MSN FP6610 Comprehensive Needs Assessment
Assignment: Comprehensive Needs Assessment
Complete an interactive simulation exploring the role of the nurse in health care coordination. Then, complete a comprehensive patient needs assessment of 4–5 pages.
Note: Each assessment in this course builds on your work in the preceding assessment; therefore, complete the assessments in the order in which they are presented.
Care coordination is an emerging and complex field in the health care system because of the growing number of providers, the various settings of care, and the numerous methods of delivering care. Hospitals are implementing several interventions to address gaps in care coordination, such as enhanced systems of communication, information technology, and personnel resourcing. This assessment provides an opportunity for you to complete a comprehensive needs assessment.
By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria:
•Competency 1: Determine the influence of current health care legislation, policy, and research on evidence-based practice in assessment by care coordinators. ◦Identify current gaps in a patient’s care.
◦Develop a strategy for gathering additional necessary assessment data not readily available from an initial patient interview.
•Competency 2: Evaluate current factors (such as population health, cost, interprofessional communications) affecting patient outcomes related to care coordination. ◦Identify factors most likely to affect patient outcomes.
◦Advocate for the benefits of a multidisciplinary approach to patient care that a care coordination plan would foster.
•Competency 3: Determine appropriate care coordination performance measures for driving high-quality patient outcomes, based on current accrediting standards and benchmarks. ◦Identify specific patient and care coordination outcome measures related to specific accrediting standards.
•Competency 4: Apply relevant evidence-based practices that reflect a shift toward a broader population health focus on patient outcomes. ◦Identify evidence-based practices from the literature necessary to successfully implement a plan of care.
•Competency 5: Communicate effectively with diverse audiences, in an appropriate form and style, consistent with applicable organizational, professional, and scholarly standards. ◦Write clearly and concisely, using correct grammar and mechanics.
◦Support main points, claims, and conclusions with credible evidence, correctly formatting citations and references using APA style.
In their book To Err Is Human: Building a Safer Health System, Kohn, Corrigan, and Donaldson (2000) identified collaborative communication and the reduction of medical errors as top priorities to improve the quality and safety of patient care. In response to this, the National Quality Forum (NQF), a nonprofit organization that works to catalyze improvements in health care, identified care coordination as an important national strategy to improve patient safety and quality of care delivery.
Coordination of care supports patient safety and quality and is a recognized professional standard shared by registered nurses regardless of their practice setting. Whether educating a patient about his or her medication and plan of care, or reviewing follow-up care, nurses are essential in facilitating the continuity of care for all patients.
Historically, nurses have engaged in coordinating care for every one of their patients. As the landscape of health care evolves, so does care coordination. Assignment: Comprehensive Needs Assessment
Kohn, L. T., Corrigan, J. M., & Donaldson, M. S. (Eds.). (2000). To err is human: Building a safer health system. Washington, DC: National Academies Press. Retrieved from http://www.nap.edu/openbook.php?record_id=9728
Questions to consider:
As you prepare to complete this assessment, you may want to think about other related issues to deepen your understanding or broaden your viewpoint. You are encouraged to consider the questions below and discuss them with a fellow learner, a work associate, an interested friend, or a member of your professional community. Note that these questions are for your own development and exploration and do not need to be completed or submitted as part of your assessment.
•What are the key reasons for completing a patient needs assessment?
•Which types of information are likely to be most valuable for improving patient outcomes?
•What are the benefits of a multidisciplinary approach to coordinated care?
Note: Complete the assessments in this course in the order in which they are presented.
To prepare for this assessment, complete the Vila Health: The Nurse’s Role in Care Coordination simulation (linked in the Required Resources). You will use the patient information from the simulation for your needs assessment.
Note: Remember that you can submit all—or a portion of—your draft to Smarthinking for feedback before you submit the final version of this assessment. However, if you plan on using this free service, be mindful of the turnaround time of 24–48 hours for receiving feedback.
Complete a comprehensive needs assessment for Mr. Decker, based on the information provided in the Vila Health simulation.
Needs Assessment Format and Length
Format your needs assessment using APA style:
•Use the APA Style Paper Template, linked in the Required Resources. An APA Style Paper Tutorial is also provided (linked in the Suggested Resources) to help you in writing and formatting your needs assessment. Be sure to include: ◦A title page and reference page. An abstract is not required.
◦A running head on all pages.
◦Appropriate section headings.
