Tag: Clinical-Nursing

Prosocial Behavior Presentation

Much of what we tend to focus on when we study social psychology are topics that often have a negative connotation such as conformity, prejudice, aggression or obedience. A huge component of the study of social psychology; however, focuses on prosocial behavior – behaviors that focus on compassion and helping others. Prosocial Behavior Presentation. For this activity, you will focus on this more uplifting aspect of social psychology. Topics that fall under the area of prosocial behavior include altruism, helping, bystander intervention, empathy, and compassion, among others.

ORDER A PLAGIARISM-FREE PAPER HERE

For this exercise, pick one day and seek to structure your thoughts and behaviors entirely around helping others. With each interaction or action you take, pause to think and ask yourself “is there a way I might help another here?” Hold a door for someone, offer your seat, share a smile, give a sincere compliment, show empathy to another, attempt to be more patient or understanding, etc. Your efforts should be in social settings that involve interactions with others (rather than something such as donating to a charity for instance) Prosocial Behavior Presentation. The goal is to be as thoughtfully prosocial in your interactions throughout the day as possible.

At the beginning of the day, jot down your general mood, feelings, attitude, etc.

Then throughout the day, whenever possible, carry a small notebook with you or make notes in an app on your phone to jot down meaningful encounters or experiences as you attempt to engage in prosocial behaviors.

At the end of the day, again reflect and take notes on how you feel, your general mood, feelings and attitudes, etc.

In a 5-7 slide PowerPoint presentation, not counting title or reference slides:

Summarize your experience. Describe the prosocial behaviors you engaged in, others’ reactions to these behaviors, and your assessment of any changes in mood, attitude, good fortune, or anything else of note you experienced.

Review what you have learned about human behavior in social settings this week in your readings and CogBooks activities. Connect what you learned or experienced through your day of conscious, prosocial behavior with the terms, concepts, and theories from your research. Integrate at least two academic sources (your assigned readings/resources can comprise one of these sources), citing any references used in APA format. Prosocial Behavior Presentation.

Describe any new insights you gained through this experience about your interactions with others on a daily basis, including any behaviors you wish to change or to continue.

Use the features of PowerPoint to your advantage to communicate your ideas – include pictures, audio recorded narration, speaker’s notes, video, links, etc. as appropriate to enhance your ideas.

Include an APA formatted title slide and reference slide. APA components such as an abstract, headings, etc. are not required since this is a PowerPoint presentation. Prosocial Behavior Presentation

Stages of Group Therapy Essay Assignment

A simple way to remember the stages of group therapy is as follows: form, storm, norm, perform, and adjourn. For its members, a therapy group begins with the group’s first gathering (form). Early meetings are frequently accompanied by some level of conflict (storm) as members learn to work together and establish the “rules” of the group. As members become more comfortable with the process (norm), their ability to work toward a common goal improves (perform). This is when the bulk of the therapy group’s productivity occurs. Finally, when the desired results have been achieved, the group terminates (adjourn). Stages of Group Therapy Essay Assignment. There are more scientific names associated with these stages, and there can be sub-stages, as well, but the underlying concepts of progression and change over time remain the same.

ORDER A PLAGIARISM-FREE PAPER HERE

Effective therapy group leaders should be aware of what clients may be feeling during particular stages of group therapy and know techniques to help the group members move throughout the various stages. In addition, therapy group leaders need to be aware of group dynamics, including recognizing how therapy groups get stuck, as well as why and how to help groups move through barriers. At times a group leader might let the group work through its own problems, but, at other times, the leader needs to be proactive and take control of the therapy group Stages of Group Therapy Essay Assignment.

For this Discussion, select one of the stages of group therapy. Consider the key characteristics of the stage you selected and how you might identify that stage during the therapy process. Also, think about the steps you might take to smoothly transition therapy group members to the next stage.

With these thoughts in mind: Stages of Group Therapy Assignment

WRITE
a brief description of the stage you selected. Then, explain how you might recognize this stage in the therapy process (e.g., what you would do or say during this stage, what therapy group members would do and say during this stage). As the group therapy leader, explain what you might do in order to transition the group to the next stage. Provide examples to support your response Stages of Group Therapy Essay Assignment.

Psychological Assessment Report Assignment
A psychological assessment report is created by psychology professionals to inform groups or individuals of the assessments appropriate for their current needs. This type of report also includes a summary of the services provided to these groups or individuals. This evaluation is used by the various entities to assess basic needs, competencies, preferences, skills, traits, dispositions, and abilities for different individuals in a variety of settings.

ORDER A PLAGIARISM-FREE PAPER HERE

Psychological reports vary widely depending on the psychology professional creating it and the needs being assessed. Some of the psychology professionals who create this type of report include counselors, school psychologists, consultants, psychometricians, or psychological examiners. This type of report may be as short as three pages or as long as 20 or more pages depending on the needs of the stakeholders. Psychological Assessment Report Essay Assignment. Many reports include tables of scores that are attached either in an appendix or integrated into the report. Despite the many variations in assessment reports, most include the same essential information and headings.

Students will choose one of the personality assessment scenarios from the discussions in Weeks Two, Three, or Four to use as the basis of this psychological assessment report. Once the scenario has been chosen, students will research a minimum of four peer-reviewed articles that relate to and support the content of the scenario and the report as outlined below. The following headings and content must be included in the report:

The Reason for Referral and Background Information

In this section, students will describe the reasons for the referral and relevant background information for all stakeholders from the chosen personality assessment scenario.

Assessment Procedures: Psychological Assessment Report Assignment

In this section, students will include a bulleted list of the test(s) and other assessment measures recommended for the evaluation of the given scenario. In addition to the assessment(s) initially provided in the personality assessment scenario from the weekly discussion, students must include at least three other measures appropriate for the scenario Psychological Assessment Report Essay Assignment.

Immediately following the bulleted list, students will include a narrative description of the assessments. In the narrative, students will examine and comment on the major theoretical approaches, research methods, and assessment instruments appropriate for the situation and stakeholder needs. In order to defend the choice of recommended assessments, students will evaluate current research in the field of personality theories and provide examples of how these assessments are valid for use in the chosen scenario. For additional support of these recommended assessment measures, students will evaluate the standardization, reliability and validity, and cultural considerations present in these personality assessments that make them the most appropriate tools for the given scenario. Students will conclude the narrative by assessing types of personality measurements and research designs often used in scenarios like the one chosen and providing a rationale for why some of those assessments were not included. Psychological Assessment Report Essay Assignment.

General Observations and Impressions: Psychological Assessment Report Assignment

In this section, students will describe general observations of the client during the assessment period provided in the chosen personality assessment scenario and explain whether the client’s behavior might have had a negative impact on the test results. Students will analyze and comment on how the APA’s Ethical Principles and Code of Conduct affected the implementation of the personality assessment during the initial process. Based on the observations and analysis, students will assess the validity of the evaluation and make a recommendation for or against the necessity for additional testing. Psychological Assessment Report Essay Assignment.

Test Results and Interpretations: Psychological Assessment Report Assignment

In this section, students will analyze the results of the assessment provided in the chosen personality assessment scenario. Based on the score, students will interpret the personality factors (conscientiousness, openness, emotional stability, introversion, extroversion, work drive, self-directedness, etc.) that are present. Psychological Assessment Report Essay Assignment.

Note: Typically, this section reports test results and is the longest section of a psychological assessment report because the results of all the tests administered are analyzed and reported. Some psychologists report all test results individually, while others may integrate only a portion of the test results. However, in this report, only the assessment presented in the chosen personality assessment scenario will be included.

Summary and Recommendations

In this section, students will summarize the test results Psychological Assessment Report Essay Assignment.  They will provide a complete explanation for the evaluation, the procedures and measures used, and the results and include any recommendations translating the evaluation into strategies and suggestions to support the client. Finally, students will provide any conclusions and diagnostic impressions drawn from the previous sections of the report.

Writing the Psychological Assessment Report

The report:

Must be six to ten double-spaced pages in length and formatted according to APA style as outlined in the Ashford Writing Center.

Must include a title page with the following:

Title of paper

Student’s name

Course name and number

Instructor’s name

Date submitted

Must include the required headings and content as listed above.

Must address the topic of the paper with critical thought Psychological Assessment Report Essay Assignment.

Must utilize assessment manuals as necessary to support the inclusion and results of the assessments.

Must use a minimum of four peer-reviewed sources, at least two of which must be from the Ashford University Library.

Must document all sources in APA style as outlined in the Ashford Writing Center.

Must include a separate reference page that is formatted according to APA style as outlined in the Ashford Writing Center. Psychological Assessment Report Essay Assignment.

Literature Review Organization SAMPLE essay

You have identified in the literature review key areas to explore for your study (these are the topic areas).  Articulate the intent for the section and the kind of articles you will review and why. List the articles using APA style references in each section.

Submit paper for the organization of your Literature Review. Paper should be 2 to 4 pages in length.

Literature Review Organization SAMPLE

Running head: LITERATURE REVIEW 1

LITERATURE REVIEW 12

Literature Review

Social networking is considered to be a form of electronic communication whereby the users are able to create online communities which give the opportunity of sharing information, thoughts, and the individuals’ messages, video, and other content. Social networking is growing, and the majorities of the population in the entire world are now engaged or are participating in social networking sites. Literature Review Organization SAMPLE essay. Many people who are using social networking are doing so for the purposes of connecting with family members, clients, networking, and doing businesses.

ORDER A PLAGIARISM-FREE PAPER HERE

Mental health practitioners have not been left behind in this change, and they are involved in social networking together with their clients to improve their connection processes. This gives them the opportunity of sharing life events and achievements. Despite the increase in the number of counselors who are using social networking to connect with their clients, there are challenges psychologists faces when using social media. These challenges are associated with ethical and legal concerns on the use of social media.

The use of social media by psychologists is exposing their personal information as well as those of their families thus leading to the interference with their professionalism, loss of confidentiality, self-disclosure, and boundaries issues that challenge their work as professionals. Psychologist’s self-disclosure during a therapy session can be considered to be therapeutic at that time; however, the use of social leads to unintentional self-disclosure and therefore it is essential for the psychologists to be more considerate. Social media use by psychologists is lending itself to be a multitude of potential ethical concerns, and it leads to a conflict of interest, privacy and confidentiality, inappropriate disclosure, and dual relationships v.

Self-Disclosure

Psychologist understands that it is their responsibility to be careful in their counseling practices to avoid inappropriate self-disclosure. There is a change in the way through therapists are interacting with other people. Literature Review Organization SAMPLE essay. However, the interface through the internet is presenting unique challenges to the therapeutic relationship concerning the ethical boundaries and privacy. The situation has been made worse due to the lack of guidelines concerning the use of social networking sites (Kellen, Schoenherr, Turns, Madhusudan, & Hecker, 2015). The use of social media by psychologists is lending itself to be a multitude of potential ethical concerns, and it leads to inappropriate disclosure. Kellen et al. (2015) stated that the postings by the psychologists on the social networking sites constitute an inadvertent form of self-disclosure to the clients and colleagues who are getting the opportunities of exploring these sites. Literature Review Organization SAMPLE essay. The chances of having an increased possibility of self-disclosure are increased by the potential of private sites being hacked and exposed. This makes private information to be visible unintentionally via social networks.

Psychologists face attempts to intentionally or unintentionally to disclose verbal and non-verbal private information about their private lives to the people online. This disclosure can sometimes be necessary with regard to the therapeutic responsibility of the psychologist and based on deliberate and timely, self-disclosure can be therapeutic. Nevertheless, the unintentional disclosure of personal information through social network sites is leading to trust and issues related to boundaries in terms of the counseling processes. Internet is accessed by many people and having access to personal information by many individuals makes the nature of therapeutic relationships and boundaries to be more complicated Literature Review Organization SAMPLE essay.

With unintended disclosure of psychologists through social networking sites, it is impossible for the psychologist to have a chance of engaging in a discussion and processing of the information with people therapeutically seeking counseling services. In this case, it is the responsibility of the psychologists to ensure that clients are protected to prevent the possibility of harm. This process is made successful by considering the content as well as the reasoning behind the self-disclosure during therapy (Afsahi, 2014).

The information which is found outside face-face communication is dangerous to the effectiveness of the treatment. Unintended self-disclosure of the personal profile is revealing all the detailed and secret information online to be accessed by online users. Disclosing those information offers opportunities to the online users to view the videos, postings, as well as photos of the psychologist which leads to the complication of the transference in the process of therapeutic treatment. When the clients access private information, it makes the psychologist less competent in offering successful and competent services due to the interference with the countertransference in the therapeutic process and well as a violation of the therapeutic boundary. Afsahi (2014) suggest that it is the responsibility of the psychologists to be well informed regarding how postings of the personal information are affecting the therapeutic process. It is also essential for the psychologists to understand how issues related to self-disclosure is complicating therapeutic boundaries which are likely to interfere with the operation of the counseling process (Afsahi, 2014).

Impact on Privacy and Confidentiality

Afshan (2014) stated that an increase in social media use had created new ethical concerns about privacy and confidentiality. Since there are no clear rules to regulate online engagement, many professionals such as psychologists are active in the social media and sharing some of their private information within the media platform without knowledge on the danger they exposing themselves into. The use of social media exposes psychologists to unwanted disclosure of their personal information to the clients. This issue also affects its relationship with the clients in case the client decides to send a friend request using a Facebook account. Such exposure leads to temptations which result in unprofessional behavior which might, in the end, leads to the loss of employment due to compromising behavior which leads to change in the therapeutic relationship.

Sometimes, psychologists are tempted to post the photos together with their families or with the client for example during a trip mission in another nation. These pictures are informing the public especially their clients concerning their whereabouts thus leading to the lack of privacy in their movements and confidentiality of the type of client who is being treated. When a psychologist accepts a friend request from a client, his or her information can be accessed by the client thus exposing his or her personal information to the clients making the counseling process not to be effective since the clients are already informed about the lifestyle and movement of the counselor (Afsahi, 2014).

Having access to the personal information of the psychologists through social networking sites makes individuals learn a great deal of personal information about the counselors. Such information is related to those of their families and relationships, political opinions, social activities which are they are engaged in, and the religion. Accessing such information introduces complex transference and countertransference concerns with regard to the role of the psychologists to his or her client (Frederick, 2015).

According to Brew et al. (2014), the use of Facebook is playing an important towards communication process between professionals and their students. However, its use is raising a challenging ethical as well as the clinical concerns to both learners and counselor educators. Some of these challenging issues are related to the boundary issues especially the risks which are associated with the privacy of the counselors’ information being accessed. It is always easier to display personal information on Facebook, for example, the email addresses the names, and the phone numbers among other crucial private information. It is also easier to share information related to political and spiritual beliefs, hobbies, and interest thus affecting the overall privacy and confidentiality of both psychologists and the clients. Therefore, these issues affect professional activities during the counseling processes (Brew, Cervantes, & Shepard, 2014).

Denecke (2015) in his study on ethical issues of social media use in healthcare stated that counselors are facing challenges related to the communication barriers in the social media, reduced privacy, and security concerns which lead to problems related to the ethical perspectives. While the use of social media platform might be helping towards improving the services of the counselors, this article shows that there are many issues within the social media applications which interfere with the privacy and confidence which needs to be carefully observed by the counselors. The therapeutic relationship in counseling procedure is suffering as a result of the loss of confidence as well as the absence of privacy as a result of exposure of the confidential information in the social media platform which is accessed by the majority of individuals including the clients. There is lack of anonymity when private information is availed within social media platform, and this leads to the loss of privacy which existed inside the consultation room in providing counseling services (Denecke et al., 2015). Literature Review Organization SAMPLE essay.

Professionalism and Therapeutic Boundaries

The availability of psychologist information within the internet or online platform has caused more complication in the nature of the therapeutic boundaries. This issue has resulted in the reduction in the amount of control which psychologists can have in what is to be disclosed to the clients or people in the online platform (Afsahi, 2014) Literature Review Organization SAMPLE essay. Giota et al. (2014) in his review focused was on the process of understanding the prevalent risks which occurs while using social media and the possible ethical dilemma presented to the psychologists and counselors while using social media. The online world is overlapping the actuality and the psychologists. Therefore ethical concerns increases and this is likely to effects the practice of counseling and therapy. Literature Review Organization SAMPLE essay. It is the responsibility of the mental healthcare professionals to be aware of the issues or risks associated with interaction with clients online. It is highly likely possible that psychotherapist can explore their feelings, wishes, and countertransference reactions to their clients. This is significantly affecting the trust and leading to an adverse impact on the therapeutic relationship at a great deal (Kyriaki & Kleftaras, 2014). Literature Review Organization SAMPLE essay.

Traditionally, the client could know little about their therapists outside the consulting room. As psychologists make their information available in the online platform, complications develop especially when the clients seek information about therapists using the online. Exposing personal information online is making it easier for the clients to send messages through social networks and some of these messages contain intimate information. In this situation, the work of psychologists is at risk since denying replying or responding to the message from the client or accepting the request leads to the feelings of rejection and abandonment by the client which leads to lack of cooperation by the client during the counseling session. Literature Review Organization SAMPLE essay. This makes the work of psychologist not to be successful. Alternatively, when psychologists decide to respond or accept the friend request. It makes it easier for them to access sensitive information about the psychologists thus leading to the development of dual relationship which in the end tampers with the effective counseling relationship and breakups in the family of the psychologists once it is detected by other partners in marriage (Kyriaki & Kleftaras, 2014). Literature Review Organization SAMPLE essay.

Authors of this article further suggest that to avoid this situation is essential that psychologists be responsible for the web presence and be aware that social media activities blur the boundaries between personal and professional lives. Literature Review Organization SAMPLE essay Psychologists must also be informed that anything being posted online is seen by several people and will always remain there if it is not deleted. Therefore, psychologists must ensure that sensitive information related to their personal and professional lives are not exposed to the media platform (Kyriaki & Kleftaras, 2014). Literature Review Organization SAMPLE essay.

