Abstract
Acute mental health patients are inherently vulnerable to various risks. They may have co-occurring medical conditions which require continuous monitoring and treatment. Nurses help these patients recover by formulating care plans, assessing and monitoring their progress, administering medication, and assisting them with behavioral interventions. Nurses also provide acute mental health patients emotional support and educate them and their families about their conditions. Nurse workload can expose patients to safety risks such as neglect, medical errors, and reduced quality care. This may further cause anxiety to the patients and their carers. Identifying the factors that cause a high nurse workload in mental health facilities is critical to facilitate interventions to improve the quality of care provision. The proposal presents various interventions to improve the nurse workload to help reduce incidences of patient safety in acute mental health facilities. The interventions include adopting technology, training nurses, and improving staffing.
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Background of the Study
Acute mental health patients are inherently vulnerable to various risks. They may have co-occurring medical conditions which require continuous monitoring and treatment. Acute mental health patients also need intensive monitoring to prevent them from committing suicide or harming themselves. According to Jacob (2022), they must be assisted in taking medication to manage their conditions. Communicating with them is difficult, making it challenging to identify other needs. Nurses help these patients recover by formulating care plans, assessing and monitoring their progress, and administering medication. Nurses also provide acute mental health patients emotional support and educate them and their families about their conditions. Guttormson et al. (2022) note that nurses must be adequately skilled and committed to accomplish these tasks. Nurses caring for acute mental health patients are prone to burnout, stress, and reduced motivation due to the high workload levels.
Nurse workload can expose patients to safety risks such as neglect, medical errors, and reduced quality care. According to Appiah et al. (2023), the safety risks can cause unnecessary stress and anxiety to the patient’s relatives and carers, reducing their trust in the healthcare system. Safety concerns could also have legal, ethical, and professional implications. For instance, patients and their relatives could sue nurses for negligence. A high workload could also force nurses to deny patients their rights to quality care, which is unethical. Professionally, this is punishable since it breaches the nursing code of ethics. However, patient safety is a genuine concern due to the high workload in acute mental health wards. The research proposal examines the nursing workload in acute mental health wards and proposes interventions to improve patient safety.
Patient Safety in Mental Health Care
Ensuring patient safety is a critical aspect of patient care. Not only is it a concern in mental health care patients but for all areas of healthcare. Schwappach and Niederhauser (2019) argue that patient safety concerns are often unnoticed. Elderly patients with acute mental health conditions could also fall, inflicting physical injuries which further affect their well-being. Patient safety involving acute mental health patients involves all the measures nurses take to promote their well-being while reducing the risk of deterioration. According to Hunt et al. (2021), it involves assessing their exposure to various risks, formulation of treatment interventions, and supporting the patient to complete their treatment. It also involves managing the patients’ behavior, preventing them from committing suicide or harming themselves, communicating with them and their families about their conditions and the recovery journey, and interacting with other professionals to ensure the patients get the best possible treatment.
Patients could have inherent personality factors that affect their safety. For instance, they could be elderly, which increases their risk of wandering or falling, resulting in further injury. Patients could also be vulnerable due to environmental factors such as inadequate ward supervision. Patients could also be situated where nurses’ ability to supervise them is limited. Thibaut et al. (2019) suggest that healthcare facilities should establish a patient safety culture to reduce the vulnerability of mental health patients. Nurses caring for acute mental health patients must be adequately skilled to understand the behavioral and physical manifestations of acute mental health patients. Inadequate training of the nurses increases the vulnerability of patients who could have underlying health conditions, increasing their safety risks. Nurses must identify the underlying risk factors that increase the vulnerability of acute mental health patients to safety risks. Notably, they must communicate and share patient information to manage emerging issues about the patients.
Challenges in Acute Mental Health Care
Like all areas of healthcare provision, acute mental healthcare has its fair share of challenges. D’Lima et al. (2017) claim that nurses must identify challenges affecting their care of acute mental healthcare patients for them to provide them with much-needed help. Giandinoto and Edward (2014) contend that mental health care patients require intensive care, which may not always be available. Rahmani et al. (2021) claim that nurses are forced to care for the patients with the available resources resulting in burnout and reduced motivation. Acute mental health patients could also have other underlying conditions demanding more attention from healthcare professionals. According to Zolezzi et al. (2017), acute mental health patients sometimes have cancer, heart disease, diabetes, and respiratory diseases complicating their treatment plans. Caring for such patients can be overwhelming for nurses, especially if the healthcare facilities are not designed to handle such issues.
