NURS FPX 4900 Assessment 3 Assessing the Problem Technology Care Coordination and Community Resources Considerations


NURS FPX 4900 Assessment 3 Assessing the Problem Technology Care Coordination and Community Resources Considerations

NURS FPX 4900 Assessment 3 Assessing the Problem Technology Care Coordination and Community Resources Considerations


Capella university

NURS-FPX 4900 Capstone project for Nursing

Prof. Name



In this assessment of the capstone project, diabetes management in my mother’s case will be discussed, considering the use of technology, care coordination, and community resources. With the continuous breakthroughs in healthcare technologies, chronic diseases can be well managed using these technological tools. Likewise, care coordination is essential to providing holistic care to diabetic patients to ensure their blood glucose levels are consistently regulated. Additionally, diabetics can improve their health by leveraging community resources, which will be highlighted in the assessment.

Impact of Healthcare Technology on Diabetes 

Healthcare technology or digital health technology tools are playing a vast role in enhancing diabetes management and prevention. Mobile health (m-health) is one example of healthcare technology impacting diabetes positively by delivering health services to diabetics through mobile phones or wireless devices. This is possible by providing reminders through instant messaging, using applications tailored to diabetes management, and wearable technologies to monitor vital signs, blood glucose levels, and physical activity estimation. Healthcare providers are connected with patients through technologies, providing diabetes care and monitoring remotely. They can also provide diabetes education, self-management, and lifestyle modification intervention through telehealth, enhancing remote access to care and patient engagement (Shan et al., 2019).

 Advantages and Disadvantages of Remote Monitoring and Telehealth

Teleconsultation and remote monitoring enhance clinical efficacy and patient accountability by improving access to remote care. These technologies also overcome geographical barriers and provide access to care for patients in distant areas. This is important in my mother’s case as she is living far from the central city and needs to commute to access care in the hospital (Kelly et al., 2020). Other benefits of m-health (using apps and reminders) include better monitoring and management of diabetes through mobile apps made for diabetes, such as reminder apps to stay consistent in lifestyle modification and promote medication adherence (Shan et al., 2019). 

However, some studies present opposing views. The disadvantages of these technologies are the high costs associated with enabling the use of m-health and telehealth which pose social inequalities to patients who are financially weak and are unable to utilize them (Khilnani et al., 2020). The financial resources are required to obtain mobile phones and a strong internet connection. Moreover, connectivity issues may occur on either side of providers and patients, hindering the effective use of these technologies. These technologies create a gap in in-person consultation, and patients may become unsatisfied due to a lack of face-to-face interactions with healthcare providers (Sharma et al., 2022).

Current Professional Practice

In my professional practice of nursing care, healthcare providers have leveraged the use of these technologies and provided remote monitoring services and teleconsultations. The nurses delegated to endocrinology departments are mainly involved in providing telehealth sessions for diabetics who cannot commute to healthcare systems. These strategies have resulted in improved health outcomes such as better glycmeic control, prevention of cardiovascular problems, and diabetes-associated complications.  I have seen similar benefits and drawbacks of telehealth, m-health, and remote monitoring. Patients and healthcare providers encounter several barriers, including poor affordability due to financial constraints, and cannot leverage the benefits of these technologies enabling home healthcare. They also encounter technological barriers, such as weak connections that hinder patient-provider engagement (Phillip et al., 2020).

Lastly, the patients need more knowledge on utilizing these phone technologies. Remote monitoring and telehealth also incur considerable costs in the initial integration and maintenance of these technologies associated with obtaining smartphones, enabling high-width internet and educational training and programs to use these technologies and apps effectively (Walker et al., 2021). Despite the negatives, my mother can utilize these technologies to manage her diabetes as she has been an active user of smartphones. However, she needs further education on using specific apps in the initial phase. This can be done by collaborating with nurse informaticists who can guide her on using new applications for diabetes management such as utilizing apps on lifestyle modifications or medication adherence. This will enable her to use these applications efficiently with adequate knowledge and maintain healthy lifestyle and promote medication adherence. Ultimately, my mother’s self-care and empowerment will improve, enhancing diabetes management. 

Use of Care Coordination and Community Resources to Improve Diabetes

Care coordination and community resources are essential for addressing diabetes and present multiple benefits to patients with diabetes. Care coordination is the delivery of joint and collaborated care to patients to provide holistic care and enhance recovery. Likewise, community resources are the tools that diabetics and healthcare providers can utilize to improve diabetes management. These community resources are the American Diabetes Association, local diabetes support groups, and DSMES programs provided by healthcare facilities and clinics. 

