Module 6: Care Coordination and Transition Management: Support for Self-Management

After completing this learning activity, the learner will be able to identify and apply the concepts important to self-management and the primary components of self-management support.

Objectives:
1. Describe the concepts associated with support of self-management by ambulatory care registered nurses who are providing care coordination and transition management within the CCTM model.
2. Discuss the need for patient-centered assessment, and incorporation of patient values, goals, and preferences into planned care activities and approaches.
3. Outline the importance of recognizing the patient and health care team as equal partners in managing chronic conditions, with the RN in CCTM focused on building the patient’s and family’s knowledge, skills, and attitudes for self-management.
4. Identify patient self-management skills, gaps or barriers often encountered by members of the health care team.
5. Demonstrate understanding of knowledge, skills and attitudes that nurses need to support self-management in patients and families.

Requirements for Successful Completion:
1. Read the PDF handout which is the chapter of the CCTM Core Curriculum that corresponds with this module.
2. Listen the module in its entirety.
3. Complete the online CNE evaluation.

Faculty, Planners and Authors Conflict of Interest Disclosure:
Speaker(s) have no disclosures to declare.

Commercial Support and Sponsorship:
No commercial support or sponsorship declared.

Accreditation Statement:
This educational activity has been co-provided by Anthony J. Jannetti, Inc. and AAACN.

Anthony J. Jannetti, Inc. is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.

AAACN is a provider approved by the California Board of Registered Nursing, provider number CEP 5366.