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NURS FPX 6610 Assessment 4 Case Presentation

Student Name Capella University NURS-FPX 6610 Introduction to Care Coordination Prof. Name Date Case Presentation Slide 1:Hello, my name is Student Name, and I am here to present the case study of a patient named Mrs. Snyder. Importance of Case Study in Healthcare Slide 2:Let’s delve into the significance of case studies within the healthcare sector. Case studies encapsulate concise and accurate medical information about patients. They play a crucial role by providing comprehensive insights into a patient’s medical condition, diagnoses, potential health complications, and treatment modalities. Incorporating real-life patient scenarios makes case studies invaluable for monitoring patients and referencing pertinent information when needed (Hinchliffe et al., 2020). Today, I will focus on transitional patient care, highlighting how multidisciplinary teams collaborate to ensure optimal patient outcomes. Transitional Care Plan and Goals of Continuing Care Slide 3:In this case presentation, I will explore transitional care within healthcare settings. Transitional care involves catering to patients during transitions between healthcare facilities to safeguard their well-being (Daliri et al., 2019). The paramount objective of hospital staff is to facilitate seamless and manageable transfers for patients. This presentation will discuss the case of Mrs. Snyder, a 56-year-old patient requiring transfer due to her critical condition. The goal of continuing care is to deliver quality treatment to Mrs. Snyder while honoring her religious and cultural beliefs, given her Jewish background, amidst her serious health challenges. Stakeholder Part in Patient Health and Safety Slide 4:Stakeholders play a pivotal role in ensuring the quality of care and safety of patients (Lianov et al., 2020). It is incumbent upon stakeholders to ensure patient cooperation and mitigate undue burdens. In Mrs. Snyder’s case, healthcare professionals must facilitate her transfer between facilities with minimal disruption. Given her Jewish faith, healthcare providers involved in the transfer process must prioritize her cultural and religious considerations. Mrs. Snyder’s preferences, including her dietary requirements for Kosher food, must be diligently addressed to provide comprehensive care (Lianov et al., 2020). Elements of Continuous Care Slide 5:Continuous care encompasses several essential components, including thorough assessment of patient and familial medical records to identify underlying health issues (Pervjakova et al., 2022). Accurate patient evaluation serves as the cornerstone for effective treatment. Additionally, meticulous collection of medical records is crucial for seamless data transmission within healthcare organizations (Asmirajanti et al., 2019). Patient Assessment Slide 6:Mrs. Snyder presents with multiple health concerns necessitating careful consideration of her medical history for transitional treatment planning. Her evaluation reveals critical conditions such as ovarian cancer and diabetes, alongside stress and depression exacerbated by chemotherapy (Khanlarkhani et al., 2021; Demir et al., 2021). Given her cultural and religious beliefs, Mrs. Snyder seeks a healthcare environment that respects her preferences while providing necessary care and support. Inter-professional Care Team Slide 7:Effective patient care requires seamless coordination among various healthcare professionals. Mrs. Snyder’s interdisciplinary care team comprises specialists addressing her diverse medical needs, ensuring adherence to treatment protocols (Ansa et al., 2020). Nurses play a crucial role in facilitating patient referrals, adjusting treatment regimens, and advocating for optimal care settings. Factors Affecting Patient Outcomes Slide 8:Patient outcomes are influenced by diverse factors, including economic status, lifestyle, social support, and environmental conditions (Chung et al., 2020). Assumption The assumption underlying