NURS FPX 4905 Assessment 2 Define and Analyse Your Healthcare Process Problem or Issue of Concern

Student Name

Capella University

NURS-FPX4905 Capstone Project for Nursing

Professor Name

Submission Date

Define and Analyse Your Healthcare Process Problem or Issue of Concern

The substance use disorder (SUD) is a continuous and complex public health issue, especially in inpatient detoxification and residential rehabilitation settings. At Immersion Residential Centre, being focused on drug and alcohol detox and long-term recovery, there exists a heavy healthcare process problem: the lack of a consistent, individualised post-detox care planning contributing to high relapse rates and treatment non-adherence (The Immersion Program, 2024).

This lack of continuity of care compromises recovery outcomes and puts clients at risk of going through the cycles of detoxification. Analysing this issue involves understanding the multidimensional nature of addiction, barriers to sustained recovery and system-level gaps in discharge planning, follow-up care and patient engagement in early stages of rehabilitation.

Description of Practicum Site

My practicum is occurring at a private for-profit health care institution, Immersion Residential Centre in Boynton Beach, Florida. The facility specialises in treating substance use with a special focus on medical detoxification and residential rehabilitation services (The Immersion Program, 2024). It has various treatment programs, such as cognitive behavioural therapy, motivational interviewing, relapse prevention strategies, and 12-step facilitation (American Addiction Centres, 2025).

The centre is licensed and certified by The Joint Commission, Drug Enforcement Agency (DEA), the state Substance Abuse Agency and the state Department of Health. It can adhere to the requirements of high-quality care (American Addiction Centres, 2025). Additionally, Immersion Residential Centre administers and prescribes medications for both alcohol and opioid use disorders, including buprenorphine, naltrexone, disulfiram and acamprosate, as part of a comprehensive Medication-Assisted Treatment (MAT) program.

The patient population at Immersion Residential Centre consists mostly of young adults of all genders who are suffering from substance use disorders such as alcohol, opioids, methamphetamines, and benzodiazepines. Many of these individuals also come with co-occurring mental health disorders, trauma histories or social instability. The centre supports patients with individualised detox protocols, counselling, group therapy and case management (The Immersion Program, 2024).

Ancillary services such as domestic violence support, social skills development and recovery coaching are also available (American Addiction Centres, 2025). While the exact number of full-time staff may vary, it is estimated that the facility may employ an approximate 40-60 full-time healthcare professionals, including nurses, physicians, licensed therapists, case managers, and recovery support staff, and all work collaboratively to provide holistic, patient-centred care.

Clinical and Operational Decisions at the Practicum Site

At Immersion Residential Centre, clinical and operational decisions are made by a multidisciplinary team of psychiatrists, nurse practitioners, therapists and addiction specialists. These decisions involve deciding on the level of care needed for each client (detox, partial hospitalisation, or outpatient), the type of MAT to be used, such as buprenorphine or naltrexone, and the therapeutic interventions to be used to address individual needs (The Immersion Program, 2024).

Operational decisions refer to providing seamless transitions from one treatment phase to another, organising the schedules of group and individual treatment, managing caseloads, and maintaining compliance with licensing bodies such as The Joint Commission and the DEA (The Immersion Program, 2024). The three-phase method of recovery (stabilisation and detox, then therapy and reintegration) used at the centre requires planning and continuous assessment to work collaboratively and provide the best outcomes.

During my practicum, I have been actively engaged in the process of contributing to the clinical and operational decision-making with the supervision of licensed professionals. I take part in interdisciplinary team meetings where I help review client progress, address treatment responses and make recommendations for changes to care plans based on behavioural observations and client feedback.

I have also been involved in discharge planning discussions and helping to identify post-treatment needs and appropriate aftercare services. In addition, I am supporting therapeutic sessions by preparing client education materials and supporting the implementation of trauma-informed practices. My role allows me to bridge academic knowledge to hands-on experience, and provides me a meaningful voice in the decision-making process and reinforces the importance of individualised and evidence-based care.

The major patient health outcomes at Immersion Residential Centre are successful detoxification, stabilisation of co-occurring mental health symptoms, improved coping strategies and long-term recovery engagement. The facility focuses on outcome tracking with relapse prevention planning, continuous mental health support and follow-up care.

Positive outcomes are also obtained through integration of 12-step facilitation, trauma-informed counselling, and pharmacological assistance based on the substance use history of each client (The Immersion Program, 2024). As part of my involvement in the practicum, I help track and record client progress, identify potential signs of relapse, and reinforce health education, all of which help support continued recovery and improvement in the quality of life for people overcoming substance use disorders.

