Care coordination plays a key role in addressing numerous issues within the American healthcare system, including its high prices, variable effectiveness and a disproportionate number of unsatisfactory outcomes for patients. The US spends more money per person on medical care than any other country. Despite this, the disjointed infrastructure frequently results in communication breakdowns and unnecessary or duplicate medical tests and treatments. As a result, there is a significant chance of inaccuracy and greater expenses in terms of financial resources and suffering for people.
The role of nurses in care coordination
Registered nurses (RN) are very familiar with the concept of care coordination; it is not new for them. Within the framework of coordination directed by the requirements and preferences of patients and their families, RNs play an essential part in the satisfaction of patients and treatment effectiveness. Patient-centered coordination of care is a fundamental aspect of nursing practice. Care coordination is crucial to enhancing the health of patients, fostering productive multidisciplinary cooperation and reducing expenses for all patient groups and medical facilities.
Care coordination is a task that assists in ensuring that the requirements and demands of patients are fulfilled continuously with regards to medical services and data sharing through people, operations and places. It also involves the purposeful organization of patient care operations among multiple parties, including the patient, who are responsible for the treatment of a patient. This helps to promote the proper distribution of health-related solutions. Primary healthcare should be provided through a cohesive, multidisciplinary team that includes a minimum of one staff care coordinator. This is the ideal coordination approach.
Multiple medical reform projects focusing on comprehensive healthcare delivery have illustrated the benefit of RNs holding care coordinating positions. The success of nurse-led and patient-centered care coordination is commonly demonstrated by nurses who create, execute and take part in care coordination initiatives and practices that aim to improve patient health results and reduce expenses.
Benefits of care coordination
Engaging nurses in care coordination has multiple benefits, such as:
- A significant decrease in emergency room visits
- Improves survival rates and lowered hospital readmissions
- Enhances level of care
- Elevates patient self-confidence in controlling their own care
- Increases safety for senior citizens when moving from an acute care facility to their homes
- Increases general patient satisfaction
- Lowers expenses and improves clinical results
- Decreases overall costs
Aspiring nurses who wish to learn more about adult patient care coordination can enroll in a distance nursing degree offered by reputable institution such as the University of Indianapolis. The accelerated bachelor of science in nursing (ABSN) degree is ideal for those who wish to transition into nursing who already possess a bachelor of science degree in another field. Topics such as nursing health assessment, transitional care and complex transitional nursing care are combined with one-on-one clinical placements to thoroughly prepare students to excel in the field of nursing.
Steps involved in nursing care
Nursing procedures are based on research methodology that nursing professionals can employ to think critically concerning their patients’ overall situation and treatment strategy. When caring for individuals in a professional context, nurses effectively employ evidence-based nursing techniques they learn during their initial nursing education.
The nursing professional requires clinical judgment to develop a broad strategy for providing care to patients when determining how a particular shift will proceed. These techniques enable nursing professionals to access all the information and medical records regarding each patient, prioritize their issues and establish objectives. The following are the steps that nurses must employ throughout the treatment process for each patient:
Assessment
When a nurse first interacts with a patient, an evaluation is conducted. If it is feasible, the nurse in charge will welcome the patient, make an introduction and describe the evaluation procedure. They then proceed to assess the individual’s medical issue, as well as their emotional and physical states, which may include discomfort or pain. This information aids the nurse in comprehending the patient’s issues in light of their usual situation. In reviewing the patient’s medical history, the nurse will consider both subjective and objective information.
Nurses have a variety of options when completing an assessment. To better understand the patient’s health and symptoms, they may question their concerns and depend on the patient’s verbal replies. If the patient is unable to speak, the nurse may seek advice from another healthcare provider or delve into the patient’s medical files. In order to evaluate the patient’s condition, vital indicators such as the patient’s blood pressure, temperature, oxygen saturation, age, weight, height and heart rate are typically recorded.
Diagnosis
Nursing professionals use the data gathered from evaluations in order to assist healthcare professionals in considering, excluding or identifying possible diagnoses. The team next determines the individual’s possible dangers after making a physiological, mental or emotional diagnosis. The team analyzes these potential risks to decide on treatment alternatives and goals. A diagnosis of illness cannot be made by a registered nurse, although they can identify particular symptoms that are connected to the patient’s illness.
Nurses are a crucial part of the healthcare team and work together with specialists to share ideas, exercise clinical judgment and provide feedback if they believe a diagnosis does not apply to the patient. However, nurses with an advanced degree, also known as nurse practitioners (NPs) or advanced practice registered nurses (APRNs), have advanced clinical abilities, so they are tasked with working autonomously without the guidance of a physician in some states. As a result, they can evaluate, diagnose and treat a patient based on their own knowledge.
