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Recommended Citation
Bartlett D, Sistare E, Washington B. Integrated Nursing Care for Severe, Persistent Mental Illness. Nurse-driven Innovations in Care Redesign and Delivery poster presentation at Elevating Nursing Excellence: Purpose, Profession, Passion; Advocate Health Midwest Region Nursing Research & Professional Development Conference 2024; November 13, 2024; virtual.
Presentation Notes
Nurse-driven Innovations in Care Redesign and Delivery poster presentation at Elevating Nursing Excellence: Purpose, Profession, Passion; Advocate Health Midwest Region Nursing Research & Professional Development Conference 2024; November 13, 2024; virtual.
Abstract
Introduction and Context: Treatment for Severe, Persistent Mental Illness requires a comprehensive, integrated clinical framework to encourage accessible mental health care1,2. The illness is marked by fluctuations in severity and stages of recovery3. Treatment is often complicated by unmet social needs and healthcare stigma1,4. The Adult Integrated Continuum clinic nurses collaborate with a multidisciplinary team to address barriers.
Implementation Strategy: Clinic nurses designed a case management program using various components of integrated treatment for the high-risk psychotropic medication, clozapine. The program began with 9 patients in 1991, and today serves 120. Dedicated nursing staff promote patient’s adherence and access to treatment while monitoring for complications. Nurses administer 600-700 long-acting antipsychotic injections monthly. Nurses track and manage the Outpatient Commitment orders often leading to reductions in incarcerations or hospitalizations. Social determinants of health are addressed at every visit with referrals initiated. The team coordinates with a designated Primary Care Practitioner providing integrated care. Nursing triage services generate crisis plans.
Outcomes and Impact: Involving patients and their families with an integrated, approachable clinical framework improves patient outcomes1,2,3,4. These actions reduce the need for high-cost services such as hospital readmission, and emergency department visits. The integrated approach to care in the outpatient clinic leads to decreased 30-day psychiatric hospital readmissions. The national 30-day readmission rate is 16% 6 while Behavior Health Charlotte was 4.23% in 2023, and 5.43% year to date.
Insights: Nurses proactively address and manage obstacles that may impede a patient’s access to treatment. Patients are considered within the broader context of their environment leading to an individualized, holistic approach to care1, 4.
Implications: Research supports care that meets the diverse needs of this population1, 3. Nurses model a clinical framework that encourages patient engagement by way of approachable care4. Nurses have worked to develop trusting, caring relationships with our patients, a component of Jean Watson’s Theory of Human Caring5.
References
1. Adepoju OE, Liaw W, Patel N, et al. Assessment of Unmet Health-Related Social Needs Among Patients with Mental Illness Enrolled in Medicare Advantage. JAMA Network Open. 2022;(11):e223985S.doi:10.1001/jamanetworkopen.2022.398S5.
2. Okoli C. Accessible Mental Health Care Us Available, Approachable, and Affordable. Journal of American Psychiatric Nurses Association. 2023; 29(4):352-355.
3. Woody C, Baxter A, Wright E, et al. Review of services to inform clinical frameworks for adolescents and youth with severe, persistent and complex mental illness. Clinical Child Psychology and Psychiatry. 2019; 24(3):503-528.
4. Fisher K, Weissinger G, O’Rorke R, et al. Consumers with Serious Mental Illness Perspectives on Care Integration: Preparation for Integration. Journal of American Psychiatric Nurses Association. 2022; 28(3):193-202.
5. Watson J. Watson’s Caring Science & Human Caring Theory. Watson Caring Science Institute. Updated 2024. Accessed May 23, 2024. https://www.watsoncaringscience.org.
6. Muhammad N., Talpur S., Sangroula N., et al. Independent Predictors of 30-Day Readmission
Document Type
Poster
Publication Date
11-13-2024
Integrated Nursing Care for Severe, Persistent Mental Illness
Introduction and Context: Treatment for Severe, Persistent Mental Illness requires a comprehensive, integrated clinical framework to encourage accessible mental health care1,2. The illness is marked by fluctuations in severity and stages of recovery3. Treatment is often complicated by unmet social needs and healthcare stigma1,4. The Adult Integrated Continuum clinic nurses collaborate with a multidisciplinary team to address barriers.
Implementation Strategy: Clinic nurses designed a case management program using various components of integrated treatment for the high-risk psychotropic medication, clozapine. The program began with 9 patients in 1991, and today serves 120. Dedicated nursing staff promote patient’s adherence and access to treatment while monitoring for complications. Nurses administer 600-700 long-acting antipsychotic injections monthly. Nurses track and manage the Outpatient Commitment orders often leading to reductions in incarcerations or hospitalizations. Social determinants of health are addressed at every visit with referrals initiated. The team coordinates with a designated Primary Care Practitioner providing integrated care. Nursing triage services generate crisis plans.
Outcomes and Impact: Involving patients and their families with an integrated, approachable clinical framework improves patient outcomes1,2,3,4. These actions reduce the need for high-cost services such as hospital readmission, and emergency department visits. The integrated approach to care in the outpatient clinic leads to decreased 30-day psychiatric hospital readmissions. The national 30-day readmission rate is 16% 6 while Behavior Health Charlotte was 4.23% in 2023, and 5.43% year to date.
Insights: Nurses proactively address and manage obstacles that may impede a patient’s access to treatment. Patients are considered within the broader context of their environment leading to an individualized, holistic approach to care1, 4.
Implications: Research supports care that meets the diverse needs of this population1, 3. Nurses model a clinical framework that encourages patient engagement by way of approachable care4. Nurses have worked to develop trusting, caring relationships with our patients, a component of Jean Watson’s Theory of Human Caring5.
References
1. Adepoju OE, Liaw W, Patel N, et al. Assessment of Unmet Health-Related Social Needs Among Patients with Mental Illness Enrolled in Medicare Advantage. JAMA Network Open. 2022;(11):e223985S.doi:10.1001/jamanetworkopen.2022.398S5.
2. Okoli C. Accessible Mental Health Care Us Available, Approachable, and Affordable. Journal of American Psychiatric Nurses Association. 2023; 29(4):352-355.
3. Woody C, Baxter A, Wright E, et al. Review of services to inform clinical frameworks for adolescents and youth with severe, persistent and complex mental illness. Clinical Child Psychology and Psychiatry. 2019; 24(3):503-528.
4. Fisher K, Weissinger G, O’Rorke R, et al. Consumers with Serious Mental Illness Perspectives on Care Integration: Preparation for Integration. Journal of American Psychiatric Nurses Association. 2022; 28(3):193-202.
5. Watson J. Watson’s Caring Science & Human Caring Theory. Watson Caring Science Institute. Updated 2024. Accessed May 23, 2024. https://www.watsoncaringscience.org.
6. Muhammad N., Talpur S., Sangroula N., et al. Independent Predictors of 30-Day Readmission
Affiliations
Atrium Behavioral Health - Charlotte