Action Plan
Self Reflection
We live in a time when mental health has been increasingly failing for many individuals. Many situations that are reflected in our societies today re increasingly convincing me, helping me to come to realize that mental health nurses matter, are essential healthcare providers, and will continue to be needed in the future. Mental health nurses are in the right position to grow in the understanding of mental health and to better identify the constructs and care practices that promote, strengthen, and protect the mental health of individuals and families.
Mental health can be a very challenging area to work in and as an experienced student nurse, I have a great admiration for the skills and commitment registered mental health nurses give. There are many qualities that a registered mental health nurse must possess. Personally, I feel that I have already developed some of these qualities given the time and experience that I have spent in the mental health field. To illustrate my capabilities, I will outline in the succeeding paragraphs the qualities that I have developed as well as the situations where I have applied them. These are experiences that I have encountered 6 months prior to registration.
A registered mental health nurse must adopt a quality of mental health practice. The nurse systematically enhances the quality and effectiveness of nursing practice (2004). As a student nurse, I have demonstrated quality by documenting the application of mental health nursing process in a responsible, accountable, and ethical manner. I also use creativity and innovation in nursing practice in order to improve the delivery of care. When I feel that the desired outcomes of quality are not achieved, I start to plan that I should incorporate new knowledge to initiate the desirable changes that are needed in the mental health area.
However, I have also reflected that the quality of mental health care or of health care for that matter also rests on other aspects. Quality of patient care is threatened by the acute shortage of nursing staff and at times a less than optimum mix of skills and experienced staff. The consequences are felt by patients or their families as well as nurses and have implications for clinical responsibilities and vulnerability to litigation.
Patients with chronic mental alterations can restore or maintain their health through a variety of strategies aided by the mental health nurse. Sometimes, mental health patients require medications to maintain or stabilize their health. A medication is a substance used in diagnosis, treatment, relief, cure, or prevention of health alterations ( 2004).
As a student nurse, I am aware that medication administration and evaluation are essential to nursing practice. We need to have knowledge about the actions and effects of the medications we deliver to the mental health patients. Given the delicate condition of the patient, the administration of medications to mental health patients is a more difficult task.
I have also reflected that in order to administer medications, it is essential for the mental health nurse to have an understanding of basic arithmetic to calculate medication doses, mix solutions, and perform a variety of other activities. This skill is important because medications are not always dispensed in the unit of measure in which they are ordered ( 2004). The registered mental health nurse must therefore be aware of approximate equivalents in all major measurement systems.
I have used my knowledge learned from many disciplines when administering medications. It is this knowledge that helps me understand why a particular medication has been prescribed for a patient and how this medication will alter the patient’s condition and behavior.
I have to admit that my weakness lies in the fact that as a nursing student I have limited experience with medication administration as it applies to professional practice. The clinical provides me as a student the opportunity to use the nursing process as it applies to medication administration. As I gain more experience in the field of medication administration, my psychomotor skills become more refined. I have learned that the attitudes of patients, knowledge, physical and mental status and responses can make medication administration a complex experience.
Standards
Standards are those actions that ensure safe nursing practice. Registered mental health nurses should be aware of nursing standards called the six rights of medication administration in order to ensure safe medication administration to mental health patients ( 2004). All medication administration errors can be linked in some way to any inconsistency in adhering strictly to the six rights of medication administration. These six rights are as follows:
- The right medication
- The right dose
- The right patient
- The right route
- The right time
- The right documentation
Maintaining Patient’s Rights
Because of the potential risks related to medication administration, the patient is also given rights. It is the patient’s right to be informed of the medication’s name, purpose, action, and potential undesired effects. The patient can also refuse medication regardless of consequences. The patient also has the right to be properly advised of the experimental nature of medication therapy and to give written consent for its use. The patient has the right to receive appropriate supportive therapy in relation to medication therapy. However, in the case of the mental health patient who may have impaired reasoning, the family of the patient can decide instead and take over the right of the patient.
Ways to Prevent Medication Administration Errors
The table below can help serve as a guide for nurses in avoiding errors in medication administration.
PRECAUTION
RATIONALE
Read medication labels carefully.
Be aware of medications with similar names.
When new or unfamiliar medication is ordered, consult resource.
Do not administer medication ordered by a nickname or unofficial abbreviation.
Do not attempt to decipher illegible handwriting.
Know patients with same last names. Also have the patients state their full names, or ask their families if you cannot talk to the patient.
Many products come in similar containers, colors, and shapes.
There are many medication names that sound alike.
If prescriber is also unfamiliar with the drug, there is greater risk for inaccurate being ordered.
Many prescribers refer to commonly ordered medications by nicknames or unofficial abbreviations.
