Mental health care
DIFFERENCE BETWEEN HISTORICAL AND CONTEMPORARY MENTAL HEALTH CARE
Mental health care practice began several years ago when relatively simple approaches to care were still being utilized. Like any other form of health care, mental health care can be evaluated based on a range of theories and models which have extensively been used to inform mental health nursing practice. This paper discusses the difference between historical and contemporary mental health care as it applies to nursing models and the nursing process.
This paper has described in details, the concepts of “nursing process” and “nursing model” and how they have evolved since conception. Moreover, this paper uses a case study to describe how the nursing process and a nursing model have been applied in nursing care provision for a patient who is suffering from a sexually transmitted infection characterized by depression.
- CONTEMPORARY AND HISTORICAL MENTAL HEALTH CARE
2.1 The Nursing Process and how it has Evolved since Conception
The principles of nursing process largely dominate mental health care practice in today’s nursing and health industry. The term “nursing process” is defined as the application of a scientific approach to care provision that involves strict adherence to distinct steps which are aimed at generating positive health outcomes for patients (Perez-Rivas, Martin-Iqlesias, Pacheco del Cerro, Arenas, Lopez and Lagos, 2016, p. 43).
According to Perez-Rivas et. al., (2016, p. 43), for a nursing process to be considered effective, the health care practitioner must complete all the documented steps because information gained from one step results into the success of subsequent steps. Approaching mental health care based on the principles of “nursing process” helps to develop critical thinking skills of nurses, which eventually translates into improved problem-solving and positive health outcomes for mentally-ill patients (Perez-Rivas et. al., 2016, p. 44).
Nursing process and its application in mental health care has greatly evolved from when it was introduced up to date. Traditionally, the nursing process extensively emphasized on health care assessment, implementation of intervention, and planning as the only phases involved in mental health care delivery. In those days, the process did not recognize the significant role played by cognitive processes in influencing decision making during care (Zamanzadeh et. al., 2015, p. 411).
However, as nurses continued to utilize the historical principles of the nursing process into practice, increasingly advanced nursing processes were integrated and this has greatly improved the overall image of the nursing process. For instance, the advanced nursing process currently integrates diagnostic reasoning that facilitates decision making which was absent in the traditional nursing process.
Through continued nursing research and practice, nursing professionals have contributed greatly to the evolution of the nursing process by identifying the need to incorporate health outcomes identification and planning into the nursing process. To date, health care professionals who handle mental health cases view the nursing process as an advanced form or practice that involves five steps: “assessment, diagnosis, outcome identification and planning, intervention implementation, and evaluation (Zamanzadeh et. al., 2015, p. 412).
2.2 How the Nursing Process was First Developed and How it is used in Contemporary Nursing
The nursing process that is used in contemporary nursing differs significantly from the one used in traditional nursing as it applies to mental health care. This is attributed to the changes that have been made on the “nursing process” since it was developed (Perez-Rivas et. al., 2016, p. 44). Nursing was first viewed as a process rather than a distinct activity in 1955 by Lydia Hall from United Kingdom.
Although many professionals in the nursing field were not sure as to whether Hall’s views were right, a few of them dwelled extensively on the topic and they began to refer to nursing as a process. Examples of authors who supported Hull in describing nursing as a process include Johnson, Orlando, and Wiedenbach and their opinions on the nursing process are available in their publications of 1959, 1961, and 1963 respectively.
By then, only three steps were used to define the nursing process and they include, “assessment, planning, and evaluation (Zamanzadeh et. al., 2015, p. 411).” These three steps provided the basis of the nursing process that traditional nurses used to deliver mental health care to patients.
Later on in 1967, an additional step described as implementation of intervention was added to the nursing process by Walsh and Yura. It is not until 1973 when the American Nurses Association (ANA) felt in necessary to incorporate diagnosis into the nursing process. During the final revision and publication of the ANA standards in 1991, another step known as identification of outcome was integrated into the nursing process.
The step was made part of the planning phase and this resulted into the generation of a nursing process that comprised of five steps namely; “assessment, diagnosis, outcome identification and planning, intervention implementation, and evaluation (Zamanzadeh et. al., 2015, p. 412).” The development of the nursing process has progressed through a number of steps which have been modified across years to generate the process that is currently used in contemporary nursing to provide care for mentally-ill patients.
Based on the nursing process, contemporary nurses frequently assess, diagnose, identity outcomes, implement interventions, and finally evaluate the effectiveness of interventions whenever they are delivering mental health care to patients.
2.3 The Nursing Model and How they Have Evolved Since Conception
Nursing models play a very important role in nursing practice in the sense that, they largely influence decision making processes by nurses concerning the most appropriate ways through which patients should be handled. A nursing model is defined as a framework of nursing concepts that act as a foundation for nursing care and that describe how given health care practices should be performed (Murphy, Williams and Pridmore, 2010, p. 23).
