Psychiatric and Mental Health Nursing: The Craft of Caring - Essay Example

? Transcript analysis assessment al affiliation Question using a therapeutic model, make an assessment of this patient using the information in the transcript and discuss how you would intervene, supporting your interventions with therapeutic rationales Transcript analysis assessment In the assessment of the patient in question, cognitive behavioral therapy (CBT) was recommended, as the best approach towards a comprehensive and detailed analysis of the patient in question. According to Grand et al (2007), cognitive behavioral therapy (CBT) is a type of psychotherapy that, works on the basis of how an individual changes the manner in which they think or feel towards a particular subject. Dobson (2001), on the other hand, argues that, cognitive behavioral therapy (CBT), refers to an array of techniques that have their basis on cognitive and behavioral approaches that endeavor to attaining changes in the manner in which people think and conduct themselves in the society. From a research conducted by Flower et al (1999), it is evident that, the major reasons towards conducting research in cognitive behavioral therapy (CBT), is to create an opportunity whereby emotional disorders are minimized, as well as, ensuring client take part in active participation in reduction of social disability risks and relapses. Barker (2003) indicates that, in the assessment procedures, it is important that patients are directed towards identifying their problems, establishing the best way forward towards attaining the best solution for their problems, and finally formulate means of working towards their therapies. The Becks inventory indicated that the client in question was suffering from depression, from an analysis and assessment of the transcript. William (1992) indicated that depression is the causative agents of depression are inclusive of dejected moods, feelings of guilt, loss of happiness, pleasure, appetite as well as, concentration. Depression also, has a high relationship with poor concentrations of clients; low energies have also been characterized in depressed individuals. Becks’ five area assessment, according to William and Garland (2002) gave comprehensive answers on why individuals experienced distorted reasoning abilities, behavior and symptoms in the course of assessment. The thoughts of Grand et al (2007) are in line with those of William and Garland (2002) in relation to the model consisting of the five principles. The model highlights issues of the environment, moods, perceptions, characteristic behaviors as well as, individuals’ physical responses. This model is useful for enabling attain an understanding on how various elements are useful are important, in the assessment and introduction of vital CBT skills. Barker (2003) argues that, this form of assessment strategy is useful for a clear evaluation of patient Marie. This strategy will assist on a great mile, why the patient thinks of her situation, why she is inclined to think that way, and if her perceptions affect her both physically and emotionally. From Marie’s response, as indicated in the respondents’ transcript, it is evident what the patient needs and the interventions required for assistance to the patient. One of the earliest symptoms of distorted emotions is deformed posture. This fact can be justified by M1 and M2. From M18 and M19, the feeling of melancholy, guilt and despair are evident. This is also an explanation of Marie’s distorted behavior as evidenced in M14. Marie is indicated to have responded ‘yes’ to a nurse, which meant that she had issues with something that belonged to her being taken. Fox and Convoy, argue that in the assessment process that it is mandatory that people are enlightened on the need to be open on their problems, as well as set clear goals on what they aim to achieve at the end of the therapy. The patient’s symptoms are evident in M18 and M19, whereby the patient’s response may either indicate the patient’s fright or sadness. The patient may also be indicated to blame herself too much and of low self esteem. From Marie’s perceptions and manner of behavior is an explanation of Marie’s altered thinking. William and Garland (2002) illustrates Marie’s way of thinking as disobliged, while Barker (2003) argues that this form of thinking emanates from automotive contemplations, which if not controlled end up having negative impacts on the individual. In some instances, if negative thoughts take over the patients point of thinking, these thoughts may lead to positions whereby they may not be in a position to control their feelings’ consequently, stressful occurrences. In times when the patient is too much stressed, there is a great likelihood that, they display symptoms like those of Marie. Lack of concentration as attributed by Marie’s response in M35 is another characteristic of stress in the patient. Marie could hardly take part in activities throughout the year. From M32, M33 and M34, the patient’s loss of appetite is evident. The patient was not under any form of diet yet, she recorded high rates of loss of appetite. Linford et al, (1997) argues that patients’ inability to concentrate and lose interest is the most outstanding cognitive anomaly, as the individuals’ mind hover from one corner to another. The patient’s actions emanate from the actions that take place around the individuals’ actions. Patients are characterized by the inability to remember all that happens around them; as their memory cannot register what goes on around them. In Marie’s case, the main issue indicated in the course of assessment is unresponsive thinking that led to the nurses having difficult times during assessment. This is an indication of the patient’s inferiority complex, guilt, low self worth, unhappiness, withdrawal symptoms and isolation issues. In turn, Marie ended up having poor social skills; she had major problems trying to interact with other individuals in the society and could also neither eat nor sleep well. M21 and M25 indicate that Marie had made several suicidal initiatives. However, the feelings are not intense as evidenced in M25. In fact, Marie suggests that the assessment should stop and that