Developing Nursing Knowledge in Mental Health Nursing

Introduction

The mental health nurses are responsible for planning and providing support and medical and nursing care to the people who have mental health issues along with physical illness. There are several mental health issues such as anxiety, depression, personality issues, eating and sleeping disorders, suicidal tendency, schizophrenia and others. In this context, the mental health nurses and other professionals are working cooperatively to maximise patient care by providing them the best quality treatment and continuous support so that the people can overcome their mental health issues and improve their living conditions. The aim of the essay is to analyse the patient condition and identify the existing issues related to physical health, mental disorder and others, for which the individuals is suffering. The essay also provides a scope to analyse the role of the mental health nurse in assessment and planning of care during illness and develop critical decision for guiding and supporting the patients with the best treatment and care. Hence, the essay is suitable to utilise the nursing skill set and knowledge to develop care plan for the patients after significant patient diagnosis by ensuring nursing interventions in mental health nursing practice.

In this context, the patient is suffering from schizophrenia, and it is necessary to diagnose the patients for identifying their physical, metal, cognitive, behavioural health conditions and assess the role of the mental health nursing professionals to support the patient. Through critical discussion and analysis, it is also possible to develop good care plan for supporting the patient to overcome the critical conditions so that the patient can maximise the standard of living. The patient is 46 years old gentleman, suffering from schizophrenia. He is living with suicidal ideation, who has sustained a wound on his left ankle. He sustained with this wound when he was attempting to end his life by running into the train truck. He is also suffering from Type 2 diabetes which raises the health implications as well as the major mental health issue of the person is schizophrenia. Schizophrenia is mainly a serious mental disorder in which the people interpret reality abnormally and it may result to the combination of hallucinations, delusions and extremely disordered in thinking and behaviour that further impairs daily functions and can be disabling. It is hereby a lifelong treatment for overcoming the condition of the patient. The patient has the suicidal tendency, and he does not have logical thinking and ability to lead his life rationally in the society.

Role of the mental health nurse in assessment and planning of care during illness

The mental health nursing professionals work as a part of the team of health care professionals and medical staff that includes social workers, doctors, therapists, general physicians, counsellors and psychiatrics. They mainly work in a range of settings including hospitals and also people’s homes to support the patient with critical mental disorder. The job responsibilities of the mental health nurses are also critical to support the patient and guide them to overcome their mental illness. Providing continuous support and giving guidelines to lead their life rationally is the role of the nursing staff in the mental health settings (Young et al., 2019). The nurses are also responsible to assess the patient critically to identify their actual mental illness, disorders and thinking process to identify the illness that the patient is suffering through. The nurses are also responsible to build strong relationship with the patient and listen their needs and personal preferences. It further helps the nursing staff to understand the patient and evaluate their thinking process. Analysing the stigma and helping the patients and his families are also the role of the mental health nursing. Developing good care plan and supporting the patients are the responsibilities of the nurses where the nursing professionals try to develop strong team work in the cursing care home to create good care plan for the patients (Haro et al., 2018). Administering the medications and arranging the equipment to treat the patient are also the roles of the nurses to develop good care plan and ensure to provide the best treatment and support to the patients so that it is possible of the patient to overcome their mental illness and lead a normal life like others. During my placement in the health care institution, I was also engaged with giving advice and arranging support for patients, relatives and carers and agreeing and reviewing care plans and monitoring progress to guide the patient. Additionally, writing and updates the patient’s records, continuous supervisions and control, assessing the treatment success at care conference and meeting are also the crucial roles of mine as a nursing professionals in the care setting to support the patients.

