Principles Of Mental Health Nursing: Addressing The Needs Of People With Altered Mental Health In Hospital And Community Settings.

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. Rehabilitation Nursing: Principles and management of patients/clients requiring rehabilitation
b. Community/Rural and Remote (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.

Description of the health issue

Mental health care is one of the greatest needs with respect to the health care services. The concept of mental health as an integral part of the health care need has only recently been recognized in the health care industry (Jacobowitz, 2013). The last few decades have been revolutionary in the context of promoting mental illnesses as a health disorder seeking proper medical attention and treatment, which undoubtedly has helped in reducing the overwhelming stigmatization and discrimination in the society for the mental illnesses. As a result, the health care principles have also changed drastically in the last few years for mental health care delivery and the care approach has become increasingly recovery oriented and patient centred (Bell & Brookbanks, 2017).

The revolutionary changes in the mental health care delivery has affected the care quality all across globe, and New Zealand has not been an exception to the scenario as well. The mental health care delivery scenario has now changed completely and the enhanced focus on recovery focused health care, patient centred approaches and priority and decision making power being given to the clients with altered mental health has been crucial in improving the quality and effectiveness of the care and has enhanced the client satisfaction levels exponentially as well (Joshanloo, Jose & Kielpikowski, 2017). This essay will explore the principles of nursing care delivery with respect to addressing the needs of people with altered mental health status in hospital and community settings.

The health issue selected is mental health, and it is very important to discuss the exact distinction between the concept of mental health and mental illness. Scott et al. (2016) have described the mental health to be a state of successful mental functionality which helps the individual to be optimally productive in the activities that he or she is engaged in and fulfilling all of the responsibilities and relationships with other people, Similarly, Kulkarni, Swinburn  and Utter (2015) have also discussed the mental health to be intricately linked with the ability in someone to adapt with the changes in life and be able to combat or cope with any crisis situation or challenge in life. Hence, mental health is essential to the personal wellbeing status of the individual, the lack of which leads to affecting the family and interpersonal relationships, and the ability to contribute to community or society. Mental illness therefore can be characterized as the altered optimal mental functionality which leads to affecting the behavioural characteristics and activities of the individual. By definition, mental disorders are the health adversities that can be characterized by alterations in the behaviour, mood, though process, activities and functionality. Hence, mental illness is a disorder with clinical manifestations which develops over time and affects the physical health, behavioural characteristics and thought process of the individual, ultimately, affecting the mental functionality (Clement et al., 2015).

Mental illness on a simpler note is the assortment of a variety of mental disorders, and each one of them has different symptoms or clinical manifestations. As a result, the mental illnesses all have a distinctly different and unique impact on the quality of life of the individual. As discussed by Wepa (2015), the psyche of different individual is unique from any other, hence the developmental trajectory of the clinical manifestations or symptoms of the mental illnesses is completely different. Hence, understanding the pathophysiology of the different mental illnesses is complex, however, a few common broad factors leading to different mental illnesses can be discussed in the context of mental illness development.

Pathophysiology of mental illnesses

For instance, heredity or genetic predisposition has been identified as a very common and impactful reason leading to mental illnesses as well, and there is mounting evidences that has indicated that the susceptibility to developing most of the mental illnesses are inherited, which is triggered by stress, abuse, or trauma. Along with that, the encounter of a largely traumatic events can lead to developing serious mental illnesses as well. As discussed by Morgan et al. (2016), the mental illnesses such as depression, personality disorders and anxiety disorders develop in individuals by the means of post-traumatic stress disorders, which is also a notable mental illness. Brain affects or injury has also been observed to cause serious mental health issues in certain groups of individuals, whereas the defects or injuries to certain areas of the brain has been previously linked to some of the mental illnesses or disabilities. Another common pathophysiological trajectory for the mental illnesses can be the prenatal damage. There is little yet strong evidence that indicated the fact that a disruption of early foetal brain development or trauma that occurs at the time of birth such as loss of oxygen to the brain tissues can serve as a contributing factor leading to mental illnesses and intellectual disabilities such as autism and cognitive impairments. Lastly, the impact of long term substance abuse has also been identified as the key contributing factor leading to developing or aggravating mental disorders such as personality disorder, paranoia, schizophrenia, anxiety, panic disorders and depression.

