Mental Health Nursing - Report Example

Mental Health Nursing According to recent research by Johnson (2007) one in every six adult Australian males suffers from clinical depression and teenagers and elderly men have higher rates. DePaulo and Horvitz (2002) state that depression in men is associated with destructive behavior, alcohol and drug abuse, and numerous medical disorders such as cardiovascular disease and diabetes. According to Yates (2009), statistics have proven over time that with the increasing complexities of daily life increase the levels of stress and hence the numbers of disorders that are related to the psychology of the human mind. It has in fact been stated by Horgan (2008) that an need for an improvement in the process governing the treatment of depression is a critical factor in the current low levels of appropriate care. Horgan (2008) further states that a health plan in this context is useful for the measurement of the dosage of medicines that the patient requires and the pother factors that need to be kept in mind in the administration of treatment- the absence of which has meant that progress in terms of levels and quality of care have been stagnating at relatively low levels. It must therefore be remembered that it is necessary to come up with identifications of the characteristics of a health plan so that these could be utilized as factors contributing to quality improvement in various aspects of depression treatment. One can also assume right at the beginning of the discussion that most health plan characteristics are associated with the quality of one important aspect of depression care along with aspects of antidepressant medication management. Patel (2003) states that there are various options for effective treatment of depression which are available, despite the fact that the impact that these treatments have in terms of effects of societal burden like the return on resource utilization are minimal. According to Hammen and Brennan (2001) the causes of the prevalence of culture of depression among the contemporary population include equal combination of social, biological, and psychological factors. According to Matthews (1995) a management plan also known as treatment plan for depression is organized into various areas hence a multidisciplinary approach is needed. One can start the discussion on an assumption that depression as a disorder has causes that are unique in every given case which would then mean for every individual there would be a specific path or a method that could be employed in the effective treatment of the problem. It can therefore also be assumed that for a treatment to be effective, in the case of a patient suffering from depression, the physician would automatically have to understand the factors that have caused the depression in the first place. Hammen and Brennan (2001) state that these factors would then ultimately have to find reflection in a clinical health plan for depression patients if the plan has to have any hopes of being effective. Matthews (1995) believes that a key problem in diagnosis that has baffled non-psychiatrist is the fact that the elaborate classification systems that exist today are solely based on the subjective descriptions of symptoms. One of the most often applied models of patient care in the context of depression is the recovery model. Reeper and Perkins (2003) state that the model, based on the innate belief that every patient has within himself an immense capability to recover from any kind of mental health problems hundred per cent, the model aims at coming up with health care objective fulfillment that would cure the illness effectively and forever. The health plan in the context of the mental health and depression affected patients take cues from this particular method in the light of the fact that the steps prescribed by the method are those that work on assumptions for cure and care that have already been outlined. These, Reeper and Perkins (2003) state are inclusive of a process of problem acceptance, solution discovery in the context of the discovered problem, and changing of lifestyle to find a more balanced way of life. Brown and Donohue (2003) believe that one of the basic reasons that the method is especially effective and is recommended in the formulation of a mental health care management plan is the fact that the method is deeply focused on the role played by the patient in process of recovery. By making the patient a part of the process, the process allows the patient to think for themselves and to participate actively in the process of their recovery. The patient is not to focus on the discovery of the causes of his illness but is to also take part in the discovery of the method that is to be utilized in the types of treatment that they think would suit their position best and they would be most comfortable with. These can take the shape of dietary medication, herbal supplements and vitamins, exercise, acupuncture, holistic methods, in addition to psychotherapy and anti-depressants along with other practices that are recommend based on the condition of the patient. The process is