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Full Dissertation title

A proposal to introduce psychoeducation approaches for implementation by nursing professionals to treat patients suffering from bipolar disorder. The proposal will be implemented in the psychiatric ward.

Key words 

Table 1- PICO format for research question

Rationale/need for the project

Bipolar disorder, is commonly referred to as manic-depressive illness and the disorder encompasses a plethora of brain disorders which are responsible for bringing about unusual alterations in the mood, energy, mood, and levels of activity of a person, thus producing difficulties in the capability to conduct daily undertakings (Faurholt-Jepsen et al., 2014). Individuals diagnosed with the mental disorder are found to participate in poor decision making, in relation to the immediate circumstances and also demonstrate a reduced want for sleep. The affected persons also report negative discernments regarding life and fail to uphold eye contact. The disorder is chiefly characterised by augmented risks of suicide among individuals suffering from the complaint, in addition to raised rates of self-harm imposing conduct (Yatham et al., 2013).

There were an estimated 4 million cases of mood disorders that also comprised of bipolar disorder among people living in the UK in 2013. Furthermore, the youth were also found at an increased likelihood of suffering from bipolar disorder, when compared to their older counterparts in 2014. While 3-4% of young people aged 16-24 years showed a positive screening for the mental illness, only 0.4% of older adults aged 65-74 years reported the same (Mental health foundation, 2015).

While the lifetime prevalence of bipolar disorder in the UK population is 1-2%, it takes approximately 10.5 years for an affected person to obtain the correct health diagnosis for the condition (Bipolar UK, 2018). Addiction is a major problem among people suffering from bipolar disorder. Most patients diagnosed with the mental illness report attempts of self-medication for reducing the severity of depression and often resort to the use of drugs and alcohol, with the aim of promoting sleep. Mixed mood episodes that are primarily characterised by the incidence of both hypomanic or manic and depressive symptoms, in association with a rapid change of the symptom types, are being progressively recognised as more prevalent among people diagnosed with bipolar disorder (Phillips & Kupfer, 2013).

Furthermore, there are several medications that are used for treating people suffering from bipolar disorder. These medications are prescribed with the intent of reducing the depressive and maniac symptoms (Bourne et al., 2013). Although valproic acid, lithium, and lamotrigine are commonly used under such circumstances, it often becomes difficult for nursing professionals and psychiatrists to determine the correct combination of medications that would prove effective (Malhi, Adams & Berk, 2010). Patients suffering from bipolar disorder also report an increased susceptibility to a plethora of other social and physical problems (Piterman, Jones, & Castle, 2010). While the psychological comorbidities most commonly assume the form of anxiety symptoms that get superimposed on depression or hypomania, there is a need to detect the exact difference between them. Physical comorbidities also express in the form of cardiovascular complications, poor diet, obesity, and hyperlipidaemia (Amann, Radua, Wunsch, König & Simhandl, 2017). Thus, it is essential for the healthcare professionals to adapt to the use of other non-pharmacological approaches as well for management of bipolar disorder symptoms among patients admitted to a psychiatric ward. Thus, the proposal aims at implementing psychoeducation, an evidence-based therapeutic intervention by nursing professionals for educating the people seeking treatment for bipolar disorder, and effectively managing their illness and other comorbidities.

Project Methodology

Aims

The project will aim to implement a change strategy that focuses on psychoeducation as an effective therapeutic tool that can be used by nursing professionals in a psychiatric ward for the management of bipolar disorder symptoms among admitted patients. The change management strategies will also be followed by recommendations that can help in operation of the intervention in nursing practice.

Literature search strategy

The strategy used in this dissertation focuses on a narrative literature review that is based upon previous findings, pertinent to the research question. Some keywords and search phrases that were used along with specific boolean operators were ‘AND’ and ‘OR’. These helped in either broadening or narrowing down the search results and facilitated extraction of relevant scholarly pieces of literature (McGowan et al., 2016). Three electronic databases namely, MEDLINE, CINAHL, and PubMed were used for the data extraction. Input of the search terms were accompanied by addition of filters and limiters that narrowed down the emphasis of the search, thus ensuring that the exploration was restricted in accordance to the research question (Aromataris & Riitano, 2014) (refer to appendix). The Appraisal Skills Programme checklist (CASP) was also used to review the articles, with the aim of obtaining appropriate and evidence-based literature on psychoeducation in mental health practice.

