Assessment 3: Care Coordination Presentation to Colleagues

Care Coordination

Nurses play a critical role in the provision of care that meets the needs of their diverse patient populations. The ability of the nurses to provide care that meets the needs of their diverse populations depends largely on the adoption of patient-centered interventions. Patient-centered interventions such as shared-decision making, patient involvement in decision-making and prioritization of the values and preferences of the patients contribute to excellence in health care. Care coordination is another aspect that enables nurses to provide care that addresses the actual and perceived needs of their patients. Through care coordination, nurses provide continuous, patient-centered care that extends beyond the clinical settings. Therefore, this presentation explores the various aspects related to care coordination and its influence on patient experiences. The presentation examines effective strategies for collaboration with patients and their families, aspects of change management that affect patient experiences, role of care coordinated plans, implications of ethical approach to care, and implications of specific health care policy provisions on outcomes of patient experiences.

Effective Strategies for Collaborating with Patients and their Families

Collaboration in patient care is critical, as it contributes to the realization of patient outcomes. Nurse practitioners and nurses can embrace a number of strategies to achieve their desired collaboration with patients and their families. One of the collaboration strategies is shared decision-making. Shared decision-making entails involving patients in making critical decisions that affect their health. Shared decision-making takes into consideration the values and preferences of the patients in the care provision process. Shared decision-making promotes the realization of care outcomes such as safety, efficiency, quality and patient satisfaction with care (Menear et al., 2020). The other strategy that nurses can use to achieve their desired goals of effective collaboration with patients and families is patient education. Nurses should educate patients on the effective ways in which their health needs can be achieved. Patient education empowers patients and their families to take a proactive role in the management of their health. It also raises their level of awareness on issues that affect their health. Patient education has also been shown to increase treatment adherence and satisfaction of patients with the care that they receive. The last strategy that nurses can use to foster collaboration between them, their patients and families is open communication. Open communication in the provision of care is important in building trust between patients and healthcare providers. Nurses should encourage patients and significant others to express their issues and concerns related to care. Openness in communication strengthens the realization of care outcomes such as informed decision-making and patient empowerment (Goodridge et al., 2018). Therefore, nurses should explore the use of the above interventions to achieve their desired outcomes of patient collaboration.

Aspects of Change Management that Affect Elements of Patient Experiences

Assessment 3 Care Coordination Presentation to Colleagues

Assessment 3 Care Coordination Presentation to Colleagues

Change management is important in health organizations, as it promotes the provision of high quality, safe and efficient care. A number of aspects of change management have a direct effect on the elements of patient experience and determinants of the ability of caregivers to provide high-quality patient-centered care. One of the aspects is active stakeholder engagement. The successful implementation of change in health organizations depends largely on the level of engagement among the adopters of the change. The implementers/adopters of the change should play an active role in change initiatives such as implementation and evaluation. Active stakeholder engagement ensures that they own the change, thereby, its successful implementation (Katzenbach et al., 2019). Active engagement also ensures that the stakeholders have adept understanding of the indicators that influence patient experiences and ways of ensuring that the needs of patients are met efficiently.

The other aspect of change that affects the element of patient experience is stakeholder empowerment through the provision of training opportunities. The successful implementation of change initiatives in health depends on the level of knowledge and skills of the adopters of the change. The adopters of the change must be trained to not only increase their level of awareness about the change but also minimize the risk of resistance to change from them. Training also impacts patient experiences since healthcare providers can implement quality interventions related to the change that underpin safety, quality and efficiency in patient care (Johnson & Davey, 2019). The last aspect of change that affects elements of patient experiences is facilitation of change through mentorship, coaching and continuous monitoring. The implementation of change requires that the adopters receive adequate support in the forms of coaching and mentorship to ensure that they have the required knowledge and skills in the provision of care to patients (Halkias et al., 2017). The adopters of change can utilize similar approaches in improving patient experience through the fostering of effective care coordination approaches such a close monitoring and follow-up to achieve optimum goals of care.

Rationale for Coordinated Care Plans Based on Ethical Decision-Making

Care coordinated care plans have been identified as the hallmark of patient-centered care in health. Care coordinated plans based on ethical decision-making are important in nursing and healthcare in general due to a number of reasons. Firstly, care coordinated plans based on ethical decision making contributes to enhanced patient experiences. Patients receive continuous, patient-centered care that addresses their actual or perceived needs. Through this focus, health organizations provide care that promotes patient satisfaction and empowerment with care (Wheat et al., 2018). Care coordinated care plans based on ethical decision making also promotes cost-efficiency in health. Care coordination empowers patients to take responsibility for their health needs. There is also the utilization of care from different healthcare professionals with the aim of optimizing the outcomes of treatment. The benefit of this approach is that patients spend less due to unnecessary hospital visits and expenditures, hence, cost-efficiency in healthcare. Care coordination based on ethical decision making also promotes quality and safety in healthcare. Inter-professional teams work together in developing the best treatment plans for the patients. The development of care plans also considers the unique care needs, values and preferences of the patients (Towfighi et al., 2017). As a result, the quality-related goals of care are achieved.

