Introduction
Professional Context
Nurses have a powerful role in the coordination and continuum of care. All nurses must be cognizant of the care coordination process and how safety, ethics, policy, physiological, and cultural needs affect care and patient outcomes. As a nurse, care coordination is something that should always be considered. Nurses must be aware of factors that impact care coordination and of a continuum of care that utilizes community resources effectively and is part of an ethical framework that represents the professionalism of nurses. Understanding policy elements helps nurses coordinate care effectively. This assessment provides an opportunity for you to educate your peers on the care coordination process.
Please watch the following brief video message for an overview of what to keep in mind as you complete your Care Coordination Presentation.
Scenario
Preparation
Check that your recording equipment and software are working properly and that you know how to record and upload your presentation. You may use Kaltura (recommended) or similar software for your audio recording. A reference page is required. However, no PowerPoint presentation is required for this assessment.
- If using Kaltura, refer to the Using Kaltura Campus resources for directions on recording and uploading your video in the courseroom.
Note: If you require the use of assistive technology or alternative communication methods to participate in this activity, please contact DisabilityServices@
Instructions
Create a presentation focusing on the fundamental principles of care coordination. The intended audience is nursing colleagues at your practicum site (though you do not actually need to present to them if you choose not to). In your presentation, include:
- A narrative script.
- A video of you presenting the script.
Your presentation should include the following:
- Effective strategies for collaborating with patients and families: Outline strategies for collaborating with patients and their families to achieve desired health outcomes.
- Consider drug-specific educational interventions and cultural competence strategies.
- Provide evidence to support the selected strategies. This could include research studies, best practices, or relevant literature.
- Aspects of change management and patient experience: Explain how aspects of change management directly impact elements of the patient experience.
- Explain how these aspects contribute to high-quality, patient-centered care.
- Consider factors such as communication, transitions of care, and patient engagement.
- Rationale for coordinated care plans: Explain the rationale behind coordinated care plans.
- Base your explanation on ethical decision making.
- Discuss the reasonable implications and consequences of an ethical approach to care.
- Consider any underlying assumptions that may influence decision making.
- Impact of healthcare policy provisions: Explain how specific healthcare policy provisions may impact outcomes and patient experiences.
- Discuss the logical implications and consequences of these provisions.
- Provide evidence to support your conclusions. This could include policy documents, research, or case studies.
- Nurse’s role in coordination and continuum of care: Raise awareness of the nurse’s vital role in care coordination and the continuum of care.
- Highlight how nurses contribute to high-quality, patient-centered care.
- Fine-tune your presentation to suit your audience (practicum colleagues).
- Stay focused on key issues related to resources, ethics, and policy in care provision.
- APA formatting and references.
- Cite 3–5 credible sources from peer-reviewed journals or professional industry publications to support your presentation.
- Include your source citations on a references page appended to your narrative script.
Presentation Format and Length
- Narrative script: Write and submit a detailed narrative script in APA formatting for your video presentation, 3–5 pages in length. Include a properly formatted APA reference list at the end of the script. This script will be submitted to Turnitin.
- Video presentation: The video-based presentation of you presenting your script (as if you were presenting to an audience) should be no more than 10 minutes in length. You can record your presentation using Kaltura (recommended) or similar software.
- You are not required to deliver the presentation live to an actual audience, but you may choose to do so.
- No PowerPoint presentation required: You do not need to create a separate PowerPoint presentation for this assessment.
- Remember to organize your content logically, engage your audience, and provide valuable insights into care coordination principles.
- Support your points with evidence from scholarly sources. Properly cite these sources using APA formatting.
Good luck with your video presentation!
Practicum Hours submission
- Use Capella Academic Portal to submit your practicum hours.
- You must complete another 10 practicum hours, for a total of 30 hours, approved by your preceptor. Submit practicum hour documentation to Capella Academic Portal.
- Failure to complete the required practicum hours will result in a non-performance for this assessment.
Please review the BSN Practicum Campus page for more information and instructions on how to log your hours.
Nursing Reflection Journal: Four Spheres of Care
Reflective Journaling
Reflective journaling serves as a powerful tool for self-reflection during your academic journey. Reflective journaling enables you to assess your performance and to develop the regular practice of self-reflection. During your practicum, you’ll complete four reflective journal entries, each aligned with one of the four spheres of care.
