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The written assignment for this unit is based on students choosing a topic from the list of topics provided and undertake a literature search relevant to the chosen topic (10 refereed  journal articles).  Students will then provide a critical analysis of the chosen topic with the support of the literature reviewed including a discussion on how the knowledge gained will assist in advancing their

role in the work place.

Principles of nursing management of patients/clients with respiratory or cardiac medical-surgical conditions.

Principles of nursing management of patients/clients with medical-surgical conditions relevant to cerebral/ neurological systems.

Principles of nursing management of patients/clients with medical-surgical conditions relevant to haematological / vascular systems.

Gerontological/Aged care nursing – Principles of nursing management of older people requiring aged care.

a.  RehabilitationNursing: Principles and management of patients/clients requiring rehabilitation

b.Community/RuralandRemote (Bush) nursing: Principles and management of clients in community health care settings

Mental Health Nursing principles (meeting the needs of people with altered mental health status in hospital/institutional and community settings.

Principles of altered mental health

The change in mental status refers to common changes in brain performance, like a misunderstanding, memory loss, loss of attentiveness, incomprehension, faults in decision making or thought, uncommon or odd behavior, underprivileged regulation of feelings, and troubles in perception, psychomotor abilities, and behavior (Wilber, 2006). However an altered mental status is clearly the feature of a number of emotional and psychiatric conditions, medical situations and harms that cause impairment to the brain, counting alcohol or overconsumption of drug and drawing syndromes, can also result in mental status alterations. Misperception, exhaustion, delirium, dementia problem, encephalopathy, and the organic brain syndrome are altogether terms that have been applied to bring up to circumstances hallmarked by psychological status alterations (King, & Avner, 2003). Various studies conducted in emergency divisions have found that AMS is the main reason for the appointment in around 4 percent to 10 percent of all patients. Altered mental status is more usual in different types of patients. Nearly 25 percent to 30 percent of elderly patients visit the emergency section with AMS (Han, & Wilber, 2013).  Significantly, an analysis of AMS can be hard to unravel in an elderly patient with dementia. Acute altered mental status is considered a very wide topic and can include any number of conditions, from minor agitation to delirium, or from sleepy to coma (Han, & Wilber, 2013). In this particular written assignment, the nursing principles that meet the needs of the patient with the altered mental condition in the hospital setting will be discussed.

Patient’s Rights and Important freedoms 

All individuals have the basic rights to acquire the optimum accessible mental health care, which must be comprised in the communal and health care system. All patients with the altered mental position or other mental illnesses or people under treatment as such persons need to be healed with esteem and mortality for the distinguishing dignity of the diseased person (Gostin, & Gable, 2004). All the people who are receiving treatment must be protected from economic, sexual, bodily and other types of maltreatment, manipulation, and low leveled treatment. The discrimination must not happen on the foundation of psychosomatic illness or others aspects. "Discrimination" is some difference, favoritism, and removal that outcomes in the obliterating or causing impairment to the same fulfillment of moralities (Drew et al., 2011). Partiality does not involve any difference, and predisposition commenced in consent form with the requirements of these ethics or principles and important to preserve the civil privileges or rights of a person with a changed mental problem or of other persons (Gostin, & Gable, 2004).

Every human with changed mental status must have the right to get all political, communal, financial, cultural, and  basic rights as accepted in the International statement of communal rights, the universal covenant on commercial, cultural and common rights, the international covenant on community and constitutional rights, and in other associated instruments, for example, the declaration on the human rights of bodily or mentally challenged individuals the values should be followed by the authority for the security of every individual under any kind of caging (Townsend, & Morgan, 2017). Any decision that, by purpose of the deceased person's mental condition, a person shortages lawful capability, and any decision that, results in such inability, an isolated illustrative must be chosen, must be made lone after a neutral trial by an autonomous and neutral group made by local law (Fortinash, & Worret, 2014). Where a federal or Supreme Court or other proficient tribunal determines that a person with Changed mental health status is unable to uphold his or her personal difficulties, measures must be taken, if it is necessary and appropriate to that individual's illness, to check the safety of his or her anxiety (Townsend, & Morgan, 2017). 

