Mental Health Nursing: Principles and Practice - Case Study Example

Mental Status Examination Assignment Student’s Name: Institution: Mental Status Examination Assignment Mental Health Services CONSUMER ASSESSMENT Date: Time: URN: U223344 Family name: Smith Given names: Harry Date of birth: 03/07/ 1997 Sex: Male General appearance Harry was standing on the road semi-naked whilst gesturing aimlessly, laughing to himself and shouting loudly at every motor vehicle passing around. On their arrival, Harry could not even acknowledge the police and refused to return to the footpath. He made a vague statement by shouting that no one had the authority to hurt him since he was invisible. His safety could only be guaranteed if the police escorted him. Behaviour Harry’s behaviour could not be tolerated. He was behaving strangely and nobody could understand his next movement. He was very unpredictable and conniving too. Speech Harry’s mode of speaking is full of lack of disbelief and discouragement. The tone of voice is low. Mood and Affect Harry’s sleep has been disturbed, and that he is often awake all night. According to his observers, he appears to fluctuate between being subdued and sad to angry and then violent with no apparent cause. Despite Harry’s denials, his observers still insist that they suspect he might be on drugs and some injecting paraphernalia were found lying in his bedroom. Another observation is that, earlier in the day, he had been acting strangely at home, and expressed fears that his younger brother was making him ill. He had left home abruptly without stating his intentions. Thought process Harry believes that other people are the cause of all his predicaments. This is the thought process of most mental patients according to the observation by Rizq (2012). For instance, Harry holds his brother accountable for making him feel sick. This kind of thought tends to make mental patients (including Harry) feel that their present medical condition is as a result of too much involvement with other people who are close by them (Ford, Roach & Roach, 2010). Thought content Harry has depression, mania, and bipolar. He has addictions to drug and easily finds it hard doing without substance and drug abuse. Perception His way of reasoning is filled with wrong side of thinking. He perceives things and people negatively, especially the way he views other people being responsible for his problems. Cognition Harry tends to respond to certain objects and situations with dread and fear, as well as with physical signs of panic and anxiety. Having an anxiety disorder means that Harry’s response is not appropriate for the surrounding circumstances. Judgment and Insight Patients’ violence has no specific vector. All clinicians serving together have equal risks of experiencing patients’ violence. Patients may direct their violence to the intended or unintended victims. Nurses serving specific patients are not the only people at risk of patients’ violence. All clinicians in a specific medical facility are at equal risk of patients’ violence. In this regard, it is important that all nurses must mutually agree on the best safety plan against any potential violence. A medical facility must have a well-coordinated safety plan for all its clinicians. Nurses must rehearse a safety drill to avert any patients’ mental violence. Medical facilities must train their workers on safety measures as a compulsory training for all nurses before employment. Neurovegetative Harry has inflexible and extreme personality traits that seem distressing to people around and likely to cause problems to them. Harry’s pattern of behaviour and thinking significantly differs from the anticipations of the society and are so rigid to an extent that they disrupt Harry’s own normal functioning. PART 2 SYMPTOM INTERVENTION It was noted that harry was becoming violent at times, thus threatening the peace of those around him. Apart from drug abuse patients, patients with mental problems also contribute hugely to hospital violence. Violent patients may physically and psychologically affect nurses as well as other patients. According to Ford & Roach (2010), one cause of violence among mental patients is AWS which is caused by abrupt stop of CNS functioning. Mentally challenged patients who have a problem with CNS functioning must therefore experience the syndrome that results from overstimulation of the nervous system caused when a person has a problem with his nervous co-ordination. There are various forms of AWS ranging from mild to severe cases. The AWS may result to patients suffering from nausea, vomiting and excess sweating. Severe cases of AWS may cause anxiety, agitation, and sometimes violence. The severity of this syndrome depends on the amount of alcohol consumed and the length of drinking time. Delirium tremens (DTs) are the worst outcome of AWS which can be fatal in some occasions. Management of AWS by nurses is critical in preventing violence among alcoholic patients. It is therefore paramount to develop ways of preventing violence among patients in addition to effective management and control measures of violent patients. Nurses must also establish emergency response measures during violent attacks by patients. Nurses should avoid denial of aggressive patients especially if they are devoted to these patients. Devotion to a patient may cause nurses to deny any dangers posed by their patients. The nurses should determine a safety management plan to avoid any aggression from their long term patients. Nurses who serve more patients are at higher risks of encountering aggressive patients. In addition, the higher a nurse’s year of practice, the more risks he is exposed to. Other factors that cause violence in patients include the nurse style of engagement with the patients as well as the type of patients treated by the nurses (Ford, Roach & Roach, 2010). Irrespective of the causes of patient violence, nurses should not take any chances. Nurses must not assume that patients will appreciate their services. Some patients blame the nurses for their illnesses. By just observing him, Harry is frustrated. The source of his frustration is yet to be known, even after being interviewed by the clinician. His frustration is shown in the manner in which he speaks slowly sometimes, and refuses to reveal much about himself. Patients may become frustrated if the nurses do not attend to them frequently as they expect. This makes patients to feel that they are not receiving desirable health care from nurses. Patients may also become angry of waiting for care for long periods of time. Patients may express their anger by hitting, screaming or yelling at the physicians. In such cases, stress management is the best response to these violent patients (Willkes, 2012). Long waiting hours or inadequate health care to patients cause them to develop stress. Reducing the patients’ stress is the best way