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Mental Health Consumer Care

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Mental Health Consumer Care

“How would you feel when almost every individual within the society treats you differently by avoiding any form of interaction? Well, no one prefers to be treated that way. Mental health consumers are more often marginalized because of their mental state. This aspect can worsen their entire being and situation, which can propel them to neglect the self. By definition, a mental health consumer refers to persons who use mental health services in order to empower their mental health status while obtaining support or treatment.

Evidently, suffering from mental illness can be devastating to a patient and that situation can affect various aspects of their lives ranging from their physical status to their emotional being. On the other hand, self-neglect refers to the behavioral situation in which a person neglects or fails to attend to their personal basic needs such as feeding, appropriate clothing, tending appropriately to medical conditions, feeding or personal hygiene. Nonetheless, in extreme cases of self-neglect, the situation can be inferred to as Diogenes syndrome (Townsend, 2013).

Despite the severity of self-neglect in a mental health consumer, nursing professionals need to care for them in an attempt to improve their mental health issues. This presentation focuses on the relevance of nursing care of mental healthcare consumers who self-neglect to modern mental health nursing as well as to recognize the appropriate linkages with other mental health care providers.

In order to appropriately identify patients suffering from mental health problems, it is ideal to identify the various aspects that help in identifying them or the factors that assist in characterizing them. Most cases involving self-neglect are often recognized as a result of numerous complaints received from several sources such as community organizations, neighbors, GPs and healthcare professionals (Naik, Lai, Kunik & Dyer, 2008).

The process of managing and identifying cases is very complex and difficult, which requires a multi-disciplinary and multi-agency approach. Based on several studies, individuals with mental health problems are often poor and indulge in smoking habits, lack exercise, consume alcohol, have poor diets and consumer other drugs (Middleton, 2008; Richardson, 2007). The deteriorating state of their daily lives often affects their energy levels, organization skills, attention, physical abilities or motivation.

The effect on the patient can cause them to neglect the self. Studies also indicate that the side effects of certain psychiatric medications can cause a decrease in the motivation levels among mental patients (Townsend, 2008; Gunstone, 2003). Therefore, self-neglect among mental patients can be caused by illness alone. With the help of medical practitioners including nursing care cases of self neglect among mentally ill patients re likely to reduce.

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Notably, nurses constitute the largest population of health care professionals, thus, they have a key role in the management and identification of self-neglect among mentally ill patients. The relevance of nursing care to mental healthcare consumers in the modern nursing practice can be identified through the assessment, diagnosis, outcome identification, planning, and implementation and evaluation steps (Peate, Wild, & Nair, 2014).

In the initial process, nurses establish a database in which the database relates to the client using assessment tools such as KELS, geriatric depression scale and nutrition assessment (Pickens et al., 2007). The next process involves identifying the patients’ health care needs as well as the specific goals for care. The third process involves establishment of the specific criteria that measures the achievement of anticipated outcomes while the forth process involves designing the most appropriate strategy that facilitates the achievement of the desired goals.

The implementation process involves initiating and finishing actions that are necessary in accomplishing goals as the final process involves determination of the degree to which the objectives and goals of the implemented care have been achieved (Boyd, 2010). Through this sequential step, a nursing practitioner is capable of analyzing personal achievements in relation to providing care to patients, especially those with mental illness and having self-neglect. The outcomes of this process help both the nursing specialists and other medical professionals to identify the various steps that in deed help in solving the problem of self-neglect among mentally ill patients, for future referencing.

Currently, the nursing profession is working towards providing holistic care to patient. This means that other than assisting patients within hospitals, nurses also help patients outside the hospitals such as acceptance within the society. With reference to mentally ill patients, they are among the mostly segregated groups of people within the society. The nursing education helps in providing additional knowledge to nurses and it is disseminated to the public by informing them that mentally ill patients are just like other people with slight differences in their ways of thinking and making decisions.

