Mental health problems, together with other illnesses need to be addressed by having organized a therapeutic plan that covers both the healthcare provider and the patient. This should encompass a multidisciplinary team, and ensure trust and confidence developed ("Therapeutic Relationship - an overview | ScienceDirect Topics", 2018). In general, mental health conditions are managed by a collaborative approach between doctor, nurse-patient and caregiver and some of these will be exploited using Janine’s case.
1. It is important to develop a therapeutic relationship between a health care provider and the patient. This type of patient health care provider relationship forms an integral part in managing the patient and creating a huge difference in patient experience and outcome of therapy ("Therapeutic Relationship - an overview | ScienceDirect Topics", 2018). Therapeutic relationship is marked by having trust in each other, building a rapport and providing an environment for helping patients to change (Keller & White, 2015). Without this relationship, it is evident that information conveyed to the patient may be overlooked.
In the modern world of health care provision, patients have rights and responsibilities that should be looked into. Despite the fact that they fully depend on the health care providers, patients should be able to ensure that their rights are not breached ("Patient Rights and Responsibilities", 2018). This is important especially in mentally challenged patients like Janine. According to Patients’ Rights & Responsibilities, (2018), patients have a right to make their own choices. These include a choice for their private life, which in this case was breached by Janine’s manager who would walk in his private room anytime.
A good therapeutic relationship is necessary to enable maximization of communication skills between nurses and patients, understand both the behaviors of the nurse and patient and to enhance patient growth (Shankar & Collyer, 2015). Before developing a therapeutic relationship, its goals should be understood. Some of the objectives include helping patients solve their problems and enhance daily living, assist clients in looking into self-defeating behaviors and finding alternatives, enhancing communication and promoting independence and ability to take care of ones’ self (Shankar & Collyer, 2015). Therapeutic relationship development involves processes like trust, respect, empathy, genuineness and reflective listening.
Trust and confidence at personal level makes interpersonal relationship easier, (Graham, Shahani, Grimes, Hartman, & Giordano, 2015). By greeting and introducing ones’ self to the patient, trust and confidence starts to build. Janine’s manager should at least greet her every morning when he comes to check on her (Janine). Trust in its entirety brings respect between the health care provider and the patient. With a high level of trust between Janine’s nurse and manager, the picture of disrespect to Janine would have not manifested.
Reflective listening and building up of rapport forms the building block of genuine interest, which is also a way of developing therapeutic relationship (Keller & White, 2015). An instance of reflective thinking is when one repeats what the patient has said to them. This makes the clinician the patient’s mirror, making them know that the clinician is trying to understand them. In overall, it fosters the patient clinician relationship, and shows genuine interest in their care.
Empathy is another tenet of therapeutic relationship. It involves accepting the patient’s story after identifying and communicating an understanding about it. It makes the patient feel understood and feel safe, (Keller & White, 2015). Empathy enhances compliance in those diagnosed with schizophrenia like Janine, ("The role of empathy in quality therapeutic engagement for increasing motivation for change in schizophrenia", 2018).
2. A nursing outline should be developed to care for patients and this should address the following aspects; mental, physical, spiritual, emotional, social and cultural requirements. This is according to Townsend & Morgan, (2017). Janine’s mental health can be addressed by adopting medical, social and psychosocial approach to treatment. Janine has had a chronic mental disorder and also experiences delusions, hallucinations and suicidal thoughts. Her condition qualifies for medical treatment like the use of antipsychotics like haloperidol and newer generation agents like olanzapine.
Treatment outcomes for the mentally ill patients can be improved by enhancing physical healthcare provision for these patients. It has been shown that mentally ill patients are at high risk of developing systemic conditions and infectious problems (Calkin, Ford, Ford & Ford, 2016). A nursing care plan for this would be to encourage close monitoring of the antipsychotic drugs for their side effects, proper feeding, bringing on board a multidisciplinary team that will ensure that systemic problems for Janine are looked into in advance before they ensue. For instance, due to her stay in the private accommodation facility, Janine is likely to develop health care acquired infections like pneumonia.
As part of a holistic nursing care, the spiritual needs of a patient should also be addressed. Interventions like scripture, referrals to meet spiritual needs and active listening are some of the ways in which Janine’s spiritual needs can be met as O’brien (2017) suggests. The World Health Organization’s definition of health also includes the mental and social well-being, which forms part of spiritual health. Assessing Janine’s spiritual needs would involve active interaction with her together with her family. Some of the interventions to achieve Janine’s spiritual needs would be assisting her in religious activities, meditation, involving the facility’s chaplain services and physical care (Singer, 2018).
Emotional needs include security, attention, friendship, attention, sense of status and privacy. Janine’s emotional needs are not being met adequately. The nursing team should design an outline on how to achieve this, ("Support Needs of People with Mental Illness in Vocational Rehabilitation Programs-the role of the social network.” 2015). For instance, the manager of the private accommodation facility is a threat to Janine’s security, friendship, privacy and does not give her attention whenever she needs it. As a measure to curb this, Community Mental Health Team (CMHT) was brought on board to look into the problem.
Social and cultural needs
Social and cultural stigma for mentally ill patients continues to be a hindrance to their care. Different societies have different cultures. Therefore they perceive mental illness differently and conceptualize its course in a diverse way. Some communities regard mental illness as a taboo especially in the developing countries, (Roberts, Mann & Montgomery, 2016). Janine’s community might be stigmatizing her because of her condition. Her social circle has reduced therefore she feels that suicide is the only way out. A nursing plan on educating the community on mental illness on social media can help alleviate these problems.
