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Transforming Nursing Practice

  1. Discuss the elements of Ben’s medical history that contribute in him being classified as medically complex

Complex Post-Traumatic Stress Disorder (Complex PTSD) was first suggested by Herman as a clinical syndrome, especially for interpersonal clinical syndromes and for the development of new psychiatric diagnoses for traumatic events such as early life child abuse and neglect (Cloitre, et al., 2014). Some mental illnesses overlap symptomatically and in most cases comorbidity is higher if not common, especially if the causes of precipitation are common or similar. Furthermore, the diagnosis of mental illness has so far been described as a theoretical framework and in most cases requires the contact of experts working in the field to study the correct psychological process and biological background. This requires re-evaluation and re-grouping of diagnoses according to the results of a new proposed study aimed at providing more efficient treatment plans for patients as needed by already established psychiatrists.

Complex PTSD is obvious because the symptoms are contagious with multi-traumatic mental illness, PTSD was mainly a question related to single event trauma, axial bilateral disorder and mainly borderline personality disorder (BPD). In addition to comorbidities, some of the major symptoms described in complex PTSD include incomplete relationships with others, isolated symptoms, sensitive or reckless behavior, irritability, and generally self-destructive behavior. Complex PTSD symptoms are defined by clusters with symptoms similar to those of extended PTSD. For example, shame, permanent loss and ineffectiveness, threats, social withdrawal, frustration, hostility, image, differences from previous personalities. It causes serious confusion in regular self-organization, identifying perception, subconscious dissociation, self-perception as negative self-perception, and intrusive perceptions, often due to interpersonal problems affecting others (Cloitre, et al., 2013).

Depression (major depressive disorder) is not only a serious but also a common medical illness by means of which thinking, feeling and activity of a person is affected. At these days a number of ways are there to treat depression. People will feel sad due to depression and gradually they will lose interest in several activities once enjoyed. In addition, this can cause a wide range of sensitive and physical problems that can reduce the ability of a person to work either at the workplace or at home (Lépine & Briley 2011).

Chronic lower back pain is defined as pain that lasts 12 weeks or more after the initial injury or treatment of the underlying cause of acute lower back pain. About 20% of people with acute lower back pain develop chronic lower back pain that lasts within a year. If the pain persists, it may not necessarily have a clinically serious underlying cause or an easily identifiable cause. In some cases, the treatment successfully relieves back pain, while on the other hand it remains stable despite treatment or surgical treatment.

All of the above mentioned medical problems are associated with medical history of Ben and this is he is classified as medically complex.

  1. Refer to the nursing care management plan for Ben. Identify and discuss any conflicting treatment or management elements of this plan.

Only a clinical psychologist or else a psychiatrist should perform the diagnosis of complex PTSD for Ben because only they will be able to identify the concerned person over time.

The psychological therapy for a long period of time is considered as the key form of complex PTSD treatment for Ben. By this Ben will be able to gain confidence in others gradually. It helps people gradually. Generally by this treatment people will able to believe other people and then they will be able to make friends slowly, looking for jobs and hobbies. Along with that, those People who are suffering from complex PTSD time and again face problems with the usage of alcohols and drug, along with depression anxiety. All of these also require treatment. Psychotherapy is a group of treatments performed by a psychologist, counselor or psychiatrist. Psychological therapy is also known as psychotherapy or talk therapy. It can be used by mentally ill people and those who want to understand themselves more (Brewin, et al., 2017).

One of the most common curable mental illnesses is depression. Among eighty to ninety percent people who are suffering from depression respond well ultimately to the treatment of depression. Depression between 80% and 90% responds well to ultimate treatment. Almost all patients get some relief from their symptoms (Segre, et al., 2010).

In the context of the nursing care management plan for depression a systematic diagnostic evaluation should be conducted by physician, prior to diagnosis or treatment. With regard to a number of cases, health care professionals may perform some blood test in order to be sure that depression is not caused by any medical condition, such as a problem related to thyroid.