Literature review

Psychoeducation is defined as the procedure that encompasses the delivery of education and pertinent information to people who seek or receive appropriate mental health services (Chan, Yip, Tso, Cheng & Tam, 2009). This is usually required by individuals diagnosed with different mental health condition and their family members. Zhao, Sampson, Xia and Jayaram (2015) define psychoeducation as the education of a person who has been diagnosed with a psychiatric disorder regarding the presenting complaints, symptoms, prognosis and treatment of the illness. They also elaborated on the fact that brief psychoeducation for any mental illness reports significant reduction in the relapse of the illness in medium term, and also promotes medication compliance among the affected people in short term. The statements are consistent with other articles that illustrated the importance of psychoeducation in improving the compliance to schizophrenia symptoms and health outcomes, without bringing about any noteworthy onset of adverse health effects (Bäuml et al., 2016).

In other words, psychoeducation have been found beneficial in improving the adherence to prescribed treatment regimen and also motivates the mentally ill patients to accept the recommended maintenance therapy, as per the healthcare guidelines. The information that is offered to patients seeking psychoeducation support often range from educating the patients on the potential benefits of the prescribed medication to enhancing their adherence, to complex, intensive interventions that cover all information related to drugs and the illness. There often exists a considerable overlap between specific psychotherapies such as, interpersonal and social rhythm therapy (IPSRT), cognitive behavioural therapy (CBT), and family-focused therapy (FFT) and psychoeducation (Lefley, 2009). D’Souza et al. (2010) conducted a randomised controlled trial to determine the impacts of psychoeducation program on the relapse rates of bipolar disorder among patients. Findings of the RCT suggested that the intervention group participants showed reduced likelihood of relapse symptoms and also had a longer relapse time (11 weeks), in comparison to the treatment-as-usual group. Although the sample size was small, further improvements were also associated with a reduction in the maniac symptoms and improved adherence to medications, thus suggesting the utility of psychoeducation in bipolar disorder management.

However, Bond and Anderson (2015) argued that individual psychoeducation programs were not much beneficial in preventing bipolar disorder relapse. Upon conducting a systematic review of randomised controlled trials, the findings suggested that psychoeducation was effective in averting any reversion of symptoms (n = 7; OR: 1.98–2.75; number needed to treat (NNT): 5–7) and hypomanic or manic recurrence (n = 8; OR: 1.68–2.52; NNT: 6–8). Showing consistency with previous findings, psychoeducation was found to improve the short?term medication knowledge and medication adherence. However, failure of the psychoeducation interventions in preventing bipolar associated depressive symptom relapse explained the presence of heterogeneity in the individual interventions.

Nonetheless, the interventions that focus on psychoeducation were found operational in bringing about statistically momentous enhancement in the compliance to medications among bipolar disorder patients in another RCT (P = 0.008). Upon subjecting patients to 50 minutes of psychoeducation sessions, lower cases of hospital admissions and disorder relapse were also found in the intervention group, compared to the control group (P = 0.000) (Javadpour, Hedayati, Dehbozorgi & Azizi, 2013). These were in contrast to the findings presented by de Azevedo Cardoso et al. (2014) who conducted an RCT for assessing the effects of brief psychoeducation on bipolar disorder. While there was no statistically significant difference in the quality of life of patients subjected to psychoeducation and medication, and the usual care group, the improvement persisted during 6-month follow-up period, thus establishing the fact that psychoeducation in addition to pharmacological intervention might prove effective in enhancing quality of life of bipolar disorder patients.

