Principles Of Nursing Management For Patients With Cerebral/Neurological System Medical-Surgical Conditions

Mental nursing health principles

Altered mental status is usually encountered among patient in hospitals. It is basically a change in emotional, intellectual, personality functioning, psychological, and typically accompanied by changes in behavior, and in case of the hospitalized patients it is nearly acute always (Xiao, et al.,, 2012). It is not an analysis but rather a collection of the variable, general neurologic symptoms demanding a further description of the cause. It can be categorized using three wide clinical areas: encephalopathic, psychiatric, or disease processes limited to the intracranial substances. Psychiatric mental conditions that may lead to altered mental status comprise schizophrenia and other mental illness, mania mainly due to the bipolar disorders, harshly decompensated chief depression, and quick development of dementia (Han, & Wilber, 2013). The Acute encephalopathy results in altered mental status due to the comprehensive brain dysfunction causing from alterable complete metabolic or toxic courses. An intracranial condition such as hemorrhage, stroke, or neoplasm may lead to the altered mental condition due to their native or universal impacts on the brain. The diseased person identified with altered mental status can be categorized as hypoactive or hyperactive (Xiao, Wang et al., 2012). Appearances of the hyperactive condition may include improved psychomotor action, labile mood, agitation, and behavioral instabilities. Hypoactive alterations may include reduced psychomotor action, an altered level of awareness, depressive affect, or drawing.  A change in mental condition refers to common changes in the function of the brain, such as amnesia, confusion, (memory loss), loss of attentiveness, disorientation and faults in thought or judgment (Xiao et al., 2012). In this specific written assignment, the principles of nursing that meet the requirement of people with the altered mental condition in the hospital will be discussed.

1. All people have the basic right to get the finest obtainable mental health attention, which should be included in the social and health care system.
2. All people with an altered mental status or other mental illnesses, or who under treatment as such individuals, shall be cured with respect and humanity for the characteristic dignity of the individual (Patel & Prince, 2010).
3. All individuals who are getting treated as such people should be protected from financial, sexual, physical and other types of mistreatment, bodily or other exploitation, and humiliating treatment.
4. The discrimination should not be there on the basis of psychological illness or others factors. “Discrimination” is any difference, partiality and elimination that results in the abolishing or causing harm to the equal fulfillment of rights (Mullen, 2009). Partiality does not comprise any difference, and inclination undertaken in agreement with the requirements of these Principles and essential to defend the civil rights of an individual with an altered mental disorder or of other persons (Patel & Prince, 2010).
5. Every individual with altered mental disease should have the right to use all political, public, financial, cultural, and  social rights as documented in the Worldwide Statement of social rights, the Global covenant on financial, Cultural and social rights, the Worldwide covenant on public and governmental rights, and in other related instruments, like the Statement on the rights of incapacitated or physically or mentally challenged persons and the Principles Body for the Safety of All People under any type of custody or Caging (Stuart, 2014).
6. Any choice that, by purpose of the patient’s mental sickness, an individual lacks lawful capability, and any choice that, in result of such inability, a private illustrative should be chosen, should be made lonely after an impartial hearing by a self-governing and impartial committee recognized by local law (Cleary, Hunt, Horsfall, & Deacon, 2012).
7. Where a court of law or other capable tribunal discover that an individual with Altered mental health status is incapable to maintain his or her personal matters, measures should be taken, if it is essential and proper to that individual’s condition, to confirm the security of his or her concern (Stuart, 2014). 

Superior attention should be provided within the limits of these values or principles and according to the context of local law linking to the safety of minors to defend the human rights of minors, counting, if essential, the appointment of an own illustrator other than the family person (Caplan, 2013).

Nurses need to treat every person with kindness and dignity; they must recognize patient’s personal requirements and show sympathy and sensitivity, and deliver care in such a way that compliments and respect all the people with altered mental health (Caplan, 2013).

