Service Improvement

Service Improvement

This chapter investigates medical attendant- patient relationship and the therapeutic alliance created to help patients with AN in their recuperation. Previous literature review recognizes the importance of the TA concept. This chapter discusses service administration improvement during nursing practice in AN patient care improvement plans. The plan aims to improve and boost the expansion of patient treatment adherence and also the probability of AN patients influence during inpatient clinical care

4.1 – Aim

There is a need to integrate measures that encourage the advancement of and fortify therapeutic alliances between nurses and patients. These measures should also address the nurse’s awareness of primary issues encompassing AN as well as its challenges and causes. These will assist in assembling and improving treatment adherence and a successful therapeutic alliance (Wright, 2015). According to Zugai (2012) and Snell’s (2010) findings, TA was promptly framed through proper communication abilities to promote rapport and understand better the requirements of patients with AN.

Through investigating ways of TA improvement in an inpatient care setting, it is possible to accomplish my objective inpatient care service improvement. Nurses invest a great deal of time and energy on patients admitted to the wards. They do this by offering care and supporting them through medical necessities provision (Sly et al., 2014). Besides, according to Bourion-Bedes’s (2013) study, the primary indicator of treatment results is a ward setting in a transient period. Knowledge acquired in this study is intended to help in establishing interventions that help promote caretaker’s skills and expertise in creating TA. These, in turn, encourages collaborative working and improve positive clinical outcomes in patients determined to have AN, and this is the objective of any mediation targeting this problematic issue.

4.2 -Practice Change

The therapeutic alliance, service improvement plan, aims to adjust nursing practice. This will include the development and execution of secured restorative interaction time among medical attendants and patients that may be conducted in the ward setting. In this situation, assigning a nurse to a newly affected patient admitted in the ward is required. The assigned personnel should have strong communication skills to form an excellent interpersonal relationship with the newly admitted patient. To improve results accuracy, staff designation should be consistent for a period of four months to a half year. However, staff allocation consistency can be a challenge at times in some cases due to issues arising from retractions or ailment of permanent hospital staff. Consistency may also be disrupted by having office medical caretakers or bank staff who are not familiar with the already existing patients’ needs and ward routine. As indicated by a study conducted by Nicotera and Walls, (2010), inclinations are limited when similar people are evaluated over an adequate time.

To achieve a successful therapeutic alliance between caregivers and newly admitted patients. Nurse allocation is critical. To determine staff allocation, individual interviews are conducted on the nurses. Nurse-patient interaction is also observed as outcomes depend on a caregiver and patient interactions. (Brandon et al., 2015) proposes the allocation of staff based on their relational abilities instead of their qualifications. The interactive capability of the nurse is established within the first hour of the initial six hours of confirmation provided that the patients are physiologically competent to undertake in the interactive process. Positive outcomes are based on the interactive process; this, therefore, requires that allocated nurses will have satisfactory abilities to negotiate therapeutic associations and limits Ballard and Crane, (2015).

This also insists on the importance of staff training to equip them with proper knowledge and skills in inpatient care in the ward setting. Acceptance and Commitment Therapy (ACT) training is also crucial to the allocated nurses. ACT recognizes the significance of medical attendant and patient relationships. Knowledge of the ACT and the implementation of acceptance and commitment therapy allows participants to focus on current experience Hayes and Wilson, (2011). Understanding of other factors influencing AN patient is also crucial in enabling the carers to identify with patients.

In the course of admission, the interactive process between the carer and patient allows both nurse and patient an opportunity to get acquainted with each other. The interactive process, therefore, helps the newly admitted patient to get comfortable for medical assessments and interventions related to anorexia nervosa. Initial interactions thus reduce distress linked to inpatient admission. Application of humanizing care and individual-centredness also quickens the improvement of remedial coalitions throughout ward admission. In the event of readmission due to a relapse in anorexia nervosa, the patient is already familiar with the existing ward setting. As a result, an interactive session will be designed to re-stimulate any restorative partnership that had been recently established or to help in creating a new interactive relationship with the newly allocated nursing staff. This change is consistent with the standards of SMART, see table 3, in the reference section.

According to Hamilton and Thompson (2012), study nurses do not invest adequate time with their patients. This poses a challenge to the carer’s ability to investigate the psychological needs and other health challenges the inpatient may have. A study conducted by the health department in 2002 further supports the need for more patient help care interactions between the nurse and patient to ensure proper clinical and other additional support input to patients already existing in hospital wards. The health department study, therefore, calls out for the maximization of patient-carer interaction during ward admission therapy.

To address patient and nurse therapeutic time, a two-session weekly appointment will be set aside to facilitate TA between the caregiver and patient. During this time, visitations from carers, relatives, and other multidisciplinary teams will be prohibited. The one-hour weekly appointment will take place between 2-4 pm every Thursday and Friday to allow for patients to have uninterrupted interaction with nurses allocated to the ward unit. The session is aimed at promoting positive changes to improve the nature of care. To achieve quality care, the parties involved during the meeting will also be educated on the importance of weekly interactive sessions. However, considering that the nurse assigned to the ward may have to address other ward obligations dealing and composing care notes to inpatients the two times hourly sessions per week may not be adequate for carer-patient interactions.

