Nursing Schizophernia in the UK - Assignment Example

Nursing Schizophernia in the UK Introduction: In the twentieth century the main aim and the role of nursing revised and modernized drastically. In the modern era in health promotion and disease prevention both have an important role in the nursing framework. In the early part of the twentieth century, before any predefined framework of nursing was in place the functions of nursing was mentioned as“the unique function of the nurse is to assist the individual, sick or well, in the performance of those activities contributing to health or its recovery (or peaceful death) that he would perform unaided if he had the necessary strength, will or knowledge. And to do this in such a way as to help him gain independence as rapidly as possible.”(Burggarf, 2012). Henderson was known as first lady of nursing. The key concept related to the two main parts of nursing I. e. Health promotion and disease prevention are individual care, promoting independence, self dependent and lifespan approach. The main questions related to nursing are how one individual does work; how to protect the health of the patients. Kulbok et.al. (2012) in their article mentioned the unique knowledge that a nurse needed to perform the work in the public health sector, community and also the importance of a good partnership the needed to effect care and treatment. Their article enlightened the historical perspective of both public health and community care from “sanitation and an infection control perspective toward challenging resources for the poor and underserved and now to its continued emphasis on participatory partnerships for effective intervention.”( Kulbok et.al, 2012). According to Burggarf (2012) transition in a core concept always play a major role and nurses are the integral part of it. According to him it is a passage between two relatively stable period of time with older patients diagnosed with dementia. Nurses play an important role in this phase to keep them mentally fit and healthy. In his article he also discussed about a patient navigation model for chronic disease which encapsulated into transformation for the health conceptual framework. This model was designed keeping in mind the behavioral changes and the concept of this model was based on the direct relationship between a patient and nurse. According to hi patient navigation , which was originally conceptualized on oncology , played a great role in the wider health care field including treatment of severe chronic diseases. (Burggarf, 2012) 2. Case study : Role of Nursing in Treatment of Schizophrenia: Following is a summery of a case study which is a clear indication about the fact that nurses are an integral part of the curative process for any person who is suffering from a chronic disease. Terry is a 26-year-old single female. She was a high school graduate and completed 1 year of college. She was born and bought up upper-middle-class family where academic and career success were extremely important as was their conservative Christian faith. Terry was a good hard working and self critical. After graduation, Terry went out of state to college. In the first year of college, she received passing grades but began to experience auditory hallucinations and delusions. She started to act in bizarrely and withdrew from people. At 18, she was hospitalized 1 month and dropped out of college. In the last 7 years was hospitalized 12 tunes. There was no history of psychiatric illness in the family. Terry was discharged from a psychiatric hospital after 2 months of inpatient treatment. Her diagnosis was schizophrenia, undifferentiated type, chronic. Her GAF at discharge was 30. She lived with her parents and was on SSI. Terry was referred by her nurse for ongoing psychotherapy as part of her discharge plan to help her adapt to the demands of community living and manage her illness. During her illness she was facing auditory persecutory hallucinations and delusions as well as frequent cognitions such as "I'm no good,"I can't do anything," "I'll always be this way." effectively she had flat affect and anxiety related to interpersonal situations and tasks and the content of the hallucinations and delusions. Interpersonally she was withdrawn and socially isolated. Behaviourally she was inactive, unable to work or live independently. Her basic self-care was severely limited. During her treatment, the nurse who was assigned to take care, played an important role by continuously interacting with her, listening to her problem carefully and analyzing those properly. Her Nurse always keeps motivating her to overcome hallucinations that she was in. Apart from the medicine, the moral and mental support and guidance provided by the nurse during her stay in hospital as well as after that helped her to get rid of schizophrenia more or less. The above case study analysis will help us to find out the answer about the different aspects associated with nursing such as: 1. Understanding legal and ethical point of view associated with nursing. 2. Role of personal and professional values of nursing, 3. Impact on individual’s belief and values in nursing. 