Nursing for Mental Illness Signifies

Discuss about the Nursing for Mental Illness Signifies.

Mental health is a health of the personality as a whole and is important than that of the physical health. Mental health is signified by a balanced development of an individual’s personality and emotional attitudes. The absence of mental illness signifies the level of emotional and physical well-being of an individual, with which one can live harmoniously with others. According to the World Health Organization, various biological and social factors influence the mental health (Caplan, 2013). The occurrence of mental illness can be attributed to series of circumstances experienced by an individual. These factors disturb emotions, psychological resilience, thought process and behavior to an extent which causes mild distress or a severe disorder. Mental disorders such as Schizophrenia, obsessive-compulsive disorder, drug dependency, bipolar disorders are highly serious. These affect an individual to an extent where an ability to perform the daily activities is impaired (Stuart, 2014). Consequently, they failed to meet the demands of the daily lives. The essay deals with the case study of Thomas who has presented himself for a checkup to deal with his mental health issues. 

In the case study, Thomas experiences irritation and nervousness at his workplace, however, he has no justification for the situation. He is consulting a doctor to deal with his clinical symptoms. It was evident that he was struggling with a mental disorder which needs to be treated. As a graduate nurse, I have been assigned by the duty doctor to assist Thomas in the interview process. Thomas has a slight accent which is difficult to place. Thus, I have to use the different set of communication skills for interviewing Thomas. According to Strauss et al., (2013), effective communication skills are essential in the field of psychiatry. My primary objective is to understand the concerning issues of Thomas in detail. Initially, I would start the conversation speaking at a slow space to get an appropriate response. Since his mind is disturbed, it is necessary to give him reassurance that his issues will be resolved. I will be careful to use specific and appropriate words to avoid misinterpretation. To keep him calm, comfortable and composed it will be better to speak in a soft tone and low volume (De Hert & Marre, 2013). As per the case study, Thomas is worried about his customers in the bank. He thinks that they are accusing him indirectly of being dirty and bad things. He is experiencing difficulty in communicating with his clients and resolving their queries. It may be his illusion. Since he is troubled with his situation and highly confused, it is necessary to have a clear and honest communication. During the interview, words shall be delivered in a way which informs and not overwhelm or upset him. I will not use authoritative tone unless demanded by the situation less it will disturb the peaceful demeanor of Thomas. Uttering fast and harsh words may make him receive conflicting messages. It may get him to believe in his illusion and decrease his self-esteem. To predict patient's responses and reactions, I will maintain a track of his nonverbal cues (posture, facial expression, clothing, and hand and eye movement). Body language is crucial in understanding a patient with mental health issues (Moss, 2015). According to Stuart, (2014) active listening and silence are important to help a patient gain a sense of control. If Thomas is allowed to speak without any interruption, he will feel relaxed and stay open mind. Orr et al., (2013) believes that reflection is a good communication skill to have a free-flowing interview. It is the best option to hire a translator for the interview in case English is a not his native language. This will make the communication system smoother. Minimizing the linguistic barrier will help the patient in discussing his problems more comfortably (De Hert & Marre, 2013). Conclusively, effective communication skills are essential in obtaining relevant information from a patient.

