NURS 8114 Framing a Practice Problem as a Critical Question With Measurable Outcomes

Sample Answer for NURS 8114 Framing a Practice Problem as a Critical Question With Measurable Outcomes Included After Question

BY DAY 3 OF WEEK 7

Post a brief explanation of your critical question. Then, synthesize the 4-5 articles you identified that address your critical question. Using the same language you would use with stakeholders, explain the critical question and the value of addressing it as a quality improvement initiative. Be specific. Cite the scholarly articles and other resources to support your post.

Read a selection of your colleagues’ posts.

BY DAY 6 OF WEEK 7

Respond to at least two of your colleagues on 2 different days by suggesting a different way of framing their critical question. Cite sources to support your posts and recommend to colleagues.

A Sample Answer For the Assignment: NURS 8114 Framing a Practice Problem as a Critical Question With Measurable Outcomes

Title: NURS 8114 Framing a Practice Problem as a Critical Question With Measurable Outcomes

Critical Question: Will a nurse education program improve their ability and understanding of teaching self-management approaches to patients newly diagnosed with Type 2 Diabetes?

Explanation of the Critical Question

This topic was inspired by the paucity of knowledge provided to newly diagnosed Type 2 Diabetes patients. Patient education is critical to improving patient outcomes (Tigestu et al., 2022). This is mainly based on the fact that the patients will understand their illnesses, the underlying causes, and triggers, what has to be done to avoid additional difficulties, and lifestyle adjustments that will ensure they live a healthy life (Banstola et al., 2022). Unfortunately, several challenges confront this profession, including a lack of expertise in patient education, insufficient time, and a lack of educational resources.

Summary of Articles

In response to the critical question, two articles were utilized. To begin, Chou et al. (2022) investigated how a training program increases nurses’ abilities, knowledge, and confidence in providing patient-centered care. The authors observed that nurses frequently had difficulty entering the neighborhood. A learning gap was observed because the nurses felt unprepared to handle the new situation in which a multidisciplinary team is involved in providing patient-centered care to patients with chronic diseases.

The findings demonstrate that when a community nurse training program is designed to fit the requirements of the community nurse, it is effective. Through this training, nurses may strengthen their skills and knowledge, therefore closing the knowledge gap.

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The second article by Romero-Castillo et al. (2022) was based on the notion that diabetes is a chronic condition that necessitates a high level of patient self-care. A four-session teaching program was administered by a nurse diabetes educator. This study employed a two-group randomized controlled trial with an intervention and a control group. The individuals in the experimental group got some health education classes, whereas the control group received the hospital’s current standard treatment offered by the endocrinology and nutrition section.

The study’s major goal was to improve patients’ awareness of nutrition and treatment management. Secondary results include improved glucose management and mood in patients. The outcomes of this study will aid in determining the influence of diabetes education on self-care and therapy in diabetic patients, as well as in reducing short- and long-term problems and healthcare expenses.

NURS 8114 Framing a Practice Problem as a Critical Question With Measurable Outcomes
NURS 8114 Framing a Practice Problem as a Critical Question With Measurable Outcomes

Stakeholder Involvement

When patients are properly informed, their self-care practices greatly improve. Diabetes education is currently provided by no certified experts. Because of this gap, nurses will be the healthcare professionals responsible for educating patients on self-care (Romero-Castillo et al., 2022). Unfortunately, this profession has several challenges, including a lack of expertise in patient education, insufficient time, and a lack of educational resources. These obstacles impede nurses from providing enough diabetes education to patients to reach the intended aim of a healthier population (Khan & Kazmi, 2022). Several academics have claimed that nurse training is critical for improving nurses’ expertise, knowledge, and confidence in their capacity to provide patient education.

