The Social Context of Ethical Practice in Mental Health Care - Essay Example

?Running head: CLIENT CASE STUDY Client Case Study (school) Client Case Study Introduction Nursing care is one of the most extensive areas of medical and health care practice. It covers a wide range of services from assessment to discharge. Nursing processes involved in nursing care are essential processes which help the patient in his recovery. The processes involved are founded on basic theories and frameworks, as well as models of care which serve to establish basis for the practice and for the appropriate delivery of care. This paper shall be a client case study discussing a patient problem from the assessment which requires nursing intervention. It shall discuss the planning, implementation, and evaluation associated with their care relating it to the nursing process and theoretical framework and model of care underpinning the assessment. The driving force for the development of mental health policies were concerns on public safety and on the minimization of risk (Fry, 2011). In the 1700s, their fears of mental illness were mostly related to their fears on witchcraft and the devil. The lower classes believed that only by using violent means could the mental illness be treated. Among the upper classes, they were keen on morally condemning such illnesses; and their fears of these diseases impacted on mental health with the attitudes of apathy being expressed against these diseases (Fry, 2011). During King George’s time when he was apparently cured of his mental illness, the attitudes towards mental illness changed and took on a more accepting attitude. The people had faith in the belief that the mental illness can be cured. As a result, asylums for the treatment of the mentally ill were established (Fry, 2011). More research on mental illness and on its treatment was carried out. Models of sanity were also conceptualized; these models were accepted among professionals and laymen. Unfortunately inasmuch as these asylums were built on noble and helpful reasons, they soon became places of incarceration for the mentally ill, not a place of treatment (Fry, 2011). The war gave birth to the so-called war trauma which was identified as a mental illness. This mental illness became the subject of many studies. However, even as the general concern was for the treatment of mental illnesses, the focus of legislation ran towards detainment and compulsory treatment (Fry, 2011). After the Second World War and with the advent of drug therapies, including tranquilizers and neuroleptics, better odds for the treatment of mental illness brought about legislation for the improvement of the treatment of patients in mental institutions (Fry, 2011). In 1983, the Mental Health Act was introduced in order to secure the rights of mental health patients and to protect public safety. The National Health Service and Community Care Act of 1990 further improved this law by introducing community care for the mentally ill. More improvements were later seen on mental health care with the amendment of the Mental Health Act as introduced by the Mental Health Act of 2007. Description of patient My client who shall be referred to as Patient A was admitted into the rehabilitation unit from Ward 8 following his right below the knee amputation. His amputation was carried out as a result of infected foot ulcers. His sutures from his amputation were recently removed and he was now set to start the rehabilitation process. The rehabilitation unit where he was admitted specializes in orthopaedic and stroke rehabilitation patients, including patients having had fractures, amputations, and patients with bodily weakness caused by paralysis as a result of strokes and spinal injuries. The unit focuses on regaining mobility for patients, helping them regain strength and coordination in their movements, and assisting them in learning ways on how to carry out their daily activities even with their disabilities. On the third of March 2011, an ectasia was detected in his right common iliac. Further infection of foot ulcers in the area led to further deterioration of his leg. An amputation was recommended. He underwent elective below knee amputation on the 22nd day of May 2011. He has had a history of circulatory issues throughout the years first with an abdominal aortic aneurysm in 2001 which was subsequently repaired. He also underwent reperfusion of his left iliac. In 2003, he was diagnosed with a left ischemic leg and underwent a thrombolysis to clear thrombus. In 2011, the ectasia in his right common iliac was detected, later causing the amputation. Assessment process The assessment process of this patient included the head-to-toe assessment, as well as specific assessment models which apply to his particular medical issues. Assessment can provide plenty of information which can be used in the implementation of adequate and appropriate care (Schilling, 2006, p. vi). The patient was first assessed in terms of his airway, breathing, circulation, disability, exposure, exposure, risk of falling, and his nutrition. Since his mobility was compromised, he was also assessed for his risk of pressure ulcers. In assessing patients it is important to ensure comprehensive assessment processes are carried out, and nurses are the best people to carry these out since they are the frontline of care (Hincliff and Schober, 1998, p. 7). In applying such processes, the patient was assessed in terms of his mobility, his standing, sitting up, walking, navigating stairs, bathing, dressing, and his other