NURS FPX 4050 Assessment 1 Preliminary Care Coordination Plan


NURS FPX 4050 Assessment 1 Preliminary Care Coordination Plan

NURS FPX 4050 Assessment 1 Preliminary Care Coordination Plan


Capella university

NURS-FPX 4050 Coord Patient-Centered Care

Prof. Name


Preliminary Care Coordination Plan

Care coordination is essential to delivering high-quality care to patients within the healthcare system. It becomes more crucial when the hospital confronts budget constraints, and the limited staff has to be managed for various roles. As a staff nurse, I have been assigned this new care coordinator role, and my responsibility is to craft a preliminary care coordination plan for residents of the Northwest Washington community facing mental health disorders. For this purpose, I will delve into physical, psychosocial, and cultural considerations while creating a care coordination plan for managing mental health disorders. Moreover, I will make specific and realistic goals for these community residents that can enable them to cope with their mental health ailments. Lastly, I will identify community resources that the affected community can utilize to improve their mental health.

Analysis of Mental Health Disorders and Associated Best Practices

Mental illness is a global health issue that has been impacting people of all ages, from children, teenagers, adolescents, and adults to older people. A mental health issue is relevant to the disturbance in an individual’s thinking, emotional dysregulation, and behavioral issues. A vast range of mental health disorders prevails in society, including mild anxiety, trauma, sleep problems, panic attacks, and depression, with a prevalence of 28 million people worldwide, whereas psychosis, obsessive-compulsive disorders, and bipolar disorders are impacting 40 million people. Schizophrenia is affecting 24 million people globally (World Health Organization, 2022).

While mental health issues are exponentially growing within societies, the gap between the need for treatment and its provision is widening due to stigma, shame, and other factors. While the physical consideration of mental health disorders includes the onset of various medical conditions such as fatigue, hormonal imbalance, digestive disorders, and headaches, patients may experience psychosocial needs such as social isolation, emotional dysregulation, and limited physical activity. Additionally, there are some cultural considerations, such as cultural beliefs and stigmas hindering patients from seeking mental health professionally, which must be considered while making care coordination plans.

Best Practices for Improving Mental Health

The best practices for improving mental health among community residents include seeking professional help to obtain an accurate diagnosis for mental health disorders and prevent other medical disorders. This includes consulting with mental health therapists, psychologists, and psychiatrists for thorough assessment and diagnosis (Reardon et al., 2019). Other practices include engaging in psychotherapy, such as cognitive-behavioral therapy (CBT) and interpersonal therapy, to manage the mental health illness associated with anxiety and depression. This will improve the psychosocial needs of mental health disorders and overcome social isolation. The CBT also improves emotional well-being and mental health (Stefan et al., 2019). 

Physical activity and exercises promote mental well-being by improving patients’ ability to endure negative thoughts and improve behavior change, such as setting goals, planning activities, and self-monitoring. All these changes lead to a better mental state, improve overall mental well-being, and prevent social isolation (Smith & Merwin, 2021). Educating people about the existence of mental health disorders and running anti-stigma campaigns on these topics can reduce the stigma and shame associated with mental health disorders. This will encourage patients and their families to seek professional help to alleviate their suffering (Walsh & Foster, 2021).

Underlying Assumptions and Points of Uncertainty 

The assumptions on which this analysis is based include mental health services and timely diagnosis, which can prevent the long-term effects of these health issues. Additionally, improved mental health can lead to better academic performance, improved relationships, and an overall healthy community. This analysis has some particular points of uncertainty, such as the availability of mental health support within the community that can alleviate the suffering of mental disorders in affected people. Moreover, the literacy level and acceptance of change among the community dwellers on the subject of mental health issues is another uncertain point. 

Specific Goals to be Established to Address Mental Health Disorders

To address mental health disorders, specific and realistic goals should be established. The goals should be tailored to the individual’s current status of mental disorder and the type of mental disorder one is encountering. These goals are based on SMART goal-setting that are specific, measurable, realistic, attainable, and time-bound. 

  • Reaching out to therapists for CBT or support groups (realistic and attainable) every week (measurable) to schedule psychotherapy and social activity for one hour (time-bound) to reduce the depressive symptoms by 10% (specific) (Stefan et al., 2019)
  • Exercising three times a week for twenty minutes (realistic) to improve mental health and mood disorders and decrease overall anxiety levels and panic attacks (attainable and specific) by 10 % (measurable) (Smith & Merwin, 2021). 
  • Conduct anti-stigma campaigns and educate the community (realistic and attainable) on mental health awareness once a month (measurable) for one year (time-bound) and enhance the health literacy of the community by 30 % to seek early help from professionals (specific) (Walsh & Foster, 2021).  

