Care of a Patient in the Mental Health Branch - Essay Example

Care of a Patient in the Mental Health Branch of the of the Care of a Patient in the Mental Health Branch Introduction Patients with mental illnesses can pose their own set of challenges to a nurse in the diagnosis and treatment of their maladies. The role of the nurse can contribute highly towards the proper monitoring, diagnosis and treatment of the mentally ill patient. In such conditions, as a nurse it is imperative to communicate with both doctor and patient regarding the feelings and apprehensions of the patient combined with the exhibited behavior. The age and sex of the patient, family history and past afflictions may also hold valuable clues in the diagnosis of mental illness. In this assignment, we are going to deal with the admission of a 50 year old male patient who has been brought in to the Mental Health Branch of the hospital. It is known that he is suffering from a mental illness but a proper diagnosis has yet to be performed by a doctor. The case is being reported by a nurse in her first year of training. The description of his behavior and the time since he has been displaying such erratic conditions needs to be ascertained, as they will point not only to his present state but also the condition he is afflicted with, the likely causes and prescribed treatment, leading towards an eventual partial or complete recovery if possible. The Role of the Professional Nurse and Its Impact on Patient Care The role of professional nursing in patient care can never be under-estimated. As most of the time it is seen that the patient communicates with his nurse, therefore the nurse can have a great impact on the patient’s proper treatment and recovery process. Nurses focus on the needs of the patient and provide individuals and their families with care and attention. The RCN defines Nursing as “the use of clinical judgment in the provision of care to enabled people to improve, maintain or recover health, to cope with health problems, and to achieve the best possible quality of life, whatever their disease or disability, until death” (RCN, 2003). The hiring and introduction of professional nurses to hospitals in the UK has had a profound and lasting impact on the health profession. The new role of the nurse as taught in colleges and universities is an expanding one and encompasses an array of new responsibilities. Where once upon a time, a nurse was content to stand by a doctor and see what he did, only speaking when spoken to and doing only as and when directed, today’s nurse has been given a role and responsibility almost equal to the doctor she is assisting on the case. Part of the enhancement of job responsibilities for professional nurses has been because of shortage of doctors or professional staff, the lack of proper interns and the general decline in health standards and patient care. Thus the expanded role of the professional nurse in the UK is making its impact felt not only on patient care but on the health profession as a whole. Registered Nurses in the UK and Codes of Conduct At present the Royal College of Nursing (RCN) and the National Midwifery Council (NMC) are two institutions that regulate the standards of professional nursing in the United Kingdom. Both of these institutions have a strict code of conduct to adhere to; in most elements the codes are similar and complementary. Their role is threefold: to promote excellence in nursing practice, to represent nurses and nursing and to shape health and medical policies. Certified membership in these professional organizations can only be accomplished after passing their exams and continuing to meet ethical codes of conduct. The RCN code of conduct touches specifically upon the spirit of selflessness, integrity, objectivity, accountability, openness, honesty and leadership (RCN, 2005). The NMC code of conduct incorporates the principles of treating everyone with care and dignity, taking responsibility for judgment and actions in patient care, enhancing safety and managing risk, puts people at the centre of care, assess and record changes and complaints, use their knowledge and experience with care and understanding, work closely with other care givers and the medical team, and lead by example in providing and maintaining standards of care (NMC website). Only a Registered Nurse has a right to practice lawfully in the United Kingdom. The protection given to this title is laid down in the Nurses, Midwives and Health Visitors Act, 1997. Aspects of Caretaking in Mental Health Taking care of mentally ill patients can be more challenging than otherwise. This is because normal physically ill patients can often communicate properly with the doctors, nurses and other hospital staff regarding their particular needs, feelings and emotions at any particular time and get their pains and causes of discomfort addressed. This is not so in the case of mental patients. Experience proves that the mentally ill patient has often to be under the constant care and supervision of a dedicated caregiver, who is his eyes, ears and mouth, his window to the world. The caregiver is usually a son, daughter, family friend or relative who has a close enough relationship and understanding of the patient’s needs. It is important that the caregiver understands the mentally ill patient and his needs or can correctly anticipate the same based upon their earlier relationship in the home environment. The Roper Logan Tierney model of Activities of Daily Living will serve