Deinstitutionalization Capstone Project - Research Paper Example

Assignment 2: Develop a matrix showing keyword searches by database and the number of hits by keyword and source. My research for this study was done on the database of EBSCO Discovery Science. Selected key words are typed at the search bar and a number of hits come up. Since I wanted to get full-text and peer-reviewed articles published within the years 2000-2012, I adjusted the settings and updated them. Upon modifying the search, another number, much less than the original number came up meaning it has screened the articles in accordance to my preferences. The following matrix illustrates the keyword searches I’ve done for the related topics for this study. From the available articles, I selected the ones I believed would be relevant to my research. Key Words Number of Hits for Sources that are Full Text/ Peer-Reviewed/Published from 2000-2012 Deinstitutionalization 10135 Elderly with mental illness 106,392 Nurse practitioner services 149,251 Health Promotion Models 308,352 Collaborative Care 290,590 Holistic Health Care 96,415 Mental Health 1,508,498 Recovery & Wellness 12,828 Assignment 3: Annotated bibliography of references on the topic of interest Ewles L, Simnett I., 2005, Promoting Health - a practical guide. Balliere Tindall: Edinburgh This book discusses a health promotion program that addresses all possible areas that could affect the health of an individual. The authors include the physical or how the body functions; mental or how the person thinks and makes judgments; social or how one maintains relationships; emotional or how a person manages his emotions and how he expresses it appropriately; spiritual or a person’s religious and personal beliefs, principles and ways of being at peace with oneself; sexual or the acceptance of and ability to achieve a satisfactory expression of one’s sexuality; societal or how a person relates to his society in terms of shelter, peace, food, income and his own contribution to society and finally, environmental or his physical environment which includes his housing, transport, sanitation, availability of clean water, pollution control. Hayden, J.A., 2008, Introduction to Health Behavior Theory. Jones & Bartlett Publishers. This book discusses the Health Belief Model (HBM) which proposes that health behaviour is determined by one’s personal beliefs or perceptions regarding a disease or disorder and the available strategies one can access to prevent it. The four perceptions, namely: perceived seriousness, perceived susceptibility, perceived benefits and perceived barriers can be used to explain why a person behaves the way he does when it comes to health. All four perceptions affect an individual’s health and well-being so these must all be kept positive in order to achieve optimal health. Pedersen, P.B. and Kolstad, A., 2009, De-institutionalisation and trans- institutionalisation – changing trends of inpatient care in Norwegian mental health institutions 1950-2007, International Journal of Mental Health Systems, 3:28 This article chronicles trends in Norwegian mental health institutions from the 1950’s to the present that leads to current trends of deinstitutionalization and trans-institutionalization of inpatient care. It concludes with the observation that deinstitutionalization may mean fewer beds available in mental health facilities but not necessarily fewer patients treated since they are just transferred to other mental health services. It also identifies the factors behind deinstitutionalization in Norway as the expansion of welfare state; increased professional focus on active treatment and increased focus on patients’ preferences. Thompson, P., Lang, L. & Annells, M., 2008, A systematic review of the effectiveness of in-home community nurse led interventions for the mental health of older persons, Journal of Clinical Nursing Journal Compilation, Blackwell Publishing, Ltd. This article is a systematic review of the literature on in-home community nurse-led interventions for elderly adults with mental health issues. Main findings of this review indicate that there is evidence to support the use of effective screening tools to identify if the elderly patients receiving community nursing care may or may not have a mental health disorder, and if they do, then collaborative care with doctors and other health practitioners should be delivered. Assignment 4: Problem Statements and Purpose Statements 1. When the time comes for deinstitutionalization, elderly adults who have been in residence in psychiatric hospitals need to be reintegrated to the community. Pederen & Kolstad (2009) believe that long-term care in hospital care can make patients feel constrained in the environment and they need to be released to live outside, mainstreamed in the community. However, they still need to be seen regularly by health workers to ensure that they are maintaining their treatment outside the facility. It is believed that this population is better off being cared for by community nurses as they are in a position to identify changes in the patients’ mental health and implement the effective strategies needed such as screening assistance with medications, monitoring for changes over time, referring to other professionals and even conduct psychotherapy sessions (Thompson, Lang & Annells, 2007). It would be worth exploring how family members of these elderly adults feel about entrusting their elderly family members to community nursing care after being under institutional care for the longest time. a. Purpose Statement for a Quantitative Study: This study will determine the openness of community members to the opening of a community care center run by nurse practitioners. Information will be derived from the results of a survey questionnaire distributed amongst the members of a community regarding their preferences of services offered. b. Purpose Statement for a Qualitative Study: The purpose of this study is to explore the insights and opinions of family members of the elderly with mental illness who have been in a residential facility regarding deinstitutionalization. Focus group discussions will be conducted to gather these views. 2. Community care centers need to adopt a health promotion program to guide the health workers with a firm philosophy of health and wellness. A commonly used health promotion model is the Health Belief Model (HBM) which proposes that health behaviour is determined by one’s personal beliefs or perceptions regarding a disease or disorder and the available strategies one can access to prevent it (Hayden, 2008). Another good health promotion program is one by Ewles & Simnett (2005). It takes a holistic health care approach, taking into account all dimensions of a person’s development. A study on how these two health promotion programs can be integrated to come up with the most appropriate program that would best suit elderly adults with mental illness would be interesting. a. Purpose statement for a Quantitative Study: This study will compare the Health Belief Model (HBM) and the Holistic Health Care approach as to its principles and features using a likert-scaled questionnaire to be distributed to nurse practitioners working in a hospital facility. It purports to determine the best features of each model and integrate it into one effective health promotion program. b. Purpose statement for a Qualitative Study: The purpose of this study is to develop a sustainable community care health promotion program for the elderly with mental illness. Input from families of residents in a psychiatric facility will be interviewed as to their preferences for their family members who will be deinstitutionalized into their care. Assignment 5: Research questions and hypotheses. Research Questions: 1. How will deinstitutionalization impact long-term residents of a psychiatric facility? 2. Are nurse practitioners qualified to run community care centers and what are the limitations for it? 3. What are the recommendable activities for elderly with mental illness who have been deinstitutionalized to the community? Research Hypotheses: 1. Deinstitutionalization will highly benefit long term patients in a residential facility because they will finally be mainstreamed into community living and this will help them regain their normal day-to-day living routines with their families and friends. 2. Nurse practitioners may be allowed to run community care clinics to administer nursing care and psychological counselling to community members. Medical diagnosis and prescriptions should still be done by medical doctors who come and visit the center to supervise them. 3. In accordance to the selected health promotion model, elderly community members with mental illness may be provided with regular recreational activities such as Bingo nights to keep their cognitive facilities alert and their social lives engaged. Their well-being should always be prioritized. Assignment 6: Apply the problem statement to various theoretical models. Deinstitutionalized elderly people with mental illness may be continued to be cared for in community care centers that prioritize their wellness and recovery. These community care centers should adhere to effective health promotion programs that will help them improve their lives to be satisfying, holistic and multi-dimensional, and this includes physical, emotional, intellectual, social, environmental, and spiritual dimensions. Their recovery outside the psychiatric facility they have come from should include the regaining of their physical, spiritual, mental and emotional balance. These concepts on wellness and recovery will be addressed by two health promotion models namely the Health Belief Model (HBM) and the Holistic Health Care approach. The Health Belief Model (HBM) proposes that health behaviour is determined by one’s personal beliefs or perceptions regarding a disease or disorder and the available strategies one can access to prevent it. The four perceptions, namely: perceived seriousness, perceived susceptibility, perceived benefits and perceived barriers can be used to explain why a person behaves the way he does when it comes to health (Hayden, 2008). Perceived seriousness is how a patient may view the severity of his illness. For mentally ill patients, knowledge of this may not be relevant to them, but for those who have retained functional mental abilities, knowing the extent of their illness may motivate them to follow through with the medical treatment customized for them. Perceived susceptibility is how one views the risks that accompany not following prescribed treatment. For