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NURS FPX 4900 Assessment 2 Assessing the Problem: Quality, Safety, and Cost Considerations

Assessing the Problem: Quality, Safety, and Cost Considerations

The management of mental illnesses, particularly bipolar disorder, presents significant challenges to healthcare systems, patients, and their families, influencing the quality of care, patient safety, and financial burdens. Managing mental illness specifically bipolar disorder presents significant challenges for patients, families, and healthcare systems due to its complex nature and variable outcomes (Cristina et al., 2023). This assessment explores the impact of bipolar disorder on patient safety, care quality, and healthcare costs through the lens of Christine and her family’s experiences. It looks at how governmental legislation, corporate policies, and state-level nursing practice guidelines affect these results. Additionally, evidence-based strategies are proposed to improve care quality, enhance patient safety, and reduce costs associated with managing bipolar disorder.

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Impact of Patient Problem

Quality of Care

Mental health conditions, particularly bipolar disorder, significantly affect the quality of care patients receive. The experience of bipolar disorder that Christine and her family have had has a substantial impact on patient safety, quality of care, and costs for the individual as well as the system. The unpredictable nature of bipolar disorder, with its alternating manic and depressive episodes, necessitates a complex and comprehensive care approach (Tsikada. 2020). Christine’s frequent non-adherence to her medication regimen during manic phases diminishes the quality of care she receives. This inconsistency disrupts the stability required for effective management of her condition, leading to frequent relapses and hospitalizations.      Peer-reviewed study by Sampogna et al. (2023) confirms that consistent medication adherence is crucial for reducing hospitalizations and improving the quality of life for individuals with bipolar disorder. Her treatment adherence is variable, which exacerbates her disease and results in inconsistent care. She frequently skips appointments and stops taking her medicine during manic stages. This discrepancy can make it difficult for medical professionals to properly manage her symptoms and customize treatment regimens to meet her requirements, which could eventually lower the standard of care (Tsikada. 2020). Furthermore, bipolar disorder’s emotional and cognitive fluctuations can make it difficult for Christine to interact with her medical team, which makes treatment even more challenging.

Patient Safety

The safety of patients like Christine is compromised by the cyclical nature of bipolar disorder. Manic episodes can result in risky behaviors, while depressive episodes increase the risk of self-harm and suicide. Christine’s history of multiple emergency department visits and hospitalizations underscores the safety risks associated with bipolar disorder. According to the National Institute of Mental Health (2024), the high rate of hospitalizations among bipolar disorder patients is a direct consequence of non-adherence to treatment protocols. For instance, stopping mood stabilizers during manic episodes can lead to severe manic symptoms, potentially resulting in dangerous behaviors such as impulsivity or aggression. Conversely, depressive episodes can increase the risk of self-harm or suicidal ideation if not properly managed. The lack of adherence to treatment plans heightens the risk of psychiatric emergencies, requiring immediate and intensive interventions that could have been avoided with consistent care.

Cost to System and Individuals

The financial burden on both the healthcare system and the individual is substantial. Christine’s need for frequent medical interventions, multiple medications, and ongoing therapies generates significant costs. The World Economic Forum projects that the expense of mental health disorders worldwide will increase from $2.5 trillion in 2010 to $6 trillion by 2030 (Forum, 2023). The expenses of medical care, such as prescription drugs, counseling, and hospital stays, can be crippling for an individual. Christine’s medical costs are greatly increased by her frequent hospital stays and emergency room visits brought on by her erratic adherence to her prescribed regimen. The system bears the cost of repeated emergency department visits and hospital stays, which are much higher than the cost of consistent outpatient care (Crowley et al., 2020). From an individual perspective, the out-of-pocket expenses for medications, therapy sessions, and managing side effects can be overwhelming, especially if insurance coverage is inadequate. Research by Isaacs and Mitchell (2024) supports this, indicating that integrated care models reduce overall costs by decreasing the need for acute care services. However, the initial investment in comprehensive outpatient care is often a barrier for many patients and families.

