Developing Autonomous Practise in Mental Health Nursing - Essay Example

Developing Autonomous Practise in Mental Health Nursing In this essay I will exhaustively describe the care dispensed to a service user reflecting upon an experience that I gained from my semester five clinical placement. I will describe the service user’s history and background to date in detail and by applying a therapeutic model of care, formulation of psychological, physical and social needs of the service user will be provided. Subsequently, based on the information acquired from the formulation, I will strive to identify the service user’s goals and therapeutic nursing interventions as well as clinical review will be conducted in order to determine the outcome of the nursing intervention provided to the service user. In addition, I will explore the therapeutic efficacy of the current clinical environment or the services provided to service user and also discuss the appropriate alternative service options available to the service user by analysing the pros and cons of the alternatives to the user. George, 41 year old Irish man, had been diagnosed with schizophrenia and past depression. His first contact with mental health services was when his mother expressed concerns about him having the potential to harm someone. He was born by vacuum extraction and unlike other normal children he had experienced retarded mental health development accompanied with slow speech. At 6 years of age, he was admitted to a special needs school in London for two years. Joining at mainstream school, he was bullied and had difficulties in forming friendships with other children. At age 15, he was expelled from the school for fighting with other children in the school and since then he never turned back to school. At the age of 25, he started working with his father but again he was unable to build cordial relationships due to his aggressive behaviour. He began to consume drugs and alcohol that further acted as a source of conflict between the father and the son that often culminated in a physical altercation. As a result of this event, he had to leave his family house. During the assessment, George describes that he hears a voice inside his head that others do not telling him to harm other people. It was reported that similar voice provoked him to harm local councillor and a person who worked in his borough housing department. On his observation by psychiatric doctor, it was reported that George’s presentation was unusual and believed he did experience regular psychotic symptoms. It was reported that he was suffering from schizophrenia disorder with the risk of violent and aggressive behaviour. Over the years, he has been admitted at various psychiatric wards and at present he is discharged into the community to live in his own flat and is being supported by the intensive supported housing team who care for and support patients to live independently in their own homes as a part of recovery process. While assessing George after a referral to the intensive support housing team during his stay as inpatient at the rehabilitation centre, he seems to be quiet and reserved and on some occasions he appeared to be distracted by his thoughts and was slightly noticed to be impatient. During the assessment, it was also reported that occasionally he declined most of the engagement and support services given to service users. Family History George was not born like other normal children; he was delivered through vacuum extraction. He was different from other children of his age in terms of his mental health development. Due to his retarded mental growth and slow speech, he was admitted to special needs school when he was 6 years of age till he was 8. He was bullied when he was at mainstream school. He left school when he was 15 years of age but later he returned to take his GCSE’s. He was the eldest of four sons and his father was a retired self-employed builder and his mother is a mental health nurse. When his father died he attended the funeral procession. He shared good relationships with his brother and sister. It was also reported that his relationship with his mother was good but he describes that he was bullied by his father as a child. There was no report of immediate relatives with any mental illness but his father’s brother had a psychotic episode about twenty five years ago. Nonetheless, he was reported to have fully recovered from the illness and there have not been reports of any episode since his recovery. Drug/Alcohol George in the past used illicit drugs and often consumed alcohols but currently he denies using drugs but admitted to drink alcohol occasionally. Social History He currently lives in his own rented one bedroom flat in the community and under the care and supervision of the intensive supported housing community team. Past Psychiatry History He has been diagnosed with schizophrenia and has exhibited regular psychotic symptoms. Risks In the past, he has had a history of sexual abuse and aggression towards his family and healthcare staff along with vandalizing properties and exhibiting threatening behaviours. These behaviours are more prominent when he is under the influence of alcohol. At present, George’s behaviour has been quite stable but not normal. Risk at the moment is medium which could increase with excessive alcohol consumption. Formulation is defined as analysing and synthesizing an individual’s presenting problem and experience using relevant theories to help explain the potential causes (Macnei, 2012). According to Winters & et. al. (2007), formulation is a process by which a set of hypotheses is produced regarding the etiology and factors that cause an individual presenting problem and that diagnosis is decoded into specific, personalized treatment interventions. It is fundamental to the practice of adolescent and child psychiatry. Late George Engel in the year 1977 offered a holistic biomedical approach which is known as the biopsychosocial model. He conceived that to comprehend and address effectively the patients’ needs and sufferings as well as to provide them a sense of being understood, clinicians must acquire considerable knowledge regarding the biological, psychological, and social dimensions of illness (Novack & et. al., 2007). Borrell-Carrió & et. al. (2004) highlighted that the biopsychosocial approach is termed as both a philosophy of clinical care and a practical clinical guide. From the philosophical perspective, it is a way of comprehending how suffering, illness and disease are influenced by multiple levels of organization that encompass the biological to the societal purviews. The biopsychosocial model from practical perspective is exaggerated as a way of comprehending the service user’s subjective experience as an indispensable contributor to precise diagnosis and humane care. Ingham & et. al. (2008) stated that the biopsychosocial model supports the application of multi-disciplinary case formulation to assimilate different elements of clinical information, expound the development as well as maintenance of mental health problems along with promoting the selection of suitable intervention to respond to those