Professional Transitions

Table of Contents

Introduction

Critical Evaluation

Strategies

Discussion

Conclusion

References

Introduction

Mental Health nursing has proved to be an important part of the rehabilitation of psychiatric patients from in-hospital care to their communities. The inpatient care received has to be therapeutic and manage the professional boundaries of the nurse-patient relationship accordingly. In a delicate and sensitive situation like that of psychiatric cases, it is of utmost importance that the mental nursing care provided deals with the goal of smooth return and reentry of the person into their previous environments without triggering readmission. In most cases, the patient shall be going back to those environments that triggered their admission in the first place. Thus, methodical discharge planning regarding these cases has a great impact on the continuum of care, as these cases require more introspection and reevaluation.

Critical Evaluation

Some articles and research papers have been explored for comprehensively understanding the mental health nursing and the importance of the nurse-patient therapeutic relationship.

The research conducted by Sharon M. Valente in her paper Managing Professional and Nurse-Patient Relationship Boundaries in Mental Health dives right into re-establishing boundaries between a registered nurse and the patient. The article discusses the sensitivity and consideration that these cases require for the mental trauma that they have faced effectively warps the strict professional boundaries dictated in patient-care. The psychiatric patients require an individualized approach that provides them with a safe environment that allows their concerns to be addressed. However, along with this a cautionary approach is needed to avoid the emotionally and mentally manipulative tactics often employed by patients acting out of trauma or psychological issues which may lead to severe violation of regulations (Slemon, Jenkins & Bungay, 2017). Thus, a delicate personal-professional boundary is to be maintained keeping in mind the special needs of the patient and the professional demands of the job, avoiding any personal conflicts that may arise in dealing with such close quarters of care-giving (Valente, 2017).

However, mostly there is a lack of such therapeutic attention to inpatient care that is dictated to be of utmost importance in mental health nursing, as discussed in the aforementioned article. This dearth is recorded in Josephien H. M. Rio, Jeffrey Fuller, Kerry Taylor, and Eimear Muir-Cochrane's findings in their paper A lack of therapeutic engagement and consumer input in acute inpatient care planning limits fully accountable mental health nursing practice. The paper discusses the lack of one to one engagement with the patient that is key to an individualistic approach. While maintaining one’s professional boundaries are perfectly logical in other cases, psychiatric patients require a therapeutic engagement and a systematic reception and introspection of their inputs and needs. This is critical in predicting and managing risk factors that endanger the patient’s mental health and a mental nurse’s duties won’t be able to be carried out unless such a reception and introspection system starts (Rio, Fuller, Taylor & Muir‐Cochrane, 2019).

Finally, in Sarah Xiao, Ann Tourangeau, Kimberley Widger and Whitney Berta’s work, Discharge planning in mental healthcare settings: A review and concept analysis of the importance of comprehensive discharge planning is discussed as an essential tactic to ensure the transitioning of mental health patients from hospitals to their communities. Such discharges should be planned by a registered mental health nurse who shall be in constant communication with the patient, patient's family, their primary caregivers, and the group of professionals dedicated to their comprehensive care (Raz, 2017). Along with this, discharge plannings are done in collaboration with community services that provide vital support in community transmission of the patient. The discharge is a critical point in inpatient care where the patient has to be transitioned into their previous environment while predicting factors that may trigger readmission, for in psychiatric cases, suicide attempts have often happened within the first few days of discharge (Xiao, Tourangeau, Widger & Berta, 2019).

