NURS FPX 4050 Assessment 4 Final Care Coordination Plan

The global burden of stroke is a big health challenge of increasing importance. According to Owolabi et al (2021), in 2019, stroke came second as the leading cause of long-term disability (143million DALYs) and death (6.6 million people) globally. In absolute terms, the last three decades has seen worldwide incidence rise by 70%, its mortality increased by 43%, and daily-adjusted life years lost due to stroke increased by 70% (Owolabi et al., 2019). This growing burden globally suggests that the present primary stroke and heart disease prevention and management strategies are either insufficiently effective or not used widely enough. At the moment, there is a lack of clarity on which interventions are practical, scalable, and cost-effective. However, there is relevant literature on previous interventions for stroke prevention. The Millions Hearts Initiative co-led by the Centers for Medicare and Medicaid Services and the Centers for Disease Prevention and Control identify several interventions and strategies for preventing stroke and heart attacks. Community health promotion strategies include physical activity, tobacco control, and sodium reduction. Clinical interventions include cholesterol management, using aspirin when appropriate, hypertension control, smoking cessation, and the use of health information technology to improve diagnosis and management of risk factors for stroke and family involvement in medical decisions.

Consider Ethical Decisions in Designing Patient-Centered

Common ethical principles, including justice, beneficence (acting in the best interests of patients), non-maleficence (not harm), and respect for persons can help identify ethical issues that could emerge during the design and implementation of public health interventions (PHIs) for stroke. Healthcare professionals play a major role in public health and have compulsory community obligations like advocating for healthcare reforms. But their primary ethical obligations are to promote the best interests of the patients. The principle of beneficence requires nurses to support health interventions that actually benefit the consumers while non-maleficence calls for ensuring community interventions cause no harm to consumers (DeCamp et al., 2018). Patient-centred care demands organizations to select PHIs that meet the needs of the patients and create systems that do not deteriorate the capacity of the team to provide patient care. Health organizations must commit to the full spirit of population health goals. When the hospital presents a health intervention to a screening measures (like screening for ischemic stroke), for instance, it needs to also dedicate to designing cate processes to prevent ischemic strokes.  NURS FPX 4050 Assessment 4 Final Care Coordination Plan

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The principle of respect for people requires safeguarding the dignity of the patient, such as allowing the patient to make informed decisions about care that is consistent with personal values (DeCamp et al., 2018). The nurse’s judgment should be recognized to help the patients make such decisions. Organizations should develop and use health interventions in manners that are evidence-based, respect cultural differences and patient preferences, and align with physician ethical responsibilities. For instance, interventions that accommodate cultural differences after discharge are effective at preventing readmissions. Procedural and distributive justice alike should be considered in an ethical assessment of public health interventions. As per distributive justice, organizations must ensure primary care clinicians have the resources, time, and administrative support to allow them provides care to the disadvantaged, healthy, and chronically ill (DeCamp et al., 2018). Ethically, procedural justice requires creating opportunities to involve patients in their own care and medical care decision-making such as through patient and family advisory councils. Patient engagement is thus key to wider justice-based obligations to design fair decision processes separate from immediate effects. Healthcare interventions must involve clinicians and patients in their development and implementation. This can result in well-designed interventions that are effective and encourages trust in the long run.

Identify Relevant Health Policy Implications for the Coordination

Obamacare, commonly known as the Affordable Care Act (ACA) did create opportunities to design and test new approaches to care delivery and payment that enhance care coordination, resulting in reduced spending, improved health, and better quality care (Chernew, Conway, & Frakt, 2020). A new initiative developed in 2014, Accountable Care Organizations (ACO), meant to specifically improve care coordination, brings together healthcare providers in the entire healthcare system to prevent medical errors and ensure that their patients do not get unnecessary services. When care coordination programs are well-designed, they can help meet triple aims by reducing wasteful spending and improving patients’ experiences and their health. For instance, the Community-based Care Transitions Program of the Centers of Medicare & Medicaid Services (CMS) coordinates hospital discharge to other healthcare settings and aims to lessen hospital readmissions (Chernew, Conway, & Frakt, 2020). More so, care coordination is facilitated through the meaningful use of health information technology.

Other Obamacare provisions target quality flaws that can result in inefficiencies and put the health of the patient at risk. The law, for example, imposes financial charges on healthcare organizations with high rates of readmissions and hospital-acquired conditions, a move that has led to a reduction in adverse health events. The Obamacare provision also sought a lasting change in how medical care is organized and provided. The ACO has been testing bundled payment system, a single reimbursement meant for all medical services needed for a certain health procedure or condition (Chernew, Conway, & Frakt, 2020). An implication for this is that post-acute, physician, or hospital services can all be covered under one payment and this should incentive different providers to collaborate well. NURS FPX 4050 Assessment 4 Final Care Coordination Plan

Priorities that a Care Coordinator would establish when discussing the Plan with a Patient and Family Member

The first nursing priority is to establish with a stroke patient is blood pressure monitoring. When people experience an ischemic stroke, inadequate blood flow caused by a blood clot might have caused the death of brain cells (Kleber, 2021). The surrounding area can be entirely lost if the efforts to promote an increase in pressure to promote collateral circulation are not done. At times the patient may be forced to go to intensive care to get neuro checks and vasoactive drips to keep it high enough to preserve the brain area. The key is to prevent the stroke from exacerbation. As such, the nurse should clarify current blood pressure medications with the doctor and order aspirin and deep venous thrombosis prevention. Another priority is to do systematic and routine neuro exams. Each time the nurse goes to the patient’s room should be a neuro examination. If something is going astray in the brain, the first thing to change is the level of consciousness or mental status. The changes may be happening if the patient suddenly falls asleep and cannot wake up. Things the nurse should check during neuro exams include vocal quality, level of consciousness, pupillary changes, orientation, and ability to follow commands (Kleber, 2021).

