The Users Experience of Critical Situations or Metal Psychiatric Medical Emergencies - Essay Example

The User’s Experience of Critical Situations or Metal Psychiatric Medical Emergencies In conditions such as debilitating mental health disorders, the healthcare approach for clinicians has for a long time centred on the more medical symptoms of the disease. There is evidence to prove in fact that doctors and more generally clinicians avoid or are reluctant to speak to patients about imminent psychological side effects of the diseased state. Consequently they tend to be sometimes inaccurate and thoroughly optimistic about the future prospects, in effect holding-up the vital sharing of information and referral to appropriate palliative care services (Christakis et al 2000). This is not quite in line with the NICE guidelines which suggest that mental health services should be provided for patients diagnosed with debilitating mental disorders that ensures that patients, and their families and carers, are well informed, cared for and supported (Nice.org.uk) There are several case studies in the literature with respect to critical situations or metal psychiatric medical emergencies. The perspective of users of the healthcare facility offered by the healthcare services is vital to gain a proper understanding of the situation. The other important aspect is the perception of palliative care and requirements of a patient suffering from a medical crisis. With respect to modern medicine the French philosopher Descartes’s writings in the 17th century, has had a very deep impact on the management of symptoms by healthcare professionals and their ways of approaching symptoms. This hence is reflected in both our perceptual understanding of them, and consequently how we attempt to manage them. As mentioned earlier the principal outlook based on the philosophies of Cartesian dualism is that symptoms should be understood as aspects of a disordered biological state. The resultant trend is reflected in modern medicine's approach to care which has largely been based on differentiating between physical and non-physical aspects of disease symptoms and subsequently targeting care at these physiological manifestations. However most patients seldom if at all distinguish between the biological and perceptual symptoms, and indeed effective and appropriate acknowledgement of personal meanings of illness and its problems are a primary step to effective care of sick individuals and their families ( Wenger, 1993; Halldorsdottir & Hamrin, 1996). Illness, as Pellegrino (1982) defines it, is only partially defined when understood as a physiological anomaly. The experience of sickness in psychiatric/brehavioural dysfunction holistically is formed by an individual's acuity of alterations in his/her existential state and should not be ignored. Overview of circumstances As a full time carer for a patient suffering from a debilitating mental health problem i.e depression I believe I am in a position to present the scenario of primary care available to such patients. The patient who for the urpose of this article shall be refreed to as Mr. A sufferes from severe depression often accompanied by panic attacks and severe breathlessness which on some occasions requires hospitalisation and even neubalisation. For the most part on these occasions,I belive neither the family nor the caregiver descriptive accounts are included in the treatment or the decision-making process. It seems that multitude of the information is obtained from rating with only the medical scales which often limits a comprehensive view of the treatment process. Generally, the family and the patient are evaluated separately. This sometimes has severe consequences and may even results in a substantially critical situation as shall be desribed further on. Nature of the crisis While there are several metaanalysis available in the literature which reveal that for patients with severely debilitating psychiatric conditions there are several specific symptoms with a weak biological basis that appear to be ignored. Some more common found symptoms that are generic across a range of cancers are, harsh inspiratory wheezing or stridor, pleural and chest wall pain and not to say the least-breathlessness. Breathlessness in particular has in recent years been the subject of extensive investigation since it is increasing being noted that it is severely distressing for patients with psychiatric conditions. Breathlessness Breathlessness has both biological and a-biological aspects, and can be likened to the perception of pain. Very simply put it is a rather distasteful sensation of being unable to take in air easily. It is easy for care givers to recognize the onset of the problem at its inception. In my experience Mr. A, suffers from this problem when he has his panic attacks. Since I am aware of the severity of this condition in his case, I called the mental health department of the local hospital who promptly called us in to the hospital. However due to unavailability of space/beds Mr A was not admitted and discharged the same day, despite my insistence that the frequency of the problem had been on the increase in past few days. However at about 10 pm I found him having a recurrent attack that was made worse by the breathlessness. His symptoms can be best described as • Part of the way toward choking; • Panicking and imagining that you are going to take