Assessing the Problem: Quality, Safety, and Cost Considerations

Part 1

Depression is a severe and persistent Mental Health disorder that cuts across millions of people globally. It is characterized by high levels of low, blended moods and lack of pleasure in most activities, with moderate to extreme loss of functioning in major life activities. However, for the individual, depression brings a strain on families and communities and is a significant drain on the health care system: Assessing the Problem: Quality, Safety, and Cost Considerations.

The effects on quality of care, patient safety, and cost implications are highlighted in this paper using findings from a practicum with a family that has major depressive disorder (MDD). Evidence-based nursing practice will also be discussed to present practical solutions for addressing or reducing these challenges.

Impact of Depression on Quality of Care

Depression primarily affects the quality of care because it lowers a patient’s engagement in and adherence to treatment regimens. Patients frequently struggle to adhere to prescribed routines because of various emotions of helplessness, rejection, or, in rare cases, memory problems. The family did indicate in this practicum that the mother’s mood was lowered by her frequent absences from scheduled therapy sessions and her inconsistent medication compliance. Such difficulties are not unique to this scenario.

Depressive symptoms are linked to poor health because patients may not seek early treatment or may not follow through on their prescribed medications, according to a study by Reynolds et al. (2022). This disengagement not only hinders recovery but also raises the likelihood of chronic complications and comorbid illnesses, which is consistent with my observations in nursing practice.

Impact on Patient Safety

Given its established links to substance abuse, hazardous behavior, and noncompliance with preventive healthcare measures, depression poses exceptional threats to patient safety. The mother’s frequent manifestations of despair during the practicum served as a reminder of the urgent necessity to ensure her safety. According to research, the roughly one million suicides that are anticipated to occur globally as a result of mental health illnesses are twice as likely to occur among individuals who have not sought medical treatment for depression (World Health Organization, 2021).

Further, apart from the acts of self-injury, patients with depression also exhibit other dysfunctional care behaviors that are fatal, like uncontrolled chronic diseases or incorrect dosing of medications. For example, as observed in my practice, some patients with chronic diseases such as diabetes, hypertension, or asthma might forget to use medicines that are critical for overall health.

Subsequently, early interventions, including recurrent safety evaluations, safety management, and family intervention, are crucial to minimize risks accompanied by depression. Based on the evidence, the family should develop measures to protect children and pathways to address such signs (Wissow et al., 2020). In this practicum, safety planning consisted of talking with family members about identifying potential triggers or emergencies.

Impact on Costs to the System and Individual

Millions of families suffer both direct and indirect financial losses as a result of depression. These include buying medications, going to therapy sessions, and going to the hospital. These expenses, which comprised the family’s budget in this practicum family, were exacerbated by sporadic out-of-pocket expenditures for services that were not covered by insurance. Indirect costs, such as lost income because the patient was unable to work and the caregiver had to accompany them, requiring longer hours off work, were in addition to these expenses.

On a systemic level, depression accounts for significant healthcare costs, such as frequent ER visits, hospital stays, and long-term care. Global estimates place the annual economic expense of depression in the billions, and its effects also include decreased productivity and an increase in disability claims (Chodavadia et al., 2023). Although differences in application still exist, policies such as the Mental Health Parity and Addiction Equity Act have attempted to remove these obstacles by establishing equal insurance coverage for mental and physical health disorders (Centers for Medicare & Medicaid Services, 2023).

Influence of Nursing Standards and Policies

Role of Nursing Practice Standards

Nursing practice standards can be seen to play a critical role in addressing depression and related challenges. The American Nurses Association (ANA) identifies the holistic, evidence-based, patient-centered care provision, including mental health assessment and interventions, as a priority to be addressed in the continuum of care (American Nurses Association, 2023).

Notably, state boards of nursing continue to encourage culturally appropriate care that is sensitive to the particular needs of patients and families. These principles are closely aligned with frameworks like the Roy Adaptation Model, which targets promoting resilience and adaptive coping strategies among patients and families (Callis, 2020). In this practicum, this model helped the family identify and fortify their strengths, engendering feelings of hope and empowerment.