she was taking up the assessors’ time for no reason. In this case study, Beck’s (1976) model will be applied. The model will aim at highlighting three notions in emotions which are inclusive of; schemas, cognitive triads and comprehension errors, also referred to as downbeat automatic thoughts. Beck et al (1976), argues that cognitive triads entail the ways in which patients view themselves, the world around them as well as, the future. Among the important aspects include tree aspects, which are important to each and every patient’s well being and delight. Cognitive attributes, indicates that beliefs and contemplations are inclined to be negative; in turn, negative ideologies become part and parcel of the patient’s view points. An illustration of this fact is justified from M25 assessment transcript, whereby Marie feels unworthy to live. According to Beck et al (1976), in their course work, they describe schemas as patterns of attitudes and values that are relatively unwavering. These patterns determine the way in which patients comprehend the world around them and the world in general. Schemas are of varying types; they settle on the way in which individuals perceive various situations. Individuals find it extremely strenuous in an attempt to focus on a singular external response or stimuli (Beck et al 1976). To prove this point, form M28 displays Marie’s mentioning of her constant tire, sleeplessness, and can hardly concentrate on anything. On the other hand, negative automatic judgments are evident in persons who have issues with their anxiety and cannot handle situations that force them to deal with anxiety-oriented situations. Barker (2003) argues that negative automatic judgments are off-putting and occur in the mind impulsively. In this respect, therefore, it is justified to argue that individuals have no control over such occurrences. At times when the patient may be undergoing periods of stress or difficult circumstances, such feelings are bound to occur in patients. Marie indicated ‘dead’ in form M21, a metaphorical statement to mean that the nurse had to carry out suicidal tests on the patient who supposedly, was on her way to suicidal risk evaluation Bark (2005). During the assessment, the supervisee had to keep a close check on the patient, and then come to a conclusion on the final thoughts on the patient’s final feedback. In the event where the patient displays negative feelings, the nurse had to devise a way in which the situation is put under control as soon as possible. The nurse must ensure, that in this instance, the nurse encourages the patient develop a positive attitude towards life; a major step towards total recovery of the patient. Administering 1-1 to Marie is a great step towards ensuring that the patient is going through a successful therapy period in her recovery process. Besides 1-1, other intervention measures include, administering the patients with important advice, mandatory for allowing them adjust their way of thinking and beliefs that they uphold. This approach can be proven to be the best approach that can be given to the patient in question. Through this approach, time management in terms of administering assistance is possible. This is warranted on the grounds that the patient spends a good amount of time seated, as cannot have sleep. Poor concentration leads to the patient falling sick constantly. Through the specified time schedules, the patient is in better position to spend quality time conducting various activities. The nurse may also opt to encourage the patient, to spend quality time with friends and relatives, as this is helpful in assistance of the patient acquiring socialization skills. From the social experience, the client is in a position to give a detailed narration of how events unfolded during a specific time. This is done with the assistance of the nurse, who assists the patient in analyzing situations on a certain time span. It is also recommended that, during the intervention, the nurse must also include dietary considerations in the therapy. Since Marie is not taking too much, it is important that all her dietary intakes are recorded and agreed upon through Socratic dialogue. The client should also put down in her diary, what she consumes in a day. She should also give the reasons behind her selection of the meals. In her diary, she should also ensure that a clear record of the reasons behind her negative thoughts. With this, it is easy to decode the best intervention measures towards the elimination of her negative thoughts. Through Socratic dialogue, approaches towards successful eliminative of the negative thoughts will be discussed and the best approach selected. In terms of weight loss and gain, observation techniques are recommended. Once the patient conforms to the idea that she may be incorporated in the society, she is likely to have a higher self esteem and have a higher morale after therapy. Question2: How would you use clinical supervision to manage any risk Marie may pose According to Department of Health (2003), clinical supervision can be described as an official process that entails specialized support and emphasis on knowledge that allows individuals under supervision acquire the necessary skills useful for completion of their course. Through supervision, individuals are also in a better position to embrace responsibility virtues, through consumer protection and provision of health care that is safe to the clients. Clinical supervisions guarantee that clinical practices are sensible, and are in line with organizational methodologies. With this in mind, practitioners are in a better position to have a detailed insight on the clinical practice. Butterworth (1992) argues that, clinical supervision is a substitute between practitioners under study, in an endeavor to allow for their development of skills that will assist in acquisition of professional capabilities. According to White (2003), the role of the supervisor is to offer support through assistance of the learner, acquire skills through application of the skills learnt in the course of study. In accordance to N.M.C (2006), clinical supervision is vital in clinical governance; and allows practitioners under study acquire skills