Nursing Care Plan For Psychotic Disorder - A Case Study Essay.

Understanding Psychotic Disorders

In a nursing care plan, the requirements of a patient availing service through correct identification of the same in encompassed through recognition of the risks of the complication which has been diagnosed. A nursing care plan in mental health nursing helps nurses to communicate efficiently with patients while working in collaboration with other nurses and healthcare workers so that the outcome which is desired can be achieved (Kitwood and Brooker 2019). The nursing care plan begins as soon as a patient is admitted to the healthcare institution for treatment. It encompasses the proper assessment of the condition of the patient followed by diagnosis and then intervention measures are decided along with the rationale for each so that an effective treatment process is achieved. This essay is a care plan for a service user who is suffering from a psychotic disorder. The name of the patient is Fanta and she has been admitted under section 3 of the Mental Health Act. Psychotic disorders are a group of mental disorders which result in abnormal perceptions and thinking. It has been found that people with psychotic disorders lose connection with reality (Clarke and Walsh 2022). The two main symptoms of this disease are hallucinations and delusions. An integrated nursing care plan for Fanta is needed to ensure their recovery of her from the current conditions. Explanation of causative factors using the Biopsychosocial model along with intervention measures to combat the risk factors will help the nurses treat Fanta in a robust manner.

The Biopsychosocial model was initiated by George L. Engel in the year 1977, which was a medical model for the explanation of psychiatric disorders along with their causative factors. This model is an interplay of three factors, namely biological, psychological and social (Bolton and Gillett 2019). With the help of this model, causative factors behind the psychotic disorder in Fanta shall be found. Every factor in the Biopsychosocial model can be categorized into predisposing, precipitating and perpetuating factors (Chambers 2017). The biological factors behind the occurrence of psychotic disorder in Fanta may be genetic predisposition such as family history, gender or any early head injury which was traumatic in nature. There is no particular gene that leads to the occurrence of psychotic disorders but multiple genes that increase the likelihood of developing the disorder. Precipitating biological factors of psychotic disorder involve drug abuse as well as a traumatic head injury. The head injury, along with compliance, is also perpetuating factor of psychotic disease. Urbanicity, getting secluded socially, maladjustment of culture and experiences of victimization which are persistent, humiliating incidents along with disruption of some family relationships, are social and psychological factors that lead to psychosis (Miklowitz 2018).  Fanta is addicted to smoking and drinking along with illicit usage of drugs, which has led her to acquire this disorder. Predisposing psychological factors of psychotic disorder involve conflicts, abuses and social exclusion. The precipitating factors of this disorder are coping style and traumatic events in life along with hopelessness (Pries et al. 2018). It was found that recently Fanta had stopped socializing with friends and in childhood, she was sexually abused. These might be reasons behind acquiring the psychotic disorder. Predisposing social factors behind the occurrence of the disease in Fanta are social isolation and gender discrimination. Disrupted family life and social network of friends are other social contributing factors behind the occurrence of psychotic disorder Fanta.

The Biopsychosocial Model

In psychiatry, each patient is considered to be different and the beliefs, wishes as well as drives of any patient may consist of facets that might impact the treatment process of the individual. To address the needs of Fanta, cognitive-behavioural therapy can be an effective procedure. Cognitive-behavioural therapy for psychotic disorders is based upon the understanding of the way people make sense of their experiences as well as why some individuals remain distressed with the same (Westbrook, Kennerley and Kirk 2011) Implementation of cognitive-behavioural therapy to Fanta will turn out to be beneficial in altering delusions rather than the standard treatment. To make the process of treatment effective, Fanta shall actively engage in the process of therapy which will enable the establishment of a good therapeutic alliance between her and the nurse. With the help of Cognitive-Behavioural Therapy, a therapist shall encourage the patient to consider various ways of understanding the things that are happening to her (Birchwood, Fowler and Jackson 2000). The main aim behind the treatment is to achieve the goals which are meaningful and important to Fanta such as distress, returning to normal life, education as well as training or gaining back a sense of control so that activities such as walking around naked or having suicidal thoughts in mind can be avoided.