In the words of Gumus, Buzlu and Cakir (2015) individual psychoeducation program do not prove helpful in reducing recurrence rates of bipolar disorder and its comorbid psychological symptoms. Although recurrence rate among patients in the experimental study was 18.9% in intervention group, in comparison to 34.1% in the control group, failure to achieve a statistical significance between the both made the researchers conclude that although individual psychoeducation sessions produce positive impacts, they are ineffective in the prevention of relapse. Besides, it was reinforced by other researchers that psychoeducation programs in addition to pharmacotherapy are a potential treatment option that can improve global functioning and medication adherence of bipolar disorder patients. Increase in medication adherence score of the psycho-educational group from 6.27(0.88) to 7.92(1.38) provided evidence for the worth of psychoeducation as an intervention in mental health settings (Bahredar, Farid, Ghanizadeh & Birashk, 2014).

Rahmani, Ebrahimi, Ranjbar, Razavi and Asghari (2016) also recommended the implementation of interventions that focused on psychoeducation in clinical settings by psychiatric nurses. Significant increase in the mean scores related to medication adherence in the experimental group than the control group established the fact that educating the patients on the benefits of the prescribed medications are a good strategy for increasing their compliance, thus managing the bipolar disorder symptoms. Psychoeducation was confirmed as the key component of collaborative models related to treatment of mental disorder that campaigns the rights of all patients being informed about the proposed plan of treatment plan. Increase in treatment adherence rate of patients in intervention group from 40.0% (14 patients/pre-test) to 86.7% (26 patients/post-test) established the benefits of six-week psychoeducation programs on adherence improvement (Eker & Hark?n, 2012).

In the words of Husain et al. (2017) a pilot study confirmed the feasibility and acceptability of psychoeducation intervention in the treatment of bipolar disorder patients by enhancing their mood and knowledge attitudes. Improved patient satisfaction (ES = 1.41), greater medication adherence (MMAS-4: ES = 0.81), enhanced measures related to quality of life (EQ-5D: ES ⇒ 0.88) and improved knowledge towards mania (YMRS: ES = 1.18), bipolar (BKAQ: ES = 0.68), and depression (BDI: ES = 1.17) helped in establishing the value of culturally adapted bipolar psychoeducation programmes (CaPE). These were consistent with findings presented by Chen et al. (2018) who conducted a qualitative study with the intent of understanding the impact of group psychoeducation on perception of inpatients after remission of manic episode in bipolar I disorder. Some of the common themes that emerged from the results were namely, (1) increased patient engagement, (2) recommendation of the intervention to others, (3) learning environment, (4) facilitators, (5) time, (6) class-taught versus discussion, and (7) suggestions, among others. It was found that psychoeducation made the patients more confident, enhanced self-acceptance of the mental disorder, helped the patients understand the side effects, and also prevented relapse. Similar findings were reported in another RCT where the patients were subjected to eight group?based psychoeducation sessions in the intervention group. Psychoeducation proved beneficial in management of bipolar disorder by reducing the mania recurrence, showing lower hospitalisation rates, and bringing about changes in depression scores, global functioning and mania (Chen et al., 2018).

Soo et al. (2018) conducted a systematic review with the aim of summarising the effectiveness of psychoeducation and its four modalities (individual, internet- based, group, family) upon bipolar disorder patients and found that the intervention played a major role in reducing illness recurrences, decreasing the duration and number of hospitalizations, increasing time to relapse of illness, enhancing treatment adherence, and reducing stigma related to mental illnesses. However, Gumus (2017) argued that individual psycho-education proved ineffective in bringing about an improvement in global functioning and quality of life of bipolar disorder patients. Nonetheless, the intervention was successful in improving participation of patients in social activities (T = 2.011; P = 0.048) and taking the initiative for self-management of condition (T =2.093; P = 0.040). The effectiveness of psychoeducation programs were also not consistent with the findings presented in another trial where the intervention was related to constraints in rate of participation among patients and a sense of motivation among them (Cakir, Bensusan, Akca & Yazici, 2009).

