A Business Plan: Developing a Nurse Practitioner Led Wellness and Recovery Center - Dissertation Example

? BUSINESS PLAN FOR A WELLNESS AND RECOVERY CENTER FOR DE ALIZED INDIVIDUALS BY AUDRY GREEN GORMAN DOCTOR OF NURSING PRACTICE CLINICAL PROJECT Submitted in partial fulfillment of the requirements for the degree, Doctor of Nursing Practice, American Sentinel University, (Date) Project Committee __________________________ Chair __________________________ Date Chair, Graduate Nursing Department CHAPTER 1 Introduction For a long-time resident of a psychiatric ward, life has become a predictable routine. He knows what happens by the time he wakes up and other interventions designed for his own case. These interventions may either be one-on-one sessions with a healthcare professional or with a group undergoing therapy. Getting plucked out of an institution where he has been accustomed to may be upsetting for him and the other residents he has been with for a long period of time as he may have nowhere else to go to continue the services he has been receiving from the medical institution. In Alabama, the Department of Mental Health announced its restructuring plan to close four of the state’s six mental health hospitals with the intention of moving 470 patients to community-based care (Beyerle, 2012). This de-institutionalization of patients is bound to cause several problems in health care and it would take a long time to build replacement facilities for these patients across the state, which includes 16-bed regional homes and crisis centers. When communities undergo widespread deinstitutionalization, individuals who have been at hospitals or 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. Even proponents of Alabama’s deinstitutionalization worry that the state will be unable to care for people with chronic and acute mental illnesses once state-run facilities are eliminated. Over the last five decades, widespread deinstitutionalization has resulted in a 90% decrease in the number of beds in psychiatric hospitals nationwide (Treatment Advocacy Center, 2012). Although other businesses in Bessemer, Alabama offer ongoing treatment for adults with behavioral health needs, the demand for these services is high and continuing to rise. There are simply not enough providers to meet the demand for mental health services. Horizon Wellness Recovery Center is a start-up residential care facility 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. Horizon Wellness Recovery Center will meet a vital need by providing compassionate, professional care to adults transitioning from long-term residential care to life in the community. This business plan will provide a comprehensive profile of Horizon Wellness Recovery Center and how it purports to offer its services to patients in need of quality health care and day treatment services especially for mentally ill adults. Problem Statement Alabama is in the process of closing all but two of its state-run psychiatric hospitals. The only two facilities remaining will be a forensic psychiatric hospital (limited to mentally ill people who have committed a crime) and a geriatric psychiatric hospital. According to the Treatment Advocacy Center (2012), a national nonprofit dedicated to eliminating barriers to the treatment of mental illness, the next several years will see virtually all patients currently under state care in Alabama forcibly released into the community. There is a clear need for treatment centers to assist with this transition, and to provide ongoing behavioral care to the thousands of adults who will no longer be able to depend on state-run institutions for psychiatric care. Background De-institutionalization of mental health servces seems to be an ongoing trend over the last decades due to the dwindling quality of hospital-based care (Scull, 1990). Sealy and Whitehead (2004) explain that deinstitutionalization comprises three processes namely the shift away from the patient’s dependence on psychiatric services in hospitals, ‘trans-institutionalization’ or moving on to general hospitals or other settings, and a growth of community-based services, both in-patient and out-patient, for people with mental health disorders and problems. Reasons for deinstitutionalization may be varied. Pederen & Kolstad (2009) have identified logical reasons as follows: Pharmacological revolution – the development of new anti-psychotic drugs in the early 1950’s found to be effective for the patients kept them out of the institutions as they were content taking the medication at home (Thornicroft & Bebbington, 1989; Jones, 1972). Critique of psychiatry and the total institutions – prolonged stay in institutions were believed to have ill effects in the 1950’s (Miller, 1985; Sheff, 2009) The welfare state – provision of welfare services such as disability pensions, housing, etc. freed long-term patients to leave the institutions (Mechanic & Rochefort, 1994) Cost containment and the fiscal crisis of the state – the 1973 oil crisis caused the drop of the economy, pressing government to cut costs on the budget. This affected