According to Frederick (2015), digital technology has introduced the boundary issues which seem to be interfering with the professional responsibilities of the psychologists (Frederick, 2015). Accessing the private information by individuals especially clients is causing a boundary confusion, and this is compromising the privacy and confidentiality. When the electronic exchanges of information between the psychologists and his or her clients occur at odd hours, then it means that the professionalism of the counselor is at risk of not following the ethical guidelines regarding the counseling practices. When psychologists are using a personal social networking site, it causes confusion in the practitioner-client boundaries. In this case, the professionalism of the psychologists might be affected since the focus of the counseling program will no longer be based on helping the patients but merely on the dual relationship which is against the ethical requirements (Frederick, 2015). Literature Review Organization SAMPLE essay.

The competence of the psychologists also remains in question when there is confusion in the boundary between the psychologist and the client. Based on the ethical guidelines, psychologists are required to understand the importance of competence counseling practice. Counselors have the knowledge as well as the skills which are related to the evaluation of the patient, treatment, intervention plan, clinical intervention, and the assessment of the overall outcome. Therefore, the behavior which is going against the ethical code of conduct of the counseling process is likely to implicate the psychologist thus putting the career at risk (Frederick, 2015). Ethical practice requires psychologists to have useful guidelines which are essential in ensuring that there is suitable encryption and appropriate actions or protocols while dealing with clients who are attempting to put their work at risk by forcing them into a dual relationship which is not part of the professional code of conduct (Frederick, 2015).

A study by Sabin et al. (2017) on professional ethics for the digits age psychiatry shows that patients are motivated to include digital technology as part of their treatment. When psychologists make their personal and professional information available within the online platform, there is a higher risk of exposing such information to many audiences including the clients which the psychologists are providing services to. Many clients are active in the social network and easily access information related to their therapists. Different clients are having varied attitudes once this information is obtained (Sabin & Harland, 2017). Literature Review Organization SAMPLE essay.

When the clients access the private and professional information about the therapist, the working relationship between the patients and psychiatrists is likely to have some ethical challenges. In this case, the professionalism of the psychologist is faced with several issues since he or she will have a problem when it comes to the management of the clinical boundaries between him or her and the client. The client or other people are having full information about the psychologists; thus some respect which had existed before due to the lack of information regarding the life of the therapists is no longer there. Psychologists also face a challenge related to the lack of establishing realistic expectations concerning the use of digital communication and failure to uphold the professional ideals (Sabin & Harland, 2017).

Mullen et al. (2014) aimed at introducing the developmental as well as the incidence of social media; reviewing the legal and ethical concerns associated to social media applications in schools; and the current approaches that school counselors are using to practice ethical interactions through social media. School counselors are facing the challenges of observing ethical practice while engaging in communication or interaction through the use of social media (Mullen, Griffith, Greene, & Lambie, 2014). However, it is a requirement that these counselors engaged in careful and considered ethical decision-making processes, especially when interacting with clients.

The relationship existing between the school counselors and the students varies and sometimes appear to be complex. Most of the time, school counselors are developing a beneficial relationship with the students which are essential in facilitating the opportunity for growth through interaction which supports the learning process. There are many barriers towards establishing such a relationship; however, it is recommended that barriers towards the establishment of the successful counselor-student alliance have to be deconstructed. Literature Review Organization SAMPLE essay.

As private information becomes available on the internet, clients or students are getting opportunities of knowing about the families as well as the relationship status of the counselors. Psychologists are faced with the challenge of overcoming the temptations which are sometimes brought by clients to be involved in an intimate relationship. According to Mullen et al. (2014), the dual relationship which is developed between the counselor and the clients comes with a lot of complicated ethical dilemmas. Literature Review Organization SAMPLE essay. A dual relationship is becoming problematic especially when it impairs the objectivity of the counseling process and leading to an increase in harm for the clients and the counseling process as a whole (Mullen, Griffith, Greene, & Lambie, 2014).

In this case, if counselors are incapable of avoiding such relationship especially those who are not beneficial towards the growth and the development of the students, more problems arise and the student might not benefit from the counseling program while at the same time the psychological profession of the counselor remaining at risk due to implications in cases the incidence is detected, or the counseling competence of the psychologists is questioned. Dual relationship increases the risk of failure to observe the confidentiality and privacy which in the end interferes with the entire process of counseling (Mullen, Griffith, Greene, & Lambie, 2014) Literature Review Organization SAMPLE essay.

References

Afsahi, A. (2014). Social networking dilemmas for psychologists: privacy, professionalism, boundary issues, and policies. Dissertation & Thesis, 175.

Brew, L., Cervantes, J. M., & Shepard, D. (2014). Millennial Counselors and the Ethical Use of Facebook. Professional Counselor.

Denecke, K., Bamidis, P., Bond, C., Gabarron, E., Househ, M., Lau, Y. S., et al. (2015). Ethical Issues of Social Media Usage in Healthcare. Yearb Med Inform, 10(1), 137-147. Literature Review Organization SAMPLE essay.

Frederick, R. G. (2015). “Clinical Social Work in a Digital Environment: Ethical and Risk-Management Challenges. Faculty Publications.

Kellen, K., Schoenherr, M. A., Turns, B., Madhusudan, M., & Hecker, L. (2015). Ethical Decision-Making While Using Social Networking Sites: Potential Ethical and Clinical Implications for Marriage and Family Therapists. American Journal of Family Therapy, 43(1), 67-83.

Kyriaki, G. G., & Kleftaras, G. (2014). Social Media and Counseling: Opportunities, Risks. International Journal of Psychological and Behavioral Sciences, 8(8), 2386-2388.

Mullen, P., Griffith, C., Greene, J. H., & Lambie, G. W. (2014). Social Media and Professional School Counselors. Journal of School Counseling, 12(8), n8.

Sabin, J. E., & Harland, J. C. (2017). Professional Ethics for Digital Age Psychiatry: Boundaries, Privacy, and Communication. Curr Psychiatry Rep, 19(9), 55 Literature Review Organization SAMPLE essay.

Crime and Mental Health Disorder Essay Paper: Goals & standards

Mental Health Disorder Week 2 Assignment

Week 2 – Crime and Mental Health Paper: Goals & standards

Make sure assignment aligns with the below questions as well as the assignment content. THANK YOU!

· Describe possible causes of mental health issues in the criminal justice system.

· Identify the behavioral criteria of common mental health disorders seen in the criminal justice system. Crime and Mental Health Disorder Essay Paper: Goals & standards.

· Describe possible causes for common mental health disorders seen in the criminal justice system.

· https://medlineplus.gov/mentaldisorders.html

ORDER A PLAGIARISM-FREE PAPER HERE

Week 2 – Crime and Mental Health Paper

Assignment Content

Write a 550- to 700-word paper on the connection between crime and mental health. Include the following:

o Describe the prevalence and causes of mental health issues in the criminal justice system.

o Describe the behavioral symptoms for three of the most common mental health disorders present in the criminal justice system Crime and Mental Health Disorder Essay Paper: Goals & standards.

o Describe the relationship between these mental health issues and crime.

Include a minimum of three sources.

Format your paper consistent with APA guidelines.

Submit your assignment.

Resources

o Center for Writing Excellence

o Reference and Citation Generator

o Grammar and Writing Guides

o Learning Team Toolkit

CPSS410 Overview of Mental Health in Criminal Justice Crime and Mental Health Disorder Essay Paper: Goals & standards

Week 2 Mental Health Issues in the Criminal Justice System

Readings:

Ringhoff, D., Rapp, L., & Robst, J. (2012). The criminalization hypothesis: Practice and policy implications for persons with serious mental illness in the criminal justice system. Best Practice in Mental Health, 8(2), 1-19.

Searches:

mental health disorders AND behavioral criteria

mental health disorders AND criminal justice system

Videos

Week 2 – Crime and Mental Health Paper Readings:

Films Media Group (1998). Criminal Justice and Brain Impairment (06:03) From Title: Mind Talk: The Brain’s New Story.

The term criminalization has been used to describe the overrepresentation of persons with serious mental illness in the criminal justice system. Public policy responses have focused on simply linking individuals with treatment. Crime and Mental Health Disorder Essay Paper: Goals & standards. Although treatment is important to minimizing symptoms, evidence indicates that nonclinical variables are greater pre- dictors of arrest than clinical variables and that risk factors for arrest are similar for persons with and without mental illness. This article reviews the literature on the link between severe mental illness (SMI) and criminal behavior; considers whether treat- ment has been effective at reducing criminal behavior among individuals with SMI; and discusses practice, policy, and crime prevention implications Crime and Mental Health Disorder Essay Paper: Goals & standards.

Keywords: criminal justice system; criminalization; risk factors; serious mental illness

Introduction

The disproportionate number of persons with severe mental illness (SMI) involved in the criminal justice system is widely recognized as a significant social problem (Lamberti, Weisman, & Faden, 2004; More & Hiday, 2006; Steadman, Osher, Robbins, Case, & Samuels, 2009; Torrey, 1995). Research estimates that 8 percent of the nation’s 13 million annual arrests involve persons with SMI (McNeil & Binder, 2007; Morrissey, Cuddeback, Cuellar, & Steadman, 2007; Steadman & Naples, 2005), although others have argued that this may represent a significant underestimation (Steadman et al., 2009). Although people with diagnosable mental illnesses often spend brief periods of time in jail (Morrissey et al., 2006), rearrest is common and poses safety risks for both law enforcement

The Criminalization Hypothesis: Practice and Policy Implications for Persons with Serious Mental Illness in the Criminal Justice System

Daniel Ringhoff, Lisa Rapp, and John Robst

Daniel Ringhoff, LCWS, is a doctoral student in the School of Social Work at the University of South Florida. Lisa Rapp, PhD, is associate professor in the School of Social Work at the Univer- sity of South Florida. John Robst, PhD, is research assistant professor in the Department of Men- tal Health Law and Policy at the University of South Florida.

© 2013 Lyceum Books, Inc., Best Practices in Mental Health, Vol. 8, No. 2, December 2012

and arrestees (Cox, Morschauser, Banks, & Stone, 2001; Hartwell, 2003; Lamb & Weinberger, 2001; Lamb, Weinberger, & Gross, 2004). Inmates with SMI may cause considerable management and financial problems for state and local correctional authorities (Clark, Ricketts, & McHugo, 1999; Domino, Norton, Morrissey, & Thakur, 2004). They also generally receive inadequate mental health treatment while incarcerated (Veysey, Steadman, Morrissey, & Johnsen, 1997). Additionally, persons with SMI are more likely to be arrested (McNeil & Binder, 2007; Teplin, 1983, 1984, 1990; Teplin, Abram, & McClelland, 1996), and to have their community supervision revoked as the result of a technical vio- lation or new offense (Skeem & Louden, 2006).

Consequently, many policy makers and practitioners have labeled this phe- nomenon as the criminalization of mental illness or the criminalization of the mentally ill, and point to inadequacies in the mental health treatment system as its primary cause (Engel & Silver, 2001; Fisher, Silver, & Wolff, 2006; Lamb et al., 2004; Teplin, 1983). Mental health advocacy groups (National Alliance for the Mentally Ill, 2001), research institutes (Soros Foundation, 1996), government related entities and committees (Council of State Government’s Criminal Justice/ Mental Health Consensus Project, 2002; Florida Supreme Court, 2007; New Free- dom Commission on Mental Health, 2003), and lawmakers (Fisher et al., 2006) have all used such terms to describe the extent of the problem. Because of the widespread influence of perceived criminalization on public policy, it is important to assess the construct’s ability to explain the current problem so that researchers, policy makers, and practitioners can have confidence they are formulating and implementing the most effective policies and interventions. The purpose of this review, therefore, is to examine the construct of criminalization and the assump- tion that it is a significant cause of the overrepresentation of persons with SMI in the criminal justice system. In addition, this article will discuss the concept of mental illness as a cause of crime and criminogenic risk factors. Finally, promising models in the criminal justice literature that policy makers and practitioners may consider when planning and implementing interventions for individuals with mental illness and criminal justice histories will be reviewed.

Deinstitutionalization and the Criminalization Construct

Criminalization has long been viewed as an unanticipated side effect of deinsti- tutionalization (Aderibigbe, 1997; Fisher et al., 2006). Rather than referring to one event or policy decision, deinstitutionalization describes a confluence of events that closed many state hospitals and indelibly changed the mental health system between the 1950s and 1990s. Salient factors that caused these changes included statutory reforms, the advent of revolutionary psychotropic drugs such as Thora- zine, state budget constraints, and exposés of deplorable conditions in state hospi- tals, as well as the Community Mental Health Centers Act of 1964, which provided an avenue for community treatment (Fisher et al., 2006; Steadman, Monahan, Duffee, Hartsone, & Robbins, 1984; Teplin, 1983, 1984; Torrey, 2008). During this time, psychiatric beds in state mental and general hospitals were significantly

2 Best Practices in Mental Health

reduced—from 559,000 in 1955 to 68,000 in 1990—as patients were released to families and facilities in the community (Aderibigbe, 1997).

To provide for these persons, funding for community mental health services increased through the creation and expansion of Medicaid and Supplemental Security Income (SSI). Funding, however, remained inadequate (Frank, Goldman, & Hogan, 2003; Petrila, 2001). Increased funding also had the unintended effect of speeding up deinstitutionalization and creating what has been called the corol- lary phenomenon of transinstitutionalization, whereby psychiatric patients are transferred back and forth between community inpatient facilities and jails (Fisher et al., 2006; Frank et al., 2003; Steadman et al., 1984; Teplin, 1983, 1984; Torrey, 2008). As a result, many persons with mental illness entered the community with inadequate housing and community supports (Torrey, 1988). Statutory reforms and more stringent civil commitment criteria further limited psychiatric disposi- tions, making it more difficult to hold and treat persons in the mental health sys- tem, and presumably shifting persons with mental illness to the criminal justice system, as communities grappled with how to manage persons exhibiting undesir- able behavior (Fisher et al., 2006). In addition, as homelessness and incarceration increased among persons with mental illness, so did the perception that the men- tal health system was failing in its mission to provide adequate services for persons with mental illness (Fisher et al., 2006; McNeil, Binder, & Robinson, 2005).

In 1972, as these events were unfolding, one California psychiatrist (Abram- son, 1972) described the disproportionate number of persons with mental illness in the criminal justice system as “the ‘criminalization’ of mentally disordered behavior” (Fisher et al., 2006, p. 545). Although many use the term criminaliza- tion to refer simply to the prevalence of persons with SMI in the criminal justice system, in particular to their overrepresentation and increased likelihood of arrest, the term has specific connotations. Most broadly, it implies that jails became substitutes for state mental hospitals, presumably because persons who were previously state hospital patients were refusing treatment in the community or unable to access treatment in the community (Fisher et al., 2006). Fisher et al. (2006) provides more detail, describing criminalization as:

a process whereby behaviors that in one era had been managed by involun- tary transport and psychiatric hospitalization became less easily managed in that way as a result of the new restrictions placed on civil commitment. With the mental health disposition less available, but still faced with a need to man- age situations involving undesirable behaviors, agents of social control— police and judges—would impose a criminal, rather than psychiatric, defini- tion of an individual’s deviant behavior. The individual would then be arrested, often on a trivial charge such as trespassing or disorderly conduct, rather than civilly committed, and in some cases detained in jail. (p. 546)

In other words, judicial professionals, such as police and judges, began using crim- inal sanctions to manage persons with SMI in the community because other men- tal health options were unavailable (Engel & Silver, 2001; Fisher et al., 2006; Teplin, 1983).

The Criminalization Hypothesis 3

Junginger, Claypoole, Ranilo, and Crisanti (2006) provided more clarification regarding criminalization and the role that symptoms might play in the arrest of people with mental illness:

Why persons with serious mental illness are more likely to be arrested and incarcerated is unclear, but a literal and popular interpretation of the crimi- nalization hypothesis implies two possibilities. First, symptoms of serious mental illness have become de facto criminal offenses; that is, person with serious mental illness are arrested and incarcerated for displaying psychiatric symptoms. Second, symptoms of serious mental illness motivate or otherwise cause actual criminal offenses. (p. 879)

This nuanced definition is important because it helps clarify how mental health symptoms have become criminalized and distinguishes between arrests resulting from the display of mental health symptoms, and those resulting from criminal behaviors that are directly or indirectly caused by mental health symptoms. Crim- inalization therefore occurs when persons with mental illness are arrested, either for displaying symptoms of mental illness or for committing minor crimes that are a direct or indirect result of mental illness, instead of being treated in the mental health system.

Assessing the Validity of Criminalization

Although there is a great deal of anecdotal evidence supporting the criminal- ization hypothesis, it is a widely understood principle that policy should be driven by rigorous research (Morrissey et al., 2006). Criminalization therefore must be found to be an important cause of the problem before policy makers rely on it to inform decisions, even though there are a disproportionate number of persons with SMI in jails and prisons. Specifically, research must show that deinstitution- alization and inadequate community resources have caused individuals with SMI to have greater involvement with the criminal justice system. However, if other nonclinical factors are found to be important to the high rates of arrest, then pub- lic policy can address the problem only through a more comprehensive treatment plan that addresses both clinical and nonclinical factors.

Are Individuals with SMI Targeted for Arrest?

Junginger et al. (2006) stated that the criminalization hypothesis implies that legal professionals, such as police and judges, treat mental illness as a crime and target mentally ill persons in the community with criminal sanctions. Several studies have examined this question using: (1) prevalence data of persons with mental illness in jails and prisons, (2) arrest rates of discharged hospitalized men- tal health patients, and (3) comparisons of arrest rates for person with and with- out mental illness (Engel & Silver, 2001; Lamb & Weinberger, 1998; Rabkin, 1979; Teplin, 1984).

