Nursing and Decision Making in Mental Health Nursing - Essay Example

?Nursing and decision making in mental health nursing An Overview of Jo’s Case Jo is a twenty-two year old young man who was admitted to a mental health care ward on an outpatient basis after staging an unsuccessful attempt to take his own life. This was not Jo’s first time to try suicide. In the past, Jo tried suicide after experiencing emotionally painful incidences. For instance, he had tried to harm himself after getting into arguments with his mother who disapproved of his friendships. It appears that Jo has a history of falling into deep depressions after such upsetting altercations that result in his trying to take his own life. While admitted as a patient in the mental health facility, Jo actually showed signs of improvement in that his emotional state grew more balanced and he showed signs of functioning as an ordinary person even though he was not given any medicine. He also regularly participated in discussions with the professionals and seemed to understand the methods to use so as to restrain his emotions when he experienced stressful occurrences in the outside world. Jo appeared to be on his way to full recovery when he was suddenly visited by two friends the evening after he had returned from his leave. The friends appeared to be in possession of cannabis as well as knives. When some of Jo’s fellow patients, who were in the same room in which Jo sat with his visiting friends, reported this to the nurses that they had heard about a prospective fight, they were removed from the room and Jo’s friends left even without being asked to. Soon after, Jo demanded to be allowed to leave the ward. Against the advice and suggestions of the nurses that he remain, he insisted and was then allowed to leave. Owing to the fact that the member of staff was anxious that Jo would return with weapons to the ward, they asked him to discharge himself before leaving. The authorities also informed the police of the presence of Jo’s friends and the fact that they were in possession of cannabis and knives before they left the ward. A Key Decision within the Case When a nurse is faced with a decision to make between harbouring a potentially destructive client or revealing his or her intentions to law enforcement authorities, the nurse is usually faced with the problem of having to decide whether to protect the other patients and respecting the rights of the patient who is showing the potential for causing harm to himself or others (Antonius, Fuchs, Herbert, Kwon, Fried, Burton, Straka, Levin, Caligor, and Malaspina 2010). In normal circumstances, the nurse would merely discuss the patient’s concerns with him or her and then offer advice on how best to tackle feelings of hopelessness and destruction before they could become unmanageable. The nurse will only consider the possibility of letting other people know about the problems of her patient if he or she refuses to take the advice that is being offered (Fiscella 2004). By letting her supervisors or even law enforcement authorities know about a client’s threats to cause harm to others, the nurse is actually violating the patient’s confidentiality (Wolf, Lehman, Quinlin, Rosenszweig, Friede, Zullo and Hoffman 2008). In this case, it can be said that the decision to inform the police of the presence of Jo’s friends and subsequent request to Jo to discharge himself from the ward when he insisted on accompanying his knife and cannabis carrying friends, is the key decision. Even though the Jo was begged to stay in the ward by the nurses, he insisted on going after his friends who had openly spoken about a fight that was going to happen. The Ethical, Legal, Political and Professional Issues that are Related to this Key Decision Professional: In psychiatric practice, patients can make the choice to refuse treatment even if it may actually improve their lives. This means that Jo was merely exercising his rights by refusing to remain at the ward even when he was asked to remain by nurses who were worried that exposure to reckless characters would merely serve to accelerate the onset of further depression, or would curtail his progress. Also, a psychiatric diagnosis cannot be used by the authorities in treatment centres to stop a patient from exercising this right. The nurses, thus, were not legally empowered to force Jo to remain in the ward even if it was for his benefit. Even though the guidelines used in most jurisdictions to enforce the involuntary commitment of a patient are limited to the potential of causing harm to others, Jo could not be detained against his will under this statute since it was his friends who were carrying knives with the possible intent of participating in a fight. The only thing that the nurses could do was to stop Jo from smuggling in any weapons when he returned to the ward later. They could not be accused of negligence when they allowed Jo to leave because it was not apparent that he was the person that may cause injury to third parties (Wolf, Lehman, Quinlin, Rosenszweig, Friede, Zullo and Hoffman 2008). Generally, medical personnel break patient confidentiality and warn others of potential problems only when: There is potential for other people suffering death, serious bodily injury, or