Nursing Care for Consumers with Mental Health Conditions - Case Study Example

Running Head: Implement & Monitor Nursing Care For Consumers with Mental Health Conditions Name: University: Course: Date: Introduction Mental health according to world health organization is a positive state of complete mental, physical, and social wellness. Furthermore, someone is mentally well when he/she has a balance between the integrated body, mind, spirit and the environment. On the other hand, mental illness/ disorder are clinically significant psychological or behavioral syndrome occurring in an individual and are associated with present distress (World Health Organization 1992, 1993). Mental disorder is normally diagnosed using criteria which include; lack of personal growth, ineffective coping with life events, unsatisfying relationship, and dissatisfaction with one’s characteristic, ability and accomplishment (World Health Organization 1993). The Human Rights and Equal Opportunity Commission (1993, pp.908, 925) summed up that people with mental disorders are among the most disadvantaged and vulnerable in our community since they might experience stigma and discrimination in many their lives aspects. Mental illness can be short-lived and fully recover while for others, it might occur throughout someone’s lifetime (The Human Rights and Equal Opportunity Commission, 1993). Socio Demographic Data Name: Mr Anderson Age: Middle-aged Sex: Male Civil status: Widowed No. of children: 1 Profession: Railway worker Case Study Analysis Mr. Anderson was referred to the acute impatient mental health unit following a referral from his employer's medical officer. This is because; he was becoming unreliable in his occupation as a rail way worker since his work requires a lot of technical skill and use of computer. According to the medical officer’s report, when interviewed, he seemed to miss many questions, making poor eye contact and generally slow to respond. Furthermore, he lacks appetite, he does not talk with his workmate and he is preoccupied with his own thoughts such as suicide attempt. As an enrolled nurse on the medical unit where Mr. Anderson has been admitted, it is my responsibility to undertake the issue and ask Mr. Anderson the entire questions relevant to the depicted condition, document the medical information from the conversation, and to report the documented conversation to the appropriate authorities. The main aim or purpose of questioning and documenting Mr. Anderson condition as a Nurse is to be in a position of defining characteristics or symptoms that differentiate specific diagnosis, to be able to provide a standardized nomenclature and languages for all mental health professions and lastly to be able to assist in identifying the underlying causes of Mr. Anderson disorder. As an enrolled Nurse, there are several responsibilities assigned in the mental health unit which includes; carrying out an assessment, development and implementation of health care plan. The Psychiatric nurse oversees the management of patient care in the mental unit. It is the responsibility of the nurse to participate with the interdisciplinary team in trouble shooting the condition of Mr. Anderson and other clients admitted to the hospital. This involves trouble shooting complex problems in patient care, documenting findings and progress in patient record, briefing the new health care providers’ pertinent information for health care provision. The nurse is responsible for carrying out daily reviewing of all patients’ information and overseeing the management of patient care, including laboratory tests and results and progress notes in patient health record. The nurse is expected to consults with physicians and other healthcare providers to update the patient progress and carrying out rotation check up in wards. The nurse is responsible in directly assessing the patient admitted in the mental unit through checking the patient’s response to treatment, examining and documenting the patient’s physical examination such as blood pressure, weight and general body response. He/she manages the inpatient or outpatient nursing care of clients, writes nursing diagnosis, establishing outcomes, administering medication and implementing health care plans including family/client teaching. The nurse is responsible in disseminating and implementing latest evidence-based nursing practices for better health care services. The nurse is responsible in identifying resources required for patient optimal care, recommends items for budget and analyzing the cost effective planned care. The nurse revises and writes the protocols and unit based procedures to reflect latest evidence in health care system. The unit nurse is responsible in ensuring that patient goals are set with involvement of the patient and the family members. The unit nurse facilitates teamwork discussion when ethical dilemmas arise, and furthermore, he/she provides the patient and family members’ education in understanding the diagnosed illness and self care concepts. The unit nurse is responsible too in providing regular formal and informal educational opportunities on the unit in order to improve clinical staff skills. He/she also guide less experienced nurses/trainee nurses in patient care, physical assessment data review and evaluation of individual outcomes (World Health Organization 1992, 1993; Ormel et al., 1994). In order to aid in proper diagnosis and effective treatment and management plan as a unit nurse, some information would have to be documented after interviewing Mr. Anderson. The risk of suicide thoughts (disturbed thought process), self confessed loss poor eye sight, risk for injury for others, anxiety, self care deficit, sleep pattern, social interaction with friends and work mates and ineffective role performance at work place. This documented conversation would be reported to the health care providers in the psychiatric unit such as the fellow nursing