Nursing A Person With Complex Needs
This paper aims to evaluate the critical health status of a patient and to assess the effectiveness of the intervention that has been implemented. It has assessed the importance of using assessment tools and the assessment processes in the planning of intervention. In this essay, the intervention has been developed for a patient who has physical and mental health issues including diabetes, schizophrenia and obesity. In childhood the patient also had the ADHD. The main purpose of this study is to explain and spread awareness of the neurodevelopmental, genetic and psychological procedures that can affect mental health. It shows how a nurse can create an environment that can promote better mental health. It also assesses the factors associated with the mental wellbeing and health of a person. It has been demonstrated the role of nurses to promote mental health and how they can take actions to protect the welfare of people who have a mental disorder. This essay will provide evidence that the biological and psychological determinants have been interrelated with each other. It is claimed that always a physical environment has to affect mental health and mental health can affect physical health.
Describing The Patient, Service And Nature Of Involvement
As per case study, the patient has diagnosed with schizophrenia, diabetes and obesity. In this scenario, the patient is a 27-year-old male of Asian ethnicity who has been diagnosed with attention deficit hyperactivity disorder at the age of 7 years. In the present situation, he is unemployed and detained in the forensic ward under section 37/41 of the act of mental health. The patient had the ADHD in his childhood. He is a fan of the football programme and he is Muslim by religion. He loved to watch television, cook and also listen to music. He had confessed that he had lost his grandfather which made him disturbed and he had been bullied in his school days (Thornicroft et al. 2019). He had her first episode of psychosis at the age of 17 years and was in contact with early intervention services. The patient got a job in 2015 and abused a customer. He also used the substances and stabbed a neighbour. This patient has complex need as he has mental illness and physical illness. In his physical assessment, it has been found that he is overweight and has diabetes.
This person has both physical and mental illness. For schizophrenia the person needs the service of mental health and to treat the diabetes, obesity he requires physical health support. In order to treat the person a multidisciplinary team is required to deliver a collaborative intervention. In this multidisciplinary team involves the mental health experts such as psychiatrist, counsellor, therapist, physician, the dietitian and other health staffs. However, the support of family is also required to improve the health. It is collaborative in nature where the nurse can form a team with the other health professionals to solve a patient care issue through sharing knowledge and evidence-based practice. In order to deliver the quality healthcare service there is need to emerge three interventions for different group of health issue. In this service, at first the severity of the illness has been assessed by the assessment tools. After the diagnosis process the interventions have been applied to treat the person. Then the evaluation of the health outcomes has been implemented to identify effectiveness of the service.
Describing And Analysing The Use Of Assessment Tools For Measuring The Needs Of The Patient
In treatment procedure the assessment tools are the major area for success of the treatment. The screening tools and assessment tools can identify the illness of the patients at early stages to provide the treatment. It can avoid or can reduce the symptoms and negative consequences of the illness. It is deliberately contributed in the improvement of health outcomes of the population in a cost-effective manner. These assessment tools have been used to support the active learning process, facilitating the team building activities and can foster the peer to peer learning process. In simple words, choosing of the appropriate assessment tool needs that consideration to the skills levels, content of the course for measuring, desired knowledge to be acquired and the nurses can apply the knowledge of using the assessment tools in problem solving and developing of new ideas, concepts and theories. In this treatment procedure a number of assessment tools are used to diagnose the illness of the patient.
· Observing behavior and asking questions about the thinking process.
· Using Brief Psychiatric Rating Scale to test behavioral abnormalities
· BMI and weight measurement
· Glucometer and Blood Glucose Monitor
Type 2 diabetes mellitus
Table 1: Overview of the used assessment tools
Schizophrenia: It has been noticed that during the assessment process the patient has issue with communication and could not convey their thought process. The mental health expert has observing the appearance of the patient and asking about the moods, thoughts, hallucinations. The counsellor has asked about the family, profession and other things. However, for assessing the negative affect or severity of the schizophrenia Brief Psychiatric Rating Scale has been used. This test looks at the almost 18 behavioral symptoms including hallucination, disorientation and hostility (Firth et al. 2019).
