Mental Health: Self and Others 

Mental State Assessment-Cormac’s

· Appearance & behaviour

  • Appearance
  • Motor behaviour
  • Attitude to situation and interviewer

He has a beard, his long, blonde hair is greasy and matted, and he has a washcloth on his head; his clothes are crushed and stained; he is very thin and he avoids eye contact. When interviewed by the nurse Cormac is cooperative. His replies are brief; often not relevant to the question asked and usually given in a monotonous tone. He is unable to remain seated for long and often gets up and goes to the window to lookout.

· Speech form

· Rate

· Volume

· Quantity of information

· Speech content

· Disturbance of meaning

· Disturbance of language

As the answers were brief and informative as per the questions being asked by the interviewer; showing that the speech form and speech consent was a bit normal. However, he showed issues of disorganized speech as he started laughing to meaningless points.

· Mood and Affect

· Mood

· Affect

· Congruency

He shows little emotion when relating his story but sometimes laughs for no apparent reason. He says he has stopped taking his medication because he felt tired all the time, had a dry mouth and had trouble passing urine.

· Form of Thought

· Excess, absence, quality of thought

· Continuity of ideas

He was facing issues with making a logical connection and organization in thoughts. As he had excessive continuity of ideas and abnormal thoughts like he believes that he can send and receive messages from God through the radio and television.

· Content of Thought

· Delusions

· Suicidal thoughts

· Other

 Cormac spends hours scrutinizing videos which he believes contain information about him. He has also been behaving strangely with customers, telling them not to buy certain brands of equipment because they contain recordings of the conversations, he is had with the national spy agency.

· Perception

· Hallucinations

· Illusions

· Depersonalisation/derealisation

Cormac’s lips occasionally move silently as if he is talking to someone and that he turns his head as if to hear someone speaking. When asked whether he can hear someone, he admits that he can hear “strangers talking about me.” He says the “voices are real, they’re not in my mind.”

· Sensorium and Cognition

· Level of consciousness

· Memory:

· Orientation.

· Abstract thinking

He is oriented to time, place, and person and his memory for recent events seems intact.

· Insight & Judgement

· Extent of individual’s awareness of the problem

· Can they make rational decisions

He had no awareness about his health issues and he had also stopped taking his medications.

Risk Assessment

· Potential for harm to self

· Potential for harm to others

· Potential for absconding

He is more likely to harm himself than to others as he had stopped his medications. Moreover, his boss keeps an eye on him to prevent him from doing mistakes.

Clinical Formulation

 

Summarize the pertinent information from the case study

Presenting factors

The presenting factors are difficulty in passing urine and medication-related issues like dry mouth. For this, the nurse should check for the allergy for the after-effects of the medications. According to Cicero, Jonas&Li, K., Perlman, et al. (2019), for treatment of schizophrenia, some negative aftereffects are observed like mouth dryness or others. 

Precipitating factors

He is in constant surveillance of his boss due to his mistakes that might lead to his jobless soon. He is also behaving strangely with customers as well. The nurse should ensure that the patient does not suffer from depression due to his upset relationship with society.

Predisposing factors

He becomes socially withdrawn, takes marijuana several times, and other mood issues. So, the nurses should encourage the patient for psychosocial and psychological aspects so that he gets encouraged to live life in a healthy style. Therefore, he should be given family therapy and psycho-education (Marder, Davidson, & Zaragoza et al., 2020).

Perpetuating factors

The patient has a poor relationship with family members, drug addict habits, socially withdrawn and he also has stopped his medications. These factors along with his incomplete information about his disease can make his condition worse.

Protective factors

As the patient is more interested in watching videos about his disease. So, he should be encouraged to use video presentations and sessions by psychiatrists, rehabilitation support, and behavioral support therapies (Kamińska, Noworyta-Sokołowska&Jurczak et al., 2017). 

Two Nursing Interventions

Cognitive-behavioral therapy – the patient needs to be given this therapy because his behavior is unstable and laughs unexpectedly. His behavior shows agitation and irritability. According to Calderon, Schneider&Target et al. (2019), this therapy helps in recognizing the delusional thoughts and testing of key beliefs. It also helps in learning and strengthening skills for coping with and reducing symptoms and stress. It helps in the identification of exacerbating symptoms, moreover, it focuses on issues like anxiety and affective disorders. The advantage of this non-pharmacological therapy is that it does not have any side effects on the body of the patients. This therapy helps in reducing hallucinations and improving social functioning.