4 Best Practices in Mental Health

Some researchers have suggested that mental illness may be associated with an increased risk of arrest. For example, Teplin’s (1983) literature review focus- ing on (1) archival studies, (2) police decision making, and (3) prevalence data, found mixed evidence that persons with mental illness were being targeted for arrest. Arrest rates were higher among offenders with previous hospitalizations than for persons with no prior arrests, but persons previously admitted to psy- chiatric hospitals had arrest rates that were higher than those of the general pop- ulation. Furthermore, persons with mental illness and no prior arrests had arrest rates similar to those of the general population. Teplin (1984) analyzed arrest rates between persons with and without mental illness. Although there was an increased probability of arrest for those showing symptoms of mental illness as compared to those who did not, the findings were based on cross-tabulation analysis absent of statistical controls for legal factors and other important vari- ables known to affect police decision making (Engel & Silver, 2001). In support of criminalization, Teplin (1983) found a majority of studies investigating police decision making provided some evidence that persons with mental illness may be targeted for arrest.

Other studies investigating police decision making, however, appear to contra- dict Teplin’s findings. When the problem of the increasing incarceration rates of persons with mental illness was first becoming evident, Bittner (1967) found that police were “reluctant to take any official action (including arrest) ‘on the basis of the assumption or allegation of mental illness’ and that officers often chose to resolve such encounters informally” (Engel & Silver, 2001, p. 229). In addition, police were not found to arrest noncommittable persons with mental illness involved in nondangerous incidents simply out of expediency (Bonovitz & Bonovitz, 1981), nor were they more likely to arrest persons with SMI or to use arrest to manage persons with mental illness (Engel & Silver, 2001). In summary, there is no conclusive answer to the question of whether persons with SMI are tar- geted for arrest.

Does Mental Illness Cause Crime?

The second interpretation of the criminalization hypothesis by Junginger et al. (2006) is that symptoms of SMI indirectly or directly cause crime. Assessing the causal link between mental illness and crime is difficult for two reasons. First, mental illness is correlated with factors that cause crime, such as criminal think- ing; and second, mental illness elevates risk factors that lead to crime, such as sub- stance abuse (Frank & McGuire, 2010). A full review of the causal link between mental illness and crime is beyond the scope of this article. However, research thus far has found convincing evidence that there is a small connection between men- tal illness and crime, although the connection is specific for certain subsets of per- sons with mental illness (Frank & McGuire, 2010). Given the link, albeit a small one, between mental illness and crime, access to community resources and treat- ment is often seen as important to reducing criminal activity. The question of the

The Criminalization Hypothesis 5

extent to which improved access and use of mental health treatment would sig- nificantly reduce crime will be addressed below.

Does Access to Mental Health Treatment Reduce Crime?

Medicaid is the principal funding source for persons with SMI and accounts for 24 percent of total revenues for the community mental health centers that pro- vide many of the specialized programs for persons with SMI (Domino et al., 2004; Frank et al., 2003; Koyanagi & Stine, 2009; McAlpine & Mechanic, 2000; Morrissey et al., 2006; National Alliance for the Mentally Ill, 2001; Petrila, 1992, 2001). Morrissey et al. (2007) examined the association between Medicaid enroll- ment upon release from jail and time in the community (i.e., time until rearrest). The study compared two groups of individuals with SMI who had been enrolled in Medicaid prior to entering jail. One group remained enrolled in Medicaid at the time of release from jail whereas the other had been disenrolled due to incarcera- tion. Morrissey and colleagues found a small association between a combination of enrollment in Medicaid benefits and service utilization and reduction in arrests in a twelve-month period following release.

While Morrissey et al. (2007) focused on disenrollment of Medicaid recipients, Domino et al. (2004) examined whether reductions in mental health services due to managed mental health care led to indirect cost shifting from insurance plans to jails and state hospitals. By analyzing pre- and postmanaged care periods and comparing the difference in jail costs, state hospital costs, and county outpatient mental health costs between these periods, they found that managed care led to indirect cost shifting, most likely through poorer access to services, resulting from a greater probability of arrest. This study highlights the importance of cross- system outcomes. By seeking to control Medicaid costs, the implementation of managed care had the unintended consequence of increasing criminal justice expenditures.

The relationship between access to treatment and arrests has also been exam- ined by following a sample of people with SMI over time and by comparing arrest rates in communities with different levels of available care. Constantine et al. (2011) followed a sample of individuals with SMI and criminal justice contacts over a four-year period. Inpatient and emergency room contacts were positively related to the number of arrests, whereas outpatient treatment was negatively associated with arrests. Outpatient visits were associated with a reduced number of felony and misdemeanor arrests, whereas inpatient/emergency room contacts were associated with felony arrests. Fisher, Packer, Simon, and Smith (2000) com- pared incarceration rates of two regional communities in Massachusetts with sig- nificantly different levels of community mental health services and found no sig- nificant difference in arrest rates. The differing service levels were the result of a federal lawsuit, which doubled the per capita mental health funding in one county as compared to other counties in the state. This resulted in greater per capita fund- ing of residential programs and case management services as well as the creation of new services such as a mobile crisis team.

6 Best Practices in Mental Health

Current Responses and Risk Factors for Crime

The mixed findings discussed above do not provide strong support for the crim- inalization hypothesis. Such inconsistent findings have also caused several to sug- gest that criminal justice outcomes are not strongly related to clinical factors (Case, Steadman, Dupis, & Morris, 2009; Erickson et al., 2009; Fisher et al., 2006; Frank & McGuire, 2010; Lamberti et al., 2004). For example, Frank and McGuire (2010) wrote:

A small fraction [Skeem et al. (2009) judge it to be one in ten] of criminals with mental illness commit crimes because of their current illness, but the elevated risk is small. Current treatment can ameliorate current illness and symptoms, but cannot reverse the past effects of illness on the accumulation of other risk factors over a person’s lifetime. (p. 4)

Indeed, other nonclinical risk factors may be just as important if not more important than current mental health symptoms. Case et al. (2009) found that prior criminal history, a risk factor for persons with and without mental illness, rather than clinical variables, predicted subsequent arrests. The importance of these findings as noted by Case et al. is that “the lack of significance of clinical variables compared with criminal history variables suggests that programs must target changeable risk factors, not just improved symptomatology and service connectedness” (p. 670).

This notion that clinical factors such as diagnosis are weak predictors of crime and recidivism is not new (Bonta, Hanson, & Law, 1998; Case et al., 2009; Erickson et al., 2009; Lamberti et al., 2004; Philips et al., 2005). In a meta- analysis of predictors of criminal or violent recidivism among offenders with mental disorders, Bonta et al. (1998) found that “clinical or psychopathological variables were either unrelated to recidivism or negatively related” (p. 139). In addition, Junginger et al. (2006) found that mental illness was unlikely to be a direct cause of arrest among persons with SMI.

Despite this evidence, public policy continues to focus on treatment and the reduction of symptoms in order to address the problem of the overrepresentation of persons with SMI in the criminal justice system. According to Fisher et al. (2006), this notion of the mentally ill offender who has been managed in the crim- inal justice system because of perceived inadequacies in the mental health system has shifted the focus of the problem from “individual psychopathology to the socio-legal/system context in which deviant behavior is exhibited” (p. 546). Responses therefore have focused on fixing the system by connecting persons to treatment in order to mediate the effects of deinstitutionalization. Consequently, mental health policy has focused on jail diversion and substituting treatment for incarceration, based on the belief that incarceration is unnecessary (Fisher et al., 2006; GAINS Center, 2010; Morrissey, Fagan, & Cocozza, 2009).

Since 1992, jail diversion programs have grown from 52 to approximately 560 (Case et al., 2009). Outcomes, however, have been mixed. Steadman and Naples (2005) found that a wide variety of pre- and postbooking diversion programs

The Criminalization Hypothesis 7

operating within the parameters of the typical judicial system reduced days spent in jail without increasing public safety risks, but did not find significant reductions in arrests during the twelve-month follow-up. On the other hand, in addition to a reduction in days spent in jail, Case et al. (2009) found that persons diverted to post- booking programs experienced fewer arrests during a twelve-month follow-up.

Prebooking programs typically involve crisis intervention teams (CIT), which consist of specially trained police officers who attempt to prevent arrest through de-escalation and/or by transporting persons to mental health centers for assess- ment rather than to jail. Compton, Bahora, Watson, and Oliva (2008) provide an overview of the research evaluating CIT programs. They found that CIT training had a positive effect on police officers’ attitudes, beliefs, and knowledge relevant to interactions with individuals with mental illness, and officers reported feeling bet- ter prepared to handle calls involving individuals with mental illnesses. Although CIT may reduce arrests and lower associated criminal justice costs, this requires that, by definition, CIT diversion must occur at prebooking.

Mental health courts (MHCs) are a specific type of postbooking diversion pro- gram that have a specialized docket and use ongoing court status reviews and sanctions to motivate treatment compliance (Marlowe, Festinger, Dugosh, & Lee, 2005). As such, MHCs provide a gateway for offenders to access treatment and community resources. Studies have found mixed results for the effectiveness of these courts. Mental health courts in Seattle, Washington, led to increased treat- ment engagement and reduced crime (Trupin & Richards, 2003), as did those in Clark County, Washington (Herinckx, Swart, Ama, Dolezal, & King, 2005). Men- tal health courts in Broward County, Florida, increased access to care (Boothroyd, Poythress, McGaha, & Petrila, 2003), but such treatment did not lead to symptom reduction (Boothroyd, Mercado, Poythress, Christy, & Petrila, 2005), and rates of rediversion after a new charge were not lower than typical recidivism rates (Boccaccini, Christy, Poythress, & Kershaw, 2005). More recent studies (McNeil & Binder, 2007; More & Hiday, 2006) have shown promise in reducing recidivism, perhaps because MHC participants receive and observe encouragement and/or sanctions during court status reviews.

Although diversion programs have been popular and may provide specific ben- efits to individuals with mental illness, there are additional factors to consider when evaluating their effectiveness. First, individuals with mental illness make up a larger percentage of persons who are at higher risk for arrest, and therefore would be expected to comprise a greater proportion of arrests (Draine, Salzer, Culhane, & Hadley, 2002). Another issue to consider is the association between conduct disorder, the precursor to antisocial personality disorder, and mental ill- ness. Research has found there is an elevated risk for children with conduct disor- der to develop adult mental disorders and that there are higher rates of childhood conduct disorder in adults with schizophrenia (Frank & McGuire, 2010; Morgan, Fisher, Duan, Mandracchia, & Murray, 2010). That said, mental illness may, indeed, play a role in other risk factors for arrest, but the other risk factors may be easier and more cost effective to manage than the mental illness itself. Managing

8 Best Practices in Mental Health

such amenable factors may make an important difference in criminal justice out- comes. Consequently, some mental health researchers have emphasized the importance of addressing nonclinical risk factors for recidivism in addition to treatment.

The Risk-Needs-Responsivity Model

The risk-needs-responsivity (RNR) model is a correctional model that may pro- vide a useful framework for developing interventions that address clinical and nonclinical risk factors for offenders with SMI (Case et al., 2009; Erickson et al., 2009; Lamberti, 2007). Developed from general personality and cognitive-social- learning theories of criminal behavior, RNR consists of a set of principles for devising crime prevention strategies that target risk factors for offending and matching services with offender characteristics (Andrews & Dowden, 2007). As its name implies, the three main principles are the risk, needs, and responsivity principles. The risk principle states that services should target offenders who pose a higher risk of recidivism because lower risk offenders, even with an absence of services, have a low probability of recidivism. The needs principle states that ser- vices should target criminogenic needs, or needs that are strong predictors of crime and can be changed, whereas the responsivity principle states that services should match offender characteristics, such as personality, learning styles, and motivational level (Andrews & Dowden, 2007).

Risk factors for crime can be dynamic or static. Dynamic risk factors, such as employment, can change, while static risk factors, such as race or gender, do not change. Other factors typically considered static include the presence of a crimi- nal history or a mental illness. One strategy of RNR is to target the offender’s dynamic risk factors. Dynamic risk factors are considered criminogenic needs as a matter of emphasis to imply that meeting the specific need that produces or pre- dicts crime should result in a reduction of crime. Matching services with the offender’s risk factors is crucial in this process. Indeed, research in correctional settings has found that mismatching low-risk offenders with intensive services increases the risk of recidivism (Andrews & Bonta, 2003).

Monahan et al. (2005) developed a model of risk assessment for violence among individuals being released from psychiatric facilities after arrest. The top ten risk factors included seriousness of arrest, drug or alcohol abuse, type of psy- chiatric diagnosis, anger control, violent fantasies, childhood abuse, previous vio- lence, age, and gender. Perhaps in contrast to studies that show clinical variables to be unimportant, psychiatric diagnosis was found to be an important factor, and both static and dynamic factors were important predictors of violence.

Several dynamic risk factors that are common among individuals with SMI are important predictors of arrest. Homelessness increases the risk of arrest among individuals with SMI (Constantine et al., 2010; Lamberti et al., 2004; McNeil, Binder, & Robinson, 2005). Substance abuse is also a clear risk factor for individ- uals with SMI. Constantine et al. (2010) found that 66 percent of a sample of

The Criminalization Hypothesis 9

individuals with SMI and criminal justice contacts in Pinellas County, Florida, had a substance abuse diagnosis, and more than 90 percent had a diagnosis or service (e.g., detox) consistent with substance use. These factors often work together: McNeil et al. (2005) found that 78 percent of inmates with SMI who were home- less at the time of arrest also had substance related disorders. In addition, they found that individuals who are homeless with substance use had longer jail dura- tions than other individuals charged with similar crimes.

Individuals with SMI often have low levels of education, and consequently, poor job prospects, both dynamic risk factors for crime (Mocan & Tekin, 2006). For example, individuals with SMI were more likely to drop out of high school and those who did graduate from high school were less likely to graduate from college (Breslau, Lane, Sampson, & Kessler, 2008). Rylance (1997) found high school dropout rates reached 50 percent among a sample of youth with serious emo- tional disturbance. Given their lower levels of education, individuals with SMI face limited labor market opportunities. Indeed, unemployment rates among individu- als with SMI were reported to be as high as 90 percent (New Freedom Commission on Mental Health, 2003). Kessler et al. (2008) found that among employed work- ers, those with SMI earn lower wages. In addition, they determined that individu- als with other less serious mental illness have earnings similar to those of workers without mental illness, suggesting that people with SMI have fewer opportunities than those with less serious mental illness. Crime and Mental Health Disorder Essay Paper: Goals & standards.

Overall, nonclinical factors may be greater predictors of recidivism than men- tal health symptoms. In addition to the studies discussed above, there is substan- tive evidence that the major predictors of recidivism include: (1) history of antiso- cial behavior, (2) antisocial cognition, (3) antisocial attitudes, (4) antisocial associates, (5) family and/or marital problems, (6) school and/or work issues, (7) lack of leisure/recreation activities, and (8) substance abuse (Andrews, Bonta, & Wormith, 2006; Andrews & Dowden, 2007). Indeed, Bonta et al. (1998) con- cluded, “the major correlates of crime are the same regardless of race, gender, class, and the presence or absence of a mental illness” (p. 139). Crime and Mental Health Disorder Essay Paper: Goals & standards.

Crime Prevention Programs

A number of mental health researchers have argued that crime prevention programs for persons with SMI should target criminogenic needs in addition to mental health treatment. There is also a growing recognition that effective, com- prehensive programs should address issues such as substance abuse and home- lessness. Specialized treatment programs such as Assertive Community Treatment (ACT) teams provide services designed specifically for high-risk individuals, which arguably offer the best access to treatment for high-risk persons with SMI in the community (Lamberti et al., 2004). Services include case management, initial and ongoing assessments, psychiatric services, employment and housing assis- tance, family support and education, and substance abuse services Crime and Mental Health Disorder Essay Paper: Goals & standards. However, whereas such comprehensive programs reduce hospitalizations, they have little

10 Best Practices in Mental Health

or no effect on incarceration rates (Erickson et al., 2009; Fisher et al., 2006; Lamberti, 2007; Lamberti et al., 2004). Unfortunately, ACT programs have not been effective at reducing arrests, perhaps in part due to their focus on mental health and only a few of the above mentioned predictors of recidivism.

As a result, forensic ACT (FACT) programs specific to reducing criminal behav- ior have been modeled after the RNR model (Erickson et al., 2009; Lamberti, 2007). Several features differentiate FACT programs from ACT programs, includ- ing the targeting of individuals involved with the criminal justice system, taking referrals from criminal justice agencies, working with criminal justice agency partners, use of court sanctions, use of probation officers, and identifying preven- tion of rearrest as the primary goal (Lamberti et al., 2004). In a limited number of studies, FACT programs have been found to reduce criminal behavior (Cusack, Morrissey, Cuddeback, Prins, & Williams, 2010; Lamberti, 2004). Crime and Mental Health Disorder Essay Paper: Goals & standards. However, only Cusack et al. (2010) used a randomized study design, and although arrests were reduced, the costs of the program were only partly offset by criminal justice and inpatient savings.

One challenge is the variation among FACT programs, which differ in the ser- vices they offer, clients they serve, and staffing (Cuddeback, Morrissey, Cusack, & Meyer, 2009). For example, some programs offer residential services whereas oth- ers do not (Erickson et al., 2009). Cuddeback et al. (2009) examined the services offered by FACT programs, and found that only 36 percent of the programs had a housing specialist on staff. In addition, although 93 percent of programs had a psychiatrist on staff and 79 percent had a registered nurse, Cuddeback et al. did not report on how many programs had psychologists, social workers, and/or men- tal health counselors on staff. Thus, it remains unclear whether FACT programs address the antisocial traits that are such important predictors of criminal behav- ior. Indeed, the focus on intensive services may be useful to stabilize untreated individuals, but long-term success may hinge on effective therapy as well as med- ication. For example, Lamberti et al. (2004) discussed the limitations of tradi- tional interventions when treating offenders with SMI in FACT programs, sug- gesting that highly structured cognitive-behavioral interventions used with correctional populations may assist with nonclinical risk factors: Crime and Mental Health Disorder Essay Paper: Goals & standards.

