Ethical And Policy Factors In Care Coordination

Select a community organization or group that you feel would be interested in learning about ethical and policy issues that affect the coordination of care. Then, develop and record a 10–12-slide, 20-minute presentation, with audio, intended for that audience. Create a detailed narrative script or speakers notes for your presentation, 4-5 pages in length.

Instructions

For this assessment:

• Choose the community organization or support group that you plan to address.
• Develop a PowerPoint with typed speaker notes (the script for your voice recording).

For this assessment, develop your presentation slides and speaker notes.

Presentation Format and Length

You may use PowerPoint (recommended) or other suitable presentation software to create your slides.

Be sure that your slide deck includes the following slides:

• Title slide.

o          Presentation title.

o          Your name.

o          Date.

o          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 with typed speaker notes and audio voice over. 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 Ethical and Policy Factors in Care Coordination 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.

• Explain how governmental policies related to the health and/or safety of the community affect the coordination of care.

o          Provide examples of a specific policy affecting the organization or group.

o          Refer to the assessment resources for help in locating relevant policies.

o          Be sure influential policies include the Health Insurance Portability and Accountability Act (HIPPA).

• Identify national, state, and local policy provisions that raise ethical questions or dilemmas for care coordination.

o          What are the implications and consequences of specific policy provisions?

o          What evidence do you have to support your conclusions?

• Assess the impact of the code of ethics for nurses on the coordination and continuum of care.

o          Consider the factors that contribute to health, health disparities, and access to services.

o          Consider the social determinants of health identified in Healthy People 2020 as a framework for your assessment.

o          Provide evidence to support your conclusions.

• Communicate key ethical and policy issues in a presentation affecting the coordination and continuum of care for a selected community organization or support group. Either speaker notes or audio voice-over are included for a proficient score; both speaker notes and the audio voice over are included for a distinguished score.

o          Present a concise overview.

o          Support your main points and conclusions with relevant and credible evidence.

Preparation

Your nurse manager at the community care center is well connected and frequently speaks to a variety of community organizations and groups. She has noticed the good work you are doing in your new care coordination role and respects your speaking and presentation skills. Consequently, she thought that an opportunity to speak publicly about contemporary issues in care coordination would be beneficial for your career and has suggested reaching out to a community organization or support group to gauge their interest in hearing from you, as a care center representative, on a topic of interest to both you and your prospective audience.

You have agreed that this is a good idea and have decided to research a community organization or support group that might be interested in learning about ethical and policy issues related to the coordination of care. Your manager has suggested the following community organizations and support groups, but acknowledges that the choice is yours.

• Homeless shelters.
• Local religious groups.
• Nursing homes.
• Local community organizations (Rotary Club or Kiwanis Club).

To prepare for this assessment, you may wish to:

• Research your selected community organization or support group.
• Review the Code of Ethics for Nurses With Interpretive Statements and associated health policy issues, specifically, the ACA.
• Review the assessment instructions and scoring guide to ensure you understand the work you will be asked to complete.
• Allocate sufficient time to rehearse your presentation before recording the final version for submission.
• As coordinators of care, nurses must be aware of the code of ethics for nurses and health policy issues that affect the coordination of care within the context of the community. To help patients navigate the continuum of care, nurses must be proficient at interpreting and applying the code of ethics for nurses and health policy, specifically, the Affordable Care Act (ACA). Being knowledgeable about ethical and policy issues helps ensure that care coordinators are upholding ethical standards and navigating policy issues that affect patient care.
• This assessment provides an opportunity for you to develop a presentation for a local community organization of your choice, which provides an overview of ethical standards and relevant policy issues that affect the coordination of care. Completing this assessment will strengthen your understanding of ethical issues and policies related to the coordination and continuum of care, and will empower you to be a stronger advocate and nursing professional.

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 4: Defend decisions based on the code of ethics for nursing.

o          Assess the impact of the code of ethics for nurses on the coordination and continuum of care.

• Competency 5: Explain how health care policies affect patient-centered care.

o          Explain how governmental policies related to the health and/or safety of a community affect the coordination of care.

o          Identify national, state, and local policy provisions that raise ethical questions or dilemmas for care coordination.

• Competency 6: Apply professional, scholarly communication strategies to lead patient-centered care.

o          Communicate key ethical and policy issues in a presentation affecting the coordination and continuum of care for a selected community organization or support group. Either speaker notes or audio voice-over are included.