Conclusion

The advanced practice diabetic nurse is an important resource for self-care and health management education. In addition to minimizing problems caused by inadequate glycemic control, the patient must be appropriately taught and self-sufficient in the administration of home therapy. The findings of the reviewed studies can give a scientific foundation for the necessity of beginning therapeutic education programs with well-organized and up-to-date training. Finally, increasing diabetes patients’ awareness would result in lower healthcare expenses due to consequences such as hypoglycemia, ketoacidosis, foot ulcers, and insulin delivery mistakes. It will also improve the emotional states and quality of life of diabetic patients.

References

Banstola, P., Yadav, D. K., & Pandey, R. (2022). Assessment of Self-care practices, Treatment satisfaction and Quality of Life among Diabetes Type2 Patients in Pokhara, Nepal. MedS Alliance Journal of Medicine and Medical Sciences2(3), 63–69. https://doi.org/10.3126/mjmms.v2i3.47751

Chou, C. Y., Le, K. M., & Low, J. A. (2022). Community nurses’ perspectives on a novel blended training approach: A qualitative study. BMC Nursing, 21, 1-9. https://doi.org/10.1186/s12912-022-00893-3

Khan, Z., & Kazmi, U. E. R. (2022). Diabetes Self Care, Resilience and Quality of Life among Patients with Type II Diabetes. Pakistan Journal of Health Sciences, 55–58. https://doi.org/10.54393/pjhs.v3i06.185

Romero-Castillo, R., Pabón-Carrasco, M., Jiménez-Picón, N., & Ponce-Blandón, J. A. (2022). Effects of nursing diabetes self-management education on glycemic control and self-care in type 1 diabetes: Study protocol. International Journal of Environmental Research and Public Health, 19(9), 5079. https://doi.org/10.3390/ijerph19095079

Tigestu, A. D., Namara, K. M., Yifter, H., & Manias, E. (2022). Development of a complex intervention for effective management of type 2 diabetes in a developing country. Journal of Clinical Medicine, 11(5), 1149. https://doi.org/10.3390/jcm11051149

A Sample Answer 2 For the Assignment: NURS 8114 Framing a Practice Problem as a Critical Question With Measurable Outcomes

Title: NURS 8114 Framing a Practice Problem as a Critical Question With Measurable Outcomes

Psychiatric mental health nurses play a crucial role in the provision of care that promote the mental health and wellbeing of the affected populations and their significant others. They work in environments that predispose them to harm from patients, their significant others, and other staff. The provision of safe environment that meets the needs of these nurses is important. However, evidence shows that psychiatric mental health nurses experience different forms of violence in their practice. Therefore, the focus of my critical question is on workplace violence and aggression on mental health nurses.

Summary of the Critical Question

As noted above, my critical question focuses on workplace violence and aggression mental health nurses. Psychiatric mental health nurses as well as other healthcare providers are increasingly predisposed to workplace violence. Violence in mental healthcare settings has increased significantly, exposing nurses working in these settings to harm and injuries compared to those working in other fields in healthcare (Niu et al., 2019). About 40-65% nurses working in psychiatric in-patient and outpatient units have experienced workplace violence, which negatively affects their health. Part of the reasons for the increased predisposition of psychiatric nurses to workplace violence is that they care for patients suffering from substance misuses issues, psychotic symptoms, and mood disorders (Konttila et al., 2021).

Psychiatric nurses also experience suboptimal working conditions, which contribute to their exposure to violence. Violence can have serious psychological and physical consequences on psychiatric nurses. For example, persistent exposure to workplace violence may predispose nurses to post-traumatic stress disorder six months after traumatic exposures, which can last up to four years. The effect of workplace violence on American government is enormous. For instance, the American Nurses Association estimates that America spends about $2.7 billion in addressing workplace violence and its effects on nurses and other healthcare providers (Dean et al., 2021; Havaei, 2021). Therefore, it is crucial that interventions that prevent and minimize violence targeted on psychiatric nurses be implemented for their health and wellbeing.