Policy Effectiveness

Policies such as the Affordable Care Act (ACA) have placed more people in a position to access mental health services, thus allowing interventions earlier and closing gaps in care disparities. The study by Zhang et al. (2022) underscored the effectiveness of the policies in reducing readmissions and enhancing continuity of care while promoting patient satisfaction. Additionally, the state-driven initiatives supporting the integration of mental health care into primary settings have also been very promising for improvement in patient outcomes of depression.

Local, State, and Federal Policies: Impact on Scope of Practice

Local, state, and federal policies have helped define the scope of practice for nursing practice. For example, the expansion of Medicaid under the ACA has transformed nursing roles in mental health promotion through services that were previously unattainable for the majority of patients (Centers for Medicare & Medicaid Services, 2023).

State-level policies supporting the promotion of mental health under community health programs have since increased nurses’ capacity to address depression comprehensively. Furthermore, federal policies, for example, the Mental Health Parity and Addiction Equity Act, have fostered interprofessional collaboration, where the nurse works with other professional mental health workers as well as social workers, faith-based organizations, and other community resources that allow the nurse to cover the many dimensions inherent in depression.

Proposed Strategies to Improve Outcomes

Education is a critical base for effective management of depression. Psychoeducation of families helps demystify depression, reduces associated stigma, and thereby empowers them to support the individual with the disorder. In this practicum, educational efforts emphasized providing family members with the knowledge and means to identify early warning signs, access appropriate resources, and communicate in supportive ways.

Consistently, telehealth has been viewed as a critical tool in overcoming various barriers to care, including those in rural or underserved areas. Telehealth platforms can address problems of transportation, stigma, and even access to therapy and counseling services. Snoswell et al. (2020) concluded that telehealth interventions increased patient involvement in treatment and reduced expenses.

Lastly, integrated care systems aim to encourage teamwork among different practitioners in managing clients. It has been documented that these models also improve and facilitate care coordination and compliance with the individual’s clinical management plan and likewise minimize the risks of subsequent hospitalization. In this practicum, a mental health counselor was contacted to help manage the mother’s needs since the treatment process was compartmentalized.

Research Evidence-Supporting Strategies

There is strong evidence that these strategies can improve the quality of care, patient safety, and cost efficiency. For example, studies by Chellappan et al. (2022) show that family involvement in psychoeducation significantly enhances treatment adherence outcomes. Similarly, collaborative care models have improved patient satisfaction and decreased usage of healthcare services.

Benchmarking and Data Utilization

Benchmarking tools, such as Medicare’s Hospital Compare and the Leapfrog Group, allow providers to compare healthcare performance. Many of these aggregate care quality and safety-cost-related data create essential online resources for making informed healthcare-related decisions.

Part 2: Documentation of Practicum Hours

Practicum Hours Summary

In the first two practicum hours, I worked with a family dealing with major depressive disorder. The family included a mother, her spouse, and two children in their teenage years. The common issues they talked about were poor communication, stigma, and financial issues.

Further, I reviewed the American Psychiatric Association’s guidelines for managing depression, which placed a strong emphasis on the value of family participation in care. Following this, in order to coordinate care and guarantee that the family received enough support, healthcare teams needed effective leadership.

Insights and Actions

1. Family Dynamics: The sessions exposed low-income family relationships and a lack of appreciation for what depression does to a family.
2. Barriers Identified: Financial issues and stigma were significant barriers to seeking help.
3. Collaborative Efforts: A mental health counselor was recruited to help the family recover.

Notably, I applied active listening to make them feel heard and provided information on how depression can lead to further complications if not treated. Subsequently, to improve my approach, I should have created more visual aids to demonstrate how depression impacts families in addition to individuals. The hours spent on these activities have been recorded on the Capella Academic Portal Volunteer Experience Form for accountability and tracking.

Conclusion

The complex effects of depression on the quality of care, patient safety, and costs call for comprehensive, evidence-based interventions. These challenges in the workplace can be relieved if healthcare professionals utilize nursing standards, supportive policies, and strategies with targeted interventions. Much emphasis was placed on family-centered and collaborative approaches during this practicum experience, further outlining nurses’ important role in changing how mental health care is delivered.

