Mental Health Nursing: Crafting Decisions and Formulating Judgments - Essay Example

?Mental Health Nursing: Crafting Decisions and Formulating Judgments PART ONE In order to contribute in the best way nurses can, it is necessary to have appropriate judgment and decision making skills. In the specified zone of mental health care, the successful establishment of nurses is not possible if they are unable to make right clinical decisions, and/or if they lack judgment skills. Bastable (2008: pp.5) believes that the role played by the nurses is that of a ‘caregiver’. Thus, during the process of coming to a decision regarding the status of patients, it is necessary for nurses to not commence through logical verifications or commonsensical conjectures; where they take risks being unaware of what the results or consequences might be. This verifies that without the help of proper clinical decisions and judgment skills, a nurse cannot cooperate in helping the patients improve and become an active part of the society. Banning (2008a: pp.188) has put forth that clinical decision making is a nurse’s everyday task when it comes to patient care. This assignment is a critical analysis of Trevor’s case by using the clinical decision making model, who is a 47 years old individual, having an account of ‘Delusional Disorder’, has been assessed and analyzed. Trevor is brought in a few hours before 6:00 pm, as my shift begins and is attached to my ward for assessment. He is apprehended under Section 2 of the Mental Health Act as he reports paranoia and aggressive behavior on his part. The wider context of the clinical process will be examined in the conclusion. In this meticulous case in which I, being a nurse, confront Trevor who is finding it difficult to tackle the state he was in, it is necessary for me to keep in mind the key issues before I began the assessment, which, in accordance to Cioffi as presented by Thompson and Dowding (2002: n.pg.) is the derivation of the nursing course. As Hegner, Acello and Caldwell (2009a: pp.15) have provided that the process of assessment for a nurse is to evaluate the patient completely, therefore, this was the time when the utilization of proper approaching, conversing, and comprehension skills was required. Being the nurse in charge, it is necessary for me to prioritize the formulation of the entire ward as equal patient care is essentially important. As put forth by Jasper (2006: pp.221), it is necessary that all decisions made by the nurse are warranted since s/he is liable for all proceedings in reference to the Nursing & Midwifery Council (2004). Thus the other qualified nurse and one of the students shall be in charge of verifying the risk of the suicide patient, while the other student is responsible for observing other patients of the ward and record any irrational scores. Thus, I will consider that the support worker shall remain available for any emergency reports by the student assisting me in the ward. Meanwhile I will assess and evaluate Trevor. The various key issues that are to be kept in mind before Trevor is assessed are formulated step by step. It has been claimed by Petersen (2007: pp.96) that “Listening to understand requires a non-judgmental attitude that can go against what most of us were taught, that is, to listen for rights and wrongs.” Thus, the approach is an empathetic yet formal approach, and one that is non-judgmental in nature as it helps the patient feel at ease with the empathy instead of discomfort. Another key issue which I would focus on will be the differentiation of the procedure of judgment before interaction. It is necessary for nurses to evaluate judgments after the interactions with the patients. The evaluation of judgments before examinations is dense as it eliminates all paths for development of a healthy nurse-patient relationship. In accordance to Hegner, Acello and Caldwell’s (2010b: pp.451) evaluation, it can be presented that the response of each patient to the nurse’s behavior is different, thus the method of variant evaluation needs to be considered. The third key issue that needs to be considered is the consultation of the right sources with regard to Trevor’s situation. This is necessary as it plays a vital role in the elimination of any ambiguities from the decision making process, and also helps quantifiable decisions to be easily made with reference to specified cases. This view can easily be elaborated by Jones and Beck’s (1995: pp.4) elucidation that right sources need to be consulted for decision making which is important for dealing with problems in the clinical health care sector. Ray et al (2011: pp.31) have specified that the process of hypothetical deduction improves the critical analysis of nurses dealing with patients from the mental health department. Another major key issue is lack of essential outcomes which are required to be avoided as they could become a hurdle in the professional development of the nurses. This hurdle can be eliminated by the process of hypothetical deduction or analysis; it helps analyzers in clinical decision making as to which alternative steps shall be taken. Thus in accordance to Dowie and Elstein (1988: n.pg.) it could be evaluated that the interpretative process can be disturbed by the use of excessive data which shall be essentially avoided. The major concern shall remain that the patient is going through delusional disorder which mostly results in abnormal behavior changes and perceptive variations. Hence, any biasness needs to be kept hidden for avoiding any sorts of offense. Such methods of communication with my patient will help me in staying away from any misunderstandings or ambiguities from both the sides. Sheldon (2009: pp.53) expresses her contemplations by saying that “Good communication skills make the difference between average and great nursing care.” In order to continue with the process of assessing Trevor’s physical, mental, social, and spiritual health care needs, it is necessary to keep in mind the above mentioned key issues. This is essential because it will develop an environment whilst approaching Trevor, which will eradicate the stroke of health issue. As put forth by Jones (2003: n.pg), training in risk assessment shall be spontaneous for nurses who work in the acute inpatient psychiatric settings in regard to managing violence and aggression. The aspects that have been mentioned above are related to the process of Trevor being brought into contact with someone that he trusts or shares a strong relationship with. Thus, after investigating who such people are that might help Trevor feel better; they will be brought in to meet Trevor. This process of routine unbolting will somewhat provide him an opportunity to recognize that his betterment lies in the treatment he will get at the medical care unit. This is due to the fact that this disease is basically the dysfunction of the cognitive thinking and emotions as mentioned by Barlow and Durand (2009: pp.498). As far as the phases of the delusional disorder are concerned it is necessary to evaluate whether Trevor is in the early stages of this disease or in the late stages. This is important because in the earlier phases, the delusions and hallucinations occur on a small level, whereas, in the later stages, these occur on a much frequent and high level. Therefore, it is necessary to control the symptoms by providing proper aid and frequent consoling measures to Trevor. In the literature gained from Ramzy and Barbara’s (1993: pp.701-707) research it was stated that the symptoms of late stages of delusional disorder verified peculiar hallucinations. Also in this stage the aural phantasms were of a minor degree. Thus, this phase makes the person less gloomy and distressing. Whereas, the data gained from the later stages of delusional disorder brought forth the symptoms not quite out of the ordinary mirages. The auditory hallucinations were increased and due to this stage the person becomes more paranoid; the personality is more schizoid. This research puts forth the most important point of assessment as it brings forth the fact that if Trevor is a patient of early delusional disorder he can be treated much more easily than that of a stance in which he suffers from late delusional disorder. On the other hand the memory of the patient also needs to be assessed and worked upon in order to continue with the management. It has been already verified in Sadock, Kaplan and Sadock’s (2007: pp.513) work that this disease is resistant to treatment, but the impact on the illness of the patient can be controlled. Many models and theories have been presented to carry on with the assessment of Trevor’s case and the imbalance of his mental state. The models represent decision making methodologies and formulation of judgments in a better and critical manner. Amongst these models is the Carnevali and Thomas’s ‘Diagnostic Reasoning Process’. Therefore, the commencing part of this paper will put forth the usage of this model to critically analyze my above mentioned assessments and their transformation after the verification of this model and its theories. PART TWO The theory presented by Carnevali and Thomas’ for the diagnostic reasoning process has been selected for the assessment of wider aspects of Trevor’s case study. This theory has been selected for understanding the significance of clinical-judgments in this case. Also, this model will help in the assessment of Trevor’s situation while considering the general analysis of decision-making theory that this model uses. The basic belief of Carnevali and Thomas behind the theory of decision making that has resulted in the formulation of heir model is that the clinician starts from the root of the problem and develops an assessment from the top. They believe that all unnecessary data needs to be discarded after its maximum use. This is thought to be important by the researchers as they believe that the major aim of the clinician to afford any sorts of decisions is to increase their focus and concentration. Hence, it automatically leads the clinician towards such decisions and judgments that are of immense potential and carry fewer risks. As far as the model is concerned, with regard to its application to this specified case, it will help me in retrieving all the data that has been stored or saved in short or long term memory as the process of gaining data and assessment of Trevor’s scenario continues. It has been put forth by Holyoake (2003: pp.98) that assessment is an ongoing process, thus data will be continually required for further assessment and diagnosis. This model basically consists of 7 stages of decision making and judgment construction which will be interpreted in the former assessment procedures. According to Cox and Hill (2010: pp. 63), the required diagnosis can be made by the help of using this model as it leads the clinician towards required answers. In accordance to the previous verification that was made regarding the assessment of the severity of Trevor’s case, it can be verified that Carnevali and Thomas’s model can help in acquiring the information that will lead us towards appropriate counters. In the first step of Carnevali and Thomas’ decision making, I will begin gaining data through observations regarding Trevor’s symptoms and indications. I will discard any unused data and will focus on what symptoms indicating the meagerness of his state. Also, through this process of information acquisition, two sides each representing the patients having severe and low degrees of delusional disorder will be assessed. Thus, the second step of this model will be applied; this will lead me towards deciding whether Trevor is a patient of severe or non-severe delusional disorder. The findings that have been gained from an examination conducted by Banning (2007b: n.pg) elaborated that through Carnevali and Thomas’s model, the process of cue collection and assessment lead towards an effective processing of information. This shall be done by creating a certified database for accumulating all the gained cues and information. This is due to the fact that deciding to approach Trevor in a specified manner before observing and gaining facts would be ineffective if his responses are not in accordance to my assumptions. Therefore, through the process of acquiring various possibilities and hypothetical deductions, I will easily