Mental health nursing

Answer

Long Answer Questions: Part 1 Q1

                According to statistics presented by the World Health Organization (WHO), more than one billion people across the globe have some form of disability. According to Vergunst, Swartz and Hem (2017), persons with disability find it difficult to access health care services and thus record a high rate of unmet health care needs. Despite having an increased need to seek health care in comparison to persons without disability, people with disability find it difficult to access health care, and hence an increased rate of unmet needs. The statistics presented by the WHO on the people with mental disorders supports this factor by depicting that approximately 85% of mentally-ill persons in developed nations do not receive any form of treatment on an annual basis (WHO 2018). The research completed by Wilkinson, Lauer, Freund and Rosen (2011) reiterate this by depicting that women with intellectual disability will rarely receive breast cancer screening in comparison to those without. Disability affects access to health care services as a result of several factors such as prohibitive costs. Transportation and health services affordability are considered as the primary factors which prevent people with disability from accessing health care services in low-income destinations. Moreover, people with disability find it difficult to access health services due to their limited availability or structural barriers. For instance, Sakellariou and Rotarou (2017) show that in the UK, inaccessible buildings and poor transportation has increased the rates at which people with disability find it difficult to access proper care services.

                Disability affects perceptions and experiences about health care. According to de Vries McClintock et al. (2016), people with disability have a negative experience and perception about health care. Notably, a person with mental disability once complained of a negative experience as the doctor found it difficult to treat his condition complaining that his symptoms were interrelated and no doctor would easily put them together (de Vries McClintock et al., 2016). Moreover, disability affects the experiences and the perception of the mentally-ill patients which further discourage them from accessing care as most patients find it difficult to communicate effectively with the health providers (de Vries McClintock et al., 2016). Notably, most healthcare providers find it difficult to communicate with patients who are mentally disabled if they are not in the company of a personal who is mentally fit. Therefore, offering care to them has proven to be a difficult factor. Moreover, gathering critical information associated with medical conditions during the events of medical emergencies for people with mental disability makes it difficult for the health care professional to administer the needed care. Moreover, Kendrick and Pilling (2012) state that lack of knowledge about the health disorders which affect mental health may influence the treatment options which further influence the treatment access of the people with a mental disability. Many people with a mental disability hold a perception that when they access care, instances of child protection cases may arise which may result to children being taken away after their diagnosis which further ends up discouraging most from accessing care (Kendrick and Pilling 2012).

                Nurses can address the issues likely to arise when dealing with patients with a mental disability. According to Knaak, Mantler and Szeto (2017), people with a mental disability have reported being dismissed and devalued by the health care professionals which have also discouraged them from accessing care. In my clinical practice, the use of models which emphasize on strong leadership when it comes to addressing the sources of stigma and implementing stigma reduction metrics will be effective in encouraging the people with disability to access care (Knaak, Mantler and Szeto 2017). Also, I would also engage in patient coaching sessions which will inform them of the importance of seeking health care and overcoming their negative perceptions about disability. This intervention will be effective in myth busting and reinforcing proper attitudes which does not negatively impact care (Knaak, Mantler and Szeto 2017). Evidently, in practice, patient coaching has proven to be an effective technique which has changed the behavior of many chronically-ill patients and hence is likely to influence how the people with disability access care. Arguably, recovery-oriented models which are also person centered have proven to be effective in informing the patients about the importance of accessing care for their personal benefits hence encouraging them to overcome the negative attitude which inhibit care access (Knaak, Mantler and Szeto 2017).

Long Answer Questions: Part 1 Q3

                Inter-professional collaboration in the field of health care has been one of the high political agendas in the recent past. Despite this, the progress to achieve this collaboration has been slow. Clients of mental health services have unique needs which require the implementation of a multidisciplinary approach to the delivery and planning of care (Lake and Turner, 2017). In the field of healthcare, collaborative efforts are effective in yielding better health outcomes for the patients being served. Evidently, the collaborative efforts of the professionals in the health care field result to enhanced skills mix, improved efficiency, intensified levels of being responsive, better holistic services, creativity and innovation alongside a better user centered practice (Green and Johnson 2015). According to the WHO, inter-professional collaboration is effective in enhancing better health outcomes by enhancing the level of responsiveness to diseases. Moreover, in collaborative care environments, conflict among the health care staff, patient mortality rates, and error incidents have also significantly declined suggests an enhanced caution and patient care.

                Inter-professional working by aid in enhancing the partnership working between the patients and the staff members by improving on communication, and hence reducing error potential. Vega and Bernard (2017) note that through inter-professional collaboration (IPC), sharing knowledge between the nurses and the patients is enhanced with an aim of ensuring that the two parties work towards a common goal. Bosch and Mansell (2015) reinforce this factor further by outlining that inter-professional collaboration is fundamental for the success of a patient-centered care. Arguably, with the IPC, the hospital staff members will focus on meeting the needs of the patient rather than the personal contributions of each professional. This is a fundamental element towards the success of the practitioner as well as the patient outcomes.