being exposed to psychological harm a certain group or person has been threatened There is imminent danger (Baer 2011). This means that the nurse has to be able to evaluate the situation so that he or she can determine if there is an actual possibility of people being harmed (Jacob and Holmes 2011). In this case, there was the possibility that Jo’s friends would cause harm to others. The situation was magnified by the fact that the friends were also carrying cannabis- a drug that would make them hyper-sensitive, if they consumed it, and more prone to picking fights. The presiding nurse acted by phoning the police to alert them of the presence of Jo’s friends because she was unsure of how things would proceed if she confronted them herself. This may have caused bigger problems and resulted in a dangerous fight. Moreover, when she removed the other patients from the room where Jo sat with his friends because her other responsibility was to protect the other patients, Jo’s friends left without causing any disturbances. The nurse, however, could not detain Jo, when he moved to follow them, because it was them and not him, who were carrying weapons. Sometimes a therapist’s viewpoint can be hard to determine because it may be that a patient talks about something they really will not do (Kaplan 2008). In this case, Jo’s friends may have bragged, in the hearing of his fellow patients, about an upcoming fight without any intention of being participants in the fight, and, thus, involving Jo in activities that would arrest all the progress he had made after his attempted suicide. Ethical: In professional counselling, health professionals have the right to stop therapy sessions at their discretion (Simon 2011). In most cases, the common reasons that cause counsellors or psychiatrists to stop seeing patients include the non-payment of fees, a patient’s refusal to apply the suggestions of the therapist, and the patient’s non-advancement in spite of the best efforts of the therapists (Rogers and Soyka 2004). Counsellors can also terminate sessions when they feel threatened by their own patients. If the therapist makes the decision to terminate sessions with a patient, it is normal for him or her to make suggestions about a different medical expert who may be better equipped with a patient’s mental issues. In this case, the nurse made the decision to terminate Jo’s session in the ward because of his refusal to comply with the regulations. Jo was asked not to follow friends who obviously had wrong intentions and would cause him to undo all his previous progress in overcoming his depression, but he chose not to listen. As he was not carrying any weapons himself, the nurse could not forcibly detain him or ask for the assistance of the law enforcement authorities in forcing him to stay where he did not wish to be. It is true that the ethical responsibility of therapists to maintain a good relationship with their clients has its limits. For instance, therapists can refuse to treat patients who may somehow bring harm to the other patients (Wolf, Lehman, Quinlin, Rosenszweig, Friede, Zullo and Hoffman 2008). This is another reason why Jo was asked to discharge himself. He had made commendable progress until his knife carrying friends came to the ward and showed off to other patients the knives they were carrying. The nurses were worried for the safety of the other patients and after removing them from the room, required for Jo to indicate that he would not put his fellow patients in such danger again by encouraging his friends to visit again. This would only be accomplished if he declined to follow them. When he refused to do so, he showed clearly where his loyalties lay. His therapists were made aware that he was not totally against his knife-wielding friends visiting him again even if this caused great discomfort to others. How my own Values and Beliefs have been influenced by this Piece of Work and the Potential Impact on Client- Centred Care This piece of work has allowed me to revise how I view my accomplishments and who I give credit for being as I am at present. I have been able to accomplish much even at a young age. Even though I had a lot of problems as a teenager, I have managed to overcome them and keep living positively in spite of them. In the past, I attributed this to my mental strength and will-power. After reading this story, however, I can honestly say that this is not entirely true. In my teenage years, my family lived in a crime-prone neighbourhood where there was little incentive to make good grades. Most of my friends in high school were more interested in being fashionable, famous, and popular. Each of them also had much older male friends who provided them with money to purchase the things they wanted. My parents, on the other hand, ensured that I did not have enough money to travel anywhere. They dropped and picked my sister and I from school and thus ensured that we did not come upon the characters that stood just outside our gates. I felt that they were stifling and old fashioned at the time, but I now understand that their intentions were good. Jo made the decision to follow his friends because of peer pressure. He had made progress since his last suicide attempt and was actually going to be discharged in a short