Develop a 3–4-page preliminary care coordination plan for a
selected health care problem. Include physical, psychosocial, and cultural considerations for this
health care problem. Identify and list available community resources for a safe and effective
continuum of care.
- Before you complete the instructions detailed in the course room, first select one of the following health care problems or issues:
Health Literacy
• Physical considerations: Low health literacy can lead to poor health outcomes and difficulty managing chronic diseases.
• Psychosocial considerations: Low health literacy can cause emotional distress, anxiety, and depression.
• Cultural considerations: Cultural beliefs and practices may influence an individual.
• Community resources: Health literacy programs, patient education materials, and health navigators can provide resources and support for individuals with low health literacy.
Environmental Health
• Physical considerations: Environmental hazards such as air pollution, lead exposure, and toxic waste can cause physical health problems.
• Psychosocial considerations: Environmental hazards can cause emotional distress, anxiety, and depression.
• Cultural considerations: Cultural beliefs and practices may influence an individual's exposure to environmental hazards.
• Community resources: Environmental health clinics, community clean-up programs, and advocacy groups can provide resources and support for individuals affected by environmental hazards.
After you have selected one of the problems/issues from the list above, return to the detailed instructions in the course room to complete your assessment.
Scenario
Imagine that you are a staff nurse in a community care center. Your facility has always had a dedicated case management staff that coordinated the patient plan of care, but recently, there were budget cuts and the case management staff has been relocated to the inpatient setting. Care coordination is essential to the success of effectively managing patients in the community setting, so you have been asked by your nurse manager to take on the role of care coordination. You are a bit unsure of the process, but you know you will do a good job because, as a nurse, you are familiar with difficult tasks. As you take on this expanded role, you will need to plan effectively in addressing the specific health concerns of community residents.
Instructions
Develop the Preliminary Care Coordination Plan
Select one of the health concerns in the Assessment 01 Supplement: Preliminary Care Coordination Plan [PDF] Download Assessment 01 Supplement: Preliminary Care Coordination Plan [PDF]resource as the focus of your care coordination plan. In your plan, please include physical, psychosocial, and cultural needs.
Full Answer Section
Physical Considerations:
- Exposure assessment: Conducting a thorough assessment of the individual's environmental exposure is crucial. This includes identifying specific hazards (air pollution, lead exposure, contaminated water, etc.), duration of exposure, and potential health risks.
- Health monitoring: Regular monitoring of relevant physical health indicators is essential. This may include blood tests for lead levels, lung function tests for air pollution exposure, and screenings for related conditions like cancer or respiratory diseases.
- Medical management: Depending on the specific hazard and its impact, medical interventions may be necessary. This could involve detoxification treatments, medication for respiratory issues, or specialized care for specific conditions.
- Preventative measures: Educating individuals on risk reduction strategies is key. This includes safe drinking water practices, proper ventilation in homes, reducing exposure to pesticides, and utilizing protective equipment when necessary.
II. Psychosocial Considerations:
- Emotional distress: Environmental health concerns can cause significant emotional stress, anxiety, and depression. Offering emotional support through individual or group therapy, stress management techniques, and connecting individuals with mental health resources is crucial.
- Social isolation: The stigma associated with environmental health issues can lead to social isolation and feelings of helplessness. Fostering community support groups and connecting individuals with advocacy organizations can help combat these feelings.
- Empowerment: Empowering individuals to advocate for themselves and their communities is essential for achieving positive change. This can involve providing training on environmental health issues, facilitating community clean-up projects, and engaging with policymakers.
- Cultural considerations: Cultural beliefs and practices may influence an individual's exposure to environmental hazards or their understanding of health risks. Respecting cultural values and incorporating culturally appropriate interventions are crucial for successful care coordination.
III. Community Resources:
- Environmental health clinics: These clinics offer specialized services for individuals affected by environmental hazards, including exposure assessment, medical management, and referrals to other resources.
- Community clean-up programs: Participating in community clean-up initiatives can help reduce environmental hazards and empower individuals to take control of their environment.
- Advocacy groups: Environmental advocacy groups can provide valuable resources and support to individuals seeking to address environmental injustices in their communities.
- Social services: Connecting individuals with social services can help them address other challenges impacting their health, such as food insecurity or housing instability.
- Educational resources: Providing access to educational materials on environmental health issues can empower individuals to make informed decisions and protect themselves from harm.
IV. Care Coordination Strategies:
- Building partnerships: Collaborating with other healthcare providers, social service agencies, environmental organizations, and community leaders is crucial for a comprehensive approach to care.
- Developing care plans: Individualized care plans should be developed in collaboration with the patient, outlining specific physical, psychosocial, and social interventions and goals.
- **Communication and ** Regular communication with the patient and other stakeholders is essential to monitor progress, address challenges, and ensure a smooth continuum of care.
- Outcome evaluation: Regularly evaluating the effectiveness of the care coordination plan and adapting it as needed to ensure optimal patient outcomes is crucial.
V. Conclusion:
Addressing environmental health concerns within a community setting requires a coordinated effort that considers the physical, psychosocial, and cultural needs of individuals. By implementing this comprehensive care coordination plan, utilizing available community resources, and fostering collaboration among stakeholders, community care centers can play a critical role in ensuring the health and well-being of individuals affected by environmental hazards.