NURS2006 Clinical Governance And Practice Improvement

Project Title:

Aggressive and Mentally Ill Patient Handling Project

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Project Aim:

Within four months, the mental health nurses will be well trained equipped and proficient enough to manage effectively the aggressive patients with mental illness in acute care setting thereby ensuring proper care provision to the distressed clients admitted in hospital.

Relevance Of Clinical Governance To Your Project:

Clinical governance is considered as a systematic approach of maintenance and improvement in terms of the quality of healthcare provision within the framework of healthcare system. It has the potential of enhancing the overall healthcare delivery experience for both the service recipients as well as the staff associated with the process. The clinicians and the administrators are likely to share equal responsibilities so that optimum outcomes may be achieved. In mental health setting, it is imperative for the nurses who are the frontline workforce designated to render quality health service to the patients to safeguard and maintain the health status of the concerned persons. Empirical findings have supported the implementation and fostering of clinical management in addition to the risk management strategies for effective performance of nursing duties. Educational programs render opportunities for the nurses to better their professional experience through scopes of improvement (Smith, Latter & Blenkinsopp, 2014). As part of clinical governance in mental health in the Australian context, various measures are in place that encompasses clinical risk management, collaboration with official visitors program, mental health legislative framework, physical healthcare of mental health consumers initiatives and suicide prevention. For clinical risk management, root cause analysis reports alongside review and assessment of mental health related clinical incidents are considered in order to conduct ongoing assessment of clinical risks. Assistance to consumers on matter related to community treatment disorders are carried out by the appointed official visitors who are entitled to visit patients in mental health inpatient facilities within the jurisdiction of NSW in Australia. Mental Health Legislative Framework renders opportunity for the review and amendment of certain mental health legislations that re in vogue. Promotion of patient safety and quality of care is further indicated through definite policy directive and guidelines that caters to both physical as well as mental health provision. In this regard, suicide prevention has gained prominence where definite strategies have been proposed to mitigate the occurrences (, 2017). Therefore, in the given project clinical governance is of particular significance to allow the nursing professionals to gain suitable training and facilities for better management of the aggressive patients with mental illness.

Evidence That The Issue/Problem Is Worth Solving:

The issues of mental health are on the surge in the recent times in Australia considering that a plethora of services have come up in order to mitigate the issue. Policies and programs are in vogue to ensure that the vulnerable population and those who have been affected by the disease get access to quality interventional services catering to their definite needs. Mental health make up of the affected individuals has been a matter of concern for the government and welfare organizations that have come up with novel strategies to resolve the situation for the mentally ill patients requiring definite care strategies. The issue of mental health has garnered considerable attention to cope up with the ensuing situation in a befitting manner at all levels of the healthcare delivery system (, 2017). However, research has focused on the circumstances relevant to the acute mental health setting where safeguarding the rights of the patients is debated. Acute mental health inpatient facilities have been put under the radar of investigation in which the locked door policies circumscribing the mental health issues have been diligently covered. The legal, ethical and clinical aspects of implementation of such policies have been recently been a topic of controversy where tensions have developed in an effort to balance individual rights along with public and personal protection (Wardle, 2015). Further research has revealed that the incidence of violence within acute psychiatric wards have threatened the safety of other patients vis-à-vis the efficacy of the treatment provided. Moreover, the factors that have been attributed to culmination of violence in such settings include male gender, lifetime history of violence and diagnosis of schizophrenia. Patients who have been admitted in acute psychiatric unit presents a likelihood of 1 out of 5 patients to commit an act of violence (Iozzino et al., 2015). The prevalence rates being of appreciable figure and the risk associated with committing of violence being high there is increased chance of being affected by mental health issues. Therefore, it is of paramount importance to conduct proper intervention strategies so that the issues may be mitigated to a considerable extent by virtue of consideration of the empirical evidences.