Summary of the Articles

The identified articles focusing on the critical question include the ones by Dean et al., (2021), Havaei (2021), and Konttila et al., (2021). The study by Konttila et al., (2021) examined the occurrence of workplace violence and its associated psychological consequences among nurses working in psychiatric outpatient settings. The authors adopted a cross-sectional study design, involving 181 nurses. The results obtained from the participants showed that most of them experienced psychological violence one year before the study was conducted.

Psychiatric nurses reported fatigue as the most common consequence of psychological violence. Forms of violence such as harassment made them feel that their integrity was violated while physical violence caused insomnia. Therefore, the authors recommended the need for de-escalation interventions to prevent and eliminate workplace violence for psychiatric nurses.

Dean et al., (2021) conducted a study that investigated the impact of workplace violence towards psychiatric mental health nurses. They sought to identify the facilitators as well as barriers to supportive resources in the psychiatry settings. The authors adopted a qualitative study approach where nurses provided their experiences with workplace violence. The analysis of data by the authors showed that psychiatric nurses frequently experienced workplace barriers, attempted to understand it, and expressed the need for supportive means for the affected populations. They also expressed barriers that affect their intent to seek support following their experiences of workplace violence.

The study by Havaei (2021) examined if the type of workplace violence that psychiatric nurses are exposed to affect their mental health. The authors adopted an exploratory correlational study design with survey methods that involved nurses from British Columbia, Canada. The research obtained responses from 2958 nurses. The analysis of data demonstrated that mental health problems increased significantly with exposure of psychiatric nurses to workplace violence. Nurses with indirect exposure to workplace violence had mild mental health problems. Most of the nurses who experienced direct workplace violence reported consequences that included anxiety, post-traumatic stress disorder, burnout, and depression compared to those without any exposure to workplace violence.

Value of Addressing the Critical Question

The evidence obtained from the above articles demonstrate that workplace violence has negative effect on the health and wellbeing of psychiatric nurses. The exposure to violence predisposes them to mental health problems such as anxiety, depression, insomnia, and post-traumatic stress disorder. Psychiatric nurses also suffer from burnout, which affect their job satisfaction, quality, and safety of nursing care (Havaei, 2021). Therefore, it is important to address the issue as a quality improvement since it affects all aspects of psychiatric care.

Evidence shows that not all nurses report their experiences with workplace violence. Addressing it as a quality improvement will provide an opportunity for all the organizational stakeholders to explore effective, evidence-based interventions they can adopt to ensure sustainable outcomes in preventing workplace violence. Lastly, addressing the issue as a quality improvement initiative will transform the organizational culture (Konttila et al., 2021). The implementors will anchor best practices for violence prevention on the existing culture, hence, safety and sustainable change in the organization.

Conclusion

In summary, psychiatric nurses are highly predisposed to workplace violence compared to other healthcare providers working in different settings. Workplace violence affect the psychological and physical wellbeing of the psychiatric nurses. It also affects the safety, quality, and efficiency of psychiatric care that patients receive. Therefore, it is important to address the issue as a quality improvement initiative to ensure the transformation of healthcare systems and the creation of sustainable change and culture of staff safety.

References

Dean, L., Butler, A., & Cuddigan, J. (2021). The Impact of Workplace Violence Toward Psychiatric Mental Health Nurses: Identifying the Facilitators and Barriers to Supportive Resources. Journal of the American Psychiatric Nurses Association, 27(3), 189–202. https://doi.org/10.1177/10783903211010945

Havaei, F. (2021). Does the Type of Exposure to Workplace Violence Matter to Nurses’ Mental Health? Healthcare, 9(1), Article 1. https://doi.org/10.3390/healthcare9010041

Konttila, J., Holopainen, A., Pesonen, H.-M., & Kyngäs, H. (2021). Occurrence of workplace violence and the psychological consequences of it among nurses working in psychiatric outpatient settings. Journal of Psychiatric and Mental Health Nursing, 28(4), 706–720. https://doi.org/10.1111/jpm.12723