Working with AN patients may prove emotionally draining and challenging at times. Cumming, (2009) insists on the need for senior managers to supervise assigned nurses to the ward units of AN patients. This provides an opportunity for nurses to share their concerns and challenges while attending to AN patients. Staff screening should, therefore, be done regularly to monitor and offer support to the staff in question. Staff supervision will, therefore, be scheduled for an hour weekly.

The therapeutic time should also be conducted in a conducive environment, as the nature of the environment influences emotions expressed during the session. The environment should promote privacy and confidentiality as patients are often concerned with privacy issues and security in one on one interactions (Edwards et al., 2006). Members should, therefore, be furnished with a private and agreeable environment without frequent interference during the meeting.

Before the application of administration service improvement into practice, a hypothetical utilization of the Plan, Do Study, Act (PDSA) cycles are implemented (Taylor et al., (2014). Broadly perceived procedure maps are also going to be utilized to examine the patient’s point of view and excursion (NHS Institute for Innovation and Improvement, 2005). This has also proven relevant at distinguishing other time zones and downsides(Gage, 2013) to acknowledge problem areas in need of improvement reflective weekly intelligent checks are going to be held. PDSA cycles have proven ideal as a quality improvement apparatus. To ensure quality, the cycles are used in evaluating ideas and anticipating issues or danger and addressing them before occurring (Gage, 2013). Lewis force field analysis may also be used to acknowledge resistors and facilitators to vary so on advice choices which will ensure that changes are progressively worthy (Nelson et al., 2013) because PDSA has proven challenging in changing situations and poor results are commonly observed in studies where the cycle was not completed (McNicholas et al., 2019).

4.3 – Evaluation of Outcomes

The statistical control apparatus (SPC) is going to be utilized to evaluate the accomplishments and manageability of the proposition. SPC is a strategy of controlling quality through breaking down a progression of data to access service improvement. (Smith and Lister, 2011). The data will include weekly AN patient’s information on weight gain, staff input, tolerant criticism, and perception of passionate strength. Data collection will be attained through a participant’s intelligence-gathering discussions and surveys. Moral endorsements will also be sought to guarantee confidentiality; consent from members will also be looked for (Moule et al., 2016).

Nurses and patients will fill out different questionnaires in order to break down information at the benchmark. In the nurse’s questioner, Likert-scale questions will be used. These questions consist of options running from strongly agree to strong differ (Likert, 1932). the survey encompasses all possible medical attendant opinion and their degree of agreement. However, a study conducted by brown suggests that Likert surveys are flopped by extreme answers or expression of no choice by medical attendants (Brown, 2000).

The subjects will also be asked open-ended queries about their emotions, and information collected will be entered into Microsoft Excel spreadsheet programming software. Graphic information will then be determined from analyzed data. A thematic analysis may then be utilized to discover regular subjects (Josh et al., 2015). information collected will then be used to access whether one on one patient-caregiver interaction has had a positive influence on TA development.

Weekly patient assessment on weight gain will be carried out. Evaluations will concentrate on 0.5-1.5kg AN patient weight gain (NICE, 2007). allocated nurses will also monitor the emotional, mental, and behavioral state of the patient in the admission unit. Release rate data will then be used to evaluate treatment results improvement, NICE (2007b) also suggests that consistent use of data motivates teams to consciously improve, and as a result, NICE improving overall data quality.

4.4 – Expected challenges and how this may be overcome

During the initial implementation of new clinical practices, numerous challenges are usually encountered. It is, therefore, imperative to anticipate such obstructions and offer possible contingency measures on how these issues may be addressed (The Health Foundation, 2012). such challenges may include hesitations from other key partners to offer support to the implementation of new, possibly beneficial clinical practices. Data collected may, however, be used to convince such stakeholders by demonstrating challenges associated with treatment adherence and how TA can assist in improving treatment results.

Medical attendants such as nurses may also possess opposing attitudes, resistance may also be as a result of already existing staff culture, and such challenges may thwart the accomplishment of therapeutic alliance objectives (Berringer and Fletcher, 2011), and as per Gage (2013), change without obstruction is no change by any stretch of the imagination, it is just a fantasy to change. All things considered, the possible challenges ought to be recognized, and consolations given through interchanges (Manning, 2006).

In conclusion, executing practice change in nursing is challenging at times, and the main challenge may be sustaining change over time without the potential prevalence of returning to dated practices. However, continuous practice review ensures a dynamic, positive change in treatment adherence results. Therapeutic adherence results may, in turn, be used in the long run as an effective proof useful in acquiring support as well as in the acquisition of extra funding and other supportive materials necessary for supporting the level of participation required and additionally extend the undertaking should interest for the activity increase past what was first anticipated.