My Developing Role as a Mental Health Nurse with my Schizophrenic Patient - Essay Example

work] My Developing Role as a Mental Health Nurse with my Schizophrenic Patient As a mental health nurse I was based in an acute ward for young adults for both male and female patients. My patient was male and aged 40 years, diagnosed with long term schizophrenia. I was involved in the admission assessment of the patient and all the nursing processesuntil I finished my placement in 2 months- time. It is said that 1.1% of the world's population develop schizophrenia of which 75% develop it between ages of 15 and 25 (PennBrain n.d.). The symptoms are disordered thinking, hallucinations and delusions, changes in sensory perception, and problems with social interaction. My client, Greg, had all of these in varying degrees at different times. According to Javitt & Coyle (2004), "Scientists have long viewed schizophrenia as arising out of a disturbance in which brain cells communicate using a signalling chemical, or neurotransmitter, called dopamine" Schizophrenia is fundamentally a physical disease of the brain like Alzheimer's. With schizophrenia, people experience a slow continuing deterioration as they get older, like Alzheimer's, but it is more commonly thought of as a neuro-developmental illness, present at birth, affecting neurological development, and becoming manifest in late adolescence (Javitt & Coyle, 2004). For many individuals, schizophrenia is a severe and enduring illness. While nurses need to understand the symptoms of the illness in order to provide specific care and treatment, it also is important to find out how people with schizophrenia embody the illness. Capturing this knowledge will help nurses to provide more appropriate care to these individuals. Following the Peplau nursing model, the following account speaks of the lived experiences of Greg with schizophrenia as I interacted with him in my practice placement. Assessment. Greg is the son of a wealthy businessman well-known in the community. He has two sisters but many half-brothers and half-sisters. The problem of Greg is that he is not on the legitimate side of the family. His mother happened to be the former housemaid of the Don. When Greg was young, he had heard all the stories about his father, but everything is hazy now. He had tasted of the good life that some fortune was able to bring just after the Don died. He now has no father but just his mother and two sisters who briefly had enjoyed all the money could bring. Still, their mother would take some trips to the wealthy side of the family and ask for help, but there is a time giving had to stop. While the first family was kind to them, the differences in not being legitimate made early marks in the mind of Greg and his sisters. But it was Greg who tried to work hard to be acceptable as the Don's son. Skinny and sickly as he was, he did everything worthy to be counted. He learned music, did much reading, engaged in philanthropic pursuits, and did some advanced schooling. Greg had worked his way to college and was able to have his name engraved in the school's board for having topped the national teacher's board exam for the year. One of his sisters found her own way through life by holding on to odd jobs, just as the mother did. The other sister became stricken with chronic lapses of schizophrenia much earlier than Greg, and clearly refused to make her own way through life. To her, she is the Don's daughter who needed never to work very hard. After taking his bachelor's degree, Greg had enrolled in a masters' program, then finally to a doctorate degree. There was no stopping with his climbing socially to improve himself. However, he was not able to finish this last degree. It was when he could not anymore stay sane with all the responsibilities. He was stricken hard with schizophrenia - one that came and went but never away. It seemed that he had it all the time, while trying to go to school. Meanwhile, her schizophrenic sister had died. Nursing Diagnosis. One critical fact of schizophrenia to realize is that it interferes with self awareness (Lepage et al, 2005). According to them, fifty per cent of the people diagnosed with a psychotic disorder either don't know or refuse to believe they have a treatable illness. This was true in the case of Greg. He had often stopped taking his medication when feeling better, or when the side effects are too unpleasant but almost always relapsed and had another psychotic episode. Greg had never fully addressed his health need since diagnosed with schizophrenia in his high school days. He had been not compliant with medication; therefore a relapse now and then was expected. To Greg, however, schizophrenia was like a game to play with, yet a disease to contend with. I was able to gather all of these information about Greg during the interview. Plan/goal. Schizophrenia is not considered curable, but it is treatable; hence, the goals of treatment are to eliminate or reduce psychotic symptoms and to increase the level of functioning (Gaultiere, 1999). I have learned that the mental health nurse is as a