In this recent context, the mental health nursing professionals are hereby efficient to meet their job role and responsibilities by working as a team and support the patient with effective assessment and diagnosis. For patient care and delivering the best quality treatment, the nursing staff members are responsible to diagnose the patient, who is suffering through schizophrenia. The mental health nurses try to develop strong bonding and create trust with the patient through internal communication and cooperation (Stanley, Balakrishnan and Ilangovan, 2017). The nurses are bound to develop strong relationship with the patient; otherwise it would not be possible to cooperate with the patient suffering from schizophrenia. Through continuous interaction and developing trust, it is possible for the nurses to engage with the patients and diagnose his problems for further intervention planning. In order to treat the patient with the best quality treatment, medications and therapies, I was responsible to develop partnership working practice and person centred care, so that the nursing staff can communicate with other health care professionals and also engage the patient in the care plan to create the best care plan. Additionally, during my placement, I was also responsible to guide the patient with the intervention planning, and continuously cooperate with the patient for giving advice and arranging support for patients, relatives and carers. The nurses in this mental health setting are also responsible to encourage the patient for taking active participation in the threat and treatment process, so that he can overcome his behavioural issues to maximise his wellbeing in long run. In this context, the patient is suffering from schizophrenia, and he is depressed for which he tried to end his life (Blanchard et al., 2017). Depression, the sense of failure and anxiety further raise the issue of schizophrenia in the patient and he needs immediate support and care from the mental health nurses to overcome his behavioural issues to live a normal life. Hence, during my placement I cared for this patient and I am responsible to support the patient, diagnose him with interaction for acknowledging his actual needs and preferences, understanding this behaviour and thinking process and guiding his with the best quality care and treatment. I have provided quality treatment through wound dressing and medications to the patient to maintain diabetes and the injuries. Time to time medicines and meals as well as supervision is effective for the nurse to take care of the individual.

Influence of assessment in clinical decisions and interventions

Patient assessment is important before developing the clinical decision to treat the patients. In this regard, the patient actual needs and preferences influence the clinical decision making process, as it is mandatory for the nursing staff to identify the patient requirement in order to create values for them, otherwise there would be non-cooperation of the patient, which may deteriorate the quality of treatment and care. Hence, before developing the clinical decisions, it is mandatory to conduct patient assessment through diagnosis and in this regard it is the major factor influencing the decision making process (Kretchy et al., 2021). Patients nurse ratio is also important factor to influence the decision making process and on the other hand, nursing skill and knowledge is influencing critical decision making practice for the benefits of the patient. In this care, the patient is suffering from schizophrenia and in this regard, patient diagnosis is important to develop the care plan, so that it will encourage the patient to take active part in the treatment process and make the treatment successful for overcoming his behavioural disorders (Wu et al., 2018).

The mental health nursing professionals in this regard conducts the patient assessment critically that influence the clinical decision making process to support the patient with the best quality care, therapy and continuous treatment. Level of self- confidence and professional commitment among the clinical and mental nursing staff are also crucial affecting the clinical decision making practice. Moreover, the organisational resources, medical equipment, technological infrastructure also influence the patient care plan, where the mental health nurses would like to utilise the resources for delivering the best quality care to the patient so that he would be able to overcome from the issue of schizophrenia and live with a healthy life style (Fiorillo et al., 2020). The patient is also suffering from type 2 diabetes and it is considered as critical health issue, which also influence the care plan of the patient. Hence, the nursing professionals must consider the health issue and mental illness before developing the care plan. Hence, the patient assessment is mandatory that is influencing the care plan where the major health and mental illness are determined to allocate the resources, provide medications and therapies for improving the living condition of the patient. During my placement I cared for this patient to ensure wound dressing by utilising the infection control and aseptic techniques. The dietary plan is also maintained or treating the issue of diabetes as it has complex health implications. I try to provide time to time medicine and insulin as well as maintain dietary chart to develop healthy eating habit of the patient. One morning, when the sugar level was low, I took the decision of not giving insulin that day and treat the patient carefully under effective supervision.

Knowledge utilised when making clinical decisions and planning care

The nursing courses are important for the nurses to develop knowledge and clinical skill to perform better. The knowledge regarding the mental health activities is mandatory to develop care plan as well as the clinical skill such as psychotherapy and other therapeutic solution must be developed to serve the patient with mental health issues. The other nursing skill set such as ability to empathize with people, good understanding of the theories of mental health and illness, verbal and written communication skills as well as resilience and the ability to maintain some psychological distance from your work are important to develop professionalism in nursing and also meet the quality standard of care in treating the patient efficiently. Hereby, the nursing skill set and knowledge are important to make good decision for the patients with mental health issues (El-Tokhy et al., 2020). The critical diagnostic skill set, problem solving skill and clinical decision making skill set are also important to assess the patient and during my placement, I have tried to develop good care plan for the patient suffering with mental health issues of diabetes, wound dressing, providing insulin and managing the psychotherapy and counselling.

