Care Analysis Of A Service User With Acute And Challenging Mental Health Problems: Biopsychosocial Essay

Care analysis of a service user you have worked with as a student during your previous clinical placement who is experiencing acute and challenging mental health problems:

Demonstrate a biopsychosocial understanding of a service users experience and an evidence based approach to your suggested intervention and treatments. State the presenting problems and how things were managed. This narrates the clinical team engagement from the first day of admission to the date of discharge and care provision after discharged. The service user should have complex needs, which can offer challenges to services.  An example of this might be

A service user who is admitted informally to an acute in patient unit where the doors are locked.  The service user may be presenting with depression, alcohol withdrawal and ideas of self-harm.

Care analysis should identify:

• Service users presenting problems, from the biopsychosocial perspective
• Risk assessment and management
• Recovery principles and engagement processes
• Legal and ethical dimensions, such as deprivation of liberty
• Role and responsibilities of the mental health nurse in accordance with NMC code of conduct 

Mental Health Disorders: Causes and Diagnosis

Mental health disorders can be described as the condition that is seen to affect the thinking, feeling as well as mood of persons. Such a situation can be seen to affect the ability of an individual to relate to others and even functioning of everyday. It has been interesting to see that even individuals will have different experiences although they may be diagnosed with the same disorders (Ramsay et al. 2017). Here, the mental healthcare professionals need to consider recovery of the patients in ways by which they would not only overcome the disorders but also have proper social life to live a better quality life. Researchers have stated that in most cases, a mental health condition is not the result of a single event but multiple linking causes of a large number of events (Valmaiki et al. 2016). Often a large number of factors are responsible that affect the mental health stability of individuals. Genetic, environment as well as lifestyle has been seen to have major impacts on the mental health condition of individuals. Often stressful professional as well personal lives or victims of traumatic life events are seen to be more vulnerable to the development of mental health conditions (Kantrowitz et al. 2016). Biochemical procedures as well as different types of circuits and basic brain structures are also contributing factors that result in mental disorders. This assignment will mainly show about how nursing professionals diagnose mental health disorders and how with the help of bio-psycho-social model of healthcare, they can successfully develop care plans which will help the patients to live better quality life.

When the patient had reached to the hospital in the nation of United Kingdom, she was panicking massively and wanted to kill herself to be free from ‘pain’. The nursing professionals communicated with her in a compassionate manner and tried to cool her down. She was not being able to trust anyone and was searching for objects to kill her. After repeated counseling of the patient and talking with her in compassionate manner, she finally cooled down. Throughout the first few hours, she was seen to talk to someone whom, only she claimed to see. When she was collected down and asked about what she is seeing, she stated that her uncle frequently disturbs her. Her husband disclosed that her uncle mentally, physically and sexually assaulted her until the time of 18 years. It was after her marriage with her husband, he came to understand all the issues and to give her better life, and he had taken her to Australia. However, situations had not been better also for them, as the patient always seems to hear the voice of his uncle strangling her or assaulting her. The periods come back to her again and again which makes her feel like killing herself to get rid of mental stress and pain. She had also stated that drinking alcohol and other such drugs help her to reduce her pain and help her to release her tensions and stress and therefore she spends most of the time on such substances. Therefore, the senior nurses critically analyzed the situations and framed out the main reasons that had affected her. She stated that the priority areas that need to be addressed in the patient are her extreme dependence on substances like alcohol and other drugs that will affect her both mentally and physically. Another priority area that also needs to be addressed by the nurses is her symptoms of schizophrenia. She is having both auditory and visual hallucinations that are torturing her and making her lead bad quality of life. She has high risk of harming herself to make her free from the immense pain that the hallucinations are providing her and therefore proper care should be taken to make her free from any sort of self-harm. Therefore, schizophrenia and alcohol and substance abuse disorder are the identified priority areas witnessed by the nursing professionals that need to be treated. 

Schizophrenia and Substance Abuse Disorders: Dual Diagnosis

Dual diagnosis can be defined as the condition when individuals have multiple needs that include both physical and mental issues and have dual mental health and substance abuse problem. They are seen to be struggling as well as unemployed and cannot hold on their job. They could be also in abusive relationship. In the depicted case also, the patient is suffering from dual mental health conditions of schizophrenia and substance abuse disorders and were also in abusive relationship ("New NICE guidance on dual diagnosis is 'desperately needed'" 2018). Therefore, the nursing professional would also incorporate bio-psychosocial model of treatment for diagnosing the issues and developing care plans. Here, the professionals not only try to determine the biological determiners but also try to find out whether any social or psychological determinants of health are affecting the clients or not (Stafford et al. 2015)..