Niu, S.-F., Kuo, S.-F., Tsai, H.-T., Kao, C.-C., Traynor, V., & Chou, K.-R. (2019). Prevalence of workplace violent episodes experienced by nurses in acute psychiatric settings. PLOS ONE, 14(1), e0211183. https://doi.org/10.1371/journal.pone.0211183

A Sample Answer 3 For the Assignment: NURS 8114 Framing a Practice Problem as a Critical Question With Measurable Outcomes

Title: NURS 8114 Framing a Practice Problem as a Critical Question With Measurable Outcomes

The overcrowded emergency room has seen more patients returning to the ED, for the same medical treatment due to poor communication between emergency personnel and patients. This is likely due to medical personnel not participating in interdisciplinary care, which is necessary for patient-centered care. Patients seek treatment and a better understanding of their diagnosis in the ED discharge planning.

Critical question

Can medical personnel be trained to effectively facilitate interdisciplinary care, resulting in exceptional patient-centered care and fewer emergency room readmissions? 

Article 1:

 Mao, W., Shalaby, R., & Opoku Agyapong, V. I. (2023). Interventions to Reduce Repeat Presentations to Hospital Emergency Departments for Mental Health Concerns: A Scoping Review of the Literature. Healthcare11(8). https://doi.org/10.3390/healthcare11081161Links to an external site.

The purpose of this study was to determine why there was such an increase in emergency room return visits with mental health patients.

Sampled size and setting- The sample size varied from n = 20 to n = 13.7 million for the various trials, and the median sample size was 583. The study participants were all patients with psychiatric diagnoses and who had had emergency visits for reasons related to their mental health issues.

Data Collection- This scoping review followed a systematic search strategy developed and applied to electronically conduct a data search in several major scientific databases. These databases are authoritative, peer-reviewed, and comprehensive and include PubMed, PsycINFO, MEDLINE, JSTOR, Scopus, and Web of Science, for interventions contributing to decreasing repeat ED visits for mental health concerns up to November 2022. Two researchers independently screened and reviewed titles, abstracts, and full-text articles that met the inclusion criteria.

Study findings- This review analyzed 26 published studies on interventions to decrease repeat visits to hospital emergency departments for mental health concerns. The interventions utilized various comprehensive and multidisciplinary services, including evidence-based behavioral and pharmacological strategies focusing on effective case management. The studies primarily consisted of observational research conducted in North America between 2010 and 2021.

Furthermore, besides the interventions examined in this review, governments and policymakers can implement cost-effective and easily scalable population-level psychological interventions, such as Text4Hope, Text4Mood, and Text4Support. These interventions have proven successful in providing psychological support services to the public and reducing psychiatric readmissions and emergency department visits across various populations.

Limitations- It is acknowledged that this scoping review has several limitations. One major limitation relates to the small number of studies that were analyzed and synthesized for qualitative analysis, which raises the importance of garnering the view and feedback of patients and healthcare providers regarding unmentioned potential effective interventions to reduce ED admission.

Article 2:

Palungwachira, P., Montimanutt, G., Musikatavorn, K. et al. Reducing 48-h emergency department revisits and subsequent admissions: a retrospective study of increased emergency medicine resident floor coverage. Int J Emerg Med 15, 66 (2022). https://doi.org/10.1186/s12245-022-00471-z

The purpose– This study evaluated the effects of an increase in the number of physicians and the 24-h coverage of emergency physicians on 48-h ED revisits with subsequent hospital admission. The characteristics and risk factors of the patients were also investigated.

Sampled size and setting- A sample size of 237 patients from each group was sufficient to ensure an 85% power to detect a decrease of 10% in the incidence between the preintervention and postintervention periods. We omitted cases with missing data, which were 3.7% of cases, and analyzed the remaining data.

