Nursing care given to a patient with paranoid schizophrenia - Essay Example

?Case Study Background This is a nursing case study prepared on the basis of the observations made by the while on a practice placement. The paper discusses the observations made about the nursing care given to a patient with paranoid schizophrenia. The study is also intended to show the role of a nurse in care; including assessment, planning, implementation and evaluation and also in the care given to the patient’s family. In this particular case, the method used was Orems Self-care model (2001) which emphasizes on improving the patient’s state of health and making them feel responsible for their own health. It is not possible to undermine the role of a nurse in this system which is mainly to promote physical, mental and social health through developing a good, trust-based relation with the patient. In addition, this case study will show how client-centered nursing models are used in which the patient’s interests and rights are respected and protected to the maximum possible extent. As Rogers C (1990) opines, the nursing team in this particular case develops strong relationship with the patient with real exhibition of sympathy, originality, and willingness to listen while dealing with the patient. As per the NMC (2008) directive that nurses should develop a deep and reliable relationship with the patient, the author engaged in conversation with the patient; and the expected result was a relationship based on respect and belief (Baker 2003). In this particular case, the patient’s individual freedom to decide her own life was preserved as far as possible (Ewles & Simnett, 2003). As per the definition by Lowden, (2002) autonomy means allowing the patient to make decisions in personal matters. The Patient The patient in this case study is named Mary. The name is imaginary to comply with NMC professional code of conduct (2002). She was 54, and was admitted to the hospital with Paranoid Schizophrenia. Before her entry into the Ward, there was a holistic and thorough assessment by the duty doctor. The basic concepts of care The method of care is totally holistic in nature. In this case, Orems (2001) Self Care Model of Nursing is used as the basic criteria and it follows the four stage nursing process of assessment, planning implementation and evaluation. As Barker (2003) observes, this holistic approach will explore the physical, psychological and social spheres of nursing assessment. Assessment The nursing process starts with assessment (Roper et al 2000) which includes all the present and historical information about the patient This must include as much information about all spheres of life as possible including the mental health, family background, education, religion, beliefs and occupation. Family history of mental disorders and other genetic factors are also taken into consideration. In addition, adequate attention is paid to the patient’s lifestyle and living situations. There are a number of ways suggested by Townsend (2006) for the assessment of patients which include consultation with other health professionals, collecting data from family members, watching and interview. In addition, according to the Oxford Nurses Dictionary (2002), a holistic assessment will consider a patient’s psychological, physiological and social life. In the opinion of Jenkins & Field (1996), collecting all these information from a patient will help a nurse in developing a healing relation with the patient. In fact, Mary had a long history of schizophrenia. For her, the disease had its beginning about thirty years ago but the disease was not diagnosed accurately in the beginning. The disease at first started in the form of tension along with sleeping problems and difficulty concentrating. But no one including her parents took the change seriously as there was a tragic incident. It was during those days that her husband died in a car accident. When she shrank more and more into her own private world, all including her parents and friends thought it as a result of the shock caused by her husband’s untimely demise. However, as she started showing total lack of emotion with a blank expression on her face, her parents smelled a rat. In addition, many a time her talks were meaningless and unrelated. In addition, she started claiming that her husband was killed by his business partner and claimed that her husband often appears to her. Being alarmed at the turn of events, and still having very poor idea about the severity of the mental disease she has developed, her parents took her to a General Practitioner. However, the antipsychotic medication provided by the General Practitioner was of little use as she did not take the medicine regularly. In addition, the intensity of delusions, hallucinations and behavioral disturbances was going higher. After thirty years of life in and around hospitals, her situation was rather pathetic on reaching here. As per records, her symptoms on reaching here are hallucinations, behavioral disturbances, delusions and anxiety. In addition, she did not follow the medications in time in contradiction with Gilliam (2006). In addition, she showed total social withdrawal (National Institute for Mental Health in England, 2006). Risk assessment was a part of the assessment to identify the possible results of the behavior expressed by the patient (Carson D. (edn) 1990). As a part of this, the history of the patient was gathered including specific incidents and medical history while thoroughly protecting the secrecy of the information in accordance with the Data Protection Act, 1998. Factors like possibility of harm to others, possibility of harm to oneself, alcohol and drug abuse, chances of discontinuing medicine were all taken into consideration and assessed. It was found that Mary does not cause any kind of harm to others but there was alcohol misuse. However, the chances of getting exploited by others cannot be neglected and most importantly, she had high suicidal tendencies. In addition, she had the tendency to discontinue her medication. Mary gave the explanation that she discontinued the medicine Sulpride because of the severe side effects including shakiness, insomnia and restlessness (NICE 2005). Though Sulpride is effective in treating schizophrenia (British National Formulary, 2006), Mary discontinued taking the medicine because of the side effects. In addition, it is effective in controlling problems associated with schizophrenia like tendency of isolation, hearing voices and so on (Healy 2006). In addition, she admitted that it was her failure in taking the medicine regularly that led to her many hospitalizations in the past. In addition, she admitted that her suicidal tendencies were the result of the frightening hallucinations she used to have. She also admitted that she used to take alcohol to escape from the frightening hallucinations. In fact, she was prescribed Diazepam to control these problems but she did not take it