Impact of State-Board Nursing Practices

Institutional and governmental regulations, together with state board nursing practice guidelines, are key factors in determining how patient, family, or public health issues like bipolar disorder affect the quality, security, and cost of care. Guidelines for nursing practice that support care focused on patients, evidence-based nursing, and interdisciplinary teamwork are established by regulations and policies (Cristina et al., 2023). For instance, standards emphasizing continuous professional development ensure nurses are equipped to implement best practices in managing chronic conditions like bipolar disorder, thereby enhancing care quality through informed decision-making and skillful intervention.

For example, to effectively manage bipolar disorder, nurses must meet the requirements set by the American Nurses Association (ANA) in mental health assessments and crisis response. Following these guidelines makes sure that nurses can recognize mood swings early on and take the right action to stop things from getting worse (Cristina et al., 2023). Additionally, professional development mandated by state boards keeps nurses updated on the latest treatment modalities in mental health care, thereby enhancing the quality of care provided to patients like Christine.

Governmental policies, such as those under the Affordable Care Act (ACA), significantly influence the management of mental health conditions (Breslau et al., 2020). The ACA mandates coverage for mental health services, including screening, diagnosis, and treatment, without additional cost-sharing, which is pivotal for early intervention and consistent care. For example, under the ACA, Christine can access regular psychiatric evaluations and therapy sessions, essential for managing her condition (Breslau et al., 2020). The policy reduces the financial barriers to continuous care, promoting better adherence to treatment plans and improving long-term outcomes. Such policies mitigate risks associated with patient aggression or self-harm during manic or depressive episodes, thereby safeguarding patient safety and enhancing overall care quality.

Organizational policies such as the Mental Health Parity and Addiction Equity Act (MHPAEA), directly impact access to and coverage of mental health services (CMS, 2023). Research by Isaacs and Mitchell (2024) supports the effectiveness of integrated care models mandated by these policies, demonstrating reduced hospitalizations and improved patient outcomes. This policy ensures that individuals like Christine have access to comprehensive mental health services without financial barriers, thereby promoting early intervention, continuity of care, and improved treatment adherence (CMS, 2023). By reducing out-of-pocket expenses for mental health treatments, governmental policies contribute to overall cost containment within the healthcare system while enhancing the affordability and accessibility of care for individuals with bipolar disorder.

Policy Impact on Nursing Scope of Practice

The influence of these policies extends to shaping the scope of nursing practice in mental health settings, including the management of bipolar disorder. Nursing scope of practice is delineated by state regulations and influenced by national standards and institutional policies that dictate the range of responsibilities and interventions nurses can undertake (Ernstmeyer & Christman, 2021). In my nursing practice, adherence to these standards and policies guides interventions by emphasizing comprehensive care planning, regular monitoring, and patient education. By adhering to state board standards and organizational policies that encourage holistic approaches to mental health care, such as integrating psychoeducation and family support, nurses can mitigate safety risks associated with bipolar disorder and improve care continuity (Laranjeira et al., 2023). These actions are aligned with evidence suggesting that coordinated care reduces emergency interventions and promotes long-term stability.

Local, state, and federal policies also influence the nursing scope of practice by defining the permissible activities and responsibilities nurses can undertake to optimize care quality, enhance patient safety, and manage costs effectively (Ernstmeyer & Christman, 2021). For instance, state-level legislation supporting telehealth expansion enables nurses to provide remote consultations and monitoring, improving access to care and reducing unnecessary hospital visits. This aligns with my practice, where leveraging telehealth under these policies has facilitated early intervention and continuity of care for patients with bipolar disorder, ultimately reducing system costs and improving patient outcomes.

Strategies to Improve Mental Illness

Integrated Care Models

Using collaborative care models to manage chronic diseases like bipolar disorder is a good way to increase patient safety, care quality, and cost-effectiveness. In these models, social service providers, psychologists, clinical and health care providers collaborate to create integrated treatment regimens that are customized to the needs of each patient. Research by Isaacs and Mitchell (2024) highlighted the benefits of implementing integrated care models that combine mental health services with primary care for patients with bipolar disorder. These models ensure coordinated care across different healthcare providers, reducing duplication of services, enhancing communication, and improving medication adherence. It also emphasized that integrated care reduces hospitalizations and emergency department visits among patients with mental health disorders, thereby lowering costs to both the individual and the healthcare system.