For your first entry, you can choose any of the four spheres, but you will need to complete all four by the end of the course. Remember that you’ll need to submit your completed nursing reflection as part of the final assessment for the course.
Instructions
Complete your first entry in 100–400 words in the Nursing Reflection Journal: Four Spheres of Care activity. You do not need to include scholarly resources or a reference list. Your reflections should be your own original thoughts. Please do not include patient or clinic identifying information.
As you complete your practicum hours (total of 40 hours required), it is good practice to complete a reflection journal entry every 10 hours. Take a moment to review the four spheres of care and the assigned readings for each assessment. This can help you focus your practicum time on specifics of learning and experiencing the courseroom content.
AACN Definition of the Four Spheres of Care
Wellness and disease prevention: This sphere emphasizes health promotion, as well as the treatment of minor uncomplicated diseases or injuries for those not experiencing chronic illness or life-limiting conditions. Prenatal care, screenings, immunizations, and health promotion are some examples of care in this sphere (AACN, 2021). Nursing knowledge and competency in disease prevention and addressing social determinants of health are vital to promoting wellness across populations.
Chronic disease management: This sphere encompasses caring for those with one or more chronic diseases and preventing adverse outcomes associated with them. Specialized nursing care is often needed for this population due to the complex needs, along with integrated interprofessional team-based care. Four in 10 Americans have two or more chronic diseases, and those diagnosed with multiple comorbidities are projected to increase.
Regenerative and restorative care: This sphere includes critical and trauma care, complex acute care, acute exacerbations of chronic disease, and care of unstable patients who are typically in acute care hospital settings (AACN, 2021). This sphere includes the acute management of illness, such as a stroke or mental health crisis, and progression through the rehabilitative phase. Nursing skills and management of these populations are resource-intensive and specialized.
Hospice and palliative care: The final sphere relates to competencies surrounding palliative care in advanced illness and hospice care at the end of life. All registered nurses provide generalist palliative care in compassionate and patient-centered care while managing pain and other symptoms associated with advanced, progressive illness. The End-of-Life Nursing Education Consortium has mapped its Competencies and Recommendations for Educating Nursing Students competencies to the new AACN Essentials to assist educators in this endeavor.
Reflection Questions
By the end of your practicum, make sure that you have answered each of these questions.
- Wellness and disease prevention: Reflect on the health promotion disease prevention interventions you witnessed in your practicum site, as it relates to the social determinants of health most prevalent in your community. What did you see? What does this time mean to you as a professional nurse in your role?
- Chronic disease management: Reflect on the integration of interprofessional team-based care as it relates to chronic disease management in your practicum site. What did you see? What does this time mean to you as a professional nurse in your role?
- Regenerative and restorative care: Reflect on the acute management of illnesses such as stroke, mental illness, and falls in your practicum site. What did you see? What does this time mean to you as a professional nurse in your role?
- Hospice and palliative care: Reflect on end-of-life nursing and advanced illness and hospice care in your practicum site. What did you see? What does this time mean to you as a professional nurse in your role?
Reference
American Association of Colleges of Nursing. (2021). The essentials: Core competencies for professional nursing education. https://www.
Competencies Measured
By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and scoring guide criteria:
- Competency 1: Create a patient centered strategy to achieve desired health outcomes.
- Outline effective strategies for collaborating with patients and their families to achieve desired health outcomes.
- Explain how aspects of change management directly affect elements of the patient experience essential to the provision of high-quality, patient-centered care.
- Competency 2: Apply the code of ethics for nursing to care coordination decisions.
- Explain the rationale for coordinated care plans based on ethical decision making.
- Competency 3: Explain how health care policies affect the coordination of patient centered care.
- Explain the potential impact of specific health care policy provisions on outcomes and patient experiences. Provides evidence to support conclusions.
- Competency 5: Apply professional, scholarly communication strategies to lead patient-centered care.
- Raise awareness of the nurse’s vital role in the coordination and continuum of care in a video-recorded presentation.
- Complete another 10 practicum hours, for a total of 30 practicum hours, approved by your preceptor. Submit practicum hour documentation to Capella Academic Portal.