4. Relevance of ethical-legal framework in decision making and 5. Role of ethical framework in justifying the decision in case of critical care, 3. General Analysis of Nuring: 3.1Nursing of Chronic Illness Schizophrenia: One of the most challenging parts associated with the nursing is to handle the case of chronic disease properly. Now a days chronic disease is the main cause behind death and disability across the world. According to the article report published by the Canadian Nursing Association non-communicable disease is the reason behind 60% of total death and 40% of global disease. By 2020 the rate is expected to go up till 73% in case of death due to chronic disease. Recently , The World Health Assembly, endorsed the WHO Global Strategy for the Prevention and Control of Noncommunicable Diseases and recently released a Global Strategy on Diet, Physical Activity and Health .Both these strategies recognize that chronic disease is a global issue that is influenced by many factors. One of the chronic disease is schizophrenia, and there are lots of challenges associated with nursing any schizophrenic patient. The global strategy designed by WHO and approved by the World Health Assembly is based on lesson learned for preventing and controlling different critical disease, it also works on future strategies related to the prevention of incurable disease.(Global strategy for the prevention and control of Noncommunicable Diseases, 2000) In the above case the treatment was divided into three phases. During the first phase of her treatment the main focus of the nurse was on her inactivity and difficulty that she was facing to manage the stress and anxiety. The weekly activity schedule designed by her nurse was helpful for her to overcome the hallucination and anxiety that she was facing. Recording all her weekly work also helped her as well her nurse and group of doctor to understand the level of improvement. After that the nurse assigned few behavioral assignments to her which ensured to increase her activity level.Stress management skill was developed in three different phases. The nurse had a detail interaction with her and based on her interest assigned her few meditation which act as her daily work course. Secondly, she was helped to figure out different points when her stress used to dominate her. As she was able to figure out the level of stress so she was able to to meditation to reduce that stress whenever it went up to high level. Finally, her habitual stress situation was identified by the nurse and with the help of meditation she was able to keep a check on that. During the middle phase of her treatment the nurse was more focused on identifying her habitual stressful behaviors and situations. After finding those out, the nurse with help of her experience , able to design a cognitive strategy to cope with those stressful habits and situations. Finally when she was able to live her normal life, the nurse who was associated with her during her recovery designed a workout process which helped her to overcome the fear of relapse of the same stressful mindset.Here we can say that, the noise associated with the treatment of Terry, we're able to communicate her thoughts properly with Terry and also able to understand clearly what was her problem. This was possible because she was maintaining a good relation with Terry and also while designing the treatment process she always keep in mind the fact that what was Terry’s age and according she designed the cure process. This was possible because the nurse , was clear to her ethical and moral views and also able to saw those problems from Terry’s perspective rather than pure medical perspective. Now, a detail analysis of the behavioral, ethical concept that the nurse during the phase of treatment and post treatment will give light to different parameters related to nursing critical disease. 3.2. Standard Method and Ethics of Nursing : A disease like schizophrenia need special care from both a nurse as well as the doctor. The above case study clearly describes that how the proper mental support and guidance from any nurse helps a schizophrenic patient to come back to normal life. It is necessary to design a proper method of working for the nurse and also the ethical perspective related to taking care the schizophrenic patient. Following are the few parameters that plays a key role in designing a framework for nurses working with the people who are affected with the disease like schizophrenia. 3.3. Nurse –Patient Interaction: Over the last fifty years or so extensive research was carried out to figure out how the nurse-patient interaction help the patient to overcome their critical illness. According to Bowers et.al (2009), the good work of the nurse was highly regarded by the patient and their families and nurses can relate many critical indent associated wit patients life while designing their treatment workflow. This can only be done if there was a good relation between the nurse and the patient. To increase the nurse patient interaction. In the UK the nursing course was restructured with special emphasis was given to building a good interpersonal skill . This training in building interpersonal skill was based on social psychology research merged with counseling psychology and psychotherapy (Bowers et.al ,2009, pp.5-6). 