Mental Health Nursing - Schizophrenia - Literature review Example

Running Head: MENTAL HEALTH NURSING Mental Health Nursing Case Study - Schizophrenia (Student Name) (University Name) (Date) Mental Health Nursing Case Study – Schizophrenia Introduction to the Case Mental health illness or sickness refers to the state of the brain which is characterized by disturbances of thought, emotions and experience severe enough to lead to functional impairment in the sufferers and which cause it be difficult for them to maintain interpersonal relationships and day to day activities (Perring, 2010). The most severe mental illnesses can be very chronic and may result in serious disability and they include illnesses such as bipolar disorder, schizoaffective disorder, major depression and schizophrenia. Mental health nursing is thus a field of nursing that deals with mental illnesses and involves the care of people from all backgrounds irrespective of age who suffer from mental illness. The jury is out on the causes of mental illnesses with there being a varied range of causes, some of which include psychodynamic, biological, social cultural, behavioral, existential, humanistic and cognitive causes (Psychodynamic Perspective, 2008). Advanced techniques in brain imaging have so far assisted doctors and health specialists in studying the main roles of structure of the brain in leading to mental illnesses. For instance, people suffering from schizophrenia are often characterized as having enlarged brain ventricles (InfraPsych, 2008). Moreover, a variety of medical conditions may cause mental illnesses including damage to the brain, strokes, imbalance of some brain chemicals such as hormones, structural abnormalities of the brain such as brain tumors, infections from viruses, abnormalities in prenatal environments and diet deficiencies- mostly in teens and young children (Reach out Australia, 2010). Nevertheless, from the existential and the humanistic perspectives, the main causes of mental illnesses result from a person’s failure to find meaning in life which leads to loss of the affected person’s potentials to fulfill their dreams (Psychodynamic Perspective, 2008). As we shall see with John, the patient in this case, his behavior directly influenced the development of his mental illness. However, in spite of these different theories, the majority of psychologists in the contemporary world also concur with the fact that mental illnesses are often caused by a combination of the factors discussed above. Schizophrenia results not only from a single cause but also from a variety of factors. Stressful events often contribute to schizophrenia development in the patients who were predisposed to the sickness. Mental illnesses have similar symptoms and thus arriving at the proper diagnosis can often be tricky. The symptoms for schizophrenia according to the Schizophrenia Fellowship of New South Wales (2008) can be divided into four categories i. e positive, negative, cognitive and mood and anxiety symptoms. Positive symptoms include delusions, hallucinations, and disorganised thoughts; negative symptoms include loss of the ability to enjoy life and lack of motivation; cognitive symptoms include lapses in concentrations; while mood and anxiety symptoms include anxiety and depression. A person with a combination of these symptoms is very likely to be schizophrenic. The subject in this case study, John, by all accounts meets the above symptoms. For instance, his poor university attendance, resignation from his part-time job and his increasingly untidy appearance are all negative symptoms and point to his loss/ lack of motivation; his increasing reclusiveness is a cognitive symptom and points to depression; while his nonsensical claim that government scientists had started to perform experiments which planted some strange ideas in his head and that caused him to hear voices in his head are clear evidence of hallucinations and are positive symptoms. Wirth such a combination of symptoms, it is almost certain that John suffer from schizophrenia. Nursing interventions for the mentally ill person Nurses play a crucial role in assisting psychiatric patients like John who are suffering from schizophrenia to use their medication properly. Data analysis has shown that comparative validations and methods used by nursing literature have helped in identifying proper treatment of patients which include the formulation of a therapeutic relationship, engagement and finding out why there is abrupt behavior change as well as persistently trying everything possible that can be of assistance to the patients. Psychiatric nurses in Australia have used a variety of individualized and varied techniques in convincing involuntary patients to take their prescribed medications. In order to transform the mental health profession, nurses have to go beyond the already existing parameters and structures to disengage from an unwelcoming and oppressive system (Meerwijk, 2010). A therapeutic alliance involves listening to a patient without being judgmental. Throughout the care of John, one of the most important factors to consider was establishing such a therapeutic- based relationship with him. According to O’Brien and Fanker (2008), the formation of a therapeutic relationship with a person suffering from mental illness is essential in promoting positive outcomes of treatment and well being. For the nurses to maintain a therapeutic relationship, factors like genuineness, emphatic understanding and unconditional positive regards are required because they allow the patients to express themselves without which the patient is very likely to turn violent. In addition, according to (Backrush, 1981), continuity of care is a necessary component of nursing in relation to dealing with mental health patients. Therefore, in case the nurse has constraints to the time they can spend with the patient, he/she should make time throughout a shift to spend some time with the patients. Of utmost importance is that the treatment goes according to a set timetable and that the rhythm of such a schedule is not disrupted for the sake of maintaining stability with the patient. This