the budget for mental health services (Pederen & Kolstad, 2009). Shift in the focus of services – medical treatment shifted its focus from long-term care to active and acute treatment (Busfield, 1986). Increased emphasis on patients’ rights and preferences – some patients in long-term care in hospital care opt to recover in their own homes as they felt constrained in the hospital environment (Pederen & Kolstad, 2009). De-institutionalization has caused a paradigm shift in terms of treatment perspective, from symptom management and relapse prevention advocated by hospital and institutional care to promotion of quality of life in deinstitutionalization and community-based care (Sartorius, 1997). Quality of life is the product of the patients’ efforts in adapting to both internal and external factors that may affect their condition upon leaving hospital and institutional care (Angermeyer & Kilian, 1997). Apart from deinstitutionalization of persons with mental health disorders, the ageing population developing mental illness in their advanced years is growing, necessitating the need for more community based nursing care. Jeste et al (1999) estimate that from four million in 1970, this number of elderly with mental illness will shoot up to about 15 million by the year 2030. 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). As Alabama moves toward closing all but two of its state-run psychiatric hospitals, nearly all of the patients currently under the care of the state will be in need of the day treatment services. The huge number of de-institutionalized patients may not have enough mental health centers to cater to their needs as they seek continuation of their treatments. Deinstitutionalization places a huge burden on communities that lack the infrastructure and resources to treat people with behavioural and mental health needs. Hence, there is a need for mental health treatment centers to offer the services they need provided by competent, compassionate and responsible health care professionals while they are mainstreamed back to the community. Due to the sensitivity of the cases of mentally ill patients and the risk of letting them be mainstreamed into the community without the constant supervision they had in mental institutions, only qualified mental health care professionals should run the treatment centers. Purpose Statement The purpose of this capstone project is to develop a comprehensive business plan to support the establishment of a nurse practitioner- led wellness and recovery center for persons with behavioural and mental health needs in Bessemer, Alabama. The center shall be called the Horizon Wellness and Recovery Center. Significance of the Study This project is for the establishment of a nurse practitioner- led wellness and recovery center in Bessemer, Alabama. The Alabama Department of Mental Health offers mental illness services with “a comprehensive array of treatment services and supports throughout five state-operated facilities and contractual agreements with community mental health centers across the state” (The Alabama Department of Mental Health, 2012 para. 3). It is reported that over 3,000 individuals are served in the state-operated facilities while over 100,000 are served in certified community-based programs. However, due to the movement of deinstitutionalization, more services are required to meet the demands of the growing number of patients with mental health issues. Given the shortage of healthcare and mental health the country there is a need for qualified healthcare providers to fill this gap. 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. It is understood how overwhelming it is for the patients to be moved out of their comfort zones and into the community which they were not part of for a long period of time while they were confined in the medical or mental institution. That is why Horizon Wellness and Recover Center can ease them in their transition by continuing the medical care they derived from their former institutions while they are situated in the community already. One significance of a center specialized in the treatment of adult mental patients is that it somehow assures the community that such patients do not go around the neighborhood without any supervision from a mental health professional. The risks of getting physically hurt by some mental patients may be high if they are released from the institutions without someone or an organization to welcome them and guide them accordingly back to community living. The Nature of the Project The business plan for the Horizon Wellness and Recover Center will cover proposed services to be offered to adults who are in the process of transitioning from life in a state-run psychiatric hospital to life in the community. It will include usual nursing care services as well as psychological services needed to maintain the physical and mental health of the patients while living in the community. In view of this, the necessary qualifications of the prospective staff shall be enumerated. It will also lay out the operations of the center including all the necessary department functions, clinic hours, emergency measures and duties of the employees and staff posted in each department. The business plan will also present a comprehensive marketing campaign designed to create interest in the center. It will also provide a proposed budget and funding sources as well as how it plans to achieve return of investment. Theoretical Framework At Horizon Wellness Recovery Center, the practitioners and staff are trained to uphold health promotion models in dealing with patients and their families. 