Master Of Mental Health Nursing: Case Study On Handling Patient With Dementia And Erratic Behavior

What? (Scenario)

Discuss about the Master of Mental Health Nursing. 

In this essay, clinical condition of patient Mr.A. is discussed. Mr. A is suffering through dementia and his behavior is erratic. In describing this event Driscoll’s reflective cycle is applied. In comprises of what?, so what? and now what? (O’Carroll, 2007). What section mainly comprises of description of the scenario. So what section comprises of analysis of the scenario and now what section comprises of reaction to the scenario. 

This is case of a patient Mr. (70 yrs.). He was admitted to the hospital one week before with problem of dementia and erratic behavior with family members and friends. I am residential nurse (RN) in the emergency ward. I reached on the ward at about 8.00 a.m. and I typically start my day with assisting the patients with their morning session daily activities. While assisting in daily undertakings, one of the patients, I came across was Mr. A.  I was asking Mr. A about his toilet use and whether he requires help. He became angry on me, started shouting at me and my colleague and moreover trying to hurt physically to me. He was wishing to meet his son. He was arguing that, hospital people are keeping him away from his son. However we know that his son died 2 years ago in a train accident.  It has been well established that people with dementia has good memory of the past (Jacques & Jackson 2000). Even though in the current situation it is not a reality, they feel or realize past facts and demand for past fact. Even though it was uneasy situation for me, I kept cool and tried to convince him and made him realize that his wish is not reality now. I was fortunate that situation got resolved and Mr. A became calm and he was ready to take assistance for toilet use.        

I had diversified feelings at the time of that incidence and I was confused about my words. Whether I said whatsoever wrong to him. I felt awkward at that time and was upset with myself. Because, I was feeling, I troubled a stable patient and due to me only, he became disturbed. I also felt that other patients in the ward got troubled due to this incidence and other patients thought I did something wrong with Mr.A. At the same I became sad because, I forced Mr. A to recollections of his expired son. Even though, I was frightened in that condition, I kept myself calm and handled situation to make him calm. However, I managed this condition on my own.

So What (Response)

Now my feeling is very pleased and I feel happy that I did good job to handle the situation. I also got the confidence that I can handle such situations in the future also. My feelings are completely different from the feelings at the time of incidence. At the time of incidence, I was afraid and confused, but now I am confident and satisfied. Overall effect of my action was positive. I understand that Mr. A has dementia problem so that I can take care of him in that direction. Also, Mr. A went to toilet and completed his routine daily activities. This is important in nursing practice to complete patients’ daily activities in smooth and comfortable manner (Baillie, 2005). This helps in making patient stable. Positive outcome of the incidence is that, I followed ethical and professional practices in the adverse conditions. This is very important in nursing practice to follow these practices in adverse conditions (Grace, 2013). Negative impact of this incidence on me is that I got abused from the patient, for whom I was taking so much care for his well-being. For me this situation was very good learning and it gave me opportunity to evaluate my behavior in difficult situations. I realized that these practices, I can’t learn from classrooms or textbooks. Experience and handling real time case like Mr. A case can teach to handle such situations. I realized that my effective communication, holistic approach for patient care and positive attitude towards patient’s condition, helped me to handle this incident to produce positive outcome form this incident (Thresyamma, 2005). Even tough, I was handling this condition independently for the first time, I learned and grasped skills and aptitude to handle such situations from my mentor.  I observed him handling such situations in couple of instances. Few people may have different feeling as compared to me in that situation. I handled that situation in more democratic way. I understood his state of mind and took him in confidence and made him calm. However, few people may have different view and approach on this situation. They might handle this condition in more autocratic manner and giving only orders to complete the daily activities. This type of approach might have led to negative consequence and Mr. A might got more irritated and that might be trouble for all the people in the ward.

I felt troubled in facing Mr. A next time because, he may not like my assistance because he had bad experience with me. However, due to his dementia, he forgot that incidence and that gave me moral boost to provide nursing practice to him. It is evident that patients having dementia can have such behavior in few instances. In such instances, these patients become more agitated and emotionally disturbed. In reality, these patients don’t wish to harm or hurt anybody physically, emotionally and psychotically (Adams and Gardiner, 2005). However, this occurs due to lack of control on themselves. Being a nurse, I know this fact and knowledge of this fact helped me take quick decisions about Mr. A and this make sense to respond to his aggressive reactive reaction.           

Structural, Policy and Legal Context

Structural, policy and legal context: Ethics and professional practice in nursing mentioned about not to unrestrained patient (Roberts and Dyer, 2004). According to the hospital policy, there is no separate arrangement or ward for such mentally ill patients. Even though such patients proved troublesome for hospital staff and other patient, such patients should be admitted along with the other patients. Moreover, there is no special staff for the management of such patients. Due to the lack of specialized human resources for such patients there is the hindrance of managing such patient as a special case. Hence, I can’t refer Mr. A to other staff members of the hospital and took responsibility to manage the condition of Mr. A. At the same time, our hospital is bound to take care of every patient, provided it is manageable with existing staff and infrastructure of the hospital. Management of the hospital made this policy and it is commitment of every staff member of the hospital to follow these hospital policies. Also, there is the flexibility in the policy of the hospital to amend the policy according to the requirement of the case and situation (Goel, 2010). One of the feasibility of policy amendment, applicable in this scenario is to invite for the consultant or specialized healthcare professional related to mental illness.  Inclusion of the expertise in the mental illness by experience is central to the healthcare management for enriching nursing service, in decision making and evaluation of the outcome (Peters, 2016).