Mrs. Snyder’s care is her adherence to Judaism, necessitating consideration of her dietary restrictions. Moreover, her family’s unstable circumstances, compounded by economic stress and familial issues, underscore the importance of ensuring her comfort and support during treatment. Areas of Uncertainties Slide 9:Uncertainty is inevitable in patient care, emphasizing the need for nurses equipped with adequate training to address critical situations effectively (Chung et al., 2020). Determination of Required Resources Slide 10:To ensure effective care for Mrs. Snyder, various resources are indispensable, including regular monitoring of vital signs, adherence to dietary guidelines, and access to necessary medical equipment (Howell et al., 2020). Conclusion Slide 11: Mrs. Snyder’s complex health challenges underscore the importance of tailored transitional care plans. By respecting patients’ religious and cultural beliefs and leveraging multidisciplinary approaches, healthcare providers can enhance patient outcomes and reduce mortality rates. Transitional care is a vital aspect of patient management, necessitating strategic initiatives to address individual needs effectively. As healthcare providers, it is imperative to prioritize patients’ well-being and ensure comprehensive care delivery. References Ansa, B. E., Zechariah, S., Gates, A. M., Johnson, S. W., Heboyan, V., & De Leo, G. (2020). Attitudes and behavior towards interprofessional collaboration among healthcare professionals in a large academic medical center. Healthcare, 8(3), 323. https://doi.org/10.3390/healthcare8030323 Asmirajanti, M., Hamid, A. Y. S., & Hariyati, Rr. T. S. (2019). Nursing Care Activities Based on Documentation. BMC Nursing, 18(1). https://doi.org/10.1186/s12912-019-0352-0 Chung, G. K.-K., Dong, D., Wong, S. Y.-S., Wong, H., & Chung, R. Y.-N. (2020). Perceived poverty and health, and their roles in the poverty-health vicious cycle: A qualitative study of major stakeholders in the healthcare setting in Hong Kong. International Journal for Equity in Health, 19(1). https://doi.org/10.1186/s12939-020-1127-7 Daliri, S., Hugtenburg, J. G., ter Riet, G., van den Bemt, B. J. F., Buurman, B. M., Scholte op Reimer, W. J. M., van Buul-Gast, M.-C., & Karapinar-Çarkit, F. (2019). The effect of a pharmacy-led transitional care program on medication-related problems post-discharge A before—After prospective study. Plos One, 14(3), 0213593. https://doi.org/10.1371/journal.pone.0213593 Demir, S., Nawroth, P. P., Herzig, S., & Ekim Üstünel, B. (2021). Emerging targets in type 2 diabetes and diabetic complications. Advanced Science, 8(18), 2100275. https://doi.org/10.1002/advs.202100275 Hinchliffe, R. J., Forsythe, R. O., Apelqvist, J., Boyko, E. J., Fitridge, R., Hong, J. P., Katsanos, K., Mills, J. L., Nikol, S., Reekers, J., Venermo, M., Zierler, R. E., & Schaper, N. C. (2020). Guidelines on diagnosis, prognosis, and management of peripheral artery disease in patients with foot ulcers and diabetes (IWGDF 2019 update). Diabetes/Metabolism Research and Reviews, 36(1). https://doi.org/10.1002/dmrr.3276 NURS FPX 6610 Assessment 4 Case Presentation Howell, D., Mayer, D. K., Fielding, R., Eicher, M., Verdonck-de Leeuw, I. M., Johansen, C., Soto-Perez-de-Celis, E., Foster, C., Chan, R., Alfano, C. M., Hudson, S. V., Jefford, M., Lam, W. W. T., Loerzel, V., Pravettoni, G., Rammant, E., Schapira, L., Stein, K. D., & Koczwara, B. (2020). Management
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NURS FPX 6610 Assessment 3 Transitional Care Plan

