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Assessment #3: Assessing the Problem: Technology, Care Coordination, and Community

Assessment #3: Assessing the Problem: Technology, Care Coordination, and Community

determine how health care technology, coordination of care, and community resources can be applied 

in a written assessment, determine how health care technology, coordination of care, and community resources can be applied to address the patient in the attached assessment.

Reflect on state board nursing practice standards and/or organization or governmental policies associated with health technology, care coordination, and community resources.

Scoring Rubric Requirement: Conducts an astute analysis of state board nursing practice standards and/or organizational or governmental policies associated with health technology, care coordination, and community resources. Clearly articulates the implications for ethical professional practice of applying standards and/or policy guidance or legislative requirements to the problem.

determine how health care technology, coordination of care, and community resources can be applied 

Assessment #3: Assessing the Problem: Technology, Care Coordination, and Community Resources Considerations

PART 1: Application of Health Care Technology, Coordination of Care, and Community Resources

            I have had two more hours with the patient for the practicum experience. These two hours focused on planning the patient’s care for the long term. In this process, healthcare technology, coordination of care, and community resources emerged as important to the patient’s care quality and safety.

Health Care Technology

            The technology was a key aspect of the patient’s care. This patient is receiving home-based care for Alzheimer’s disease, diabetes, and hypertension. Although the care plan involves having home-based care professionals, it is crucial to collaborate with other professionals responsible for the patient’s mental and physical health issues. Technology was an essential aspect of enabling efficient collaboration. In particular, this patient’s care involves the application of Telehealth applications to ensure collaboration between the patient, her family, and her providers. Telehealth refers to the distribution of healthcare services through communication technologies (Alexander, Powell, & Deroche, 2020). This technology allows patients to receive care in different locations from their providers. In this case, the patient is receiving care from her home while her providers are at the hospital, where she receives her primary healthcare. Telehealth technology improves patient care quality because it ensures that patients can reach their provider from whichever location they are and at any time. This technology plays a crucial role in ensuring the patient in the practicum meeting has access to high-quality professional assistance at any time.

Coordination of Care

            Technology also played a key role in the coordination of care. Coordination of care refers to the deliberate organization of patient care activities between several participants to facilitate efficiency and effectiveness in the care delivery process (Droz, Senn, & Cohidon, 2019). For the patient in this practicum experience, coordination of care is between the home health nurse, her physicians, and her family. Each of these parties plays a vital role in ensuring the efficient provision of services that enhance her wellbeing. One of the strategies that have been used to ensure better coordination of care is effective communication. Each of the patient’s care participants is involved in consistent communication of the patient’s condition and her care needs. This communication helps each of the parties understand the role they will play in their care. For instance, her physicians will be available for check-ups and prescriptions when needed. The home health nurse will provide her with her daily care needs, and the family members will provide her with social and emotional support in the care process. This kind of coordination improves the quality of the patient’s care outcomes.

Community Resources

            Several community resources have been explored to help this client as she manages her physical and mental health issues. One of the resources that have been considered is support groups for Alzheimer’s disease. There exist many support groups for Alzheimer’s disease that offer people suffering from this disorder and other dementias support. These groups are excellent sources of practical advice that help patients with Alzheimer’s to cope better with their condition (Scharett et al., 2017). They get to understand the disorder from the experiences of people who have had it. This community resource can be beneficial for the client as it will help her adjust better to the recent changes made in her care.

PART 2: Report on Experiences

            For the second 2 hours of my practicum, I met with the same patient as the previous session. The patient is J.S., is a 68-year-old woman with Alzheimer’s disease. She also has a history of diabetes and hypertension. She lives with her daughter, but the rest of her children are married and living with their families. Due to her physical and mental health needs, this patient needs home-based nursing care.

In this session, I learned the important components that go into planning home-based care. Technology emerged to be an important aspect of patient care when offered remotely. It is through technology that the patient remains connected to her providers while at home. Telehealth applications were suggested as essential ways of keeping the patient connected to her primary care providers. These technologies help keep her family involved in her care despite them not being in the same house as she.

            Evidence played an essential role in this care planning process. I researched data on home healthcare for patients with Alzheimer’s. Evidence shows that consistently having a caregiver for patients with this disorder is important as they are exposed to many safety issues. Römhild et al. (2018), in an article for the Journal of Health and Quality of Life Outcomes, wrote that home-based care helps to improve the quality of life of people who have Alzheimer’s disease. Based on this evidence, I concluded that get a caregiver for the client is the best course of action.

However, developing a good quality home care plan equipped with the right technologies and the right professionals coordinating their care is relatively expensive. In this experience, I had to pay attention to the possible effects of costs on the patient. We reviewed the costs that it would take to integrate official telehealth technologies in this care. This seemed to be a tremendous burden on the patient and her family. Therefore, a decision was made to use the day-to-day telecommunication tools such as calls, text messaging, and social media messaging to coordinate the patient’s care.

Exploring the impact of this care on the patient’s safety and the experience was key to this care plan. We had to integrate strategies of care that enhance the patient’s safety and maximizes positive outcomes. Therefore, we had to explore data from past studies to inform the decisions that are made on this patient’s care. There was a plan to let the patient’s family care for her. Still, a study by Yıldızhan et al. (2019) showed that non-professional caregivers who are tasked with taking care of people with Alzheimer’s often experience burnout. It was likely that this family would experience the burnout and jeopardize the safety of the patient. Thus, the plan of the patient’s care involved the hiring of a professional caregiver.

The care plan also considered the issue of change. Based on experiences, patients may have a hard time transitioning in their care. When there are significant changes in a patient’s care processes, they can experience difficulty adjusting to the changes. Therefore, planning for change is important when creating new components in a patient’s care plan. In this case, the plan is to transition the patient slowly into the new care plan. She will be introduced to the caregiver and assisted in getting comfortable before the actual care process begins.

In conclusion, working with this patient has been interesting so far. The process has been easy because the patient’s family has been very active in this process. No experience has been surprising so far. It has been great to work with a patient who is willing to participate in the care process. Additionally, it has been great working with an active family that is willing to offer their patient some support.


Alexander, G. L., Powell, K. R., & Deroche, C. B. (2020). An evaluation of telehealth expansion in US nursing homes. Journal of the American Medical Informatics Association.

Droz, M., Senn, N., & Cohidon, C. (2019). Communication, continuity, and coordination of care are the most important patients’ values for family medicine in a fee-for-services health system. BMC family practice20(1), 19.

Römhild, J., Fleischer, S., Meyer, G., Stephan, A., Zwakhalen, S., Leino-Kilpi, H., … & RightTimePlaceCare Consortium. (, 2018). Inter-rater agreement of the Quality of Life-Alzheimer’s Disease (QoL-AD) self-rating and proxy rating scale: secondary analysis of RightTimePlaceCare data. Health and quality of life outcomes16(1), 131.

Scharett, E., Madathil, K. C., Lopes, S., Rogers, H., Agnisarman, S., Narasimha, S., … & Dye, C. (2017). An investigation of the information sought by caregivers of Alzheimer’s patients on online peer support groups. Cyberpsychology, behavior, and social networking20(10), 640-657.

Yıldızhan, E., Ören, N., Erdoğan, A., & Bal, F. (2019). The Burden of Care and burnout in individuals caring for patients with Alzheimer’s disease. Community mental health journal55(2), 304-310.



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