NURS FPX 4065 Assessment 3: Ethical and Policy Factors Guide
Student name
Capella University
FPX 4065
Professor Name
Submission Date
Ethical and Policy Factors in Care Coordination
Hi, I am _______. In this presentation, I shall touch on an ethical and policy consideration of the coordination of care in order to fill the gaps in care at Valley Health Center.
Care coordination is significant in enhancing patient outcomes, especially in the case of vulnerable groups, who experience barriers to accessing healthcare services. The coordination of care among the community health organizations depends greatly on the policies of the government at the federal, state, and local levels. Valley Health Center has operated in accordance with the federal and state laws that have assisted in developing, funding, and offering healthcare services. The Affordable Care Act (ACA), Medi-Cal, Patient-Centered Medical Homes (PCMH), and Accountable Care Organizations (ACO) are some of the policies that can be put in place (Albertson et al., 2021). The policies also promote increased access to healthcare services and coordination of healthcare providers. Conversely, they too face ethical conflicts, including ethical issues relating to equity, access to care, and distribution of healthcare resources. The nurses and the care coordinators must balance between the requirements of policies and, on the other hand, provide fair and patient-centric care to the patients at low risk.
Effect of Governmental Policies on Coordination of Care
The government healthcare policies play significance in the planning of care coordination in healthcare organizations within communities. The organization, funding, and evaluation of the services in my practicum location, in Valley Health Center, are determined by the policies of both federal and state healthcare systems. The policies affect the staffing pattern, referral system, and preventive health services for the vulnerable groups. In this case, the care should be integrated, especially when it comes to cases like prolonged issues and dangerous diseases. The model of coordinated care can minimize rehospitalization of the patients by about 18-20% of the high-risk group and limit the outcomes of the patients and reduce health care expenditure (Agency for Healthcare Research and Quality, 2024). The healthcare providers can learn these policies in order to make sure that the respective healthcare services are provided to the patients as early as possible.
Affordable Care Act (ACA)
The ACA is regarded as one of the most powerful ones with reference to care coordination in the United States (U.S.). ACA has expanded the sphere of individuals, care delivery models that fulfill the care demands of the patients, such as the establishment of PCMH and ACO (Department of Health & Human Services, 2024). To facilitate this movement towards the provision of care to the patients within the long-term care integrated health care facility these models enable the health providers to work together with the move towards the provision of care to the patients within the long-term care integrated health care facility. Since the time it was enacted, the ACA has ensured that the affordability of care has been made more affordable. The health insurance, which has been covering over 40 million Americans, has been made accessible as per provisions of the ACA and has offered more people access to the preventive as well as primary care services (Kenton, 2022). Valley Health Center can adopt it, and such programs would eventually result in the possibility of interdisciplinary cooperation between nurses, physicians, social workers, and case managers in achieving better patient outcomes.
Medi-Cal
Another major policy, which affects the organization of care, such as the Medicaid program, is Medi-Cal. This policy exists in California and entails the medical service provisions for low-income earners. The increase in Medi-Cal since the ACA was enormous, and the agency would be able to offer access to millions of individuals who had never had access to it. Since 2023, there have been over 15 million California citizens registered for Medicaid, and Medicaid is among the largest Medicaid programs in the U.S. (McConville and Mustala, 2024). Nevertheless, the large number of health care patients covered is also an issue that has dictated the care providers who are most likely to make referrals, follow-ups, and referrals to care services. The responsibility of exposing the patients to such systems would be assigned to the care coordinators of the Valley Health Center in an attempt to determine whether the patients are getting the right healthcare services or not.
State Immunization Requirements
The critical assumptions concerning the use of such sources are that evidence-based research, which can be found in peer-reviewed journals, is considered a reliable source of information and how to make clinical judgments, and that the results of research could be extrapolated to other health care facilities. The other assumption is that the strategies mentioned above that control antibiotic resistance, including stewardship programs, infection-control strategies, provider-educational strategies, and responsible prescribing strategies, may be helpful in their application to various types of patients and settings. Additionally, one can suppose that such sources will be timely and reflective of the current trends, issues, and advancements in managing resistant infections to contribute to developing efficient prevention and treatment models (Mohammed et al., 2025). The information contained in the journals can be deemed as reliable because the journals are credible, the authors are the ones working in the area of infectious disease and population health, and the research studies they conduct are valid research designs, which can be applied to the area of clinical practice in order to fight antibiotic resistance.
Ethical and Policy Implications in Care Coordination
The dilemma for health practitioners is also in the nature of the ethical questions, where health practitioners are trying to fill the gaps in the healthcare provision. It seems that, though the number of people falling within the precincts of healthcare coverage has increased as a result of the ACA, some people cannot access healthcare services, as is the case with undocumented immigrants. Approximately 45% of the undocumented adults are uninsured. This casts doubts on the issue of justice and fair play (McKeown, 2023). This comes along with some ethical issues of equality and equal access to health care. Nurses are forced to balance between beneficence and nonmaleficence, autonomy and justice in allocating scarce slots of appointments and services.
