NSG 4076 Week 10 Project – Evaluation of Plan Effectiveness Criteria

NSG 4076 Week 10 Project – Evaluation of Plan Effectiveness Criteria

Over the past ten weeks, we have been working with our aggregate communities to develop and implement a care plan based on the strengths and weaknesses of the aggregate community. We will now discuss the strengths and weaknesses of the aggregate community, the community risk assessment, the care plan, the implementation process, and the evaluation of the implementation process. In working with our communities, we have been able to develop an understanding of the needs of the communities, and hopefully, our care plans have been able to show signs of improvement from the time of implementation.

Aggregate Strengths

During my evaluation of my aggregate, two distinct strengths that I noticed were the aggregate’s ability to identify resources available to them as well as their ability to seek medical attention during acute crises. Homeless individuals don’t have access to a wide range of things, such as food and shelter, on their own, but there are many agencies and systems that are able to help them (Guerrero et al., 2018). In my interviews with my aggregate, each one of them was able to identify resources that I did not know were available. Many of the patients in my aggregate know the signs of withdrawal and can identify when they are in danger. These individuals then seek out medical attention to prevent themselves from developing severe and life-threatening symptoms.

Aggregate Weaknesses

Although the aggregate has knowledge of systems in place to help them, I noticed that they are exceptionally weak in seeking these services out prior to being in dire need. The patients that I interviewed came into the hospital because they had no other options. They had allowed themselves to get to the point where they did not have any other option but to seek. Medical attention because they did not utilize the resources available to them. Addiction is a second weakness that I was able to identify during my aggregate assessment. Homeless individuals have a much higher likelihood of developing addiction due to the high rate of drug availability on the street, especially around Gracepoint, which is the focus of my aggregate community (Fletcher & Reback, 2017).

Community Assessment

Defining the Community

The community that has been identified as the focus of the aggregate is a three-mile radius surrounding Gracepoint, one of the crisis stabilization units in Tampa, FL. The focus for this capstone project is placed on mental health patients, especially those who are homeless. In the area surrounding Gracepoint, there is a drug problem that has attracted many homeless individuals who are addicted to different drugs; however, the drug that is most prevalent in this area is heroin. Heroine is a drug that has been around for a long time, but recently, there have been new forms of the drug being created that are less expensive, which has only increased the problem that our society faces (Azuz, Asher, & Curnow, n.d.). This portion of the assessment was completed by performing the windshield survey in weeks one and two of this course.

People and Health Statistics

In the community surrounding Gracepoint, there are many homeless individuals who reside there. As you drive through the community, you will see that there is a tent city set up in one of the fields at the edge of the defined community. The drug problem that has been identified for this community is one of the problems that plague our nation, and the rate of overdose in homeless patients addicted to drugs has been increasing in recent years (Opioids & Florida, 2014).

Systems in Place

During the windshield survey in week one, we gathered information regarding the resources that are available within a three-mile radius of Gracepoint. As identified in the windshield survey, the primary resources available to this community are gas stations and convenience stores. When driving through the community, you will be unable to identify other businesses that are currently open due to the downtrodden community in which we are focusing.

Data Analysis

Based on the interviews with the patients from the aggregate at the Practicum site, as well as the windshield survey completed in week one, we can identify that this community is in desperate need of assistance. The drug problem that this community faces is the primary issue that needs to be addressed since it is the root cause for the other issues that this community endures. By decreasing the number of patients in this area who are at risk for developing substance abuse issues, we can help to reduce the number of overdoses within the community, leading to an overall improvement in the community’s health (Opioids & Florida, 2014).

Care Plan

Assessment

While working with my targeted aggregate, one of the primary issues identified was that the patients were at an increased risk for suicide. Mental health is a serious issue in the homeless population, which is a serious cause for concern (Stanhope & Lancaster, 2016). Many of the patients were suicidal for several reasons; however, drug and alcohol dependence was one of the reasons that was reported by 70% of the patients that I interviewed. We need to address this problem so that we can meet the Healthy People 2020 goal of decreasing the number of patients who commit suicide (Office of Disease Prevention & Health Promotion, 2018).

Drug and alcohol abuse are other very serious issues among the homeless population (Sinyor et al., 2017). As a crisis stabilization unit Gracepoint offers services that help patients cope with both mental health and substance abuse issues; however, according to J. Smith, the patients who leave Gracepoint often feel that they do not get the necessary help that they need to be successful after discharge from the facility (personal communication, October 28, 2018) One of the biggest concerns with patients being addicted to drugs and alcohol is that these substances lead patients to be at an increased risk for developing suicidal ideations (Sinyor et al.,2017).