Some patients with mental health conditions are elderly, increasing their safety risks. For instance, an elderly patient with dementia may wander off and fall, sustaining severe injuries. The implication is that they need close monitoring, which may not always be available. Turale and Nantsupawat (2021) claim that close monitoring may not always be possible due to the mental health care professionals’ shortage. The other problem common in providing mental health care for such patients is the manifestation of aggression and aggression. Accoring to Cuomo et al. (2020), attending to aggressive and violent acute mental health care patients can be challenging for healthcare professionals. Besides the patient hurting themselves, they can also inflict severe injuries on the patient. Nurses can avoid attending to such a patient, especially if they feel threatened. Ordinarily, medical personnel should be trained to deal with aggressive and violent patients. Despite the training, nurses continue to experience challenges dealing with such patients.
Sometimes, nurses must use seclusion and isolation to deal with aggressive patients. While these interventions guarantee the safety of the healthcare practitioner, they may be traumatising to the patient. According to Chieze et al. (2019), it may be counterproductive since it makes the patient agitated, which could lengthen their hospitalisation. Haugom et al. (2019) add that seclusion and restraint could also stress the patient, resulting in depression. Acute mental health patients may take longer to recover if they suffer from other psychological conditions like anxiety and depression. The other challenge affecting the care of acute mental health patients relates to the abuse of alcohol and other substances. Volkow et al. (2021) indicate that most patients suffering from mental health conditions also have substance abuse problems, making diagnosing their condition difficult. According to NIDA (2020), treating substance abuse while treating mental health problems complicates the treatment plans. It also results in delayed recovery since the patient may suffer from relapses that disrupt the long-term treatment plan.
Mentally ill patients face stigma worldwide. Some people associate it with witchcraft, curses, and substance abuse, further stigmatising the patients. As a result, mentally ill patients of their families take long to seek medical treatment for such patients. Consequently, they are presented in the hospital with severe mental illnesses which take longer to treat. Drake et al. (2020) claim that nurses may experience burnout and stress due to these challenges, affecting the quality of care. They may also suffer from unreasonably high workloads, resulting in medical errors, absenteeism, and demotivation, increasing patient safety risks. The treatment of mentally ill patients is complicated by factors such as stigmatisation, substance abuse, shortage of nursing staff, comorbidities, and trauma due to seclusion and restraint. The current study focuses on the impact of nurse workload on patient safety care.
Nursing Workload and Patient Safety
Challenges experienced when caring for acute mental health patients stresses nurses resulting in depression. According to Alghamdi (2016), nursing workload refers to the ratio of patients a nurse must care for during their shift. Ivziku et al. (2021) describe nursing workload as the work that a nurse must accomplish over a specified duration of time. Alghamdi (2016) claims that nursing workload relates to the ratio of nursing staff available to serve a particular number of patients over a duration. Fagerström et al. (2018) posit that nurses’ workload determines their effectiveness in caring for patients suffering from chronic illnesses. Caring for acute mental health patients involves diagnosing their conditions, formulating treatment plans, and helping them take their medication. It also involves helping the patients and their families understand their conditions while offering emotional support.
Ordinarily, such work would not be difficult for nurses in a standard healthcare facility setting. However, as Ackley et al. (2017) observe, it becomes challenging when dealing with acute mental health patients due to the complexity of their needs. For instance, a mental health patient could have comorbidities like heart disease, diabetes, and respiratory diseases. They could also be diagnosed with substance abuse, implying that nurses dealing with such patients have a higher workload than nurses dealing with ordinary patients. Havaei and MacPhee (2020) claim that nurses may fail to treat underlying conditions affecting mentally ill patients, like substance abuse, due to a high workload. A high workload results in stress and burnout, which could affect the nurse’s ability to continue providing quality healthcare. Farmakas et al. (2014) state that the work environment can also affect nurses’ workload. For instance, if nurses attending to mental health patients work many hours without breaks, they will likely get stressed, which could affect their performance.
Patients’ personalities, aggressiveness, and violence also contribute to the nurses’ high workload. Cranage and Foster (2022) identify additional contributing factors, including inadequate skills, shortages of staff, and lack of supportive management, which they argue increases nurses’ workload. Chang et al. (2019) argue that whichever the causative factor, a high nurse workload affects their ability to provide quality care. The most common indicator of a high nurse workload is stress and burnout. Nurses may withdraw or get stressed due to the pressure to deliver at work. They may make avoidable errors diagnosing patients or administering patients, risking their safety. A high workload can also affect the nurse’s concentration and attention to detail. Towards this end, they may not recognise when the patient’s deteriorating mental health makes them take longer to recover.
