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Nursing Management of Care Delivery and Therapeutic Interventions Essay

Nursing Management of Care Delivery and Therapeutic Interventions

Summary Management of a Proposed Service Improvement

Word Count: 1,051

The following assignment will discuss a proposed service improvement. It will detail what the proposed improvement will be, why this is a significant improvement to current services. How the plan would be managed and implemented. The student has chosen to plan an improvement to physical health needs assessments for mental health service user’s in the care of community teams.

Physical health is historically largely overlooked in mental health services, although many people with severe and enduring mental illnesses are at an increased risk of contracting serious illness, for example, diabetes, coronary heart disease and obesity (DH, 2006 a). The ‘Refocusing the Care Programme Approach’ 2008 document, discusses the links between mental ill health and physical ill health and the consequential increase in the rate of mortality and morbidity for those with mental health illness. The possible reasons for these inequalities include; side effects from medication leading to physical ill health i.e. weight gain, raised blood pressure. Low expectations of health care services, issues around stigma and possible communication problems with health care professionals. (DH 2006 b).

The Sainsbury centre for mental health (SCMH) states that someone with a schizophrenic illness could expect to die up to ten years younger than someone who does not have a mental health illness (SCMH, 2010). This shocking statistic is a prime example of the inequalities faced by those with mental health problems within the health care services. For these reasons the student feels that more rigorous and frequent physical health assessments are required for those people with mental health illnesses, to monitor any changes to the state of their physical health.

Within the student’s community placement areas there has been a lack of detailed physical health checks or assessments. Although the community teams deliver effective care for the clients mental health needs there appears to be a lack of awareness around physical health needs and the importance of regular checks. The current physical health assessments that are undertaken in the students ward consists of a very basic overview of any current diagnosed health issues, any medications prescribed for said illnesses and generalised questions around smoking, smoking cessation services etc. Rethink, a national mental health charity, recognises the short comings of mental health professionals concerning current physical health assessments.

It has therefore published a detailed physical health check for practitioner’s use. The student has created a physical health assessment using the Rethink model. The rethink PHC complies with all aspects of annual review process put forward by the department of health (DH 2006 c). This includes basic health checks such as; blood pressure, BMI, current meds and any side effects, blood tests and lifestyle review i.e. smoking, alcohol intake. The student has taken the lead from the Rethink PHC document as it appears very thorough and detailed. The student PHC contains the headings below (See Appendix 1): General Health and lifestyle

Symptoms checklist
Screening checks
Action Plan
The student feels the most effective use of the PHC would be to conduct the full assessment at least once every four months, increasing frequency when and if necessary. This enables the service user and the mental health practitioner enough time to take effective action on any identified needs and assess the outcome. The student plans to implement this service improvement in a staged approach using the NHS institute for innovation and improvement model for improvement (NHS 2005). (See Appendix 2).

The first stage of the plan will involve liaising with the multi disciplinary team, consisting of mental health nurses, occupational therapists and social workers. Discuss the current system of PHC and the various aspects of how the new PHC will be implemented and managed. Discuss with staff the proposal of offering this PHC to clients on a four monthly basis and the rationale behind it, this being the likelihood of a person with a mental health problem suffering from a serious physical illness. The Chief Nursing Officer’s review of mental health nursing, ‘From values to action 2006’ recommends that mental health nurses attain the skills required to improve the physical well-being of people with mental health problems. In a community setting, many RMN’s as well as other mental health practitioner’s act as care co-ordinators and, as such, are in a particularly strong position to ensure that the whole range of health needs are assessed and responded to. (DH 2006 d).

In doing so, community teams would be offering completely holistic care. All mental health practitioners within the team would be given training around the various parts of the assessment and how to utilise the tool most effectively. The Rethink document is accompanied by a Physical Health Check Information resource Pack; this document can be downloaded for free from ‘the mental health shop, (The mental health shop, 2007). There would be a hard copy of this document available to all practitioners to assist with implementation of the PHC. Once the training is complete and staff have gained consent from clients the PHC will be put into action. The student feels that the most effective management of the implementation would be to offer time within clinical supervision and multi disciplinary team meetings to discuss any queries around implementation or the effective use of PHC. The student feels that the system should be revised after a period of eight months to gain insight from practitioners and service user’s about the effectiveness of the PHC and if there are any suggestions for improvements to the plan.

The student has included a copy of the questionnaire’s that would be distributed to staff and clients after a period of eight months (See Appendix 4 and 5).This process would be extremely beneficial to gain the points of view of those conducting the assessment and those who are subject to the assessment. The student has included a flow chart showing the staged implementation (see Appendix 3). In discussing the proposed improvement and detailing why this would be an effective change the student has demonstrated the current need for better physical health monitoring within mental health services as a hole, but specifically focusing on community care. Completing the implementation of these more detailed checks should allow service users a better quality of life and make a change to the overall life expectancy to someone that is
diagnosed with a mental health illness.

Department of health. (2006 a). Choosing Health: Supporting the physical health needs of people with severe mental illness. Pg 7. Retrieved from the department o health website: http:[email protected][email protected]/documents/digitalasset/dh_4138290.pdf Department of health. (2006 b). Choosing Health: Supporting the physical health needs of people with severe mental illness. Pg 8. Retrieved from the department o health website: http:[email protected][email protected]/documents/digitalasset/dh_4138290.pdf Department of health. (2006 c). Choosing Health: Supporting the physical health needs of people with severe mental illness. Pg 14. Retrieved from the department o health website:

http:[email protected][email protected]/documents/digitalasset/dh_4138290.pdf Department of Health. (2006 d). From Values to action: The Chief Nursing Officer’s review of Mental Health Nursing. Retrieved from the department of health website:

http:[email protected][email protected]/documents/digitalasset/dh_4133840.pdf Department of Health. (2008). Refocusing the Care Programme Approach: Policy and Positive practice Guidance. DH Publications: London

NHS Institute for Innovation and Improvement. (2005). Improvement Leaders’ Guide. Process mapping, analysis and redesign. General improvement skills. Retrieved from the Chester University Intranet:

http://ganymede2.chester.ac.uk/view.php?title_id=483592 Sainsbury Centre for Mental Health. (2010). Mental Health Inequalities: Measuring what counts. Retrieved from the Sainsbury Centre for Mental Health website:

http://www.scmh.org.uk/pdfs/mental_health_inequalities_paper.pdf Rethink. (2007). The PHC: a physical health check for mental health service users. Retrieved from the Rethink website:

http://www.gmw.nhs.uk/sites/earlyinterventiontraining/Rethink%20PHC%20final.pdf Rethink. (2007). Physical Health Check Information Resource. Retrieved from the mental health shop website: http://www.mentalhealthshop.org/applications/shop/mhs_complete.rm?delivery=fa

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