Discuss about the Mental Health Nursing And Challanges.
Mental health nursing is challenging work that involves supporting a person’s recovery and enabling them to have control over their life. This essay focuses on my role as a mental health nurse in treating a 15 year old boy who had been suffering from acute depression and anxiety. Adam lives with his parents and his sister. He loves riding bikes and mountain racing. He adores his pet cat Roger and always cares for her. He was not addicted to any drugs or alcohol. Adam is very much attached to his grandmother. He considers his sister to be the only one who understands Adam. Adam dreams of becoming a pilot or a professional mountain bike rider. It should be mentioned beforehand that Adam had been a victim of child sexual abuse by his uncle. On discovering his misdeeds, his uncle was handed over to the cops. It was reported that the sexual abuse took place with Adam for almost 9 months. Recently on hearing the news of his uncle’s release from the jail, Adam has again re-entered in to depression and has often attempted suicides. The whole essay is based on the recovery plan for Adam. This essay provides with a mental health assessment of Adam which focuses on the predisposing, perpetuating, precipitating and the protecting factors for this ailment.
The later portion of the essay also throws light upon the different nursing interventions for the self management of the disease. The report also discusses bout the use of the dialectical therapies in combination with the antipsychotics to treat the disorder.
Background: Adam was a 15 years old teenager, who had been suffering from borderline personality disorder. Adam stayed with his family. He was sexually abused by his uncle, when he was only 5 years old. Adam has been receiving treatments for depression since he was 10 years old. He had been received extensive counseling and anti depressant medications since he was 6 years old. Twice he was admitted to the local mental health facility due to his suicidal tendency. On hearing the news of his uncle’s release he has again entered a depressive phase. He had started skipping meals, stopped riding bikes, and stopped attending school.
Appearance: Adam was tall and slim for his age, Caucasian with blue eyes and blonde hair. He had dark circles and his hair appeared unorganized. He was in green gym shorts, t-shirt and joggers.
Behavior: was avoiding eye contact. He was clasping his hands during the interview, looking down at the floor.
Mood and affect: Adam was quiet and sullen throughout the interview. He was responding to the question with just a ‘yes’ or ‘no’.
Speech: Adam talked slowly and almost in whispers.
Cognition: Cognition is alright, except he often feels worn out and suicidal.
Thoughts: Anxious, suicidal feeling, always feels depressed and tired.
Perception: Considers himself to be responsible for all the problems in the family, including the disturbances in his parent’s marriage. He feels he is a failure and therefore should end his life.
Insight and judgment: He denies thoughts of suicide but when asked about thoughts of self-harm he admits “yeah”. He expresses feeling guilty about all the troubles and holds himself responsible.
The above mental assessment had provided us with the information regarding the psychological condition of Adam. From the signs shown by Adam, it is evident that he might have been suffering from post traumatic disorder after the sexual abuse. A person’s experiences in childhood help to shape up the health and well being of a person throughout the life. Child sexual abuse can leave permanent scars on the brain of children that can have long term effects in future. It becomes very difficult for the victims to forget the pain and the trauma of the incident throughout his life. The small things can trigger intense reaction in them; they feel confused and unclear about their life. Acute depression and anxiety can lead them to suicides. In Adam’s case we can relate all the symptoms of a post trauma (Crowe, Carlyle & Farmar, 2008).
In Adam’s case, the presenting problem was that he was suffering from acute anxiety and depression and often thought of finishing himself. He had lost the appetite to attend school to peruse his dreams. He had also ceased practicing his favorite hobby. The news of release of his uncle who was in jail for few years in charge of child sexual abuse, is the precipitating factor. It was reported that Adam’s mother regularly felt guilty over the CSA. Adam’s parents were also suffering from problems in their marital life, although they were still together. Adam always found himself guilty of everything that has happened in the family, which can be considered as the perpetuating factors (Crowe, Carlyle & Farmar, 2008).
The protecting factors that would help Adam to come back to the normal pace of life are- his adherence to the therapeutics, sharing of the grievances to his parents, spending more time with his loved ones, be it his sister or his grandmother or his beloved cat. Adam should keep himself busy with constructive duties (Crowe, Carlyle & Farmar, 2008). He should strive in his dreams of becoming a pilot or a professional mountain bike rider.
A set of nursing interventions have been prepared taking into account, Maslow’s hierarchy of needs, which states- Physiological needs, Safety needs, Social belongings Esteem , self realization and self transcendence.
Highest priority nursing care needs
In order to provide psychological and spiritual support to Adam and to refrain him from suicidal attempts the caregiver should be able to create a non threatening environment for Adam, where Adam could share his concern. In order to assess the fear or the trauma in the patient, the caregiver should ask him about his back ground, child hood, relationships in a non threatening way (Easton, Renner & O’Leary, 2013). In case of treating post sexual assault trauma in teenagers it is essential to build up an environment of trust, as in most of the cases the patient is not willing to get the treatment such that he opens up his expressions (Townsend, 2014). A patient might not find it comfortable to discuss his past experiences with the caregiver; therefore maintenance of confidentiality is very necessary. Talk therapy is generally the first choice of treatment for the patient. Talk therapies are effective in reducing anger, suicidal attempts and self harm in patients (Jackson et al., 2014). As a registered nurse I should be able to provide a holistic care of approach for improving the overall functioning and social adjustment in Adam.
