A Nurse Practitioner-Led Residential Behavioral Health Care Treatment Center - Dissertation Example

? A Nurse Practitioner Led Residential Behavioral Health Care Treatment Center Table of Contents 0 Introduction 1 Executive Summary 2.0 Introduction 2.1 Literature Review 2.1.2 Obsessive Compulsive Disorder 2.1.3 Psychological or Neurological Conditions 2.2 Competitive Analysis 2.2.1 Size 2.2.2 Scope 2.2.3 Product/ Service Offering 2.2.4 Indirect Competition 2.2.5 Future Competition 2.3 SWOT Analysis: 2.3.1 Strengths 2.3.2 Weaknesses 2.3.3 Opportunities 2.3.4 Threats 2.4 Business Conditions, Excellent or Poor; Political Chapter 1 1.0 Introduction Because of deinstitutionalization that occurred in Alabama and led to the transfer of mentally ill individuals from the public mental hospitals to other alternatives in the local community, I have decided to develop a Recovery Center that will accommodate some of these people. The center will help the mentally ill people find a place where they can live until they recover. 1.1 Executive Summary When communities undergo widespread deinstitutionalization, individuals who have been in various hospitals or in other long-term care facilities for many years often find the transition to community life upsetting and overwhelming. Deinstitutionalization also places a burden on the community, which frequently lacks the infrastructure and resources to accommodate people in need of long-term care for behavioral disorders and other psychological and/or neurological conditions. Horizon Wellness Recovery Center, TBD (also known as “the Company”) is one of the start-up residential care facilities that will provide on-site and in-home care for adults who have recently been transferred out of long-term care facilities due to Alabama’s ongoing statewide deinstitutionalization. The Company will open for business in the spring of 2014 in Bessemer, Alabama, a city outside of Birmingham, and will serve people within a 50-mile radius of the community. The Company will begin by serving six residents and 12 daycare patients with behavioral care needs. Operating hours will be from six a.m. to six p.m., with some overnight care available. A social worker and a nurse practitioner will offer psychiatric assessments, medication management and follow-up care, and general care and supervision both on-site and in patients’ homes. Nursing technicians will be on hand, to monitor patients’ physical wellness. Horizon Wellness Recovery Center’s revenue will come from patients’ insurance companies. The Company will meet a vital need by providing compassionate, professional care to adults transitioning from long-term residential care to life in the community. Chapter Two 2.0 Introduction The company will provide services to patients suffering from behavioral disorders, and psychological or neurological conditions. Patients suffering from behavioral disorders include those with Attention Deficit Hyperactivity Disorder, Obsessive Compulsive Disorder and Postpartum Depression. 2.1 Literature Review 2.1.2 Disorders. Within the spectrum of the mental health care facility there is the recognition that multiple forms of mental health challenges will be dealt with. In these regards, this report considers these mental health concerns from a comprehensive literature review. One of the most prevalent mental health issues embodied in many institutionalized patients is obsessive-compulsive disorder. The examples of obsessions include unacceptable religious thoughts, fears of possible harm to a loved one and the excessive need to certain things correctly (Wang, Grados, Nestadt, et. al 2012, p. 4). Compulsions include unnecessary rereading, repeating phrases mentally and the repetition of routine actions a number of times until it feels correct (Wang, Grados, Nestadt, et. al 2012, p. 4). My organization will use psychopharmacological ways and psychological ways in treating patients suffering from these conditions. Medications that inhibit serotonin like the selective serotonin reuptake inhibitors will get provided to these patients. Psychological methods such as, exposing the patients to stimuli that they avoid, and preventing them from doing any of their anxiety reducing activities is another method that will get used by professionals in the institution. Another prominent neurological condition that will be care for within the facility is bi-polar disorder. Bipolar Disorder has been characterized as, "an affective disorder that is characterized by at least one episode of mania formerly referred to as manic depression" (Francis 1997, p. 60). Nearly one percent of the world’s population is afflicted with it, and the illness seems to affect all nations and ethnic groups. Contemporary research among biomedical experts and psychotherapists has been attempting to determine the exact cause of bi-polar disorder. While no ultimate conclusions have been determined, studies have revealed a number of consistent results. Most research attests that bi-polar is oftentimes found in families, which logically implies a genetic basis for the disorder. While Bipolar disorder may be a highly debilitating disease, there exist a number of treatment options. Treatment for the disorder before the 1970s was non-existent. Patients were often sent to psychiatric wards or in less severe instances instructed to merely cope with their disorder. Since the early 1970s, a number of treatment options have emerged that have progressively reshaped the therapeutic climate. While many of these treatments are medicinal treatments, there is a wide-variety of options for patients suffering from Bi-polar symptoms. Long-term treatment options include group living situations and half way houses. Long-term care can involve both inpatient and outpatient treatment options. The inpatient options are beneficial to patients that necessitate constant monitoring, oftentimes those who as previously stated pose a risk to themselves and society. Outpatient options are beneficial for more stable patients that are ready to be reestablishing their lives after a trying period and