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NURS_FPX4900 Assessment 3-1 Technology, Care Coordination, and Community Resources Considerations

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Leadership, Collaboration, Communication, Change Management, and Policy Considerations

Capella University
NURS-FPX4900: Capstone Project for Nursing
Dr.
January 11, 2024

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Technology, Care Coordination, and Community Resources Considerations

Optimizing congestive heart failure management requires adequate knowledge of technology, care coordination, and community resources. The considerations are components of patient-centered practices where healthcare providers dedicate time and energy to responding to patients’ expressed needs and preferences. Healthcare professionals also initiate care coordination and technology use to streamline access to information, education, emotional support, and other interventions that relieve anxiety associated with CHF management (Halatchev et al., 2020). This project encourages patients to utilize technologies such as telehealth and community resources that enhance improvements in emotional, physical, and mental wellness. Consistent efforts promote greater certainty regarding CHF, recovery, and self-efficacy.

Technology Relevant for CHF Management

Technology strengthens interdisciplinary integrated care relevant for improving the quality, cost, and safety of patient care. The concept makes the care team responsive to challenges triggered by one of the incapacitating and progressive conditions. Notably, CHF management goals entail improving symptoms, restoring functional capacity, and empowering patients to make informed decisions on best practices for reducing social and economic burden of the disease. Telehealth is among the viable technologies for patients to achieve the goals. The tool facilitates remote patient management to optimize care processes through agile patient status monitoring (Silva-Cardoso et al., 2021). Patients access care from their convenient locations. Similarly, telehealth is a tool that supports accessible and continuous education, promotion, and medication adherence.

Patients have increased control of the disease process due to their close proximity to primary care providers and specialists. Telehealth is also ideal for overcoming inequalities, reducing overload on health systems, and reducing costs (Zhu et al., 2020). Patients benefit from teleconsultations that improve assessment of symptoms, weight, blood pressure, and other physical signs. The technology is also applicable for follow-ups, appointments, and rehabilitation exercises that promote agile communication between patients and healthcare providers (Zhu et al., 2020). However, successful adoption of telehealth depends on stakeholders’ ability to overcome costs and barriers associated with the tool. Internet connectivity, technological adherence, and education are considerations that make telehealth ideal for managing CHF.

Care Coordination to Enhance the Quality of CHF Care

Care coordination is a priority for successful management of CHF. The process means embracing excellent communication to support patients when hospitalized and after discharge. As patients understand their health care needs and quality outcomes better, it is necessary to improve experiences through care coordination (Geiger et al., 2020). The Centers for Medicare & Medicaid Services (CMS) encourages healthcare providers to create an environment that fosters and improves the quality of care. One advantage of care coordination is increased access and availability of essential health services (Geiger et al., 2020). The concept boost patient engagement through flexible access to information, scheduling of appointments, and access to support services. Patients also benefit from reduced travels due to multidisciplinary appointments, streamlined clinical care, and reduced redundancies across the care continuum. This project focuses on the need for integrated hospital services, patient needs, and information flow to meet expectations for exceptional CHF care. Patients feel empowered as active participants with the autonomy to make informed choices about treatment pathways and decisions necessary to improve quality of life (Geiger et al., 2020). Primary care providers and specialists collaborate to design health goals and embrace proactive patient engagement throughout the care process.

Community Resources

• CHF Support Networks are necessary to guide patients through recommended self-management and best practices for adhering to the standards. The networks initiate online and offline conversations meant to motivate patients and help them overcome fear and anxiety associated with CHF symptoms and progression.

• Local walk-in clinics for cardiovascular conditions are important for encouraging positive health-seeking behaviors and attitudes. The resources help patients overcome the risk of delayed or postponed care by streamlining access and availability of essential health services including medications, lifestyle counseling, nutritional counseling, and mental health treatment.

• CHF chat sessions provide patient-driven services where patients living with CHF and family members seek information and share experiences about the disease. The engaging, educating, and empowering platforms help build healthier lives through proactive peer support.

• CHF fact sheets provided by social workers, local health care centers, and community-based health organizations make patients and families familiar with proper treatment, lifestyle changes, and other interventions necessary to improve quality of life. The resource provides evidence on the best practices for managing pain, stress, and other symptoms.

• Community food programs such as the Meals on Wheels make patients familiar with recommended diet and food habits. The information makes individuals responsive towards calls for consistent self-management practices throughout the care process.
Practice Standards and Policy to Support Care Coordination

Successful CHF management depends on nurses’ commitment to upholding values, behaviors, and attitudes that improve care coordination. Frontline roles and experience make nurses major players in identifying barriers and enablers of patient-centered and evidence-based care (King-Dailey et al., 2022). The nursing team initiates collaborative discussions with physicians, nutritionists, pharmacists, and other groups to identify and respond to patient needs and expectations. Nurses understand team-based functions, advocacy roles, and obligations toward helping patients navigate the healthcare system.

The nursing team also demonstrates leadership qualities and traits that make them responsive to patients’ cultural needs and expectations (King-Dailey et al., 2022). Nurses appreciate diversity and uphold values and attitudes that allow them to provide compassionate, respectful, and empathetic care across the continuum. Further, practice standards encourage nurses to acquire strong care coordinator skills appropriate for providing counseling services and facilitating shared decision-making. The skills make the nursing team responsive to client preferences. Thus, nurses should acknowledge the unique roles that allow them to influence the direction of CHF treatment.

The Affordable Care Act provides options for coordinating care, utilizing technologies such as telehealth, and integrating community resources to improve quality, safety, and cost of patient care. The policy enhances successful navigation of a complex healthcare system by enabling patients to interact with primary care providers and specialists (Kilgore et al., 2017). The various professionals coordinate with each other to protect patients from unnecessary emergency care, repetitive diagnostic tests, hospitalization, and readmissions. Bringing together disparate members of the healthcare workforce makes the Affordable Care Act appropriate for improving communications, addressing pain and symptom management, psychosocial needs, and functional aspects, and reducing health disparities (Wadhera et al., 2018).

 

The end goals include improving patient experiences, reducing costs, and facilitating meaningful use of health information technologies. The Centers for Medicare & Medicaid Services is a component of ACA that demonstrates efforts designed to reduce hospitalization associated with escalated CHF symptoms. Thus. ACA is an excellent legislation that highlights the need for well-coordinated CHF management to reduce morbidity and mortality rates (Wolfe & Maddox, 2019). Adequate knowledge of ACA’s provisions allow patients and healthcare professionals to make informed decisions about pathways that improve the quality, safety, and cost of health services.

 

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