Batista, Baes and Juruena (2011) opined that psychoeducation based interventions had the potential of significantly improving the treatment adherence, clinical course, and psychosocial functioning of all bipolar patients. It also decreased the number of recurrences and relapses per patient and augmented the time to manic, depressive, mixed, and hypomanic recurrences. The length and instances of hospitalizations were also lower among patients subjected to the intervention. This was consistent with results of another RCT where psychoeducation reduced percentages of mood relapse (χ²=6.53; p=0.011) and increased the relapse free time periods experienced by bipolar disorder patients (log?rank χ²=4.04; p=0.044). This helped the authors conclude that group based psychoeducation intervention for caregivers of bipolar patients can be considered as an useful adjunct to typical treatment for patients in dropping the risk of relapses, particularly hypomania and mania, in bipolar disorder (Reinares et al., 2009).

However, Zaretsky, Lancee, Miller, Harris and Parikh (2008) contended that following optimisation of pharmacological treatment, longer duration of adjunctive CBT was found to deliver supplementary benefits over short-term psychoeducation programs for management and treatment of bipolar disorder. Findings from another cluster feasibility randomised trial that comprised of community mental health programs (hourly sessions of psychoeducation) suggested that the intervention was an effective approach in preventing relapse of bipolar disorder symptoms and also improved the occupational and social functioning among the patients (regression coefficient 0.68, 95% CI 0.05–1.32) (Lobban et al., 2010). Morriss et al. (2016) suggested that although structured group psychoeducation was not able to prove its clinically effectiveness, when compared to parallel intensive un-structured peer support programs, the former was better acceptable and helped in enhancing the outcomes among participants by reducing their bipolar episodes. The findings reported higher attendance in the psychoeducation groups, in comparison to peer support (median 14 sessions vs nine sessions; p=0·026). Furthermore, only 58% participants subjected to psychoeducation experienced relapse of next episode of bipolar disorder, compared to 65% in the other group.

According to Kallestad, Wullum, Scott, Stiles and Morken (2016) bipolar disorder patients who were subjected to group psychoeducation (GP) demonstrated lengthier survival times when compared to individual psychoeducation (IP), over a period of 27 months (p<0.05). GP cases associated with harmful substance abuse comorbidity reported shortest survival time, while those without the comorbidity survived more (p=0.02). Significant lessening in hospital admissions upon implementation of the group based intervention also proved the efficacy of psychoeducation in bipolar disorder management (p=0.04). BalancingMySwing, a nursing based psychoeducation program was also found to improve the adherence to medications among Taiwanese Han-Chinese bipolar II disorder patients. Owing to the fact that medication adherence is considered crucial for long-term management of mental illness management, and non-adherence can pose major challenges while treating bipolar disorder patients, the results helped the authors to establish the efficacy and worth of the nurse-led psychoeducation program (Lin, Berk & Hsu, 2017).

In the words of George, Sharma and Nair (2013) significant improvements  were observed in a randomised controlled trial among the patients suffering from bipolar disorder who were placed in the intervention group that comprised of four sessions of psychoeducation. Substantial enhancement of attitude and knowledge scores among the investigational group, compared to the control group (p =0.001) established the worth of the psychoeducation program. Although not noteworthy, differences were also observed in the adherence to intervention between the two groups (p = 0.111). Thus, the results confirmed the fact that psychoeducation based intervention concomitant with pharmacotherapy acted as an easy, cost-effective and feasible intervention for enhancing treatment adherence among bipolar disorder patients.

Pakpour et al. (2017) also conducted a study where patients with bipolar disorder were randomised to an intervention group that encompassed five sessions of psychoeducation and motivational interviewing, together with their family members. Patients in the intervention group demonstrated enhancement in adherence to medications (baseline score: 6.03; score at the sixth month: 9.55) when compared to those in the usual care group. Furthermore, those subjected to psychoeducation and motivational interviewing sessions were able to manifest improvement in all scores related to their secondary outcomes as well. This confirmed the effectiveness of psychoeducation approaches on functional and clinical outcomes of bipolar disorder patients. Parallel to the aforementioned findings, psychoeducation was found to exert long-term prophylactic impacts on bipolar disorder affected individuals in another RCT. Patients who had been administered the psychoeducation program manifested longer time to recurrence for bipolar disorder (log rank=9.953, P<0.002). The intervention group also reported lesser instances of disease recurrence (3.86 v. 8.37, F=23.6, P<0.0001) of any kind. Additionally, the patients were found to spend less time in being acutely ill (154 v. 586 days, F=31.66, P=0.0001) (Colom et al., 2009).

