Assessing the Problem: Quality, Safety, and Cost Considerations Assignment

Assessing the Problem: Quality, Safety, and Cost Considerations Assignment

Part 1: Impacts of Mental Health on the quality of care, patient safety, and costs

Like a medical crisis, a mental health crisis can be devastating for people, families, and communities. Although it is impossible to predict an individual crisis, we can organize how we structure our services and our approaches to be most successful in providing to those who experience a mental health crisis (SAMHSA, 2020). Frequently, this experience is made worse with the delay, arrest, and even denial of service, which compromises the person, law enforcement, emergency department, and justice system resources in a manner that creates an undue burden on these people. In the absence of or insufficient crisis care, the costs increase as there is only an option of excessive dependent shorter-period hospital stays that leads to readmissions, over-use of police, and human catastrophes that arise from a lack of access to care.

It should be emphasized that the current emergency service delivery model is fragmented and offers little counseling or help to some individuals who are left untreated or ignored instead of being admitted to the hospital. These individuals often fall back into the cycle of rehospitalizations, the criminal justice system, living homeless, imminent death, and committing suicide (SAMHSA, 2020). A comprehensive and integrated public health system is the front line for preventing outbreaks of public and patient safety, civil rights, extraordinary and unacceptable loss of lives, and waste of resources. Crisis care that saves lives and dollars consistently needs a systems-based approach. This section explores how these crises affect quality of care, patient safety, and costs. Additionally, it proposes strategies to improve these areas and analyzes the impact of state board nursing practice standards and organizational policies.

Quality of Care

Mental crisis response services are an essential part of any mental health services framework. A thoroughly functioning crisis response system can fill the gap between community-based public providers, perform outreach by establishing connections between community-run help and mental health care services, and build better relationships with communities by providing comfort to the affected persons that their health needs are met during mental health crisis (National Alliance on Mental Illness, 2024). Sometimes, the most critical need during a crisis is immediate and qualified assistance. Nevertheless, the lack of mental health professionals, especially in rural areas, may lead to delayed treatment (National Alliance on Mental Illness [NAMI], 2024). Such delay may exacerbate the situation and slow the recovery process. A fragmented healthcare system can be a barrier containing crisis intervention, aftercare treatment, and community-based support services (Maulik et al., 2020). People may fall into the cracks, resulting in lapses in care and, thus, in the compromising of recovery (SAMHSA, 2020). SAMHSA’s research in 2021 indicated that only 47.2% of adults experiencing mental illness had been treated in the preceding year. This clearly underlines the vast disparity between the need for and the availability of quality mental health care.

Moreover, the stigma associated with mental illness is a factor that can lead to a widening of the gap in the quality of care received by individuals in crisis (Naslund & Deng, 2021). Studies have demonstrated that people with mental health crises often face difficulties in searching for the right healthcare services, which results in poor information sharing among providers. This gap in integration may limit the reach of the behavioral health care system that we, nurses, are able to see in action. The crisis individuals go through when they cannot find either a psychiatrist or a therapist who is able to accommodate them is a common situation that most frequently leads to frustration and only worsens the affected person’s condition.

Patient Safety

Mental health crises pose tremendous difficulties for the safety of patients, as during crisis periods, those experiencing the situation may have a high probability of self-harm, committing suicide, or hurting others. Inadequate provision of the right help promptly may increase the possibility of these tragic outcomes (American Foundation for Suicide Prevention [AFSP], 2023). The emergency departments during a crisis often become overcrowded. In this situation, medication errors can happen more often (The Joint Commission, 2023).

Moreover, as Savva et al. (2022), medication errors are most likely to occur in high-pressure situations like emergency departments, where crisis intervention is usually required. Nurses are a vital element of patient care during the crisis period to achieve the safety of the patients. By implementing calmness and a supportive presence, appraising suicide risk, and administering drugs properly, nurses can protect those in crisis.