Potential Impact of Policy Provisions on Outcomes and Patient Experiences

Healthcare policies have a significant impact on the outcomes of care as well as patient experiences. Healthcare policies such as the Affordable Care Act (ACA) and Health Insurance Portability and Accountability Act (HIPAA) have considerable implications for patient care and patient experiences. Accordingly, healthcare organizations and providers must abide by the regulations of HIPAA in providing coordinated care. Health organizations embrace interventions such as ensuring confidentiality and privacy of the data of their patients. In addition, health organizations perform regular security audits to determine the integrity of their systems in promoting safety of the patient data (Wenzl, 2018). The adoption of the ACA also has implications to healthcare. Accordingly, ACA expanded the access of the population to health insurance coverage in the United States. The implication of this policy is that the population of patients who can benefit from care coordination has increased significantly. Barriers to healthcare such as cost have also been eliminated increasing the quality of care that the population accesses (Schmittdiel et al., 2017). Therefore, the policy provisions such as those of ACA and HIPAA improve the care outcomes and patient experiences with the healthcare systems.

Nurses Role in Care Coordination and Continuum of Care

Nurses have a vital role to play in care coordination and continuum of care. Firstly, nurses act as advocates of their patients. Nurses ensure that the care that patients receive through the care coordinated programs respects their rights and needs. Nurses also ensure that the care promotes safety, quality and efficiency. Nurses also act as source of health education information for their patients in care coordination and continuum of care. Nurses educate their patient about the effective interventions that they can use to achieve their health outcomes. They also guide their patients in embracing lifestyle and behavioral interventions that will contribute to the promotion of their health (Donelan et al., 2019). Nurses also explore and link patients to the available resources in the community that are essential for the realization of their care needs. For example, nurses link patients with the existing social support groups and programs to ensure that the patients receive the social, psychological and emotional support that they need for the effective management of their health problems. Lastly, nurses perform assessment, planning, implementation, monitoring, and evaluation of the care plans developed for the patients in the care coordination program (Swan et al., 2019). The diverse roles enable nurses to ensure that evidence-based care is given to optimize on the outcomes of treatment.


In summary, care coordination and continuum of care contribute to the optimization of care outcomes. Effective collaboration between patients, nurses and their families is important in facilitating safety, quality and efficiency in healthcare. Nurses and healthcare providers should explore ways in which aspects of change management may be incorporated into healthcare practices that improve patient experiences. In doing this, nurses should take into consideration the provisions of various policies in healthcare that influence care coordination and continuum of care.




Donelan, K., Chang, Y., Berrett-Abebe, J., Spetz, J., Auerbach, D. I., Norman, L., & Buerhaus, P. I. (2019). Care Management For Older Adults: The Roles Of Nurses, Social Workers, And Physicians. Health Affairs, 38(6), 941–949.

Goodridge, D., Henry, C., Watson, E., McDonald, M., New, L., Harrison, E. L., Scharf, M., Penz, E., Campbell, S., & Rotter, T. (2018). Structured approaches to promote patient and family engagement in treatment in acute care hospital settings: Protocol for a systematic scoping review. Systematic Reviews, 7.

Halkias, D., Santora, J. C., Harkiolakis, N., & Thurman, P. W. (2017). Leadership and Change Management: A Cross-Cultural Perspective. Taylor & Francis.

Johnson, J. A., & Davey, K. S. (2019). Essentials of Managing Public Health Organizations. Jones & Bartlett Learning.

Katzenbach, J., Thomas, J., & Anderson, G. (2019). The Critical Few: Energize Your Company’s Culture by Choosing What Really Matters. Berrett-Koehler Publishers.

Menear, M., Dugas, M., Careau, E., Chouinard, M.-C., Dogba, M. J., Gagnon, M.-P., Gervais, M., Gilbert, M., Houle, J., Kates, N., Knowles, S., Martin, N., Nease, D. E., Zomahoun, H. T. V., & Légaré, F. (2020). Strategies for engaging patients and families in collaborative care programs for depression and anxiety disorders: A systematic review. Journal of Affective Disorders, 263, 528–539.

Schmittdiel, J. A., Barrow, J. C., Wiley, D., Ma, L., Sam, D., Chau, C. V., & Shetterly, S. M. (2017). Improvements in Access and Care through the Affordable Care Act. The American Journal of Managed Care, 23(3), e95–e97.

Swan, B. A., Haas, S., & Jessie, A. T. (2019). Care Coordination: Roles of Registered Nurses Across the Care Continuum. Nursing Economic, 37(6), 7.

Towfighi, A., Cheng, E. M., Ayala-Rivera, M., McCreath, H., Sanossian, N., Dutta, T., Mehta, B., Bryg, R., Rao, N., Song, S., Razmara, A., Ramirez, M., Sivers-Teixeira, T., Tran, J., Mojarro-Huang, E., Montoya, A., Corrales, M., Martinez, B., Willis, P., … Vickrey, B. G. (2017). Randomized controlled trial of a coordinated care intervention to improve risk factor control after stroke or transient ischemic attack in the safety net: Secondary stroke prevention by Uniting Community and Chronic care model teams Early to End Disparities (SUCCEED). BMC Neurology, 17(1), 24.

