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Experiencing a mental illness and the personal recovery can be a unique and an isolating journey.
As a Mental Health Nurse (MHN) working in the acute adult mental health hospital setting, (use recent peer reviewed evidenced based literature to) critique and argue the recovery strategies that the Mental Health Nurse (MHN) would implement with Ben who is a compulsory client under the Victorian Mental Health Act (2014) while recovering from a drug induced psychosis.
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Recovery strategies for a patient with drug induced psychosis
Mental health nurses works with a variety of patient with different mental disorders and they need to follow treatment strategies very strictly. It is a challenge for them to work closely with a patient like Ben who is recovering from a drug induced psychosis. There are various methods available for him but choice of treatment would be the sole decision of medical professionals after proper investigation of his status. The following therapies are recommended for mental health nurses –
A mental health nurse should observe Mr. Ben’s behavior at the first moment to decide about the strategy or any other intervention plan. It is important to note down his risk behavior that could be harmful for self or others hence it is the responsibility of the nurse to keep a track of all signs and symptoms of Mr. Ben who is visiting regularly. The risky behavior could be due to uncontrolled psychotic symptoms, depression or anxiety (Galanter, Kleber, 2008). A nurse should immediately start psychological interventions in an order to start a better treatment. If a patient remain untreated then risky behavior could lead to feeling of self-neglect that could be life threatening for the patient. Psychological interventions require following strategies to be followed by the nurse –
Firstly, a nurse should plan out to normalize psychotic symptoms. Patient centered approach would definitely help for better recovery from a drug induced psychosis as it seeks people’s desires, opinion to find out better solution. It is important to pay attention and respect to patient’s thoughts. Health of the people can be managed effectively through sharing of decisions.
Earlier people were given mental healthcare services by the service provider or nursing staff as they used to feel that it is good for the patient. The scenario has changed and service providers have become flexible in their approach and first discuss with the patient and family members. Patient center care is an individual or personalized care having following advantages –
Patient centered care remove pressure from the healthcare staff and patients receive the service as per their desire (Hughes, 2011). Also improves the quality of services. It also assists to reduce the psychotic symptoms and change the thought process of the client or patient. Therefore, strengthening of thoughts of people is an important strategy from public health point of view. Patient centered approach is an added advantage to modify the thinking process of the client.
Another important approach is to prevent social isolation would change the mindset of the client. It has been observed that client with mental disorders does not participate in social activities and shows withdrawal behavior which put them under mental stress. This again leads for depressive behavior among client. Hence, a mental health nurse has to promote activities for social gathering and this will somehow would control psychotic expression. Attention must be paid for relapse prevention of the mental disorder by the nurse (Jordaan et al, 2009).
|It follows different approaches for a patient who is recovering from a drug induced psychosis.||Client centered mental care|
|Prevention from social isolation|
|Promotion of social activities|
|Modification of thinking process|
|Attention on prevention of relapse case|
A mental health nurse could start psychological interventions for Mr. Ben to begin his social participation and to modify the thinking process in an order to reduce his stress level.
Cognitive behavior therapy
Early intervention methods like cognitive behavior therapy is an effective way of management of a patient recovering from a drug induced psychosis. It is very important to identify the early symptoms of the client. This understanding promotes healthy behavior among client with mental disorder. Management can become more successful by taking motivational interviews of the client. This assists to find out the early symptoms of psychosis – depressive and anxiety symptoms. Regular meetings with mental health counselor or trained mental health nurse effectively change the thinking process of the client (Puri, 2012). The change could be permanent also. The goal of cognitive behavior therapy is to change the behavior and thought process of the client.
Cognitive therapy uses interpersonal skills of a mental health nurse as healthcare strategies to promote positive thinking and behavior of the client. A mental health nurse advocates for those patients who cannot share their feelings hence in this scenario understanding of needs is very crucial.
Interpersonal communication works on similar principle of Maslow’s hierarchy of needs. Maslow’s theory has three steps to achieve effective communication power – safety, love & esteem, and self-actualization. Safety is very important at first point. From client point of view, he must feel secure while treatment or within the hospital. Once this stage is crossed, a bond is established between patients and nurses. Finally self-actualization denotes development of inner sense towards good health of the people. Experiences and education level of nurses are directly related to feelings, perceptions, and values of the patient.
Exchange of information and ideas happens through communication and mode of interaction could be verbal & nonverbal. Interpersonal skills assist in creating a healthy environment to impart knowledge or information. As nursing profession is to work with patients so non-verbal function more effectively than verbal method of communication. Miscommunication has negative impact on services as they disrupt the whole chain of communication and medical errors occur because of the same reason. Regular sessions helps to analyze the actual thinking process of the client along with the symptoms of anxiety or fear. Once a mental health nurse finds out the cause of fear then it becomes easier to deal with the client’s mental health (Barnett, Werners & Secher, 2007).
|Cognitive behavior therapy|
|Effectively address the client’s needs and find out the associated symptoms||Early strategy to search out causes of fear, anxiety or depression.|
|Continuous interview sessions to understand the verbal and nonverbal process happening within client’s mind|
Sometime causes of stress or depression go unnoticed during the course of the treatment. Hence cognitive behavior therapy might work effectively if considered for Mr. Ben. Regular interviews would help to comprehend his thought process which would assist for treatment. These sessions can be conducted through a mental health nurse as they an expert to do so.
