Essay On Mental Health

The collection of services offered to treat an illness or process is referred to as an episode of care (or "episode"). According to the National Health Service (NHS 2022), when the first line of treatment listed in the care plan is given, the episode of care begins. One or more interactions with diagnostic or therapeutic professionals in relation to a treatment plan developed after an evaluation or assessment make up an episode of care. The evaluation or testing procedure is not taken into account. If a different treatment requirement is discovered while carrying out a treatment plan, a patient may have concurrent episodes of care. Episode of care also has a cost-benefit ratio as it is an all-encompassing payment model which covers all services related to the treatment of a medical event, a condition or a sickness. Programs that offer episodes of care combine comprehensive treatment with cost cutting in a way that also enhances the member experience. The patient in turn benefits from a healthcare provider's adherence to quality standards in terms of their health.

Being a nursing practitioner in the mental health unit, I come across several patients and incidents every day. I would like to refer to one such interaction with a patient admitted in the mental health department on account of the progressive condition of dementia and urinary tract infection. Being a nurse, it is my responsibility to maintain privacy and confidentiality of the patient, which has been outlined in the Code of Conduct for nurses by the Nursing and Midwifery Council (NMC 2018) of the United Kingdom (UK). As privacy and confidentiality is recognized as a right of patient, hence, for the purpose of this essay I would be referring to the subject by a pseudonym, Mrs. K. Mrs. K was a 76 years old lady diagnosed with the middle stage of dementia due to which she was feeding and drinking in an inconsistent manner. She has also been diagnosed with urinary tract infection due to her decreased mobility with progression of the disorder. Her family carer, a nurse appointed from our organization for her care at home, noted several changes in her behavior like anxiety, depression, agitation, hallucination and delirium. The nurse also reported that Mrs. K had experienced burning sensation during urination, had pain in the sides of her stomach as well as her lower abdomen, and her urine appeared dirty and cloudy with a foul odour. Diagnostic tests done in the hospital confirmed blood in her urine sample, which indicates the occurrence of urinary tract infection. In the hospital, she also faced difficulty in communication and appeared confused and agitated when I asked her about the health issues. Thus, she required immediate intervention and care with regards to her situation.

I selected this incident, out of many, as it was crucial for me to analyse the declining health status of Mrs. K and provide immediate intervention to ease her pain. In this reflective essay, I would deal with this clinical scenario in which I was directly involved while practicing as a student mental health nursing practitioner in my healthcare organization. I would consider the roles and responsibilities of a nurse based on appropriate policies and code of conduct in dealing with an episode of care in the UK. I would analyse the episode of care for Mrs. K on the basis of up-to-date references from peer reviewed journals and government policies that are in force within the boundary of the country. This reflective essay would help me demonstrate my attitude toward delivery of care to the patient, management style that I adopted to ease the situation, and leadership qualities led to holistic care of the subject.

 

 

The nursing process refers to a systematic, logical planning approach that directs all nursing actions in providing all-encompassing, patient-focused care. In order to give a patient, the greatest care possible, the nursing process, which is a type of scientific reasoning, calls for the nurse to use critical thinking. As stated by Lilley, Collins and Snyder (2022), the main purpose of this process is- to determine the health status of patient and any current or future needs for medical treatment through thorough assessment; to create strategies to address the needs identified through assessment; to provide specialised nursing treatments in order to satisfy such demands; to improve human functions and their reactions to health and sickness while implementing the greatest caregiving research currently available; and to create a database with information on the health status of the client, health issues, their response to disease or illness, and capacity to manage healthcare requirements. Despite the benefits of nursing process, nurses have several strengths and weaknesses, hence, I should be conscious of these. Self-awareness is one of the most important strengths that is required to be taken care of. I should be aware of all the steps that should be taken to improve the health status of an individual and develop an appropriate nursing care plan. Not being aware of patient condition and wrongful diagnosis can become a nurse’s weakness, hence, it needs to be avoided. Nursing process occurs in 5 steps- assessment, diagnosis, planning, implementation, and evaluation, as stated by Lilley, Collins and Snyder (2022).

