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  • Internal Code :
  • Subject Code : NURS1007
  • University :
  • Subject Name : Nursing

Health Research

Introduction to Nursing Care in Mental Health Patients

Mental health is the psychological wellness standard or lack of mental disorder. It is also the state of somebody who "functions satisfactorily at a behavioral and emotional level." Through an individual's viewpoint of mental illness, rehabilitation involves gaining and maintaining hope, having an awareness of one's abilities and limitations, participating in an active social life, and achieving individual freedom, social identification, significance and meaning in life, and a healthy sense of identity (Schaefer et al., 2017). 'Patient-centredness' has historically been perceived within mental health care to reflect a holistic approach with such a mentality of respect for other people and their unique challenges and demands. Though it is necessary to demonstrate that such skills can be acquired by professionals through professional development (Brooker & Latham, 2015). It is identified that the nursing staff had a stigma towards mentally ill people and a strong inclination towards patient social exclusion. Considering the stigma of nurses, in this essay, the role of physical and mental health correlation, the importance of recovery model of care, and mental state examination have been discussed along with the steps nurses can take to help the patients with mental disorders.

Comorbidity of Both Physical and Mental Health Issues

As a first step, it is important to understand and recognize the reality of the co-morbidity of various conditions, and especially the combined incidence of mental and physical disorders is the rule instead of an exception which have to be treated in almost all patients keeping these things in view. The incidence of comorbid mental and physical disorders has risen significantly in the last two decades, approaching epidemic levels in many countries. For people over the age of sixty, the occurrence of two or even more disorders at the same time is becoming the norm instead of an exception (Ashworth et al., 2015). Comorbidity does not mean simply adding two diseases which follow their normal trajectories independently. The simultaneous involvement of two or more diseases will exacerbate the diagnosis and treatment of all the present diseases, lead to a growing number (and severity) of symptoms, and find it tougher and, probably, less successful to treat any of these. Clinical and non - clinical specialists and primary care physicians typically focus on the disease they know a lot about and want to treat, often lacking or misjudging the significance of mental illnesses which may also be prevalent. For them, the link between the pain that sometimes follows a physical illness (e.g. cancer) and a psychiatric condition (e.g. depression) is not apparent, and they continue with single-disease therapies in the expectation that the psychological problems related to the physical condition will vanish until the physical disorder is addressed (Buetow, 2016).

Mental health professionals are no better at recognizing comorbid symptoms than most professionals. They often treat the mental condition in which they have considerable experience, and sometimes neglect or under-treat a comorbid physical disorder by missing a medical test that might warn them of another disease. Effective treatment of comorbidity – at the patient and public health level – would entail a significant reorganization of medical training and a restructuring of health care services (Ben-Assuli & Padman, 2020). Primary care doctors may be qualified to recognize and manage patients with comorbidities, but clinicians in all fields do have to accept some responsibility for resolving the problem of comorbid conditions in the individuals they manage. Health care would need to be adapted to the fact that many people who come to receive assistance are likely to be suffering from some of the more than one disease. Researchers need to pay much more attention to the similarities in the initiation and progression of mental and physical disorders and the development and implementation of comorbid conditions therapeutic approaches (Jorm et al., 2017).

Recovery Model of Care Utilized by Mental Health Services

The recovery model is patient-centered and works towards the holistic approach to mental health care. Over the past decade, the model has fast gained popularity and has become the general framework in mental health care. It is made up of two easy grounds: that healing from a state of mental disorder is achievable, and that the most efficient rehabilitation is patient-driven (Ellison et al., 2018). Its core idea, as the model name suggests, is the assumption that people will rebound from mental illness to lead complete, fulfilling lives. Until the mid-1970s, many clinicians claimed that mental health patients were destined to live with their condition indefinitely and could not contribute to the system (Jacob, 2015). This belief particularly affected people with schizophrenia, schizoaffective disorder, and bipolar disorder.

Training of nurses in the area of patient rehabilitation is a growing issue that health care providers support as the most critical process in care delivery. Contemporary nursing trainings offer general nursing education that will later be learned in practice but have neglected to include instruction in advanced nursing fields such as clinical nursing, and how to administer groups and provide recovery-oriented care. Recovery efforts in health care are critical in the final step of case management seeking complete restoration to normal health status of a patient. Health care recovery is conceived as the patient who is connected to health care professionals to greatly improve their treatment and healing process (Vos, 2016). Health care workers play an important role in improving outcomes by displaying a positive attitude, implementing surgical procedures, and getting the adequate strategies to enable patients on their journey to recovery (Vos, 2016). Recovery is therefore crucial not only in reported trials as well as in rehabilitation services environments where the goal of nursing care is to prolong life.

