Ethical and Policy Factors in Care Coordination
School of Nursing and Health Sciences, Capella University
NURS-FPX4050 Coordinating Patient-Centered Care
April 20, 2022
Ethical and Policy Factors in Care Coordination
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A variety of issues relating to medical law and ethics have had a significant impact on care coordination. As an example, ethics and legal problems in the healthcare industry have had a significant impact on the nursing home industry. Still, it has been essential to comprehend how to raise awareness of crucial ethical and policy issues among the general population. Nurse practitioners have an ethical responsibility to their patients and to the continuum of care as a whole. It is probable that the breadth of care coordination in an interprofessional medical environment is facilitated by electronic health records (EHRs). Coordination of care may be difficult due to the fact that many hospitalizations require the cooperation of numerous departments, insurance providers, and outpatient visits. Improved patient satisfaction with treatment, reduced readmission rates, and shorter hospital stays are all intended outcomes of integrated care.
Ethical and Policy factors in Care Coordination
Care coordination has been profoundly influenced by a number of medical law and ethics concerns. The nursing home business, for instance, has been profoundly affected by ethical and regulatory concerns in the healthcare sector. However, learning how to inform the public about significant policy and ethical issues has been crucial. For the benefit of their patients and the progression of care throughout the continuum, nurse practitioners must adhere to the code of ethics. Care coordination in a multidisciplinary healthcare environment can merely include giving patients access to their electronic health records (EHRs). However, since many illnesses need the involvement of several departments, insurance providers, and outpatient visits, coordinating treatment may be challenging. The goals of integrated care are to increase patient satisfaction with treatment, decrease the likelihood of readmission, and decrease the length of stay.
Health Policy Issues that Influence the Coordination of Care
Care coordination issues have been connected to electronic health record (EHR) systems. The major problems stem from insufficient communication, which has led to an increase in clinical errors. Unfortunately, it is common for healthcare workers to have poor communication skills when it comes to managing patients’ medical records. Negative outcomes, such as medical mistakes, may emerge from a failure to communicate amongst healthcare providers, which may have a major impact on the coordination of care for the patient.
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Ethical standards, regulatory processes, and a code of ethics are relied on by nurses to provide the greatest quality of treatment. The goal is to ensure that those who work in healthcare facilities, such nursing homes, do so in a way that keeps them safe and productive on the job. Ethical principles center on the welfare of the patient and selflessness. Nurses are essential to the provision of care, the prevention of illness, and the restoration of health for those residing in nursing homes.
Care coordination is also negatively impacted by certain provisions of existing health insurance policies. Low-cost health coverage options are few in the United States. Therefore, certain groups, such as minorities and the poor, may go without health coverage. Those who lack health insurance are likely to struggle far more than those who have it. Uninsured people may be unable to get the medical attention they need due to the exorbitant expense of doing so. It has an immediate effect on how well patients’ treatment is coordinated.
Four principles underpin the ethics of care: beneficence, nonmaleficence, autonomy, and justice. These concepts provide nurse practitioners with a foundation upon which to base their decision-making in times of clinical stress. Care coordination and health insurance are inextricably intertwined. Patients, especially foreign nationals, who are not protected by the statute may find it hard to get health insurance in the United States. Immigrants without health insurance face financial hardships while seeking medical care. The effect on the management of patient care is substantial.
Government Policies associated to Safety or Health influencing Coordination of Care
The United States government has the primary duty to protect patients’ well-being. Because they drastically shift the therapy continuum, the approved policies are critical to achieving this purpose. Protecting patients’ confidentiality is one of Health and Human Services (HHS) primary missions. Medical records may be shared between medical professionals and community groups according to HIPAA (Gray, 2022). A patient’s confidential clinical information may be compromised if their Protected health information (PHI) is disclosed, which might hinder efforts to coordinate their….
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The HIPAA regulation may have far-reaching effects on how well medical records are shared across facilities. Under HIPAA, medical professionals may legally discuss a patient’s medical history with one another. In the course of care coordination, PHI cannot be shared with anyone who is not directly involved in the patient’s care. HIPAA allows for the disclosure of a patient’s health information to the patient’s intimate contacts, including family, friends, and clergy (Oyeleye, 2021). The patient’s poor choices, if they exist, take on more significance. Thus, HIPAA is seen as crucial to the unfettered exchange of patients’ medical records for the sake of evidence-based decision making.
