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Ethical and Policy Factors in Care Coordination

Ethical and Policy Factors in Care Coordination

Hello, good morning. My name is _, and welcome to today’s presentation. Today’s focus is on homeless shelters and ethical and policy factors affecting these institutions’ healthcare coordination. The presentation explores policies and ethical factors that hinder or facilitate care access in these health facilities that nurses should consider as they prepare their care coordination plans.

These local, regional, and national policies aim to protect patients in healthcare and the flow of care activities. They dictate all activities, most of which have legal implications when not adequately followed. Knowledge of these policies and ethical care coordination factors is vital for all healthcare providers and facilities involved anywhere in the care continuum. Homeless shelters handle patients with various needs, including health, and handle patient data and are thus affected by the ethical and care coordination policies.

Policies affecting Care Coordination and Care Continuum

In care coordination, the Affordable Care Act (Obamacare) is at the frontline in ensuring every individual has access to affordable healthcare coverage. Kilbourne et al. (2018) show that the act lifted barriers to insurance access for vulnerable groups whose access to care was otherwise compromised. These groups include the working poor, children, immigrants, women, and individuals with chronic illnesses.

Most of these individuals are found in homeless shelters. Kilbourne et al. (2018) note that the act promotes care coordination and extends the care continuum by increasing access to insurance coverage plans (tax credits and fair pricing). It also promotes safe health information technology and supports health promotion over curative health services.

The HIPAA act, like the ACA, dramatically influences care coordination and the continuum of care. According to Qin (2019), HIPAA protects information flow by regulating which information should be secured, how it flows, who can access it, and for what reasons it can be used. Homeless shelters collect patient information, including their details, family and social history, and health history, which must be protected at all costs.

Qin (2019) also notes that HIPAA punishes offenders who breach the set protocols and share patient information without attention to safety details. HIPAA requirements vary and state to state depending on their supreme court rulings. HIPAA also protects vulnerable populations such as the LGBTQ community against discrimination.

The HIPAA has developed software whose use is specific to homeless shelters. Khurshid et al. (2020) note that homeless shelters’ HIPAA software, like electronic health records, keeps individuals’ information safe. HIPAA requires the transmission of information, especially health records, between homeless shelters and healthcare providers to be safe to maintain patients’ privacy and confidentiality. HIPAA applies fines to individuals and institutions that do not comply with its guidelines. Thus, Knowledge of and implementation of their requirements is thus vital.

Impact of Nurses Code of Ethics and Care Coordination and Care Continuum

Nurses’ conduct is governed by the nurses’ code of ethics, besides the local, state, and federal regulatory and policy requirements. Anders (2018) note that the code of ethics ensures that nurses maintain professional, quality, and ethical requirements as they perform their duties. The code of ethics shapes nurses’ actions in care coordination in the care continuum and dictates the roles nurses can and cannot play.

The code of ethics requires nurses to be patient advocates who provide care that ensures patient comfort and safety. It also requires nurses to consider the psychosocial, cognitive, and spiritual needs besides the physiological needs. Anders (2021) also notes that the code of ethics requires nurses to develop a conducive working environment and collaborate with other healthcare providers to provide quality and safe patient care. Thus, the nurses’ code of ethics greatly influences care coordination and the care continuum.

National, State, and Local Policies That Raise Ethical Questions For Care Coordination

Some policies have been cited for causing problems in ethical care coordination. These include the HIPAA, the US patient self-determination policy, and mandatory reporting. Policies and regulations help improve healthcare delivery, care coordination, quality assurance, and patient safety. Mason (2018) notes that homeless families have increased over time.

Homeless shelters, educators, care providers, and police officers are mandatory reports to child and social protective services. Mason (2018) notes that the dilemma strikes when homeless shelters have to decide between reporting these children in homeless families and maintaining family integrity which is integral to the child’s physical and psychosocial development. Valenzuela-Garcia et al. (2021) argue that children should be brought up in familiar environments, and family cohesiveness in these homeless shelters enhances the quality of life of the children and the parents.

Another policy raising ethical questions is the US patient self-determination act. Lindberg et al. (2019) note that the self-determination act allows the patient supremacy in healthcare decisions regarding their health. These include accepting or refusing care interventions. Lindberg et al. (2019) also note that healthcare decisions require Knowledge and skills. While the policy protects the interests of pains, it could potentially limit care coordination and the care continuum when the patient has limited Knowledge of their health condition.