Discuss commonly encountered physical, mental, cognitive, behavioural health conditions of the patient

Through patient diagnosis, it is possible to identify the physical, mental, cognitive, behavioural health conditions of the patient, where the major issue of the patient is schizophrenic. The issues are discussed further.

Physical health

The patient is diagnosed with schizophrenia, are also suffering at a high risk of poor physical health outcomes. The condition of the body is being deteriorated over time due to the issue of schizophrenia. The schizophrenic patients are at increasing risk of weight gain leading to the issue of obesity. These further increases the health difficulties die to obesity, where he would not be able to move and conduct the daily social activities. The abdominal obesity, metabolic syndrome and cardiovascular disease are the common health impacts of schizophrenia for which the overall health condition of the patient will be deteriorated (Sandoval, Torous and Keshavan, 2017). Additionally, obesity is a major health implication of schizophrenia patient. In this context, the patient is 46 years old and he is already suffering from Type 2 diabetes which is serious health issue. Additionally, the other health impacts due to Type 2 diabetes and schizophrenia will be high blood pressure, cholesterol, heart disease and others related to obesity, which will deteriorate the condition of his health in long run.

Mental condition

Schizophrenia is a serious mental disorder in which people interpret reality abnormally. This may result delusion, extremely distressed in thinking and behaviour as well as hallucinations. The patient is not able to make decision in his life, and there is abnormality in living his life. He also has suicidal tendency and his thinking process is not rational. His words are not making any sense and his behaviour and thoughts are also irrelevant with the natural activities in lives. He is not able to organising time, living his life healthily and he is also not taking medicines due to the physical and mental illness. Hence, disorganised speech and disorganised behaviour are the major negative mental condition that the patient is suffering from, due to the issue of schizophrenia (Mohr et al., 2018).

Cognitive condition

Cognitive dysfunction is a core feature of schizophrenia, which reduces the cognitive skill among the patients. The cognitive skill deficits mainly occur across several domains such as attention, verbal learning, and memory, working memory and executives functions. The patient is already a middle aged and he is also suffering from Type 2 diabetes. Cognitive approach is mainly the way that the people think, to process information and work accordingly to live a healthy lifestyle. However, the patient with schizophrenia has the cognitive issues, related to lack of attention, poor working memory, Poor hygiene and grooming habits, Loss of pleasure or interest in life, less energy, lack of motivation, withdrawal from family and friends, lack of learning and verbal memory, problem in reasoning and thinking process as well as speech of processing and lack of problem solving (Vasiliu, 2018). The patient has the symptom of non-cooperation and lack of attention which raise issues for the mental health nursing professionals to treat the patient with good care and treatment. Due to non-cooperation and lack of attention in the care home, the patient raises problems for the nurses to understand and acknowledge his actual needs and preferences. Additionally, lack of speech, silent behaviour, poor in discussing his past medical history due to memory loss and lack of behavioural integrity, the nurses will face the issue of patient assessment for developing good care plan.

Behavioural health conditions

There are behavioural changes among the patients who are suffering from schizophrenia. The major behavioural issues in the patient are a change in grades social withdrawal, trouble in concentrating, speaking less, and lack of energy, no interest in life, temper flares and difficulties in sleeping (El-Mallakh, Rhodes, and Dobbins, 2019). These are the major behavioural issues, suffered by the person with schizophrenia. The patient is a middle aged person who is suffering from schizophrenia and there is sleeping and eating disorders for which he is standard of living is being deteriorated over the period of time. His behavioural changes happen when he has the suicidal tendency and he tried to end his life. Temper flares and social withdrawal are also critical symptoms of the patient, for which he feel alone and tried to end his life.

