NUR 4955 FSSC Nursing Leadership & Social Responsibility Paper Describe how your project and developing paper is meeting both the 3 NUR 4955 course objecti

NUR 4955 FSSC Nursing Leadership & Social Responsibility Paper Describe how your project and developing paper is meeting both the 3 NUR 4955 course objectives and the selected EPSLOs. This requires thoughtful reflection about your project and how you correlate the EPSLOs to the project and final paper.

EPSLOs:

7. Summarize the components of leadership and followership in professional nursing practice.

8. Interpret the social responsibility of the nursing profession in the development and implementation of health care policy.

Use the paper included to answer this discussion Running head: STRESS MANAGEMENT
Stress Management and the Prevention of In-Patient Readmissions in a Psychiatric Setting
Kari M. Garber
Florida SouthWestern State College
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STRESS MANAGEMENT
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Stress Management and the Prevention of In-Patient Readmissions in a Psychiatric Setting
Introduction and Definition of Practice Setting
One of the most important areas in healthcare is mental health. There is an alarming rise
in the occurrence of mental health disorders in contemporary society. The focus of this paper is
the psychiatric setting. Mental illnesses constitute approximately one-third of disability in the
world today (Lake, 2017). In the USA, the burden of mental health care has increased
significantly with more people suffering from various disorders annually. Mental health nurses
and other professionals working in the psychiatric setting are charged with the responsibility of
facilitating high-quality care to patients suffering from various mental health disorders. The
purpose of this paper is to examine an aspect of quality care in mental health. The current paper
will identify the problem and its significance as well as conduct a literature review. More
importantly, it will propose a suitable evidence-based intervention to address the problem along
with the means of evaluation. It is imperative to enhance the practice of mental health nursing as
this area is becoming highly relevant in modern healthcare.
Problem Statement
The main problem in this context is the high rate of psychiatric in-patient readmissions in
acute care hospitals. In the USA, there is currently an alarmingly high rate of hospital
readmissions among patients with psychiatric disorders. Research illustrates that hospital
readmission within the first 30 days of discharge is detrimental to the overall health outcome of
patients with mental illnesses (Benjek and Chen, 2018). Furthermore, the high rate of
readmissions is associated with higher treatment costs and care management services (Benjek
and Chen, 2018). The burden of cost affects both the government and the patient by straining
national and individual resources respectively.
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Significance of the Problem for Nursing Practice
The problem if high readmission rates in psychiatric care is significant for nursing
practice because it illustrates a deficiency in the quality of care that is provided. Essentially,
research indicates that high readmission rates indicate inadequacies in the pre-and post-discharge
treatment of mental health patients (Kalseth, 2016). Mental health nurses are partly responsible
for ensuring efficient pre- and post-discharge treatment is provided to their patients. In many
cases, when adequate care is provided, the in-patient readmission rates reduce significantly.
Notably, in this context, readmission is measured by a patient’s return to the hospital within the
first 30 days of discharge.
Furthermore, the problem of high readmission is significant for nursing practice in mental
health because it indicates the severity of an illness and the extent of disability regarding the
patient. This is an important area for nurses to focus on as a guide to implementing suitable
interventions to address serious mental health illnesses.
Literature Review
Benjek and Chen define readmission as “an unplanned, inpatient admission, for any
condition, within thirty days of discharge from the initial admission” (2018, p. 1). In the USA,
the issue of hospital readmissions is so important that the government initiated the Hospital
Readmission Reduction Program (HRRP) as a law in 2010 (Centers for Medicare and Medicaid
Services, 2018). In a research study, Kalseth et al note that repeated hospitalizations have
adverse disruptive effects on patients and their friends and families (2016). Furthermore, their
study also notes that readmission rates are often employed as an identifier of the quality of
mental health care provided by a hospital.
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In an alternate research study, Lake identified that mental disorders can result in
numerous comorbid conditions and a high rate of mortality (2017). Essentially, the implication is
that high readmissions are an indicator of the persistence of a mental illness. “A serious and
persistent mental disorder can result in patients losing up to four years of life, compared to
individuals without mental disorder.” (Sprah et al., 2017, p. 1).