your last breath; • Wishing you could get more breath, getting exhausted; He also said in b/w breathes that • It frightened the life out of me – like suffocation; • It feels like I'm not going to breathe again; Assessment My study of the situation made me feel that for the medical practioners working with the patient and the family in the treatment of depression is significant in terms of the continuity of care and also to avoid such critical situations. This has been previously identified in the literature as well(Mohr, 2000; Pickens, 1998). The observation of the family should be taken into consideration in order to understand the current conditions of the patient and to help the patient live in a comfortable and compatible fashion with the family. A dynamic participation of the care giver in the treatment process and contribution of their experiences of the medical developments of the patient has would be useful in obtaining treatment goals and avoiding emergencies. Management of breathlessness for psychiatric patients Given the high incidence of breathlessness in mental health patients it is but natural that it should be targeted for further study and for its management. Conventional approach to the managing breathlessness offers a dominant instance of the rather severe limitations of relying solely on bio-medical techniques to address symptom clusters and construction. However with respect to the patients case studies reveal that even while breathlessness has been understood as a essentially sensory perception of a biological disorder withinthe body and attributed to a recognizable cause, it has largely been defined by its physiological parameters,. Examples of such parameters and aetiology are pleural effusion, lymphangitis, tumour infiltration, chest infection, etc., and has been managed accordingly ( Ahmedzai, 1993; Booth et al., 1996; Boyd & Kelly, 1997). However what this brings out is that such an approach confines treatment and management of distressing symptoms to a cause and effect approach to symptom management. The patient on the other hand may not be a direct cause of the effects that are thus seen or the symptoms ( Radley & Billig, 1996). The person with breathlessness needs care that is largely targeted at at the individual rather than his biological condition. This is where palliative care can be effectively brought in and is indeed. Based on my experience and and deriving from it, I believe palliative care nursing should introduced for mental health patients individual specific needs. This is derived from the awareness that effective therapy can only be attained in a more satisfactory manner if the nature and impact of the condition and psychological state of the patient have been studied and understood from the perspective of the individual suffering it. In this respect it would be advisable for clinicians to pay attention to the opinions of the care givers and family of the patient or atleast provide basic awereness to them to deal with it . In Mr A’s case, I believe had I been adequately trained to react to the situation it may have helped to avoid the situation turning critical. As well as nursing and medical input, physiotherapy is often helpful, particularly for advice on positioning patients in bed, percussion, huffing, control of hyperventilation, and relaxation methods.’. Practical measures for the aid of patients include the following. – all of which have been summarised by Davis(1995). Nursing Breathlessness is not a classic symptom relating to such problems and hence proviioson need to be made specially for patients who do suffer from it. Patients who were offered in an out-patient setting and within a rehabilitative framework, a nurse based intervention to combat this problem focussing on functional and emotional aspects of breathlessness reported improvement in their condition. While evidently this can only be an augmentative model in addition to the regular medical treatment, it is possible to conclude that such a framework could provide much relief to the family and the patients alike. Sources Ahmedzai S. (1993) Palliation of respiratory symptoms. In Oxford Textbook of Palliative Medicine (eds Doyle D., Hanks G. & MacDonald N.). Oxford University Press, Oxford, pp. 349–378. Booth S., Kelly M., Cox N., Adams L., Guz A. (1996) Does oxygen help dyspnea in patients with cancer? American Journal of Respiratory Critical Care Medicine 153, 1515 1518. Corner J., Plant H., Warner L. (1995) Developing a nursing approach to managing dyspnoea in lung cancer. International Journal of Palliative Nursing 1, 5 11. Christakis NA, Lamont EB. Extent and determinants of error in doctors' prognoses in terminally ill patients: prospective cohort study. BMJ 2000; 320: 469-473 Davis C (1997) ABC of palliative care: Breathlessness, cough, and other respiratory problems BMJ 1997;315:931-934 Directory of Hospice and Specialist Palliative Care Services, Hospice Information Service, St Christopher’s Hospice, London 1999. Geraci JM, Tsang W, Valdres RV, Escalante CP. Progressive disease in patients with cancer presenting to an emergency room with acute symptoms predicts short-term mortality.Support Care Cancer. 2006 Oct;14(10):1038-45. Epub 2006 Mar 30. Nice.org.uk Radley A. & Billig M. (1996) Accounts of health and illness: Dilemmas and representations. Sociology of Health and Illness 18, 220 240. 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