Introduction

NURS FPX 6610 Assessment 1: The older population, who are weak and have various comorbidities, are at risk of poor health outcomes with every clinical admission. Through patient physical examination, self-reporting symptoms, psychological and socioeconomic state, and more, the health care system uses a comprehensive needs assessment tool to monitor the delivery of quality care and improved health outcomes (Ghimire & Dahal, 2021). In this work, a full needs assessment of a 79-year-old diabetic patient experiencing sepsis is simulated.

The purpose of this study is to comprehend the role that care coordination plays in locating and closing gaps in the provision of patient care. In a similar vein, the study lists numerous therapeutic techniques for gathering crucial patient data and taking into account risk variables such as societal, psychological, and interpersonal aspects that could affect a patient’s health results. Once more, the article identifies evidence-based methods that work well for care coordination and highlights the advantages of interdisciplinary teamwork for better patient outcomes (Brooks et al., 2020).

 

Current Gaps in Mr. Decker’s Care

Mr. Decker, a diabetic patient aged 79, was readmitted to St. Anthony Health Facility due to sepsis from a severely infected toe. After receiving treatment for a severely infected toe two weeks prior, Mr. Decker was readmitted because he disregarded the doctor’s orders. His readmission to the Villa health system was caused by multiple deficiencies in care coordination. These gaps could consist of:

  • Improper monitoring by healthcare providers. After the patient was released from the hospital, the case manager tasked with overseeing Mr. Decker’s care neglected to follow up. The case manager, on the other hand, depended on the nephew of Mr. Decker’s assurance that they would take care of him. Nevertheless, unanticipated societal variables contributed to the failure of that effort (Engle et al., 2021). 
  • The case manager did not carry out a thorough, all-encompassing needs assessment (NURS FPX 6610 Assessment 1) prior to releasing Mr. Decker. The case manager was thus blind-spotted and failed to see that Mr. Decker lacked a social support network that could assist with the administration of antibiotics. 
  • Absence of an integrated approach to healthcare. The medical professionals neglected to take into account risk variables like age and diabetes that, if left unchecked, could have a detrimental effect on Mr. Decker’s health outcomes. 

The patient-centered assessment method can be used to address all of Mr. Decker’s care gaps, including his needs in terms of physiology, psychology, social work, and finances. When compared to doctor-centered care, the patient-centered assessment approach improves the quality of care delivery and patient health outcomes (Morris et al., 2022). This allows the case manager to effectively integrate the aforementioned care gaps through care coordination.

Types of Information Suitable to Assess Mr. Decker’s Care

In order to perform a comprehensive patient evaluation, the case manager will want the following details to be supplied:

  • The subjective and objective data, past medical history, physical examination, and diagnosis of Mr. Decker will shed light on the best course of treatment and prognosis following discharge.
  • Implementing a successful care plan for Mr. Decker is influenced by his cognitive condition, family circumstances, financial situation, and ethnic and religious backgrounds.
  • The case manager will use Mr. Decker’s schedule, regular behaviors, preferences, and interests as a guide to create a successful patient-centered care plan.


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