Student Name Capella University NURS-FPX 6610 Introduction to Care Coordination Prof. Name Date Transitional Care Plan Introduction Transitional care plays a crucial role in ensuring the quality of care and safety of patients, particularly during shifts between different phases of treatment. This assessment focuses on developing a transitional care plan for Mrs. Snyder, a 56-year-old patient with diabetes admitted to Villa Hospital due to an infected toe. The plan aims to address her healthcare needs and identify communication barriers that may affect the overall transitional process (Korytkowski et al., 2022). Key Elements & Information Needed for High-Quality Treatment Effective patient care relies on precise diagnosis, continuous monitoring, and comprehensive medical records management (Watts et al., 2020). Key elements necessary for Mrs. Snyder’s treatment include: Medical Records Collecting Mrs. Snyder’s medical records enables a better understanding of her health status, facilitating accurate diagnosis and treatment of associated conditions (Chen et al., 2018). Medication Reconciliation Accurate medication reconciliation ensures appropriate treatment, minimizes errors, and improves patient outcomes (Fernandes et al., 2020). Emergency and Advance Directive Information Obtaining advance directive information and understanding Mrs. Snyder’s preferences and religious beliefs are vital for providing patient-centered care and preventing complications (Dowling et al., 2020). Patient Feedback Incorporating patient feedback helps healthcare professionals tailor treatment plans to meet individual needs and enhance patient satisfaction (Moghaddam et al., 2019). Plan of Care and Education Customized care plans and patient education are essential for empowering patients like Mrs. Snyder to manage their conditions effectively (Dyer, 2021). Community and Health Care Resources Access to community resources and support services is critical for preventing adverse outcomes and promoting patient well-being (Yue et al., 2019). Insightful Assessment of Patient’s Needs A comprehensive assessment, including medical tests, prescriptions, counseling documents, and social support, is necessary for seamless transitions and optimal care delivery (Humphries et al., 2020). Importance of Key Elements of a Transitional Care Plan Each key element contributes to the effectiveness of transitional care plans by addressing patients’ unique needs and ensuring continuity of care (Blackwood et al., 2019). Potential Effects of Incomplete or Inaccurate Information on Care Incomplete or inaccurate information can lead to treatment delays, medication errors, and compromised patient safety (Zirpe et al., 2020). Importance of Effective Communication Effective communication fosters trust, enhances collaboration, and reduces the risk of adverse events, ultimately improving patient outcomes (Garcia-Jorda et al., 2022). Potential Effects of Ineffective Communications Ineffective communication may result in treatment delays, health disparities, increased costs, and diminished patient satisfaction (Raeisi et al., 2019). Barriers to the Transfer of Accurate Patient Information Challenges such as staffing shortages, incomplete medical histories, and inadequate training in electronic health records can impede the transfer of accurate patient information (Ilardo & Speciale, 2020; Tsai et al., 2020). Strategy to Establish Absolute Understanding of Continued Care Effective strategies include meticulous planning, follow-up sessions, and clear communication to ensure the seamless transfer of information and improve patient outcomes (Glans et al., 2020). Conclusion A well-executed transitional care plan is crucial for optimizing patient care during healthcare transitions. By addressing key elements, overcoming communication barriers, and implementing effective strategies, healthcare providers can ensure Mrs. Snyder receives the best possible care and support her in managing her diabetes effectively. References Moghaddam, M. A.A., Zarei, E., Bagherzadeh, R., Dargahi, H., & Farrokhi, P. (2019). Evaluation of service quality from patients’ viewpoint. BMC Health Services Research, 19(1). https://doi.org/10.1186/s12913-019-3998-0 Blackwood, D. H., Walker, D., Mythen, M. G., Taylor, R. M., & Vindrola-Padros, C. (2019). Barriers to advance care planning with patients as perceived by nurses and other healthcare professionals: A systematic review. Journal of Clinical Nursing, 28(23-24), 4276–4297. https://doi.org/10.1111/jocn.15049 