1. A nursing determination that an individual has a psychological disease should be made in accord with globally established medical principles.
2. A determination of altered psychological sickness should never be prepared on the source of economic, governmental, public status, or association of a racial, cultural, religious, or any other motive not directly associated to altered mental wellbeing position.
3. Professional or family conflict, or any non-conformity with social, ethical, political or traditional values or spiritual beliefs prevailing in an individual’s community, should never be a defining factor in identifying altered mental illness (Videbeck, & Videbeck, 2013).
4. A experience of previous treatment or hospital admission as a patient should not of itself defend any current or upcoming determination of altered psychological sickness.
5. No nurse or authority should categorize an individual as having, or then specify that an individual has, a psychological disease except for determinations openly connecting to mental disease or the costs of mental sickness (Videbeck, & Videbeck, 2013).

The nurses should consider the confidentiality if the patient’s information. The right of privacy of information regarding all people to whom these Values apply must be appreciated (Appari, & Johnson, 2010).

1. Every patient should have the right to be cured and be concerned for, as far as conceivable, in the community or hospital.  
2. Where disease management takes place in the psychological health facility, the patient should have the right, if conceivable, to be cured or treated in the presence of his or her family member, relative or friend (Slade, 2010).
3. All patients should have the right to choose the treatment appropriate to their cultural background (Slade, 2010).

1. All the patient in a hospital setting should be given the right to obtain such wellbeing care that is proper to their health requirements and is permitted to receive attention and cure options in accord with the similar level as other sick persons.
2. It is the moral and professional duty of a nurse to protect the patients from injury, including infection, fall, unfair medication, and mistreatment by other hospitalized people, worker or any activity that can cause mental suffering or physical discomfort (Bauer, & Alegría, 2010).

1. The least restrictive atmosphere should be provided to the patients and with the minimum obstructive or disturbing treatment suitable to the diseased person’s wellbeing requirements and the necessity to protect the bodily safety of others.
2. The management of disorder and care of each patient must be grounded on the separately approved plan, shared with the person, checked or reviewed frequently, revised as essential and delivered by skilled and nurses (Elder, Evans, & Nizette, 2011).
3. Mental health assistance must be delivered in accord with appropriate values of beliefs for psychological health nurses, including worldwide acknowledged standards like the Values of medical principles accepted by the United Nations General Assembly. Psychological health information and abilities should never be neglected.
4. The disease management of each patient should be focused on conserving and improving personal autonomy (Storm, & Edwards, 2013).

1. Drug administration should meet all the health requirements of the person with altered mental health status, should be delivered to the patient specifically for therapeutic or investigative purposes. Nurses should only administer a drug of recognized or established efficacy.
2. All drug should be administered to the patient according to the prescription provided by the authorized physician and should be recorded in the records of the patient (Stuart, 2014).

1. Treatment should not be provided to the patients without their knowledgeable consent.
2. Informed agreement is the consent received spontaneously, without pressures or inappropriate stimuli, after proper revelation to the person of suitable and clear data or information in an agreement and language understood by the mentally ill person on:

 (a) The investigative assessment;

 (b) The reason, process, Likely period and predictable advantage of the planned treatment;

 (c) Substitute modes of cure, counting those less invasive;

(d) Probable discomfort or pain, threats, and adverse effects of the planned cure (Storm, & Edwards, 2013).

1. The patient may demand the existence of an individual or family member or relative during the process for permitting consent.
2. The diseased person can decline or end treatment. However, the costs of declining or stopping the treatment must be clarified to the patients or their family member.
3. The patient should certainly not be asked or encouraged to abandon the right to knowledgeable consent. Still, the patient does the same, then, it should be clarified with the patient that the procedure of disease management cannot be started without the informed consent (Stuart, 2014).
4. The suggested plan of treatment can be provided to patients without a person’s informed consent in the following condition (Grol, Wensing, Eccles, & Davis, 2013):

(a) The diseased person is, at the related time, detained as an instinctive patient;

(b) An self-governing authority, having in its ownership all related data, counting the information, is fulfilled that, at the related time, the person lacks the capability to provide or refuse knowledgeable consent to the suggested plan of cure or, if local legislation so delivers, that, having respect to the person’s own protection or the wellbeing of others, the diseased person awkwardly refuses such consent (Durie, 2011).

