Intervention Plan Design Essay

 Intervention Plan Design Essay

Nurse managers and other healthcare leaders play vital roles in healthcare improvement. The focus is on patient safety and improved patient outcomes amidst the health dynamics introducing health problems daily. Healthcare leaders evaluate healthcare and determine the best intervention to implement change for better results. They also evaluate these interventions to ensure they align with nursing principles, theoretical underpinnings, and internal and external regulatory requirements. They also evaluate their impact on target populations and stakeholders to ensure they have delivered the most benefits and least harm. This essay analyzes a quality improvement project and vital factors in its implementation.

Intervention Plan Components

The major components of the intervention to address the problem are a shift to using first-generation antipsychotics compared to second-generation antipsychotics in reducing metabolic syndrome in mentally ill patients. The intervention will entail prescriptions of typical antipsychotics for patients at higher risk for developing metabolic syndrome and for individuals with the syndrome. The healthcare providers will ensure patients only take approved typical antipsychotics with similar functions to the prescribed atypical antipsychotics and a lower side effects profile. The goal is to maintain the clinical and therapeutic effectiveness of the treatment interventions when controlling metabolic syndrome. The newly diagnosed patients who sign the informed consent will be randomized into two groups. The experiment group will be put on typical and the second on atypical antipsychotics that are FDA-approved to manage the specific symptoms. Evaluation will entail reporting the incidences and prevalence of individuals who develop the condition or signs and symptoms within six months. Another evaluation basis will be on the patients who develop side effects that warrant changes in therapy.

Another group of significance will be the patients with the condition. Patients who present to the clinic with signs and symptoms of metabolic syndrome will receive a therapy changing atypical to typical antipsychotic, and the results observed. Data evaluated will include the differences in remission from metabolic syndrome. The data from the first and second groups will help determine the effectiveness of typical antipsychotics in preventing metabolic syndrome and their role in remission from the condition most commonly caused by atypical antipsychotics.

The intervention targets the minority blacks and Hispanics in the Bronx, New York. These two ethnic groups carry a significant risk (genetic, social, and environmental) for metabolic syndrome, a significant problem (Gurka et al., 2018). In addition, the burden of mental health illnesses is higher in adults above 20 years. The population suffers an already high burden of metabolic syndrome due to their genetic predisposition and other factors such as poor access to health. Hispanics and minority blacks often have poor living conditions that limit healthy practices such as healthy diets and exercise. Low income also increases their susceptibility to mental health illnesses and metabolic syndrome. Other interventions, such as dieting and exercising to reduce metabolic syndrome burden in patients with mental illnesses, are effective and less harmful but are hardly implemented. Thus the proposed intervention carries a sizeable probability of success.

Theoretical Foundations

Theories in nursing can focus on the entire discipline or some aspect of it. They serve as vital references during practice, change their postulations a be widely applied across the nursing profession. Most nursing theories are patient-centered and focus on delivering the most good to patients. Utilitarianism is a theoretical model of morality borrowed from sociology that will greatly guide the interventions. The overall goal of the intervention, synonymous with the utilitarian theory, is to achieve the greatest good for most of these patients and prevent the debilitating effects of metabolic disorders and associated health and medical issues (Smart, 2020). Typical antipsychotics are generally avoided due to their severe side effects, and atypical medications are preferred for their clinical effectiveness and less severe side effects. However, atypical antipsychotics present a higher risk for metabolic syndrome, a condition with a high risk for patients developing diabetes and associated health illnesses such as hypertension which complicate illnesses. This project aims to balance these side effects while producing optimum health outcomes.

The utilitarian model has strengths and weaknesses relevant to the intervention plan. The model applies to societies with diverse cultures and religions suitable for this special population. In addition, it uses natural intuition and bases everything based on happiness. The intention is to prevent metabolic disorders in the population of interest. One of the weaknesses is the possibility of harm to a small group, particularly the participants. The experiment is not risk-free, and mitigating the risks is thus critical. The outcomes in the future are usually unpredictable, making the model application somewhat challenging.

Martha Roger’s theory, “Science of Unitary Human Beings (SUHB),” views nursing as both an art and a science that relies on scientific knowledge to implement changes that positively impact patients and the general health of patients (Gunther, 2021). Nurses also view the profession as a holistic profession that views a patient as a whole. The objective is to ensure the patient heals wholly: spiritually, socially, cognitively, and physiologically. Another intention is to ensure recovery from a disease or illness with minimal side effects. In addition, this project aims to ensure that patients receive minimal to low health risks as healthcare professionals attempt to manage their mental health illnesses.