activities of daily living. His bowel function, initial wound, BMI, as well as his environment, and pain levels were also assessed. Outline of assessment process and identification of the underpinning theoretical framework Theories on the assessment processes applied above is based on Orem Self-Care Deficit Framework. Self-care is basically about a person’s ability to care for himself, and at the opposite end of self-care is dependent care, which is about providing for the essential needs of children and those who may be physically or mentally disabled. Theories can have varying applications in any practice, especially in the health care setting (McKenna, 1996, p. 3). In this setting, the patient’s therapeutic needs are the needs which arise from his disease or infirmity (Pearson, et.al., 1996, p. 92). It is the responsibility of nurses to address health deficits and therapeutic self-care needs in instances when these patients cannot provide for their needs (Aggleton and Chalmers, 2000, p. 573). Nursing care is based on various aspects of care and when nurses provide care for their patients, there is a fuller delivery of care (McKenna, 1996, p. 165). Needs which are only partly administered is seen when the nurses and the patients provide partial care. Educational and supportive care is therefore needed and administered through health education, health teachings and supportive care (Baillie, 2005, p. 69). Patients with limited mobility – as in this patient who had a below the knee amputation have therapeutic self-care needs because they have various risk factors, including risk factors for pressure sores, falls, constipation, and poor circulation. As such, this patient needs comprehensive nursing care, as well as an adequate adaptation to stimuli (Roper, et.al., 1996, p. 15). The care staff is there to compensate for the limitations of the clients and their families in meeting their self-care needs and therapeutic demands (Pearson, et.al., 1996, p. 6). Discussion relating to patient care One of the nursing problems for this patient is his risk for pressure ulcers. Based on the Waterlow Pressure Assessment Score, the patient has a high risk of developing pressure ulcers. There are various interventions which can be implemented for the patient in order to prevent the patient from developing pressure ulcers. Pressure ulcers are known to develop when persistent pressure is placed on the bony protrusions in the body, pressures which then interrupt the free flow of blood to the body, thereby causing tissue necrosis (Van der wee, et.al., 2005, p. 262). The accepted capillary pressure is from 20 to 40 mmHG; this pressure enables the flow of adequate oxygen into the cells of the body, helping prevent and manage tissue necrosis. These pressure ulcers can develop in a matter of hours (Schoonhoven, et.al., 2002, p. 797). It is therefore important to apply preventive measures for pressure ulcers in the earliest time possible. The prevention process calls for the interaction of different interventions and after much evaluation of these interventions, an agreement was made on the fact that these interventions must be based on relieving pressure on the bony protrusions in the skin. These interventions include the removal and the redistribution of weight on the pressure-sensitive areas in the body. One such intervention includes repositioning of the patient every 2 hours (Clark, 2001, p. 78). Changing the patient’s position every two hours takes off the weight concentration in one area of the body and transfers it to another part at regular intervals. Using support surfaces on beds and chairs can also help reduce the patient’s risk for pressure ulcers. The dynamic devices are applicable for high-risk patients. These devices include air-fluidized beds (LeGood and McInnes, 2004, p. 313). These beds help to make adjustments in the pressure exerted on the patient’s back, making it more distributed and making appropriate changes when necessary (LeGood and McInnes, 2004, p. 313). Other preventive measures include nutrition changes which includes a daily diet rich in protein (Johnston, 2007). Protein is an important nutrient for wound healing in general and it can achieve therapeutic levels in the patient with adequate servings of high protein and energy foods of drinks in a day (Johnston, 2007). This intervention has to be coordinated with a dietician in order to establish the most appropriate servings for foods to suit the client’s taste. Various studies point out the importance of nutrition, especially among the elderly patients in the prevention and management of pressure ulcers (European Pressure Ulcer Advisory Panel, 2002, p. 96). Studies also point out that significant weight loss can impact on the development of pressure ulcers with such loss causing deterioration in the daily life and activities of the patients (Odlund-Olin, et.al., 2005, p. 263). With weight loss, these patients have less energy in carrying out their activities, making them less able to maintain mobility. Recommendations for nutritional supplements are made by other studies as these can help increase patient strength and improve their nutritional status (Odlund-Olin, et.al., 2005, p. 263). Through improved nutritional status, the patients are more able to carry out their daily activities, as well as reduce their risks for infections (Odlund-Olin, et.al., 2003, p. 263). Keeping the patient clean and dry is also an important preventive measure for pressure ulcers. By keeping the patient dry, skin rashes can be avoided. With continually wet surfaces, dirt and