The Role of Mental Health Nurse: Schizophrenia - Coursework Example

Explore your developing role as a mental health nurse with reference to your work with a client during the practice placement Schizophrenia There are several sub-types of schizophrenic disorders that cause distortions of thinking and perceptions in spite of clear consciousness and intellectual capacity. There may be cognitive deficits evolving overtime. Thought echoes, thought insertion, thought withdrawal, thought broadcasting, delusional perceptions, delusions of control, hallucinatory voices commenting on or discussing the patient in the third person, thought disorders and negative symptoms are the pathological phenomena associated with the disorders. These disorders are either continuous or episodic. The episodic disorders can be progressive or stable deficit or it can be more than one episode with complete or incomplete remission. The diagnosis of schizophrenia should not be made when there are extensive depressive or manic symptoms unless the schizophrenic symptoms were found to have occurred earlier to the manic symptoms. It should not also be diagnosed as schizophrenia when there is a brain disease or when the individual is on drug intoxication or withdrawal.1 Mental health nursing is thought to be also related to the aspects other than biological science because human body existed much earlier to the advent of medicine as a branch of knowledge. Mental health professionals need to perceive how pathological changes and environment interfere with homeostatic actions of the body and affect the thought process, feelings and conduct. There are arguments that whole persons can be perceived only in the social context, that there is something called mind operating separately, and that biological knowledge by the mental health nurses will make them more oriented towards medicine and as a result they would not take care of the mentally ill adequately under the belief that cure-care models are not compatible as they are thought to be mutually exclusive. As regards the first argument about whole persons, even though it is necessary to understand an individual with reference to his/her social and cultural environment, there can be still path physiological changes affecting the functioning of an individual. As for the second one relating to mind, those who are against biological knowledge for mental health nurses fail to appreciate the interface between mind and brain. They should appreciate that for any input there must an output. Hence, what ever the brain receives, interprets, processes, integrates, coordinates and stores are reflected as outputs in the total personality, thoughts, feelings and behaviour of an individual. The third argument is that by acquisition of biological knowledge, mental health nurses will fail to recognise the caring aspects of mentally ill persons. Cure-care models are not mutually exclusive. Knowledge of biological science does not affect and intervene in the caring ability of the mental health nurses. On the other hand, it will only enhance the caring ability and caring of the mentally ill patients. Therefore, if true holistic care is to be ensured, mental health nurses need to have biological knowledge too.2 Mental health nurses need to understand the importance of nutrition that helps maintain body functions. Unless they have the relevant knowledge, it will be difficult to appreciate the importance of healthy diet. It is not sufficient if they only know about chemical medication. They should know how food taken by individuals impacts on their moods and how a change in the diet can make a difference in quality of life. Problems diagnosed as mental health related can be in reality due to nutritional factors such as blood sugar, deficiencies in fat and minerals, fungal overgrowth in the gut etc. Maintenance of blood sugar level is the most important aspect of mental health. Caffeine and processed sugar by intake of coffee by mentally ill patients can cause blood sugar levels to increase and release of insulin to reduce the sugar level that can lead to panic reactions in them and make them irritable, sloppy and tearful. The cycle will restart when they again take more sugar due to irritability etc. 3 thus a holistic approach is a prerequisite for professional development of a mental health nurse for her effective care delivery. Case presented The patient Pamela has arrived at rehabilitation and recovery cell. She is 35 years old with a long history of schizophrenic disorder. As seen above she appears to have been experiencing episodic attacks, talks about her as a third person, She hears external voices of her classmates and others at school. She is not interested in continuing with her medication and insisting that she is not mentally ill. After a course of Aminulpride, she has drowsiness, blurred vision and has had some weight gain although she admits to being a lot better after the medication. First of all, with the biological and other knowledge, I have had, I should rule out these behaviours of the patient as due to her diet or any biological disease. Though she has the long history of schizophrenia, it is quite likely that she might have contracted other diseases during the period and might have become used to particular diets. I have