NURS FPX 6614 Hypo Assessment 1 Defining a Gap in Practice

NURS FPX 6614 Hypo Assessment 1

Hypo NURS FPX 6614 Assessment 1

Assessment 1: Defining a Gap in Practice: Executive Summary



Capella University


Professor’s Name 

March, 2024

Defining a Gap in Practice: Executive Summary

In the realm of improving healthcare outcomes, clarity and precision are paramount for stakeholder engagement. Utilizing a PICOT question becomes pivotal as it encapsulates the essence of the improvement project in one succinct sentence. This tool proves invaluable in articulating the specifics of the project, aiding in stakeholder buy-in. This is particularly relevant in our assessment, where we aim to address a gap in practice related to care coordination for heart disease at different levels. As we delve into defining this gap in the subsequent executive summary, the PICOT question will serve as the guiding beacon, providing a clear direction for our exploration of interventions and offering decision-makers the key elements essential for informed choices and justifications in the realm of heart disease management (Mechanick et al., 2020).

Clinical Priorities for a Specific Population

Analyzing clinical priorities for a specific population is instrumental in shaping effective care coordination processes that influence health outcomes positively. In the context of heart disease, a prevalent health concern, it is crucial to recognize and rectify deficiencies in care coordination across various levels– organizational, regional, or national. The selected population, individuals with heart disease, often face challenges stemming from fragmented care processes, inconsistent communication between healthcare providers, and varying approaches to patient education (Ferreira et al., 2020). This disconnection contributes to suboptimal health outcomes and increased healthcare costs

The identified gap revolves around the need for a cohesive and standardized care coordination framework to enhance the overall management of heart disease. Currently, the lack of coordination leads to inefficiencies, communication lapses, and suboptimal patient education. The PICOT question strategically guides our research, aiming to explore interventions that address this gap and improve the coordination of care for individuals with heart disease. By posing this question, we set the stage for a comprehensive examination of the existing practices and the potential impact of implementing a more organized and patient-centric care coordination approach (Hasson et al., 2020). This research aims to provide decision-makers with actionable insights, helping them understand the key elements required to make informed decisions and justifying the adoption of effective care coordination strategies in the context of heart disease management.

Identifying Information Gaps and Alternative Scenarios

In the pursuit of improving healthcare outcomes for individuals with heart disease, it is crucial to clearly define the scope of the project. Utilizing a PICOT question serves as a concise way to summarize the essence of the improvement initiative. For our assessment focusing on heart disease care coordination, a critical gap in practice emerges related to information management (Kadambi et al., 2020). Currently, there is a lack of standardized procedures for gathering and sharing information about heart disease care across different levels – organizational, regional, and national. This information gap hinders effective decision-making, contributing to suboptimal patient outcomes and increased healthcare costs. 

To comprehensively address this gap, our research aims not only to identify information gaps but also to explore alternative scenarios and strategies that add depth to the analysis. This involves investigating technological solutions, enhancing communication protocols among healthcare providers, and fostering collaborative approaches. By delving into these alternative scenarios, we intend to provide decision-makers with an understanding of challenges and opportunities in information management for heart disease care coordination (Skivington et al., 2021). This aligns with the executive summary’s purpose, serving as an actionable document that outlines key elements essential for decision-makers to make well-informed choices and justifications in the pursuit of improved healthcare outcomes for individuals with heart disease.

PICOT Question to a Gap in Practice

To tackle the identified gap in practice related to heart disease care coordination, our PICOT question is structured to explore the impact of implementing a standardized care coordination process on health outcomes over a specific time frame of 12 months. This inquiry establishes a distinct structure for our study, enabling us to evaluate the impact of standardized care coordination on enhancing health results for individuals with heart disease. By applying this PICOT question, we aim to delve into the potential benefits and challenges of implementing a standardized care coordination process, providing valuable insights for decision-makers.

Do individuals experiencing heart-related conditions (P) through lifestyle modifications (I)  as opposed to pharmaceutical interventions (C) witness enhanced cardiovascular well-being (O) within a twelve-month timeframe (T)?

