For a client to experience positive mental health outcomes, care from the Mental Health Nurse (MHN), will include therapeutic engagement & therapeutic treatment modalities.
Angelina Parker is an 18 year old single woman who has commenced her first year of nursing at a Melbourne university. She moved from Warrnambool at the start of the year and lives with two other female university students. Angelina has both parents that she is close to and a younger sister who is in year 9. There is no family history of mental illness or substance misuse and Angelinaâ€™s developmental milestones are all normal. She was a high achieving student and enjoyed sports with a good social networks of friends.
Over the last two weeks, Angelina's roommates have been concerned with her mental state as Angelina has been displaying the following symptoms of depression: depressed mood most of the day & everyday., feelings of hopelessness, helplessness and worthlessness., decreased interest in her nursing subjects and missing classes, weight loss of ~8kgs., insomnia, psychomotor retardation, fatigue, reduced concentration & attention with all the above symptoms leading to thoughts of suicide without suicidal intent or plan.
As a result, Angelina has not paid her rent and did not attend her nursing examinations earlier today. Her parents were contacted by the roommates and once they arrived, drove Angelina to the emergency department for a mental health review. The MHN arranged for admission in the acute inpatient ward due to her symptoms of depression.
Using sources relevant to Mental Health Nursing (MHN);
Discuss how the MHN will use therapeutic engagement skills with Angelina.
Discuss what therapeutic treatment modalities can be used for Angelina on the ward.
Types of Engagement Skills
In Australia, the MHN reports that most cases of chronic mental illness are due depression: either socially or economically associated (Reich, 2015). Also, the bipolar condition and schizophrenia disorder have been on the increase up to the early 2000s after which the federal government is liaising with the MHN, and the state governments intervened through regulation of Medicare safety net and Medicare Levy (Dzipora and Ahern, 2013). Besides, the WHO reported that most native Australian presented increased cases of mental health disorder as compared to the foreigners: the underlying factor alludes to the colonial rule which oppressed the natives (World Health Organization Dept. of Mental Health and Substance Abuse, 2014).
However, the case focuses on an 18-year-old woman Angelina Parker a first year nursing student at a Melbourne university. At the start, Angelina indicated stable mental health and was a high performing student, but later her roommates find out that she displays symptoms of depression and thoughts leading to suicide. As a result, Angelina parents are contacted, and she is taken to an acute inpatient ward. As such, ideas in this article seek to illustrate the therapeutic engagement skills and the treatment modalities the MHN will use on Angelina. Notably, the paper will have two main sections analyzing the level of engagement expertise and the treatment modalities to be used. Furthermore, the article will sum up the ideas concerning the thesis statement as shown below.
The section will outline what therapeutic communication in mental health is. Also, a definition of engagement in tandem with the treatment is given. Further, the section will identify and explain the types of engagement skills: building rapport, cross-cultural communication, questioning techniques, communication with health carers as partners in care, getting it right from the service user perspective, and what to do when communication becomes challenging as shown.
Therapeutic communication in mental health is the procedural process through which health care providers offer a holistic service to the patient with the inclusion of both the patients and family consent (Fartinash and Worret, 2014). On the other hand engagement in treatment means the period of integration of values, beliefs, and attitudes into care provision (Videbeck, 2013). That said, it is considered wise to recognize the engagement skills to be used with Angelina. First, is building a rapport. As a care provider, you ought to open up a good communication with Angelina and consider her emotional state. To start with, take the time to introduce yourself to Angelina paying attention to details on name, profession, and how much time you intend to use. Then, ensure you allow Angelina to be part of the discussion by asking her opinion on how she likes to be addressed. Also, to create a rapport with Angelina, you should include her family members in decision making. Notably, as a care provider, you need to be an active listener through the interaction so as to capture finer details (Townsend, 2014). Again, to make the conversation last, the care provider should avoid using mental health jargon and use simple language.
Secondly, the care provider should master the technique of questioning so as to avoid offending either the family members of Angelina. Proper questioning techniques need to set a stage for assertiveness where verbal and nonverbal communication cue coexist (Robson et al., 2013). Angelina presented with reduced concentration and ideas of suicide hence increased chances of disagreement and stressful conversation. Her emotional nature characterized by anger may obscure the given information thus the difficulty in assessing the situation and providing solutions. However, the condition can be avoided if the care provider in charge is keen to identify Angelina's physiologic responses and allows her time to cool down before questioning her.
Thirdly, confrontations during the interaction with Angelina such as shouting and throwing things in the ward are an important tool of therapeutic communication. In case Angelina loses her cool and starts confronting the nurse in charge it will be substantial for the nurse to maintain silence and point out the relationship between what she says and her behavior. According to Rosenhan, 2016 he is of the opinion that when people learn to appreciate the discrepancies in interpersonal communication, then they will change their behavior for good. That said, it is evident that Angelina will confront the care provider as a defensive mechanism. Therefore, the nurse in charge should focus on her behavior to provide the medical solution and not her personality. Furthermore, as a nurse, it is important to impart information so as to satisfy patient's needs. For instance, when Angelina tries to find out why she cannot focus on school anymore it is for the doctor to offer a guideline and manual in line with the family members to have Angelina contented. Also, the imparted information helps to shift her level of awareness and thinking of school for the better.