On the other hand, lowering the nurse’s workload can help guarantee patient safety outcomes. According to Banda et al. (2022), nurses with adequate time to care for clients exceed the expectations of satisfying patients and their families. They are also not likely to make any medication errors since they are focused and attentive. Informed of this development, mental health facilities must prioritise the staffing requirements to ensure nurses have a low workload. They must also allocate the necessary resources to support their work. Doing so and listening to them is critical to enhancing the quality of care. It also helps reduce patient safety risks emanating from high nurse workloads. Therefore, improving nurses’ workload through evidence-based interventions is critical to enhancing patient safety.
Problem Statement
Acute mental health patients have unique needs that require continuous monitoring. Mental health facilities must avail trained nurses and supporting materials and facilities to facilitate their recovery. While nurses do their best to help patients recover, they face challenges due to high workloads. High workload causes burnout, stress and demotivates nurses, affecting their quality of care. It also increases their likelihood of making errors and contributes to high nurse turnover rates. High turnover rates of nurses due to high workload reduces the number of practitioners available to treat acute mental health patients, further compounding the problem. A review of previous research reveals that despite the importance of patient safety while attending acute mental health patients, there is a gap in the relationship between nurse workload and patient safety in acute mental health facilities. There is a need to identify the specific factors that cause a high nurse workload in mental health facilities to help identify possible interventions to improve the quality of care provision.
Significance of the Study
The proposal aims to recommend interventions to help improve the quality of care for acute mental health patients by proposing measures that enhance patient safety by lowering nurse workloads. The vulnerability of acute mental health patients to various safety risks due to the complexity of their needs for special care and close monitoring informs this study. The study appreciates that nurses’ workload is high due to the shortage of healthcare practitioners compared to the many acute mental health problems cases. The background of the study has revealed that high nurse workloads contribute to safety risks which further reduces the quality of care. The current study seeks to explore the extent that nurse workload affects the quality of care in mental health wards. It also seeks to propose interventions to reduce the workload to promote the quality of care. The study findings are expected to help policymakers formulate strategies around staffing needs to ensure that the quality of care is not compromised. It will also contribute to the literature on nurse workloads and patient safety.
Chapter Summary
The chapter discusses patient safety in mental health care, acute mental health care challenges, and the impact of nursing workload on patient safety. It also presents a statement of the problem for the current study, which identifies the research gap. Ultimately, it describes the significance of the study to policymakers and the academic fraternity. The next chapter reviews past research articles on nursing workload and patient safety to understand other researchers’ perspectives and to identify possible interventions to enhance the quality of care.
Literature Review
Introduction
The literature review section presents an overview of existing research on the impact of nursing workload on the quality of care and patient safety in acute mental health care. It identifies gaps based on previous research as a foundation for the current study. The section explores patient safety in acute mental health wards, particularly the need to ensure patients reside in a safe environment. It also highlights the challenges nurses face when caring for mentally ill patients as indicated by practical observations and the extent to that workload impacts their work. The literature review further examines the factors contributing to high nurse workloads, nurse experiences, and the various interventions that medical facilities have used to alleviate the challenge.
Patient Safety in Mental Health Care
Patient safety is one of the core tenets of quality care for acute mental health patients. The significance of patient safety arises from the uniqueness and complexity of the needs of mentally ill patients. Schwappach and Niederhauser (2019) posit that acute mental health patients pose a significant threat to nurses serving them, especially if they are aggressive and violent. Cho, Lim, and Kim (2023) examined the impact of patient violence on nurses. They found out that nurses’ complaints about patient aggression was a common and frequent phenomenon. Researchers have also examined various aspects of patient safety, particularly the factors affecting patient safety in the last four decades. Cuomo et al. (2020) describe patient safety promotion as all the interventions that mental health facilities use to ameliorate harm, medical errors, and deterioration of the mental health of patients undergoing treatment. They explored the epidemiology of adverse conditions of patients undergoing mental health treatment to understand their safety risks. Cuomo et al. (2020) identified significant safety risks affecting patients undergoing treatment, including non-drug-related adverse events, drug-related events, and medical errors. They also explored the various interventions and strategies that medical health facilities can adopt to reduce the risks.
