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Engagement in Assessment, Plan, and Evaluation of Care
Case Scenario
Patient: Max B is a 29-year-old male patient living alone. Recently resigned from the formal employment where he was working as a teacher after he suspected that someone was watching over him.
History: Max B has a history of auditory hallucinations, and has been previously diagnosed with schizophrenia. He also has a history of taking marijuana when he was 20 years. The patient was on medications, but stopped taking medicines two days when he realized that there were no changes. The symptoms have worsened over the past few days. Mr. B feels isolated and disconnected from friends and family members.
Presenting Symptoms
Mr. B presents with increased symptoms of auditory hallucinations. He complained of feeling insecure, and was suspecting that the neighbour was spying on him. During the interview, Mr. B could be seen standing up and looking out through the window. He stated that he was hearing the neighbours voice and was feeling insecure that the neighbour had installed a secret camera in his house. He was afraid of walking alone in the hospital compound because he felt that someone was following him.
Nurses have a direct role to play when treating, managing, and assessing the efficacy of treatment in mental health care. The Code of Nursing and Midwifery Council (2018) stipulates the behaviors and professional standards that nurses are expected to uphold when treating and managing patients. The field of Mental Health Nursing is one of the essential fields of nursing where students learn, develop, and practice the professional code through hands-on activities and reflections. Critical reflections equip students to challenge the learners assumptions while equipping one with the knowledge and skills required to provide appropriate patient-centered care. In this paper, I reflect on how I engaged in the assessment, planning, and assessment of care for Mr. B, a psychotic patient during one of my curriculum placements.
Patient Assessment
Patient assessment is the first process in the nursing processes of care. Peck et al. (2020, p. 19) defined assessment as a form of dialogue between the patient and healthcare teams based on a discussion of the issue that the patient faces with a goal of improving the quality of care. We opted to use the shared decision-making model (SDM) to help Mr. B to realize his role in the treatment process. There are other models such as the biopsychosocial model and socio-ecological model, that could have been used, but we saw that these other models could not empower Mr. B to take part in self-care. The goal of assessing and involving the patient was to obtain a comprehensive understanding of the underlying issue, and create treatment plans supported by the patient for managing the symptoms of the psychiatric condition (Harris & Panozzo, 2019, p. 34). I was directly involved in assessing, planning the future of care, and evaluating of care that was administered to Mr. B.
The use of the shared decision-making model equipped me with significant insights into mental health nursing. I noticed that the shared-making model was also effective in uniting the team involved in Mr. Bs treatment. I observed that the nurses involved in assessing Mr. Bs needs of care were always engaging in shared decision-making. Allerby et al. (2020, p. 46) defined shared decision-making as a process where a team of experts come together to expand their knowledge about the needs of care for a patient. During the assessment of care, we sat down with the patient and interviewed him to understand social, physical, and psychological needs that could be required in managing the symptoms of psychosis. The patient was supportive and was ready to collaborate whenever we sought his input or contribution to the treatment plan. It could not have been easy to make significant progress if we had opted for the socio-ecological or biopsychosocial models, which recognize that health and well-being are determined by multifaceted factors (Chudyk et al., 2018, p.6). SDM models helped us to narrow down to specific factors rather than taking a general approach.
The assessment of Mr. B revealed significant needs that are common for patients suffering from mental health problems. During the assessment, I noted that the patient needed both safety and rehabilitation to enable him live a comfortable life. Mr. B had indicated that he was feeling insecure and the neighbor was plotting to kill him as seen in the case scenario. There was a need to discuss with the team involved to alleviate the symptoms of psychosis while also involving the patient in making decisions regarding the safety and rehabilitation needs (Alegria et al., 2018). The nursing supervisor suggested that we use a patient-centred psychosis care (PCPC) approach to make an effective plan of care for Mr. B. Patient-centred care has proved to be an effective evidence-based care that involves the healthcare team and the patient, including the family or relatives of the patient to make decisions about the treatment plan (Allerby et al., 2022). The involvement of the patient in planning his future treatment was necessary, as it helped the nursing team to identify potential challenges that could be encountered and prepare to address them with the help of Mr. B and his family.
The success of patient engagement in mental health nursing has often relied on therapeutic engagements and communication. Effective communication is one of the essentials highlighted in the Nursing and Midwifery Council (NMC). (2018). When dealing with psychotic patients, therapeutic communication is essential for addressing the psychological and physical needs that could undermine the efficiency of the interventions(Jakes, 2018, p.89). During the assessment and planning of care for Mr. B, I maintained eye contact with the patient, listened to him attentively, and did not disrupt him with questions when he was talking. I nodded to agree with what he was saying when he needed a response or feedback from me and the team. I provided the patient and the team with the required information while remaining objective in my communication to avoid interfering with the patients point of view. Previous studies such as Fusarpoli et al. (2022), Schmidt and Uman (2020), and Sonmez et al. (2020) found that team communication in in therapeutic care increase collaboration and patient satisfaction, including adherence to medications and plans of care. Furthermore, the involvement of patients in treatment plans empowers patients to be responsible for self-management and is also a form of respecting self-determination in the treatment and management of psychiatric conditions such as psychosis (Siregar et al., 2021, p. 16). When working with the team to decide on the effective plan of care for Mr. B, we made sure that the patients had the final decision, in regard to his physical and mental safety to make the treatment plan successful.