Behavior change therapy
Behavior change assists assist to understand the client’s attitude for prevention and treatment approaches. The above strategy is based upon the following attributes – perceived severity, perceived benefits & risks, action, and self-efficacy (Saddichha et al, 2010).
Perceived severity – seriousness of the issue (mental status)
Perceived benefits – patient’s perception towards effectiveness of treatment or actions performed to fight against the mental disorder
Perceived risks – patient’s perception for risks associated with treatment procedure
Self-efficacy – patient’s determination to perform a particular behavior
Behavior change strategy is essential from a nurse point of view as it finally work upon self-efficacy nature of the patient. In the beginning, a patient perceive behaves in a very negative way and perceives that mental status cannot be changed. Nursing practices develop self-efficacy behavior that strongly affect self-determination to adapt their life style and start working on positive thinking.
|Behavior Change Strategy|
|Helps to understand client’s perspective towards the current mental status||Perceived severity of mental disorder|
|Perceived benefits of the treatment and care|
|Self-determination for positive thinking|
Behavior change therapy would probably work Mr. Ben with following objectives:
Family interventions have been established as one of the effective method of treatment of psychotic mental health issues which almost doubles the effectiveness of medications. The term family psychoeducation has become an important aspect of care and treatment. It denotes incorporating patient’s family members, care givers, and friends in treatment and rehabilitation process. The method includes imparting knowledge pertaining to mental health illness helps to improve the quality of life of the patient. The following skills are improved through training and guidance of family members - problem solving skill, coping skill, and communication skill. This assists to comprehend the mental status of the patient as they know him in a better way by noticing each activity. Psychoeducation combines family experience and guidance to help the patient to cope up the situation. Sometime patient is also included within family psychoeducation program. The main focus of family education is the family not the patient. Family intervention offers an advantage over others as patient belong to the same group and they know him very well so his behavior could be easily predicted in difficult situation (McFarlane, Cook, 2007).
|Stakeholders||Goals||Roles & Responsibilities|
|Family Members||Strengthening of client’s morale, work in coordination with nurse to boost up the confidence level.||Provide assistance to the client, Make him comfortable, Develop an interactive environment etc.|
|Friends||finding out ways to reduce the anxiety level, Initiate sports activities with the client||Playing games with client, physical activities and build up strong relation.|
|Care Groups||Provide emotional support||Assistance and support to face social activities|
A nurse can choose this method as an alternative approach of care and treatment. He would definitely get benefits of family interventions. Family and friends understand his feelings, thoughts and actions. Nurse can design different sessions with his family.
Art therapy is an effective strategy to express the feelings of the patient. It is not a treatment method rather an expressive therapy which cannot be communicated by the patient himself. The importance of nonverbal communication is known for treatment of mental health disorders. A patient is motivated or encouraged to express himself through some figures, paintings, diagrams etc. Patient is facilitated by a mentor to draw something in any form of art that helps to understand the meaning of his life. Art created by the patient is interpreted by the facilitator to imply it for further treatment. A mental health nurse could play a role of the facilitator as she regularly works with such type of patient and understand their mental psychology. Art therapy helps for –
Using art therapy helps to manage stress and anxiety of an individual. It has been noted that an individual with mental illness is as creative as normal person. It works excellently as a complementary strategy for the treatment of a mentally ill patient.
It becomes somewhat difficult to analyze the art created by the patient if facilitator is not trained for art therapy. This would probably give an incorrect information related with patient to health staff and disrupts the chain of care & treatment. Comprehension of pictures is an important task for the nurse or facilitator. The artistic nature of this recovery method makes it an important treatment tool for mental health illness.
It is predicted that Mr. Ben would recover from his current situation if taken for art therapy by a nurse. He can express his views or feelings through images, paintings. The challenge for a nurse is to pursue him to take part in such activities.
There are certain groups with having individuals with same level of mental status as the patient. Support group are also known as one of the important recovery method for a patient with drug induced psychosis. Treatment of an individual revolves around communication and a strong relation with the group members. Here again, a mental health nurse could be the group facilitator to introduce the patient in front of the group. It is her duty to make him comfortable initially to take part in the conservation. Possibly patient would express himself among like-minded people that would be noted by the nurse. Once patient starts sharing his thoughts then it becomes easier for a nurse to understand his feeling or mental status. Participation develops trust for the other group members as they also share their own status.
A nurse must be trained for the facilitation process to take part in such discussions. She must be aware of the non-verbal and verbal mode of communication. Along with this, it is important to know how to take discussion note as whole treatment would depend upon that information. These days discussions are also video recorded so that a medical doctor could easily grasp the feelings of an individual and this would lead to a better decision for patient care. Decision making process can be misleading if group discussion not recorded properly. Hence sole responsibility lies on part of a mental health nurse to deliver right information to the doctor. One of the biggest drawback of the method is to find out the right support group and then invite them for the participation. It is not an easy task for the hospital staff. Hospitals dealing with mental health problems maintain close contact with such groups.
Support groups can be an option for Mr. Ben to recover easily if it is adopted. It is difficult to say about the effectiveness of this therapy.
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