Non-drug-related adverse events affecting acute mental health patients include falls, assaults, sexual harassment, and self-harm. According to Turner et al. (2020), 70% of falls by mental health patients result in severe injuries which further prolong their hospital stay. Cuomo et al. (2020) identified Alzheimer’s disease, age, and dementia as the main factors contributing to falls in acute mental health patients. Aggression and violence by some patients against fellow patients and staff members also caused safety concerns in acute mental health wards. The findings collate with Nzaumvila et al. (2022), who observed that some patients injured others, prolonging their hospital stay. Patients also sexually harass other patients and staff members, raising safety concerns. However, the most common non-drug-related safety concern was due to physical harm. Most patients attempt to harm themselves due to anxiety and depression. Drug-related safety concerns were minimal since they were manageable either by withdrawing the responsible drug or administering another drug to counter the effect of the drug, raising safety concerns.
Patient safety risk factors can also arise from medical errors at diagnosis, preventive, or treatment phases. Factors contributing to medical errors are complex and could be classified into patient-related, nurse-related, or systematic. Patient factors include acute psychiatric behavior such as being suicidal, leading the patient to overdose or underdose. In contrast, nurse-related medical errors relate to mistakes due to the nurse’s omissions or commissions, which expose the patient to safety risks. This study focuses on nurse workload, which Cuomo et al. (2020) believe is partly to be blamed for medical errors. Dewa et al. (2018) investigated patient safety in acute mental health wards. They noted that research on patient safety for mental health patients was less extensive than for physical health patients. Therefore, it is impossible to define patient safety due to the inherent nature of the disorder.
Suicide ideation is considered a symptom instead of a patient safety risk, complicating the analysis. Using a qualitative research design, Dewa et al. (2018) engaged mental health patients to understand their perception of patient safety, aiming to identify critical research areas. They found that there was a need for mental health facilities to formulate safety plans to improve quality care for their patients. Kwobah et al. (2023) also established that incidents threatening the safety of acute mental health patients were common. However, unlike Dewa et al. (2018), Kwobah et al. (2023) used a qualitative descriptive research technique. D’Lima et al. (2016) investigated patient safety in Canada. They also established that the physical environment of the wards impacted patient safety. However, according to them, the main factor which affected patient safety was the nurse workload. High nurse workloads affected the performance of nurses, adversely impacting their ability to provide quality care.
Nursing Workload and Patient Safety
There is no doubt about the role of nurse workload in the quality of care for acute mental health patients. Existing research reveals that a higher nurse workload is associated with more patient safety incidences, such as self-harm, falls, neglect, and medical errors. Almenyan et al. (2021) examined the relationship between nurse workload and patient safety in intensive care units. They noted that the last four decades had witnessed an increasing demand for healthcare services, straining the available healthcare resources. Almenyan et al. (2021) attribute this increase to emerging epidemics, epidemiological changes, and an aging population. As primary caregivers, nurses ensure that people needing healthcare services are promptly attended to regardless of the existing resource constraints. Towards this end, Almenyan et al. (2021) conducted a systematic literature review to establish whether nurse workload significantly impacted the quality of service provision. They established that the high demand for healthcare services meant nurses had to do more work than usual.
Nurses, like most professionals, experience pressure when the workload is high. They may feel like the pressure to deliver is not commensurate with their compensation. Azevedo et al. (2021) claim that the nurse workload has increased to the detriment of nurses and their patients. Azevedo et al. (2021) found that higher nurse workload contributed to medical errors, reduced quality of care, and increased mortality. Nursing is a profession that requires professionalism and utmost dedication. Wihardja et al. (2019) claim that the nursing profession has various hardships, such as the condition of the patient, a challenging work environment, and the requirement to interact with others. Inadequate skills or inability to manage emotions can make the work challenging. According to MacPhee et al. (2017), nurses working in acute mental health facilities and ICUs often have more responsibilities than in a standard hospital setting. As a result, the workload may stress them.
Stressed nurses experience burnout or feel demotivated. Wihardja et al. (2019) used cross-sectional quantitative research to identify the correlation between factors attributed to nurses’ workload and their impact on patient safety. They established that individual characteristics influenced their susceptibility to mental workload. Nurses who did not know how to manage their emotions were more likely to be demotivated by a higher workload, which further impacted their performance at work. The findings agree with Moghadam et al. (2021) that the work environment and the condition of the patients affected the nurses’ ability to cope with stress. For instance, mental health patients with underlying conditions demanded more attention, draining the nurses’ efforts. The shortage of nurses aggravated the situation, resulting in a high workload. Wihardja et al. (2019) claim that a high workload directly correlates to patient safety incidents. Due to fatigue, nurses will likely make errors while caring for patients. Therefore, there is a need for further research to identify interventions that could help mitigate this concern.
