In this assignment, nursing assessments and interventions for a geriatric client suffering from long term mental illness, depression and suicidal tendencies is studied with reference to relevant theories, nursing assessments and interventions. Systematic approach of studying nursing process will be explained along with a role of mental health nurse in care assessment of the patient. There are four stages which are identified in the nursing process that are assessment of patient, planning of care, implementing care which is designed and evaluating the care against the interventions designed. A well-developed problem solving structure will be designed in order to layout, structure, present and organise a nursing intervention based on the assessment of the case study. In the first section, a detailed price of a client will be given. The following section will describe a well-planned nursing health assessment followed by interventions and approaches. In the entire nursing plan, it is made sure that client is totally involved so that he can be educated and empowered. In addition, nursing plan would be based on person centred approach and interventions will mainly be based on evidences observed trough the client. In a accordance with the confidentiality criteria developed by nursing and midwifery council, a pseudonym will be given to the patient analysed in the case study by the name (Jane).
Jane, a 79 year old female was admitted in a mental nursing ward after a week of regular medical check-up. On admission, she was diagnosed of abdominal pain and temperature. She was described as confused, disoriented and adamant to leave her house. She was single without any close acquaintances living nearby. One of her relative who stays far away believes that she is depressed and required regular, dedicated care in a facility. When her neighbours were contacted, they expressed that she began to feel isolated after three of her friends who used to accompany her to day centre passed away. They also said that Jane was terrified with a thought of leaving her home and joining a residential unit. Further evaluation of Jane revealed that she has not been eating properly, not been taking care of herself hygiene and the hygiene of surroundings. In addition, it was also reported that she had arthritis which lowered her mobility due to which she did not take liquids in the evening with fear of moving in the night. Although treated for her UTI with antibiotics, her other symptoms continued to progress and detailed evaluation of her medical condition revealed that she was suffering from depressive illness.
Nursing assessment revealed that the mon conditions from which Jane was suffering are poor hygiene, reduced appetite, loneliness, lack of interest in life and unwillingness to move out of home with a feeling of insecurity. In order to improve Janes situation, the primary assessment done wad a good psychosocial assessment which is believed to aid the patient as therapeutic tool where patients could express their concerns to an external person seeking possible help (Rose and Barnes, 2008). This assessment is regarded to be patient centred and important in developing a well evaluated care plan which would favour and stabilise condition of James. This assessment utilised recovery model intervention in which clients explored their feelings, thoughts and ability to discover their illness and motivate themselves to improve their life (Repper and Perkings, 2007).
Presenting the conditions and symptoms of Jane, it was observed that her depression score was 19/21 based on the Beck Depression Inventory (Beck et al., 1971). These high scores revealed that any kind of self-report interventions designed in these cases are often unhelpful as the clients in these conditions either under present their symptoms or mislead evaluators in order to reduce their depression score whereby they could avoid facing further interventions.(Castillo, 2003). Therefore, Department of Health suggested the assessors to use proper assessments that would target the patients care strategy. It was also suggested that evaluation of proper interventions would reduce demand for any extra services.