Opioid treatment intervention policies vary by state and present various ethical issues in care coordination and the care continuum. Muller et al. (2021) note that restrictions in some states that individuals with previous opioid addiction should not receive opioid treatment exist. While the policy is reasonable due to the high possibility of addiction recurrence, severe pain, such as cancer pain, may not respond to interventions other than opioid interventions. These policies may limit care interventions, especially when they are most needed.

Factors That Contribute to Health, Health Disparities, and Access to Services

Factors affecting health, health disparities, and access to healthcare services are majorly population factors: social determinants of health. According to the Healthy People 2020 report, these factors include: “education level, income level, social support, availability of health services, socioeconomic conditions, culture, and job training” (Healthy People 2020.gov, n.d.).

These factors determine one’s ability to purchase insurance, get information on health insurance, and pay for hospital expenses. Other factors, such as culture, determine individuals’ health practices, such as diet, exercise, ad health-seeking behavior. Social determinants of health also affect an individual’s ability to pay for healthcare services and access quality information, basic needs, and health services.

Education and training determine the job one can work and subsequent income and quality of life. Employment status determines the income and psychological health of individuals. Palmer et al. (2019) note that individuals’ social determinants of health significantly affect the quality of life and are the basis for health disparities. All these factors thus affect health, health disparities, and access to healthcare services.

Key Policy and Ethical Issues Affecting Homeless Shelters

Homeless shelters’ ethical and policy issues majorly stem from the nature of their services and compliance with public health requirements. According to Moffa et al. (2019), problems in homeless shelters that could cause ethical and policy issues include funding, resource adequacy, capacity, gender issues, and individual holistic care. These ethical issues could lead to various legal issues and should be addressed promptly.

Lepore et al. (2019) note that regulatory agencies and the law, such as the shelter and housing standards, require homeless shelters to prepare emergency, security, and operational plans yearly to relevant authorities to prove their existential relevance. They are also due for inspections to ensure they meet the minimum regulatory standards (safety) to help meet holistic patient needs from workers to resources. Lepore et al. (2019) note that homeless shelters must comply with these requirements and ensure they meet the bare minimums before licensure, explaining the reasons for many unlicensed shelters

Ethical issues include funding for homeless shelters. Funding is the most significant ethical issue that could lead to legal and policy problems. Paat et al. (2021) note that patient data is needed to gather enough resources from the government or charities. Information sharing must meet HIPAA, IHI, and AHRQ requirements and should be de-identified. However, some donors require complete information, and with the current policies, the demand poses ethical, policy, and legal issues in the healthcare facility.

Conclusion

Care coordination spans all institutions, especially those interacting with the healthcare sector. Policies such as HIPAA and ACA significantly affect care access and coordination. They have strict requirements, and every nurse must know and follow them for effective care delivery. Nurses’ actions are also guided by the nurses’ code of ethics, which dictates their expected professional conduct and ethics adherence.

Factors affecting healthcare access are majorly social determinants of health, such as employment, education, training, and culture. Understanding them helps care providers serve populations adequately. Homeless shelters are some organizations facing many ethical, regulatory, and policy issues that affect the care continuum and care coordination. Care coordination in these facilities thus requires extensive Knowledge of the policies and ethical considerations surrounding them.

References

Anders, R. L. (2021, January). Engaging nurses in health policy in the era of COVID‐19. In Nursing Forum (Vol. 56, No. 1, pp. 89-94). https://doi.org/10.1111/nuf.12514

Healthy People 2020.gov (n.d.). Social Determinants of Health. Washington, DC: US Department of Health and Human Services, Office of Disease Prevention and Health Promotion. https://www.healthypeople.gov/node/3499/2020/topics-objectives/topic/social-determinants-health

Khurshid, A., Rajeswaren, V., & Andrews, S. (2020). Using blockchain technology to mitigate challenges in service access for the homeless and data exchange between providers: a qualitative study. Journal of Medical Internet Research, 22(6), e16887. https://doi.org/10.2196/16887

Lepore, M., Greene, A. M., Porter, K., Lux, L., Vreeland, E., & Hawes, C. (2019). Unlicensed care homes in the United States: A clandestine sector of long-term care. Journal of Aging & Social Policy, 31(1), 49-65. https://doi.org/10.1080/08959420.2018.1485397

