Addressing Fragmentation Of Care In Psychiatric Patients: A Guide To Resolute Measures Essay Samples

Jane Doe

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Health care professionals use various mechanisms to influence health outcome as expected by community, government, and other stakeholders. Psychiatric care sector faces challenges including fragmentation of patient care stemming from inadequate interdisciplinary collaboration. Since psychiatric patients may have other physiologic illness in-addition to mental health illness, a relapse in one system tends to affect other (American Hospital Association [AHA], 2012). Fragmentation of care in this context refers to break in continuity of a holistic care regimen. Psychiatric patients based on nature of illness are subjected to fragmented care stemming from lack of interdisciplinary collaboration and inadequate discharge after care plans. Psychiatric nurse practitioners deal with revolving door phenomena on a daily basis. Factors contributing to revolving door phenomena also affect transition of care in psychiatric patients. Inadequate discharge planning and interdisciplinary communication encourages frequent readmission and fragmentation of care in psychiatric patients (Botha et al., 2010). Although, factors affecting effective transmission of health care also relates to different aspects of human functioning and behavior, area of interest will focus on care givers. A psychological approach is used to identify different concepts promoting fragmentation of patient care and poor care transition. Collaboration in terms communication between patient and health care team supports effective transition of care thereby improving quality of health care delivery (Moran, Burson and Conrad, 2014). The Phenomenon of interest (POI) discussion will focus on development of discharge planning strategies for improved care continuity via effective intra-professional communication.

Phenomenon of Interest: Addressing Fragmentation of Care in Psychiatric Patients

The main objective of selecting this POI is to address fragmentation of patient care and explore effects of medication management coordinators to continuity of care after discharge. The rise in frequent readmission has affected insurance reimbursement promulgating a financial challenge to free standing psychiatric facilities. Quality improvement articles by Maples et al. (2012), reports approximately 40% of mentally ill patients are readmitted approximately 6 months after discharge. Nursing science leads to new understanding and knowledge brought about by various philosophies (Whittemore, 1999). The selected POI assists in improving quality of health care offered in psychiatric health care facilities through ensuring a comprehensive care planning, treatment, and assessment prior to discharge. Consequently, health care facilities can properly plan to transfer patients to right provider since a detailed history of present illness will be available. The conceptual benefits of addressing care fragmentation promotes effective collaboration between health care professionals, enhances accountability and coordination of care services (Registered Nurses' Association of Ontario, 2014).

Intra-Professional Communication and Use of Medication Care Coordinators

Inadequate communication and coordination of care after discharge is an important factor responsible for fragmentation of care in psychiatric patients. Communication in health care goes beyond information delivered through a word of mouth. The problem of communication has affected care delivery for many decades and professionals ought to find solutions to fragmentation of patient care. Norgard (2011) reveals a common factor affecting patient outcome is lack of inter-professional communication among professionals and patients. An effective patient-centered plan of care helps in ensuring active participation of different professionals involved in a patient care. According to Bainbridge and Nasmith (2011), psychiatric nurses should be educated on the importance of inter and the intra-professional communication because it ensures a collaborative, patient-centered practice which promotes effective care transition between health professionals. Individuals with behavioral health disorders need medical attention in hospital and at home. Psychiatric nurses are obligated to promote effective collaboration between care professionals. An effective intra-professional collaboration helps minimize major problems such as non-compliance, which are associated with psychiatric patients (American Hospital Association, 2012).The importance of care continuity is underestimated considering fragmentation of care affects optimal functioning. Availability of patient care givers during admission and discharge process increases effectiveness of care (Maples et al., 2012). Therefore, use of medication coordinator management program aimed at reducing care fragmentation, communication of pertinent health care information, and reducing readmission in severely mentally ill mimics an effective intervention.

Primary Philosophic Viewpoint- Qualitative and Quantitative

The philosophy of science, knowledge and theory are significance to the nursing profession. Scholars have raised several concerns about empirical content of psychiatric medicine. Neglecting roles of philosophy in psychiatric nursing is impossible because people would never understand important aspects of nursing that promotes patient outcome (Pesut & Johnson, 2007). However, despite level of evidence in psychiatric medicine, effects of communication and care fragmentation, the primary viewpoint employed is based on chaos and complexity. Chaos and complexity science impacts how this philosophy of interest evaluates and seeks truth about effective psychiatric care with reference to optimal functioning, adherence and continuity of care. A registered psychiatric nurse should apply experience and theory-based knowledge in psychiatric nursing practice (College of Registered Psychiatric Nurses of B.C, 2012). Application of these concepts plays a major role in achieving better discharge outcome. According to Bruce, Retze, and Lim (2014), understanding philosophy does not only help in getting the correct answer to emerging problems in the profession of nursing but also gives nurses varying views and knowledge on how to improve nursing practice. Issues of noncompliance are best resolved by patient education but may not always be possible in psychiatric patients due to cognition. Therefore, based on chaos and complexity of psychiatric medicine, addressing professional aspects of possible relapse is important to psychiatric care. Since predicting and understanding human behavior is complexity and almost impossible, implementing measures to reduce fragmentation of care is imperative. Analytic philosophy of science does not help to define this particular phenomenon of interest more fully because there needs to be more focus on the patients overall status as opposed to values and quantities of information related to their illness, this is important, but the numerical portion of readmission is not encouraging without action or intervention (Tieszen, 2011; Rickles, Hawe, & Shiell, 2007).The major issues care coordination solves include uneven quality, disappointing patient outcomes, and high costs of care due to fragmentation.

Quantitative Philosophy

The alternate method of quantitative philosophy bases finding on measured statistical analysis of controlled studies. The quantitative approach also plays a significant role in influencing the selection of the phenomenon of interest. On the issue of significance, the continental philosophic approach provides more information regarding the general nature of a phenomenon as it affects a large group of people. If applying this methodology in the POI, specific records of patients and patient care would be required. For example, which nurses are sharing care for the patient, all the medical records, conversations with doctors and families, all the way up through discharge. Records such as these would be kept and compared over a period to measure the results on the status of patient care. The use of this information may tell the health care administrator and caretakers the quality of the interpersonal communication. If the outcome of patient care is repeatedly weak, the data collected will be likely to find where the issue may lie. The flaw of the quantitative philosophy in caparison to the qualitative philosophy is that human experience has the power to change natural conditions and shape them according to the nurse's needs (Holloway & Wheeler, 2013).

Conclusion

The POI of concern entails development of a discharge planning process capable of increasing collaboration between care professionals and use of medication care coordinators to enhance continuity of care after discharge. The analysis uses experience gained in psychiatric nursing profession and empirical psychiatric knowledge in establishing a specific phenomenon. A systematic review article by Knapp, Beecham, David, Tihana, & Smith (2011) explored socio-economic impact of care fragmentation and suggests categorizing patients level of care based on severity and distinct mental needs is cost effective. Psychiatric nurses are advocates of care; and because resources must be managed in a concerted manner, tailoring discharge plan to meet individual patient needs is in accordance to delivering a quality and cost-effective care.

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