Theses and Dissertations at Montana State University (MSU)
Permanent URI for this collectionhttps://scholarworks.montana.edu/handle/1/733
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Item A quality improvement project to bolster psychiatric advance directive utilization in community mental health(Montana State University - Bozeman, College of Nursing, 2024) Fonner, Laira Lee; Chairperson, Graduate Committee: Lindsay Benes; This is a manuscript style paper that includes co-authored chapters.Background: This quality improvement (QI) project aimed to increase Psychiatric Advance Directive (PAD) use in a community mental health organization serving clients with severe mental illness (SMI). PAD utilization has been shown to decrease involuntary hospitalization rates and associated coercive treatments, such as forced medication and seclusion and restraint for this vulnerable patient population. Local Problem: In Montana, busy clinicians rarely offer PAD education and assistance to clients with SMI. However, studies have demonstrated increased PAD utilization followed by reduced involuntary hospitalization rates for clients receiving these services from Peer Support Specialists (PSSs). PSSs are trusted employees with SMI working in outpatient mental health facilities. Methods: This quality improvement project established a repeatable PAD implementation workflow in an outpatient mental health care organization where PSSs were trained to facilitate PAD support events. Interventions: Interventions included hosting three online training workshops for PSSs followed by peer- facilitated events to offer client education and assistance in PAD completion. Event attendees were asked to complete event feedback surveys. Results: All invited PSSs attended one of the three online training workshops (n=X). X clients attended peer-facilitated events of X invited. Only two clients completed documents during the peer- facilitated events. Five clients started documents and wished to complete them later. None of the attendees completed event feedback surveys. Conclusions: The project successfully increased PAD awareness and utilization for PSSs and clients with SMI. The project team successfully established a repeatable workflow to bolster PAD use and generated organizational enthusiasm to continue utilization efforts.