To avoid a breach of confidentiality service user will be referred to

To avoid a breach of confidentiality service user will be referred to as “Danielle”, a pseudonym (Griffith, 2015). In health care setting it is patient’s right to be independent for their private and health information that what and how much information should be shared to others, (Nursing and Midwifery Council, 2018). In addition, Nurses are required to obtain valid consent from patient before any treatment and People with learning disability should not be assumed to not have capacity to understand information. The Mental Capacity Act 2005 requires that every adult has the right to make decisions concerning their care and treatment, everyone must be assumed to have capacity and provide consent unless determined otherwise (MCA, 2005). Therefore, the learning disability nurse should assume that Danielle has capacity unless determined otherwise.The purpose of this assay is to analyse the bio-psycho-social factors influencing the psychological vulnerability and well-being of people with learning disabilities. In addition, identify the relevant evidence and explain the rationale for interventions adopted in supporting the psychological and mental health needs of service-users. To achieve this, the student nurse will use the given case study firstly, to introduce Danielle’s biological, psychological and social health needs. Secondly, analyse how Danielle’s health needs could impact/influence her psychological health and wellbeing. Thirdly, the student nurse will consider the prevalence of Bipolar for people with learning disability in the UK. Finally, the nurse will use the assessment tools (Pass add) to assess, plan, implement and evaluate Danielle’s psychological health and wellbeing, In 1977, American Psychiatrist George Engel introduced the Biopsychosocial Model. The model accounted for biological, psychological, and sociological interconnected spectrums, each as systems of the body. The Biopsychosocial model provides a basis for understanding the determinants of disease and arriving at a rational treatments and patterns of health care, a medical model must also consider the patient, the social context in which he/her lives, and the complementary system devised by society to deal with the disruptive effects of illness (Wade & Halligan, 2017). Linking to the case study, the nurse will use the Biopsychosocial model to determine Danielle’s biological, psychological and social health needs. Danielle is 53 years old, she has a little sister named Kelly (pseudonym). Danielle lives in supported living house and has a carer who comes once a week for four hours to help her with bills and finances. Danielle works at the local sport centre where she helps in administration. Danielle got paid for her job and she really enjoys working. Working and getting paid help her not only to socialise with others but also to be financially independent. She has some facilities at the centre. For example, she has free swimming session and she really enjoys swimming. In addition, Danielle has mild learning disability, mental health and Bipolar mood Disorder. Danielle also has psoriasis and she has red patches on her neck and arms and she is very anxious and embarrassed about that. Danielle is on Olanzapine and lithium that helping to restore the balance of certain natural substances in the brain and to treat certain mental/mood conditions (schizophrenia, bipolar disorder) (Kluge et al., 2014). Danielle has difficulty to sleep, she is not eating properly, and she forgot to eat, or she is saying that she is not hangry. She has some pain in her joint (symptoms of psoriasis) (Tsoi et al., 2012). Several studies have identified the strong association between the presence of chronic pain and mental health conditions, such as depression, anxiety or mental health in general (Bair et al., 2008). For example, there is a link between depression and pain. (Davis et al., 2011). According to Davis et al., (2011), 65% of patients with depression experienced pain, this review concluded that patients with moderate to severe pain were more likely to experience greater symptoms of depression, no awareness to treatment for depression, and worse depression outcomes, such as lower quality of life and decreased work function.One of the side effects of Danielle’s medication is lack of sleep (Norris et al., 2013). Danielle’s sister stated that she has very bad sleep, Sleep problems appear to represent an underappreciated and important warning sign and risk factor for suicidal behaviours. (Ribeiro et al., 2012). The same research indicating that disturbed sleep may lead to depressed mood as well as anxiety, drug abuse, and alcohol abuse symptoms. In addition, Bassett, et al., (2015) stated that, poor sleep behaviour occurring over a limited time period induces changes in mood as well as diminishes awareness and cognitive performance. However, the effects of poor sleep behaviour are cumulative. More specifically, chronic poor sleep and chronic insomnia have been linked to elevated risks for negative physiological and mental health outcomes. Therefore, several lines of evidence suggest stress and it is related physiological changes as a possible link between poor sleep and detrimental health outcomes. (Bassett, et al., 2015). Linking to the case