3.4. Decision Making framework: According to Thomson and Dowding n.d., health care decision making was always full of uncertainty and the people associated with this job have to take into consideration this uncertainty while taking their decision. Judgment and decision making were always interlinked when someone is taking care of a patient who was suffering from a critical disease like schizophrenia and one cannot be properly implemented without understanding the other factor. Any nurse, who was associated with any schizophrenic patient must consider following aspects before taking any decision . These were: 1. Working for the benefit of the patient. 2. A detailed research of the patient’s health that ensured what kind of treatment he or she can able to handle. 3. A vision for the future outcome. Nurses in the UK were taking on new roles such as health promoters. They were giving diagnostic and prognostic information to the patient to ensure that their relationship with the patient was maintained on a smooth line. Their relation with patients was also helpful to assess the health risk as well as to diagnose the disease at a very early stage. If the diagnosis was started at the very early stage of disease as complex as schizophrenia chances of total current was very high.The old guideline for the UK nurses was replaced by the more advanced professional practice oriented guideline in 1992which was helpful to increase the level of accountability of the nurses and also increased their decision making ability related to different critical disease. (Thomson and Dowding, 2002, pp 4-5) 3.4.1. Theories Related to Judgement and Decision Making: According to (Thomson and Dowding, n.d., the theories of judgement and decision making was divided into three categories namely normative , descriptive and prescriptive. The normative model of decision making was based on more statistical approaches, and it was pre-assumed that whatever decision was taken are logical and based on the ideal situation. In case of descriptive decision, it was more concentric on the process by which the decision was made. The perspective theory always tried to improved existing judgement by analysis the situation in which the judgement was taken and what was the consequence of that decision. The perspective mode was always review oriented. (Thomson and Dowding, 2002, p8) If we considered the treatment of the schizophrenic patients and the role played by the nurse we can say the decision taken by her were more based on perspective approach as she continuously evaluating her result in co-relation with the patient’s present scenario. This process of continuous evaluation and ability to make changes in her decision making process always helped to successfully deal with critical diseases like these. 3.5. General Approach of Nurse in Schiziophenic Treatment: From the above case study analysis as well as other general practice which associated with the nursing schizophrenia following steps one nurse can adopt to ensure that her patient get totally cures.According to Preman.d., the steps that could be taken to ensure speedy recovery of any schiziophernic patient were: Ensured that patient gets a therapeutic environment while he or she was undergoing the treatment, ensured that patient get involves in any kind of work to decreased the hallucinations and increase self esteem, increase him or her to participate in social activities(post treatment phase) and support during convalescence.(Prema, 2006, pp.137-142). 3.6. Ethical Aspects of Nursing: According to reports published by the College of Nurses of Ontario, ethical values were an integral part of nursing especially for those who were associated with treatment of critical illness like schizophrenia. Nurses associated with the curing process of disease like schizophrenia encountered ethical conflict and uncertainty in their everyday’s practice due to ever changing healthcare system and values. According to them understanding and communicating value were more helpful to overcome this conflict and ethical issues related to nursing. There was no better solution just because every situation could not have the same solution. Nurses who are associated with treatment like schizophrenia had to deal with conflict of values and ethics while nursing any patient. According to them, nurses must consider their own behavioral directives carefully while making any decision related ethical care of critical diseases. While taking the decision, nurses needed to be aware of their own values, aware about the client’s clinical condition and ethics, and they also required the ability to think about the problem from a client perspective. These helped them to take an appropriate decision which they can easily clarify for the patient as well as to their family by stating her ethical and moral values (Practice Standard n.d. p.3). If we analyze the above case study it is clearly visible that while taking a decision regarding the treatment of the patient the clear ethical value and knowledge about client helped the nurse to take the decisive call. As she was clear to her ethical values as well as well as about client situation, she was able to explain her decision easily to the patient as well as her family. As her patient was a student so he was given more emphasis on the values that associated with students and their studies. 