FPX-NURS 4050: Coordinating Patient-Centered Care
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The role of care coordination is crucial in managing patients within the community setting, especially in light of the recent budget cuts and relocation of the case management staff to the inpatient setting. As a staff nurse taking on this expanded role, it is essential to plan effectively to address the specific health concerns of community residents. One such health concern is cognitive impairment, particularly Alzheimer’s disease (AD), which is a progressive neurodegenerative disorder that affects cognitive functions, memory, and behavior. Capella 4050 Assessment 1. This assessment will analyze Alzheimer’s disease, identify best practices for health improvement, establish specific SMART goals to address the problem, and explore significant community resources for a safe and effective continuum of care while considering the physical, psychosocial, and cultural needs of the affected population.
Alzheimer’s disease (AD) is a prevalent health concern worldwide, affecting more than 50 million people globally. As a progressive neurodegenerative disorder, AD significantly impacts cognitive functions, memory, behavior, and the ability to perform daily activities. The burden of AD extends to patients, families, caregivers, and communities, resulting in substantial social, emotional, and economic challenges (Meyers et al., 2022). The best practices for health improvement in Alzheimer’s disease encompass three main areas of consideration: physical, psychosocial, and cultural.
Patients with AD often experience physical difficulties, including mobility impairments, balance issues, and reduced motor skills. Effective management of these physical challenges involves providing individualized care plans that address specific needs, such as physical therapy, occupational therapy, and fall prevention strategies (de Oliveira Silva et al., 2019). Evidence from clinical trials and systematic reviews supports the use of tailored exercise programs to improve physical function and reduce the risk of falls in patients with AD (Mok et al., 2020).
AD patients and their caregivers are at risk of experiencing various psychosocial issues, such as social isolation, caregiver burden, depression, and anxiety. Best practices for addressing these concerns include providing psychosocial support, counseling, and interventions tailored to the individual’s needs (Meyers et al., 2022). A meta-analysis demonstrated the effectiveness of non-pharmacological interventions, such as cognitive stimulation, reminiscence therapy, and psychoeducation, in improving the psychosocial well-being of patients with AD (Cammisuli et al., 2022). Furthermore, engaging patients in social activities and providing support groups for caregivers can help alleviate stress and promote overall well-being (Skov et al., 2021).
Cultural factors play a significant role in the understanding and management of AD. It is essential to consider patients’ cultural backgrounds and beliefs when planning care and support services. Best practices for culturally sensitive care include incorporating cultural competence training for healthcare professionals, providing educational materials in multiple languages, and engaging with community-based organizations to facilitate culturally relevant support (Babulal et al., 2019). A study highlighted the positive impact of culturally tailored interventions on caregiver outcomes, including decreased depression and burden (Mok et al., 2020).
Despite the evidence supporting these best practices, there are still underlying assumptions and points of uncertainty in the analysis. These include the limited understanding of the underlying causes and mechanisms of AD, the lack of curative treatments, and the variability in the effectiveness of interventions depending on individual and cultural factors (Cammisuli et al., 2022).
In addressing Alzheimer’s disease in the community setting, the following SMART (Specific, Measurable, Achievable, Relevant, and Time-bound) goals are proposed:
Ensuring that individuals at risk of developing Alzheimer’s disease receive timely interventions and support requires improving early detection and diagnosis rates. A SMART goal for this objective is to implement routi
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