This report is an investigation of the effectiveness of coordinating integrated healthcare.” You are required to select a patient with a chronic / long term condition and explore the nurses role in coordinating integrated healthcare.
This will be completed by focussing on addressing LO1 – L04.
Remember that your work will need to be supported with references (Harvard style) and follow the presentation guidelines outlined within your module handbook.
Your report should look polished and professional.
Make sure your report is well presented, with correct information on the title page, numbered pages, and clearly labelled including numbered sections.
Make sure you have followed the structure and style specified in your assignment brief.
Use a formal academic language and be as brief and concise as possible, using supporting evidence.
You must follow the outline within your “Guidance on report writing.” For example:
Title page
Contents page
Abstract /Summary
Introduction
Main text
Conclusion
Recommendations
Reference list
Appendices – including care pathway (flow chart)
Specifically, your report should include a patients journey of care in relation to a focus on the learning outcomes. Refrain from adding any headings apart from the heading outlined above.
A long-term illness -: stroke with deteriorating mental health illness
Learning Outcome Part 1
You are required to complete a report with a content of 3000 words which will contribute to 80% of your module marks.
LO1
Analyse the role of the nurse, other professions, and agencies in integrated health care delivery.
(450 words approximately).
Guidance for LO1 Content
• Define coordinated integrated care delivery, detail the importance, and look at potential obstacles.
• What is the nurses’ role in coordinating integrated care.
• Look at the importance of the role of the nurse in relation to the NMC standards.
• In relation to your chosen topic, look at the role of the other professions who are involved and are integral in the patient’s journey.
• Consider what agencies are involved or could be involved in providing support to the patient and their family. How do these influence and contribute to care delivery?
• What is the role of the nurse in relation to facilitating the transitional care of a patient.
(Things might help, think about a patient you have nursed with a long term condition and with your patient as your focus, discuss the following question which will assist you in building the content for your report
Look at the Five Year Forward View and the influence this has on integrated care delivery? What does this document discuss in relation to integrating care? How is the nurse’s role influenced by this? What is the nurse role in relation to coordinating integrated care? What is the nurse’s role in relation to communication, why is this important in influencing the delivery of care? What is the nurse’s role in relation to the Nursing and Midwifery Council?
What is the nurse’s role in the transitional process and supporting the patient and their family? Considering your patient and their long-term condition, think about those professions that would be integral in the care journey of the patient? Considering your patient and their long term condition, what agencies could support your patient further?)
LO2
Evaluate the physical. psychological and social aspects of care provision including self – care management for people, carers and families. (450 words approximately).
Guidance for LO2 Content
• Look at what self – care is and the importance of this for the patient, the impact on their carers and their family in the prevention of re hospital admission and in providing and promoting quality coordinated integrated care delivery.
• Review the complexities of managing the provision of psychological, cognitive, behavioural, social and physical care needs across a wide range of care settings.
• Consider the agencies that might support the provision of self -care.
• What structured educational programmes are available in supporting the patient and their family and or carers.
• Look at the pillars of self -care / house of care model in relation to self – care, how do these models influence self -care of the patient.
(This might help, Think about your chosen patient and their long term condition now discuss the following:-
PHYSICAL aspects of care provision. Consider how this long term condition affects the person physically? What are the physical constraints? Does this physical limitation bear any consequences on the social circumstances of your patient?
PSYCHOLOGICAL aspects of care provision. Has your patient any known / diagnosed mental health conditions? How are they coping with this long term condition?
SOCIAL aspects of care provision. Is your patient able to work? Is your patient retired? Who do they live with? What activities are they involved in?
What is self – care management?, 3. Why is self – care management important to the patient and their family / carers? 4. What is the nurses role in relation to supporting the patient / family / carers in self – care management? 5. Discuss the 7 pillars of self – care in relation to your patient and their chosen condition).
. LO3
Appraise models of care delivery when supporting a patient requiring an interagency approach to care provision. (450 words approximately).
Guidance for LO3 Content
• In relation to your chosen topic, review and discuss a model of care delivery in the coordination of integrated care.
• Consider how this model fits in with the delivery of coordinated integrated care.
• Look at the impact of existing health policies for the nursing and social care professions, detailing the influences on organisation and in the delivery of care.
Appraise models of care delivery when supporting an individual and their family/carers requiring an interagency approach to care provision.
(This might help-: Think about the patient and Looking at the Five Year View and the influence this has had on the new care models. Why have these new care models been developed? In relation to the new models of care, analyse the following models of care and explain how these model influence the care provided to your patient and their family in relation to their long term condition? Acute Care Collaboration, Urgent and emergency care, Multispeciality community provider, Integrated primary and acute care systems, Enhanced health in care homes, Specialised care, detail what vanguards are and how these can influence care delivery? What is telehealth technology, and how could this be utilised to support your patient and their long term condition? )
. LO4
Analyse the importance of interdisciplinary, interprofessional and interagency communication and working amongst care providers. (450 words approximately).
