Assessing Mental Health Nursing Practice

Introduction

Nursing practice is a crucial aspect of patient care (Anderson R. M. et al, 2015). Mental health comprises of the emotional, social and psychological well-being of an individual. Mental health disorders include clinical depression, anxiety disorders, bipolar disorder, dementia, hyperactivity disorder and schizophrenia (Aschbrenner K. Et al, 2016). Mental health nursing requires advanced therapeutic skills and pedagogical skills because the disorders exhibit a similar yet unique symptom for each patient. Nurses need to be aware of all the mental, physical, behavioral, social, cognitive and spiritual needs of the patient to be able to nurse them to health (Berggvist A. Et al, 2017).

The Roper model has been used from the 20th century for general assessment of the progress of patients from the day they are admitted to when they are fully well (Ehrlich C. Et al, 2018). The essay aims to assess if mental health nurses are aware of the needs of their mental disorder patients using the Roper assessment model (Doyle L. Et al, 2017). In mental health nursing, it is used to investigate the physical and mental stability of patients and to identify their needs effectively (Simonelli-Munoz A. J. et al, 2017). It will be used to determine Mr. John Dermott’s progress from his first diagnosis in 2003 to today. The model will also reflect how Mr. John’s life has been affected after being diagnosed with paranoid schizophrenia.

DISCUSSION

Nurses are at the forefront in providing primary health care for mental disorder patients. Nursing education is very broad and nurses are trained in all necessary fields intensively (Brouse T. Et al, 2016). Their syllabus has been revised to include the basic mental health nursing knowledge and concepts early. enough, giving them the opportunity to develop the necessary skills needed in the field(Calton T. Et al, 2017). The focus in their training depends on their country’s needs varying from how to properly assess mental health patients to advocating for better mental health services and community mental health awareness(Chee K. Et al, 2018). The major problem facing mental health care is the lack of knowledge and skills on how to handle each patient in the uniquely because different patients with the same disorder sometimes have different symptoms (Cronenwett L. Et al, 2019).

The Roper Assessment Model has been used assess and monitor the progress of mental disorder patients (Van Wel T. F. et al., 2017). It has provided information on the mental and physical stability of patients to be able to come up with an effective treatment regimen for them (Blomqvist M. Et al, 2018). The model assesses how a person can perform societal duties and activities of living independently. Most mental disorder patients begin from a stage where they completely depend on help to do some activities of living and they are expected to progress to a level that they can independent work alone (Blythe J. Et al, 2019). A cognitive approach is always used in the assessment and care of the mental health patients.

The mental health assessments in the model include: the patient’s ability to maintain a safe environment for themselves and others, how well the patient communicates with others, if the patient is able to wash and dress themselves appropriately, if the patient is capable of working and playing with others and how the patient expresses their sexuality (Bradshaw T. Et al, 2015). During Mr. John’s first psychotic episode in 2003, he set light a car, believing the owners used it to spy on him. He created an unsafe environment for him and those around him. His communication was also not clear with everyone around him because he was delusional and he was hallucinating. He was unemployed and could not work with others and although he had previously been in a long term relationship in the university he had just broken it off. His sexual fleets reflect on his body image, self-esteem and values (Lambert T. Et al, 2017). His sexual life shows he has a low self-esteem. There is social stigma in the society because every patient is considered a mad man (Lassenius O. Et al, 2018). The negativity around these patients, make them lose hope and their self-esteem is lost, they do not take care of themselves eventually leading to physical illness (Laursen T. M. et al, 2019). The Roperts model helped in assessing and illustrating his mental instability (Crump C. Et al, 2015).

The physical health assessments in the model are: the food, drinks and substances the patient takes, their body vital signs and their sleep and wake patterns (De Hert M. Et al, 2016). Mental and physical illness have been closely related and they cause premature death in several patients. Schizophrenia patients have co-morbidities like cardiovascular disease including ischemic heart diseases and cancers (Jormfeldt H. 2016). John is already a chronic smoker who smokes 40 cigarettes per day and cannabis predisposing him to throat and lung cancer and addiction. He also takes 21 units of alcohol per week which contributes to obesity resulting in cardiovascular disorders and liver cirrhosis. During psychotic episodes patients may hurt themselves and even die (Kemp V. Et al, 2019). Many mental disorder patients engage in substance abuse to be able to cope with their mental disorder symptoms, which affects their health and lowers their life expectancy ( Svedberg P. Et al., 2019). Furthermore, to maintain physical health, enough finances are needed to afford healthy food and many patients lack the finances to purchase good food, contributing to the their physical illness and worsening their mental symptoms (Keogh B et al, 2016). Physical activity by these patients also contribute to their general health. Most of them are not physically active and end up gaining weight from food and some medication which eventually makes them hate their body image (Weinmann S. Et al, 2015).

Nurses have developed a patient centered program for their mental patients that focuses on their mental, physical, behavioral, social, cognitive and spiritual needs (Enarsson P. Et al, 2019). All these needs complement each other in their roles because medical treatment does not always work efficiently because it does not automatically improve the patient’s mental health and most of the time the patient become fully dependent on their medication (Robson D. Et al., 2019). Annually, 450 million people suffer from mental or behavioral problems and more than 1 million people try committing suicide (Erdner A. Et al, 2015). Individual mental health nursing for each patient was initially adopted however the patients still felt separated from the society and alone.

