ABSTRACT
INTRODUCTION: Programs for assertive community treatment (PACT) serve persons with severe mental illness who have been unsuccessful with traditional outpatient services. Many PACT clients struggle to obtain symptom relief with medications that often have poor efficacy and undesired side effects, which can result in nonadherence, relapse, and increased health care utilization with associated costs. AIMS: This quality improvement project aimed to improve client and PACT program outcomes by incorporating pharmacogenomic testing into the psychopharmacological decision-making process. METHODS: The project used a pre-posttest design with each client serving as their own control to evaluate changes in clients' symptoms and program outcomes resulting from pharmacogenomics-guided medication management. RESULTS: Following project implementation, clients' symptoms were decreased and both engagement in care and stability in the community increased. Psychiatric hospitalizations and associated costs decreased. CONCLUSIONS: This project suggests utility for using pharmacogenomics testing to personalize care for persons with severe mental illness.
Subject(s)
Community Mental Health Services , Mental Disorders/drug therapy , Patient Care Team/organization & administration , Pharmacogenomic Testing , Precision Medicine , Chronic Disease/drug therapy , Female , Humans , Male , Middle Aged , Program Evaluation , Quality ImprovementABSTRACT
Safe prescribing for persons with severe mental illness requires laboratory monitoring for psychotropic drug levels and metabolic side effects. Barriers to appropriate and timely monitoring increase when clients must obtain phlebotomy services at a separate facility. This quality improvement project was conducted within a program for assertive community treatment (PACT). Specific aims were to increase access to laboratory testing, improve efficiency, and lower costs by implementing on-site specimen collection. Outcomes, measured three months post-implementation, indicate that over half of all labs were obtained on-site, clients and staff were pleased with increased efficiencies, and costs were reduced by 37%.
Subject(s)
Biomarkers , Community Mental Health Services/organization & administration , Health Services Accessibility/organization & administration , Mental Disorders/nursing , Monitoring, Physiologic/nursing , Quality Improvement/organization & administration , Aged , Community Mental Health Services/economics , Comorbidity , Cost Control/economics , Cost Control/organization & administration , Efficiency , Female , Humans , Male , Mental Disorders/economics , Middle Aged , Phlebotomy/nursing , Quality Improvement/economics , United States , WorkflowSubject(s)
Naloxone , Narcotic Antagonists , Pulmonary Edema , Humans , Naloxone/therapeutic use , Narcotic Antagonists/therapeutic use , Edema , Male , AdultABSTRACT
Little is known about the perceptions of nursing students externing in newly developed hospital-based programs that focus on socialization and transition to the registered nurse (RN) role rather than on institutional recruitment and retention goals. This qualitative study explored student nurse externs' expectations, experiences, and benefits of participation in a student-focused externship program. Externs wanted to gain experience with skills and learn what it was like to be an RN. Goals were met or exceeded by becoming comfortable in the externship role, growing in skill performance and confidence, and becoming members of the healthcare team. The experience fostered growth from the novice to advanced beginner level of nursing practice. Externs saw the program participation as a valuable way to gain experience and learn what it was like to be an RN.
Subject(s)
Attitude of Health Personnel , Education, Nursing, Continuing/organization & administration , Internship, Nonmedical/organization & administration , Nursing Staff, Hospital , Students, Nursing/psychology , Adult , Aged , Arizona , Career Mobility , Clinical Competence/standards , Goals , Health Services Needs and Demand , Humans , Interprofessional Relations , Middle Aged , Nurse's Role/psychology , Nursing Education Research , Nursing Methodology Research , Nursing Staff, Hospital/education , Nursing Staff, Hospital/psychology , Preceptorship/organization & administration , Program Evaluation , Qualitative Research , Socialization , Staff Development/organization & administration , Surveys and QuestionnairesABSTRACT
New models of providing care to chronically ill persons are needed that can facilitate a more integrative approach to patient care. The purposes of this article are to describe the utilization of a theory synthesis process for development of a client-focused approach for advanced practice nurse (APN) management of chronic illness and to present the Model for Promoting Process Engagement. The model was developed as a theory-driven intervention to address complexities of chronic illness care. This APN practice model is the direct result of the synthesis of a number of differing theoretical models developed by the authors in previous individual research endeavors.
Subject(s)
Chronic Disease/nursing , Comprehensive Health Care/methods , Models, Nursing , Nurse Practitioners , Caregivers/psychology , Decision Making , Humans , Mental Disorders/psychology , Patient-Centered Care/methods , Process Assessment, Health Care/methodsSubject(s)
Home Nursing/methods , Massage , Palliative Care/methods , Terminal Care/methods , Humans , Rural PopulationABSTRACT
Individuals with mental retardation and their parents/guardians have long been neglected in health care research. In this study we used a qualitative methodology to describe the experiences adults with mental retardation and their parents/guardians have with the delivery of primary care services. Semi-structured in-depth interviews were conducted with 12 adults who had mental retardation and 9 parents/guardians. The grounded theory approach was utilized to guide data collection and analysis. Findings suggest an overall positive experience with primary care services. Unique themes were identified that distinguished parent/guardian experiences from those of adults with mental retardation, who focused on immediate, concrete issues related to service delivery, whereas parents/ guardians focused on more peripheral or abstract issues related to the delivery of primary care.