Three Interviews in the Clinical Practice Area - Assignment Example

Contents: Welcome to the module:..3 Introduction:.4 Ground rules:...5 Service user interview:.6 d Nurse Carer interview7 Third Interview:8 Extra information gathered during the PBL 1 question & answer session...9 Clinical assessors verification form:10 Part 2 Assignment to be submitted with this workbook..11 INTRODUCTION: As you will have read from the assignment guidelines, you are required to conduct three interviews in your clinical practice area that will enable you to gain insight as to how a 'service user' perceives his or her mental health crisis, how the named nurse / carer perceives the 'service users' crisis and also how one other health care professional perceives the 'service users' crisis (this other person could be the 'service users' psychiatrist, social worker, occupational therapist etc the choice is yours). More specifically, the basis of the interviews should explore the 'nature of the service users 'crisis'; the assumed cause(s) of the service users 'crisis' and 'what the respondents believe needs to be done' about the service user's 'crisis'. Example questions that could be asked of the service user include: "How would you describe your current crisis/what brought you to the attention of the mental health service" "What has been happening to you/others that has brought you to this point" "What do you feel has caused your current situation/brought you to the attention of the mental health services" What has been happening to you/others that may have caused you to be referred to the mental health services "What do you believe needs to be done to help you overcome your current situation" What do you feel needs to be done by the mental health services to help you overcome your current situation" You have been provided with this workbook in which to document the information that you gather from all three interviews. Please write down the questions that you asked and the responses that were given. This information will then be summarised and presented to a group of peers and an assessor in your PBL 1 assessment SERVICE USER INTERVIEW: What does the service user believe to be his/her present mental health problems/crisis The service user in his own opinion believes that he suffers from some sort of depression. He claims that his problems at the moment were that he was suffering from anxiety and in the morning panic attack. He believes that this response was because he is worried about his father ie if dad pass away who is going to take care of me. when asked if he did have any auditory hallucination he went on to say that he did here voices but did not want to talk more about it. Conceptual Model Analysis I started with the humanistic approach so as to make the client at ease and for him to be able to express himself more. I then went onto the medical model to try to figure out what he was suffering. Some data from the interview give evidence service user has p[sychotic symptoms, e.g. auditory hallucinations. There is acknowledged that patients with mental disorders are not able to percept their condition critically and usually underestimate the severity of disease. This patient believes he has depressive state thus he is ready to perceive the model of "sick person" and wish to regain his health. There is known that psychotic symptoms in schisophrenia could be related to dopaminergic hyperactivity in the brain structures. Thus medical interventions based on the use of antidopaminergic drugs (e.g. Ziprasidone (Geodon), Quetiapine (Seroquel) could be effective in the disease management. It seems that the psychotic symptoms reported by the client have the endogenic origin, i.e. they are not caused directly by external causes. What does the service user believe are the causes of his/her present crisis Service user believes that the cause of his present crisis is due to the wrong chemical release in his brain and added that it is genetic as he got a family history of metal illness in his family. Thus his mother was treated in mental hospital and his father was alcohol abused. He added that he has never taken any illicit substances when ask about the voices he claims that they were from people who were doing black magic on him. He further stated that the causes of his illness were also due to a fail marriage that he never managed to consume. He was force into it by his family and he supposed that his former wife and her mother put the evil eye on him. Conceptual Model Analysis Here the medical model was first use as he started to tell me that the cause of his illness was due to chemical in the brain. I then tried a social approach to try to find out more about his environment he comes from as well as to get a bit more information on his family background. There is important to obtain more information about his medical history, occupational anamnesis (including his experience in military service etc) and his history of travel, and history of alcohol abuse. Alcohol is legal psychoactive substance and it's available for the adults anywhere. Furthermore, some studies demonstrated the strong contribution between alcohol abuse and the occurrence of schizophrenia. There is a dilemma: what is the primary process in the comorbidity of alcohol abuse and schizophrania. Some researchers believe that patients suffering schizophrenia can use alcohol or other psychoactive substances to self-regulate their mental conditions. Other specialists argued that alcohol abuse just precedes schizophrenia (Chambers et al. 2001). What does the service user believe needs to be done about his/her present crisis The service user firmly believes that medication is one of the main things, which is helping him to cope and be able to go out with his dad. He stated that the also needs some psychological support in the form of therapies to build his confidence up , to be able to function at a 'normal' human being and integrate in society .when ask what does he mean by normal he just stated like 'you'. He also wants to go to university but need to do his GCSE first. Conceptual Model Analysis Again the medical model is being use as the user believes that medication is the way forward for his treatment. But I also tried to use the social model while questioning him about how to help him to integrate back in the community. This integration is a necessary element of life quality improvement. Because the service user has not completed