Nursing Mental Health Evaluation of Care - Coursework Example

Caring for the mental health patient can give rise to various issues and problems that often make a crucial difference to the treatment and recovery of the patient. There are various considerations in the care of the mental health patient from admission to discharge. These considerations are important to note because they span legal and physiological issues that are vital in the care of the mental health patient. From the taking of the patient history, issues that may be seen at this stage may be attributed to the manner by which history is extracted from the patient. When asking questions related to the mental health of the patient, it is always best to have “a nonjudgmental, matter- of-fact approach” (Molony, 2003). In taking their history, the mental health professional and the various professionals should listen carefully to the patient. Prying too deeply into their lives should be avoided and information should not be forced out of patient. Information extracted should focus on what the patient is comfortable discussing. Many patients are reluctant to discuss their condition and to reveal information about their mental health because of the stigma associated with mental illness. Society often labels mentally ill patients as dangerous. Society has a picture of the mentally ill patient, and this image is often distorted and exaggerated. Mentally ill patients are often shunned from the rest of society for reasons which are often misguided. Lack of knowledge and enlightenment about mental illness on the part of the patient may also be attributed to limited information sharing on the part of the patient. Patients are mostly not aware that what they are feeling is attributable to some form of mental illness. In these instances, they do not exactly know which information indicative of mental illness they should share with their caregiver. For them, these are just feelings and emotions. To the enlightened medical personnel, these may be symptoms of an illness. In caring for the mentally ill patient, the medical personnel were able to ensure that history taking was taken in a non-judgmental, comfortable, and non-prying manner. Through a comfortable and subtle interview, the patient was able to open up about the events leading up to her suicide attempt. She was able to reveal information about her emotional state and other psychological conditions that reveal mental illness. As regards age factor, a study comparing older and younger mental health patients revealed that older patients are less likely to open up about their illness and symptoms. They opt more to be self-reliant and independent as compared to their younger counterparts (Wetherell, et.al., 2008). In caring for the patient in this instance, she was seen as more open about her feelings and about her illness. Her problems initially manifested when she was a teenager and her initial presenting symptoms were those commonly seen in teenagers. Teenagers are typically very conscious about their weight and body image; they are also emotional eaters; and they do not get along well with their parents. They do not also deal well with criticism from their parents and they rebel or act-out against them, in this instance-the client attempted suicide. As for co-morbidities in mental health patients, there are various associated conditions and illnesses that may be seen in these patients. Based on a paper submitted to the American Psychiatric Association, the most common cause of death for mentally ill patients was heart disease and suicide. Co-morbid conditions commonly seen were hypertension, pneumonia, influenza, heart disease, and obesity (Miller, et.al., 2006). Co-morbid factors seen in the patient was suicide and potential for obesity. In her case, it is good to note that her attempt at suicide did not end tragically and conclusively. Timely medical intervention was able to prevent her untimely demise and now her real condition was revealed and is now being treated by mental health professionals. As for her potential for obesity, this is seen in the way she expresses her emotions. She tends to overeat when she is depressed. During her depression and illness, she gained weight. Comments from her mother about the need to take care of herself and of her weight triggered instances when she was spurred to keep eating. Moral support from family was very important in dealing with the co-morbid conditions seen in this patient. Underlying relevant pathophysiology supported by diagnostic results was carried out on the patient. Issues seen in conducting diagnostic tests is mostly manifested in the intrusiveness and the relevance of tests chosen to diagnose the patient’s condition. Many patients are subjected to various diagnostic procedures before their condition is definitely established. It may be necessary to perform only those tests that can definitively diagnose the patient and establish co-morbid conditions. In this patient, only those relevant and important laboratory studies were undertaken in order to diagnose her condition. They were used to rule out other conditions that can cause her presently observed symptoms. These tests included the thyroid function tests and thyrotropin-releasing hormone stimulation test to detect underlying hypothyroidism. Hypothyroidism may cause depression. The Dexamethasone Suppression Test (DST) was also conducted in order to determine if her depression may be responsive to antidepressant or electroconvulsive therapy (ECT). A Polysomnography was also conducted in order to determine if there was an increase in the overall amount of rapid-eye-movement (REM) sleep and shortened REM latency period. Other diagnostic tests such as CT scan or magnetic resonance imaging (MRI), complete blood count (CBC), chemistry panel, rapid plasma reagin (RPR), human immunodeficiency virus (HIV) test, EEG, vitamin B12 and folate levels, and toxicology studies were also conducted in order to determine her physical condition (OBrien, J., & Barber, B., 2000).These tests helped rule out any other underlying conditions that may lead to her present condition and establish firmly that she really is mentally ill. Her current medical treatment