Conclusion

(c) The self-governing authority is fulfilled that the suggested plan of cure is in the finest concern of the patient’s wellbeing requirements (Storm, & Edwards, 2013).

1. All treatment must be instantly noted in the diseased person’s medical records, with a suggestion of whether instinctive (involuntary) or voluntary (Durie, 2011).
2. Physical limitation or involuntary isolation of a diseased person should not be engaged excluding in accord with the publicly accepted processes of the psychological health facility and specifically when it is the lone means existing to stop instant or forthcoming injury to the diseased person or others. It should not be lengthy outside the time period which is rigorously essential for this determination. Complete occurrences of physical limitation or involuntary isolation, the motives for them and their behavior and degree needs to be documented in the medical record of the patient (Fiorillo et al., 2011).
3. Purification should never be used as a cure for psychological sickness.
4. the main medical or surgical process can be used on an individual with altered mental status only where it is allowable by local law, where it is determined that it can best attend the wellbeing requirements of the diseased person and where he or she provides informed consent, excluding that, where the individual is incapable to provide knowledgeable consent, the process should be approved only after autonomous review (Fiorillo et al., 2011).

1. the patient in the mental or psychological health hospital setting must be knowledgeable earlier after admission, in a document and in the understandable language to the patients, of all their rights in relevant to the Principles and according to the national law, which material or information should include a clarification of those rights and the process of applying them illustrative (Molodynski, Rugkåsa, & Burns, 2010).
2. If the diseased person is not capable to understand such information, the patient’s rights should converse to the personal illustrative (Molodynski, Rugkåsa, & Burns, 2010).

All the patient in a psychological health hospital setting should in specific possess the right to get full admiration or respect for their:

 (a) Acknowledgment everywhere as an individual earlier the law;

 (b) Privacy (Kakuma et al., 2011).

1. Where a patient requests cure in the mental health hospital setting, all efforts should be prepared to escape involuntary admission.
2. Admission to a mental health hospital should be controlled in a similar way as admission to other facilities for any other disease.

Nurses and other healthcare providers work together to ensure that the patient will receive a high-quality care and treatment that also reach to the client satisfaction

According to the report published by New Zealand College of mental health nursing (2004);

• The standards are apprehension with the performed work and the results of the professional physician in the setting of their normal working environment.
• The standards for specialized practice comprise a definition of the important personal characteristics that are supposed to underlie proficiency in the perspective of psychological health nursing.

The principles for the specialized practice state the level of task performance needed the results to the projected and the background in which the medical task performance takes place (Fiorillo et al., 2011). The nurses should build a therapeutic communication with the patient with altered mental health status. The patient with mental issues often seems to be problematic and out of control, in this case, the nurses should not be irritated and deal with them calmly (Arvaniti et al., 2009).  Sometimes the client’s behavior might be disturbing and aggressive; in that case, the nurses should protect themselves to and report to the concerning person or physician (Arvaniti et al., 2009).

Conclusion

The altered mental health issue is the psychological problem that encountered among the impatient. It is considered as the changes in the intellectual, emotional, mental, personal and brain functioning, which usually accompanied by the changes in the patient’s behaviors. Patient with Altered mental health issues often not dealt with dignity and appropriately the medical staff or nurses sometimes become rude and careless. Therefore these principles related to psychological health issues are essential to discuss. Some of the principles include considering the freedom and simple rights of the patient, protecting the minors, determining the mental health illness, keep the patient information confidential, providing standard care, involving them and their family in decision making, treatment that is going to be used should be discussed with them and their family, medication should be standardized, and the consent form should be taken from the patient and if the patient is incapable to provide the consent form then it should be discussed with their family member. The patients often ask for the presence of a family member or other relative in the treatment process, therefore it should be considered. The privacy for the patient should be provided, the patient should be informed in detail about the treatment process and the expected time it takes to recover, the nurses should follow the standard process of keeping the patient safe from infection, self-harm, harm or other injuries. The nurses should record the treatment and patient’s information in the medical record sheet.