Patient’s Rights and Important Freedoms

High quality care must be delivered within the boundaries of these standards or principles and according to the framework of local regulation connecting to the well-being of minors to protect the their essential rights, as well as, if needed, the choice of an specific illustrator other than the member of the family (Bolster, & Manias, 2010). Nurses must treat each person with gentleness and respect; they should notice patient’s particular desires and display sympathy and kindliness, and provide intervention in such a way that praises and respect all the individuals with changed mental status (Bolster, & Manias, 2010).

A nursing purpose in relation to that a person has a psychological sickness must be made according to the internationally accepted medical principles. A determination of disturbed psychological status should not be organized on the foundation of economic, governmental, civic status, or connotation of a racial, cultural, sacred, or any additional motive not openly associated to altered psychological health position (Battersby, Von Korff, Schaefer, Davis, Ludman, Greene, & Wagner, 2010).

Professional or family conflict, or any non-conformity with social, ethical, political or traditional values or spiritual beliefs prevailing in an individual's community, should never be a defining factor in identifying altered mental illness (Johnstone, 2015). An involvement in earlier treatment or hospital visit as a diseased person must not of itself secure any contemporary or coming determination of changed psychological condition. No nurse or authority needs to classify a person as having, or then stipulate that a person has, a mental problem excluding for determinations willingly connecting to a psychological disorder or the prices of mental issues (Battersby, et al., 2010).

The nurses must consider the privacy or confidentiality of the information related to the patient. The right of confidentiality of person’s information about all individuals to whom these Ethics or principles apply necessarily be appreciated (Baird et., 2014).

  1. Every person with mental illness must have the basic right to be healed and be worried for, as far as feasible, in the communal or hospital.  

  2. Where illness management carried out in the facility of psychological health, the patient must ensure to have the right, if feasible, to be healed or treated in the existence of his or her relative, family member, or friend (Fairweather, Sanders, Cressler, & Maynard, 2017).

  3. All patients should have the right to choose the treatment appropriate to their cultural background (Fairweather, Sanders, Cressler, & Maynard, 2017).
  1. Every patient admitted to the hospital setting should be given the right to obtain such wellbeing care that is proper to their health requirements and is permitted to receive attention and cure options in accord with the similar level as other sick persons.

  2. It is the ethical and practiced duty of the nurses to safeguard the diseased person from harm, counting contamination, fall, partial treatment, and maltreatment by other hospitalized person, employee or any action that can lead to psychological suffering or bodily discomfort (Townsend, & Morgan, 2017).

The minimum restricting atmosphere must be maintained near the diseased person and with the lowest uncooperative or disturbing disease management proper to the mentally unwell person’s wellbeing desires and the requisite to care for the physical safety of other people.

The supervision of disorder and upkeep of each mentally ill person requisite be to deal with the specific approved plan, mutual with the patient, tested or reviewed regularly, revised as needed and carried out by trained and skilled nurses (Parahoo, 2014).

 Mental health services must be conveyed according to the suitable principle or standards for nurses provides psychological interventions, counting global acknowledged standards, for example, the standards of medicinal principles acknowledged by the United Nations General Assembly. Information on mental health and capacities must never be ignored.

The sickness management of all patients must be concentrate on keeping and improving individual autonomy (Videbeck, & Videbeck, 2013).

Administration of drug must reach the standard of every health requirements of the diseased person with the changed mental health situation, must be brought to the patient particularly for investigative or therapeutic purposes. Nurses are expected to administer a medicine or drug of accepted or proven efficacy.

All medicines or drugs must be administered to the mentally ill person according to the instruction provided by the official physician and must be documented in the recording sheet of the patient (Parahoo, 2014).

Minor people’s safety

Treatment must not be used for the mentally ill person without their knowledgeable consent.

Informed written agreement is actually the consent expected naturally, without pressures or wrong inducements, after accurate revelation to the mentally sick person of proper and understandable information in a written agreement and language that is understandable by the diseased person on the analytical assessment; the aim, process, expected period and probable benefit of the scheduled treatment; additional modes of medication, together with those less invasive; feasible discomposure or pain, dangers, and opposing effects of the scheduled cure (Schenker, & Meisel, 2011).

The mentally ill person may request for the existence of his or her family member or and relative at the time of the practice for authorizing consent.

The person with mental issues can avoid or refuse the treatment. But, the problems associated with declining the treatment necessarily are explained to the individual or their family member.

