The Management of Patients With Dual Diagnosis - Research Paper Example

Introduction This paper is a case study of a patient with a dual diagnosis or a co-morbid condition. The case study is described within the paper in line with the complexity of the problems and needs that are faced by the patient. In addition, the impact of these problems and needs on health care providers are provided within the case study analysis. More importantly the assessment of the patient, the diagnosis of the co-morbid condition and the interventions that were employed in therapy are discussed, analyzed and evaluated. Finally the lessons that I learned in nursing care in the management of the case of dual diagnosis are explained at the end of the paper. Case Study Ms. M is a 26 year old patient who is referred for nursing care by her advisor at work. This followed significant changes in her normal behavior. The patient history demonstrates that Ms. M stays late without any sleep and wakes up earlier than anybody within her neighborhood. Her employee is also concerned by the fact that she started submitting her work late regardless of her usual behavior in the past when she used to meet all work deadlines. In addition, the workmates have noticed that Ms. M is more enthusiastic and energetic in the morning than before. Ms. M’s sister whom they stay with reports that she suddenly becomes irritable and has been talking about becoming a model despite the fact that she never had interest in modeling before. Ms. M also admits that she has trouble concentrating at work and that sometimes she feels lonely. Complexity of Patient Needs/Problems From the case study, it is evident that Ms. M is exhibiting multiple symptoms which reflect the complexity of her problems and needs. Ms. M’s symptoms are becoming a problem that is likely to cause her to be terminated from work. This is revealed by the loss of concentration at the work place and failure to meet deadlines as she is required. In addition, Ms. M is faced with a social problem at her work place. This is disclosed by the fact that she reveals her loneliness when at work. In addition she needs understanding from her colleagues at the work place who are unable to comprehend the sudden changes in her behavior. Moreover, Ms. M has a problem with sleep which illustrates that she is not having adequate rest at night. The sudden episodes of energy and enthusiasm that Ms. M demonstrates in the mornings reveal an underlying problem. The complexity of problems and needs that the patient has means that effective nursing care, through assessment, diagnosis and treatment, is required in order to allow the patient to regain her normal condition and lifestyle. Impacts on Service Providers The needs and problems that the patient is experiencing mandates health care providers to employ their legal, ethical and professional obligations and responsibilities to ensure that the condition of the patient is improved. According to Norman and Ryrie (2009, p. 36), health care providers are mandated by the legal and ethical framework of practice to play their roles effectively so that the needs of patients are met and their problems solved through the processes of proper assessment, diagnosis and treatment. In addition, the needs of the patient and the problems that she is experiencing requires that health care providers implement and apply the knowledge and skills that they have acquired through training and experience to treat the patient without any form of bias (Blows, 2003, p. 45). Assessment The symptoms of the patient and the complexity of her needs and problems reveal a differential diagnosis of a co-morbid condition or dual diagnosis. This means that the assessment of the patient will be focused at determining the symptoms of the two disorders within her co-morbid condition. Rassool (2006, p. 124) shows that in dual diagnosis, nurses and other health care providers employ psychological assessment procedures so that the symptoms of the patient can be evaluated to determine the underlying conditions. A comprehensive medical history was therefore the basis upon which the psychological assessment of Ms. M was achieved. The collection of patient history about Ms. M was conducted in congruency with the standards of ethics and professionalism which govern mental care. The assessment process aimed at using the patient history to assess the mental disorder and the drug problem that was being experienced by the patient. In this regard, during the assessment, the patient was assured that the information that she gave during history taking was solely purposed to be used in making her condition better. This encouraged the patient to talk about her feelings and problems in addition to the kind of drug that she was using so that she would alleviate the symptoms of the mental disorder. Etiology and Diagnosis According to Norman and Ryrie (2009, p. 45) 2 out of 3 patients with psychological disorders engage in self medication because they are motivated by the need to overcome bad feelings by alleviating the symptoms of the psychological disorder. Therefore these patients engage in the use of alcohol and other drugs of abuse as a remedy for the underlying psychological disorder. This often leads to drug dependence because withdrawal from the use of alcohol and other abusive drugs leads to onset of the symptoms of the psychological disorder (Rassool, 2006, p. 28). Since drugs of are temporal remedies of symptoms, continues use of these drugs leads to co-morbid occurrence of both a drug addiction problem and psychological disorder which is referred to as dual diagnosis (Blows, 2003, p. 51). The diagnosis of Ms. M was achieved through the application of the Diagnostic and Statistical Manual of the American Psychiatric Association (DSM-IV). Rassool (2006, p. 132) explains that SDM-IV is an effective diagnostic model which is applicable in the diagnosis of co-morbid conditions. The criterion that was used in the diagnosis of Ms. M’s co-morbid condition was therefore extracted from manual. This model was effective in the diagnosis because it was used to establish a distinction between the causes of the drug addiction problem and the psychological disorder that she was experiencing. Tummey (2005, p. 57) illustrates that before a conclusive diagnosis for a co-morbid condition is achieved, DSM-IV should be employed in conjunction with the symptoms of the patient are derived during the process of taking patient history. The symptoms of