Skills and nursing interventions

Table of Contents

INTRODUCTION:

The focus of this assignment is to evaluate the assessment and care plan of a service user under the mental health services. This essay will use an evidence-based approach which will enable a record, review, and monitor the improvement of the patient. The evidence-based practice is framed and organized approach in accepting a research-based accomplishment of effectiveness to inform practice (Olfson,2009) The care plan used would be found in the appendix. According to Gulanick and Myers (2017), describes a nursing care plan as a document which gives direction on the kind of care an individual may require, which pinpoint the assessment about the patient’s health, how, when and where to use the right interventions and what is the expected patient outcome.

This essay will make more emphasizes on the skills and nursing interventions contained in the care plan. The service user will participate throughout the course of their treatment.  A person-centred and interventions that are evidence-based will be displayed throughout the essay. A full background of the service user receiving care in the acute unit will be provided. Nursing care plan helps people to understand the patient and promote continuous care provided. Throughout this essay, l will maintain confidentiality by adhering to the Nursing and Midwifery Council (NMC,2015). The pseudonym (Kim) will be used throughout the essay. Kim has been diagnosed with schizophrenia.Biography:I had my placement in a recovery unit which is a 20-bedded adult ward with male and female patients aged between 18-65 years with a typical stay of 3-12months, the unit provides care for both acute and forensic patients. I choose Kim during this assignment because l wanted to understand more about schizophrenia disorder, the symptoms, treatment, and causes. Kim is a 28 years old single woman with the diagnosis of schizophrenia.

She was admitted under section 3 of the Mental Health Act 1983 as amended by 2007 in a low secure unit. Kim was admitted into the hospital for attempted suicide by drowning herself.Kim said she has never been married and had no partner at the time of her admission, though in the past she said has been in a relationship. Kim said it didn’t work well because her ex-partner was abusive towards her and gives her illicit drugs. Kim said her mother also suffered from schizophrenia. Kim stated that her birth was normal had a good childhood and upbringing. Kim said she has been a frequent patient to the acute ward for the past five years with a history of disengagement and not using her medication. Kim state that she is a hyperactive person with bizarre behaviour (believe the Queen is her grandmother) Kim said she has a college qualification but has never been able to keep a job because of her mental illness and so she has been on benefit most of her life. Kim also said she experience the television talking to her always, telling her to do bad things to people or herself. She said she enjoys working with animals, baking and watching ‘Coronation Street’.

Assessment: In mental health, assessment involves planning, implementation, evaluation and assessment (APIE). According to Barrett et al (2009) pinpoint they should be six different stages which should be included in the nursing stages and should not be ignored that is systematic diagnosis and recheck (ASPIRE). Assessment helps the team to understand the service user as an individual, It gives an understand and extensive background which will help nurses to utilized different therapeutic approaches and tools. Holland (2008) describes assessment as a continues process which is used to clarify the service user’s needs, what they prefer and the strength of the service users. (Jenkins,2008) describes the first stage before assessment, the nurses should inform the patient the reason why the assessment is carried out, making sure the environment is the conducive and coping mechanism of the service user. The method of using assessment for a patient with mental health involves gathering various information.

The nurse will use both non-verbal and verbal communication.  Barker and Buchanan-Baker (2005) argue, saying to understand the patient will we have to be an ‘apprentice’. Barker (2008, pp.66) defines assessment as a method of understanding the patient through the gathering of important data relevant to the patient’s mental health. Wrycraft (2015) argues it is difficult to understand another person, in the way they feel. This helps to understand the patient. It is also vital to look at the different aspect of the patient during the assessment, such as family background, history, symptoms, beliefs, feelings and many more. During assessment getting, relevant information is the optimist thing because you will get to know what the patient can do as well as what they cannot do.

McCormack, Manley, and Garbett (2004) identify that the way of getting information involves a certain level of relationship with between the patient and nurse which involves interaction effectively to be able to build the relationship. Kim had a good rapport with my mentor since she was admitted previously in the unit and they share few hobbies together. Models: According to Pearson and Vaughan (1993) A model represent the image of practice which represents the actual thing. A nursing model is significant to decide what is essential and important in giving individualized care (Barrett, Wilson, Woollands 2009) Roper, Logan and Tierney describe a nursing model as an important aspect of ‘nursing activities’ in various field of nursing. The Roper, Logan, and Tierney model (1996) emphasis on 12 activities of daily living. The nursing model uses a holistic care approach. Choosing the ideal model is essential because it makes the care planning works. Pearson and Vaughan (1993) explain that the nursing model is relevant in hospital settings. A model is a norm and values which needed to be followed to achieve a significant goal. Most of the nursing models have their own advantages and disadvantages it’s up to nurses to choose any relevant one for their own individual patient.