and awareness that will allow them perk up their skills of handling patients in clinical settings. Lillyman and Ghaye (2007) on the other hand, indicate that, clinical supervisions cannot be defined and monitored by managerial control. The managers cannot keep on monitoring the progress of practitioners in practice. Clinical supervision is only possible through private encounters between the individual under practice and the supervisors. The supervisor must ensure that, they constantly evaluate the persons under study, devise the best forms of practice, and finally ensure that all the skills taught are learnt and put into practice. According to Proctor’s (1987) model, this approach is the best that can be applied in this context. This model recommends for multiplicity of nursing perspectives that incorporate mental health nursing (Faugier, 1995). Proctor’s (1987) model uses the tree form of supervision, which are inclusive of formative, normative and restorative assessment procedures. Scott (2004) argues that these forms of assessments are recommended for their ability to cope with the diverse nursing contexts’ diversity. Sloan (1995) indicates that, Proctor’s model has its roots from counseling and is able to handle various themes at a go. The formative aspect focuses on reflective learning through the provision of frameworks and procedures of reflective learning. Formative function of learning allows the persons under study acquire the necessary skills that allow them evaluate their performance on the basis of performance. Individuals; in turn are in a position to gain expertise responsible for their application of concepts learnt in clinical settings (Cutclffe and Proctor’s 1998). Bark (2009) indicates that, the formative aspect gives an explanation of the reflective procedures that the supervisee has gone through, that have in turn contributed to their learning skills in the clinical setting. Though the patient was in a position to answer questions in a good way, the supervisee should have incorporated the use of full sentenced answers, which were to be indicated in the M36 form. The patient, in this context, is quoted to say that she cannot see them- they’ll see how bad I am. The supervisee used her own manifestations to improve the patient’s care, upon posing questions on the patient that indicated her own perception, as opposed to the previous N1 transcripts. According to Flower (1998), formative phases of therapy entail development if skills and ability of the learners to reflect upon experiences that they have undergone. With formative phases, the supervisee is in a better position to assess the suitability of their work, build up abilities and acquire skills that have a high correlation with the clinical practice (Cutcliffe and Proctor 1998). Rhodes and Jake (2009) indicate that, it is the sole responsibility of supervisee to edify the patient on the negative automatic reasoning in generating depressed dispositions or melancholic feelings. They also argue that the patient must be advised on the application of suitable methodologies to curb these feelings. An evidence of this fact is from M1 transcript, where the patient answers, that she feels guilt because she has let many people down. Through Socratic questioning, patients are in a better position to come to tangible conclusions through subjection to closed questions. For instance, in order to arrive to a conclusion on the issue of suicide, the Socratic dialogue allows the supervisee weigh the advantages and disadvantage of each reason; thus, allow the patient reach the best conclusion. Socratic dialogue also gives reasons behind the interventions selected and their suitability on the patient. Normative form of assessment, on the other hand, seems to pose a lot of doubts to the supervisor and supervisee. According to Proctor (1998), normative aspect puts much emphasis on managerial issues that highlight on safeguarding professional principles. Lillyman and Ghaye (2007) argue that normative aspect allows for promotion and compliance with the policies that relate to clinical assessments. The supervisee at N16 indicated that she could not perform her usual tasks, of caring for their patients. She indicated that felt guilty of not performing her usual tasks. Driscoll (2007) supports this argument by indicating that, normative aspect engages responsibility in clinical practice and a patent rationalization of the roles of the nurses. However, it was not very clear on what the supervisors expect at the end of the practice, especially in alleviating the patient’s anxiety. Sloan (1999) indicates that the proctor model is inefficient and should not be used in the clinical setting. He continues to argue that the model does not have proper guidance on its functionality. Mitchell (1998) argues that, this model does not play the major role of identification of the philosophies and values that act to dictate clinical practice. The invigorating aspect of clinical assessment advocates for emotional aspects of the supervisees on their functionality. According to Bishop (1998) the factors that determine clinical supervision is the relationship between the patient and supervisee. Driscoll (2007), on the other hand, shed light on the restorative functions of supervision and explained how the supervisee reacts emotionally to the demands of the health care milieu. In this context, the patient is recorded to have lost a lot of weight as indicated in M22 and M23. This leads to the supervisee making numerous consultations on what is required of the supervisee to alleviate the situation. Incorporation of the Proctor’s model will ensure that the supervisee is given an opportunity to select the best method that will ensure that the best assessment process to the patient is possible, and will be administered on an immediate effect. According to Driscoll (2007), the supervisee may find themselves in a position that, they are overcome by their feelings for the patient; resultant from constant working with them. From the transcript, it is evident that, the client bears with her emotions in a myriad of ways. M21 and M22 are evidences of the statements of negative thoughts by the patient. For the supervisee to establish good