Nursing interventions in mental health nursing practice

For treating the patient efficiently, nursing interventions are mandatory where the nurses must focus on developing good intervention planning in order to maximise the quality of life and protect the life of the patient, who has the suicidal tendency in past. The intervention planning will be developed further,

Rehabilitation is important to treat the patient with schizophrenia, where he has the suicidal tendency in past. The patient is not able to make decision and there is social withdrawal from the family and friend. During my placement, it is important to arrange rehabilitation centre for the patient, where he is supported with social skill and job training developmental programs, which would be beneficial to improve his mental condition and guide him to involve in the social activities.

Cognitive remediation is mandatory to be developed for intervention, which is an effective learning technique to resolve the problems and behavioural disorders. The information processing, continuous support, skill developmental activities are effective for guiding the patient. There would be computerised exercise to strengthen mental skill set and also there will be daily exercise classes for supporting the patient with schizophrenia and also diabetes. I also focused on engaging him in different social activities and training through which the patient is able to develop cognitive skill, problem solving and decision making skill, improve memory and organise the working activities to live a normal life.

Individual psychotherapy and counselling is necessary to be developed to treat the patient with quality care and support and improve understanding about lives. Through communication and cooperation, the counsellor must provide support to the patient and help him to improve his ideas about problem solving and learn coping with the existing issues. This will provide a scope to the patient to resolve the existing issues, and give importance to own life. During my placement, I have provided quality care to this patient and it is also possible to overcome the physical illness, where the patient is supported to take medicines on time, maintain social activities and improve their mental condition through relationship building. In the counselling process, the patient will be encouraged with different social activities and there will be family psychotherapy, where the family members and friends are included to support the patient, so that he will not feel alone and overcome his issues.

Medication is necessary to be implemented where the doctors, psychiatrics and general physicians provide prescribed medicine and insulin to the patient due to the issue of Type 2 diabetes and wound in his ankle. The primary medications used to treat schizophrenia are called antipsychotics. Some of the new drugs to treat the patient are Aripiprazole, Asenapine, Clozapine, Ziprasidone etc., which are crucial to treat the mental disorders of the patient. The medicines about diabetes and the injury in his ankle are also necessary to be provided for overcoming his physical health issues.

Conclusion

It can be concluded that, the nursing professionals in the mental health care setting is responsible to conduct effective patient assessment and develop intervention planning for helping the patient to overcome his physical and mental illness. The patient is mainly suffering from schizophrenia and also he has type diabetes and wound in his left ankle. Medication in this regard is important to improve mental condition and also overcome the physical illness. Additionally, the nursing staff members aim at developing rehabilitation and counselling session as well as psychotherapy by involving the family members so that the patient would be supported with social skill and exercise, daily social activities to improve his living standard in long run.

Reference list

Blanchard, J.J., Bradshaw, K.R., Garcia, C.P., Nasrallah, H.A., Harvey, P.D., Casey, D., Csoboth, C.T., Hudson, J.I., Julian, L., Lentz, E. and Nuechterlein, K.H., 2017. Examining the reliability and validity of the Clinical Assessment Interview for Negative Symptoms within the Management of Schizophrenia in Clinical Practice (MOSAIC) multisite national study. Schizophrenia research, 185, pp.137-143.

El-Mallakh, R.S., Rhodes, T.P. and Dobbins, K., 2019. The Case for Case Management in Schizophrenia. Professional case management, 24(5), pp.273-276.

El-Tokhy, F.S.E., Abdel-Mottaleb, M.M., El-Ghany, E.A. and Geneidi, A.S., 2020. Transdermal delivery of second-generation antipsychotics for management of schizophrenia; disease overview, conventional and nanobased drug delivery systems”. Journal of Drug Delivery Science and Technology, p.102104.

Fiorillo, A., Barlati, S., Bellomo, A., Corrivetti, G., Nicolò, G., Sampogna, G., Stanga, V., Veltro, F., Maina, G. and Vita, A., 2020. The role of shared decision-making in improving adherence to pharmacological treatments in patients with schizophrenia: a clinical review. Annals of General Psychiatry, 19(1), pp.1-12.