Care Planning
Care planning is the second stage of the nursing process. Stangl et al. (2019, p.13) defined care planning as an outline of the future directions that could be involved in the treatment and management of symptoms and issues identified in the assessment stage of the nursing process. I am impressed that we involved the patient in care planning by asking him about his wishes and preferences, rather than imposing what we already know to the patient. For instance, during the planning of care, the supervisor asked the patient: We have several alternatives that could be used to help you manage the symptoms of this condition, what would you prefer? . van der Gaag et al. (2019, p. 90) discussed the importance of involving patients in the plan of care as a strategy of patient-centered care. Our decision to involve Mr. B in coming up with the plan of care using the patient-centered model helped us to identify other barriers at the social and family level that could have undermined the effectiveness of the plan.
My involvement in care planning for Mr. B was quite challenging at the beginning, but I became fully empowered when we had come up with a flexible plan for the client. It was challenging at the start because I had become emotionally attached to the patient and was not sure how the patient could live alone at home. I felt that Mr. B needed to have someone manage him or look over him when out of the hospital. However, after further discussion with my supervisor, I was able to think critically, challenge my assumptions, and develop problem-solving skills that helped us come up with a working plan of care for Mr. B. According to Jauhar et al. (2019, p. 67), the nurse is expected to formulate a plan of care that reflects the clients needs and preferences. After agreeing with Mr. B, we came up with a cognitive behavioral therapy (CBT) that could help him manage the symptoms of psychosis. Our goal was to empower the patient to make independent decisions while reducing chances of self-harm to the patient. Care planning is appropriate when it empowers the patient to self-manage the symptoms where there are difficulties in accessing the professional.
Evaluation of the Plan of Care
Evaluation is the final step in the nursing process of care. It is a process of checking and determining the efficiency of the care plan to determine what is working, how it is working, and making recommendations for possible changes when new needs emerge (Lien et al., 2021, p. 670). I was also involved in the evaluation of the plan of care for Mr. B, even though my supervisor was took the responsibility of signing the records. During the evaluation of the care plan, we involved Mr. B by asking him about the progress he was making and the impact of the CBT interventions in managing the symptoms of psychosis. We also asked the client to make recommendations on future plans of care and how the intervention could affect his daily life.
Where I did better and where I need Improvement
I can attest that my involvement in the three nursing processes of care for Mr. B had a significant impact on my perception of nursing care. The professional team was supportive and allowed me time to think critically while also involving me in making decisions when engaging with Mr. B. I learned the importance of using a patient-centered approach when treating psychosis and other mental health issues. For instance, I discovered that involving the patient using the patient-centered care model played a significant role as a form of empowerment (Mao & Agyapong, 2021). Mr. B felt empowered when we asked him his preferences when planning for his care. This strategy helped the patient to feel less inclined towards thinking that he was being forced into the treatment plan. It also increases collaboration and adherence to medications as explained by Batinic (2019, p. 180). The two-way communication with Mr. B during the assessment challenged by perceptions about psychosis, equipped me with new knowledge and provided an opportune moment for me to apply critical thinking and problem-solving skills.
I developed teamwork skills when engaging in the assessment, care planning, and evaluation of the treatment plan for Mr. B. Existing literature on teamwork and collaboration in the treatment and management of psychiatric conditions indicate that patients face multifaceted issues that cannot be addressed from a single point of view. In some cases, healthcare professionals may be required to use knowledge from other fields of nursing such as rehabilitation, psychiatry, community health nursing, and emergency (Shim & Compton, 2020, p.90). When planning for Mr. Bs rehabilitation, a psychiatrist helped us determine the underlying condition, while a community health nurse helped us in drafting the plan of care that could help the client when discharged to the community. The emergency nurse was available to address the emergency symptoms of psychosis, and the rehabilitation nurse was involved when we needed to consult about the safety of the patient outside the healthcare facility. All the professionals worked in collaboration to make sure that the patient received the required care to alleviate the symptoms of psychosis while also taking into consideration the efficacy of the treatment interventions. The community health nurse helped the team to view the condition from a socio-cultural context as explained by Susser and Martinez-Ales (2018) during the nursing process of care. I understand the challenges that one encounters when treating patients with psychiatric conditions, but I believe that I am now prepared to address similar issues in the future.