Generally, it is the consensus of several research studies that hospital readmissions in
psychiatric practice settings are a major problem in America with one in every seven patients
being readmitted (Sprah et al., 2017). This calls for the employment of measures to reduce the
high rate of hospital readmissions.
Proposed Interventions and Justification
Given the importance of the problem, there are numerous proposed interventions to
resolve the issue. One of the interventions that are widely publicized is Assertive Community
Treatment (ACT), which is a community-based care model that mainly helps people with serious
mental illnesses such as bipolar and schizophrenia (Clausen et al., 2016). Moreover, other
proposed interventions are Compulsory Treatment Orders (CTOs), Involuntary Outpatient
Commitment (OPC), collaborative care, case management, peer support, and psychoeducation.
While many of these interventions are useful in reducing readmissions in psychiatric care, they
each have their limitations mainly because they rely on external support and resources more than
internal measures by the patients.
In this context, the most suitable intervention is the cognitive-behavioral stress
management approach. “Stress management program with cognitive-behavioral approach
includes elements such as awareness of stress, relaxation training, identification or dysfunctional
thoughts, cognitive restructuring, problem-solving process training, asserting training, anger
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management, and time management” (Ghazavi, 2016, p. 1). The justification for selecting this
intervention is that it addresses common psychiatric problems such as depression, anxiety, social
isolation, coping demands, and poor self-control all of which are crucial in managing mental
illnesses (Shariatkhan, Farajzadeh, and Khazaee, 2017). The premise of this method is that
reducing stress is the most effective way of reducing readmissions for psychiatric patients.
Implementation of Intervention
Briefly, a person’s capacity to minimize stress and cope effectively under stress is
referred to as stress management (Sahranavard et al., 2018). Stress management enhances an
individual’s health both mentally and physically. “Psychotherapy is effective when the patients
realize that their problems are not only physical but are influenced by their dissatisfaction,
conflicts, and psychological problems” (Ghazavi et al., 2016, p. 1). Cognitive-behavioral therapy
(CBT) is considered to be one of the most important psychotherapy methods of treating
psychiatric disorders (Sahranavard et al., 2018). In CBT, patients are guided to detect the errors
in their behaviors and thoughts and how to amend them. The proposed intervention strives to
combine CBT with stress management techniques.
Implementing the cognitive-behavioral stress management approach in the present
psychiatric setting will require the integration of psychoeducation techniques. Psychoeducation
mainly relates to providing patients and their families with the necessary information to handle
their individual situations (Srivastava and Panday, 2017). The plan for implementation includes
the hosting of programs that endeavor to provide psychiatric patients with the necessary
education regarding how to manage stress pre- and post-discharge. Notably, the idea for this
implementation approach is derived from the study conducted by Ghazavi et al in 2016. In the
study, the researchers organized eight sessions weekly for programs that ran for 90 minutes,
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which significantly improved the patients’ quality of life. However, to minimize cost and other
resources, the proposed implementation program will host six sessions of 90-minute programs
every week.
During the session, patients will be given information on how stress and poor stress
management affect an individual’s health both physically and mentally. More importantly, the
sessions will provide patients with information on how to cope with stressful conditions to
enhance their stress management abilities. This includes insight on relaxation techniques, the
importance of exercise and social interaction, as well as enforcing certain lifestyle changes to
enhance their stress coping mechanisms. Furthermore, patients will be guided on how to
understand cognitive distortions in alignment with CBT such that they can unlearn certain
behaviors and eliminate thoughts that increase their stress levels. Basically, the current
implementation strategy focuses on teaching patients how to cope with stressful situations
particularly when they are discharged from hospital. The sessions will begin during their hospital
stay and continue even after they are discharged from hospital.
Certain resources will be required for implementation. Firstly, nurse volunteers must be
recruited to run the program. Essentially, given that the sessions are hosted once every week, six
nurse volunteers will be required to host the sessions for six weeks. While in the study the
researchers used pamphlets to aid the learning process, the current strategy will minimize on
costs by replacing pamphlets with emails. Essentially, each patient will receive an email
summarizing the sessions for each week. Fundamentally, the emails are important to serve as
reminders for patient activities during the week before the next session.