was adhered to during the treatment of John. Creating good communication is crucial in health and social care practices because the patients and the health care professional require a clear understanding of each other so that the patient can receive the best care possible (Meerwijk, 2010). This implies that providing good care to the patient would be next to impossible if the patient’s requirements are not clearly stated and understood. It is important to establish rapport and good communication which is what was necessary with John in helping ease his anxiety. Patients like John would be at a higher risk of frustration and anxiety if communication attempts are unsuccessful and thus such an approach was highly necessary when dealing with John. In that regard, the tone of voice, facial expressions and how the nurses presented themselves had a huge impact on the therapy and went long way in helping reduce John’s apprehension. For violent patients, the nurses are advised to speak in low tones for the patient to feel comfortable in the new environment. Approaches taken to support the family of mentally ill support persons According to Elder (2009, p. 446), schizophrenia places a huge burden on family members and this has been true in Australia where the deinstitutionalization of patients has been going on since the 1980’s. To ease this burden, hospitals and nurses should go beyond just hospitalization, psychiatric examinations and drug treatments but extend their services towards provisions of beddings, clothes and food which further enhance a therapeutic relationship. In addition, implementation of electronics in nursing practices should be encouraged whereby mentally unhealthy peoples’ families can keep in touch easily with their schizophrenic family member electronically to help improve communication. Practitioners currently use e-communication as a clinical communication in an effort to decrease costs, maximize patient clinical results and improve clinical efficiency. At times it is hard for the family members to offer support to their patients in case they have to go to work on daily basis. It is thus important for the family members to be persuaded to take an option of community day care because in most case, community care reassures that they have proper resources to support the patients during the day (Australian Medical Association, 2003). Family care employees have been identified to provide support in the homes of the patients at day time. In addition, they provide social support which is much needed for the mentally sick patients. The nurses in such cases use resources from the existing local community in providing the required support. This kind of support is important because it does not only enable the patients to stay home as they get their recovery but it also ensures that the family members go to work in the process avoiding job losses. The nurses provide education about depression, early warning signs, medication, stress management and also address health issues to the families and the patients. This has been recognized to make the patients feel less isolated because they are with supportive people as well as getting normal daily activities around them. The patients feel confident with the support of family care nurses and this helps them explore and manage their illness more than they could have done if they were hospitalized. According to Legatt (2000), families of the mentally ill should seek more help from non-governmental organizations (NGOs) that play key roles in providing support to consumers affected by mental distress. The NGOs establish this by complementing the existing mental health services, strengthening society partnerships and support as well as providing direct service delivery to the patients and their families. The nurses who work for the NGOs are aware and knowledgeable of the range of services needed by the patients they attend to. The nurses also raise community awareness to the people. Family members are requested to attend trainings from such community based awareness campaigns to get more educated on how to cope with the mental health patients (Australian Medical Association, 2003). Four Commonly Used Medications That Would Be Used For the Condition in Australia Medications for the mental illnesses have been in use since 1950s where there was the use of antipsychotic chlorpromazine. These medications have improved the lives of patients with mental health disorders for the better. In occasional cases, the medications shorten the course of an episode of the sickness. The medications that are best recommended are neuroleptic as they affect the neurotransmitters in the body that allow communication among the nerve cells. Several new drugs for schizophrenia were introduced by the term atypical antipsychotics because they had fewer side effects than other older drugs. They became so effective that they were used as first line treatment. The first atypical antipsychotic medicine was clozapine (Clozaril) which was introduced in the Australia in the year 1990. It was found to have more curative effect than other conventional antipsychotic medications in patients who had developed a resistance to other treatments of schizophrenia. In addition, it was noted to reduce risks of tardive dyskinesia which is a movement disorder. However, due to a side effect known as agranulocytosis (a blood disorder of loss of white blood cells) patients who used clozapine were supposed to take blood tests often, a major inconvenience plus an expensive undertaking due to the high costs incurred with the medication. After the introduction of clozapine, other atypical antipsychotics were developed and tested in the laboratories and used widely in Australia. At first risperidone (Risperdal) was introduced followed by olanzapine (Zyprexa). Quetiapine (Seroquel) came third and then ziprasidone (Geodon) being the fourth. Each of these drugs has its side effects but they are generally better tolerated compared to the earlier medicines. However, they have different places in the treatment of schizophrenia so the doctors are advised to choose wisely when prescribe them for patients. The