Borulkar, R., Dhande, P., & Dhande, P. (2022). Medication Reconciliation: A beneficial tool in patient safety 1 1. Bharati Vidyapeeth Medical Journal (BVMJ), 2(3). https://bvmj.in/journal/borulkar_2022.pdf Chen, Y., Ding, S., Xu, Z., Zheng, H., & Yang, S. (2018). Blockchain-based medical records secure storage and medical service framework. Journal of Medical Systems, 43(1). https://doi.org/10.1007/s10916-018-1121-4 Cullati, S., Bochatay, N., Maître, F., Laroche, T., Muller-Juge, V., Blondon, K. S., Junod Perron, N., Bajwa, N. M., Viet Vu, N., Kim, S., Savoldelli, G. L., Hudelson, P., Chopard, P., & Nendaz, M. R. (2019). When team conflicts threaten the quality of care: A study of health care professionals’ experiences and perceptions. Mayo Clinic Proceedings: Innovations, Quality & Outcomes, 3(1), 43–51. https://doi.org/10.1016/j.mayocpiqo.2018.11.003 Dowling, T., Kennedy, S., & Foran, S. (2020). Implementing advance directives—An international literature review of important considerations for nurses. Journal of Nursing Management, 28(6). https://doi.org/10.1111/jonm.13097 Dyer, E. (2021). It’s about people: Caring agents and satisfied patients are key to a successful healthcare call center culture. Management in Healthcare, 6(2), 134–141. https://www.ingentaconnect.com/content/hsp/mih/2021/00000006/00000002/art00004 NURS FPX 6610 Assessment 3 Transitional Care Plan Fernandes, B. D., Almeida, P. H. R. F., Foppa, A. A., Sousa, C. T., Ayres, L. R., & Chemello, C. (2020). Pharmacist-led medication reconciliation at patient discharge: A scoping review. Research in Social and Administrative Pharmacy, 16(5), 605–613. https://doi.org/10.1016/j.sapharm.2019.08.001 Fiorillo, A., Barlati, S., Bellomo, A., Corrivetti, G., Nicolò, G., Sampogna, G., Stanga, V., Veltro, F., Maina, G., & Vita, A. (2020). The role of shared decision-making in improving adherence to pharmacological treatments in patients with schizophrenia: a clinical review. Annals of General Psychiatry, 19(1). https://doi.org/10.1186/s12991-020-00293-4 Garcia-Jorda, D., Fabreau, G. E., Li, Q. K. W., Polachek, A., Milaney, K., McLane, P., & McBrien, K. A. (2022). Being a member of a novel transitional case management team for patients with unstable housing: an ethnographic study. BMC Health Services Research, 22(1). https://doi.org/10.1186/s12913-022-07590-6 Glans, M., Kragh Ekstam, A., Jakobsson, U., Bondesson, Å., & Midlöv, P. (2020). Risk factors for hospital readmission in older adults within 30 days of discharge – A comparative retrospective study. BMC Geriatrics, 20(1). https://doi.org/10.1186/s12877-020-01867-3 Humphries, C., Jaganathan, S., Panniyammakal, J., Singh, S., Dorairaj, P., Price, M., Gill, P., Greenfield, S., Lilford, R., & Manaseki-Holland, S. (2020). Investigating discharge communication for chronic disease patients in three hospitals in India. Plos One, 15(4), 0230438. https://doi.org/10.1371/journal.pone.0230438 NURS FPX 6610 Assessment 3 Transitional Care Plan Ilardo, M. L., & Speciale, A. (2020). The community pharmacist: Perceived barriers and patient-centered care communication. International Journal of Environmental Research and Public Health, 17(2). https://doi.org/10.3390/ijerph17020536 Kaper, M. S.,
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NURS FPX 6610 Assessment 2 Patient Care Plan

Student Name Capella University NURS-FPX 6610 Introduction to Care Coordination Prof. Name Date Patient Care Plan Patient Identifier: 6700891Patient Medical Diagnosis: Poorly controlled anxiety, obesity, HTN, DM, and Hypercholesterolemia Nursing Diagnosis Assessment Data Goals and Outcome Nursing Interventions Rationale Outcome Evaluation and Re-planning First Diagnosis:           Risk of improper healthcare management – Subjective: Patient is Mrs. Snyder, 56 years old, under treatment for hyperglycemia and uncontrolled diabetes. Patient will report improvement in eating habits and personal health. – Raise awareness about self-care management – Encourage diabetes self-monitoring at home – Teach insulin administration techniques