The state level expanded Medi-Cal has contributed positively to healthcare coverage, but the absence of professionals can delay the potential of providing the coverage to a fraction of the patients. The resultant effect will be the creation of an ethical dilemma scenario as the care coordinators will have to make decisions based on the patient’s needs and limitations of the healthcare system. On the local level, understaffing and resources necessitate prioritization in allocating resources (Ratnapradipa et al., 2023). The medical administrators are expected to apply the rules and regulations of medical ethics, i.e., beneficence, autonomy, and justice, in order to prescribe how they themselves should be in the hands of the patients.
Impact and Consequences of the Policies
The healthcare policies, inasmuch as the implications they have in the healthcare delivery in organizations, particularly the Valley Health Center, are significant. The facilitating policies have strengthened the interdisciplinary collaboration and communication between the caregivers and models of care. The ACA has also, to a large extent, enhanced the preventive health care services. The increased utilization of primary care in the country increased by almost 6% due to the expansion of Medicaid. However, the healthcare policies can also be applied to administrative functions in healthcare (G Udensi et al., 2025). Being subjected to numerous documentation, assumptions, referrals, and insurance verifications may be endured by nurses and care coordinators. This is an administrative imperative, which at times can be a frustrating aspect of service delivery and is one of the reasons why the medical practitioners are under stress.
Impacts at the National, State, and Local Levels
On the national level, ACA has revolutionized the care coordination payment and accountability system by formulating models of results-based payment and delivery. Such models, too, require a significant amount of documentation, monitoring, and follow-up of the care teams to improve patient outcomes, and can, therefore, constitute a significant amount of administrative workload and an additive source of stress. To provide a value-based payment system in a country, as Etges et al. (2023) state, aggregate outcome tracking and quality reporting are required. This implies that additional efforts and control over its adherence are needed in the administration. This will result in burnout of the care coordinators, and the number of direct contacts with the patients will also decrease, adversely affecting the quality of care.
The state level has been able to cover greater numbers of people receiving healthcare services due to low incomes and underserved populations with the expansion of Medi-Cal in California. Instead of an increase in the number of patients, there has been an increase in the number of services provision which has consequently posed problems in terms of service acquisition in a timely manner. The fact that in the Medi-Cal EM, every fourth rural patient (25 per cent) is covered, which implies that they have problems related to access to specialist health care, which can also speak in favour of the system overload, and which can be deemed a sign of inequality in service delivery.
At the level of a local community, the policies of the local health department based on compulsory testing or wearing masks, which the COVID-19 pandemic brought, mediated the implementation of the patient engagement strategies. The risk of misinformation about its measures was shown to lead to patient resistance, affecting patient trust and attitudes towards vaccination (Chirico & Teixeira da Silva, 2023). Care teams also needed to alter their strategies towards communication and coordination to adhere to patient-centered care. These mutually reliant policies have shown how care coordination needs to establish the balance between the regulatory factors and patient demands that potentially may demand innovation and utilization of scarce resources.
Factors Contributing to Health Disparities and Access to Services
Social, economic, and systemic factors are some of the causal factors that cause health disparities in Valley Health Center. The vulnerable patients will also tend to seek care in the worst way possible since some of them are not insured, culturally insensitive, and distrust their medical care providers. Other social factors, such as poverty, unstable housing, low literacy, and others, are also complicating these issues and leading to poor health outcomes (Coombs et al., 2022). To check such inequalities, the nurses will map care with the social workers and case managers, and in the process, the patients will be granted holistic care not only in the medical care context but also in social and mental care. The approach is associated with the ethical principle of justice, and it is directed at decreasing the gap in care and enhancing the long-term health outcomes. A combination of healthcare delivery and social support has led to Valley Health Center providing equitable, holistic care, especially to the underserved population.
The Role of the Code of Ethics in Care Coordination
The Code of Ethics of Nurses is one of the most important guides in the ethical care management that ensures that the care given to the patient is in an observance to the principle of autonomy, a promoter of beneficence, an outcast who prohibits harm, and a supporter who promotes the establishment of fairness. Nurse champions representing the patients who might be experiencing one of the above-mentioned barriers that might be limiting their access to care, such as the uninsured, cultural difference as well as institutional bias (American Nurses Association, 2025). Ensuring that all patients, irrespective of their socioeconomic statuses, are provided with quality care that is fair is an extremely important advocacy.
In practice, the cooperation of nurses and other health care providers, such as social workers, case managers, and other health care providers, is witnessed in order to provide holistic care that cannot be simply based on the aspect of medicine alone, but it is encompassed within additional aspects that include social, economic, and psychological aspects, as well as poverty, housing, and education. As established, team-based care leads to improved health outcomes in patients with underserved populations since the social determinants are considered in the treatment plan (Laari & Duma, 2023). It is expected that the nurses will be in a position to ensure that care delivery is patient-centered, culturally sensitive, and equitable, and foster interdisciplinary collaboration to bridge the health disparities in accordance with the ethical principles.
