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

Student Name

Capella University

NURS-FPX 4065

Professor’s Name

Submission Date

Ethical and Policy Factors in Care Coordination

Effective care coordination for older adults with hypertension requires an integrated approach that combines ethical nursing practice with compliance to health policies that promote safety, equity, and quality of care. At Mercy Hospital, hypertension remains a prevalent chronic condition among older adults and requires long-term management strategies that involve interdisciplinary collaboration, patient education, and continuous monitoring. Ethical principles such as autonomy, beneficence, nonmaleficence, and justice guide clinical decision-making and ensure that care delivery respects patient rights while improving health outcomes. At the same time, healthcare policies at the federal, state, and organizational levels shape how care is coordinated, funded, and evaluated within healthcare systems (Varkey, 2021).

Governmental health policies significantly influence how hypertension care is delivered and coordinated in hospital settings. Policies establish standards for preventive care, chronic disease management, and interdisciplinary collaboration, ensuring that patients receive consistent and evidence-based treatment. In the context of older adults with hypertension, these policies emphasize early detection, lifestyle modification, medication adherence, and long-term monitoring. Such frameworks help organizations like Mercy Hospital implement structured care coordination models that improve continuity of care and reduce complications associated with uncontrolled blood pressure (Gago et al., 2024).

One of the most influential federal policies affecting care coordination is the Affordable Care Act (ACA). The ACA promotes preventive healthcare services, chronic disease management, and value-based care models that shift the focus from service quantity to patient outcomes. Through mechanisms such as Accountable Care Organizations (ACOs) and Patient-Centered Medical Homes (PCMHs), the ACA encourages collaboration among healthcare professionals to improve communication and continuity of care. Preventive services such as hypertension screening, wellness visits, and nutritional counseling are provided with reduced financial barriers, which improves early detection and treatment adherence among older adults (Ercia, 2021). This policy strengthens care coordination by ensuring that patients remain engaged in continuous and structured healthcare services.

Another key policy is the Centers for Medicare & Medicaid Services (CMS) Chronic Care Management (CCM) program. This program supports patients with multiple chronic conditions, including hypertension, by reimbursing healthcare providers for non-face-to-face care coordination activities. These include medication reconciliation, care planning, and follow-up communication. At Mercy Hospital, nurses and case managers use CCM services to monitor patients remotely, coordinate interdisciplinary care, and ensure adherence to treatment plans. This approach is particularly beneficial for older adults with limited mobility or transportation challenges, as it improves access to continuous care and reduces hospital readmissions (Jang et al., 2024).

The Million Hearts® Initiative is another important national program that directly impacts hypertension management. This initiative focuses on preventing cardiovascular events such as heart attacks and strokes by promoting evidence-based interventions, including blood pressure control, sodium reduction, and smoking cessation. Healthcare organizations participating in this initiative implement standardized treatment protocols and community outreach programs to identify at-risk populations. Mercy Hospital aligns with this initiative by promoting patient education, conducting blood pressure screenings, and collaborating with community health partners to improve cardiovascular outcomes (Wall et al., 2020).

Ethical considerations play a critical role in the implementation of these policies. While policies aim to improve population health outcomes, they may sometimes create ethical challenges related to patient autonomy, privacy, and equity. For example, standardized treatment protocols may not always align with individual patient needs, particularly when socioeconomic or cultural factors affect treatment adherence. Care coordinators must balance policy compliance with ethical sensitivity to ensure that care remains patient-centered and equitable (Eastman et al., 2022). Ethical decision-making in such cases requires nurses to adapt care plans to individual circumstances while still meeting organizational and regulatory expectations.

At the national level, Healthy People 2030 provides measurable objectives to reduce chronic disease prevalence, including hypertension. This initiative emphasizes health equity, prevention, and population health improvement. However, ethical challenges arise when standardized health goals do not fully account for social determinants of health such as poverty, food insecurity, or limited healthcare access. Nurses must ensure that these goals are applied flexibly to avoid unfairly penalizing vulnerable populations while still promoting improved health outcomes (Ochiai et al., 2021).

At the state level, programs such as the Kentucky Heart Disease and Stroke Prevention Program support hypertension management through community-based screening, education, and care coordination. While these initiatives enhance collaboration between healthcare providers and public health agencies, they also raise ethical concerns regarding confidentiality and informed consent when sharing patient data across systems. Patients must be fully informed about how their health information is used, and consent processes must be transparent to maintain trust and uphold ethical standards of autonomy and beneficence (Olejarczyk & Young, 2024).