Conversely, the impacts of a psychoeducation intervention Beating Bipolar on the psychological quality of life were not adequately established in another study (Smith et al., 2011). Following randomisation of bipolar disorder patients to the intervention group that comprised of Beating Bipolar intervention, no significant differences were found between them and the control group, in relation to the measures of primary outcomes (WHOQOL–BREF scores). Although the psychoeducation program brought about modest enhancement in the psychological subsection of the outcome measures, lack of variation in the secondary outcomes failed to confirm the worth of the program. According to Proudfoot et al. (2012) online psychoeducation program was not able to result in any momentous improvement in relation of perceptions of symptom control, reduced stigmatisation perceptions, and enhancements in the depression and anxiety symptoms among the bipolar disorder patients. This made the authors elaborate on the need of longer term coaching for online psychoeducation programs, before they are implemented upon bipolar disorder patients.

However, the Beating Bipolar proved its efficacy in another trial where it assisted bipolar disorder patients gain an insight into their illness, adopt a healthy behaviour, adhere to personal routines and adopt a positive attitudes towards their medications. Owing to the fact that most participants considered the programme likely to be advantageous for the recently diagnosed patients, this online psychoeducation package proved its worth for managing the mental disorder in question (Poole, Simpson & Smith, 2012). Colom (2011) also illustrated that psychoeducation can be categorised as a simple intervention for treatment of mood disorder and act in the form of an illness-focused and simple therapy that has prophylactic usefulness in all chief mood disorders. Successful implementation of these psychoeducation programs require an appropriate setting that includes team effort, open-door policy, and empowerment of therapeutic coalition.

Contrariwise, results of a post hoc analysis that encompassed a 5-year follow-up study failed to establish the benefits that psychoeducation exerts on bipolar disorder patients. The intervention was found beneficial in only treating patients who reported six previous episodes of the mental disorder. Patients with seven or more episodes did not display any significant development with psychoeducation, in relation to time to relapse. Patients with greater than 14 episodes were not benefitted from psychoeducation, in terms illness time reduction. However, the intervention brought about benefits in relation to reduced time spent in depression, hypomania and mixed episodes among those with 7-8 episodes (except mania) (Colom et al., 2010). Stafford and Colom (2013) also confirmed the role of psychoeducation in stabilising bipolar disorder symptoms, reducing chances of relapses, and increasing the time required for recurrence of the complaints. They elaborated on the fact that psychoeducation acts as an unassuming method of supporting the prevention of future bipolar episodes by conveying behavioural training, with the aim of improving insight of illness, identifying early symptoms and developing coping strategies. The intervention was also found to empower all the patients for their active participation in their treatment regimen, thus providing them independence, counteracting the prevailing disengagement of the therapist and the patients, and increasing the awareness and acceptance of the challenges that might be encountered during the treatment of bipolar disorder.

Isasi, Echeburua, Liminana and Gonzalez-Pinto (2014) opined that combination of psychoeducation and cognitive behavioural therapy is effective in the long run for managing patients diagnosed with refractory bipolar disorder. While those subjected to the intervention reported fewer rates of hospitalization, in comparison to the control group during the 12-month evaluation (P = 0.015), they also demonstrated reduced symptoms of anxiety and depression in 6 months (P=0.006; P=0.019), 12 months (P=0.001; P<0.001) and 5 years (P<0.001, P<0.001). Substantial differences that appeared in mania and misadjustment (P=0.009; P<0.001) also established the role of the combination treatment in bipolar disorder management. The effectiveness of two online programs MoodSwings (MS) and MoodSwings-Plus (MS-Plus) were also confirmed by a reduction in the mania and depression symptoms in another study where the program that contained CBT along with psychoeducation (MS-Plus) proved more beneficial in management of the mental disorder (Lauder et al., 2015). These aforementioned literature form the rationale for the implementation of psychoeducation as a change management strategy across a psychiatric ward.