                It is also a fact that an effective IPC will aid in enhancing the partnership working between the patients and the staff through an enhanced patient education and engagement in the care offered (Morley and Cashell 2017). Through patient education, the mentally-ill patients can be encouraged to embrace positive behavioral changes such as taking part in the process of decision making and the participation in effective self-care (Malla, Joober and Garcia, 2015). When providing the patients with information, responsive and consistent approaches are implemented by the staff members to guarantee their understanding and hence exposing them to an environment where they can take part in making effective decisions related with care. Arguably, patients should be considered as the primary actors in the process of medical decision-making while the health professionals are required to offer a supportive role. When the patients are effectively trained on self-care, their general level of satisfaction with the care services is enhance which is further associated with better outcomes.

                Bridges, Davidson, Odegard, Maki and Tomkowiak (2011) further provide that effective inter-professional working can aid in enhancing partnership working between the staff and the patients by enhancing the patient safety benefits which further enhances patient outcomes. Evidently, fostering collaborative teams have the potential of benefiting the patients through a reduction in medical error. Rosen, DiazGranados, Dietz, Benishek, Thompson, Pronovost and Weaver (2018) argue that when the inter-professional collaboration team is resilient with the members trained to work cooperatively, safely and in a coordinated manner, then they are likely to be focused in preventing events which may result to poor quality assurance measures. There are several cases where poor practices resulted to untold events. For instance, poor communication failures among healthcare professionals in health care resulted to poor patient outcomes. For example, in acute care setting, the members of the IPC are required to engage in effective communication when handing over during shift changes. However, this was not the case in Welfare and Sports acute care setting in Netherlands in 2011. Evidently, the members of the collaboration team referred to as the Netwerk Acute Zorg failed to engage in effective communication to establish an agreement about the team collaboration in the acute care setting. As a result, a seamless transition was not experienced between the acute care phases thus hindering the continuity of care. The outcome was detrimental as it constituted patient neglect and the potential patient harm which could have been avoided. Notably, the failure in communication increases the potential for patient complications and their stay in the hospitals as well as a reduced patient satisfaction (Van Leijen-Zeelenberg et al. 2015).

Conclusion

                To summarize, nursing professionals should consider working collaboratively to offer adequate care to mental health patients. Additionally, effective policies should be established to enhance the rate at which people with disability access care to promote their health outcomes.

Transcript Analysis

Part 2, Q1

                Lussier and Richard (2009) derive that nurses have a responsibility of handling patient cues. Approximately 85% of diagnoses in general in mental health can be generated from analyzing the symptoms of the patient. Therefore, effective listening is considered as a critical skill which the health professionals should have (Jahromi, Tabatabaee, Abdar and Rajabi, 2016). In the transcript, the nurse missed several cues relayed by the patient. For instance, Mr. Dhesi tried to show his concern about what could go wrong during the surgical process that could require resuscitation. Additionally, the patient also posed a question about what do not attempt resuscitation (DNAR) is and why it is associated with resuscitation. However, the nurse overlooked the cues leaving the patient’s concerns unaddressed. Engaging in active listening could have assisted the nurse to spot the indirect aspect of the cue relayed by the patient, hence making it possible for the nurse to “test” the patient’s reaction. Active listening would, therefore, be considered as a technique which could have enhanced the nurse-patient relationship.

                Active listening could have also made it possible for the nurse to identify Dhesi’s non-verbal cues and the need for clarification. For instance, if the nurse was actively listening, she could have established that the patient was confused about why they were engaging in the resuscitation discussion. Therefore, she could have taken the initiative to expound on the matter to provide the patient with a peace of mind before undergoing through the surgical process. Moreover, through active listening, the nurse could have established that the patient was getting agitated with how she was handling his concerns. For instance, the patient’s facial expression and tone of voice after the nurse called him “silly” suggested his agitation.

Part 2, Q 2

                Discriminatory attitude is one of the common barriers to effective communication between the nurse and the patient. Norouzinia, Aghabarari, Shiri, Karimi and Samami (2015) outline that nurse-related barrier such as the practitioner’s negative attitude can inhibit effective communication. In the transcript, the nurse shows several discriminatory attitudes which can be detrimental to the manner in which the patient values the ongoing interaction. One of the discriminatory attitudes evident in the case includes the nurse’s statement that she prefers the Sikh to the Muslims and even goes further and considers Poles to be better than Muslims. Also, the nurse appears to have a discriminatory attitude against the old people. This is illustrated at the point where the patient mentions that he runs 5 miles to keep fit. Evidently, at this point, the nurse said to the patient that at his age, he does not want to upset the doctors.

