XQ4005 Assessment Instructions Summary
The XQ4005 Performance Task requires a 5–7 slide Quality Improvement Plan presentation with speaker notes. The learner identifies three organizational-level quality care issues relevant to the practice area, presents one piece of supporting evidence for each issue, and applies Lewin’s Change Theory to propose a nurse-driven change for one quality-care or safety issue.
The presentation should use scholarly writing conventions and properly formatted APA citations and references. The supplied instructions identify mental health nursing as the practice area and provide resources on Lewin’s change model, Kotter, Prosci ADKAR, and healthcare quality management.
Completed XQ4005 Assessment
Quality Improvement Plan
Quality Care Issues in Mental Health Nursing
Bini Chirackal Babu
RN-BSN Program, Walden University
NURS 4106: Quality & Safety
Module 5, Organizational Change Presentation
Month 06, 2025
Quality Care Problem 1 – Identifying a Mental Health Care Issue
- Problem 1: Medication non-adherence in mental health patients
- Common issue leading to hospitalization or relapse
- Non-adherence negatively impacts treatment outcomes (Spath & Devane, 2023).
- Patients skip medications due to side effects
- Lack of education increases misunderstanding about medications
- Can be addressed at organizational level through interventions
Speaker Notes
Many people in mental health care do not stick to the prescribed drug schedules, making medication non-adherence a significant concern. As a result, patients experience more severe symptoms, are admitted more often to hospitals and the overall healthcare bill increases (Spath & Devane, 2023). Various factors may cause people not to follow their treatment, such as unwanted effects of medicines, not knowing why the treatment is needed or poor communication between doctors and patients. Following a treatment plan with prescribed drugs is significant for mental health patients, as skipping doses may cause their symptoms to return. At the organizational level, education is offered to patients and communication with patients is improved to promote better following of the suggested treatments. Actions at this phase can improve how diseases are handled and help better care for patients.
Problem 1 - Medication Non-Adherence in Mental Health
- Medication non-adherence is common among mental health patients
- Research shows 40-60% of patients non-adherent
- Increases risk of relapse and re-hospitalization
- Research article: "Barriers to Medication Adherence" (Muench & Hamer, 2010)
- Improved education can enhance adherence rates
- Addressing non-adherence improves patient outcomes
Speaker Notes
The study of Muench and Hamer (2010) suggests that medication compliance is an essential concern in mental health care, as almost half to three-quarters of patients fail to follow the prescriptions from their doctors. Failure to follow treatments can significantly increase the risk that a patient will relapse and require rehospitalization, which harms their mental well-being. The significance of having this issue is highlighted in illnesses like schizophrenia, which rely on daily medication to control symptoms. Forgetting medicines, facing discrimination and experiencing side effects are highlighted by the research as the main obstacles in following the treatment (Duncan & Best, 2019). Informing people about the value of taking medications, together with better help and guidance, may result in more people following their treatment plans. This supports the importance of emphasizing patient education and better communication between providers and patients to deal with medication non-adherence.
Quality Care Problem 2 – Identifying a Mental Health Care Issue
- Problem 2: Lack of patient-centered care in mental health settings
- Inadequate communication between providers and patients
- Patients feel marginalized, affecting treatment adherence (Burnes, 2020).
- Organizational impact: lower patient satisfaction and outcomes
- Patient-centered care leads to better treatment adherence
- Improvement can be driven through staff training
Speaker Notes
Paying attention to patients’ needs and including them in their care ensures better results for mental health patients. Still, several mental health facilities see patients complaining that their involvement is limited and that they do not receive enough communication regarding their treatment (Burnes, 2020). A lack of participation in patient care usually results in patients being less satisfied and following their treatments less faithfully. Patients who sense that their providers do not respect them become less likely to follow the care instructions and participate in treatments. Ensuring patients are heard helps mental health organizations deliver better care and achieve better patient outcomes. Staff can be trained to focus on what patients need and to engage in transparent discussions, improving patient’s experience and treatment success.