•Your needs assessment should be 4–5 pages in length, not including the title page and references page.
Cite 3–5 sources of scholarly or professional evidence to support your assessment.
Conducting the Assessment: Assignment: Comprehensive Needs Assessment
Note: The requirements outlined below correspond to the grading criteria in the scoring guide. Be sure that your needs assessment addresses each point, at a minimum. Read the Needs Assessment Scoring Guide to better understand how each criterion will be assessed.
•Identify current gaps in the patient’s care. ◦Use an appropriate needs assessment tool to identify gaps.
◦Consider the types of patient information that will be most useful in assessing the current level of care.
•Develop a strategy for gathering additional, necessary assessment data not readily available from an initial patient interview. ◦Consider the full range of interrelated needs that affect the patient’s health.
•Identify factors most likely to affect patient outcomes. ◦Consider the potential effects of these factors on outcomes.
◦What evidence do you have to support your conclusions?
•Identify specific patient and care coordination outcome measures related to specific accrediting standards. ◦What are the applicable accrediting standards?
◦What is the rationale for measuring outcomes based on accrediting agencies?
◦How would you describe the relationship between specific outcomes and standards?
•Identify evidence-based practices from the literature necessary to implement a plan of care successfully. ◦Are your sources relevant and credible?
◦Consider best practices, having a population-health focus on patient outcomes.
•Advocate for the benefits of a multidisciplinary approach to patient care that a care coordination plan would foster. ◦What are the key points in your argument?
◦What evidence do you have to support you assertions? Assignment: Comprehensive Needs Assessment
•Write clearly and concisely, using correct grammar and mechanics. ◦Express your main points and conclusions coherently.
◦Proofread your writing to minimize errors that could distract readers and make it more difficult to focus on the substance of your needs assessment.
•Support main points, claims, and conclusions with credible evidence, correctly formatting citations and references using APA style. Assignment: Comprehensive Needs Assessment
Comprehensive Needs Assessment
The Influence of Healthcare Policy on Evidence-Based Practice
Health legislation, policy, and research affect clinical practices in a manner that requires clinical practitioners to restructure how they work schedules and strategies to meet the thresholds of evidence-based practices. Evidence-based practice is an important national and global agenda for health policy and research. The United States has formulated various policies in the health system to regulate health practices. These policies have introduced both positive and negative effects in the health systems and, most especially, the affordable evidence-based practices. The current Patient Protection and Affordable Care Act (PPACA) in the United States’ health care policy system was introduced with the purpose of cutting costs, increasing the number of insured patients, health equality and enhance the quality of hospital care for all patients (Huntington et al., 2011).
However, the policy is already causing gaps in the healthcare system. There is a looming shortfall of health professionals in the next decade. The PPACA is resulting in poor health quality because of the burden and pressure on the fewer health practitioners in the public health sector. The shortage of public health workers, increased waiting time, limited time with caregivers, shortened time with providers and patient dissatisfaction are important aspects of quality care affected by the health policy (Huntington et al., 2011). Evidence-based practice is centered on quality mechanisms, and this means that if structures out in place do not provide room for accuracy, then the results remain questionable.
More information about implications of healthcare policies on evidence-based practices can be gathered from nurses and private medical practitioners who were affected by the introduction of policies such as the ACA. This is because the policies affecting evidence-based practices tend to affect the healthcare workers more than they affect the patients. The compulsory health insurance scheme in for all Americans tended to affect insurance companies and patients who entrusted their insurance health providers than any other insurer. Information from such source can have more weight than the one gotten from patients.
Factors affecting Patients’ Outcomes related to Care Coordination
Care coordination is the act of deliberate organization of patient care activities and programs between two or more healthcare participants concerned in patients’ care to facilitate the proper delivery of health care services (Hillis et al., 2016). This involves organization of activities by looking beyond and identifying the aspects that require improvement or increased satisfaction. Factors most likely to affect patients’ outcomes include population health and interpersonal communication. The population of patients’ needs to be placed at the center of care coordination. The healthcare organizations are supposed to assess and understand the population they are serving fully. The assessment of the population should happen before strategies and plans meant for the improvement of health care. Population planning means assessing the community and identify its healthcare needs and then setting the goals.