References

Appari, A., & Johnson, M. E. (2010). Information security and privacy in healthcare: current state of research. International Journal of Internet and enterprise management, 6(4), 279-314.

Arvaniti, A., Samakouri, M., Kalamara, E., Bochtsou, V., Bikos, C., & Livaditis, M. (2009). Health service staff’s attitudes towards patients with mental illness. Social psychiatry and psychiatric epidemiology, 44(8), 658-665.

Bauer, A. M., & Alegría, M. (2010). Impact of patient language proficiency and interpreter service use on the quality of psychiatric care: a systematic review. Psychiatric Services, 61(8), 765-773.

Caplan, G. (2013). An approach to community mental health (4^th ed.). New York: Routledge.

Cleary, M., Hunt, G. E., Horsfall, J., & Deacon, M. (2012). Nurse-patient interaction in acute adult inpatient mental health units: a review and synthesis of qualitative studies. Issues in Mental Health Nursing, 33(2), 66-79.

Durie, M. (2011). Indigenizing mental health services: New Zealand experience. Transcultural Psychiatry, 48(1-2), 24-36

Elder, R., Evans, K., & Nizette, D. (2011). Psychiatric & Mental Health Nursing-E-Book (2^nd ed.). NSW: Elsevier Health Sciences.

Fiorillo, A., De Rosa, C., Del Vecchio, V., Jurjanz, L., Schnall, K., Onchev, G., & Georgiadou, E. (2011). How to improve clinical practice on involuntary hospital admissions of psychiatric patients: suggestions from the EUNOMIA study. European Psychiatry, 26(4), 201-207.

Grol, R., Wensing, M., Eccles, M., & Davis, D. (Eds.). (2013). Improving patient care: the implementation of change in health care (2^nd ed.). New Jersey, US; John Wiley & Sons.

Han, J. H., & Wilber, S. T. (2013). Altered mental status in older patients in the emergency department. Clinics in geriatric medicine, 29(1), 101-136.

Kakuma, R., Minas, H., van Ginneken, N., Dal Poz, M. R., Desiraju, K., Morris, J. E., & Scheffler, R. M. (2011). Human resources for mental health care: current situation and strategies for action. The Lancet, 378(9803), 1654-1663.

Molodynski, A., Rugkåsa, J., & Burns, T. (2010). Coercion and compulsion in community mental health care. British medical bulletin, 95(1), 105-119.

Mullen, A. (2009). Mental health nurses establishing psychosocial interventions within acute inpatient settings. International Journal of Mental Health Nursing, 18(2), 83-90.

New Zealand college of mental health nursing (2004). Standard of practice for mental health nursing in New Zealand (2^nd edition). Retrieved from: https://www.nzcmhn.org.nz/files/file/10/Standards%20full%20copy%20for%20website1.pdf

Patel, V., & Prince, M. (2010). Global mental health: a new global health field comes of age. Jama, 303(19), 1976-1977.

Slade, M. (2010). Mental illness and well-being: the central importance of positive psychology and recovery approaches. BMC health services research, 10(1), 26.

Storm, M., & Edwards, A. (2013). Models of user involvement in the mental health context: intentions and implementation challenges. Psychiatric Quarterly, 84(3), 313-327.

Stuart, G. W. (2014). Principles and Practice of Psychiatric Nursing-E-Book (10^th ed.). Missouri: Elsevier Health Sciences.

Videbeck, S., & Videbeck, S. (2013). Psychiatric-mental health nursing (6^th ed.). Philadelphia: Lippincott Williams & Wilkins.

Xiao, H. Y., Wang, Y. X., Teng-da Xu, H. D. Z., Guo, S. B., Wang, Z., & Yu, X. Z. (2012). Evaluation and treatment of altered mental status patients in the emergency department: life in the fast lane. World journal of emergency medicine, 3(4), 270.