 

In the first phase, assessment is done through gathering, compiling, verifying, and documenting the health status of patients, as per Perez Rivas et al. (2016). The authors, Perez Rivas et al. (2016), stated that there are various ways to gather this information such as by collecting the objective and subjective symptoms, and verbal and non-verbal data. On the first meeting of a nurse with a patient, nurses are typically expected to perform an assessment to determine the patient's health issues as well as their physical, mental, and emotional state. They are also expected to create a database about the reaction of patient to the identified health issues or illness as well as their capacity to manage their healthcare needs. Thus, it can be said that critical thinking abilities are essential in this respect. In the case of Mrs. K, data collection can be done through her physical examination, health interview, observation or even through a secondary data source (Perez Rivas et al. 2016). I observed her objective and subjective symptoms and assessed that she could not move frequently, and required assistance in eating and drinking. Also, she was reluctant to eat and experienced pain during urination. Her decreased mobility resulted into decreased self-care and hygienic conditions that led to the development of urinary tract infection. The verbal data from her family carer also revealed certain behavioral changes that were related to the progression of the disease in a dementia patient. The secondary sources of data, that is, the diagnostic urine test which reported blood in urine was also used. These data were validated by cross checking with adequate research-based data and the assessment of her illness was concluded. After drawing the inference, Mrs. K’s patient-specific data were documented appropriately so that it can be understood by the entire healthcare team (NMC 2022).

 

In the next phase, diagnosis of the patient condition is required to be done. According to Lilley, Collins and Snyder (2022), at this stage, the nurse reviews all the data gathered to determine the condition and requirements of the patient. In order to make a diagnosis, the data of the subject is analysed, and health issues, strengths, and risks related to the disease are noted before making a diagnostic statement about the potential of a patient or the current health situation he is facing. Standing (2020) stated that planning and implementing patient care is made easier by using clinical judgement to formulate a nursing diagnosis. In this case, I noted the previously documented mental health issue that Mrs. K had, which is dementia, due to which she had difficulty of speech and communication as well as experienced confusion, as stated by Klimova and Kuca (2016). According to Sipila et al. (2021), the diagnosis of urinary tract infection is closely related to dementia. Urinary tract infection is diagnosed in around one third of dementia patients. Its development is quite common in dementia patients mostly due to lack of personal care and hygiene and also, due to old age. As Mrs. K had dementia, it was most likely that she had developed urinary tract infection. But before making a diagnostic statement, I had to be sure of its occurrence. Small (2020) observed the change in behavior of dementia patients like hallucination, delusion, anxiety, agitation, aggression, and depression, if they are suffering from urinary tract infection. This diagnosis can be related to the case of Mrs. K, who was facing such similar situations. Gupta, Grigoryan and Trautner (2017) shed light on the symptoms of urinary tract infection, which included pain in the lower abdomen, burning sensation during urination, and the presence of blood in urine. All these were noted in Mrs. K, which proved the occurrence of urinary tract infection in her.

 

In the following step, planning is done to manage the issue. At this stage, nurses plan the course of nursing interventions. According to NMC (2022), it should be done on the basis of the principles of evidence-based practise (EBP), goals and outcomes that directly affect patient care are developed during the planning phase. These patient-specific objectives and their accomplishment help to guarantee a successful outcome. In this stage of goal planning, an official process known as a nursing care plan is crucial. Care plans offer a roadmap for individualised care that is catered to a person's particular requirements (Smith and Field 2018). Care plans improve documentation, communication between members of the healthcare team, and continuity of care throughout the healthcare system. It also accurately identifies current needs and recognises potential requirements or concerns of the patient. This planning done should be person-specific, measurable, attainable, realistic, and time-oriented (Stonehouse 2017). In the case of Mrs. K, I suggested that she should be given appropriate prophylactic antibiotics immediately, as these were found to be quite effective by the authors, Ahmed et al. (2018). They also outlined the time frame within which noticeable changes can be observed within the patient, that is, within 24 to 48 hours of administration of medications. The total duration of this antibiotic therapy should be 10 to 14 days as mentioned by Ahmed et al. (2018). During her hospital stay, Mrs. K can be treated with antipsychotic drugs to reduce the symptoms of anxiety, stress, and hallucination, as prescribed by Donegan et al. (2017). According to Murphy, Holmes & Brooks (2017), her nutritional and hydration needs can be addressed by getting to know their food and drink preferences and giving them something they like to eat. Nursing care plan should also include the steps to be taken for holistic care after discharge of the patient. Hence, I recommended simple and yet beneficial exercises for her to improve her balance and strength, as per the observations of Bundy and Minihane (2018), who revealed that proper exercise can reduce the rate of progression of dementia. In post-discharge regime, I included the use of antibiotics to prevent recurrence of urinary tract infection.

