Intervention Plan Design
Nurse managers and other healthcare leaders play vital roles in healthcare improvement. The focus is on patient safety and improved patient outcomes amidst the health dynamics introducing health problems daily. Healthcare leaders evaluate healthcare and determine the best intervention to implement change for better results.
They also evaluate these interventions to ensure they align with nursing principles, theoretical underpinnings, and internal and external regulatory requirements. They also evaluate their impact on target populations and stakeholders to ensure they have delivered the most benefits and least harm. This essay analyzes a quality improvement project and vital factors in its implementation.
Intervention Plan Components
The major components of the intervention to address the problem are a shift to using first-generation antipsychotics compared to second-generation antipsychotics in reducing metabolic syndrome in mentally ill patients. The intervention will entail prescriptions of typical antipsychotics for patients at higher risk for developing metabolic syndrome and for individuals with the syndrome.
The healthcare providers will ensure patients only take approved typical antipsychotics with similar functions to the prescribed atypical antipsychotics and a lower side effects profile. The goal is to maintain the clinical and therapeutic effectiveness of the treatment interventions when controlling metabolic syndrome. The newly diagnosed patients who sign the informed consent will be randomized into two groups.
The experiment group will be put on typical and the second on atypical antipsychotics that are FDA-approved to manage the specific symptoms. Evaluation will entail reporting the incidences and prevalence of individuals who develop the condition or signs and symptoms within six months. Another evaluation basis will be on the patients who develop side effects that warrant changes in therapy.
Another group of significance will be the patients with the condition. Patients who present to the clinic with signs and symptoms of metabolic syndrome will receive a therapy changing atypical to typical antipsychotic, and the results observed. Data evaluated will include the differences in remission from metabolic syndrome. The data from the first and second groups will help determine the effectiveness of typical antipsychotics in preventing metabolic syndrome and their role in remission from the condition most commonly caused by atypical antipsychotics.
The intervention targets the minority blacks and Hispanics in the Bronx, New York. These two ethnic groups carry a significant risk (genetic, social, and environmental) for metabolic syndrome, a significant problem (Gurka et al., 2018). In addition, the burden of mental health illnesses is higher in adults above 20 years. The population suffers an already high burden of metabolic syndrome due to their genetic predisposition and other factors such as poor access to health.
Hispanics and minority blacks often have poor living conditions that limit healthy practices such as healthy diets and exercise. Low income also increases their susceptibility to mental health illnesses and metabolic syndrome. Other interventions, such as dieting and exercising to reduce metabolic syndrome burden in patients with mental illnesses, are effective and less harmful but are hardly implemented. Thus the proposed intervention carries a sizeable probability of success.
Theories in nursing can focus on the entire discipline or some aspect of it. They serve as vital references during practice, change their postulations a be widely applied across the nursing profession. Most nursing theories are patient-centred and focus on delivering the most good to patients.
Utilitarianism is a theoretical model of morality borrowed from sociology that will greatly guide the interventions. The overall goal of the intervention, synonymous with the utilitarian theory, is to achieve the greatest good for most of these patients and prevent the debilitating effects of metabolic disorders and associated health and medical issues (Smart, 2020).
Typical antipsychotics are generally avoided due to their severe side effects, and atypical medications are preferred for their clinical effectiveness and less severe side effects. However, atypical antipsychotics present a higher risk for metabolic syndrome, a condition with a high risk for patients developing diabetes and associated health illnesses such as hypertension which complicate illnesses. This project aims to balance these side effects while producing optimum health outcomes.
Martha Roger’s theory, “Science of Unitary Human Beings (SUHB)”, views nursing as both an art and a science that relies on scientific knowledge to implement changes that positively impact patients and the general health of patients (Gunther, 2021). Nurses also view the profession as a holistic profession that views a patient as a whole. The objective is to ensure the patient heals wholly: spiritually, social, cognitively, and physiologically.
Another intention is to ensure recovery from a disease or illness with minimal side effects. In addition, this project aims to ensure that patients receive minimal to low health risks as healthcare professionals attempt to manage their mental health illnesses.
The healthcare public health dashboard for mental health and electronic health records will be vital technologies for this intervention. The EHR will be vital technology for data collection, entry, and analysis in the project. Health dashboards are enhanced EHR technologies that will allow data tracking and visualization of the project’s performance over time (Hemler et al., 2018). The two healthcare technologies can be used to plan and implement the project.
They will also help collect, analyze, and disseminate data and showcase progress in achieving the set targets. Healthcare dashboards help show the organization’s performance against internal and external benchmarks and are significant to this project.