The patient must positively not be inquired or stimulated to abandon the right to well-informed consent. Still, if the patient does not want the same, then, it must be elucidated with the person that the treatment process of a related disorder cannot be initiated without the knowledgeable consent (Parahoo, 2014).

The recommended plan of disease management can be delivered to a diseased person without his or her informed consent in some situations, given below;

  • The diseased person is, at the related time, detained as an instinctive patient.

  • An autonomous authority, having the ownership of all associated data, including the data, is contended that, at the expected time, the individual lacks the ability to deliver or decline the consent to the recommended plan of healing or, if local regulation so provides, that, having admiration to the individual’s own protection or the wellbeing of others, the diseased person knowingly refuses such consent.

  • The autonomous authority satisfied that the recommended plan of healing or treatment is in the best concern of the mentally ill person’s wellbeing necessities (Stuart, 2014).

Every treatment should be immediately noted in the patient’s medical record sheet, with a recommendation of whether instinctive or voluntary (Stuart, 2014).

Physical issues or involuntary separation of a patient must not be avoided and the treatment should be provided according to the publicly recognized practices of the mental health facility and precisely when it is the single means present to stop prompt or upcoming injury to the mentally ill person or others. It must not be extended and outside the recommended time period which is thoroughly necessary for the determination. The complete occurrences of physical restriction or involuntary separation, the objects for them and their personal behavior and rate instantly noted in the patients’ medical record sheet (Morgan et al., 2012).

The standard medical or surgical practice can be applied on the person with altered mental status specifically where it is permissible by the public law, where it is resolute that it can best appear to the wellbeing needs of the mentally ill individuals and where they arrange for the informed consent, without that, where the diseased person is unable to provide the knowledgeable consent, the practice must be accepted, only after the autonomous assessment (Franklin, Rowland, Fox, & Nicolson, 2012).

The individual in the psychological or mental health hospital setting essentially be knowledgeable previously after admission, in a paper and in the reasonable language to the diseased person, of all their human or basic rights appropriate to the values and principle and according to the general law, which data or information should comprise an explanation of those rights and the procedure of applying them descriptively (Szmukler, Daw, & Callard, 2014). If the mentally ill person is not capable to recognize such information, the rights of the person must converse to the particular illustrative (Molodynski, Rugkåsa, & Burns, 2010).

Resolving the mental sickness

Every patient in a hospital must be in particular keep the right to acquire full respect or admiration for their: response everywhere as a person before the law; privacy or confidentiality (Shea, 2016).

Where the mentally ill person requests, medication in the hospital setting, every effort must be prepared to avoid the involuntary admission. Admission to the hospital must be organized in a parallel way as admittance to other amenities for any other illness. Nurses and other staff should work collectively to make sure that the person will get a good care and disease management that also complete or fulfill the client satisfaction

The values or principles should be apprehensive with the completed work and the outcomes of the specialized physician in the hospital setting of their usual functioning environment. The values for particular practice embrace a definition of the significant personal features that are imaginary to underlie ability in the viewpoint of mental health nursing. The standard and principles for the particular exercise the level of job performance desired the outcomes to the predictable and the circumstantial in which the therapeutic task presentation takes place (Shea, 2016). The nurses must form a therapeutic communication with the diseased person with altered mental health status. Any patient with mental problems frequently seems to be difficult and hard to handle, in this case, the professional nurses must not be irritated or annoyed and deal with them steadily and or calmly (Stuart, 2014).  Occasionally the patient’s behavior might be worrying and violent; in that case, the mental nurses should safeguard themselves and talk to the concerning physician or higher authority (Stuart, 2014).

Conclusion

The altered mental health problem is the problem associated with the brain functioning that generally caused among the hospitalized person. It is found that the alterations in the cerebral, emotional, psychological, and personal well-being which usually escorted by the fluctuations in the patient’s activities or behavior. The person with Altered mental wellbeing problems frequently not dealt appropriately and with dignity, the medical professionals or nurses occasionally become impolite and careless. Thus, the essential principles correlated to the psychological health problems are crucial to discuss. Certain principles comprise considering the basic human rights of the diseased, caring the minors, determining the psychological health disorder, keep the diseased person information private, providing high quality care, including them or/and their family members in decision making process, planned cute methods must be disclosed with them and their relative or family member, medicine used for the patient must be uniform, and the treatment-related consent form must be taken from the diseased person and if the person is not able to provide the document then it must be debated with his or her family member. The individual often requests for the attendance of a known. The secrecy for the patient must be delivered, the patient has to be knowledgeable with the treatment detail and the predictable of recovery, the nurses must follow the regular process of protecting the patient from contamination, self-harm, other injuries. They should also record the disease management process and the patient's data in the individual’s record sheet.