Data Collection- This study was based at the ED of the urban 1500-bed tertiary care King Chulalongkorn Memorial University Hospital (KCMH), Bangkok, Thailand. The annual ED visit rate among adult patients is approximately 40,000 patients per year. The medical records of all adult patients who revisited the ED within 48 h after initial discharge from July 1, 2014, to June 30, 2019, were extracted from our ED administrative database and retrospectively reviewed in terms of patient information, disease category, length of stay during the first ED visit, hospital visits within the previous 12 months, underlying diseases, and triage level according to the emergency severity index (ESI) score. 

Study findings- After conducting a study, it was found that there was no correlation between increasing the number of emergency department physicians and the rate of ED revisit admissions. However, it was identified that certain factors may help prevent patients from returning to the ED within 48 hours. As emergency care strives to be more patient-centered, it is important to continue developing interventions that can improve the quality of care provided to ED patients.

Limitations- The study was a retrospective study carried out in a single tertiary hospital, and therefore, the results may not be generalizable to other settings. Furthermore, the availability of insufficient data was difficult to overcome. 

Article 3:

Tsai, H., Xirasagar, S., Carroll, S., Bryan, C. S., Gallagher, P. J., Davis, K., & Jauch, E. C. (2018). Reducing High-Users’ Visits to the Emergency Department by a Primary Care Intervention for the Uninsured: A Retrospective Study. INQUIRY: The Journal of Health Care Organization, Provision, and Financing. https://doi.org/10.1177/0046958018763917

The purpose– One of the main objectives of the healthcare system is to decrease the number of unnecessary visits to the emergency department (ED). To investigate the effectiveness of a primary care intervention, a retrospective cohort study was conducted at a nonprofit hospital. The study examined the impact of an in-hospital clinic for poor and uninsured adult patients, which was free of charge. The study evaluated the rates of ED visits and the severity of emergencies before and after the implementation of the intervention.

Sampled size and setting- Of total 108 717 adult ED visits, 2898 (2.7%) were excluded due to missing patient identifying information.  the distribution of 105 819 visits by year and user type. Overall, ED volumes increased over the study period. After excluding 1-time ED patients whose visit ended in an inpatient admission, the mean annual visit volume was 16 372 preintervention and 18 496 postintervention. Annual visit volumes contributed by preintervention high-users declined in the postintervention period by 53.8% (P < .001).

Data Collection-  This study is an observational analysis of a non-profit, religious missionary hospital’s effort to reduce low-severity emergency department visits through a primary care intervention. The hospital is situated in the inner-city region of Columbia, South Carolina and gathered billing data for all emergency department visits made by adults aged 18 and above over two periods. The pre-intervention period spanned from August 16, 2009, to August 15, 2011, while the post-intervention period was from August 16, 2011, to August 15, 2014. The data were categorized based on the patient’s name, social security number, and date of birth.

Study findings- According to the study, patients who had an established primary care physician (PCP) were less likely to return to the emergency department (ED) for follow-up care. Those who did not have an established PCP or were in the process of finding one were more likely to return to the ED. The study also suggests that having a multidisciplinary care approach, including free-standing clinics and PCPs, can help alleviate the burden on the emergency room.

Limitations- study addresses several limitations of the above study, notably (1) offering a longitudinal study of the ED population; (2) tracking individual patients’ ED use patterns before and after implementation of the intervention to examine utilization changes by user type; (3) studying a hospital-funded, on-campus primary care clinic which ensured prompt patient acceptance into primary care; (4) a clinic with a systematic approach to care continuity and care coordination implemented by salaried medical and ancillary providers offering dependable provider availability; and (5) a systematized approach to facilitate real access to ancillary medical services (pharmaceuticals, laboratory, and imaging services) that are critical to making a primary care intervention meaningful for the goal of reducing avoidable medical care.

Article 4:

Moe, J., Kirkland, S. W., Rawe, E., Ospina, M. B., Vandermeer, B., Campbell, S., & Rowe, B. H. (2017). Effectiveness of Interventions to Decrease Emergency Department Visits by Adult Frequent Users: A Systematic Review. Academic Emergency Medicine24(1), 40-52. https://doi.org/10.1111/acem.13060

The purpose– Frequent emergency department (ED) users are high-risk and high-resource-utilizing patients. This systematic review evaluates effectiveness of interventions targeting adult frequent ED users in reducing visit frequency and improving patient outcomes.