doctors consider the patient’s disease signs, patient’s weight, age as well as the medication history of the family. In relation to the dosages, some drugs are more potent than others calling for the doctor to prescribe a lower dosage than for the less potent drugs. For the less potent drugs, a higher dosage is normally prescribed. Some antipsychotic drugs may be taken just once on daily basis as opposed to other drugs which are taken many times in a day. Several side effects of these drugs are mild and some common ones disappear or lessen after a few weeks of treatment. Some of these side effects include rapid heartbeat, drowsiness and dizziness when a patient changes position during bed or resting time. Some patients who are under medication increase weight thus the need to have frequent exercise. Other side effects include skin rashes, sunburn, menstrual period problems and a decrease in sexual interest or ability. If a side effect happens, the doctor should be notified for the change of medication, dose reschedule or prescription of another medication which may help in controlling the side effects (Bilder et al, 2007). Reflection on how it felt working with John Working with John was both a positive and negative experience- positive in the sense that it was heart lifting to see him improve but negative in seeing how at times he suffered. I believe that the society’s support is necessary in treating those who are viewed as having limitations in their functional capability for them to be felt as members of the society. The experience with John is evidence that critical thinking is crucial in the daily nursing practice. This is due to the fact that critical thinking (an organized and an active cognitive relationship that one should use carefully in examining one’s ways of thinking and the thinking of others) would dictate the best way of approaching situations. Caring for patients like John, involves more than actual kindness, empathy, attention and compassion. It requires skills that require a care taker to have an orientation towards human science- having care that involves the patients relationship and showing experiences in everyday life of nursing practices. In other words, it needs interpersonal relationships which require administration of care (Mental Health Foundation of Australia (Victoria), 2009). Another observation is that caring for the mentally ill patients enables both the nurses and family members to place a patient in a family, society and culture context. This context helps the nurses to not only teach and direct themselves concerning the importance of interacting with the patient as a human being rather than a patient, but it also provides the nurses with the capability of practicing their profession better in line with the tenets of their work as opposed to just science or technology. This is crucial in developing the profession as a mental health nurse. Meeting patients physical requirements is also very key. According to Marini (1999), a theory by Watson on transpersonal caring was widely used to determine the perception of mental sick patients on the caring capability of nurses. It was noted that the most essential component in caring for the mentally sick is the ability of the nurses to meet their patient’s physical requirements. In other words, during the care of John, it was necessary to take care of his physical needs such as ensuring he was clean, comfortable, well- fed and not sick in any way. Other measures that were necessary were massages, soothing, touching and feeling them; sitting with them on the bed side, emotionally connecting with the patients while giving them the needed nursing care. These practices allow the nurses and family members care for their patients as well as themselves. It should be seen as a mutual relationship between the patient and the nurses so as to increase the awareness as well as promote a healing and recovering environment. Conclusion In a nutshell, it is very evident that anyone is capable of developing a mental illness such as schizophrenia as did our patient, John. Understanding the illness, its causes and symptoms are necessary in effectively dealing with it. In addition, nurses are required to have an understanding of various factors that influence the practice itself so as to make sense of mental health nursing practices. Some of the factors include health plans and policies, theories about various aspects of mental health and its practices, cultural and social factors together with the values, attitudes and beliefs which guide peoples thinking. Some disorders could be mild, serious and long lasting but these conditions can be diagnosed through proper tests and be treated medically. Mental diseases are not a death sentence and most patients can lead better lives through treatment using psychotherapeutic medications which have become increasingly essential elements in the successful treatment of mental sicknesses. With early diagnosis, proper treatment and the involvement of the patient’s family members, schizophrenic people can lead next to normal lives and thus the attainment of this should be the focus of mental health practitioners in the country. References Australian Medical Association. (2003). Fund schizophrenia care says Fels. Retrieved September 1, 2010 from http://ama.com.au/node/1355 Backrush (1981).Continuity of care for chronic mental patients: a conceptual analysis. Am J Psychiatry Vol 138:1449-1456. Bilder, Robert M. et al .(2007). Neurocognitive Effects of Clozapine, Olanzapine, Risperidone, and Haloperidol in Patients with Chronic Schizophrenia or Schizoaffective Disorder. 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Retrieved September 1, 2010 from http://au.reachout.com/find/articles/understanding-schizophrenia-and-getting-help Rosenheck R, Lam JA. (1997). Homeless mentally ill clients’ and providers’ perceptions of service needs and clients’ use of services. Psychiatric Services: Vol 48: 381-6. Schizophrenia Fellowship of New South Wales. (2008). Schizophrenia- Symptoms. Retrieved September 1, 2010 from http://www.sfnsw.org.au/About-Mental-Illness/Schizophrenia/Symptoms/default.aspx Read More