Guidance for LO4 Content
• Define what interdisciplinary, interprofessional and interagency working is in relation to coordinating integrating care.
• Analyse and discuss the importance of effective communication amongst healthcare providers.
• Look at the 6c and the NMC standards in relation to this.
• Discuss the importance of communication, team working in the success of integrated working.
• Consider the benefits and complexities of communication within a collaborative forum.
• Consider a communication tool such as SBAR, which will assist in the communication process within teams.
(This might help-: Why is integrated working important in the treatment of this patient? What are the barriers to teamwork, and how could you overcome them in your setting? How does poor teamwork affect healthcare settings? Why is communication important in teamwork, and what are the potential consequences if it goes wrong? As a nurse, you are tasked with being a leader and also being part of a team. What skills do you require to do this and how could you ensure your team is working efficiently?In relation to the NMC standards, can you explain what is expected in relation to teamwork?)
( The outcome must meet the following GAME Attributes: Self-awareness, Resilience, Problem-solving, Effective Communication, Collaboration, Confidence, Life-long learning, Adaptable Also includes elements of Care, Compassion, Communication, Competence, Commitment, Courage which is part of the 6 Cs).
Part 2
Producing a care pathway (flow chart) – Part of Assessment 1
You are required to design a care pathway (flow chart) that will contribute to your module marks.
From your chosen topic, you are required to develop a care pathway (flow chart),
outlining the roles and responsibilities of each discipline involved to support the delivery of care to people, their families and carers requiring a multidisciplinary approach.
This will need to be completed on A4 and attached as an appendix to your report.
1) Remember to frame your work with a title.
2) Follow the guidelines for the presentation of written assessments, be consistent with the display of data.
3) Remember to include a MINIMUM of 2 references within your care pathway.
(On the page draft of the care pathway (flow chart) representing the care journey of your patient in support of their long term condition. Remember to include a title to frame your work, include the patient and the family in the delivery of this.
Care Pathway (Flow chart) representing the care journey of a patient with. Long term condition.)
Indicative Reading
https://www.bolton.ac.uk/library/Study-Skills/Referencing/Home.aspx
SubjectHelp@Bolton.ac.uk
Baillie L (2014) Developing Practical Skills. London. CRC Press.
Crinson I (2009) Health Policy: A Critical Perspective. London. Sage.
Delves-Yates C (2015) Essentials of Nursing Practice. London. Sage.
Ecert R, West, M, Altman D, Steward K and Pasmore B (2014) Developing a Collective Leadership Strategy for Healthcare. London. The Kings Fund.
Glasby J and Dickinson H (2014) Partnership Working in Health and Social Care: What is Integrated Care and how can we deliver it? 2nd ed. Bristol. Policy Press.
Goodman B and Clemow R (2010) Nursing and Collaborative Practice: A Guide to Inter Professional Working. London. Sage.
Grant P and Chika-Ezerloha I (2014) Developing Diabetes Integrated Care Pathways. Practical Diabetes 31(8), pp 319-322.
Holland K, Jenkins J, Soloman J and Whittam S (2008) Applying the Roper Logan, Tierney Model in Practice. London. Churchill Livingstone.
Kritika S and Manthorpe J (2014) Care Pathways for Dementia: Current Perspectives. Dove Medical Press 9, pp 2055-2063.
MacArthur J (2016) Review: Developing the Delirium Care Pathway. Journal of Research Nursing, 21(6).
Moulin M (2002) Delivering Excellence in Health and Social Care. Buckingham. Open University Press.
National Audit Office (2017) Health and Social Integration. London. National Audit Office.
National Institute for Health and Clinical Excellence (2019). Nice Pathways {Online} Available from
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Praetorius T (2016) Improving Care Coordination Using Organisational Routines, Care Pathways as a Coordination Mechanism, Journal of Health Organisation and Management, 30 (1), pp 85-108.
Shaw S, Rosen R and Rumbold B (2011) What is Integrated Healthcare? An Overview of Integrated Care in the NHS. London. Nuffield Trust.
Social Care Institute for Excellence (2018) Integrated Care, Measuring Processes. {Online}. Available from https://www.scie.org.uk/integrated-health-social-care/measuring- Progress/ Role- Multidisciplinary Team {Accessed 12 July 2019}.
Stanhope V, Ashenburg S and Schlamith L (2017). Social Work and Integrated Healthcare: from Policy to Practice and Back. Oxford. Oxford University Press.
The Kings Fund. (2019) Our work on joined-up health and care services. [Online]. Available from https://www.kingsfund.org.uk/topics/integrated-care. [Accessed 12 July 2019].