Telehealth and Remote Monitoring

Expanding telehealth services for bipolar disorder patients can increase access to care, particularly in remote or underserved areas. Telehealth allows for regular check-ins, medication management, and psychotherapy sessions from a distance, improving patient convenience and reducing travel costs (Gajarawala & Pelkowski, 2021). Sharma and Devan (2021) have indicated that telepsychiatry interventions can lead to comparable clinical outcomes as in-person visits while reducing overall healthcare expenditures. Utilizing telehealth can also enhance patient safety by facilitating early intervention and monitoring of symptoms. Telehealth can also support proactive monitoring of a patient’s mental health status, enabling early intervention and preventing costly acute care episodes. Moreover, the utilization of telehealth technologies aligns with healthcare trends toward digital transformation, offering potential cost savings through operational efficiencies and reduced administrative overhead.

Patient and Family Psychoeducation

Providing comprehensive psychoeducation to patients and their families about bipolar disorder can significantly improve treatment adherence, early recognition of symptoms, and crisis management skills. Programs that educate patients about their condition and its management have been associated with reduced relapse rates and improved quality of life (Iuso et al., 2023). By empowering patients and families with knowledge, nurses can enhance self-care practices and promote proactive healthcare-seeking behaviors, ultimately reducing healthcare costs related to acute exacerbations.

Collaborative Care Teams

Establishing collaborative care teams that include psychiatrists, primary care providers, nurses, social workers, and psychologists ensures a holistic approach to managing bipolar disorder. These teams facilitate comprehensive assessments, individualized care plans, and regular follow-ups, promoting continuity of care and patient safety (Ee et al., 2020). According to research by Loots et al. (2021), collaborative treatment can help bipolar patients better adhere to their drug regimens, experience less severe symptoms, and function better overall.

Benchmark Data Sources

Benchmark data from various studies and reports provide compelling evidence of the effectiveness of these strategies in improving care outcomes, enhancing patient safety, and reducing healthcare costs associated with bipolar disorder and other serious mental illnesses. Furthermore, it was reported that the lifetime expenses per individual for bipolar disorder in the United States vary from $11,720 for a solitary manic episode to $624,785 for a disease course characterized by recurring episodes (Clubhouse International, 2024). Additionally, a study published in the American Journal of Emergency Medicine found that telemedicine visits for mental health conditions can lead to significant cost savings per visit, ranging from $19 to $121 (Kanda Software, 2024). Expanding mental wellness services to 5% of adults who suffer from severe mental illness in the US could lead to a net societal benefit of over $8.5 billion, demonstrating the potential economic advantages of increased mental health care access. The CMS offers comprehensive data on healthcare costs, reimbursement rates, and the impacts of policy changes on healthcare expenditures

During the two practicum hours, I discussed the challenges of managing Christine’s condition with her family, emphasizing the importance of consistent treatment adherence. Managing her bipolar disorder requires a regimen of mood stabilizers and antipsychotics, which her insurance partially covers. We discussed the potential benefits of telepsychiatry in providing convenient access to mental health services and reducing the barriers to regular care. I emphasized the importance of adherence to treatment plans and medication regimens to stabilize mood episodes and manage symptoms effectively. Drawing on evidence from studies on bipolar disorder treatment costs and the economic benefits of telemedicine visits, I highlighted how these interventions could not only improve Christine’s quality of life but also potentially reduce healthcare costs associated with frequent emergency department visits or hospitalizations.

Conclusion

Addressing the multifaceted challenges posed by mental illness requires a comprehensive approach integrating evidence-based practices, policy support, and collaborative care models. By adhering to nursing practice standards and leveraging organizational policies that prioritize patient-centered care and interdisciplinary collaboration, nurses can mitigate safety risks, enhance care quality, and optimize resource allocation. The strategies outlined, such as integrated care models, telehealth utilization, and patient education initiatives, offer promising avenues to improve outcomes for individuals like Christine while supporting sustainability within healthcare systems. Continued research and evaluation of these approaches will be essential to further refine interventions and ensure equitable access to high-quality mental health care.

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The post NURS FPX 4900 Assessment 2 Assessing the Problem: Quality, Safety, and Cost Considerations appeared first on Top My Course.

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