Nursing Care for Consumers with Mental Health Conditions - Research Paper Example

Implement and Monitor Nursing Care for Consumers with Mental Health Conditions Introduction Mental health problems are not too hard to imagine thesedays. Almost everyone at some point in their lives has come to experience some form of mental health problem – from the mildest form of depression to the most severe case of schizophrenia. This paper shall discuss the implementation and monitoring of nursing care for consumers with mental health conditions. More particularly, it shall evaluate the case of Mr. Anderson who has been admitted to the acute inpatient mental health unit after he was referred by his employer’s medical officer. It shall discuss the manifestations of Mr. Anderson’s condition and also discuss the important related functions and interventions which shall then be implemented by this nurse in order to appropriately address Mr. Anderson’s mental health problem. Nursing Responsibilities I have different responsibilities as far as Mr. Anderson is concerned. First and foremost, I have to recognize and accept the client as an individual (Schultz & Videbeck, 2009, p. 29). He is a person who is apart from everyone else; he has individual thoughts, emotions, and experiences which make him unique. This recognition would prompt me to treat and manage his case based on his individual circumstances, not based on generally prescribed interventions for patients manifesting his symptoms. Another responsibility that I need to fill in behalf of my client is to be his advocate (Schultz & Videbeck, 2009, p. 29). Since, he is not in the best position to care for his needs, my role would be to ensure that his rights and needs as a patient are protected and cared for. My role as a patient advocate would involve “acting on the client’s behalf when he or she cannot do so” (Videbeck, 2008, p. 96). As a nurse, my role in Mr. Anderson’s case is also to assess and plan his care (Schultz & Videbeck, 2009, p. 29). This assessment should be conducted in a detailed manner and in a manner appropriate to Mr. Anderson’s needs and condition. The assessment process shall be discussed in detail in the paragraphs that would follow. My role as a nurse would also involve “accepting the client’s perceptions and expressions of discomfort” (Schultz & Videbeck, 2009, p. 29). I have to accept that my client’s expression of discomfort are legitimate expressions without having him prove to me that he is really feeling that way. This would help establish trust and confidence between myself and Mr. Anderson and it would help him open up more about his feelings. Another responsibility I have is to respect Mr. Anderson’s stated needs, desires and goals within the limits of safety, ethics, and good nursing care (Schultz & Videbeck, 2009, p. 29). Mr. Anderson would likely express needs which might not seem conventional; however, I have to understand these needs based on his personal circumstances. My acceptance however has to be made based on the limits imposed by my practice and the legal impositions of the health care profession. One of my main responsibilities with regard to Mr. Anderson’s care is also to provide for him a safe and therapeutic environment (Schultz & Videbeck, 2009, p. 29). This therapeutic environment will help Mr. Anderson recover from his mental illness and for him to be safe from a self-induced harmful behavior. I have to make sure that Mr. Anderson would not attempt and succeed in any attempts to commit suicide. Information to Document The conversation with Mr. Anderson that I would document would primarily be his suicidal thoughts and ideation. Having suicidal thoughts are one of several indications for possible manifestations of a major depressive disorder. Mr. Anderson’s suicidal thoughts also have to be documented in order to notify the other staff and to possibly place him on suicide watch. I would also document the fact that Mr. Anderson is slow to respond to the conversation and the fact that he also makes poor eye contact. These qualities speak to Mr. Anderson’s mood and affect (O’Brien, et.al., 2008, p. 47). By noting Mr. Anderson’s mood and affect, it is possible to make an accurate assessment and evaluation of his mental affectation (O’Brien, et.al., 2008, p. 47). Mr. Anderson’s preoccupation with his thoughts is also another matter that has to be documented. Again, this is a characteristic which indicates a possible mental disorder. I would also document Mr. Anderson’s lack of appetite. The lack of appetite is often an indication of a major depressive disorder. It is also important for me to document Mr. Anderson’s inability to sleep because, this symptom, when taken into consideration with all other symptoms the patient is exhibiting, Mr. Anderson, may possibly be suffering from a major depressive disorder. As far as his behavior is concerned, I would also document Mr. Anderson’s mannerisms, his gestures, and his gait (O’Brien, et.al., 2008, p. 47). It