References

Baird, M., Blount, A., Brungardt, S., Dickinson, P., Dietrich, A., Epperly, T., & McDaniel, S. (2014). Joint principles: integrating behavioral health care into the patient-centered medical home. The Annals of Family Medicine, 12(2), 183-185.
Fairweather, G. W., Sanders, D. H., Cressler, D. L., & Maynard, H. (2017). Community life for the mentally ill: An alternative to institutional care. Routledge.

Battersby, M., Von Korff, M., Schaefer, J., Davis, C., Ludman, E., Greene, S. M., & Wagner, E. H. (2010). Twelve evidence-based principles for implementing self-management support in primary care. The Joint Commission Journal on Quality and Patient Safety, 36(12), 561-570.

Bolster, D., & Manias, E. (2010). Person-centered interactions between nurses and patients during medication activities in an acute hospital setting: qualitative observation and interview study. International journal of nursing studies, 47(2), 154-165.

Drew, N., Funk, M., Tang, S., Lamichhane, J., Chávez, E., Katontoka, S., & Saraceno, B. (2011). Human rights violations of people with mental and psychosocial disabilities: an unresolved global crisis. The Lancet, 378(9803), 1664-1675.

Fortinash, K. M., & Worret, P. A. H. (2014). Psychiatric Mental Health Nursing-E-Book. Elsevier Health Sciences.

Franklin, P., Rowland, E., Fox, R., & Nicolson, P. (2012). Research ethics in accessing hospital staff and securing informed consent. Qualitative health research, 22(12), 1727-1738.

Gostin, L. O., & Gable, L. (2004). The human rights of persons with mental disabilities: a global perspective on the application of human rights principles to mental health. Md. l. rev., 63, 20.

Han, J. H., & Wilber, S. T. (2013). Altered mental status in older patients in the emergency department. Clinics in geriatric medicine, 29(1), 101-136.

Johnstone, M. J. (2015). Bioethics: a nursing perspective. Elsevier Health Sciences.

King, D., & Avner, J. R. (2003). Altered mental status. Clinical Pediatric Emergency Medicine, 4(3), 171-178.

Morgan, R. D., Flora, D. B., Kroner, D. G., Mills, J. F., Varghese, F., & Steffan, J. S. (2012). Treating offenders with mental illness: A research synthesis. Law and Human Behavior, 36(1), 37.

Parahoo, K. (2014). Nursing research: principles, process, and issues. Macmillan International Higher Education.

Schenker, Y., & Meisel, A. (2011). Informed consent in clinical care: practical considerations in the effort to achieve ethical goals. JAMA, 305(11), 1130-1131.

Shea, S. C. (2016). Psychiatric Interviewing E-Book: The Art of Understanding: A Practical Guide for Psychiatrists, Psychologists, Counselors, Social Workers, Nurses, and Other Mental Health Professionals. Elsevier Health Sciences.

Stuart, G. W. (2014). Principles and Practice of Psychiatric Nursing-E-Book. Elsevier Health Sciences.

Szmukler, G., Daw, R., & Callard, F. (2014). Mental health law and the UN Convention on the rights of persons with disabilities. International journal of law and psychiatry, 37(3), 245-252.

Townsend, M. C., & Morgan, K. I. (2017). Psychiatric mental health nursing: Concepts of care in evidence-based practice (9th ed.P). Philadelphia: FA Davis.

Townsend, M. C., & Morgan, K. I. (2017). Psychiatric mental health nursing: Concepts of care in evidence-based practice. FA Davis.

Videbeck, S., & Videbeck, S. (2013). Psychiatric-mental health nursing. Lippincott Williams & Wilkins.

Wilber, S. T. (2006). Altered mental status in older emergency department patients. Emergency Medicine Clinics, 24(2), 299-316.

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