Usage of antipsychotic medications is a crucial part of the biological treatment of psychotic disorders. Stabilisers of mood present a key part of the biological treatment of psychotic disorders. Prompt initiation of the treatment of drugs is vital since the illness-related alterations taking place in the brain can be reduced using the same. During the initial phase of treatment, the goal of the care giver is to reduce the nature of hostility in an attempt to make the patient get back to normal (Walker 2017). Antipsychotic medicines work by blocking the impacts of dopamine which is a chemical substance transmitting the message of the brain. However, the care giver or the nurse has to keep in mind that the side effects can affect different people in different manners. Antipsychotic drugs used shall help Fanta to reduce feelings of restlessness and anxiety (French et al. 2010). Clozapine is two medicines that are required to be given to Fanta. Clozapine shall primarily be effective for treating psychotic disorders as it leads to a reduction in the tendency of suicidal behaviours in patients. Clozapine functions by blocking the receptor in the brain for certain neurotransmitters such as dopamine receptors. The mechanism by which Clozapine exerts its effectiveness involves the blocking of 5-HT2A/5-HT2C serotonin receptors along with a receptor of Dopamine (Healy 2008). This creates an antagonistic effect that is able to elicit the psychotic effects without inducing any kind of extrapyramidal effects on the motor system which is associated with antagonists of D₂ dopamine receptor.

Among social interventions, family intervention therapy can be effectively implemented for the treatment of the psychotic disorder. It is a way that will help Fanta and her family (her brother and his wife) cope with her mental health condition of Fanta. Psychotic conditions are severe issues of mental health and they are treatable (Puntis, Oke and Lennox 2018). Support and care from the family will help in achieving better outcomes. Family interventions for psychotic disorders are evidence-based episodes of talking therapies which can significantly reduce rates of relapse and rates of hospital readmission along with improvement of medicinal adherence along with social functioning. In family therapy, the mental health nurse shall conduct a series of meetings that shall take place over a series of times (Chambers 2017). In such meetings, there shall be a discussion on the condition of Fanta and how it may worsen along with the treatments which may help her recover from the same. The therapy will enable the exploration of ways to support the patient with a psychotic disorder. It will help Fanta to solve practical problems that are caused by a psychotic disorder such as planning ways to manage episodes in future.

Cognitive-Behavioral Therapy for Psychotic Disorders

Since Fanta has faced a difficult childhood of sexual harassment and was characterized by suicidal thoughts, the mental health nurse must take care considering interventions in practice which are sound enough to overcome these criteria. Psychotic disorders are characterized by social exclusion and must be intervened with efficiency (Jones, Jones and Beauvais 2022). There are some interventions which will help the nurse to help Fanta overcome the condition of Psychotic disorder efficiently by meeting all her necessary needs. The patient must be promoted complete safety during treatment. This can be done on the basis of evidence-based recommendations in the sector of healthcare for the promotion as well as protection of a quality health while upholding a quality of service of care (NICE 2022). Any type of suicidal ideation can be considered through the framing of a plan. The plan should be efficiently implemented by using resources that will make the patient adhere to these resources. The nurse must observe any unusual behaviour such tendenices of self-harm and take steps which would prevent the same and keep the patient safe. The nurse must be able to promote effective therapeutic relationship irrespective of the clinical setting in which the patient is being kept. For this, the nurse has to effectively take charge of deciding and designing the setting where the patient will be observed (Percy and Richardson 2018). The nurse should meet Fanta at regular intervals while talking to her about how she is feeling. The duration of meetings must be predetermined. The mental health nurse should maintain some boundaries while interacting with Fanta. There should be communication that are formal and does abuse or hurt the sentiments of the patient. The nurse must not violate her own as well as boundaries of the patient. Communication skills should be integrally maintained with patients who suffer from psychotic disorder (Norman and Ryrie 2013). Such skills are active listening, maintenance of eye contact, nodding on getting response from the patients to ensure validation, taking turns to talk using pronouns. With the help of inculcation of communication skills, the patient can be made to socially interact with others while remaining completely realistic with the patient (Sibiya 2018). The nurse must be compassionate and sympathetic with Fanta so that she can cope with her trauma and sorrows of sexual abuse, suicidal tendencies, social isolation and depression along with her loss of job as a hairdresser due to her unusual behaviour of psychotic disorder. It is important to remodel the thinking patterns of the patient which will facilitate cognitive restructuring in her. A process of though-stopping in a case of psychotic disorder will stop negative thinking patterns such as suicide attempts and enhance the critical though process of the patient.