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. 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. Since one purpose of deinstitutionalization is getting the patients mainstreamed into the community, another good health promotion program that Horizon Wellness and Recovery Center advocates is one by Ewles & Simnett (2005). It takes a holistic health care approach, taking into account all dimensions of a person’s development. Ewles & Simnett (2005) 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). Horizon Wellness and Recovery Center collaborates with the patients’ families in order to achieve goals set up for the patients in all aspects of his or her healing and recovery as he or she rejoins the community as a functioning member. Diagram of Horizon Wellness & Recovery Center’s Theoretical Framework Definitions Collaborative care - “Interdisciplinary collaboration refers to the positive interaction of two or more health professionals, who bring their unique skills and knowledge, to assist patients/clients and families with their health decisions.” (Enhancing Interdisciplinary Collaboration in Primary Health Care Initiative (EICP), 2005) De-institutionalization – “The release of institutionalized people, especially mental health patients, from an institution for placement and care in the community” (The Free Dictionary, 2012). Health Belief Model (HBM) – “Health behaviour is determined by personal beliefs or perceptions about a disease and the strategies to decrease its occurrence (Hochbaum, 1958). Holistic health care – “an approach to analysing illness and providing healthcare that acknowledges and responds to all factors relevant to the health (or ill- ness) of a person.” (Wade, 2009) Mental Health – “a broad array of activities directly or indirectly related to the mental well-being component included in the WHO's definition of health: ‘A state of complete physical, mental and social well-being, and not merely the absence of disease’. It is related to the promotion of well- being, the prevention of mental disorders, and the treatment and rehabilitation of people affected by mental disorders” (World Health Organization, 2012) Mental Illness – “a wide range of mental health conditions — disorders that affect your mood, thinking and behavior. Examples of mental illness include depression, anxiety disorders, schizophrenia, eating disorders and addictive behaviours” (Mayo Clinic, 2012). Mental retardation – “a disability characterized by significant limitations both in intellectual functioning and in adaptive behavior as expressed in conceptual, social, and practical adaptive skills (American Association on Mental Retardation, 2002). Nurse practitioner – “A registered nurse with special training for providing primary health care, including many tasks customarily performed by a physician” (American Heritage Dictionary of the English Language, 2009). Nurse practitioner run clinics – a clinic providing medical treatments run by a Nurse practitioner. Perceived Barriers – “ an individual’s own evaluation of the obstacles in the way of him or her adopting a new behaviour” (Haden, 2008). Perceived Benefits – “a person’s opinion of the value or usefulness of a new behaviour in decreasing the risk of developing a disease (Hayden, 2008). Perceived Seriousness – “an individual’s belief about the seriousness or severity of a Disease (Hayden,2008) Perceived Susceptibility – the perception that “the greater the perceived risk, the greater the likelihood of engaging in behaviours to decrease the risk” (Hayden, 2008). Quality of care with nurse practitioners – “provision of high-quality, patient-centered care and improvement of the health status of those they serve” (American College of Physicians, 2009) Recovery – “a deeply personal, unique process of changing one’s attitudes, values, feelings, goals, skills and/or roles. It is a way of living a satisfying, hopeful, and contributing life even with limitations caused by the illness. Recovery involves the development of new meaning and purpose in one’s life as one grows beyond the catastrophic effects of mental illness." (Anthony, 1993) Wellness – “a choice to assume responsibility for the quality of your life. It begins with a conscious decision to shape a healthy lifestyle. Wellness is a mind set, a predisposition to adopt a series of key principles in varied life areas that lead to high levels of well-being and life satisfaction.” (Ardell cited in ILRU.org, 2002) Wellness and recovery center –place where an individual works toward recover from illness and