rapport between them and the patients, it may take too long. Butterworth et al (1997) indicate, that the Proctor’s model enables the supervisee trace any form of changes in the in the clinical supervision. This may be job dissatisfaction, changes in emotional stress, amongst others. Sloan and Wastson argued that Proctor’s model offers no guidance to the clinical supervision on what to apply, most applicably on the restorative aspect of the model. According to Botterworld (1997), his study has a great correlation with the work of Coombes (1997). Their work bring to light that clinical supervisions are not clear on the advantages to the supervisees. Driscoll (2007) argues that, the three major functions of clinical supervision, have over the years, been well organized, in such a way that, are keenly applied, but may be used as flexible mechanisms to guide clinical assessments. Question3: what factors would the nurse in the transcript take into account when developing a therapeutic relationship? Reynolds (2000) defines therapeutic relationship as purposeful goal oriented associations, whose aim is to advance suitable interests and outcomes in patients. According to Nelson (2005), it is vital that the nurse and the patient develop a sensible relationship between the in an attempt to ensure that patients are safe as well as make them feel secure during their assessment procedure. If the patients feel safe and secure, then they are likely to have a quicker and safer healing. High-quality therapeutic relationships are most important in cases where patients are subject to mental illnesses (Barker, 2009). Listening and having discussions with the patients, according to Stein-Parbury (2000), is the best therapy that patients may undergo. During discussions, the nurse is likely to have an understanding of the patients’ mind-sets and emotions. According to Kirschenbaun and Henderson (1990), compassion, congruency and affirmative regard on the patients contribute a great mile to therapy. These founding basics have their roots from Carl Rogers; that allow patients give their views on what they feel on their conditions. According to Rogers (1990), empathy is the capability of the client to discern what they feel on what is around them and how they affect their well being. Rhodes and Jakes (2009) argue that, if the patient is directed towards sensible conditions, personal development and indulgence is possible for such clients. Reynolds (2000) continues to argue that, empathy is very useful to the nurses and clients. Alternatively, Tolan (2003) indicates that, empathy reaffirms what other individuals have said. To support this argument, N4 transcript indicates what the patient felt and repeated upon the statement that she was bad. According to Stuart (2009), confessions by the nurses must be beneficial to clients in terms of successful therapeutic approach. Mitchell (1998) argues that the nurses must be fully aware of the client’s view point on the world as well as their lived; this would enable the nurses understand the patient in an easier manner, even without full background information on the patient. In this case, the nurse was recorded to guess information that was not relevant to the supervisor making it difficult for the patient to access proper health care. Rogers (1961) argues that endless encouraging regards work a great mile in the assistance of the patient heal despite what they go through is positive or negative. Healthy development of patients can be attributed to positive remarks by the nurses to the patients. All patients, that have undergone this therapy, record positive developments, unlike those that have not. According to Tolan (2003), positive remarks to patients, allows individuals have an explanation of all the activities they engage in, how they think and even what they feel. Positive remarks can be applied in the clinical supervision setting whereby, the nurse and patient relate to what take part is valid or not. Form N26 is a proof of what the nurse says is beneficial, as well as, the manner in which she holds high, the opinions of patients, regardless of suitability and validity. At most times, the nurses urge patients to open up and give their views on what they feel inside and what they recommend to their healing process. This is proven by transcript M, where the patient admits being guilty and that, all people have done to him make them feel worthless and hopeless. According to Mitchell (1998), positive remarks on the patients may be described as total approval by the nurses, that are not by any chance and means contaminated by what the clients think and feel on themselves. Sloan (1999) on the other hand, believes that congruency lies within sensible communication strategies between patients and nurses. In this context, it is most probable that the clients are likely to open up and give their honest view on what they feel deep within their souls. Mitchell (1998) attests to the fact that, Karl Rogers held the opinion that congruency comes through no other means, but genuineness on the clients’ side that contributes to sensible therapy on the patients. In relation to Tudor et al (2004), for congruency to be achieved in the therapy program, it is important that, each party plays the role of being open and sincere in their inner thoughts and feelings. A proof of this fact is evident in transcript M25 that indicates Marie feels that she is taking up too much time that would otherwise be subjected towards other therapy approaches. The nurse, in this context, urges Marie to open up and clearly state what makes up her day to day activities. Conclusively, Barker (2009), states that a good therapeutic rapport is vital in any form of medical administration. Good rapport allows for patients cope effectively with the situations at hand as well as, counter threats that may be posed on their health. Gilbert (2007) finalizes by indicating that quality therapeutic relationships are extremely vital; as it is through such relations that stable foundations on creation of successful therapies are based. Bibliography Baker, P, 2003, Psychiatric and mental health nursing: the craft of caring, London: Hodder Arnold. 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