Mental Health Nurses are the Best People to Aid Recovery of Depressed and Cardiac Patients - Assignment Example

?Mental Health Nurses are the Best People to Aid Recovery of Depressed and Cardiac Patients Introduction The relationship between a patient and a mental health nurse in clinical practice is the foundation of successful mental health outcome, and necessitates the creation and maintenance of open communication and trust. The role of the mental health nurse in patient recovery is extremely vital, thereby putting them at the top of the recovery model. Recovery is a practical and theoretical model of care where in the focus is on an individual’s capability to live their lives as they want (Alpert & Fava 2004). Recovery is not merely about mitigating or removing symptoms; it concerns a person’s life battling mental disorder (Nemeroff 2008). In this perspective, recovery has several implications, and it is a personal and a complex experience, not an inactive mechanism. A recovery-oriented framework is strengthened by a focus on several defensive factors that can be developed to lessen the effect and severity of the mental problem. Defensive factors play several roles (Ai, Rollman & Berger 2010). They can absorb negative effects and provide a defence against risk factors. Moreover, they may disrupt the mechanisms through which risk factors work (Ai et al. 2010, 27). Defensive factors can be classified into three groups: community; peers and family; and the individual. Beforehand, the lived experience of the mentally ill individual was at the centre of the care paradigm (Alpert & Fava 2004). Yet, at some point in the twentieth century, the emphasis changed and the biomedical framework governed mental health care and placed importance on symptoms diagnosis and mitigation, mainly through prescription, with the personal experience acquiring less importance (Alpert & Fava 2004). Nevertheless, the present-day have seen a change towards a recovery model where in the individual is the centre of care. In this person-oriented approach towards recovery the mental health nurse takes precedence over other medical practitioners (Nemeroff 2008). This essay will try to prove that the mental health nurse is the best person to aid recovery. The essay will analyse severe depression and cardiovascular disease by using the PICO format. Patient/Problem The pervasiveness of mental health problems in patients with cardiovascular illness is currently established. Over the recent decade, several studies have linked anxiety and depression with cardiovascular problems, as well as fatal heart attacks (Bogner, Ford & Gallo 2006). A wide-ranging analysis of empirical studies about cardiac patients’ psychosocial medications indicates that a vast sum of resources have been employed in this attempt (Pignay-Demaria, Lesperance, Demaria, Frassure-Smith & Perrault 2003). Hence, it is vital for mental health nurses to be knowledgeable of the important developments that have taken place. A vast number of studies and reviews over the recent decade have analysed the impacts of depression on cardiovascular problem. They propose a relationship between cardiovascular problems and depression, but not a decisive causality trend (Ai et al. 2010). The findings can be classified into three groups (Ai et al. 2010). Primarily, depression portends the start of and weak diagnosis for cardiovascular illness (p. 27). Second, the connection between heart disease and depression is due partly to the connection between cardiac patterns and risk factors and depression like refusal to take medication, poor compliance to minor precautionary treatment, social exclusion, and withdrawal from rehabilitation courses (Ai et al. 2010). Third, some studies indicate that coronary heart disease may reinforce depressive symptoms, particularly among women. Certainly, a significant number of Myocardial Infarction (MI) survivors are experiencing depression (p. 27). Duits and colleagues (1997), in an analysis of 17 potential investigations of psychosocial results after cardiac surgery, discovered that preoperative depression and anxiety portended postoperative mental instability. Pignay-Demaria and colleagues (2003), in another study, demonstrated that depression portended a variety of postoperative cardiac occurrences, such as Coronary Artery Bypass Graft (CABG), acute MI, unstable angina, angioplasty, and death. This finding, according to Ai and colleagues (2010), gives emphasis to the significance of preoperative diagnosis and intervention in depressed patients. Intervention The usual treatment given is selective serotonin reuptake inhibitors (SSRIs) and cognitive behavioural therapy (CBT). The comorbidity of cardiovascular illness and mental health problems has been