 

The next step represents the implementation phase. In this phase, nurses execute the treatment plan throughout the implementation phase of nursing process. According to Stonehouse (2017), it entails taking action and actually carrying out the nursing interventions specified in the care plan. Each patient should receive a specific intervention that focuses on attainable goals (NMC, 2022). It involves taking care of a patient directly or performing crucial medical procedures like administering medication. It also calls for teaching and advising the patient about ongoing health management and referring the patient for follow-up sessions. As per the care planning of Mrs. K, administration of appropriate prophylactic antibiotics, as prescribed by the doctor, was done by me after monitoring her vital signs. After the pain in her lower abdomen subsided, I treated her with antipsychotic drugs as prescribed by the doctor. This reduced the symptoms of hallucination, anxiety and depression and she dozed off to sleep for a while. I continued the antibiotic therapy for urinary tract infection for a period of 10 to 14 days, as per the care plan. During her hospital stay, I showed her some simple exercises that she can do while at home which can reduce the progression of dementia. I also guided her about the importance of exercises and the way she can engage and motivate herself in doing it regularly.

 

The next step is evaluation phase. A successful patient outcome depends heavily on this last stage of the nursing process. Every time a healthcare professional steps in or administers treatment, it is their duty to evaluate or reassess to make sure the intended result has been achieved (NMC 2022). The three probable patient outcomes include improvement in patient condition, stabilization of the condition, or worsening of the condition after implementation of the care plan. According to Stonehouse (2017), steps for evaluation may include data collection, comparison of data with outcomes desired, analyzing patient response to nursing care, and identifying the factors of success or failure. After evaluation, the nursing care plan may be continued or modified or terminated on the basis of patient response to it. This step also includes discharge planning of patient. As per the requirements, I collected both subjective and objective data of Mrs. K after 14 days of administration of prophylactic antibiotics. I monitored her vital signs which appeared to be normal and she was feeling better. The symptoms of abdominal pain and burning during urination were gone and her urinalysis revealed absence of blood in it. The antipsychotic drugs helped reduce the signs of hallucination, anxiety, stress and depression. Through she had a little difficulty in communication, her confusion regarding regular activities seemed to lessen. I also observed that she did not show as much enthusiasm in performing exercises regularly, though she was motivated by her family carer. As she was feeling good, she suggested that she should be discharged as soon as possible.

 

 

From the evaluation of the above clinical scenario, patient care plan formulation, and its implementation, it can be said that the nursing care plan was partially successful. To reflect on my experience of handling Mrs. K, who had both mental health as well as physical health issues, I selected Rolfe’s reflective model as it ensures simplicity and straightforwardness. This model demands answer in three steps- what, so what, and now what. The element ‘what’ refers to description of the event and reflection of one’s self-awareness on it. In this case, the presenting problems of Mrs. K included the progression of dementia and the occurrence of urinary tract infection. This is the first time that I had to deal with a dementia patient with the complaint of a physical issue. Evidence-based records show that urinary tract infection in dementia patients can show symptoms of anxiety, depression, agitation, hallucination, delusion, and delirium. The change in smell and texture of her urine and occurrence of burning sensation during urination along with pain on the sides of her stomach as well as her lower abdomen, prompted me and her doctor to perform a urinalysis to confirm the issue of urinary tract infection. The diagnostic test confirmed its presence. I sympathized and empathized with her at the times of pain and it had a negative impact on me as I felt worried and sad. The next element ‘so what’ refers to the analysis and evaluation of the situation. I strictly followed the nursing process, step-by-step, so that I am able to understand the health status of patient, discuss it with the physician, and take actions to relieve Mrs. K from her pain. As per the evidence-based strategy, I followed the 5 steps of nursing practice, that is, assessment, diagnosis, planning, implementation, and evaluation. I collected both the objective and subjective data and also took help of secondary data, that is, her diagnostic urine test results to assess her condition. Nursing diagnosis could be made easier by using clinical judgement and reasoning supported by evidence-based theories. The occurrence of dementia, lack of personal care, hygiene and old age were identified as the main causes of the development of urinary tract infection in the patient. She also lost her appetite which also needed recovery. Hence, care planning for her was also done on the basis of appropriate evidences. Appropriate prophylactic antibiotics and antipsychotic drugs were administered by me as per the directions of Mrs. K’s doctor. Her eating habits could be improved by providing her with food and drinks of her choice. Her care plan also included simple and effective exercises that could slow the progression of dementia. On implementing these strategies, I found that Mrs. K’s condition improved rapidly. She could eat much more than before and also appeared physically better after the implementation of interventions. But I noticed one problem with the care plan. Mrs. K was not interested in doing the suggested exercises that have been proven to reduce the time frame of progression of dementia. Though supported by her carer she was not motivated to continue with her exercises. The last element of the model, that is, ‘now what’ refers to the concern or insights into the previously mentioned elements, so that nursing practice can be improved in the future. According to it, the nursing care plan was partially successful as it helped in Mrs. K’s recovery during hospital stay. But in the long run, the problem of dementia would increase severely. Intervention involving change of lifestyle like introduction of exercise in the post-discharge regimen could slow down the process of disease progression. But Mrs. K was reluctant to perform it. This can be recognized as a failure on my side as I could have changed my approach of the introduction of exercise in her regimen. I only showed her the exercises that she can do but did not educate her on its importance. Specific exercises can improve mobility and muscle strength in people living with dementia. Simple aerobic exercises can reduce cognitive impairment severely. Symptoms of anxiety, stress and depression- the most common symptoms of dementia- could also be avoided and mood of a patient can be improved drastically. This non-pharmacological intervention is highly effective and it can keep an individual cognitively healthy. Hence, in the future, I would keep this in mind that the role of certain non-pharmacological interventions in the life of patients should be explained in detail to encourage them to follow the patient-centered care plan. The key takeaway from this case is the knowledge that it imparted me and the mistakes that I reckoned and observed that hampered patient care. I can use this knowledge in a different healthcare setting as well and would keep this in mind that health literacy should be prioritized to make the nursing care plan work for patients.