Lindberg, J., Johansson, M., & Broström, L. (2019). Temporising and respect for patient self-determination. Journal of Medical Ethics, 45(3), 161-167. http://dx.doi.org/10.1136/medethics-2018-104851

Mason, M. (2018). Best Practices in Primary Care for Families Experiencing Homelessness. https://sophia.stkate.edu/internal_awards/235

Moffa, M., Cronk, R., Fejfar, D., Dancausse, S., Padilla, L. A., & Bartram, J. (2019). A systematic scoping review of environmental health conditions and hygiene behaviors in homeless shelters. International Journal of Hygiene and Environmental Health, 222(3), 335-346.https://doi.org/10.1016/j.ijheh.2018.12.004

Mueller, S. R., Glanz, J. M., Nguyen, A. P., Stowell, M., Koester, S., Rinehart, D. J., & Binswanger, I. A. (2021). Restrictive opioid prescribing policies and evolving risk environments: a qualitative study of the perspectives of patients who experienced an accidental opioid overdose. International Journal of Drug Policy, 92, 103077. https://doi.org/10.1016/j.drugpo.2020.103077

Paat, Y. F., Morales, J., Escajeda, A. I., & Tullius, R. (2021). Insights from the shelter: Homeless shelter workers’ perceptions of homelessness and working with the homeless. Journal of Progressive Human Services, 32(3), 263-283. https://doi.org/10.1080/10428232.2021.1969719

Palmer, R. C., Ismond, D., Rodriquez, E. J., & Kaufman, J. S. (2019). Social determinants of health: future directions for health disparities research. American Journal of Public Health, 109(S1), S70-S71. https://doi.org/10.2105/AJPH.2019.304964

Qin, F. (2019). The Debilitating Scope of Care Coordination Under HIPAA. NCL Rev., 98, 1395.

Valenzuela-Garcia, H., Molina, J. L., Lubbers, M. J., & Grau, J. (2021). The relational vulnerability of people experiencing multiple exclusion homelessness (MEH) in Spain. International Journal of Environmental Research and Public Health, 18(19), 10275. https://doi.org/10.3390/ijerph181910275

4050 Assessment 2: Ethical and Policy Factors in Care Coordination

Select a community organization or group that you feel would be interested in learning about ethical and policy issues that affect the coordination of care. Then, develop and record a 10-12-slide, 20-minute presentation, with audio, intended for that audience. Create a detailed narrative script or speakers notes for your presentation, 4-5 pages in length.

Introduction

As coordinators of care, nurses must be aware of the code of ethics for nurses and health policy issues that affect the coordination of care within the context of the community. To help patients navigate the continuum of care, nurses must be proficient at interpreting and applying the code of ethics for nurses and health policy, specifically, the Affordable Care Act (ACA). Being knowledgeable about ethical and policy issues helps ensure that care coordinators are upholding ethical standards and navigating policy issues that affect patient care.

This assessment provides an opportunity for you to develop a presentation for a local community organization of your choice, which provides an overview of ethical standards and relevant policy issues that affect the coordination of care. Completing this assessment will strengthen your understanding of ethical issues and policies related to the coordination and continuum of care, and will empower you to be a stronger advocate and nursing professional.

It would be an excellent choice to complete the Vila Health: Ethical Decision Making activity prior to developing the presentation. The activity provides a helpful update on the ethical principles that will help with success in this assessment.

Preparation

Your nurse manager at the community care center is well connected and frequently speaks to a variety of community organizations and groups. She has noticed the good work you are doing in your new care coordination role and respects your speaking and presentation skills. Consequently, she thought that an opportunity to speak publicly about contemporary issues in care coordination would be beneficial for your career and has suggested reaching out to a community organization or support group to gauge their interest in hearing from you, as a care center representative, on a topic of interest to both you and your prospective audience.

You have agreed that this is a good idea and have decided to research a community organization or support group that might be interested in learning about ethical and policy issues related to the coordination of care. Your manager has suggested the following community organizations and support groups, but acknowledges that the choice is yours.

  • Homeless shelters.
  • Local religious groups.
  • Nursing homes.
  • Local community organizations (Rotary Club or Kiwanis Club).