inadequately treated and recognised (Schein, Bernard, Spitz & Muskin 2003). For instance, among patients with Congestive Heart Failure (CHF) and MI regular diagnosis of and prevention and medication of depression are unusual (Schein et al. 2003). Furthermore, a number of interviewed physicians regarded depression after a severe heart attack to be an expected stress-associated response (Waldstein & Elias 2001). Problems with clinical evaluation could also be ascribed to the fact that mental health problems and CHD have indications that coexist or to the lack of knowledge of the patients and medical practitioners of the overlap (Lavretsky, Bastani, Gould & Huang 2002). In several instances, indications of mental health problems could be wrongly interpreted as an effect or outcome of heart disease. The prognosis of CHD and mental health illnesses in women is particularly hard to ascertain due to gender-linked disparities in the diagnosis of CHD (Ai et al. 2010). Although indications are diagnosed, pharmacological treatment of depression is hard provided the complicated cardiac disease’s pathophysiology (Schein et al. 2003). For instance, monoamine oxidase inhibitors and tricyclic antidepressants have cardiotoxic outcomes, and a number of SSRIs work with prescriptions generally used for medication of cardiovascular problems, such as digoxin and warfarin (Ai et al. 2010). Yet, the application of SSRIs alongside cognitive-behavioural therapy has been suggested for the remedy of depression in individuals with CHF (Ai et al. 2010). Current medical tests have proven that citalopram and sertraline, which are SSRIs, are safe to apply in the medication of patients with depression and CHD (Schein et al. 2003). The issue of whether the clinical remedy of depression enhances the prognosis of CHD has not been determined. A number of thorough reviews have suggested that present remedy for depression has not automatically enhanced cardiovascular results of CHD as well as cardiac absent survival in people with severe MI (Bogner, Cary, Bruce & Reynolds 2005). Nevertheless, the post hoc examination of another major medical test, the Enhancing Recovery in Coronary Heart Disease (ENRICHD) test, showed that the application of an SSRI for the treatment of depression in individuals who had suffered an MI decreased chronic MI or death rate by 42 percent (Ai et al. 2010). Another major test, the Cardiac Randomised Evaluation of Antidepressant and Psychotherapy Efficacy (CREATE) test (Ai et al. 2010, 28), has provided substantiation for the effectiveness of SSRIs in individuals with CHD. Comparison Intervention Both the ENKICHD and CREATE tests failed to substantiate the ultimate advantage of CBT and psychosocial intervention with depression or anxiety on CHD-associated clinical results (Ai et al. 2010). In the test of ENRICHD, findings indicated that the white males were more prone to gain from the cognitive-behavioural intervention than were the minority groups and women (ibid, p. 28). Even though the causes of differences like this are usually vague, it is probable that minorities and females have vital requirements that were not addressed by medication in the trial design (Ai et al. 2010). A number of studies have showed that low socioeconomic standing, generally confronted by marginalised minorities, may set off unfavourable emotions, a determinant of weak cardiac functioning (Anthenelli 2010). A current study reported a high incidence of cardiovascular illnesses in underprivileged minority groups. However, the mental health illnesses of patients with health diseases from minority groups stay inadequately studied (Bogner et al. 2006). The surfacing evidence has promoted the application of interventions to remedy the particular requirements of these groups. In relation to gender-associated results, a small study found out that a group-focused CBT factor integrated into a fitness course for cardiac treatment enhanced the mental health and strength of women, but not men (Ai et al. 2010). The disparity was ascribed to the relative immobility of older women, indicating that women with CHD may require various forms of interventions that underline assistance and encouragement for exercise (Lavretsky et al. 2002). These findings were mainly attributable to the absence of mental health emphasis in the tests and the failure or refusal to employ more qualified mental health nurses to aid patients with MI in their recovery (Ai et al. 2010). Outcome Even though findings concerning the impact of CBT on mortality associated with heart disease remain uncertain (Nemeroff 2008), thorough medical tests have constantly referred to the advantages that mental health nurses have on the quality of life and health of patients experiencing cardiac