Community mental health teams are the patient centered programs that were introduced to provide biological, psychological and social interventions to mental patients (Gothefors D. Et al, 2016). This program was proposed by nurses and it has been a great progress in mental health nursing because it has enabled the nurses to identify and meet the needs of their patients as they monitor their progress through the Roper model(Graham C. Et al, 2017). The teams are organized to meet frequently and weekly to enable the program to be effective (Wardig R. E. et al., 2019). John McDermott has been a member in his local community mental health team from 2005. After his care begun at this community center, he has not had any psychotic episode until 2016. His progress on the Roper model was substantial throughout this time because he maintained a safe environment, he communicated well with everyone in the team and made several friends in the mental community and within his neighborhood. He was also working as an advocate for the rights of mental health service users. However, his sexual and romantic relationships have not been stable.

The psychological interventions done in these teams include individual or group counselling that focuses on emotions and behavior growth (Happel B. Et al, 2019). Counselling is essential in understanding and learning how to properly communicate with others it helps build cognitive needs and enhance mental stability. Social interventions involves creating a family and a social support team in the community (Scott D. Et al, 2015). John has found friends and a passion for advocating for mental health just within his community mental health team. This has given him a sense of belonging knowing that there are other people just like him. His behavioral and social needs are met through these social interventions (Shiner B. Et al, 2016). Biological interventions include providing information to the patients about how to improve their physical health. Diet improves both physical and mental health. Tryptophan rich meals boost neurotransmitter levels such as those of serotonin that elevate mood (Hardy S. Et al, 2019). However, diet is influenced by the financial stability of these patients. John is unemployed and lives off universal credits which may not enable him to afford the best meal to improve his health. Exercise and yoga lessons are also conducted in the teams to help improve the patient’s physical health (Heald A. Et al, 2016).

Nursing practice is both a science and an art that requires a purposeful, bold and creative person(Hennekens C. H. et al, 2017). A successful nurse cannot do without either. Nursing is a scientific discipline that incorporates theory, research and evidence in the field. It is built from the anatomy, physiology and chemistry of the body. Therefore, it important for a nurse to ensure their scientific facts are correct before handling a patient to facilitate adequate patient care (Hodgson M. H. et al, 2018). Nursing is an art because creativity facilitates how the science is applied. The art includes pedagogical skills when communicating with the patient and the ability to pick up what is unsaid by the patient (Hultsjo S. Et al, 2019).

A well trained nurse with good scientific and art skills will efficiently follow up the care of the mental patient with the Roper model. Previously, less attention was given to the art aspect of nursing resulting on a strained relationship between the nurse and the patient and there was only an objective gaze which only focused on the disease and not an individual’s experience (Ussher M. Et al., 2016). Developing a relationship with the patient is important because they have to trust you to enable you to fully help them recover (Johnstone R. Et al, 2015). Despite the necessity of this art, it is mostly an intuition developed by the nurse over time hence nurses are urged to practice with passion as much as possible to be able to be more efficient.

Effectively addressing the mental and physical needs of a patient requires concise assessment (Leucht S. Et al. 2015). The Roper assessment model has been a standard assessment tool with reliable frameworks that should be considered to be able to give the proper care to a patient. The frameworks are:

Environmental framework : the environment may increase or decrease the severity of the mental disorder. It is important to understand the patient’s environment to know the best care (Linhorst D. M. et al., 2017).

Political-economic framework: the vulnerable groups in the society based on gender, ethnicity and economic status may present similar mental disorders and should be treated with care (Lundstrom S. Et al., 2018). The ability of the government to provide funding for the programs mental for the mental disorder affects the quality of care given (McDevitt J. Et al., 2019).

Biological framework: the type of mental disorder influences its assessment and the type of care given (Montejo A. L. 2015).

Socio-cultural framework: language, culture and religion must be respected during assessment (Nyeboe L. Et al, 2016). The economic status of a patient influences their ability to access necessary medication and better treatment (Leutwyler H. Et al., 2016).

Based on the frameworks above, assessment should note the cultural, lifestyle and health beliefs of a patient before coming up with an appropriate care plan because they influence physical and mental needs (Pekkala E. Et al, 2017). Communication should be efficient during assessment and the nurse should not the verbal and nonverbal responses of the patient to note mental needs. There should always be a cultural negotiation and compromise depending on the culture, views and problems of the patient (Roberts S. Et al., 2017). The nurse should also respect and maintain a good rapport with the patient ensuring they are sensitive and make them safe despite their culture.

CONCLUSSION

Mental health nursing is a delicate and important aspect in the medical field that requires passion to work effectively (Sorenson M. 2018). The correct assessment of a patient’s condition facilitates better care that will improve the quality of life of the patient (Usher K. Et al., 2015). The Roper assessment tool is thorough and it effectively outlines the progress of a patient and guides the nurse to understand the patients’ needs (Verhaeghe N. Et al, 2018).

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