Change management

Change management can be defined as the procedure that has the prospective of managing the way by which accountable individuals prepare, upkeep and equip others in effectively adopting change, with the purpose of driving organisation results and success (Burke, 2017). While all changes are exceptional in their individual kind, all individuals are diverse and decades of investigation have recommended that activities can also be undertaken for manipulating people in discrete transitions (Kuipers et al., 2014). In other arguments, change management policy offers some type of organized approach for assisting people in administration that traffics from the current position to the future circumstances. Some of the most shared change management replicas are the Lewin’s change management model, ADKAR model, PDSA model (Ashkenas, 2013). The PDSA change management model will be adopted in this healthcare scenario.

The primary advantage of the PDSA model is related to the fact that it places a due focus on the development and improvement, in addition to implementation of the change that is required. PDSA model will be favoured over other change management strategy due to the fact that it is a powerful approach for fetching a spurt in quality enhancement (Moule, Evans & Pollard, 2013). This can be accredited to the fact the model creates the provision for its leaders to evaluate and explore the change on a small care, with the intent of determining the effectiveness, prior to its complete implementation on a wider scale. The model also allows the leaders to recognise the worth and lucrativeness of the change, upon its application in real-time settings, on a wider scale. Furthermore, the fact that the PDSA approach facilitates the implementing leaders to identify the potential barriers and challenges that are not ostensible prior to the application of the proposed tactic creates the provision for bringing about much needed modifications and amendments before the actual change. The model can be defined as a shorthand for assessing a change, and emphases on its preparation, operation, reflexion of results and acting on the evidence that has been obtained (Donnelly & Kirk, 2015). The foundation for application of the PDSA model is demonstrated by the systems theory that places an attention on the type of the complex organisations (Rice, 2013). The theory embraces the opinion that alterations made in one segment of the organisation have the competence of disturbing the other portions, with foreseeable behavioural configurations (Al-Haddad & Kotnour, 2015). Hence, while articulating an effective organisation strategy for psychoeducation based treatment adoption in the psychiatric unit, the fact that minor modifications can bring about great variations in the entire administration will considered. The PDSA method to be used for operative change management will encompass the following stages:

• P- planning the implemented change
• D- conducting change
• S- studying data before and after the change and reflecting on the information
• A- acting on the obtained information and devising future plans

However, one major drawback of the selected change management model is that it needs extra time from the concerned staff and administrative personnel for working through the aforementioned four stages of the model. This often leads to difficulties in the implementation of the proposed change in a stressful and complex work environment. Although the PDSA model is habitually used in the context of healthcare and is permitted all healthcare institutes as well, its implementation does not appear quite easy. In theory, it is advised not to use the PDSA Cycle for once, because it is imagined to be a unceasing improvement device. Upon completion of one PDSA Cycle, another one begins, using the information learned from the preceding cycle as a preliminary point. Nonetheless, most healthcare facilities would execute a single cycle and not repeat it. They might even fail to utilise data from previous cycles, prior to beginning the second one. Failure to achieve the four steps in precise order is another challenge that might be encountered in healthcare scenario.

Project initiation

The mental and physical health of the persons suffering from the recognised mental illness must be perceived that would enable the early acknowledgement of co-morbid conditions and the obligation for realizing major lifestyle variations or introducing rapid action. Project initiation would start with the implementation of a care plan that would be executed by three persons working in the psychiatric ward (Gareis, 2013). The plan would primarily encompass screening the patients for the severity of comorbid and bipolar disorder symptoms with the use of standardised questionnaires, and determining their knowledge on the disorder. This would be achieved by recruiting experienced mental health nursing professionals and members of the hospital administration. While the former will be directly involved in subjecting the patients suffering from bipolar disorder to the psychoeducation sessions, the latter will have the role of explaining potential benefits of the proposed change to the key stakeholders.