References

American Nurses Association. (2023, June 1). What is evidence-based practice in nursing? ANA Nursing Resources Hub. https://www.nursingworld.org/content-hub/resources/workplace/evidence-based-practice-in-nursing/

Callis, A. M. (2020). Application of the roy adaptation theory to a care program for nurses. Applied Nursing Research, 56(151340). https://doi.org/10.1016/j.apnr.2020.151340

Centers for Medicare & Medicaid Services. (2023, September 6). The Mental Health Parity and Addiction Equity Act (MHPAEA) | CMS. Www.cms.gov. https://www.cms.gov/marketplace/private-health-insurance/mental-health-parity-addiction-equity

Chellappan, X., Bhawana, K., & Rohilla, J. (2022). Efficacy of family psychoeducation on drug compliance, self-esteem and caregivers’ burden among selected psychiatric inpatients from a tertiary care centre, North India. Industrial Psychiatry Journal, 31(1), 89. https://doi.org/10.4103/ipj.ipj_190_20

Chodavadia, P., Teo, I., Poremski, D., Fung, D. S. S., & Finkelstein, E. A. (2023). Prevalence and economic burden of depression and anxiety symptoms among Singaporean adults: results from a 2022 web panel. BMC Psychiatry, 23(1). https://doi.org/10.1186/s12888-023-04581-7

Nakao, M., Shirotsuki, K., & Sugaya, N. (2021). Cognitive–behavioral Therapy for Management of Mental Health and stress-related disorders: Recent Advances in Techniques and Technologies. BioPsychoSocial Medicine, 15(1), 1–4. https://doi.org/10.1186/s13030-021-00219-w

Reynolds, C. F., Jeste, D. V., Sachdev, P. S., & Blazer, D. G. (2022). Mental health care for older adults: recent advances and new directions in clinical practice and research. World Psychiatry, 21(3), 336–363. https://doi.org/10.1002/wps.20996

Snoswell, C. L., Taylor, M. L., Comans, T. A., Smith, A. C., Gray, L. C., & Caffery, L. J. (2020). Determining if Telehealth Can Reduce Health System Costs: Scoping Review. Journal of Medical Internet Research, 22(10). https://doi.org/10.2196/17298

Wissow, L. S., Platt, R., & Sarvet, B. (2020). Policy recommendations to promote integrated mental health care for children and youth. Academic Pediatrics, 23(2). https://doi.org/10.1016/j.acap.2020.08.014

World Health Organization. (2021). Depression. Www.who.int. https://www.who.int/health-topics/depression

Zhang, Q., Wang, J., & Neitzel, A. (2022). School-based mental health interventions targeting depression or anxiety: A meta-analysis of rigorous randomized controlled trials for school-aged children and adolescents. Journal of Youth and Adolescence, 52(1). https://doi.org/10.1007/s10964-022-01684-4

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In a 5–7 page written assessment, assess the effect of the patient, family, or population problem you’ve previously defined on the quality of care, patient safety, and costs to the system and individual. Plan to spend approximately 2 direct practicum hours exploring these aspects of the problem with the patient, family, or group you’ve chosen to work with and, if desired, consulting with subject matter and industry experts. Document the time spent (your practicum hours) with these individuals or group in the Capella Academic Portal Volunteer Experience Form. Report on your experiences during your first two practicum hours.

Introduction
Organizational data, such as readmission rates, hospital-acquired infections, falls, medication errors, staff satisfaction, serious safety events, and patient experience can be used to prioritize time, resources, and finances. Health care organizations and government agencies use benchmark data to compare the quality of organizational services and report the status of patient safety. Professional nurses are key to comprehensive data collection, reporting, and monitoring of metrics to improve quality and patient safety.

Preparation
In this assessment, you’ll assess the effect of the health problem you’ve defined on the quality of care, patient safety, and costs to the system and individual. Plan to spend at least 2 direct practicum hours working with the same patient, family, or group. During this time, you may also choose to consult with subject matter and industry experts.

To prepare for the assessment:

• Review the assessment instructions and scoring guide to ensure that you understand the work you will be asked to complete and how it will be assessed.
• Conduct research of the scholarly and professional literature to inform your assessment and meet scholarly expectations for supporting evidence.
• Review the Practicum Focus Sheet: Assessment 2 [PDF], which provides guidance for conducting this portion of your practicum.

Note: As you revise your writing, check out the resources listed on the Writing Center’s Writing Support page.