  • Population: Individuals with heart disease diagnosis.
  • Intervention: Implementing standardized care coordination.
  • Comparison: Assessing non-standardized care impact.
  • Outcome: Evaluating health outcomes influence.
  • Time: 12-month analysis of coordination effectiveness.

Explanation of Gap in Practice

The selected gap in practice revolves around the absence of a standardized care coordination process for individuals with heart disease at different levels—organizational, regional, and national. The lack of uniformity in care coordination results in fragmented approaches, inconsistent communication between healthcare providers, and variations in patient education protocols (Mahrer et al., 2021). This disjointed system can lead to suboptimal health outcomes and increased healthcare costs. The absence of standardized care coordination impedes effective decision-making and hinders the delivery of cohesive and patient-centric care for those diagnosed with heart disease. Consequently, there is a pressing need to bridge this gap by investigating the impact of implementing a standardized care coordination process over a 12-month period, ensuring that decision-makers have the necessary insights to enhance heart disease management strategies at various healthcare levels. The need for change is evident, supported by scholarly evidence emphasizing the positive impact of standardized care coordination on patient outcomes within a specified time frame.

Potential Services and Resources for Care Coordination


Evaluating the landscape of resources available for care coordination in heart disease management is crucial for addressing the identified gap. The examination encompasses existing healthcare infrastructure, personnel, and technological tools. Current resources may include specialized cardiac care units, skilled healthcare professionals, and integrated health information systems. In addition, community-based resources, such as support groups and educational programs, contribute to holistic patient care (Khera et al., 2020). This assessment aims to identify the strengths and weaknesses of available resources, providing decision-makers with insights into optimizing and expanding the support infrastructure for individuals diagnosed with heart disease.

Potential Services

Critical to enhancing care coordination is a thorough evaluation of potential services tailored to the specific needs of the heart disease population. Services may range from personalized treatment plans and rehabilitation programs to telehealth services for remote monitoring. Exploring potential services involves considering multidisciplinary approaches, including collaboration among cardiologists, nurses, nutritionists, and mental health professionals (Neubeck et al., 2020). By identifying these services, decision-makers can strategically implement interventions that address the unique challenges faced by individuals with heart disease. This comprehensive approach aligns with the overarching goal of improving health outcomes through a well-coordinated and patient-centric care continuum.


An integral aspect of the assessment involves critically examining the barriers that may impede effective care coordination for individuals with heart disease. Barriers could include limited access to specialized care, fragmented communication between healthcare providers, and socioeconomic factors affecting patient adherence. Scholarly resources will be employed to substantiate this critical analysis, offering decision-makers a well-informed understanding of challenges in the current system. Addressing these barriers is pivotal for the success of any intervention aimed at improving care coordination, ensuring that the proposed services and resources align with the identified gaps, and overcoming existing challenges in heart disease management (Salomon et al., 2021).

Type of Care Coordination Intervention That Would Be Best Fit

In addressing the identified gap in practice related to heart disease care coordination, a pivotal aspect involves determining the most effective type of care coordination intervention. To create an impactful interprofessional collaboration strategy for improving population health outcomes, it is imperative to first assess the current landscape of care coordination processes. This assessment entails a comprehensive analysis of existing care models, communication channels between healthcare providers, and patient engagement strategies (Arabi et al., 2020). By scrutinizing the strengths and weaknesses of the current system, decision-makers can discern the specific needs of the heart disease population and formulate a tailored interprofessional collaboration strategy. This strategy aims to foster seamless communication among diverse healthcare professionals, ensuring a holistic approach to heart disease management that is evidence-based and patient-centric.

Furthermore, the evaluation extends to identifying the type of care coordination intervention that would best fit the unique requirements of the heart disease population. This involves outlining specific and practical ways to address the care coordination intervention, considering factors such as the integration of technology, standardization of protocols, and the establishment of interdisciplinary teams. Scholarly resources will be leveraged to support evidence-based recommendations, offering decision-makers a robust foundation for implementing effective care coordination strategies. By delineating the most suitable intervention, decision-makers can proactively guide the improvement project towards evidence-based practices, thereby enhancing the overall quality of care for individuals with heart disease at the organizational, regional, or national level.

