The objective of the essay is to construct an effective discharge plan for a mental patient to assure quality life after getting discharged. In the case study, Victoria is a registered nurse in a mental health setting and was keen to understand the perspective of the patient. She worked hard to develop a trust relationship with Mrs Mary Brown Taylor, who was a mental patient therein. With thorough care and support of Victoria, Mary got the ability to self-care. The task given to Victoria was to develop a concrete discharge plan for Mrs Mary to address her social and psychological needs.
Therapeutic Relationship plays an essential role in mental health nursing. The concept has emerged in parallel to professional nursing care. It is also derived as helping the relationship between nurses and patients, a therapeutic alliance, and trusting relationship (Kisely et al., 2016). Nursing skills important for building a therapeutic relationship are aiding development, teamwork involving patients in the care plan, comfortable environment, positive first impression, ability to listen, empathy, and consistency.
As per the study of Buraityte & Butkute, (2018), a discharge plan of mental patients must include the collaborative effort of all clinical departments. Along with it, the discharge planning needs to be maintained by active post hospital support programs. Trust plays an important role to involve patients in post hospital care programs. Association between the care providers and patients encourages the patients to access social resources in their community. It assists the patients to gain quality of life by rehabilitation and improving social life. Simultaneously, Saxena & Belkin, (2017), found that patients suffering from lack of trust do not participate in post hospital care and increases the chances of readmission.
Therefore, the therapeutic relationship is the best tool to develop trust with the patient, as it allows to understand and act according to the needs and requirements of patient’s perspectives, social values, spiritual needs, and individual demands. In the case of Mr Mary, Victoria has been able to gain the trust of the patient, so it is easy to involve Mr Mary in the post hospital care services.
The assessment of the learning requirements of mental patients involves to analyse what they already know, and what they need to or want to learn to live a better life and capability of their learning. These questions would assist the nurses to evaluate the best way to teach the patients and construct effective discharge planning (Kisely, 2016). The entire process involves interviewing patients. The first type of questions would involve background information about the patient like –
What do you do in your daily life?
How do you feel after the health treatment?
Do you miss your family or social gatherings?
The second round of questions would involve assessing the learning capacity of patients, like –
What do you fear the most?
How would cope with your fears?
What do you know about their mental state?
In the third round of questions, the learning style for patients would be accessed to set strategies, like –
What time of day do you feel active?
Do you prefer to read or hear?
Lastly, the readiness of patients to participate in the learning activity would be assessed like –
Are you eager to live a quality life?
What changes would you like to bring?
The above questions could be interviewed by Victoria to Mr Mary and further implement the below development strategies in the discharge planning to improve the quality of life of Mr Mary after hospitalisation.
The first strategy is to organise community based activities. As per the case scenario of Mr Mary, social inclusion seems to be the best psychological treatment to enable her to live a quality life. Community based programs are organised locally by local health authorities, involving psychological patients, disabled patients, vulnerable people, social backward classes, and other self – help groups. The association among people increases their confidence to communicate and coordinate with the outer world (Enos, 2015). The community based programs include some creative activities like plantation, attending workshops, participating in group plays, and classes like anxiety management, depression controlling, motivating self-esteem and confidence. Weekly classes and activities are organised to engage people with one another.
Therapeutic classes are held so that ongoing issues and problems of the patients are identified. It is one of the vital parts of discharge planning, as post therapeutic relationship enables the nurses to maintain trust with patients and detail them the problems that they are facing after getting discharged from hospital. Saleem & Gul, (2018), marked that community based mental health programs play an active role in the rehabilitation of mental patients after their discharge. The community based programs organise and involve respective patients in activities, which empower them to combat daily psychological problems encountered in life.
The second strategy is to develop collaborative health support. The study of New, McDougall & Scroggie, (2016) highlighted that discharge planning requires a team approach that must involve patients, as well as their family members, the team of psychologists, psychiatrist, social worker, vocational specialist, case manager, and housing professionals. The entire team must be involved in developing a concrete discharge plan. The community partners along with peers, friends, and relatives of the patients should be involved. A collaborative approach must be maintained by the team that is enabled to meet various needs of the patients and stay comprehensive.
A comprehensive approach to empower mental patients to involve satisfying or addressing their multiple needs across the health system. Coordinated and continuous support that is realistic and practice must be provided with maximum available resources for the benefiting quality of life for the patient. The study also showed that a higher number of patients involved in collaborative development planning are associated with aftercare services or post hospital health care services and their tendency to readmission in a health care setting is low, as compared to patients not involved in collaborative development planning (Buraityte & Butkute, 2018). Moreover, a multidisciplinary health support team would enable the patients to overcome various types of difficulties in life, whether it could be financial, legal, social, biological, or others.
