Professional Issues in Mental Nursing as Charlene`s Restless Leg Syndrome - Essay Example

?PART INCIDENT (CHARLENE’S RESTLESS LEG SYNDROME CASE) Incident/ Case Study During my internship in a hospital whose are predominantly multi-racial, a middle aged alcoholic Chinese woman (Charlene) suffering from mental sleeping disorder (which was later diagnosed as Restless Leg Syndrome) visited the facility, in the company of a friend. She had suffered the condition for sometime in silence due to discrimination from her family members. She could have sought medical help earlier (as it later emerged) but her predispositions and beliefs as a Chinese in regards to mental illnesses coupled with perceived communication-cultural gaps/biases in the medical facilities as dominated by the British nurses discouraged her immensely. Further she had prior to visiting the facility felt that mentally ill patients were frowned upon even by the nurses and other medical practitioners. She had complained of having problems in sleeping, feeling restless and having low concentration at the workplace for many months. Upon her arrival, she was taken for mental illness examination but the mental illness responsive capacity of the hospital was inadequate. However, her situation was handled and her husband and close family members were counseled against the belief that mental illnesses are superstitiously caused. In the process of treatment, a number of psychiatrists and nurses from other hospitals and the nearby University of Manchester were regularly consulted and the nurses worked hand in hand with us in training and in practice. One low of the treatment was observed when one of the nurses supervising her at night fell asleep several times and often failing to administer drugs. Professional Issues that Emerged: the Extent to which they were Addressed and the Learning Outcome in the Context of Professional Nursing Literature Conceptualization of the Charlene’s Condition, Diagnosis and Treatment Charlene, after observation and examination was diagnosed with Restless Leg Syndrome (RLS). RLS is one of the most common sleep disorders among the aged and those in the middle age. Overall, this kind of sleep disorder is genetic and Charlene had displayed all its features. The patient feels some tingly sensations that lead to restlessness. Generally, RLS impedes patients sleep often until morning when the condition becomes less severe (Biley, 2010). The symptoms of Restless Leg Syndrome are many. They include the feeling of unpleasant condition in the leg. This feeling is usually discomforting and tends to increase when one lies down or when one sits. The discomfort is turned into a relief when one stands up and begins to move about. The pain in the legs many times is however severely experienced in the night when the patient is sleeping and dealing with the problems often staying awake, or moving about when others are sleeping. The patients sleep is indeed often disrupted at night and this is the reason the condition is called Restless Leg Syndrome because the pain normally results to discomfort leading to one moving about. Noteworthy though is the fact that the pain does not always just occur in the legs alone. Instead, the pain can also be experienced in the arms as well, and many times this kind of pain is not easy to explain even though it is much different from muscle cramps (Biley, 2010). Restless Leg Syndrome involves ‘tingling, burning sensation and prickling’(Chaudhri, 2004) One may sometimes feels as if some foreign stuff have gotten into the skin and are crawling in there causing the patient to be jumpy or at least feeling so. All these symptoms and pain are usually a lot more experienced at night when one is less active. Sometimes the symptoms can also subside only to come later with greater motion and intensity (Biley, 2010). The other major symptom experienced by those suffering from Restless Leg Syndrome and which Charlene narrated is the Periodic Limb Movements of Sleep (PLMS). The patient may have this condition are remain immediately unaware due to the simple facts that it normally happens when one is asleep. The common denominator however is the fact that those who suffer from Periodic Limb Movements Syndrome don’t enjoy quality and lengthily sleep and causes even disruption not only to the individual but his/her partner whom they may share a bed with. This condition is attributed to a chemical called dopamine. Dopamine is released from the brain and causes the movements of the sufferer’s muscles (Chaudhuri, 2004) It is a genetic condition usually inherited from parents or in one’s biological lineage. The condition and the symptoms of PLMS is usually intensified when one gets pregnant. The other factors which aggravate it include excessive consumption of alcohol, diseases such as diabetes, and iron deficiency. Nash and Ramnos (2010) for affirm that alcoholism particularly interferes with the nerves in ones hands and feet. It was not easy to diagnosis Charlene with the Restless Legs Syndrome because it is always easy to correctly cite. The doctor, who first attempted it could not cite it correctly, and a consulting clinical