Discussion:

Screening is the administration of measures or tests to distinguish individuals who may have a condition from those who probably do not have it.  Discuss the advantages and disadvantages of screening.  

Instructions: 

Post your discussion to the Moodle Discussion Forum.  Initial post must be made by Day #3.  Word limit 500 words.  Reply to at least two other student posts with a reflection of their response.  Please make sure to provide citations and references (in APA, 7th ed. format) for your work.  

Assessment 4

Final Care Coordination Plan

INTRODUCTION- For this assessment, you will evaluate the preliminary care coordination plan you developed in Assessment 1 using best practices found in the literature.

INTRODUCTION-This assessment provides an opportunity to research the literature and apply evidence to support what communication, teaching, and learning best practices are needed for a hypothetical patient with a selected health care problem.

NOTE: You are required to complete this assessment after Assessment 1 is successfully completed.

PREPARATION- You are encouraged to complete the Vila Health: Cultural Competence activity prior to completing this assessment. Completing course activities before submitting your first attempt has been shown to make the difference between basic and proficient assessment.

In this assessment, you will evaluate the preliminary care coordination plan you developed in Assessment 1 using best practices found in the literature.

To prepare for your assessment, you will research the literature on your selected health care problem. You will describe the priorities that a care coordinator would establish when discussing the plan with a patient and family members. You will identify changes to the plan based upon EBP and discuss how the plan includes elements of 
Healthy People 2030.

INSTRUCTIONS- Note: You are required to complete Assessment 1 before this assessment.

For this assessment:

· Build on the preliminary plan, developed in Assessment 1, to complete a comprehensive care coordination plan.

Document Format and Length

Build on the preliminary plan document you created in Assessment 1. Your final plan should be a scholarly APA-formatted paper, 5–7 pages in length, not including title page and reference list.

Supporting Evidence

Support your care coordination plan with peer-reviewed articles, course study resources, and Healthy People 2030 resources. Cite at least three credible sources.

Grading Requirements

The requirements, outlined below, correspond to the grading criteria in the Final Care Coordination Plan Scoring Guide, so be sure to address each point. Read the performance-level descriptions for each criterion to see how your work will be assessed.

· Design patient-centered health interventions and timelines for a selected health care problem.

· Address three health care issues.

· Design an intervention for each health issue.

· Identify three community resources for each health intervention.

· Consider ethical decisions in designing patient-centered health interventions.

· Consider the practical effects of specific decisions.

· Include the ethical questions that generate uncertainty about the decisions you have made.

· Identify relevant health policy implications for the coordination and continuum of care.

· Cite specific health policy provisions.

· Describe priorities that a care coordinator would establish when discussing the plan with a patient and family member, making changes based upon evidence-based practice.

· Clearly explain the need for changes to the plan.

· Use the literature on evaluation as a guide to compare learning session content with best practices, including how to align teaching sessions to the Healthy People 2030 document.

· Use the literature on evaluation as guide to compare learning session content with best practices.

· Align teaching sessions to the Healthy People 2030 document.

· Apply APA formatting to in-text citations and references, exhibiting nearly flawless adherence to APA format.

· Organize content so ideas flow logically with smooth transitions; contains few errors in grammar/punctuation, word choice, and spelling.

Additional Requirements-Before submitting your assessment, proofread your final care coordination plan to minimize errors that could distract readers and make it more difficult for them to focus on the substance of your plan.

Portfolio Prompt: Save your presentation to your ePortfolio. Submissions to the ePortfolio will be part of your final Capstone course.

Context- Care coordination is the process of providing a smooth and seamless transition of care as part of the health continuum. Nurses must be aware of community resources, ethical considerations, policy issues, cultural norms, safety, and the physiological needs of patients. Nurses play a key role in providing the necessary knowledge and communication to ensure seamless transitions of care. They draw upon evidence-based practices to promote health and disease prevention to create a safe environment conducive to improving and maintaining the health of individuals, families, or aggregates within a community. When provided with a plan and the resources to achieve and maintain optimal health, patients benefit from a safe environment conducive to healing and a better quality of life.

Course Competencies- By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and scoring guide criteria:

· Competency 1: Adapt care based on patient-centered and person-focused factors.

· Design patient-centered health interventions and timelines for a selected health care problem.

· Competency 2: Collaborate with patients and family to achieve desired outcomes.

· Describe priorities that a care coordinator would establish when discussing the plan with a patient and family member, making changes based upon evidence-based practice.

· Competency 3: Create a satisfying patient experience.

· Use the literature on evaluation as a guide to compare learning session content with best practices, including how to align teaching sessions to the Healthy People 2030 document.