study, Danielle behaviour has been changed during the past weeks, therefore, her sister started that she started to swear to staff and she is very aggressive as well as very rude, this could be because of her lack of sleep and could lead to behaviour that challenge. (Hurley, 2008).In addition, Danielle has psoriasis. Psoriasis is a condition that features red patches of skin topped with silvery scales. Joint pain, stiffness and swelling are the main symptoms of psoriatic arthritis. In addition, psoriasis is a common inflammatory skin disease, which affects around 2% of the population in the UK (Cohen et al., 2012). Onset may occur at any age, they can affect any part of the body, including fingertips and spine, and can range from relatively mild to severe. Psoriasis can occur at any age and is equally distributed between men and women. (Wojtyna, et al., 2017) As with other skin diseases, visible disfigurement triggers negative reactions in others, which can cause much of the readily measurable psychosocial burden of the disease. However, the impact of psoriasis on patients’ lives and well-being is often higher than in other skin and chronic diseases. (Hong & Koo, 2008). To date, extensive literature describes the co-occurrence of psoriasis and depression, suicide ideation, anxiety, sexual dysfunction and alcohol addiction (Wojtyna, et al., 2017). Physical, psychological and socioeconomic burdens of psoriasis include skin discomfort, disfiguration, feelings of stigmatization, and inconvenient and uncomfortable skin therapies (Hrehorów, 2012). These burdens may lead to negative affect (in particular sadness, loneliness, and anger), may strongly influence body image, and may eventually result in negative mental health outcomes. It has also been reported that women with psoriasis might incur a higher risk for psychological comorbidities than do men (Wojtyna, et al., 2017). It should also be emphasized that the psychological impact of psoriasis may be highly individual and often not in proportion to the clinical severity of the disease, or to the extent and the location of skin lesions. Furthermore, perceived social support and positive, acceptable experiences of social interactions may be of particular importance for this group of patients. However, social support can have different effects depending on the gender of the recipient and the match between the type of social support and the individual’s needs. For example, Janowski et al. (2018) found that social support might generally be more effective in preventing depression in women than in men with psoriasis. Linking to the case study, Danielle’s health condition of having psoriasis could stop her to be socially engage, to go for swimming or work. For example, in front of people, she will feel embarrassed to show her body or her skin condition. Therefore, this could lead to social exclusion and isolation. (Selten et al., 2017). Selten et al., (2017), suggest that social exclusion has an impact on human dopaminergic functioning and thereby influences the risk of developing psychosis. Therefore, Danielle’s social activities help her to socialise with others, avoid stress, depression and reduce bipolar’s symptoms. Bipolar mood disorder is a complex mental illness characterized by uncertainties of mood between the highs of obsession and the lows of depression with periods of relatively normal mood in between (McKenna & Eyler, 2012). Alterations of brain structure and function combined with environmental factors (stressors, sleep deprivation or sleep much, weight gain or loss….) are thought to cause a dysregulation of mood, sleep, cognition, endocrine function, and motor systems forming complex and dynamic interactions (Catapano, et al., 2009). Other symptoms can be, hallucinations, inability to communicate due to markedly speeded up, slowed down or distorted speech. Bipolar disorder affects more than 1% of the world’s population irrespective of nationality, ethnic origin, or socioeconomic status and represents one of the leading causes of disability among young people (Grande et al., 2017). In a worldwide mental health survey, the prevalence of bipolar disorders was consistent across diverse cultures and ethnic groups, with an aggregate lifetime prevalence of 0·6% for bipolar I disorder, 0·4% for bipolar II disorder, 1·4% for subthreshold bipolar disorder, and 2·4% for the bipolar disorder spectrum. With respect to sex, bipolar I disorder affects men and women equally while bipolar II disorder is most common in women. (Grande et al., 2017). In addition, people with learning disabilities suffer from mood or bipolar disorders at a similar or even higher rate than general population (Morgan et al., 2008); such dually diagnosed people with learning disabilities are often more functionally impaired and require more health needs support than those without learning disabilities (Morgan et al., 2008). As hospitalizations are often required in managing acute episodes of bipolar disorders, with estimated prevalence rates at 1.04% for learning disability (Maulik et al., 2011) and 3 to 5.84% for bipolar disorders among the general population (Hoertel et al., 2013), a substantial number of individuals dually diagnosed with bipolar disorders and learning disabilities will be

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