Another intervention is psycho-education therapy is important for the patients because it will the patient to understand his disease more so that he does not miss his medication and his conditions are kept under control. According to McMurran, Day& Reilly et al. (2017), this therapy includes information and education to the patient about the diagnosis, coping strategies, rights, appropriate resources, and treatments. As this is commonly formatted in a group format this will help in developing healthy social relationships as well.

Long Term Interventions

For long term interventions, the patient should be encouraged to antipsychotic medications. The nurse should timely perform the monitoring and evaluation of his health progress and deterioration reposts. According to Stroup & Gray (2018), antipsychotic medications in the case of schizophrenia patients help in, managing disordered thinking and other related complications. The patient should be taught about self-management with the medications and this long term intervention will help the patient to observe and measure the outcomes of his health; thereby, making him independent and life with quality care services. Moreover, it is found that if the patients are treated with antipsychotic medications in long-term interventions when such patients face low mortality risks. Although, it is also found that long-term use of such medication might affect the body with cardiovascular or other health complications. However, with timely assessment and evaluation such complications can be managed and prevented.

SMART Goal

The SMART goal is specific for schizophrenia complications treatment that can be measured as well with timely measurement by the nurse or self-managements. It can be achieved with therapies and pharmacological interventions to attain the goal of normal life. This goal will be achieved by the nurse and the patient, as timely interventions are performed and evaluation is conducted. It might take a long time with non- pharmacological interventions and fast recovery with pharmacological interventions.

SBAR

The patient’s name is Cormac and he is a 24-year-old single man. He is a patient of schizophrenia and his condition is slightly unstable. He felt tired all the time, had a dry mouth and had trouble passing urine. He is also thinking excessively about unnatural ideas and thoughts. The assessments showed that he might lose his job due to his current health complications, he is socially withdrawn, and due to skipping of his medicines he’s condition is getting unstable. He is having dry mouth, urine passing issues, and emotionally depressed about his condition. For this condition he should be recommended with non- pharmacological interventions and pharmacological interventions.

Nursing Care to Mental Health Settings - Part 2

Schizophrenia is a chronic medical condition with complex symptoms that may hinder therapeutic interaction. One of the biggest challenges is the difficulty for both the nurse and the patient in understanding the symptomatology (Crider, 2020). The goal is often to resolve the complexities of the therapeutic partnership between the nurse and the schizophrenic individual. Authenticity, empathy, knowledge of the person and the condition, non-stigmatization, and the willingness to function as a team is important qualities which the nurse should have to be successful in the clinical connexion. Working with experts in the condition, the significance of compliance and declining self-stigma is essential. Therefore, maintaining a therapeutic relationship with the individual with schizophrenia is a continuous task that must follow the different phases of the condition in collaboration with the family and society (Kurebayashi, 2016). Having compassion for such persons requires caregivers to have a strong capacity for knowledge of mental illness and compassion and non-stigmatization, to establish an effective and fruitful therapeutic relationship. The nurse should be able of seeing, in accordance with the signs, that there is indeed an individual in severe mental distress, depression, helplessness, and puzzlement, and that he can consider suicide (Niryani, &Wardaningsih, 2020).Nurses need to be able to recognize that these people are living in a scary, surreal world and have difficulties in separating reality from hallucinations and delusions since they believe that all is true. For all of these factors, it takes a lot of dedicated effort for nurses to understand the individual with schizophrenia whose been struggling from a psychiatric illness and that learning to deal with hallucinations and stick to treatment is necessary to avoid relapse. Thus, the nurses must show to patients amid delusions that they agree that the individual has that perception even since they do not share the opinion (Pinho et al., 2017).It is necessary not to address or deny creed so as to not risk losing faith. Therefore it is important to use sufficient evidence as a therapeutic strategy. For instance, "I recognize that you believe this is accurate, but I don't think it is the same." One should also affirm truth and speak about actual people and things, preventing ruminant thought in delusional beliefs.

The recovery process offers a holistic perspective of persons with mental disorders that emphasizes not only the conditions but on the individual. The approach indicates that such progress is possible, and it is not an endpoint but a path. Compassion and commitment on the part of mentally disturbed people, their families, mental health professionals, health care organizations, social programs, and the community are involved in the process. A nurse needs to use clinical contact with these individuals to reach rehabilitation and for more promising outcomes (Harris&Panozzo, 2019).The recovery process is highly affected by the desires and behaviors of individuals and involves a well-organized family, friends, or skilled support system. Often, adopting modern and creative ways of functioning needs the mental health care system, primary care, public healthcare, and social. Together with the compassionate support from clinicians, the recovery model focuses on helping people with mental problems and depression see beyond merely surviving and living. It helps them to step ahead and take initiatives (Harris&Panozzo, 2019). It supports the view that they should go on with their lives, accomplish work, and having connections that add value to their lives.