psychiatrist was called upon The diagnosis was initially difficult because the condition’s symptoms and features are more often than not mistaken with those showing nerves as well as stress and muscle cramps. Interestingly also is the fact most patients who suffer from this condition rarely ask for medical attention. The process of diagnosis of the condition by the clinical doctor, it emerged, involved a number of issues and steps. The doctor asked Charlene a number of questions. The questions included knowing the regularity of experiencing pain by the patient, and what the symptoms were in general and specific. Beyond this the doctor asked the patient questions in regard to sleeping patterns as well as knowing the cycles of when the pain subsides or when the she got relieved. From literature, it temporary and immediate way to relieve pain by the patients is by him moving about. This stops the restlessness and relieves him/her from the intense pain. The doctor would recommend that the patients stretch and walk as an exercising measure to aid him or her in keeping the pain at bay. In the event that one suffers nutritional deficiency then it is recommended that he or she takes care of that (Chaudhuri, 2004). In Charlene’s case, the doctors recommended change of lifestyle. The doctor should recommend that she stops taking alcohol and that the nursing team should enforce this by way of continuous advice to her while attending to her in admission room. Medicine was also administered to her. Medication on the other hand is also the way to deal with the situation of Restless Leg. These medications include antidepressants, relaxants among others. Staff Values and Ethical issues that Emerged During the handling of Charlene’s a number of ethical values were observed. This was also anchored on by understanding the Chinese culture within the nursing profession. The entire nursing team including myself, with the exception of a few, had to consciously or unconsciously understand the cultural context from which Charlene came, and the discrimination there in. Indeed, in medical literature, culture has been identified as one of the factors that medical practitioners the world over consider while dealing with patients as a social construct (Wilson, 2010). Wilson notes that religious values, practices, traditions have not only been linked to disease acquisition, but also its management and how health matters are handled by different cultures across the world. Beyond this, culture is linked to how people choose what health care systems, providers and choices they make (Basavanthappa, p168). The hospital was aware of this. Often than not, health care practitioners within the facility approached patients (not just Charlene) with predetermined expectations and perceptions about a patient’s behaviors and attitudes based on our own beliefs about culture and religious norms. This is due to the hospital recognition of stigma associated with mental illness. Indeed, Battams (2010) reckons that there are many barriers to right to health for people with mental illness Generally cultural elements influence how people think and provide a broad framework of resolving issues, including health matters (Thompson, 2002) and this understanding came to the fore (p168). Complex traditional values and norms including folklore medicine, and belief system determine how people and plays an extremely vital role in the ways clients perceive health and health practices. Indeed, Barker (2011) also notes that biased assessments of risks where racism runs and cultural backgrounds are frowned upon portends a likelihood unethical biases (Barker 2011p. 2567). It is fundamental for their definition of health and illness and the decision to seek nursing care and support (Basavanthappa, p171). Culture has been defined broadly as encompassing ‘a view of the world, a set of values, beliefs and traditions which are handed from one generation to the next’’(Basavanthappa, p183) In dealing with Charlene’s case, the cultural phenomenon influence on how nurses treat patients in hospitals was keenly observed in a number of ways, one of which was to link culture and how they would function in considering how to deal with a Chinese patient, especially in the nursing rooms. Overall, a number of ethical principles are paramount when dealing with patients in respect to culture and these were applied. They include: ‘’Respect of persons; respect for autonomy; respect for freedom; respect for beneficence (doing good); respect for nonmaleficnece (avoiding harm to others); respect for veracity (truth telling); respect for justice; respect for fidelity (fulfilling promises); Confidentiality, which is respect to not diverging confidential information’’ (Basavanthappa, p174; Harrison et al, 2010) Interestingly, all these elements are tailored around respect of universal culture (Basavanthappa, p176). For instance, in nursing, respect of persons entails regarding the clinical situations but also to all life situations. Broadly, the principle guides nurses how to treat individuals with dignity (Madison, 2010). Autonomy on the other hand entails the recognition that individuals have independent