as a good nursing model to emulate here. Establishing Trust and Removing Barriers One of the first tasks that a doctor or nurse has in dealing with patients is to put them at ease, take charge and establish an atmosphere of trust and understanding. They must elicit the feeling that they are there to help the patient, cure his condition or ease his present discomfort. The nurse should acknowledge that no actions are undertaken without getting consent from the patient. Performing undesirable actions would not have a positive influence on assessment procedure and further recovery. Common law has established that patients have a right to what happens to their own bodies. Acting without consent of a patient may attract penalties of battery and even negligence if the actions taken prove to be wrong or harmful (www.wales.nhs.uk). To encourage trust, a nurse should listen to patients and interpret their needs and concerns. It is important to set a relationship of trust between a patient and a nurse as it facilitates adherence to treatment plan by a patient and one’s awareness of its significance. Effective communication in a health care setting is of great importance for positive results in the treatment process. It is a challenge for a care provider to concentrate wholly on a patient with his specific problems, considering every detail, understanding the person’s background and interpreting different meanings in everyday situations (Kitson, 1999). The nurse should use Ida Jean Orlando nursing process theory of care to elicit the patient compliants as well as observe patient discomfort and record the need for additional care and support here. Making an Initial Assessment of the Mentally Ill Patient on Admission Admission of patients with mental health problems is a complex process. It should be always preceded by planning. An essential part of it is choosing an appropriate nursing model to be followed. It is already mentioned that use of Roper et al. nursing model would be useful here. An initial assessment requires a detailed personal history, which usually may be obtained from interviews. The nurse should be aware of effective interview techniques and nursing ethics. Physical examination is an important part of the assessment. Usually simple cardiovascular (pulse, blood pressure) and neurological (muscle tone and reflexes, cranial nerves) examination will be enough. Laboratory investigations should be performed considering a patients past health and intended treatment. The next stage of assessment involves gathering information to place the present complaint in the context of patients psycho-social development, pre-morbid personality and current circumstances. Then all the findings should be summarized. They normally include description of the complaint, relevant medical history and medication, results mental state examination, estimation of degree of urgency and indication of referrer’s expectations (Davies, 1997). Different Types of Communication and Potential Barriers Communication in nursing can be a complicated process and the possibility of sending or receiving incorrect messages due to certain communicational barriers frequently exists. That’s why understanding of the key components of the communication process is essential for the nurse. Among the potential barriers to effective communication are language and ethnic barriers, staffing shortages, distractions, noise, usage of jargon and some others (Magee, 2010). The nurse’s task is to remove these barriers. The language barrier may be overcome by providing an interpreter. Distraction will be avoided if a nurse has appropriate communicative skills. Communication between doctor, nurse, patient, caregivers and the rest of the medical team is very necessary especially if the condition is serious and a lot of different people or teams are involved with the case. In such instances updated records also play an invaluable part and should be read chronologically to check on the latest changes in the patient’s condition or medication (www.patientsafetyfirst.uk) The expression of thoughts and feelings should be encouraged without blaming, judging or belittling (Dziopa & Ahern, 2009). The psychiatric nurse should be ready to listen and support the patient in any situation. Not only the ability, but the desire to understand the patient is required. The nurse should be involved in patient situation, as patients may expect nursing staff to understand them even when they are unable to express their needs verbally (Berg and Hallberg, 2000). Making sure that the patient and the caregivers will follow a treatment plan and advice about changes in lifestyle would maximize positive outcomes of treatment (Maguire and Pitceathly, 2004). Anti-Discriminatory Practices: Valuing Equality and Diversity across Populations Anti-discriminatory practice is a key issue in contemporary mental health nursing along with above-mentioned. Nurses should have respect for patient diversity irrespective of age, ethnicity, gender, religious or any other differences. No therapeutic practice can be considered truly holistic and professional without such attitude towards the patient. The feeling of discrimination can make a patient get angry, annoyed and become withdrawn. Such behaviors make efficient communication and treatment impossible. Using the model of trans-cultural nursing provided by Madeline Leininger would be very useful here (Leininger, 1995), as decisions should be made according to the patient’s beliefs, culture and