Mental illness is the most neglected health problem not only in the United States but all over the world. A cancer diagnosis is one painful experience that can lead to posttraumatic stress disorder (PTSD), a serious mental illness that jeopardizes the patient’s physical and/or psychological well-being (Unseld et al., 2019). Although it is well known that cancer patients frequently experience anxiety, sadness, and other forms of mental anguish, the prevalence of PTSD has not yet been adequately studied in this patient population (Unseld et al., 2019). The data gathered from the chaplain, social worker, and nurse manager show that a lot of the cancer patients in the unit experience posttraumatic stress disorder symptoms. Symptoms of PTSD include trouble sleeping or concentrating, continuous feelings of fear or anger, nightmares and flashbacks, loss of interest in activities and relationships, and strong feelings of guilt, hopelessness, or shame (Posttraumatic stress disorder and cancer 2022). However, because they are more concerned with curing cancer, nurses and physicians don’t stress the mental health care for these individuals. Therefore, the aim of this project is to emphasize screening for mental health disorders, especially in oncology patients, and giving them the appropriate referrals for treatment.
The plan-do-study-act (PDSA) cycle has been selected as the process improvement paradigm. The most well-known paradigm for process improvement is the PDSA cycle (Spath, 2018). Since the steps cycle and repeat, the model is built to ensure ongoing improvement (Spath, 2018). The PDSA approach is the most effective for this problem in the oncology world because it will help to incorporate and manage changes as they occur.
Plan – cancer care guidelines advise routine patient distress screening because one in three cancer patients report considerable distress (Neal et al., 2021). The healthcare system’s workflow was modified iteratively, including procedures to link the questionnaire with the current electronic health records (Neal et al., 2021). The facility has a distress screening tool that is part of the patient’s admission data. Nurses will diligently screen all patients for their level of distress. When a patient provides a high number for their level of distress, the system automatically creates a referral to the chaplain and social worker. A committee will be formed to monitor how many patients have a high level of distress and ensure that the patients will get referrals to the interprofessional team, such as the chaplain, social worker, case manager, and behavioral team. The committee will also gather data about how many patients who have distress or PTSD symptoms seek treatment for mental health symptoms. It is also the responsibility of the committee to educate nurses about PTSD screening and implement mandatory education about mental health upon patients’ discharge.
Do – form the committee that will consist of nurses, patient care technicians, a nurse manager, a chaplain, a social worker, and a case manager. Weekly meetings and report about distress and PTSD screening will be provided to monitor the progress. Nurses and patient care technicians are to observe patients closely and pay attention to their level of distress. Nurses are to report and or recommend to the primary care team if the patient may need a behavioral team referral. The committee will monitor and gather data about how many patients seek behavioral treatment.
Study – collect the information from the admission data distress screening tool to see if nurses are compliant in screening patients for their level of distress. Compare the rate of the distress screening tool to the rate of patients who seek behavioral treatment. Collect the data on how many patients with a high level of distress were counseled on mental health and treatments upon discharge. The committee can analyze if screening for mental health distress diligently will help oncology patients for their overall health and get the appropriate treatment in a timely manner.
Act – if the study shows that having a regular and mandatory distress screening tool for oncology patients is effective in screening and providing patients with their mental health disorder, particularly PTSD, then the process will be implemented. The committee can assess the workflow in an iterative feedback process based on the data gathered.
PTSD can occur after a person goes through an event or see a situation that is traumatic, such as a cancer diagnosis. PTSD sufferers could refuse the testing, therapies, and care they require after recovery (Post-traumatic stress disorder and cancer 2022). It may also make other issues more likely to occur (Post-traumatic stress disorder and cancer 2022). Depression, drug and alcohol abuse, and eating problems are a few of these (Post-traumatic stress disorder and cancer 2022). Work and personal relationships may be impacted by PTSD (Post-traumatic stress disorder and cancer 2022). Cancer patients who have PTSD should seek treatment for their mental health.
