Care of a Client with Complex Mental Health Care Needs - Essay Example

?Assessment and Care of a Client with Complex Mental Health Care Needs Introduction The assessment and care of a client with complex mental health needs is one of the enormous challenges mental health nursing faces. Assessment is a continuous, regular, and involved process. At every contact with the client, the psychiatric nurse should be evaluating the client’s condition. Mental health care must be performed within the framework of the Care Programme Approach (CPA) which is still the foundation of the mental health policy of the UK government and is tasked to make sure “that all patients are assessed and that no one who might be vulnerable is missed” (Forster, 2001, p. 15). This involves a methodical evaluation of the social and health care requirements of an individual who has been brought to the ‘specialist mental health services’ (Forster, 2001, p. 15). An important component of the CPA is the assigning of a service provider who will work with the client and his/her family or caregivers to evaluate needs, create and carry out a care plan. In the CPA service provider task, the nurse is largely involved in locating an array of assessment needs, several of which could be outside the own knowledge or capability of the nurse. Besides the troubles brought about by mental disorders, numerous clients with serious and chronic mental disorders will be further impaired by ‘secondary impairment’ (Bartlett & Sandland, 2007). This will lead to a kind of disability marked by difficulty carrying out daily tasks such as cooking, going to the grocery, using public transport, and so on. Professional assessments from service providers should be requested. In nursing theory and practice, bipolar disorder is classified as one of the most complex mental health disorders. The best nursing care takes place during the acute illness stage and remission (Suppes & Dennehy, 2010). This paper presents a case study of the mental health condition of Ms. M, a young adult who displays symptoms of bipolar disorder. Case Background Ms. M is a 26-year-old white female who works as an accountant in a law firm. She was a dedicated employee and always accomplishes her work tasks on time. However, her workmates and her advisor noticed a sudden change in her behaviour. She eventually became tardy. Her performance at work began to deteriorate. Ms. M herself admitted that she has difficulty concentrating at work. She also said that she feels lost and lonely at times. Her sleep patterns also became abnormal. She sleeps late but wakes up very early. But, interestingly, she began to show more enthusiasm and energy in the morning. Her sister reported that Ms. M became short-tempered all of a sudden and has been, for the first time, openly expressing her desire to become a model. Ms. M was diagnosed with depression and alcohol related problems. Ms. M’s mental health condition may be caused by genetics or environmental factors. A depressive episode may take place without any clear cause. It could be that something stressful in Ms. M’s immediate environment caused the sudden changes in her behaviour; it could be a stressful event at work or at home. A medical condition can also cause episodes of depression, such as brain tumour or stroke (Videbeck, 2010). According to Boyd (2008), use of substance and consumption of alcohol may also activate symptoms of depression. Case Analysis The symptoms of Ms. M are indicative of bipolar disorder. An individual episode of abnormal and chronic irritable mood. During Ms. M’s episodes of mood disorder, the following symptoms of bipolar disorder have continued: difficulty concentrating; more conversational than normal; excessive energy and enthusiasm; abnormal sleeping patterns; and increased confidence (e.g. desire to enter modeling). The mood disorder is quite serious to cause noticeable disruption in occupational performance or in personal relationships. The symptoms may be triggered by alcohol related problems. Because bipolar disorder often includes depressive and manic episodes, knowledge of the interaction between these affective conditions is vital to assessment and care. Since Ms. M has been referred to nursing care, assessment of her mental health care needs should begin promptly. The assessment stage requires the collection of information about Ms. M, her family, and peers through observations, examinations, and interviews. The assessment of Ms. M’s mental health condition is performed in a nursing home to exclude any manifestations of major depression resulting from a brain accident (Mueser et al., 2003). Two kinds of information are acquired: subjective and objective (Carpenito-Moyet, 2006). Subjective information are collected as Ms. M, her family, friends, and colleagues give details instinctively during the interviews. In addition, it can incorporate any remarks made by Ms. M, for instance, “I feel so lonely. I do not want to live anymore”. This subjective