quasi-friend, especially in cases where the client is at considerable risk of relapse. Greg seemed to be a good one at relapse because of his history of being complacent to medication. I remembered that and I knew that would be one of my challenges. Greg has lost most of his community relationships now as schizophrenia seems to drive people away and schizophrenic people become highly stigmatized (Gaultiere, 1999). I know I had to act as one whose visits my client would look forward to. I would have to help negotiate compliance to his medication, his housing, a meaningful activity, a look into isolation issues, and everything else that living in the community required of him. I learned that antipsychotic medication, such as chlorpromazine and fluphenazine were employed for schizophrenia patients that they may get well. I also learned that social skills training and therapy were needed and so, we planned with the team that we would work on these. People with schizophrenia can come alive talking about things in the past before they became ill. They are best encouraged to talk, and by talking, they may be understood better. I had planned to be a friend to my client to encourage him to soften up. As it was, he seemed so distant and unreachable at times. The Peplau relationship model along which I shall discuss our nurse-client involves the following phases in the following order: orientation, identification, exploitation, and finally resolution. Interventions. My nurse-client relationship with Greg began with an easy note because knowing his story had provided me with a window into his life. I found my client ahead of me in the facility; therefore orientation to his environs was not a problem. The client is not a newcomer; he had already made himself at home after quite a long while, as judged from the easy conversation he takes on with the nursing staff. This led us to the next phase of our relationship, which is identification. I have learned how assessments were made. In the process, I also learned how interventions should be carried out. I knew that assertive communication is to be used, as well as other skills like listening and not being judgemental. All throughout, I was keen to use what Batt & Taylor (2006) referred to as emotional face processing. I was careful to look at Greg's face to read his emotions as I might be intruding much into his psychological space (Fischer, 1991). The client and I were quickly able to identify problems that required attention. These problems included the client's feelings of guilt toward her dead sister. At one time when she was groggy from one of her medications, he had attempted to rape her, had not the mother prevented him. This may refer to what Mostafanejad (2006) wrote as "embodied relationality where illness as a mediator of social relationships," reflected in how Greg's illness affected his relationship with others. He had lost the sensitivity in knowing that his supposed rape-victim was a sister. Greg had explained that the schizophrenic sister was often asleep with her legs wide open in the sala. On my priming, Greg talked more and revealed about his experiencing auditory hallucinations. If he was depressed, the side effects of his medications were burdensome and had distorted his perception of his body (Mostafanejad, 2006). We had identified the client as requiring some form of additional support, given that he had been relatively stable for sometime now. We entered the next phase of our relationship referred to by Peplau as exploitation. As we had developed a trusting relationship with one another, the client discussed more about his thoughts and feelings. He expressed his feelings of mixed emotions about his sister's death, blaming himself. He was assured that those feelings and thoughts are normal. Given that he had attempted to rape her sister, it is only natural that the client would experience feelings of guilt and remorse about his sister's passing. Somehow, I was also guided by Langleben et al's (2005) research. While I let Greg tell his stories, I also studied his face to see if he was lying -- with just one thing or a series of events. Greg looked hopeful of recovering, though, as evidenced by his ability to study. He was told that the feeling of sadness he was experiencing is well within the range of normalcy given that this was his sister, and the feeling of relief was of one more liability going. Being the eldest, he had to become the breadwinner of the family, and without him, the aging mother was burdened into having to earn, too, for the sick sister. Therefore, his feelings were sorted out as such. He had called the marriage of her housemaid-mother to the Don, phenomenal, and he had taken a preference to phenomenal set-ups. His ambivalent feelings about this marriage were still called normal. This acknowledgement and assurance that his feelings were normal and to be expected provided comfort and relief for Greg. He was greatly relieved to hear that such feelings could be expected. With each interaction, the client became more visibly comfortable. He could sleep normally then. Later, he reported