At the local level, community health improvement plans promote collaboration between hospitals, schools, and public health organizations to address chronic disease management. These initiatives improve population health by identifying at-risk individuals and connecting them with appropriate services. However, limited resources often create ethical challenges related to fairness and resource allocation. Care coordinators must ensure that decisions regarding access to services such as screenings or nutritional programs are based on clinical need and vulnerability rather than convenience or institutional efficiency (CDC, 2024).

The ethical implications of these policies highlight the ongoing tension between population-based healthcare strategies and individualized patient care. While national and state programs promote standardization and efficiency, they may unintentionally overlook unique patient needs. Without careful ethical oversight, these tensions can lead to disparities in care, reduced patient trust, and decreased engagement in treatment plans. Therefore, ethical frameworks such as the American Nurses Association (ANA) Code of Ethics are essential in guiding nursing practice and ensuring that care coordination remains patient-centered, fair, and transparent (Numminen et al., 2024).

The ANA Code of Ethics provides a foundational framework for ethical nursing practice in care coordination. It emphasizes respect for patient autonomy, advocacy for vulnerable populations, and commitment to justice in healthcare delivery. Provision 2 highlights the nurse’s primary commitment to the patient, ensuring that care is individualized and responsive to patient needs. Provision 8 emphasizes collaboration with other healthcare professionals and communities to promote public health and improve care outcomes. These principles support effective hypertension management by encouraging interdisciplinary communication, continuity of care, and patient engagement (Dellasega & Kanaskie, 2021).

Additionally, Provision 3 emphasizes the nurse’s responsibility to protect patient rights and reduce health disparities. In the context of hypertension care at Mercy Hospital, this includes identifying barriers such as financial limitations, transportation challenges, and limited health literacy, and connecting patients to appropriate resources such as telehealth services or community-based programs. Provision 9 further supports advocacy for system-level changes that promote equitable access to care and resource distribution. These ethical principles ensure that care coordination is not only efficient but also just and inclusive (Haddad & Geiger, 2023).

In conclusion, ethical and policy factors are deeply interconnected in shaping effective care coordination for older adults with hypertension. Federal initiatives such as the ACA, CMS Chronic Care Management program, and Million Hearts® Initiative provide structured frameworks for improving care delivery and patient outcomes. However, ethical principles guided by the ANA Code of Ethics ensure that these policies are implemented in a way that respects patient dignity, autonomy, and equity. The integration of ethical decision-making with health policy compliance enables Mercy Hospital to deliver coordinated, patient-centered care that improves long-term outcomes and reduces health disparities.

References

Centers for Disease Control and Prevention. (2024). Community health assessment & improvement planning. https://www.cdc.gov

Dellasega, C., & Kanaskie, M. L. (2021). Nursing ethics in an era of pandemic. Applied Nursing Research, 62, 151508. https://doi.org/10.1016/j.apnr.2021.151508

Eastman, M. R., Kalesnikava, V. A., & Mezuk, B. (2022). Experiences of care coordination among older adults. Patient Education and Counseling, 105(7). https://doi.org/10.1016/j.pec.2022.03.015

Ercia, A. (2021). The impact of the Affordable Care Act on access to care. BMC Health Services Research, 21(1), 1–9. https://doi.org/10.1186/s12913-021-06961-9

Gago, C., et al. (2024). Hypertension management in healthcare systems. Implementation Science Communications, 5(1). https://doi.org/10.1186/s43058-024-00587-8

Haddad, L., & Geiger, R. (2023). Nursing ethical considerations. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK526054/

Jang, J., et al. (2024). Chronic care management services. Journal of the American Geriatrics Society, 72(9), 2730–2737. https://doi.org/10.1111/jgs.19066

Numminen, O., et al. (2024). Use and impact of the ANA Code. Nursing Ethics, 31(8), 1389–1412. https://doi.org/10.1177/09697330241230522

Ochiai, E., et al. (2021). Healthy People 2030 indicators. Journal of Public Health Management and Practice, 27(6), 235–241. https://doi.org/10.1097/phh.0000000000001424

Olejarczyk, J., & Young, M. (2024). Patient rights and ethics. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK538279/

Varkey, B. (2021). Principles of clinical ethics. Medical Principles and Practice, 30(1), 17–28. https://doi.org/10.1159/000509119

Wall, H. K., et al. (2020). The Million Hearts initiative. Journal of Cardiopulmonary Rehabilitation and Prevention, 40(5), 290–293. https://doi.org/10.1097/hcr.0000000000000547