The SUHB theory’s major strength is its ability to assist in developing hypotheses and proposing relationships in various situations, such as intervention-outcomes relationships. The theory will thus help link the intervention to outcomes. However, the model does not outline the nurse’s role in health, nor does it define a healthy state. The theory does not have a testable hypothesis which may limit its application in the intervention plan.

The healthcare public health dashboard for mental health and electronic health records will be vital technologies for this intervention. The EHR will be vital technology for data collection, entry, and analysis in the project. Health dashboards are enhanced EHR technologies that will allow data tracking and visualization of the project’s performance over time (Hemler et al., 2018). The two healthcare technologies can be used to plan and implement the project. They will also help collect, analyze, and disseminate data and showcase progress in achieving the set targets. Healthcare dashboards help show the organization’s performance against internal and external benchmarks and are significant to this project.

Stakeholders, Policy, and Regulations

The proposed intervention will be affected by various stakeholder needs. These stakeholders include patients, care providers, healthcare leaders, and external regulatory agencies. The external regulatory agencies require research involving high-risk populations to be registered and approved by the research board. These regulatory agencies will shape the research to ensure it meets the ethical and legal principles and guidelines. This research involves adults with mental health illnesses, and thus the registration of this research is paramount.

Patients’ collaboration and acceptance of this project will greatly impact the project. Their collaboration is based on their knowledge needs and how they are et. Any change resistance to the QI could cripple it, leading to resource and time wastage. However, patient compliance in all vital processes (pre-implementation survey, implementation, and evaluation) of quality improvement projects could lead to increased efficiency in data collection and the success of the QI (Bergerum et al., 2019). Typical antipsychotics are more efficacious due to their mechanism of action but are also associated with more severe side effects due to their actions only of dopaminergic receptors.

Healthcare providers are tasked with carefully evaluating care interventions before implementing them. They will also collect data for the QI on areas such as the incidence and prevalence of metabolic syndrome and side effects. They are the labor for the QI, and their involvement is integral in all its steps. Interprofessional collaboration introduces new ideas and perspectives and will help improve, thus promoting success (Lising et al., 2021). Healthcare leaders will analyze the data on these interventions to make sound clinical decisions.

Many institutions limit typical antipsychotic use due to the perceived side effects. These policies will markedly limit the number of medications used in the experiment and will greatly affect the generalization of the results. Chokhawala and Stevens (2022) note that regulations require periodic patient evaluation. These clinic appointment regulations will also impact patient follow-up. These clinic visits will increase contact with patients, promoting the interventions’ success.

The US Food and Drug and Drug Administration agency is of paramount significance in this study. The recommendations from the governing body will be paramount for this study and a great limiting factor. Medications must be FAD-approved for their acceptance as initial therapy for patients in this study; off-label drugs are reserved as second-line medications (Vijay et al., 2018). Other bodies include the DSM-5, which will help diagnose and initiate management for patients with mental health illnesses. The reports written will also be submitted to the National Institute of Mental Health for further action.

Ethical and Legal Implications

There are various ethical and legal considerations in this study. The first and most important aspect of the intervention is informed consent. Varkey (2019) notes that all interventions without informed consent are illegal and have significant legal and ethical problems. All individuals involved in the process must sign an informed consent form. The involvement of their primary caregivers is paramount because of their mental condition. Other ethical and legal implications include adherence to internal and external requirements. Adequate change management will also favor the project to produce better outcomes. The professionals must deeply understand the project before its implementation, from its objectives to evaluation.

Typical antipsychotics are widely known for their extensive side effects. Bahta et al. (2021) note that patients on first-generation antipsychotics experience side effects that affect medication adherence. The events could also affect their stay in the program. Some patients with severe side effects will require withdrawal from the program and subsequent management to ensure any harm is mitigated early. Webushet et al. (2019) show that patients developing drug side effects should receive therapy changes to minimize the side effects, promote drug adherence, and promote better health outcomes.

However, Chokhawala and Stevens (2022) provide new insights into using first-generation antipsychotics. According to the researchers, first-generation antipsychotics can be used safely with careful dose titration, avoiding polypharmacy, high doses, and highly potent drugs (Chokhawala & Stevens, 2022). They note that first-generation antipsychotics are highly efficacious but poorly tolerated and have severe side effects, especially when used in high doses.

Withdrawal of a therapeutically effective agent that is present and approved is against ethical codes regulating research with human subjects. There will be a few exemptions during the project when administering the antipsychotics. For example, quetiapine is the only FDA-approved antipsychotic medication for depression in bipolar 1 disorder. Other antipsychotics used are off-label medications, and prescribing such to the patients during the study may present a legal issue. Alternatives include using other non-antipsychotic medications, such as sertraline, that are FDA-approved for depression. The project may be adept in making and covering such adjustments, which may present a significant ethical and legal issue for this project.