bout with bi-polar disorder. As one might imagine, it’s necessary for patients to have a highly functional and open relationship with their caring practitioner, as there are frequent relapses that accompany outpatient options. Indeed, "Under no circumstances should one attempt to care for a person in an extreme state without the aid of a trained physician and hospitalization" (Finkelman 1997, p. 30). Within the context of the care facility this is a highly significant consideration then as the nurse practitioners will constitute the trained physicians that are able to address these concerns. Another significant consideration within the spectrum of mental disorders is post-traumatic stress disorder. Post-traumatic stress disorder is a severe anxiety disorder that can arise after exposure to extreme psychological trauma. While generally associated with soldiers returning to society after war, post-traumatic stress disorder has been associated with a wide array of traumatic conditions. Nursing practitioners have a strong role to play with treatment of this disorder. Blizzard, Kemppainen & Taylor (2009) argue that while nurse practitioners can contribute to the direct treatment, there role is more prominently linked to identifying the disorder. Because of the complexity of the disorder as not simply existing in the outward manifestation of anxiety but in the root cause of trauma, it is highly necessary for the nursing practitioner to work towards this identification. Additionally, care facilities are recognized for the potential treatment of post-traumatic stress disorder through a variety of programs. Cahill & Foa (2004,p. 34) note that the most notable programs involve exposure therapy, stress inoculation training, and variants of cognitive therapy. One of the central thorough-puts of these mental health investigations in the nursing care context is that the individuals afflicted with these disorders demonstrate a lack of functional living skills. Indeed, this concern area spans an array of disorders and factors. In addressing this issue a variety of comprehensive treatment options are necessary. Most specifically in this context is the recognition that increased socialization and community integration is necessary. 2.1.2 Psychological or Neurological Conditions. While obsessive-compulsive disorder constitutes one of the major mental health concerns exhibited by patients, miscellaneous psychological and neurological conditions are also of large-scale concern. Within the context of behavioral care centers neurological conditions have been recognized as constituting some of the most prominent treatments areas. Indeed, Chahine (2008, p. 1265) notes that neurological disorders were the second most prominent in-house treatment concerns after cancer. These conditions include people suffering from mental illness. There are numerous risks involved with putting people suffering from mental retardation in the same surrounding with the people suffering from dementia. The people suffering from mental retardation can cause bodily harm to the weak, elderly patients (Chahine 2008, p. 1265). Mentally retarded people cannot think rationally and hence they are not responsible for anything they do (Chahine 2008, p. 1267). Elderly people suffering from dementia can also pose a threat to the mentally retarded people (Chahine 2008, p. 1267). In my organization, there will be services and programs available for people suffering from mental retardation that are not available nor mandated for the nursing home residents. Another prominent neurological condition that must be considered within the context of this specific mental health clinic is schizophrenia (Bell 2006, p. 21). Schizophrenia is recognized as a breakdown in thought processes and poor emotional responsiveness (Bell 2006, p. 21). It is characterized by a general disorganized thinking, and is often accompanied by delusions, voices, and paranoid beliefs (Phelan 2000, p. 190). Because of the severity of the disorder it should be no surprise that it is one of the most prominent causes of hospitalization and a great amount of the individuals admitted into this particular nursing care facility will assuredly be afflicted with schizophrenia. There is correspondingly a number of nursing care considerations related to this specific disorder. There are a great amount of drug treatment options for individuals with schizophrenia. Some of the most prominent such treatment options have been drugs such as Seroquel or lithium; both when administered at a high dosage have demonstrated effectiveness contingent on the severity of the individual’s schizophrenic symptoms (Phelan 2000, p. 192). Undoubtedly these will be prominent treatment mechanisms at the facility. In addition to medication, nurse practitioner led practices include non-drug treatment options. Group meetings have been implemented as a means of talk therapy in relation to schizophrenia. This approach largely adopts a cognitive-behavioral stance to treatment. Ultimately, these nurse practitioner led methods will be implemented within the care facility. Another prominent consideration within the treatment care facility is atypical psychosis. While the previously considered mental disorders represent medically defined diagnostic criteria, atypical psychosis is recognized as a more subtle form of diagnosis. Atypical psychosis, “include postpartum psychotic episodes; psychoses with unusual features (e.g., persistent auditory hallucinations as the only disturbance); and psychoses with confusing clinical features that make a more definitive diagnosis impossible” (Smith 1998, p. 895). As these severe conditions involve a wide-spectrum of disorders, nurse practitioner led options vary. To a great extent the nature of these disorders involves a degree of severity that necessitates patients are housed permanently within the facility and their living arrangements are tailored to the specific level of dysfunction of their condition. Within this spectrum of recognition is the nature of dual diagnosis. Dual diagnosis is the comorbid condition of a mental illness and a substance abuse problem. As one considers there is a considerable spectrum of disorders that fall within this category, as mental disorders are frequently accompanied by substance abuse problems. In this spectrum of recognition care facilities are understood as necessarily involving both treatment for substance abuse problems, as well as care directed at the underlining mental disorder. 