Holistic Assessment Process Based on the Goal of Facilitating Recovery - Essay Example

?The holistic assessment process based on the goal of facilitating recovery Introduction The holistic assessment process is one of the most valuable and useful processes which can be used in order to ensure the delivery of adequate and efficient health services. Holistic assessment also seeks to ensure a well-rounded evaluation of patients, considering all of their concerns as well as their needs. This is a case study of a service user demonstrating the principles of recovery as applied to a holistic assessment and identification of needs for a service user with schizophrenia. This paper shall first present an overview of the clinical presentation of the service user. Secondly, it will identify the needs of the service user required to achieve recovery. Lastly, it shall present a critique of my involvement in the assessment process and how this reflected the principles of recovery. Body Overview Mrs. Smith is 46 years old, and was admitted to the mental health unit after she accused her son of apparently spying on her. She also attempted to slash her wrists claiming that there were some implants there placed by government agents spying on her. She is married and has been for the past 20 years and has been a math teacher at a local community college for the past 10 years and before that, has worked as an analyst with the Federal Bureau of Investigation (FBI). She has three children, all grown and she is living with her husband and one of her children. She has an IQ of a genius and has had no known history of any mental illness. For the past ten years however, she expressed that sometimes she has often felt depressed, but did not seek professional mental health. Her husband declares that he also noticed his wife being paranoid about other people spying on them. He also shared that he thinks his wife is sometimes speaking to someone that he could not see, and that when he asked her who she was talking to, she said she was talking to her friend. She also believes that she is secretly working for the FBI and is sending and interpreting coded messages for them. She also believes that as a result of her work with the FBI, Russian spies want to kill her and so she is suspicious of every mail man or stranger that knocks on their door. As a result of her delusions, she was asked to take a sabbatical leave of absence from her work and to seek mental help. She is however in major denial over her mental health, insisting that what she sees and what she believes are all real. Two weeks prior to her current admission, after her husband left for work, she locked herself in the house and refused to open it to anyone. She drew the curtains and turned off all the lights. She then went to the bathroom and locked herself, taking with her a baseball bat to serve as a ‘weapon’ to ward off any supposed attackers. Her son came over to check on her and when he could not get in the door, used his key to get in the house. When his mother was not answering his calls, he then checked every room and found the bathroom door locked. He also heard his mother telling him to go away and leave her alone. Worried that his mother is hurt, he kicked the bathroom door open and as soon as he did, his mother started hitting him with the baseball bat. After subduing his mother, he called the emergency services for assistance. She was later referred to the mental health unit after the health professionals considered a possible mental health affectation. Assessment of needs In assessing the patient’s needs, I evaluated her ability to carry out her daily activities, mostly in relation to self-care (functional needs) (Velligan, et.al., 2004). I also evaluated her family situation, especially in relation to potential family caregivers who can supervise her care and assist her in her daily activities and support her during her recovery period. I also assessed her psychological health and emotional health, interviewing her and her family while asking pertinent questions relating to her feelings and her ability to cope with stress (Popescu and Miclutia, 2009). The interview with the patient also included an assessment of her knowledge of mental illnesses, mental health, and schizophrenia. Based on the data on the patient, her needs and concerns include: self-care or functional needs; preventative needs in relation to her risk to self and her risk to others; her social needs, mostly in relation to companionship; her emotional needs which contribute to her psychological distress; her cognitive needs in relation to information on her disease; and her physical needs, mostly those which relate to her transportation. Her primary need relates to her self-care. The state of her mental health has caused her to neglect her activities of daily living, including her grooming, dressing, bathing, food preparation and other household work. Her delusions also present a risk to herself and to other individuals, believing that other people want to kill or harm her and in defence, she feels the need to physically battle anyone trying to get near her. Her husband is away at work most of the time, and so she is in need of constant supervision and companionship which they cannot physically provide. Her paranoia is also causing her much psychological distress, increasing her heart rate and blood pressure. She often suffers from much distress in the presence of other people and she also becomes distressed when she is alone at their home. She is also in need of crucial and relevant information about her mental health, most especially, information on schizophrenia. She does not have enough information and data about the disease and this is likely contributing to her firm denial about her illness and her mental state (Anderson, et.al., 1986). She needs to be educated about her disease and about her options and her chance of managing her disease (Anderson, et.al., 1986). Based on the stress vulnerability model, individuals have biological, psychological, and social concerns