April 25, 2020
Janet’s problem will be known after being diagnosed .Based on my assessment; I will have to list some priority nursing issues for Janet and eventually chose a nursing plan for her. Before all this Janet will be taken through a session in which she will be subjected to assessment and Diagnosis. The assessment and diagnosis of the mental or psychiatric problem that she could be suffering from has to take place in order to help in coming up with the best and effective treatment plan for Janet. At this stage there is need for more keenness lest the wrong diagnosis is done consequently leading to administration of the wrong treatment plan. The diagnosis of mental problems or illness will basically incorporate both the psychiatric and the behavioral methods. According to Ralph and Taylor (2005, p8) a lot of emphasis should be placed on the comprehensive assessment of the client’s behavior; this will basically be based on the client’s family history, her personal and informant mental and medical clinical interviews, Janet’s rating scales, direct or physical observations, and a critical experimental analysis of certain behavior that she exhibits (Basavanthappa, 2007, p387) .At this stage am well equipped with different models that will help me have a basis for making differential diagnoses to confirm and prove the presence or absence of some of the most common mental illnesses or any other related psychiatric disorders or behavior that Janet Gray could be suffering from.
Like it is always with most mental health professionals especially the care givers and nurses in psychiatric centers or mental hospitals, I will have to asses and diagnose Janet by first of all ascertaining her particular illness or even the circumstances surrounding the mental disorder she could be suffering from. Some professionals, like clinical psychologists in some cases tend to avoid diagnosis and opt for other assessment methods for instance formulation of the client’s circumstances and difficulties which I don’t think I would recommend in this case. Most of the mental health complications are normally assessed and treated by physicians whenever clients approach them during consultations (Bull, 2006, p 7). If upon examination it is found that Janet’s case is very complicated, just like psychiatrist always do, I might just refer her for more or further specialized diagnosis depending on how acute or chronic the case may be. The best diagnostic practice in matters concerning mental health nursing services that this plan recommends is the use of interviews, commonly referred to as mental status examination in the nursing field.
By using these methods the concerned care giver will be able to make judgments on the state of Janet by basically looking at her appearance and how she behaves. Other reliable methods that the nursing plan will heavily rely on include scrutiny and analysis of symptoms that are self reported the mental health history of Janet Gray, and his or her current life circumstances (Raghavan and Patel, 2005, p 5). The views and opinions or observations of relatives, friends, associates or any other third party may be considered to help come up with the best treatment plan. A physical check or examination to check for mental instability, ill health or the effects of previous medications or some other drugs that were recently used will have to be conducted. At times psychological examination or testing is done by use of paper and pen kind of questionnaires or computerized questionnaires, and this may at times include the use of algorithms where by Janet will be required to tick off some standardized kind of diagnostic criteria, unfortunately that won’t be used in this case. Alternatively if Janet’s case is so special a neuro-imaging tests may be used .There are so many other methods that can be use but unfortunately time and budgetary constraints may not allow.
It may be unfortunate that financial issues on the side of my client may limit the kind of diagnosis or treatment that I will give because some of the diagnostic methodologies are very expensive. To have a clear understanding of what kind of treatment to give her, I intend to use structured and in most cases closed ended approach to accurately evaluate her. Evidence-based methods of assessment are to be used in order to come up with accurate diagnosis. Keen observation has to be taken because most mental illness that involve hallucinations and delusions particularly schizophrenia tend to be improperly diagnosed at times due to the presence unclearly understood psychotic symptoms which are normally instigated by at times poor diet .Comorbidity may also arise and this ought to be taken care of because it is a very common phenomena in psychiatric assessment and diagnoses, that is, the same client given a diagnosis or mental examination in more than one group of disorder.
Goal and expected outcomes of Janet’s nursing plan
A mental health care plan for Janet Gray will basically have the following stages; assessment, nursing diagnosis, outcome criteria, the nursing interventions rationales and evaluation. Each stage has expectations which will ensure that the whole process and care plan runs smoothly .A mental nursing care plan basically cares for people of all ages with different mental illness or distress, like schizophrenia, psychosis, bipolar disorder, depression and dementia and the expected out comes and goal always vary (Pryjmachuk, 2010, P 207).The goals of Janet’s care plan will be unique in their own right. Managing to handle and deal with challenging behavior that may come up during the session will be of utmost importance, and the whole administration of medication that relates to the mental problem. According to Carpenito-Moyet (2008, p 35) just like any other form of nursing, this mental health nursing plan will basically work within the usual nursing models. It will utilize the usual nursing care plan, and will aim at caring, managing and treating the client. According to Jones (2009, p161) the emphasis of this particular mental health nursing plan is to try at all costs to develop a therapeutic relationship with the client. In practice, this care plan will ensure that the nurse engages the client in care in a more positive, friendly and in a more collaborative which will help to empower the client to contribute to the therapy by drawing on his or her inner abilities and resources in addition to what the nurse or the care giver is providing.