                The discriminatory attitudes of the nurse towards the patient can have several potential concerns such as the establishment of a poor relationship with the patient. Arguably, patients are known to be less acceptant of nurses who have different interpretations (Varcarolis 2012). Additionally, this can also affect the patient’s self-esteem hence discouraging him from engaging in effective self-expression which may further affect how he feels about the services offered by the institution. Arguably, the patient may find it difficult to communicate his concerns about the surgical process which further suggests a reduced patient interaction. Notably, communicative needs and the ways of expressing emotion vary in different religions and culture. As a result, the nurses are required to have sufficient knowledge regarding the language, culture, beliefs and customers of the patients to assist them in engaging in effective communication without judgment or prejudice.

                The discriminatory attitude can also result to patient anxiety and tension as he will be in fear about his safety. Evidently, the patient will lose trust in the staff members and their capacity to provide safe and adequate care for him. According to Norouzinia et al. (2015), if the nurses fail to be successful in establishing an effective communication with the patients, the patient will lose trust in the process as well as in the other members of the medical team which may poses further challenges to the patient’s health. It is also a factor that the discriminatory attitude of the nurse may discourage the patient from undergoing through a surgical procedure as intended through a decreased morale. Stimpson and Joyce (2013) suggest that the poor attitudes in communication create instances of incomplete communication. With the incomplete delivery of information, Dhesi may show a lack of trust in the process and also decide not to undergo through the surgical process which could have enhanced his quality of life. Also, the negative attitudes can also give rise to conflict which may occur between the nurse and the patient. Evidently, the constant ridicule of the patient regarding his age and knowledge is highly likely to prompt him to limit his form of communication during the interaction. The potential outcome of this is increased dispute between the two parties which further disrupts the professional atmosphere and the ability to offer effective health care services.

Part 2, Q 3

                Nurses are the direct care providers in a health facility. The smallest delay in the provision of care by the nurses can constitute medical negligence. Despite the fact that the medical team is composed of different professionals, the nurses have a direct relationship with the patients and the image they create will affect how the patient accepts the other members of the multidisciplinary team as highlighted by their ability to establish an effective means of communication (Kwame and Petrucka 2020).  In the transcript, several instances of disempowerment can be seen based on the manner of the nurse’s communication as he interacts with the patient. For instance, it can be seen that the nurse constantly engages in flattery when interacting with Mr. Dhesi. For instance, the nurse asks the patient if he has false teeth after putting forth a statement about his old age. After the patient states that all his teeth are real, the nurse asks if she can take a look and later indicates that she is kidding. Additionally, the nurse also disempowers Dhesi by failing to show a genuine interest in him during the assessment process. This is reflected by the fact that the nurse constantly fails to listen to the patient. Clearly, Dhesi uses cues to show his concerns and areas where he needs clarification but the nurse ignores him and instead continues with his assessment process. Moreover, at the end of the assessment, the nurse notes that the patient has already consumed too much of her time and there are already other patients waiting.

                The nurses’ disempowerment is associated with several drastic impacts. For instance, the patient ends up losing his sense of safety as he does not understand what may happen if his surgical process fails and resuscitation is needed. Additionally, the disempowerment results to drastic negative impacts for Dhesi as he loses his sense of love and belonging as reflected in the Maslow’s hierarchy of needs. Moreover, his self-esteem levels go down especially since the nurse constantly attacked him for his old age and knowledge potential (Vertino 2014).

Part 2, Q 4

                According to Hanson and Pitt (2017), informed consent before surgery is a fundamental component of surgical practice. An informed consent for a surgical process will require that surgeons engage in communication with their patients about the surgery required to take place to ensure that a patient haves trust in the surgeon’s specialty and the process (Hamaguchi 1998). Evidently, it is a legal expectation that all patients should complete an informed consent before undergoing through a surgical procedure. In the case, it is evident that the patient was not informed of all the necessary risks likely to occur during the surgical procedure but he was still required to sign the informed consent. The fact that he was not aware of the fact that he might face complications and require resuscitation supports this fact. Additionally, it is evident that the surgeon is directly impacted with the responsibility of informing the patient about all the necessary requirements, including the risks associated with the process before the patient signs the informed consent. This creates an opportunity for the patient to engage in a discussion with the surgeon before the surgical process. However, it is evident that the nurse was the one who took this responsibility and in turn did not answer most of the questions posed by the patient.

                The manner in which the consent matter was handled in the case might result to several consequences. For instance, a legal consequence may be experienced in this case whereby the facility may be charged for overlooking the legal guidance about patient consent. Medical negligence is also a potential consequence in this case. Notably, the patient will be undergoing through a surgical process that may pose a danger to his health without his knowledge. This may further affect the physical and mental health of the patient in the future (Agozzino, Borrelli and Cancellieri 2019).

Conclusion

                Conclusively, nurses have a responsibility to understand the patient’s verbal cues within a mental health facility. This can only achieved through an effective means of communication between the nurses-patient interactions. Thus, it is recommended that nurses should go through mandatory training to enhance their skills to effectively interact with the patients.