information is interpreted by the nurse afterwards. On the other hand, objective information contain details to identify Ms. M’s physical strengths, weaknesses, and changes. Objective information is concrete and measurable details acquired through physical tests (Carpenito-Moyet, 2006). In addition, objective information can incorporate recognisable behaviours of Ms. M like being talkative or sad. A comprehensive assessment is used, which contains information about Ms. M’s social, spiritual, cultural, psychological, and biological needs. This form of assessment is usually performed alongside other service providers or health care practitioners like social workers, psychiatrists, and physicians. Neuroimaging may be recommended to prevent incorrect diagnosis. It has generally been used to verify symptoms of bipolar disorders (Jakopac & Patel, 2009). During assessment, the psychiatric nurse makes use of an assessment instrument to acquire accurate data, monitor Ms. M’s behaviour and appearance, and assess her mental condition. One method to enhance identification of bipolar disorder is to use a screening instrument, like the Mood Disorder Questionnaire—a self-report screening tool designed to diagnose individuals showing symptoms of bipolar disorder (Suppes & Dennehy, 2010, p. 108). If Ms. M is diagnosed with alcohol-related problems and the symptoms appeared in direct connection with the alcohol-related problems, or the symptoms immediately subside when Ms. M is alcohol-free, this may indicate that the symptoms are triggered by alcohol consumption. Nevertheless, it is important to keep in mind that during a manic period several people tend to seek pleasurable activities that compel them to consume alcohol. In other words, the mania may be encouraging the consumption of alcohol instead of the other way around (Timby & Smith, 2005). According to Videbeck (2010), a family history or past medical history of bipolar disorder would imply that a manic period is the more probable cause. Possible Interventions Although bipolar disorder is a complex mental health disorder, it is still treatable. In the case of Ms. M, it seems that her bipolar disorder symptoms are triggered by her alcohol consumption. Several nursing interventions can effectively alleviate these symptoms and eliminate the cause of the disorder. First, since Ms. M’s capacity to cope with stimuli (e.g. stressful events) is weakened, it is important to reduce stimuli from the immediate environment as much as possible. React to signs of anxiety by getting rid of stimuli and possibly putting Ms. M in a separate room. Second, motivate her to express her emotions, especially those negative ones. Search for ways to lessen her anxiety. Third, monitor her sleep patterns and be attentive to signs of exhaustion. Ms. M has a tendency to ignore signs of exhaustion and disregard her need for sleep or rest. Reducing stimuli (e.g. lights, sounds) is one way of encouraging her to sleep or rest/ Administer sleeping pills or sleep-inducing activities if required (Boyd, 2008). Fourth, motivate her to become self-reliant. She must be motivated to be self-reliant as possible to enhance her sense of worth and self-respect. Fifth, encourage her to perform easy tasks. Slowly raise the difficulty of the tasks. Provide feedback at every stage of completion. Ms. M is experiencing difficulties carrying out complicated activities. Encouraging her to perform various tasks, with varying levels of complexity, will help bring back her normal capabilities. Sixth, educate Ms. M and her family, friends, and colleagues about bipolar disorder and alcohol-related problems. Ms. M herself, her family, and peers may have insufficient or no knowledge about bipolar disorder or the importance of long-term, regular treatment. Educate them about indications of relapse, like abnormal sleep patterns and mood swings. If Ms. M can identify indications of imminent relapse, she can immediately ask for treatment to prevent relapse. In treating or managing bipolar disorder, interruption of further mood periods in the future is a vital process. Bipolar disorder is usually persistent and repetitive; hence, Ms. M and her family must be properly educated about the nature and treatment for bipolar disorder and on how adjustments in everyday routines and medication may be beneficial to the prevention of relapse or recurrence. The service provider must stress the significance of long-term, regular treatment, reduction of internal and external stimuli, reduction of alcohol consumption, elimination of stress, and maintenance of a regular and normal sleep pattern. Clients with bipolar disorder have a greater tendency to commit suicide, particularly in the initial stages of the illness. The service provider must aggressively look for signs of suicidal tendency and immediately respond to it through appropriate interventions (Weinstein, 2010). Numerous studies have been carried out to find out how to discourage suicide and mood problems, but identification