resources, ethical issues, and policy issues that affect the coordination of care.
Record a video of your presentation.
Note: For this assessment, develop your presentation slides and audio script, then record your presentation. You are not required to deliver your presentation to an actual audience.
Presentation Format and Length
You may use PowerPoint or other suitable presentation software to create your slides. If you elect to use an application other than PowerPoint, check with your faculty to avoid potential file compatibility issues. You can also record your presentation using Kaltura or Adobe Connect.
Be sure that your slide deck includes the following slides:
Title slide.
Presentation title.
Your name.
Date.
Course number and title.
References (at the end of your presentation).
Your slide deck should consist of 10–12 slides, not including a title and references slide. Your presentation should not exceed 20 minutes.
Create a detailed narrative script for your presentation, approximately 4–5 pages in length.
Supporting Evidence
Cite 3–5 credible sources from peer-reviewed journals or professional industry publications to support your presentation. Include your source citations on a references page appended to your narrative script.
Grading Requirements
The requirements outlined below correspond to the grading criteria in the Care Coordination Presentation to Colleagues 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.
Outline effective strategies for collaborating with patients and their families to achieve desired health outcomes.
Provide, for example, drug-specific educational interventions, cultural competence strategies.
Include evidence that you have to support your selected strategies.
Identify the aspects of change management that directly affect elements of the patient experience essential to the provision of high-quality, patient-centered care.
Explain the rationale for coordinated care plans based on ethical decision making.
Consider the reasonable implications and consequences of an ethical approach to care and any underlying assumptions that may influence decision making.
Identify the potential impact of specific health care policy provisions on outcomes and patient experiences.
What are the logical implications and consequences of relevant policy provisions?
What evidence do you have to support your conclusions?
Raise awareness of the nurse’s vital role in the coordination and continuum of care.
Fine tune the presentation to your audience.
Stay focused on key issues of import with respect to the effects of resources, ethics, and policy on the provision of high-quality, patient-centered care.