time, but he compromised all that in order to be accepted by his friends. The influence of peer pressure cannot be understated. Peer pressure is not something that merely affects adolescents. Even adults seek to conform to what others want them to be by purchasing the ‘right’ cars or houses. Moreover, peer pressure tends to affect adolescents more deeply because they are not yet mature enough to grasp the importance of considering the consequences of an action before doing it (Bostick and Everall 2007). Teenagers also tend to rush into participating in actions that they deem to be a sign of their being ‘grown men’ or ‘grown women’. In this case, Jo may have followed his friends to their rendezvous because he wished to be a part of their clique and craved their acceptance. Attempted suicide is something that scars a person’s reputation and can result in other people shunning the person who did it. Jo had probably experienced this before and was thus pleasantly surprised to see his two friends at his ward. Their acceptance of him prompted him to forgive all their other flaws, even at the expense of his own mental well-being. For me, Jo’s story helps me to understand the importance of surrounding one’s self with good friends and acquaintances; because it is easier to do this than begin fighting the effects of a unhelpful friends to one’s attitude. The Potential Impact on Client- Centred Care Generally, client-centred care is more concerned with assisting a patient to participate in his or her own treatment process even through the use of unorthodox counselling methods (Sommerbeck 2003). The client-centred therapist will allow his or her patient to move towards progress at their own timing without making suggestions or ‘instructing’ them about where they ought to go next (Wolf, Lehman, Quinlin, Rosenszweig, Friede, Zullo and Hoffman 2008). The client-centred care-giver usually has great belief in the inherent capacity of human beings to chart their own courses; believing that people have the power to bring healing to themselves. Client-centred therapy can be used in the cases of patients who have different types of mental disorders or problems that can be positively influenced by the use of psychotherapy (Todd and Bohart 2006). Mental health practitioners who make use of client-centred care usually try to generate a therapeutic environment that is mainly empathetic, and accommodating. The two main elements of client-centred care are that it is: Non-Directive: The care givers allow their patients to give suggestions and lead in any discussions. They keep from steering their patient in the direction which they feel denotes progress Stresses on Unconditional Positive Acceptance: Client-centred caregivers exhibit complete acceptance for their patients at all times According to Carl Rogers, the initiator of this model, any competent client-centred therapist will have to have the following characteristics (Oordt, Rudd, Jobes, Fonseca, and Runyan 2005): Absolute positive regard for the patient: The care-giver or counsellor has to accept the patient with all his or her failings and show care and acceptance of them in spite of their present problems. Carl Rogers was of the opinion that people with mental issues become that way because they become aware of the fact that they will only benefit from true acceptance if they conform to the accepted standards of society (Warner 2006). By generating an atmosphere of unconditional acceptance, a client-centred therapist will be able to inspire his or her patient to speak about any subject freely without fearing censure, and thus disapproval. Being Empathetic and Considerate: The nurse has to be insightful when working with patients. This means that when the client expresses his or her opinions, the therapist does not analyse them for their faults, but expresses their real meaning to the client in the hope of making them appear more clearly (Warner 2006). This allows the client to benefit from a deeper understanding of his or her own deeper thoughts, and feelings. Genuineness: In society, few people feel comfortable enough to express their real emotions to others. The client centred therapist has the responsibility of sharing his or her emotions with the patient in an honest manner (Warner 2006). This will prompt the client to feel free to do the same thing and possibly develop this into an everyday habit. Through the use of these three characteristics, patients can begin to develop psychologically, and become more aware of why they do the things they do. If they should become aware that certain personal traits need to be changed, they will initiate the necessary changes without being compelled to do so by any individual. Many times, when therapists or nurses, as in this case, are assigned to work with people who were suicidal, they may be ambivalent about using client-centred tactics to deal with the problem since they are aiming at ensuring that the suicide attempt does not happen again (Jobes, Wong, Conrad, Drozd and Neal-Walden 2005). They are most likely to use tested methods that have been successful in the past- particularly those that recommend dealing with depression and mood swings by taking prescriptions. Due to the fact that this kind of therapy revolves around developing the self