Working with Acute Mental Health Needs Clients - Essay Example

Introduction As technology is advanced, the facilities and the speed at which the mankind works is advanced, so is the deterioration of both the physical and mental health is advancing. Serious mental health problems have become a very common issue, its number increasing through the years. Many mental disorders have been recognized and are being treated over time. The case study that I have selected is Depression or depressive disorder. The depression can be of either way, with the symptoms in smaller scale, that the patient themselves overcomes or in a larger proportion that ends up in an PICU. This case, I feel is an perfect case were the parse theory nursing can be applied on reflective studies. The theory that explains the need for the health practitioner (nurse), the patients family and the co-operation of patient in the possible cases, where they can help by expressing their feeling ,the changes they undergo and their mental wish and strength. This paper will examine the Parse method of nursing with respect to the care mentally depressed patients. What is Depression or depressive disorder:- the condition selected for case study An survey done in America states that in any given period of one year 9.5percent of adult American population suffer from depressive illness. Depressive is often found to interfere with the normal functioning and is found to cause pain and suffering not only to the sufferers but also to their family member and serious depression is found to spoil the life of the ill person as well as the family, much of these suffering is unnecessary. This is because of the lack of knowledge that depression is curable thanks to the innumerable research and therapies. (Robins & Regier, 1990) Depressive disorder may be defined as a illness that involves the body, mood and thought, affecting the person’s eating and sleeping pattern about the views he has about himself. It should not be confused with the passing blue mood and here the patient cannot pull himself or herself without medical intervention. The disorders are of different types based on their symptoms, severity and illness period. Major depression that disables the patient’s normal life style. Dysthymia, long term but doesn’t disable the patient and another being the Bipolar disorder- the maniac depressive illness- that has cycling mood changes The symptoms of the depression is persistent, sad or anxious or angry mood, feeling of pessimism, guilt, insomnia, loss of appetite and weight loss or weight gain, restlessness, irritability and suicidal thought. Persistent physical symptom as headache, digestive disorder doesn’t respond to treatment. In mania the symptoms are abnormal elation, unusual irritability, and less need of sleep, increased thoughts and sexual desires, poor judgment, poor social attitudes with abundance of energy. (Ferketick etal.,2000) The causes of depression might be : It may run in families, a biological vulnerability that can be inherited. Being with low self-esteem with pessimistic views about the world, an psychological predisposition. Physical changes in body may attribute to mental change as well, medical illness as stroke, Parkinson’s, heart attacks, prolonged recovery period may cause an apathy of patients. A sudden change in life style, loss of beloved, difficult relationship and financial problem. A combination of genetic, physiological and environmental factor. Depression is found to exist variedly in different groups. Women are found to be twice more vulnerable than men. May be due to hormonal factors as menstrual cycle change, pregnancy, postpartum etc. mainly it is premenstrual syndrome or post birth of the baby. Though less number of men than women is affected, the suicide rate is more in men and they suffer increased rate of CHD than women due to depression. The often-missed group is older persons who are unexpressive in depression. (Blehar &Oren ,1997) The diagnosis includes, Primary physical examination and test to rule out any physical ailment Psychological evaluation with a psychiatric The good diagnostic evaluation in that angle starts with collection of the patients history, habits as drug and alcohol, suicidal intention and inquiry about family history and mental status evaluation The treatment is out come of diagnosis: Psychotherapy in mild case Variety of antidepressant medication in moderate cases Or a combination of both is highly effective Electro convulsive therapy when the depression is severe or life threatening and who cannot under take antidepressant medication, and for better effect is taken as 3 per week. (Frank etal.,1993). . Parse Method of Nursing- The theory selected for reflection Nursing theory can be considered as a name given to a body of knowledge that effectively governs the nursing practice. Nursing models can be described as conceptual models that is coherently constructed of theories and concepts. These theories helps nurses to assess, plan, and implement patient care by providing a framework within which to work. They also help nurses achieve uniformity and seamless care Parse’s method of nursing is developed on the philosophy of the Theory of Human Becoming is an holistic model of nursing theory. The Parse method is generally phenomenon based. The respondents who are being studied are portrayed as experiences by the caregivers who care for them. These respondents who are studied are generally considered as “universal lived experiences of health”. They encompass varied emotions such as grief, restricted-feeling free, and suffering. Parse (1995) says that the patients being studied are individual persons who are capable of portraying through various means like descriptions, language, verse, signs, or diagrams the gist of the occurrence under study. Parse’s hypothesis allows the caregiver to think of the new consequences of various situations, which permits the nurse to flow with the tide of the patient’s rhythms and permits the patient to stretch beyond the present moment (Hickman, 2002). The three major principles of Parse's theory are the basis for the nursing model. (Progress in Self Psychology, (1992). Progress in Self Psychology, 8:215-228) Parse Method’s first rule affirms that “Structuring meaning multidimensionality is co-creating reality through the languaging” (Hickman 2002). The first rule can be summarized as the realism of the normal everyday human existence, which is based upon the template of their previous experiences. Imaging in the context of the first principle of the Parse’s method implies information and this information encompasses both the tacit and explicit information. Languaging in the context of the Parse’s method is described as the combination of principles and metaphors in the course of moving and talking. Valuing is defined