of suicidal tendencies in medical practice is still problematic. Interventions that apply an educational model intended to eliminate the distinct stressors that aggravate the frequency of depressive episodes in females have been quite effective (Claridge, 2002). These interventions are designed to enhance self-reliance and sense of worth and ease despair and loneliness, which consequently reduce the emergence of depression. A Reflection Nurses working with patients with bipolar disorder and a history of alcohol-related problems usually sympathise and identify with them and also start to feel lonely or restless. They may then try to avoid interacting with these patients to break away from these negative emotions. The nurse should observe his/her emotions and responses thoroughly when working with patients with bipolar disorder to be certain s/he meets the obligation to build a positive, therapeutic relationship with the patient. Individuals with bipolar disorder, like Ms. M, are generally gloomy, distrustful, and incapable of developing new insights without difficulty. They feel useless and lonely. The nurse tends to become engrossed with recommending ways to resolve the issues. Unfortunately, some patients find some of these suggestions impractical. The nurse may feel useless and uncertain of his/her professional ability if his/her suggestions are rejected by the patient. The nurse does not attempt to resolve the patient’s issues, unless the patient is having a crisis or suicidal tendencies (Norman & Ryrie, 2009). Rather, the nurse administers therapeutic methods to motivate patients to solve their own problems. Studies have reported that patients are more inclined to carry out solutions they create on their own (Weinstein, 2010). Making and actualising their own solutions endows patients enhanced self-esteem and capability. Working with patients with bipolar disorder can be very tiring or fatiguing. They are too energetic that the nurse may feel exhausted or drained after looking after them. The nurse may feel upset or impatient because these patients perform the same actions repetitively. It is very difficult to stay patient and composed with the manic patient, but it is important for the nurse to give limitations and instructions in a composed way until the patient can regulate his/her own actions by him/herself. There are several points that can be learned from working with patients with bipolar disorder. First, if a specific care programme is disturbing, it is important to consult another specialist about the care programme, how it is performed, and its outcome. Second, it is helpful to keep a journal to manage or cope with anger, disappointment, and other negative emotions. Third, do not attempt to resolve a patient’s issues. Apply therapeutic methods to assist him/her in looking for appropriate solutions. Fourth, plan definite, brief interactions with manic patients to get rid of spontaneous avoidance of them. And ultimately, bear in mind that patients with bipolar disorder may appear happy or enthusiastic; but they are miserable within. Conclusions The case of Ms. M requires nursing interventions for bipolar disorder. The changes in her behaviour, particularly as regards her sleep patterns and mood swings, are indicative of bipolar disorder. The initial diagnosis shows that Ms. M is suffering from depression and alcohol-related problems. This diagnosis implies that her symptoms are triggered by her alcohol-related problems. Therefore, it is important for the nurse to first eliminate the cause of the symptoms through assessment and care. Although it is difficult to work with patients suffering from bipolar disorder, it is still an opportunity for nurses to learn vital lessons from their therapeutic relationship with the client. References Bartlett, P. & Sandland, R. (2007) Mental Health Law: Policy and Practice. London: Oxford Press. Boyd, M. (2008) Psychiatric Nursing: Contemporary Practice. UK: Lippincott Williams & Wilkins. Carpenito-Moyet, L. (2006) Handbook of Nursing Diagnosis. UK: Lippincott Williams & Wilkins. Claridge, G.D. (2002) Personality and Psychological Disorders. UK: Arnold. Forster, S. (2001) The Role of the Mental Health Nurse. UK: Nelson Thornes. Jakopac, K. & Patel, S. (2009) Psychiatric Mental Health Case Studies and Care Plans. UK: Jones & Bartlett Learning. Mueser, K., et al. (2003) Integrated Treatment for Dual Diagnosis: A Guide to Effective Practice. New York: Guilford Press. Norman, I. & Ryrie, I. (2009) The Art and Science of Mental Health Nursing. UK: Open University Press. Suppes, T. & Dennehy, E. (2010) Bipolar Disorder Assessment and Treatment. UK: Jones & Bartlett Publishers. Timby, B. & Smith, N. (2005) Essentials of Nursing: Care of Adults and Children. UK: Lippincott Williams & Wilkins. Videbeck, S. (2010) Psychiatric-Mental Health Nursing. UK: Lippincott Williams & Wilkins. Weinstein, J. (2010) Mental Health, Service Involvement and Recovery. UK: Jessica Kingsley Publisher. Read More