Sampled size and setting- A total of 6,865 citations were identified and 31 studies included. Designs were noncontrolled (n = 21) and controlled (n = 4) before–after studies and randomized controlled trials (n = 6). Frequent user definitions varied considerably and risk of bias was moderate to high. Studies examined general frequent users or those with psychiatric comorbidities, chronic disease, or low socioeconomic status or the elderly.

Data Collection- Comprehensive searches of seven electronic databases (Medline, EMBASE, CINAHL, SCOPUS, PsycInfo, Proquest Dissertations and Theses, and BASE) were conducted from database inception to October 2014.

Study findings Interventions aimed at frequent ED users have been found to reduce their visits and potentially improve their housing stability and socio-economic status. However, further research is needed to determine their cost-effectiveness and establish standardized definitions.

Limitations- This review has some limitations that should be noted. One major issue is the significant variability among the studies, particularly in terms of definitions and methods, which made it impossible to conduct a meta-analysis and draw strong conclusions. However, we were able to calculate a median rate ratio to compare post- versus pre-intervention ED visits, which is a different technique that does not require pooling of data and can provide insight into the average effect of interventions. Our analysis of subgroups indicated that some of the variability could be attributed to differences in clinical subgroups and intervention types, but the overall I2 value remained high.

Relevance to questions- All four articles are relevant to the question of how emergency personnel can decrease the patient load experienced in emergency situations. Each of the articles emphasizes the importance of patient-centered care in the emergency room. This is achieved through interdisciplinary and multidisciplinary care, as well as providing patients with overall good education and ensuring they have a clear understanding of the instructions given to them.

 References

Mao, W., Shalaby, R., & Opoku Agyapong, V. I. (2023). Interventions to Reduce Repeat Presentations to Hospital Emergency Departments for Mental Health Concerns: A Scoping Review of the Literature. Healthcare11(8). https://doi.org/10.3390/healthcare11081161Links to an external site.

Moe, J., Kirkland, S. W., Rawe, E., Ospina, M. B., Vandermeer, B., Campbell, S., & Rowe, B. H. (2017). Effectiveness of Interventions to Decrease Emergency Department Visits by Adult Frequent Users: A Systematic Review. Academic Emergency Medicine24(1), 40-52. https://doi.org/10.1111/acem.13060Links to an external site.

Palungwachira, P., Montimanutt, G., Musikatavorn, K. et al. Reducing 48-h emergency department revisits and subsequent admissions: a retrospective study of increased emergency medicine resident floor coverage. Int J Emerg Med 15, 66 (2022). https://doi.org/10.1186/s12245-022-00471-zLinks to an external site.

Tsai, H., Xirasagar, S., Carroll, S., Bryan, C. S., Gallagher, P. J., Davis, K., & Jauch, E. C. (2018). Reducing High-Users’ Visits to the Emergency Department by a Primary Care Intervention for the Uninsured: A Retrospective Study. INQUIRY: The Journal of Health Care Organization, Provision, and Financing. https://doi.org/10.1177/0046958018763917

Staff shortages in medical-surgical units have gotten so bad that on New Year’s Day, only two nurses were present in each medical-surgical unit at our facility. The charge nurse and a fellow nurse cared for nine patients each. Our agency nurses are not renewing their contracts, and our registry nurses will not sign up to come to work. An older agency nurse at work who has worked in many different hospitals said that the workload at our facility is heavy compared to other places where she worked and that staff would stay if the workload gets reduced or the number of patients that staff cares for gets reduced. According to our staffing plan on the unit, each nurse is to be assigned four patients, and the charge nurse is to be assigned two patients. The critical question is, will the nurses who have not quit due to being loyal go on strike due to bad working conditions and staff shortage?