Conclusion

Metabolic syndrome remains a problem in mentally ill minority blanks and Hispanics taking second-generation antipsychotics. Metabolic syndrome is complex in mentally ill patients and is hard to control because coordination of common interventions such as exercising and diet is extremely difficult in this population. Other determinants of health also play a vital role in the health of these populations. The intervention of choice, first-generation antipsychotics to replace second-generation antipsychotics, faces many regulatory and policy barriers revolving around the efficacy and safety o these medications. There is hope in the efficacy and utilization of typical antipsychotics in preventing metabolic syndrome among mentally ill patients owing to the severe effects of metabolic syndrome on individuals and the controllability of the side effects of typical antipsychotics,

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References

Bahta, M., Ogbaghebriel, A., Russom, M., Tesfamariam, E. H., & Berhe, T. (2021). Impact of adverse reactions to first-generation antipsychotics on treatment adherence in outpatients with schizophrenia: a cross-sectional study. Annals of General Psychiatry, 20(1), 1-7. https://doi.org/10.1186/s12991-021-00348-0

Bergerum, C., Thor, J., Josefsson, K., & Wolmesjö, M. (2019). How might patient involvement in healthcare quality improvement efforts work—A realist literature review. Health Expectations, 22(5), 952-964. https://doi.org/10.1111/hex.12900

Chokhawala, K., & Stevens, L. (2022). Antipsychotic medications. In StatPearls [Internet]. StatPearls Publishing.

Gunther, M. E. (2021). Martha E. Rogers: Unitary human beings. Nursing Theorists and Their Work E-Book, 183.

Gurka, M. J., Filipp, S. L., & DeBoer, M. D. (2018). Geographical variation in the prevalence of obesity, metabolic syndrome, and diabetes among US adults. Nutrition & Diabetes, 8(1), 1-8. https://doi.org/10.1038/s41387-018-0024-2

Hemler, J. R., Hall, J. D., Cholan, R. A., Crabtree, B. F., Damschroder, L. J., Solberg, L. I., Ono, S. S., & Cohen, D. J. (2018). Practice facilitator strategies for addressing electronic health record data challenges for quality improvement: EvidenceNOW. The Journal of the American Board of Family Medicine, 31(3), 398-409. https://doi.org/10.3122/jabfm.2018.03.170274

Smart, J. J. C. (2020). Utilitarianism and its applications. In New directions in Ethics (pp. 24-41). Routledge. https://doi.org/10.4324/9781003031475-2

Varkey, B. (2021). Principles of clinical ethics and their application to practice. Medical Principles and Practice, 30(1), 17-28. https://doi.org/10.1159/000509119

Vijay, A., Becker, J. E., & Ross, J. S. (2018). Patterns and predictors of off-label prescription of psychiatric drugs. PLoS One, 13(7), e0198363.

Wubeshet, Y. S., Mohammed, O. S., & Desse, T. A. (2019). Prevalence and management practice of first-generation antipsychotics induced side effects among schizophrenic patients at Amanuel Mental Specialized Hospital, central Ethiopia: a cross-sectional study. BMC Psychiatry, 19(1), 1-8. https://doi.org/10.1186/s12888-018-1999-x

Lising, D., Sinclair, L., Rowland, P., & Baker, G. R. (2021). Translating concepts to practice: Examining the synergy of interprofessional competencies and quality improvement. Journal of Interprofessional Education & Practice, 24, 100440. https://doi.org/10.1016/j.xjep.2021.100440

Assessment 3 Instructions: Intervention Plan Design

Top of Form

Bottom of Form

Develop a 4-6 page holistic intervention plan design to improve the quality of outcomes for your target population and setting.

Introduction

Note: Each assessment in this course builds on the work you completed in the previous assessment. Therefore, you must complete the assessments in this course in the order in which they are presented.

Your application of the PICOT approach to developing your problem statement and the research that you conducted and synthesized in your literature review are the foundation and framework that you will need to successfully build your intervention plan. This plan will lay out specific components of the intervention you are planning to address the need you have identified for the target population and setting. You will justify your approach to the intervention plan by integrating appropriate theoretical foundations. You will also analyze and address the needs of stakeholders, requirements of regulatory bodies, and ethical and legal considerations. It is important to have a sound intervention plan design in place before trying to work on the details of implementation and evaluation.

Preparations

• • Read Guiding Questions: Intervention Plan Design [DOC]. This document is designed to give you questions to consider and additional guidance to help you successfully complete this assessment.
  • As you prepare to complete this assessment, you may want to think about other related issues to deepen your understanding or broaden your viewpoint. You are encouraged to consider the questions below and discuss them with a fellow learner, a work associate, an interested friend, or a member of your professional community. Note that these questions are for your own development and exploration and do not need to be completed or submitted as part of your assessment.