The only equipment required to conduct the sessions are a computer and projector for
making presentations. Given that these are largely available at the facility, acquiring them would
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not be a challenge. Furthermore, apart from nurse volunteers, other stakeholders are certified
therapists. It is imperative to enlist a practicing therapist who can sit in on the session and
provide guidance whenever needed. Multidisciplinary collaboration is often important in
improving patient outcomes through education (Green and Johnson, 2015).
Concerning regulatory factors, permission will be obtained from the hospital’s
administration for the sessions to be held at the facility weekly. It is important to adhere to the
policies and protocols of the hospital regarding patient education to avoid legal and ethical
ramifications in the future. All the methods that are provided to the patient regarding cognitivebehavioral stress management techniques will be based on evidence retrieved from research
materials. This will ensure that they only serve to benefit the patients and not harm them.
Evidence-based practice is the basis for the implementation process. To ensure compliance with
regulatory and legal components, no untested methods will be proposed to patients during the
sessions.
Barriers to Implementation
Implementing the cognitive-behavioral stress management intervention will incur certain
obstacles. One potential barrier is resistance by stakeholders. This particularly relates to the
hospital’s administration and the healthcare practitioners that will be required to volunteer their
services, especially nurses and therapists. Healthcare workers are known to work for long hours
(Wong, Chan, and Ngan, 2019). It would be difficult to convince them to volunteer their extra
time to the program. Moreover, the hospital’s administration may be unwilling to support the
program due to potential legal ramifications for errors. Overcoming this obstacle of resistance
requires a convincing proposal to the stakeholders. People are often more inclined to support and
sacrifice for causes that they believe in. Both the administration and the staff should be
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persuaded concerning the benefits of the proposed program. Essentially, reducing hospital
readmissions is beneficial to these stakeholders in the long run. The hospital will not only
minimize its costs but also it will be ranked highly in terms of providing high quality psychiatric
care. Furthermore, when hospital readmissions reduce, the additional workload and stress for the
staff also minimize.
An additional barrier is that patients may be unwilling to participate in the sessions at
first. This is an obstacle that can be addressed in two ways. Firstly, patients can be handled in the
same way as the hospital staff, whereby they may be convinced of the benefits of the program.
Moreover, recruiting patients’ families to support the program will prompt patients to participate
in the programs. Essentially, patients may be allowed to attend the weekly sessions with a close
family member or friend for support.
Evaluation of Intervention
The evaluation process is arguably the most important process of running the program.
Essentially, evaluation involves monitoring the program to ensure that it is yielding the desired
results (Cheng et al., 2017). In this case, the evaluation will focus on the main goal of the
intervention, which is to reduce the rate of hospital readmissions.
The first indicator of progress will be a reduction in hospital readmission for psychiatric
patients within the first 30 days of discharge. Before the program is launched, the rate of
readmissions at the facility will be examined. Upon completion of the program, the rate of
readmissions, particularly involving the patients that participate in the program, will be reviewed
to determine whether any changes have occurred. If the readmission rate reduces, it would prove
that the program is effective. However, if it remains constant or increases, it would prove the
ineffectiveness of the program.
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Another method of evaluation would be to conduct an examination or therapy session
with the psychiatric patients that participate in the program before, during, and after the
completion of the program. As has been established, one of the main reasons for high
readmission is the severity of an illness to the point whereby a patient is overwhelmed.
Therefore, if a patient’s condition is severe at the beginning of the program, regular assessments
will be conducted to determine whether their condition is improving over the course of the
program.
Impact of the Proposed Intervention
The anticipated impact of the proposed intervention is that it will reduce the rate of
psychiatric hospital readmissions at the facility. The working concept is that one of the main
reasons why psychiatric patients get readmitted is their inability to effectively cope with the
stressors in their regular lives once they are discharged from the hospital. The implementation of
the cognitive-behavioral stress management approach is intended to improve their stress
management and coping mechanisms, which will undoubtedly reduce the rate of hospital
readmissions for psychiatric patients. Moreover, it is anticipated that the proposed intervention
will help to reduce the cost of mental health care once hospital readmissions are minimized.
