Quality Improvement - Smoking Cessation on Ruby Ward: A Critical Review (Thesis Sample)

Quality Improvement - Smoking Cessation on Ruby Ward: A Critical Review First and Last Name Department and Academic Institution Course Name and Number Instructor Due Date Quality Improvement - Smoking Cessation on Ruby Ward: A Critical Review Introduction This critical review plans and organizes to explore quality improvement and its importance in the nursing profession. It will assist nurses assisting patients with mental health issues, especially those already admitted in the Ruby ward. Therefore, the report has a case scenario that might lower the mortality or the quality of life of mental health patients. I have encountered this scenario in my practise and would like to address it effectively. However, there are risk factors that can lower the efficacy of proposed quality improvement practices. The report will illustrate evidence-based practices, professional dilemmas, and strategies required for quality teamwork. Ward stakeholders should employ a reliable leadership approach to address the patients' mental and psychological challenges. My hospital’s Ruby ward has more cigarette smoking behaviour than other wards in the facility. The administration has implemented several cessation plans that have proven to be futile and frustrated the previous nurses. The records show that some of the admitted Ruby ward patients are current or previous smokers. They trace back to two years before the start of medication and three months after discharge from hospital. The facility has strategies that assist them cease smoking during their stay, though most of them start smoking again after discharge. The same applies to alcohol consumption, though naltrexone and disulfiram drugs given lowers the proportion of alcoholics after discharge. The availability and affordability of tobacco also increase its consumption, especially if patients have anger issues. Smoking behaviour affects the oxygen supply in the body, which escalates mental health issues. Therefore, ineffectively smoking cessation plans prevent the nurse from achieving the clinical objectives. One patient who was admitted to the ward is Mr. Whites, a 36-year-old man and a past smoker, admitted due to dementia. He had a severely impaired memory and judgment that affected his social skills and daily functioning. Therefore, the role of the nurses was to use medication and therapies to improve his memory, language, and problem-solving skills. They achieved their goals, and Mr. Whites was discharged to join his family. However, after losing employment, he started smoking to control anxiety and tension. The habit exposed him to stress and depression, making him easily irritable and aggressive. Eventually, he was re-admitted to the mental health ward, which increased the healthcare burden. The above-mentioned scenario and key elements illustrated in Mr. Whites's medical history can be essential in demonstrating the knowledge and professional practices that mental health care nurses should employ. The report will focus on features of quality improvement and its importance in improving healthcare outcomes. Quality improvement (QI) is “a systematic approach that uses specific techniques to improve quality. It requires infrastructure—systematic and disciplined ways to eliminate waste from processes, improve outcomes and experiences for patients, and eradicate mistakes” (Drew, 2020). Moreover, healthcare providers should demonstrate organizational patience and a culture that allows positive change (Drew, 2020). They also invest in continuous improvement, where nurses treat patients and also improve their service delivery approach. The NHS Long Term Plan (LTP) targets to offer NHS-funded tobacco treatment services to all inpatients who smoke by 2023/24. It applies to physical and mental health inpatients, though the report only focuses on the latter (NHS, 2022). The plan prioritizes pregnant women and their partners to improve the health of their unborn children. Moreover, it allows QI in smoking cessation through the provision of specialist mental health and learning disability services (NHS, 2022). The QI is important is smoking exposes mental health patients to behavioural risks, metabolic risks, and environmental or occupational risks. The smoking cessation project will employ QI to effectively analyze patient cases and maintain engagement between the multidisciplinary stakeholders in the hospital (Liu et al., 2017). It will also establish appropriate service and treatment plans for mental health patients to improve their smoking behaviour. Moreover, it will be advisable to critically analyse the resources lacking in the healthcare setting and perform quality assurance. The report will also evaluate all solutions available for the healthcare problems of high smoking behaviour. The strategy allows the presentation of issues affecting mental healthcare and nursing practice that lowers the quality of