Anti depressant and antipsychotic medications like selective serotonin reuptake inhibitor (SSRI) medications sertraline (Zoloft) andparoxetine (Paxil) can be given to Adam to relieve his depression to some extent (Pescosolido, 2013). Cognitive behavioral therapy can be applied to deal with patients like Adam. He should be taught how to calm down the emotional turmoil, to control tolerate distress and impulsivity. As a registered nurse I should be able to help Adam to gain control over his fears by changing his negative way of thinking. Adam should be taught to improve his interpersonal skills so that he is able to achieve his dreams.
In this report an ISBAR handover had been provided.
Identify- Adam, 15 years old, lives with his parents and his sister
Situation- Adam had been showing acute signs of depression since the news of his uncle’s release from the jail.
Background- Adam had been a victim of child sexual assault for nine months by his own uncle.
Assessment- Feeling of self harm, depression, loss of appetite, feeling of exhaustion, withdrawal from the society.
Recommendation- It is recommended that the patient requires sufficient psycotherapies therapies in combination with the medications. Medicines like Diazepam and Thiridazine can be administered. The triggering factors that can take him back to those traumatic times should be avoided.
The Therapeutic application in patient
Post traumatic stress disorder (PTSD) can be caused as an aftermath of the child sexual abuse. As child doesn’t understand the sexual perspective of adults, an intentional exposure to these events can cause trauma in children, which may last till death, just as we can see in case of Adam that his doctors have already admitted that Adam may show recurrent episodes of suicide (Bison et al., 2013).
Patients who are suffering from PTSD are always on a roller coaster ride of emotions (Evans, Lizette & O’Brien, 2017). A holistic care of approach from the care givers and self recovery strategies can definitely bring about change in the life of the patients like Adam. As a registered nurse it is necessary to build up an interpersonal relationship with Adam, otherwise I will not be able to administer the treatment in a non threatening way (Evans, Lizette & O’Brien, 2017). I should abide by the nursing codes of ethics and should maintain the confidentiality of Adam’s case.
It has been mentioned earlier that psychosocial or talk therapies are capable of reducing the depressions in the patients. While caring for Adam, I have tried to understand his feelings and his concerned in an unbiased way. Acceptance of the different cultures and perceptions without judgment is another point of being a mental health care nurse (Townsend, 2014). There are different type of therapies that can be used for treating BPD, such as dialectical behavioral therapy, Metallization-based therapy (MBT), Transference-focused therapy (TFP), Good Psychiatric Management, Self-Care activities (Carman et al. 2012). Adam would require cognirtive behavioral therapy as it would teach him to control his emotions, reduce the self destructive behavior. (Carman et al. 2012).
For a nurse working in a mental health care, it is ready to accept the cultural diversity of the patients and respect them without any judgment (Cox, 2013a). A nurse-client relationship of trust cannot be built unless the nurse is able to cope up with the cultural background of the patient (Cox, 2013b). As the case of Adam is quite sensitive, I should deal with the matter sensitively and confidentially. The concept of cultural safety involves empowerment of the healthcare practitioner and the patient. The determinants of ‘safe’ care are defined by the recipient of care, Adam in this case. The main aim of the treatment had always been to provide comfort and safety to the patient, irrespective of any social stigma (Baldwin et al., 2014)
In the assessment I have already discussed about the Maslow’s hierarchy of care.
According to Maslow’s hierarchy physiological needs are the basic needs that are required for the well being of a person. It is evident from the case study that Adam was skipping his meals as he lacked the drive to have food or do any work. As a registered nurse it I my duty that Adam gets proper nutrition, hygiene, proper sleep , correct medications that would help to relax his muscles and brain (Ackley, Ladwig & Makic, 2016).
As a care giver I should be aware of Adam’s safety. I should come out of my boundaries to provide a holistic care approach to Adam.
As a part of the cognitive behavioral therapy, I can ask my patient to confront with the traumatic event by thinking about his experience in detail. At that time I would help him to cope up with any distress that he is feeling (Jackson et al., 2014).
I should try to create an environment such that the patient does not feel devalued. I should be able to set self recovery plans for Adam, such as avoiding mood altering drugs, quitting of drugs, eating a balance diet, minimizing stress, distraction from the triggers of depression. Adam should be taught how to deal with the different hurdles of life and thrive for his dream (Townsend, 2014).
As a nurse I should administer he various relaxation techniques, such as taking short tests, taking him out on a walk. Thus it can be said that a proper psychological therapies is combination with medicines followed by a proper discharge plan can help to improve the life style of Adam.
References
Ackley, B. J., Ladwig, G. B., & Makic, M. B. F. (2016). Nursing Diagnosis Handbook-E-Book: An Evidence-Based Guide to Planning Care. Elsevier Health Sciences.
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Cox, L. (2013a). Cultural Safety in Introducing mental health nursing: a service user-oriented approach (2nd edition). Sydney: Allen & Unwin.
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Easton, S. D., Renner, L. M., & O’Leary, P. (2013). Suicide attempts among men with histories of child sexual abuse: Examining abuse severity, mental health, and masculine norms. Child Abuse & Neglect, 37(6), 380-387. https://doi.org/10.1016/j.chiabu.2012.11.007
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