staff, physician, psychiatrist and laboratory technologist as this would enable discussion and consultation hence leading to provision of proper health care management plan. It would be important to inquire other information from Mr. Anderson in order to enable timely and accurate diagnosis of his condition which will lead to reliable treatment plan. Family history of such or related condition, memory lapse, if hallucination is experienced, medical history, past experiences whether he had been abused earlier or any other trauma she had been subjected to, his social interaction with other relatives, Mr. Anderson nutritional status Anxiety Anxiety is one of the common feelings in human beings and can be described as a vague feeling of uneasiness which brings about discomfort which actually results in an automatic response. Studies shows that the causes of anxiety are not known or are they specifically defined since in normal circumstances it is caused by a feeling of apprehension that is brought about by individual anticipation for any form of danger. Furthermore, studies shows that anxiety can be seen as an alarming signal which actually senses any impeding danger hence enabling an individual to take any necessary measures to curb the threat (WHO, 1993). To begin with the most prominent signs of an individual suffering from anxiety include the following; low self esteem, dysfunctional family system, powerlessness as well as lack of control when it comes to dealing with life real situations and retarded ego development. An individual suffering from anxiety can be identified by the following characteristics. First and foremost is the feeling of increased form of helplessness. Overexcitement, restlessness, lack of good eye contact lack of enough sleep, increased cardiac as well as respiratory rates and lastly difficulty when it comes to learning of new things (WHO, 1992, 1993; Wilkin, 2003). Anxiety is one of the common diseases in human beings which are easily manageable at any given level within seven days. In order for nurses to effectively deal with anxiety, then the following therapeutic nursing interventions are very important to the patient. First of all patients suffering from anxiety should be trained on ways which they can use to identify any particular events that maybe major causes of anxiety and on how to adequately deal with such events or characters as recognition can be seen as the first step in elimination of any given type of maladaptive response.. Secondly the nurse should be willing to stay with the patient and at the same time be in a position to ensure that the patient is safe and all his/her nursing priorities are fulfilled. In addition to the above the patient’s methods of coping with anxiety should be examined by the nurse dealing with the patient by identifying the patient’s strengths and weaknesses as this will help in determining which methods can be implemented in order to reduce the feeling of powerlessness. Quiet environment should be provided to the patient as this will help in reducing stimuli since any level of anxiety can only be reduced in a calm atmosphere as this will give a patient time to examine his/her life without any disturbance. Lastly anxiety medications should be administered such as TCAS, Buspirone, SNRIS, diazepam, chlordiapoxide among others as well as proper client monitoring (WHO, 1992, 1993; Boyd, 1998; Wilkin, 2003). Depression Depression can be seen as a social isolation condition which is brought about by a feeling of loneness that is commonly experienced by individuals which in normally circumstances is perceived as negative by other individuals. This actually results in an insufficient or even sometimes ineffective quality of a given social exchange. Depression is one of the key diseases an individual suffers from and the following are the key symptoms or signs. To begin with the first sign is the development of regression, egocentric behaviors, disturbed thoughts, fear of rejection, impaired, unsolved grief and lastly absence of availability of significant others or peers. In addition depression is therefore characterized by the following characteristics; sadness, dullness, being uncommunicative, being withdrawn, lacking eye contact, having meaningless actions, dysfunctional interaction with family members as well as other people and lastly feeling of discomfort when it comes to social situations(WHO, 1993; Wilkin, 2003). In order to deal with this disease then the following remedies should be taken by nurses concerned .First of all is that nurses should develop a trusting relationship with the patient as this will make the patient voluntarily spend more time with the nurse hence the nurse will in turn help the patient to actually deal with the situation. Secondly the patient should be trained on the relevant ways which can help the patient to be able to deal with any possible egocentric characters that can be offending to others or can even tamper some given relationships. Thirdly the nurse should be in a position to develop a therapeutic nurse patient relationship where the patient feelings, presence, acceptance will be accepted. This one on one relationship will encourage the patient to be free to express his/her feelings freely hence promotion of a feeling of emotional security for the patient. Furthermore the patient’s should be encouraged to participate in given level of activities as this will act as an incentive for the patient’s reinforcement of feelings. The patient should therefore be taught on assertiveness as well as positive interactions with other individuals or people and this should not be done in a judgmental manner rather in a non-judgmental manner. By doing this it will encourage the patient to positively think about life and hence help the patient to effectively realize how to appropriately interact with other people positively (WHO, 1992, 1993; Wilkin, 2003). Schizophrenia Is a psychotic disorder resulting from disruption in cognitive