NRSG263 Principles of Nursing Mental Health

It is evident that young adolescent and children are found to be suffering from mental illness and stress which affects the quality of life and also increases mortality rate.

The common mental illness observed among young adolescents are anxiety disorder, mood disorders, attention deficit disorder, disruptive behaviour, borderline personality disorder and even suicidal thoughts.

It has been found that childhood trauma and negligence might result in the development of adverse mental health disease. 

It has been found that anxiety-disorder is one of the most common type of disorder which affects almost 8.2% of the children in Australia.

It is the second most common disorder among all the children which accounts almost 6.9% illness in Australia and it is often found among girls.

The most common types of anxiety disorder found among individuals are generalised anxiety disorder, obsessive-compulsive disorder, panic disorder, social phobia, separation anxiety disorder and selective mutism (Wehry et al., 2015).

The condition of anxiety can be assessed by the Hamilton Anxiety Scale which is an easy and effective interview measure for assessing the condition of anxiety. 

The patient (Emma) in the provided case study was a 12 year old girl who was found to have poor performance in academic over 9 months from level A to C.

She was also found to have lost interest in her activities, misses school regularly and needs effective intervention.

The patient was found to be suffering from childhood trauma due to negligence from her step-father. The child’s mother was a drug addict which also effected her condition.

She was suffering from lack of proper attention, love, affection from her family which triggered the condition of stress and trauma in this child.

The child patient (Emma) was found to be suffering from post-traumatic disorder and lack of family support which resulted in the development of anxiety disorder and lack of interest in work, school and daily work (Gillies et al., 2016). 

Psychopharmacological treatment

The child (Emma) in the provided case study can be treated with the help of tricyclic antidepressant and selective serotonin reuptake inhibitors for reducing the condition and symptom of anxiety among children.

In order to consider the safety and efficacy, the selective serotonin reuptake inhibitors (SSRIs) is considered to be the first-line of drug for providing treatment to anxiety among children.

The child can also be provided with tricyclic antidepressant if the consumption of selective serotonin reuptake inhibitors fails to reduce the symptom.

The patient can be provided with Citalopram, sertraline, vilazodone, fluvoxamine, escitalopram which belongs to selective serotonin reuptake inhibitors (Amitai et al., 2016).

These drugs were found to treat the condition of anxiety by reducing or blocking the re-absorption of serotonin in the neurons and it is found to be a good influencer upon emotion, mood and sleep (Fasipe, 2019).

The application of these drugs will help the child in balancing the emotion and grow interest in work and reduce the stress (Wang et al., 2017).

Legal and Ethical issues

The ethical issue which might arise while providing care to this patient’s are- lack of proper consent while providing care, the child might feel uncomfortable and refuse the treatment process and malpractice might occur in this case.

Similarly, the patient cannot be provided with proper education about the treatment process which might also harm the treatment process.

According to the ethical concept of Beneficence- it is the duty of nurses to act good and provide care which will be beneficial for others. Here, in this case, refusal to treatment by the child or the family might arise ethical dilemma in this case (Bipeta, 2019).

The ethical dilemma might also occur due to autonomy, as the patient’s mother was found to be drug addict and her father neglects the child which might accept the decision-making related to treatment.

Nursing intervention

The nurse in this case can effectively communicate with the patient and try to develop a trust worthy relationship.

Rationale- The effective therapeutic relationship will help the nurses to determine the patient’s exact cause of developing the condition and current mental state which will help in planning effective treatment plan (He et al., 2015).

The communication intervention will lower the stimuli of anxiety by providing the patient with a calm and secure environment which will help in better coping with the present situation (Liu & Yang, 2021).

Effective communication will help in providing a role model for the child and thereby will grow interest in various work and reduce the issue of lack of proper attention in this child.

Nursing care- Guided Imagery

The nurse can also provide the patient with guided imagery which will help in diverting the mind of the child and grow interest in various work (Bandelow et al., 2017).

Multidisciplinary team

The multidisciplinary team comprises of various mental health professionals staff such as psychiatrists, social workers, psychiatric nurse and occupational therapist for providing care to the patient and thereby helping them to cope up with the situation (Tabaerna et al., 2020).

In order to provide the patient with care, the team must consists of cognitive behavioural therapist, social worker, psychiatrists and psychiatric nurses.