Instructions
Complete this assessment in two parts.
Part 1

• Assess the effect of the patient, family, or population problem you defined in the previous assessment on the quality of care, patient safety, and costs to the system and individual. Plan to spend at least 2 practicum hours exploring these aspects of the problem with the patient, family, or group. During this time, you may also consult with subject matter and industry experts of your choice.
  Document the time spent (your practicum hours) with these individuals or group in the Capella Academic Portal Volunteer Experience Form. Use the Practicum Focus Sheet: Assessment 2 [PDF] ]provided for this assessment to guide your work and interpersonal interactions.

Part 2
Report on your experiences during your first 2 practicum hours, including how you presented your ideas about the health problem to the patient, family, or group.

• Whom did you meet with?
  • What did you learn from them?
• Comment on the evidence-based practice (EBP) documents or websites you reviewed.
  • What did you learn from that review?
• Share the process and experience of exploring the influence of leadership, collaboration, communication, change management, and policy on the problem.
  • What barriers, if any, did you encounter when presenting the problem to the patient, family, or group?
    • Did the patient, family, or group agree with you about the presence of the problem and its significance and relevance?
    • What leadership, communication, collaboration, or change management skills did you employ during your interactions to overcome these barriers or change the patient’s, family’s, or group’s thinking about the problem (for example, creating a sense of urgency based on data or policy requirements)?
  • What changes, if any, did you make to your definition of the problem, based on your discussions?
  • What might you have done differently?
    

    Assessing the Problem: Quality, Safety, and Cost Considerations

Requirements
The assessment requirements, outlined below, correspond to the scoring guide criteria, so be sure to address each main point. Read the performance-level descriptions for each criterion to see how your work will be assessed. In addition, note the additional requirements for document format and length and for supporting evidence.

• Explain how the patient, family, or population problem impacts the quality of care, patient safety, and costs to the system and individual.
  • Cite evidence that supports the stated impact.
  • Note whether the supporting evidence is consistent with what you see in your nursing practice.
• Explain how state board nursing practice standards and/or organizational or governmental policies can affect the problem’s impact on the quality of care, patient safety, and costs to the system and individual.
  • Describe research that has tested the effectiveness of these standards and/or policies in addressing care quality, patient safety, and costs to the system and individual.
  • Explain how these standards and/or policies will guide your actions in addressing care quality, patient safety, and costs to the system and individual.
  • Describe the effects of local, state, and federal policies or legislation on your nursing scope of practice, within the context of care quality, patient safety, and cost to the system and individual.
• Propose strategies to improve the quality of care, enhance patient safety, and reduce costs to the system and individual.
  • Discuss research on the effectiveness of these strategies in addressing care quality, patient safety, and costs to the system and individual.
  • Identify relevant and available sources of benchmark data on care quality, patient safety, and costs to the system and individual.
  • Document the time spent (your practicum hours) with these individuals or group in the Capella Academic Portal Volunteer Experience Form.
• Use paraphrasing and summarization to represent ideas from external sources.
• Apply APA style and formatting to scholarly writing.

Additional Requirements

• Format: Format your paper using APA style. APA Style Paper Tutorial [DOCX] is provided to help you in writing and formatting your paper. Be sure to include:
  • A title page and reference page. An abstract is not required.
  • Appropriate section headings.
• Length: Your paper should be approximately 5–7 pages in length, not including the reference page.
• Supporting evidence: Cite at least 5 sources of scholarly or professional evidence that support your central ideas. Resources should be no more than five years old. Provide in-text citations and references in APA format.
• Proofreading: Proofread your paper, before you submit it, to minimize errors that could distract readers and make it more difficult for them to focus on its substance.

Competencies Measured
By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and scoring guide criteria:

• Competency 3: Transform processes to improve quality, enhance patient safety, and reduce the cost of care.
  • Explain how a patient, family, or population problem impacts the quality of care, patient safety, and costs to the system and individual.
  • Propose strategies to improve the quality of care, enhance patient safety, and reduce costs to the system and individual and document the practicum hours spent with these individuals or group in the Capella Academic Portal Volunteer Experience Form.
• Competency 5: Analyze the impact of health policy on quality and cost of care.
  • Explain how state board nursing practice standards and/or organizational or governmental policies can affect a patient, family, or population problem’s impact on the quality of care, patient safety, and costs to the system and individual.
• Competency 8: Integrate professional standards and values into practice.
  • Use paraphrasing and summarization to represent ideas from external sources.
  • Apply APA style and formatting to scholarly writing.