The duty nurse with specific patients can face aggression, verbal abuse, and emotionally-taxing situations. He may be the same with the nurse because the patient was aggressive with his mother. The other problem that the nurse will face during clinical practice is that even the individual denies mental illness and the difficulty of exposure to the erratic actions of patients (Carlbo et al., 2018). Nurses can also experience elevated levels of violence and hostility from this specific patient. So, treating patients in mental health settings is critical for nurses to have a commanding presence and communication skills.

The nurse can use Peplau's interpersonal relationship theory with a patient with schizophrenia. That theory will help the nurse cope with the patient's violent and volatile behavior. This principle provides the first approach to the action of nurses based on delivering treatment in collaboration with the patient instead of doing something to the patient (Deane& Fain, 2016). That will help the nurse gain the patient's trust. Peplau's interpersonal relationship theory is focused on four psychobiological interactions that motivate patients to establish positive reactions to needs, anger, dispute, and distress, and describes four phases in the nurse/patient relationship that start with an introduction, recognition, manipulation, and settlement.

References for Nursing Care to Mental Health Settings

Calderon, A., Schneider, C., Target, M., &Midgley, N. (2019). ‘Interaction structures’ between depressed adolescents and their therapists in short-term psychoanalytic psychotherapy and cognitive behavioral therapy. Clinical Child Psychology and Psychiatry24(3), 446-461.

Carlbo, A., Claesson, H. P., &Åström, S. (2018). Nurses' experiences in using physical activity as complementary treatment in patients with schizophrenia. Issues in Mental Health Nursing39(7), 600-607.

Cicero, D. C., Jonas, K. G., Li, K., Perlman, G., &Kotov, R. (2019). Common taxonomy of traits and symptoms: Linking schizophrenia symptoms, schizotypy, and normal personality. Schizophrenia Bulletin45(6), 1336-1348.

Crider, A. (2020). Schizophrenia: A biopsychological perspective. Routledge.

Deane, W. H., & Fain, J. A. (2016).Incorporating Peplau’s theory of interpersonal relations to promote holistic communication between older adults and nursing students. Journal of Holistic Nursing34(1), 35-41.

Harris, B. A., &Panozzo, G. (2019). Therapeutic alliance, relationship building, and communication strategies-for the schizophrenia population: An integrative review. Archives of Psychiatric Nursing33(1), 104-111.

Harris, B., &Panozzo, G. (2019). Barriers to recovery‐focused care within therapeutic relationships in nursing: Attitudes and perceptions. International Journal of Mental Health Nursing28(5), 1220-1227.

Kamińska, K., Noworyta-Sokołowska, K., Jurczak, A., Górska, A., Rogóż, Z., &Gołembiowska, K. (2017).Risperidone and escitalopram co-administration: A potential treatment of schizophrenia symptoms with less side effects. Pharmacological Reports69(1), 13-21.

Kurebayashi, Y. (2016). A literature review on Study’s methodology of nursing care for Patients with schizophrenia considering their neurocognitive functions. Journal of Human Sciences13(1), 2019-2031.

Marder, S. R., Davidson, M., Zaragoza, S., Kott, A., Khan, A., Wang, X., & Daniel, D. (2020). Issues and perspectives in designing clinical trials for negative symptoms in schizophrenia: Consensus statements. Schizophrenia Bulletin Open1(1), sgz001.

McMurran, M., Day, F., Reilly, J., Delport, J., McCrone, P., Whitham, D., & Adams, C. E. (2017).Psychoeducation and Problem Solving (PEPS) therapy for adults with personality disorder: A pragmatic randomized-controlled trial. Journal of Personality Disorders31(6), 810-826.

Niryani, F. I., &Wardaningsih, S. (2020). The implementation of nursing care for schizophrenia patients in inpatient units of a psychiatric hospital in Yogyakarta. UI Proceedings on Health and Medicine4(1), 98-101.

Pinho, L. G. D., Pereira, A., &Chaves, C. (2017). Nursing interventions in Schizophrenia: The importance of therapeutic relationship. Nurse Care Open Access Journal3(6), 00090.

Stroup, T. S., &Gray, N. (2018).Management of common adverse effects of antipsychotic medications. World Psychiatry17(3), 341-356.

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