Education and self-monitoring vital for diabetes control Assessment of glucose logs and lifestyle changes; medication adjustment if needed Risk of a consistent rise in diabetes – Objective: Admitted to ED with sugar levels of 230-389, dyspnea, abdominal discomfort, malaise, urination problems, and HTN. – High consumption of cookies and snacks. Patient will reduce weight in 3 months. Patient will control snacking habit in 1 month. – Educate on lifestyle modifications – Teach insulin administration Lifestyle changes crucial for diabetes management Regular monitoring of weight and snacking habits; review after 1 and 3 months Second Diagnosis:           Higher domestic burden and difficulty in meal preparation – Subjective: Patient experiences constant anxiety, depression, overwhelmed feeling, and weakness due to family responsibilities. – Husband provides validation, leading to neglect of personal health. Patient will improve mental health and emotional well-being. – Prescribe tolerable anxiolytics – Weekly counseling sessions (CBT) – Provide access to mindfulness and spiritual healing therapies Pharmacological and psychotherapeutic approaches essential for anxiety control Weekly assessment of anxiety level and adjustment of interventions as needed Third Diagnosis:           Ovarian Cancer – Subjective: Patient fearful of chemotherapy, weak, and less immune. Fear of failing as caregiver for elderly mother. – Fear of acute pain, discomfort with surgery. Obesity and airway difficulty. Patient will have multiple options for better care of her mother through facility placement. – Refer to counselor for caregiver role – Find social worker for facility placement – Implement pain assessment thrice a day – Educate on nonpharmacological pain management Ensure patient and caregiver support, pain relief, and improved quality of life Regular assessment of pain and caregiving needs; adjust interventions accordingly References Cancer. (2021, October 6). Managing diabetes when you have cancer. Cancer.net. https://www.cancer.net/navigating-cancer-care/when-cancer-not-your-only-health-concern/managing-diabetes-when-you-have-cancer Carolina, C. M. (2019, October 16). Unlocking the full potential of self-monitoring of blood glucose. Uspharmacist.com. https://www.uspharmacist.com/article/unlocking-the-full-potential-of-selfmonitoring-of-blood-glucose Goodtherapy. (2019, September 23). Therapy for self-love, therapist for self-love issues. Goodtherapy.org. https://www.goodtherapy.org/learn-about-therapy/issues/self-love Heart. (2021, May 6). Living healthy with diabetes. Heart.org. https://www.heart.org/en/health-topics/diabetes/prevention–treatment-of-diabetes/living-healthy-with-diabetes Hoyt, J. (2022, May 26). Assisted living & senior placement agencies. SeniolLiving.org. https://www.seniorliving.org/placement-agencies/ NURS FPX 6610 Assessment 2 Patient Care Plan Pegg, S., Hill, K., Argiros, A., Olatunji, B. O., & Kujawa, A. (2022). Cognitive behavioral therapy for anxiety disorders in youth: Efficacy, moderators, and new advances in predicting outcomes. Current Psychiatry Reports, 24(12). https://doi.org/10.1007/s11920-022-01384-7 Ramzan, B., Harun, S. N., Butt, F. Z., Butt, R. Z., Hashmi, F., Gardezi, S., Hussain, I., & Rasool, M. F. (2022). Impact of diabetes educator on diabetes management: Findings from diabetes educator assisted management study of Diabetes. Archives of Pharmacy Practice, 13(2), 43–50. https://doi.org/10.51847/2njmwzsnld Sheikhalipour, Z., Ghahramanian, A., Fateh, A., Ghiahi, R., & Onyeka, T. C. (2019). Quality of life in women with cancer and its influencing factors. Journal of Caring Sciences, 8(1), 9–15. https://doi.org/10.15171/jcs.2019.002 Ströhle, A., Gensichen, J., & Domschke, K. (2018). The diagnosis and treatment of anxiety disorders. Deutsches Aerzteblatt Online, 115(37). https://doi.org/10.3238/arztebl.2018.0611 USC. (2018, January 9). What does self-care mean for diabetic patients? Nursing.usc.edu. https://nursing.usc.edu/blog/self-care-with-diabetes/ NURS FPX 6610 Assessment 2 Patient Care Plan

