1.Discuss the key Interpersonal skills you will use to engage with Andrew.
2.The doctor stated that Andrew has symptoms of a Psychosis. Using correct clinical terms and the clinical cues in the scenario, discuss three important signs and symptoms that support the doctor’s opinion.
3.Andrew asks you why he has a prescription for medication. Briefly discuss how you would respond.
4.The GP has requested Andrew is informed and carefully monitored over the next few weeks. Briefly discuss your plan.
Listening: The skill would assist in getting the information required from Andrew. It would be normal that Andrew would not be able to have the necessary vocabulary or knowledge to describe what is the problem with him or the symptoms he is experiencing (Addington, 2016). Using listening as an interpersonal skill in nursing I would be able to pick on the clues as explained by Andrew and hence use them to depict what is the best appropriate diagnosis.
Communication: This is an important skill as far as the passage of information between the various parties in concerned. As a nurse, the information gathering is fundamental as it would be used by the doctor in planning for medication. It is thus important for the information to be to very accurate and reliable to help in the establishment of a viable follow-up and action care plan (Page, 2014).
The communication should be such that it is accommodative of Andrew’s situation. Proper and effective communication between the doctor, nurse and the patient is just as important as prescribing the medication for a condition. With proper medication, the best care and maintenance strategies would be established that would ensure Andrew’s condition is brought to the board. I would:
Patience: Understanding the prevailing conditions of Andrew would be quite being helpful in coming up with a strategy on how to engage him. Being patient enough would give Andrew time to explain him. He might periodically disrupt me while talking but it would important that I understand him (Organization, 2012). The patient might be in need of some information that may not be available at the time.
It would up to me as a nurse ensure I remain calm and not give a negative response to the demand of information. Andrew believes what he is experiencing is true and thus I would need to be calm enough as he brings up his version of the experiences without necessary disregarding everything prematurely.
Based on the scenario given, the following are the three distinct symptoms of psychosis as evidence:
Delusions: this refers to a strong and unshakable belief in something that is not true or which cannot be justified to be existing (Hermann, 2010). Delusions cannot be shaken even if a proof of non-existence is provided. In the given scenario, Andrew the following examples of delusions
Hallucination: Involves hearing, feeling, smelling, tasting or smelling something does not actually exist (Ries, 2010). Andrew feels the sounds of people talking about him and even attempts to look for them with his eyes.
Blunting empathy: This refers to reduction in the levels of emotional reaction in a person. It is expected that Andrew would explain the conditions he undergoing with emotions as it is normal but he expresses his feelings with a lot of normalcy. He does not adopt any gestures or animal in the expressions on the face to illustrate the people he believes are following him and causing him the harm he talks about. (Angelini, 2012)
Reducing suffering and morbidity of the patient and the family: Psychosis patients tend to believe that medication does not have any significant impact as far as improving their health is concerned. On the contrary, increased adherence to medication would increase the chances of survival of Andrew (Miller, 2015). On medication, the symptoms would be greatly suppressed thereby improving the existing current condition.
Improved medical adherence would also help in improving the comfort of the family. Following the symptoms that Andrew experiences, he would find it a challenge to effectively relate with the family due to fear of the unknown. On proper medication, his health condition would improve and thus tend to normalcy and as such improving the social family relationship.
Decreases the cost of re-hospitalization (Hermann, 2010): In a case of non-compliance with the medical prescription, chances are that, the patient would have to visit the hospital on a regular basis. This would culminate into a drain of the family resources in a bid to help Andrew keep up with his life. This would also mean the Andrew will be spending a lot of his time seeking medical services from the hospital. This is a situation that can be reverted when the patient continues with the medical prescription as issued by the doctor. Adherence to the prescription ensures the symptoms and signs are contained early enough as opposed to waiting to go the hospital when the health condition worsens (Whitaker, 2010).
Reduces or eliminates symptoms: Adherence to the prescribed medication instructions is vital in the reduction or even total elimination of such symptoms as depression that the patient might have been going through (Angelini, 2012). The reduction levels are significant enough that should medication continue the patient will finally be completely remitted of his condition. This eliminates the myth and belief that those suffering from mental disorders are not treatable. Such information would be very vital to Andrew and would help him change his attitude and perception of what he had thought of himself. Through adherence to medication he would have the opportunity to still find self-worth in himself upon the reduction or even permanent elimination of some of the symptoms he could be experiencing (Hermann, 2010).
