Organizational Needs Assessment

Comprehensive Essay Example on Healthcare Organizational Needs Assessment

Introduction

Purpose Statement

The purpose of this paper is to conduct an organizational needs assessment at Bryn Mawr Nursing Home.

Practice Problem

Treatment nonadherence is a clinical issue affecting patients receiving Schizophrenia medication. Treatment nonadherence is associated with significant health outcomes for patients and healthcare facilities, including worsening conditions, risks or mortality, and increased healthcare costs (Cutler et al., 2018; Viveiros et al., 2020). Bryn Mawr Nursing Home shares similar concerns, and an appropriate quality improvement initiative is necessary to improve patient outcomes.(Comprehensive Essay Example on Healthcare Organizational Needs Assessment)

Paper Overview

This paper discusses nonadherence as a significant clinical issue at Bryn Mawr Nursing Home worth intervention. A report on comprehensive organizational needs assessment providing a detailed discussion of the practice problem, stakeholder identification, and practice gap analysis is reported in this paper. This paper is based on the concept that DNP-trained nurses play crucial roles in healthcare. Most significant is the quality improvement role (Bolad & Loos, 2020). To spearhead quality improvement, a comprehensive organizational needs assessment is necessary. Organizational needs assessment allows DNP-prepared nurses to identify gaps between current performance and the required performance.(Comprehensive Essay Example on Healthcare Organizational Needs Assessment)

Practice Problem

Treatment nonadherence among Schizophrenia patients remains an area that requires clinical improvement at Bryn Mawr Nursing Home. During my practicum, I interacted with patients presenting worsening symptoms due to treatment nonadherence. The patients gave three reasons for nonadherence: a negative attitude towards medication, lack of awareness of their illness, and poor relationship with the psychiatrists. Nonadherence was common among patients taking antipsychotic medication.(Comprehensive Essay Example on Healthcare Organizational Needs Assessment)

Further literature analysis revealed that medication nonadherence among Schizophrenia is a common clinical issue in mental healthcare practice that requires clinical intervention. A narrative review by Salzmann-Erikson & Sjödin (2018) showed that individuals diagnosed with Schizophrenia remain uninformed about prescribed medication by healthcare professionals. Consequently, poor therapeutic alliance often leads to higher rates of nonadherence. Salzmann-Erikson & Sjödin (2018) also argued that despite the inadequate understanding of prescribed medication, patients usually value conversations with healthcare professionals, highlighting a significant practice gap that requires improvement. Remaining ignorant about medication presents a significant barrier to treatment adherence, and involving patients in their care remains a crucial practice concept that, when wholly adopted, can improve treatment adherence and consequent patient outcomes.(Comprehensive Essay Example on Healthcare Organizational Needs Assessment)

Although a persistent phenomenon, medication nonadherence among Schizophrenia patients has been significantly studied, antipsychotic nonadherence was common among Schizophrenia patients and related to comorbidities, substance abuse, limited insight into medication and illness, suicide history, treatment efficiency, adverse outcomes, cost of medication, lack of social support, perceived stigma, treatment complexity, substance abuse, and attitude towards medication (Lieslehto et al., 2022; Semahegn et al., 2020). Lieslehto et al. (2022) further argue that nonadherence to antipsychotic medication is associated with differences in administration routes administration, prescription of other concomitant medication, and existing comorbidities. Moreover, half of the patients taking medication report nonadherence, increasing the risk of relapse and rehospitalization (Kikkert et al., 2017). These studies corroborate the findings at the practicum site. Therefore, a comprehensive strategy targeting the factors associated with nonadherence is long overdue.(Comprehensive Essay Example on Healthcare Organizational Needs Assessment)

Stakeholders

Stakeholders are key entities for the successful implementation of this DNP project. In healthcare, stakeholders can be individuals, groups, or another entity privy to the proposed improvement initiative and are central to decision-making and quality improvement within a given jurisdiction (Petkovic et al., 2020). As such, stakeholders facilitate the seamless implementation of an evidence-based project. In this project, internal and external stakeholders will be involved. Internal stakeholders will include nurse leadership, e.g., nurse managers, the nursing director, unit nurses, and the preceptor. The internal stakeholder will be crucial in providing will provide skills, knowledge, and leadership to facilitate the proposed change intervention. (Comprehensive Essay Example on Healthcare Organizational Needs Assessment)

External stakeholders will include target patients, project sponsors (if any), and the Chamberlain faculty of nursing. The identified stakeholders will support the DNP project by providing the required resources and academic guidance. The target patients are the end consumers of the proposed intervention. Their commitment to the study and contribution will facilitate the successful implementation of the project. The opinions and perceptions of the project sponsors and the chamberlain nursing school will guide the project’s trajectory, increasing its robustness and generalizability.(Comprehensive Essay Example on Healthcare Organizational Needs Assessment)

As the primary researcher, I will create awareness about the evidence-based project among the relevant stakeholders through seminars and other related platforms with interactive engagements. All the stakeholders will support the intervention considering its impact on the patient’s health and quality of care intervention. As such, no stakeholder is likely to resist the proposed intervention. However, the patients and nurse leaders will have the most influence. Their involvement will be central to the success or failure of the project. Failure of the patients to participate or drop out of the project is likely to limit the robustness of the outcomes, and a lack of support from the institution’s leadership will limit or affect the project entirely.(Comprehensive Essay Example on Healthcare Organizational Needs Assessment)