Interventions for Improving Nursing Workload to Enhance Patient Safety when Caring for Acute Mental Health Patients
There is no doubt about the impact of nurse workload on patient safety. Although indirectly, nurse workload adversely impacts the nurse’s performance and ability to deliver quality care, affecting patient safety. A stressed and demotivated nurse can commit significant errors that can jeopardise the health of their patients. However, research reveals that medical care facilities can use various interventions to reduce this risk. The first intervention relates to using technology to enhance the nursing workload. According to Ibrahim et al. (2022), using technology to match hospital admissions with available nurses can help reduce the strain on nurses. Colizzi et al. (2020) researched the use of technology to establish the effectiveness of technology in matching nursing staffing levels to lower nurse workload and improve quality care for mental health patients. Using a systematic review, they established that there was a direct correlation between using technology to enhance nurse ratios and patient safety.
Improving staffing ratios can also increase the efficiency of nurses and reduce workload among nurses. Patient safety concerns are prevalent when there is a staff shortage since nurses are forced to attend to more than one patient. However, existing research shows a strong correlation between staffing levels and patient outcomes. According to Mapanga et al. (2019), achieving an optimum nurse-patient ratio helps reduce self-harm, falls, and medical errors. Nurses also feel energised and serve the patients and their relatives better. Gureje and Oladeji (2022) researched how staffing levels impacted the quality of care in a mental health facility. The quantitative research revealed that nurses were strained in their work due to the unique needs of their clients. The findings also revealed that the medical facility had experienced high staff turnover rates due to reduced job satisfaction and low staff morale. However, the management noted that meeting their staffing needs could help improve the quality of service that was lacking.
Training is a critical component of the human resource function. Besides increasing the competitiveness of an enterprise, it helps reduce errors, reducing the cost of operation. Training in the healthcare sector is equally crucial since it determines the quality of care. Caring for patients with special needs like acute mental health requires highly trained and disciplined employees. Most patients admitted with acute mental health conditions have underlying conditions that necessitate a high level of skills. Kumar et al. (2021) examined the preparedness of nurses to deal with patients with acute mental health patients. The study with a control variable compared the findings to establish the effectiveness of training on the competencies of nurses. The findings revealed that training was critical in treating acute mental health patients. The findings agree with Kilbourne et al. (2018), who noted that the delivery mechanism, content, and frequency of nurse training impacted their competence. Therefore, mental heal facilities must use training as a core intervention to enhance service provision in the care of mental health patients.
Conclusion
The literature review examined existing research about nurse workload and patient safety. The review revealed that nurses and doctors sometimes fail to speak out about identified safety concerns due to the work environment. It also revealed that patients with acute mental health conditions are vulnerable to self-harm, suicide, neglect, and disrupted treatment. The literature review also revealed that it is challenging dealing with acute mental health patients due to the complexity of their needs. Further, that nurse workload can cause burnout which affects the nurse’s ability to continue providing quality healthcare. Therefore, improving nurses’ workload through evidence-based interventions is critical to enhancing patient safety.The next chapter presents the interventions proposed to reduce nurse workload and reduce patient safety incidences which will ultimately improve quality care for acute mental health patients in wards.
The Proposal
Aim
The background of the study and the literature review informs the interventions proposed in this section. The literature review has revealed that acute mental health patients have complex and unique needs. As a result, they need consistent care and close monitoring to facilitate their full recovery. Close monitoring also helps reduce patient safety incidences such as self-harm or falls. Nurses are critical in the recovery journey of acute mental health patients. However, they face challenges that affect their performance, like pressure to deliver, high workload, and inadequate training. Some patients also have special needs, which the nurses might find challenging. If not supported, nurses facing these challenges may experience stress or burnout, subsequently affecting their ability to work and reducing the quality of care provided. This section proposes various interventions to improve the nurse workload to help reduce incidences of patient safety in acute mental health facilities.
