RE-HOSPITALIZATION OF PSYCHIATRIC PATIENTS 1
Re-Hospitalizationof Psychiatric Patients
ChamberlainCollege of Nursing
NR451RN Capstone Course
Re-Hospitalization of Psychiatric Patients
A significant number of psychiatric patients have been readmitted tohospitals. In particular, these clients have manifested a lack ofknowledge of anti-psychotic medications and their side effects.However, evidence-based research has shown that proper casemanagement can reduce the cases of re-hospitalization. It has alsobeen proven that hiring a multidisciplinary team enhances the qualityof care.
The John Hopkins Nursing Evidence-Based Practice Process is used as aguideline for the formulation and translation of evidence intopractice. The practice model comprises of the three pillars ofnursing, namely, practice, education, and research. In addition, themodel also shows that both non-research and research evidence must beused as the basis for decision-making (Delaney & Jackson, 2014).According to the model, both external and internal factors must beevaluated before changing any aspects of the practice. The firstsegment of the model concerns the identification of a reasonablequestion. Subsequently, it is critical to conduct a systematicsynthesis of both non-research and research evidence. Notably, thefinal phase involves the implementation of the outlined change(Delaney & Jackson, 2014). Nurses should utilize this model as aguide to initiate change since the findings are substantiated and inharmony with established practice. Furthermore, the practice teamdetermines the feasibility of practice changes before recommendingthem for adoption.
Step 1:Recruit Interprofessional Team
The interprofessional team will include:
one case manager
two social workers
Assembling a multidisciplinary team heightens the importance ofcollaboration. The case manager will serve as the leader of theproject. Physicians and nutritionists will provide admitted patientswith quality care. On the other hand, the social workers will developand spearhead client outreach programs.
Step 2:Develop and Refine the EBP Question
The research question concerns whether a high nurse-patient ratiocombined with consistent case management can lead to better recoveryrates and reduce instances of re-hospitalization for adult patientswith mental illnesses. Such cases of re-hospitalization ordinarilyoccur due to factors such as lack of knowledge concerning theircondition and appropriate medications. Besides, some patients returnto hospitals due to non-compliance of anti-psychotic treatments.
The first part of the PICO evaluation includes various factors aboutthe patient, population, or problem. For example, the psychiatrichospital could have a low nurse-patient ratio that fails to cater foradult patients with mental illnesses. The problem could also arisedue to a lack of case management systems. Many patients manifestanosognosia in that they are oblivious to their illness (Delaney &Jackson, 2014). Besides, some patients do not adhere to prescriptionsand other contraindications for the use of anti-psychotic medication.Additionally, deficiency in the quality of medical care could leadother clients to become dissatisfied. Furthermore, many patients lacksufficient family or communal support during and after theirhospitalization. The follow-up efforts do not suffice to facilitatefull recovery after hospital discharge.
Granted, it is important to obtain some perspective on the issue ofre-hospitalization of adult psychiatric patients. Therefore,comparisons with other forms of practice or treatment can contributeto developing actionable goals and objectives (Kolbasovsky &Meyerkopf, 2010). The impact of a low nurse-patient ratio on mentalhealth clients can be compared with that of adequate nursingstaffing. Furthermore, the adverse effects of inconsistent casemanagement can be compared to the favorable effects of competent casemanagement.
Step 3: Definethe Scope of the EBP
Readmission of mentally-ill patients presents various problems forevidence-based practice. For example, it heightens the cost ofmedical care. Re-hospitalizations of psychiatric patients lead toconsumption of limited medical resources. Therefore, patients have topay more to benefit from the health care system. Additionally,re-hospitalizations hinder other patients from receiving quality,focused care. Sadly, the fixed number of hospital beds means thatsome clients would have to be turned away from the clinic(Kolbasovsky & Meyerkopf, 2010). Besides, doctors and nurses arestressed when they have to attend to the same patient for extendedperiods. Clinicians also dread the prospect of lawsuits that questionnot only their qualifications but also their professionalism(Kolbasovsky & Meyerkopf, 2010). Consequently, some mental healththerapists experience self-doubt whenever their abilities arechallenged.
On a broader scale, re-hospitalization of mentally-ill patientscreates turmoil in the healthcare system. The government and localauthorities customarily implement laws seeking to curb theinconsistencies in healthcare. Hence, considerable amounts of fundshave been set aside for financing the government`s initiatives(Kolbasovsky & Meyerkopf, 2010). However, re-hospitalization ofpsychiatric clients depletes some of the allotted funds.Consequently, other sectors of health care may be compromised due tolack of adequate funding.
Steps 4 and 5:Determine Responsibility of Team Members
The case manager oversees the project to ensure that establishedtimelines are met. Also, the case manager must evaluate the progressof the project to ensure that there is adequate manpower toaccomplish the tasks at hand. Besides, the social workers areresponsible for conducting client outreach programs. Therefore, suchworkers can identify the particular factors in the patient`senvironment that cause frequent re-admissions. Social workers arealso empowered to educate family members on the best ways to providesupport to the client. Doctors and nurses are responsible forproviding care that suits the needs of the patient.