in relation to their health and vulnerability (Zubin and Spring, 1977). Biologically, the patient already has a vulnerability to schizophrenia because she has a genetic predisposition to the disease. Schizophrenia has been known to be passed on from one generation to another (Picchioni and Murray, 2007). There are various estimates on the hereditability of schizophrenia because of issues encountered in separating the impact of genetics and the general environment. The biggest risk in the development of this disease is on first degree relatives (Picchioni and Murray, 2007). As was mentioned, Mrs. Smith’s father has been diagnosed with this disease and has passed on the disease to her. Although Mrs. Smith has not been known to be easily stressed, her genetic predisposition has made her vulnerable to the disease and has also made her vulnerable to stress. Her enforced sabbatical has also made her vulnerable (Nuechterlein and Dawson, 1984). Although she is usually very tolerant of changes or stressors in her life, her sabbatical has placed her in a social environment where she has feels unwanted, and this seems to have increased her vulnerability to the disease (Nuechterlein and Dawson, 1984). Based on the above vulnerabilities, there is a need to increase and improve her coping skills and change the environmental elements which surround her life. There is nothing which can be done anymore about the genetic traits she possesses, nevertheless, she can be prescribed anti-psychotic drugs in order to reduce the impact of her symptoms (Harris Interactive, 2008). There is also a need to improve her coping skills in her family, community, and work life. Improving these skills would likely ensure better self-efficacy and self-acceptance as well as improve her ability to care for herself (Australian and New Zealand College of Psychiatrists, 2005). Critique of the assessment process Based on my participation in the assessment process, I can generally deduce that I was able to fit my practice and actions into the principles of recovery. During my initial assessment of the patient, I tried my best to honestly and deeply probe into the emotional and mental health of the patient. The assessment process was able to emphasize the user’s hopes and demonstrate the development of trusting relationships (NHS, 2010). During the assessment process, I asked the patient how she felt about her mental health and if she believed she would ever have a relatively normal life. She said that she hoped she would have a chance to get through her mental health issues, but she felt that her issues were very much insurmountable. I then went on to specifically inquire about her primary concerns about her mental health. She said that she was very much concerned that her mental instability might cause her to hurt her family. She also said that she was concerned about being a burden to her family by being unable to carry out her daily activities. She also believed it a matter of pride to be able to independently carry out her activities and daily living and she wanted to be able to do that without assistance from other people. It was imperative for me to listen to her hopes and her preferences (NHS, 2010). I listened attentively to her and did not attempt to make any personal judgments on her or her situation. I also respected her options for her care. She preferred a community management of her disease and she did not want to be committed to a mental institution. A final assessment on her possible discharge to community management was not yet decided by her mental health care team. I remained courteous with her at all times, and I maintained sensitivity to her values and beliefs (NHS, 2010). I also tried my best to be objective and to avoid any discriminatory pre-judgments on her as a mentally ill individual (NHS, 2010). I knew that she had schizophrenia, but I also believed that she still had the right to make certain choices on her life and her health. I treated her like an individual and like a relatively logical person during my assessment process, especially as she appeared calm, but only slightly agitated and stressed during the interview. Applying these considerations during the assessment process allowed me to use the various principles of recovery for the benefit of the patient (Keefe, et.al., 2004). A holistic approach to assessment was applied. This assessment included considerations on her psychological, emotional, spiritual, physical, and social needs. The assessment of the patient’s psychological needs was based on observations on her appearance and demeanour, inquiring her thoughts, delusions, hallucinations, and moods (One World Publications, n.d). Assessment of emotional needs included an evaluation of how she felt about her current mental health and her preferences in her care (NICE, 2009). The assessment revealed that she was sad about her diagnosis and her mental health condition, and she preferred to eventually be discharged and to live a relatively normal life. Her physical needs included assistance in her activities of daily living, food preparation, and transport. In assessing her physical needs, it was evaluated that she could not carry out her activities of daily living because she was still tormented by her delusions and paranoia. She was often afraid to be alone in her home, to go inside dark rooms, or to turn on the stove because of various fears and paranoid thoughts of impending danger. Moreover, due to her compromised mental health, she could not drive safely anywhere. Based on such assessment, her physical needs relate to how she would undertake her activities of daily living and how she would transport herself from one place to another (Velligan, et.al., 2004). The assessment of her social needs included an evaluation of her social activities with friends, family, and her community (Harris Interactive, 2008). An interview with her and with her family revealed that she has shunned herself away from any social engagements with friends and family. Her paranoia about other people has also