Medication: Brain chemistry contributes to human depression and can be a cause of treatment. For this reason, antidepressants may be suggested to help change the chemistry of the human brain (Essa, Ismail & Hassan 2017). These drugs are not tranquilizers or else sedatives. These are not habit forming. Usually, there is not any stimulating impact of Antidepressants on people who are not facing depressions. Antidepressants may improve mental health slightly within the first 1-2 weeks of use.

Usually it is recommended by Psychiatrists generally that after consuming antidepressants for at least 6 months or more than 6 months, their symptoms have improved as well as condition of their mental health has been improved. In addition, maintenance therapy for a long period of time might be recommended by Psychiatrists for reducing the risk of future episodes in some people at high risk (Cloitre, et al., 2011).

  1. Consider Ben’s situational complexity. Identify and discuss how these factors may create barriers to Nursing management.

Barriers to successful PTSD treatment

Why the elderly are not treated with PTSD, there is a lot of disrespect for those who experience the symptoms of PTSD. These individuals are often identified as incompetent, unpredictable and possibly dangerous. As a result, veterans and military personnel developing PTSD are reluctant to seek treatment for embarrassment and embarrassment. Others are afraid to be hospitalized because of their mental health.

Other barriers to treatment are:

Anxiety of being seen as weak or out of control- Many employees and women are afraid that other people will observe them as weak or crazy when they find a “shrink”. In addition, experienced individuals may lose control by sharing strong emotions and creating strong emotions for external traumatic events (Reger, et al., 2017).

Concerns about spending, logistics and care- Many older people face logical problems in facilitating mental health care. Some people have to travel long distances to get this kind of healthcare. In addition, some seniors are concerned about the type of treatment provided by the Department of Veterans' Affairs of Australia

 (and do not believe in the treatment system and seek help from the private sector. (HammFaber, et al., 2012).

Fear of losing work- Often, active service members are late in seeking treatment for PTSD because they are afraid of losing their jobs.

Concerns about drugs and group therapy- Veterans often cite medications as a major barrier to medical care. Many older people do not want to prescribe drugs to treat their PTSD. Also, many do not trust psychologists or therapists and some are not interested in group therapy (Foa, Gillihan & Bryant 2013).

Environmental factors- Violence, neglect, abuse, or constant exposure to poverty can put some people at risk of depression.

Barriers to improving the treatment of depression are well known. The patient resists the diagnosis of mental illness, does not want to receive treatment, or does not follow the prescribed treatment. The primary care physician cannot diagnose the patient's depression, prescribe appropriate treatment, and follow-up with the patient after starting treatment. Psychiatrists and other mental health professionals are not available to many of the depressed people (elderly, rural, sick and financially disadvantaged). Healthcare systems often fail to manage mental health counseling services to support the work of primary care physicians who treat the majority of depressed patients. It is important to understand the barriers to advanced care, but focusing only on barriers is contagious and preventable. Obstacle regiments tend to be passive negotiations. Lighting offers possible solutions to experimentation try things out and make things work (Kapural, et al., 2013).

  1. A diagnosis of more than one medical condition (multimorbidity) is a well-documented barrier to effective care delivery. Provide a brief discussion relating to how multimorbidity impact diagnosis and treatment for complex patients.

There is a growing need for primary care providers and their service provider systems to treat multiple permanent treatments or “multimorbidity” patients. The change in the epidemic has been attributed to longevity due to advances in medical technology with risks associated with unhealthy lifestyles. In most cases this variant can lead to multimorbidity due to inconsistencies in the definition and measurement of the study, but presents a significant problem that can increase rapidly with age. Diversity in the population living in socio-economic deprivation areas seems to have been socially organized 10 to 15 years ago. Also, current risk-based simulation modeling estimates that by 2035 the spread of complex multiple expansions (4 or more conditions) will double. Decreased function or cognitive activity leads to autonomy, which can affect mental health and the purpose of life. Also, some long-term improved states such as heart failure and chronic preventable pulmonary disease (COPD), reduce life expectancy. Patients with multiple diseases often become heavy users of healthcare, often meeting with various primary and secondary care specialists, each of whom is isolated and focused on a specific condition or physiology (Boyd & Fortin 2010). When multiple appointments and treatments are added to the challenges presented by a potential illness, patients and their families / carers may feel an additional burden of treatment. Many times, this burden goes beyond the patient's ability to perform the task of finding the patient (Roiser, Elliott & Sahakian 2012). A patient who integrates into a low-patient and low-level system is willing to take multimedia care. General approaches may be most appropriate for increasing responsibility for coordinating care across sectors based on “long-term continuity of care according to patient needs”. Highly ill patients are already using GPs in the UK and Australian national countries, where GPs act as gatekeepers for other healthcare professionals. However, in many places, the general practice model revolves around a single disease management, which still reflects the research agenda behind the production of secondary care, medical education curricula, and evidence to inform clinical practice (Carek, Laibstain & Carek 2011).