Application of assessment tools in Obesity: The patient is looking overweight and to ensure the physical health status there is need to apply the appropriate assessment tools. Two assessment tools have been used such as BMI and weight measurement.
Weight measurement: In weight measurement the human body is referred to be the weight. In this measurement the weight machine has been used to get the accurate body weight of the person. It can help the nurse to get the knowledge that the person is overweight or not. In this measurement, the person need to be stand and straight on the weight machine. After measurement of the body weight it has been identified that he is overweight against his body height (Sigafoos and Gevarter 2019).
BMI: Body mass index measurement refers to the ratio of the height and weight. It can estimate the body fat and identify the risks that can be raised due to more body fat. It helps to know the dietary requirements considering the age and activities.
BMI = Weight (Kg)/ Height2 (M)
According to BMI if the value is below 18.5 then the person is under weight and in between 18.5 to 24.9 is meant to be healthy. Above 30.0 is meant to be the obese. This person has the BMI above 30.0 which confirmed the obesity.
Obesity is associated with different chronic conditions that can be raised in the body. In the assessment, the blood glucose level has been assessed with blood glucose monitor.
The Blood Glucose Monitor is used for regular blood test. It is known as the home blood sugar meter. It is used to examine the blood glucose level in the body. The patient has blood glucose level above the normal level 140mg/dl. The blood glucose level of the patient is more than 200mg/dl which is indicating the diabetes. BMG is used as the assessment tool to identify whether the patient has diabetes or not (Ee et al. 2020). This is a simple investigation for detecting the hyper or hypoglycaemia and for indicating the ability of the patient to balance the normoglycaemia. For monitoring level of blood glucose in the blood the glucometer has been applied. The glucometer or glucose meter is a small device that can measure the sugar level after taking blood sample from the patient. This assessment tool is also used for diagnosis process of the patient.
These assessment tools have ensured that the patient has schizophrenia, diabetes and obesity. These tools have confirmed the needs of the patient. Using of these assessment tools can impact the treatment through narrowing down the diagnostic procedure and allows the nurses to track the effectiveness of treatment (Ee et al. 2020). The above nursing assessment tools can help people to provide the safe and evidence based care to the patients. This assessment procedure impacts the outcomes by making sure that the patients are transported to the appropriate receiving facilities.
The Social And Physical Environment Of The Person
As per Chaudhury et al. (2018), indirectly, the physical environment can affect mental health through altering the psychosocial procedure with known sequelae of mental health. Factors of the physical environment can impact the biology or neurochemistry of a person increases the chance of mental disorders (Lähteenvuo et al. 2021). Socially supportive and dependable relationships, personal control and restoration from fatigue and stress are impacted by the properties of the environment. Social environmental factors, as well as some physical environments, can affect the mental health of people. This study has shown that restoration from fatigue stress can affect mental peace. It is supported that poor environmental conditions, ethnic habits or culture can affect mental health. Some toxic conditions can comprehensively enhance mental illness.
In this situation, a nurse can improve the physical environment and the mental health of the patient. Nurses can make holistic care that can address the mental state (Björk et al. 2020). Although registered nurses could not prepare for psychiatric nursing, they still have the responsibility to give care for the people who have mental illness and help them to get treatment for the mental distress. Nurses can get an overview of a person’s health history and make empathy a validation after assessment. They can empower and make partnerships with the patient to make a positive environment. However, this paper has shown how nurses can contribute to the improvement of mental health through making positive environments and interventions.
In this case, the person has developed ADHD at 7 years old. He has faced bullies from the peer group in the school. He had experienced several vulnerable incidents that have led to this situation (Maj et al. 2021). The most important incident of his life is the death of his grandfather which results in the unsatisfactory result of the GSCE examination. He has seen that his father used to smoke cannabis and was abusive to his mother many times. His mother also smoked cigarettes and used alcohol at the time of pregnancy. This person has stated that he is facing psychotic episodes at 17.