Strategies

The patient in the discussion here is Mrs. Mary Brown Taylor, an elderly lady who had been admitted with acute depression, mild malnutrition and dehydration, sleep deprivation, and a general loss of affect that impacted her ability to self-care. Post recovery, her discharge planning is to be done by Victoria, a mental health nurse in such a way to eliminate all possible risk factors and avoid readmission. The following strategies can be undertaken to plan the patient’s discharge:

  • Taking-in valuable input from the patient regarding their care and rehabilitation and communicating said concerns and inputs to the primary caregiver. The trusting relationship that has developed between the patient and the nurse shall prove key in extracting vital and authentic information which will help in planning an individualistic approach for the patient’s care (Arroyo-Marlés, Guevara-Lozano, Pérez-Giraldo & Sánchez-Herrera, 2017).
  • The patient’s psych evaluation should be regarded in this matter and the trigger points that gave rise to the current patient’s condition or cause further hindrance to their health should be eliminated (Herbst, 2019). In this case, loneliness is a key reason, which is seen as a leading cause of geriatric depression. Community services carried out by nonprofit and government organizations can be involved in this process to keep the patient occupied in community building activities that shall help them combat their loneliness.
  • The fear of safety is another concern that arises from insecurity in a fast-paced neighborhood. The nurse can either help the patient become more proficient in tackling such issues, by teaching them to avail online services or can communicate with local authorities to look after such needs. Re-contact with friends and family can also help in combating with the patient's isolation life. Contact and positive communication with people of similar ages can help the patient regain their sense of being (Malmström et al., 2016).

Discussion

The aforementioned strategies are mentioned keeping in mind the prior complaints that the patient had that had been factorial in their admission. These strategies not only keep in mind the comprehensive care that has to be delivered for the maintenance of the optimum quality of life, but also the elimination of factors that can trigger readmission in psychiatric patients like this (Dlamini & Shongwe, 2019). As a mental health nurse, these strategies are key in a therapeutic engagement with the patient. But at the same time, these strategies also explore the ethical and practical issues that are involved in inpatient care. The rationale behind these strategies is to have a professional introspection into the patient's needs and in addressing them instead of the scope of practice and treatment. Medical care has to take lead in such cases of comprehensive care, coordinating with the patient's family and primary caregivers (Li et al., 2018). The ethical standards of mental health nursing urge the registered nurse in considering the patient's rehabilitation along with recovery for a better quality of life post-recovery. Such practices require taking the input of the patient themselves and the consumers of such care (Jensen et al., 2016). The continuum of care is done following the medical curse of treatment taken that keeps in mind the physical and medical needs of the patient. These needs are to be properly and communicated to the patient and their caregivers to avoid any disruption in treatment.

However, most importantly, a carefully considered discharge plan has to take into account the mental and social needs of the patients for these affect the physical and medical causes directly. In complex cases like these, it is of utmost importance that an overall comprehensive approach is taken to ensure the patient’s full recovery. In most cases, due to lack of therapeutic engagement or lack of a trusting relationship between the nurse and the patient, the discharge planning fails to fully satisfy the patient’s need or even ensure a full recovery that leads to eventual readmission and sometimes death due to suicide. Every psychiatric case is different and demands creative solutions that satisfy individualistic needs (McAllister, Robert, Tsianakas & McCrae, 2019). However, such needs can only be evaluated and assessed on the occurrence of positive authentic communication that gives the nurse inputs and insight into the type of care the patient needs. These procedures are to be made in sync with the whole team of professionals that are working for the patient's care and treatment and input from every stratum is important. A professional and considerate approach is what makes the inpatient care efficient, which can tackle the emotional and mental complexities that are often associated with these cases without being personally affected or involved in such (Mabire, Dwyer, Garnier & Pellet, 2017).

Conclusion

With the evolution in healthcare and the variations in treatments, the standards of nursing have to change as well, for maintaining a standard of quality. The patient’s life is of utmost importance, as a whole, where their mental health is a key component. Careful consideration and professional approach into the patient’s comprehensive care can resolve any outstanding factors that may cause hindrance to the patient’s wellbeing. Thus, a discharge plan done in therapeutic engagement with the patient’s individualistic need is key to helping the patient recover fully and function again as an enthusiastic and contributing member of the community. Mental health nursing’s key goal is to provide psychiatric patients with a wholesome approach that takes care of their specialized needs and understands the difficulties and oddities that one may face or has to overcome in comparison to another healthy full-functioning member of the society and how these circumstances demand the eventual relaxation of strict professional protocols that sometimes prove to be an obstacle in the path of patient-nurse trust-building.