The nursing staff would examine the patients in the psychiatric ward by monitoring their current stages of physical and mental health through several examinations. The nursing staff would be authorised with the duty of growing a consciousness of the intervention (psychoeducation) that needs to be implemented. There would be some mandatory contraindications such as acute suicidal ideations, hearing of imperative sounds, massive though disorders, and manic heightened mood.

1. Plan– The first stage would encompass a plan that will help in introducing psychoeducation sessions in the psychiatric ward, with an emphasis on bipolar disorder patients. All the nursing professionals (fresh graduates and experienced registered nurses) will be introduced to the plan of action. Prior to the application of the intervention, the psychiatric ward manager will be requested to sanction the proposed transformation. There is mounting evidence for the fact that change leadership focuses on the capability of an individual (the leader) to encourage and excite others via vision, personal advocacy, and increased access to essential resources (Kouzes, 2014). These help in the formulation of a platform that facilitates the change process. Internal communications also play a vital role in the change processes. Thus, the ward manager must demonstrate best communication skills by being specific, clear and direct, while allowing the concerned nurse gain a thorough understanding of the need for implementing psychoeducation as a part of treatment program. Cooperation and teamwork have been found imperative in healthcare settings, with the aim of resolving all kinds of conflicts (Shrader, Kern, Zoller & Blue, 2013). Thus, following organisation of meetings and seminars that help others to understand the advantages of the proposed intervention, regular feedback will be taken from the receivers in the form of surveys and questionnaires to determine their opinion on the projected change. Further efforts must also be taken by the ward manager to educate the fresh graduate nurses on the potential advantages that the service users (bipolar disorder patients) might gain upon adherence to the psychoeducation sessions, in relation to their mental state, health and overall wellbeing.
2. Do– The stage will encompass the nursing staff working across the psychiatric wards who will help in successful implementation of the psychoeducation program by attending different workshops and training sessions. These programs will be responsible for educating the concerned staff and advocating for the rights of the patients (Ailey, Lamb, Friese & Christopher, 2015). The selected nurses will assign the bipolar disorder patients admitted to the psychiatric wards into different groups where they will receive two weekly sessions of psychoeducation, each lasting for 60 minutes. The sessions will be conducted over a period of four months. The major topics that will be addressed during such sessions would comprise of recognition of mental illness, treatment modalities, and coping skills (Lyman et al., 2014). The sessions will culminate with the formulation of a personal care plan that will be put to practice, upon observing relapse of any manic or depressive symptoms of the illness. In addition to the nurses, a psychotherapist will also supervise the sessions.

• Study– An analysis of the functioning will be done by collecting responses to specific questionnaires that will determine the success of the nursing professionals in adapting to the change process. Discussions will also be held by the ward manager with each group member to gain a sound understanding of the feelings and experiences of the patients, subjected to the sessions. Conducting clinical audits will also help in supervising the implemented change and identifying regions of improvement (Taylor et al., 2013).

1. Act– Changes in mood burden, depressive episodes, manic episodes, and social adjustment will be evaluated by dissemination of standardised questionnaires. All the nurses and the psychotherapist will be reminded to regularly record patient observations and shall be trained about the significance of finishing the intervention.

My character in this change management occasion will be that of an associate of the project team. I would acts as the project manager and would be responsible for justifying the funding and cost of the proposed plan. A comparison shall be made between the costs of usual care and psychoeducation by formulating cost-effectiveness acceptability curves that will help me to demonstrate the cost differences between the conventional treatment methods and the change process. Recording the reduction in relapses would also help in the process. I would take all conceivable labour to guarantee that the project obtains sufficient capitals, while handling the dealings with the key shareholders and the funder. I would look for funds for the change management by applying for a district mental health grant to the government. I would embrace a visionary headship style and would try to look outside the trials and ambiguity of the current scenario.