Key Stakeholders:

Management of aggressive psychiatric patients is a challenging task on the part of the nurses who are considered as the forerunners of healthcare delivery system. The close association of the nurses with the patients to render quality healthcare service is particularly important for carrying out the nursing interventions in a satisfactory manner. Thus, the need of mental health nurses are felt in a more rigorous manner to ensure that optimal care is rendered to those in need. Investigations carried out with respect to mental health nurses the views of the service users as well as the perceptions and needs of the nurses themselves have been taken into consideration to procure a holistic insight on the profession. Careful analysis of the study findings brought to the forefront that professional skills, personal attributes in conjunction with environmental factors are all responsible for imparting discernible impact on mental health nursing. Self-awareness and reports alongside adequate emphasis being laid on the basics of relationships have been suggested as per the research findings. Passionate outlook towards the profession alongside better understanding and empathy towards the psychiatric patients have been considered vital so that optimal care may be provided to the concerned individuals. Hence, attention being streamlined to simple things shows potential for improvement of the degree of satisfaction among the service users thereby mitigating the distress levels significantly and accounting for a conducive environment suitable for speedy recovery (Gunasekara et al., 2014). Further study carried out with respect to mental health nurses has lead to the emergence of three pivotal themes that affect the profession. The three overlapping themes detected in this context refer to the perception of recovery, practical realities and congruent humanistic approaches. Hence, the chances of recovery for the patients have been fund to be directly dependent on the interventions received from the nurses to treat their conditions (Cleary et al., 2013). Therefore, it is integral for the nurses who may be reckoned as the chief stakeholder who are responsible of providing comprehensive treatment to the distressed aggressive mentally ill patients to be proficient enough to undertake activities that are suitable for treating them in a succinct manner. Acquisition of pertinent and prudent knowledge is desirable to maintain the professional competency on the part of the nursing professionals. Thus, the necessity to conduct appropriate training sessions to safeguard the health of the clients is desirable for harboring positive outcomes for the patients receiving care.

CPI Tool:

In the proposed project in order to address the objectives, implementation of appropriate tool is necessary. In an effort to address the project aims satisfactorily, the Plan-Do-Study-Act (PDSA) cycle format will be utilized. The proposed changes will be tested in the real world setting by proper planning, trial, and observation of the results in conjunction with performing acting depending on what is learnt from the process thereby acknowledging and promoting the action-oriented learning. Research has highlighted on the importance of effective communication as a crucial aspect of rendering safe and quality healthcare service to patients. Enhanced communication among the service providers and consumers besides effective communication among the healthcare staff have been identified crucial to ensure safety and quality of health services directed to the management of the distressed mentally ill patients. Competencies in addition to simple and cost-effective interventions are desirable for promulgating measures suitable for maintaining the safety and health of the affected individual. Initiatives taken at the organizational level is of particular relevance and significance so that optimal outcome may be achieved through utilization of specific and most appropriate tool (Richards, 2016). A relevant study carried out in the context of mental health nursing has highlighted on the use of PDSA model to drive change in the given setting with the aim of reducing harms to patients caused by use of restraint. Safety for both patients and staff may be ensured through observance of definite strategies that address the monitoring of improvements. The findings depicted that a changed scenario with the culture of use of restraint is possible through abidance of the monitoring regime (Bell & Gallacher, 2016). Therefore, it will be most suitable to use the PDSA model so as to review and assess the changes within the given framework of acute mental health setting.

Summary Of Proposed Interventions:
Training sessions conducted every week for the sake of imparting education with respect to the use of restraints in case of the aggressive psychiatric patient for the nursing professionals.
Maintenance of restraint data collection tool to document the use of restraints depending on the situational demands.
Physical interventions training need to be conducted on presentation of information related to restraint data collection.
Adherence to proper medications on the basis of the information retrieved from daily chart as prescribed by the physician with respect to the management of patient.
Check of the nurse’s performance on a daily basis to avoid the missing out of drug regime for the patients.
Educate the nurses on attending the diverse needs of the mentally ill patients through appropriate knowledge acquisition on matter related to mental health disorders.
Posters inside the mental health acute setting will demonstrate the applicability of the various resources such as restraints for informing the nurses regarding their uses.
Imparting knowledge regarding the conformance with the appropriate codes of conduct and established guidelines to maintain professional competency and simultaneously ensure generation of positive outcomes for the distressed patient. 
Barriers To Implementation And Sustaining Change:

The proposed project is likely to encounter certain challenges that might impede the progress of the projected plan of work and lead to unsuccessful fulfillment of the desired objectives.  Primarily, the reluctance and stereotyped mindset on the part of the nursing professionals to welcome the desirable changes might act as a major impediment. Selection of the appropriate patients who require the interventions might also be problematic as inaccurate detection might lead to adverse consequences and inappropriate intervention application. Financial constraints due to lack of funding for undertaking the training sessions for the requisite number of mental health nurses might also impede the project in a significant manner. Compromise made with respect to the conduct of the training session might lead to negative repercussions due to insufficient access to the required resources thereby endangering the mental health related healthcare service availability to the patients. Another crucial aspect is the improper job distribution among the concerned healthcare professionals might threaten the success of the project. Project objectives might be at stake due to lack of collaboration and cooperation among the healthcare staff. Research has revealed that integrated healthcare management has the potential to provide holistic support for safeguarding the interests of the patient and maintaining the supreme quality of provision for healthcare (Durbin et al., 2016). Therefore, dearth of integrated care facility might jeopardize the purpose of the project. Further study has shown that effective communication and establishment of therapeutic relationship with the clients on the part of the mental health nurses is a prerequisite to mitigate the distress of the psychiatric patient.  Failure to express compassion, empathy and foundation of therapeutic relationship with the patient might culminate in negative outcomes (McAndrew et al., 2014). Thus, in this project if the nurses do not turn up to the desired level of competency as expected out of them, the purpose of project will be defeated.

Evaluation Of The Project:

The project will be conducted within a timeframe of four months commencing from January 2018 till April 2018. The entire project will be carried out within the acute care setting of the mental health unit in a hospital in Australia. Prior to the commencement of the project, the mentally ill patients who are aggressive will be identified properly by means of utilizing definite psychological tool.  The necessary data pertaining to the patient will be safely kept in the custody of the registered nurse appointed in the unit. Training with respect to handling of aggressive and mentally ill patients will be arranged for the enrolled nurses recruited in the ward. In addition to impart of training norms, these nurses will be instructed to maintain their daily progress report and handling of the patient while on duty by documenting their distinctive activities in a diligent manner. Elaborate documentation of their activities will ensure that they abide by the conventional approach and act in conformity with the accepted practices. Training session will be conducted on a daily basis to inform them about their duties and actions to be taken while handling aggressive psychiatric patients. Follow up will be directed on a weekly basis where the restraint data collection maintained by the nurses as instructed to them will be monitored to see whether desired intervention has been followed by the patient. Training will be conducted on daily basis for the first month, weekly in the second month and twice a month in the third month. The last month will be kept entirely for assessing the effectiveness of the training directed to the nurses to better equip them with knowledge and available interventions to provide optimal care facility to the client without harming their individual rights. At the end of four month all the data accumulated will be analyzed for the given timeframe to check for any signs of improvement in clinical practice.

References (2017). Mental health | Retrieved 5 September 2017, from

Bell, A., & Gallacher, N. (2016). Succeeding in Sustained Reduction in the use of Restraint using the Improvement Model. BMJ quality improvement reports, 5(1), u211050-w4430.

Cleary, M., Horsfall, J., O’Hara?Aarons, M., & Hunt, G. E. (2013). Mental health nurses’ views of recovery within an acute setting. International Journal of Mental Health Nursing, 22(3), 205-212.

Durbin, A., Durbin, J., Hensel, J. M., & Deber, R. (2016). Barriers and enablers to integrating mental health into primary care: a policy analysis. The journal of behavioral health services & research, 43(1), 127-139.

Gunasekara, I., Pentland, T., Rodgers, T., & Patterson, S. (2014). What makes an excellent mental health nurse? A pragmatic inquiry initiated and conducted by people with lived experience of service use. International Journal of Mental Health Nursing, 23(2), 101-109. (2017). Clinical Governance in Mental Health – Clinical governance. Retrieved 5 September 2017, from

Iozzino, L., Ferrari, C., Large, M., Nielssen, O., & De Girolamo, G. (2015). Prevalence and risk factors of violence by psychiatric acute inpatients: a systematic review and meta-analysis. PloS one, 10(6), e0128536.

McAndrew, S., Chambers, M., Nolan, F., Thomas, B., & Watts, P. (2014). Measuring the evidence: Reviewing the literature of the measurement of therapeutic engagement in acute mental health inpatient wards. International journal of mental health nursing, 23(3), 212-220.

Richards, K. L. (2016). Improving Quality And Efficient Communication Between Providers And Nursing-a Psychiatric Sbar Tool (PSYCH).

Smith, A., Latter, S., & Blenkinsopp, A. (2014). Safety and quality of nurse independent prescribing: a national study of experiences of education, continuing professional development clinical governance. Journal of advanced nursing, 70(11), 2506-2517.

Wardle, J. (2015). Tensions and risks in the blanket use of locked door policies in acute mental health inpatient facilities: balancing human rights, clinical utility and public and patient protection. Psychiatry, Psychology and Law, 22(1), 32-48.