NURS FPX 6610 Assessment 1 Comprehensive Needs Assessment

Student Name Capella University NURS-FPX 6610 Introduction to Care Coordination Prof. Name Date Comprehensive Needs Assessment Comprehensive needs assessment plays a crucial role in aiding healthcare professionals to utilize various resources for enhancing patient care. This assessment aims to identify gaps in patient care and strategize care coordination to overcome these gaps effectively. Additionally, it helps in recognizing patients’ needs and devising methods for assessing them. Moreover, care coordination is pivotal for optimizing patient care, and this discussion encompasses diverse strategies for achieving this objective, along with emphasizing interdisciplinary team collaboration. Current Gaps in Patient Care The case of Mr. Decker, a 79-year-old diabetic patient presenting with an infected toe, underscores prevalent gaps in patient care. His failure to adhere to post-discharge guidelines resulted in readmission with a serious infection. Several factors contributed to these gaps, including Mr. Decker’s low-income status, insufficient post-discharge healthcare education, and lack of patient condition evaluation post-discharge. The Patient-Centered Assessment Method, utilized to assess Mr. Decker’s needs, ensured the fulfillment of his physiological, social, religious, and psychological requirements (Perazzo et al., 2020). This approach prioritizes patient-centered care, facilitating healthcare professionals in addressing patients’ emotional needs comprehensively. Informational Needs for Optimal Patient Care Critical information required for assessing the current level of care includes Mr. Decker’s medical records, encompassing details such as age, weight, and allergies, as well as insights into his emotional state, preferences, medical regimen, and religious beliefs. Strategy for Gathering Additional Necessary Data Engaging in preliminary discussions and interviewing Mr. Decker’s family members, particularly his spouse and children, can provide valuable insights into his behavior, interests, dietary habits, and other pertinent factors essential for tailored care. Leveraging electronic health records while ensuring HIPAA compliance further aids in acquiring comprehensive patient data. Societal, Economic, and Interdisciplinary Factors Affecting Patient Care Factors such as financial constraints, aging, and limited social support significantly impact patient care outcomes. Mr. Decker’s low-income status and inadequate social support exacerbate his health challenges, highlighting the need for tailored interventions addressing socioeconomic determinants of health. Professional Standards Influence on Patient Care and Care Coordination Outcomes Organizations like the National Quality Forum and the Agency for Healthcare Research and Quality establish standards aimed at enhancing patient safety and care coordination outcomes. Implementing frameworks like the Care Coordination and Transition Management Logic Model facilitates effective care coordination, emphasizing patient-centered approaches and interdisciplinary collaboration. Evidence-Based Practices for Successful Implementation of Patient Care Coordination Evidence-based strategies such as GENESIS and routine evaluation protocols offer effective means of managing elderly patients with infections like Mr. Decker. These approaches prioritize early detection and intervention, thereby mitigating adverse outcomes associated with complex medical conditions. Benefits of Multidisciplinary Approach to Patient Care Adopting a multidisciplinary approach enhances patient care by leveraging diverse expertise to address multifaceted health concerns comprehensively. This collaborative model optimizes treatment planning and reduces errors, ultimately improving patient outcomes and minimizing healthcare utilization. Conclusion In conclusion, comprehensive needs assessment, informed by evidence-based practices and interdisciplinary collaboration, is integral to enhancing patient care