alienated many of her friends. She now feels even more embarrassed about engaging in social activities due to her diagnosis. She does not want to be labelled as ‘crazy’ and she also does not want to be ostracized by her community. The assessment operated from a basis of strength/assets and they encouraged empowerment of the service user (NHS, 2010). During the assessment, I was able to establish what the patient’s strengths and assets were. For one, she is an extremely logical person. Although, she was very much in denial about her schizophrenia during admission, being confronted with an explanation of the disease and the symptoms she was manifesting, she was eventually convinced that indeed she was mentally ill and that her powers of deduction convinced her that she needed mental help. This eventually allowed us to move forward with the management of her mental health (NHS, 2010). It was also established during the assessment process that the patient was very much willing to consider the various changes in her life she needed to make and that she needed to take medications in order to manage her condition. She was also very much willing to attend regular psychotherapeutic sessions in order to aid her recovery. She believed that such sessions would help her cope with her symptoms and ensure that she would not relapse in her illness. These strengths were used in order to evaluate her needs (NHS, 2010). In establishing the patient’s needs, the patient was still very much logical about her fears and her paranoia. She also recognized the fact that her current needs revolved around her inability to carry out her basic activities because of her fears and paranoia. The assessment involved the patient’s family and friends and was carried out with the patient’s agreement (Pharaoh, et.al., 2010). The family was interviewed and their possible contribution to her care was also evaluated. Their ability to provide physical and emotional support was highlighted and they were able to express that most of them had to work and there was no one available who could care for Mrs. Smith 24 hours a day, seven days a week. Her friends could also only occasionally look in on her and lend their emotional support. The patient consented to her friends and family being interviewed during the assessment process. Summary Based on the above assessment and presentation of facts, it can be deduced that Mrs. Smith is suffering from paranoid schizophrenia. Based on a holistic assessment of her symptoms and her current condition, she presents with the following needs: assistance with her daily activities, preventative needs on self risks of harm and harm to others, companionship, transportation, and social and emotional support. Her physical needs mostly relate to her self-care needs, transportation, and preventative needs against self-harm and harm to others. Her psychological needs are based on her needs for social and emotional support. Her preferences include community care, not institutionalization. She also recognizes that she needs anti-psychotics and psychotherapy in order to cope with her symptoms. Her vulnerability to the disease is genetic, but has been exacerbated by psychological distress and her emotional vulnerabilities. Nevertheless, she presents with a strong prospect for relative recovery because of her willingness to accept treatment and her willingness to cooperate with the mental health professionals. Her needs for the moment relate to an intense mental health plan which would require longer stay in the mental health unit. Her progress through the mental health plan would however dictate the rest of her care and her possible discharge into the community mental health setting. References Anderson, C., Reiss, D., and Hogarty, G., 1986. Schizophrenia and the family: a practitioner's guide to psychoeducation and management. London: Guilford Press. Australian and New Zealand College of Psychiatrists, 2005. Schizophrenia [online] Available at: http://www.health.gov.au/internet/main/publishing.nsf/content/7A1EECF65DD9A90CCA25725A00211781/$File/schizo.pdf [Accessed 04 July 2012]. Harris Interactive, 2008. Schizophrenia: Public Attitudes, Personal Needs [online] Available at: http://www.nami.org/SchizophreniaSurvey/SchizophreniaAttitudesandAwareness.pdf [Accessed 04 July 2012]. Keefe, R., Goldberg, T., Harvey, P., and Gold, J., et.al., 2004. The brief assessment of cognition in schizophrenia: reliability, sensitivity, and comparison with a standard neurocognitive battery. Schizophrenia Research, 68, 283– 297. National Health Services, 2010. Principles of recovery oriented mental health practice [online] Available at: http://www.health.gov.au/internet/main/publishing.nsf/content/DA71C0838BA6411BCA2577A0001AAC32/$File/servpri.pdf [Accessed 04 July 2012]. National Institute of Clinical Excellence, 2009. NICE clinical guideline 82: Schizophrenia [online] Available at: http://www.nice.org.uk/nicemedia/pdf/CG82NICEGuideline.pdf [Accessed 04 July 2012]. Nuechterlein, K. and Dawson, M., 1984. A Heuristic Vulnerability-Stress model of Schizophrenia. Schizophrenia Bulletin, 10, pp. 300-12. Pharoah, F., Mari, J., Rathbone, J., and Wong, W., 2010. Family intervention for schizophrenia. Cochrane Database Syst Rev, 12. Picchioni, M., and Murray, R., 2007. Schizophrenia. BMJ, 335(7610), pp. 91–95. Popescu, C. and Miclutia, I., 2009. Met and unmet needs of patients with Schizophrenia - brief research report of a Romanian sample. Journal of Cognitive and Behavioral Psychotherapies, 9(2), pp. 161-167. One World Publications (n.d). How is schizophrenia diagnosed and what are its symptoms? [online] Available at: http://www.oneworld-publications.com/pdfs/Schizo_sp.pdf [Accessed 04 July 2012]. Villegan, D., DiCocco, M., Bow-Thomas, C., Cadle, C., and Glahn, D., et.al., 2004. A brief cognitive assessment for use with schizophrenia patients in community clinics. Schizophrenia Research, 71, 273– 283. Zubin, J. and Spring, B., 1977. Vulnerability: a new view on schizophrenia. Journal of Abnormal Psychology, 86, pp. 103-126 Read More