Community Resources for Safe and Effective Continuum of Care

  • Active Minds is a non-profit organization that promotes the well-being of people suffering from mental health disorders. It provides information on statistics, signs, and symptoms and offers self-care tools and resources, such as free access to the Porchlight app that helps people seek mental health from home. It also provides community resources for stigma and resilience and ways to take action on recovering from mental health issues, enhancing patient safety (Malmon,2022). Further, the helpline generated by Active Minds, which is texting BRAVE to 741-741 or calling the Suicide Prevention Lifeline at 1-800-273-TALK, ensures the continuity of care by addressing emergencies and providing effectively. These resources are available 24/7 for people; hence, they provide confidential support to patients, enhancing patient safety and an effective continuum of care by reducing the number of suicidal attempts. The Active Minds organization is located at 2001 S Street NW, Suite 700, Washington, DC, 20009, which can be easily accessible by the community residents (Active Minds, 2018).
  • Social health support groups such as NAMI  (National Alliance on Mental Illness) stimulate patient empowerment by providing social support to patients facing similar issues by sharing their coping strategies, reducing social isolation, and overcoming psychosocial barriers to mental health. This purpose of NAMI is indirectly impacting patient safety. The NAMI is available through a helpline by calling 800-950-6264 or texting “Helpline” to 62640 and provides services to all areas of Washington, DC (NAMI, 2019). Through helplines, organizations can provide coordinated care without breaking the continuity, and the patients may receive support within their residencies without delays or interruptions These community resources can be practical tools for an effective and safe continuum of care as affected members can acquire social support and improve their coping skills by reducing stigma, and patients may actively seek non-judgemental care. 

NURS FPX 4050 Assessment 1 Preliminary Care Coordination Plan

  • The Dorm-Young Adult Intensive Outpatient Program (IOP) Treatment, Washington, D.C., is a mental health service that community members can utilize at 1814 N St NW, Washington, DC 20036, United States, and patients can acquire psychotherapy and other interventions from healthcare professionals resulting in enhanced patient safety and continuum of care (The Dorm, n.d.).
  • 988 Suicide and Crisis Lifeline is another community resource that provides suicidal preventive interventions to depressed and mentally ill patients in the whole U.S. This will save many patients from committing suicide as it is available 24/7 and provides confidential support to distressed ones (988 Suicide And Crisis Lifeline, n.d.).


To sum up, the preliminary care plan discusses mental health disorders and the broad analysis that includes various types of mental health issues. Furthermore, I discussed the best practices for improving mental health, such as psychotherapy, seeking professional help, and integrating physical activity into lifestyle. Moreover, community resources like Active Minds, NAMI Connections, The Dorm, and 988 Suicide and Crisis Lifeline are valuable tools that can provide a safe and effective continuum of care to affected patients with mental health disorders. This preliminary plan can serve the community residents in improving their mental health conditions and overall well-being.


Active Minds. (2018). Active minds – changing the conversation about mental health 

The Dorm. (n.d.). Intensive outpatient mental health program for young adults – D.C. 

Malmon, A. (2022). Self-Care 

NAMI. (2019). NAMI connection | NAMI: National alliance on mental illness 

Reardon, T., Harvey, K., & Creswell, C. (2019). Seeking and accessing professional support for child anxiety in a community sample. European Child & Adolescent Psychiatry29(5), 649–664. 

Smith, P. J., & Merwin, R. M. (2021). The role of exercise in management of mental health disorders: An integrative review. Annual Review of Medicine72(1), 45–62.

NURS FPX 4050 Assessment 1 Preliminary Care Coordination Plan

Stefan, S., Cristea, I. A., Szentagotai Tatar, A., & David, D. (2019). Cognitive‐behavioral therapy (CBT) for generalized anxiety disorder: Contrasting various CBT approaches in a randomized clinical trial. Journal of Clinical Psychology75(7), 1188–1202.  

Walsh, D. A. B., & Foster, J. L. H. (2021). A call to action. A critical review of mental health related anti-stigma campaigns. Frontiers in Public Health8 

World Health Organization. (2022). Mental disorders 

988 Suicide & Crisis Lifeline. (n.d.). Our crisis centers

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