Some of the interventions include adult protection services, drug misuse rehabilitation, housing services, budgeting services and neurological assessment among many others (Lauder, Anderson & Barclay, 2005). These shape the current approach in providing care to patients by integrating friendly approaches towards the patients. By dealing with cases of self neglect, nurses are capable of reducing the stigma that mental patients receive, which in turn promotes their general well-being.

In conclusion, within the modern nursing field, practitioners are more propelled towards the identification and management of self-neglect cases among mentally ill patients as a means of preventing the reoccurrence of the phenomenon. Since nurses constitute the largest portion of individuals within the health care sector, they play a chief role in ensuring the provision of proper care to patients.

In the nursing profession, taking care of mentally ill patients helps in identifying the most appropriate ways of providing care. Treating mentally ill patients with self-neglect issues helps in improving the health of the patients in general.”

References

Boyd, M. (2010). Psychiatric nursing: Contemporary practice. Philadelphia: Lippincott Williams & Wilkins. https://books.google.co.ke/books?id=a-GcGVtBnqQC&pg=PA893&lpg=PA893&dq=Nursing+Care+of+Mental+patients+Who+Self+%E2%80%93+Neglect+relevance++to+contemporary+mental+health+nursing.&source=bl&ots=H7F7RnZ_WT&sig=hFRFTS4lxe5tl53BEFM-1drGcpA&hl=en&sa=X&redir_esc=y#v=onepage&q=Nursing%20Care%20of%20Mental%20patients%20Who%20Self%20%E2%80%93%20Neglect%20relevance%20%20to%20contemporary%20mental%20health%20nursing.&f=false

Gunstone, S. (2003). Risk assessment and management of patients whom self-neglect: a ‘grey area’ for mental health workers. Journal of Psychiatric and Mental Health Nursing, 10, 3, 287-296. http://onlinelibrary.wiley.com/doi/10.1046/j.1365-2850.2003.00568.x/abstract

Lauder, W., Anderson, I., & Barclay, A. (2005). A framework for good practice in interagency interventions with cases of self-neglect. Journal of Psychiatric and Mental Health Nursing, 12, 2, 192-198. http://www.ncbi.nlm.nih.gov/pubmed/15788037

Middleton, J (20 June, 2008). Self-neglect 2: nursing assessment and management. Nursing Times. Retrieved from http://www.nursingtimes.net/roles/older-people-nurses/self-neglect-2-nursing-assessment-and-management/1584631.fullarticle

Naik, A. D., Lai, J. M., Kunik, M. E., & Dyer, C. B. (2008). Assessing capacity in suspected cases of self-neglect. Geriatrics, 63, 2, 24-31. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2847362/

Peate, I., Wild, K., & Nair, M. (2014). Nursing Practice: Knowledge and Care. Hoboken: Wiley. https://books.google.co.ke/books?id=xqXCBwAAQBAJ&pg=PA250&lpg=PA250&dq=Nursing+Care+of+Mental+patients+Who+Self+%E2%80%93+Neglect+relevance++to+contemporary+mental+health+nursing.&source=bl&ots=a6pjAEpAMS&sig=XBJXGriVDaILTkHpVefKU3FG_2o&hl=en&sa=X&redir_esc=y#v=onepage&q=Nursing%20Care%20of%20Mental%20patients%20Who%20Self%20%E2%80%93%20Neglect%20relevance%20%20to%20contemporary%20mental%20health%20nursing.&f=false

Pickens, S., Naik, A. D., Burnett, J., Kelly, P. A., Gleason, M., & Dyer, C. B. (2007). The utility of the Kohlman evaluation of living skills test is associated with substantiated cases of elder self-neglect. Journal of the American Academy of Nurse Practitioners, 19, 3, 137-142. http://www.ncbi.nlm.nih.gov/pubmed/17341281

Richardson, B. K. (2007). Psychiatric nursing. Clifton Park, NY: Thomson Delmar Learning. https://books.google.co.ke/books?id=yw2HAQAACAAJ&dq=psychiatric+nursing+by+richardson&hl=en&sa=X&redir_esc=y