3. Therapeutic approach towards Janine’s mental condition needs collaborative work between the patient, health care providers, family, community and friends, (Bolton, Gunnell & Turecki, 2015). A combination of physical (drugs), social and psychosocial therapy will confer a better outcome.
This includes the use of antipsychotics to alleviate Janine’s symptoms of hallucination and suicidal thoughts. Typical antipsychotics like haloperidol and the newer agents like olanzapine are some of the drugs that can be used as suggested by Jorm (2017). Sedatives like lorazepam can be used in acute psychotic states that Janine experiences (Sørup, Hallas, Brunak & Andersen, 2017). Monitoring of the drugs should also be done since they have side effects. This needs a multidisciplinary team between the patient, doctor, nurse and pharmacist to help recognize these side effects. Part of the physical approach includes compliance therapy where a caregiver, doctor and nurse have to make sure that the patient takes the drugs. It goes with acceptance and commitment therapy where the patient has to accept that they have a mental condition, and that they will be committed to take them and adhere to medication.
Physiological therapy combines both patient and doctor interaction. It is based on the principles of therapeutic factors. Success in this form of therapy needs the health care provider to select the right therapy for the patient, prepare adequately and ensures that the therapy is available, (Alan & Szmelskyj, 2015).
Psychotherapy also involves cognitive, behavioral and cognitive behavioral therapy. Behavioral therapy will ensure that Janine learns adaptive behaviors like engaging in her social activities more whenever she experiences suicidal thoughts, (Scheff, 2017). Cognitive therapy corrects an inaccurate way of thinking. The patient’s thoughts are evaluated and an explanation for the role of cognitive perpetuating the problem is provided to the patient. Janine’s case includes how to identify suicidal thoughts and the way of overcoming those (Bushby et al., 2010). This method also needs collaboration between the patient, doctor and a psychologist. Cognitive behavioral therapy combined the two interventions described above.
The importance of social factors as predisposing and precipitating factors for mental illness cannot be underestimated. For Janine, they include having a manager who does not understand her and lack of friends, (O’Hara & Wisner, 2014). Psychiatric admission forms part of the management of mental illness especially when the patient is a risk to the community or when their condition is worsening. This method also needs a collaborative approach between the doctor, nurse, patient and community health care providers who provide psychological interventions like medication, telephone support, and home visits, (Strauss, 2017). The family can also be included to offer emotional support and as part of psychiatric rehabilitation. A proper nursing care is needed for such patients when they are admitted. As part of addressing her social needs, Janine has been employed by consumer run initiative and also attends a community support facility for her social activities. Chronic psychiatric disorders like Janine’s can also be managed by rehabilitation, although prognosis is better when the patient agrees to be rehabilitated, (Mishara & Chagnon, 2016).
4. Multiple and diverse factors are associated with psychiatric disorders. The contributing factors differ from each patient. A single factor can also lead to several and different disorders. Risk factors can be divided into psychologic, biologic and social factors and each entity has predisposing, precipitating and maintaining factors, (Ward, White & Druss, 2015)
Predisposing risk factors
Predisposing risk factors increases an individual’s vulnerability to developing a mental disorder. This can be assessed in order of biologic, social and psychological aspects. Questions to ask include if there is a history of mental illness in Janine’s family, any form of trauma or personality disorders when looking at the biologic factors. However, the case presented no biologic factors can be picked as shown by Morgan & Ho (2017). Social factors can be assessed by finding out any physical or emotional deprivation during childhood, family discord, bereavement or a history of separation from loved ones. Difficulties at work or financial constraints are also part of this. Janine does not display any of these predisposing factors. Psychological risk factors that makes one likely to have mental illness include inappropriate parenting models, maladaptive behaviors or even some forms of personality disorders (Dennis et al., 2009). This is not displayed in Janine’s case scenario.
Precipitating risk factors
This determines when the illness starts. They are non-specific and only determines the time the illness starts and not the type of illness. Biological factors include recent physical disease like infections, injury causing disability or malignant disease, therefore, it is important to ask about these, (Morgan & Ho, 2017). Janine shows no precipitating biological factors. Social aspects include recent life events like those involving loss of loved ones or a threat. The Psychological part of this includes a response to biologic or social factors, low self-esteem, hopelessness and helplessness. An in-depth interview into biologic or social factors can give a clue to this.
Maintaining risk factors
Maintaining factors prolongs the already existing disorder, longer than it is usually expected. The question to ask one’s self is that why is there no recovery. These can also be divided into biological, social and psychosocial factors. Biological ones include physical disease or chronic pain, (Morgan & Ho, 2017). In Janine’s case, the limp and chronic pain after an accident could be the maintaining factor for her mental illness. Acute episodes of her illness also suggest that she is not compliant to her medications. This can also be explained by her indulging in cannabis smoking with residents in the private accommodation thus needs to be reminded to eat and take her medication.
Examples of social factors are adverse social environment, lack of intimate relationships and negative interactions, (Morgan & Ho, 2017). In Janine’s case, her environment at the private accommodation facility is harsh, characterized by the manager who does not care about her needs. Negative interactions with the residents of the facility have led her to use cannabis, therefore, preventing better management of her condition. The psychosocial aspect includes lack of friends, therefore, making her hopeless and lonely therefore prolonging her illness.
In conclusion, Janine’s case has been evaluated and therapeutic interventions put across in a matter that demonstrates the need for trust, confidence and multidisciplinary team action ("Therapeutic Relationship - an overview | ScienceDirect Topics", 2018). Individual therapeutic interventions have also been put across and discussed. Furthermore, Janine’s risk factors for developing her mental illness has been highlighted too while relating to her clinical scenario. A nursing plan has been included.
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