Summary of the Selected Nursing Diagnosis

In addressing the gap in practice related to heart disease care coordination, the selected nursing diagnosis revolves around the fragmented approach in managing cardiac patients. The identified issue stems from inconsistent communication among healthcare providers, disparate patient education methods, and a lack of standardized post-treatment follow-up protocols. To develop stakeholder understanding and support for collaborative care, the nursing diagnosis emphasizes the need for a cohesive and comprehensive care coordination framework. This framework aims to enhance communication channels, implement standardized patient education strategies, and establish protocols for consistent post-treatment follow-up (Jeong et al., 2020). By summarizing the nursing diagnosis, decision-makers can grasp the intricacies of the issue, paving the way for collaborative strategies that address the specific needs of individuals with heart disease at the organizational, regional, or national level.

Example for Strategies

To effectively address the identified nursing diagnosis and bridge the gap in heart disease care coordination, specific and relevant strategies must be employed. One such strategy involves the implementation of a centralized communication system that ensures seamless information exchange among healthcare professionals involved in the care continuum. Additionally, employing technology-driven patient education platforms can enhance accessibility and standardization of educational materials. Best practices include developing interdisciplinary teams to facilitate post-treatment follow-up, ensuring that patients receive consistent and evidence-based care. These strategies, supported by scholarly evidence, not only summarize the nursing diagnosis effectively but also provide decision-makers with actionable steps to guide the collaborative care improvement project. The assessment of the issue serves as a foundational step in this process, setting the stage for informed decision-making and stakeholder buy-in.

Planning of Intervention and Expected Outcomes

Developing the intervention to enhance care coordination for heart disease entails a thorough strategy in accordance with the guidelines and benchmarks set by the scope and standards of care coordination practice. In the beginning, a multidisciplinary team consisting of healthcare professionals such as nurses, physicians, and allied health personnel will be established to guarantee a comprehensive viewpoint. The intervention will focus on developing standardized care protocols, enhancing communication channels among healthcare providers, and implementing patient education strategies. Anticipated results encompass increased patient compliance with treatment regimens, decreased instances of hospital readmissions, and improved overall health results for individuals diagnosed with heart disease (McMahan et al., 2020). The intervention aims to streamline the care coordination process, ensuring a seamless transition of care and fostering collaboration among healthcare providers for the benefit of the specific population.


The expected outcomes of the care coordination intervention are multifaceted, with a primary emphasis on enhancing the quality of care for individuals diagnosed with heart disease. By implementing standardized care protocols and improving communication, the intervention aims to reduce instances of medical errors, improve patient satisfaction, and ultimately contribute to better health outcomes. Additionally, the intervention seeks to optimize the allocation of healthcare resources, resulting in cost savings for both the healthcare system and patients. Overall, the anticipated outcomes align with the overarching goal of creating a more efficient and patient-centered care coordination process for heart disease at the organizational, regional, or national level.


The assumptions underlying this analysis include the expectation that healthcare providers are willing to collaborate in an interdisciplinary team and that the implementation of standardized care protocols will be met with positive reception from both healthcare professionals and patients. Furthermore, the assumption is made that enhanced communication and patient education will lead to improved adherence to treatment plans. These assumptions form the basis for the proposed care coordination process and underscore the importance of fostering a supportive and collaborative healthcare environment. The intervention’s success hinges on addressing these assumptions and continuously assessing and adapting the care coordination process to meet the evolving needs of the specific population with heart disease.