References:
Neal, J. W., Roy, M., Bugos, K., Sharp, C., Galatin, P. S., Falconer, P., Rosenthal, E. L., Blayney, D. W., Modaressi, S., Robinson, A., & Ramchandran, K. (2021). Distress screening through patient-reported Outcomes Measurement Information System (PROMIS) at an academic cancer center and network site: Implementation of a hybrid model. JCO Oncology Practice, 17(11). https://doi.org/10.1200/op.20.00473
Post-traumatic stress disorder and cancer. Cancer.Net. (2022, September 1). Retrieved from https://www.cancer.net/coping-with-cancer/managing-emotions/post-traumatic-stress-disorder-and-cancer
Spath, P. (2018). Introduction to Healthcare Quality Management, Third Edition (Gateway to Healthcare Management) (Third). Health Administration Press
Unseld, M., Krammer, K., Lubowitzki, S., Jachs, M., Baumann, L., Vyssoki, B., Riedel, J., Puhr, H., Zehentgruber, S., Prager, G., Masel, E. K., Preusser, M., Jaeger, U., & Gaiger, A. (2019). Screening for post‐traumatic stress disorders in 1017 cancer patients and correlation with anxiety, depression, and distress. Psycho-Oncology, 28(12), 2382–2388. https://doi.org/10.1002/pon.5239
Week 3 Practicum discussion.
Increased fall rates among the elderly, especially in long-term facilities, are a current problem and are the leading cause of many injuries and even death. This affects the quality of life and care of many of our elderly. For this week’s practicum discussion, I will discuss how to implement the FADE quality improvement model to the above practicum problem. FADE is a quality improvement model for F-focus, A-analyze, D-develop, and E-execute.
F-focus. The process to be improved is the fall rates in the elderly population living in long-term care facilities. Falls pose a severe risk for the elderly living in long-term care facilities. An average nursing home with 100 beds reports 100 to 200 falls annually. Each year, 3 million older people are treated in emergency departments for fall injuries. Each year at least 300,000 older people are hospitalized for hip fractures. Moreover, approximately 1,800 older adults living in long-term care facilities die each year from fall-related injuries, and many of these falls go unreported (Centers for Disease Control, 2009). This is a call for concern.
A-Analyze. In this step, I will discuss some of the root causes of these falls. There are several reasons why older adults fall more. Some Predisposing factors include unsteady gait and balance. Muscle weakness and gait problems are the most common causes of falls among elderly residents, accounting for about 24% of nursing home falls (nursinghomeabusecenter.com, 2023). Other causes include weak muscles, poor vision, medications, dementia, hypotension, stroke, Parkinson’s disease, arthritis, epilepsy, and poor eyesight and hearing. Other reasons can be loose rugs, clutter, inappropriate footwear, belongings placed too far to reach, and wandering patients. Some of the causes of these falls are a lack of staff, a high patient-to-nurse ratio, poor bed placement for high-risk patients, and a lack of accurate fall assessments. Here are some facts or statistics about these falls. Between 50% and 75% of nursing facility residents fall each year. About 5% of US adults aged 65 and older reside in nursing homes, and deaths due to falls make up 20% of deaths in the same age group. Between 2%-6% of nursing home falls result in some fracture. Between 16%-27% of nursing, home falls are caused by environmental hazards, such as equipment in the hallways. About 35% of injuries due to falls occur in residents who cannot walk on their own (nursinghomeabusecenter.com, 2023).
D-develop. This step is where action plans to solve the problem are developed and communicated. The first step is to do fall risk assessments upon admission and reassess quarterly or as needed. They’re creating a fall prevention plan or program, considering predisposing factors. For example, assessing patient cognitive abilities, gait, locomotion, vision and hearing tests, medications that may trigger sedation, Range of motion, evaluating footwear for proper fit and nonskid, and checking for environmental clutter. Most importantly, it is to look into patient staffing needs and ensure that staff-to-patient ratios are not too high, impeding quality of care. Reassess the location of increased fall-risk patients and provide placement closest to the nursing station.
E-execute. In the phase of the model, fall prevention plans or programs are put in place or executed. Establish a fall committee where the members are committed to leading the initiative. Assign a dedicated clinical resource nurse who will provide support, clinical expertise, mentorship, and leadership ( McCarthy et al., 2023). Teach staff fall prevention strategies and educate residents about falls, their causes, and prevention. Fall precautions are implemented for all fall-risk patients, like bed alarms, monitors, and every 2-hour patient rounding. Bed placement closets to the nursing station and beds on lowest positions when the patient is in bed and fall mats at the bedside. Installing nightlights in every room and proper functioning call lights. Ensure staff is answering call lights promptly, and check call light logs every shift. Toileting and changing residents to avoid falls from urgency, frequency, or discomfort. Ensure therapy referrals are made for patients with a decline or change in ROM or gait. Keep wheelchairs, call bells, phones, and essential belongings within reach. Communicate with providers regarding medication reconciliation for medications triggering sedation in patients. Making sure patients get their yearly vision and hearing test.
