Approach To Assessment And Care For A Patient With Mental Illness Essay.

For one of the below patient case presentations, discuss how you would approach assessment and care:

1.Explain what is involved with developing a therapeutic relationship that is respectful of the patient’s choices, experiences and circumstances.

2.Outlines and  nursing care consistent with the patient’s mental, physical, spiritual, emotional, social and cultural needs (as applicable).

3.Discuss  therapeutic interventions which could be included in the patient’s care; include any appropriate collaborative multi-disciplinary involvement.

4.Discuss the existing risk factors for the patient. What questions might you ask to ascertain potential risk factors?

Developing a Therapeutic Relationship

1.With respect to nursing care especially in psychiatric or mental health nursing, development of a therapeutic relationship through interpersonal interaction forms the core or the fundamental element of providing mental health care. However establishment of a proper therapeutic relationship requires a great deal of skill set (Townsend & Morgan, 2017). According to a study, provision of therapeutic care to these individuals, demands intensified presence and not closes or disappearances. This is not however not possible in all cases as provision of care to the mental health patients is often in conjunction with treatment of an involuntary manner. According to Boszormenyi-Nagy & Framo, (2013), the amount of therapeutic relationship developed between the care giver and the patient can be measured through the elements like warmth or judgementalness. Through this a therapeutic relationship can be distinguished a being good or bad (Videbeck & Videbeck, 2013).

The major elements that are believed to be part of the development of a therapeutic relationship that is respectful of the patient’s choices, experiences and circumstances comprises of firstly the element of understanding. Conveyance of understanding is important as the patient instills the feeling of being important. This feeling is significant for these individuals for survival in the society, as they are often stigmatized because of their mental illness (Lloyd-Evans et al., 2014). The nurses empower them and in turn influence their treatment, thus in turn promoting individualized care. In addition to understanding, another element is active listening. Through active listening, the care givers are able to better hear out the patients and can provide proper attention to the needs of the patients (Dixon, Holoshitz & Nossel, 2016). The patients also understand in this way that their care givers are interested in their care giving process. Another element is proper communication, and appreciation of the problems and the circumstances of the patient. In order to develop a unique therapeutic relationship with the patient, an in depth personal knowledge is required of the patient. This helps the care givers to understand the uniqueness of the situation of the patient. In a study, it was stated that rather than displaying just a acting out behavior, the professionals must make an effort to look beyond the superficial situation and understand the true meaning of the behavior of the patient (Chinman et al., 2014).  However developing an in depth knowledge requires a level of understanding requires time and skill to understand.

Nursing Care for Patients with Mental Illness

Another important aspect is the respect towards the unique personal experience of the patient. According to (Rüsch et al., 2014), the mental health nurse or care giver is required to treat the patient’s personal experiences as a gift brought to the relationship. It is the duty of the professional to encourage the expression of thoughts and feelings, without any blaming or judgment. In order to encourage this type of understanding, the psychiatric or the mental health care giver must interact with the patient foremost as a human being. Apart from the sharing of experiences that are common in nature, which might be similar backgrounds or mutual adversities, the professionals also been found to help the patient in establishing a connection with them and to feel understood (Robson et al., 2013).

2.According to reports, individuals suffering from psychological disorders not only suffer or lack proper care, but also undergo experiences of stigma, in addition to shame, exclusion along with high frequency of death (Corrigan, Druss & Perlick, 2014). This is often related to the primary nursing care and the health services that are available. According to the outlines of the Family Health Strategies (FHS), modality of care along with attention that exists within the psychological health environment, that includes not only help to the individuals who are in psychological distress or the people who have already established mental disorders but it also helps the development of actions in addition to early detection which are preventive in nature along with involving the person and his family (Mårtensson, Jacobsson & Engström, 2014).

In the given case, the patient Kate lacks care as well as social and emotional support often, therefore she often feels isolated and shamed about her mental illness, this is ten reasons she avoids talking to other people and also with her family members. Although Kate receives help from the community mental health service, but apparently is not useful because it has not made differences in her behavior and continues to have episodes where she forgets things and has other problems (Dolman, Jones & Howard, 2013). In this case, for provision of proper care to Kate, education of the nurses is required in order to develop proper care. The nurses need to undergo special training so that they are able to deal with such situations adequately. A major concern is the provision of appropriate medical control. Often there is lot of confusion in drug therapy since the patients do not adhere to the treatment (Rosenbaum, Tiedemann & Ward, 2014).