The third strategy is regular meetings with patients. Regular meetings with the patients by the self-help groups would ascertain safe health and quality life of the patients after their discharge. The self-help groups regularly visit patients and assess problems or issues faced by the patients. They could also suggest different workshops for motivation development, cognitive skills, and empowerment of the patients. Social inclusion of the patients is also encouraged by organising community events (Saxena & Belkin, 2017). One of the most important parts in regular visits with patients is to check whether they are following their medications properly and going to their general physicians regularly.
Tailored based mental care support is also provided in regular visits with patients and necessary feedback is provided to the health care team. For instance, if the patient is suffering from acute depression due to loneliness and lack of confidence to meet with new people. In such case, the health care provider could provide cognitive therapy. Cognitive therapy is short term psychotherapy following the concept of thinking and emotional feeling of the patients. It depends on the present communication, behaviour, and thinking skills of the patients rather past experiences of the patients. It is problem solving oriented (Saleem & Gul, 2018). Based on the learning capacity of the patients, they could be provided with skill development books or enrolled in motivational classes.
The significance of the first strategy is that it is essential in the discharge plan of mental patients, as it enables them to overcome loneliness. Depression due to loneliness and lack of communication are often visible among patients that tends them to readmit in hospitals. Community programs organise care services to empower patients. The collaborative approach increases the strength of the patients to live a healthy and safe life with all round support to combat their daily issues in life. Lastly, regular visits to patients with tailored services allow the health care organisations to check the wellbeing of the patients after their discharge and whether they are following the discharge guidelines properly or not (New, McDougall & Scroggie, 2016). Cognitive therapies would allow the patients to solve their present problems in life and enhance their quality of life.
Community development classes are effective for Mrs Mary as she has been suffering from depression due to loneliness in her life. Depression seems to be the core problem in her life that have given rise to malnutrition, sleep deprivation, inability to self-care, and dehydration. Thus, in community programs, Mrs Mary could engage with many people like her and take part in group activities and make friends share her feelings and emotions. A collaborative approach would assist Mrs Mary to the fear of safety from high rise apartments. For instance, psychotherapists and volunteers could support her to go out and pay her bills and buy foods and overcome the problems of malnutrition (Kisely et al., 2016). Likewise, cognitive therapy would assist Mrs Mary to solve the new problems that she would face in post hospitalisation.
As a graduate in the clinical nurse, it could be summarised that trust is the main source of building a therapeutic relationship with patients in nursing. Apart from medicines, interaction and coordination with patients play the main role in treating the patients. The treatment of the patient is not completed until and unless health life is assured for the mental patients in post hospitalisation period. Thus, effective discharge planning is needed to assure that mental patients are leading a good life even after they are discharged from the care support of the health settings.
Buraityte, A., & Butkute, B. (2018). Development of monitoring system for primary mental health care. European Journal Of Public Health, 28(suppl_4). doi: 10.1093/eurpub/cky213.212
Enos, G. (2015). Agency works on hospital discharges for patients with mental health needs. Mental Health Weekly, 25(20), 1-6. doi: 10.1002/mhw.30188
Kisely, S. (2016). Involvement of patients in planning their future treatment may reduce compulsory admissions to hospital. Evidence Based Mental Health, 20(1), 26-26. doi: 10.1136/eb-2016-102530
Kisely, S., Wyder, M., Dietrich, J., Robinson, G., Siskind, D., & Crompton, D. (2016). Motivational aftercare planning to better care: Applying the principles of advanced directives and motivational interviewing to discharge planning for people with mental illness. International Journal Of Mental Health Nursing, 26(1), 41-48. doi: 10.1111/inm.12261
New, P., McDougall, K., & Scroggie, C. (2016). Improving discharge planning communication between hospitals and patients. Internal Medicine Journal, 46(1), 57-62. doi: 10.1111/imj.12919
Saleem, T., & Gul, S. (2018). Use of emotion regulation strategies across family systems. International Journal Of Mental Health, 47(3), 228-235. doi: 10.1080/00207411.2018.1485459
Saxena, S., & Belkin, G. (2017). Knowledge gaps in implementing global mental health activities. Global Mental Health, 4. doi: 10.1017/gmh.2017.20
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