Roper, Logan and Tierney model are significant on twelve activities of living which the patient is being accessed. It is suggested that the model is useful for accessing the intensive care environment. It promotes continuity and independence of the patient activities of living. The Roper, et, al. model gives lesser problems among the nursing team, because is easy to understand, follow and not complicated. Tierney (1998) believe the model encourage nurses to work together with medicine instead of differentiating the two. The model can be used in the various nursing field, the ADL helps nurses to formulate an individual nursing care plan. The activities of living by Roper, Logan, and Tierney was argued by Fraser (1996) that the method was physical in assessing the patient. it as being criticized as too medically align an emphasis mainly on activities of living, also used basically for the checklist (ticking box) by nurses on how the life of a patient has changed since admitted instead of promoting independence.  Peplau nursing theory suggests that the reason for nursing is to help the patient recognized their problems and work towards the same goal of helping the needs of the patient.

The model emphasis on interpersonal value, the importance of nurses, it says the nurse’s patient should work together. Peplau suggested that nurses should have a good therapeutic relationship with their patient because it gives the patient a sense of belonging in their journey. The tidal model is a recovery model which can be used as a basis for interdisciplinary mental health care. The model is a recovery model which was developed by Dr. Phil Barker and Poppy Buchanan-Barker which helps with the understanding of mental health (Barker and Buchanan-Barker,2010) The tidal model has been said to be person-centred care, it has helped patients to get better and involved in their care. (Morrisey and Callaghan, 2011) Tidal model, helps people with mental health recovered and be in charge of their own lives. It focuses on recovery journey when the patient is at its lowest, facing difficult times (Barker and Buchanan- Barker, 2010) The nursing model identifies that the nurse can use a “holistic assessment” which helps the patient to express their own experience. The model emphasis on person-centred care and the patient take control of their own lives. In this model, the nurses have the opportunity to explore the patient background and problems which has to lead to their admission. I have adapted the Tidal nursing model for this assessment and care planning which will be used throughout this assignment, this model will give more insight into an understanding of the process of assessment and care planning.

Diagnosis

Schizophrenia is a psychotic disorder, it is split into two positive and negative. Schizophrenia is a complex disorder which affects people mainly with mental health (Rigby and Alexander 2008) There are different treatment option which professionals can explore. Auditory hallucination is a popular symptom of paranoid schizophrenia which affects their daily life activities and social life. Kim experiences an auditory hallucination. The Diagnostic and Statistical Manual of Mental Disorder (DSM) 5 analyse Schizophrenia, for a service user must have 2 symptoms of this either Hallucinations, delusion, or disorganized speech (Frankenburg,2018) Holzman (2012) disagree, made different concerns in respect to using Diagnostic and Statistical Manual of Mental Disorder (DSM-5) and the effect on the person involved. Kim has been diagnosed with Paranoid Schizophrenia which is prominent hallucination and delusions (International Classification of Diseases {ICD} 10 Data, 2018) with Kim her symptoms are delusions, she believes people want to kill her through the television. According to DoH (2010) expressed that permission is a very important part of stages of care and treatment, the patient gave us verbal permission and my mentor explained to Kim the reason for the meeting and asked for her consent before allowing me into the room. My mentor told her she may wish not to attend the meeting, it was entirely up to her. My mentor chooses a quiet room outside the ward, the setting of the room was arranged in a way that would have a good eye contact, a comfortable posture.

The environment was relaxing which helps patient to concentrate and participate throughout the assessment period Egan (1998).  Kim was welcomed by my mentor and compliment her dressing also offered her a cup of tea. Throughout the assessment, Kim was at ease. The tidal nursing model suggests that a person-centred care will help patient engagement and cooperation. Mental health nurses can use varieties of communication methods. NMC (2015) suggests the different kinds of techniques, says the code which nurses can use verbal and non-verbal communication method to have a clear understanding and needs of the patient. Riley (2008) describes communication as a method of getting or obtaining messages. Ali (2018) pinpoint that from time to time non-verbal communication can be robust than spoken words. Assessment should be straight-forward and easy to understand, it should have patient medication prescription and diagnosis. Kim responds to all the questions she was asked, though some questions where distressed for her. My mentor made sure all the questions were short and open which encouraged her to respond and give feedback.