Costs

Patients in crisis may go to the ED for an acute intervention, leading to more significant healthcare costs. In more complex cases, when the problem worsens, inpatient services or further healthcare expenses may be required (Roennfeldt et al., 2021). As per Bommersbach et al. (2023), people with mental health conditions make up a substantial portion of ED visits or hospital admissions. Mental health crises can also contribute to indirect costs like lost productivity caused by taking days off (de Oliveira et al., 2022). Nurses understand the hospital financial burden that psychiatric emergencies might bring to the system. Promoting the establishment of early interventions and outside hospital care models where they can attend to alternative treatment options are the ways through which nurses can contribute to cost-effective care.

Impact of State Board Nursing Practice Standards and Organizational Policies

The state board’s standards of nursing practice and organizational policies can create quality care, ensure patients’ safety, and reduce mental health crisis costs. State nursing practice standards typically define that the nurses should assess for mental health problems and issue referrals to appropriate clinics. These standards serve as a helpful guide for nurses to recognize patients in crisis and promptly respond to their needs ( National Council of State Boards of Nursing [NCSBN], 2023). NCSBN has created a comprehensive framework for mental health nursing practice that emphasizes a well-rounded approach, encompassing assessment, intervention, and appropriate referrals for individuals facing psychological challenges. How nurses respond to mental health crises is heavily influenced by organizational guidelines on mental health crisis intervention protocols, the use of technology, and collaboration with other healthcare professionals (ANA, 2023). The American Nurses Association (ANA) has released position statements on telehealth and crisis intervention, emphasizing the importance of following best practices and ethical guidelines.

Strategies to Improve Quality of Care, Enhance Patient Safety, and Reduce Costs

Building upon the challenges discussed earlier, the following strategies have the potential to lower expenses, improve patient safety, and raise the quality of care for adults experiencing mental health crises:

• Enhance the Availability of Crisis Intervention Services:
  • Increased financial resources and the development of infrastructure can facilitate the expansion of telehealth services, particularly in the context of crisis intervention. This would enable individuals residing in geographically isolated regions or facing physical limitations to obtain assistance from certified mental health practitioners promptly (McBain et al., 2023).
  • The expansion of crisis text lines offers an alternative means of communication for those who are unable to use phones or are reticent to make phone calls.
  • Culturally Competent Services: The establishment of crisis intervention services that are culturally competent guarantees that all individuals, irrespective of their ethnicity or heritage, feel at ease when seeking assistance.
• Transitions and Care Coordination Improvements: Standardized Protocols:
  • A more coordinated approach can be achieved by implementing standardized protocols for crisis intervention and referrals among various healthcare organizations (National Alliance on Mental Illness [NAMI], 2023).
  • The implementation of “warm handoffs,” which involve a crisis hotline staff member establishing a direct connection with a mental health professional at a community center, has the potential to optimize transitions and guarantee that individuals receive suitable subsequent care (SAMHSA, 2023).
  • The implementation of peer support programs as part of the continuum of care has the potential to offer sustained assistance and facilitate social integration for individuals who have experienced a crisis (SAMHSA, 2023).

Part 2: Practicum Experience Report

Meeting with Individuals Affected by Mental Health Crises:

During my initial two hours of practicum, I had the chance to connect with individuals and their loved ones who were in the process of recovering from a mental health episode. Using open and emphatic discussions, I was able to understand their experiences in accessing mental health care, maneuvering the healthcare system, as well as how they handle stress in times of crisis.

Learning from Patient Experiences:

Listening to open discussions among patients demonstrated a clear picture of mental health crises’ significance to health care provision, patient care, and expenses. Some people have shared experiences of being overwhelmed and upset with the fact that they could not see a mental health professional promptly, which led to prolonged suffering and, sometimes, further deterioration of their condition. Aside from the medications’ affordability and the effects of the medicines, patients shared these issues as common themes during our discussions.

Reviewing Evidence-Based Practice Documents

I studied several evidence-based practice documents and tried to familiarize myself with the contours of crisis intervention, mental health treatment modalities, and healthcare policy. These resources proved tremendously valuable as they provided external guidance to help understand the best possible ways of dealing with a mental health crisis, such as early intervention, thorough assessment, and multi-disciplinary teamwork. Furthermore, beyond these insights, I understood the role of nursing standards and practice as well as policy initiatives as the fundamental drivers and tips for mental health care provision and improving patient outcomes.

Leadership, collaboration, communication, change management, and policy study.  