is important to document this behavior because they may be used to determine Mr. Anderson’s state of mind and consequently help the medical health care team in making an accurate diagnosis of his condition. Mr. Anderson may not be open about the way he actually feels, or he may conceal what he is actually feeling. By taking note of non-verbal gestures, the communication process between me and the patient may be improved. I would also document Mr. Anderson’s speech patterns. As was previously mentioned, Mr. Anderson is slow to respond. This lifelessness in his speech patterns has to be documented because again, it would help us diagnose Mr. Anderson’s mood and affect (O’Brien, et.al., 2008, p. 47). By determining his mood and affect, we may be able to establish his emotional and mental disorder and to come up with a nursing care plan which would fit his symptoms, his personal circumstances, and his needs. Again, it is important to document all these details which may impact on the diagnosis and the plan of care for Mr. Anderson. Report I would report my conversation with Mr. Anderson to my immediate supervisor, who shall then refer these symptoms to Mr. Anderson’s attending physician or mental health professional. Through proper referral, the attending physician can then make his assessment and subsequent diagnosis of Mr. Anderson’s condition. After the doctor or the mental health professional diagnoses Mr. Anderson with a major depressive disorder, the doctor can also make the necessary orders on Mr. Anderson’s care. Mr. Anderson may need to be placed on suicide watch. In such an instance, the supervising nurse has to inform the other members of the nursing team to never leave Mr. Anderson alone. The relevant questions that I would be asking Mr. Anderson would relate to his feelings of killing himself. By asking him related questions, I might be able to determine when and how he plans to commit suicide. I would also ask him how he felt when he saw someone getting shot in front of him and how he has dealt with such an event ever since. This would help determine, if he is dealing well with the traumatic experience and how he is dealing with it. By asking him about the incident, it is possible to assess his coping skills and the current defense mechanisms he is putting up in place. Relevant Questions The relevant questions which I would also be posing on Mr. Anderson would include his perception of himself (Barker, 1997, p. 168). This would entail comparing himself with how he thinks he should be. By asking this question, it is possible to determine Mr. Anderson’s personal goals and whether or not he still thinks he can achieve these personal goals. It may even help reinvigorate Mr. Anderson’s goals in life, and to encourage him towards achieving them. It is also relevant to ask Mr. Anderson’s goals and expectations of himself. By asking this, it is possible to determine the goals he has set for himself, if they are realistic goals, and the likeliness of him achieving them (Barker, 1997, p. 168). It is important to ask these questions of Mr. Anderson because they help set more achievable goals. It would also help in coming up with initial steps towards improving Mr. Anderson’s outlook and life goals. Mr. Anderson’s goals may not be realistic, and by assessing such goals with him, certain adjustments may be made in order make them more achievable. It is also important to assess with Mr. Anderson his strengths and weaknesses (Barker, 1997, p. 168). By assessing his strengths and weaknesses, the nurse can establish what parts of Mr. Anderson’s personality or psyche may be used in order to help Mr. Anderson out of his depressed state. By exploring his weaknesses, it is also possible to avoid the pitfalls which may prevent the medical and nursing interventions from being effectively applied to Mr. Anderson. Finally, it is also important to ask Mr. Anderson about his support system and about the people in his life who matter most to him and who he can turn to for support and encouragement (Barker, 1997, p. 168). By asking Mr. Anderson about his support system, their help can be sought in order to come up with an effective plan of care for Mr. Anderson. The members of the family may not always be perceived by the patient as his support system; therefore, it is important to ask the patient who he considers as his support system. Assessment 2 Anxiety Anxiety as defined by Stein & Walker (2002, p. 5) “is an uncomfortable internal state (that is, something people feel inside) usually associated with uncertainty or the unknown”. This emotion is likened, most of the time, to fear. However, where fear is associated with an object of fear, anxiety is not. It is a general discomfort and even ‘fear’ of the unknown. There are various therapeutic nursing interventions for anxiety, but the most primary and therapeutic intervention for Mr. Anderson is to provide emotional and moral support. It is also important to stay with Mr. Anderson (Carpenito-Moyet, 