Ethical And Policy Factors In Care Coordination

Care Coordination and Selected Group

The Agency for Healthcare Research and Quality describes care coordination as the “deliberate organization of patient care activities between two or more participants, including the patient, involved in a patient’s care to facilitate the appropriate delivery of health care services” (cited in Bower, 2016, p.99). Bower (2016) also adds that care coordination is the act of marshaling people and resources to facilitate appropriate care delivery. In essence, care coordination is the intentional organization of patient care to achieve effective care. Physicians may achieve this effectiveness by exchanging information with their colleagues during the various phases of patients’ illnesses. As scholars observe, care coordination is a critical foundation for continuum-based care (Bower, 2016). This practice enables healthcare practitioners involved in various stages of a patient’s illness, from diagnosis to follow-up services, to work jointly to enhance care delivery effectiveness and promote patients’ safety.

Selected Group

For this assignment, I choose to address care coordination in community nursing homes, which is somewhat a continuum-based care. Notably, individuals in nursing homes receive an array of healthcare services over a prolonged duration. Therefore, the group may be interested in understanding government policies and their effect on care coordination. I also selected the nursing homes because of the numerous challenges that such communities have experienced in the past, such as poor-quality care, which increases the risks of falls and infections among patients (Carey et a., 2018). Poor quality care is somewhat a product of the bare minimum wages that community nursing home nurses receive, discouraging their optimal performance at work. This aspect could explain why nurses, notably psychiatrists, working for elderly adult patients in the nursing home have a low acceptance of patients enrolled in Medicare because of the low reimbursement than the private sector.

Impact of Government Policies Related to Health on Coordination of Care

An analysis of government policies related to health suggests that the latter has highly incentivized care coordination. Notably, federal policies have helped encourage care coordination in healthcare. Among ways in which the guidelines have achieved this goal is by establishing programs to defragment the nation’s health system, promote uninterrupted care, and enhance the management of transitions between care delivery points (Emmer, 2013). Government policies such as ACA have incentivized care coordination by establishing programs that encourage caregivers to manage health holistically rather than episodically. For example, a program such as Accountable Care Organizations (ACOs) facilitates coordination among physicians and other caregivers to create a system that holistically provides care to Medicare beneficiaries (Emmer, 2013). Other policies such as Medicare and Medicaid foster care coordination by reducing unnecessary costs associated with redundant medical procedures.

Application in Nursing Homes

Like health care sites, nursing homes are significantly affected by governmental policies related to health and community safety. Among the policies that affect nursing homes is the Affordable Care Act (ACA). ACA enhances access to and quality of care in nursing homes through medical partnerships (Collins & Saylor, 2018). For example, because of the promotion of medical integration by ACA, nurses working in nursing homes can work jointly with specialists in other medical facilities or refer patients to other specialists for care. HIPPA is also a critical health policy that affects the nursing home community. The policy ensures that patients’ information is not disclosed to third or unauthorized parties.

National, State and Local Policy Provisions that Raise Ethical Questions and Dilemmas for Care Coordination and their Implications

While most policy provisions positively impact the quality of care offered to patients and their families, some raise ethical questions and dilemmas for care coordination. Among policies that bring such effects are the patient protection and Affordable Care Act. On the one hand, the ACA provides health coverage to thousands of low-income earners. However, the policy provisions limit coverage for undocumented immigrants in the country, raising ethical questions about whether the policy is socially just. The policy also affects coordination of care among undocumented immigrants because it may be difficult for physicians to coordinate disease management throughout the continuum of care in instances where patients admitted to nursing homes lack the financial capacity to cater to healthcare costs.

Moreover, the ACA raises ethical questions on healthcare providers’ ability to enhance care quality while maintaining low costs. The policy provisions attempt to minimize expenditures while encouraging care providers to improve the quality of care. The conflicting agendas raise ethical questions on whether caregivers are renumerated accordingly for the effort put into enhancing the quality of care.

Evidence to Support Conclusions

My conclusions about ACA and its ethical questions are supported by various literature that addresses health insurance plans in the country. First, statistics reveal approximately 12 million undocumented immigrants in the United States (Beck et al., 2019). Unfortunately, a majority of this population lives in low socioeconomic status, which is compounded by limited health insurance coverage. As observed by Joseph and Marrow (2017), federal insurance plans are unavailable for this population despite being available for other immigrants. Therefore, undocumented immigrants pay high-out-of-pocket costs to access healthcare in the country.