is drug therapy (clozapine). Patient was non-compliant with her medication during the last month. Her non-compliance was triggered mostly by comments from her mother about her eating habits. Clozapine presents various adverse effects, one of which is weight gain (Patient UK, 2008). This should have been understood by her parents. By the patient’s accounts, her mother is always harping about her weight gain. Considering the fact that her depression can trigger “emotional eating” on the patient, coupled with clozapine’s contribution to her weight gain, her parents are not doing her any favours by commenting on her weight gain and eating habits. There are ways of initiating change in their daughter’s eating habits that would not be as denigrating or vilifying. The patient’s non-compliance with medication reflects a relapse in her condition. Her will to help herself and to regain normal social and work functions were affected due to her medication non-compliance. Interventions by other professionals and medical team members for mental health patients is mostly seen with the involvement of psychiatrists, nurses, pharmacists, general practitioners, clinical psychologists, and other members of the health care team. According to the Royal College of Psychiatrists (Timms, 2006), psychiatrists and clinical psychologists help accurately assess the patient’s condition. Their training in mental health also helps them come up with intervention and treatment appropriate for the patient’s condition. A wrong diagnosis can be disastrous to the patient. And a wrong treatment or intervention can also make the patient’s situation worse. In caring for the mentally ill patient, the nurse has to understand the emotional boundaries of the patient. As opposed to normal patients, mentally ill patients are very wary of having their personal spaces intruded upon. Hence, it is important for the nurse to understand the patient’s condition and to tread lightly. Pharmacists’ role is vital in caring for the mental health patient. Their responsibility is on making the patient understand the importance of medication compliance and on making sure that the patient understood the dosage and manner of intake of the medications. Her duty is also to warn the patient of possible medication side-effects. The pharmacist should also warn the patient of dangerous interactions that their present drugs might have with other medicines. The patient was properly informed of the possible adverse effects of her medication. She also had interactions with psychiatrists and clinical psychologists while she was in the mental health unit. These mental health professionals performed various diagnostic tests in order to accurately determine her mental status. Her interaction with the nurses and the student nurse enabled her to express her feelings. Through this interaction, the student nurse was able to understand aspects of patient behaviour and the causes of such behaviour. Underlying psychopathological conditions in mental health patients may be assessed through diagnostic and laboratory tests. Psychopathological conditions may be accurately assessed through psychological and mental health assessment tests. These tests are “used to enrich or refine data collected in a clinical interview in order to arrive at the standardised multi-axial diagnostic formulation” (IGDA Workgroup, 2003). The psychopathological condition of the patient is this instance was assessed by the psychiatrists and clinical psychologists. Previously mentioned diagnostic and laboratory tests were also done in aid of diagnosis. The student nurse also made her own assessment of the patient using the Australian Mental Health A1- assessment of current presentation form as a tool. Through this test, this student was able to assess and collect information on the client needed in the implementation of the care plan. She also assessed for the presence of depressive symptoms over a two-week period. She also assessed the patient on whether or not she had five or more of the following symptoms occurred nearly everyday for most of the waking hours. These are depressed mood, anhedonia (inability to experience pleasure), significant weight loss or gain (more than 5% of body weight per month), insomnia or hypersomnia, increased or decreased motor activity, anergy (fatigue or loss of energy), feelings of worthlessness or inappropriate guilt (may be delusional), decreased concentration or indecisiveness, and recurrent thought of death or suicidal ideation (with or without plan). (Carpenito, L. J., 2002). Through these tests, she was now able to verify the condition of the patient and to determine applicable interventions for her care. In the present stressful society, many people often find themselves in depressed and melancholy moods. Our human interactions span different aspects of expression—“psychological needs for harmony and understanding; the social needs for community and relatedness; and the spiritual needs for a meaningful relationship with the Absolute” (Kreps, 2008). When these aspects are not properly nourished, it leaves us cut off from the rest of the world, even ourselves. Often, the manifestation for lack of nourishment in the above areas results to depressed moods and consequently leads to other psychological illnesses. In this instance, the patient felt misunderstood by her parents, especially her mother. Her inability to deal with what she perceived as her mother’s rejection resulted in her drawing into herself and in thinking self-destructive thoughts. The psychosocial factors seen in this mentally ill patient stemmed largely from her impaired relationship with her family which largely affected her interaction with her social group and her work mates. Specific nursing care for mentally ill patients is mostly manifested by nurses with specific mental health training. Mental health training is vital in this situation because the nurse is usually the one person in the mental health team who will have the longest contact with the patient. Her interventions will have the most impact on the patient’s care and recovery. These nurses will work with the mental health care team to ensure patient recovery. Aside from performing basic