Management of psychosis requires a combination of both medical and non-medical strategies. The medical strategies deploy a considerable adherence to medical prescription as issued by the doctor (Treatment, 2015). As a result of the myths and perceptions on medical prescription of psychosis, most of the patients would be reluctant to undertake a strict medical adherence. A monitoring plan in the medical aspect would ensure the patient abides by the prescribed dosage.
In order to achieve this, the patient would have to be constantly reminded to ensure he does not skip any of the dosages (Organization, 2012). Other reasons for non-adherence to prescription include forgetfulness. A psychosis patient would easily forget to take medication and give a lot of attention to the hallucinations and delusions he is experiencing.
Non-medical monitoring plans include psychological interventions, psychoeducation for family and the patient, advice on lifestyle and diet besides individual support therapy. Psychological interventions form an integral part of the monitoring and management of psychosis (Miller, 2015). The forms of psychological interventions include cognitive remediation, case management, family treatment, and training in social skills as well as vocational rehabilitation. While deploying this strategy, the focus would be on meeting the specific needs of both the patients and the family.
Psycho-education for the patient and the family aims at educating and informing both the patient and the family about the disease. Short and simple explanations on the complexity and the nature of Andrew’s disease, treatment, the length of treatment time and the most probable side effects can be communicated to the family through psycho-education (Tisdale, 2012). While administering this plan it would be important that care is taken to ensure clarity of the information to be passed. This would be inclusive of the language deployed in offering explanations.
During this education, the causes of the disease would not be blamed on any one, whether the family or the patient. The responses from the patient and the care givers would be used in establishing a better management plan (Goodkin, 2015). The patient can as well be advised on what diet to rely on and the lifestyle to lead so as to lower the suffering and morbidity that comes with the disease. A change in the diet and lifestyle has an impact on the metabolic side effects. An intervention into the lifestyle and diet would help in reducing the mobility and suffering levels. Such interventions include physical exercises and modifications of the diet. The above plans would see a significant improvement in the health condition of the patient and the family at large (Twomey, 2009).
References
Addington, J. (2016). Working with People at High Risk of Developing Psychosis: A Treatment Handbook. Manchester: John Wiley & Sons.
Angelini, L. (2012). Immune-mediated Disorders of the Central Nervous System in Children. Oxford: John Libbey Eurotext.
Broussard, B. (2009). The First Episode of Psychosis: A Guide for Patients and Their Families. New Delhi: Oxford University Press.
Goodkin, H. P. (2015). Wyllie’s Treatment of Epilepsy: Principles and Practice. Charlottesville: Lippincott Williams & Wilkins.
Hermann, R. C. (2010). Improving Mental Healthcare: A Guide to Measurement-Based Quality Improvement. Chicago: American Psychiatric Pub.
Iedema, R. (2012). Patient-Clinician Communication: An Overview of Relevant Research and Policy Literatures. London: UTS Centre for Health Communication.
Miller, R. G. (2015). Signs and Symptoms. New York: Lippincott Williams & Wilkins.
Organization, W. H. (2012). Monitoring and Evaluation of Mental Health Policies and Plans. New York: World Health Organization.
Page, A. (2014). Keeping Patients Safe: Transforming the Work Environment of Nurses. Manchester: National Academies Press.
Ries, R. (2010). Assessment and Treatment of Patients with Coexisting Mental Illness and Alcohol and Other Drug Abuse. Salt Lake: DIANE Publishing.
Tisdale, J. E. (2012). Drug-induced Diseases: Prevention, Detection, and Management. New York: ASHP.
Treatment, C. f. (2015). Substance Abuse Treatment for Persons with Co-occurring Disorders. Chicago: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatment.
Twomey, T. M. (2009). Understanding Postpartum Psychosis: A Temporary Madness. New York: Greenwood Publishing Group.
Whitaker, H. A. (2010). Handbook of Neurolinguistics. London: Academic Press
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