When in doubt, ask the prescriber. Unless nurse questions order that is difficult to read, chance of misinterpretation is very high.
It is common to have two or more patients in the hospital with the same or similar last names. Special labels n a medication book can warn off potential problems.
Risk Management Process and Action Plan
Mental health nursing is a profession in which “genuine human to human connection should be of particular interest and priority” ( 1995). The identity of mental health nurses should be continually sought and defined in the relationship. However, it has been argued that mental health nursing is in danger of losing its identity if mental health nurses become puppets and just simply imitate psychiatry’s footsteps, particularly after the field of psychiatry has debated the wisdom of an exclusive focus on explanations and treatments in the realm of biology (2003).
The action plan should also include how as a registered mental health nurse I was able to educate my patients and their families. First it is important that as a registered mental health nurse I am aware of nursing theories that are applicable to the mental health patient. One such theory that is important is the preventive theory. Preventive theory as developed by (1964) has three dimensions: primary, secondary, and tertiary. Primary prevention emphasizes health promotion and prevention of disability or disease. Education is the principal vehicle for this kind of prevention. Early case detection and prompt treatment if disease occurs constitute secondary prevention. Tertiary prevention refers to minimizing the severity and residual effects of the disability or disease. Rehabilitation is the principal method for this kind of prevention.
Certain social, political, and economic actions on behalf of a patient’s mental health are inherently compatible with professional values, and should be considered by all mental health nurses. Nurses can be excellent participants and leaders on community action boards, bringing to them special healthcare system knowledge.
Corporate Level
Various health groups in different countries have set up policy and health program developments, and strategic goals in relation to minimizing risk for errors when it comes to medication administration. Various health services and agencies have come up with a clinical guideline for medication administration risk assessment and prevention of errors.
The answer to reducing the prevalence of medication administration errors lies not in implementing any one strategy, but in providing an institution-wide prevention program. Assessments need to be repeated regularly throughout a patient’s hospital stay and when there is a significant change in health status. A number of risk-assessment tools can be used (2004).
Organization Level
A major challenge in many areas of medical practice is to successfully implement guidelines for clinical practice. A recent review of effective strategies for implementing guidelines against medication administration errors concluded that active strategies were more successful in reducing the rates. The most effective strategies used targeted educational sessions and, in particular, multiple approaches.
To formulate the action plan on this level, hospitals and other health care organizations can develop reporting and feedback processes for tracking medication administration to mental health patients and the occurrence of errors. Health care organizations can also develop and implement a comprehensive education program for nursing staff on assessment, identification of risk and management of medication administration.
Project Level
Healthcare professionals must work together in groups or teams in the care of a mental patient especially when it comes to administering medications.
Nursing director:
The nursing director has the role of getting reports from the head nurse. These reports would include statistics of how many incidents of errors in administration of medication to mental health patients are occurring in the hospital and how it is prevented according to new research. In addition, the nursing director also has the responsibility of providing qualified nurses and offers them new courses for continuing education.
Head nurse:
The head nurse plays an important role to prevent the incidence of medication administration errors. The head nurse has the responsibility of providing the policy and procedure in the unit for all staff; as well as making the staff understand the need and importance of such policies and procedures. The head nurse must also distribute enough staff nurses to cover all shifts in the hospital unit because a shortage of nurses may cause bad care for the patients that could lead to an increase in the incidence of medication administration errors in the unit.
Clinical instruction:
Education and clinical instruction of mental patients and their caregivers is an important function of health care professionals, especially of the nurses (2004). Also, the caregivers of the mental patients should be the ones that should be more educated about the situation since mental health patients could have deficits in their understanding level. There are times that the caregiver should be the one to administer medications to the mental health patient. There are a variety of educational tools, including videotapes and written materials that can be used by the nurse when mental health teaching patients and their caregivers or family to prevent the errors in medication administration. Patient instruction should be individualized for each patient, depending on the degree of mental health impairment of the patients.
Nurse:
The nurses are responsible for regularly monitoring patients and giving them the correct medication. However, the nurse does not have the sole responsibility for medication administration. The prescriber and pharmacist also help ensure the right medication gets to the right patient. But still, the registered mental health nurse administering medications is accountable for knowing which medications are prescribed, their therapeutic and nontherapeutic effects, and the medications associated to nursing implications. The registered mental health nurse is also responsible for knowing why the patient needs the medication and determining if the patient and their family require supervision with administration and education about the medication and its effects.
Individual Level
All health care professionals should receive relevant training or education in medication administration and the prevention of errors in the field. Health care professionals with recognized training the administration of medications should cascade their knowledge and skills to their local health care teams. An inter-disciplinary approach to the training and education of health care professionals should be adopted.
Credit:ivythesis.typepad.com
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