NSG 4076 Week 10 Project – Evaluation of Plan Effectiveness Criteria

Diagnosis

One diagnosis that has been identified for patients within my chosen aggregate is as follows: Risk for suicide related to alcohol and substance abuse as evidenced by feelings of hopelessness and feelings of despair related to the patient’s inability to control their use of alcohol and other substances (Munn, 2017).

The second diagnosis related to my chosen aggregate is related to alcohol and substance abuse. The diagnosis is Feelings of powerlessness related to episodes of compulsive use, followed by failed attempts at detoxification as evidenced by the patient’s ineffective attempts at recovery and sobriety (Healey, 2013).

Planning

The desired outcome for these patients relating to suicide is a decrease in the number of suicide attempts, as well as success rates. If we can decrease the number of patients who commit suicide, then we will be able to say that the plan of care has been successful in the aggregate. For our plan of care, we would like to see a minimum of a ten percent decrease in suicidal patients admitted to Gracepoint over the next six months.

The plan for this aggregate relating to substance abuse is a decrease in the number of patients who regularly and compulsively use alcohol and other substances. By decreasing the number of patients who are addicted to drugs and alcohol, we will hopefully also notice a decrease in the number of patients suffering from suicidal ideations, as well as suicide attempts. For our plan of care, we would also like to see a decrease in the number of patients admitted to Gracepoint for alcohol and substance abuse by at least ten percent over the next six months.

Interventions

One intervention that we can incorporate into the plan of care is assisting patients with developing healthy coping mechanisms to deal with feelings of suicide (Munn, 2017). During interviews with my chosen aggregate, lack of healthy coping mechanisms has been identified as one of the primary causes for suicidal ideations. By helping patients develop healthy coping mechanisms,, we can help them find an outlet for their feelings in a way that is not harmful to the patient or those around the patient. Healthy coping mechanisms can range from drawing, exercising, reading, writing, and many other things that are not harmful. When patients have an outlet for their emotions, they are less likely to bottle up their feelings of depression, guilt, sadness, and hopelessness until these feelings become an overwhelming burden, leading them to thoughts of suicide (Munn, 2017).

Another intervention that we can employ relating to suicide is to assist patients in identifying the positive things in their lives that they must live for (Munn, 2017). Many patients who are homeless or dependent on mind-altering substances may not be able to adequately see the positive things in their lives without getting someone to help them realize what they have rather than what they do not have. My patients feel as though they don’t have anything to live for until you start talking to them about their family, friends, pets, and any number of positive things in the patient’s life. During your interview with your patients, they often make statements about what is negative and causing their feelings of suicide; therefore, as the health professional, you often need to help direct the conversation in a more positive manner so that the patient is able to see that there is, in fact, a light in their life that they may be overlooking (Munn, 2017).

Drug and alcohol abuse are very serious problems in our country, especially with patients who are homeless or low-income (Healey, 2013). One intervention that we can employ to help patients suffering from these issues is to help the patient identify long-term treatment facilities that will be able to help them detoxify from the substances that they have become addicted to (Healey, 2013). In these long-term treatment facilities, the patient will not only get the assistance that they need to detox from the addictive substances, but they will also get assistance with identifying ways to stay away from these substances in the future, which is crucial to the patient’s future success in refraining from relapse.

Secondly, we can also help the patients identify support systems that they can rely on in times of crisis. Peer groups, family, friends, and coworkers are also imperative parts of helping our patients achieve success in preventing relapses in their sobriety; therefore, we must include these individuals in the patient’s treatment (Healey, 2013). Having people whom you can rely on in times of need is something that everyone needs, but individuals who have issues with addiction need this more than anyone else, in my personal belief. Addiction is one of the worst diseases in our country due to its prevalence in every part of the country. Everywhere you turn, there is a bar on the corner serving drinks in the middle of the day, and for patients with addiction, this is a huge temptation that provides an immense risk. We need these patients to have people that they can utilize in times of need, even if it is not someone that they know personally but someone they may have met in Alcoholics Anonymous (Healey, 2013).