The mental illness recovery model is often compared with what's recognized as the medical model. The medical model suggests that psychiatric conditions have physiological causes, and the emphasis is mostly on the use of drugs for treatment. Although the two approaches are often viewed as opposed to each other, experts have indicated that they are similar and that they should be used together (Hogan, 2019). The medical model implies that biological causes are completely treated and people obtain the treatment. While the recovery model ensures patients can be involved directly in their treatment. The model of recovery offers the individual achievement and support groups individuals have to cope with their disease and work towards improvement.

Importance of A Mental State Examination (MSE)

In neurological and psychological practice, the mental status test or MSE is an important part of the clinical evaluation process. It is an organized way of examining and identifying the mental wellbeing of a patient at a given instant of time, underneath the contexts of presence, attitude, behavior, mood, and effect, speech, the process of thought, content of thought, perception, cognition, knowledge, and judgment (Yong-Shian et al., 2016). The MSE aims to gain a detailed cross-sectional overview of the mental condition of the client which, in conjunction with the biographical and contextual details of the clinical history, enables the healthcare provider to produce an accurate assessment and strategy suitable for consistent care planning. The mental status check is a basic skill of professional (mental) health care staff. This is an integral part of the initial clinical evaluation in an ambulatory or clinical hospital setting (Arnfred et al., 2018). It is a process of collecting information based on monitoring the behavior of the patient, whereas the patient is still in the view of the healthcare professional during the interview.

Information is typically documented as free-form text by using default headings. The information gathered in the MSE is used to produce a description, a clinical framework, and a recovery plan along with the biographical and social details of the clinical past. There are possible issues when the MSE is implemented in a cross-cultural setting where there are different cultural contexts for the clinician and patient (Morrison, 2016). For example, the culture of the patient can have specific standards for the appearance, actions and emotion display. There is a need to differentiate culturally normative moral and religious views from hallucinations and delusions-they that appear identical to one who may not realize that they have different origins. Cognitive examination often has to take into account the patient's language and educational context. Another possible confounder is the ethnic prejudice of clinicians.

Steps to Engage and Support a Person with Mental Health Needs

Nurses are not away from misperceptions associated with mental health and sometimes cause their work to be influenced by these unfounded fears. In taking care of a patient, the nurses at times participate in "avoidance" behaviors including weak eye contact, responding slowly to the call light, ignoring or missing requests or spending the "necessary" minimum amount of time just to complete the basics (Wright et al., 2017). Such patterns of avoidance hinder the ability to better identify and respond to patients ' needs in the treatment. As a nurse, in the acute care setting, they possess the chief skills required to care for persons with a co-occurring mental health disorder. The nurses should have the capacity to comprehend and treat symptoms that are associated with the disease process that may occur (Gillespie et al., 2019). Commit to lifelong learning. With potential risks, foresee and intervene to offer compassionate, personalized care to those who need it.

It is often difficult for individuals living with severe mental illness to engage in ongoing care, with dropout rates. Poor involvement can lead to even worse health outcomes, with recurrence and rehospitalization of the symptoms. Numerous variables can influence the degree of patient commitment, including therapeutic partnership, care availability, and a patient's faith that the therapy will meet their specific objectives. these obstacles can be removed by nurses efficient care. The target becomes more complicated when mentally disturbed individuals undergo a "real" disease and need admission to an acute hospital environment (Kazdin, 2017). The requirements of mentally ill patients will challenge nurses who are unfamiliar with evidence-based treatment options. The nurses can learn and/or develop skills that can help nurses in the intensive care environment and increase patient safety in the treatment of people with mental health problems.

Developing advanced assessment, preparation, treatment, and decision making in the acute care environment may greatly enhance patient outcomes with co-morbid mental health and physical needs. However, first, we have to overcome obstacles to quality treatment, one of which is stigma. Another obstacle to seeking successful, compassionate treatment is discerning what you think about people with mental illness (Iseselo, Kajula & Yahya-Malima, 2016). As this phase is linked to proactive practice, stressing the effect of values on the treatment to patients is illustrated here. Nurses have to express their views about mental illness to patients, their families, and themselves. Nurse will guard against allowing their practice to be influenced by stigma (Alexander, Ellis & Barrett, 2016). Read about mental illness and substance use disorders, and build a therapeutic relationship/partnership and promote. The nurse can participate in therapeutic connection while protecting the patient from all the stigma involved.

