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Planning and Presenting a Care Coordination Plan

There is a need to organize health care services to ensure that when developing a care coordination strategy, the best outcomes for patients are achieved. The first step is to establish the NURS FPX 6618 Assessment 1 requirements of the patient by assessing the patient’s medical history, status, and his or her ability to pay for the treatment. Then, a comprehensive strategy is formulated as to how the separate medical professionals, equipment, and approaches will interact. It should be more specific for the individual and based on their requirements and preferences; the focus should be on the professional approach and relationship, communication, and, of course, the involvement of the patient. In order to help the patient and the patient’s family understand the plan, it is necessary to define the steps, goals, and results that are expected. There is therefore the need to have care collaboration systems that are effective in delivering quality patient-centered care and better health outcomes (Gonzaga, 2018).

Vision for Interagency

An interagency coordinated care plan for end-of-life patients is a healthcare delivery model that involves healthcare practitioners, social service providers, and community organizations to enhance the lives of these patients in their last days (Librada-Flores et al., 2020). Family and the patient can help a central hub in which doctors, hospice staff, counselors, and palliative care specialists can exchange information to ensure that the patient is fully being managed in terms of pain, mental health, and other symptoms. This would ensure that patient’s medical needs were well catered for while at the same time attending to their psychological and even spiritual needs. Also, jobs, volunteer work, and community service projects would also help and encourage people, thus helping families to reduce stress and feel like they are a part of something during this difficult period. This goal aims to offer complete, accurate, and patient-centered death care that is humane, as comfortable as self-directing, and free from mental health issues as possible (Sjöberg et al., 2021).

Ideas for Organizing Consolidated Care

In this regard, there is a need to integrate the care services and support in a manner that will be comprehensive and efficient in the delivery of end-of-life care. Follow these five precise steps for this to happen. Create care teams of doctors, nurses, social workers, and spiritual caregivers from all over the hospital. These teams would spend time assessing the needs of each patient, come up with care plans that would suit each patient, and then monitor the care plans and make changes where necessary depending on the patient’s condition (McDonald et al., 2018). All the healthcare workers who are involved in the management of a patient can use the same integrated EHR system. If patients’ information including medicines, treatment plans, and patient preferences could be shared in real-time, then everyone would be informed and thereby minimize the occurrence of errors (Butler et al., 2020).

NURS FPX 6618 Assessment 1 Community-Based Care Facilities

Introduce community-based care facilities or centers that allow people to get therapy, support groups, and other services. The patients would not be required to visit different healthcare facilities because these entities would be integrated (Hojjat-Assari et al., 2021). Ensure that there are well-equipped telemedicine departments as well as distant tracking systems where patients can be attended to from the comfort of their homes. This could improve the patient’s quality of life and would decrease the anxiety that is associated with frequent visits to the hospital (Steindal et al., 2019). Each of the aspects of end-of-life care should be made known to the workers, caregivers, and all medical personnel. This involves knowing how to interact with people, how to handle pain, and how to encourage people mentally. In this case, all those who are involved in the patient’s care are educated to ensure that they are well-prepared to handle his or her needs (Teixeira et al., 2019).

Identifying the Organizations and Groups

In order to meet all the needs of the patients who are at their last stages of life, numerous organizations and groups have been created. These are the companies and groups that usually assist in the care of this community. According to Shalev et al. (2022), NHPCO is the largest organization in the United States that seeks to further enhance the provision of hospice and comfort care. NURS FPX 6618 Assessment 1 hospice staff and other individuals in the field of end-of-life care by providing them with tools, educational materials, and support (Capc, n.d d. ). ADEC is an organization that promotes the notion of teaching people how to deal with death, grief, and thanatology; the study of death. Healthcare givers who deal with patients in their last moments of life and their families are educated and assisted by them (Elderly, n.d d. ). The American Geriatric Society (AGS) is an organization that aims at enhancing the health of elderly persons, including those with terminal illnesses. It provides the practitioners who deal with seniors with guidelines and other resources such as standards (American Geriatrics Society, 2019).

Environment and Provider Capabilities

The environment and the abilities of the staff who provide services in the area of life’s final stages are very significant for the provision of compassionate care to patients and their families. This may be in a hospital, a hospice, or even in a patient’s home; the environment should be welcoming and the patient should be treated with dignity and courtesy in a serene environment that does not harm the patient’s mental status. It also employs a number of healthcare providers, counselors, and volunteers who have received training on how to offer counseling on bereavement, psychological support as well as spiritual care. Thus, patients’ right to privacy should be observed, the patient’s culture should be considered, and communication with the patient should be effective (Gómez-Vírseda et al., 2019). This also means that quality end-of-life care that is in accordance with the patient’s preferences and values has to be delivered while continually educating oneself and being open to change in the light of new medical knowledge and ethical norms (Russell et al., 2023).