Psychotherapy

The cognitive behavioural therapist will help in reducing the negative perception of the child and develop interest in work by concentrating in positive aspects of life. The behavioural therapist will help in providing proper technique in controlling emotions (Kaczkurkin & Foa, 2015).

Social workers- The social worker will involve the child in various social activities for reducing trauma and providing her with a positive environment.

Nurses- the nurse will help in providing the patient with comfort for coping up with the situation by providing CBT therapy (Hudson et al., 2015).

Conclusion

It has been found that anxiety-disorder is one of the most common type of disorder which affects almost 8.2% of the children in Australia.

The child patient (Emma) was found to be suffering from post-traumatic disorder and lack of family support which resulted in the development of anxiety disorder and lack of interest in work, school and daily work. 

The ethical issue which might arise while providing care to this patient’s are- lack of proper consent while providing care, the child might feel uncomfortable and refuse the treatment process and malpractice might occur in this case.

The effective therapeutic relationship will help the nurses to determine the patient’s exact cause of developing the condition and current mental state which will help in planning effective treatment plan.

In order to provide the patient with care, the team must consists of cognitive behavioural therapist, social worker, psychiatrists and psychiatric nurses.

References

Amitai, M., Taler, M., Carmel, M., Michaelovsky, E., Eilat, T., Yablonski, M., ... & Fennig, S. (2016). The relationship between plasma cytokine levels and response to selective serotonin reuptake inhibitor treatment in children and adolescents   with depression and/or anxiety disorders. Journal of child and adolescent psychopharmacology, 26(8), 727-732.

Bandelow, B., Michaelis, S., & Wedekind, D. (2017). Treatment of anxiety disorders. Dialogues in clinical neuroscience, 19(2), 93–107. https://doi.org/10.31887/DCNS.2017.19.2/bbandelow

Bipeta R. (2019). Legal and Ethical Aspects of Mental Health Care. Indian journal of psychological medicine, 41(2), 108–112. https://doi.org/10.4103/IJPSYM.IJPSYM_59_19

Fasipe O. J. (2019). The emergence of new antidepressants for clinical use: Agomelatine paradox versus other novel agents. IBRO reports, 6, 95–110. https://doi.org/10.1016/j.ibror.2019.01.001

Gillies, D., Maiocchi, L., Bhandari, A. P., Taylor, F., Gray, C., & O'Brien, L. (2016). Psychological therapies for children and adolescents exposed to trauma. The Cochrane database of systematic reviews, 10(10), CD012371.   https://doi.org/10.1002/14651858.CD012371

He, H. G., Zhu, L. X., Chan, W. C. S., Liam, J. L. W., Ko, S. S., Li, H. C. W., ... & Yobas, P. (2015). A mixed‐method study of effects of a therapeutic play intervention for children on parental anxiety and parents' perceptions of the intervention. Journal of Advanced   Nursing, 71(7), 1539-1551.

Hudson, J. L., Rapee, R. M., Lyneham, H. J., McLellan, L. F., Wuthrich, V. M., & Schniering, C. A. (2015). Comparing outcomes for children with different anxiety disorders following cognitive behavioural therapy. Behaviour Research and   Therapy, 72, 30-37.

Kaczkurkin, A. N., & Foa, E. B. (2015). Cognitive-behavioral therapy for anxiety disorders: an update on the empirical evidence. Dialogues in clinical neuroscience, 17(3), 337–346. https://doi.org/10.31887/DCNS.2015.17.3/akaczkurkin

Liu, H., & Yang, Y. (2021). Effects of a psychological nursing intervention on prevention of anxiety and depression in the postpartum period: a randomized controlled trial. Annals of general psychiatry, 20(1), 2.   https://doi.org/10.1186/s12991-020-00320-4

Taberna, M., Gil Moncayo, F., Jané-Salas, E., Antonio, M., Arribas, L., Vilajosana, E., Peralvez Torres, E., & Mesía, R. (2020). The Multidisciplinary Team (MDT) Approach and Quality of Care. Frontiers in oncology, 10, 85.   https://doi.org/10.3389/fonc.2020.00085

Wang, Z., Whiteside, S., Sim, L., Farah, W., Morrow, A., Alsawas, M., ... & Murad, M. H. (2017). Anxiety in Children.

Wehry, A. M., Beesdo-Baum, K., Hennelly, M. M., Connolly, S. D., & Strawn, J. R. (2015). Assessment and treatment of anxiety disorders in children and adolescents. Current psychiatry reports, 17(7), 52.

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