Date of Award


Document Type

Open Access Thesis

Degree Name

Master of Arts in Nursing (MAN)



First Advisor

Joyce P. Miller RN DNP

Second Advisor

Kathleen Clark DNP, RN


Healthcare in the United States is fragmented and costly. Care coordination positively impacts healthcare cost and quality in healthcare systems. Case managers, social workers, and community health workers create health care teams in a health care home model. A team approach, formed by relationships built from collaboration, communication, and application of Complexity Theory, produces these outcomes. Relational coordination based on shared goals, shared knowledge, and mutual respect creates the framework from which to establish a team. Watson's Caring Science theory provides the conceptual framework to support the connectedness that occurs within a team approach. Creating a collaborative team of case managers, social workers, and community health workers could improve quality of care and reduce healthcare cost for patients in a healthcare system. The project brings together three roles from different disciplines who must work collaboratively together as a tearn to assist patients in achieving their healthcare goals. By incorporating the attributes of interdisciplinary collaboration within this team, everyone will be united working toward the common outcome of care coordination.


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