2.1.3 General Mental Health Home Concerns. While specific mental health disorders represent the backbone of the health care facility, this research and literature review recognizes that there are specific concerns related to the nature of the care facility itself. Elstad & Hellzen (2010) conducted a qualitative study of mental health work in community health care centers. The study specifically aimed to gain professional’s perspectives on their work in the mental health center context as a means of developing proscriptive structural components. Specifically the research demonstrated a number of consistent themes. Most notably, these involve the importance of flexibility and socialization. These elements have been considered within the structure of the development of this specific system. In addition to general qualitative assumptions, the literature has demonstrated a number of more specific area concerns. One mode of examination considers age as a prominent notion. For instance, Law (2008) argued that putting people under the age of 65, suffering from mental illness in nursing homes is not a wise idea, and it falls contrary to both the state and federal policy. Law (2008) Nursing homes may offer bed and medication management but lack the active or intensive mental health treatment. People suffering from mental diseases are extremely vulnerable due to the cognitive impairments that can affect vital aspects in their life. They require a safe and conducive environment to stay, get treatment and probably return to a normal state. They need to get an opportunity to get treatment and to return to their communities. Mentally ill persons who also serve as convicted felons will get accommodated. When a person is mentally ill, their needs cannot be met in the jail. They require active treatment that is consistent with a psychiatric hospital or a rule 36 facility for more intensive treatment. These people require appropriate and better treatment for their mental diseases that will ensure no repetition of the crimes they committed. They need better treatment and hope that one day they can go back to a more productive life. My institution will ensure that these individuals get the best treatments. 2.2 Competitive Analysis The company expects stiff competition from JBS Mental Health and Eastside Mental Health Center both situated in Birmingham Alabama. The nature of the organization, however, is such that specialization, insurance, and location will greatly influence flow of clientele. In these regards, the business model need not reflect that of traditional marketing concerns. 2.2.1 Size. Eastside Mental Health Center is one of the private and nonprofit society mental health centers. It is a tremendous organization that serves nearly 3200 adults and children. Additionally, it is well established in the community with a strong brand identity and positive reputation. 2.2.2 Scope. Eastside aim is providing cost effective, accessible, and high quality professional services and programs to people suffering from different mental illness and living in Alabama. While Eastside excels in scope of operations and long-term reputation, the organization’s large-scale nature may present specific difficulties for patients with specific issues who require more specialized care concerns. 2.2.3 Product/ Service Offering Services provided is to ensure a significant degree of independent living in an environment that is less restricted. The services focus on the recovery of patients, customer satisfaction and should be offered with the utmost respect and dignity. The staff gets treated well, and their input becomes encouraged. The institution aim is to promote the personal and professional growth of the staff. While the structural amenities are of definite concern, they are secondary to business operations in the realm of human resource management. In these regards, the organization believes that through building strong human resource staff they will be able to develop the quality care concerns that are necessary for long-term organizational success. The institution provides outpatient services such as; psychiatric evaluation, intake evaluation, peer support specialist services, transportation for the Medicaid Eligible, family support and education, and also crisis after hours phone counseling. The center gives intensive programs such as, intensive day treatment, rehabilitative day program and assertive community treatment. From more general qualitative notions specific patients are afforded greater degrees of flexibility in accord with prominent literature. Socialization is also implemented, as specific patients are placed into integrative community health care programs. 2.2.4 Indirect Competition Horizon Wellness Recovery Center expects stiff competition from nursing homes providing care to the mentally ill, and also the Alabama Department of Corrections that provide services to convicts suffering from mental illness. At home care is also recognized as a potential option for some patients. In all situations the organization recognizes the importance of cost, efficiency, and staff as a means of remaining competitive in the market. 2.2.5 Future Competition The company expects competition from other recovery centers yet to be established in the region. Additionally, there is the potential of telehealth options contributing to the competitive imbalance. 2.3 SWOT analysis: 2.3.1 Strengths 1. A number of my staff members have worked with the Department of Corrections and can therefore, work with prisoners suffering from mental illness properly. This specific experience can constitute a strong competitive advantage, as this is a specialization area that can differentiate the organization for the earlier mentioned Eastside healthcare. 