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Capella 4050 Assessment 2

Capella 4050 Assessment 2 Ethical and Policy Factors in Care Coordination

Student Name

Capella University

NURS-FPX 4050 Coord Patient-Centered Care

Prof. Name

Date

Introduction 

Good morning everyone! My name is ________ and I am a registered nurse as well as a care coordinator at Lodi community care center. Thank you for joining me today. In this presentation, I will be discussing some of the governmental policies related to health and safety in nursing homes. Moreover, I will highlight some of the ethical dilemmas that arise due to these policies related to care coordination which will also cover the code of ethics for nurses and care coordinators. The goal of today’s presentation is to make you all understand the importance of ethical considerations and health policies for your patients in a community setting so that you can maintain the continuum of care through effective coordination. 

Moving forward some of you here are care coordinators and may have an idea about the concept of care coordination while others who are frontline nurses might have this knowledge gap. So let us first understand the concept so that we can build an equal pace of this presentation. According to the Agency for Healthcare Research and Quality (AHRQ), care coordination is defined as a thoughtful organization of activities related to patient care and the distribution of sensitive patient information with concerned individuals in an appropriate manner so that patient’s health and safety are maintained and healthcare providers can deliver effective care (Agency for Healthcare Research and Quality, 2018).

To ensure that patient/resident care is coordinated appropriately, the U.S. government has established various policies which are essential for healthcare organizations to follow so that effective, equitable, and safe healthcare is provided. 

Governmental Policies Affecting the Coordination of Care

The Affordable Care Act (ACA) is one of the most relatable governmental policies for residents in nursing homes. The Patient Protection and Affordable Care Act which is widely known as ACA is a reform act signed in 2010 that has major 3 goals related to healthcare; 1) an affordable health insurance policy, 2) a Medicaid program that covers low-income individuals, and 3) innovative medical care methods to lower the costs of healthcare (McIntyre & Song, 2019). This act, for instance, proposes the obligation of providing accessible and affordable care to those who are deprived of quality healthcare.

Moreover, ACA creates opportunities to innovate new care models which improve care coordination among healthcare providers, leading to enhanced healthcare quality. A study suggested that with the help of ACA in long-term care settings (nursing homes), the quality of care is improved which is evident by the decreased number of readmissions, and reduced incidences of adverse events like falls and pressure ulcers (Walker et al., 2020). 

Another policy that applies to the health and safety of residents in nursing homes and covers the second half of care coordination’s definition is related to protected health information (PHI). This policy falls under the Health Insurance Portability and Accountability Act (HIPAA) which was established in 1996. It is a federal law that entails healthcare organizations to follow standard guidelines for the protection of patient’s health information (Moore & Frye, 2019).

Capella 4050 Assessment 2

For example, HIPAA policy impacts care coordination in a way that healthcare providers follow appropriate channels to reveal patient information with informed consent and coordinate among themselves to maintain the confidentiality and privacy of information. Most of the community care centers and nursing homes use electronic residents’ records too which adds another responsibility of care providers to ensure information is secured and saved in encrypted software. 

Let’s discuss another national-level policy that is particular to nursing homes. The Nursing Homes Reform Act (NHRA) was established with the purpose to provide quality care by preparing individualized care plans for the residents addressing their rights of freedom and dignity (Werner et al., 2022). This act also relies on monitoring the actions of healthcare providers for the provision of quality care. Thus, provoking healthcare providers to coordinate patient care and work collaboratively to ensure residents’ health and safety is a priority. This law prepares healthcare providers to meet the standards of care through planning and executing safe practices for quality healthcare. 

All of these governmental policies advocate that healthcare providers especially nurses should coordinate with other team members to provide safe and quality healthcare. Care coordinators play a vital role in monitoring and evaluating the care that is being provided. I hope everything is clear to you all, if you have any questions, please park them for a Q&A session at the end. 

Policies that Raise Ethical Dilemmas for Care Coordination

Implementation of any policy requires healthcare providers to ensure that ethical principles are being followed. These principles include autonomy (right of freedom and choice), beneficence (right of benefit), non-maleficence (to not harm consumers), and justice (equality and equitability). Most of the time healthcare policies give birth to ethical dilemmas which are situations in which healthcare providers are stuck between legal or ethical perspectives. Ethical decision-making models help in these regards which are not a part of today’s presentation, however, we will be discussing some of the ethical dilemmas that arise due to national and state-level policies. 

The first ethical dilemma that I will discuss is the violation of the ethical principle of justice through the unequal distribution of Medicaid services. Under the Affordable Care Act (ACA), Medicaid services are not available to every individual and there are certain coverage gaps too. The insurance and Medicaid services cover only individuals who are between 100% to 400% of the federal poverty level which makes low-income individuals to be deprived of these services.

Furthermore, many preventable diseases are not covered by this insurance (respiratory problems – asthma, and sleep problems), and citizens who are non-filed immigrants are also excluded from the services (Adashi et al., 2022; Wallack, 2021). This becomes an ethical dilemma for healthcare organizations to either follow the rule of justice or legal policies. Currently, we follow policies only but have petitioned along with other community centers to bring an updated reform in this matter. 

Capella 4050 Assessment 2

The second ethical dilemma is for healthcare providers, especially nurses. “Caring for self or caring for others”. This dilemma arises with the increased number of residents in nursing homes due to affordable and quality healthcare policies. The increasing number of residents inclines the chances of nurses’ burnout eventually leading to staff shortages. The excessive workload that affects nursing practices puts nurses on the scale to decide between themselves and others resulting in poor quality of care and poor patients (Haahr et al., 2020). It is therefore essential that nurses are empowered and their profession is valued so that healthcare entities don’t lose their frontline forces. 