minds and can therefore act on their own and govern their actions. Regardless of culture, veracity entails the fact that nurses should be able to tell the truth to provide ‘accurate information and real health status of patients and the process and reality that the treatment involves’’ (Basavanthappa, p 176: Madison, 2010). There were issues Specific to Chinese Culture which we endeavored to understand in the understanding of Charlene’s Case. The Chinese are heterogeneous. They include people from the mainland china, Taiwan, Hong Kong, as well as the South East Asian Countries. These groups portray different linguistic, social, economic and political diversities. Overall, their cultural beliefs have notions on health, illness and disease acquisition. For instance, mental illness and disability by most Chinese are still associated to some mysterious cause. Those who suffer disability or mental illness have guilt linked to the fact that some curse, ancestral spirit or otherwise of mystery may be the reason why an individual suffers such misfortune. Notably, they are more comfortable with people who get injuries that lead to limiting physicality than those who suffer congenital physical or mental disorders (Basavanthappa, p181). This means that many Chinese up to today still seek traditional healers for mitigations of such conditions. Communication barrier and choice of health care providers and response to treatment is another area which required scrutiny (Catherine & Timmins, 2006) and applied in the case. The Chinese have a number of cultural patterns which influence their choice and decisions around the kinds of health care provisions and systems they choose. Thus these factors should be considered by health practitioners when dealing with patients (Basavanthappa, p182) One is that Chinese are generally shy people when in a context they’re not used to. Thus a nurse dealing with them may consider greeting them gentle and in friendly tones, a factor which we applied. Because of the respect Chinese accord to the elderly, health practitioners ought to address such people with ‘’Mr. or Mrs.’’ Titles and so we addressed Charlene as Mrs. Lee, as her she was Charlene Lee. When addressed as such they are likely to feel comfortable and stick to such health facility for further services. Chinese generally consider being addressed by elderly people by their first name as disrespectful. (Basavanthappa, p.197; Catherine & Timmins, 2006)) Other than this, Chinese people tend to communicate differently say with the English people. They tend to communicate ‘less directly’ and less ‘assertively’’. Their communication relies more on gestures, signs, eye messages and facial expressions among other non-verbal cues. Some of these expressions connote different meanings with other cultures particularly the American and English culture. For instance, while Britons use direct eye contact as show of trust and attentiveness; the Chinese perceive it as intimidating. In fact for the Chinese looking directly at an elderly person may be interpreted as being disrespectful. These communication challenges have been determinant for a Chinese to choose where they seek health care, with the consideration of the latter being more attractive ((Basavanthappa, p.207). We thus endeavored to keep this in mind while addressing Charlene, her relatives who came to see her, and her husband. Staff Professional Development and Training: The Importance of Collaborative Nursing The hospital facility where I was attached works as a partnership organization with the University of Manchester, and in the process of training a relatively high number of trainers were also lecturers at the University. Thus, it was largely an issue of collaborative training for us, since even the main psychiatrist was a lecturer at the aforementioned university. Some Nurses whom we mingled with in the process were also outsourced from the same institution and others. This development was important for us to do a close scrutiny of what collaborative nursing is all about in practice, in out entire experience during the attachment and in Charlene’s case. . Collaborative nursing has a number of advantages. Nursing schools, colleges, and universities continue to see it as a fundamental recourse important for improvement of training at a low-cost as well as one that portends little conflict in management of nursing education. Indeed, as many countries across the world including the USA, United Kingdom, Australia, Canada among others continue to experience shortage in nursing personnel, there is need for solutions which collaborative model provides (AJAN, 2006). It encompasses a vision to promote enhanced provision of services to the citizenry that arise from quality, low cost, and efficient training that focuses on collaboration. Low cost is where there is a deliberate pull of resources during training by adapting collaborative methodologies between colleges and universities and hospitals. In the end, quality is attained as students and instructors from diverse backgrounds bring experience and expertise on the table (COU, 2010). There are specific benefits that collaborative nursing