Stakeholders, Policy, and Regulations
The proposed intervention will be affected by various stakeholder needs. These stakeholders include patients, care providers, healthcare leaders and external regulatory agencies. The external regulatory agencies require research involving high-risk populations to be registered and approved by the research board. These regulatory agencies will shape the research to ensure it meets the ethical and legal principles and guidelines. This research involves adults with mental health illnesses, and thus the registration of this research is paramount.
Patients’ collaboration and acceptance of this project will greatly impact the project. Their collaboration is based on their knowledge needs and how they are et. Any change resistance to the QI could cripple it, leading to resource and time wastage.
However, patient compliance in all vital processes (pre-implementation survey, implementation, and evaluation) of quality improvement projects could lead to increased efficiency in data collection and the success of the QI (Bergerum et al., 2019). Typical antipsychotics are more efficacious due to their mechanism of action but are also associated with more severe side effects due to their actions only of dopaminergic receptors.
Healthcare providers are tasked with carefully evaluating care interventions before implementing them. They will also collect data for the QI on areas such as the incidence and prevalence of metabolic syndrome and side effects. They are the labor for the QI, and their involvement is integral in all its steps.
Interprofessional collaboration introduces new ideas and perspectives and will help improve, thus promoting its success (Lising et al., 2021). Healthcare leaders will analyze the data on these interventions to make sound clinical decisions.
Many institutions limit typical antipsychotic use due to the perceived side effects. These policies will markedly limit the number of medications used in the experiment and will greatly affect the generalization of the results. Chokhawala and Stevens (2022) note that regulations require periodic patient evaluation. These clinic appointment regulations will also impact patient follow-up. These clinic visits will increase contact with patients, promoting the interventions’ success.
The US Food and Drug and Drug Administration agency is of paramount significance in this study. The recommendations from the governing body will be paramount for this study and a great limiting factor. Medications must be FAD-approved for their acceptance as initial therapy for patients in this study; off-label drugs are reserved as second-line medications (Vijay et al., 2018).
Other bodies include the DSM-5, which will help diagnose and initiate management for patients with mental health illnesses. The reports written will also be submitted to the National Institute of Mental Health for further action.
Ethical and Legal Implications
There are various ethical and legal considerations in this study. The first and most important aspect of the intervention is informed consent. Varkey (2019) notes that all interventions without informed consent are illegal and have significant legal and ethical problems. All individuals involved in the process must sign an informed consent form. The involvement of their primary caregivers is paramount because of their mental condition.
Other ethical and legal implications include adherence to internal and external requirements. Adequate change management will also favour the project to produce better outcomes. The professionals must deeply understand the project before its implementation, from its objectives to evaluation.
Typical antipsychotics are widely known for their extensive side effects. Bahta et al. (2021) note that patients on first-generation antipsychotics experience side effects that affect medication adherence. The events could also affect their stay in the program.
Some patients with severe side effects will require withdrawal from the program and subsequent management to ensure any harm is mitigated early. Webushet et al. (2019) show that patients developing drug side effects should receive therapy changes to minimize the side effects, promote drug adherence, and promote better health outcomes.
However, Chokhawala and Stevens (2022) provide new insights into using first-generation antipsychotics. According to the researchers, first-generation antipsychotics can be used safely with careful dose titration, avoiding polypharmacy, high doses, and highly potent drugs (Chokhawala & Stevens, 2022). They note that first-generation antipsychotics are highly efficacious but poorly tolerated and have severe side effects, especially when used in high doses.
Withdrawal of a therapeutically effective agent that is present and approved is against ethical codes regulating research with human subjects. There will be a few exemptions during the project when administering the antipsychotics. For example, quetiapine is the only FDA-approved antipsychotic medication for depression in bipolar 1 disorder.
Other antipsychotics used are off-label medications, and prescribing such to the patients during the study may present a legal issue. Alternatives include using other non-antipsychotic medications, such as sertraline, that are FDA-approved for depression. The project may be adept in making and covering such adjustments, which may present a significant ethical and legal issue for this project.
Metabolic syndrome remains a problem in mentally ill minority blanks and Hispanics taking second-generation antipsychotics. Metabolic syndrome is complex in mentally ill patients and is hard to control because coordination of common interventions such as exercising and diet is extremely difficult in this population. Other determinants of health also play a vital role in the health of these populations.
The intervention of choice, first-generation antipsychotics to replace second-generation antipsychotics, faces many regulatory and policy barriers revolving around the efficacy and safety o these medications. There is hope in the efficacy and utilization of typical antipsychotics in preventing metabolic syndrome among mentally ill patients owing to the severe effects of metabolic syndrome on individuals and the controllability of the side effects of typical antipsychotics,
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