Students will be expected to Demonstrate achievement of the intended learning outcome via combination of written coursework and a peer group assessment
1. 2000 word written discussion of a comprehensive of a patient assessment related to mental health nursing demonstrating awareness of mental, physical , cognitive, behavioural, social and spiritual using an identified Nursing assessment framework.
Mental Health Nursing
Through this paper, the main assessment is to understand comprehensive patient assessment and the role of mental health Nursing. In the case study, John aged 40, is diagnosed with paranoid schizophrenia which is observed to be a severe mental illness, which can create an illusion and hallucination to lose the ability and understand the discrimination between reality and imagination (Jariwala, 2018). It is important to note, how the phase of schizophrenia can stay for a lifetime. The mental illness creates disturbances and plays with the patient mind and behavior, as one form a set of thoughts, behavior, and feelings. To access the mental condition of the patient John, it is important to understand the background of the patient how the patient is feeling currently and what is his support system. They often experience psychotic episodes that are caused due to schizophrenia and there is a single range of crises, that can create a chronic experience.
John McDermott, aged 40, a paranoid schizophrenia patient, is currently unemployed, receives a universal credit and smokes on an average of 40 cigarettes a day, consumes 21 units of alcohol and has an average of £ 10 worth per week, that helps to stay him relax. By background, John has a mother and pays her visit timely and has earned a degree in Psychology from a renowned University. During the graduation, he had a passive relationship, which broke off, leading to more facing more failed relationships and actively participating with sex workers. Even though mentally he is sound and social, he is vocal of facing mental health problems and issues. While attending the recent Community Mental Health Centre, taking an injection dose of Flupeptixol Deconate 300mg, he complained of feeling lethargic and apathetic (Jiang, 2020). Also, the concern was showing persistent cough, which comes during day time and John feels pointless about leaving the cigarette, as he has nothing else to do. On evaluation for the mental health assessment, he has shown below signs-:
Lethargic/unwanted health side effects caused due to the medication
Mental Health issues
Anxiety caused due to the inability to find a partner
Lack of employment/meaningful activity
From the given case, the chosen physical health issue would be of “sexual health” and mental health issue would be of “lack of employment and doing any meaningful activity”.
To overcome the situation of John, who is getting a support system from the government and also is unemployed, it is important to make John get a job. As John is qualified from the reputed university, he would be able to get a suitable job and profiles. By getting the desired job, the patient can not only pay his medical bills, reduce the government funds, but can also keep himself distract and feel more engaged.
When experiencing schizophrenia, an individual faces auditory hallucinations that can constantly cause the patient to feel distressed and feel in a negative debilitation. Often the individuals can also experience constant symptoms of feeling and reacting differently. It can cause an auditory hallucination that can cause an individual to act, behave and interpret in an irrational manner (Mudgal, 2020). They also exhibit a behavior, which causes an inability to function and can cause them to feel loner and have an unexciting social life. In schizophrenia, there is a constant illusion, which causes a mental disturbance and inability to think and relate to the current scenarios. The nursing intervention can be to get social support from the close family members and also discuss patient helplessness, inability to think and feeling alienated can be treated through making understand the consequences and repercussions. The patient needs to be also corrected through medication and treatment and get support from the family member, society and good wishes.
Nursing interventions in reducing individual distress would help to overcome the auditory hallucinations (Morera-Fumero, 2017). Often the interventions to help the patient can be treated through self-assessment tools designed for the patients; ensuring to timely intervene and also talk with someone, make the patient feel engaged by making them listening to certain music and watching the TV. At the same time, to teach the patients in engaging and using the relaxation techniques, motivating the patients to interact and discuss their issues with the staff. Often in the complicated cases of schizophrenia, it can be treated, by making mental health nurses use ways to overcome problems such as distressing auditory hallucinations related to each patient and overcoming it through the self-assessment tools. The nurses should scale and record, how the patient is feeling and experiencing through an unpleasant voice and rate them as per the inpatient version (Huang, 2018). The nurse can also command in keeping how to make the patient feel safe and within the boundary of the safety protocol. It can be done through the auditory hallucinations questionnaire and through designing an interview of the guide-inpatient version.