Interventions and Rationale for using them
To address Janet’s the problem and minimize the devastating effects that come with it to family and friends, there are a few options of what I may recommend for her depending on the diagnosis. This will be justified also to as why I intend to use the said intervention. The interventions will basically include any of the following management and treatment strategies suggested bellow. Janet’s case will require an intervention that will help in ensuring that problem is managed or treated .Janet’s mental disorder requires her to be either admitted to a psychiatric hospitals, in clinics or in a community mental health services. According to Fortinash and Holoday (2008, .p 24) this service ought to be based on a kind of a recovery model which is basically meant to support Janet and make her to be independent and also help her to make right choices in her personal journey to become resourceful and have a meaningful life, but the interesting thing is that at times the client may be treated against their will in a few cases. There are quite a number of different types of treatment plans and what is believed to be the most suitable will by and large depend on the severity of the disorder and Janet with whom I will attempt to develop collaborative relationship with. According to Woods Phil, Some of the treatment plans that Janet may be put under will depend on the diagnosis and they may include the following.
(a) Admission at a therapeutic community
One of the options for Janet is to be admitted at a therapeutic community. A therapeutic community is a concept largely used in the UK to basically describe small group where patients who have mental illnesses are put together and they get significantly involved in decision making and all together get involved in the running of the unit. This is after they have undergone therapy and counseling to help them develop some sense of collective responsibility and accountability, maturity and citizenship, which will later on help them to be self reliant (Woods, 2009 p 15).
The therapeutic communities are structured in such a way that they encourage the recovering patients to have some sense of personal responsibility to avoid being depended on friends, relatives or professionals long enough. For instance in the case of Janet Gray who experiences nausea, she lacks confidence and fears while in public, chain smoking and takes excessive alcohol till she passes out, clearly she has a mental problem and such a facility would be one of the best options for her. At the therapeutic communities, she will be encouraged to actively participate in the therapy so as to bring strength into the therapy. The presence of the group in a therapy session in away encourages the patients and makes them to be easy and relaxed.
This concept of mental hospitals as therapeutic communities in some places is used to describe a kind of group-based therapeutic approach to helping patients with mental problems ranging from drug addiction to mental disorders. This type of approach is normally residential, where by the therapist and their clients live together .It incorporates concepts like group psychotherapy and many other practical group activities. Mental hospitals as therapeutic communities have so far gained huge reputation for being successful in rehabilitating people with mental disorders and illnesses.
In places like Britain this approach of therapy has been used to treat both moderate and serious personality disorders. Some of these illnesses range from more serious one like schizophrenia which at times manifests itself in mild forms with little hallucinations like the case we are presented with in the video to less noticeable ones like being socially withdrawn. Mental hospitals have been used as centers for therapeutic communities to treat complex interpersonal and emotional problems .The same has been replicated in other places like the U.S. The development of therapeutic communities in places like the U.S took a slightly different path, for instance they started by having some sort of communities arranged in a hierarchical order commonly referred to as concept houses which only targeted alcoholics and other forms of drug addicts.
After Janet has been taken to hospital and there is little improvement ,it is always advised that she may have to be transferred to an institution where she can slowly but sure be initiated back in the community .This will have to be done to basically help bring her back to normal society life but this cannot be done or effected instantly ,it is a gradual process and as she is taken through she will be equipped with other basic skills to help her empower herself economically .Other aspects of her case that contribute to this problem should also be sorted out in such an institution, for instance her loneliness and worry could be attributed to the fact that she is not in a stable relationship-she reported that the boyfriend is not that serious. This could be a source of anxiety. This deinstitutionalization is basically an arrangement whereby few people live within the premise of a mental hospital as patients and also little mental health care is given. This concept is largely because of the need to close public hospitals and this is normally done by slowly transferring patients with mental problems to community-based institutions for patients with mental problems. This was a development that started in taking place in the late twentieth century.
This arrangement provides the patients with a wide variety of services aimed at improving health. Deinstitutionalization also shows the development of structures, experience, practice and rationale for mental health. In the U.S, sometimes back hospitals were mainly built to handle patients with chronic illnesses and matters concerning mental health were by and large a local arrangement and a responsibility.
According to many, hospitalization was not providing cure as many expected. This led to the development of community mental institutions by individual states. Initially mental treatment was reported to have very little efficacy. A keen scrutiny on deinstitutionalization reveals that there is a shift in demographics and geographic areas in as far as coverage is concerned (Austin, 2010 p 200).A perfect example is the decrease in the in inpatients at most mental health care all over. This in many ways compliments the services formerly procured by organizations offering general Medicare.
