Mental Health Nursing: Distress or Illness

The mental state examination was done on patients by the following ways:

Level of consciousness- In this the nurse examines state of wakefulness in patients and observes any disorientation, hallucination or irritability sign in patients. To reduce level of consciousness finding the type of stimulus to arouse patient is necessary (Townsend, 2014). 

Appearance and general behavior- The patient’s physical appearance gives a lot of information about the patients. The signs of bruises on Mr. Gray’s neck gave idea that the patient had tried to commit suicide (Townsend, 2014).

Affect and mood- Patients display a range of mood such as dysphoric (depression, anxiety), euthymic (normal) or euphoric (elevated sense of well being). I started to judge patients on this belief (Forbes & Watt, 2015).

Thought and perception- Nurse assesses to judge patients perception about problems in life (Forbes & Watt, 2015)

After mental state examination, the nurse can interpret that patient has all the symptoms related to mental illness or major depressive disorder. I could relate his condition to mental illness because of symptoms like anxiety, mood swings, withdrawal from groups, loss of interest in group activities, loss of appetite and suicide attempts or thought. I have seen several patients with mental illness, and they also have similar symptoms. It is necessary to reduce this symptom to check the severity of the condition on patients and prevent any harm to them (Happell & Gaskin, 2013).

Three nursing problems/issues for the care of patients:

The three challenges for nurses in the management of a patient with depression or mental illness are interaction with patients, tolerating their aggressive behaviors and supporting them to understand their problems. Stigma and discrimination are associated with the care of such patients and nurse should try to avoid any biases in care. This attitude is the reason for delayed nursing care. It would be hard for nurses to tackle their aggressive behavior and start a conversation with such patients (Townsend, 2014). Secondly, these patients have their own set notion about their life, and they feel they are no more useful to the society. So this attitude leads to suicidal thought in them. Eliminating this thought and instilling in them that life is worth living is the most difficult task by a nurse (Robson et al., 2013). High competency in mental health nursing is required to plan a therapeutic approach to care for Mr. Gray. As Mr. Gray had tried to attempt suicide, understanding of the phenomenon of suicide and risk factors of suicide is essential for care in patients. The nurse must be aware of the impact of their reactions and attitude on patients (Storm & Edwards, 2013).

Goal of nursing care:

Based on analysis of the issues, the goals of priority of care for the patients are as follows:

• Interaction with patients in a slow pace and pleasant tone. This is needed to form one-on-one relation with client and help the client to enhance communication, problem solving and social skills (Townsend, 2014).
• Encouraging Mr. Gray to verbally express his feelings. In this context, it is important for nurse to establish therapeutic relation with the client and plan the duration of therapy (Stuart, 2014).
• Help patient identifies their strength and weakness. Constructive feedback will be given to the client to increase his self-esteem. Another goal is to identify discrepancies between the client’s verbalized intentions and non-verbal behavior carefully (Stuart, 2014).
• It will be necessary to establish consistency and build trust with the patient. The nurse will instill them with positive concepts of life and telling him they are valuable to family members and society. The factors that will facilitate trust within the nurse/patient relationship are recognizing client’s feeling, respecting them and having a judgmental attitude (Kutney-Lee & Aiken, 2015).
• Engaging them in activities that bring out his frustration and unpleasant mood. The nurse will teach her how to self-monitor his symptoms and encourage him that he can control his emotions and feelings (Townsend, 2014.
• Realistic resolution of problems and advising family members to provide him adequate emotional support. It will also be important to provide a calm environment so that patient feel safe from psychological and physical threats attitude (Kutney-Lee & Aiken, 2015).
• Prevent suicidal thought in patient by making them aware that life is worth living. Reminding client about positivtoes in life is essential to change his thought proves and suicidal intention (Caplan, 2013).

Nursing care of patient:

The planned course of action for care of Mr. Gray is as follows:

• As the patient had attempted suicide, had several bruises on his body due to a suicide attempt and he was interacting with people, the nurse will first try to know the cause of not being able to cope with life struggles. Knowledge of situational factor in patients will help in the understanding of Mr. Gray's current situation and identify the cause of grief in the patient. The nurse will then aid the patient with an effective coping strategy (Stuart, 2014).
• Nurse need to identify the source of stressors in patients and verbally commend them for their strengths (McElroy et al., 2014).
• The nurse will make sure that Mr. Gray has not left alone all the time. There is maximum chance that Mr. Gray might try to harm himself while he is alone. Therefore, it is necessary to have nurse and other staff around him for some days (Seo et al., 2015).
• The nurse will empathetically communicate with patients and encourage family members to verbalize their problems in life (Curtis et al., 2013).
• Monitor risk of harming material in and around the patient and remove them away.
• Encourage patient to take part in activities that boost their self-esteem on completion of activities (McElroy et al., 2014).
• The nurse will provide mental and physical activities within his ability such as exercise, muscular relaxation and proper nutrition to treat anxiety and depression in Mr. Gray.
• The patient will be given antidepressant-like Venlafaxine to treat anxiety and depression in Mr Gray (McElroy et al., 2014).
• As the patient is not taking proper meals, multivitamins will be given to treat weakness in patients (Townsend, 2014).