The case study of Thomas highlights several potential signs and symptoms. Three significant symptoms will be discussed in this essay. After the physical checkup and the interview, the doctor explains that the condition could be related to “episodes of psychotic symptoms" followed by "confusion and distress." This condition of Thomas was acknowledged based on his behavior and symptoms as appeared after his arrival in the clinic. He was rarely interacting with other visitors in the clinic and others too seemed to avoid him. It may happen that his prevailing mental illness was a cause of his social withdrawal. According to Galderisi et al., (2013) the tendency to withdraw socially occurs in people with psychotic disorders and is associated with three factors which are “introversion, divergent thinking, and alienation”. The resultant outcome of the collective action of these three factors includes decreased capacity to perceive reality. Such individuals have impaired capability of judgment particularly in a social situation. It is evident from the research paper of (Moss, 2015), that people were experiencing psychological disorder experience social isolation. It correlates with the situation of Thomas where he faces difficulty in social interaction. Poor judgment in the social situation is also one of the aspects of emerging schizophrenia (Patra & Sood, 2013).  Divac et al., (2014) States that a person fails to connect socially when he feels inadequate in comparison to others. Eventually, these people tend to feel isolated. In psychology it is also called as having an “external locus of control” (De Hert & Marre, 2013). People with external locus feel that they cannot control their problems. It also appears that Thomas is having an illusion that his customers dislike him. He thinks that they accuse him of being dirty and bad things. He never faced any direct accusation. People experiencing illusion get distanced from reality which leads to hallucination (Kinon et al., 2015). They have a different pattern of emotions. Such individuals are incapable of thinking in a logical and organized manner. When people tend to believe their hallucinations as real, they undergo depression. It significantly affects their communication skills which may be a reason for his customer’s dissatisfaction. It is the hallucination that gave rise to confusion, irritation, and nervousness in Thomas at his workplace. These clinic manifestations of psychotic disorders are menacing which disturbs and exacerbate the mental illness (Patra & Sood, 2013).

Thomas should be provided with education about his medication before he leaves the clinic. Doctor has provided Thomas with a script of 5mg Olanzapine nocte. He was also given an appointment for the next day. According to Kinon et al., (2015) Olanzapine is an atypical antipsychotic drug and is approved by US “Food and Drug Administration”. It has been proven to be effective in the treatment of Schizophrenia and manic episodes (Moss, 2015). Thomas is advised by the doctor to take the medicine at night to prevent dizziness. Doctor had prescribed this drug to prevent recurrence of symptoms in Thomas. It is necessary to educate Thomas about the allergic reactions that may occur as a side effect of medication (Divac et al., 2014). He should be advised to immediately report in case of allergic symptoms such as itching, rash, swollen face, and shortness of breath (Kinon et al., 2015). He is encouraged to take well-balanced diet to avoid constipation which is a common side effect of Olanzapine (De Hert & Marre, 2013). This medicine also causes dryness of mouth.  Hence, he should be informed that this condition can be avoided by consuming sugar-free sweets or chewing sugar-free gums. Since this drug induces excess sleep, patients may experience unusual muscle movement (Elliott et al., 2012). Therefore, Thomas should be made aware of these side effects so that he does not enter into a panic mode. It is also necessary to educate Thomas about the appropriate storage conditions of these drugs. Thomas should be strictly prohibited of alcohol intake. Frith, (2014) reveals that the alcohol consumption along with intake of Olanzapine increases drowsiness. Some people have phenylalanine intolerance, and Olanzapine contains aspartame (source of phenylalanine) (Strauss et al., 2013). This drug should be avoided in case Thomas is diagnosed with phenylketonuria. If Thomas, has a medical history of glaucoma, he should be prescribed an alternative medicine. There are some rare symptoms associated with drugs such as ciprofloxacin, fluvoxamine when taken together with Olanzapine. Immediate medical intervention is required when patient experiences muscle stiffness, increased heart rate, unusual sweating, and high temperature. It is an indication of serious neuroleptic malignant syndrome (Patra & Sood, 2013). Therefore, Thomas should take care of additional complexities if noticed and immediately inform his doctor. Conclusively, patient education is essential to prevent an adverse situation that may arise due to medication errors.