The mental health nursing sector of New Zealand is focussed on the recovery oriented competencies. It is a philosophical approach that has been opted to ensure that the focus care service delivery and treatment planning is emphasizing on the aspect of recovery. It helps the individuals suffering with a mental disorder get the ideation of re-joining their earlier life and regaining control of their life. The New Zealand is not the only health care sector that has integrated recovery oriented care planning and implementation in their mental health care principles, the concept of recovery focussed mental health care service delivery is a global trend, all of the developed nations and most of the developing nations have integrated and improvised their mental health care service delivery scenario to a recovery oriented one. However, for the context of mental health care sector of New Zealand, the mental health care service delivery functions on the basis of recovery competencies (O'Hagan, 2001).

Considering the mental health status in New Zealand, Fleming et al. (2014) have stated that poor mental health is a sentient issue for the New Zealand, especially for the population of young adults and adolescents. The study has mentioned that more than a quarter of the population aged 15-25 suffers from one or the other kind of mental illnesses as per the DSM-V criteria. Along with that, in support authors have mentioned that deliberate self-harm and suicide are issue of considerable concern for the adolescents in the New Zealand. Elaborating on the issue further Fleming et al. (2014) has also stated that New Zealand has the highest rate of completed youth suicides all across the globe for the age group of fifteen to nineteen year olds. Along with that almost a quarter of total percentage of individuals being aged 10–19 years have been hospitalized for deliberate self-harm. Although, there has been considerable debate regarding which population is most affected population in the demographics of New Zealand, the most of the evidence indicates at the fact that the young generation is far more affected by the mental disorders than the normal population, and the issues have been escalating for the young adult age groups in the last decade as well. A major contributing factor leading to the present situation has been the fear of rejection, stigmatization and uncertainty after diagnosis which had led to reduced help seeking behaviour among the target group. As a result the mental health nursing principles have been designed on the basis of recovery oriented competencies to help reduce the fear in the target group and encourage enhanced help seeking behaviour with the hopes of gaining recovery (Lim, Wynaden & Heslop, 2018).

Principles of mental health nursing

There are 10 integrated principles of the recovery oriented competencies practiced abundantly in the New Zealand (O'Hagan, 2001). The first principles is “Understanding the recovery principles and experiences in Aotearoa/NZ context”. It states that the mental health nurses have to apply the Treaty of Waitangi to recovery, the philosophical foundations of recovery, demonstrate knowledge of and empathy, and understanding of the principles, processes and environments that support recovery. Hence, in this context, it can be mentioned that the principles aim at addressing the need for a compassionate, empathetic and culturally safe approach to care and engagement. Bennett and Liu (2018) have stated that the importance of the treaty of Waitangi is extremely high on the development of compassionate and empathetic care approaches for the individuals. This treaty has been the understanding between the maori or natives of New Zealand and the British, and this treaty helps to acknowledge and address all of the indigenous values such as whanaunganga (family relationships), wairua (spirituality), and whakapapa (geneology) to be introduced as indigenous concepts in mental health nursing principles.

Similarly, the second principle is “recognising and supporting the personal resourcefulness”, which states that a mental health nurse must consider human resilience and strength, dealing constructively with trauma or crisis, encouraging positive self-image, hope, motivation, and culture (O'Hagan, 2001). As discussed by Xie et al. (2015), the personal strengths such as the self-efficacy, confidence in using their personal strengths, and resourcefulness is intricately linked to positive mental health, hence it has immense benefits in application in the mental health nursing. The third principle is associated with “diverse views on mental illness, treatments, services and recovery” which guides the nurses to acknowledge understanding of different type and view of mental illness and treatment options facilitating an integrative and holistic care principles. The fourth principle is associated with “self-awareness and skills to communicate respectfully” with the clients. As discussed by Parker et al. (2017) self-aware and respectful interpersonal communication is a very important and crucial aspect of recovery focused mental health care delivery which helps patients feel secure and respected. Especially, as for New Zealand, the target patient population is young adults and adolescents, the added respect in communication will help in developing a therapeutic relationship with the clients.