Evidence Supporting Problem 2 - Lack of Patient-Centered Care
- Patients report feeling unheard in mental health settings
- Lack of involvement correlates with poor outcomes
- Research: "Patient-Centered Care in Mental Health" (Duncan & Best, 2019)
- Improved communication leads to better adherence
- Patient satisfaction rises with active participation in care
- Patient-centered approaches enhance treatment success
Speaker Notes
Duncan and Best (2019) explored patient-centred care in mental health settings. They discovered that people often believe they are not considered or valued, especially if they have no part in making decisions. When patients are not involved in their care, this usually leads to less strict follow-up and more unhappiness with their treatment. Research suggests that patients engaged in their care and have their opinions recognized tend to stick with treatment and experience greater success (Muench & Hamer, 2010). When patients can participate in their treatment, the results may be more positive for their mental health. Such evidence demonstrates that putting patients at the centre of care both makes patients happier and leads to stronger clinical results.
Applying Lewin’s Change Theory to Medication Non-Adherence
- Lewin’s Change Theory: Unfreeze, Change, Refreeze
- Unfreeze: Recognizing the issue of non-adherence
- Change: Implement educational programs for patients (Burnes, 2020).
- Refreeze: Integrate adherence strategies into routine care
- Engage patients in their care decisions for success
- Monitor adherence to ensure sustainable improvement
Speaker Notes
Using Lewin’s Change Theory, clinicians and caregivers can address non-adherence to mental health medications using the stages of Unfreeze, Change and Refreeze. The first thing in the Unfreeze stage is admitting and noticing that the organization is not following the procedures as expected (Burnes, 2020). The problem could be studied by conducting assessments to assess its overall impact. At this stage, effective educational programs are offered that cover the necessity of the patient’s drugs and identify the main reasons for not taking them regularly. Giving patients and their caregivers more opportunities to talk with healthcare professionals is part of it (Duncan & Best, 2019). At the Refreeze stage, new tactics are incorporated into the company’s way of doing things, so the focus on adherence stays a regular part of the culture. This requires rechecks and added adherence support as part of the usual treatment to ensure patients continue to do well.
Continuing Lewin’s Change Theory Application and Conclusion
- Refreeze: Incorporating adherence strategies in daily practice
- Train staff to support medication adherence
- Use technology for monitoring and reminders (Kotter (n.d.).
- Regular follow-up ensures sustained improvements
- Change enhances patient outcomes and quality of care
- Final thoughts: Lewin’s model fosters long-term success
Speaker Notes
The next step in Lewin’s Change Theory is the Refreeze stage, which helps sustain the changes. Medication adherence strategies should be used as part of daily practice. Training staff to notice and manage non-adherence is essential, and technology can help remind individuals to take medication and update caregivers when they forget (Kotter (n.d.). Following up regularly with patients is vital to sustaining their adherence and making them feel supported throughout their treatment. By following these steps, the changes are made a regular part of the organization’s way of doing things. Improved adherence by patients leads to better mental health and a general rise in the overall quality of health care. Long-term success can be reached through Lewin’s model because it promotes change that lasts.
References
Kotter. (n.d.). The 8 steps for leading change. Retrieved from https://www.kotterinc.com/methodology/8-steps/
Burnes, B. (2020). The origins of Lewin’s three-step model of change. The Journal of Applied Behavioral Science, 56(1), 32–59. https://journals.sagepub.com/doi/full/10.1177/0021886319892685
Prosci. (n.d.). The Prosci ADKAR model. Retrieved from https://www.prosci.com/methodology/adkar
Spath, P., & Devane, A. (2023). Introduction to healthcare quality management (4th ed.). Health Administration Press.
Chapter 10, “Managing the Use of Healthcare Resources” (pp. 315–319).
Muench, J., & Hamer, A. M. (2010). Barriers to medication adherence: A critical review of the literature. Journal of Clinical Psychiatry, 71(10), 1210–1217. https://doi.org/10.4088/JCP.09r05791
Duncan, E. A., & Best, M. (2019). Patient-centered care in mental health: An integrative review. Journal of Psychiatric and Mental Health Nursing, 26(2), 98–106. https://doi.org/10.1111/jpm.12482