An additional impact of the proposed intervention is that it will improve the general
health of psychiatric patients. Research highlights stress as one of the major impediments to
good health and a high quality of life (Slavich, 2016). The intended impact of the proposed
intervention is that patients’ health will improve significantly due to effective stress
management. Subsequently, their quality of life will also be enhanced due to their capacity to
handle unexpected challenges in their lives.
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Dissemination of Results
Dissemination of the results of a project is important because it provides a chance for
others to learn from the implemented practices (Curtis et al., 2017). In this context, the results of
the study will be disseminated through the use of professional nursing journals. Professional
nursing journals are often accessible to practicing mental health nurses. Once the project is
complete and the findings are documented, the records will be distributed via professional
nursing journals to ensure that the information is available publicly to any nurses or healthcare
practitioners that may be interested in pursuing a similar course to reduce their rates of patient
readmission in psychiatric care.
In conclusion, the proposed intervention is aimed at reducing the problem of high rate of
hospital readmissions for psychiatric patients. The problem is significant to nursing practice
because it signifies a deficiency in the quality of care that is provided to psychiatric patients
before and after discharge from the hospital. According to available literature, high rates of
hospital readmissions have adverse effects to all stakeholders including the government, hospital,
staffs, and the patients. Subsequently, the proposed intervention is cognitive-behavioral stress
management, which will be implemented by holding weekly sessions to teach patients about
stress management and coping mechanisms. The main barrier to implementation is stakeholder
resistance. Moreover, one of the ways of evaluation is by examining the rise or fall in hospital
readmission rates. Ultimately, the anticipated impact of the proposed intervention is to reduce
hospital readmissions for psychiatric patients. Conclusively, the findings of the project will be
disseminated through professional nursing journals.
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References
Benjenk, I., & Chen, J. (2018). Effective mental health interventions to reduce hospital
readmission rates: a systematic review. Journal of hospital management and health
policy, 2, 45. https://doi.org/10.21037/jhmhp.2018.08.05
Centers for Medicare and Medicaid Services. (2018). Hospital Readmission Reduction Program.
Retrieved from https://www.cms.gov/Medicare/Quality-Initiatives-Patient-AssessmentInstruments/Value-Based-Programs/HRRP/Hospital-Readmission-ReductionProgram.html
Cheng, J., Chu, Y., Li, Y., Tan, Q. (2017). Research and perspectives on criteria for evaluation of
nursing research achievements. Chinese nursing research, 4(3), 107-112.
Clausen, H., Landheim, A., Odden, S., Šaltytė Benth, J., Heiervang, K. S., Stuen, H. K.,
Killaspy, H., & Ruud, T. (2016). Hospitalization of high and low inpatient service users
before and after enrollment into Assertive Community Treatment teams: a naturalistic
observational study. International journal of mental health systems, 10, 14.
https://doi.org/10.1186/s13033-016-0052-z
Curtis, K., Fry, M., Shaban, R. Z., & Considine, J. (2017). Translating research findings to
clinical nursing practice. Journal of clinical nursing, 26(5-6), 862–872.
https://doi.org/10.1111/jocn.13586
Ghazavi, Z., Rahimi, E., Yazdani, M., & Afshar, H. (2016). Effect of cognitive-behavioral stress
management program on psychosomatic patients’ quality of life. Iranian journal of
nursing and midwifery research, 21(5), 510–515. https://doi.org/10.4103/17359066.193415
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Green, B. N., & Johnson, C. D. (2015). Interprofessional collaboration in research, education,
and clinical practice: working together for a better future. The Journal of chiropractic
education, 29(1), 1–10. https://doi.org/10.7899/JCE-14-36
Kalseth, J., Lassemo, E., Wahlbeck, K., Haaramo, P., & Magnussen, J. (2016). Psychiatric
readmissions and their association with environmental and health system characteristics:
a systematic review of the literature. BMC psychiatry, 16(1), 376.
https://doi.org/10.1186/s12888-016-1099-8
Lake, J., & Turner, M. S. (2017). Urgent Need for Improved Mental Health Care and a More
Collaborative Model of Care. The Permanente journal, 21, 17–024.
https://doi.org/10.7812/TPP/17-024
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