problems. Provided these gains, an expert group has proposed that individuals with CHD be regularly diagnosed for depression and recommended for therapy if depression is determined (Wagner, Austin, Davis, Hindmarsh, Schaefer & Bonomi 2001). Frequently mental health nurses are the best people to make sure that the mental health needs and recovery of the patients are met, monitored, and addressed as a crucial element. A current review of literature on psychosocial medications for individuals with heart diseases led to varied results about the outcome of psychosocial treatments on clinical outcomes. To enhance outcomes, it may be vital to enhance organisation restructuring of care, management, and assistance at the least (Schein et al. 2003). These initiatives are founded on best health management practices and can be described applying the model of chronic care introduced by Wagner and associates (2001). A large number of medical experiments have shown the success of this model at enhancing outcomes for patient with chronic illnesses (Anthenelli 2010). Success has presently been demonstrated in patients with heart illnesses as well (Bogner et al. 2005). Mental health nurses can serve a function in this practice. Not like ‘carved-out’ health management courses which has a tendency to concentrate on patients without employing mental health nurses and have been less successful than expected at enhancing outcomes or mitigating costs of health care, integrated care is regarded as a ‘carved-in’ mechanism for medicating patients (Ai et al. 2010). It involves thorough check-up by mental health nurses or other health care professional who conforms to evidence-based medication procedures; aids patients with the regularity and time of interactions needed to inform them about their disease and its medication alternatives; takes into account the previous treatment experiences and present inclinations of patients; educates about self-management methods; engages physicians as involved contributors in the care of their patients through routine and prompt two-way sharing of actual medical information; enthusiastically monitors the reaction of patients to treatment and indicates adjustments in therapy when recommended; and fosters collaborative care and referral of care to physicians when patients refuse or fail to react to preliminary treatment (Ai et al. 2010). Importantly, co-management or collaborative treatment is a central component of the recovery framework currently supported by major professional groups to mobilise and compensate physicians for giving premium care for chronic diseases (Alpert & Fava 2004). The discoveries of the ENRICHD test indicate that there are a number of psychosocial variables, such as aggressiveness, resentment, that are unrecognised (Ai et al. 2010). The CBT puts emphasis on the mitigation of symptom and expected aid seem to be inadequate, specifically for dealing with the needs of minorities and women struggling to deal with actual difficulties and the implications of these difficulties within the perspective of their personal experiences (Nemeroff 2008). To mitigate inconsistencies and discriminations in health care, interventions should be personalised to embody particular socio-demographic variables, value systems, and cultural contexts (Bogner et al. 2006). Findings propose that medicating generalised anxiety and depression can enhance quality of medication. Interventions should be versatile, integrating anger and stress management (Schein et al. 2003). Teaching self-management and relaxation may be useful in reducing physical symptoms of anxiety and depression. Confronted by the risks of heart attack and fatality, patients have to create more practical objectives, create new practices, such as compliance to treatment, and reconstruct a new goal and purpose for their existence (Alpert & Fava 2004). Even though inpatient environments may prohibit adequate time to deal with these concerns, recommendation of patients for psychosocial check-up will be crucial to cardiac care and treatment (Ai et al. 2010). In addressing multifaceted cardiac care, mental health nurses may apply a ‘person-in-environment’ (Ai et al. 2010, 29) model and their health care organisations for clinically and socially vulnerable people. Vulnerability in cardiac patients may interlock with believed discrimination, prejudice, unstable family relationships, and problems acquiring access to health care services, financial difficulties, and prior trauma (Bogner et al. 2005). Interventions that centre on relationships with others may be more successful for patients with a familial or community preference than interventions that concentrate on enhancing views of self-management (Schein et al. 2003). To alleviate fear of