MENTAL DISORDER

MENTAL DISORDER

Introduction

Mental Health is the capability of a person, the group and the environment to communicate with each other in manners that enhance self-esteem, the holistic progress and utilization of cognitive capabilities (2005). The definition of mental health reflects a number of themes, including psychological and social harmony and integration, quality of life and general well- being, self-actualization and growth, effective personal adaptation, and the mutual influences of the individual, the group, and the environment. Furthermore, it emphasizes the social context of mental health by explicitly indicating the importance of social justice and equality to mental well-being. The definition also recognizes that all individuals possess a capacity for mental health, whether or not they have a mental disorder.

            With the emergence of different mental health problems, psychiatric nursing tries to handle and control the problems brought by mental illness and mental disorder towards their societies.     

 

A.   Brief Biography

 

Mary Browning is 54 year old part-time teaching assistant in a local primary school. She lives at home with her husband John and two cats. She is premenopausal and consults her doctor about feeling tired recently. Clinically the doctor suspected that Mary is a little anemic and arranged some blood tests. Physical examination of  revealed nutritional deficiencies and excesses in addition to weight changes that led to her depressive disorder. Pre-menopausal women are at risk of developing late-life depressive disorder.

B. Symptoms of the Disorder

Mary Browning experienced more physical illness than younger individuals. She attributed her depressive symptoms to concurrent medical problems: the demoralization and fatigue that accompany her physical illness or the effect of prescribed medications (2002). Persons over the age of 65 represent only 12-13% of the population but receive approximately one-third of medications prescribed. Mary Browning cited that she bore a disproportionate burden of life’s vicissitudes: loss, and conflict, physical illness, and disability.

C. Diagnosis

Late-life depression is not a necessary consequence of normal aging. It is a widespread and serious medical disorder. Significant depressive symptoms affect over 5 million of the 35 million people over the age of 65 years in the United States (:2005). The consequences of this are substantial: impaired compliance with medical treatment, over utilization of health care resources, diminished quality of life, and premature mortality. Nevertheless, depression is frequently under diagnosed; when properly diagnosed, it is often under-treated. The purpose of this chapter is to illustrate the magnitude of the problem in order to lay the groundwork for discussion of diagnosis and treatment of this condition and its related variants.

For all of these reasons, the prevalence of late-life depression on her may be routinely underestimated. Unrecognized depression in a medical setting can prolong the length of hospital stay, increase the use of other health resources, and add to the cost of care (2005). Depression may decrease motivation to care adequately for an existing medical condition. For instance, patients with diabetes and comorbid depression comply poorly with medications and diet and subsequently have more difficulty achieving

D. Recommendations

The individual healthcare worker’s ability to do what is proposed with proper competence and skill is, of course, crucial in ensuring that the best is given to patients, specifically for those who have underwent surgical operations.  But professional competence is only part of the picture. The role of the nurse in the treatment or intervention of major depressive disorder among elderly is an essential part of the professional healthcare team through collaborative practice must always give priority through caring its patient and giving all the possible assistance in order to alleviate their sufferings from pain. The provision of holistic care for other people as well as the utilization of various complementary healing modalities is the foundation of nursing.

According to  (2005), provision of care is what a nurse does and happens to be the earliest characterization of nursing, which was actually based from the Greek word “therpeia”, meaning therapy. In (1980), a therapist refers to a person that has undergone training on various methods of treatment and rehabilitation aside from the use of drugs or surgery. A therapeutic is then someone who is capable of applying these methods of treatment to cure diseases.

Provision of care is a vital aspect of nursing and the fundamental role of nurses (2003). Based from the statement of Reverby (1987), the role of the nurses basically evolves from the historical depiction of women as care providers of vulnerable individuals within the community. Initially, caring is an imposed role among women, especially during the period of mass epidemics and wars. During this time, the nurses were then a paid workforce. In  own words, nurses were “ordered to care in a society that refuses to value caring” (1987, p.1). The provision of sufficient attention to the comfort as well as the support of health and treatment of patients is also part of the nurses’ role. In the traditional perspective however, caring does not require any specific knowledge or skill. Caring appears to be something that naturally comes out of women, especially when they are adequately directed by medicine and administration.

Nurses, as expert caregivers, must be aware of themselves in order to participate fully in a therapeutic relationship. This implies that the development of nurses is centrally founded on their ability to integrate feelings with knowledge and experience (2004). Nurses must process their own subjective experience of self with the caring relationship in a way that they are able to remain focused on the patients’ needs (2004). One might think that the integrated awareness of self, other and environment gives the nurses a comprehension and openness required to authentically and fully participate with the caring-healing intention of therapeutic relationship.  

Humanistic nursing is described as embracing more than a benevolent technically competent subject-object one-way relationship guided by a nurse on behalf of another. Rather, humanistic nursing is defined as dictating that nursing is a “responsible searching, transactional relationship whose meaningfulness demands conceptualization founded on a nurse’s existential awareness of self and the other” (  1988). Nursing is an experience lived between human beings. All therapeutic action initiated by the nurse in the care of another human being occurs through a self in action, but this is not necessarily through the therapeutic use of self or the art of nursing. (1996) points out that for some nurses, the therapeutic use of one’s self may be simply the implementation of a nursing technique such as the administration of oxygen and not the giving of one’s self.