· Competency 4: Defend decisions based on the code of ethics for nursing.

· Consider ethical decisions in designing patient-centered health interventions.

· Competency 5: Explain how health care policies affect patient-centered care.

· Identify relevant health policy implications for the coordination and continuum of care.

· Competency 6: Apply professional, scholarly communication strategies to lead patient-centered care.

· Apply APA formatting to in-text citations and references, exhibiting nearly flawless adherence to APA format.

· Organize content so ideas flow logically with smooth transitions; contains few errors in grammar/punctuation, word choice, and spelling.

Scoring Guide

Use the scoring guide to understand how your assessment will be evaluated.

Final Care Coordination Plan Scoring Guide

CRITERIA	NON-PERFORMANCE	BASIC	PROFICIENT	DISTINGUISHED
Design patient-centered health interventions and timelines for a selected health care problem.

Consider ethical decisions in designing patient-centered health interventions.

Identify relevant health policy implications for the coordination and continuum of care.

Describe priorities that a care coordinator would establish when discussing the plan with a patient and family member, making changes based upon evidence-based practice.

Use the literature on evaluation as a guide to compare learning session content with best practices, including how to align teaching sessions to the Healthy People 2030 document.

Apply APA formatting to in-text citations and references, exhibiting nearly flawless adherence to APA format.

Organize content so ideas flow logically with smooth transitions; contains few errors in grammar/punctuation, word choice, and spelling.

• Review the readings in the White, Dudley-Brown, and Terhaar text. With your current health care organization (psychiatric behavioral hospital), or an organization you are targeting for your DNP Project, in mind, consider the area(s) of greatest challenge with regard to translating and applying evidence for a practice change initiative, e.g., leadership, technology, collaboration, stakeholder buy-in. Focus on the relevant text chapter(s) in your Discussion preparation.
• Consider theories and best practice recommendations for addressing your identified challenges and barriers to translating and applying evidence that would support practice change initiatives.
• Reflect on the philosophy of nursing practice that you developed. Consider your role as a DNP in creating an organizational culture that embraces evidence-based practice and quality improvement. 

With these thoughts in mind …

Post an explanation of the challenges and barriers to translating and applying evidence for practice change in your target health care organization (Behavioral health hospital). Briefly explain your issue(s) of concern and describe specific approaches for addressing these challenges. Explain how you view your role as a DNP in creating a health care culture that promotes translation of evidence for quality improvement and explain why. Then, recommend actions and activities you could model and lead, including through an EBP QI project, to advocate for quality improvement and social change in nursing. Be specific and provide examples and at least 3 references.

• White, K. M., Dudley-Brown, S., & Terhaar, M. F. (Eds.). (2019). Translation of evidence into nursing and healthcare (3rd ed.). Springer.
  • Chapter 15, “Interprofessional Collaboration and Teamwork for Translation” (pp. 299–314)
  • Chapter 16, “Creating a Culture That Promotes Translation” (pp. 315–334)
  • Chapter 17, “Best Practices in Translation: Challenges and Barriers in Translation” (pp. 337–346)

To Prepare:

• Reflect on the four peer-reviewed articles you critically appraised in Module 4, related to your clinical topic of interest and PICOT.
• Reflect on your current healthcare organization and think about potential opportunities for evidence-based change, using your topic of interest and PICOT as the basis for your reflection.
• Consider the best method of disseminating the results of your presentation to an audience. 

The Assignment: (Evidence-Based Project)

Part 4: Recommending an Evidence-Based Practice Change

Create an 8- to 9-slide narrated PowerPoint presentation in which you do the following:

• Briefly describe your healthcare organization, including its culture and readiness for change. (You may opt to keep various elements of this anonymous, such as your company name.)
• Describe the current problem or opportunity for change. Include in this description the circumstances surrounding the need for change, the scope of the issue, the stakeholders involved, and the risks associated with change implementation in general.
• Propose an evidence-based idea for a change in practice using an EBP approach to decision making. Note that you may find further research needs to be conducted if sufficient evidence is not discovered.
• Describe your plan for knowledge transfer of this change, including knowledge creation, dissemination, and organizational adoption and implementation.
• Explain how you would disseminate the results of your project to an audience. Provide a rationale for why you selected this dissemination strategy.
• Describe the measurable outcomes you hope to achieve with the implementation of this evidence-based change.
• Be sure to provide APA citations of the supporting evidence-based peer reviewed articles you selected to support your thinking.
• Add a lessons learned section that includes the following:
  • A summary of the critical appraisal of the peer-reviewed articles you previously submitted
  • An explanation about what you learned from completing the Evaluation Table within the Critical Appraisal Tool Worksheet Template (1-3 slides)