problems. Ghaemi (2009) claimed that the biopsychosocial model appears to be more scientific than other approaches such as medical model. The biological aspect of George’s illness can be best described by the stress vulnerability model. As per Goh & Agius (2010), the stress vulnerability model proposed by Joseph Zubin and Bonnie Spring is a very effective method for determining and treating relapses of mental health illness. According to this model, an individual possesses vulnerabilities that are static which include genetic characteristics and life experiences, when paired with one or a number of irresistible stressor it can cause an individual to suffer from poor health. The stress vulnerability model propagates that people have unique biological, psychological and social elements which encompass both strengths and vulnerabilities for responding to stress. Ormel & et. al. (2001) claimed that life events which imply a series of happenings promoting changes have a long-lasting impact on an individual. Reportedly, stressful life events and long-term difficulties are considered as risk factors for poor mental health (Nusslock & et. al., 2011; Seeds & Dozois, 2010). It is apparent in the case of George as he has experienced several negative life events in the past. Notably, when he was in school, he had an experience of being bullied. Not only in school, but he had an experience of being bullied by his father as well. He had experienced a feeling of isolation when he was in school as he had experienced difficulties in forming friendship. His bitter experiences of engaging in a cordial relationship with his father led him to be homeless and develop the habit of consuming drugs and alcohols (Bulmash & et. al., 2009). Psychological causes for George’s illness aligned with the stress vulnerability model is that he has undergone a stressful life and long-term difficulties in the past. The degree of vulnerabilities in an individual is observed to be varying from one individual to another. George’s relationship with his father and the experience of being bullied in school coupled with the experience of being homeless together contributed towards increasing the level of his stress. The social factor of George’s illness can be related with the aspect of social isolation. According to Grassian (n.d.), an individual who has the prior experience of isolation from family and friends often result in experiencing mental health illness. According to Lester & et. al. (1983), the theory of hierarchy of needs proposed by Abraham Maslow suggests that psychological health of an individual is stable when these needs are satisfied. However, George has experienced instability in his living situation as well as in employment while most of his needs were largely unmet. Apparently, such instability has made it difficult for him to fulfil his needs, which has resulted in developing an aggressive and hostile behaviour (Zalenski & Raspa, 2006). Health needs assessment is a systematic process of identifying unmet health needs of a patient, and making changes to promote rapid recovery (Elkheir, 2007; Wakins & et. al., 1998). Evans & et. al. (2000) postulated that needs assessment is a complex process. Thus, it has been claimed that considerable care is essential when selecting assessment instrument to be applied in the proposed setting. My commencement of placement followed with George’s transfer and admission into the intensive support housing team. In order to conduct a full assessment of George’s needs, I engaged in accessing his clinical records to update myself with his history and major life events. After accessing the clinical records of George, it was reported that he had recently met with a community psychiatrist and a core assessment has been completed using a semi-structured interview. According to Piercy (2004), semi-structured interview involves a series of open-ended questions accompanied with queries that appraise for more comprehensive and contextual data. Additionally, respondents’ in semi-structured interview provide rich and in-depth information that aid a researcher to understand the shared conditions in which the respondents’ live as well as meanings related to their experiences. My mentor was allocated as George’s care-coordination and I worked as an associate nurse which offered me with an opportunity to closely involve in his care. During the assessment process, George’s level of physical, mental and social health was assessed using general health and national scale (McDowell, 2006). Carrying out the assessment which involved exploring George’s clinical records along with information collected from previous assessments and with the cooperation of multi-disciplinary team (MDT) members, I and my mentor were able to determine George’s goals. Furthermore, I was able to ascertain therapeutic nursing interventions related to George’s need. Abdulrahman (2011) stated that MDT is a group of health care members from different disciplines who are engaged in providing care and support to patients for ensuring rapid recovery. Therapeutic nursing interventions are treatment approaches taken by the nurses to meet the needs of George regardless of the specific aim (Varcarolis, n.d.). Psychological Goal To build the therapeutic nurse-client relationship with George It was identified that George has been experiencing psychotic symptoms accompanied with disruptions to normal emotions and hallucinations while at times has been demonstrating aggressive behaviour towards patients and staff. Thus, it was agreed to provide him with 10mg of olanzapine daily. Physical Goal To ensure and maintain adequate dietary habit in George For ensuring good health of George, we were engaged in monitoring food and food intake needs regularly and regular weight checks were conducted. Social Goal To reduce George’s feeling of social isolation and involve him in social activities In order to meet the social needs of George, he was encouraged to participate in the weekly activities and facilities to attend gym and also the weekly swimming sessions were provided. Clinical review of George was conducted thrice in a week by the MDT members. The objective behind the clinical review was to determine the progress in interventions adopted to assist in his recovery. The clinical review that was conducted during my placement reflected positive signs of recovery in George’s health. George expressed that he has been experiencing an element of comfort, security, relaxation and confidence while being treated at home. It was also reported in the meeting of MDT members that George’s involvement in social activities has been the most influential reason behind his improvement. The team members were also highly satisfied with the progress that was visible in the health of George. References Abdulrahman, G. O., 2011. The Effect of Multidisciplinary Team Care on Cancer Management. Pan African Medical Journal, pp. 1-5. Bulmash, E. & et. al., 2009. Personality, Stressful Life Events, and Treatment Response in Major Depression. Journal of Consulting and Clinical Psychology, Vol. 77, No. 6, pp. 1067-1077. Borrell-Carrió, F. & et. al., 2004. 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