Implicit in FACT’s design to promote engagement of clients in psychopharma- cology, addiction treatment, and community support services is the notion that such interventions will reduce criminal recidivism. Although intensive services may reduce recidivism among persons who are arrested as a result of untreated psychosis, drug addiction, or homelessness, such services are prob- ably not sufficient for everybody. Individuals with co-occurring psychopathy may also benefit from additional interventions that directly target antisocial attitudes, skills, and cognitions. Research in populations of persons who do not have a mental illness has suggested that the most effective approaches to individuals who are at a high risk of criminal recidivism incorporate highly structured cognitive-behavioral interventions. (p. 1291) Crime and Mental Health Disorder Essay Paper: Goals & standards.

The Criminalization Hypothesis 11

For psychotic offenders, Lamberti (2007) recommended utilizing a conceptual framework that includes three areas of focus: (1) competent care, (2) access to treatment services, and (3) use of legal leverage. Most importantly, competent care requires care providers who are knowledgeable of the criminal justice system in order to utilize legal leverage; familiar with cognitive-behavioral interventions, which have proven effectiveness in correctional settings for persons without men- tal illness; and familiar with strategies that promote treatment adherence such as motivational interviewing.

Discussion

An enormous number of studies have been conducted regarding criminal behavior among individuals with SMI. This article provides an overview of this very complex topic to assist researchers, policy makers, and practitioners in understanding the current evidence. However, it does not represent an exhaustive review of the literature.

This article has examined the evidence that supports and contradicts the crimi- nalization hypothesis in order to evaluate the assumption that it is a significant cause of the overrepresentation of individuals with mental illness in the criminal justice system Crime and Mental Health Disorder Essay Paper: Goals & standards. The evidence suggests that there is only a small correlation between mental illness and crime, and that mental health treatment alone will, at best, play a small role in reducing criminal behavior among individuals with SMI. Thus, there is not strong support for a key assumption of the criminalization hypothesis.

Although treatment alone is unlikely to reduce arrest rates significantly, access to evidence-based mental health services remains a crucial first step in a compre- hensive strategy. Current research suggests crime prevention strategies should also draw from criminology and correctional models to develop interventions that target criminogenic needs in addition to connecting persons to services that treat mental health symptoms (Case et al., 2009; Fisher et al., 2006; Lamberti, 2007; Silver, 2006). For this to happen, mental health policy makers may need to shift their thinking away from criminalization, perhaps to a view that understands that many persons with SMI can be criminal offenders in need of treatment that incor- porates clinical and nonclinical factors, rather than victims of the mental health system as criminalization implies. Even current comprehensive and costly treat- ment programs that focus on medication, substance abuse treatment, and com- munity services may have relatively little effect because they do not address essen- tial factors related to crime. Antisocial traits are consistent predictors of criminal behavior that may be most effectively addressed through cognitive behavioral therapy. As Morrissey et al. (2009) discuss, there has been greater emphasis on collaborations between the criminal justice and mental health treatment systems to address the unique needs of individuals with SMI.

Social workers and human service workers in a case management role should incorporate criminogenic needs into individual treatment plans. Although case managers typically address certain criminogenic needs, such as housing and employment, in individual treatment plans, they often overlook others, such as Crime and Mental Health Disorder Essay Paper: Goals & standards

12 Best Practices in Mental Health

antisocial behavior, antisocial cognitions, antisocial attitudes, and antisocial asso- ciations. However, evidence indicates that antisocial behaviors and thinking are the greatest risk factors for re-offending. Not only should case managers be able to assess for criminogenic needs and incorporate them into individual treatment plans, but they also need to be able to link clients to programs/interventions that specifically target criminogenic needs.

Moreover, social workers and counselors in therapist roles should have knowl- edge of cognitive behavioral therapies used in correctional settings to address anti- social behaviors and thinking. There are many cognitive behavioral therapies, such as Reasoning and Rehabilitation, Moral Reconation Therapy, Aggression Replacement Therapy, Interpersonal Problem Solving Therapy, and Thinking for a Change, that have proven effective in correctional settings and could be modified to work with offenders with SMI (Landenberger & Lipsey, 2005; Rotter & Carr, 2010). Whereas any generic cognitive behavioral therapy approach is likely to show positive effects, those tailored to address specific criminal behaviors are more likely to produce better criminal justice outcomes.

Clearly, there is importance in matching services to risks and focusing on crim- inogenic needs and high-risk offenders. In real world settings, however, there is often a tendency to focus more attention on low-risk clients who are less difficult to work with and more likely to complete treatment. The RNR strategy is a useful approach that social work administrators and practitioners can apply to counter this tendency when designing and implementing interventions for offenders with SMI.

Ultimately, research should inform policy as well as social work practice guide- lines. As evidence suggests, the construct of criminalization may be too simplistic to guide either. Because criminalization may contain incorrect assumptions about the problem and not fully explain the causes of the disproportionate number of persons with SMI in the criminal justice system, it may limit efforts by social work administrators and practitioners to address the problem. Thus far, twenty years of evidence suggests that simply connecting persons to mental health services does not significantly reduce incarceration rates (Bonta et al., 1998; Draine et al., 2002; Fisher et al., 2006; Lamberti, 2007; McNeil & Binder, 2007; Silver, 2006; Steadman et al., 2009). Furthermore, according to Fisher et al. (2006), the focus on treating mental health symptoms not only neglects other approaches to reduc- ing crime, but it also neglects the psychosocial rehabilitation model’s emphasis on the person as separate from the illness and, in doing so, “reinforces the label of ‘person with mental illness as a master status’—that status which above all others defines the individual’s position with the mental health system, the criminal jus- tice system and society in general” (p. 549). Crime and Mental Health Disorder Essay Paper: Goals & standards.

Clearly, there is considerable room for additional empirical study. Rigorous research is needed to determine whether programs meet the standards to be con- sidered evidence-based practices. Many pre- and post-booking programs have either been the subject of little research, or have found only modest support in studies. Issues of cost effectiveness are rarely dealt with in studies. In addition, part of the RNR model is responsiveness. In an era of limited public resources,

The Criminalization Hypothesis 13

research must consider which programs can be cost effective in addressing the needs of people most likely to be responsive. Almost certainly, one inherent chal- lenge in past studies that examine the effectiveness of an intervention is that some subjects will not be receptive no matter how effective the treatment.

References Abramson, M. F. (1972). The criminalization of mentally disordered behavior:

Possible side effect of a new commitment law. Hospital and Community Psychiatry, 23(4), 101–107.

Aderibigbe, Y. A. (1997). Deinstitutionalization and criminalization: Tinkering in the interstices. Forensic Science International, 85(2), 127–134.

Andrews, D. A., & Bonta, J. (2003). The Psychology of Criminal Conduct. Cincinnati, OH: Anderson Publishing Co.

Andrews, D. A., Bonta, J., & Wormith, J. S. (2006). The recent past and near future of risk and/or need assessment. Crime & Delinquency, 52(1), 7–27.

Andrews, D. A., & Dowden, C. (2007). The risk-need-responsivity model of assessment and human service in prevention and corrections: Crime- prevention jurisprudence. Canadian Journal of Criminology and Criminal Justice, 49(4), 439–464.

Bittner, E. (1967). The police on skid-row: A study of peace keeping. American Sociological Review, 32(5), 699–715.

Boccaccini, M. T., Christy, A., Poythress, N., & Kershaw, D. (2005). Rediversion in two postbooking jail diversion programs in Florida. Psychiatric Services, 56(7), 835–839. Crime and Mental Health Disorder Essay Paper: Goals & standards.

Bonovitz, J. C., & Bonovitz, J. S. (1981). Diversion of the mentally ill into the criminal justice system: The police intervention perspective. American Journal of Psychiatry, 138(7), 973–976.

Bonta, J., Hanson, K., & Law, M. (1998). The prediction of criminal and violent recidivism among mentally disordered offenders: A meta-analysis. Psy- chological Bulletin, 123(2), 123–142.

Boothroyd, R., Mercado, C. C., Poythress, N. G., Christy, A., & Petrila, J. (2005). Clinical outcomes of defendants in mental health court. Psychiatric Ser- vices, 56(7), 829–834.

Boothroyd, R., Poythress, N. G., McGaha, A., & Petrila, J. (2003). The Broward County mental health court: Process, outcomes, and service utilization. International Journal of Law and Psychiatry, 26(1), 55–71.

Breslau, J., Lane, M., Sampson, N., & Kessler, R. C. (2008). Mental disorders and subsequent educational attainment in a US national sample. Journal of Psychiatric Research, 42(9), 708–716.

Case, B., Steadman, H. J., Dupis, S. A., & Morris, L. S. (2009). Who succeeds in jail diversion programs? A multi-site study. Behavioral Sciences and Law, 27(5), 661–674.

14 Best Practices in Mental Health

Clark, R. E., Ricketts, S. K., & McHugo, G. J. (1999). Legal system involvement and costs for persons in treatment for serious mental illness and sub- stance abuse disorders. Psychiatric Services, 50(5), 641–647.

Compton, M. T., Bahora, M., Watson, A. C., & Oliva, J. R. (2008). A comprehen- sive review of extant research on crisis intervention team (CIT) pro- grams. The Journal of the American Academy of Psychiatry and the Law, 36(1), 47–55.

Constantine, R. J., Andel, R., Petrila, J., Becker, M., Robst, J., Teague, G., . . . Howe, A. (2010). Characteristics and experiences of adults with a serious mental illness who were involved in the criminal justice system. Psychiatric Services, 61(5), 451–457.

Constantine, R. J., Petrila, J., Andel, R., Givens, E., Becker, M., Robst, J., . . . Howe, A. (2011). Arrest trajectories of adult offenders with a serious mental illness. Psychology, Public Policy and Law, 16(4), 319–339.

Council of State Governments. (2002). Criminal justice/mental health consensus project report. New York: Author. Crime and Mental Health Disorder Essay Paper: Goals & standards.

Cox, J. F., Morschauser, P. C., Banks, S., & Stone, J. L. (2001). A five-year pop- ulation study of persons involved in the mental health and local cor- rectional systems: Implications for service planning. The Journal of Behavioral Health Services & Research, 28(2), 177–187. doi: 10.1007/ BF02287460

Cuddeback, G. S., Morrissey, J. P., Cusack, K. J., & Meyer, P. S. (2009). Challenges to developing forensic assertive community treatment teams. American Journal of Psychiatric Rehabilitation, 12(3), 225–246.

Cusack, K. J., Morrissey, J. P., Cuddeback, G. S., Prins, A., & Williams, D. M. (2010). Criminal justice involvement, behavioral health service use, and costs of forensic assertive community treatment: A randomized trial. Community Mental Health Journal, 46(4), 356–363.

Domino, M. E., Norton, E. C., Morrissey, J. P., & Thakur, N. (2004). Cost shifting to jails after a change to managed mental health care. Health Services Research, 39(5), 1379–1401.

Draine, J., Salzer, M. S., Culhane, D. P., & Hadley, T. R. (2002). Role of social dis- advantage in crime, joblessness, and homelessness among persons with serious mental illness. Psychiatric Services, 53(5), 565–573.

Engel, R. S., & Silver, E. (2001). Policing mentally disordered suspects: A reexam- ination of the criminalization hypothesis. Criminology, 39(2), 216–219.

Erickson, S. K., Lamberti, J. S., Weisman, R., Crilly, J., Nihalani, N., Stefanovics, E., & Desai, R. (2009). Predictors of arrest during forensic assertive commu- nity treatment. Psychiatric Services, 60(6), 834–837.

Fisher, W. H., Packer, I. K., Simon L. J., & Smith, D. (2000). Community mental health services and the prevalence of serious mental illness in local jails: Are they related? Administration and Policy in Mental Health Services and Research, 27(6), 371–382. Crime and Mental Health Disorder Essay Paper: Goals & standards.

The Criminalization Hypothesis 15

Fisher, W. H., Silver, E., & Wolff, N. (2006). Beyond criminalization: Toward a criminologically informed framework for mental health policy and ser- vices research. Administration and Policy in Mental Health and Mental Health Services Research, 33(5), 544–557.

Florida Supreme Court. Steering Committee on Families and Children in the Court. Mental Health Subgroup. (2007). Mental health: Transforming Florida’s mental health system: Constructing a comprehensive and competent criminal justice/mental health/substance abuse treatment system: Strategies for planning, leadership, financing, and service development. Retrieved July 19, 2009, from http://www.floridasupremecourt.org/pub_info/documents/ 11-14-2007_Mental_Health_Report.pdf

Frank, R. G., Goldman, H. H., & Hogan, M. (2003). Medicaid and mental health: Be careful what you ask for. Health Affairs, 22(1), 101–113.

Frank, R. G., & McGuire, T. G. (2010). Mental health treatment and criminal justice outcomes (NBER Working Paper No. 15858. Issued April 2010). Retrieved from http://www.nber.org/papers/w15858

GAINS Center. (2010). What is jail diversion? Retrieved April 14, 2010, from http://gainscenter.samhsa.gov/topical_resources/jail.asp

Hartwell, S. (2003). Short-term outcomes for offenders with mental illness released from incarceration. International Journal of Offender Therapy and Comparative Criminology, 47(2), 145–158. doi: 10.1177/0306624X03251093

Herinckx, H. A., Swart, S. C., Ama, S. M., Dolezal, C. D., & King, S. (2005). Rear- rest and linkage to mental health services among clients of the Clark County mental health court program. Psychiatric Services, 56(7), 853–857.

Junginger, J., Claypoole, C., Ranilo, l., & Crisanti, A. (2006). Effects of serious mental illness and substance abuse on criminal offenses. Psychiatric Ser- vices, 57(6), 879–882.

Kessler, R. C., Heeringa, S., Lakoma, M. D., Petukhova, M., Rupp, A. E., Schoen- baum, M., . . . Zaslavsky, A. M. (2008). Individual and societal effects of mental disorders on earnings in the United States: Results for the National Comorbidity Survey Replication. American Journal of Psychiatry, 165(6), 703–711.

Koyanagi, C., & Stine, L. (2009). Shifting focus: The impact of the deficit reduc- tion act and Medicaid regulations on national mental health policy. Home Health Care Management and Practice, 21(4), 271–280.

Lamb, H. R., & Weinberger, L. E. (1998). Persons with severe mental illness in jails and prisons: A review. Psychiatric Services, 49(4), 483–492.

Lamb, H. R., & Weinberger, L. E. (2001). Persons with severe mental illness in jails and prisons: A review. In H. R. Lamb & L. E. Weinberger (Eds.), Deinstitutionalization: Promise and problems (pp. 29–49). San Francisco: Jossey-Bass.

Lamb, H. R., Weinberger, L. E., & Gross, B. H. (2004). Mentally ill persons in the criminal justice system: Some perspectives. Psychiatric Quarterly, 75(2), 107–122.

16 Best Practices in Mental Health

Lamberti, J. S. (2007). Understanding and preventing criminal recidivism among adults with psychotic disorders. Psychiatric Services, 58(6), 773–781.

Lamberti, J. S., Weisman, R., & Faden, D. I. (2004). Forensic assertive community treatment: Preventing incarceration of adults with severe mental illness Psychiatric Services, 55(11), 1285–1293. Crime and Mental Health Disorder Essay Paper: Goals & standards.

Landenberger, N. A., & Lipsey, M. W. (2005). The positive effects of cognitive–behavioral programs for offenders: A meta-analysis of factors associated with effective treatment. Journal of Experimental Criminology, 1(4), 451–476.

McAlpine, D. D., & Mechanic, D. (2000). Utilization of specialty mental health care among persons with severe mental illness: The roles of demograph- ics, need, insurance, and risk. Health Services Research, 35(1, Pt. 2), 277–292.

McNeil, D. E., & Binder, R. L. (2007). Effectiveness of a mental health court in reducing criminal recidivism and violence. American Journal of Psychia- try, 163(9), 1395–1403.

McNeil, D. E., Binder, R. L., & Robinson, J. C. (2005). Incarceration associated with homelessness, mental disorder, and co-occurring substance abuse. Psychiatric Services, 56(7), 840–846.

Marlowe, D. B., Festinger, D. S., Dugosh, K. L., & Lee, P. A. (2005). Are judicial status hearings a “key component” of drug court? Six and twelve months outcomes. Drug and Alcohol Dependence, 79(2), 145–155.

Mocan, N., & Tekin, E. (2006). Ugly criminals (No. w12019). National Bureau of Economic Research.

Monahan, J., Steadman, H. J., Robbins, P. C., Appelbaum, P., Banks, S, Grisson, T., . . . Silver, E. (2005). An actuarial model of violence risk assessment for persons with mental disorders. Psychiatric Services, 56(7), 810–815.

More, M. E., & Hiday, V. A. (2006). Mental health court outcomes: A compari- son of re-arrest and re-arrest severity between mental health court and traditional court participants. Law and Human Behavior, 30(6), 659–674.

Morgan, R. D., Fisher, W. H., Duan, N., Mandracchia, J. T., & Murray, D. (2010). Prevalence of criminal thinking among state prison inmates with serious mental illness. Law and Human Behavior, 34(4), 324–336.

Morrissey, J., Cuddeback, G., Cuellar, A., & Steadman, H. (2007). The role of Medicaid enrollment and outpatient service use in jail recidivism among persons with severe mental illness. Psychiatric Services, 58(6), 794–801. Crime and Mental Health Disorder Essay Paper: Goals & standards.

Morrissey, J., Steadman, H., Dalton, K., Cuellar, A., Stiles, P., & Cuddeback, G. (2006). Medicaid enrollment and mental health service use following release of jail detainees with severe mental illness. Psychiatric Services, 57(6), 809–815.

Morrissey, J. P., Fagan, J. A., & Cocozza, J. J. (2009). New models of collaboration between criminal justice and mental health systems. American Journal of Psychiatry, 166(11), 1211–1214.

The Criminalization Hypothesis 17

National Alliance for the Mentally Ill. (2001). The criminalization of people with mental illness. Where we stand. Arlington, VA: Author.

New Freedom Commission on Mental Health. (2003). Achieving the promise: Transforming mental health care in America (Final Report DHHS Pub. No. SMA-03-3832). Rockville, MD: Author.

Petrila, J. (1992). Redefining mental health law. Law and Human Behavior, 16(1), 89–106.