therefore based on an innate acceptance of the principal of consent and in has to work, which according to Lodge (2010) is in keeping with the duty of care that is a necessity where medical professionals are concerned. The idea therefore would be to not allow the patient to do anything that would harm them, while displaying a respect for the wishes of their patients and in adhering to the requests they receive. The guiding principle behind this theory is that it gives the patient a more active roll in their own health and recovery, and will therefore make them responsible for their own improved lifestyle and well being on a long-term basis. Dudgeon (2004) outlines the principles governing an effective collaborative health treatment and management plan in the case of a patient that is affected with depression. One can outline the major aspects of the multidisciplinary factors of the plan along the following lines in keeping with the overview provided by the author. 1. The first requirement is that of a project/ patient coordinator. This is the physician in most cases, but in cases of depression the psychologist or the group therapy leaders could also be made the role model. The other members of the team consist of the resource persons like the nurses, pharmacists, among others. The group together supervise the range of situations of care that is necessitated in the creation of support for the patient’s system integration 2. Change to clinical practice takes time and must include significant system support that is evident to frontline personnel. Over time there will be improved outcomes in patient care. 3. The standardized assessment tools, collaborative care plans, and symptom management guidelines provide a common “language” across the continuum of care. Documentation materials that support the assessment tools and collaborative care plans must be standardized and in place at the time of implementation. This ensures accurate, effective, and efficient communication. Ongoing site-specific education programs should be designed to meet the healthcare professionals’ and patients’ needs. 4. Ongoing evaluation (for example, with chart audits and focus groups) should be part of the implementation process. Potential barriers to implementation are then avoided or managed in a timely fashion. Based on these considerations, one could now outline the basic structure of the function of the nurse as a mental health care professional along the following lines: According to Connolly and Bernstein (2007) the first priority is the determination of whether or not a client with depression is suicidal. If a client has suicidal tendencies or hears voices commanding him/her to commit suicide, measures to provide a safe environment become the first necessity. If the client has a suicide plan, the nurse asks additional questions so as to aid the determination of lethality of the intent and the plan. The nurse is duty bound to report this information to the treatment team. Connolly and Bernstein (2007) also state that it health care personnel follow hospital or agency policies and procedures for the institution of suicide precautions such as removal of harmful items, increased supervision among other things. Psychiatry Association Guidelines (1998) argue that it is also important that the nurse be able to cultivate a meaningful contact with clients who have depression and to begin a therapeutic relationship regardless of the state of depression. Some clients are quite open in describing their feelings of sadness, hopelessness or even agitation. Yet others might not be able to sustain a long interaction so several shorter visits help the nurse to assess status and to establish a therapeutic relationship. The nurse might also find it difficult to interact with the patient because he or she empathises with such sadness and depression. Videbeck (2005) suggests that the nurse also might be placed in apposition where they might become emotionally vulnerable and feel like they are “unable to do anything” for patients characterised by limited responses. Clients with psychomotor retardation with characteristics such as slow speech; slow movement and a slow thought process are extremely non-communicative or at times even are mute. The duty of the nurse in their capacity of a mental health care professional would be to sit with the patient for a few minutes at intervals throughout the day. The nurse’s presence conveys genuine feeling, interest and caring. It must be noted here that it is not really necessary that the nurse talk with the client the entire time; silence can convey that clients are worth while even on instances when their interaction is at a minimum. Where the multidisciplinary teams to deal with depression is concerned, researchers are yet to arrive at a conclusion with respect to the kind of team and the kind of treatment and the kind of setting in which this treatment has to be provided. Areán, Hegel and Reynolds (2001) for example argue that it would be a feasible option if one was to make an attempt at implementing psychotherapy in primary care settings, patient preference for psychotherapy, and the