The nurse should also focus on another priority area: measures to prevent a stroke from happening, treating stroke caused by brain bleeding, and reducing further complications. The nurse should design measures to improve mobility and prevent deformities like elevating the affected arm to prevent fibrosis and edema (Tang et al. 2020). The nurse should also establish an exercise program to enhance blood circulation, maintain joint mobility, and prevent further deterioration of the neuromuscular system. The nurse should discuss with the patient how to prevent should pain such as by practising a range of motion exercises. Tell the patient how to improve self-care such as by assisting with dressing activities, encouraging personal hygiene activities, and ensuring the patient does not ignore the affected area. Lastly, the nurse should improve family coping by providing counseling and support to the family and developing attainable goals for patients at home (Tang et al. 2020).  NURS FPX 4050 Assessment 4 Final Care Coordination Plan

Use the literature on evaluation as a guide to compare learning session content with best practices, including how to align teaching sessions to the Healthy People 2030 document

Education for stroke patients, their caregivers and families is an important section of stroke care that need to be included as part of all medical encounters. An individualized education plan should cover all important aspects of stroke care and delivery, and cover content specific to the readiness level of care. Education topics include stroke awareness and action, rehabilitation, transitions, and community integration (Cameron et al., 2017). Stoke awareness and action should cover signs and symptoms of stroke when to seek help, and risk factors for stroke like smoking and hypertension. Rehabilitation should cover the type of rehabilitation exercises and activities that should and could be done between scheduled sessions with therapists (Cameron et al., 2017). Transitions should include things like self-management skills of daily living and appropriate expectations for recovery of deficits, likely transition points appropriate to the person, and time frames. Community integration should include the type of services available in the community and how to access them like communication support and mobility assistance, need for follow-up care, and physical adjustments like preventing complications, medication adherence, and post-stroke fatigue. Other content areas should include nutrition (healthy eating strategies), coping with perceptual deficits, and financial resources (Cameron et al., 2017).

The best practice for stroke awareness, recognition and response include educating all members of the public and all medicals providers that stroke is a medical emergency, education to focus on recognizing the signs and symptoms of stroke and actions to take when witnessing and experiencing the signs of stroke, and education to include information that stroke affects people of all age including old adults, newborns, and children (Boulanger et al., 2018). The best practice for emergency medical services management of acute stroke patients includes asking the patient to immediately contact 911 when they experience signs of stroke. Furthermore, screen clinically and with neurovascular imaging patients with disabling acute ischemic stroke within 24 hours of stroke symptom onset (Boulanger et al., 2018). NURS FPX 4050 Assessment 4 Final Care Coordination Plan

Healthy People is an effort from the national government which sets objectives and goals to enhance the health and overall well-being of its people in the US. Since organizations, communities, and states in the US use Healthy people’s objectives to determine their priorities, healthcare educators can also benefit from it. The Healthy People 2030 can help educators improve the wellbeing and health of stroke patients through four practical ways. The first is through the identification of needs and priority populations (Healthy People, 2022). Here the educator can brown objectives to learn about national goals to promote good health and see how these goals align with their priorities. After this, the educator can set own targets by finding using national data to set goals for their programs. The third way is by finding inspiration and practical tools. The educators learn about successful interventions, programs, and policies, and by looking for evidence-based resources used in the community (Healthy People, 2022). Lastly, the educator can monitor national progress and use the information for benchmarking (Healthy People, 2022). They can check for updates on progress towards attaining national objectives and use the information to inform program and policy planning.

References

Boulanger, J. M., Lindsay, M. P., Gubitz, G., Smith, E. E., Stotts, G., Foley, N., … & Butcher, K. (2018). Canadian stroke best practice recommendations for acute stroke management: prehospital, emergency department, and acute inpatient stroke care, update 2018. International Journal of Stroke, 13(9), 949-984.

Cameron, J. I., O’Connell, C., Foley, N., Salter, K., Booth, R., Boyle, R., … & Heart and Stroke Foundation Canadian Stroke Best Practice Committees. (2017). Canadian stroke best practice recommendations: managing transitions of care following a stroke, guidelines update 2016. International Journal of Stroke, 11(7), 807-822

Chernew, M. E., Conway, P. H., & Frakt, A. B. (2020). Transforming Medicare’s Payment Systems: Progress Shaped By The ACA: A narrative review of Affordable Care Act payment reforms. Health Affairs, 39(3), 413-420.

DeCamp, M., Pomerantz, D., Cotts, K., Dzeng, E., Farber, N., Lehmann, L., … & Tilburt, J. (2018). Ethical issues in the design and implementation of population health programs. Journal of general internal medicine, 33(3), 370-375.

Healthy People. (2022). Use healthy people 2030 in your work. https://health.gov/healthypeople/tools-action/use-healthy-people-2030-your-work

Kleber, K. (2021, March 11). Nursing priorities for stroke patients. FRESHRN. https://www.freshrn.com/nursing-priorities-ischemic-stroke-patients/

Owolabi, M. O., Thrift, A. G., Mahal, A., Ishida, M., Martins, S., Johnson, W. D., … & Group, S. E. C. (2021). Primary stroke prevention worldwide: translating evidence into action. The Lancet Public Health.

Tang, E. Y., Robinson, L., Exley, C., Flynn, D., Stephan, B., & Price, C. (2020). Care priorities for stroke patients developing cognitive difficulties: a Delphi survey of UK professional views. BMC health services research, 20(1), 1-9.