Petrila, J. (2001). Financing public mental health services: Beyond managed care. In L. E. Frost & R. J. Bonnie (Eds.), The evolution of mental health law (pp. 75–100). Washington, DC: American Pyschiatric Association.

Phillips, H. K., Gray, N. S., MacCulloch, S. I., Taylor, J., Moore, S. C., Huckle, P., & MacCulloch, M. J. (2005). Risk assessment in offenders with mental dis- orders: Relative efficacy of personal demographic, criminal history, and clinical variables. Journal of Interpersonal Violence, 20(7), 833–848.

Rabkin, J. G. (1979). Ethnic density and psychiatric hospitalization: Hazards of minority status. American Journal of Psychiatry, 136(12), 1562–1566.

Rotter, M., & Carr, A. (2010). Targeting criminal recidivism in justice-involved people with mental illness: Structured clinical approaches. The CMS National GAINS Center. Retrieved August 24, 2010, from http://gains center.samhsa.gov/cms-assets/documents/69181-899513.rottercarr 2010.pdf

Rylance, B. J. (1997). Predictors of high school graduation or dropping out for youths with severe emotional disturbances. Behavioral Disorders, 23(1), 5–17.

Silver, E. (2006). Understanding the relationship between mental disorder and violence: The need for a criminological perspective. Law and Human Behavior, 30(6), 685–705.

Skeem, J. L., & Louden, J. E. (2006) Toward evidence-based practice for proba- tioners and parolees mandated to mental health treatment. Psychiatric Service, 57(3), 333–342.

Soros Foundation. (1996). Research brief: Mental illness in US jails: Diverting the non-violent, low-level offender (Occasional Paper Series No. 1 Center on Crime, Communities and Culture). Available: http://www.prison policy.org/scans/research_brief__1.pdf

Steadman, H. J., Monahan, J., Duffee, B., Hartsone, E., & Robbins, P. C. (1984). The impact of state mental hospitalization deinstitutionalization on US prison population, 1968–1978, Journal of Criminal Law and Criminology, 75(2), 474–490 Crime and Mental Health Disorder Essay Paper: Goals & standards.

Steadman, H. J., & Naples, M. (2005). Assessing the effectiveness of jail diversion programs for persons with serious mental illness and co-occurring sub- stance use disorders. Behavioral Sciences and the Law, 23(2), 163–170.

Steadman, H. J., Osher, F. C., Robbins, P. C., Case, B., & Samuels, S. (2009). Prevalence of serious mental illness among jail inmates. Psychiatric Services, 60(6), 761–765.

18 Best Practices in Mental Health

Teplin, L. A. (1983). The criminalization of the mentally ill: Speculation in search of research. Psychological Bulletin, 94(1), 54–67.

Teplin, L. A. (1984). Criminalizing mental disorder: The comparative arrest rates of the mentally ill. American Psychologist, 39(7), 794–803.

Teplin, L. A. (1990). The prevalence of severe mental disorders among male urban jail detainees. American Journal of Public Health, 80(6), 663–669.

Teplin, L. A., Abram, K. M., & McClelland, G. M. (1996). Prevalence of psychi- atric disorders among incarcerated women jail detainees. Archives of General Psychiatry, 53(6), 505–512.

Torrey, E. F. (1988). Nowhere to go: The tragic odyssey of the homeless mentally ill. New York: Harper Collins.

Torrey, E. F. (1995). Jails and prisons—America’s new mental hospitals. Ameri- can Journal of Public Health, 85(12), 1611–1613.

Torrey, E. F. (2008). The insanity offense. New York: Norton. Trupin, E., & Richards, H. (2003). Seattle’s mental health courts: Early indica-

tors of effectiveness. International Journal of Law and Psychology, 26(1), 33–53.

Veysey, B. M., Steadman, H. J., Morrissey, J. P., & Johnsen, M. (1997). In search of the missing linkages: Continuity of care in U.S. jails. Behavioral Sciences & the Law, 15(4), 383–397.

The Criminalization Hypothesis 19

Copyright of Best Practice in Mental Health is the property of Lyceum Books, Inc. and its content may not be

copied or emailed to multiple sites or posted to a listserv without the copyright holder’s express written

permission. However, users may print, download, or email articles for individual use Crime and Mental Health Disorder Essay Paper: Goals & standards.

Financial healthcare management essay – CPT code 99214

Case Study: You are assessing the payer–patient mix for a health care organization. Currently, your payer mix is 40% Medicare, 10% Medicaid, 25% traditional indemnity insurance, 20% managed care, and 5% self-pay patients. Complete the following:

Using the most common office visit, CPT code 99214, determine the reimbursement from the Centers for Medicare and Medicaid Services (online fee schedule available for Medicare).

Using the same CPT code, 99214, determine the be possible to obtain actual reimbursement information from your personal insurance carrier. If the information is not available, assume reimbursement by traditional indemnity insurance is usually 200% reimbursed more than Medicare and Medicaid, and managed care is usually 133% more than Medicare and Medicaid.

Compose an accounts receivable benchmark from this information showing columns for current, 30–60, 61–90, 90–120, and greater than 120 days. Financial healthcare management essay – CPT code 99214.

BUY A PLAGIARISM-FREE PAPER HERE

Assess the information for areas of improved reimbursement of at least 20% or more.

Evaluate the options available to change the payer–patient mix with consideration of related legal and ethical issues.

Propose a best strategy with justification and rationale based on effective decision-making tenets.

Spreadsheets demonstrating the accounts receivable analysis will be attached as appendices, and there will be at least 7 relevant peer-reviewed academic or professional references published within the past 5 years. Also attach appropriate fee schedules. Financial healthcare management essay – CPT code 99214.

Endocrine System Essay

Pre-Lab Evaluation Answers.

The endocrine system produces hormones to regulate the internal environment of the body therefore keeping the parameters of the body at a relatively constant level. The hormones work by a feedback mechanism whereby if a parameter goes high or low it stimulates the production of the hormone that is responsible for regulating it back to the normal level. This is important so that the cells are at the environment at which they work best Endocrine System Essay.

Parathyroid hormone, a hormone responsible for calcium regulation, is produced by the parathyroid glands. They are two glands and are located on the posterior aspect of the thyroid glands. Secretion of parathyroid hormone is inversely related to serum calcium level. The direct action of parathyroid hormone is on bone and kidneys. It causes release of calcium from the bone and reabsorption in the kidneys thereby raising the level of calcium in blood (Lok, U, 2014).

BUY A PLAGIARISM-FREE PAPER HERE

On the anterior aspect, the chief cells of the thyroid glands produce calcitonin. Calcitonin is antagonistic to parathyroid hormone and functions to reduce the amount of calcium in blood.

 

The two hormones secreted by the thyroid gland are T3 and T4, they are important in regulating the metabolism of the body. A high level of T3 and T4 results in high metabolism. The difference between them is that T3 has three molecules while T4 has four. T3 is the more active one. They require iodine in their structure (Mullur, R, 2014).

Corticosteroids are a group of drugs/hormones that resemble in structure the hormones that are produced by the cortex of the adrenal gland. An example is prednisone. They are mostly used to treat autoimmune inflammatory diseases. Their effects include hyperglycemia and weight gain; they also depress the hypothalamo-pituitary-adrenal axis Endocrine System Essay.

Adequate blood sugar levels are essential so that cells can be able to take in the sugar to perform their metabolic functions. Insulin is the hormone that is responsible for transporting glucose into the cells. Normal blood sugar levels in humans are 3.9-5.4 mmols/l for fasting blood sugar and 5.5-7.0 mmols/l for random blood sugar. The pancreas produces insulin to reduce the blood sugar when it is high, while the liver stores glycogen, which is converted into glucose to raise the blood when it is low (Hill,N, 2011).

Post-Lab Evaluation Answers

The significance of the HbA1c test is to determine whether blood sugar control has been adequate over the past 3 months. In Mr Joe’s case it has been poor. The diagnosis is poorly controlled diabetes mellitus Endocrine System Essay.

If Joe were honest he most likely responded by saying that he has not been watching his diet. I would explain to Joe that Diabetes is a chronic disease that results from either inadequate or lack of insulin and that it is not cured by medication but is instead controlled by a lifetime of oral or injectable drugs that are essential to control his blood sugar.

I would explain to Joe that there are different methods of controlling his blood sugar. I would start by advising him to pursue a change in diet and lose some weight and also advice him that he does not have to be on insulin shots if his blood sugar control is adequately controlled by oral medication.

In the short term Joe could go into diabetic ketoacidosis, a hyperosmolar state or hypoglycemic coma. In the long term Joe could have vision loss, heart disease, kidney disease, peripheral neuropathy and leg ulcers.

I would advice Joe to talk to his son about diet modification and weight loss. And also for him to do follow the same advice. Endocrine System Essay.

References

Lok, U., Hatipoglu, S., Gulacti, U., Arpaci, A., Aktas, N., & Borta, T. (2014). The Role of Thyroid and Parathyroid Metabolism Disorders in the Etiology of Sudden Onset Dizziness.
Medical Science Monitor : International Medical Journal of Experimental and Clinical Research
,
20
, 2689–2694. http://doi.org/10.12659/MSM.891305

Mullur, R., Liu, Y.-Y., & Brent, G. A. (2014). Thyroid Hormone Regulation of Metabolism.
Physiological Reviews
,
94
(2), 355–382.
http://doi.org/10.1152/physrev.00030.2013

Hill, N. R., Oliver, N. S., Choudhary, P., Levy, J. C., Hindmarsh, P., & Matthews, D. R. (2011). Normal Reference Range for Mean Tissue Glucose and Glycemic Variability Derived from Continuous Glucose Monitoring for Subjects Without Diabetes in Different Ethnic Groups.
Diabetes Technology & Therapeutics
,
13
(9), 921–928. http://doi.org/10.1089/dia.2010.0247 Endocrine System Essay

Power use and misuse essay example
.

TS Eliot wrote, “Half of the harm that is done in this world is caused by people who have power and want to feel important. They do not mean to do harm… they are simply absorbed in the useless struggle to think well of themselves.” (Manning & Curtis , p. 167)

Please do Exercise 8-1, p. 169. What kind of power does your supervisor commonly use, and what has been the outcome of their behavior…on the employees, on the company?

BUY A PLAGIARISM-FREE PAPER HERE

Exercise 8–1 What Type of Power Does Your Supervisor Use?

Indicate how strongly you agree or disagree with the following statements as they describe your immediate supervisor. If you are not currently employed, evaluate a supervisor you have had in the past. For each statement, select the most appropriate response, using the following scale: 1 = strongly disagree; 2 = disagree; 3 = neither agree nor disagree; 4 = agree; 5 = strongly agree.

My supervisor 1
.

1
.   ______ Recognizes efforts and rewards accomplishments.

2
.   ______ Uses fear to control behavior.

3
.   ______ Shows appreciation for work well done.

4
.   ______ Manipulates others to gain compliance.

5
.   ______ Makes timely decisions to get things done.

6
.   ______ Stays abreast of job-related news.

7
.   ______ Exercises authority and power of position.

8
.   ______ Provides skill and advice to solve job problems.

9
.   ______ Maintains access to important facts and data.

10
.   ______ Keeps job knowledge current.

11
.   ______ Has high ideals and standards of conduct.

12
.   ______ Thinks clearly and explains things logically.

13
.   ______ Causes people to respect what he or she stands for.

14
.   ______ Creates a vision and strong sense of purpose.

15
.   ______ Gets the facts before making decisions.

16
.   ______ Motivates others and inspires them to action. Power use and misuse essay example

Scoring:

Power of the Position

1
.   Add the numbers assigned to statements 1 and 3. This is the 
reward power
________

2
.   Add the numbers assigned to statements 2 and 4. This is the 
coercive power
________

3
.   Add the numbers assigned to statements 5 and 7. This is the 
legitimate power
________

4
.   Add the numbers assigned to statements 6 and 9. This is the 
information power
________

Power of the Person

5
.   Add the numbers assigned to statements 8 and 10. This is the 
expert power
________

6
.   Add the numbers assigned to statements 11 and 13. This is the 
referent power
________

7
.   Add the numbers assigned to statements 12 and 15. This is the 
rational power
________

8
.   Add the numbers assigned to statements 14 and 16. This is the 
charisma power
________

Discussion:

The effective leader emphasizes the power of the person to accomplish goals. This involves maintaining knowledge and skill (expertise), having high moral character (referent power), demonstrating effective problem-solving ability (rational power), and motivating and inspiring people (charisma). The effective leader also uses the power of the position to reward efforts and accomplishments (rewards), make effective decisions (legitimacy), and keep people informed on important matters (information). The effective leader rarely if ever uses fear (coercion) as a form of power. Coercion involves threats, punishment, and negative rewards. It usually leads to negative feelings of resentment and counterproductive work behavior—complaints, rebellion, and reduced productivity.

Power

Exercise 8–1 What Type of Power Does Your Supervisor Use?

Indicate how strongly you agree or disagree with the following statements as they describe your immediate supervisor Power use and misuse essay example. If you are not currently employed, evaluate a supervisor you have had in the past. For each statement, select the most appropriate response, using the following scale: 1 = strongly disagree; 2 = disagree; 3 = neither agree nor disagree; 4 = agree; 5 = strongly agree.

My supervisor 1
.

1
.   
4
Recognizes efforts and rewards accomplishments.

2
.   
2
Uses fear to control behavior.

3
.   
4
Shows appreciation for work well done.

4
.   
2
Manipulates others to gain compliance.

5
.   
3
Makes timely decisions to get things done.

6
.   
3
Stays abreast of job-related news.

7
.   
5
Exercises authority and power of position.

8
.   
4
Provides skill and advice to solve job problems.

9
.   
4
Maintains access to important facts and data.

10
.   
4
Keeps job knowledge current.

11
.   
4
Has high ideals and standards of conduct.

12
.   
4
Thinks clearly and explains things logically.

13
.   
4
Causes people to respect what he or she stands for.

14
.   
4
Creates a vision and strong sense of purpose.

15
.   
4
Gets the facts before making decisions.

16
.   
4
Motivates others and inspires them to action.

Scoring:

Power of the Position

1
.   Add the numbers assigned to statements 1 and 3. This is the 
reward power

8

2
.   Add the numbers assigned to statements 2 and 4. This is the 
coercive power

4

3
.   Add the numbers assigned to statements 5 and 7. This is the 
legitimate power

8

4
.   Add the numbers assigned to statements 6 and 9. This is the 
information power

7

Power use and misuse essay example

Power of the Person

5
.   Add the numbers assigned to statements 8 and 10. This is the 
expert power

8

6
.   Add the numbers assigned to statements 11 and 13. This is the 
referent power

8

7
.   Add the numbers assigned to statements 12 and 15. This is the 
rational power

8

8
.   Add the numbers assigned to statements 14 and 16. This is the 
charisma power

8

What kind of power does your supervisor commonly use, and what has been the outcome of their behavior…on the employees, on the company?

My supervisor appears to use more of power of the person rather than power of the position. That is because she scores more highly in the power of person scores when compared to the power of position scores Power use and misuse essay example. In fact, she is an effective leader who has much expertise to include knowledge and skills having scored 8 out of 10. Additionally, she has a high moral character with a score of 8 out of 10. Also, she makes good use of rational power with a good problem-solving capacity having scored 8 out of 10. Besides that, she is charismatic with the capacity for motivation and inspiration with a score of 8 out of 10.

With regards to use of the power of position, my supervisor appears be an effective leader. She scores 8 out of 10 in reward power, by rewarding her subordinates efforts and accomplishments. Also, she has legitimacy as a leader by scoring 8 out of 10 in making effective decisions. Additionally, she makes very little use of coercive power, scoring 4 out of 10 to show that she rarely uses fear, negative rewards, punishment and threats against her subordinates. Furthermore, she has a score of 7 out of 10 with regards to information power, showing that she jeeps people informed about important matters. Power use and misuse essay example. In essence, she is an effective leader as evidenced when she makes extensive use of power of the person although she could improve her performance in this regard by increasing the scores from 8 to 10. She could also improve her power of position by increasing her reward, legitimate and information power scores (getting them to 10) even as she reduces her coercive power score (getting it to 1).

As a person in a position of power, my supervisor has invested in the development of her leadership skills. As her subordinate, I feel that I am valued and directed to work more effectively in ensuring that the organization goals are met. Also, I feel that I am attracted to remain her subordinate and feel the desire to stay loyal to her. That is because she recognizes my input, focuses on the well-being and growth of me as a subordinate and the work environment even as she engenders as sense of belonging. Her functional attributes are individualized consideration, intellectual stimulation, inspirational motivation, charisma, empowerment, appreciation of others, modeling, service, trust, integrity, honesty, and vision. This is contrasted to traditional leadership where the leader’s primary focus is on power of the position and less on power of the person in exercising the accumulated power to be at the top (Manning & Curtis, 2003; Marquis & Huston, 2014). In this respect, my supervisor is an effective leader Power use and misuse essay example.

 

References

Manning, G. & Curtis, K. (2003).
The Art of Leadership
. New York, NY: McGraw Hill Professional.

Marquis, B. & Huston, C. (2014).
Leadership Roles and Management Functions in Nursing: Theory and application
(8
th
ed.). Philadelphia, PA: Lippincott, Williams & Wilkins Power use and misuse essay example.

Staffing & Compensation Plan

Please ensure this CLC – Staffing & Compensation Plan Sample Essay Papers work has scholarly references; free of plagiarism, free of grammatical error. Ensure all free of incorrect spelling.

CLC – Staffing & Compensation Plan Sample Essay Papers is a Collaborative Learning Community (CLC) assignment.

Develop a 750-1,000 word high level staffing and compensation plan. The plan should contain an introduction and conclusion that make relevant connections to the course objectives.

BUY A PLAGIARISM-FREE PAPER HERE

The purpose of this CLC – Staffing & Compensation Plan Sample Essay Papers assignment is to simulate the thought process that managers use when planning for staffing and compensating employees Staffing & Compensation Plan. Students are not expected to produce a detailed proposal. Rather, the expectation is that students demonstrate consideration of the multiple complexities involved in staffing and compensation.