In the course of my direct care to patients and families, I happened to meet with numerous difficulties in managing mental health crises temporarily. Stigma, difficulty in receiving services, and continuous discrepancies in care delivery were among the major issues discovered. Harnessing my leadership, communication, and collaboration skills, my perseverance allowed me to move the barriers and foster a conducive environment that was free of discrimination for open dialogue and shared decision-making.

Barriers Encountered

The initial doubts and fears of some patients and family members about the condition of the patients who suffer from mental health crises were evoked by their worries about the judgment from society and discrimination from other people. Nevertheless, with education, empathy, and evidence-based reasoning, I could talk about accessing timely intervention and seeking appropriate help from these peers.

Effecting Change

The mental health crisis is, therefore, associated with reduced competence of care, patient safety, and costs. It was inducing interesting debates about potential approaches to this issue. Cooperation with the patients, relatives, and community stakeholders I suggested that education on crisis intervention protocols, improving care coordination, and promoting mental health literacy can be changed for the better. Through empowering individuals to become advocates for change, my goal is to contribute to the development of mental health care systems that are more responsive and compassionate.

Conclusion

By improving access to resources, coordinating care more effectively, and integrating technology strategically, we can make significant strides in addressing mental health emergencies. This will result in better quality of care, increased patient safety, and reduced costs. Nurses play a crucial role in advocating for these reforms and ensuring the welfare of individuals experiencing mental health crises. The assessment thoroughly analyzed the issue, suggested evidence-based solutions, and emphasized the impact of nursing practice standards and organizational policies. Through interdisciplinary collaboration and the implementation of these measures, we may establish a more efficient and helpful system to treat mental health crises.

References

American Foundation for Suicide Prevention [AFSP]. (2023). AFSP 2023 annual report | Talk away the dark. Annual2023.Afsp.org. Accessed April 9^th 2024 from https://annual2023.afsp.org/research-grants

American Nurses Association. (2020). Ethics and human rights. ANA. Accessed April 9^th 2024 from https://www.nursingworld.org/practice-policy/nursing-excellence/ethics/

Bommersbach, T. J., McKean, A. J., Olfson, M., & Rhee, T. G. (2023). National trends in mental health-related emergency department visits among youth, 2011-2020. JAMA, 329(17), 1469. https://doi.org/10.1001/jama.2023.4809

Cuomo, A., Koukouna, D., Macchiarini, L., & Fagiolini, A. (2020). Patient safety and risk management in mental health. Textbook of Patient Safety and Clinical Risk Management, 287–298. https://doi.org/10.1007/978-3-030-59403-9_20

de Oliveira, C., Saka, M., Bone, L., & Jacobs, R. (2022). The role of mental health on workplace productivity: A critical review of the literature. Applied Health Economics and Health Policy, 21(2). https://doi.org/10.1007/s40258-022-00761-w

Maulik, P. K., Thornicroft, G., & Saxena, S. (2020). Roadmap to strengthen global mental health systems to tackle the impact of the COVID-19 pandemic. International Journal of Mental Health Systems, 14(57). https://doi.org/10.1186/s13033-020-00393-4

McBain, R. K., Schuler, M. S., Qureshi, N., Matthews, S., Kofner, A., Breslau, J., & Cantor, J. H. (2023). Expansion of telehealth availability for mental health care after state-level policy changes from 2019 to 2022. JAMA Network Open, 6(6), e2318045–e2318045. https://doi.org/10.1001/jamanetworkopen.2023.18045

Naslund, J. A., & Deng, D. (2021). Addressing mental health stigma in low-income and middle-income countries: A new frontier for digital mental health. Ethics, Medicine and Public Health, 19, 100719. https://doi.org/10.1016/j.jemep.2021.100719

National Alliance on Mental Illness. (2024). Getting Treatment During a Crisis | NAMI: National Alliance on Mental Illness. Www.nami.org. Accessed April 9^th 2024 from  https://www.nami.org/About-Mental-Illness/Treatment/Getting-Treatment-During-a-Crisis

NCSBN. (2023). Nursing Regulation. NCSBN. https://www.ncsbn.org/boards.page

Roennfeldt, H., Wyder, M., Byrne, L., Hill, N., Randall, R., & Hamilton, B. (2021). Subjective experiences of mental health crisis care in emergency departments: A narrative review of the qualitative literature. International Journal of Environmental Research and Public Health, 18(18), 9650. https://doi.org/10.3390/ijerph18189650