Evaluation

Once we have implemented the aforementioned interventions, we will need to evaluate the success rate of the plan of care. To perform this evaluation, we will need to examine the number of admissions to Gracepoint for suicidal ideations, and suicide attempts six months from the time we implemented our plan of care to determine if there has been at least a ten percent decrease in the number of admissions. We will also need to examine the city of Tampa’s medical examiner’s records of patients who have become deceased related to suicide. Once we have performed the evaluation, we will be able to determine if our current plan is successful or if we need to revise the plan of care for future implementation.

Since Gracepoint is the primary source of alcohol and substance abuse inpatient treatment with the aggregate community, we will need to evaluate their admission records related to admits for alcohol and substance abuse six months after we implement our plan of care. If there has been a trend showing a decrease in the number of admissions by at least ten percent, then we can determine that our plan of care is successful. If there has not been a 10 percent decrease, we will need to revise the plan of care for future attempts.

Intervention Implementation

The first intervention that will be implemented in this care plan is for the nurse to help the patient develop healthy coping mechanisms through individual therapeutic discussion. The nurse will help to facilitate this discussion with the patient after they have time to build a rapport with one another. When you can bond with a patient on a personal level as well as a professional level, then you have an increased likelihood of helping the patient to come to the desired outcome that you desire (Stanhope & Lancaster, 2016).

The second intervention that will be implemented is staff assisting with getting the patient into a long-term rehabilitation facility prior to discharge. According to the aggregate population that has been evaluated, one of the biggest hurdles that prevent these patients from getting long-term help is due to the hassle of getting into a long-term program. Currently, Gracepoint does not help with getting the patients into long-term detoxification programs, but if we are able to help eliminate the hassle of the patient dealing with the hoops that these programs make them jump through, then we will be able to potentially increase the number of patients who get long-term help. For this process to be successful, the nurse will need to obtain information regarding long-term facilities in their local communities. The nurse will also need to be familiar with the admission criteria for each of these facilities.

The last intervention that we will implement is helping the patient to identify current and future support systems that they can utilize to help them reduce their risk for suicide. When patients have strong support systems that they can turn to in times of crisis, they are able to get assistance that they otherwise would not have (Guerrero et al., 2018). The nurse will be able to assist the patient with determining support systems that would be beneficial to the patient by helping the patient do a thorough evaluation of the people and places that are most common to them. If the patient is unable to identify support structures, then the nurse will be able to help the patient by providing resources that are available to everyone.

Care Plan Evaluation

Implementation

When implementing this care plan, the first intervention that was incorporated was to help patients identify healthy coping mechanisms that they can use in times of crisis. Throughout the interviews with the aggregate population, it was determined that the primary reason they were turning to drugs and alcohol was due to stressful events that were occurring in their lives. Keeping this in mind, it became apparent that we needed to help the patients identify healthy coping mechanisms that would keep them from turning to these self-destructive substances. To implement this intervention, Julie, the nursing staff, and I began to speak with each of our patients during their time in our facility to help them determine what other coping mechanisms would help them with their stress. Through therapeutic communication, along with some intrapersonal reflection by the patients, we have been able to help the patients that we have worked with to realize that through self-medication with addictive substances, they are merely adding another stressful event into their lives. The patients were able to explain to us that they now had to deal with the original problem as well as worrying about how they were going to get their drugs or alcohol on top of this. Each patient then signed a contract that the hospital has that states that they will refrain from seeking out drugs or alcohol after discharge; while this contract is not legally binding, it is a way for the hospital and staff to try to help hold the patient accountable for their actions after discharge.

The second intervention that was implemented was for the nursing staff to establish referrals for patients seeking long-term rehabilitation after discharge from the hospital. To implement this process, the nursing staff was educated by Julie and me on the different programs in the area. We also created a referral document that we can disseminate to the patient population regarding these resources, which includes their admission criteria, fee schedules, and services offered. This process seems to be beneficial to our patients because, in our initial interviews, one of the things that was identified as a barrier to seeking treatment was the hassle of having to get a referral, appointment, or admission to long-term rehabilitation facilities. Since the inception of this process, we have helped 41 patients get placed in local rehabilitation centers in the greater Tampa Bay area. In the time the patients were referred to the care plan re-evaluation, we have not seen any of these patients return to our facility for substance abuse, depression, or suicidal ideation issues.