According to Varcarolis (2014, p 24) suggests that looking out for patients’ ‘non-verbal cues’ benefit us to know what questions to ask without making the patient angry. As a nurse, one must be a good listener not only for the patient, but also things not mentioned. Active listening requires good eye contact (Miller and Webb,2011) My mentor had a good therapeutic relation, Kim engaged well throughout the assessment. She was asked if she had any questions but nodded her head saying no. My mentor avoids using phrases and ambiguity words, instead she used words that can be understood by the help patients to avoid misinterpretations.Assessment involves many aspects not only collection of information, but it also entails the use of effective communication and a good insight of the person suggested by Wycraft (2015) Assessment encourages people to talk about the problem they are experiencing. It is very important that nurses show genuine concerns towards their patient. Listening is very important and it can be shown by verbal gestures i.e. nodding your head, facial expression. Giving feedback to the person to show you understand all that was discussed during the assessment is important.Tidal models believe that recovery begins when a patient is admitted into mental health services and in their minimal level.

Tidal model is a very good model to use in mental health settings because is among the most successful models, the other models are more into evaluating the patient and make the nurses to decides on what they believe is the problem and what other measures to follow. Though the model is criticised to be laid back nursing model. The tidal model allows the patient to tell experience like storytelling, by encouraging them to look back and evaluate the experience and progress. The model put more emphasis on Recovery.Risk assessment helps to have a good understanding of an individual’s probability of being violent, helping the individual to improve and have effectual treatment programs. (Snowden et.al., 2009) Kim shows two signs of aggression which needs to be looked at in the risk assessment.

Risk assessment was carried out by my mentor, Kim has been aggressive towards other in the past when deluge with schizophrenia symptoms. Kim told my mentor that her delusional belief is getting better after being hospitalized. The two things that influence Kim’s symptoms and behaviour, is when not using her prescribed medication and illicit drugs. Kim history of schizophrenia with delusional thoughts could be seen as a warning sign of potential risk to herself or others. Kim said during the assessment that her illness had made her break up from her first boyfriend and as a result, be she had not been able to get into a relationship. At the moment Kim is not a threat to herself because she uses her medication regularly. Kim was asked a direct question if she had any definite plan to end her life or potential to harm others. My mentor intervention was to guide her in small steps like healthy coping mechanisms to overcome stressful times.I have been able to discuss my patient (Kim) who was admitted to an acute unit due to an about her attempt to kill herself by drowning, this is not her first admission to the unit. Kim is diagnosed with paranoid schizophrenia which she really struggles with. Kim had an assessment with my mentor in a side room outside the ward.

My mentor was Kim previous primary nurse in her first admission, Kim already had a good therapeutic relationship with her. I explore the different nursing model and I the strengths and weakness of the model and why l chosen the Tidal nursing model which is a recovery model. Care planning:Care planning:A care plan is formulated by the nurse in agreement amongst the other professionals and the patient. Is a therapeutic method which involves working together with the patient, their families and carers.A care plan is a documented plan from a nurse’s view on how to take care of a person. Barrett, Wilson, Woodlands (2012a) suggests, a care plan is a document which helps to understand risk and needs of a person being cared for. The main diagnosis Kim is Paranoid schizophrenia, as the process of identifying the problem of Kim’s condition continues, after many background investigation my mentor found out that her ex-partner bullies her by talking her down. A care plan is a ‘living document’ which is shared between the primary nurse, the patient you are caring for and a care co-ordinator. A care plan is used to set sensible goal for the patient recovery and guiding their conditions.

It is written in a simple way which the patient can understand and if necessary visual aids to help the person understand (McDaniel et.al.,2014) The patient views should be seen in the care plan. According to Haggerty et al.,2013, criticise that using a simple language does not reflect the patient’s view in the care plan.     APPENDIX 1:Assessment NursingDiagnosis Plan Intervention EvaluationObjective: Her thoughts and feels is not the realityAgitatedSubjective: Patient said the television speaks to her, she had used illicit drugs in the pass, mom had schizophreniaParanoid schizophreniaViolenceHallucinationPatient would not be violent to peersBe able to recognised the triggers and verbalise it with staffPatient would have a better relationship with peers and staff Encourage patient to speak with staff if she hears voices in her head. Have a flash which she shows staff when struggling with her symptoms