Steps 6 and 7:Conduct Internal/ External Search for Evidence and Appraisal ofEvidence
The research focused on peer-reviewed articles found in mainstreamjournals of mental health. The evidence was qualitative since it wasobtained from studies conducted at psychiatric hospitals.Consequently, the research was extensive enough to cover the issuesunder investigation. The strength and reliability of the research aremanifested through the considerable sample sizes used in the citedstudies.
Steps 8 and 9:Summarize the Evidence
Cox, Penny, Statham, and Roper (2003) demonstrated that consistentcase management along with the cooperation of a multidisciplinaryteam led to a decrease in hospital readmissions. Frauenfelder,Müller-Staub, Needham, and Achterberg (2013) considered thesignificance of several treatments by nurses. The article proved thatpsychiatric nurses could enhance the quality of patient care inparticular settings. Qualitative research was used to demonstrate thevital role played by nurses in ensuring patients` safety andwell-being (Delaney & Jackson, 2014). Kolbasovsky and Meyerkopf(2010) examined the factors causing patient readmissions. The articleshowed that proper case management leads to a decrease inre-hospitalization rates. Another study in a psychiatric facilityrevealed the impact that lack of knowledge had on hospitalreadmissions (Zhang, Harvey, & Andrew, 2011).
Step 10:Develop Recommendations for Change Based on Evidence
Research-based evidence indicates that patient readmissions can bereduced by implementing proper case management. Also, it would besuitable to use a multidisciplinary team to improve the quality ofmedical care.
Steps 11, 12,and 13, 14: Action Plan
Various intervention methods can be used to address the researchproblem. For example, psychiatric units must have an adequatestaffing of nursing to guarantee the safety of mentally-ill patients.In this regard, mental health therapy aides can be recruited toevaluate the psychology of clients. Moreover, it is vital to ensurethat consistent case management is implemented. Consequently,patients would receive proper referrals to relevant facilities.Programs have to be created to guarantee that patients are educatedon the available resources of mental health. In this respect, theteaching of clients should be undertaken in accordance with theirlevel of understanding. Such education is focused on the side effectsand adverse effects that must be reported to doctors and or nurses.In addition, family members and other frequent associates need tolearn about the disease process. Subsequently, all stakeholdersshould benefit from advocacy in that they can ask questions andprovide suggestions concerning the patient`s care. Implementing sucha plan would take two years. Regular appraisals will be conducted toevaluate the outcomes and collect results.
Steps 15 and16: Evaluating Outcomes and Reporting Outcomes
Desired outcomes include an improvement in clients` recovery process.Another outcome concerns a decrease in the occurrences of hospitalreadmissions. Achieving such targets would be possible if thepatients complied fully with medical prescriptions. It would also beexpected that adult clients have an excellent grasp of anti-psychoticmedications including their side effects and contraindications foruse. Such outcomes would be measured using objective questionnaires.Subsequently, the results will be reported to key stakeholders duringfollow-up sessions conducted after the patients are discharged.
Steps 17:Identify Next Steps
On a large-scale, the plan will be implemented by educating othernurses and doctors in the facility. Indeed, the entire facility willbenefit from the recommendations pinpointed in the research. Thebenefits of the program will be highlighted to ensure that theimplementation becomes permanent.
Step 18:Disseminate Findings
The findings will be communicated internally through memos on noticeboards. Employee portals could also be used to post additionalinformation. On the other hand, external parties could learn aboutthe findings through mail postings and medical journals.
Indeed, many psychiatric patients have been readmitted since theylack sufficient knowledge of their anti-psychotic medications. Suchclients also lack adequate family support. Nevertheless,evidence-based research has shown the positive impact of adoptingproper case management and educating clients. The Evidence-BasedPractice Model magnifies the significance of identifying a researchproblem, conducting systematic review of research evidence, andimplementing the recommendations.
Cox, W. K., Penny, L. C., Statham, R. P. & Roper, B. L. (2003).Admission Intervention Team: medical center based intensive casemanagement of the seriously mentally ill. Care ManagementJournals, 4(4), 178-184.
Delaney, K. R. & Johnson, M.E. (2014). Metasynthesis of Researchon the Role of Psychiatric Inpatient Nurses: What Is Important toStaff? Journal of the American Psychiatric Nurses Association,20(2), 125–137.
Frauenfelder, F., Müller-Staub, M., Needham, I., & Achterberg,T. (2013). Nursing interventions in inpatient psychiatry. Journalof Psychiatric & Mental Health Nursing, 20(10), 921-931.
Kolbasovsky, A., Reich, L., & Meyerkopf, N. (2010). Reducingsix-month inpatient psychiatric recidivism and costs through casemanagement. Care Management Journals, 11(1), 2-10.doi:10.1891/1521-09188.8.131.52.
Zhang, J., Harvey, C., & Andrew, C. (2011). Factors associatedwith length of stay and the risk of readmission in an acutepsychiatric inpatient facility: A retrospective study. Australianand New Zealand Journal of Psychiatry, 45(7), 578-585.