References for Treatment of Complex PTSD

Boyd, C. M., & Fortin, M. (2010). Future of multimorbidity research: how should understanding of multimorbidity inform health system design?. Public health reviews32(2), 451-474.

Brewin, C. R., Cloitre, M., Hyland, P., Shevlin, M., Maercker, A., Bryant, R. A., ... & Somasundaram, D. (2017). A review of current evidence regarding the ICD-11 proposals for diagnosing PTSD and complex PTSD. Clinical psychology review58, 1-15.

Carek, P. J., Laibstain, S. E., & Carek, S. M. (2011). Exercise for the treatment of depression and anxiety. The International Journal of Psychiatry in Medicine41(1), 15-28.

Cloitre, M., Courtois, C. A., Charuvastra, A., Carapezza, R., Stolbach, B. C., & Green, B. L. (2011). Treatment of complex PTSD: Results of the ISTSS expert clinician survey on best practices. Journal of traumatic stress24(6), 615-627.

Cloitre, M., Garvert, D. W., Brewin, C. R., Bryant, R. A., & Maercker, A. (2013). Evidence for proposed ICD-11 PTSD and complex PTSD: A latent profile analysis. European journal of psychotraumatology4(1), 20706.

Cloitre, M., Garvert, D. W., Weiss, B., Carlson, E. B., & Bryant, R. A. (2014). Distinguishing PTSD, complex PTSD, and borderline personality disorder: A latent class analysis. European Journal of Psychotraumatology5(1), 25097.

Essa, R. M., Ismail, N. I. A. A., & Hassan, N. I. (2017). Effect of progressive muscle relaxation technique on stress, anxiety, and depression after hysterectomy. Journal of Nursing Education and Practice7(7), 77.

Foa, E. B., Gillihan, S. J., & Bryant, R. A. (2013). Challenges and successes in dissemination of evidence-based treatments for posttraumatic stress: Lessons learned from prolonged exposure therapy for PTSD. Psychological Science in the Public Interest14(2), 65-111.

Hamm‐Faber, T. E., Aukes, H. A., de Loos, F., & Gültuna, I. (2012). Subcutaneous stimulation as an additional therapy to spinal cord stimulation for the treatment of lower limb pain and/or back pain: a feasibility study. Neuromodulation: Technology at the Neural Interface15(2), 108-117.

Kapural, L., Vrooman, B., Sarwar, S., Krizanac-Bengez, L., Rauck, R., Gilmore, C., ... & Mekhail, N. (2013). A randomized, placebo-controlled trial of transdiscal radiofrequency, biacuplasty for treatment of discogenic lower back pain. Pain Medicine14(3), 362-373.

Lépine, J. P., & Briley, M. (2011). The increasing burden of depression. Neuropsychiatric disease and treatment7(Suppl 1), 3.

Reger, G. M., Browne, K. C., Campellone, T. R., Simons, C., Kuhn, E., Fortney, J. C., ... & Reisinger, H. S. (2017). Barriers and facilitators to mobile application use during PTSD treatment: Clinician adoption of PE coach. Professional Psychology: Research and Practice48(6), 510.

Roiser, J. P., Elliott, R., & Sahakian, B. J. (2012). Cognitive mechanisms of treatment in depression. Neuropsychopharmacology37(1), 117-136.

Segre, L. S., O'Hara, M. W., Arndt, S., & Beck, C. T. (2010). Nursing care for postpartum depression, part 1: do nurses think they should offer both screening and counseling?. MCN. The American journal of maternal child nursing35(4), 220.

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