NURS FPX 4065 Assessment 2 Preliminary Care Coordination Plan

Name

Capella university

NURS-FPX4065 Patient-Centered Care Coordination

Prof. Name

Date

Preliminary Care Coordination Plan for Adult Mental Health Patients in Acute Healthcare Settings

This care coordination plan has been developed to address the needs of adult patients admitted to acute healthcare facilities with mental health conditions. These individuals often encounter overlapping physical, cultural, and psychosocial challenges, which complicate treatment and hinder recovery. A collaborative, multidisciplinary approach is required to provide holistic care, maintain continuity across services, and support long-term health and quality of life.

Physical Considerations and Best Practices

Risks

Adults with serious psychiatric conditions are at high risk of developing comorbid physical illnesses. Cardiovascular disease, diabetes, respiratory disorders, and metabolic dysfunctions are frequently observed among this population. Evidence suggests that individuals with severe mental illness have a 15–20-year shorter life expectancy compared to the general population (Nielsen et al., 2021). Multiple factors, such as sedentary lifestyles, poor dietary practices, healthcare access barriers, and side effects from psychotropic medications, contribute to this increased vulnerability.

Best Practices

Mitigating these risks requires integration of preventive and medical interventions:

• Routine Health Screenings: Regular monitoring of body mass index (BMI), blood pressure, glucose, and lipid levels can support early detection of chronic diseases.

• Lifestyle-Focused Programs: Structured exercise regimens, smoking cessation strategies, and individualized dietary guidance promote healthier living and reduce disease burden (Koomen et al., 2022).

• Medication Oversight: Continuous evaluation of medication side effects ensures safe use of psychotropics and minimizes risks of long-term complications.

Table 1. Physical Considerations and Best Practice Approaches

Physical Consideration	Best Practice Approach
Risk of cardiovascular, metabolic, and respiratory diseases	Implement regular screenings (BMI, glucose, cholesterol, blood pressure)
Reduced lifespan in psychiatric populations	Provide lifestyle-focused interventions (exercise, diet modification, smoking cessation)
Adverse drug reactions from psychotropics	Conduct close supervision and timely pharmacological adjustments

Understanding Mental Illness

Mental illness involves disturbances in emotions, behavior, and cognition, which affect daily functioning and decision-making. Causes may include biological predispositions, psychological stressors, or developmental conditions (Stein et al., 2021).

In the U.S., 1 in 5 adults is affected by a mental illness annually. In Florida, approximately 2.8 million adults have reported mental health struggles, and nearly 41% experienced anxiety or depression symptoms in 2021 (NAMI, n.d.). This data emphasizes the urgent need for evidence-based, coordinated care strategies to enhance recovery and improve quality of life.

Cultural Considerations and Best Practices

Barriers and Challenges

Cultural stigma, myths, and deeply rooted traditional beliefs can prevent patients from acknowledging mental health conditions or seeking treatment. Many individuals avoid care due to fear of discrimination, social exclusion, or community disapproval.

Best Practices

Culturally sensitive approaches can overcome these barriers:

• Culturally Adaptable Care: Aligning care strategies with patients’ cultural values and practices helps build trust and engagement (Ahad et al., 2023).

• Culturally Competent Education: Awareness campaigns designed for specific cultural groups reduce stigma and encourage help-seeking. These can include family workshops, community seminars, and faith-based programs.

• Inclusive Communication: Providing resources in multiple languages ensures accessibility and broadens patient understanding.

Table 2. Cultural Considerations and Recommended Best Practices

Cultural Challenge	Recommended Best Practice
Stigma and misconceptions	Provide culturally relevant health education and awareness programs
Hesitation to seek treatment	Incorporate cultural traditions into care planning
Lack of knowledge on mental illness	Offer multilingual educational campaigns and resources

Psychosocial Considerations and Best Practices

Psychosocial challenges are major determinants of mental health outcomes. Individuals with psychiatric conditions often face emotional instability, strained relationships, social withdrawal, and ineffective coping strategies. These factors contribute to reduced community participation and poor decision-making capacity.

Evidence-Based Practices

• Mindfulness-Based Cognitive Therapy (MBCT): A combination of mindfulness and CBT techniques helps reduce depression relapse and improve resilience (Gkintoni et al., 2025).

• Stress Management Interventions: Yoga, meditation, and breathing exercises help patients regulate stress and promote relaxation.

• Group Psychotherapy: Peer-support therapy builds social networks, improves self-esteem, and provides a sense of belonging (Marmarosh et al., 2022).