Above all information are required to know in the assessment for the nurse to identify the risk factors that can trigger their current health issues. Comorbidity of the substance use and loss of the loved one have triggered the development of schizophrenia. The overall social factors and mental status of the patient have triggered the complexity of the Schizophrenia. It has been identified in the evidences that a long term physical health condition would increase the depression or anxiety.
Schizophrenia can shorten the lifespan of the person up to 30 years due to the diabetes or other health condition (Sigafoos and Gevarter 2019). The person has the risk factors of obesity as he has no proper knowledge of diet. He has continued to drink alcohol and other substances that make his digestion process poor. He always assumed that someone can attack him and it leads him to stab his neighbour. Due to abnormal activities of enzymes or hormones the patient has gained weight which is associated with the diabetes. On the other hand, the deterioration of physical health can significantly increase the risk of developing the mental health issues. This patient had multiple factors that he has less activity or sedentary lifestyle, high level of prevalence of obesity, poor diet and the side effects of substances. Even this person has used the antipsychotic medication for the ADHD that has stimulated the Schizophrenia. In schizophrenia, people generally intends to be inactive and lead a life alone.
Analysing Effects Of Biological, Social And Psychological Factors On Mental Health
There are some mental illness that have been associated to the abnormal functioning of the nerve cell circuits that can connect the specific brain regions. Several biological factors can make negative impact on the mental health status.
Genetics: Genetics, brain injury, infections, substance abuse and other factors may increase different disorders. This person has facing many stress, abusive incidents in school and traumatic events like death of grandfather. This person inherits a susceptibility to the Schizophrenia. The way how the genes of this patient interact with the environment triggers the mental disorders (Firth et al. 2019).
Substance use: This patient has used the substances for a long term which is linked with the schizophrenia. The usage of substances make barrier for the smooth work of the hormones and enzymes that are affecting the cognitive and neurological development of the person (Corbett et al. 2020). Other factors such as poor nutrition and low activity acts as the risk factors of his present mental health.
This patient has suffered from emotional abuse and faced death of his grandfather. He has been neglected in his family as his father and mother used to drink alcohol and other substances. He has poor ability for relating to others as he had ADHD (Gold et al. 2020).
Social factors are certain stressors that may be trigger the illness of a person who is already susceptible to the mental illness. Bullying in schools, substances usage of parents, neglect from the parents, loneliness, anxiety, death of his grandfather, involved in substance use all factors are contributing in the development of Schizophrenia (Ee et al. 2020). This patient has social expectation from his family, friends and neighbours which have not been met.
Critically Appraise The Nursing Interventions
In the intervention, the nurse has used the collaborative intervention with emerging three to four treatment strategies. Different treatment procedure for different illness with support of multidisciplinary health experts. For schizophrenia the psychiatrist and counsellor are involved. In order to treat the schizophrenia the nurse has used the mindfulness based intervention. Mindfulness based intervention can support the patients with schizophrenia through opening the awareness and non-judgemental acceptance. It can allow a more adaptive strategy for coping and controlling over the psychotic episodes to be applied by the patient (Alsubaie et al. 2017).
The training of mindfulness can enhance the ability of a person to regulate the thought and emotion process in a constructive way. This MBI may empower the ability of one to accept and can tolerate different negative thoughts, feelings and sense of peace in mind. In this mindfulness intervention the basic element that the nurse is used training. This intervention can examine the treatment effects to the patient. It is argued by Hodann-Caudevilla et al. (2020), MBI is comparable to those obtained by the therapy of cognitive behaviour for psychosis. MBI includes those activities that help people to be active and happy. In this MBI the mindfulness-based stress reduction and mindfulness based cognitive therapy have been included. It is mentioned by Böge et al. (2020), MBI have clinical relation in the treatment of the patients with schizophrenia. It is one of the promising cure procedure for schizophrenia in developing countries. Long durations of the hospitalization, high amount of symptom burden and cost intensity of the disorders. As it is a collaborative intervention where the multidisciplinary team is working the counsellor and psychiatrist are working together in this intervention. Psychiatrist is implementing the intervention and the counsellor has tracking the progress and evaluating the health status of the patient.