Colleagues response: My colleagues also responded positively to this scenario. In handling this situation other nurse and ward boy helped me. It has been well established that recovery or management of the health conditions can be enhanced and carried out by sharing experiences of different stakeholders in the healthcare management and partnerships among the colleagues (Corrigan et al., 2005). They tried to convince Mr. A, that nursing staff is for the welfare of the patients including you. He should believe and keep faith on the nursing staff, if he wants to recover from this condition.

Recovery-focused response: In the case of Mr. A, recovery means coming out of the erratic behavior, calm down and believe on others because he is not remembering many things due to his dementia. Recovery in the mental patients is of two types. It comprises of firstly, internal individual process and secondly, repetitive association between patients experience and social conditions (Anthony, 2000; May, 2000). In case of Mr. A, internal individual process of recovery is very less. However second type recovery where patient experience and social conditions in the form of me and my colleague’s positive attitude towards recovery of Mr. A helped his recovery from this condition. Nursing staff should be optimistic about the recovery of the mental illness of the patient. This optimism of the nursing staff augments hope and confidence of the nursing staff for the recovery of the patient and also works positively towards the recovery of the patient (Roberts & Wolfson, 2004; Repper and Perkins, 2003). They helped me in assisting him physically to take to the toilet and two other senior members in the ward to calm down him.  

Colleagues Response

I learned that effective communication with the dementia patients is very important because these patients forget very easily and they are unaware of actual reality. If I would not have done anything for Mr. A, he might have got more irritated and his daily activities might have got disturbed and this might led to more psychological and biological problems in Mr. A. I could have prevented this incidence from happening.

How the outcomes could have been improved? : It is evident that patients are more cooperative and understands more, if they are provided with person centered care. In this person centered care, there is good reputation between patients and nurses (Colomer and de Vries, 2016). It is well established that communication with dementia patient is very difficult task for nurse. However, person centered care would help to have good communication among them and it helps to avoid such aggressive behavior of the patient. Person centered care in mentally ill patients, required to be handled considering the history and life story of the patient. In person centered approach patient’s social, psychological, physical, cultural, sexual and spiritual aspects should be considered and provide intervention such that patient’s self-government and self-determination should not be affected (Brooker, 2003). Next time, I will focus on person centered care in such patients.  

This incident also facilitated me to recognize gaps in my mental and psychological knowledge and certainly I will look into it and bridge this gap by gaining more knowledge and experience (Jensen and Inker, 2015). So that, I can handle such circumstances more efficiently. For cultivating this knowledge I should discuss with my seniors about their experiences. After attainment of positive outcome in this case, I got more confidence and moral boost in my nursing practice. As a result, in future I will take more challenges in clinical setting and handle these cases effectively by implementing my knowledge, skills, techniques and experience. 

Conclusion:

In this essay, an emergency patient with dementia and erratic behavior is mentioned and my reflection on the scenario in terms of its effect on me, response and efforts form the colleagues in the management of the patient and cooperation from other patients is discussed. In the discussion on the reflection in this case different aspect of the hospital like structure, human resources, and policies are considered. In the recovery of the patient both the patient related and social aspects are considered. Even tough, I handled this case effectively, it could have been managed more effectively with the implementation of person centered approach for Mr. A.

References:

Adams, T., & Gardiner, P. (2005). Communication and interaction within dementia care triads Developing a theory for relationship-centred care. Dementia, 4(2), 185-205. 

Anthony, W.A. (2000). A recovery-oriented service system: Setting some system standards. Psychiatric Rehabilitation Journal, 24(2), 159-168. 

Baillie, L. (2005). Developing Practical Nursing Skills. London: Hodder Arnold. 

Brooker, D. (2003). What is person-centred care in dementia?. Reviews in Clinical Gerontology, 13(3), 215-222. 

Colomer, J., &  de Vries, J. (2016). Person-centred dementia care: a reality check in two nursing homes in Ireland. Dementia, 15(5), 1158-1170. 

Corrigan, P., Slopen, N., Gracia, G., Phelan, S., Keogh, C., & Keck, L. (2005). Some recovery processes in mutual-help groups for persons with mental illness; 11: Qualitative analysis of participant interviews. Community Mental Health Journal, 14(6), 721-735. 

Goel, S. L. (2010).  Health Care System and Hospital Administration: Health policy and programmes. Deep and Deep Publications. 

Grace, P.J.  (2013). Nursing Ethics and Professional Responsibility in Advanced Practice. (2^nd ed.). Jones & Bartlett Learning. 

Jensen, C.J., & Inker, J. (2015). Strengthening the Dementia Care Triad Identifying Knowledge Gaps and Linking to Resources. American Journal of Alzheimer’s Disease and Other Dementias, 30(3), 268-275. 

Jacques, A., and Jackson, G. (2000). Understanding Dementia. London. Churchill Livingstone. 

May, R. (2000). Routes to recovery from psychosis: The roots of a clinical psychologist.Clinical Psychology Forum, 146, 6-10. 

O’Carroll, M., Robert, A., & Park, J. (2007). Essential Mental Health Nursing Skills. Elsevier Health Sciences. 

Peters, M. (2016). BMA Complete Home Medical Guide: The Essential Reference for Every Family. Dorling Kindersley Ltd. 

Repper, J. & Perkins, R. (2003) Social Inclusion and Recovery A Model for Mental Health Practice. Balliere Tindall, Edinburgh, London. 

Roberts, G. & Wolfson P. (2004). The rediscovery of recovery: open to all. Advances in Psychiatric Treatment, 10, 37-49. 

Roberts, T. G., & Dyer, J. E. (2004). Student teacher perceptions of the characteristics of effective cooperating teachers: A delphi study. Proceedings of the 2004 Southern Agricultural Education Research Conference, 180-192. 

Thresyamma, C.P.  (2005). Fundamentals of Nursing.  Procedure Manual for General Nursing and Midwifery Course. Jaypee Brothers Medical Publishers Pvt Ltd.