Wenzl, R. (2018). HIPAA Compliant Patient-Provider Communication: Student-Clinician Perceptions. 36.

Wheat, H., Horrell, J., Valderas, J. M., Close, J., Fosh, B., & Lloyd, H. (2018). Can practitioners use patient reported measures to enhance person centred coordinated care in practice? A qualitative study. Health and Quality of Life Outcomes, 16(1), 223.


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The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies.

Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances.

If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect.

I do not accept assignments that are two or more weeks late unless we have worked out an extension.

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Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class.

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Important information for writing discussion questions and participation

Welcome to class

Hello class and welcome to the class and I will be your instructor for this course. This is a -week course and requires a lot of time commitment, organization, and a high level of dedication. Please use the class syllabus to guide you through all the assignments required for the course. I have also attached the classroom policies to this announcement to know your expectations for this course. Please review this document carefully and ask me any questions if you do. You could email me at any time or send me a message via the “message” icon in halo if you need to contact me. I check my email regularly, so you should get a response within 24 hours. If you have not heard from me within 24 hours and need to contact me urgently, please send a follow up text to

I strongly encourage that you do not wait until the very last minute to complete your assignments. Your assignments in weeks 4 and 5 require early planning as you would need to present a teaching plan and interview a community health provider. I advise you look at the requirements for these assignments at the beginning of the course and plan accordingly. I have posted the YouTube link that explains all the class assignments in detail. It is required that you watch this 32-minute video as the assignments from week 3 through 5 require that you follow the instructions to the letter to succeed. Failure to complete these assignments according to instructions might lead to a zero. After watching the video, please schedule a one-on-one with me to discuss your topic for your project by the second week of class. Use this link to schedule a 15-minute session. Please, call me at the time of your appointment on my number. Please note that I will NOT call you.

Please, be advised I do NOT accept any assignments by email. If you are having technical issues with uploading an assignment, contact the technical department and inform me of the issue. If you have any issues that would prevent you from getting your assignments to me by the deadline, please inform me to request a possible extension. Note that working fulltime or overtime is no excuse for late assignments. There is a 5%-point deduction for every day your assignment is late. This only applies to approved extensions. Late assignments will not be accepted.

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Plagiarism is highly prohibited. Please ensure you are citing your sources correctly using APA 7th edition. All assignments including discussion posts should be formatted in APA with the appropriate spacing, font, margin, and indents. Any papers not well formatted would be returned back to you, hence, I advise you review APA formatting style. I have attached a sample paper in APA format and will also post sample discussion responses in subsequent announcements.

Your initial discussion post should be a minimum of 200 words and response posts should be a minimum of 150 words. Be advised that I grade based on quality and not necessarily the number of words you post. A minimum of TWO references should be used for your initial post. For your response post, you do not need references as personal experiences would count as response posts. If you however cite anything from the literature for your response post, it is required that you cite your reference. You should include a minimum of THREE references for papers in this course. Please note that references should be no more than 5 years old except recommended as a resource for the class. Furthermore, for each discussion board question, you need ONE initial substantive response and TWO substantive responses to either your classmates or your instructor for a total of THREE responses. There are TWO discussion questions each week, hence, you need a total minimum of SIX discussion posts for each week. I usually post a discussion question each week. You could also respond to these as it would count towards your required SIX discussion posts for the week.

I understand this is a lot of information to cover in 5 weeks, however, the Bible says in Philippians 4:13 that we can do all things through Christ that strengthens us. Even in times like this, we are encouraged by God’s word that we have that ability in us to succeed with His strength. I pray that each and every one of you receives strength for this course and life generally as we navigate through this pandemic that is shaking our world today. Relax and enjoy the course!

Hi Class,

Please read through the following information on writing a Discussion question response and participation posts.

Contact me if you have any questions.

Important information on Writing a Discussion Question

  • Your response needs to be a minimum of 150 words (not including your list of references)
  • There needs to be at least TWO references with ONE being a peer reviewed professional journal article.
  • Include in-text citations in your response
  • Do not include quotes—instead summarize and paraphrase the information
  • Follow APA-7th edition
  • Points will be deducted if the above is not followed

Participation –replies to your classmates or instructor

  • A minimum of 6 responses per week, on at least 3 days of the week.
  • Each response needs at least ONE reference with citations—best if it is a peer reviewed journal article
  • Each response needs to be at least 75 words in length (does not include your list of references)
  • Responses need to be substantive by bringing information to the discussion or further enhance the discussion. Responses of “I agree” or “great post” does not count for the word count.
  • Follow APA 7th edition
  • Points will be deducted if the above is not followed
  • Remember to use and follow APA-7th edition for all weekly assignments, discussion questions, and participation points.
  • Here are some helpful links
  • Student paper example
  • Citing Sources
  • The Writing Center is a great resource