Benefits of Care Coordination and Use of Community Resources 

 In diabetes, care coordination is pivotal as patients require multidisciplinary care comprising medication therapy from physicians, pharmacists, and nurses, dietary management from dieticians, and lifestyle modification, including education on self-management and physical activity from nurses and physiotherapists. By inculcating coordinated care, healthcare professionals can deliver patient-centered care, essential for improving diabetes through self-management.  Developing care coordination plans through joint efforts of healthcare professionals also leads to better glycemic control, reduced diabetes-associated problems, and improved quality of life.

This occurs when patients are receiving appropriate medication therapy for diabetes from the interdisciplinary collaboration of physicians, pharmacists, and nurses, resulting in regulated blood glucose levels. Furthermore, lifestyle modification through nurses’ educational programs and practical assistance from dieticians and fitness experts, results in improved quality of life in diabetics. Since coordinated care plans are based on patient-centeredness, it will likely result in patient adherence to medication and treatment plans, eventually improving blood glucose regulation.

NURS FPX 4900 Assessment 3 Assessing the Problem Technology Care Coordination and Community Resources Considerations

Such a result prevents diabetic complications such as blindness, peripheral neuropathy, and cardiovascular problems, ultimately saving the additional costs associated with treating these complications (McLendon et al., 2019). However, some critics have opposing views and consider care coordination a time-consuming and exhausting step that causes patients and healthcare to face diverse barriers, such as fostering inconsistent and inadequate communication and collaboration. Consequently, it leads to delayed care treatment for patients and undermines patients’ ability to self-manage their diabetes. Ultimately, patients experience poor recovery and the onset of diabetes complications (Maneze et al., 2019).

On the other hand, effective utilization of community resources such as DSMES educational programs provided by healthcare clinics assist patients to become well-educated about their health conditions and improve their self-care behaviors in diabetes management (Amy, 2022).  Moreover, patients will be empowered with motivation acquired from support groups for diabetes, improving their glycemic levels as they adhere to healthy lifestyles and medication plans. Utilizing diabetes helplines such as toll-free helplines on diabetes care and support will reduce hospitalization and emergency department visits by providing immediate services and education through helplines (Mukpalkar et al., 2020). In my nursing practice, I have witnessed fragmented care coordination and inconsistent use of community resources by patients due to multiple factors such as lack of awareness and limited existence of these resources.

 Barriers to Care Coordination and Use of Community Resources

 While care coordination and leveraging community resources substantially improve diabetes, specific barriers hinder the use of these strategies and tools effectively. Care coordination is affected when communication and collaboration among healthcare professionals are inadequate, creating a fragmented healthcare system. Moreover, the lack of interoperability of healthcare technologies like EHRs to facilitate care coordination also hampers it. Furthermore, healthcare disparities based on socioeconomic status, ethnicity, and geographical differences also limit care coordination.

Considering barriers to the use of community resources, patients with diabetes may be unaware of their presence and availability due to knowledge gaps blocking their practical use. Additionally, there can be limited community resources, making it difficult for diabetics to access them. Other barriers include exorbitant costs for community resources related to healthcare expenses and transportation, which patients with diabetes may not be able to afford (Nikitara et al., 2019). My mother also faced these barriers, such as inconsistent communication among interdisciplinary team members, which interfered with coordinated care delivery. Moreover, she was unaware of community resources available for diabetes, on which she acquired knowledge from me and other nurses.

State Board Nursing Practice Standards and/or Government/ Organizational Policies on Health Technology, Care Coordination, and Community Resources

The American Nursing Association (ANA) supports using health information technologies, provides standard guidelines to nurses, and has launched various initiatives in collaboration with the HIT committee (American Nurses Association, 2019). Similarly, ANA has informed nurses of their care coordination responsibilities, including collaboration with multidisciplinary teams to improve patient care quality and satisfaction (ANA, n.d.). The ANA has further provided standards on using community resources, such as guidelines provided by the American Diabetes Association (ADA) and CDC on diabetes management. These guidelines will enable care coordination among nurses, which is crucial for managing diabetes.