Deinstitutionalization is at times used to refer to the adjustment process whereby people removed from institutions. It’s always encouraged because at times people are normally so used to the structured lifestyles of mental institutions which makes it difficult for them to adjust and fit in the social environment. The whole concept of deinstitutionalization will give recovering Janet an opportunity to gain back their freedom and in the process get empowered by making more responsible decisions and right behaviors.
If she gets admitted to such an institution, all this will be made possible with the assistance of social workers in those community bases mental organizations. Recovering patients are in a better position to recover and get back to everyday’s life away from institutional rules and regulations. This concept promotes recovery and empowerment among patients despite the raging debate concerning the best concept or arrangement to treat and address mental health.
This is one of the most common options for most mental illnesses and disorders. There are many types and varieties of this. One of them is cognitive behavioral therapy abbreviated as (CBT), this may be used because it’s normally based on basically modifying the thought patterns of a client and some common behaviors that are normally associated with a particular disorder. Another effective plan is using psychoanalysis; this basically entails addressing the underlying psychic and mental conflicts and defenses in a client. This ensures that the nurse gets to understand the thought process of the client and attempt to get to his phenomenological world i.e. his or her way of thinking or looking at things. This has been a very common and dominant concept in the world of psychotherapy. Systemic therapy and family therapy can also be very instrumental when it comes to handling mental problems.
Here Janet will basically be put up in place where she can mingle and address a network of others or their significant others. At times the approaches in psychotherapy are normally based on humanistic methodologies .In some instances; there are a number of various specific therapies that are normally used for particular mental disorders depending on various factors that emerge at the diagnosis stage. Some mental health practitioners often use an eclectic or what is a normally referred to as in medical term as integrative approach (Melillo, 2005 p 282). Much may probably depend on the kind of therapeutic relationship that I will have created with Janet , some of the problems that may arise or hamper progress when using this method may include problems to do with trust, privacy and confidentiality and of course others which crop up during the engagement process.
When it comes to medication there are always a group of drugs that Janet must take depending on how severe their cases may be .Medication is a major option for most mental disorder practitioners. Psychiatric medication is normally divided into different groups. Antidepressants are normally used for treating problems to do with clinical depression and at time those that are related to anxiety disorders .Another group of medication that Janet may be given is ,anxiolytics which are normally used for treating patients with anxiety disorders and also related problems like insomnia (Videbeck, 2010, p 236). Mood stabilizers are normally put in use primarily in cases where bipolar disorder is detected. Antipsychotics is also another group which comprise of drugs that are normally used when treating psychotic disorders, notably particularly for positive symptoms problems like schizophrenia. Other drugs like stimulants are normally put in use when problems to do with ADHD. Some of these drugs despite the different conventional names given to them, some of them may be used to treat related problems.
There can be problems that arise when some of these medicines are improperly used. The adverse effects that come with in appropriate use of medication has dire and profound consequences and therefore it is always advised for the patients to strictly adherence to them, and there is always criticism concerning pharmaceutical and medical marketing and related professional conflicts of interest and therefore the nurse has to be professional and recommend the best and appropriate drugs. Another sophisticated method that can be used is Electroconvulsive therapy which is sometimes used in very severe cases, In case all other interventions which are used to treat her fail and incase she is diagnosed with very severe intractable mental depression have been unsuccessful then this may be an option. Psychosurgery is also one of those complicate methods of treatment that can be used although it is still considered experimental but can be resorted to incase things become thick. This is normally done after a client is referred to neurologists.
In a bid to know whether some of the interventions taken will have worked or not, there are quite a number of methods I will use. First I will ask friends and relatives to give reports on any improvement or whether her problem deteriorated. In case the form of intervention that is taken fails to give the desired results, then I’m afraid I will have to recommend and refer for further professional counseling and other interventions like co-counseling among peers. By evaluating her progress and the interventions taken, I will be in apposition to scrutinize the effects of Psycho education programs that she will have undergone. Psycho education is a very important program because it entails educating the client and giving her knowledge on some psychological aspects in regard to mental illness.
Without proper psycho education chances of relapse are very high and that is why I will have to see to it that she benefits from it. This may provide her and her significant others with the information to have basic understanding of the problem and to also manage their problems. After the evaluation of some of the used interventions, I intend to incorporate other creative therapies which will help her enjoy and get entertained at the same time for her to heal completely for instance those that involve music, also art therapy or even drama therapy. After the evaluation aspects like which lifestyles she can change or adjust to will be discussed together with other social support measures.
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