In conclusion, the proposed care coordination intervention for individuals with heart disease at the organizational, regional, or national level presents a systematic and collaborative approach to address existing gaps in practice. Following the guidelines and norms outlined in care coordination practices, the intervention aims to improve overall health outcomes by implementing standardized care protocols, enhancing communication channels, and providing patient education. The expected outcomes encompass reduced hospital readmissions, improved patient adherence to treatment plans, and streamlined healthcare delivery. While assumptions underlie the proposed intervention, continuous assessment, and adaptation will be crucial to ensuring its success. This research emphasizes the significance of an interdisciplinary approach, effective communication, and patient-centered strategies in shaping a more efficient and responsive care coordination process for individuals with heart disease. The proposed intervention, rooted in evidence-based practices, holds the potential to bring about positive changes in the landscape of heart disease care coordination, ultimately benefiting both healthcare providers and the specific population in focus.


Arabi, Y. M., Fowler, R., & Hayden, F. G. (2020). Critical care management of adults with community-acquired severe respiratory viral infection. Intensive Care Medicine, 46(2), 315–328.

Ferreira, J., Sarda, C., & Rello, J. (2020). Burden of community-acquired pneumonia and unmet clinical needs. Advances in Therapy, 37(4), 1302–1318.

Hasson, F., Nicholson, E., Muldrew, D., Bamidele, O., Payne, S., & McIlfatrick, S. (2020). International palliative care research priorities. BMC Palliative Care, 19(1).

Jeong, E., Park, J., & Lee, J. (2020). Diagnostic test accuracy of the nursing delirium screening scale. Journal of Advanced Nursing, 76(10), 2510–2521.

Kadambi, S., Loh, K. P., Dunne, R., Magnuson, A., Maggiore, R., Zittel, J., Flannery, M., Inglis, J., Gilmore, N., Mohamed, M., Ramsdale, E., & Mohile, S. (2020). Older adults with cancer and their caregivers — current landscape and future directions for clinical care. Nature Reviews Clinical Oncology, 17(12), 742–755.

Khera, A., Baum, S. J., Gluckman, T. J., Gulati, M., Martin, S. S., Michos, E. D., Navar, A. M., Taub, P. R., Toth, P. P., Virani, S. S., Wong, N. D., & Shapiro, M. D. (2020). Continuity of care and outpatient management for patients with and at high risk for cardiovascular disease during the COVID-19 pandemic. American Journal of Preventive Cardiology, 1, 100009.

Mahrer, R., Østergaard, B., Brødsgaard, A., Konradsen, H., Svavarsdóttir, E. K., Dieperink, K. B., Imhof, L., García‐Vivar, C., & Luttik, M. (2021). Healthcare practices and interventions in Europe towards families of older patients with cardiovascular disease. Scandinavian Journal of Caring Sciences.

McMahan, R. D., Tellez, I., & Sudore, R. L. (2020). Deconstructing the complexities of advance care planning outcomes. Journal of the American Geriatrics Society, 69(1).

Mechanick, J. I., Farkouh, M. E., Newman, J. D., & Garvey, W. T. (2020). Cardiometabolic-based chronic disease, addressing knowledge and clinical practice gaps. Journal of the American College of Cardiology, 75(5), 539–555.

Neubeck, L., Hansen, T., Jaarsma, T., Klompstra, L., & Gallagher, R. (2020). Delivering healthcare remotely to cardiovascular patients during COVID-19. European Journal of Cardiovascular Nursing, 19(6), 147451512092453.

Salomon, J., Ericsson, A., Price, A., Chandrashekhara Manithody, Murry, D. J., Chhonker, Y. S., Buchanan, P., Lindsey, M. L., Singh, A. B., & Jain, A. K. (2021). Dysbiosis and intestinal barrier dysfunction in pediatric congenital heart disease is exacerbated following cardiopulmonary bypass. Basic to Translational Science, 6(4), 311–327.

Skivington, K., Matthews, L., Simpson, S. A., Craig, P., Baird, J., Blazeby, J. M., Boyd, K. A., Craig, N., French, D. P., McIntosh, E., Petticrew, M., Rycroft-Malone, J., White, M., & Moore, L. (2021). Framework for the development and evaluation of complex interventions: gap analysis, workshop and consultation-informed update. Health Technology Assessment, 25(57), 1–132.



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    NURS FPX 6610 Assessment 4

    Name Capella University FPX6610: Introduction

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    Name Capella University FPX6610: Introduction

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