References

Arroyo-Marlés, L., Guevara-Lozano, M., Pérez-Giraldo, B., & Sánchez-Herrera, B. (2017). Commitment and a sense of humanity for the adaptation of patients during hospital care. Journal Of Nursing Management, 26(5), 548-554. doi: 10.1111/jonm.12581

Dlamini, S., & Shongwe, M. (2019). Exploring mental health nurses’ perceptions on factors contributing to psychiatric readmissions in Eswatini: A qualitative study. International Journal Of Africa Nursing Sciences, 11, 100157. doi: 10.1016/j.ijans.2019.100157

Herbst, A. M. (2019). Evaluation of a Discharge Medication Assistance Program (DMAP) to Reduce Psychiatric Readmissions (Doctoral dissertation, University of Kansas).

Jensen, J., Egerod, I., Bestle, M., Christensen, D., Elklit, A., & Hansen, R. et al. (2016). A recovery program to improve quality of life, sense of coherence and psychological health in ICU survivors: a multicenter randomized controlled trial, the RAPIT study. Intensive Care Medicine, 42(11), 1733-1743. doi: 10.1007/s00134-016-4522-1

Li, J., Talari, P., Kelly, A., Latham, B., Dotson, S., & Manning, K. et al. (2018). Interprofessional Teamwork Innovation Model (ITIM) to promote communication and patient-centred, coordinated care. BMJ Quality & Safety, 27(9), 700-709. doi: 10.1136/bmjqs-2017-007369

Mabire, C., Dwyer, A., Garnier, A., & Pellet, J. (2017). Meta-analysis of the effectiveness of nursing discharge planning interventions for older inpatients discharged home. Journal Of Advanced Nursing, 74(4), 788-799. doi: 10.1111/jan.13475

Malmström, M., Ivarsson, B., Klefsgård, R., Persson, K., Jakobsson, U., & Johansson, J. (2016). The effect of a nurse led telephone supportive care programme on patients’ quality of life, received information and health care contacts after oesophageal cancer surgery—A six month RCT-follow-up study. International Journal Of Nursing Studies, 64, 86-95. doi: 10.1016/j.ijnurstu.2016.09.009

McAllister, S., Robert, G., Tsianakas, V., & McCrae, N. (2019). Conceptualising nurse-patient therapeutic engagement on acute mental health wards: An integrative review. International Journal Of Nursing Studies, 93, 106-118. doi: 10.1016/j.ijnurstu.2019.02.013

Raz, B. (2017). Discharging patients. Nursing Standard, 31(31), 64-65. doi: 10.7748/ns.31.31.64.s49

Rio, J., Fuller, J., Taylor, K., & Muir‐Cochrane, E. (2019). A lack of therapeutic engagement and consumer input in acute inpatient care planning limits fully accountable mental health nursing practice. International Journal Of Mental Health Nursing, 29(2), 290-298. doi: 10.1111/inm.12684

Slemon, A., Jenkins, E., & Bungay, V. (2017). Safety in psychiatric inpatient care: The impact of risk management culture on mental health nursing practice. Nursing Inquiry, 24(4), e12199.

Valente, S. (2017). Managing Professional and Nurse–Patient Relationship Boundaries in Mental Health. Journal Of Psychosocial Nursing And Mental Health Services, 55(1), 45-51. doi: 10.3928/02793695-20170119-09

Xiao, S., Tourangeau, A., Widger, K., & Berta, W. (2019). Discharge planning in mental healthcare settings: A review and concept analysis. International Journal Of Mental Health Nursing, 28(4), 816-832. doi: 10.1111/inm.12599

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