The HITECH Act also supports using healthcare technology to facilitate patient recovery and improve the quality of care through care coordination. The HITECH policies on patient privacy and confidentiality are essential for nurses in guiding them on the proper and meaningful use of healthcare information technologies such as data sharing through telehealth or EHRs (HIPAA Journal, 2023). Similarly, the American Diabetes Association has provided guidelines on using community resources such as DSMES programs and managing diabetes utilizing diabetes self-management toolkits and support from local community centers on diabetes (ADA, n.d.). These guidelines, standards, and policies are essential for managing diabetes in patients like my mother, who is in the early phase of diagnosed diabetes.

By using these standards and guidelines, I can effectively use technology such as providing telehealth services to my mother when I am unavailable to her and ensure she acquires care coordination and utilize community resources effectively. The implications for ethical professional practice of these guidelines will include achieving patient well-being through implementation of principles of beneficence and non-maleficence. Moreover, the patient’s protected health information (PHI) will be secured when ethical professional guidelines are practices.  I have also documented two practicum hours spent with my mother in learning about her experience with technology, care coordination, and use of community resources.


This assessment covers the technology use, care coordination, and community resource utilization for diabetes management. Telehealth, m-health, and remote monitoring are specific technologies that have been substantially used in literature and have resulted in improved health conditions. Moreover, care coordination and using community resources for diabetes can also control glycemic levels effectively. Lastly, ANA, ADA, and HITECH Act policies that guide nurses and patients on healthcare technologies, care coordination, and community resource utilization have been discussed. 


ADA. (n.d.). Discover the power of diabetes support | ADA. 

American Nurses Association. (2019). Health IT 

Amy, A. G. (2022). Improving the utilization of diabetes self-management education and support (DSMES) for patients with type II diabetes in the primary care setting. 

ANA. (n.d.). Care coordination and the essential role of nurses | american nurses association (ANA) 

HIPAA Journal. (2023). What is the HITECH act 

Kelly, J. T., Campbell, K. L., Gong, E., & Scuffham, P. (2020). The internet of things: Impact and implications for healthcare delivery. Journal of Medical Internet Research22(11). 

Khilnani, A., Schulz, J., & Robinson, L. (2020). The COVID-19 pandemic: New concerns and connections between eHealth and digital inequalities. Journal of Information, Communication and Ethics in Society18(3), 393–403. 

NURS FPX 4900 Assessment 3 Assessing the Problem Technology Care Coordination and Community Resources Considerations

Maneze, D., Weaver, R., Kovai, V., Salamonson, Y., Astorga, C., Yogendran, D., & Everett, B. (2019). “Some say no, some say yes”: Receiving inconsistent or insufficient information from healthcare professionals and consequences for diabetes self-management: A qualitative study in patients with type 2 diabetes. Diabetes Research and Clinical Practice156, 107830. 

McLendon, S. F., Wood, F. G., & Stanley, N. (2019). Enhancing diabetes care through care coordination, telemedicine, and education: Evaluation of a rural pilot program. Public Health Nursing36(3), 310–320. 

Nikitara, M., Constantinou, C. S., Andreou, E., & Diomidous, M. (2019). The role of nurses and the facilitators and barriers in diabetes care: A mixed methods systematic literature review. Behavioral Sciences9(6), 61. 

Phillip, M., Bergenstal, R. M., Close, K. L., Danne, T., Garg, S., Heinemann, L., Hirsch, I. B., Kovatchev, B., Laffel, L. M., Mohan, V., Parkin, C. G., & Battelino, T. (2020). The digital/virtual diabetes clinic: The future is now—recommendations from an international panel on diabetes digital technologies introduction. Diabetes Technology & Therapeutics23(2). 

Shan, R., Sarkar, S., & Martin, S. S. (2019). Digital health technology and mobile devices for the management of diabetes mellitus: State of the art. Diabetologia62(6), 877–887. 

NURS FPX 4900 Assessment 3 Assessing the Problem Technology Care Coordination and Community Resources Considerations

Sharma, V., Feldman, M., & Sharma, R. (2022). Telehealth technologies in diabetes self-management and education. Journal of Diabetes Science and Technology, 193229682210930. 

Walker, A. F., Hood, K. K., Gurka, M. J., Filipp, S. L., Anez-Zabala, C., Cuttriss, N., Haller, M. J., Roque, X., Naranjo, D., Aulisio, G., Addala, A., Konopack, J., Westen, S., Yabut, K., Mercado, E., Look, S., Fitzgerald, B., Maizel, J., & Maahs, D. M. (2021). Barriers to technology use and endocrinology care for underserved communities with type 1 diabetes. Diabetes Care44(7), dc202753. 

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