Obtain the Instructor’s approval on the selected organization before writing the Staffing and Compensation Plan which should include:

ORDER A PLAGIARISM-FREE PAPER HERE

Introduction.

Discussion of the staffing needs of your organization.

Explanation of the compensation plan for your organization.

Description of the employee benefits offered.

Conclusion.

Incorporate three to five resources (including your textbook) to support your Staffing and Compensation Plan.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this
CLC – Staffing & Compensation Plan
Sample Essay Papers
assignment
to Turnitin. Please refer to the directions in the Student Success Center. Staffing & Compensation Plan.

pdsa model of change in nursing essay

Quality/Safety Improvement Model

Quality/Safety Improvement Model

Name:

Institution:

Abstract

Medical errors depict a severe public wellbeing issue and pose a risk to the security of patients. As health centers introduce an ‘error’ as a research and clinical need, the response to maybe the most crucial inquiry remains indefinable: How can you define a medical error? To diminish therapeutic faults, exact measurements of its occurrences, founded on definite, and predictable definitions, are critical essentials for successful actions. In spite of having a growing literature and research body to study on errors in medicine, few undertakings have measured or defined the issue unswervingly. Rather, analysts have embraced substitute measures of error that to a great extent rely on antagonistic patient injury or outcomes (that is outcome-dependent). pdsa model of change in nursing essay
.
An absence of institutionalized classification and the utilization of various and overlapping meanings of medical error have barred data analysis, synthesis, collaborative work, and assessment of the effects of alteration in health care conveyance. The essential goal of this audit is to highlight the requirement for a robust, wide-ranging and collectively acknowledged meaning of therapeutic error that unambiguously incorporates the crucial areas of error causative ness and catches the defective procedures that cause errors, independent of result.

BUY A PLAGIARISM-FREE PAPER HERE

Quality/Safety Improvement Model

Introduction

The issue of patient safety plays a significant role in health care. The prominence of the issue is fueled by the intensifying body of research that demonstrates a high frequency of medical error combined with a couple broadcasted therapeutic error cases that have over the years raised a public concern over the issue of patient safety in the contemporary health care conveyance. Medical faults can be said to be avoidable adverse effect or event of care. They are a leading cause of many deaths in several parts of the world and even in most cases exceed the deaths caused by vehicle accidents, heart failure, or even breast cancer (Palmieri et al., 2008). They comprise of incomplete or erroneous treatment or diagnosis, and incorrect execution of an appropriate care method. Errors caused by humans have been involved in about 80 percent of adversative happenings that happen in complex healthcare units. The dominant part of medical errors emanates from faulty systems and inadequately composed procedures versus incompetent practitioners or poor practices.

According to a study conducted by Gitomer, the vulnerability of medicine to error is turning out to be deceptive (2005). The research revealed that the errors are more prevalent in intensive care units whereby nurses are involved in the medical recovery of the error (that is recognizing, interposing, and correcting them) and preventing adverse effects. Despite the fact that medical practitioners have been identified for preventing errors from occurring, only lately have approaches for error retrieval been designated in the literature. Analysis that have recently shown that failure results from a system and human failures have given people a call to action to start systematically addressing the issue. pdsa model of change in nursing essay
.

Problem of Discussion

The issue of medical errors was recently brought to the public following a series of deaths caused by health systems and human faults. Several reports introduced the issues of health safety into the awareness of the people and stressed on four key points. That medical errors are costly and frequent, they are caused by systems, can be prevented and safety enhanced, and medication-connected adverse events are the primary causes of injuries. Recent attempts have been made to think about what can be done to achieve the next level of health safety (Gitomer, 2005). Medical experts have recommended that the security of patients depend more on averting overwhelming incidents by improving systems as it relies on increasing people’s ability to the point of health care to eliminate dangerous situations by recognizing those errors.

To minimize the occurrence of medical mistakes, medicinal service providers should identify their causes, device measures, and quantify the success of improvement endeavors. In addition, exact estimations of the occurrence of error founded on precise and steady definitions, are crucial essentials for powerful actions. pdsa model of change in nursing essay. Unfortunately, what is viewed as a medical error has been affected by contrasting settings and purposes, for example, quality control, legislation, research, insurance, statutory regulations, morals, and legal action. Subsequently, an absence of institutionalized terminology and the utilization of various and covering meanings of restorative error has hindered data analysis and synthesis, evaluation, and collaboration of the effect of changes on medicinal services delivery (Thomas &Brennan, 2011). Researchers have adopted surrogate error measures, such as critical incidents, preventable adverse activities, violations, slips, iatrogenic illness, potentially compensable occurrence, and noxious episodes pdsa model of change in nursing essay.

Aim

Programs to reduce Medication Errors

The objective of this discussion is to study programs, which have over the years proved to be effective in the reduction of medical errors. The systematic nature of medication errors involves a multi-disciplinary approach. Programs projected in the medical literature need the involvement of drug manufacturers, pharmacists, communication efforts, as well as information systems (personnel, software/hardware) of hospital staff to minimize medication errors. Technological programs to offer solutions to the medication errors will continue to transpire as healthcare continues with their efforts to improve quality and safety in all health aspects of healthcare delivery (Cohen, 2007). Despite that there is evidence of the advantages and improvement in centers due to the implementation of such programs, inquiries continue to arise. There have been writings showing the business case of programs, such as the MFI (Model for Improvement) and PDSA (Plan-Do-Study-Act) tools pdsa model of change in nursing essay. To recognize the full advantages of these approaches, implementations should be combined with adequate training and support, engaged at all levels, easy to utilize, counterpart prevailing protocols, and tools within the organization and be a part of the all-inclusive Quality Care Program (QCP) or Quality Improvement (QI).

Intended Improvement

Utilization of MFI and PDSA as project Management Resources

Conveying changes in the quality and security of healthcare remains a worldwide challenge. Currently, Quality improvement (QI) systems, for example, the MFI and PSDA cycles have been utilized as part of an endeavor to drive such enhancements. The system is used as a part of medicinal services change; nevertheless there is a small overall assessment of how the strategy is connected (Schilling & Joint Commission Resources, Inc., 2009). This paper proposes a hypothetical structure for surveying the nature of the use of MFI and PDSA cycles and investigates the superiority and steadiness of PDSA cycle presentation against this basis as recognized in several peer-review journals. pdsa model of change in nursing essay.

It is important to bring into practice several quality improvement techniques and tools, which enable the identification of ineffectiveness and inefficiency in the health services and propose the practical changes that can be brought to the system. One of the most recommended tools is the Model for Improvement (MFI) and Plan-Do-Study-Act (PDSA), which comprises of a standard theoretical accounting, supported by the Institute of Healthcare Improvement (IHI) and National Health Service (NHS) as a primary approach to promoting and fostering exertions in quality management (John Corrigan &Donaldson, 2007) pdsa model of change in nursing essay. It incorporates execution appraisal and the utilization of evidence-based discoveries as a method for affecting the desired change in the medicinal services division, a zone where the need for security and quality change cannot be disregarded.

IHI endorses the MFI as an approach to guide improvement activities. It was developed by Associates in Process Improvement, is a very simple, yet very influential implement for accelerating medical error recovery. The tool is advantageous in that it does not replace any other change models that health centers may have adopted but is meant to increase growth. It has over the years been implemented successfully by numerous health care firms in many nations to advance many distinct medical procedures and effects pdsa model of change in nursing essay.

The MFI has two major parts, which include the Plan-Do-Study-Act (PSDA) cycle meant to test changes in the health settings. The cycle is important as it guides the change test to determine if it is an improvement. The other part is the three central questions, which are addressed in any order. The MFI and PSDA tool requires an organization to include the right people in the procedure improvement team to ensure that the medical error is alienated. Teams tend to differ in composition and size. Therefore, each organization can focus on building a team that suits its own requirements (Barach &Small, 2010). pdsa model of change in nursing essay. To implement the tools, an organization should first set its aims. The goals should be measurable as well as time-specific and should be able to outline the particular patient population, or any other system that may be affected.

Outcome Measure to delineate the Goal

Increased enthusiasm for patient wellbeing, error elimination, and the nature of human services has prompted the improvement of various execution measures (procedures and results) to assess frameworks of consideration. pdsa model of change in nursing essay. In considering precise results measures, it is unclear that national post-mortem examination rates keep on declining in light of the way that post-mortems have generally served as the “best quality level” in the quality certification of therapeutic consideration. Progresses in therapeutic innovation, including complex imaging systems, percutaneous biopsy, fine needle yearning, and a large number of new research center strategies, have strengthened symptomatic carelessness and have prompted the discernment that post-mortem examinations are no longer essential (Thomas & Brennan, 2011). Despite the fact that new indicative procedures can give definitive clinical data, these strategies can likewise add to False-positive and false negative conclusions and do not apparently diminish the rate of misdiagnosed as found via post-mortem examination.

Nevertheless, doctors have persuaded themselves and their patients that new therapeutic innovation has come to such an abnormal state of symptomatic exactness that the post-mortem is out of date. The fact of the matter is that when the last result is demise, the autopsy still remains the best accessible instrument for assessing symptomatic exactness (Stamatis, 2011). In this manner, when appropriately utilized, post-mortem information has a colossal potential for the distinguishing proof of correctable orderly mistakes in indicative processes. When medical errors occur and if physicians are blamed, then the society develops a preventive culture and 3 sorts of strategies may follow: an endeavor to (1) “execute the person,” (2) “distort the information, corrupt the standard, get control of the unsafe procedure,” and (3) “diverse attention”(Stamatis, 2011).

Critical Analysis of the Value of the Tool to Supporting the Initiative pdsa model of change in nursing essay.

In spite of expanded interest in examination of the change of medication errors, evidence of sustainable QI intercession remains blended, proof of viable QI intercessions stays blended, with numerous deliberate audits inferring that interventions are just compelling in particular settings. To comprehend these discoveries, it is imperative to appreciate that conveying changes in medicinal services require the modification of procedures within complex social frameworks that change after some time in anticipated and unanticipated ways. Research discoveries highpoint the persuasive impact that local context can have on the achievement of an intervention and, in that capacity, “single bullet” medications are not anticipated to convey predictable enhancements (Joint Commission Resources, Inc., 2009). Rather, viable intermediations should be multi-faceted, complex, and developed iteratively to adjust to the publics and react to unexpected obstacles and inadvertent effects. pdsa model of change in nursing essay. Finding powerful QI systems to bolster iterative improvement to evaluate and test interpositions to care is important for high-value and high-quality delivery care in financially constrained settings.

MFI and PSDA tools provide a technique for structuring iterative advancement of variation, either as an impartial strategy or as a significance aspect of more extensive QI methodologies, for example, Total Quality Management (TTM), Lean, Continuous QI, or Six Sigma. Despite expanded utilization of QI strategies, the indication basis for their adequacy is reduced and under-theorized (McLaughlin & Kaluzny, 2014). MFI and PDSA cycles are regularly a focal component of QI activities; however, a couple of formal target assessments of their viability or application have been conveyed out (Cohen, 2007). Some MFI and PDSA methodologies have been exhibited to result in massive changes in consideration and patient effects while some have shown no changes at all.

Tool- Major Discussion

Healthcare centers need to be ready to learn how to use the MFI tool, and especially, how to undertake continuous and systematic procedures for trusting and implementing improvements to eliminate medical faults by applying the PSDA improvement cycles. Their primary focus is to instill the two models in their daily practices. pdsa model of change in nursing essay. Each advancement activity chosen by experts should be a prospect to persuade them to consider a data-driven and a systematic methodology to testing, implementing, and supporting change (Stamatis, 2011). A significant part of presenting a culture of quality is through enabling the practice to change its attention from individuals to procedures. Health organizations can get hindered in looking for people to blame for less than optimal results, a model that can produce a problem-focused and a punitive work context. Medical experts can employ the MFI and PSDA tools to aid practices in proposing a changed to thinking about their system and how they can modify them to increase productivity.

The MFI and PDSA cycles are straightforward yet powerful models that assist in developing of practices. One of the most ultimate methodologies to doing this is to urge the practice to undergo the control of completing a change structure in light of the MFI (Graham, 2005).The minor demonstration of finishing the structure aids in strengthening the thought and fabricates the inward discipline and ability to utilize a characterized procedure for testing and embracing changes to the typical course of business.

The MFI and PDSA models work hand-in-hand and are the standard used QI approaches in healthcare. The MFI utilizes a rapid cycle processes, which are the PDSA cycles to test the impacts of minimal changes, make them, and eventually spread the efficient transformation through the practice or the institution. The PDSA users follow a recommended four-stage cyclic study approach to acclimatize to changes geared towards improvements. In the first stage, which is plan, change to lead the growth is developed, the second stage “do” is whereby the change is tested, while the “study” stage scrutinizes the success of that particular change (Graham, 2005). The final stage, which is “act” recognizes adaptation and the process can lead to the formation of a new cycle (See Appendix 1). You may not achieve the expected results when changing the methods, so it is efficient and safer to test out progress on a small group afore making them the solutions. Utilizing the PDSA cycles is essential as it enable individuals to test out modifications before the final implementation and offer stakeholders with an opportunity to see if that change will work. pdsa model of change in nursing essay.

The PDSA cycle encompasses testing the new changes for instance, try the contemporary ways of giving drugs to patients or even attempting to use new patient data sheet with a designated patient groups before introducing that change to all healthcare systems. It is essential to test change before applying it as it saves time, money, and risk, it is secure and less disruptive for staff and patients, and usually there is less resistance (Speroff & O’Connor, 2014).The following are the recommended ways of how to test the PDSA models:-

• An arrangement of various cycles to test thoughts. One can adjust these from the administration change direct, so there is proof that the change meets expectations

• Test on a small group of people. For instance, begin with a patient or a physician at one evening facility and expand the rates as you improve the thoughts

• Test the projected change with individuals who have faith in the change. Try not to attempt to change individuals into tolerating the adjustment at this step

• Just actualize the thought when convinced that you have considered and tried all the conceivable methods for accomplishing the change

• The MFI, model on the other hand, starts by asking three main questions:

• What is the organization trying to achieve?

• How will one know if a modification is a progress? pdsa model of change in nursing essay.

• What are the changes that we choose that results in improvement? (See Appendix 2)

QI members, therefore, present and examine changes deliberated to attain the aims of development using sequential PDSA cycles till they achieve the change that the organizations believe will eliminate medication errors (Thomas & Brennan, 2011). By answering the above three questions, teams will be focused towards setting vibrant and engrossed goals. These objectives require clinical leadership and should emphasis on issues that raise concern. The statement objectives should be bold in its aims, be consistent with goals, and should have clear and predictable targets. For instance, to reduce errors in cancer treatment, health practitioners should focus on improving access, diagnosis speed, treatment speed as well as the patient care of individuals who are susceptible of suffering from bowel cancer. The reduction of medical errors using the MFI model cab be achieved by initiating booked appointments and admissions, minimizing the time from referral to initial exact treatment to not more than 15 weeks, and lastly, guaranteeing that 80% of patients are deliberated by the multidisciplinary team.

How to realize if the modification is a progress after applying the MFI and PSDA models

Physicians should quantify results, for example, diminishment in the period a patient needs to hold up so as to answer this inquiry. In the event that they make an improvement, this ought to influence the measures and exhibit over time if the transformation has prompted feasible adjustment (Fain, 2013). The steps in this model are instruments for learning and showing change, not for judgment. Every task group ought to gather information to exhibit whether changes result in change. They should report change monthly on time arrangement diagrams known as ‘run charts’ or measurable procedure control graphs. There are numerous probable changes that a team can make. Though, scientific literature evidence and past advancement programmes propose that there are fewer chances that are likely to lead to improvement. It is probable that numerous PDSA cycles could be running simultaneously or sequentially (See Appendix 3 and 4 respectively).

To accomplish effective change endeavors in a given erroneous health care system framework the MFI and PDSA models accentuates the need to select the most appropriate personnel, which is critical to the general change in quality procedure. Just as the incorporation of different health care providers with fluctuated training levels and executive sponsors is vital to the development of a successful team, so is the consideration of team members acquainted with the different components of the procedure needing change (Boaden et al., 2008). pdsa model of change in nursing essay The decision of these members depend on the requirement for the group to speak to four distinctive key zones of specialization in the given human services foundation: every day authority of the organization, official sponsorship, clinical administration, and specialized abilities. It is not until the decision of colleagues is deliberately and precisely impacted, that achievement will be acknowledged in the manageability and usage of the proposed enhancements in quality.

Thinking of the consistent choice of the significant goals of the change extend typically takes after the group’s determination when utilizing the MFI and PDSA device for quality change. The apparatus proposes the definition of objectives that are reasonable, achievable, time cognizant, quantifiable, and particular. For the change’s achievement of value undertakings, outside and inner monetary backing is essential as it encourages mere execution of the task, investigation of the outcomes and reasonable usage of the proposed changes (See Appendix 5).

With an end goal to answer this quality change instrument’s inquiry of how the proposed change can promote upgrades in quality, a hypothetical bookkeeping of the measures identifying with the structure, procedure and results is recommended as it gives a guideline to the group’s usage learning of the association needing the change (Fain, 2013). By doing this, significant structure changes are sure to be, and this may, in the long run, lead to a decent result. The estimation method most regularly utilized is the utilization of procedure measures, and this is basic, particularly given that most ventures of enhancing quality are organized with the fundamental point of changing a predetermined defective system. In addition, a method for measuring the spontaneous ramifications of the foreseen change is additionally a need for the quality change group. The procedure’s determination and result means go before a relatively dreary methodology of gathering pattern information (Langley et al., 2009). This information accumulation technique mostly depends on relevant choices, for example, to where the information will be gotten, the amount of information ought to be gathered, the recurrence with which it will be examined, the venture orchestrators, and how the outcomes will be introduced to the venture’s partners.