It is essential for people dealing with psychosis to comply with the medication and therapy sessions (Divac et al., 2014). I will frame a strategy to address the medication compliance issues that may arise in a case of Thomas. Initially, it is necessary to identify the factors causing non-adherence to medication. Side effects of medicines are one of the main causes of non-compliance. I will perform regular monitoring of heart rate and blood pressure. I would conduct laboratory tests to assess the blood glucose levels, and ALT (De Hert & Marre, 2013). Immediate action should be taken in case of Anticholinergic side effects. To prevent noncompliance, I would inform doctor to provide the substitution for the medicines. It is necessary to monitor if side effects are caused by other drugs taken in combination and take necessary action (Hasan et al. 2013). I would educate him about all the possible side effects that may arise due to Olanzapine so that he is mentally prepared to cope up and avoid nonadherence. According to Patra & Sood, (2013) nonadherence to the medication in patients is caused by the poor relationship with psychiatric staff. Therefore, I will build the strong rapport with Thomas during his treatment. I will maintain his dignity and respect, explain things, and involve him and his partner in all the treatment-related decisions. Orr et al., (2013) believes that individual with mental illness strictly complies with the treatment if they are satisfied with the care services provided. Hence, I would assess the level of satisfaction that Thomas experiences from the services provided by the doctor and me to ensure medication compliance. Minimizing the language barrier will help the patient in discussing his problems more comfortably and adhere to the treatment (Patra & Sood, 2013). In a case of difficulty in maintaining medical compliance, it is advised that Thomas must openly and honestly communicate with his partner about his symptoms and the other treatment requirements. It is necessary for the patients with a psychological disorder to engage in self-education to learn to maintain a healthy lifestyle (De Hert & Marre, 2013).  Awareness related to one's disease helps an individual to take care better of his illness. It will help Thomas to engage in health-promoting activities such as exercises, walking, maintaining diet and social engagement. I will provide Thomas with additional study material which will help him cope up with his disease. I would narrate his stories of clients who have completely overcome their psychosis by strictly adhering to the medication. It will help motivate Thomas and decrease nonadherence of medication.

The essay has clearly presented the communication skills needed for a nurse to deal with Thomas. It has highlighted the clinical symptoms observed in Thomas and supported the same with evidence. It has discussed the education that is needed to provide Thomas regarding his medication. Lastly, it has explained the strategies to deal with medication compliance issues that may arise in a patient.

References

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

De Hert, M., Guiraud-Diawara, A., & Marre, C. (2013). 2584–Comparison of metabolic syndrome incidence among schizophrenia patients treated with asenapine versus olanzapine. European Psychiatry, 28, 1.

Divac, N., Prostran, M., Jakovcevski, I., & Cerovac, N. (2014). Second-generation antipsychotics and extrapyramidal adverse effects. BioMed research international, 2014.

Elliott, D. S., Huizinga, D., & Menard, S. (2012). Multiple problem youth: Delinquency, substance use, and mental health problems. Springer Science & Business Media.

Frith, C. D. (2014). The cognitive neuropsychology of schizophrenia. Psychology Press.

Galderisi, S., Bucci, P., Mucci, A., Kirkpatrick, B., Pini, S., Rossi, A., ... & Maj, M. (2013). Categorical and dimensional approaches to negative symptoms of schizophrenia: focus on long-term stability and functional outcome. Schizophrenia research, 147(1), 157-162.

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Kinon, B. J., Kollack-Walker, S., Jeste, D., Gupta, S., Chen, L., Case, M., ... & Stauffer, V. (2015). Incidence of tardive dyskinesia in older adult patients treated with olanzapine or conventional antipsychotics. Journal of geriatric psychiatry and neurology, 28(1), 67-79.

Moss, R. (2015). Communication Skills of Novice Psychiatric Nurses with Aggressive Psychiatric Patients.

Orr, F., Kellehear, K., Armari, E., Pearson, A., & Holmes, D. (2013). The distress of voice-hearing: The use of simulation for awareness, understanding and communication skill development in undergraduate nursing education. Nurse education in practice, 13(6), 529-535.

Patra, B. N., Khandelwal, S. K., & Sood, M. (2013). Olanzapine induced neuroleptic malignant syndrome. Indian journal of pharmacology, 45(1), 98.

Simpson, G. M., Glick, I. D., Weiden, P. J., Romano, S. J., & Siu, C. O. (2014). Randomized, controlled, double-blind multicenter comparison of the efficacy and tolerability of ziprasidone and olanzapine in acutely ill inpatients with schizophrenia or schizoaffective disorder. American Journal of Psychiatry.

Strauss, G. P., Horan, W. P., Kirkpatrick, B., Fischer, B. A., Keller, W. R., Miski, P., ... & Carpenter, W. T. (2013). Deconstructing negative symptoms of schizophrenia: avolition–apathy and diminished expression clusters predict clinical presentation and functional outcome. Journal of psychiatric research, 47(6), 783-790.

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