Despite my positive experience in assessing, planning, and evaluating the plan of care for Mr. B, I acknowledge that there are some areas that I underperformed and I look forward to improving in future. My supervisor advised me to maintain eye contact with the patient during the assessment, but I kept looking down when Mr. B looked at my face. I was also nervous when the client stated that he his neighbor was surveying him and could kill him any time. I became emotional when I learned that the client had little control over the symptoms of psychosis and that he had resigned from his employment because he was feeling insecure. While Avry et al. (2020) discussed that sharing the patients emotions helps in understanding the underlying condition, there are instances I felt that the patient was pretending and was not seeing some of the things that he was seeing. I am convinced that the knowledge and skills I acquired from the encounter have prepared me for my future career practice in the field of mental health nursing.
Caring for patients diagnosed with psychiatric conditions requires teamwork and collaboration. Assessment, preparation, and evaluation of care plans for psychotic patients entail collaboration and involvement of the plan users to increase compliance and utilization of the plan. My participation in the case scenario of Mr. B equipped me with knowledge and skills that will have positive impacts on my future career practice. I will continue working on the limitations I identified in this reflection to be well-equipped to address patients from different cultural backgrounds.
Reference List
Alegria, et al., 2018. Social determinants of mental health: where we are and where we need to go. Current Psychiatry Reports, 20, pp.1-13.
Allerby, K., Goulding, A., Ali, L., and Waern, 2022. Increasing person-centeredness in psychosis inpatient care: staff experiences from the Person-Centred Psychosis Care (PCPC) project. BMC Health Services Research, 22(1), pp. 1-12.
Allerby, K., Goulding, A., Ali, L., and Waern, M. 2020. Striving for a more person-centered psychosis care: results of a hospital-based multi-professional educational intervention. BMC psychiatry, 20(1), pp. 1-10.
Avry, S., Molinari, G., Betrancourt, M. and Chanel, G., 2020. Sharing emotions contributes to regulating collaborative intentions in group problem-solving. Frontiers in Psychology, 11, p.11-60.
Batinic, B. (2019). Cognitive models of positive and negative symptoms of schizophrenia and implications for treatment. Psychiatria Danubina, 31(2), pp. 181-184.
Chudyk, A.M., Waldman, C., Horrill, T., Demczuk, L., Shimmin, C., Stoddard, R., Hickes, S. and Schultz, A.S., (2018). Models and frameworks of patient engagement in health services research: a scoping review protocol. Research Involvement and Engagement, 4(1), pp.1-8.
FusarPoli et al. 2022. The lived experience of psychosis: a bottomup review cowritten by experts by experience and academics. World Psychiatry, 21(2), pp. 168-188.
Harris, B.A. and Panozzo, G., 2019. Therapeutic alliance, relationship building, and communication strategies-for the schizophrenia population: An integrative review. Archives of Psychiatric Nursing, 33(1), pp.104-111.
Jakes, S. (2018). Loss of Self in psychosis: Psychological theory and practice. Routledge.
Jauhar, S., Laws, K.R. and McKenna, P.J., 2019. CBT for schizophrenia: a critical viewpoint. Psychological Medicine, 49(8), pp.1233-1236.
Lien et al., 2021. Challenging mental illness stigma in healthcare professionals and students: a systematic review and network meta-analysis. Psychology & Health, 36(6), pp.669-684.
Mao, W. and Agyapong, V.I., 2021. The role of social determinants in mental health and resilience after disasters: Implications for public health policy and practice. Frontiers in Public Health, 9, p.658528.
Nursing and Midwifery Council (NMC). (2018) The Code: Professional Standards of Practice and Behaviour for Nurses and Midwives Nursing and Midwifery Council. NMC. [online]. Web.
Peck et al. 2020. Development of a lived experience-based digital resource for a digitally-assisted peer support program for young people experiencing psychosis. Frontiers in Psychiatry, 11.
Schmidt, M., and Uman, T. 2020. Experiences of acute care by persons with mental health problems: An integrative literature review. Journal of Psychiatric and Mental Health Nursing, 27(6), 789-806.
Shim, R.S. and Compton, M.T., 2020. The social determinants of mental health: psychiatrists roles in addressing discrimination and food insecurity. Focus, 18(1), pp.25-30.
Siregar, I., Rahmadiyah, F. and Siregar, A.F.Q., 2021. Therapeutic communication strategies in nursing process of angry, anxious, and fearful schizophrenic patients. British Journal of Nursing Studies, 1(1), pp.13-19.
Sonmez et al., 2020. Cognitive behaviour therapy in early psychosis with a focus on depression and low self-esteem: A randomized controlled trial. Comprehensive Psychiatry, 97, pp.152-157.
Stangl et al., 2019. The health stigma and discrimination framework: a global, crosscutting framework to inform research, intervention development, and policy on health-related stigmas. BMC medicine, 17, pp. 1-13.
Susser, E., and Martinez-Ales, G. 2018. Putting psychosis into sociocultural context: an international study in 17 locations. JAMA Psychiatry, 75(1), pp. 9-10. Web.
Van der Gaag, M., van den Berg, D., and Icing, H. 2019. CBT in the prevention of psychosis and other severe mental disorders in patients with an at risk mental state: A review and proposed next steps. Schizophrenia Research, 203, pp. 88-93.
Do you need this or any other assignment done for you from scratch?
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