This kind of nursing is described as the “lending” rather than “giving” of one’s self (2002). The difficulty with this “lending” perspective is that although the nurse may be technically competent, she or he remains aloof and the deeper existential needs of the patient remain unaddressed. While possibly providing increased personal comfort to the nurse, the avoidance of the risk of deeper emotional engagement also risks losing the opportunity for personal growth and fulfillment when the nurse does not fully participate in life experiences.

There are many kinds of nurses according to their specialty, and one of which is the psychiatric nurse. In this manner, psychiatric nurses practice with autonomy and independence, and are accountable for caring patients with neurological problems or those diagnosed with aneurysms, brain tumours, cerebrovascular disease, degenerative spine disease and epilepsy. It is noted that caring for individuals with neurological dilemma and disabilities needs a special skills and knowledge to sustain the quality of life, functional level and patient outcomes. In addition, illnesses and injuries that cover the nervous system often have extensive effects on different aspects including physical, cognitive, personality and patients’ behaviour. In this manner, nurses who are assigned to assist psychiatric patients must have the ability to combine theories and practice efficiently, since caring for these patients is considered as multidisciplinary (2002).

Primarily, the main goal of this paper is to critically analyse a certain nursing practice whose field in to assist patients with major depressive disorder.  In addition, this paper will attempt to provide an in-depth knowledge and understanding of a current area of practice in relation to the clinical management of the psychiatric patients.

 

Nurses may assume a special role with very ill patients in which direct
and continuous support of physiological, emotional, social, and spiritual
functions is provided. Nurses may use a wide variety of skills and techniques to take care of patients. A problem-solving or nursing process approach is generally accepted by professional and educational groups; practice, licensing, and ac- crediting bodies; and the institutions where nursing is practiced as an appropriate framework for nursing practice and activities (1990; 1993). This approach includes assessing and diagnosing patient problems, planning and goal setting for individual patient needs, intervening for each problem, and evaluating results. Pain and anxiety are examples of patient problems for which nurses might intervene. In hospitals, nurses might be involved in direct care of patients, management, teaching, research, or consultation regarding patient care. Nursing roles in hospitals may also encompass coordinating the multiple services involved in patient care (1993).

The direct care nursing role in critical care settings, specifically those patients experiencing neurological problems and diseases involves assessing the complex interplay of illness or dysfunction of the individual as a physiologic and psychologic whole. Herein, the psychiatric nurse may be considered an extension of the functions of a patient unable to care for her-himself. The patient crisis may be elective surgery, overwhelming infection, trauma, angina, or multiple system failure and coma. The nurse provides physical care and monitors vital functions including heart rate; blood pressure; skin integrity; bowel and bladder functions; nutritional, fluid, electrolyte, and mobility status; and mentation. In addition, the psychiatric nurse assesses for abnormalities and takes action to help the patient return to normal function (1987).

Conversely, in the field of nursing, there can be seen different models in which the psychiatric nurses can use in order to promote quality care among patients as well as provides respect on their autonomy. According to (1992), advocacy model can be used to let the psychiatric nurse put into practice the skills and the knowledge that they have learned.  Advocacy model is the model for nursing practice which was developed as nursing developed its own sense of professional identity, separate from duties to physicians and institutions. 

Under this model, the primary role of the psychiatric nurses is to protect or safeguard the rights and interest of its patients.  Here, the psychiatric nurses must be able to recognize the rights of the patients undermined by their institutional practices and unequal power structures.  Moreover, the psychiatric nurses must be able to do its duty to empower patients, both directly by supporting and respecting patient autonomy or independence and indirectly by working to changes of practice to disempowering the patients.  The psychiatric nurses have a duty to respect the patient’s rights to self-determination and confidentiality which is under the patient autonomy.  The principle of patient’s autonomy expresses that nurses have a job to treat the patient according to the patient’s desire, within the limits of accepted treatment and to protect the patient’s confidentiality and privacy. Under which, the nurses has the core responsibility to let the patients be involved in treatment decisions in a meaningful way with due consideration being given to the patients’ demands, desire and abilities and safeguarding their private life (Bernal. 1994).

One of the considered topics attached to nursing practice in relation to patient autonomy is how they do documentations and record keeping, for it is very important not only for the record of the hospitals but most especially to the patient. This means that the cognitive knowledge that psychiatric nurse have learned for many years in doing record keeping and filing must be applied and put into practice effectively. For example, generating documentation of very sensitive and personal matters in a patient’s medical records creates a corresponding responsibility for the nurse and their job is to protect that patient’s constitutional right to privacy.

On the other hand, there exist some instances where public policy concerns override or at least limit the patient’s right to privacy.  In these cases, concern over public health, or to prevent abusive or criminal conduct, commands that the nurse make reports to the appropriate health or law enforcement agency. One thing is very apparent; the patient has an absolute right to their own medical records.  Even then, our technological advancements make transmission of records more risky.  Any time documents are sent in the mail or electronically, there should be a clear provision set out at the beginning of the document stating that these matters are the personal, confidential medical records and the sole property of the patient and hospital.

Moreover, nursing practice dictates that any discussion or other transmission of sensitive patient information should be conducted with the utmost care and discretion.  The psychiatric nurse should be aware that the health service delivery environment is fear-provoking, intimidating, and alien to most people. Further, inconsiderate regard for privacy and confidentiality can greatly diminish the patient’s experience in that environment. Thus, issues about documentation and record-keeping of patients suffering from neurological problems and illnesses should be given enough focus by the one who are authorized to do it, i.e. psychiatric nurses.

 

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