In terms of interpersonal communication, care coordination is important in the current health system that is complex for patients. The healthcare system that is not interoperable can cause setbacks for patient services and delay or fail the purpose of evidence-based practice in the hospitals and other healthcare facilities. Proper communication and coordination in the interoperable system can monitor activities of other practitioners within a facility and know who is involved in the care of a single patient (Hillis et al., 2016). This means that communication as a factor affecting care coordination results to transparency and accountability.
A care coordination plan results in various benefits to both the patient and the healthcare givers. Care coordination ensures the accuracy of procedures, efficiency of implementation of health tasks and accountability of activities. The benefits further cut health costs to the patients that may arise as a result of readmissions and medical errors. Hospital facilities and resources can be properly utilized if coordination is taken care of in the facility.
Care Coordination Performance Measures based on Accreditation Standards
Performance measures refers to a change in the health of a person, a group of people, an organization or a population that is associated with a health intervention or a series of health interventions. Performance measures are usually driven by national standards, international standards, and financial incentives. The following are some of the specific outcome measures for patient care coordination: (Tzelepis et al., 2015).
Mortality rates: When mortality rates as pertain to a particular illness reduce by a certain percentage, then there is an indication of improvement in care coordination activities.
Readmissions: Readmissions after hospitalization may indicate that the initial care did not achieve the healing levels. When the rates of readmissions increase, then the performance measures prove to be below the standards of the expected healthcare facility performance.
Safety of care: The safety of care while a patient is in a healthcare facility can be determined by issues such as Hospital Acquired Infections (HAI). Whenever this happens, it may indicate that the degree of care coordination at the facility did not meet the accreditation levels.
Patient’s experience: Assessment of the perception a patient has regarding the quality of care at the facility may determine the degree of care coordination being practiced at the facility. This can serve as the best performance measure since patients have visited different health care facilities and have the ability to compare the current from previous health care services.
Evidence-Based Practiced for Implementation of a Plan of Care
No patient would want to hear that they went for treatment at a facility and acquired another health condition. Nurses have a key role to prevent another infection while a patient is undergoing treatment. Since hospital-acquired infections may indicate an outbreak of a particular disease in the population, this element of evidence-based practice can be used to structure a health care plan. This is because detection of an infection should immediately trigger an investigation and research into the occurrence to assess a possible outbreak in the population (Seddon et al., 2015). The issues concerning health hygiene become crucial since infection control calls for adherence to infection control policies of hospitals which include keeping the hospital environment clean, wearing protective attires and proper hand washing.
Gathering and Presenting Data to Staff and Physicians
Data concerning blood pressure results, Oxygen use by patients and the overall data pertaining a particular infection should be organized and presented to the physician and other authorized hospital officials. This kind of data indicates evidential practice and coordination within the organization and gives a trend of activities and the type of patients visiting health facilities in the population. This information helps in structuring health plans because it gives the facility and insight into areas requiring much input concerning certain illnesses (Seddon et al., 2015). The facility can design plans for improvement through facilitating health faculties that receive many patients by the allocation of enough resources. Also, the health planning can balance its expenditure by reducing expenditure on illnesses that do not affect many people in the population. Assignment: Comprehensive Needs Assessment
Hillis, R., Brenner, M., Larkin, P. J., Cawley, D., & Connolly, M. (2016). The role of care
coordinator for children with complex care needs: A systematic review. International Journal of Integrated Care, 16(2), 1–18.
Huntington, W. V., Covington, L. A., Center, P. P., Covington, L. A., & Manchikanti, L. (2011).
Patient Protection and Affordable Care Act of 2010: reforming the health care reform for the new decade. Pain physician, 14(1), E35-E67.
Seddon, D., Krayer, A., Robinson, C., Woods, B., & Tommis, Y. (2013). Care coordination:
Translating policy into practice for older people. Quality in Ageing and Older Adults, 14(2), 81–92.
Tzelepis, F., Sanson-Fisher, R. W., Zucca, A. C., & Fradgley, E. A. (2015). Measuring the
quality of patient-centered care: Why patient-reported measures are critical to reliable assessment. Patient Preference and Adherence, 9, 831–835.
Comprehensive Needs Assessment Scoring Guide
Comprehensive Needs Assessment Scoring Guide
Criteria Non-performance Basic Proficient Distinguished
Identify current gaps in a patient’s care. Does not identify perceived gaps in a patient’s care. Identifies perceived gaps in a patient’s care unsupported by the available data. Identifies current gaps in a patient’s care. Identifies current gaps in a patient’s care, based on a comprehensive, patient-centered needs assessment that includes patient-reported data.