Conclusion on Nursing Care in Mental Health Patients

The incidence of comorbid mental and physical disorders has risen and both the health state are interdependent. The simultaneous involvement of physical and mental disorders exacerbate the diagnosis and treatment of all the present diseases, lead to a growing severity of symptoms. Hence MSE is to obtain a comprehensive cross-sectional description of the client's mental state. This allows the health care professional to generate a suitable diagnosis and formulation suitable for consistent care planning. The information gathered in the MSE is used to produce a description, a clinical framework, and a recovery plan. The recovery model is a person-centered and have a holistic approach towards mental health well-being. The model provides a general framework of mental health care. Developing the advanced assessment, preparation, treatment, and decision making in the acute care environment may greatly enhance patient outcomes with co-morbid mental health and physical needs. The nurses can help to overcome obstacles to quality treatment, one of which is stigma. Another obstacle to seeking successful, compassionate treatment is discerning what you think about people with mental illness.

References for Nursing Care in Mental Health Patients

Alexander, V., Ellis, H., & Barrett, B. (2016). Medical-surgical nurses' perceptions of psychiatric patients: A review of the literature with clinical and practice applications. Archives of Psychiatric Nursing30(2), 262-270.

Arnfred, S. M., Gefke, M., Høegh, E. B., Hansen, J. R., Fog-Petersen, C., & Hemmingsen, R. (2018). Mental Status examination training for medical students: The development of an educational video library with authentic patients. Academic Psychiatry42(3), 432-433.

Ashworth, D. K., Sletten, T. L., Junge, M., Simpson, K., Clarke, D., Cunnington, D., & Rajaratnam, S. M. (2015). A randomized controlled trial of cognitive behavioral therapy for insomnia: an effective treatment for comorbid insomnia and depression. Journal of Counseling Psychology62(2), 115.

Ben-Assuli, O., & Padman, R. (2020). Trajectories of repeated readmissions of chronic disease patients: Risk stratification, profiling, and prediction. MIS Quarterly44(1).

Brooker, D., & Latham, I. (2015). Person-centred dementia care: Making services better with the VIPS framework. Jessica Kingsley Publishers.

Buetow, S. (2016). Person-centred health care: Balancing the welfare of clinicians and patients. Routledge.

Ellison, M. L., Belanger, L. K., Niles, B. L., Evans, L. C., & Bauer, M. S. (2018). Explication and definition of mental health recovery: A systematic review. Administration and Policy in Mental Health and Mental Health Services Research45(1), 91-102.

Gillespie, S. M., Manheim, C., Gilman, C., Karuza, J., Olsan, T. H., Edwards, S. T., ... & Haverhals, L. (2019). Interdisciplinary team perspectives on mental health care in VA home-based primary care: A qualitative study. The American Journal of Geriatric Psychiatry27(2), 128-137.

Hogan, A. J. (2019). Social and medical models of disability and mental health: Evolution and renewal. CMAJ191(1), E16-E18.

Iseselo, M. K., Kajula, L., & Yahya-Malima, K. I. (2016). The psychosocial problems of families caring for relatives with mental illnesses and their coping strategies: A qualitative urban based study in Dar es Salaam, Tanzania. BMC Psychiatry16(1), 146.

Jacob, K. S. (2015). Recovery model of mental illness: A complementary approach to psychiatric care. Indian Journal of Psychological Medicine37(2), 117.

Jorm, A. F., Patten, S. B., Brugha, T. S., & Mojtabai, R. (2017). Has increased provision of treatment reduced the prevalence of common mental disorders? Review of the evidence from four countries. World Psychiatry16(1), 90-99.

Kazdin, A. E. (2017). Addressing the treatment gap: A key challenge for extending evidence-based psychosocial interventions. Behaviour Research and Therapy88, 7-18.

Morrison, J. (2016). The first interview. Guilford Publications.

Schaefer, J. D., Caspi, A., Belsky, D. W., Harrington, H., Houts, R., Horwood, L. J., ... & Moffitt, T. E. (2017). Enduring mental health: prevalence and prediction. Journal of Abnormal Psychology126(2), 212.

Vos, J. (2016). Working with meaning in life in chronic or life-threatening disease: A review of its relevance and the effectiveness of meaning-centred therapies. In Clinical Perspectives on Meaning (pp. 171-200). Springer, Cham.

Wright, J. H., Brown, G. K., Thase, M. E., & Basco, M. R. (2017). Learning cognitive-behavior therapy: An illustrated guide. American Psychiatric Pub.

Yong-Shian, G. O. H., Selvarajan, S., Chng, M. L., Tan, C. S., & Yobas, P. (2016). Using standardized patients in enhancing undergraduate students' learning experience in mental health nursing. Nurse Education Today45, 167-172.

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