Townsend, M. C. (2008). Nursing diagnoses in psychiatric nursing: Care plans and psychotropic medications. Philadelphia: F.A. Davis Co. http://www.sbmu.ac.ir/uploads/townsend2011.pdf

Townsend, M. C. (2013). Essentials of psychiatric mental health nursing: Concepts of care in evidence-based practice. Philadelphia: F.A. Davis Co. https://books.google.co.ke/books?id=cxdengEACAAJ&dq=Essentials+of+psychiatric+mental+health+nursing:+Concepts+of+care+in+evidence-based+practice.&hl=en&sa=X&redir_esc=y

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Applying cultural sensitive care

Legal and ethical consideration

In this case study, there is conflict between the nurse ethical responsibilities to her patient, legal responsibility to her employer and legal duty to the physician; which exposes the RN to professional risk. This is a challenging situation as there is inadequate guide in resolving such kind of dilemmas. For instance, the nursing standards and law are vague about rights to ethical decisions made by RNs. The code of ethics does not offer legal protection to RN who works as patient advocate (Hunt, 2013).

In this case, the role of the nurse is to remain cultural competent. The RN must respect the patient decision even when the patient’s decision is irrational or wrong. The RN should advise the patient about their clinical opinion without putting pressure on them to accept the RNs advice. While doing so, the RN should be careful not to use words and actions that disrespect the patient values and beliefs (Hinkle & Cheever, 2013).

RNs support to patient decision

The RN can offer support to patient’s decision by (Taylor, Lilis, LeMone, & Lynn, 2011);

Being an active listener

This is important as it helps establish mutual relationship and trust to the RN. It is a way for RN to show their concerns to the patient. The RN should ask the patient about their understanding of the health condition, which will help RN to address any misconceptions.

Explain medication detail

Most of the healthcare medical terms are jargons to ordinary people. It is important to discuss all the details associated with the medication, his risk level and programs which could help with the patient cost management and coping strategies.

Explore alternative approaches

Some of the patients could be comfortable to seek alternative medication such as herbal remedies or traditional healers. The RN must be thoroughly informed about the alternative medication because some of the treatment could be harmful. If considered as an alternative, the nurse can refer the patient to a certified practitioner. In Some cases, religious rituals such as prayers can be integrated into practice.

Example of major religion

An example of a religion that could possibly be holding similar doctrines is Muslim religion. Devout Muslims can reject medication containing alcohol such as those used during the peri-operative procedures, or medications made from pork derivatives. In medical situations which are not of emergency, the RN should educate the patient, but help them preserve their values and believes (Smith, 2013). This includes exploring other beliefs that do not contradict to their beliefs. These small accommodations could pay off the patient emotional well-being. Therefore, to remain culturally competent care, the RN must perform cultural assessment in order to understand their perception of illness and wellness (Kee, Hayes, & McCuistion, 2015).

References

Hinkle, J., & Cheever, K. (2013). Brunner and Suddarth’s textbook of medical-surgical nursing (13th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.

Hunt, R. (2013). Introduction to community based nursing (5th ed.). Philadelphia, PA: Lippincott, Williams and Wilkins.

Kee, J., Hayes, E., & McCuistion, L. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). St. Louis, MO: Elsevier.

Taylor, C., Lilis, C., LeMone, P., & Lynn, P. (2011). Fundamentals of nursing: The art and science of nursing care (7th ed.). Philadelphia, PA: Lippincott, Williams and Wilkins.

Smith, L. (2013). Reaching for cultural competence. Nursing, 43(6), 30-38.

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Treatment Plan: Case Study

TREATMENT PLAN

CLINICIAN NAME: LEAH CLIENT NAME: GINA S.

