Haas, PhD, RN, FAAN; Beth Ann Swan, PhD, CRNP, FAAN; & Traci S. Haynes,
MSN, RN, CEN (Editors)
The Care Coordination and Transition Management
(CCTM) Core Curriculum, 1st
Edition text covers nine evidence-based dimensions:
- Education and engagement of patients and families
- Coaching and counseling of patients and families
- Patient-centered care planning
- Support for self-management
- Nursing process (proxy for monitoring and evaluation)
- Teamwork and collaboration
- Cross setting communications and care transitions
- Population health management
There is also an
introduction chapter dedicated to the transition from acute care to ambulatory
care and the critical nature of hand-offs in ensuring patient safety and
quality of care. Two chapters are devoted to technologies that provide decision
support and information systems for all dimensions of care coordination and
transition management: one focused on informatics, and one focused on
telehealth nursing practice.
The text is written for
nurses in all settings, from ambulatory care to hospitals, extended care
facilities to student nurses. The text is evidence-based and is organized to
include definitions, learning outcomes and objectives, a table of knowledge,
skills, and attitudes (KSAs), and nationally recognized core competencies for
quality and safety education for nurses (QSEN), inter-professional
collaborative practice, and public health nursing competencies.
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The Core is the
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