services. The challenges lead to a high mortality rate among the patients and miss the objectives of healthcare services (Liu et al., 2017). Discussion Mental health nursing requires equal attention with other nursing profession to improve its assistance and care services. The strategy will assist mental health nurses in guaranteeing quality health and psychological services to their clients (Liu et al., 2017). They can critically evaluate challenges facing mental health patients and follow them up after discharge. Moreover, they access and review patients records on psychological illnesses and mental challenges before diagnosis. The critical analysis will also explore pre-determined NHS guidelines on the treatment of mental health challenges (Walker, McGee, and Druss, 2015). Effectively clinical treatment and therapeutic interventions assist mental health care nurses in addressing mental health challenges and their related physical issues. Background of the Report Richardson, McNeill, & Brose (2019) discovered that mental health conditions increase the health and life expectancy of patients. For instance, a female mental patient can die 12 years earlier than their healthy counterparts. The same happens to men, where health and life expectancy inequality increases to 15.9 years. The inequalities result from differences in smoking prevalence between the mental health patients and the general population. Therefore, people with mental health conditions have a higher probability of being smokers and even heavy smokers or highly dependent than their non-mentally ill counterparts. The authors also noted there is no relationship between mental health illness and the desire to cease smoking (Richardson et al., 2019). Moreover, there was a negative relationship between mental health illnesses and the probability of successively ceasing smoking. Countries like the UK and the US have employed several tobacco control strategies that have lowered smoking prevalence. Therefore, the challenge only lies in the discrepancy between smoking percentages for individuals with and without mental issues. The prevalence among people with common health illnesses rises to 50 % in England and higher in those with severe problems like post-traumatic stress disorder (Brose, Brown, Robson & McNeill, 2020). The same trend exists in the US, implying mental health illnesses raise the challenges of smoking. The relationship is bidirectional, where smoking and mental health problems affect each other. Smokers with mental health problems consume more nicotine since they are likely to be heavy smokers. Moreover, those suffering from schizophrenia, bipolar disorder, depression, and anxiety escalate their symptoms after smoking (Brose et al., 2020). Smoking also interferes with treatment efficacy, making smokers spend more time in hospitals. Salt & Osborne (2020) claimed that lower life expectancy is only one negative impact of smoking on mental health patients. The behaviour lowers an individual's employment prospects and earnings. Moreover, it raises healthcare needs and spending, exposing the addicts to poverty. Most adult smokers understand these issues and desire to quit, only that they lack adequate assistance. Salt & Osborne (2020) noted that 50 % of lifetime smokers in the UK succumb to addiction. Therefore, the country loses 96 000 people annually, of which 30 others suffer from smoking-related illnesses. The inferences illustrate enough reasons to employ quality improvement when treating mental health patients who are smokers. Smoking cessation offers several short-term merits to the patients (Salt & Osborne, 2020). For instance, tobacco lowers their disposable income since they spend smoking is an expensive habit. It consumes 14.6 % of the earnings of smokers in social housing, 6.9 % for homeowners, and 5.8 % for those in privately rented houses (Salt & Osborne, 2020). Consequently, quitting smoking can rescue more than 1 million from poverty and a lower proportion of social housing tenants. QI will also ensure the economic disadvantages of mental health patients do not compromise healthcare quality. Moreover, it will prevent smokers below the poverty line from resulting in illicit and cheap tobacco that increases addiction and expose them to other mental and physical illnesses. Brose et al. (2020) discovered that smokers with mental health problems have the same probability of attempting to quit as other smokers. However, the cessation rates are lower among mental health patients, citing the need for more QI interventions. The more successful the cessations will be, the better the mental health of the patients. They lower anxiety, depression, and stress levels, which later foster psychological quality of life and positive affect (Brose et al., 2020). Moreover, quitting smoking allows mental health care nurses to lower the required dosage and lowers drug side effects. The QI interventions should control the uptake of smoking, increase the frequency of ...