And the last dilemma is one that we all must have encountered most of the time in our workplaces. Autonomy vs beneficence. Often the right to autonomy clashes with the right of beneficence in terms of care and treatment. It is also observed while protecting patients’ information as per HIPAA rule which states to include patients’ consent before the dispersion of information. This becomes an ethical problem for healthcare providers to choose between what patient wants and what is beneficial for them. A study recommends that integrating both principles helps in achieving desired outcomes (Cheraghi et al., 2023). The rule of beneficence should include patient’s autonomy thus making them agree on what is best for them 

Impact of Code of Ethics for Nurses 

As nurses are frontline staff in providing care, the major responsibility of incorporating ethical principles lies within their job roles. So they need to understand the impact of the code of ethics on care coordination and the continuum of care. The Code of Ethics for Nurses with Imperative Statements which is commonly called The Code was established to provide a guide for nurses to carry out their nursing practices in a way that provides quality care addressing all ethical considerations (American Nurses Association, 2017). Nurses should follow these ethical guidelines at every step of their care even in nursing homes.

The code of ethics enables nurses to make decisions based on residents’ respect, needs, preferences, and cultural and social norms, and by empathizing with them. Ethics also play an important part in coordinating care and preserving the continuum of care (American Nurses Association, 2012). They give an opportunity to nurses and other healthcare providers to develop consumer-centered care where the purpose is to give them full autonomy to choose their care plan and treatment and to do what is beneficial for them.

Furthermore, ethics are connected with the Healthy People Act 2030 which covers the aspect of providing safe and equitable care to every individual without noticing their social determinants (gender, culture, economic, and social factors) (U.S. Department of Health and Human Services., n.d.). Thus these governmental policies should direct nurses and other healthcare providers to ensure that quality care is provided through effective care coordination keeping in mind the ethical principles of healthcare practices.  

Conclusion

To conclude my presentation, I would like to summarize the content covered today. Initially, we talked about what is care coordination in which we discussed that the provision of quality care through coordinated care plans is essential for better outcomes. Then we discussed Affordable Care Act, HIPAA, and NHRA laws for health, safety, and care in nursing homes. Then we discussed some of the ethical dilemmas that are associated with these policies and in the end discussed the role of nurses in terms of coordinating care and maintaining the continuum of care using ethical principles and policies. Your questions are most welcomed now. Thank you. 

References

Adashi, E. Y., O’Mahony, D. P., & Cohen, I. G. (2022). Stamping out the Medicaid coverage gap: An ACA imperative. The American Journal of Medicine135(8). https://doi.org/10.1016/j.amjmed.2022.03.033 

AHRQ. (2018). Care Coordination. Retrieved April 7, 2023, from https://www.ahrq.gov/ncepcr/care/coordination.html 

American Nurses Association. (2017). Code of Ethics for Nurses. Retrieved April 8, 2023, from https://www.nursingworld.org/practice-policy/nursing-excellence/ethics/code-of-ethics-for-nurses/ 

American Nurses Association. (2012). Care Coordination and Registered Nurses’ Essential Role. Retrieved April 7, 2023, from https://www.nursingworld.org/~4afbf2/globalassets/practiceandpolicy/health-policy/cnpe-care-coord-position-statement-final–draft-6-12-2012.pdf 

Cheraghi, R., Valizadeh, L., Zamanzadeh, V., Hassankhani, H., & Jafarzadeh, A. (2023). Clarification of ethical principle of the beneficence in nursing care: An integrative review. BMC Nursing22(1). https://doi.org/10.1186/s12912-023-01246-4  

Capella 4050 Assessment 2

Haahr, A., Norlyk, A., Martinsen, B., & Dreyer, P. (2020). Nurses’ experiences of ethical dilemmas: A Review. Nursing Ethics27(1), 258–272. https://doi.org/10.1177/0969733019832941 

McIntyre, A., & Song, Z. (2019). The US Affordable Care Act: Reflections and directions at the close of a decade. PLOS Medicine16(2). https://doi.org/10.1371/journal.pmed.1002752  

Moore, W., & Frye, S. (2019). Review of HIPAA, part 1: History, protected health information, and privacy and security rules. Journal of Nuclear Medicine Technology47(4), 269–272. https://doi.org/10.2967/jnmt.119.227819  

U.S. Department of Health and Human Services. (n.d.). Social Determinants of Health – Healthy People 2030. Retrieved April 8, 2023, from https://health.gov/healthypeople/priority-areas/social-determinants-health 

Walker, V., Ruley, M., Nelson, L., Layton, W., & Coustasse, A. (2020). The effect of the affordable care act on Medicaid payments in long-term care facilities. International Journal of Healthcare Management15(1), 62–69. https://doi.org/10.1080/20479700.2020.1843886 

Wallack, A. R. (2021). Medicaid expansion and insurance reform under the Affordable Care Act: The new federalism of health policy or the same old same old? The Affordable Care Act as a National Experiment, 31–38. https://doi.org/10.1007/978-3-030-66726-9_5 

Werner, R. M., Konetzka, R. T., Grabowski, D. C., & Stevenson, D. G. (2022). Reforming nursing home financing, payment, and oversight. New England Journal of Medicine386(20), 1869–1871. https://doi.org/10.1056/nejmp2203429 

Capella 4050 Assessment 2