Further investigation of the MFI and PDSA uncovers that after the doable change thoughts have been chosen, trying of these progressions begins quickly. It additionally stresses the need to investigate all the conceivable picked up thoughts considering that all sequences do come full circle into upgrades yet rather, all enhancements emerge from specific changes. The last and most imperative step of the MFI and PDSA quality change instrument is the execution and sustainment of the proposed modification thoughts (Gitomer, 2005). It incorporates the foundation of a demonstrated rundown of proposals that can be controlled to offer ascent to broad framework changes considered for enhancing social insurance results pdsa model of change in nursing essay.

Conclusion

MFI and PDSA are practices that every medical practitioner should become familiar with and feel comfortable using them. They are essential tools for organizations or individuals trying to advance quality, especially in health institutions. In the clinical context, doctors are focused on minimizing waiting times in emergency divisions, improving safety standards compliance in surgical and medical units, and lessening infections through increased hand washing acquiescence. The success of using the tools involves participation, communication, and organization of the entire medical team by ensuring that all units are ready to implement the changes. The MFI and PDSA models are a successful and famous instrument that are utilized to deliberately accomplish positive results as for upgrades in quality pdsa model of change in nursing essay. It is additionally apparent from the content that change in quality is to a great extent subject to five achievement components: advancing and keeping up a society of dynamism and well-being, including significant partners, a building up a comprehension of the current issue, testing of the recommended change thoughts, and a dynamic checking of the discoveries with respect to reporting and execution in endeavors to keep up the coveted change. Every one of these components has been analyzed in the analysis of these tools.

References

Barach P., & Small S. D. (2010). Reporting and preventing medical mishaps. Lessons from non medical near miss reporting, 320, 759-763.

Boaden R., Harvey G., Moxham C., & Proudlove N. (2008). Quality improvement: theory and practice in healthcare. NHS Institute for Innovation and Improvement. University of Warwick: Coventry UK.

Cohen M. R. (2007). Medication Errors (2nd Edition). Washington, DC: American Pharmacist’s Association.

Fain, J. A. (2013). Reading, Understanding, and Applying Nursing Research. Philadelphia: F.A. Davis Company.

Gitomer R. S. (2005). Improving access, quality of care, and patient satisfaction in a general internal medicine practice. Journal of Clinical Outcomes Management, 12(5), 245-249.

Graham, N. O. (2005). Quality in health care: Theory, application, and evolution. Gaithersburg, Md: Aspen Publishers. pdsa model of change in nursing essay.

John L.T., Corrigan J.M., & Donaldson M. (2007). To Err is Human: Building a Safer Health System. Washington, DC: National Academy Press.

Joint Commission Resources, Inc. (2009). Cost-effective performance improvement in behavioral health care. Oakbrook Terrace, IL: Joint Commission Resources.

Langley G. L., Nolan K. M., Nolan T.W., Norman C. L., & Provost L. P (2009). The Improvement Guide: A Practical Approach to Enhancing Organizational Performance (2nd edition). San Francisco: Jossey-Bass Publishers.

McLaughlin, C. P., & Kaluzny, A. D. (2014). Continuous quality improvement in health care: Theory, implementation and applications. Gaithersburg, Md: Aspen Publishers, Inc.

Palmieri, P. A., DeLucia, P. R., Ott, T. E., Peterson, L. T., & Green, A. (2008). The anatomy and physiology of error in averse healthcare events. Advances in Health Care Management. Advances in Health Care Management, 7, 33—68.

Schilling, L., & Joint Commission Resources, Inc. (2009). Implementing and sustaining improvement in health care. Oak Brook, IL: Joint Commission Resources.

Speroff T., & O’Connor G. T. (2014). Study designs for PDSA quality improvement research. Quality Management in Healthcare, 13, 17-32.

Stamatis, D. H. (2011). Essentials for the improvement of healthcare using Lean & Six Sigma. Boca Raton: CRC Press pdsa model of change in nursing essay.

Thomas E., & Brennan T. A. (2011). Errors and adverse events in medicine: an overview. In: Vincent C, editor. Clinical risk management: enhancing patient safety, 1, 31-43.

 

Quality Improvement Project for Patient Prescription Record

The aim of this quality improvement project is to ensure that nurses record in the designated box on patients Prescription and administration record (to be referred to as: Kardex) if High Dose Antipsychotics Monitoring is Applicable YES or NO (to be referred as: applicable Y/N) and subsequently if yes, that the High Dose Antipsychotic Therapy monitoring form (to be referred to as: Monitoring form and the Early Warning Signs (EWS) Form have been activated for completion. The purpose of this is to secure patient safety from the side effects of the medication.

There is widespread evidence which clearly links antipsychotic medication contributing to physical health problems such as cardiovascular problems, weight gain, endocrine problems, metabolic syndrome and sudden death (Gumber et al, 2010; Churchword et al, 2009; Tyson et al, 1999). Many premature deaths of people with serious mental illness are due to poor medical care that fails to monitor risk factors which may be due to side effects of medication (Cohen & Hove, 2001). A council report by the Royal College of Psychiatrists (2006) revealed that past audits of high dose antipsychotic prescribing for in- patients showed poor adherence to monitoring recommendations. All patients on high dose antipsychotic treatment must be monitored. These guidelines attempt to clarify the identification of patients on high dose antipsychotics, factors to be taken into account before such prescribing and the documentation required when antipsychotics are prescribed in high dose; furthermore it is a policy requirement of Forth Valley that this documentation is completed for these patients (Forth Valley, 2011) pdsa model of change in nursing essay.

The charge nurse highlighted a concern when evaluating the patients Kardex audit, it showed 100% non-compliance for the completion of the Yes/No response for high dose antipsychotics monitoring. Subsequently when the patients are receiving high dose antipsychotics, there was inconsistency of the completion of the Therapy monitoring form and EWS form. A recent audit of patient Kardexes confirmed the charges nurse finding (see Pareto chart, Appendix B).

To begin the process of the quality improvement project, a general ward meeting was held and attended by all staff in the ward that was on shift. During the meeting the charge nurse highlighted the recent findings of the Kardex audit. pdsa model of change in nursing essay. Concerns were raised that many areas on the Kardex were not being completed, and reminded staff nurses that this is not acceptable and needs to be improved. As a nurse it is extremely important to keep accurate documentation, good record keeping is an fundamental part of nursing practice, and is necessary to the delivery of safe and effective care (Nursing and Midwifery Council, (NMC) 2010).

As an attempt to focus the quality improvement project more specifically the results of the audit were presented using a Pareto chart (Appendix B). The data confirmed the areas on the Kardex which were not being completed however, high dose antipsychotic monitoring Yes/No was the highest at 100% non-completion, therefore it was agreed that a new strategy would be implemented to improve this. McLaughlin and Kaluzny (2006) state that the defect focused on does not necessarily need to be the greatest frequency to be improved first, but attention should be given to that defect that may have a devastating result, such as an adverse event or even death. However the defect in this instance was the highest and potentially could cause an adverse event.

Get help with your essay today
, from our professional essay writers!

Qualified writers in the subject of nursing are ready and waiting to help you with your studies.

Following the meeting a questionnaire (Appendix C) was devised and completed anonymously by the pharmacists, consultants and staff nurses to identify the root causes of why this area on the Kardex was not completed. A fishbone diagram was used to illustrate the findings (Appendix D). When populating the fishbone diagram with the data, it was clear to see that there were many reasons that each member of the multidisciplinary team had not completed the applicable area on the Kardex. Role confusion was a common theme from each member of the team. Hill-Smith et al (2012) claims that this is not unusual within multi-disciplinary teams and that respectful communication and clear instructions is of high importance in the delivery of high quality clinical care pdsa model of change in nursing essay. Therefore based on these findings PDSA one was developed (Appendix G1). This tested whether the nurse attending the MDT meeting completes the Applicable Y/N on the patients’ Kardex following an email reminder and a verbal prompt from charge nurse before attending the meeting. The test confirmed there was a breakdown in communication, the nurse did not receive the email or a verbal reminder from the charge nurse prior to attending the MDT meeting therefore they were not aware of the procedure that had been discussed and as a consequence the applicable area on the form was not completed, this was confirmed by an audit of the Kardex (Appendix H). This informed the decision for PDSA two (Appendix G2). The nurse coordinating the shift should use the visual prompt situated on the shift coordinating sheet to remind the nurse attending the MDT meeting, to update applicable Y/N on the patients Kardex. The small change of a visual reminder on the shift coordinating sheet proved to be success. It reminded the coordinating nurse to verbally prompt the nurse attending the MDT meeting to complete the patient’s Kardex in the applicable area, which was shown by the Kardex audit after the shift; all patients’ Kardexes were completed and as a consequently the Therapy form and EWS from were also initiated for completion. These findings are consistent with Simpson (2007) research, where teams have clear operating procedures in place, care coordinating is enhanced.

The assumption was that the email and verbally prompt from the charge nurse would result in nurses completing the Applicable Y/N on all patients Kardexes, following the MDT meeting by 23rd February 2014 by 100%. Furthermore, if yes the Therapy form and the EWS form activated for completion pdsa model of change in nursing essay.

Audits were carried out on the dates shown to give a snapshot of the completion of Applicable Y/N on all patients Kardexes in the IPCU ward at that time. Initial findings of the first audit by the charge nurse on 01/02/2014 revealed that Applicable Y/N was completed 0%. The second audit carried out to confirm the previous results on 08/02/2014 which confirmed the charge nurses findings of 0% compliance of Applicable Y/N. PDSA one was carried out on 10/2/2014 the change revealed 0% improvement in the completion of Applicable Y/N. PDSA two was implemented on 21/2/2014 the change was successful, the results of the audit revealed that Applicable Y/N was completed on all patients Kardexes by 100% this in turn activated the completion of the Therapy form and EWS Form.

Comparison of questions, predictions, and analysis of data:

Engaging with the quality improvement (QI) project has required me to learn and apply new skills in practice.

The process of plan, do, study, act (PDSA) cycles were a new technical skill which I had to not only learn myself, but teach fellow staff nurses on the ward, as this was also, a new process to them. I learnt that PDSA cycles provisionally test an idea by testing a change and assessing its impact. After implementing the first cycle, I learnt that it does not always get the results expected when making changes to your process; it taught me that it was better, and more effective to trial a small change to see if it made a difference, before implementing the change permanently. This also gave staff the opportunity to be involved and offer suggestions and see if the proposed changes would work.

I also learnt that communication is an essential and fundamental process during the course of the QI. According to Adams (1999), to persuade others to make an improvement or change, the negotiator must be influential. The Charge nurse in this instance was the influential position to lead change. Unfortunately they were not able to fulfil their obligation in PDSA one, but they carried out the ward meeting and used this as a platform to discuss the Kardex audits with the staff which informed them of the need to make an improvement in practice. Once the need for the new process was established and its principles by the email from the charge nurse, informing the reasoning for a change in practice, this was used as a base for PDSA two pdsa model of change in nursing essay. I learnt that it is just as important to define the risk of not making a change (Plummer, 2000) and in this circumstance, changing practice would not only enhance quality of care to patients, but it would promote the involvement between staff nurses and the MDT, building trust and confidence to make the change, whereas the risk of not making the change, could potentially cause an adverse event

Get help with your essay today
, from our professional essay writers!

Qualified writers in the subject of nursing are ready and waiting to help you with your studies.

A final learning point I would like to include was how staff nurses initially were resistant to change. In my opinion from observing, the nurses were quite defensive as though they were being blamed for not doing their job correctly. The questionnaire used was an effective communication tool and successful resource for managing this resistance. It give staff the opportunity to anonymously feedback their reasons for not completing the applicable area on the Kardex, it also let them express their opinion without being condemned. Also, I feel that during this time, they were able to adjust and prepare for the change which minimised resistance (Bernhard and Walsh, 1995). I felt it was essential to take note of all their views as individuals and as team members, which provided further explanation of their reasoning for non-completion. Accountability was a consistent reason used by nurses for their reason for non-completion, as they felt it was a doctor or the pharmacist role and they did not want to be accountable for making the decision. When it was clarified that it was a team decision, by email from the charge nurse, the nursing staff felt supported. Mitchell (2001) states that accountability in nursing is a complex issue and acknowledged the importance of team support in the identification of roles and responsibilities. Frequent ideas and conversations with staff were held over the ten days, in advance of the change in PDSA two which I feel made the improvement successful and run smoother as nursing staff were aware of the new change.

I have learnt that within nursing it is important to continually improve the way we work. Working at every level developing the knowledge, technical skills, including leadership, are vital for long-term improvement. Continually learning may be important not only to ensure that we have the skills needed to improve the quality of healthcare, but also to enhance the motivation to do so.

Discuss the project’s significance on the local system and any findings that may be generalizable to other systems:

Relocation to a new site change what been good practice and now a gap had appeared in the process of monitoring patient.

The outcome of this project was a success. It was predicted that by 23rd February 2014 applicable Y/N would be completed by 100%. By establishing the success of the visual prompt in PDSA two on the co-ordinating sheet, was a very small but effective change.

As a consequence, at the following staff meeting it was decided that the visual prompt would be a permanent fixture on the coordinating sheet, as it was a sustainable reminder to future shift coordinators, thus improving the initiation of therapy monitoring and EWS forms, and overall patient safety outcomes. pdsa model of change in nursing essay.

Discuss the factors that promoted the success of the project and that were barriers to success. What did you learn from doing this project? What are your reflections on the role of the team?

The factors which promoted success in the project were support and leadership from the charge nurse at the beginning of my placement. They helped identify areas in the ward which they felt needed improvement. Furthermore, as a student who had never been in a mental health ward, I felt overwhelmed with the task and this support and guidance helped me through the project.

The use of the tools were a great way to involve staff on the ward to feel part of the project and broke down the barriers of pointing blame and focussed their attention in a systematic way, and explored the potential causes of the non-completions.

I was amazed as how such a small change help facilitate and test change in a manageable way. I now understand that Quality improvement as a way of approaching change in healthcare that focuses on self-reflection, assessing needs and gaps, and considering how to improve in a multifaceted manner. I feel I have gained an enormous understanding in about quality improvement in that it aims to create an ethos of continuous reflection and a commitment to ongoing improvement. It provides nurses to gain an the skills and knowledge needed to assess the performance of healthcare and individual and population needs, to understand the gaps between current activities and best practice and to have the tools and confidence to develop activities to reduce these gaps pdsa model of change in nursing essay.

Thus, the scan did not focus only on narrowly defined quality improvement models such as ‘plan, do, study, act’ (PDSA) cycles.

Nurse Standards And Documentation Nursing Essay

Nursing standards are expectations that contribute to public protection. They inform nurses of their accountabilities and the public of what to expect of nurses. Standards apply to all nurses regardless of their roles, job description or areas of practice.(College of Nurses Ontario, 2008, para.1).

Documentation is one of the vital components of ethical, safe and effective nursing practices that provide comprehensible image of the client health status and their outcomes. (Practice Standards, 2008, para.2).Whether the documentation is in electronic or written format, hence documentation communicates the nurse observations, decisions, and outcomes for the client. According to the Aga Khan University policy of Documentation of Nursing Care (2008), “documentation is a direct nursing activity that ensures the evidence for provision of nursing care and continuity of care.” (p.1.1). The quotation indicates that for every events and record it is very important to do documentation as evidence so that the staff would legally be safe. Moreover nursing care provides good and healthy communication between the staff and the patient and further this provides the good continuity of care to the patient. According to Kimberly (2003),”if it wasn’t documented, it wasn’t done.” (para.1). This revealed that in the clinical setting, if the documentation is not complete, then the work will be count incomplete pdsa model of change in nursing essay.

During my senior electives in my practice setting in Private Wing II (medicine unit) I encountered many issues regarding documentation on bedside files. I observed most of the nursing staff not following the documentation policy. For example, absence of events related to abnormal vital signs, patient response during invasive and non invasive procedures, abdominal pain complaint and its monitoring scale, errors in 24 hours calculations of intake output flow sheet that can impact on patient negative and positive balance pdsa model of change in nursing essay. Moreover, issues related Nasogastric feeding and patient’s tolerance ability, absence of initials and dates on weekends and wrong addressograph of patient on intake output flow sheets, non useable abbreviations, illegible writing and inaccuracy of nursing notes, all these issues identified during rounds and in morning over. So, I planned and decided to bring these documentation issues in front of my preceptor and manager not only to approve my project, but really want staff to work on it so that they would legally be safe and performance of the organization should be maintained. My preceptor and manager appreciated me and approved my project and this is how my project journey begins. We all nurses knew that documentation is an ethical and legal issue and making a single error in documentation can put the staff in lawsuit. Therefore to bring improvement in staff documentation practices and to observe staff knowledge I developed a questionnaire tool. At last, I come to conclusion that staff really needs to work on documentation as there is a gap identified in some of the staffs knowledge about documentation. Both preceptor and manager appreciated me and permit me to work on it as issues of documentation on clinical setting quite common now a day that does not only put the staff in trouble but this can affect the organization. Therefore, I discussed all the related issues regarding documentation with preceptor and manager and finally the project approved by them. Nursing manager and preceptor considered that work on documentation is a good project so that staff should think of it and work on it in order to bring improvement in their documentation and not make further errors that can affect the patient quality of care as this is an ethical issue. For assessing the need of the selected topic, I developed a pre test questionnaire based on staff knowledge about nursing documentation and finally I come to conclusion via assessment that staffs really have to work on documentation as some of the staff had lack of knowledge regarding nursing documentation. Some of the staff have knowledge but do not show accountability which can put the unit and other staff in trouble. I also identified other issues for practice based project. Firstly, non compliance to infection controls policy. The purpose of not selected the topic was that, all the units Head nurses, Clinical Nurse Instructors (CNI) and Infection Control Staff members are working together on it pdsa model of change in nursing essay. In addition, they do reinforce unit staffs to attend the infection control sessions on constant basis not only to prevent them but also prevent the other members and patients from infectious diseases. Secondly, bed sore issues are the most common problem I identified in unit. The reason for not selecting the topic was as the Case Manager of the unit already made a project on it, she performed rounds on daily basis and every month she takes sessions on bed sores for the staff. Thirdly, communication gap among the staff and patient. For that, CNI and Head Nurse (HN) are taking classes of morning and evening shift staffs on regular basis.