Develop a strategy for gathering additional necessary assessment data not readily available from an initial patient interview. Does not suggest a general approach for gathering needs assessment data from an initial patient interview. Suggests a general approach for gathering needs assessment data from an initial patient interview. Develops a strategy for gathering additional, necessary assessment data not readily available from an initial patient interview. Develops a strategy for gathering additional necessary assessment data not readily available from an initial patient interview. The strategy reflects a holistic, coordinated care perspective.
Identify factors most likely to affect patient outcomes. Does not identify factors having some effect on patient outcomes. Identifies factors having some effect on patient outcomes, including those that are substantially unrelated to patient outcomes. Identifies factors most likely to affect patient outcomes. Identifies factors most likely to affect patient outcomes. Describes clear cause-and-effect relationships supported by credible evidence.
Identify specific patient and care coordination outcome measures related to specific accrediting standards. Does not identify patient and care coordination outcome measures. Identifies patient and care coordination outcome measures. Identifies specific patient and care coordination outcome measures related to specific accrediting standards. Identifies specific patient and care coordination outcome measures related to specific accrediting standards. Provides justification for following accrediting agency guidelines and articulates clear relationships among outcomes and standards.
Identify evidence-based practices from the literature necessary to successfully implement a plan of care. Does not identify evidence-based practices that support a plan of care. Identifies evidence-based practices that support a plan of care. Identifies evidence-based practices from the literature necessary to successfully implement a plan of care. Identifies evidence-based practices from current and credible sources, necessary to successfully implement a plan of care from a population-health perspective.
Advocate for the benefits of a multidisciplinary approach to patient care that a care coordination plan would foster. Does not list benefits of a multidisciplinary approach to patient care that a care coordination plan would foster. Lists benefits of a multidisciplinary approach to patient care that a care coordination plan would foster. Advocates for the benefits of a multidisciplinary approach to patient care that a care coordination plan would foster. Advocates for the benefits of a multidisciplinary approach to patient care that a care coordination plan would foster. Presents an astute, well-reasoned argument supported by credible evidence.
Write clearly and concisely, using correct grammar and mechanics. Does not write clearly and concisely, using correct grammar and mechanics. Writing is not consistently clear or concise, or errors in grammar and mechanics inhibit effective communication. Writes clearly and concisely, using correct grammar and mechanics. Writes clearly and concisely. Grammar and mechanics are error-free.
Support main points, claims, and conclusions with credible evidence, correctly formatting citations and references using APA style. Does not support main points, claims, and conclusions with relevant and credible evidence, correctly formatting citations and references using APA style. Main points, claims, and conclusions are not well supported. Sources lack relevance or credibility, or are incorrectly formatted. Supports main points, claims, and conclusions with credible evidence, correctly formatting citations and references using APA style. Supports main points, claims, and conclusions with relevant, credible, and convincing evidence. Source citations and references are error-free.
ADDITIONAL INSTRUCTIONS FOR THE CLASS
Discussion Questions (DQ)
- Initial responses to the DQ should address all components of the questions asked, include a minimum of one scholarly source, and be at least 250 words.
- Successful responses are substantive (i.e., add something new to the discussion, engage others in the discussion, well-developed idea) and include at least one scholarly source.
- One or two sentence responses, simple statements of agreement or “good post,” and responses that are off-topic will not count as substantive. Substantive responses should be at least 150 words.
- I encourage you to incorporate the readings from the week (as applicable) into your responses.
- Your initial responses to the mandatory DQ do not count toward participation and are graded separately.
- In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies.
- Participation posts do not require a scholarly source/citation (unless you cite someone else’s work).
- Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything that is due during the week.
APA Format and Writing Quality
- Familiarize yourself with APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of APA format (if required).
- Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation.
- I highly recommend using the APA Publication Manual, 6th edition.
Use of Direct Quotes
- I discourage overutilization of direct quotes in DQs and assignments at the Masters’ level and deduct points accordingly.
- As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content.
- It is best to paraphrase content and cite your source.
- For assignments that need to be submitted to LopesWrite, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me.
- Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes.
- Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own?
- Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for tips on improving your paper and SI score.
- The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies.
- Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances.
- If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect.
- I do not accept assignments that are two or more weeks late unless we have worked out an extension.
- As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.
- Communication is so very important. There are multiple ways to communicate with me:
- Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class.
- Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.