that he was no longer experiencing auditory hallucinations. Our relationship then entered the final phase, resolution. Greg became less dependent on me for one to one interactions and no longer sought further assistance in arranging continuing supports in the community. He would have to continue, however, to have identification with helping persons until he becomes fully normal. Evaluation. Psychological. From what I could see in Greg's case, he would have benefited from early diagnosis. According to Lepage et al, (2005), patients would suffer very little disability if their illness was "nipped in the bud". Negative, mood and cognitive symptoms may provide some key to this disease early on. That he was hearing voices that seemed to be inside his own head is common to schizophrenic patients according to Dr. Bill Gaultiere (1999), executive director of New Hope. Sociological. Schizophrenia is claimed not to be understood very well by those who have had it (Gaultiere, 1999) and yet it is a serious and potentially very destructive illness (Javitt & Coyle, 2004). There is a lot of suffering associated with schizophrenia, foremost of which is the severing of social connections. People with schizophrenia often find that they have been excluded from community life (Levinson, 2006). Greg would need more connections with others and could benefit from his mother visiting him now and then. There is still a sister, but it appears that she, too, has some toxic personality (Brasher, 2003). Much help could be had with affirmative relationships. Physical. Somehow, taking in medications have a way of putting the patient in stupor for many hours or days o end. But even without the stupor, taking medication can be very tiring for the patient. There have to be ways wherein the patient will take in a new outlook on medication before he tires up. In the mornings, sunshine is very much needed by patients like Greg. I think mornings in the sunshine became one part of his happier days where conversations turned to books. Greg loved books and a book in the morning, closely associated with sunshine and talk had motivated him to find the sun. There is hope that he would continue doing so for his physical health primarily. My limitations. Maintaining my professional knowledge in the field of mental health had me reading books about schizophrenia. In talking with Greg, I knew I should never have to make false promises, such as when he is to be become perfectly normal. In the untangling of his mixed feelings, however, I had maintained assertive communication with him according to the NMC Code of Conduct (2004). I also knew that I had to keep every sensitive information about him if it did not have any connection with his case to minimize risk to the patient (The NMC Code, 2004). This would include personal complaints about previous nurses he had had. These were all part of keeping the trust that the patient had given me, but there has to be balance. Part of my duty to my patient was in pointing out to him the areas where he could improve. I realize this could be done only in the things he was willing to tell me - in his own stories, as he talked to me. With these limitations, I carried on my job armed with competencies required of mental health nursing students. References 'Quick facts: Schizophrenia,' PennBrain. University of Pensylvania. Available at: http://www.med.upenn.edu/pennbrain/schizo.htm 'The NMC code of professional conduct: standards for conduct, performance and ethics.' 2004. Available at: http://www.nmc-uk.org/aDisplayDocument.aspxDocumentID=201 Batty M, & Taylor MJ., The development of emotional face processing during childhood, Dev Sci., Mar 2006. 9(2):207-20. PMID: 16472321 [PubMed - indexed for MEDLINE] Brasher K.J., 2003, Toxic Relationships: How to Regain Lost Power in Your Relationship, ISBN-10: 0972731407. A Better Life Publishing Co., LLC Fischer, W. 1991,The psychology of anxiety: A phenomenological description,The humanistic psychologist, 19 (3), 289-300. Gaultiere, B. 'Understanding and Help for Schizoprenia.' August 25, 1999, Available at: http://www.newhopenow.com/notes/archive/schizoprenia.html Javitt, D.C. & Coyle, J.T. "Decoding Schizophrenia." Scientific American. January 2004. Volume 290, Number 1. Langleben D.D, Loughead J.W, Bilker W.B, Ruparel K, Childress A.R, Busch S.I, Gur R.C. Telling truth from lie in individual subjects with fast event-related fMRI. Hum Brain Mapp. 2005 December 26(4):262-72. PMID: 16161128 [PubMed - indexed for MEDLINE] Lepage, M Menear, M., Montoya, A. & Achim, A.2005. Associative interference does not affect recognition memory in schizophrenia. Schizophrenia Research,Volume 80,Issue 2-3,Pp. 185-196. Levinson D. F. The genetics of depression: a review. Biol Psychiatry. 2006 Jul 15; 60(2):84-92. Epub 2005 Nov 21. Review. PMID: 16300747 [PubMed - indexed for MEDLINE] Mostafanejad, K. 'Reducing the isolation of young adults living with a mental illness in rural Australia.' International Journal of Mental Health Nursing Volume 15 Issue 3. P. 81. September 2006 doi:10.1111/j.1447-0349.2006.00421.xVolume 15 Issue 3. Read More