Planning
The healthcare provider team collaborates to develop an individual’s care plan following a diagnosis. The planning process consists of two major parts:
Collaborating with multidisciplinary teams
A variety of medical professionals must be involved in the planning of medical treatment for patients. Every group member’s contribution is distinct. For instance, a nursing professional is in charge of organizing care to assist the healthcare staff in achieving the patient’s desired result. A nursing professional may prepare and maintain a treatment plan record that all members share to ensure that each person within the group can assess the patient’s progress. The team may additionally review such updates to adjust the patient care plan as necessary. The members of the multidisciplinary team may include nurse practitioners (NPs), licensed practical nurses (LPNs), registered nurses (RNs), certified nursing assistants (CNAs), general practitioners, doctor assistants, specialists, psychologists and medical assistants, among others.
Setting goals
Both the patient’s short-term goals, which may be accomplished in a matter of hours or days, and long-term goals, which may take a matter of weeks or months, are often included in this phase of planning. SMART objectives, which are specific, measurable, achievable, relevant and time-bound, are frequently used by nurses throughout the planning phase to maintain motivation and track performance. Nurses regularly consult with the patient in the process of developing the objectives that make up their treatment plan. Patient’s reservations, preferences and personal care objectives are discussed with them, and their emotional state is observed. To explain the strategy and address any concerns that the relatives of the patient might be experiencing, nurses may also speak with them.
Implementation
The patient care plan is then put into practice by nursing professionals by carrying out the SMART objectives and healthcare procedures decided upon by the care team. During the implementation, nursing professionals may offer indirect care, such as observing the patient’s condition and alerting their supervising doctors or specialists to any problems, or direct supervision, which includes treatments the nursing professionals carry out themselves. Depending on the care plan, the duties of the nurses throughout this phase may change. In addition, during this phase, nurses regularly monitor and document the patient’s vital signs. Nurses verbally interact with the patient in order to assess and evaluate how well the medical staff is handling their care. Nurses are in charge of administering the patient’s recommended medications and performing diagnostic procedures. In addition, they utilize healthcare tools to deliver treatments and physical support to patients.
Nurses are also frequently in charge of monitoring the execution of both their own plans and those carried out by other healthcare staff. They operate as a bridge between medical professionals and patients to relay vital information as they act as the patient’s initial point of contact. Treatments are evaluated by nurses using their clinical expertise and critical thinking abilities to ensure they meet the demands of the patient as well as the objectives of the team. If nurses have any concerns, they can discuss these with the patient and the medical team to determine if any adjustments need to be made.
Evaluation
During the evaluation phase, the healthcare team evaluates the efficacy of their treatment strategies and execution approaches. Nurses may carry out these assessments at various stages as they keep an eye on the patient’s development and wellbeing throughout the treatment process. In addition, nurses can also decide whether to continue with their existing plan or change strategies to better meet the needs of the patient by assessing if they enable the patient to move closer to their goals. Evaluation that takes place after the completion of patient treatment may help medical workers improve their approach to planning in the future.
Educating and advocating
Throughout their care, educating patients about their health conditions and providing them with clear guidance on how to cope with their illness is one of the primary facets of a nurse’s job. These instructions might include descriptions of the patient’s prescribed medicines, the time of their follow-up consultation, and instructions on how to perform rehabilitative exercises or practices, among similar topics. Educating patients might also include counseling regarding the patient’s dietary habits, workout routine and physical health. Additionally, nurses may need to inform and educate caretakers or the families of patients regarding any additional post-treatment lifestyle requirements.
In order to provide patients with the finest care and to ensure their safety, nurses regularly act as advocates for their health and general wellbeing. This type of advocacy entails motivating patients to share any concerns as well as interpreting health-related data or diagnoses to ensure the patient comprehends the crucial elements. Another way that nurses assist patients is by providing them with referrals to resources available through other organizations that they may need. Nurses can act as a representative for the people they treat by paying close attention to their concerns, respecting their choices and communicating their wishes to family members and other staff members.
Conclusion
The role of nurses in treating patients during both hospital stays and outpatient treatment is crucial. Nurses are required to utilize evidence-based methods and approaches to organize care for patients with complicated needs. This requires a comprehensive approach towards patient care, which includes assessment, diagnosis, planning, implementation, evaluation and education. In addition, nurses should also know how to work and collaborate as part of a multidisciplinary healthcare team to obtain better patient outcomes. Following these procedures can benefit not only the patient but also the entire healthcare industry.