brings. One such is in curriculum development. COU (2010) reckons that ‘evidence-informed’ medical investigation is a centrality in the progress and anchoring of nursing as a discipline as well as an occupation. Evidence focused research, accordingly, presume a healthy setting for research in nursing as well as training which can be sustained overtime. Besides, such an endeavor presents an instrument that enables yearly update of the nursing courses syllabi in relation to existing information developed and the methodical progress attained (COU, 2010; AJAN, 2006). The second benefit which was observable is accessibility. Usually, collaborations enhance accessibility to nursing education in major cities across many countries or states where it is practiced, and brings together students of different backgrounds. Beyond this is the aspect of resources. Evidently, by participating and working together, colleges and universities as well as hospitals would pull resources (libraries, laboratories, and apparatus, databases, faculty, and instruction rooms) and enhance what could not have been achieved by one entity. Kleinberg (2010) notes that, a number of these programmes successfully lead to excellent associations and relationships between universities and nursing scholarship organizations (COU, 2010). The idea is that, education is enhanced in terms of quality and accessibility and experience that expands student’s wakefulness and promotion of better usage of resources is achieved. In the end, this brings in diversity, which is important in contributing the quality and versatility of programs, improved quality of graduates and by extension quality and expansion of health care at large (Kleinberg, 2010). Broadly speaking, collaborative programs have many other advantages. They generally include ‘’ system stability, health system efficiency, reduced cost of the system and general consistency as a policy in training’’ (COU, 2010). Risk Management Related to sleep accidents and Nursing Management (A focus on the case of one nurse falling asleep on duty and injuring herself with injection implements) In literature, Psychologists have identified two types of risks associated with sleep management. One is the low performance or loss of it altogether when one falls asleep at the work place. This often happens when the individual is ‘un-stimulated and bored even without sleep debt’’ (Gregory, 2009 p.4). The second one is observed in the decreased performance at the work place in line with build up to sleep debt. This often slows down work and hand eye activities are the most affected. In this the process of making decisions is slowed and becomes an uphill task. Moreover, the astuteness, efficiency as well as effectiveness is highly affected (Gregory, 2009.p.4). The second conception happened to have been cited for the ‘sleeping nurse’ The efficiencies are affected in two ways. One is for the stimulated conditions, for example carrying out tasks under a struggle, stress, or in the situations where one experiences phobia. Two is for the passive tasks such as paying attention when being taught or when instructions are being given at the work place or in school or when driving a car (Plaford, 2000). Many times however, efficiency in performance is more observable in a continuous process where one is on and off in the sleep, often called fishing in some quarters, leading to an abrupt and absolute loss in performance at the work place. This is more dangerous when one’s job description and activities therein are routinized like nursing (Plaford, 2000). It was thus agreed that sleep models will be used in understanding and mitigating sleep related problems and injuries among nurses. Care for ach other became paramount. Indeed, this was important and reasoned with NMC (2008) assertion that care for each other in nursing profession is of paramount importance. Gregory et al (2004) observes that efficiency reduction and loss associated with inactive performance at the work place can be envisaged using the sleep injury model. This model is used to measure this within the confluence of activities or tasks within impairment coming from activities related to sleep, alcohol use among other issues. (Gaillard & Steyers, 1993).The Sleep Model is used to measure and predict the amount of sleep one gets and the counter measures involved-associated with ‘alertness from sleeping studies in sleep laboratory as observed by Froberge in 1977. Indeed the Sleep Model has been viewed as having reliable base for predicting odds ration using the injury theory (Plaford, 2000). It has been observed that based on measurements that had been used for alcohol association in performance and accidents, the sleep model can authoritatively by some sort of default used in predicating ratios in for sleep management (Shneerson, 2000; Johnson et al, 2010). For instance citing a person who has had sleep related accidents in connection sleep debt and the use of caffeine this way of measurements is easily justifiable (Bartely, 2008) The sleep model using without using ‘latency’ in computing these ratios these days and the predefinition in away demonstrate the requirement for a ‘stimulating environment when sleep debt is building up (Galliard and Steyers, 1993).Further it shows why the ratios in terms of accidents numbers are usually higher during night hours and often at the beginning of the afternoon. PART 2: ON-GOING PERSONAL PROFESSIONAL DEVELOPMENT AREAS The three areas of focus include: Understanding Ethics in Nursing as a Professional Requirement and Its Significance in Health Care Provision One of the ongoing personal learning area and experience accruing from my placement in the facility zeroes on the importance of norms/ethical standards for the profession. Norms in my understanding and as APA (2003) observes in a profession, refers to the ideals of that profession and defines distinct behavior types (dos and don’ts) that guide the professionals as they conduct their business. In a sense, they guide the conduct of the individuals involved and provide the ground upon which the codes are assessed. (APA, 2003) The specific roles of these norms and codes of ethics which Wright (2000) notes and which I have been paying attention to ever since my placement include the following: One is the establishment of the professions integrity. This role is largely associated with creation and maintenance of the profession’s capability based on societal norms of respect and responsibility (Wright, 2000). The role separates and makes the field of nursing and other medical professional a unique ‘’community of common purpose’’ and forms a unitary agreement among the members of the profession and thereby by extension boosting the confidence of other members of society in it. In obeying confidentiality for instance, I observed Charlene’s willingness to give more information regarding her condition and experience, more so when only one nurse was paying a lot of attention to her, which makes a case for case management. This something in intend to push coz even Hall (2008) observes that adoption of case management as a strategy of organizing mental health management improves quality of service provision. Further, the integrity of the profession is anchored on the fact that the ethics code is streamlined for the members to focus on the activities and the duties they have for the entire society (Burgess, 2008). This was truer in the Charlene’s case. The hospital team did not express biases or personalized opinion. Most of the activities that were done were indicative of the desire to change human lives to the better. I therefore intend that in my practice, I will not only enforce them but endeavor to create a checklist, and mark their application or lack of it thereof, with the mindset of ever improving upon them. The lesson which I did confirm and which is increasingly forming my personal professional development area is that ethics code and norms functions in creating public trust. I will seek to achieve this by showcasing the profession and its members as responsible and in a functional high standard profession in relation to societal universal beliefs and expectations, by formulating programmes and initiatives to raise awareness, where it does not exist, on professionalism of nursing so that hospital visitation becomes a norm. Broadly, ethics is seen as a social agreement or a covenant that the profession has with the larger members of the society (APA, 2003). Charlene response to come for further examination and confide in the facility must have been anchored on the exhibition of this role during her treatment and care at the hospital. The role in which societal norms come in handy is on education and professional enculturation (Wright, 2000).This socialization role is based on societal values and the professional standards defining what nurses should expect of themselves and others in the profession as well. A code in this sense is thus perceived as a document that facilitates supports and provides a roadmap on how psychologists should mitigate and makes decisions as they practice (APA, 2003). In deed most decisions were carried out with this is mind. The third role which I continue to factor in is the enforcement of values. The norms are important offering a basis of a checklist and a monitoring tool (Norman & Iain.2009). I endeavor to keep a commitment that these roles will define the types of behaviors considered as violations or the ones that go against grain in providing a roadmap and guide for nurses to avoid such behaviors, and help the clients in making complaints about such violations. Conventional morality is concerned with the moral standards in a given societal setting. Those with conventional moral reasoning consider what the society say or feel about their behaviors. Participants here accept the social norms as provided in the society and are bound to them regardless of their consequences. Such conventional moral reasoning has the weakness in establishing its strength or appropriateness and there may be difficulties in abiding by them. Conventional morality is also subject to frequent changes and what is conventionally moral in one society can be immoral in an adjacent society and it is still subject to debate (Zain, 2008). The understanding that culture, (the Chinese culture in