NUR5125 - Integrated Care Delivery for People with Complex Needs across the Life Span

Objectives:

On successful completion of the module, apprentices will be able to:

1 - Explain the roles, responsibilities and scope of practice of different members of the nursing and interdisciplinary team and own role within it.

2 - Critically discuss the complexities of working across organisational and professional boundaries in providing care to people with a range a health care needs.

3 - Outline the complex nature of a range of specific conditions across different settings and the lifespan, recognising how to assess, manage and escalate risk.

4 - Critically analyse how the Nursing Associate works within a team collaboratively to support care integration and to maintain the effectiveness of care interventions across a range of specialist services.

5 - Apply evidence-based approaches to the delivery of integrated care for people with complex care needs, in the planning, monitoring and evaluation to maximise involvement, decision-making and independence in their own care.

Content:

This module aims to equip you with the knowledge and skills to work as part of an interdisciplinary team to contribute to care across organisations and settings and to provide safe, compassionate care to people with complex care needs and/or multiple co-morbidities, their families and carers. The module will explore a range of complex conditions across different age groups, settings and lifespan. You will learn how different providers and organisations contribute to the care of an individual and recognise where individuals may be at risk. You will situate this within the Nursing Associate role, and examine how you can work in partnership with other members of the multi-disciplinary team to support integrated care to plan, prioritise, organise and manage oneself whilst recognising your own limitations and professional boundaries and enable others to make informed decisions in shaping the design and delivery of care to effectively improve the outcomes of care for individuals through the lifespan.

Key topics covered in this module include the roles and responsibilities in interdisciplinary teams; social care providers; role of different health care providers, collaborative working; human and environmental factors; sharing information across teams and escalating concerns; communication to support team working; the patient and family role in monitoring care; supporting people at the end of life and bereaved families, recognising and supporting those in emotional, behavioural or cognitive distress; safe discharge and transition of care; therapeutic relationships, end of life decisions, advanced planning, living wills, lasting powers of attorney, organ and tissue donation protocols, mental health crisis and risk management, mental capacity, consent, vulnerability, frailty, cancer care, dementia, shared decision-making and supporting individuals, their families and carers to manage their own care when appropriate, critical incident analysis and reporting systems, medicines optimisation, concordance, adherence and compliance, polypharmacy. You consider the complexities of managing the provision of care needs across a wide range of specialist services and the challenges of caring for and supporting people within their own home or community. You will understand the principles of The House of Care (HoC) as a coordinated service model that enables patients with long-term conditions (LTCs) and clinicians to work together to determine and shape the support needed to enable them to live well with their condition and explore the evidence base for care pathways as a complex intervention for the mutual decision-making and organisation of care processes for people with complex care needs and/or co-morbidities.

Learning and Teaching Information:

Research informed key lectures will introduce the weekly content of the module identifying theories/principles/concepts enabling you to develop your knowledge and skills. This will be supported by blended learning pre and post session activities on Moodle and you will be expected to engage with a range of activities including pre-reading to prepare you for lectures and follow-on activities to enable ongoing self and tutor assessment of your progress and application of knowledge and skills. The lecture content will be supported by seminars enabling smaller group discussion where you will consolidate your knowledge and critically engage with best evidence to support your professional development and to apply your learning to clinical practice, activities will include role play, problem-based learning, and practice-based scenario exploration. Where appropriate specialist practitioners and service users and carers will be invited to contribute to sessions to increase the authenticity of lived experience of the module content and highlight employability links. Learning styles will be supported by a variety of resources including videos, reading material, discussion and debate, e-learning modules, problem solving and practical tasks. You will be expected to utilise appropriate digital technologies and study skills to engage with additional resources and in independently directing your own learning.

Planned LTU Off-the-Job Delivery Learning:

Lectures
Hours: 36
Intended Group Size: Cohort

Seminars
Hours: 18
Intended Group Size: 30

Directed Study
Hours: 6
Intended Group Size: Individual



Minimum Self-Directed Off the Job Learning (e.g. Self-directed Study)
Hours: 90



Further Details Relating to Assessment

Post session activities submitted through Moodle will facilitate ongoing formative assessment opportunities via lecturer or peer feedback, these may include responses to case studies, quizzes, forum posts or blogs and self-assessment. One draft opportunity will be provided for your patient pathway case study with feedback provided at least one week prior to summative submission.

Patient Pathway Case Study: You will write a 2000-word patient pathway case study. You will reflect on a patient you have worked with who has complex care needs and receives integrated care. This case study can be developed using a negotiated style and a range of methods for example using PowerPoint, infographics, video recordings, word document, flow charts. Whichever media you chose the case study will include a structured multidisciplinary plan of care outlining the roles and responsibilities of each discipline and how interprofessional team working supports the integrated, safe and effective delivery of care to improve health and wellbeing outcomes, how the patient, carers and family have been involved in decision making, monitoring and evaluating their own care and how they have been supported to do this. Your work will be informed by the contemporary evidence base for integrated care delivery, and you will also demonstrate the role of the nursing associate in supporting integrated care delivery.

Apprentices should be referred to Module Handbooks for full details of how to approach this assessment.

Please note that there is no compensation, each component must be passed at 40% - NMC regulations.

Assessment:

Fact File

Module Coordinator - PRS_CODE=
Level - 4
Credit Value - 15
Pre-Requisites - NONE
Semester(s) Offered -

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