quality. Addressing societal, economic, and interdisciplinary factors affecting patient care outcomes requires concerted efforts guided by established professional standards. By embracing patient-centered approaches and leveraging multidisciplinary expertise, healthcare professionals can optimize care coordination and improve patient safety and well-being. References Artiga, S., Orgera, K., & Pham, O. (2020). Issue brief disparities in health and health care: Five key questions and answers. Deancare.com. https://deancare.com/getmedia/e00c9856-28d0-4c63-b2c0-9bf68cadcebb/Disparities-in-Health-and-Health-Care-Five-Key-Questions-and-Answers.pdf Bleakley, G., & Cole, M. (2020). Recognition and management of sepsis: The nurse’s role. British Journal of Nursing, 29(21), 1248–1251. https://doi.org/10.12968/bjon.2020.29.21.1248 Hofmann, F., & Erben, M. J. (2020). Organizational transition management of circular business model innovations. Business Strategy and the Environment, 29(6), 2770–2788. https://doi.org/10.1002/bse.2542 Ko, H., Park, Y.-H., Cho, B., Lim, K.-C., Chang, S. J., Yi, Y. M., Noh, E.-Y., & Ryu, S.-I. (2019). Gender differences in health status, quality of life, and community service needs of older adults living alone. Archives of Gerontology and Geriatrics, 83, 239–245. https://doi.org/10.1016/j.archger.2019.05.009 Kregel, H. R., Murphy, P. B., Attia, M., Meyer, D. E., Morris, R. S., Onyema, E. C., Adams, S. D., Wade, C. E., Harvin, J. A., Kao, L. S., & Puzio, T. J. (2022). The geriatric nutritional risk index as a predictor of complications in geriatric trauma patients. Journal of Trauma and Acute Care Surgery, 93(2), 195–199. https://doi.org/10.1097/TA.0000000000003588 LeRoith, D., Biessels, G. J., Braithwaite, S. S., Casanueva, F. F., Draznin, B., Halter, J. B., Hirsch, I. B., McDonnell, M. E., Molitch, M. E., Murad, M. H., & Sinclair, A. J. (2019). Treatment of diabetes in older adults: An endocrine society* clinical practice guideline. The Journal of Clinical Endocrinology & Metabolism, 104(5), 1520–1574. https://doi.org/10.1210/jc.2019-00198 NURS FPX 6610 Assessment 1 Comprehensive Needs Assessment Liu, X., Xu, Y., An, M., & Zeng, Q. (2019). The risk factors for diabetic peripheral neuropathy: A meta-analysis. Plos one, 14(2), 0212574. https://doi.org/10.1371/journal.pone.0212574 Mertens, F., Debrulle, Z., Lindskog, E., Deliens, L., Deveugele, M., & Pype, P. (2020). Healthcare professionals’ experiences of inter-professional collaboration during patient’s transfers between care settings in palliative care: A focus group study. Palliative Medicine, 35(2), 026921632096874. https://doi.org/10.1177/0269216320968741 Milgrom, J., Hirshler, Y., Reece, J., Holt, C., & Gemmill, A. W. (2019). Social support—A protective factor for depressed perinatal women? International Journal of Environmental Research and Public Health, 16(8). https://doi.org/10.3390/ijerph16081426 Namburi, N., & Lee, L. S. (2022). National quality forum.Europepmc.org https://europepmc.org/article/med/31751044 Ni, Y., Liu, S., Li, J., Dong, T., Tao, L., Yuan, L., & Yang, M. (2019). The effects of nurse-led multidisciplinary team management on glycosylated hemoglobin, quality of life, hospitalization, and help-seeking behavior of people with diabetes mellitus. Journal of Diabetes Research, 2019, 1–9. https://doi.org/10.1155/2019/9325146 Villanueva, L. M.P., Palafox, B., Amit, A. M. L., Pepito, V. C. F., Ab-Majid, F., Ariffin, F., Balabanova, D., Isa, M.-R., Mat-Nasir, N., My, M., Renedo, A., Seguin, M. L., Yusoff, K., Dans, A. L., & Mckee, M. (2022). Prevalence, determinants and outcomes of traditional, complementary and alternative medicine use for hypertension among low-income households in Malaysia and the Philippines. BMC Complementary Medicine and Therapies, 22(1). https://doi.org/10.1186/s12906-022-03730-x NURS FPX 6610 Assessment 1 Comprehensive Needs Assessment Perazzo, M. F., Serra-Negra, J. M., Firmino, R. T., Pordeus, I. A., Júnior, P. A.M., & Paiva, S.
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