A patient’s condition from a coordinated-care perspective.• Assess a patient’s condition from a coordinated-care perspective.
o Consider the full scope of the patient’s needs.
o Include 3–5 pieces of data (subjective, objective, or a combination) that led to a nursing diagnosis.
• Develop nursing diagnoses that align with patient assessment data.
o Write two goal statements for each diagnosis.
o Ensure goals are patient- and family-focused, measurable, attainable, reasonable, and time-specific.
o Consider the psychosociocultural aspect of care.
• Determine appropriate nursing or collaborative interventions.
o List at least three nursing or collaborative interventions.
o Provide the rationale for each goal or outcome.
• Explain why each intervention is indicated or therapeutic.
o Cite applicable references that support each intervention.
• Evaluate care coordination outcomes according to measures and standards.