To overcome the mental and physical symptoms, the patient cognitive thinking is also hampered, such as the patient feels negative, constantly feels pressurized, stressed and has faulty beliefs and dysfunctional therapy (Rössler, 2019). Through providing cognitive behavioral therapy, the patient can be treated through a variety of strategies and correct their approaches and thinking. With the help of Cognitive behavioral therapy, while correcting the schizophrenic patient, the sole aim is not to cure auditory hallucinations which can rapidly decrease in the frequency and duration of length and encounters in experiencing the auditory hallucinations. Subsequently, it also helps to reduce the distress which has been caused due to the auditory hallucinations and has momentum, which can make the patients feel in control of everything. Also, the strategies to distract the techniques such as making the patient feel comfortable through proposing the distraction techniques includes a normalizing rationale and also how the patient would be responding. The mental nurses can take care of techniques such as distraction techniques along with keeping the patients feel busy, engaged in regular activity scheduling and also feel competing stimuli (Bliksted, 2017). The sole purpose of including the distraction techniques is to focus on providing normalizing rationale and make the patient overcome the auditory hallucinations. Through the rational approach, it helps to reduce the level of anxiety and alienation and at the same time, rational responding can help to overcome the automatic negative thoughts that can help in overcoming the hallucinations. The benefits of approaching a schizophrenic patient are to ensure providing benefits and make the cognitive nursing intervention to perform by constantly interacting, distract the patient and keep them engaged in the communication with patients. The limitations of having a cognitive nursing intervention are that it can only be provided by trained nurses within the hospitals or community settings.
Through the cognitive-behavioral approach, John lost and insufficient ability to concentrate, focus and also access the problems. It can help to explore the opportunity which can provide better control over the human mind and help in the cognitive nursing intervention every time.
The patient can experience a lack of social behavior and would be unkeen to feel alienated from society. Often the patient can feel characterized and would constantly feel unrealistic, having a “gross distortions caused due to the reality; having a withdrawal feeling from the social interaction along with facing disorganization that can cause an effect over the perception and though. The social behavior which John would also experience here is of lack of interaction, low engagement and also feels alienated. He would show disinterest and low interactions also would feel low emotions and interaction level. Due to the patient's condition, he would often feel hallucinated and instable along with constantly hearing of voices and have a disorganized speech. The nurse, can assess the episodes of patient feeling unsocial, unfriendly and support through the stress reduction techniques such as meditation, yoga techniques or through tai chi.
The spiritual needs of the patient can be treated through spiritual treatment, which would involve medication and participating in more community activities. The involvement of the spiritual activities would help to gradually reduce the low dose of the medication. Through the spiritual needs, the patient's inability to leave cigarettes and alcohol would also gradually reduce. The basic purpose is to make the patient feel and empathize with the situation and create a caring attitude towards the other sufferance. Through keeping the patient engaged in the pastoral programs and involving in the community programs, can help in overcoming the medication which would remain a personal choice.
As John is heterosexual, by making the patient understand his sexual behavior and engagements, it would be important to educate and make him feel settled with finding one partner. As schizophrenia patients feel alienated and lack social skills, the mental health nurse can provide an overall guidance and support system, by making the patient understand his support system.
The behavior of the patient has to be constantly monitored, such as in the case John shows a constant lethargic, slow movement and inability to feel a lack of control over his motor activity. The nurse has to intervene and also focus on providing a level of cooperativeness and approach the patient in a compiled manner. It can be done by bringing constant changes to the motor activity and also provide control over the movements or control psychomotor agitation. The patient also experiences psychotic symptoms that can constantly make them feel shy, introvert and unable to concentrate, Such as John while experiencing a high episode of the psychotic disorder, would try to avoid eye contact and have minimal control over the expressions, face emotions and have minimal eye contact. All this is caused due to the auditory hallucinations and experiencing a lack of inability to concentrate within the particular medicine such as clozapine. The high doses and constant medication can cause side effects of tardive dyskinesia. The nurse can also monitor and control the patient's inability for the speech assessment and constantly access through the observation of rate, includes a variation in the tone and volume, along with making the patients experiencing difficulties in thought processing and providing support in the communication.
Often the physical nature of the schizophrenic patient is to feel impatient, cannot think out of boundaries and at the same time, can feel constantly restless, perplexed and feeling restricted (Dorofeikova, 2018). The patient can also suffer due to experiencing a constant mental distraction which is an illusion and facing perceptual disturbances that can relate to the delusional thought processes. It can cause a restricted range of how to experience and describe the emotional volatility and expressions. The patient also experiences a change in the mood, which is referred to as the patient's inability to describe the reasons and relate to the feelings. The nurses can record the episodes, days and time, to relate with the disturbing instances and frequency of it. The patients are unable to express how they are feeling and what they are feeling, due to what. With mental health, they feel constantly barricade in experiencing the best of physical health. They feel constantly slow, lethargic and unmotivated to do certain things and needs. Often the mood can also be dependent on how the patient can feel current symptoms about the patient current and past experiences (Rao, 2016). Such as how individuals can also feel affected due to the psychotic symptoms which the patient would relate by feeling agitated and constantly showing frustrated. It can also create delusional material which can make the patients feeling a suspicious mood.
To conclude, how some of the patients suffering from paranoid schizophrenia, have suffered a low phase in their life, which has created a hallucination. They often experience psychotic episodes that are caused due to schizophrenia and there is a single range of crises, that can create a chronic experience. It is important to note, how the phase of schizophrenia can stay for a lifetime. To provide a mental health assessment of the patient, as a nurse they should document and understand the range of problems, that can cause positive and negative symptoms related to the condition.