National, State, and Local Policy that raise Ethical Questions for Coordination of Care
Following nursing policies and procedures is crucial to providing quality care to patients. When it comes to carrying out the federal government’s mandate to ensure that its citizens have access to quality healthcare, no other department compares to HHS. Care coordination has suffered as a consequence of the Affordable Care Act’s increased national debt, which has been caused by socioeconomic imbalances. The number of people who may get insurance subsidies is limited by the law. Most immigrants cannot afford medical coverage. While both Medicare and Medicaid only serve the tax-paying population, many charity organizations, like as homeless shelters, are frequently overlooked in the establishment of proper regulations that permit effective treatment and coordination.
For a field to be accepted as a serious occupation, it must follow established guidelines for training and oversight. The nursing profession is facing increasing ethical challenges and concerns as a result of the proliferation of regulations designed to safeguard nurses and their clients during the process of making decisions. Nurses may still need to make the call of whether or not to disclose a specific piece of health information about a patient, even while national privacy legislation addresses confidentiality.
Impact of the Code of Ethics for the Nurses on the Continuum of Care
When it comes to serving the community and using evidence-based practice, a nurse may look to the code of ethics as a guidance. The code of ethics mandates that nurse practitioners carry out their responsibilities regardless of their personal histories, geographic locations, or levels of education. The ANA code of ethics equips nurses to make moral judgments throughout the nursing process. By adhering to a strict code of ethics, nurses may ensure that patients’ rights are protected and that healthcare is available to those who need it (Hajiaghamohsen et al., 2022). Ethical questions might occur at any point throughout treatment. The ANA’s code of ethics may be used to solve ethical issues that arise at any point in the care process. Nurses are expected to act independently while caring for patients. The code of ethics may have unexpected repercussions that hinder patient care consistency and treatment coordination.
Along the whole spectrum of care, nurses are responsible for upholding the values of fairness, accountability, honesty, nonmaleficence, beneficence, and independence. While advances in healthcare technology have helped reduce ethical ambiguity, there are concerns that they might undermine treatment coordination and continuity. When professional guidelines need to be delivered quickly during care coordination, moral anguish and anxiety might spike. Fines, legal action, suspension, or even termination may be levied for code of ethics violations. Given the complex and fast-paced nature of nursing, a code of ethics is especially important in guiding practitioners toward more logical decision-making. Nursing practice should be guided by ANA principles at all times. Due to resource constraints, all patients must be given equal consideration. However, healthcare professionals who breach the code of ethics at any time are subject to discipline.
Discuss the Nursing Homes and Health Policies
Health privacy regulations like HIPAA must be followed while coordinating care in nursing homes. HIPAA has improved the safety and well-being of patients in facilities like nursing homes by making it simpler for staff to access patients’ medical records. The doctor-patient relationship improves. Compliance with HIPAA requirements (Boltz, 2023) is critical for nursing homes to protect their patients’ health and well-being, since data availability facilitates the implementation of care coordination choices. Health care policy for nursing homes is crucial to both improving the standard of care and ensuring the safety of patients. The longevity and quality of life of nursing home residents depend on our ability to ensure their health and happiness.
Ethical and Policy Issues affecting the Continuum and Coordination of Care in Nursing Homes
Problems of ethics and government oversight plague nursing homes as local entities. Healthy People 2030 outlines the benefits of incorporating social factors, such as fostering social and physical ties to improve public care. By ensuring the continuity and coordination of care, the ACA protects the privacy of nursing home residents (Hakimjavadi et al., 2023). Patients’ abilities to maintain confidentiality over their medical records have an impact on management of care and end-of-life decisions. Medical professionals need to understand how their patients’ financial situations may be affected by their treatment. Nursing facilities need to improve their clinical care. The implementation of the legislation has been problematic despite extensive attempts to expand access to medical care. The outcomes of nursing home patients should not deteriorate due to healthcare providers’ lack of knowledge of ethics and regulations.