Gap Analysis Table

What is currently happening at the practicum site?	What should be happening at the practicum site based on current evidence?	What is your practice gap? (state what is currently happening and state what should be happening)	Why is there a practice gap?	What factors are contributing to the practice gap?	What evidence do you have to demonstrate there is a practice gap?
There are high rates of medication nonadherence among Schizophrenia patients. There is no clinical practice intervention for reducing treatment nonadherence among Schizophrenia patients in the Memory Care unit.(Comprehensive Essay Example on Healthcare Organizational Needs Assessment)	Primary Mental Health Nurse Practitioners (PMHNPs) should adopt an evidence-based clinical practice intervention to treat Schizophrenia symptoms better. The evidence-based clinical practice intervention to be used is motivational interviewing using technology.(Comprehensive Essay Example on Healthcare Organizational Needs Assessment)	About half of schizophrenia patients report treatment nonadherence. However, there are no existing interventions to mitigate the high rates of medication nonadherence by PMHNP nurses when providing treatment. (Comprehensive Essay Example on Healthcare Organizational Needs Assessment)	Lack of knowledge on the role of motivational interviewing on medication adherence among schizophrenia patients.(Comprehensive Essay Example on Healthcare Organizational Needs Assessment)	Negative attitude toward medication, patients’ lack of awareness of their illnesses, and poor therapeutic alliance between patients and psychiatrists. Other factors include comorbidities, substance abuse, suicide history, adverse treatment outcomes, perceived social stigma, lack of insight into medication, treatment efficiency, treatment costs, and treatment complexity.(Comprehensive Essay Example on Healthcare Organizational Needs Assessment)	Comments by the patient and the PMHNPs; The patients reported concerns with medication nonadherence due to; Negative attitude towards medication, lack of awareness of their illness, and poor relationship with the psychiatrists. The PMHNP reports no intervention to mitigate the factors associated with medication nonadherence among Schizophrenia patients.(Comprehensive Essay Example on Healthcare Organizational Needs Assessment)

Conclusion

The purpose of this paper was to conduct an organizational needs assessment at Bryn Mawr Nursing Home. The assessment ascertained treatment nonadherence among Schizophrenia patients and the lack of clinical practice intervention for reducing treatment nonadherence among Schizophrenia patients in the Memory Care unit. About half of the schizophrenia patients reported treatment nonadherence. However, there are no existing interventions to mitigate the high rates of medication nonadherence by the PMHNP nurses when providing treatment, which is attributed to a lack of knowledge on the role of motivational interviewing on medication adherence among schizophrenia patients. Other factors include negative attitudes towards medication, patients’ lack of awareness of their illnesses, and poor therapeutic alliance between patients and psychiatrists.(Comprehensive Essay Example on Healthcare Organizational Needs Assessment)

Moreover, stakeholders will play a crucial role in ensuring the seamless implementation of the evidence-based intervention at Bryn Mawr Nursing Home. All the stakeholders identified are likely to support the project implementation, and no stakeholders are perceived to resist the project implementation. The stakeholders with the most influence in the project will be the participating patients and the Bryn Mawr Nursing Home leadership. (Comprehensive Essay Example on Healthcare Organizational Needs Assessment)

References

Boland, M. G., & Loos, J. R. (2020). Spotlight on Nursing: The Doctor of Nursing Practice (DNP): Preparing Hawai’ i’s Nursing Care Providers. Hawai’i Journal of Health & Social Welfare, 79(6), 204. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7281346/

Cutler, R. L., Fernandez-Llimos, F., Frommer, M., Benrimoj, C., & Garcia-Cardenas, V. (2018). Economic impact of medication nonadherence by disease groups: a systematic review. BMJ open, 8(1), e016982. https://doi.org/10.1136%2Fbmjopen-2017-016982

Kikkert, M. J., & Dekker, J. (2017). Medication adherence decisions in patients with Schizophrenia. The Primary Care Companion for CNS Disorders, 19(6), 26621. https://doi.org/10.4088/PCC.17n02182

Lieslehto, J., Tiihonen, J., Lähteenvuo, M., Tanskanen, A., & Taipale, H. (2022). Primary Nonadherence to Antipsychotic Treatment Among Persons with Schizophrenia. Schizophrenia Bulletin, 48(3), 655-663. https://doi.org/10.1093/schbul/sbac014

Petkovic, J., Riddle, A., Akl, E. A., Khabsa, J., Lytvyn, L., Atwere, P., … & Tugwell, P. (2020). Protocol for developing guidance for stakeholder engagement in health and healthcare guideline development and implementation. Systematic reviews, 9(1), 1-11. https://doi.org/10.1186/s13643-020-1272-5

Semahegn, A., Torpey, K., Manu, A., Assefa, N., Tesfaye, G., & Ankomah, A. (2020). Psychotropic medication nonadherence and its associated factors among patients with major psychiatric disorders: a systematic review and meta-analysis. Systematic Reviews, 9(1), 1-18. https://doi.org/10.1186/s13643-020-1274-3

Viveiros, C. P., Tatar, C. R., Dos Santos, D. V. D., Stefanello, S., & Nisihara, R. (2020). Evaluation of nonadherence to treatment among patients with Schizophrenia attending psychosocial care centers in the south region of Brazil. Trends in psychiatry and psychotherapy, 42, 223-229. https://doi.org/10.1590%2F2237-6089-2019-0072