Researchers are of the opinion that schizophrenia is a type of psychosis that is a type of mental illness. In this type of mental illness, persons are not able to differentiate between the reality and what is imagined. They seem to lose touch with reality and the entire world seem to be a jumbled place containing different types of confusing thoughts, sounds as well as images. The behavior of people with schizophrenia seems to be strange and shocking to the people of the society (Vancampfort et al. 2016). A sudden change that takes place in the individuals in behavior as well as in personality takes place when people suffering from schizophrenia are seen to lose touch with reality is called as the psychotic episode. Similarly, in case of Maryam as well, several psychotic episodes had take place. Researchers are of the opinion that hallucinations are mainly false perceptions and inaccuracies which affect the senses of patients and cause them to see, hear, taste or smell which are not done by others. In the acute phases, people are seen to insist that they are hearing different kinds of voices or visualizing episodes that are not heard or seen by others (Seidman and Nodentorft 2015). Researchers are of the opinion that hallucinations may respond  to situations when the levels of stress is lessened in the patient and when treated with antipsychotic medication. Researchers also suggest that when patients are kept busy, it helps them in living better as remaining busy provides helpful distractions. Often experts in the field of mental health science advise the therapists to encourage the patients to discuss in details the times when hallucinations occur. This can help the therapists to understand that exact triggering factors that are resulting in occurrence of the hallucination periods. The professionals can realize the exact nature of the stress that is actually leading to the occurrence of such episodes. Researchers also suggest that another strategy by which the healthcare professionals can effectively handle the patients (Stafford et al. 2015). They need to point out to the patients making them understand that they have some levels of control over their hallucinations. In certain studies, it has been seen that patients often develop the habit of listening or seeing voices of episodes as if they are passive recipients. Often it is seen that directing their minds to other areas of interests and thereby helping them to recognize that they no longer wait to hear or see incoming voices of episodes are found effective in a large number of trials. Researchers suggest that encouragement of the patients to preserve and not to give up as well as to discuss the things with the professionals and providing reassurance to the family are important part of the treatment procedure of such patients.

Interventions Adopted by the Nursing Professionals

After entire discussion with the healthcare team in details, the care coordinator has appointed two experienced nurses and two junior nurses for caring of the patient. An expert was assigned to evaluate and monitor the health of the patient on a daily basis to measure the development of the patient. Moreover, he was also assigned the duty to counsel the patient according to her needs so that she can gradually come out from the periods that took place during her teenage years that comes back to her as nightmares in her lonely periods. The four nurses planned several interventions so that proper care can be taken to her and to make her overcome her periods of hallucinations. The for nurses ad accepted the fact in front of the patient that the voices and visions which she sees are indeed real to the patients but they continued to explain to her that although she heard and saw such periods but they could not see of visualize any of the episodes. Researchers are of the opinion that healthcare professionals should stress on the words as “your voices” or “voices that you hear”. The main rationale provided by the researchers is that when the healthcare professionals validate that their reality does not include voices, this will make the patient cast “doubt” on the validity of the voices that will make her question about the reality of her imaginable voice (Stafford et al. 2015). The second intervention that was also applied is to be alert for signs of increasing fear, anxiety as well as agitation among the patients. This might help the nursing professionals to herald different hallucinatory activity that can be considered as frightening to the client and on which the client might act upon like self harm or similar other activities. The third intervention that was adopted by nurses was the explorations of how the clients experience the hallucinations. The main rationale of this intervention is that exploring the hallucinations and thereby sharing the experiences of the patient will help to give the patient a sense of power. By empowering her, he would be able to undertake self-management skills to overcome the hallucinatory visions of the voices. The fourth intervention that also contributed to good health of the patient is to help the client identify the needs that are underlying the hallucinations (Larelle 2014). The main point here is to find out the ways by which the needs of the patients can be met. Hallucinations might reflect needs for anger, power, self-esteem and sexuality. In case of Maryam, it is seen that the incidences that had happened with her during the times of adolescence had affected hr so deeply that the fear of the incidences and the pain she had faced had been impregnated in her mind deeply. In the present times, her lonely days and feeling of helplessness, isolation from the society, his habit of drug abuse and many others are creating stress in her which are making her go through similar pains faced by her in those days. Her loss of power, self-esteem and sexuality in earlier times are affecting her present day life for which she is having severed hallucinations (Laruelle 2014). Her linking up of her present condition with that of previous incidences or even feeling of insecurity had been resulting as triggering factors for the events. The nurses had been able to recognize them and were counseling her in ways by which she can overcome such emotional turmoil and look at the positive and better parts of life. Another intervention that the nurses also took was to stay with the patient and directing them to tell the voice (which they hear) to go away. Researchers have seen that clients can indeed learn to push the voices aside when repeated instructions are given to the patients after establishing the framework of trusting relationship (Sommer et al. 2016). On the fourth day of the treatment, Maryam was seen to be gradually becoming successful in showing positive results on her mental health conditions and was successfully being able to handle herself during the times of psychotic episodes. The other interventions included the patients in discussing simple, basic as well as reality-based topics of conversations helping the client to focus on one idea at a time. As Maryam is stressed right now, she might had confused as well as disorganized thinking. Therefore, in this situation the intervention had helped her lot to focus as well as comprehend reality-based issues. Risk assessment was done to keep her away from the objects that would induce her hallucinatory activities. Another interesting intervention that also provided was engaging the patient in different reality based activities like card playing, drawing, writing, doing simple arts and crafts, listening to music and many others. The main rationale for this intervention was that the nurses wanted to redirect the client’s energies towards acceptable activities (Ince 2016). This is mainly because, it would help her to decrease the possibility of acting on the hallucinations and thereby help her to distract herself from the visions and voices. All these helped Maryam to gradually overcome her symptoms of hallucinations and lead her towards better lives. 

