NURS FPX 4065 Assessment 3 Ethical and Policy Factors in Care Coordination

NURS FPX 4065 Assessment 3

Ethical and Policy Factors in Care Coordination
 

Student name

Capella University

NURS-FPX 4065

Professor’s Name

Submission Date

Slide: 01

• Ethical and Policy Factors in Care Coordination

Hello, my name is…… This presentation will address the ethical and policy issues of coordinating care to fill the gaps in care at the Valley Health Center.

Slide: 02

Government policies have a great impact on care coordination in community-based environments among vulnerable populations. In the structuring, funding, and provision, the health care in the Valley Health Center operates under the policies offered by the federal and state legislations. These policies include the Affordable Care Act, Medi-Cal, Patient-Centered Medical Homes (PCMHs), and Accountable Care Organizations (Ercia, 2021). In that sense, such policies also pose certain serious questions of ethics and health, particularly about equity, access, and utilization of resources. As observed, nurses encounter several ethically sensitive cases that are elucidated in the Code of Ethics since nurses have a mandated duty of striking a balance between the dilemmas in a bid to provide full patient-centered care.

Slide: 03

• Effect of Governmental Policies on Coordination of Care

Policies on health play a significant role in the way care is delivered, particularly to the grassroots level clients considered vulnerable in society. In my practicum site, the policies determine how care coordination is planned, resourced, and even evaluated in Valley Health Center; the policies at the federal and state levels determine the overall approach to care. These policies are relevant to the organizational care service delivery and define factors such as staffing patterns and outreach. The issue of coordination is vital as far as health equity and population health are concerned (Itchhaporia, 2021). These policies are necessary to ensure that the patients receive the required, correct, and complete treatment by knowing about them.

Slide: 04

• Affordable Care Act

As far as care coordination is concerned, the Affordable Care Act (ACA) is the most important policy. Examples of such models supported by the ACA include PCMHs and ACOs, which are intended to improve the level of coordination and effectiveness of the patient care delivery system (US Health Policy Gateway, 2023). These models aim to reduce fragmentation and assist in delivering integrated care across various contexts, including hospitals. Thus, nursing has utilized multiple practitioners such as nurses, social workers, and case managers at the Valley Health Center. Some of them are engaged in teamwork, which helps to coordinate care, recognize discrepancies in prescriptions, and transfer patients to the appropriate specialists or departments.

Slide: 05

• Medi-Cal

The next policy pertains to health care availability to Medicaid expansion in California, including the ACA, or Medi-Cal. Such growth has increased the accessibility of insurance to low-income citizens of the state; it also offers advantages to the undocumented subjects under the limited scope (Dietz et al., 2022). In a health insurance plan with a high number of patients covered, care coordinators have a legal obligation to assist with explaining the requirements and guiding patients towards receiving suitable covered services. The growth has provided others with an opportunity to access health care services, which include mental health, nutritional counseling, and preventive health services. As a result, the care team caregivers are better placed to provide effective and personalized care to the large population of patients.

Slide: 06

• State Immunization Requirements

These legal authorities also impact the coordination of care in health facilities in two ways. The care teams needed to be responsive and nimble to changes in the specific immunization requirements and COVID-19 emergency orders in one state, as the state established them. During the COVID period, the staff monitored and distributed information about the vaccine and appointments, introduced quarantine measures, and otherwise addressed the needs of patients who were placed under quarantine (Blake et al., 2022). These mandates drew on the federal and local policies that were aimed at improving and sustaining the state of order. In short, government policies influence the organization, approach, and moral dynamics, as is typical of care coordination within the community health facilities through legislation.

Slide: 07

• Ethical and Policy Considerations in Care Coordination

The ethical dilemmas associated with care coordination are eliminated or prevented by the national, state, or local policies. As an example, at the national level, the ACA enhances the delivery of insurance coverage. Still, the undocumented patients are not able to enjoy full insurance coverage, and this introduces an ethical issue of justice/ equal access. A study by Catterson et al. (2022) has noted that this exclusion deprives the undocumented people of healthcare, and the care team is confronted by one or more of the following ethical dilemmas when treating such patients.

At the state level, Medi-Cal in California has expanded coverage. Still, the lack of specialists means patients do not have access to them, thereby creating an ethical dilemma of fairness and timely access. At the local level, policies such as compulsory COVID-19 vaccination caused moral conflicts between the common good and individual freedoms in terms of patients refusing the vaccine on cultural or religious grounds (Olick et al., 2021). Such scenarios place care coordinators in a state of moral dilemmas, including beneficence, autonomy, and justice, when it comes to Valley Health Center engaging in intensive patient sensitization concerning the COVID-19 vaccines.

Slide: 08

• Impact and Consequences of the Policies

In Valley Health Center, national and state-related policies are reflected in various aspects of care teams and services. As a result of the ACA’s focus on ACOs, a model of care has emerged in which nurses and social workers collaborate on transitions of care, and this is ideally beneficial but highly resource-intensive. Nonetheless, according to Kyle and Frakt (2021), these models contribute to the bureaucracy of treatments and the strain on healthcare, which has been observed to lead to delays in service delivery at Valley Health Centre. With the expansion of Medi-Cal, there is a higher movement of patients, which poses a challenge to public health systems in terms of traffic that requires referral, screening, and benefits in terms of alignment. Catterson et al (2022) confirmed that Medi-Cal enrollees have to wait a long time to get their appointments, which indicates that the system is overstrained. The consequences imply that, despite the provisions established in the policy to improve the quality of care, they contribute to overload and multiplication of the challenges of an ethical care service provider, as anticipated by our own team.