his GCSE yet there is expediently to provide him opportunity to obtain necessary training. In this way community and family based support services play a key role in the maintenance of patient's social adaptation. Perhaps we should discuss the issues of further carrier development and social integration of the patients together with his friends and relatives. Other useful model in the interaction with the service user is represented by humanistic approach. It places great value on the "dignity of the individual" and, consequently, has focus not on the control on the service user but on understanding him. Social adaptation will not depend only on the support from patient's social environmental but also on his abilities for self-understanding, for altering his or her self-concept, attitudes and self-directed behaviour. Nevertheless for realizing listed properties the service user need friendly social climate. So needs of the client could be divided into two domains: demand for changes of internal conditions (e.g. by medications or psychotherapy) and external environment. Process of recovery depends upon both internal and external conditions. Thus psychodynamic model is also useful for understanding the needs of the service user because uncovering unconscious conflicts and repressed analysis is to enable people to gain insight and uncover unconscious conflicts and repressed material (e.g. biography facts influenced on client's psychodevelopment). NAMED NURSE / CARER INTERVIEW What does the named nurse believe is the nature of the service user's present crisis The nurse believes that the client is currently suffering from acute paranoid schizophrenia. This belief is supported by the following facts: the service user was admitted to the ward as he was experiencing auditory, visual and tactile hallucination. He presented also with delusion of grandiose and believed he was in the SAS, army special forces. He also suffers anxiety, which appears to be triggered by family conflict. He also tends to isolate himself and does not seem to interact with fellow clients. Conceptual Model Analysis Disease model is the most important for understanding nature of the crisis because nurse provides not only psychological support but deals directly with pharmacotherapy. Accordingly to the DSM-IV the diagnosis of schizophrenia requires the presence of psychotic symptoms during 6 months (or longer) and social/occupational dysfunction. Aetiology and pathogenesis of this disease are still unknown but there is evidence that schizophrenia is associated with defects of brain neurochemistry. Modern theories of schizophrenia development also discuss the role of genetic factor and antenatal (i.e. intrauterine) events as well as the impact of psychosocial factor. In the modern day pharmacotherapy, i.e. the use of antipsychotic (antidopaminergic, antiserotononergic, anticholinergic, neuroleptic etc) medications became a first line of disease management whereas counselling and behavioural therapies gained secondary or supportive role. There is important argument for the use of new antidopaminergic drugs (e.g. risperidone (Belivon, Rispen, Risperdal), clozapine (Clozaril, Leponex, Fazaclo), olanzapine (Zyprexa, Zydis), quetiapine (Seroquel), ziprasidone (Geodon, Zeldox), amisulpride (Solian), aripiprazole etc) that these compounds have less adverse effects and more effective than other agents. Otherwise, the nurse should apply sociological model because anxious state of the client is triggerred by the family conflict. The patient can have difficulties with motivation, routine activities, family/social relationships. But these social issues also linked to the medical approach because the patient requires some kinds of individual and group psychotherapy, patient's counselling by the issues of job seeking, education and vocational activities and skills required for successful social integration. Because of tendency for self-isolation there is important to involve his friends (because the patient lost contact with other members of family) in the program of patient's rehabilitation. What does the named nurse believe are the causes of the service user's present crisis The nurse believes that this is due to the break down of the family structure and genetic issues. His mum was also suffering from mental illness i.e. schizophrenia and was never around when he was young. There also seems to be a lack of social status i.e. he feels insecure as well as he feels socially rejected. Partly due to his failed arrange marriage and the other part is he did not manage to join the army. Conceptual Model Analysis Medical model is helpful for explanation the dependence of this case on family history because he was susceptible for mental disorders and had direct relatives (mother) suffering schizophrenia. OMIM database (2006) listed 22 loci related to the disease, furthermore, some of described chromosomal abnormalities (e.g. 11q) are associated with schizophrenia. But family conflict and poor social adaptation of the service user seem to be a trigger for disease development. Consequently, even successful medication treatment will not provide the stable remission if social support is weak and inappropriate. To improve social rehabilitation there is not enough only provide support from patient's "social setting" but also help him with his personal growth and maturation. In the analysis of patient crisis the nurse could also use psychodynamic model because some details of family history (mother's disease, family isolation) are associated with possible involvement of transference. Nurse's support can improve patient's awareness of his past experience and related emotions and, finally, improve his understanding and resolve psychological crisis. What does the named nurse believe needs to be done about the service user's present crisis The nurse believes that he should undertake anxiety management as a sort of treatment. The modern guidelines of mental disease management pay more attention to anxiolytic medications but other therapeutic strategies could be useful also. Social anxiety frequently is associated with schizophrenia and significantly worsens the level of social adaptation. He should also be encourage in engaging in meaning full activities i.e. looking for jobs and colleges courses. There is also a need to improve his social situation and reducing the isolation. Medication seems to work rather well with him, especially