utility of primary care versions of therapy in treating depression in older adults. Interestingly enough in this context the Australian National Mental Health Strategy aims at the promotion of the mental health of the community, prevent development of mental disorder, reduce the impact of mental disorder to individuals and families and assure the rights of the patient with illness. Igreja (2004) states in this context that it could be understood that providing collaborative care in circumstances where the consumer does not have legal power to refuse treatment is tricky. Happell et. Al., (2008) outline the duty of the nurse in this context in as the responsibility be to take every opportunity to encourage consumers to make choices, highlight and attempt to facilitate the preferences of the consumer wherever possible, advocate for the preferences of the patient and be knowledgeable about the other resources and agencies in existence for referral purposes. Elder, Evans and Nizette (2009) argue that given the fact that Australian policy framework support increased consumer and carer involvement in aspects of the treatment such as medication management and discharge planning, a lot of focus in recent times has been devoted to the derivation of an understanding of expectations of patient and their experiences of care. The other basic functions of the mental health nursing professional would remain similar to general nurses. Elder, Evans and Nizette (2009) also argue that they would be expected to promote sleep and rest, engage in client activities, encourage patient to verbalize and describe emotions thereby aiding therapy and work with client in terms of medication planning and management so as to reinforce the effectiveness of anti-depressant therapy. In conclusion therefore one may bring to light the increasing expectations of the nursing health care professional in light of the recent focus and choices backed by factors of cost and clinical effectiveness. Lodge (2010) states that the future of the mental health nursing seems likely to become more rather than less complex as is demonstrated by the simple act of planning a mental health care plan and formulating the description of role played by various teams of treatment. At the same time however the development of the advanced practitioner role is representative of a future in which mental health nurses would play an increasing role in the provisions and development of clinical services. Reference: Ellen S, Selzer R, Norman T, Blashki G. Depression and anxiety - Pharmacological treatment in general practice,Australian Family Physician 2007; 36(4); 193-288 Johnson C. Managing mental health issues in general practice, Australian Family Physician 2007; 36(3): 202-5 Harrison C, Britt H. (2004). The rates and management of psychological problems in Australian general practice. Australia N Z J Psychiatry. 38. 781–88 DePaulo, J. R., and Horvitz, L. A., (2002). Understanding depression: what we know and what you can do about it. Wiley Books. p120-122 Hammen, C., & Brennan, P. A. (2001). Depressed adolescents of depressed and nondepressed mothers: Tests of an interpersonal impairment hypothesis. Journal of Consulting and Clinical Psychology, 69, 284-294 Matthews. B., (1995). ‘Introducing the care programme approach to a multidisciplinary team: the impact on clinical practice’. Psychiatric Bulletin. 19, 143-145 Patel V, et al. (2003): Efficacy and cost-effectiveness of a drug and psychological treatment for   common mental disorders in general health care in Goa, India. London, institute of  psychiatry Yates, W. R., (2009). Anxiety Disorders. ,  Laureate Institute for Brain Research [Guideline] American Psychiatric Association. Practice guideline for the treatment of patients with panic disorder. Work Group on Panic Disorder. American Psychiatric Association. Am J Psychiatry. May 1998;155(5 Suppl):1-34 Connolly, S. D., and Bernstein, G. A., (2007). ‘Practice parameter for the assessment and treatment of children and adolescents with anxiety disorders’. Journal of American Academy Child Adolescence Psychiatry.  46(2):267-83. Videbeck, S. L., (2005). Psychiatric mental health nursing. Wolters Kluwer Health. pp317-320 Areán, P. A., Hegel, M. T., and Reynolds C. F., (2001). ‘Treating Depression in Older Medical Patients with Psychotherapy’. Journal of Clinical Geropsychology. 7(2). 93-104 Lodge, G. L., (2010). ‘Empowerment and the recovery model’. The Psychiatrist. 34: pp116-117 Happell, B., Cowin, L., Roper, C., Foster, K., McMaster, R., (2008). Introducing Mental Health Nursing: A Consumer Oriented Approach. Allen and Unwin. Pp144-146 Elder, R., Evans, K., and Nizette, D., (2009). Psychiatric and Mental Health Nursing. Elsevier Australia. Pp75-80 Reeper. J., and Perkins, R., (2003). Social inclusion and recovery: a model for mental health practice. Elseiver Health Sciences. Brown, C. and Donohue, M. V., (2003). Recovery and wellness: models of hope and empowerment for people with mental. Routledge. pp77-82  Igreja V, et al. (2004): Testimony method to ameliorate post-traumatic stress symptoms. Britain,   the royal college of psychiatrists. Read More