nursing care to the patient, she will also “socialize with them and lead them in educational and recreational activities” (Bureau of Labor Statistics, U.S. Department of Labor, 2008). These interventions will help slowly and gradually draw out the patient outside his or her shell. This will also distract the patient from any melancholy or suicidal thoughts. The patient in this case, while in the mental health unit was cared for by the nurses. The nurses enticed the patient to join in some of the socialization activities in the unit. The student nurse also helped the patient express her frustrations and her feelings through regular patient-nurse sessions. Through psychotherapy, the student nurse was able to understand the patient’s frustrations and moods. Through the nurse’s special training, they were able to “observe patients and report any physical or behavioral signs that might be important for the professional staff to know” (Bureau of Labor Statistics, U.S. Department of Labor, 2008). The nurses also provided moral and emotional support to the patient, especially during her treatment and therapy sessions. The milieu factors are those that “manipulate the environment so that all aspects of the client’s hospital experience are considered therapeutic”(Ivya, K, 2008). Through milieu therapy, the client is expected to learn how to function in society. Through this therapy, she will be taught interaction and relationship skills in preparation for her re-entry to society. The patient in this instance through her psychotherapeutic sessions and through milieu therapy was slowly drawn out of her shell. This part is still a working progress because during the last month or so, she withdrew from her social and work interactions. With more sessions, she can potentially re-enter society and have a relatively normal interaction with her social set and her work mates. There are various improvements that may be adapted in the care of the mentally ill patient. According to Thomas, et.al. (1997), “cooperation and collaboration between health and social care services mental health and primary care teams is often poor”. They further say that primary care teams often lack the necessary training to competently care for the mentally ill patient. For the mentally ill patient undergoing drug therapy, there is a need for them to undergo regular assessment for adverse drug effects. The proper assessment tool to assess the neuroleptic side effects of psychiatric drugs must also be applied to the patient. This will help assess and distinguish the adverse effects from the symptoms of the mental illness. It will also help determine the gravity of the neuroleptic side effects of the psychiatric drugs on the patient and determine if changes in the medication or adjustments in dosage need to be made (Jha, 2004). From a legislative standpoint, this student is of the opinion that changes in the Mental Health Act need to be made. The Mental Health Act defines mental disorder in very generic terms. It makes possible a wealth of interpretation to be made on the term. Once a person is qualified as mentally ill under the act, he or she will lose the usual rights and privileges that ordinary citizens are normally endowed with. He will now be subject to various medical procedures without his consent (informed or otherwise). Various clinicians opine that there are some medical conditions and some illnesses that present with neurological symptoms; however, they are not, in the technical and/or medical sense, mentally ill. To subject them to procedures normally meant for mentally ill patients would potentially cause them more harm than good. Works Cited Bureau of Labor Statistics, U.S. Department of Labor (2008) Occupational Outlook Handbook, 2008-09 Edition, Nursing, Psychiatric, and Home Health Aides, on the Internet. Retrieved 17 October 2008 from at http://www.bls.gov/oco/ocos165.htm Carpenito, L. J. (2002). Nursing Diagnosis: Application to Clinical Practice. Philadelphia: Lippincott Williams and Wilkinson Clozapine (2008) Patient UK 2008. Retrieved 16 October 2008 from http://www.patient.co.uk/showdoc/30003674/ Doebbeling, C. (May 2007). Treatment of Mental Illness. Merck Manuals. Retrieved 16 October 2008 from http://www.merck.com/mmhe/sec07/ch098/ch098d.html IGDA Workgroup (2003). Supplementary assessment procedures — psychopathological, neuropsychological and physical aspects. British Journal of Psychiatry. 182: s48-S49 Ivya, K. (23 August 2008) Milieu Therapy. Nursing Planet. Retrieved 16 October 2008 from http://nursingplanet.com/nr//index.php?blog=1&p=68&more=1&c=1&tb=1&pb=1 Jha, S & Current Medicine Group (2004), Side-Effects Scales, CNS Forum, Retrieved 17 October 2008 from http://www.cnsforum.com/clinicalresources/ratingscales/ratingpsychiatry/side_effects/#Simpson Kreps, I. (2008) Depression: A bio-psycho-social-spiritual analysis. Islamic Magazine. Retrieved 17 October 2008 from http://www.islamicamagazine.com/issue-12/depression-a-bio-psycho-social-spiritual-analysis.html Miller, B. (October 2006). Mortality and Medical Comorbidity Among Patients With Serious Mental Illness. Psychiatric Services Online. Retrieved 14 October 2008 from http://www.psychservices.psychiatryonline.org/cgi/content/full/57/10/1482 Molony, T. (2003). History Taking. American Dental Hygienists Association. Retrieved 14 October 2008 from http://www.adha.org/CE_courses/course10/mental_health.htm OBrien, J., & Barber, B. (2000). Neuroimaging in Dementia and Depression. Advances in Psychiatric Treatment, 6: 109-119 Taylor, M. & Fink, M. (2006). Melancholia: The Diagnosis, Pathophysiology, and Treatment of Depressive Illness. New York: Cambridge University Press Timms, P. (2006). The Mental Health Team. Royal College of Psychiatrists. Retrieved 15 October 2008 from http://www.rcpsych.ac.uk/mentalhealthinfo/treatments/thementalhealthteam.aspx Thomas, B., et.al. (1997). Stuart and Sundeens mental health nursing: Principles and Practice. London: Elsevier Health Sciences. Wetherell, J. (2008). Mental health treatment preferences of older and younger primary care patients. Centre National dela Recherchie Scientifique. Retrived 13 October 2008 from http://cat.inist.fr/?aModele=afficheN&cpsidt=16378992 Read More