2008, p. 77). By staying with Mr. Anderson, he would be prevented from succeeding in his suicidal plans and he would also have someone to talk to or to just be with. I would also allow Mr. Anderson to manifest his preferred defense mechanisms (Carpenito-Moyet, 2008, p. 77). If his choice is to just keep quiet, or to cry, or to laugh out loud, or to even get angry at anyone then I should allow him to use his preferred methods of coping. It would allow a free expression of his emotions and would free Mr. Anderson from the encumbrances of propriety. It would also be important for me to speak slowly and calmly (Carpenito-Moyet, 2008, p. 77). In speaking with Mr. Anderson, a calm manner and demeanor is important because it would help project a calming influence on Mr. Anderson. It would also help him to relax and to deal with his emotions accordingly. It is also important for me to be aware of my own concerns and to avoid reciprocal anxiety (Carpenito-Moyet, 2008, p. 77). As a psychiatric care nurse, I should be aware of my own issues and not to allow my own feelings and emotions to be tangled up in Mr. Anderson’s. It is also important for me to respect Mr. Anderson’s personal space (Carpenito-Moyet, 2008, p. 77). If Mr. Anderson prefers not to be around other people and for me to not sit or stand too close to him, then I should respect his personal space (Carpenito-Moyet, 2008, p. 77). This would help develop a trusting relationship between myself and Mr. Anderson and to eventually help him to open up more about his feelings and his thoughts. Depression Depression refers to the “symptom of feeling sad, but most appropriately describes a symptom complex or syndrome that includes cognitive and physiologic components in addition to affective ones” (Fleisher, 2006, p. 1817). The DSM-IV enumerates the following symptoms which, when present, may confirm a diagnosis of a major depressive disorder (Potokar & Thase, 2003, p. 4). These symptoms have to be present every day or almost every day for two weeks or more (Potokar & Thase, 2003, p. 4). 1. Patient may be: a. In a depressed mood or b. Has lost interest or pleasure 2. With the following (at least 5) symptoms of the following: a. Significant weight change even when not dieting b. Insomnia or hypersomnia c. Psychomotor agitation d. Feelings of worthlessness or guilt e. Fatigue of loss of energy f. Diminished ability to think g. Recurrent thoughts of death or suicide One of the primary interventions for major depressive disorders is the administration of anti-depressants. In these instances, my role is to note that there are no adverse interactions between the different drugs that are being administered to the patient. It is also important for me to educate the patient about the possible side effects or adverse reactions he can expect from such antidepressants. In instances when therapeutic interventions are administered to the patient, my role would be to develop an effective therapeutic relationship with the patient. In these instances, it is important for me to establish and maintain a supportive relationship with him (Boyd, 2005, p. 346). This means being available to the patient in times of crises; it also means being vigilant and watchful for instances when the patient may engage in self-harm (Boyd, 2005, p. 346). It is also important to educate the client about his illness and about the different possible ways of addressing the client’s symptoms and manifestations. As part of the therapeutic relationship, it is also important to apply cognitive therapy. Cognitive therapy “uses techniques, such as thought stopping and positive self-talk, to dispel irrational beliefs and distorted attitudes” (Boyd, 2005, p. 347). In these instances, whenever the patient has thoughts of despair, I can help the patient talk his way out of his miserable thoughts, and to dispel his irrational beliefs. As a nurse, I would also be involved in behavioral therapy with the depressed client. In this type of therapy, I would be involved in activity training, social skills, training, and self-control therapy (Boyd, 2005, p. 347). Through behavior therapy, it is possible for the patient to learn how to interact with the outside world and with other people in general in order to minimize moments of loneliness and despair. Schizophrenia Schizophrenia is “a disturbance that must last for six months or longer, including at least one month of delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, or negative symptoms (Stahl, 2000, p. 368). The delusion seen in this disorder mostly manifests as delusions of persecution, although other delusions such grandeur, somatic or religious also manifest (Stahl, 2000, p. 368). It is the most well-known psychiatric disorder and is also the most common in the United States. This disorder involves affectations of the synaptic relays in the neurons of the brain which lead to the different manifestations seen in this psychiatric illness. There are various interventions for this