eventually achieves wellness through various interventions and services provided by health professionals. Scope and Limitations This scope of this project only covers details in the business plan of a nurse practitioner-led wellness and recovery center for individuals with mental illness after they have been deinstitutionalized from mental health facilities in Alabama. It will also be limited to following its theoretical framework as inspired by the Health Belief Model and the Ewels & Simnett health promotion model and will only cover the needs of the people of Alabama. Summary This first chapter discusses the proposal to create a business plan for a nurse practitioner-led wellness and recovery center for individuals with mental illness. It explains why such a business is necessary to establish in the state of Alabama due to the deinstitutionalization of patients in state-run mental institutions into communities. This chapter also presented the theoretical framework that will guide the center in the provision of high quality nursing care to their patients. References American College of Physicians (2009) Nurse Practitioners In Primary Care. Retrieved on July 25, 2012 from http://www.acponline.org/advocacy/where_we_stand/policy/np_pc.pdf American Heritage Dictionary of the English Language 4th Ed. (2009) Houghtton Mifflin Company Angermeyer MC, Kilian R (1997) Theoretical models of quality of life for mental disorders. In: Katschnig H, Freeman H, Sartorius N (eds) Quality of life in mental disorders. John Wiley and Sons, Chichester, pp. 19–30 Anthony, W. A. (1993). Recovery from mental illness: The guiding vision of the mental health service system in the 1990’s. Psychosocial Rehabilitation Journal, 16(4), 11-23. Beyerle, D. (2012) Bentley halts construction on psychiatric facility, Retrieved on July 25 from http://www.tuscaloosanews.com/article/20120314/NEWS/120319849?p=1&tc =pg Busfield J. (1986) Managing Madness. Changing ideas and practice London: Hutchinson. 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. Enhancing Interdisciplinary Collaboration in Primary Health Care. Primary Health Care: A Framework That Fits (April 2005) http://www.eicp- acis.ca/en/resources/pdfs/Enhancing-Interdisciplinary- Collaboration-in-Primary-Health-Care-in-Canada.pdf (last accessed July 2006) 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. Hochbaum, G.M. (1958) Public Participation in Medical Screening Programs: A Socio-psychological Study (Public Health Service Publication No. 572). Washington, D.C.: Government Printing Office ILRU.org (2002) Definitions of Health and Wellness, Retrieved on July 25, 2012 from http://www.ilru.org/healthwellness/healthinfo/wellness-definition.html Jeste, D.V., Alexopoulos, G.S., Bartels, S.J., Cummings, J.L., Gallo, J.J., Gottlieb, G.L., Halpain, M.C., Palmer, B.W., Patterson, T.L., Reynolds, C.F. III & Lebowitz, B.D. (1999) Consensus statement on the upcoming crisis in geriatric mental health: research agenda for the next 2 decades. Archives of General Psychiatry 56, 848–853. Jones, K (1972) A History of the Mental Health Services London: Routledge and Kegan Mayo Clinic (2012) Mental Illness, Retrieved on July 27, 2012 from http://www.mayoclinic.com/health/mental-illness/DS01104 Mechanic D, Rochefort D: Deinstitutionalization of the Mentally Ill. Efforts for Inclusion. In Inescapable Decisions. The Imperatives of Health Reform Edited by: Mechanic D. New Brunswick/London: Transaction Publishers, 165-212. Miller, A. (1985)Deinstitutionalisation in retrospect. Psychiatric Quarterly 57:160-171. 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 Sartorius N (1997) Quality of life and mental disorders: a global perspective. In:Katschnig H,Freeman H,Sartorius N (eds) Quality of life in mental disorders. John Wiley and Sons, Chichester, pp. 319–328 Scull A (1990) Deinstitutionalization: cycles of despair. Journal of Mind and Behaviour 11:301–312 Sealy P, Whitehead PC: Forty years of deinstitutionalization of psychiatric services in Canada: An empirical assessment. Canadian Journal of Psychiatry-Revue Canadienne de Psychiatrie 2004,49:249-257. Sheff, T.J. (2009) Being Mentally Ill: A Sociological Theory New York: Aldine 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. The Alabama Department of Mental Health (2012) Division of Mental Health & Substance Abuse Services, Retrieved on October 12, 2012 from http://www.mh.alabama.gov/MI/?sm=b The Free Dictionary (2012) Deinstitutionalization, Retrieved on July 27, 2012 from http://medical-dictionary.thefreedictionary.com/deinstitutionalization 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. Thornicroft G, Bebbington P (1989) Deinstitutionalization - from Hospital Closure to Service Development. British Journal of Psychiatry1989, 155:739-753. Wade, D. (2009) Holistic Health Care: What is it, and how can we achieve it?, Retrieved on July 23, 2012 from http://www.noc.nhs.uk/oce/research- education/documents/HolisticHealthCare09-11-15.pdf World Health Organization (2012) Mental Health, Retrieved on July 26, 2012 from http://www.who.int/topics/mental_health/en/ Read More