Center for Disease Control and Prevention (2009). Falls in nursing homes. Retrieved on November 8, 2009, from http://www.cdc.gov/HomeandRecreationalSafety/Falls/nursing.htmlLinks to an external site..
McCarthy, R., Adedokun, C., Fairchild, R. (2023). Preventing Falls in the Elderly Long-Term Care Facilities. Journal of Nursing. Retrieved from: https://rn-journal.com/journal-of-nursing/preventing-falls-in-the-elderly-long-term-carefacilities#:~:text=Falls%20pose%20a%20serious%20risk,death%2C%20and%20in%20older%20peopleLinks to an external site..
Nursing home abuse Center: Protecting Our Seniors, (2023). Nursing Home Falls. Retrieved from: https://www.nursinghomeabusecenter.com/nursing-home-injuries/falls-fractures/#:~:text=Muscle%20weakness%20and%20gait%20problems,of%20themselves%20and%20getting%20around
The quality improvement model for solving the practice problem identified in this paper is the FADE model. The identified practice problem is falling in home health clients. This evaluation aims to find any patterns or trends in unfavorable incidents and create a strategy to stop them from happening again.
Applying FADE to Falls in Home Health Clients
Focus: The problem has been that home health patients have been falling in their home settings. Home health clients receive care in their own homes or assisted living facilities. These patients receive essential medical care at home thanks to the agency’s nursing staff. About 2% of patients experience at least one fall (Sam, 2022). Falls cause injuries one out of every four times, with 10% of those injuries being severe (Sam, 2022). Falls are a high-risk adverse event for the home health company, according to the statistics given. This information emphasizes the company’s need to decrease the frequency of falls among its patients. Unfortunately, this also lowers the standard of care and results in unhappy patients.
Analyze: Assessment of the problem shows that the risk of falling increases due to several reasons, including changes brought on by aging in the patient’s body, such as weakening muscles and stiffening joints, less sensation in your lower limbs, poor eyesight, slowed reaction time, and cognitive loss. New health issues, pharmaceutical side effects, mainly if the patient uses five or more prescription drugs, sensory, unsteadiness, and balance issues, insufficient exercise, an unhealthy diet, dehydration, low calcium levels, trip and skid risks, including carpets or floor mats, uneven or wet surfaces, and inadequate illumination indoors or outdoors all enhance the risk of fractures in the event of a fall. The patient’s falls are spontaneous but can be prevented by caution.
Develop: Several methods can decrease falls in a home health setting. One tactic is thoroughly assessing each patient’s fall risk (Harper, 2021). Based on this assessment, the home health team can create a personalized plan for each patient to address their fall risk. Next, the agency can take action to reduce the risk of damage to patients and deliver the best level of care by educating patients, training personnel, and assessing the policies and processes in place. To help reduce patient falls, the literature suggests routine staff visits and the development of a fall protocol (Hogan Quigley, 2021). Additionally, studies have demonstrated that all staff members are accountable for fall prevention and that effective communication among healthcare team members can significantly reduce falls (Garcia, 2022).
Execute: The scheme mentioned above is implemented. After some time, there is a discernible improvement in the decline in the number of home health patients. Although some falls were still observed, the caregivers did a decent job overall. Still, there is an opportunity for development.
References
A, Garcia (2022). Nurses’ Perceptions of Recommended Fall Prevention Strategies: A Rapid Review. Journal of nursing care quality, pp. 249–256.
Hogan Quigley, B. (2021). Fall Prevention and Injury Reduction Utilizing Virtual Sitters in Hospitalized Patients: A Literature Review. Computers, Informatics, Nursing, pp. 929–934.
Sam, P. R., & Lee, P. (2022). Perception: A Critical Analysis of the Hospitalized Patients on Falls. International Journal of Nursing Education, 14(3), 127–130. https://doi.org/10.37506/ijone.v14i3.18365Links to an external site.
Harper, A. (2021). Falls in older adults: causes, assessment, and management. In Medicine.