Key Stakeholders
Mental is a significant health concern today. As a result, various stakeholders are interested in ensuring that those affected receive quality healthcare. Patients suffering from various mental illnesses are critical stakeholders in providing quality mental health service care. As the individuals who need care, they deserve the best. They must also be guaranteed to be attended to by highly skilled personnel during their recovery journey. The other critical stakeholder in mental health is the health practitioners, including nurses practicing in acute mental health wards. As the primary caregivers, they must be given all the support they need to deliver quality care. They must also be trained regularly to ensure they have relevant skills for emerging situations. They must be committed to their service and serve with dedication. The third group of stakeholders comprises the policymakers and regulators in the medical profession. They set the operating standards that healthcare providers must abide by to ensure patients receive quality healthcare. Policymakers also formulate interventions to ensure that health practitioners’ welfare is addressed. The last stakeholder is the community where all these stakeholders reside. The community must ensure that everyone has access to quality healthcare services.
Method
Since patient safety incidents arise from a high nurse workload, I intend to introduce interventions to reduce the workload. Specifically, I want to reduce the nurse-patient ratio in healthcare facilities. I will achieve this through collaboration with the key stakeholders in the mental health sector. My proposal adopts the PDSA model which involves planning, doing, studying, and acting to reduce patient safety concerns due to nurse workload. According to Knudsen et al. (2019), the PDSA is an iterative process which allows nurses to identify problems and formulate evidence-based interventions. It also promotes continuous quality improvement which is critical in enhancing patient welfare.
Planning: The planning phase involves identifying the research problem which is low quality care due to a high nurse workload. The high nurse workload in acute mental health wards causes stress and burnout in nurses affecting their performance. The quality improvement proposal seeks to alleviate this problem by reducing nurse workload. Specifically, it intends to increase staffing ratios. It will also establish a mechanism to identify staffing challenges in mental health wards.
Do: I will identify the population of patients in mental health wards vis-à-vis the population of nurse practitioners. I will compute the ratio for every healthcare facility. I will then compare this with the recommended ratio of one nurse for every four patients. The recommended ratio is informed by Sharma and Rani (2020), who claim that the nurse-to-patient ratio should be 1:6, 1:4, and 1:2 for ordinary, unique, and critical health facilities. Based on the findings, I recommend that affected institutions hire more nurses to meet their staffing needs.
I will also require the institutions to produce training records for their nurses to evaluate their effectiveness in reducing patient safety incidences. According to Crawford et al. (2015), most healthcare facilities do not train their nurses regularly. As a result, their nurses do not know how to deal with patients requiring specialised treatment, such as acute mental health patients. For institutions that provide their training plans, I will review the content for suitability to ensure that it prepares the nurses adequately to deal with acute mental health patients. According to Caulfield et al. (2019), training for nurse practitioners dealing with mental health patients should cover comorbidities since some patients have underlying conditions. Such a training plan prepares the nurses to deal with the patients better.
After reviewing the training plans, I will help the institutions formulate tailor-made training plans for their facilities. I will also propose that they conduct the training regularly to enhance the competency of their nurses. According to Ayano et al. (2017), periodic training helps learners accumulate knowledge. It also helps learners associate concepts with learned knowledge. Therefore, training should be consistent. I am also proposing using technology to manage staff and patient records. Specifically, I propose a hospital management information system to compute the nurse-patient ratio. Such a system will help the management track their nurse workload and adjust accordingly.
Study: I will conduct regular monitoring to ensure that the institutions maintain the recommended staffing levels. Monitoring will involve obtaining nurse daily registers to establish whether they were matched as proposed. I will also review the training plans to evaluate the sufficiency of training content and the frequency. I will also evaluate the effectiveness of the hospital management information system in helping the facilities track staffing ratios.
Act: Based on the findings of the review, I will redesign the proposal. I will also engage the nurses to understand their challenges. Based on the information obtained, I will continue with the quality improvement process.
Establishing Measures
Critical deliverables for my proposed intervention include a lower nurse workload, reduced patient safety incidences, and enhanced quality care. The lower nurse workload will be measured by the ratio of nurses to patients and obtained from the hospital management information system. It is expected to reduce after the institution hires more nurses. The patient safety incidences will be measured through the number of reported cases. The cases that will be considered include attempted self-harm, falls, and medical errors. They will be recorded in a report maintained in the nurse waiting room. The third deliverable, quality service, will be measured using weekly dismissal rates. I expect dismissal rates to increase following the implementation of the intervention.
Governance and Ethics
The success of a medical intervention depends on the governance framework regulating it. My proposed intervention is founded on best practices in the nursing profession. I will also maintain a high level of confidentiality of all data collected and used during the implementation of this intervention. Where consent is needed, I will obtain it to avoid infringing on individual privacy rights.
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