to play my role of a carer at every stage of the treatment being given to Pamela. The drug given may not be sufficient or may be an outdated one and there may be a new drug that can be tried for better and faster results. Nursing Diagnosis A mental health nurse, like a nurse of any other branch, has to make a health assessment of a patient. The health assessment is gathering and making analysis of data to identify client’s problems and to decide on the care to be provided. Assessment lasts from the time of admission until discharge. The tool for a nurse to make an assessment is a framework or model already prescribed by nursing theorists. Nursing process follows selection of a model for a systematic problem solving exercise involving few interconnected stages. A five-stage model that will be ideal is Assessment, Nursing Diagnosis, Evaluate the care, Implement the care plan and Care planning. The first stage of health assessment is collection of biographical data, taking of history of medical, surgical, psychological, social, cultural and spiritual health besides ‘history and data about daily activities of living (adl).’ The second stage of nursing diagnosis is stating the actual problem, likelihood of further problems developing and documenting of the findings by the nurse. The third stage of care planning underscores setting up of clear goals relevant to the problems that are identified, understandable, measurable, observable in behavioural forms and attainable. This is followed by deciding on nursing actions to achieve the goals. The fourth and fifth stages of evaluation of care and implementation of the care plan would be alternating, as evaluation would involve revisiting nursing outcomes and adjusting the care plan as maybe necessary. The data collected for assessment must scientific and objective. Subjective data relates to health history of sensations and symptoms such as pain, shortness of breath and anxiety. Objective ones are signs of the disorder taken from physical examinations and measurements such as blood pressure, urine output, aggression etc. Subjective assessment and objective assessment must correspond to each other. However, there can also be contradictions that should prompt investigation that is even more careful. Interviewing the client, interviewing the client’s relatives or any other significant person are the techniques for the above exercise. Reference to medical records brought by client or retained by the hospital will also give insight into the client’s condition. The data so collected must be validated and organised. The second stage of nursing diagnosis that is different from medical diagnosis involves identification of problems requiring nursing interventions. Models suggested for mental health nursing are Roper et al’s model (2000), Peplau’s (1991) Interpersonal Model and Barker (2001) Model. Of these, Roper et al’s model is generally used in mental health nursing. 4 Roper et al give 12 activities of living which can be used for assessment of how, why, when and where the patients carry out their living activities so that it will produce a comprehensive picture of the patients’ life styles and point out the existing or potential problems requiring nursing care. This British model developed by Roper, Logan and Tierney use the following 12 living activities as a framework for assessment.5 1 Maintaining safe environment, 2 Communicating, 3 Breathing, 4 Eating and Drinking, 5 Eliminating, 6 Personal Cleansing and Dressing, 7 Controlling body temperature, 8 Mobilizing, 9 Working and Playing, 10 Expressing sexuality, 11 Sleeping and 12 Dying The above will appear in a typical assessment sheet paper and it can be ideally used to assess Pamela’s case presented in this study. It will be relevant to recall Peplau’s observations about the mental health nurse: Considerations of [the patients] and interests as persons having dignity and worth are primary values inherent in the design and execution of nursing services. These values should be implicit in a nursing approach for the care of patients having a diagnosis of schizophrenia. In keeping with these claims, it would behove nurses to give up the notion of a disease, such as schizophrenia, and to think exclusively of patients as persons. 6 While Psychiatrists look out for signs and symptoms of schizophrenia, mental health nurses should enquire into the problems experienced by schizophrenic persons as humans. Hence, in the present case of Pamela, a mental health nurse will be more interested in the patient as Pamela rather than a person of schizophrenia while interviewing her to collect information about her.7 Properly cared schizophrenic persons can maintain normal life in which process mental health nurses play a crucial part since they move with them not as a psychiatrist but as persons keenly interested in them. Leete E (1989), a schizophrenic person herself testifies in her book How I Perceive and manage my illness , Schizophrenia Bulletin 15:197-200, that she is able to maintain her employment and societal connections “through carefully considered strategies in situations of anxiety, tendency to misinterpret situations, difficulties in concentration and inability to respond quickly.”8 She has prescribed about 20 coping strategies for different types of