To prepare for this assessment, you may wish to:

  • Research your selected community organization or support group.
  • Review the Code of Ethics for Nurses With Interpretive Statements and associated health policy issues, specifically, the ACA.
  • Review the assessment instructions and scoring guide to ensure you understand the work you will be asked to complete.
  • Allocate sufficient time to rehearse your presentation before recording the final version for submission.
Recording Equipment Setup and Testing

Check that your audio speaker and PowerPoint software are working properly. You can record audio directly to your slides, using PowerPoint or other presentation software.

Note: Technical support about the use of PowerPoint, including voice recording and speaker notes, can be found on Campus’s Microsoft Office Software page.

  • If using Kaltura, refer to the Using Kaltura tutorial for directions on recording and uploading your presentation in the courseroom.

Note: If you require the use of assistive technology or alternative communication methods to participate in this activity, please contact DisabilityServices@capella.edu to request accommodations.

Instructions

For this assessment:

  • Choose the community organization or support group that you plan to address.
  • Develop a PowerPoint with typed speaker notes (the script for your voice recording) and audio voice-over recording, intended for that audience. Video is not required.

Note: PowerPoint has a feature to type the speaker notes directly into the presentation. You are encouraged to use that feature or you may choose to submit a separate document. See Microsoft Office Software for technical support about the use of PowerPoint, including voice recording and speaker notes.

For this assessment, develop your presentation slides and speaker notes, then record your presentation. You are not required to deliver your presentation to an actual audience.

Presentation Format and Length

You may use PowerPoint (recommended) or other suitable presentation software to create your slides and add your voice over. If you elect to use an application other than PowerPoint, check with your faculty to avoid potential file compatibility issues.

Be sure that your slide deck includes the following slides:

  • Title slide.
    • Presentation title.
    • Your name.
    • Date.
    • Course number and title.
  • References (at the end of your presentation).

Your slide deck should consist of 10–12 slides, not including a title and references slide with typed speaker notes and audio voice over. Your presentation should not exceed 20 minutes.

Create a detailed narrative script for your presentation, approximately 4–5 pages in length.

Supporting Evidence

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.

Grading Requirements

The requirements outlined below correspond to the grading criteria in the Ethical and Policy Factors in Care Coordination Scoring Guide, so be sure to address each point. Read the performance-level descriptions for each criterion to see how your work will be assessed.

  • Explain how governmental policies related to the health and/or safety of the community affect the coordination of care.
    • Provide examples of a specific policy affecting the organization or group.
    • Refer to the assessment resources for help in locating relevant policies.
    • Be sure influential policies include the Health Insurance Portability and Accountability Act (HIPPA).
  • Identify national, state, and local policy provisions that raise ethical questions or dilemmas for care coordination.
    • What are the implications and consequences of specific policy provisions?
    • What evidence do you have to support your conclusions?
  • Assess the impact of the code of ethics for nurses on the coordination and continuum of care.
    • Consider the factors that contribute to health, health disparities, and access to services.
    • Consider the social determinants of health identified in Healthy People 2020 as a framework for your assessment.
    • Provide evidence to support your conclusions.
  • Communicate key ethical and policy issues in a presentation affecting the coordination and continuum of care for a selected community organization or support group. Either speaker notes or audio voice-over are included for a proficient score; both speaker notes and the audio voice over are included for a distinguished score.
    • Present a concise overview.
    • Support your main points and conclusions with relevant and credible evidence.
Additional Requirements

Before submitting your assessment, proofread your presentation slides and speaker notes to minimize errors that could distract readers and make it more difficult for them to focus on the substance of your presentation.

Portfolio Prompt: Save your presentation to your ePortfolio. Submissions to the ePortfolio will be part of your final Capstone course.

Competencies Measured

By successfully completing this assessment, you will demonstrate your proficiency in the course competencies through the following assessment scoring guide criteria:

  • Competency 4: Defend decisions based on the code of ethics for nursing.
    • Assess the impact of the code of ethics for nurses on the coordination and continuum of care.
  • Competency 5: Explain how health care policies affect patient-centered care.
    • Explain how governmental policies related to the health and/or safety of a community affect the coordination of care.
    • Identify national, state, and local policy provisions that raise ethical questions or dilemmas for care coordination.
  • Competency 6: Apply professional, scholarly communication strategies to lead patient-centered care.
    • Communicate key ethical and policy issues in a presentation affecting the coordination and continuum of care for a selected community organization or support group. Either speaker notes or audio voice-over are included.