Diagnosis (es):
DSM 5 Code Diagnostic Classification
309.81 (F43.10) Posttraumatic stress disorder (PSTD)
Medications: Prazosin and sertiline
Supports/Strengths: Prazosin would be appropriate for this patient because it has been shown to reduce insomnia and nightmares. Sertiline is also necessary since it is an anti-depressant hence will help in management of anxiety and depression. This agent also aids in improving the patient’s concentration and sleeping problems.
Presenting Problems: Leah presents with flashbacks and nightmares to an extent that she fear sleeping alone. She has disturbing thoughts, dreams as well as feelings related to the terror attack that occur at her school. Moreover, Leah develops distressing and repetitive images of the attack. The event has made it difficult for her to concentrate in class or even remember what was taught in previous classes.
Treatment Recommendations: a) Psychotherapy is the primary treatment for patients suffering from PSTD. Leah should therefore be subjected to exposure therapy, a form of psychotherapy, which helps a patient to safely face what they find frightening so that she can learn to cope with the negative thoughts that she has. This technique uses virtual reality programs that would help Leah to re-enter the setting similar to that of the attack. Cognitive therapy should also be used to help Leah change her ways of thinking.

b) Medications such as diazepam an anxiolytic agent or sertraline an anti-depressant can be used to manage Leah’s symptoms.

Desired Goals of Tx: The psychotherapy treatment will help Leah learn ways of coping with the symptoms of the attack that she witnessed. They drugs can help in relieving symptoms of fear, depression, and anxiety that Leah is going through. This will in turn improve Leah’s sleeping problems and concentration in class. Additionally, Leah is expected to start socializing with her classmates just like she used to.
Frequency of Tx: Treatment should be initiated immediately and maintained and the patient is stable enough. The initial dose of sertiline should be 10mg once daily and increased to 20 mg after one week. Adjustments should be made weekly based on patient presentation. However, the patient should be monitored since administered agents, that is, sertraline and diazepam are associated with severe side effects.

Project Length of Treatment: Approximately 2- 3months
Supportive Background Documentation for Diagnoses and Meds:

PSTD is the primary diagnosis in the case study presented. This is because the disorder occurs as a result traumatic events such as traffic collisions, sexual assault, or terror attacks. Patients suffering from PSTD present with nightmares, flashbacks as well as distressing and repetitive images (Williams et al., 2013). These findings are consistent to those presented in the case study, hence proving that the Leah has PSTD.

TREATMENT GOALS/INTERVENTIONS
CLINICIAN NAME: LEAH CLIENT NAME: GINA S.
Long Term Goals:

– Exercise proper sleeping patterns

– Patient should demonstrate proper control and relaxation techniques
Short Term Goals:

– Patient should manage her feelings and fear.

– Improved social interaction

-Improved concentration

TREATMENT GOALS/PROBLEMS, STRENGTHS, BARRIERS, PERSON RESPONSIBLE

Goal #1: Leah should demonstrate control and relaxation techniques
OBJECTIVES: Distinguish between present and memory. She should also recognize environmental triggers and react to them appropriately.
INTERVENTIONS: Evaluate the patient’s symptoms, encourage her to identify terrors, use de-escalation techniques in her management, and use virtual programs to boost Leah’s courage.
Target Date: December 20^th, 2016 |Review Date: |Completed ?yes, ?no | New Target Date: |Review Date: |Completed ?yes, ?no
TREATMENT GOALS/PROBLEMS STRENGTHS BARRIERS PERSON RESPONSIBLE
Goal #2: Improved social interaction
OBJECTIVES: Patient will interact effectively with her peers. Her concentration in class should also improve. Leah should also use proper skills when initiating and maintaining an interaction.
INTERVENTIONS: Enquire which symptoms she experiences when she starts feeling anxious. Leah should be trained on how to briefly remove herself when she feels agitated and engage in exercises that relief anxiety such as deep breathing. This will aid in improving her sense of control in public.

Reference

Williams, A. M., Richardson, G., & Galovski, T. E. (2013). Posttraumatic Stress Disorder. Anxiety Disorders: A Guide for Integrating Psychopharmacology and Psychotherapy, 176.

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