In order to treat the obesity the nurse has assessed the severity by BMI and weight measurement. The dietitian has made a strict diet chart for the patient which is controlling over the intaking of fat. It has considered. The weight loss diet plan is a major part of intervention or treatment of obesity. The dietitian has included plenty amount of fruits, vegetables in the diet plan. Meat, eggs, beans and some non-dairy sources have been included in the diet (Boles Kandimalla and Reddy 2017). However, regular exercise is a part of this intervention to maintain the calorie. According to Freitas et al. (2017), exercise in obesity not only reduce the risk factors of obesity. It can reduce the asthma and other chronic conditions.
Diabetes can be managed by proper diet plan and self-management. For self-management the nurse has given proper education how to manage diabetes. The importance of monitoring blood glucose level per day has been conveyed to the patient and give instruction how the patient can use glucometer to check the blood glucose level in blood. According national standard of 2017, the Diabetes self-management education and support is the critical component of the care for all people who have diabetes (Beck et al. 2017). As per Sherifali et al. (2018), self-management education can facilitate the patient to take decisions that results in the improvements in attitude, knowledge and healthy behavior. It is a systematic intervention that involves self-monitoring type active participation and making decision by applying the skills and knowledge (Borgestig et al. 2021).
However, in this intervention the health professionals also given pharmacological support to the patient. The prescribed medications to control diabetes and schizophrenia has been followed. It has been given to the patient on regular basis.
However, these circumstances can be warranted the reframing of current treatment procedure towards the more evidence-based integrative model that may better address the issues of real-world psychiatric disorders and mainly comorbid physical conditions. The patient has multidisciplinary issues with complex needs; a complex intervention needs to be implemented which is built up from the number of elements that may act both interdependently and independently (Sildorf et al. 2018). Different health service activities can be considered complex. Evaluation of complex interventions would pose a considerable issue and needs a substantial investment of time. As the patient has mental health issues and physical health issues, the intervention considers pharmacological therapy and evidence-based supportive social therapies. It has been followed the integrative model of care that embodies evidence informed, a personalised approach using the adjunctive and pharmacological treatments through an approach of collaborative care. The intervention plan and design has been presented below –
For the complex needs of this patient, collaborative care approach has been followed in this intervention. As per Enggaard et al. (2020), it is an evidence-based intervention approved by using the RCT tool in several studies. Needed to foster a close working relationship between the healthcare team members (Hwong et al. 2021). It can involve the integration of primary and secondary healthcare for delivering high-quality care for the patient and improving results of both physical and mental health. Collaborative care engages more than one health care professional from mental and physical healthcare. In this intervention, systematic efforts have been used to treat the comorbidity of schizophrenia, diabetes, obesity and ADHD. In this intervention, integrative therapies and lifestyles have been analysed for their usefulness as adjunctive therapies for ADHD and schizophrenia. CBT therapy has been merged with physical activity as a treatment of ADHD and Schizophrenia.
Even psychoeducation for the patient and family have been used to treat the mental illness. In a few randomised studies, the efficacy of CBT has been found in adult ADHD as it can affect the aspects of emotion, core symptoms, time management and self-esteem strategies. CBT is one of the limited types of the talk therapy technique. For treating schizophrenia, this CBT is used with medication in the intervention plan (Kafali et al. 2020). In this talking therapy, the symptoms such as hallucinations, the confused pattern of thoughts and difficulty in focusing can be eliminated. Check in about present mental outlook, discussion of the present medication status, following up on topics discussed in the previous sessions and reflections from the patient (Raymond et al. 2019). These overall stages have been performed in this CBT therapy for this patient. To treat obesity, the diet has been maintained and encourages the patient to monitor the glucose level in the blood by using the devices. The changes in lifestyle including exercise and diet plan, help cure diabetes.
This intervention plan has included the physical activity, interventions of dietary, behavioural therapies and prescribed medicines in this collaborative care. The effectiveness of this intervention plan has been evidenced by (Ee et al. 2020).