Nursing models have been developed to help direct nurses on the best approaches they should take to improve patient outcomes and to explain why certain approaches as relevant. Different nursing models exist and their goal is to assist nurses to achieve various nursing components based on the nature of a mental health issue they are handling at any given time (Springer and Casey-Lockyer, 2016, p. 647).
Nursing models have significantly evolved since their conception due to constant changes in patients’ needs and due to rapid technological advancements in the contemporary world which tend to change approaches to care. Nursing models were first developed in the United States way back in 1960s (Murphy, Williams and Pridmore, 2010, p. 23). In 1960, the United States was characterized by a number of cultural, technological and social transformations which influenced nursing professionals to make changes that were aimed at improving nursing practice.
For this reason, traditional nursing models were developed based on their effectiveness in meeting basic medical goals. For instance, the “medical model” provided a foundation only for the management of physical health problems. Nurses in the United Kingdom began to apply nursing models into practice in 1970s (Murphy, Williams and Pridmore, 2010, p. 24).
Since then, significant transformations in the world have helped nurses to build a body of knowledge that has been used to develop modern nursing models. Nursing models which are used in contemporary nursing to deliver mental health care have been developed to guide nurses on how they can handle patients with a wide variety of health problems as opposed to traditional models (Springer and Casey-Lockyer, 2016, p. 660).
2.4 Total Patient Care: A Historical Nursing Model
An example of a historical nursing model that is rarely used by today’s nurses is Total Patient Care which is also known as Private Duty Nurses. Total Patient Care is a nursing model that conceptualizes that, for nurses to deliver quality patient care, they must have a small number of patients that they can effectively handle at any given time. The nurse should then work in collaboration with other registered nurses to ensure that the patients being attended to receive maximum care.
Total Patient Care model guided traditional nurses to work with small groups of mentally-ill patients that they could effectively handle at any given time. Although Total Patient Care can still be used to guide clinical decisions in today’s health care settings, today’s health care organizations rarely utilize this model to deliver mental health care (Mary and Sandra, 2004, p. 291).
2.5 Watson’s Theory of Caring: A Contemporary Nursing Model
Through his theory of caring, Jean Watson greatly influences clinical decision making processes by today’s nurses, especially those who deliver care to patients with mental health problems. This contemporary nursing theory conceptualizes that there are four major factors that determine positive patient outcome during care delivery. These factors include the personality of the care giver, the patient’s health status, the environment in which care is delivered, and the nursing process (Ozan, Okumus and Aytekin, 2015, p. 26).
These factors influenced Watson to assume that the most effective form of care is that which is delivered interpersonally. In addition, the nurse should take time to understand specific health problem that a patient is suffering from. Again, it is the responsibility of the nurse to create caring environment for his or her patient. Furthermore, nursing lies at the center of caring and intended health outcomes will only be achieved if the right nursing processes are followed. Watson’s theory of caring is widely used in nursing practice today (Ozan, Okumus and Aytekin, 2015, p. 25).
- SERVICE USER’S HISTORY
A service user whom I have cared for in the past is a female patient aged 16 years and who suspected that she was suffering from a sexually transmitted infection and was therefore in need of medical care. I had to take historical data before I could identify the best component of the nursing process to use in order to confirm presence or absence of a sexually transmitted infection.
My patient was an orphan who stayed with her uncle at the time of visit. At the time of visit, she was feeling depressed and psychologically disturbed because of her health condition. In addition, she was part of a group of commercial sex workers in the city despite her young age, and she uses money earned from the business to earn a living. She had also been in an intimate relation with different partners without protection.
Her uncle used to beat her up every time he was at home and therefore, she feared staying at home. The patient had not taken any medication prior to visiting the health care facility. I applied the nursing process to deliver the most appropriate nursing care for the patient.
When I was handling my patient, I greatly relied on the nursing process that is majorly used in contemporary nursing. By following the five steps of the nursing process, contemporary nurses are able to provide quality care that addresses specific patients’ needs. During assessment phase, the contemporary nurse collects, verifies, organizes, interprets, and documents patients’ health data that will be used to accomplish the subsequent steps.
After collecting relevant data, the contemporary nurse ensues to diagnosis phase where he or she analyzes the collected data to make a clinical judgment which is aimed at identifying a specific health problem that the patient is suffering from (Perez-Rivas et. al., 2016, p. 44).
Once a specific health problem is identified, the contemporary nurse proceeds to the third phase where he or she identifies the most appropriate health outcomes that the patient should be assisted to achieve. It is in this phase where the nurse documents a plan of how the patient can be helped to achieve the proposed outcomes. In the fourth phase, the contemporary nurse implements the right intervention as documented in the plan (Zamanzadeh et. al., 2015, p. 416).