Fanta said that she was having a normal life where she used to interact socially with people and dress up in a clean and nice manner. But ever since she has been struck with depression, she has lost interest in interacting with people. The sexual harassment during the civil war has led her into a lot of mental pressure and this has made her become addicted to substance usage. Loss of parents had a serious effect on the mental health of Fanta. She lived on a low income and was having sleep deprivation along with gain in weight. Her illness was taking a toll on her mental health and hence she needed assistance and support for recovery (Westbrook, Kennerley and Kirk 2011). The Care Program Approach has been implemented by the mental health nurse that consists of certain principles facilitating holistic collaboration and assessment into the field of mental healthcare. In the Care Program Approach, the mental health nurse is assisted by a care coordinator who is employed to cater to the needs of the patient (Care Programme Approach 2022). With the help of this approach, an integrated and effective nursing care plan can be achieved, which can provide continuous care along with the maintenance of safety and quality while sustaining compliance of the nursing practice. Since this approach minutely assesses the needs of the patient in details, it provides positive and effective results to the patient. Through cognitive-behavioural therapy, family-based intervention and antipsychotic medication management, the mental health nurse could achieve effective recovery from psychotic disorder that was evident. After the completion of the treatment procedure, Fanta will no longer feel contemplated to interact socially. She would be able to overcome suicidal thoughts while get rid of her substance abuse habits.

Antipsychotic Medications for Psychotic Disorders

While providing treatment to patients for overcoming their health complications, every nurse should maintain some ethical code of conduct. For providing care and treatment to Fanta, the nurse followed NMC code of conduct. There are four domains of this code of conduct which says that the patient must maintain professional ethics and values, think systematically and embrace leadership along with technology (NMC 2022). According to this code of conduct, the nurse should be in pure character and remain diligent while taking care of the patient. The behavior of the patient has to be sober and modest where every duty being carried out by the nurse must be prompt and devoid of any kind of anxiety (NMC 2022). Treatment of the patient will make utilization of the NHS Long Term Plan. This plan states that every patient shall have access to digital consultations of the GP along with hospital support that is redesigned. Through this, an estimated number of 30 million trips to hospitals can be saved for patients (Plan 2022). While treating Fanta, the nurse will take into consideration the same and doing consultations online so that she does not have to spend much time commuting to the clinic for treatment. The Mental Act 1987, which was revised in 2007 is responsible for amending laws that are associated with care and treatment of patients. This enhances provisions of care for the patient while maintaining privacy of the patients (THE MENTAL ACT 1987 2022). From various research on the cases of psychiatry, it has been revealed that sometimes, there are crucial ethical issues which are different from other genres of medical field. Such issues may be associated with informed consent of patients and the patient party. Breach of privacy of patients, occurring conflicts of interest and holding misconception of several therapeutic processes associated with placebo, exploitation as well as vulnerability of the nurses. Abnormal behaviour of Fanta was one of the operational challenges which made it a problem to interact with Fanta. The patient was rigid and did not want to follow treatment measures diligently. She denied to cooperate by revealing incidents that required proper care plan. Since the mental health nurse carried out her duty with utmost care, there were no unmet needs of the patient as such.

It can be concluded that, an effective nursing care plan is very important for the treatment of any kind of psychiatric disorder. The Biopsychosocial model, the various risk factors associated with disease has been determined. The effectiveness of cognitive behavioural therapy, family-based intervention and antipsychotic medication therapy has been explained in the essay clearly. The implementation of Care Program Approach has been discussed with evidence that shows the effectiveness of the same in treating patients. The nurse faced some ethical issues during the procedure of treatment but it was handled with care.

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