Nurses’ Role in the Coordination and Continuum of Care
Care coordination refers to the type of service that is provided to patients outside of the healthcare facility. The between-visit care has a positive impact on health and reduces the risk of disease progression. Care coordination and continuum of care are based on the notion of person-centered assessment and care. It represents a philosophical approach to the development, application, and delivery of care services that are respectful, responsive, and aligned to the preference of individual patients. In light of individual needs and circumstances being vastly diverse and unique, care providers and organizations also need to become more adaptive, creative, and innovative in providing meaningful and valuable supportive services (McCormack & McCance, 2016). The development of this essay focuses on addressing nurses’ role in the provision of care coordination and potential approaches to the continuum of care, identifying suitable support and inherent challenges and ethical considerations that may exist.
There are four essential elements that ensure effective coordinated care. The first is to allow for access to all needed health care services and needed providers. Nurses and doctors have to identify and communicate the treatment plan to their patients. The second element is to develop collaborative communication with the clients. Here, it is important to ensure smooth transitions through providers and care plans, so the patient’s experience is positive. Nurses have to double-check the treatment plans so they address all of the patient’s needs, and all specialists involved in the process are able to contact patients regularly.
Thirdly, care coordination has to focus on the whole needs of the patient and their family. This element may be challenging because of the diverse cultural or religious backgrounds of patients. Hence, cultural competence, which is an inclusive concept used to explain strategies developed to ensure that nursing students can offer standard healthcare to people of diverse backgrounds, is required of nurses. Treating patients with respect and dignity, as well as engaging their families in the process of recovery, has a positive effect on the treatment plan realization and improves patient outcomes. The fourth element is to provide information to the patient and family in a manner they can understand. This way, the patient’s experience is enhanced as effective communication and a person-centered approach ensure patient satisfaction and more effective treatment due to lack of misunderstanding.
Therefore, an effective strategy for collaborating with patients and their families to achieve desired health outcomes would be scheduling a meeting. At that meeting, a nurse and, if possible, specialists that are involved in the care plan would communicate the measures that are needed to be taken and address the expected patient outcomes. During the meeting, all the questions from family members should be answered to minimize misunderstanding. Further, a nurse should schedule regular calls and video-chats and keep in contact with the patient through messaging.
An example of a drug-specific educational intervention can be seen in the case of asthma treatment. For instance, a patient has been prescribed Salbutamol 100 micrograms per dose with a metered-dose inhaler (MDI), CFC-free. A patient should inhale one or two puffs up to four times a day when required to relieve asthma symptoms. In this case, the nurse should deeply explain to the patient and his family that to achieve the asthma quality care levels or standards as reflected by NICE, there is a need to carry out an asthma review every single year (Swan et al., 2019). Moreover, the educational intervention should include training on how to properly use the inhaler.
Various reviews have explored the impact of cultural competence initiatives on nurses. The outcomes of these reviews indicate that cultural competence studies can be useful in improving knowledge, patient satisfaction, skills, and attitudes (Flood & Commendador, 2016). However, some current studies outline the lack of enough evidence concerning the relationship between developed organizational behaviors and cultural competency or patient health outcomes (Swan et al., 2019). There is also limited consensus on the most appropriate means of developing cultural competency and heated debate as to whether the initiatives to develop cultural competency can cause decreased health disparities triggered by racial discrimination.