2. My institution will have an individual risk assessment for every individual placed there so as to ensure that staff know, understand and protect individuals from their own problems as well as from the risks of other residents. While primarily implemented for patient and staff safety, this will also have the indirect effect of improving organizational efficiency and long-term reputation management. 3. The institution will not socially isolate the mentally ill so as not to deprive them emotionally and physically. Indeed, socialization and flexibility in interaction are recognized as prominent contributing elements for long-term health. There will be an integrative health care program instituted then that combines the institutional environment with community-based interaction. 4. High quality patient care to the mentally sick. Specialization in areas yet to be determined will also be implemented. 5. My organization gets totally immersed in Enterprise Application Integration (E A I) and IT, from the computerized clinical record system (CPRS) to bedside terminals, to barcodes for medications and supplies to integrated professional workstations (P W S). 6. My institution will provide medical and health insurance to the staff members in order to attract workers in the center. Human resources constitutes a prominent organizational strategy. 7. Providing a conducive and comfortable environment for people receiving health care, and for health practitioners, health care environment designed for comfort, safety and functionality, providing access to social, emotional and spiritual support for mentally ill together with their families, as well as for staff of the facility; appropriate and flexible visiting policies; risk management policies (i.e. infection control guidelines) that protect the public, patients and staff; and use of waiting rooms and other public spaces within the premises of health care facilities and organizations for opportunistic health education. 8. Involving patients and families in healthcare decisions that directly affect their care 9. Understanding a patient’s individual characteristics and experiences is another thing the center will consider seriously. 10. The institution will increase interaction with patients to ensure their comfortable stay. 2.3.2 Weaknesses 1. Lack of real-time access to current, comprehensive patient medical information, which is easily retrievable for patients can be a hindrance to the success of the organization. 2. The high costs required in developing the center. 3. Lack of trust from the community. 4. Dealing with some patients can be tiresome and stressful. 2.3.3 Opportunities 1. The deinstitutionalization that led to the transfer of people from the public mental hospitals opened a way for the development of the company. The influx of mentally people everywhere will provide the company with the patients. 2. The use of new technology in assessing patients and staff records. 3. Lack of better facilities in the nursing institutions and other recovery centers. 2.4.4 Threats 1. Introduction of other mental recovery centers in the same region. 2. Upgrading of the nursing institutions to offer better services and programs to the mentally ill patients. 3. New regulations targeting the development of new rehabilitation and recovery centers. 2.4 Business Conditions, Excellent or Poor; Political The business conditions at the time are excellent. There are a number of mentally ill patients requiring professional help. Most of them lack better places to go, and this will provide an opportunity for the center to develop. The state of Alabama and society has done a terrific job in rethinking, recognizing and developing various ways for the mentally disabled citizens. Introduction of four and five bed foster home care that provides wavered services is an example of this. The state of Alabama has integrated the most institutionalized citizens into community settings, comprising some of the mentally challenged citizens with extremely challenging and difficult behaviors, and in a much compromised physical condition. The Olmstead Decision clearly requires every institution to do this for all disabled citizens, including the mentally ill and mentally retarded individuals with challenging behaviors and criminal histories. However, we, the states, counties and the public in general, have failed in doing this in any consistent way. Concisely, it is my assertion that many of the recently established nursing homes have the hidden agenda of making money. This, therefore, results to exceedingly low quality of patient care as the owners go ahead and take as many mental ill and mentally retarded patients as they possibly can. However, there exists only a handful that gets set up with the aim of taking excellent care of these people. Unfortunately, the centers are unaffordable as compared to the rest, hence sidelining the financially unstable families that need this service (Stout, 2005). The Mental Retardation and Mental Health Ombudsman, and the Olmstead Act, considered protections for all disabled individuals under the age of 65, in nursing homes prior to the issue of sex offender placement came to fruition and offered protection on the grounds of vulnerability. Both programs mandate ways of treating the elderly and mentally retarded individuals (Law, 2008). Nursing homes are not the best place to for a physically handicapped, or a mentally retarded individual because there is the lack of counseling and personal care. Therefore, it is imperative for the government to ensure safety post deinstitutionalization. References Alligod, M. (2006). The nursing theorists and their work. St. Louis, Mi: Mosby. Bell V. (2006) Explaining delusions: a cognitive perspective. Trends in Cognitive Science. 2006;10(5):219–26. Blizzard, S. J., Kemppainen, J., & Taylor, J. (2009). Posttraumatic stress disorder and community violence: An update for nurse practitioners. 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