enthusiasm and energy that Ms. M demonstrated at work during the morning hours are indicative of alcohol abuse. This is related to the fact that she was not exhibiting this kind of behavior in the past. Moreover the fact that she takes alcohol in the morning illustrates that she is a habitual taker. More importantly is the fact that she risks taking alcohol while going to work. This shows that she is dependent on alcohol. In this sense a conclusive diagnosis of alcohol addiction was defined as Ms. M’s conclusive diagnosis for one of her conditions within the dual diagnosis. The trouble that Ms. M exhibits with sleeping, reduced concentration, her irritability, slowness at work, loneliness and interest in new activities were among the symptoms that were used to diagnose depression as one of her co-morbid condition. Rassool (2006, p. 27) emphasizes that depression presents itself with symptoms such as feelings of loneliness and emptiness, irritability, loss of interest in favorite activities, lack of sleep and a reduction in the span of concentration. In this sense a conclusive diagnosis of alcohol addiction with an underlying depression was reached as the two conditions that comprised of Ms. M’s dual diagnosis. Interventions The intervention for the nursing management of Ms. M’s dual diagnosis was achieved through a design and implementation of a treatment plan. According to Rassool (2006, p. 142), the treatment of a co-morbid condition requires that a dual-diagnosis model is employed because it is the most effective approach to the management of a dual diagnosis. Because of this, the treatment plan for Ms. M was aimed at achieving a simultaneous therapy for both alcohol addiction and her depression. In the treatment interventions for Ms. M, an in-patient program was employed with a goal of achieving a successful treatment of her two conditions at the same time. The initial intervention that was used in the treatment of Ms. M was detoxification. This was aimed at cleaning her system from alcohol and the related dependence. The patient was enrolled for a two week detoxification program to pave was for the start of the rehabilitative process for her dual diagnosis. Blows (2003, p. 48) points out that rehabilitation programs are designed to help patients with a co-morbid condition to overcome the symptoms of the mental disorder and the drug abuse problem which they experience. The rehabilitative phase in Ms. M’s therapy therefore involved the application of group therapy as well as individual therapy sessions. In these forms of psychotherapy the patient was encouraged along with others with similar problems to speak about their worries and problems and their desire to overcome them. In addition the phase of rehabilitation allowed Ms. M to engage in educational programs in which she was encouraged to avoid alcohol and control her fears. Evaluation of interventions and Assessment The methods used to assess the patient were in line with the ethics of nursing practice as well as the legal framework and standards for health care. For example the taking of patient history and the use of her heath records preserved her rights for privacy and confidentiality of personal data. Moreover, the consent of the patient was obtained for the various procedures that were employed in treatment such as detoxification. In this sense, it is arguable that evaluation of the patient and the interventions which were used in her management were effective. More significantly is the fact that all evaluation and interventions of the care of the patient had a goal of improving her condition and helping her to overcome her problems. This is in line with the standards for quality and safety in care of patients. Furthermore, evidence based practice was employed in the assessment and treatment of the patient. This is related by the use of diagnostic and management approaches that are supported by scientific literature such as DSM-IV. In addition, the cultural values and beliefs of the patients were respected in the treatment process as postulated by evidence based practice in nursing care. Lessons Learned The experience in the care of Ms. M allowed me to learn important lessons in health care. Most importantly I was able to appreciate the application of psychological assessment in the evaluation of a co-morbid condition. Additionally, I was able to apply the knowledge and skills that I had learned in class to achieve effective patient assessment through history taking and applying theory in care. Moreover, the diagnostic processes for the patient’s co-morbid condition allowed me to have skills of diagnosing both a substance abuse problem and a psychological disorder. More notable is the application of the Diagnostic and Statistical Manual of the American Psychiatric Association in diagnosis of co-morbid condition which improved my experience in nursing care. Evidence based nursing care as employed in the management of Ms. M allowed me to appreciate the role of scientific literature in achieving high quality care. It is important to note that I was able to learn these lessons through the team work and the assistance of other health care providers in the management of Ms. M’s dual diagnosis. Conclusion In line with the case study analysis within this paper, it is conclusive that the management of patients with dual diagnosis requires keen assessment of their conditions and understanding of the etiology and symptoms of both conditions for accuracy in drawing a conclusive diagnosis. This is then followed by the application of interventions that are supported by scientific evidence for high quality and safe care. Ethical and legal frameworks in addition to professionalism must also be adhered to in care of patients with co-morbid conditions. These considerations are attributed to the successful diagnosis and treatment of Ms. M whose dual diagnosis condition was evaluated within this paper. References Bartlett, P. & Sandland, R., 2007, “Mental Health Law: Policy and Practice”, Oxford Press, London. Blows, W.T., 2003, “The Biological Basis of Nursing”, Mental Health, Routledge, London. Norman, I. & Ryrie, I., 2009, “The Art and Science of mental Health Nursing”, A textbook of principles and practice, Open University Press. Rassool, G. H., 2006, “Dual Diagnosis”, Nursing care and management, McMillan Press. Rassool, H., 2006, “Dual Diagnosis Nursing”, Blackwell Publishers. Tummey, R., 2005, “Planning Care in Mental Health Nursing”, Palgrave, Macmillan. Read More