Therapeutic Interventions for Mental Health Patients

Although Kate received support from her partner and her mother in law, however on some occasions they too give up on her as they find her a little too much. In such cases, it is the duty of the caregiver or the nurses to perform activities in relation to the patient and her family. It is required of the health worker to make visits to the patient at least on a weekly basis and confront the patient with the mental problems (Acharya et al., 2017). There needs to be communication between the patient and the health professional to the extent possible. In times when there is a need for consultation, a doctor might also accompany the health worker to see the patient. Communication with the members of the family also should be a part of the nursing plan especially in order to raise awareness about the mental illness or the situation that the patient is facing (Berk et al., 2013). In relation to the present mental, social and emotion condition of Kate, the nursing care should involve several goals which will include implementation of interventions in order to manage the patient’s depression and other existing problems. Gaining of weight is another problem which Kate was facing which requires proper counseling. The family should be encouraging in making the patient participate in such programs so that there is a continuity of care.

3.In order to properly manage Kate’s given condition, several therapeutic interventions can be carried out. A common four step approach can be followed for providing a therapeutic intervention. The steps include: Recognition, assessment along with initial management of the symptoms of the illness. This is followed by persistent sub-threshold depressive symptoms or mild to moderate depression or anxiety disorder. The next step involves persistent sub-threshold depressive symptoms or mild to moderate depression or anxiety disorder with inadequate response to initial interventions along with moderate and severe depression. This is followed by a complex and severe depression or anxiety disorder, risk to life or severe self-neglect (Kazdin & Rabbitt, 2013).

One of the interventions can be participation in the group of psychotropic and psychological care. Suggestions had been made by researchers that to form a group of self-help which also involves a psychologist. This type of multidisciplinary team might be useful in appropriate management of the condition of the patient. These groups conduct programs which addresses the mental health problems of these patients. These services are also involved in providing a holistic care to the patients (Yanos et al., 2015). Even the family members should be a part of these services so that family member is deinstitutionalized. There is a need for the patient to be again inserted in the community and be accepted in a social way. The family who do not have access to such services and activities soften suffers and are extramural. Implementation of interventions by public health services needs to be highlighted, in order to provide proper guidance, and give subsidies to allow them to provide care for the weakened members (Beutler & Clarkin, 2014).

Identifying Risk Factors for Patients with Mental Illness

The interdisciplinary practice team needs to be located in a primary care setting in order to deliver psychosocial and behavioral treatments. A single primary care physician needs to coordinate the care. The practice team needs to help this physician in order to coordinate interdisciplinary treatment planning (Ward, White & Druss, 2015). It is also their duty to monitor for increased levels of care. This presents a collaborative model with integration of services that can be provided as an intervention to the patients with mental illness. Studies have shown that effective collaboration which is well coordinated and similarly integrated provides a key mechanism to deal with difficult resistant patients who present with multiple comorbidities (Hawton et al., 2013). It has been seen that issues that address the effective collaboration are multifaceted and complex. Several previous attempts have been taken to address these problems. This intervention takes into consideration and additionally addresses all the problems of the patient without the exclusion criteria. This process of implementation along with its benefits and limitations has been perceived (Said, Kypri & Bowman, 2013).

4.The existing risk factors for the patient in terms of the individual are identified as prevalence of low self-esteem. The patients often have lower wish to live along with prevalence of depression and anxiety in the patients. Additionally there is attention-deficit hyperactivity disorder which is often experienced by the patient. There is also oppositional or conduct disorder somatic complaints which is seen to be accompanied with feelings of sadness or loneliness which is quite common. In addition to this there is factors of insomnia, fatigue with forgetfulness. The patient gets irritating feelings, often has difficulty in concentrating in tasks and suffers from feelings of worthlessness. There are presence of internalizing and externalizing behaviors along with aggression and high levels of anger which comes from the prevalent interpersonal problems. Abdominal obesity is another problem that effects self-image, which is perceived as another risk factor along with need to feel pleasure (Rasic et al., 2013).

In terms of family related factors there is risk in difficulties with family relationships especially with parents and siblings.  Low emotional support at home during childhood along with history of sexual abuse as a child adds up to the factors. Bad experience of family communication is also a factor (Daumit et al., 2013). In terms of social factors of risk, there is a bad experience working at the deli where she forgets her tasks. She is currently experiencing ‘episodes’ and gets anxious, dropping dishes and forgetting disorders.

In order to ascertain the potential risk factors, the following questions might be asked to the patients:

What is the problem you are currently facing with your health?

What is your relation with your family members?

Why are you not comfortable with talking with your parents?

How is your relationship with your children and your partner?

In what way does your partner support you through your prevailing health condition?

How the service provided by the community health providers helpful to you?

If possible, elaborate on the experiences you had as a child.

How bad is your insomnia?

Does working at the deli help to you to overcome your health situations?

How is the medication for your health issue affecting you and your body?

Did you take part in any intervention or service programs?

If yes, do these interventions help to address your problems?

Have your condition improved after being part of these programs?

References

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