bacteria can build and can enter the skin through breaks in the skin, including skin rashes or thinner layers of skin where bony protrusions are (Baranoski, 2006, p. 399). Once these small breaks in the skin get infected, these skin breaks would get bigger and lead to pressure sores. It is therefore important to keep the patient clean and dry in order to prevent infection, skin breaks, and bacteria build-up (Gupta, et.al., 2004, pp. 1-2). Changing the patient’s clothes must be a daily habit, or more frequent when they get soiled. The change of positioning would also help circulate the air on the patient’s back preventing sweat from wetting the patient’s clothes. Regularly assessing the patient for pressure ulcers is also an important preventive measure (Walsh, 1998, p. 23). The Waterwall scale must be used on a daily basis to check the patient for pressure ulcers. Risk areas on the person’s back or any other body parts must be identified and checked regularly to establish possible appearance of pressure ulcers (Lindgren, et.al., 2004, p. 57). If areas of the skin indicate possible development of pressure ulcers, the appropriate management measures must immediately be applied in order to prevent the pressure ulcer from progressing further. In effect, if these pressure ulcers cannot be prevented from surfacing, early management measures must be immediately applied to prevent these ulcers from progressing further. These early management measures include: keeping area clean and dry, placing additional padding on the bed or chairs, and changing position of the patient every 2 hours. By regularly checking on the patient, the lines of communication are also kept open and can help secure early detection and treatment of diseases (Balzer-Riley, 2004, p. 6). The major factors in the prevention of decubitus ulcers include the promotion of movement, avoidance of pressure, removal of pressure, and distribution of pressure. Such interventions must be coordinated and monitored based on individual prevention plans (Anders, et.al., 2010, p. 376). The interventions which promote movement help to improve the compromised mobility of the patient and also helps prevent contractures. These measures include the activation of nursing care to encompass interdisciplinary rehabilitation. The process of changing positions is a measure which is meant to reduce pressure; it is also meant to be applied based on each patient’s qualities (Bours, et.al., 2002, p. 99). Changes in position include the combined “30 degrees and 135 degrees oblique positioning on alternating sides; limbs and pressure points shall be kept free of pressure” (Anders, et.al., 2010, p. 371). Attention is also needed in issuing instructions and on involving the patient and his family in order to teach them, in this case, to teach the wife about the measures they can apply to prevent the formation of pressure ulcers. A meta-analysis from the Cochrane database revealed that pressure-distributing positioning aids like super-soft foam mattresses are preferred over traditional foam mattresses because they significantly decrease the incidence of decubitus ulcers (McInnes, et.al., 2008). However, these foams alone are not enough to prevent pressure ulcers; regular repositioning and movement-promoting interventions also have to be implemented in order to eliminate the incidence of pressure sores. According to evidence, the best system to use for pressure sore prevention, is one that allows alternating reduction of pressure while also promoting movement as much as possible (Bours, et.al., 2002, p. 100). Gentle positioning as well as the use of sheepskins has also been useful in reducing the shearing forces (Anders, et.al., 2010, p. 377). It is also important to place the patient in the best position – one which allows pressure reduction with frequent changes in position and still allows movement to the greatest possible degree (Bours, et.al., 2002, p. 100). The patient’s wheelchair must also not be used for extended use, meaning, the patient must not stay in the wheelchair for prolonged periods of time. He must be made to navigate without the wheelchair in order to prevent the occurrence of pressure sores. The efficacy of the interventions shall be established by regularly monitoring and assessing the patient’s pressure points, detecting signs of pressure sores and establishing whether pressure on his back is relieved/redistributed/reduced by the different interventions being implemented. Conclusion The patient was assessed based on different models or tools. These tools considered the risks involved in the patient’s condition, including his risks for falls, pressure ulcers, and similar health issues. In considering his risk for pressure ulcers, interventions include the relief and the redistribution of pressure on the back and other bony protrusions in the skin. Specific measures include the use of mattresses and padding on chairs and beds. Repositioning of the patient regularly can also assist in preventing pressure ulcers. It is also important to keep the patient clean and dry in order to prevent infection and the formation of pressure sores. Adequate nutrition is important for the patient in order to prevent weight loss or too much weight gain; nutrition is also crucial in fighting off infection and to keep the body healthy. Works Cited Aggleton, P. and Chalmers, H. (2000) Nursing Models and Nursing Practice (second edition) Basingstoke: MacMillan Press Anders, J., Heineman, A., Leffman, C., Leutenegger, M., & Profener, F. 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