Although I would support the team members to regulate their best potential and realise the ideas, implementation of a paternalistic leadership will be crucial in the scenario (M. Taylor, Cornelius & Colvin, 2014). I would adopt a managerial approach that will make me act as a dominant authority. I would use my organisational power for supporting the team members in the change management process. The major benefit of this leadership style can be attributed to the completion of tasks within stipulated time, thus exceeding the goals (Aycan, 2015). I will develop the action plan and accomplish its deliverables, enlist qualified nursing staff for the change process, manage the team, and take regular updates on the success of the program. The unit cost of psychoeducation are an estimated £119 per session that are conducted over a period of one hour. We would try to restrict the costs to £150 for each session of 90 minutes (McMurran et al., 2011).  These costs will be subsidised by the health department, government, and eminent non-profit organisations that are mindful of the probable benefits of the plan. Analysis of the articles included in the review propose that apparent benefits will overshadow the costs and jeopardies (if any).

Subsidy will be assimilated by inspecting whether the zone we are concerned with, is addressed by the NIH mission. A cautious preparation will initiate by lettering a grant about the scheme in a way that will excite the fund granting authorities. A budget plan will accompany the grant proposal, prior to its submission. A baseline valuation will be steered to classify the definite barriers to the process. Lack of employee involvement and inadequate communication strategies might make the staff repel changes in the treatment for bipolar disorder (Doppelt, 2017). Approaches for actual communication can help in plummeting communication barriers. Additionally, taking all likely efforts not to oversee the inclinations and approaches of the employees would aid in reducing odds of resentment and clash (Kadu & Stolee, 2015).

The measurable outcomes will encompass assessing the organisational performance. The primary question would encompass ‘whether the results obtained were anticipated from the plan’ (Bourne, Pavlov, Franco-Santos, Lucianetti & Mura, 2013). The primary outcome will be related to investigating the impacts of the psychoeducation on the relapse of bipolat disorder symptoms. These will be measured with the use of Longitudinal Interval Follow-up Evaluation (LIFE) scale, Modified Social Adjustment Scale, Clinician-Administered Rating Scale for Mania, and 17-item Hamilton Depression Rating Scale (Gunderson et al., 2011). Some of the secondary parameters that would be measured are namely performance enhancement, willingness to change, plan adherence, and speed with which the plan was executed (Lozano, Ceulemans & Seatter, 2015). The change management process will also be evaluated using different procedures such as, presence and training participation figures, tracking change management, communication effectiveness, profit realisation, timeframe observance, and plan progress (Kenny & Bourne, 2015).

The future insinuations are related with the fact that the change model will enable building of new knowledge into the investigational process of directing psychoeducation among bipolar disorder patients across the psychiatric ward. It will assess if the trial has fixed the clinical problem. Flexibility of the PDSA model will also permit acceptance of other non-pharmaceutical mediations for the management of mental illnesses.

Conclusion

To conclude, the change management method should be realised for enabling the administration of psychoeducation based intervention among bipolar disorder service users in a psychiatric unit. Thus, psychoeducation will be implemented with the aim of reducing severity of mania and depression symptom relapse among bipolar disorder patients, with the aim of enhancing their health outcomes.

References

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Al-Haddad, S., & Kotnour, T. (2015). Integrating the organizational change literature: a model for successful change. Journal of Organizational Change Management, 28(2), 234-262. https://doi.org/10.1108/JOCM-11-2013-0215 

Amann, B. L., Radua, J., Wunsch, C., König, B., & Simhandl, C. (2017). Psychiatric and physical comorbidities and their impact on the course of bipolar disorder: A prospective, naturalistic 4?year follow?up study. Bipolar disorders, 19(3), 225-234. https://doi.org/10.1111/bdi.12495 

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Ashkenas, R. (2013). Change management needs to change. Harvard Business Review, 16(April). Retrieved from https://www.newoaksconsulting.com/assets/docs/Change_Management_Needs_to_Change_-_HBR.pdf 

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