SCENARIO: Imagine that you are a staff nurse in a community care center. Your facility has always had a dedicated case management staff that coordinated the patient plan of care, but recently, there were budget cuts and the case management staff has been relocated to the inpatient setting. Care coordination is essential to the success of effectively managing patients in the community setting, so you have been asked by your nurse manager to take on the role of care coordination. You are a bit unsure of the process, but you know you will do a good job because, as a nurse, you are familiar with difficult tasks. As you take on this expanded role, you will need to plan effectively in addressing the specific health concerns of community residents.
A) Identify a health concern as the focus of your care coordination plan. In your plan, please include physical, psychosocial, and cultural needs.
*****Chosen health concern is heart disease (specifically, hypertension and Stroke)****
Analyze a health concern and the associated best practices for health improvement.
Provide a perceptive analysis of a health concern and the associated best practices for health improvement. Provide credible evidence for best practices and articulate underlying assumptions and points of uncertainty in the analysis.
B) Describe specific goals that should be established to address a selected health care problem.
Ensures that the goals are realistic, measurable, and attainable.
C)Identify and list available community resources for a safe and effective continuum of care.
Identify significant and available community resources for a safe and effective continuum of care.
Provide a comprehensive list of resources, with credible evidence of their contribution toward improving community health.
Please use 3 credible sources from peer-reviewed journals or professional industry publications that are within 5 years old
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