Evaluate nursing care strategies:

The above nursing care strategies will be helpful for patients to reduce his morbidities due to mental illness and strengthen his coping strategies. Verbal and empathetic communication with the patient will help Mr. Gray in verbally expressing his feelings (Seo et al., 2015). Teaching the client coping strategies will help him in overcoming his frustration and reacting better to stressful situations in life. Involving the patient in fun activities will him forget his grief and cherish the moment for some time. It is also necessary to make patients aware of their strength and weakness and commend to enhance the self-esteem of patients. All the treatment planned for patients related to medications and other intervention should always be communicated to patient and family members so that they develop an understanding of the medical condition and prepares them for possible (Videbeck, 2013). Proper communication with the patient is always necessary to reduce their anxiety and fear. Once the nurse can build a good rapport with the patient, then Mr. Gray will easily verbalize his feelings. Active listening skill is also important for nurses to make the patient feel that they care for them. Relaxation technique appropriate for a patient like music, drawing, etc. helps them in coping and reducing their anxiety and grief (Klainin-Yobas et al., 2012).

Reflection on patient’s outcome:

After the analysis of the patient situation and planned nursing care for Mr. Gray, the nurse can reflect that patient-centered care is very essential in care for such patients. This is because mental ill-health or patients with depression may suffer from these conditions due to their own personal suffering in life. So after this patient, I learnt that knowing the cause is critical to determine the level of grief they are suffering from. Treating patient with major depression does not only involve giving them appropriate medication, treat their wounds and give them appropriate nutrition. It has a much bigger dimension of a nursing acre which means understanding the impact of certain situations in their life and how their coping skills have been affected by it. It is because of their inability to cope with change that builds frustration, hopelessness and grief in the patients. The ultimate impact of all this activity is thought of suicide or trying to attempt suicide (Adams & Iseler, 2014).

Mr. Gray was also initially very aggressive at the time of admission and hardly interacted with anyone. But during a conversation with him, the nurse could know that he was expected to take over his family farming business, but his farm has been affected by long-standing drought conditions. This was the reason for his depression which was related to financial insecurities in life. Sympathetic conversation with nurse helps patient to verbalize their problems in life. When nurse taught positive attitude towards life and teach him coping skills to tackle life situation, his conditions improved a lot. Now he was more positive at the time of discharge and in a pleasant mood. He has also made his plan how to tackle the problems in hs business, and he planned to take alternative business options. Thus analysis of patients through clinical reasoning cycle gave an insight into the understanding the complexities involved in mental health nursing.

Reference

Adams, K. L., & Iseler, J. I. (2014). The relationship of bedside nurses' emotional intelligence with quality of care. Journal of nursing care quality,29(2), 174-181.

Caplan, G. (2013). An approach to community mental health (Vol. 3). Routledge.

Curtis, J. R., Back, A. L., Ford, D. W., Downey, L., Shannon, S. E., Doorenbos, A. Z., ... & Arnold, R. W. (2013). Effect of communication skills training for residents and nurse practitioners on quality of communication with patients with serious illness: a randomized trial. Jama, 310(21), 2271-2281.

Forbes, H., & Watt, E. (2015). Jarvis's Physical Examination and Health Assessment. Elsevier Health Sciences.

Happell, B., & Gaskin, C. J. (2013). The attitudes of undergraduate nursing students towards mental health nursing: A systematic review. Journal of Clinical Nursing, 22(1-2), 148-158.

Klainin-Yobas, P., Cho, M. A. A., & Creedy, D. (2012). Efficacy of mindfulness-based interventions on depressive symptoms among people with mental disorders: a meta-analysis. International journal of nursing studies, 49(1), 109-121.

Kutney-Lee, A., & Aiken, L. H. (2015). Effect of nurse staffing and education on the outcomes of surgical patients with comorbid serious mental illness.Psychiatric Services.

McElroy, S. L. (2014). Prescribing antidepressants for bipolar depression: what does the evidence say?. The Journal of clinical psychiatry, 75(9), 24-24.

Robson, D., Haddad, M., Gray, R., & Gournay, K. (2013). Mental health nursing and physical health care: A cross‐sectional study of nurses' attitudes, practice, and perceived training needs for the physical health care of people with severe mental illness. International Journal of Mental Health Nursing, 22(5), 409-417.

Seo, M., Kang, H. S., Lee, Y. J., & Chae, S. M. (2015). Narrative therapy with an emotional approach for people with depression: Improved symptom and cognitive‐emotional outcomes. Journal of psychiatric and mental health nursing, 22(6), 379-389.

Storm, M., & Edwards, A. (2013). Models of user involvement in the mental health context: intentions and implementation challenges. Psychiatric Quarterly, 84(3), 313-327.

Stuart, G. W. (2014). Principles and practice of psychiatric nursing. Elsevier Health Sciences.

Townsend, M. C. (2014). Psychiatric mental health nursing: Concepts of care in evidence-based practice. FA Davis.

Videbeck, S. (2013). Psychiatric-mental health nursing. Lippincott Williams & Wilkins.