Many articles on nurses striking are available via the Walden Library, and one article reviewed showed how the working conditions of registered nurses who work for Baystate Franklin Medical Center were getting worse and worse. Apart from needing an adequate number of nurses to care for their patients safely daily, the leaders at the center want to shorten both nurses’ sick and vacation times (RNs at Baystate Franklin, 2017). The hospital administrators have hundreds of vacant registered nurse positions available because they refuse to hire nurses for open positions (RNs at Baystate Franklin, 2017). The Baystate Franklin Medical Center administrators also do not want to agree to nurses’ terms to have a safer workload by hiring more nurses to provide safer patient care, eliminating nurses having to work overtime (RNs at Baystate Franklin, 2017). The wrong benefits the Baystate Franklin Medical Center management kept providing their nursing staff led to a single-day strike by two hundred registered nurses (RNs at Baystate Franklin, 2017).

A second article reviewed is about the understaffing of nurses at a Washington Hospital Center, which happens to be the largest medical center in Washington, DC (Smith, 2011). The article narrated how the health center’s administrators refused to take nurses’ concerns about patients’ safety and hiring adequate nursing staff seriously at the bargaining table during negotiations (Smith, 2011). Because the healthcare leaders at the hospital centers did not hire adequate nursing staff to care for their patient population, the nurses on their team quit, and about 1,300 nurses left the job in a period (Smith, 2011). Likewise, nurses at the Washington Hospital Center went on a one-day strike to force the hands of the leaders of the health center to advocate for patients by having sufficient nursing staff to care for patients (Smith, 2011).

A third article evaluated how nurses all over the country plan to take action by striking at selected hospitals, and they put a plan in place to leave their duties every two hours at a time (Keane & Maloney, 2015). The nurses are striking at certain hospitals, so only one hospital in a district will be affected. Also, so hospital administrators can use other hospitals to convert potential problems they may not be able to handle in their facilities (Keane & Maloney, 2015). The nurses are striking due to nursing shortages, overcrowding of patients, and patients’ lack of safety day after day in the hospitals where they work (Keane & Maloney, 2015).

A fourth article narrated how union members of the Minnesota Nurses Association (MNA) striked to improve the safety of the patients they care for and their working conditions (Rabbers, 2010). The strike by the MNA members promoted the highest number of nurses striking at a time in the United States (Rabbers, 2010). The MNA nurse members want their hospital leaders at their various hospitals to have a plan that will ensure enough nurses are staffed each day on each unit to provide safe care to patients based on patients’ acuity (Rabbers, 2010). The nurses also want their healthcare leaders to have a plan for professional development, implement technologies in their patient care, and prepare them for emergencies (Rabbers, 2010). The various hospital administrators disregarded the nurses and their union concerns. The various hospital administrators also made the MNA nurses and their union aware of their plans for the nurses at their organizations, which included taking away some of the retirement benefits of their newly hired nurses (Rabbers, 2010).

Nurses are likely to strike to improve working conditions at our facility. If nurses go on strike, no one will be available to care for patients since agency nurses are not renewing their contracts, and one of them says the workload at our facility is heavy. The Registry nurses need to sign up to come to work. Nurse managers who have not worked at the bedside or provided bedside care to patients since becoming managers will have to take on nursing duties, and the care that patients get if nurses go on strike will probably be poor. Our organization leaders need to provide adequate staffing of nurses to care for our patient population and decrease nurses’ workload to make working on medical-surgical units an attractive place for nurses to want to work as a quality improvement initiative.

Critical Question; The Impact of effective discharge planning in continuity of care after hospital psychiatric discharge.

  Discharge planning is a structured procedure that results in the creation of a personalized, continuous care and support plan that addresses a patient’s needs after they are discharged from the hospital (Ameen et al., 2019). It starts with a patient’s initial, quick assessment and symptom stabilization upon admission, along with treatment planning. It’s linked to both hospital readmissions and continuity of care (Xiao et al., 2019).