 

 

Ahmed, H., Farewell, D., Jones, H.M., Francis, N.A., Paranjothy, S. and Butler, C.C., 2018. Incidence and antibiotic prescribing for clinically diagnosed urinary tract infection in older adults in UK primary care, 2004-2014. PloS one, 13(1), p.e0190521.

 

 

Bundy, R. and Minihane, A.M., 2018. Diet, exercise and dementia: the potential impact of a Mediterranean diet pattern and physical activity on cognitive health in a UK population. Nutrition Bulletin, 43(3), pp.284-289.

 

 

Donegan, K., Fox, N., Black, N., Livingston, G., Banerjee, S. and Burns, A., 2017. Trends in diagnosis and treatment for people with dementia in the UK from 2005 to 2015: a longitudinal retrospective cohort study. The Lancet Public Health, 2(3), pp.e149-e156.

 

 

Gupta, K., Grigoryan, L. and Trautner, B., 2017. Urinary tract infection. Annals of internal medicine, 167(7), pp.ITC49-ITC64.

 

 

Klimova, B. and Kuca, K., 2016. Speech and language impairments in dementia. Journal of Applied Biomedicine, 14(2), pp.97-103.

 

 

Lilley, L.L., Collins, S.R. and Snyder, J.S., 2022. Pharmacology and the nursing process E-Book. Elsevier health sciences.

 

 

Murphy, J.L., Holmes, J. and Brooks, C., 2017. Nutrition and dementia care: developing an evidence-based model for nutritional care in nursing homes. BMC geriatrics, 17(1), pp.1-14.

 

 

NHS Wales Data Dictionary, 2022. Episode of Care (Diagnostics & Therapy Services). [online] Available at: <http://www.datadictionary.wales.nhs.uk/index.html#!WordDocuments/episodeofcarediagnosticstherapyservices.htm> [Accessed 6 August 2022].

 

 

Nursing and Midwifery Council (NMC), 2022. The Code Professional standards of practice and behaviour for nurses, midwives and nursing associates. [online] Available at: <https://www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/nmc-code.pdf> [Accessed 6 August 2022]. 

 

 

Pérez Rivas, F.J., Martín‐Iglesias, S., Pacheco del Cerro, J.L., Minguet Arenas, C., Garcia Lopez, M. and Beamud Lagos, M., 2016. Effectiveness of nursing process use in primary care. International Journal of Nursing Knowledge, 27(1), pp.43-48.

 

 

Sipilä, P.N., Heikkilä, N., Lindbohm, J.V., Hakulinen, C., Vahtera, J., Elovainio, M., Suominen, S., Väänänen, A., Koskinen, A., Nyberg, S.T. and Pentti, J., 2021. Hospital-treated infectious diseases and the risk of dementia: a large, multicohort, observational study with a replication cohort. The Lancet Infectious Diseases, 21(11), pp.1557-1567.

 

 

Small, G.W., 2020. Managing the Burden of Dementia-Related Delusions and Hallucinations.

 

 

Smith, B. and Field, L., 2018. Nursing Care: An essential guide for nurses and healthcare workers in primary and secondary care. Routledge.

 

 

Standing, M., 2020. Clinical judgement and decision making in nursing. Sage.

 

 

Stonehouse, D., 2017. Understanding the nursing process. British Journal of Healthcare Assistants, 11(8), pp.388-391.