Conclusion

Often there are large numbers of factors that often lead substance abuse disorders. Often denial and ineffective individual coping are two of the factors that may make individuals depend on substance use. Individuals also do substance abuse when they suffer from powerlessness, imbalanced nutrition as well as low esteem (Negar and Prinz 2015). Altered family process, sexual dysfunction as well as deficient knowledge are also other reasons that may lead a person to take up substance abuse. The main reason for Maryam’s taking up of such a habit is her inability to cope up with her situation both from the past and from the present. She had taken up the habit in her younger years as she wanted to overcome the stress caused by the physical and mental torture done by her uncle. In the present generation also, it was also seen that loneliness throughout the day and her social exclusion had been the main reason for her containing her substance abuse (Thurgood et al. 2016). Moreover, her symptoms of hallucinations had also resulted in aggravating the substance abuse disorder symptoms, as she believed that alcohol and other drugs helped her to live in an alternate reality that is not as stressful as her real life (Campbell et al. 2014). All these are symptoms of her ineffective coping that had thereby resulted in such situation.

A substance abuse counselor is to be appointed for the patient who would help the patient by properly counseling her and providing her with effective alternatives by which she can cope with the stress and turmoil she is having. The nursing professionals would then be determining the social determinants of mental health that are affecting Maryam. They would be analyzing the current situations, previous methods as well as other methods of coping with the problems of life (Kinnibrgh et al. 2017). When the nursing professionals would investigate the issues, they will be able to find information about Maryam’s degree of denial, acceptance of personal responsibility, commitment to change. Maryam was set limits so that she can follow through the behaviors that she had agreed to follow to the substance abuse counselor. Patient had learnt manipulative behaviors through her life and for that she needed to learn new ways of getting needs met. Therefore, if she is made a situation where she needs to follow through the consequences of failure to maintain the limits, she would be able to change her ineffective behavior to some extent. The nurses can also encourage Maryam’s verbalization of the feelings, fears as well as anxiety. This would in turn help the patient to come to terms and thereby handle many long unresolved issues successfully (Galanter et al. 2014). The nursing professionals also helped the patient to explore different types of alternative coping strategies. Researchers have also stated that often patients do not have or may have little knowledge about the different adaptive responses to manage stress. Therefore, they need to learn other options for managing stress, feelings, pressures, loneliness, time and relationships without drugs (Donovan et al. 2015). The nursing professionals also assisted Maryam to learn and encouraged her to use proper relaxation skills that were guided by imagery and different visualization. These helped Maryam to relax and develop new ways to deal with stress and solve problems that came in her way. 

In the discharge plan, the nursing professionals and incorporated effective ways by which Maryam’s social determinants of her ill health could have been addressed. He feeling of loneliness were affecting her and making her feel insecure for which her old memories were rushing back to her. Therefore, these situations were discussed with her husband in details as he as quite concerned about her health. Her husband was highly supportive and he decided to change is working schedules so that he can spend most of the time with her wife as she needed his support. Structural diversion activity that related to the recovery was also proposed. This included social activity where she would be introduced so that she can feel herself included by the society (Pitschel et al. 2015). The more the patient remains included in the different community based activities in her lone time, she will feel better and her requirements to take drug and alcohol will eventually reduce. She can include herself in different activities like writing, painting, different workshops and others both in her home and in the communities (Degnan et al. 2018). These would help her overcome her perception that she would not be accepted in society and would help her to mingle with everyone successfully. Moreover, support services were also suggested to her husband so that he can appoint social carer for his wife accordingly. 

Conclusion

A case study was provided where the patient was suffering from schizophrenia and substance abuse disorders. She was therefore suffering from complex symptoms that were attended by nurses by identifying the symptoms, the causes and then the priorities. Proper healthcare team composing of care coordinator, senior nurses and junior nurses, experts, substance abuse counselors, social care workers and others were proposed. Proper bio-psychosocial model was followed where her biological, psychological and social determinants of health were identified and accordingly interventions were set. 

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