For patients getting in-patient psychiatric care, continuity of care is a crucial factor in determining both the short- and long-term outcomes of their health care. This is important because poor outcomes, such as an increased risk of relapse, homelessness, suicide, and engagement with the criminal justice system, are linked to a lack of continuity in care (Smith et al., 2020).

Effective discharge planning covers the therapeutic, educational, cultural, and social interventions required to protect and improve a patient’s health and well-being in the community (Ameen et al., 2019). The transition from inpatient psychiatric units to community-based care is facilitated by the implementation of discharge practices such as corresponding with outpatient clinicians, making timely appointments for outpatient follow-up care, and providing discharge reports to outpatient physicians (Smith et al., 2021). It is also enhanced by family involvement during the discharge process. Research has shown that a thorough discharge plan and continuity of care were substantially correlated with family support during inpatient treatment (Haselden et al., 2019).

There are steps that can be taken to ensure an effective discharge planning that will support continuity and coordination of care and treatment. This includes identifying the barriers to effective discharge planning in the organization and tailoring proposed solutions to support implementation. Care and service coordination, collaborative, patient-centered care, resource availability management, thorough needs assessment, and outlining the roles and responsibilities of all team members involved in departure planning are some of the suggested solutions (Xiao et al., 2019).

Care and service coordination- Discharge planning must be coordinate amongst team members within the organization, providers outside the organization, and community resources.

Thorough assessment of needs assessment and patient centered care- To provide an effective discharge planning, a proper assessment of the patient needs to be done to determine the health, social, economic needs specific to the patient. Then the plan has to be tailored to the patient as an individual.

Resource availability management- The organization has to use its human, physical, and   financial resources efficiently in planning for a discharge.

 Outlining roles and responsibilities- Each team member involved in discharge planning, that is, psychiatrists, nurses, social workers, need to understand their roles and responsibilities. Frequent in-service discharge planning training should be performed in the organization.

Collaboration- This is the most crucial aspect of discharge planning. Effective collaboration and communication between team members and providers of mental health acre outside the organization will go a long way in establishing continuity of care.

References

Ameen, S., Gowda, M., Gajera, G., & Srinivasa, P. (2019). Discharge Planning and Mental Healthcare act 2017. Indian Journal of Psychiatry61(10), 706. https://doi.org/10.4103/psychiatry.indianjpsychiatry_72_19

Haselden, M., Corbeil, T., Tang, F., Olfson, M., Dixon, L. B., Essock, S. M., Wall, M. M., Radigan, M., Frimpong, E., Wang, R., Lamberti, S., Schneider, M., & Smith, T. E. (2019). Family involvement in psychiatric hospitalizations: Associations with discharge planning and prompt follow-up care. Psychiatric Services70(10), 860–866. https://doi.org/10.1176/appi.ps.201900028

Smith, T. E., Haselden, M., Corbeil, T., Tang, F., Radigan, M., Essock, S. M., Wall, M. M., Dixon, L. B., Wang, R., Frimpong, E., Lamberti, S., Schneider, M., & Olfson, M. (2020). Relationship between continuity of care and discharge planning after hospital psychiatric admission. Psychiatric Services71(1), 75–78. https://doi.org/10.1176/appi.ps.201900233

Smith, T. E., Haselden, M., Corbeil, T., Wall, M. M., Tang, F., Essock, S. M., Frimpong, E., Goldman, M. L., Mascayano, F., Radigan, M., Schneider, M., Wang, R., Dixon, L. B., & Olfson, M. (2021). Factors associated with discharge planning practices for patients receiving inpatient psychiatric care. Psychiatric Services72(5), 498–506. https://doi.org/10.1176/appi.ps.202000021Links to an external site.

Xiao, S., Tourangeau, A., Widger, K., & Berta, W. (2019). Discharge planning in Mental Healthcare Settings: A review and concept analysis. International Journal of Mental Health Nursing28(4), 816–832. https://doi.org/10.1111/inm.12599