Capella 4050 Assessment 4 Final Care Coordination Plan NURS-FPX 4050 Coord Patient-Centered Care Final Care Coordination Plan

In every healthcare organization, care coordination is pivotal for desired outcomes in patients’ well being. By utilizing care coordination, healthcare personnel can ensure the efficacious health changes in patients. The care coordination plan aids the care coordination procedure by making sure that all the patients, specifically the patients with lifestyle changes, get to acquire the best possible healthcare (Beth et al., 2019).

Nurses must coordinately work with the community resources to obtain the best healthcare results, especially in care coordination. Besides, the healthcare coordination plan must be in accordance with the regulations of Federal rules and practical to ethical guidelines. The following final care coordination plan is developed  on the basis of  assessment 1 which was the preliminary care coordination plan.

In this study, the final care plan discussed is primarily  for patients suffering through COPD (Chronic Obstructive Pulmonary Disease). COPD (Chronic Obstructive Pulmonary Disease) is heterogenous lung disease characterized by shortness of breath, cough and exacerbation due to abnormalities in airways such as bronchitis, emphysema. Use of care coordination plan will help maximize the health benefits to COPD patients (Raaijmakers et al., 2023).

Patient-Centered Health Interventions and Timelines

Patient-Centered care therapies bring astonishing effects to the betterment of a patient’s health as the therapy provided is centered to an individual patient based on the needs of the particular disease of the patient and according to the patient’s priorities. Due to the primary focus of therapy on a patient’s health and well-being, this approach is better than conventional hospital-centered approach which keeps the hospital’s advantage in mind rather than patient’s health (McFarland et al., 2019).

Long term care plan for COPD should try to minimize the risk of exacerbations and delay their onset to decrease the burden on the health care system and enhance health related quality of life. The keys of primary care COPD management comprise smoking cessation, vaccination, physical activity, pulmonary rehabilitation in cases of dyspnea and functional disability, care of exacerbations that arise, and maintenance pharmacotherapy to alleviate exacerbations.

Multiple barriers contribute to the inefficient treatment of patients suffering from COPD. Lack of organizational services during transitions of care is one of these barriers that hinders the proper treatment of COPD patients. Certain health interventions that can be done in this regard are spreading awareness and educating professionals about the disease itself, describing current services and guidelines, and evaluating the resources and practices with respect to the guidelines.

Capella 4050 Assessment 4

Healthcare personnel can also improve the services by facilitating the vaccination process and ensuring access to smoking cessation and pulmonary rehabilitation programs on an ongoing basis. Lack of screening services is another barrier to the proper treatment of COPD patients. This is improved by ensuring the availability and easy accessibility of this spirometer in primary care units and by providing other healthcare professionals with the necessary knowledge about this service.

Another issue that healthcare professionals confront in the poor treatment of COPD is a lack of patient adherence. This can be overcome by providing patient education, developing a questionnaire to identify patients’ educational needs and personalizing the intervention, and involving patients, caregivers, and family members in COPD education interventions (Slevin et al., 2019).

Different community sources practices can connect COPD patients with community stop-smoking groups, gyms, American Lung Association Chapters/BetterBreathers Clubs. A collaborative relationship between the physician, nurse, pharmacist, ER specialists, and physical therapist should be ensured to provide continuous coordinated therapy to the patient. Care transition is done like pulmonologist referral should be made and coordinated when needed. Referral to pulmonary rehabilitation and access to the exercise after formal rehabilitation can be made by practice (Vachon et al., 2022).

Ethical Decisions in Designing Patient Centered Healthcare Interventions

Patient-centered care has achieved  importance lately as it comprises making decisions with regard to patients’ likelihood  along with  incorporating them  in the entire therapeutic plan. Patients’ families equally contribute with nurses and other healthcare personnel to share knowledge about the patients’ conditions, their lifestyles and habits and to help in getting patients’