The fifth principle instructs the nurses to “understand and actively protect the service rights of the users”, involving human rights principles and issues, within mental health context and beyond it, protecting and promoting the clients to understand and exercise their rights (O'Hagan, 2001). As discussed by Baby, Glue and Carlyle (2014), the target population of New Zealand, is young individuals most of which are culturally diverse, hence, they mostly lack understanding of their rights and even if they understand the rights, they cannot adequately exercise it, which is addressed effectively by the principle. The sixth and seventh principle of the services includes focus “discrimination and social exclusion” and “culturally safe care for indigenous clients”, where the nurses are required to demonstrate knowledge of discrimination and social exclusion issues and its impact and demonstrate familiarity with different approaches to reducing discrimination with culturally safe care delivery. Thornicroft et al. (2013) has stated that anti stigma and discrimination campaign in the New Zealand, “Like minds, Like mine” has identified that Family, friendship, and social life were the most common areas of discrimination reported by the clients, and the rate of stigma or discrimination have been the highest in the culturally diverse groups. Hence, this recovery focused principle in NZ has the potential to improve practice essentials drastically. The eighth principle emphasizes on “comprehensive knowledge of community services and resources” and the ninth principle focuses on “service user movement”, two very importance principles of practice focusing on helping the mental patients discover the most applicable support service for them and participate using the service user movement. The Stevenson et al. (2015) have mentioned in this context that the community service in NZ has yielded a variety of positive results in the mental patients. The last principle encompasses a crucial aspect of recovery “family or whanau perspectives and is able to support their participation in services”. It guides the nurses to involve the range of family participation and the principles and policy behind it and demonstrate knowledge of the methods of family participation (O'Hagan, 2001). As discussed by Slade et al. (2014), the impact of family participation is immense as a strong support network for the mental patients, especially for the young adults. The support from the family acts as the greatest source of hope, resilience and comfort in dealing with the hardships and complexity of therapy and the mental disorder itself. In New Zealand as well, the additional informal support by incorporating family participation in care planning, community engagement and therapeutic sessions has yielded positive results mostly.

Undoubtedly, the mental health nursing principles that are being practiced in the present day scenario in the New Zealand addresses all of the emerging care needs of the nation and its target mentally ill population, the presence of literature evidence addressing each of the principle is few and not optimally effective either. It has to be mentioned that the “Recovery Competencies for New Zealand Mental Health Workers have been proposed by the mental health commission of the new Zealand in the year of 2001, and even after more than one and half decades of this framework in practice, the literature evidence us lacking terribly in addressing key issues and concerns regarding how effective and efficient the principles have been in improving the mental health status of the target population (Murray et al., 2017). Along with that, the evidence that has been incorporates only briefly address the principles, and there is no critical or extensive details mentioned on what exact measures have been taken to ensure optimal effects in the practice scenario. Along with that, the exact impact in terms of numerical statistical data on the efficiency or success of the principles is missing largely. The absence of randomized control trails and similar high level evidences focussing entirely on the effectiveness of the principles is another great limitation in understanding how the mental health principles have been improved and enhanced the mental health status of the target population of New Zealand. Along with that, the general lack of generalizability, transferability and small sampling had been considerable limitation of the evidences that had been incorporated in the studies.

Conclusion:

On a concluding note, the mental health care delivery scenario has changed drastically in the New Zealand and the incorporation of the recovery oriented competencies have made a drastic revolution in the attitude of the society towards mental illness. Along with that, the improvements in the health care service delivery scenario for the New Zealand, with respect to the recovery oriented principles has helped improve the practice standards of the mental health workers and enhanced the cultural safety of the care service as well. Although, the availability of the evidences on the effectiveness of the mental health care is lacking and the available evidences lack generalizability, transferability and have very small sampling. As a result, there is need greater emphasis on the effectiveness of these principles in action, the exact intervention management plans and policies designed and implemented and how it has impacted or improved the mental health status of the target population.

References:

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Bell, S., & Brookbanks, W. (2017). Mental health law in New Zealand. Thomson Reuters New Zealand Limited.

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