The nurse then proceeds to the fifth phase where he or she evaluates the effectiveness of the implemented intervention in generating the proposed health outcomes for the patient. In case the proposed health outcomes are not realized following intervention implementation, the nurse is compelled to change the intervention until the intended results are obtained (Perez-Rivas et. al., 2016, p. 44).
A component of the nursing process that I used to exercise care for the patient was taken from the Assessment, Diagnosis, Planning, Implementation, and Evaluation (ADPIE) model described above, considering the fact that it is the one that is widely used in contemporary nursing. I decided to use Diagnosis component of the ADPIE to maximize nursing care for my patient.
By choosing diagnosis component, I wanted to bring together all the historical data that I had gathered into meaningful information. Specifically, when conducting diagnosis on the patient, I used the data that I had already collected to make clinical judgment about my patient and the family. This enabled me to understand that risk factors that exposed by patient to acquiring sexually transmitted infections.
Furthermore, I was able to predict possible responses that she could receive from family members if she approached them with her health problem. Generally, diagnosis provided me with the basis for selecting the most appropriate nursing intervention that could generate positive health outcomes for my patient.
The type of diagnosis that I conducted on the patient was possible nursing diagnosis. A possible nursing diagnosis is conducted when a patient’s problem requires additional analysis for the presence or absence of a health problem to be confirmed (Perez-Rivas et. al., 2016, p. 44). In the case that I was handling, it was not yet confirmed that the patient was suffering from sexually transmitted infections. The client was worried that she might have acquired sexually transmitted infections owing to her sexual behaviours in the recent past. Such thoughts had severe impact on her mental health. Data obtained from this diagnosis helped me to confirm presence of a sexually transmitted infection (Zamanzadeh et. al., 2015, p. 416).
Diagnosis was a very important component of ADPIE for my patient because it acted as a link to the other aspects of the nursing process namely; planning, implementation, and evaluation. The diagnosis was the second phase of the nursing process that was performed after collecting data in the assessment phase. Information gathered during diagnosis phase was extremely useful in the subsequent steps because I utilized it to identify the best health outcomes for my patient and to select a nursing intervention that could generate those outcomes for my patients. Diagnosis was very important in the overall nursing process because it helped me to come up with the right interventions that were intended to generate improved health outcomes for the patient (Zamanzadeh et. al., 2015, p. 416).
When I was providing nursing care to my patient, I paid greatest attention to Watson’s Theory of Caring mode. I utilized the four major factors that determine positive patient outcome during care delivery as described in Watson’s theory of caring. Specifically, I strived to; build strong interpersonal relationship with the client, establish specific health problem the patient was suffering prove, create an environment suitable for nursing care, and to adhere to all steps of the nursing process (Ozan, Okumus and Aytekin, 2015, p. 25).
Historical and contemporary mental health care differ significantly due to evolutions in nursing theories and models which have taken place over the years. For instance, while traditional mental health care was delivered using a nursing process that only involved three steps, delivery of contemporary mental care utilizes a nursing process with five steps.
Additionally, while traditional mental health care was based on historical nursing models, today’s mental health care is guided by contemporary nursing models such as Watson’s theory of caring model. The evolutions of the nursing process and the developments of nursing models have brought about significant improvements in health care delivery particularly in mental health care.
From this case study, I have learnt the importance of implementing contemporary nursing processes and nursing models in care delivery. I will utilize this knowledge to improve the quality of mental health care that I will deliver in future. As a student nurse, I will take my time to evaluate and understand changes in nursing models and components of the nursing process as they apply to mental health care.
Mary, T. & Sandra, L. 2004, “Traditional models of care delivery: What have we learned?” Journal of Nursing Administration, vol. 34, issue 6, pp 291-297.
Murphy, N., Williams, A. & Pridmore, J. A. 2010, “Nursing models and contemporary nursing 1: The development, uses and limitations,” Nursing Times, vol. 1, issue 106, p. 23-24.
Ozan, Y., Okumus, H., & Aytekin, A. 2015, “Implementation of Watson’s theory of human caring: A case study,” International Journal of Caring Sciences, vol. 8, issue 1, pp. 25-35.
Perez-Rivas, F., Martin-Iqlesias, S., Pacheco del Cerro, K., Arenas, C., Lopez, M. & Lagos, M. B. 2016 “Effectiveness of nursing process use in primary care,” International Journal of Nursing Knowledge, vol. 27, no. 1, pp. 43-47.
Springer, J. & Casey-Lockyer, M. 2016, “Evolution of a nursing model for identifying client needs in a disaster shelter: A case study with the American Red Cross,” Nursing Clinics of North America, vol. 15, no. 4, pp. 647-662.
Zamanzadeh, V., Valizadeh, L., Tabrizi, F., Behshid, M. & Lotfi, M. 2015 “Challenges associated with the implementation of the nursing process: A systematic review,” Irarian Journal of Midewifery Research, vol. 20, no. 4, pp. 411-419.
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