Determining the Resource Needs of the Population

Identifying the needs of dying patients for resources is quite a challenging task that demands consideration and allocation of time and resources to address the needs of the patients (Wallace et al., 2020). Below are the NURS FPX 6618 Assessment 1 resource requirements, which also factor in the operational and capital budgeting requirements. This comprises drugs, dressing materials, catheters, and any other disposable medical gadgets. These are necessary for the patient’s comfort and cleanliness such as diapers, toiletries, and beddings for the adult patients. Items to be used in cleaning and maintaining the care facility, hygienic items, and sanitation products. Other items consist of stationery, forms and documentation.

These include the certified nursing assistants (CNAs), the social workers, the chaplains, and the volunteers. This can include the acquisition of new medical equipment like hospital beds, oxygen concentrators, and vital signs monitors among others Changing the physical structure of the hospital to improve the patient’s comfort and support. If the patient requires any transport, it is necessary to own or have facilities for the same for the patient.

Logical and Valid Inferences

From the facts, it can be argued that patients who require end-of-life care have numerous resource requirements and hence require proper management of their funds. There are some budget lines such as capital investment, personnel, and materials, which are likely to increase. This is evidence of the fact that it is not easy to give good care in this situation. This is evident from the fact that the budget has allocated money for medical staff and materials which are core in medical information and tools. Using the money to buy things like medical tools and building enhancements is important as to ensure the environment is conducive (Kapologwe et al., 2020). In any case, where resources are being shared out, one has also to think of the unforeseen events that may occur. These are the Funding sources that can help to maintain financial balance such as grants, gifts, and refunds. Such people, who are at the end of their lives, require effective and continuous care and attention (Noonan et al., 2022).

NURS FPX 6618 Assessment 1 Project Milestones

Complete the needs assessment report that includes the personal details, patient preference, and any gaps in end-of-life care that have been identified. Providing avenues through which patients, their families, healthcare workers, and community groups can be engaged actively such as through polls, conversations, or focus group interviews (Kim et al., 2018).

Developing and implementing individualized care plans with evidence base for those people receiving end-of-life care. It is important that the medical staff is trained on the new care standards so that they can effectively deliver quality end-of-life care (Ferrell et al., 2018).

The quality of the care that is delivered to the patients and their families towards the final few months of their life is monitored, and evaluated. Terminal patients could benefit from other aspects such as a reduction in pain, anxiety, and other discomforts (Valaitis et al., 2019). Combining these goals and end measures, you may get a better understanding of the project’s objectives and what you will receive in return. It ensures that the project addresses all the needs in this critical area of health care by considering the original assessment, the alterations that will be made, and their impact on the quality of life of EOL care patients in the long run (Valaitis et al., 2019).

Presentation of Project to Decision-Makers

NURS FPX 6618 Assessment 1 is a large project that we are suggesting and the purpose of it is to improve the lives of those who are in their last moments of life. The process of dying requires more and more care as well as better quality care services from the current society. This project is therefore undertaking to address that gap. The focus of our project is the patients receiving end-of-life care. We want to enhance their well-being, ensure that they are comfortable, and support them and their families in this challenging period (Shalev et al., 2022).

Goals of the Project

Improve care • Provide more emotional care • Enhance communication • increase awareness

The activities and the schedule that have been planned for the project.

First, it is necessary to understand what has to be done (Months 1-2); second, it is necessary to design and plan (Months 3-4); third, it is necessary to do it (Months 5-10); and fourth, it is necessary to review the situation and make changes (Months 11-12).

Goals and Expectations

This helped the patients to be happier and increased the quality of their lives.
Fewer burdens on patients and their families and more attention to the mental health of those patients.
Community members are now aware that such services exist in society especially those in the community. • Some of the NURS FPX 6618 Assessment 1 impacts include a reduction in the number of readmissions in hospitals and low costs of health care services.
Designing a model for compassionate and sustainable death – A discussion (Ferrell et al., 2018).

It is crucial therefore to enhance services of end-of-life care so that those at the dying stage of their lives receive the same tend, quality services as any other patient in need. This project plan describes a step-by-step approach to how the needs of the families and patients in receipt of end-of-life care will be addressed. This plan should be implemented to enhance the quality of life in the community especially those who are in difficult situations and reduce the overall utilization of the healthcare services. The assistance and approval of the people who are in a position to make management decisions is necessary for this critical project (Kim et al., 2018).

Conclusion

Last but not least, coming up with and implementing this care coordination plan can be regarded as a major achievement because we shall be in a position to offer our patients health care services that are coordinated and have synergy. These include defining jobs, tasks, and ways of communicating as this can assist patients to perform better, improve workflow, and make efficient use of resources. We would like to thank our NURS FPX 6618 Assessment 1 healthcare team and other stakeholders who are involved in our business to ensure that this plan is implemented. This means that we will continually pursue the welfare of the patient and adjust the way we handle him or her to accommodate the transformation of health care.

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