of preventing patients’ violent acts. Nurses must be empathetic to patients in order to reduce their stress (Ford, Roach & Roach, 2010). They must address the patients concern and worries. Nurses must reduce the patients’ feelings of frustrations. They must assure the patients that they are giving their best to ensure that patients recover. Nurses must understand and cooperate with the patients to prevent straining their relations with their patients. This will prevent patients’ violent behaviors especially from frustrations. A safety plan is crucial while engaging with patients of different kinds. Nurses must consider their age and physical state while developing safety plans. Nurses’ safety plan must consider the type of patients’ aggression. There are different forms of patients’ violence apart from physical assault. For instance, patients or incorporation with others may make abusive and unnecessary phone calls to clinicians. In this case, the nurses’ safety plan should involve disconnecting those lines to avoid any numerous calls from the patients. The type of violence acts by the patients should determine the kind of safety plan adopted. All nurses must have a safety plan irrespective of how grateful the patients look. Nurses devoted to specific patients must also have safety plan to eliminate any risk of violence (Norman, 2013). All nurses must be conversant on what measures to take in case of violence from patients. This enables nurses to coordinate safety response to patients’ aggressive acts. A well rehearsed and coordinated safety response plan eliminates the safety risks experienced by all nurses in a medical facility. This is opposed to medical facilities that do not have a coordinated safety response plan which may experience numerous violence attacks on nurses and other clinicians. Another way of responding to patients mental violent behaviors is by use of time out. This is mostly applicable to inpatient settings. This method decreases the need for seclusion among patients. Time out involves removing situations that stimulates socially unacceptable behaviors among patients. Nurses should take patients to a quiet room where the patients stay there for some period until they become non-aggressive. Nurses then allow patients out of the time out region after they are calm. Patients can also convince the nurses when they are ready to leave the time out region. Time out is not seclusion although the two seems similar. Harry’s case is that of aggression, and it is as though he is coming out of control. Emergency staff may respond to mentally violent patients through disengagement .This entails the nurse avoiding the violent patient. However, this response is the worst method because it does not solve the problem of a patient’s violence behaviors. Instead, a patient’s aggression may increase and become out of control. This risks not only the staffs’ safety, but also other patients’ safety. Disengagement by the Emergency staff may also worsen the patient’s medical condition. This is because it causes inconsistency in providing health care since nurses are unable to attend to the violent patients (Rizq, 2012). This may cause disagreements with other staff members who may oppose withdrawal of care from patients. Emergency staff should avoid disengagement from their patients however violent they may be. Disengagement does not solve the patients’ violence problem but rather, it is a means of running away from the problem. Nurses should use better response methods than disengagement. An effective way of preventing aggression among patients is by use of structured room programs. These programs limit the amount of time patients spend in their rooms. Nurses should ask patients to be in their rooms for specific time periods or ask patients to leave their rooms for specific time periods. The most appropriate time of allowing patients to be out of their units is when other patients are out of their units. These programs allow patients to be away from situations that may cause agitations or aggregations. This decreases stimulation of violence perceived by the patients. The main purpose of these programs is to prevent crisis that would complicate patients’ behaviors and response (Lee et.al, 2011). Nurses can also apply action management principles to violent patients. One action management act is limit setting where the patient is told the acceptable and unacceptable behaviors. Nurses must state the consequences of any unacceptable violence actions to the patients. Patients can avoid violent behaviors when nurses communicate to them the limits of their behaviors in a respectful manner. It is important that nurses avoid being authoritative because this may make patients to respond angrily or aggressively. All nurses must know the consequences of unacceptable behaviors to avoid being manipulated by the patients to evade the consequences of their actions. Limit setting enables nurses to enforce punitive actions that prevent other violent behaviors. Limit setting gradually decreases the unacceptable actions (Myers 2012). According Willkes (2012), nurses can also use cathartic activities to respond to patients’ agitations. Physical cathartic actions are useful in releasing patients’ aggressive feelings. These activities also prevent further development of destructive violence forms. Nurses should guide patients to use physical exercise equipment or running around the halls as a way of releasing tension. However, these activities if not well managed may increase the patients’ agitations. Emotional cathartic actions are more effective responses to patients’ violent acts than physical activities (Myers, 2012). Nurses should guide their patients to write down their feelings as a way of monitoring them. Deep breathing and relaxation exercises are effective in controlling patients’ violence. Nurses must pursue patients to discuss their emotions with them. This helps patients to recover control of their emotions and consequently, lower their aggressive feelings. References Ford, S. M., Roach, S. S., & Roach, S. S. (2010). Roach's introductory clinical pharmacology. Philadelphia, Wolters Kluwer/Lippincott Williams & Wilkins Health. Lee, S.W., Morley, M., Taylor, R.R., Kielhofner, G., Garnham, M., Heasman, D., Forsyth, K. (2011) ‘The development of care pathways and packages in mental health based on the Model of Human Occupation Screening Tool’, The British Journal of Occupational Therapy.73(6): 284-294 Myers, S. (2012). Patient safety and hospital accreditation: a model for ensuring success. New York, Springer Pub. Co. Norman, I. (2013). Art and science of mental health nursing: principles and practice. S.l, Open Univ Press. Rizq, R. (2012). 'The perversion of care: Psychological therapies in a time of IAPT'. Psychodynamic Practice, 18(1), 7-24. Willkes, G. M. (2012). 2013 oncology nursing drug handbook. Sudbury, Jones & Bartlett learning. Read More