Get help with your essay today
, from our professional essay writers!

Qualified writers in the subject of nursing are ready and waiting to help you with your studies.

In order to support the need of the project, I reviewed the previous quarterly internal audits results of nursing documentation, which showed that staff does not following the principles and the policy of nursing documentation. The main observations in these audits were non useable abbreviations in nursing notes and in flow sheets i.e. @, cc, KCL, etc. Moreover, unauthorized staff documentation, wrong addressograph and wrong calculations of 24 hours documented and identified in intake output flow sheet in the month of February 2010 – May 2010. The major observations which I found during the rounds were almost same except one which has not mentioned in audits observation was the events of patient complain, abnormal vital signs and invasive and non invasive procedure that I identified. All these issues have now become the priority of a unit. Therefore, being a responsible staff I decided to take this project as a challenge and plan to work on it. As the documentation is an ethical and legal concern that provides quality care to the patient. Moreover, documentation is a basic tool of communication in which nurse does assess patient’s condition in order to document patient’s records, so that staff would legally be safe and patient care not compromised pdsa model of change in nursing essay.

Based on above observations and from the audits results, I developed a pre test questionnaire according to staff need that contains 15 questions. For maintaining reliability of the questionnaire it was checked by the preceptor and facilitator. After substantiation of the pre test, I made it fill with the Nursing Assistant (NA’s) and Registered Nurses (RN’s). I took 20 samples of the staffs that were 40% staffs of the unit. Although pre test require 15 questions but I scrutinize the five major priority questions of the test. An assessment results reveals that 65% staffs answer correctly about the best definition of nursing documentation. Moreover, 50% staffs did correct answer on purpose of 24 hours of intake output balance documentation. Furthermore, 25% staffs answer correctly on purpose of intake out put documentation in flow sheet. Besides this, 50% staffs gave correct answer on responsible of documenting IV fluids and intake output calculations of 24 hours.

Analysis of the issue with evidence based literature:

According to Aga Khan Policy of Documentation in Nursing Care (2008), “Patient record is a legal document; therefore must present legible, accurate, timely, objective and complete information about patient and intervention. (1.2). This definition clearly explains the standard documentation that are necessary for all nursing staff in order to be legally safe as documentation is an ethical and legal issue all over the world. According to Connor, K. et al (2007), “nursing documentation has a high priority in all trusts because analysis of records of care and observations has revealed that use of multiple charts and repetitive recording causes practical and legal issues.”(para.2). The above quotation indicates that repetitive records can affect patient’s quality of care. Moreover, this can take the staff in law suit. Furthermore, organization performances would get affected if it’s taken in the court. Hence, this has been observed that lack of thorough documentation and nurse accountability reveals many complaints and investigations arising from clinical incidents which were leading to indefensible claims for the staff. According to NMC (2002), “Vigilance is required to ensure high standards in record keeping, whether records are in written or electronic form. The audit of patient documentation is a facet of risk management that can help to promote quality of care.” Wood, C., (2003) believe that any notes or records demand legal documentation, and if any judgment, vague or unsubstantiated documentation found, it would be difficult to maintain professional reliability in the court. (para.2). Hence, good record keeping promotes better communication as well as continuity, consistency, efficiency that further reinforce professionalism within nursing. pdsa model of change in nursing essay.

Integration of the Model:

I run this project through PDSA model, visualized by Walter Shewhart in 1930’s and further this was adopted by W. Edwards Deming in 1950’s. This model is known as Shewhart cycle, Deming cycle, Plan-Do-Study-Act cycle, and Plan-Do-Check-Act cycle. Also known as Learning and Improvement cycle. In this model, the cycle shows the framework for the improvement of a process or system. (Refer Appendix A). According to Kevin (2008), once target improvement areas identified, the model will provides a framework that can further used to guide the entire project or to develop the specific objects. (para.2). Furthermore, the PDSA cycle also used when starting a new improvement project or when implementing any change. Besides this, PDSA cycle also used as a model for continuous improvement in quality care. According to Tague (2004), The PDSA cycle has 4 steps for carrying out the change. Just the circle has no end; it should be repeated again and again for continuous improvement (para.3). Taking this point I would add that in the same manner unless the staff brings change and improvement in them, ongoing sessions for the documentation, activities of documenting notes quizzes and review of policies should be continue. Here I would integrate this model with my project. The first step is plan, in this step I identified the area that needs improvement pdsa model of change in nursing essay. Furthermore, I collected data and planned strategies accordingly for change. I identified four issues from the unit and analyzed the significance of each issue. I discussed each problem with my preceptor and planned for prioritizing the issues. Moreover, CNI planned a meeting with unit manager for selection the priority issue for the project. Finally after the discussions and come to conclusion I selected the topic documentation based on staff knowledge, attitude and practices during the clinical setting. I gathered data through observations during rounds and knowledge identified via pre test. I planned strategies for implementations, that is session awareness and develop innovative flyer. Moreover, discuss with CNI that PowerPoint presentation should be done via multimedia and for the nursing notes activity White Board with markers should be needed. The second step is do, in this implementation of the project done. I conducted three sessions on different days for all the staffs. I carried out the session in the evenings shift staffs. Moreover, for each session I developed an innovative flyer, and pasted on noticed board for the announcement of the session. (Refer Table 1. Action Plan). Moreover, I taught and encouraged the staff how to retrieve the policy on the computer pdsa model of change in nursing essay.

Get help with your essay today
, from our professional essay writers!

Qualified writers in the subject of nursing are ready and waiting to help you with your studies.

For sustainability of the project, I discussed with all team members about the results of the project. Moreover, I explained them that for effectiveness of the project’s results they have to initiate the staff and take the responsibility to observe the staff’s documentation practices in their shifts. In addition, I arranged a meeting with the nursing documentation monitors of the unit and give them the responsibility conduct in service sessions in every fifteen to twenty days. The third step of the model is study, for that I searched many relevant literature that supports my nursing documentation project. And If I take the component ‘check’ of PDCA model I evaluated the staff by post test; Moreover, I present different scenarios for the staff, based on documentation practices where staffs have to demonstrate documentation according to its principle. Furthermore, I took the redemonstration of the process of retrieving documentation policies and observations to evaluate the staffs on their nursing documentation practices. The fourth and last step of the model is act. In the act phase, first I used power point presentation lecture with two way communication, and showed pamphlets and cards which I made for them for my sustainability. It is decided that the improvement has come in them or not, whether their practices changed or not. Improvement practices bring changed in them or not. For this project the time was short, so I could not able to perform this step completely but I handed all my things to CNI and the volunteers for further proceed the session. pdsa model of change in nursing essay.

Implementation:

Implementation is the most important component of the project. I applied multiple strategies in order to implement the project effectively. My first strategy was to provide knowledge to staff about the documentation and its practices. I searched many literatures on the selected issue and review and retrieved nursing documentation policies and further discuss with my preceptor and facilitator. Also developed PowerPoint presentation slides on the selected project. According to Green, Palfery, Clark & Anastasi 2002, ” The slides are similar to lecture and work well for initial explanation and clarifying the concepts of the learners.” (p.2). To observe the enhancement knowledge of the staff, I showed power point presentation slides to the staff, before conducting the session I also showed the slides to my preceptor and facilitator. After justification of the presentation, I conducted three sessions on different days. The reason for three sessions was to expand information to different groups of staff. I conduct all my sessions in overlapping timings and most of the time evening staff attend my session rather than morning. I considered, this strategy was appropriate and relevant to the practice because mosts of the evening staff does attend the sessions on different topic so they do not have to tense that they are giving extra timings to the project or applying any efforts. Green, Palfrey, Clark & Anastasi 2002, “The slides are similar to lecture and work well for initial explanation and clarifying the concepts of the learners”. (p.2). Moreover, I encouraged the staff to participate actively because this helps the staffs to express out their views and carried out their personal experiences and learn different concepts via groups. “Group discussions are good for problem solving, critical thinking and demonstrating different points of views among learners.”(p.1). My second strategy was to teach the process of retrieving the documentation policy for the staff and encouraged the staff to re demonstrate it. Also redemonstrate the nursing notes in order to observe the practices of the staff following A-G assessment. The strategy was very effective because here I come to know the staff practices and their knowledge. According to Rodrigo, Meredith& Moore 2003, “Kinetics learners learn by doing and prefer learning that involves movement, active participation, and concrete objects. (p.1). My third strategy was to develop an innovative flyers that I pasted on the unit notice board for the reinforcement and remembrance of the staff. pdsa model of change in nursing essay.

Evaluation:

In evaluation, for RNs I distributed nursing notes paper to observe their documentation

practices Moreover, I asked staffs about the Aga Khan University documentation policy. For

nursing assistant (NA) I distributed intake output flow sheet where I asked them to document

routine amount of fluid intake measurement. Furthermore, I asked the staffs about the

documentation error policy. It is saying that no project will be successful without knowing its

outcomes. After the implementation I performed an evaluation of my presentation. After

providing them the session on documentation, I found t nursing staffs were able to clarify their

concepts about the documentation and its error policy. To observe the base line knowledge

among staff regarding nursing documentation. For that purpose, I have utilized evaluation tool

on nursing documentation formulated by me, after preceptor’s guidance and approval. (See

results of evaluation (Refer Appendix B). The implementation analysis indicates that 85% of my

project went successfully (Refer Appendix C). In addition, staff participated well; share the

realistic examples related clinical. Moreover, suggested to have these kinds of sessions on

quarterly basis so that to improve the knowledge. Furthermore, also suggested to have an activity

on nursing notes so that they can bring change in documentation practices.

Limitations:

Time period for project was short that is why unable to involve all staff in

implementation of the project. Another reason for not attending the session by staff was, most of

the staffs were busy in providing care to the patient. Moreover, for the evaluation of project I

Get help with your essay today
, from our professional essay writers!

Qualified writers in the subject of nursing are ready and waiting to help you with your studies.

have two weeks in identifying needs, selecting priority issue, observations, assessment and

evaluation of the project which was a great challenge for me. Furthermore, lack of resources was

a big issue as Learning Resource Center was full most of the time and lots of budgeting issues

for assessment, evaluation and on articles but with the great support of preceptor and ongoing

facilitation by my facilitator made my life easy in the completion of running the project

successfully, smoothly and timely pdsa model of change in nursing essay.

Recommendations:

There are certain recommendations in regards of nursing documentation. Policy of

Documentation should be reviewed on daily basis in unit for the knowledge and bring

improvement in nursing documentation. Secondly, sessions, quizzes on the nursing

documentation should be conducted every month by assigned nursing staffs or Clinical

Nurse Instructor (CNI) in order to observe staff knowledge. Furthermore, 8 steps of

audit checklist need to be followed and referred. Moreover, nursing documentation should be

done by utilizing audit tool every quarterly, for the improvement of practices

and monitoring of compliance to documentation policy.

Conclusion:

To conclude, I will say that documentation plays a vital role in nursing practice because

this communicates health care providers about patient assessment, planning, interventions

and evaluation of the patient condition. Moreover, it an ethical issue that is a legal

documentation and ultimately this safe staff for any legal actions. Documentation shows

honesty and care for the patient which should be done on time. If care is not documented, it

means it’s not done.

In the last, I would say that this project enhanced my learning. It provided me an

opportunity to work as a team member with staff, Head Nurse (HN) and Clinical Nurse

Instructor (CNI). This project also enhanced my leadership style what I learned the concept in

class. Despite of all this, the project helped me to work independently and to study about

nursing documentation in depth. Moreover I learned to integrate new concepts and model that

would further help me in my profession career.

The Plan Do Check Act Information Technology Essay

Introduction

Quality can be defined as standard; it is the degree of excellence of something compared to things of similar kind, continuous improvement is the major factor that effects the level of quality of a good or service where emphasis is achieving the approved standard for a routine basis, by only producing or providing services on or above standard but never below par. It is about meeting the needs of customers on a regular basis as for the price they are paying; they need the standard quality to be maintained for the goods and services they purchase. Good functions, long life, consistency and reliability are some of the attributes of quality which have to be maintained pdsa model of change in nursing essay.

There are several quality improvements systems which could to be followed:

The PLAN-DO-CHECK-ACT (PDCA CYCLE)

The PDCA cycle is also known as the demand cycle; it is a tool which could be followed to solve problems of quality management, its first step includes plan, which lists down the goals which have to be accomplished, the barriers in getting those goals and the strategy and tactics used for coping up with them. This step provides a route or guideline for the next step and it acts as the pillar of achieving the targets. The next phase is the Do phase, once the information has be gathered and a guide line be made, it is time to implement on those plans; this could be done on minute scale or in a lab which could be tested outside the usual production procedure. After, doing what had been planned it is time to check what has been tested, take out valid information on the way used in the testing, the final step which rounds of this cycle Is the Act phase, which completes the cycle though the action been taken on the process. It could be positive or negative based on the information gathered from the act phase, thus the entire cycle or process makes sure that quality is maintained on a continuous basis where procedures are tested and implemented to carry out the plans until the best could be achieved.

As Donald W. Benbow et al. said,” It has been observed that many organizations are pretty good at the Do and Check phases, but falls down on the plan and act phases. Perhaps this is partly due to the impulses to “Don’t just stand there, do something” (p.6) pdsa model of change in nursing essay.

Donabedian Model

In 1996 Avedis Donabedian published the frame work for quality evaluation in health care. According to Donabedian (Donabedian, 2003, 52) this assessment is based on the premise that heath care quality is more effectively measured by scrutinizing care in domain of structure, process and outcome. A set criterion is developed to assess past performance.

The structure in the model relates to the integrity within the health care institute to check if resources needed to carry out high –quality care are sufficient and used proficiently. After the structure the process includes evaluating the actual heath care activities by comparing it with the standard made by the peer groups. The last part in the model consists of outcome, According to Rick Daniels, Rick Daniels (2006), “Outcome is in terms of the recovery, restoration of function, and of survival. (p.493). this method also states about the importance of being customer focused whether it be internal customers as employees or external customers which have not been employed but who uses the services of the association.

ISO – 9000 Standard

The ISO -9000 basically covers the rules at to the complete quality management system. It states the value of good business practice and just guides line on the ways which have to be implemented to perform such actions. There are 5 groups which make up this Standard,

Quality management system: There are requirements which apply to all aspects of the process; it gives guidelines on the responsibilities, control process and the records which have to be documented.

Management responsibility: Such requirements explain the role of the upper management in assessing customer needs, planning and the reviewing of performance pdsa model of change in nursing essay.

Resource Management: This covers the requirements on how to administer the resources of the organization through activities such as employee training and other tools to develop the human capital.

Product comprehension : This group is the core of this standard, it involves all and responsibilities and the necessary requirements of how to manufacture your product or deliver your services

Analysis and improvement: This requirement involves the process to check on the performance and fix if any gap exists between the standard and the actual.

As stated by (Larry Webber, 2011), “ISO 9000 Certification is simply a way to prove to your customer that you know how to run your business” (p. 30).

ISO 9000 benefits firms as it provides a system for continuous improvement which increases efficiency and decreases the cost associated with the production.

Lean Production:

Lean is a process which was derived from the Toyota production system, it emphasizes on the flow and speed of the production cycle of goods and services in an organization. It helps in minimizing waste which could be caused through over production, carrying of products, inventory management, idle employee or even the entire activity in the process of the product. The focus it to add value to the entire system and decrease the cost of production. Lean management includes several processes including Kanban, Total productive maintenance, Quick change over and others. This system eliminates the main problem associated with production and highlights the causes and improves it for a fast cycle. The lean methods in regards to heath care are standard processes and realizable methods as mentioned by (Jackson, 2011) (p. 19 ) .

Six Sigma:

This process focuses on the expectations of the customers by applying the best use of scare resources to generate profits for an organization. It is a product enhancement method where the entire 6 processes enable the solution to quality problems pdsa model of change in nursing essay. The six steps which include to enable the process to meet the objective are:

Introduce works and management to the system by letting them know about your intension to follow Six Sigma and make them aware that it will now be used as the new standard for operations

Assign someone to manage and check the process in getting the set quality; appoint auditors form the Six Sigma belt to verify operations on a regular basis.

Explain the main attributes of the satisfaction wanted by customers regarding your product or service, and recognize what they consider vital in the purchase.

Recognize any mistake or errors found in the process, check out the level of complains and evaluate the require repairs.

Identify the main causes of the error or the mistake and the inefficiency caused to the customers, improve the product according to needs or redesign if necessary.

Keep on reviewing it until perfect Six Sigma standard is achieved. pdsa model of change in nursing essay.

The benefit of this method is focuses on the continuous devolvement of business improvement by achieving and maintaining quality in an organization.

The Donabedian’s model standard used in a health care Institution for providing safety to patients, the structure-process outcome model has helped in a lot of health service institutions, for examining health services and patients outcome. A structure as defined by Donabedian has to be implemented in the institute for providing services and creating value for patients.

A number of medical training programme have been made to assist in the strategy, purpose and effectiveness to provide best results for the patients, the model allows for the extent variability related to the client and the providers including nurses or physicians by giving the best outcome through a complete process which includes, cost reduction and patient / provider satisfaction. It is important for the health care institution to allow care to their customers according to the benchmark set with a continuous process. There are several factors which has to be implemented by the institute to be quality orientated, these factors would include:

As mentioned by (James, 1989) certain factory are necessary for the institute to meet certain standards including Hospital cleanliness, Smoothness of admission/discharge, Accuracy and clarity of billing statements, Courtesy of hospital employees, Level of technology available , Nurse competence and availability of physician specialists. (p. 20) pdsa model of change in nursing essay.

Conclusion

All these models and steps used in sectors for quality improvement, are the basis on which every company should work nowadays, companies are getting more efficient and productive when they use the above standards in their production processes, it helps them minimize cost by reducing wastage if any and also making the best out of the scare resources of labor and capital. Implementing these models could be costly for institutes, as forms, documentations and practices are measured and checked, but it leads to the safety and success of the organization and also it provides value for the customers which are the highest priority for every institution to generate profits pdsa model of change in nursing essay.