operations and it affects the thinking, behavior, emotions and ability of an individual to perceive reality. There are subtypes of schizophrenia which include; paranoid, catatonic, disorganized, residual and undifferentiated type. The key symptoms of this mental disorder are associated with; in ability of an individual to trust, panic level of anxiety, an individual has got low self-esteem, in adequate support systems, negative role model and underdeveloped ego. While the main characteristics feature of this condition is evidenced by; the suspiciousness of others which leads to change in societal participation, inability to meet basic needs and unsuitable use of defense mechanism. Furthermore, an individual suffering from schizophrenia experiences wrong interpretation of environment, hyper vigilance, easily distracted and inaccurate non reality-based thinking. Schizophrenia is managed by orienting the patient to develop trust to the healthcare worker for one week, the followed by giving the room to client to demonstrate more adaptive therapeutic coping skills through interaction and willingness (WHO, 1992). There are a number of psychiatric nursing interventions to schizophrenia condition and the rationale. This include; the act of encouraging mutual relationship with client and the health care staff as this will lead to trust development, there is need to avoid physical contact as this might result to patient interpreting as a threatening gesture. During care and management, it is necessary for a psychiatric nurse to avoid laughing, whispering in a situation where a patient can see but not hear as the patient might raise some suspicion and believe that others are discussing them and furthermore, secretive behaviors raises paranoid feelings. The psychiatric nurse is expected to be honest and reliable in promises as this will enhance a trusting relationship. During meals a creative approach has to be adopted when handling the schizophrenic patient such as provision of canned food or family style presented food. This is because the patient might believe there is an attempt of poisoning plot if such strategies are not taken care of and he/she might refuse to eat meals presented openly on tray. The client has to be, mouth checked to ensure he/she swallows the tablets and pills as they might believe drugs given are meant to poison them and in most cases they tend to discard them. Lastly it is important to spend time with client even if it means just sitting in silence for a while as this might help the client to improve perception of self as a worthwhile person and boost the self esteem, and encourage mutual relationship with other people. There are two major classifications of schizophrenia medications; typical antipsychotic (examples are; Haldol, Chlorpromazine, Prolixin, Serentil, Trilafon and Mellaril) which are used in treatment of positive symptoms and atypical antipsychotics (examples are; Zyprexa, Risperdal, Seroquel, Geodone, Clorazil and Abilify) used in treatment of both positive and negative symptoms (WHO, 1993, Boyd, 1998; Wilkin, 2003). Bipolar Affective Disorder Bipolar affective disorder is an affective mental disorder occurring due to disruption in cognitive operations and activities. This condition is characterized by repeated periods of irritable moods and fluctuation of activity level by being significantly disturbed. This condition normally results due to hereditary factors, biochemical alterations, unmet dependency needs and unresolved grief. The defining symptoms include; suspiciousness, delusions of grandeur, decreased ability to grasp ideas, egocentricity, hyper vigilance, and altered attention span. The recommended nursing management plan and medication start with accepting client false belief status but not sharing the delusion and this positive response would convey to the client that you accept the delusion as reality. It is not recommended to argue with the patient or deny the belief but rather using reasonable doubt as a therapeutic technique is advisable; Arguing leads to lack of trust. During management plan, it is necessary to focus on reality by talking about real events and real people or using real situations and events to divert client from monotonous false verbal ideas. It is important to provide positive reinforcement when the client is able to differentiate between reality and non reality scenarios. This reinforcement enhances client self esteem and further encourages the development of desirable character. It is recommended to teach the patient to be in a position of intervening with ‘thought-stopping technique’ which has commands such as ‘stop!’ as this will interrupt undesirable thoughts which can leads to undesirable emotions and character. It is not advisable to touch any how as in most cases suspicious clients perceives touch as a threatening and may respond with aggression (WHO, 1993; Wilkin, 2003). References Boyd, M.A.; Nihart, M.A, 1998, Psychiatric Nursing: Contemporary practice, Philadelphia: Lippincott Human Rights and Equal Opportunity Commission 1993, Human Rights and Mental Illness, Report of the National Inquiry into the Human Rights of People with Mental Illness, AGPS, Canberra Ormel, J., VonKorff, M., Ustun, T.B., Pini, S., Korten, A. & Oldehinkel, T. 1994, 'Common Mental Disorders and Disability Across Cultures, Results From the WHO Collaborative Study on Psychological Problems in General Health Care', Journal of The American Medical Association, vol. 272, no. 22, pp. 1,741–1,748. World Health Organization 1992, The ICD–10 Classification of Mental and Behavioural Disorders Clinical descriptions and diagnostic guidelines, World Health Organization, Geneva World Health Organization 1993, The ICD–10 Classification of Mental and Behavioural Disorders Diagnostic criteria for Research, World Health Organization, Geneva Wilkin P, 2003, in: Barker, P, 2003, Psychiatric and Mental Health Nursing: The craft of caring, London: Arnold, pp. 26–33 Read More