Notably, use of humor in engaging Angelina will sustain the conversation as there are necessary acknowledgments of humor. Recent studies indicate that humor initiates laugh which is a strategic plan aimed at relieving the muscle tension and stress (Mohr et al., 2013). Malchiodi, 2013 is of the opinion that laughter stimulates body physiologic processes such as respiration hence strengthening the heart rate and serves a homeostatic role in activating endorphins which improve the mood. Through creating rapport with Angelina, the care provider should be keen to identify if humor works. If it provokes her to react strangely, the nurse should be ready to withdraw to avoid violence. That said, the paper shifts attention to the therapeutic treatment modalities used for Angelina as shown below.
The MHN is keen to recognize the significant role of individualized treatment in Australia using different treatment modalities. Also, a report by the WHO indicated that some treatment modalities are more effective than others depending on the degree of mental health disorder. That said, the treatment modalities to be used with Angelina include:
The model employs an engaging framework that aims at understanding Angelina's behavior, thoughts, and feelings. Moreover, the cognitive behavioral therapy abbreviated as CBT enables the nurse to identify the negative feelings and thought patterns while interacting with the Angelina (Stuart, 2014). Also, the CBT enable the care provider to have an in-depth understanding of the positive behavioral aspects exhibited by Angelina. At the end of the therapy, Angelina is in a position to differentiate between the negative and positive feelings, thoughts, and behaviors.
The therapy is commonly abbreviated as DBT and is a skill-oriented model that pays attention to emotion regulation and ensuring effective interpersonal communication between patients and care providers. Research shows that the model is useful in treating a patient with borderline personality disorder (Barker, 2013). Integrating DBT with Angelina' case helps her overcome her emotions through the provision of stress management skills. Again, the DBT offers a platform for the nurse to be an active listener.
Motivational interviewing is a treatment modality that focuses on strengthening a patients' will to change (Galanter et al., 2014). Subsequently, the model advocates for a patient-centered scheme so as to address all issues affecting the patient (Barker, 2013). For instance, motivational interviewing in Angelina's condition will facilitate analysis of hr ethnic background, the level of education, past medical history, and the causal agent for depression through the use of simple language. Moreover, the form will allow Angelina the option to choose between what is right and what is not at the end of the day: though it emphasizes on adopting the best behavioral aspects.
Recreation therapy is a treatment modality that aims at bringing back concentration by unwinding the patient from the normal daily routines (Australian, 2017). The treatment is mostly provided by professional care providers who are dedicated to using natural sites such as mountains, rivers, and game parks to conduct sporting activities. Importantly, recreation therapy allows exchange f ideas as the team is made up of diverse ethnic backgrounds and different world views. As a result, Angelina will channel most of her energy in building social skills which are a plus at an individual level.
Research shows that patients treat with music therapy heal faster than patients who seek other treatment modalities. The underlying reason is that the brain is made up social constructs which when stimulated they respond to the art and relax the patient (Cunningham et al., 2014). The therapy is offered by professionals who have certified degrees from recognized institutions, and they use music programs targeting needs of patients and groups.
Equine therapy is an effective therapy that involves associating patients with horses. Through the interaction with the horse, a patient is able to develop interpersonal communication skills as well as build his/her self-confidence and problem-solving. After the therapy the horse is usually submissive to the patient, an indicator that the patient has been able to build the trust is responsible, and can control his/her emotions.
The model asserts that change in patients happens in stages and is not one significant change (Happell and Gaskin, 2013). Also, the therapy as several steps namely pre-contemplation: a phase where a patient has not acknowledged that there is a behavioral change which needs to be corrected. Contemplation: the period when a person accepts there is a behavioral problem but is not ready to change. Determination: the period when the patient is willing to undergo counseling and reform. Action: the phase showing how the patient is coping with the proposed guidelines. Maintenance: a period when the patient upholds the proposed behavioral change. Relapse: a phase when the patient lacks proper monitoring and resorts back to the previous behavior.
The corrective measure is used to identify signs of depression and trauma at an early stage and offers a manual to rehabilitate the patients (Videbeck, 2013). Subsequently, the model can be used on both an individual level and at a group level. Notably, the measure is highly recommended as it emphasizes on changing an individual's emotional state, increase participation in group work, and increase safety feelings. However, in case Angelina presents with difficulty in verbal expression it is recommended that art therapy is used. The art therapy breeds creativity in the way an individual expresses his/her opinions. Different materials such as paper and pencil are used to ensure the idea is understood. Also, sign language can be used in case of severe conditions.
My opinion is that the current trends in Australian mental health indicate real efforts aimed at combating the condition. The reports by the MH N and the WHO reflect how committed the nation is to ensure that mentally disturbed individuals and their families get the best of services just like other citizens. The case of Angelina Parker allows one to assess the possible outcomes associated with mental health nursing treatment: where family communal psychiatric-mental health nursing is of significance role. To that, it is possible to discern that the Australian mental health nurse is strategically positioned to tackle future mental health problems as their current trends and the background analysis shows how prepared they are.
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