awareness, self confidence, and self esteem of a patient, it can successfully be used to treat depression conditions like those of Jo (Saha and Cooper 2008). Essentially, Jo may have shown better improvement if this method were used to treat him when he first came to the medical facility after committing suicide. In the days since his registration, Jo had shown remarkable progress in his disposition even though he was not taking any medication. This means that he was interested in improving his own mental health and situation, even if without the input of the others. People who are interested in exploring the reasons why they feel what they do and who feel that they should take responsibility over their actions and feelings are more inclined to favour client-centred care approach. In the client-centred approach, Jo would be empowered by the fact that his nurses would perceive him as being the best authority of what his own emotional requirements were. He would also be inspired by their belief in his capacity fulfil his own physical and mental goals. All this would be provided in an atmosphere of acceptance; which encourages a client to dare to think of him or herself as being all that he or she usually just ‘supposes’ he or she can be. These are all particularly empowering traits because, in normal circumstances, patients in hospital or mental practice settings are either penalised for the actions that got them there, or have their ways of thinking analysed and corrected by other individuals who supposedly have discovered better ways of coping with life’s problems than their patients (Wolf, Lehman, Quinlin, Rosenszweig, Friede, Zullo and Hoffman 2008). In addition, people or patients in hospital settings experience a feeling of being ‘de-personalised’. They are denied constant contact with family and friends and are put in unfamiliar surroundings (Kyler 2008). Most of the time, their decisions or requests are not taken seriously; particularly if their reason for being there is attempted suicide, like Jo. By choosing to support how the client sees the world, the client centred therapist breaks into the physical as well as mental isolation being experienced by the client and offers him or her the chance to respond to a human role. With such attention constantly being focused on his personal capacity to cause major improvement to take place in his own mental well being, Jo would gradually be encouraged to move away from constantly seeking to maintain the facade of being ‘one of the boys’- something that may have stopped him from choosing to follow his friends on the night he discharged himself. In the light of the acceptance of the client- centred therapist, Jo would have been able to begin to sort out the host of terrifying emotions and feelings that drove him to attempt suicide. Additionally, he would be encouraged to stop trying to live up to others’ expectations and would instead start to focus on what he felt was the right thing for him to do. He would value the trait of openness in all relationships in himself as well as other people. Having believed that he had the power to alter his own circumstances, Jo would begin to treasure all his emotions, including the negative ones, without being threatened by them. His goals would change and he would start to be more open to going through different experiences without constantly seeking to control his circumstances. With the knowledge that it was quite possible to permit himself to experience negative emotions without having to be catastrophic consequences for it, and having the freedom to feel deep emotions in the presence of a second individual, Jo would be free to live his life without fearing that he would be driven to yet another suicide attack. His trust in himself would allow him to embrace new experiences without fearing that they may drive him back to retrogressive practices that were harmful to him. This kind of self-disclosure is something that can only be enjoyed by a person who is allowed to accept his or weaknesses in spite of the objections of others. The problem that has been raised with this theory is that it calls for a person to be exposed to a therapist in very controlled settings where the therapist is trained to create an empathetic atmosphere for the patient. Critics of this theory usually state that it is unrealistic since the conditions with an accepting therapist who understands and does not judge cannot be recreated on the outside. Still, once a person has accepted him or herself, he or she learns how to be a therapist to him or herself and thus does not require the input or assistance of others in order to maintain a balanced emotional state. As a client’s perception about who he or she is begins to gradually change, his or her behaviour will also change accordingly. With the increased understanding of him or herself, the client becomes even more encouraged about the future and in the end learns how to become his or her own therapist. References Antonius, D., Fuchs, L., Herbert, F., Kwon, J., Fried, J.L., Burton, P.S., Straka, T., Levin, Z., Caligor, E. & Malaspina, D. (2010) ‘Psychiatric assessment of aggressive patients’, The American Journal of Psychiatry, vol. 167, no. 3, pp. 253-259. Baer, M. 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