• • • What theoretical nursing models, strategies from other disciplines, and health care technologies could help support or justify your approach to the intervention plan?
    • What evidence from the literature or best practice supports the intervention plan components you identified?
    • What, if any, potential is there for technology to help in the development or implementation of the intervention plan components?
    • What is the impact of stakeholders, health care policy, or regulations?\
    • Are there any ethical or legal considerations related to the development or implementation of the intervention plan components that need to be kept in mind? If so, what are they?

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Instructions

Note: The assessments in this course are sequenced in such a way as to help you build specific skills that you will use throughout your program. Complete the assessments in the order in which they are presented.

You intervention plan design will be the second section of your final project submission. The goal for this is to design a holistic plan that should be able to improve the quality of outcomes for your target population and setting. Provide enough detail so that the faculty member assessing your intervention plan design will be able to provide substantive feedback that you will be able to incorporate into the other project components in this course, as well as into the final draft of your project.

At minimum, be sure to address the bullet points below, as they correspond to the grading criteria. You may also want to read the scoring guide and Guiding Questions: Intervention Plan Design document (File Attached separately) to better understand how each criterion will be assessed. In addition to the bullet points below, provide a brief introduction that refreshes the reader’s memory about your problem statement and the setting and context for this intervention plan.

***Reminder: these instructions are an outline. Your heading for this section should be Intervention Plan Components and not Part 1: Intervention Plan Components.

Part 1: Intervention Plan Components

• • Define the major components of an intervention plan for a health promotion, quality improvement, prevention, education, or management need.
  • Explain the impact of cultural needs and characteristics of a target population and setting on the development of intervention plan components.

Part 2: Theoretical Foundations

• • Evaluate theoretical nursing models, strategies from other disciplines, and health care technologies relevant to an intervention plan.
  • Justify the major components of an intervention by referencing relevant and contemporary evidence from the literature and best practices.

Part 3: Stakeholders, Policy, and Regulations

• • Analyze the impact of stakeholder needs, health care policy, regulations, and governing bodies relevant to health care practice and specific components of an intervention plan.

Part 4: Ethical and Legal Implications

• • Analyze relevant ethical and legal issues related to health care practice, organizational change, and specific components of an intervention plan.

Address Generally Throughout

• • Communicate intervention plan in a professional way that helps the audience to understand the proposed intervention.

Additional Requirements

• • Length of submission: 4–6 double-spaced pages.
  • Number of resources: 5–10 resources. (You may use resources previously cited in your literature review to contribute to this number. Your final project will require 12–18 unique resources.)
  • Written communication: Written communication is free of errors that detract from the overall message.
  • APA formatting: Resources and citations are formatted according to current APA style. Header formatting follows current APA levels.
  • Font and font size: Times New Roman, 12 point.

Competencies Measured

By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria:

• • Competency 1: Lead organizational change to improve the experience of care, population health, and professional work life while decreasing cost of care.

• • • Explain the impact of cultural needs and characteristics of a target population and setting on the development of intervention plan components.
  • Competency 2: Evaluate the best available evidence for use in clinical and organizational decision making.

• • • Evaluate theoretical nursing models, strategies from other disciplines, and health care technologies relevant to an intervention plan.
    • Analyze the impact of stakeholder needs, health care policy, regulations, and governing bodies relevant to health care practice and specific components of an intervention plan.
  • Competency 3: Apply quality improvement methods to impact patient, population, and systems outcomes.

• • • Define the major components of an intervention plan for a health promotion, quality improvement, prevention, education, or management need.
  • Competency 4: Design patient- and population-centered care to improve health outcomes.

• • • Explain the impact of cultural needs and characteristics of a target population and setting on the development of intervention plan components.
  • Competency 6: Evaluate the ability of existing and emerging information, communication, and health care technologies to improve safety and quality and to decrease cost.

• • • Justify the major components of an intervention by referencing relevant and contemporary evidence from the literature and best practices.
  • Competency 7: Defend health policy that improves the experience of care, population health, and professional work life while decreasing cost of care.

• • • Analyze relevant ethical and legal issues related to health care practice, organizational change, and specific components of an intervention plan.

Note: You will also be assessed on two additional criteria unaligned to a course competency:

• • Communicate intervention plan in a professional way that helps the audience to understand the proposed intervention and the implications of the plan that must be taken into account.
  • Demonstrate completion of hours toward the practicum experience.

See the scoring guide for specific grading criteria related to these additional requirements.