rejection, reprisal, or discrimination, it is vital to acknowledge contextual variables like drug dependency, domestic abuse, non-traditional family arrangements, and same-sex relationships (Wagner et al. 2001). It is also crucial to recognise concerns that could conceal symptoms, like anxiety over legal repercussions or discrimination (Ai et al. 2010). In addition to fundamental clinical knowledge, mental health nurses will also require facts on cardiac-particular healthy routines and suitable physical exercises. Immigrants or minorities may lack custom of rigorous Western-form fitness courses to enhance their quality of life (Bogner et al. 2006). Community-focused programmes and integrative treatment can have favourable outcomes for cardiac patients and women with health problems (Ai et al. 2010). Mental health nurses should be knowledgeable of these strategies that may be well appropriate with the cultural practices or routines of minority patients. Conclusions The explanations why depression is usually insufficiently addressed and treated in cardiac patients have yet to be completely explained. Depression normally is expressed by grief but can be determined without this particular aspect. Since elders with persistent clinical illnesses such as heart diseases may not show grief or sorrow and because other indications like weakness or weariness are pervasive to cardiovascular problems and depression, overlap in symptoms may reinforce the failure to recognise depression by physicians. On the other hand, patients and physicians might think that depression is a natural response to heart problems. Previous researchers of depression in the perspective of clinical comorbidity evaluated the presence of depression to be a mental outcome of experiencing a disease. Furthermore, a number of physicians may be hesitant to interview their patients regarding their symptoms of depression and patients may be unwilling to reveal these specific symptoms. Moreover, successful treatment of comorbid cardiovascular disease and depression necessitates knowledge of the interaction between these health disorders. Primary health physicians may be hesitant to recommend antidepressants to cardiac patients due to possible negative side effects or due to the fact that elders with heart diseases may previously be taking a lot of prescriptions. However, thus far, no earlier studies have distinguished how different forms of heart disease interact with the diagnosis and treatment of depression by physicians and mental health nurses. References Ai, A.L., Rollman, B.L. & Berger, C.S. (2010) ‘Comorbid Mental Health Symptoms and Heart Diseases: Can Health Care and Mental Health Care Professionals Collaboratively Improve the Assessment and Management?’ Health and Social Work, 35(1), 27+ Alpert, J. & Fava, M. (2004) Handbook of Chronic Depression: Diagnosis and Therapeutic Management. New York: Marcel Dekker. Anthenelli, R. (2010) ‘Comorbid Mental Health Disorders,’ Alcohol Research & Health, 33(1-2), 109+ Bogner, H., Cary, M., Bruce, M. & Reynolds, C. III (2005) ‘The Role of Medical Comorbidity in Outcome of Major Depression in Primary Care: The Prospect Study,’ The American Journal of Geriatric Psychiatry, 13(10), 861+ Bogner, H.R., Ford, D.E. & Gallo, J.J. (2006) ‘The Role of Cardiovascular Disease in the Identification and Management of Depression by Primary Care Physicians,’ The American Journal of Geriatric Psychiatry, 14(1), 71+ Duits, A.A., Boeke, S., Taams, M.A., Passchier, J., & Erdman, R.A. (1997) ‘Prediction of quality of life after coronary artery bypass graft surgery: A review and evaluation of multiple, recent studies,’ Psychosomatic Medicine, 59, 257-268. Lavretsky, H., Bastani, R., Gould, R. & Huang, D. (2002) ‘Predictors of Two-year Mortality in a Prospective ‘upbeat’ Study of Elderly Veterans with Comorbid Medical and Psychiatric Symptoms,’ The American Journal of Geriatric Psychiatry, 10(4), 458+ Nemeroff, C. (2008) ‘The Curiously Strong Relationship between Cardiovascular Disease and Depression in Elderly,’ The American Journal of Geriatric Psychiatry, 16(11), 857+ Pignay-Demaria, V., Lesperance, E., Demaria, R.G., Frasure-Smith, N. & Perrault, L.P. (2003) ‘Depression and anxiety and outcomes of coronary artery bypass surgery,’ Annals of Thoracic Surgery, 75, 314-321. Schein, L., Bernard, H., Spitz, H. & Muskin, P. (2003) Psychosocial Treatment for Medical Conditions: Principles and Techniques. New York: Brunner-Routledge. Wagner, E.H., Austin, B.T., Davis, C., Hindmarsh, M., Schaefer, J. & Bonomi, A. (2001) ‘Improving chronic illness care: Translating evidence into action,’ Health Affairs, 20(6), 64-78. Waldstein, S. & Elias, M. (2001) Neuropsychology of Cardiovascular Disease. Mahwah, NJ: Lawrence Erlbaum Associates. Read More