Table 3. Psychosocial Considerations and Evidence-Based Practices

Psychosocial Need	Evidence-Based Practice
Emotional instability	Mindfulness-Based Cognitive Therapy (MBCT)
Stress and anxiety	Yoga, meditation, controlled breathing
Social isolation	Group therapy sessions to build peer support

Underlying Assumptions and Uncertainties

• It is assumed that MBCT and lifestyle modifications can benefit all patient groups.

• It is assumed that culturally sensitive education universally reduces stigma.

• Uncertainty remains regarding the effectiveness of stigma-reduction programs across different cultural groups.

• Resource limitations in acute healthcare settings may restrict the implementation of best practices.

SMART Goals

• Goal 1: Initiate weekly MBCT sessions for adults with psychiatric conditions in Florida.

  • Target: Achieve a 40% reduction in depressive symptoms within six months, measured using the Patient Health Questionnaire (PHQ-9).

• Goal 2: Conduct biweekly culturally tailored workshops to raise awareness and reduce stigma.

  • Target: Achieve a 60% improvement in patient knowledge and stigma reduction, measured via pre- and post-intervention surveys in six months.

Community Resources

Sustained mental health recovery requires connection with community resources. These services provide continuity of care, support systems, and affordable access to therapeutic programs.

Table 4. Community-Based Mental Health Resources

Resource	Services Provided	Contact Information
Mental Health Association of Central Florida (MHACF)	Peer counseling, free therapy, educational workshops	Phone: 407-898-0110; Address: 605 E Robinson St., Suite 450, Orlando, FL 32801
Caron Florida	CBT, DBT, group/individual therapy, medication management	Phone: 1-855-548-0352; Address: 7789 NW Beacon Square Blvd, Boca Raton, FL
NAMI Florida	Advocacy, awareness campaigns, peer support	Phone: 850-671-4445; Address: P.O. Box 302, Ocala, FL 34478
Care Resource	Affordable therapy, psychiatric programs, community-based services	Phone: 305-576-1234; Address: 3510 Biscayne Blvd., Miami, FL 33137

References

Ahad, A. A., Sanchez-Gonzalez, M., & Junquera, P. (2023). Understanding and addressing mental health stigma across cultures for improving psychiatric care: A narrative review. Cureus. https://doi.org/10.7759/cureus.39549

Care Resource. (2025). Behavioral health. Care Resource. https://careresource.org/services/behavioral-health/

NURS FPX 4065 Assessment 2 Preliminary Care Coordination Plan

Caron Florida. (2024). Mental health program. Caron Transformational Care. https://www.caron.org/treatment-programs/mental-health-program

Gkintoni, E., Vassilopoulos, S. P., & Nikolaou, G. (2025). Mindfulness-based cognitive therapy in clinical practice: A systematic review of neurocognitive outcomes and applications for mental health and well-being. Journal of Clinical Medicine, 14(5), 1703. https://doi.org/10.3390/jcm14051703

Koomen, M., van, J., Deenik, J., & Cahn, W. (2022). Lifestyle interventions for people with a severe mental illness living in supported housing: A systematic review and meta-analysis. Frontiers in Psychiatry, 13, 966029. https://doi.org/10.3389/fpsyt.2022.966029

Marmarosh, C. L., Sandage, S., Wade, N., Captari, L. E., & Crabtree, S. (2022). New horizons in group psychotherapy research and practice from third wave positive psychology: A practice-friendly review. Research in Psychotherapy: Psychopathology, Process and Outcome, 25(3), 643. https://doi.org/10.4081/ripppo.2022.643

MHACF. (2025). About us. Mental Health Association of Central Florida. https://mhacf.org/learn-more/

NAMI Florida. (2025). Mission. National Alliance on Mental Illness Florida. https://namiflorida.org/about-nami-florida/mission/

National Alliance on Mental Illness. (n.d.). Mental health in Florida. National Alliance on Mental Illness. https://www.nami.org/wp-content/uploads/2023/07/FloridaStateFactSheet.pdf

NURS FPX 4065 Assessment 2 Preliminary Care Coordination Plan

Nielsen, R. E., Banner, J., & Jensen, S. E. (2021). Cardiovascular disease in patients with severe mental illness. Nature Reviews Cardiology, 18(2), 136–145. https://doi.org/10.1038/s41569-020-00463-7

Stein, D. J., Palk, A. C., & Kendler, K. S. (2021). What is a mental disorder? An exemplar-focused approach. Psychological Medicine, 51(6), 894–901. https://doi.org/10.1017/S0033291721001185