The final intervention that was implemented into this care plan was the identification of support systems for each of our patients. Studies have shown that having a healthy support system in times of crisis is one of the most important aspects of maintaining a healthy distance from turning to self-destructive coping mechanisms (Healey, 2013). Through one-on-one sessions with the patients, the nursing staff has been able to help patients realize that people in their lives can be extremely helpful when they are having moments of weakness. Many of our patients stated that they felt as though they did not seek help from close friends or family because they did not want to feel like a burden; however, they did not consider the amount of stress and anxiety their substance abuse and suicide attempts may impact the ones that they love. By educating the patients on the stress that loved ones feel when they are experiencing a loved one suffering from mental health issues, many of our patients began to realize that they may be a bigger burden by not asking for help. We do still have those few patients who state they would rather not tell their friends and family, which we respect, so in these situations, we have been providing public resources that the patient may turn to, such as the suicide prevention hotline, Alcoholics Anonymous, and Narcotics Anonymous support groups.

Signs of Success

The goal of the care plan is to see a decrease in the number of patients admitted to Gracepoint by a minimum of ten percent over the next six months. At the time the evaluation was completed for the implantation of our care plan, we had already seen a decrease in the number of re-admitted patients suffering from suicidal ideations and substance abuse issues by two percent over the past five weeks. Many of the patients who would come into Gracepoint were frequent-flyers who were admitted for the same issue weekly, if not more. The fact that we are already starting to see a decrease in these numbers shows that going the extra mile and ensuring that patients are discharged with the resources that they need to succeed is one of the most crucial aspects of medical care. The nursing staff work hard, and they are very busy; however, does this mean that they don’t need to go that extra mile to ensure that patients are set up for success? As nurses, we all know that it is not easy to do our jobs, especially when we have six or more patients at one time, but if we can put in that little bit of extra work, then it would save us excess work in the future.

NSG 4076 Week 10 Project – Evaluation of Plan Effectiveness Criteria

Aggregate Interviews

In evaluating the effectiveness of our care plan, two patients who were frequent flyers to the hospital were chosen for an interview. The first patient that was interviewed was M. Underwood. M. Underwood is a 42-year-old male who suffers from frequent alcohol-induced suicidal ideations. When speaking with Mr. Underwood about the information he was presented at his last discharge, he stated that the information he was given has been what has kept him from coming back to the hospital. He stated that he was not aware that there were so many things that he could do to distract himself when he was feeling the urge to drink. Mr. Underwood states that he has been going to Alcoholics Anonymous meetings twice a day for three weeks now, and he is proud to announce that he has been sober for 18 days currently. For Mr. Underwood, this is a huge accomplishment because when he was admitted several times a week, his blood alcohol level was four times the legal limit due to the amount of alcohol he consumed daily. My preceptor and I consider this a success so far. Mr. Underwood has not been readmitted to the hospital, and he has been sober for 18 days, so that shows that our interventions may be working and having the desired effect on the aggregate.

The second person who was interviewed for this evaluation was N. Gronek. N. Gronek is a 28-year-old female who suffers from frequent bouts of depression and self-harm attempts due to heroin withdrawal. At the time this interview was done, N. Gronek was being released from a 21-day inpatient rehabilitation program in Tampa that she was referred and transferred to at the time of her last admission to Gracepoint. N. Gronek states that she has been sober for 21 days. She states that this is the first time that she has been to an inpatient rehabilitation center, and she thinks that this is the first step in helping her get sober for good. One of the issues that N. Gronek identified as a source of stress for her was living with her sister. N. Gronek’s sister is a heavy intravenous drug abuser, and N. Gronek states that she will not be living with her sister any longer. She states that she contacted her father during her time in rehab and that she will be living with him because he wants to help her stay sober. N. Gronek was able to identify her plan for refraining from heroin use, which she states is to refrain from interacting with known intravenous drug users, attend daily Narcotics Anonymous groups, and follow up with outpatient mental health services three times a week during her transition period from inpatient to outpatient. It is the hope of N. Gronek to go to college to become an addiction counselor. She states that her time in the inpatient rehabilitation center helped her to realize that there are people out there, including herself, whose lives have been completely destroyed by substance abuse, and she wants to help people get back onto a healthy path in their lives.