Impact of Code of Ethics for Nurses on Coordination and Continuum of Care

Based on my assessment, the code of ethics for nurses positively impacts coordination and continuum of care in many ways. For example, one of the codes of ethics for nurses governs colleagues’ relationships by advocating for respectful, professional, and caring relationships. Such codes promote better handling of ethical challenges among nurses and facilitate the restoration of lasting workplace relationships vital for coordination and continuum of care (Magelssen et al., 2018). Moreover, some ethics codes advocate for better relations between nurses and patients, thus facilitating care coordination between the patients and nurses (American Nurses Association, 2015). The other critical way the code of ethics for nurses promotes coordination and continuum of care is by encouraging interdisciplinary nurses’ communication. Communication fosters better cooperation among nurses and provides a conducive working environment (Magelssen et al., 2018). Communication among interdisciplinary teams also enables nurses to coordinate care across the various phases of a disease and accord patients quality care.

Factors that Contribute to Health, Health Disparities and Access to Services

Health disparity and differences in access to services are significant issues affecting various populations in the country. Health, health disparities and access to services are influenced by many factors, including income, residential segregation, government policies, and ethnicity. For example, low income and separation of some groups to low-end neighborhoods constraints people’s access to quality care accessible in affluent neighborhoods. A similar effect is created by unfavorable government policies and belonging to minority groups.

Social Determinants of Health

Besides the overall factors contributing to health disparities, social determinants make some people healthy and others unhealthy. Health People 2020 provides five social determinants of health: economic stability, education, health and healthcare, neighborhood and built environment, and social and community context (“Social determinants,” n.d.). For example, economic instability such as poverty and unemployment expose people to nutrition diseases and constrains their ability to access good diets. Therefore, economically stable people are more likely to be healthy than their counterparts. In essence, the five elements are the core social factors that make people healthy or unhealthy.

Conclusion

To sum up the presentation, it is evident that coordination of care, notably in the United States, is affected by government policies. These government policies also impact coordination in community programs such as nursing homes, as elaborated. Moreover, it is evident that besides promoting care coordination, some federal policy provisions such as ACA raise ethical questions in care coordination. Besides national policies, nurses’ codes of ethics positively impact care coordination and the continuum of care by fostering cooperation among caregivers and patients. This presentation also reveals that despite the government’s effort to promote care coordination, social, economic, and political factors continue to affect health and health disparities.

References

“Social determinants of health” (n.d.). Healthy People.gov. https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-health/interventions-resources

American Nurses Association. (2015). Code of ethics for nurses with interpretive statements (2nd ed.). American Nurses Association.

Beck, T.L., Le, T., Henry-Okafor, Q., Shah, M.K. (2019). Medical care for undocumented immigrants. Physician Assistant Clinics, 4(1), 33-45. https://dx.doi.org/10.1016%2Fj.cpha.2018.08.002

Bower, K. A. (2016). Nursing leadership and care coordination: Creating excellence in coordinating care across the continuum. Nursing Administration Quarterly, 40(2), 98–102. https://doi.org/10.1097/naq.0000000000000162

Carey, K., Zhao, S., Snow, A.L., & Hartmann, C.W. (2018). The relationship between nursing home quality and costs: Evidence from the VA. PLOS ONE, 13(9), 1-9. https://doi.org/10.1371/journal.pone.0203764

Collins, B.L., & Saylor, J. (2018). The Affordable Care Act: 8 years later. Nursing Management, 49(8), 42-48. https://doi.org/10.1097/01.numa.0000538917.37912.d4

Emmer, S. (2013). Care coordination under the Affordable Care Act: Opportunities and challenges for geriatric care managers. Journal of Aging Life Care. https://www.aginglifecarejournal.org/fall-issue-article-title-goes-here-and-is-pretty-long-so-thats-that/

Joseph, T.D., & Marrow, H.B. (2017). Health care, immigrants, and minorities: Lessons from the affordable care act in the U.S. Journal of Ethnic and Migration Studies, 43(12), 1965-1984. https://doi.org/10.1080/1369183X.2017.1323446

Magelssen, M., Gjerberg, E., Lillemoen, L., Førde, R., Pedersen, R. (2018). Ethics support in community care makes a difference for practice. Nursing Ethics, 25(2), 165–173. https://doi.org/10.1177/0969733016667774