Haro, J.M., Altamura, C., Corral, R., Elkis, H., Evans, J., Krebs, M.O., Zink, M., Malla, A., Méndez, J.I., Bernasconi, C. and Lalonde, J., 2018. Understanding the course of persistent symptoms in schizophrenia: Longitudinal findings from the pattern study. Psychiatry research, 267, pp.56-62.

Kretchy, I.A., Appiah, B., Agyabeng, K., Kwarteng, E.M., Ganyaglo, E. and Aboagye, G.O., 2021. Psychotropic medicine beliefs, side effects and adherence in schizophrenia: a patient–caregiver dyad perspective. International Journal of Clinical Pharmacy, pp.1-11.

Mohr, P., Galderisi, S., Boyer, P., Wasserman, D., Arteel, P., Ieven, A., Karkkainen, H., Pereira, E., Guldemond, N., Winkler, P. and Gaebel, W., 2018. Value of schizophrenia treatment I: The patient journey. European Psychiatry, 53, pp.107-115.

Sandoval, L.R., Torous, J. and Keshavan, M.S., 2017. Smartphones for smarter care? Self-management in schizophrenia. American Journal of Psychiatry, 174(8), pp.725-728.

Stanley, S., Balakrishnan, S. and Ilangovan, S., 2017. Psychological distress, perceived burden and quality of life in caregivers of persons with schizophrenia. Journal of Mental Health, 26(2), pp.134-141.

Vasiliu, O., 2018. Therapeutic management of schizophrenia and substance use disorders dual diagnosis-clinical vignettes. Romanian Journal of Military Medicine, 121(2), pp.26-34.

Wu, Y., Kang, R., Yan, Y., Gao, K., Li, Z., Jiang, J., Chi, X. and Xia, L., 2018. Epidemiology of schizophrenia and risk factors of schizophrenia-associated aggression from 2011 to 2015. Journal of International Medical Research, 46(10), pp.4039-4049.

Young, A.S., Cohen, A.N., Hamilton, A.B., Hellemann, G., Reist, C. and Whelan, F., 2019. Implementing patient-reported outcomes to improve the quality of care for weight of patients with schizophrenia. The journal of behavioral health services & research, 46(1), pp.129-139.

Appendix: Care plan

Demonstrating required care plan across the life span of the patient for mental health nursing practice

Patient detail

The patient is 46 years old gentleman, suffering from schizophrenia. He is living with suicidal ideation, who has sustained a wound on his left ankle. He sustained with this wound when he was attempting to end his life by running into the train truck. He is also suffering from Type 2 diabetes which raises the health implications as well as the major mental health issue of the person is schizophrenia.

Nursing problems

The major two problems of the patient are,

Mental issue schizophrenia

Health issue due to obesity and wound on his left ankle

Patient’s assessment

Goals

The goals of the mental health nurses are,

To promote healthy lives and improve wellbeing of the individuals

To protect the life of the patient, who is suffering from schizophrenia

To improve his health condition through diabetes treatment

To maximise standard of living and improve cognitive skill

To support vulnerable people in the society

Intervention care plan for the patient

It is necessary to prescribe medicines for the mental illness of schizophrenia, which are such as Aripiprazole, Asenapine, Clozapine, and Ziprasidone. Providing medicine for diabetes so that it would be possible to maintain blood sugar level is mandatory. The nursing staff members provide time to time medicines and support them to overcome their illness.

Providing dietary plan and improving the healthy eating habits are essential to intervene and guiding the patient to stay safely and healthily are essential.

The psychotherapy treatment must be developed through counselling, discussion with family and friends and supporting the patient to share the difficulties and thoughts. Involvement of the family and friends is important to support the patient, fulfil his personal needs and create values for him.

Cognitive remediation through information processing, continuous support, skill developmental activities are essential to guide the patient and improve morale and values in life, so that the suicidal tendency and behavioural problems can be mitigated.

The rehabilitation activities are necessary to be designed well with training and job arrangements, exercise programs and other skill improvement activities though communication and team working, so that it would be possible for the nursing staff to support the patient in improving mental condition to live a healthy life.

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