regularly complaining of drowsiness, confusion and stomach disturbances (Healy 2006). At this juncture, one should remember the British National Formulary (2006) point that the abdominal problems indicate a dislike. After collecting all these information, Mary and her parents were informed about the assessment. Planning After assessment, the next stage was planning. In this stage, the team of nurses discussed the assessments and after considering all the aspects of the issue, a care plan was developed for Mary (CPA 1991). This was followed by proper recording and documenting of the plan according to NMC (2008) Record and Record Keeping. Thereafter, a copy of the prepared plan was handed over to Mary in accordance with CPA (1991). According to Article 8 of the Human Right Act, 1998, the patient has the right to know his treatment. In addition, a care plan has the value of a legal document in a court of law (Care Programmer Approach 1991) and according to Christensen and Kenny (1986), care plan can be used as a way to record all the details of the patient including diagnosis, possible results, purpose, and goals. In addition, the importance of recording is stressed by Roper et al (2000) as they suggest its use as a means of communication among all members who provide care. After preparing and signing the care plan, a copy will be provided to Mary (Barker 2003) as the patient’s wishes are to be respected (CPA 1991). As a part of the treatment, a Multi Disciplinary Team (MDT) was organized. The MDT included Mary, her patents, Consultant Psychiatrist, Psychiatrist Nurse, Occupational Therapist and Support Worker. Both Baker (2003) and Nelson (2001) agree on the point that it is necessary to conduct MDT meetings for care planning in which the assessment should be analyzed and further course of procedure should be decided. In this particular case of Mary, the decision was to adopt an Enhanced Care Program Approach (1991) which is totally patient-centered and is expected to meet the needs of this particular client by allowing individual participation (NSFMH 1999). In addition, the MDT made the following conclusions: the author was supposed to take the patient for a walk as a member of the nursing team. According to More and Thomas (2000), regular walk can help solve the problem of hearing voices. Moreover, the nursing team was to help Mary distinguish between reality and hearing voice. Thirdly, antipsychotic medication was to be administered to reduce disorganized thoughts. Also, a plan was developed to control the patient’s alcohol misuse with the help of the entire MDT team including Mary’s parents. Implementation The first issue that was addressed in the treatment was the tendency of social isolation. To improve the situation, a number of activities were to be introduced. First of all, the patient was encouraged to take part in discussion groups and other such programs (Naidoo and Wills, 2004). By encouraging her to take part in events where social skills are promoted, the problem of social isolation was reduced considerably (The Social Exclusion Unit 2004). The second issue of consideration was the hallucinations. It was decided in the care plan that Mary should be helped to distinguish between reality and imagination and that the members of the team will go on providing her feedback on her hallucinations thus enabling Mary to believe the nurses more and more. In addition, the patient will be given clear idea about the benefits and side effects of each medication (NICE Guidelines, 2005) and the team will precisely follow the decided course of medicine and will monitor the patient closely for any changes. The next thing to be addressed was her sleep disturbances. As a part of this, health problems, disturbances including light, heat and noise (Barker 2003) were all identified and the team made sure that she gets proper sleep and as per requirement, she was allowed holistic drink to encourage sleep. The next issue of consideration was the alcohol misuse of the patient. In this case, the MDT team took help from the patient’s parents too. This step is in accordance with the NMC directive that a nurse must respect the skills and ability of colleagues. The first step was to make Mary understand that it is common for people like her to use alcohol to manage their mental problems (Baker 2003). In addition, the team will monitor the possibility of side effects due to the use of antipsychotic medicines through Neuroleptic Side Effect Rating Scale (LUNSERS, 1995). Moreover, the team will make Mary understand how alcohol can be replaced by relaxation techniques to reduce the mental problems and also the side effects of medicines. As Krupnick and Wade (1993) observe, such relaxation techniques will help the patient be relaxed with increased self-esteem. Evaluation The Care Program Approach (1991) suggests that care plan is to be reviewed every six months and according to National Service Framework for Mental Health, 2000, this will ensure that the patient is getting high standard service. Evaluation is the assessment as to how much the care plan succeeded in achieving the expected result (Townsend 2006). As a part of this, the success of each step in the implementation stage is assessed. In addition, the patient’s opinion about the treatment is documented. In the case of Mary, she expressed total satisfaction in the treatment provided. Thus, by allowing the patient to have a word in the decision making or review, the total participation and cooperation of the patient is ensured. In the review, considerable improvement was visible in the patient. First of all, the patient was willingly taking the medication and cooperating with the treatment. However, it was decided that Mary should continue with her counseling sessions with the Drug and Alcohol Team. Thus, this improvement in the condition of Mary proved Gilliam’s (2006) claim that the result of the treatment of schizophrenia relies heavily on proper multidisciplinary team’s effective functioning and more importantly, in the attitude, skills and positive approach of the nurses. Thus, from the above case, it becomes evident that assessment, planning, implementation and evaluation are all necessary steps involved in mental health treatment At this juncture, the nursing team informed Mary’s parents about their rights for a careers care plan (CPA 1991) as they come under the purview of career according to The Careers Act (1994). In addition, there is the Careers and Disable Children Act of 2000 that enables careers to help the disabled with the help of local authorities. Conclusion In the above case, the author’s duty was to establish a good, curative relationship with the patient but the experience helped the author understand the role of a nurse in mental health care. Thus, it was a success story where the author got a chance to become a part of a successful nursing team and understand the need for thinking to make ones thinking better as Acheson D (1999) observes. Read More