situations likely to be distressing or difficult.9 About Pamela’s hearing of voices when there is no one there, or if she happens to see things or persons what others do not, these experiences of Pamela are known as ‘hallucinations’ It happens when she holds strong beliefs that others in the environment do not share. For example, if Pamela thinks there is a conspiracy against her by some one else or that some body else is controlling her thoughts, such a feeling by Pamela is ‘paranoid delusion’ Looking at the Leete’s account of herself, it is not necessary that one should resign themselves to a life of illness and disability. Most people who experience such psychotic symptoms once do not experience again in their lifetime. However, persons like Pamela who continue to get repetitive episodes do manage to carry on with a high quality of life. They are able to stick on to their jobs and have continuing relationships with their friends, relatives and colleagues. The only difficulties these people like Pamela likely to have are social stigmatisation, social isolation, and poverty and any direct consequences of the disease itself. Dr Rufus May says From a week into my second admission, I was visited every day by the same friend, Catherine. She wasn’t alienated by visiting a psychiatric hospital. This accepting and supportive approach was a very useful alternative story to most of my friends of the time who stayed away. Catherine recounts believing that the situation I was in was something I could get over. It was invaluable to have someone around who believed I could make a full recovery. My recovery was about how to gain other people’s confidence in my abilities and potential.The toughest part was changing other peoples ’expectations.’ Dr Rufus May – personal account10 The personal accounts of Dr Rufus May and Leete are inspirations for mental health nurses to enable the present patient Pamela to recover quickly and lead a normal life. The mental health nurses must be at the same time aware that recovery from psychotic experiences are fast in some persons and too slow in some other persons. Few persons recover from single episodes and still others continue to have continuous episodes. Long term studies indicate that one third of the patients completely recover and a quarter of them remain with the disorders permanently. Mental health workers are said to fall into the trap of ‘clinician’s illusion’ that recovery is rare and those affected have to be tied up with them for the rest of their lives. Some mental health workers are of the view that future of their career is bleak when many people who have recovered do not contact them again.11 Most of the schizophrenic disorders are related to patients’ childhood experiences that they recall during the assessment by the mental health nurses. They do so confiding in them and hence the close and enduring relationship the patients would like to have with the mental health nurses need not be overemphasized. Schizophrenic disorders are attributed even to birth complications that the mental health nurses must appreciate that the patients are not personally responsible for such a disorder. A Swedish study suggests that there can be several birth complications to develop as schizophrenic disorders. About 238 persons born between 1987 and 1995 out of 500,000 persons born during the same period, developed the disorder due to birth complications such as “extreme prematurity of eight months or even less, malnutrition during pregnancy evidenced by low birth weight and lean body and lack of oxygen at the time of birth evidenced by premature detachment of placenta, breech delivery, irregular breathing or low heart rate or a need for Caesarean section because of respiratory distress”.12 Mental Health Nurses also have to make sure they meet with conditions regarding patients’ consent as stipulated in the Mental Health Act 1983 (England) or The Mental Health (Scotland) Act 1984 as the case may be. Confidentiality is another aspect that the mental health nurses should not ignore as it lies at the heart of ethical relationships between the nurses and the patients.13 Regular reflective practice on the part of the nurses will also help them in their professional development on a sustained basis. Mental Health Nurses are expected to use clinical supervision for their reflective practice. It may be relevant to mention here that as a result of training being provided to mental health nurses as well as patients (service users) by Sandwell Mental Health NHS and Social Care Trust since 2002, there has been a marked improvement in the language used by both the nurses and patients. Patients also have developed their own recovery based wellness plans.14 Conclusion The development of role of mental health nurses therefore is a life long learning and life long experience. They hold themselves as an important conduit between the patients, society, psychiatrists and patients’ friends and relatives as a source of reassurance. The success of the mental health nurses in their career or rather job satisfaction depends on the lasting relationship they will have with the patients even after their recovery not as health care professionals but as part of their lives and members of their communities whom they can confide in. Read More