example, if a mentally ill patient perceives the risk of their emotional outbursts to increase if they do not take their medication, and that this could lead to more serious complications, then they are more likely to take their medication. Hayden (2008) explains that a perception of increased susceptibility or risk is associated with healthier behaviours and decreased susceptibility to unhealthy behaviours. Beliefs can also be combined to come up with behaviour change. When the perception of susceptibility is combined with the perception of seriousness, a perceived threat is produced (Stretcher & Rosenstock, 1997). When a patient perceives the threat to a serious disease has serious risk, then it is most likely that a behaviour change (such as following doctors’ orders) is bound to follow. Perceived benefits are opinions of the value of a new behaviour in decreasing the risk of negative outcomes. When a patient perceives that a treatment will bring him relief from discomfort or help him behave more appropriately with others, then it is more likely that he will cooperate. Finally, perceived barriers are what individuals believe to hinder them from achieving their goals of adopting new behaviours. These may be major barriers such as being deinstitutionalized and have no home to go to or having major health complications that makes the individual suffer more. These may also be minor barriers like lack of transportation going to the recovery and wellness center or a minor setback in scheduling. The Centers for Disease Control and Prevention (2004) advise that for a new behaviour to be adopted, an individual needs to believe that the benefits it brings outweigh the consequences of continuing old behaviours. When this is the case, barriers are overcome and new behaviour is engaged in. These beliefs of each patient shall be analyzed by the staff to guide them accordingly in the provision of appropriate treatment for them. Ewles & Simnett (2005) explain the Holistic Health Care approach, taking into account all dimensions of a person’s development. They summarize the various aspects needed to be addressed in health promotion. It should include the physical or how the body functions; mental or how the person thinks and makes judgments; social or how one maintains relationships; emotional or how a person manages his emotions and how he expresses it appropriately; spiritual or a person’s religious and personal beliefs, principles and ways of being at peace with oneself; sexual or the acceptance of and ability to achieve a satisfactory expression of one’s sexuality; societal or how a person relates to his society in terms of shelter, peace, food, income and his own contribution to society and finally, environmental or his physical environment which includes his housing, transport, sanitation, availability of clean water, pollution control (Ewles & Simnett, 2004). Assignment 7 : Choose the appropriate design for your capstone project. My capstone project will be a business plan that details everything necessary to set up a nurse-practitioner-run wellness and day treatment center for adults with mental illness. This is to address widespread deinstitutionalization where long-term residents in psychiatric facilities need to transition into community life. My goal is for these patients to be eased into the community and reduce their stress in their transition by providing suitable services for them. The business plan will include my intended vision and mission, philosophy, and the details of the marketing and operations in order to see the feasibility of this noble project. Since the project will cover a wide scope of knowledge and information on my chosen topic, the research design will include a thorough literature review on the areas of deinstitutionalization and community nursing care, the health promotion programs of Health Belief Model and Holistic Health Care as well as on statutory requirements to run such community care facility. I will also conduct interviews with families of elderly residents of a psychiatric facility to help guide me on their preferences in the community care service they want for their family member to transition into. References Centers for Disease Control and Prevention (2004) Program Operation Guidelines for STD Prevention: Community and Individual Behavior Change Interventions. Retrieved July 29, 2012 from http://www.cdc.gov/std/program/community/9- PGcommunity.htm. Ewles L, Simnett I (2005). Promoting Health - a practical guide. Balliere Tindall: Edinburgh Hayden, J.A. (2008) Introduction to Health Behavior Theory. Jones & Bartlett Publishers. Pedersen, P.B. and Kolstad, A. (2009) De-institutionalisation and trans- institutionalisation – changing trends of inpatient care in Norwegian mental health institutions 1950-2007, International Journal of Mental Health Systems, 3:28 Stretcher, V. & Rosenstock, L.M. (1997) The Health Belief Model. In K. Glanz, F.M. Lewis & B.K. Rimer (Eds.), Health Behavior and Health Education: Theory, Research and Practice (2nd ed.). San Francisco: Jossey-Bass. Thompson, P., Lang, L. & Annells, M. (2008) A systematic review of the effectiveness of in-home community nurse led interventions for the mental health of older persons, Journal of Clinical Nursing Journal Compilation, Blackwell Publishing, Ltd. Read More