Process Issue Identification

One of the most critical healthcare processes in issues at Immersion Residential Centre is the lack of continuity of care after detoxification, especially for patients diagnosed with SUD and co-occurring mental health conditions (American Addiction Centres, 2025). While detox and initial stabilisation are critical first steps, many patients struggle to transition into long-term treatment because they are not given any planning for follow-up, have an individualised aftercare plan, or any help in the reintegration process.

This gap has a significant effect on the outcome of the patient, which often leads to relapse, readmission, and disrupted recovery progress (David et al., 2022). Given that the Immersion Centre works within a structured, three-phase model, any breakdown in this process, particularly when it comes to the handoff from residential treatment to outpatient care, can impact the long-term trajectory of recovery and result in poor treatment outcomes.

The issue is critical with regard to national data. An estimated 48.5 million Americans aged 12 and older have struggled with substance use disorder in the past year, and more than 20.4 million adults were suffering from co-occurring mental health and substance use disorders (American Addiction Centres, 2024). These numbers highlight the complexity of a SUD treatment and how beneficial it is to be able to access integrated and sustained care beyond the detox phase.

Research has shown that people with both SUD and mental health conditions are faced with an increased risk for relapse if they do not receive well-coordinated care (Sweileh, 2024). At Immersion Centre, developing a strong discharge plan for each patient that is accompanied by available outpatient therapy, medication management and community-based support is critical for lowering relapse rates and improving recovery outcomes. Addressing this gap in the healthcare process can lead to more stable, empowered and long-term recovery for patients who are facing the challenges of addiction and mental health.

Impact Analysis

The lack of good continuity of care after detoxification has a significant impact on the outcome of patients as well as the performance of the whole organisation. From a quality perspective, patients who are not given individualised, ongoing treatment plans are more likely to experience relapse, resulting in cycles of readmission, which interrupt sustained recovery (Owusu et al., 2022).

This leads to the disruption in the quality of care and defeats the purpose of residential facilities, such as Immersion Residential Centre, that strive to offer a comprehensive healing environment. Safety is also violated when clients with co-occurring disorders are discharged without proper follow-up services such as psychiatric counselling, medication management, or peer support (Ådnanes et al., 2020). These people are at increased risk for overdose, self-harm or mental health deterioration, particularly during the first few weeks of post-detox recovery.

At the organisational level, this process gap also causes financial strain and inefficiencies. When clients relapse and want to be readmitted, it leads to increased healthcare utilisation at the expense of treatment outcomes (Birhan et al., 2025). This increases the cost of operation for the facility, burdens staff with repeated crisis intervention, and decreases bed availability for new admissions.

Additionally, insurance reimbursement models increasingly link to outcome-based measures, so poor continuity of care may have a negative impact on funding, accreditation, or payer relationships (Wagenschieber & Blunck, 2024). Programs without structured follow-up are also at risk to their reputation in the community. They may not be able to retain their clients or see program completion rates, which are also critical metrics for organisational success.

The root causes of this problem include a lack of coordination between the residential and outpatient services, inadequate staffing of aftercare planning, and a systemic lack of investment in transitional care programs. A significant part of this is the lack of development of integrated treatment pathways which support clients holistically at all stages of recovery.

According to the research by Sweileh (2024), people with co-occurring mental disorders need continuous, coordinated care to achieve and maintain recovery. Still, there are many programs which still treat addiction and mental health issues in silos. Without strong communication and partnership between the phases of treatment, patients fall through the cracks, compromising both their health and the cost-effectiveness of care delivery.

Conclusion

The identified process issue at Immersion Residential Centre, the lack of effective continuity of care after detoxification, poses significant challenges to both client recovery outcomes and organisational efficiency. As a graduate nursing student participating in a practicum at this facility, I have noted that the lack of aftercare planning and poor integration between inpatient and outpatient services contribute to relapse and additional healthcare costs and safety for clients with co-occurring disorders.

Addressing this issue, through coordinated treatment pathways, individualised discharge planning, as well as follow-up support, will not only improve quality and safety but will also reduce the rate of readmissions and promote the success of long-term recovery. Through my work in this environment, I am committed to making meaningful contributions to meaningful change, including supporting advocacy for sustainable, client-centred solutions that are evidence-based practice.

Explore Next Assessment: NURS FPX 4905 Assessment 3

Struggling with NURS FPX 4905 Assessment 2? Get step-by-step guidance and expert help to boost grades fast and succeed confidently.