As our health care delivery system has undergone profound change in the past decade, providers are expanding services from inpatient facilities to a variety of alternative settings, including home health care. Academic programs offering nursing education are recognizing the need to parallel this trend and have been placing student nurses in community-based and home care settings for clinical experience. Careful attention to curriculum development and effective management of students in a home care practicum can help ensure adequate preparation of graduate nurses who are likely to be employed in a variety of outpatient settings, including home health care.
Health care reform has had a profound effect on the way psychiatric treatment occurs in this country. Decreasing length of stay, increasing acuity, and reducing staff levels are making traditional approaches to mental health care infeasible. Resources already in place may still be focusing on long-term treatment issues and do not facilitate rapid stabilization and discharge planning that includes continued care within an integrated system.
Research supports the feasibility of quality mental health care, which can be accomplished in shortened lengths of stay, as long as clinical managers plan inpatient programs focused on shortterm goals followed by appropriate aftercare. In addition to recommendations for clinical managers, this article provides a proposal for executives redesigning a mental health care delivery system, which includes the goals of rapid assessment and stabilization, as well as discharge planning and appropriate follow up within an integrated system.
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