Conclusion

Throughout this capstone project, I have learned a lot of very valuable lessons from my preceptor and my patients. I have discovered that when people are suffering from mental health issues, they are significantly more likely to be at risk for self-harm, which is a problem that needs to be addressed. The care plan that I have helped to implement is something that I will be following up on in the future. I have discussed this project with the administration at Gracepoint, and they have agreed to let me continue to work with them in the future to come up with ideas on how to improve their patient care. I will be continuing with my master’s degree to be a psychiatric mental health nurse practitioner in January, and this project is something that I plan to work on throughout the duration of my master’s program. I have discovered a passion for working with patients who are suffering from substance abuse issues, and I think that if more people were to take an active role in patient care for this population, we could see a decrease in the amount of substance abuse that our nation is currently facing.

References

Azuz, C., Asher, Z., & Curnow, R. (n.d.). U.S. government concerned with synthetic drug usage; Liberation party losing some South Africans support; Celebrities boycotting Beverly Hills hotel in support for human rights. Student News (CNN). Retrieved from https://www.thecampuscommon.com/library/ezproxy/ticketdemocs.asp? sch=suo&turl=http://search.ebscohost.com.southuniversity.libproxy.edmc.edu/login.aspx ?direct=true&db=rch&AN=32U0277728730SNN&site=eds-live

Fletcher, J. B., & Reback, C. J. (2017). Mental health disorders among homeless, substance-dependent men who have sex with men. Drug & Alcohol Review, 36(4), 555-559.

Guerrero, E. G., Song, A., Henwood, B., Kong, Y., & Kim, T. (2018). Response to culturally competent drug treatment among homeless persons with different living arrangements. Evaluation and Program Planning, 66, 63–69. Retrieved from https://doi- org.southuniversity.libproxy.edmc.edu/10.1016/j.evalprogplan.2017.10.005

Healey, J. (2013). Drugs and Addiction. Thirroul, N.S.W.: Spinney Press. Retrieved from https://www.thecampuscommon.com/library/ezproxy/ticketdemocs.asp? sch=suo&turl=http://search.ebscohost.com.southuniversity.libproxy.edmc.edu/login.as px?direct=true&db=nlebk&AN=569131&site=eds-live

Munn, F. (2017). Ensuring suicide prevention is everyone’s business. Nursing Standard, 32(13), 12–13. Retrieved from https://www.thecampuscommon.com/library/ezproxy/ticketdemocs.asp? sch=suo&turl=http://search.ebscohost.com.southuniversity.libproxy.edmc.edu/login.as px?direct=true&db=rzh&AN=126379708&site=eds-live

Office of Disease Prevention & Health Promotion. 2018. Mental health and mental disorders. Retrieved from https://www.healthypeople.gov/2020/topics-objectives/topic/mental- health-and-mental-disorders/objectives

Opioids and Florida: Rx ODs down, but heroin ODs up. (2014). Alcoholism & Drug Abuse Weekly, 26(27), 3. Retrieved from https://www.thecampuscommon.com/library/ezproxy/ticketdemocs.asp? sch=suo&turl=http://search.ebscohost.com.southuniversity.libproxy.edmc.edu/login.aspx ?direct=true&db=pwh&AN=97214010&site=eds-live

Sinyor, M., Kozloff, N., Reis, C., & Schaffer, A. (2017). An observational study of suicide death in homeless and precariously housed people in Toronto.  The Canadian Journal   of Psychiatry / La Revue Canadienne de Psychiatrie, 62(7), 501–505. Retrieved from https://www.thecampuscommon.com/library/ezproxy/ticketdemocs.asp? sch=suo&turl=)http://search.ebscohost.com.southuniversity.libproxy.edmc.edu/login.as px?direct=true&db=psyh&AN=2017-29988-010&site=eds-live

Stanhope, M., & Lancaster, J. (2016). Public health nursing: Population-centered health care in the community (9th ed.). St. Louis, MO: Mosby

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Evaluation of Plan Effectiveness Criteria You spent the last few weeks implementing a portion of the comprehensive care plan you developed for the aggregate. An evaluation of plan effectiveness is now due. In the evaluation component of the Capstone project, you are expected to evaluate the effectiveness of the intervention.

The following are some questions you should seek answers to: Did I implement the intervention as planned? If not, what were the reasons? Are there visible signs of success (for example, reduced health issues)? If yes, describe. Interview at least two members of your group to learn their views about the effectiveness of the intervention. Finally, compare the projected effectiveness of your plan before implementation with the actual effectiveness after implementation. You may want to use the responses to the above questions 1 and 2 to measure the actual effectiveness of the intervention.