SAMHSA. (2020). National guidelines for behavioral health crisis care -A best practice toolkit knowledge informing transformation national guidelines for behavioral health crisis care best practice toolkit national guidelines for behavioral health crisis care -A best practice toolkit knowledge informing transformation. Accessed April 9^th 2024 from https://www.samhsa.gov/sites/default/files/national-guidelines-for-behavioral-health-crisis-care-02242020.pdf

Savva, G., Papastavrou, E., Charalambous, A., Vryonides, S., & Merkouris, A. (2022). Exploring nurses’ perceptions of medication error risk factors: Findings from a sequential qualitative study. Global Qualitative Nursing Research, 9. https://doi.org/10.1177/23333936221094857

The Joint Commission. (2023). Emergency department boarding’s impact on patient care and clinician well-being | the joint commission. Www.jointcommission.org. Accessed April 9^th 2024 from https://www.jointcommission.org/resources/news-and-multimedia/news/2023/11/ed-boarding-impact-on-patient-care-and-clinician-well-being/

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Part 1

Assess the effect of the patient, family, or population problem you defined in the previous assessment on the quality of care, patient safety, and costs to the system and individual. Plan to spend at least 2 practicum hours exploring these aspects of the problem with the patient, family, or group. During this time, you may also consult with subject matter and industry experts of your choice. Document the time spent (your practicum hours) with these individuals or group in the Capella Academic Portal Volunteer Experience Form. Use the Practicum Focus Sheet: Assessment 2 [PDF] Download Practicum Focus Sheet: Assessment 2 [PDF]provided for this assessment to guide your work and interpersonal interactions.

Part 2

Report on your experiences during your first 2 practicum hours, including how you presented your ideas about the health problem to the patient, family, or group.

• Whom did you meet with?
  • What did you learn from them?
• Comment on the evidence-based practice (EBP) documents or websites you reviewed.
  • What did you learn from that review?
• Share the process and experience of exploring the influence of leadership, collaboration, communication, change management, and policy on the problem.
  • What barriers, if any, did you encounter when presenting the problem to the patient, family, or group?
    • Did the patient, family, or group agree with you about the presence of the problem and its significance and relevance?
    • What leadership, communication, collaboration, or change management skills did you employ during your interactions to overcome these barriers or change the patient’s, family’s, or group’s thinking about the problem (for example, creating a sense of urgency based on data or policy requirements)?
  • What changes, if any, did you make to your definition of the problem, based on your discussions?
  • What might you have done differently?

The assessment requirements, outlined below, correspond to the scoring guide criteria, so be sure to address each main point. Read the performance-level descriptions for each criterion to see how your work will be assessed. In addition, note the additional requirements for document format and length and for supporting evidence.

• Explain how the patient, family, or population problem impacts the quality of care, patient safety, and costs to the system and individual.
  • Cite evidence that supports the stated impact.
  • Note whether the supporting evidence is consistent with what you see in your nursing practice.
• Explain how state board nursing practice standards and/or organizational or governmental policies can affect the problem’s impact on the quality of care, patient safety, and costs to the system and individual.
  • Describe research that has tested the effectiveness of these standards and/or policies in addressing care quality, patient safety, and costs to the system and individual.
  • Explain how these standards and/or policies will guide your actions in addressing care quality, patient safety, and costs to the system and individual.
  • Describe the effects of local, state, and federal policies or legislation on your nursing scope of practice, within the context of care quality, patient safety, and cost to the system and individual.
• Propose strategies to improve the quality of care, enhance patient safety, and reduce costs to the system and individual.
  • Discuss research on the effectiveness of these strategies in addressing care quality, patient safety, and costs to the system and individual.
  • Identify relevant and available sources of benchmark data on care quality, patient safety, and costs to the system and individual.
  • Length: Your paper should be approximately 5–7 pages in length, not including the reference page.
  • Supporting evidence: Cite at least 5 sources of scholarly or professional evidence that support your central ideas. Resources should be no more than five years old. Provide in-text citations and references in APA format.