Mental health Nursing and Quality Process: A Conceptual Review

INTRODUCTION

This article would review the conceptual ideologies that are used currently in the field of Mental Health Nursing. Quality assurance and Quality Improvement process are the two sides of a coin that is engrossed by multiple control indicators decided by the Mission, vision or values of the sector which you are working with. In terms of my experience with mental health, will discuss some practical aspects on how do we assure quality care when providing nursing care in a hospital sector and improve patient satisfaction and assured outcome which can be elicited through evidence based practice or data driven. Let us discuss some scenario in this article where I will highlight practical implication towards developing Quality improvement project and quality control indicators that will enrich your knowledge in new dimension of care.

Acute Unit Case Scenario-1

It was noted that for the past 6 months the total number of restrain applied was of high volume, ranging 70-80 per month. The time of restrain applied per patient exceeded 60 mintues and multiple restrains for the same patient on the same day is pretty alarming. The unit manager discussed the same concerned with departmental head who decided to look into this matter and advised the Nurse Unit Manger to develop an alternative to this. A Quality improvement project is being preceded with the aim to reduce the application of restrain in the unit.

What we need to know

• Find the Process to improve/Project Identification

• Organize a team

• Clarify current process

• Select the improvement¹

1) Project Identification:

The identified issue is considered as an opportunity for improvement.³ In the above mentioned case scenario the identified process related to over-use of restrain in Male acute ward need improvement and corrective actions so as to reduce patient restrains and engage patients in more productive activities rather than confining clients to bed or seclusion that may deteriorate patient clinical progress and well-being.

2) Organize a team

• Lead Manager: Unit Manager/HOD
• Strategy Lead: Unit: Multi- disciplinary team 
• Coordinator: Deputy Unit Manager/ Assigned designee 
• Participants: Unit Staffs

3) Clarify Current Process 

• High Levels of restrain evidence by long duration of restrain exceeding 60 mintues 
• Recognition of risk assessment that may turn into violent or aggressive behavior

4) Quality Improvement Model

The Framework that can be used to promote success by implementation of the process as defined.

W. Edward Deming: Model for Improvement^1-4

Plan:

• Identification of specific area for improvement including establishing indicators 
• Decide on which strategy to use

Do:

• Carryout the plan for improvement³ 
• Begin analysis of the data

Study: 

• Examine the results 
• Compare the data with predications

Act: 

• What changes are to be made 
• Next cycle

Technical Details for the implementation of the Project

1. Benchmarking: 

• Internal benchmarking: Acute Ward- A to Acute ward- B
• External Benchmarking: Hospital A (Cardiac ICU) to Hospital B (Cardiac ICU)⁴

2. Target Rate:

Improve 50% from current Status, in other words Decrease 50% of restrains applied by using alternative techniques by the end of 2019¹

3. Key Performance Indicator:

• It is a type of Performance measurement. This allows the team leader to monitor the success of their operations
• The calculation performed can be in Percentage or rates.⁴

4. Information technology

The process of appropriate presentation of data collected and explained using accurate statistical charts and diagrams.⁴

CONCLUSION

Quality Improvemnet process is a step that we all need to perform to advance our performance from the current status to higher hierarchy. This conceptual review is a outline on how we can improve ourselves and the services we provide to a better quality so as to improve both customer and service provider satisfaction.

CONFLICT OF INTEREST: None