4. Future Practice: Challenges and Possible Solution: Schizophrenia is one of the most critical disease, that need proper medication as well as help and support of the Medical staff specially nurse who are associated with the patient. The disease deals with more psychological and mental problem which need proper attention and support. Along with the medicine the moral and psychological support provided to any client is an integral part of the treatment process. 4.1. Challenges Associated with Nursing Schizophrenia: The two main challenges for Nurses who are associated with the chronic disease. The first one is prevention of the disease and the second one is managing the condition of the patient effectively when the disease first recognized by the doctor. Both of these processes are long term and can be better addressed by an effective relation maintenance between the patient and nurse. This long term relationship is generally set up during the initial phase of treatment i.e. intervention of nurse are really crucial at this point of treatment. Secondary and tertiary phase of treatment of any chronic disease does not provide an opportunity to set a good and healthy relationship between the patient and the nurse as the scope of personal care is very less in this phase. Generally , nurses are the members of the integrated multidisciplinary team, and have a very important role to play. The key role of any nurse associated with the treatment of any chronic disease have to perform following key roles: 1. Nurses have to the first and consistent point of contacts for the patients 2. Nurses have to play an important role to gather information about patient family background, social and economical condition which is essential in developing cure policy. 3. With the help of their skills in health education nurses have to help patients to develop and prevent management strategies, which are appropriate for them as well as their family to ensure that community resource can be best utilized for their treatment. 4. Nurses have to be skilled in assessment of ongoing care and family support. 5. Nurses always play an important role advocating for the people who are suffering from chronic disease (Chronic Disease and Nursing, n.d., pp.2-4). 4.2. Community Nursing Practice and Future development: When we consider the nursing practice of schizophrenia, community nursing played a major role in this in the UK. All the present model of nursing related to this disease was motivated from the community psychiatric nursing. This method was not only helpful to bring the ethical and moral values among nurse who want to be associated with nursing of schizophrenia, but also helped them to develop a stable work pattern based on their moral values and ethics. According to Greene (1968), the development of community psychiatric nursing (CPN) was way back in the year 1954, when a group of ward based nurse was sent into the community to follow up with the patients who were suffering from schizophrenia. Their main objective was to follow the progress of the schizophrenic patient and also administrating their medication. During the initial phase, the CPN was mainly dealing with schizophrenic patient but from 1980 the process started to change drastically. After the establishment of the district general hospital the CPN started to work more independently. (Greene, 1968, pp.175-184). At present, pre-registration training of nurses is generally taking place in different nursing universities instead of hospital based training school, But these trainings are more academically oriented hence the skill set development are less looked after. Therefore it has been noted that new age nurses need more skill training compared to that of the old time. As the CPN training for nurses is not mandatory in the UK the level of moral and ethical involvement among nurses who are associated with critical disease are comparatively less than that of the older time (Brooker & White, 1998). 4.3. Current Trend of Nursing Program: In the UK, the nursing module underwent a lot of changes keeping in mind the future perspective. Since 1995, a common nursing training program was designed keeping in mind the association of the group of nurse with schizophrenic patients, and the model was known as Thorn Program. The main emphasis of this program was on the evidence based skill development, but according to Lewis. Churchill and Hotopf (1997), the evidence based training program in case mental health care system for nurse was not appropriate. According to them the further research and study was needed to develop a more effective training method (Lewis, Churchill and Hotopf 1997, pp.3-7). In the UK, a radical change in the nursing education system was noticed based on the basis of evidence based training system. The area of medication management related to the disease like schizophrenia also undergone a rapid change and also have the opportunity of future development. According to Kemp et. al (1998), the research clearly shown that giving cognitive behavioral interventions with specific focus on non- compliance can yield benefits for the patient. But, the study also clearly pointed out the fact proper training for the nurse is also very time consuming, for example, the present training program for nurses need 80 hours of classroom training as well as assignment with the patients. (Kemp et. al, 1998,413-419) According to Drury et al (1996), psychological interventions applied to a patient during his or her treatment times always provide lasting benefits. According to them the family intervention was available for any patient at the early stage of their treatment, hence the nurse who was associated with the patient have to well equipped with the practice of providing psychological intervention. According to their study the moral and ethical view point of nurse here plays a major role (Drury et, al, 1996, pp.602-607). From the detail analysis of the case as well as reviewing different authors point of view regarding nursing we can say that while treating any patient who is suffering from any kind of critical illness different behavioral factors as well as ethical factors of the nurse play a major role. While designing patient’s treatment process nurse have to take into consideration the moral and economical as well as the sociological aspects related to the patient and she must control her own behavioral approach to ensure that the patient get proper treatment. If she able to get along with her patient then it will be easier for her to design the mediation process because for any kind of chronic illness like schizophrenia the moral support as well a psychological support is as important as the medical treatment. The future research in this field can be designed taking into consideration the moral ethical as well as the legal concept that are associated with the nursing of chronic disease like schizophrenia. The research can be done to figure out how a nurse should behave ethically and what should be her moral when she will be associated with any schizophrenic patient. What will be her approach towards the patient, what are the key points that one nurse should consider while designing the mediation process of her patient. The research can also be done on the line of ethical and legal concept of treatment, whether taking the option of electronic shock therapy is essential at the beginning or not and how a nurse should work to help her patient overcome the mental stress or hallucinations that one may be associated with the disease of schizophrenia. 5. Conclusion: It is very clear that dealing with any patient who is suffering from schizophrenia is not an easy job. The process of treatment is not only dependent on the medication but regular moral and mental support also needed for that patient to overcome the mental hallucination and delusion that one is going through. Talking to a patient who is in a mode of hallucination or express delusions about some unreal thing is not an easy job. But these patients need their nurse to talk to them, help them to get our from their hallucinations and delusions by means of regular medication or other work process which they like to do or believe can perform without any kind of mental stress. Nurses who are associated with the treatment of schizophrenia needs to ethically and morally very strong, motivated and must posses a friendly behavior so that patients can share their problems with them. Although the nursing practice Around the world related to this kind of critical disease are continuously going through various updating and revisions but still regular research and case oriented analysis need to be done so that a common uniform approach at the initial level of treatment for schizophrenia can be figured out for all the nurses who are associated with the treatment of this disease. References 1. Burggraf, V., (2012) "Overview and Summary: The New Millennium: Evolving and Emerging Nursing Roles" OJIN: The Online Journal of Issues in Nursing, Vol. 17, No. 2. 2. Bowers, L. et.al (2009), “Communication skills for nurses and others spend time with people who are very mentally ill”, City University. 3. Brooker, C. And White, E. (1998). The Fourth Quinnenial Survey of CPNs. Manchester: Department of Nursing, University of Manchester 4. Chronic Disease and Nursing: A Summary of the Issues (n.d.), Canadian Nurses Association. Retrieved on 18-09-2013 from http://www2.cna-aiic.ca/cna/documents/pdf/publications/BG3_chronic_disease_and_nursing_e.pdf. 5. Drury, V. et al (1996) Cognitive Therapy and Recovery from Acute Psychosis: a controlled trial II. Impact on recovery time. British Journal of Psychiatry, Vol.169, 602–607. 6. Global strategy for the prevention and control of noncommunicable diseases(2000), Resolution (WHA 53.14), World Health Organization, retrieved on 19-09-2013 from http://www.who.int/nmh/publications/wha_resolution53_14/en/ 7. Greene, J. (1968) The psychiatric nurse in the community nursing service. International Journal of Nursing Studies, Vol.5, pp. 175–184. 8. Kemp, R., et al (1998) Randomized Controlled Trial of Compliance Therapy. 18-month follow-up. British Journal of Psychiatry, Vol.172, pp. 413–419. 9. Kulbok, A. P et.al (2012), Evolving Public Health Nursing Roles: Focus on Community Participatory Health Promotion and Prevention, OJIN: The Online Journal of Issues in Nursing, Vol.17, No.2 10. Lewis, G., Churchill, R. & Hotopf, M. (1997) Systematic reviews and meta-analysis. Psychological Medicine, 27, pp. 3–7. 11. Prema,TP and KF Gracy (2006), Principles and Practice of Psychiatric Nursing, Jaypee Brothers Publishers. 12. Thompson, C. and Dowding, D. (2002), Decision Making and Judgement in Nursing – an introduction, Churchill Livingstone Read More