disorder. The primary intervention is the administration of antipsychotics. It is important for the nurse to note adverse reactions that these antipsychotics may have with the other drugs the patient may possibly be taking. It is also important for me to educate the patient on the adverse effects that these drugs may bring him. On a more therapeutic level, it is important for me to create a non-threatening environment for the client, most especially when the patient manifests with paranoid schizophrenia (Isaacs, 2005, p. 135). It is also important for me to draw the patient into joining the interactive activities in the clinic. This will help minimize the patient’s time alone when he may continue to feed on his paranoia or his delusions. It is then important for me to spend as much time as possible with the client; however, it is important to let the patient initiate the relationship (Isaacs, 2005, p. 135). This will help minimize tension and minimize suspicion about my role in his life. Bipolar Affective Disorder Bipolar affective disorder is a broad description for “a chronic and severe psychotic mental disorder where there are recurrent episodes of depression and mania affecting mood, thinking and behavior” (Millar & Walsh, 2000, p. 25). This disorder is also known as manic depression because the patient often fluctuates between these extreme emotions. It manifests as a chronic disorder with recurrent swings between mania and depression (Millar & Walsh, 2000, p. 25). Again, the primary intervention for this disease involves psychiatric drugs. In this instance, it is important for me, as a nurse, to make sure that the medications of the patient do not have adverse reactions with each other. It is also important for me to inform the patient of possible side effects that may be expected from the medications he is taking. On a therapeutic sense, my role as a nurse would be to note the changes in the mood of the patient. In instances when the patient is manic, it is important to protect the patient and other people from possible aggressive behavior, self-harm, and harm to others that the patient may bring (Boyd, 2005, p. 383). In instances when the patient is depressed, it is important for me to stay with the patient and prevent possible self-harm. It is also advisable for me to involve the family in counseling sessions in order to allow them to express their feelings about the patient’s condition, and also to allow the nurse to explain better the psychological condition of the patient (Boyd, 2005, p. 383). When the expected side effects of the drugs would hit, it is also important for me to provide the patient emotional support to the patient and to encourage him in dealing with these side effects (Boyd, 2005, p. 383). When support is given to the patient, adherence to patient medication is improved. The above conditions present a wide range of interventions which the psychiatric nurse has to fulfill. Mr. Anderson’s conditions present as a major depressive disorder, and therefore require necessary assessment and interventions which range from proper assessment to proper endorsement of care. The above-enumerated diseases refer to major psychiatric disorders which have become fairly common in the health care practice. Corresponding nursing interventions start off with an emphasis on the nursing responsibilities related to psychopharmacology. This is followed by supportive treatment – mostly required in instances involving the different aspects of therapy and therapeutic nursing. Works Cited Barker, P., 1997, Assessment in psychiatric and mental health nursing: in search of the whole person, London: Stanley Thornes Publishing, Ltd. Boyd, M., 2005, Psychiatric nursing: contemporary practice, Pennsylvania: Lippincott Williams & Wilkins Carpenito-Moyet, L., 2008, Nursing diagnosis: application to clinical practice, Pennsylvania: Lippincott Williams & Wilkins Fleisher, G., Ludwig, S., & Henretig, F., 2006, Textbook of pediatric emergency medicine, Pennsylvania: Lippincott Williams & Wilkins Isaacs, A., 2005, Mental health and psychiatric nursing, Pennsylvania: Lippincott Williams & Wilkins Millar, E. & Walsh, M., 2000, Mental health matters in primary care, London: Nelson Thornes Publishing O’Brien, P. & Winifred, K., & Ballard, K., 2008, Psychiatric mental health nursing: an introduction to theory and practice, Massachusetts: Jones & Bartlett Potokar, J. & Thase, M., 2003, Advances in the management and treatment of depression, London: Informa Health Care Schultz, J. & Videbeck, S., 2009, Lippincotts Manual of Psychiatric Nursing Care Plans, Pennsylvania: Lippincott Williams & Wilkins Stahl, S., 2000, Essential psychopharmacology: neuroscientific basis and practical applications, Cambridge, UK: Cambridge University Press Stein, M. & Walker, J., 2002, Triumph over Shyness: Conquering Shyness and Social Anxiety, USA: McGraw-Hill Publishing Videbeck, S., 2008, Psychiatric Mental Health Nursing, Pennsylvania: Lippincott Williams & Wilkins Read More