lifestyles. Accountability, Consent and Confidentiality: How They Impact on Patient Care It is clear that the standard of patient care is impacted by the principles of accountability, consent and confidentiality that have been afforded to a particular patient. Among one of the most important aspects of care-taking is acknowledgement of patient’s right for confidentiality. It’s especially essential for work with people with mental diseases. The patient feels safe and comfortable if he is sure that no one has an access to his personal information. On the other hand, a patient may become depressed if his private information is disclosed. All patients should be guaranteed that any information given in confidence will only be used for the purposes for which it was given and will not be disclosed to others for any other reasons without their prior permission (Royal College of Nursing, 2005). The nurse must assure the patient that the information they provided won’t be disclosed. Ensuring confidentiality is an essential part of nursing ethics. Confidentiality applies to health records as well (Royal College of Nursing, 2005). Developing Meaningful Planning in Patient Care Through the Use of Nursing Models & Establishing Intervention Points Through Set Goals A nursing model is a collection of interrelated concepts that provides direction for nursing practice, research and education that approaches the nursing process in a logical, systematic way and influences the very data the nurse collects (Rambo, 1984). One mental health nursing model uses a Tidal Approach. This model was developed by Professor Phil Barker, Poppy Buchanan-Barker and their colleagues. The Tidal Model’s main idea is that there is a continuous process of change inherent in all people. Its aim is to reveal the meaning of peoples experiences. Supporters of this model emphasize the importance of patients’ own voice and wisdom. They empower people to lead their own recovery rather than being directed by professionals (Barkway, 2009). According to Barker (2008), six philosophical assumptions are used in Tidal model: belief that curiosity is virtuous, belief in power of resourcefulness, respect for the persons wishes, considering crisis as a new opportunity, the virtue of pursuing elegance. In other words, the main assumption of this model is that the person’s problems as well as needs change continuously from day to day. Effective care needs to be based on a realization of the changing nature of people and their life circumstances. Another modern nursing model was developed by Nancy Roper, Winifred Logan and Alison Tierney and is called the Roper-Logan-Tierney Model of Nursing. It’s widely used in the U.K and is based on activities of living. The aim of this model is to give answer to the question “what living means” and to categorize the answers into Activities of Living, among which are communication, eating and drinking, working and playing, sleeping, washing and some others. On the basis of these activities, the patient’s level of independence is assessed and all the patient’s needs are defined and met (Roper, Logan and Tierney, 2000). In case the set goals are not being achieved, the nurse may have to find out why and establish suitable intervention points. The Importance of Record Keeping While following a nursing model helps both to plan and to conduct an admission, appropriate record-keeping helps nurses in organizing the work process. It is important that nurses keep records about patients in appropriate way in accordance to legislation requirements. One of the advantages of keeping record is that it is an integral means of communication between nurses. Nurses are required to write down all the information accurately. All records should be made with patient involvement, considering their thoughts and opinions. Records should be written down in time immediately after any event has occurred. The records should provide both nurse and doctor with correct and valid information about care and treatment planning, about the decisions which the nurse made and the care performed. Conclusion Mental health nursing service is different from other services, as it is one of the most complex and demanding areas of nursing. The key task of the mental health nurse is to take care of patients and their families- this involves having both good communication skills and good knowledge about medication. A nurse is the best advocator of his patient’s case, an educator to the patient and his family. He or she helps a patient with the activities of daily living and also helps in the discharge and recovery process, explaining the medication, treatment or exercise and lifestyle regimen that has to be followed. Involving the family and caregivers in the post-discharge process reduces the possibility of re-admission or other complications. The nurse is also in charge of the patient’s and his family’s welfare. The process and speed of a patient’s recovery often depends on the nurse’s treatment, as nurse is a person who is constantly near the client, assisting and supporting him. The main aspects of professional nursing covered in the assessment are ensuring patient’s confidentiality, acknowledgement of importance of well record-keeping and following a nursing model, inapplicability of discriminatory practice, significance of effective communication with patient for successful treatment process. It is clear that the nurse plays a significant role in patient’s well-being and recovery. 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