According to Beck et al (1998), the dimensions of health involves being spiritual, biological, cultural and social. In this particular intervention of nursing, the health of Jane and his social wellbeing can be improved with the help of a nurse. In implementing the strategies of intervention, it is highly necessary for the nurses to follow the approach of problem solving Mathews (1996). So in order to perform an intervention of nursing on providing good care on Jane, the process of nursing is utilized by the mental health nurses. According to Allen (1991), in providing good care for the patients, the nursing process involves problem solving approach. It involves four stages of step by step process. In planning proper care to the patients, hierarchy of needs by MaslowâÂ€
(1954) acts as a guide to the nurse. All human necessities are addressed in this. Pillings (1991) explained that it is very important to make sure that all the patients’ needs are fulfilled irrespective of their health. Regardless of the wellbeing, considerable data regarding human necessities were explained by Abraham Maslow. The rationale involved in MaslowâÂ€
hierarchy of needs as a tool of assessment is that, it is highly important to first address the physiological needs of the patient. If the nurse fails to do so it may lead to the death of the patient. So in the present case study, the nurse assessed that Jane did not have the ability to suffice his physiological requirements rather than his other necessities. Jane would not be able to possess self-esteem if Jane’s physiological requirements like unhealthy eating and poor hygiene were not addressed. In the process of assessment, the nurse identified few physiological needs that are important. They are unhealthy eating habits, high alcohol intake, suicidal thoughts, poor hygiene etc. A framework model is considered as an artifact that adds up points to new thoughts and ideas Roper et al (1983). According to Newton (1991), a model is defined as gathering of mental images that depicts the nursing responsibilities of a nurse. This model helps in providing direction and structure to fulfill its goal. Roper, Logan and TierneyâÂ€
(1983) Activities of Daily Living is the model of nursing that is chosen for the present intervention. This particular model was chosen as it utilizes the systematic approach and implements Maslow model by first emphasizing on physiological necessities. So in the present case study, the activities of health promotion were planned by the nurse to improve the health of James and prevent further deterioration. According to Kemn and Close (1995), definitions and approaches of health promotion, the health promotion is defined as involving the activities that are necessary to prevent illness and disease and in improving the community’s wellbeing. Jane was explained about the process of intervention before initiating it. This is based on the Newton model (1991) which explains the importance of autonomy and choice that should be given to the patient and should be given the freedom to take decisions where ever necessary and important. In the process of assessment four stages were worked out by the nurse based on the Roper, Logan and Tierney (1983) model. This was implemented by first gathering necessary data from Jane, reviewing the information that is collected and recognizing the problems which are in priority. Another important model that can be used in assessing the James health is the Oremas self-care model (1985). According to this model, in maintaining the health, life and wellbeing, activities were initiated and performed by the individuals. In the present case study of Jane, more prompting is required regarding his self-care. So this model could be utilized to support Jane to suffice his needs of personal cleansing without excess prompting. According to Brown (1995), Planning refers to the activity of the nurses which involves taking necessary actions that are required based on the recognized needs. During the process of planning it is important for the care nurses and clients to give a thought on goals aims and their objectives. According to Ewles and Simnett (1999), an aim refers to the outcomes that are achieved on long term in a particular time period. In the case of Jane, the primary objective is to make him understand the necessity of taking healthy food with regards to his weight. Another objective is to make him aware of good hygiene with respect to his wellbeing and health. In the present case the goals that were established include:
Make Jane to adopt health eating and develop healthy lifestyle by encouraging him, make Jane to practice good hygiene to prevent him from diseases. The objectives are required to be time framed, realistic, achievable, measurable and specific (Fawcett et al 1997). Objective refers to the process that is intended by the teacher to achieve Kiger et al (1995). In this case Jane is allowed to eat only limited food during his meal. He is take proper care to avoid diabetes. He is made to perform his daily routines like bathing himself, changing the socks and putting in the laundry etc. The nurse that is concerned with taking care of Jane would conduct one to one sessions so as to develop healthy eating habits. The nurse would refer Jane to dietician to solve the issues of overweight through diet. It is necessary for the staffs who are concerned with providing health care to Jane to attend training classes on healthy eating. Educative leaflets could be provided to Jane. The nurse would also take the opinion of James regarding the personal hygiene through open ended questions. It was observed that a felt need is expressed by Jane when he expressed feelings of faithlessness and confidence.
From the detailed assessment of Jane and interventions applied by the staff, great knowledge and information on various aspects of care planning was learnt, analysed and understood. The care planning included detailed assessment which served to be one of the vital component in care planning. Next, in the planning stage, the evaluating nurse acquired a detailed understanding on the methods of addressing needs of the clients during which they took into consideration all the predetermining and necessary factors. The main factors which were taken in to account were the cognitive abilities of the people suffering with mental illness. The evaluating nurse regarded that communication with the patient is necessary at all times of delivery of care. In addition, it was also evaluated that good interpersonal skills are required for development of good holistic care. As a part of psychosocial individualized intervention, Jane was empowered and encouraged to engage in wide range of social activities where she can mingle with general population.
Further, this essay has describes the various aspects that are involved in care planning. The essay has also laid emphasis on the imperative role of a mental health nurse in the management of health of people suffering with various kinds of mental illness. As suggested by the NMC in the year 2002, nurses should act proactively to pick, identify and reduce the risks to the clients. The whole assessment, evaluation and intervention prove that there are various things which are kept in kind before implementing a care process. In addition to the nursing process and care planning, there are other factors that include the nurse’s role, consent from the patient, multi-agency working and self-empowerment which aid in efficient care implementation
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