amisulpride. Conceptual Model Analysis The achievable compliancy and treatment outcomes depend on the understanding of medical model of disease. Patients suffering schizophrenia with manifested anxiety had worse prognosis for a disease clinical course (e.g. lower social adjustment and lower quality of life, higher risk of suicidal attempts etc). The treatment algorithm is impersonalised and it's based on the best available evidence (e.g. systematic reviews and meta-analyses of randomised clinical trials) but not on the individual properties of the service user. There is important that patient is motivated to seek job and continue his education. This motivation is helpful for control on the compliancy and allow do use psychoterapeutical techniques. Amisulpride is one of the most effective modern antipsychotic medications. It is a selective dopamine antagonist having very high affinity for D2 and D3 dopaminergic receptors. But after normalising biochemical processes there is necessary to pay more attention to the program of counselling and social reintegration. THIRD INTERVIEW: Title/designation of interviewee: Approved social worker What does this professional believe is nature of the service user's present crisis Diagnosis of paranoid schizophrenia and experiencing auditory, visual and tactile hallucination. He also presented with delusion of grandiose hence this admission. This illness may have been trigger by his social environment. Conceptual Model Analysis The analysis is started from medical model. Compliancy with pharmacological treatment and its outcomes determine the effectiveness of the efforts directed for optimising patient's social reintegration. Because of advanced social care the absolute majority of schizophrenia patients are able to participate in the community life. Social worker assistance allow them to figure out their needs for accomplishing the best possible level of social adaptation. Thus medications are essential part of treatment, but for a full recovery the patients should participate in other types of treatments. What does this professional believe are the causes of the service user's present crisis The condition surrounding his illness could have been triggered by the social environment he grew up in. Mum never went around when they were young as she was suffering from schizophrenia. All family member have left home, he was the only one living with his dad. There seems to be an emotional blackmail involved. The father seems to be the dominant figure. The motivation behind all this is that the dad is his career and is getting benefits, which is fuelling his alcohol habit. He seems emotionally abuse. He cannot cope in making decision and his mental illness is an escape from reality. The delusion of grandiose may represent his desires. There is also a crisis of cultural identity as he is quite westernised but there is expectation as well being a Muslim. There is also the fail marriage, which also affected his life. Conceptual Model Analysis Described issues are explainable by the sociological model. We can recognise the set of social impacts were neglecting and isolation play the prominent role. Social skill training allows improving social functioning by the remediation in the field of routine activities, employment, and communication. The support and improvement of patient's self-estimation is aggravated by his delusion of grandiose but there is a background for developing stable model of behaviour in community and further career development. Because the patient lost his contacts to other members of his family the social worker will look for other opportunities of his social integration, e.g. the support of his mates or teachers of secondary school. The intercultural conflict between Muslim and Western traditions are also important trigger of the disease. Finally, personal failure with unwanted marriage require the reaction of specialist also. What does this professional believe needs to be done about the service user's present crisis The service user requires support for reintegration in the community. He need more information about his illness and perspectives of its treatment. He is interesting to be involved in the process of decision-making and wish to complete his education. He doesn't think about other marriage because he separated from his girlfriend due to the disease. Patient also hopes to participate more actively in the life events of Muslim community. He requires supported employment programs and training for improvement skills of coping with emotional pressure. Conceptual Model Analysis Sociological model could be applied for described needs. Social support program will include the patient education and his involving in the programs of educational and employment support. Because of his interest to reintegration in Muslim community there is expediently to establish close contact with its representatives. INFORMATION GATHERED DURING QUESTION AND ANSWER SESSION: Reflections upon your PBL 1 assessment and how your learning was enhanced by the experience: In spite some conflicts between different models used for explaining nature of crisis and approaches for its management there is common tendency: the optimum results are achievable if multidisciplinary approach is applied. Because of the information gap between the service user and the professionals providing care to him there is necessary to simplify complicate theoretical knowledge when client get information about his disease and the options of its management. Because the health condition is acute the medical approach has some preferences as the most universal and impersonalised but for supporting clinical success and for reintegration in the community other models should be also used. The usefulness of multimode approach is related to the complexity of aetiology and pathogenesis of the disease. Nevertheless each participant of the process of service (including the object of this service i.e. patient's) has different focus in answering similar questions. The main goal of the service is not only manage clinical manifestations occurred in patient but also develop effective program of the support for optimum level of social integration. From this problem-based-learning I obtained skills of critical appraising the information obtained from the different participants of the service process. These skills could help me to cope with similar professional problems in further work. Read More