understand the sort of approach that shall be adapted and obtained. Even though this procedure is of critical nature as a person cannot always remember or memorize whatever s/he processes, it is necessary for the application of data for settling in the clinician’s mind. Thus, the step of uniting all the cues will be accommodating. In a study conducted by Lauri, et al. (2004: pp.83-90), in order to understand whether or not this analytical model ensued to be successful for nurses in long term patient care and decision making, it was achieved that information collection, problem definition, and planning of concerns were the major expansions. However, this process is only useful for long term analysis as the process of obtaining data and its implementation for judgments needs a lot of time and instance. This critical analysis has been itself verified as a large quantity of time and a hefty amount of assessment tools are required for covering the steps of this process. As this process needs estimation and implementation of the expanded information, it is by no means meant for short term patient care. Assessment of the model put forth by Carnevali and Thomas (1993: pp.293-295) themselves is that they consider it to be one which brings forth the ‘second sense’ of nurses and makes them experts in clinical decision making. The analysis conducted in the former part of this paper which referred to the hypothetical deduction is the one that matches with the model. The next step of repossessing analytical possibilities from all the information of long term storage will help in understanding Trevor’s state of complete predicament. Similarly, in accordance to Bucknall’s (2003: pp.310-319) study, it was found that the environment majorly influences decision making as well as the patient’s situation, resource availability, and interpersonal relationships. According to Cruz, Pimenta and Lunney (2009: pp.121-127), many accuracies are found from pretests to posttests by using this model. In case of any distractive side encounters by the student nurses, it is important that the support worker is assigned to Trevor for any sudden behavioral implication; it has been argued by the Royal College of Psychiatrists (2009: n.pg) that the staff level on all stages needs to be stabilized. Thus, it is necessary that crisis security back up is kept ready and alert for any overnight support. This is also a part of Carnevali and Thomas’s model as it specifies bringing forth the right aspect of decision making and judgment for the clinician by comparing the source data with the case data. As Sands (2009: pp.298-308) evaluates, this model leads towards evidence-based decision making since it produces better results after every analysis. Thus, by applying this model of processing decision making, a prearranged analysis of the probabilities of the specific case of Trevor can be brought forth and an apposite identification can be carried out. References: Banning, M 2008a. A review of clinical decision making: models and current research. Journal of Clinical Nursing, 17, pp. 187–195. Banning, M., 2007b. A review of clinical decision making: models and current research. Journal of Clinical Nursing, 17 (2), pp. 187-95. Barlow, D.H. and Durand, V.M., 2009. Abnormal psychology: An integrative approach. Belmont: Cengage. Bastable, S. B., 2008. Nurse as educator: principles of teaching and learning for nursing practice. Canada: Jones & Bartlett. Bucknall, T., 2003. The clinical landscape of critical care: nurses’ decision-making. Journal of Advanced Nursing, 43(3), pp. 310-319. Carnevali, D. L. and Thomas, M.D., 1993. Diagnostic reasoning and treatment decision making in nursing. Journal of Nursing Staff Development, 9(6), pp. 293-295. Thompson, C. and Dowding, D., (eds.), 2002. Clinical decision making and judgment in nursing. London: Elsevier Science. Cox, C. and Hill, M., 2010. Professional issues in primary care nursing. West Sussex: Blackwell. Cruz, D.M., Pimenta, C.M. and Lunney, M., 2009. Journal of Continuing Education in Nursing, 40(3), pp. 121-127. Davidson, A., Ray, M. and Turkel, M., (eds), 2011. Nursing, caring, and complexity science: For human-environment well being. New York: Springer. Dowie, J. and Elstein A.S., (eds.), 1988. Professional judgment: A reader in clinical decision making. Newcastle upon Tyne: Athenaeum. Hegner, B., Acello, B. and Caldwell, E., 2009a. Nursing assistant: A nursing process approach – basics. New York: Cengage Learning. Hegner, B.R., Acello, A. and Caldwell, E., 2010b. Nursing assistant: A nursing process approach – basics. New York: Cengage Learning. Jasper, M., 2006. Professional development, reflection and decision-making. Oxford: Blackwell. Jones, J. (2003). What education and training do mental health nurses want? A survey of qualified mental health nurses working in acute inpatient psychiatric settings in the UK. London: Royal College of Nursing (RCN) Institute. Jones, R.A.P., Beck, S.E., 1995. Decision making in nursing (nursing education). New York: Cengage Learning. Lauri, S., Salantera, S., Chalmers, K., Ekman, S.L., Kim, H.S., Kappeli, S. and MacLeod, M., 2004. An exploratory study of clinical decision-making in five countries. Journal of Nursing Scholarship, 33(1), pp.83-90. McGee, P. and Castledine, G. (eds.), 2003. Advanced nursing practice (second edition). Oxford: Blackwell Publishing. Petersen, J., 2007. Why don't we listen better?: Communicating & connecting in relationships. Tigard: Petersen. Ramzy, Y. and Barbara, S.C., 1993. Clinical characteristics of late-onset schizophrenia and delusional disorder. American Psychological Association, 19(4), 701-707. Royal College of Psychiatrists, 2009. Acute mental health care: briefing note. Available at: http://www.rcpsych.ac.uk [Accessed 5th January 2012]. Sadock, B.J., Kaplan, H.I. and Sadock, V.A., 2007. Philadelphia, Kaplan and Sadock's synopsis of psychiatry: Behavioral sciences/clinical psychiatry. Lippincott Williams & Wilkins. Sands, N., 2008. An Exploration of clinical decision making in mental health triage. Archives of Psychiatric Nursing, 23(4), 298-308. Sheldon, L.K., 2009. Communication for nurses: Talking with patients. Sudbury: Jones & Bartlett. Read More