Slide: 09

• Impacts at the National, State, and Local Levels

National and state policies are reflected in various aspects of care teams and services offered at the Valley Health Center. As a result of the ACA’s focus on ACOs, transition of care is now a care model in which nurses and social workers collaborate, which is most favorable but is highly resource-intensive. Nevertheless, these models also contribute to the treatment bureaucracy and pressures on healthcare, which have been reported to result in delays in the provision of services at Valley Health Centre (Kyle and Frakt, 2021). The expansion of Medi-Cal has led to an increase in patient traffic, posing a challenge to public health systems due to the additional workload that requires referrals, screenings, and benefits coordination. Catterson et al (2022) have determined that the time Medi-Cal enrollees wait to get their appointment is very long, and that is a clear indication that the system is strained.

This implies that despite the policy provisions in place to improve care quality, they result in an overload and compounding of the challenges faced by an ethical care service provider, as envisaged by our own team. At the national scale, ACA has transformed the operation of care coordination payment and accountability systems by encouraging payment and delivery models that are outcomes-based and time-consuming in terms of requirements of documentation and follow-ups by the care teams. As Gesner et al. (2022) note, these changes will most likely lead to burnout among care coordinators and could result in less time being spent with patients. Medi-Cal has expanded its coverage in the state, increasing health coverage rates, but provider commitments have been lacking; consequently, access to care remains a challenge, particularly for rural and underserved populations. According to the California Health Care Foundation (2024), approximately 38 percent of Medi-Cal patients in rural communities face the issue of being unable to obtain a timely appointment with a specialist.

On the local level, local ordinances that attempted to create testing or even the compulsory wearing of facemasks affected the information and interaction of nurses with patients, particularly in areas where these measures were perceived to infringe on patients’ freedom during the pandemic. So much fake news was spread about the virus, and as a result, large groups of people developed a negative attitude towards the vaccines (Zimmerman et al., 2022). They are policies at various levels, and they are interconnected, which implies that when implemented, they require care coordination to accomplish this and, nevertheless, integrate with what the patients demand. They needed to reform their methods of dealing with countries and utilize their resources in a way that would enable them to work on behalf of the latter without necessarily being subservient.

Slide: 10

• The Role of the Code of Ethics in Care Coordination

The Code of Ethics of Nurses plays a significant role in regulating the process of care organization and continuation, and appropriate autonomous choices of patients, which are grounded on the most important ethical values: respect, beneficence, non-maleficence, and fairness. These values guarantee that every patient of various social and cultural backgrounds receives equal and quality care needed to address their health concerns (Varkey, 2020).

In the case of low-income or undocumented patients at Valley Health Center, the Code of Conduct expects nurses to become advocates for the Code authority in health treatment despite the client-generated impediments, such as ineligibility for health insurance, culturally appropriate care, or institutionalized discrimination (American Nurses Association, 2025). This advocacy also ensures that, besides being treated appropriately, vulnerable patients have a fair and just opportunity at patronage, thus making the process comprehensive and human. Nurses are supposed to provide care to the patients simultaneously, but the rights of the patients should not be breached when the care is being given; the care should also be provided in accordance with both the principles/standards of ethics and the requirements that the patient possesses.

In this instance, they are centered on patient advocacy and partnership, both internally and externally within health care facilities, in addressing the vast numbers of needy health care consumers who originate in the deprived settings. The nurses at Valley Health Center have collaborative relationships with case managers, social workers, and other healthcare providers to address the medical and non-medical needs of the patient, including their biological, psychological, economic, and social needs, such as poverty, education, and housing.

This practice renders care holistic, whereby the health condition of an individual does not deteriorate in the long term. The literature is extensive, indicating that team-based care, particularly among patients who have disadvantaged backgrounds, will improve the health of the patient as the entire needs of the patient are addressed (Kongkar et al., 2025). The Code of Ethics identifies the moral requirement of nurses to collaborate with other employees to ensure that clients experience optimum care and relative human enhancement in overall health, and consequently, health equality and reduction of health disparities.

Slide: 11

• Factors Contributing to Health Disparities and Access to Services

The following are the determinants affecting health disparities and access to services among the vulnerable patients of color in Valley Health Center. The uninsured nature, lack of culturally sensitive services, and low trust in the health facility are some of the challenges faced by such patients and contribute to the already existing disparities. Social inequality factors, including poverty, lifestyle, unstable residence, and low literacy levels, contribute to the challenges and lead to poor health (Centers for Disease Control and Prevention, 2024)—the Valley Health Center.

As an organization that upholds the rights of patients, the nursing staff operates according to the Standards of Professional Practice for Registered Nurses and the ethical code of nurses. They physically collaborate with Codeher professionals, including social workers and case managers, to address both the medical illness and its associated social and mental components. The practice aligns with the principle of justice by eliminating care gaps and enhancing the population’s future health through the integration of disparate healthcare elements. In general, healthcare is complex and challenging for those who face health vulnerabilities.

Slide: 12

• Conclusion

Policies like the Affordable Care Act and Medi-Cal implemented by the government are useful in ensuring continuity of care in meeting the health requirements of the population, particularly in the underserved areas. However, these policies aim to expand access to healthcare; they pose several ethical issues concerning equity, opportunity, and distribution.

The Code of Ethics of Nurses can assist the nurse in addressing these challenges since it contains the description of the necessity to advocate on behalf of the patient, the impact of social determinants on health, interdisciplinary relationships, and collaboration. They are highly necessary to provide care needed to the vulnerable sector and, at the same time, attempt to fill the gap in the system. Coordinating care thus implies that nurses perform their health care responsibilities guided by ethical principles that aim to improve social justice in society.

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