this case was) is different provides a sample that respect for patients cultural backgrounds is important in nursing service provision and care. In a medical setting, ethics should thus be applied in determining the rights and privileges of the employees, their roles in ensuring service confidentiality, the roles of the top management in keeping privacy, determination of programmes in health facilities’ organization dealings as well as advertisement. It will also enable the management to curb vices like harassment at work, biased recruitment, and selection of new employees, poor price evaluation, as well as establishing poor marketing strategies. It helps the management in various conflict resolutions. Ethics will also define the roles that politics play in hospital management. The manner in which activities are formulated, scheduled, and executed must be in accordance with some kind of pre-established legislation (Fry & Johnstone, 2008). Collaborative Nursing: Importance and Gaps which should be addressed The importance and Weaknesses entailed in collaborative Nursing are many and a number of issues ought to be addressed. In my professional development, collaborative nursing as an important area in providing health-care remains as a foremost important segment and the gaps within it should be addressed and the myths demystified. In deed, as the Manchester Hospital, some associations have continually witnessed bottlenecks as they try to collaborate. However, as noted by COU (2010), the challenges only indicate that collaborative policies are still mounting, and therefore should not be dismissed but ‘built upon’ as work in improvement (COU, 2010). I intend to keep in mind and respond with dedication, that whenever I will be called upon to extend my services outside my jurisdiction, in providing nursing and health-care training activities. This is because of the fact that collaborative nursing dismisses the debate that permits ‘stand-alone degrees (Harris et al, 2002).’ In the course of attending to mental patients, it was also evident that each of them required personalized attention, and thus I intend to advocate for case management. This is because that kind of approach would entail universities’ possibility of incorporating the thinking that funding would then be allowed to flow directly to them and not other colleges, with a result that would be chaotic. The thrust of the argument, which I buy, therefore, is that allowing colleges to recommend ‘stand-alone degrees’ would bring about the risk of instability in a collaborative system, thereby portending a likely negative sway on students and the future ‘supply’ of nurses on health care system getting disoriented (Kleinberg, 2010. COU, 2010) The other way to examine this is by looking at the cost of the system. The idea here is that is that in the absence of collaboration, there is the risk of ‘duplicating resources’ which means ‘duplicating costs’. This automatically translates into addition of more resources including libraries, laboratories, and books among other requirements. In the end, it means additional ‘operational and capital funding’ (Kleinberg, 2010) As a professional nurse in the making, I however recognize the importance of collaborative nursing. If it is implemented cautiously, collaborative nursing as an approach would cater for both the interests of students, health care system, as well as other organizations in the end. Conceptualization of the Mental-illness and the Necessity to raise de-mystify barbaric beliefs Regardless of the fact that mental illness is common, it emerged that it feared by many people. CNHA (2003, pg.2) notes that stigma still exist for those suffering mental illness, as either cursed or having some mysterious causes. Barker (2011) notes that biased assessments of risks where racism runs and cultural backgrounds are frowned upon portends a likelihood unethical biases (Barker 2011p. 2567). I thus intend to facilitate if given an opportunity, demystification of such barbaric beliefs. One way of this is the application of entire scientific model in conceptualization of mental-illness in the United Kingdom and else where-as used as a promotion tool in understanding mental illness. For instance, in Charlene’s case the model was largely biological. In this for instance, the patients are understood as having thoughts as well as feelings resulting from ‘biochemical and bioelectrical processes both in brain and her body. In Scientific literature, the core of biological model in understanding abnormal behavior reckons that thoughts, emotions and behavioral patterns should be tailored around understanding biological bases. The belief is anchored on the fact that such behavior is caused by the malfunctioning in the structures of an organism. Mostly, the proponents of this school of thought and those who subscribe to it mention the brain as the originator of such malfunctioning. Stinston (2010) affirms that Clinical psychologist and psychiatrist have since discovered that there is a link between certain behavior, disorders and the problems experienced by the brain or its components. 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