It is stated by Instanes et al. (2018), collaborative or including non-pharmacological and pharmacological treatment in the intervention is one of the successful treatment plans to meet the complex needs. This intervention plan is not only about the treatment process. It is also about the development of a healthy environment. The nurse has promoted health by making good relationships with the patient (Cashin et al. 2018). This intervention is also intended to encourage healthy behaviours and identify or treat the symptoms at the early stage of the patient (Eaton et al. 2019). In this practice, the nurse has integrated the promotion of mental health and prevention. The nurse has ensured good communication with a mutual learning process to promote health. This intervention can help the nurse take the actions mentioned above for overall patient care (Carney et al. 2021). It includes the treatment teaching moments that are intended to enhance the patient’s comfort and health. This intervention plan is implemented in this overall nursing plan.
In nursing practice, the important area is to ensure the protection of health, well-being and human rights. There is a need to protect the patient from living free from abuse, harm and neglect. There is no doubt that early intervention is most vital in the safeguarding of vulnerable adults. Early intervention can promote the safety, development and stability of society at a huge cost saving (Chen et al. 2018).
Ethical consideration: During the development of the intervention, the nurse has the responsibility to give impartial care and can ensure safety in emergencies. The nurse has maintained the confidentiality of the patient during the intervention and identified the safeguarding concerns, and taken action (Dindo Van Liew and Arch 2017). The nurse has considered the right to live in the safety of adults and make sure they are free from neglect and abuse. The nurses have supported and considered the wishes to make decisions in their interest. In this intervention, the nurse has included the least number of restrictions about leading a life (Madden et al. 2021).
The patient has participated as fully as possible in any decision about the intervention. In this intervention, the patient has wished to participate in exercise and want to eat low priced food that is included in the diet (Machiels et al. 2017). In the making of intervention, the nurse has tried to protect the well-being, rights, safety by measuring with the scale of risk-benefit, confidentiality and privacy of the vulnerable subjects that are appended safeguards which are prerogatives of the boards of ethical review (Hynie 2018). During this intervention, the nurse has balanced the accountability through maintaining anonymity and encouraging the patient to communicate openly.
Contribution Of A Nurse In Promoting A Healthy Environment
In primary healthcare, the nurses are at the main role of coordination. Registered nurses are best able to perform health promotion activities by improving the quality of life by assessment of needs of the individual, recognition of resources, education and establishment of programs to eliminate the mortality rate and costs of the healthcare (Van den Bergh et al. 2020). The nurses can educate the patient on how the patient can use different monitoring devices to observe the glucose level in the blood. Nurses can work in different venues with a wide range of responsibilities in the prevention or intervention and wellness of the patient (Yu 2018).
The nurses can respect health promotion activity and implement various health promotions. In this intervention and nursing care, the nurse has played the role of general health promoters who are patient-focused. In the context of general health promoters, they expect to have the basic knowledge of health promotion which are effective action (de Nooijer et al. 2021). The nurse has applied the knowledge of health education in the intervention. Motivates the patients by giving health education. It is stated by Eaton et al. (2019), while the health promotion for the patient groups who need a high level of care and the curing process is required. In this case, the nurse can involve the health promotion activities in the regular nursing practice (Kelley et al. 2020). The nurse has professionally interacted with the physical illness by recognising the signs and symptoms of the patient then promoting health.
It can be concluded that the nursing intervention is effective for the comorbidity of diabetes, schizophrenia, obesity and ADHD. The intervention has included all types of protection or safeguards for the patient. This paper has established that the physical or biological environment of a person has a relationship with mental health. It is appropriately displayed that the nurse can promote a healthy environment that can improve a person’s mental health. Complex care is quite difficult to implement as it has to include multidisciplinary health experts and proficiency. There is no doubt that the above intervention can give a better result for the patient to recover quickly. It has been presented that a person’s physical environment is associated with mental illness. It has been shown comprehensively that physical health deterioration and social circumstances may cause mental illness. However, in this intervention, the nurse has taken the right decisions and given priority to the patient’s wishes during the implementation of the intervention. This paper has achieved all learning outcomes by discussing the role of nurses in the treatment of complex needs and it has presented the aspects of neurodevelopment biological and genetics factors that may vary in the development of the intervention.
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