Nursing Care Coordination and Policies in Nursing Homes
Since nursing homes often help people who have ongoing health issues, healthcare coordination rules like the Affordable Care Act (ACA) have been crucial (Goldberg et al, 2023) for the industry. Affordable health insurance plans that include nursing home care may be available to patients. Due to HIPAA regulations, patients may be certain that their health records will be kept confidential. Nursing homes also provide their patients’ loved ones with 24 hours a day, 7 days a week of security. However, a variety of health insurance plans in the United States guarantee that people will get treatment if they become ill or injured. The Affordable Care Act is crucial because it guarantees that those living in nursing homes may affordably get medical coverage. Because of comprehensive resident injury insurance, nursing home residents may feel safe at all times (Goldberg et al, 2023). Patients’ private medical records are always protected while they receive ongoing care coordination in nursing homes. HIPAA and the Affordable Care Act have improved the coordination and continuity of care provided to nursing home residents.
How HIPAA Policy has contributed to Nursing Home Coordination of Care
Nursing home residents’ personal health information is protected by HIPAA’s strict regulations, which have reduced the likelihood of fraud and abuse. Despite the community group’s emphasis on clinical safety, HIPAA has ensured the financial security of people receiving home care. The legislation requires that protected health information (PHI) be kept for as long as necessary, even if the patient has revoked permission for its release. Patients in nursing homes that get coordination and continuum care may now see their medical records thanks to HIPAA (Karam et al., 2021). Thanks to HIPAA standards, nursing home patients may rest easy knowing that their protected health information will be kept private at all times. The people residing in nursing homes may gain significantly from the rule. Major benefits include keeping PHI encrypted and developing appropriate federal and privacy breach reporting procedures.
Conclusion
People who require healthcare outside of the confines of a medical facility or their own homes have an important resource in the form of nursing homes in their communities. The community should have a discussion on many policy and ethical problems. Thanks to HIPAA and the ACA, patients now have better access to coordinated, continuous care. Individuals’ ability to resolve clinical challenges may improve if they have a firm grasp of healthcare ethics and policy. The community setting offers significant benefits in terms of continuity and coordinated treatment, notwithstanding the limitations imposed by ethical considerations. It is the responsibility of the federal government to address all moral and policy concerns. The health of nursing home residents might be improved by the provision of services that raise their standard of living and happiness
References
Boltz, M. (2023). Long-Term Care and the COVID-19 Pandemic: Lessons Learned. Nursing Clinics, 58(1), 35-48. https://doi.org/10.1016/j.cnur.2022.10.004
Goldberg, L., Rankine, J., Devlin, B., Miller, E., & Ray, K. N. (2023). School Nurse Perspectives on Collaboration With Primary Care Providers. Journal of School Health. https://doi.org/10.1111/josh.13325
Gray, J. M. E. (2022). HIPAA, Telehealth, and the Treatment of Mental Illness in a Post-COVID World. Okla. City UL Rev., 46, 1. https://heinonline.org/hol-cgi-bin/get_pdf.cgi?handle=hein.journals/okcu46§ion=5
Hajiaghamohseni, Z., Sweeney, J., Anderson, M. C., Duarte, S., & Evanko, C. (2022). Continuum of Care Screener: A Risk Mitigation Tool to Guide Decision Making When Environmental Factors Affect Service Delivery. Behavior Analysis in Practice, 15(2), 495-504. https://doi.org/10.1007/s40617-021-00672-7
Hakimjavadi, R., Karunananthan, S., Alexander, G., Fung, C., Gazarin, M., Houghton, D., … & Liddy, C. (2023). What is the level of information technology maturity in Ontario’s long-term care homes? A cross-sectional survey study protocol. BMJ open, 13(2), e064745. http://dx.doi.org/10.1136/bmjopen-2022-064745
Karam, M., Chouinard, M. C., Poitras, M. E., Couturier, Y., Vedel, I., Grgurevic, N., & Hudon, C. (2021). Nursing care coordination for patients with complex needs in primary healthcare: A scoping review. International Journal of Integrated Care, 21(1). https://doi.org/10.5334%2Fijic.5518
Oyeleye, O. A. (2021). The HIPAA Privacy Rule, COVID-19, and nurses’ privacy rights. Nursing2022, 51(2), 11-14. https://doi.org/10.1097/01.NURSE.0000731892.59941.a9