Conclusion
The continuity of care and its access by the underprivileged populations are highly dependent on the government programs, ACA, and Medi-Cal. Whilst these policies have the advantage of increased opportunities of accessing healthcare, it is also accompanied by ethical considerations of equity and resource distribution, as well as patient prioritization. The Nursing Code of Ethics gives nurses the tools that could possibly guide them in the steps involved towards attaining all these issues since it highlights the concept of patient advocacy, the influence of social determinants of health, and the importance of partnership among the professionals of the healthcare field. Such morals can assist the nurses in Valley Health Center to structure their care in a way that will holistically and fairly treat vulnerable populations.
References
Agency for Healthcare Research and Quality. (2024). Agency for Healthcare Research & Quality https://www.ahrq.gov/
Albertson, E. M., Chuang, E., O’Masta, B., Lye, I. M., Haley, L. A., & Pourat, N. (2021). Systematic review of care coordination interventions linking health and social services for high-utilizing patient populations. Population Health Management, 25(1), 73–85. https://doi.org/10.1089/pop.2021.0057
American Nurses Association. (2025). Code of ethics for nurses. American Nurses Association. https://codeofethics.ana.org/home
Centers for Disease Control and Prevention. (2025). Centers for Disease Control and Prevention. U.S. Department of Health & Human Services. https://www.cdc.gov/
Chirico, F., & Teixeira da Silva, J. A. (2023). Evidence-based policies in public health to address COVID-19 vaccine hesitancy. Future Virology, 18(4). https://doi.org/10.2217/fvl-2022-0028
Coombs, N. C., Campbell, D. G., & Caringi, J. (2022). A qualitative study of rural healthcare providers’ views of social, cultural, and programmatic barriers to healthcare access. BioMed Central Health Services Research, 22(1), 438. https://doi.org/10.1186/s12913-022-07829-2
Department of Health & Human Services. (2024). U.S. Department of Health & Human Services. HHS.gov. https://www.hhs.gov/
Dismore, L., Frew, K., Wakefield, D., Bryan, C., & Swainston, K. (2025). Remote and rural communities face inequalities in access to specialist palliative care. Could telemedicine enhance care? A qualitative study of patients, carers, and healthcare professionals’ experiences of video consultation. Palliative Care and Social Practice, 19. https://doi.org/10.1177/26323524251380632
Etges, A. P. B. de S., Liu, H. H., Jones, P., & Polanczyk, C. A. (2023). Value-based reimbursement as a mechanism to achieve social and financial impact in the healthcare system. Journal of Health Economics and Outcomes Research, 10(2), 100–103. https://doi.org/10.36469/001c.89151
G Udensi, C., Vunnava, R., & Juliet Durojaye, T. (2025). Interdisciplinary collaboration in healthcare management: strengthening healthcare delivery – A review. International Journal of Advanced Multidisciplinary Research and Studies, 5(5), 210–216. https://doi.org/10.62225/2583049x.2025.5.5.4881
Kenton, W. (2022, September 23). Affordable Care Act (ACA): What it is, key features, and updates. Investopedia. https://www.investopedia.com/terms/a/affordable-care-act.asp
Laari, L., & Duma, S. E. (2023). Health advocacy role performance of nurses in underserved populations: A grounded theory study. Nursing Open, 10(9), 6527–6537. https://doi.org/10.1002/nop2.1907
McConville, S., & Mustala, S. (2024, January 17). Medi-Cal has expanded health coverage in California. Public Policy Institute of California. https://www.ppic.org/blog/medi-cal-has-expanded-health-coverage-in-california/
McKeown, A. (2023). Ethical challenges and principles in integrated care. British Medical Bulletin, 146(1), 4–18. https://doi.org/10.1093/bmb/ldac030
Ratnapradipa, K. L., Jadhav, S., Kabayundo, J., Wang, H., & Smith, L. C. (2023). Factors associated with delaying medical care: Cross-sectional study of Nebraska adults. Biomed Central Health Services Research, 23(1), 1–10. https://doi.org/10.1186/s12913-023-09140-0
FAQs
Q1: What are ethical principles in nursing practice?
Some important aspects that can assist the nurses to make right judgment regarding their patients include the following. The four ethical principles in nursing include autonomy, beneficence, non-maleficence, and justice.
Q 2: In what ways does health care policy affect the nursing practice field?
Health policies in the health sector guide the nursing profession on what should be done when it comes to setting standards for practicing health care delivery.
Q3: What is the role of a nurse in ethical decision-making?
Ethical issues in nursing cannot be separated from the nurse because he will always advocate for his patients, maintain their privacy, and utilize theories in ethics in challenging scenarios. Nurses work together with other team members of the healthcare system to make sound decisions.
Q4: Why should we consider patient autonomy an important issue in medicine?
Patient autonomy helps to ensure that people can have the ability to take control over their own health issues. This will foster confidence and satisfaction among patients.