as the sequence of living as per one’s prized belief and at the same time adding to their world view. The second rule of the Parse method postulates “Co creating rhythmical patterns of relating is living the paradoxical unity of revealing-concealing, and enabling-limiting, while connecting-separating” (Hickman 2002). This is a concept, which denotes a multidimensional universe that is created by everybody in the process of living and dying. Relationships usually force human beings to disclose a part of them but simultaneously it also keeps a part of them hidden. Hickman (2002) has postulated that the caregiver stays within this structure and travels with the tide of situational context, at the same time helping them to distinguish and identify the accord in their own context. Powering, originating, and transforming are the fundamental concepts of this principle. Powering is the stimulating energy which characterizes a typical human encounter. Originating refers to the process of determining the various ways by which an individual can either conform or not while living. The individual determines a personal method to live his life. That method creates personal uniqueness. Transforming refers to the creation of diversity (Hickman 2002). The nurse guides the family “to plan for the changing of lived health patterns” (Hickman 2002). The Parse method is planned in such a manner so as to guide further research and practice. This method identifies three basic theoretical models. Parse has stipulated that the caregiver’s relationship with the patient and the extended family unit is vital to the family ventilating their feelings. As the family and the caregiver exchange their thoughts about their existing situation, the family appreciates the significance of their situation. (Hickman, 2002). Parse method’s second theoretical construct center’s on the relationship of the caregiver with the patient and their immediate family circle. By combining various rhythms of life, transcendence is achieved. The patients determine various ways to stay together and finally the choices result in transcendence (Hickman 2002). The third theoretical structure allows for the enlightenment of the various relating ways for the nurse, the patient or family to be together. Multiple viewpoints shed light on the familiar perspective but also concurrently recognize new possibilities. Case study: PICU – the Psychiatric Intensive Care Unit is described as an small highly staffed, low designed ward, designed to treat the acute psychotic symptoms. (Steve brown and nick brass, 2004) The is case of Mrs . Janettee, a 60 years old lady, was admitted in the hospital as a case of severe depression. She had refused to take food for last 10 days and declined to go through her routine day activities as even brushing and bathing. When admitted she was in a confused and perplexed state and she had violent outbursts for more than six times in last 10 days.so her sleep, appetite and psychomotor activity was not normal and she was found to have suicidal intention with two attempts for suicide in the last month. When interrogated she spoke in a detached tone but at that her behaviour was calm. When her son was interrogated to shed light on the patients past history, it was known that earlier she had never visited mental health professionals. She is a patient with hypertension and hyperglycemia and was under medication. 5 years back one of her son has died in accident and 2 years later to that her husband died of lung carcinoma. The same year she underwent hysterectomy for the diagnosis of uterine cancer. Close to her husband’s death she started saying that she was able to hear her husband and son’s voice which earlier was a solace then became a terror to her that lead to serious episode of often mood swing, un explained physical ailment, anxiety, unable to be alone- all typical symptoms of hallucination and depression. None of her relatives had ay past psychiatric disorder.(Allen and Cohyney, 1995) On initial conclusion on symptoms and case history, the patient had prominent psychotic symptom, age above 50, marked stressor agents and factitious symptom. Thus it could be clearly seen that it is depression due to the dissociative disorder, but the depressive disorders were difficult to manage. She also has a feeling that her only son who now is settled with a family is not concerned about her and no body cares for her. (Faya etal,1994) The treatment for her was planned in three phases as medication, psychotherapy and ECT. First she was started with the anti depressant therapy that would keep her calm and ward off her suicidal thought. It was given for 2- 4 weeks initially with added ECT. She was on haloperidol 15 mg and diazepam 22 mg.. (Welner etal., 1974) Then the psychotherapy was started with the interpersonal therapy and cognitive behavioural therapy. In initial she was kept under high security due to her strong suicidal thought which was released as she slowly started recovering slowly hope was instilled in her. Then she was made to talk with her family and both sides were made to understand the situation on these combined treatments she slowly recognized that the trauma has passed and she has to live with facts and that she is loved and cared by her family she was discharged later with antidepressant therapy for 6 months and 2 month psychotherapy to avoid the relapse. (Watkinsetal.,1993) (Hollon etal.,1993) (Kendler etal.,1993) Effectiveness of the Parse Method in the Care of depressive patients: The basic premise of the Parse method is to envision the various possibilities. The patient normally expresses the various possibilities as either “what is” or “what will-be all-at once”. The patient pictured varied behaviors and imagined the various possibilities that were still imaginary in nature. The patient characterized their feeling and hopes as “not-yet” (Allchin-Petardi 1999). In the second notion the patients moved from their present situation to their future objective that they hope to attain. This according to the Parse’s Theory of The Human Becoming this is referred to as “powering”. Final concept of the Parse method is referred to as the formidable ambiguity. This method stressed on the individual’s ability to examiner their troubled situations in more than one fashion (Allchin-Petardi 1999). “All the participants were subjected to the different types of situation, the only commonality was the overwhelming nature of the situation which they were subjected to, moreover there were multiple means of surmounting the overwhelming odds and reach out of the ambiguity”. (Allchin-Petardi 1999). The human beings who have progressed in a unique and a constructive path will ensure that along with the path, which they have created for themselves, the Enabling-limiting will create a path for others to follow (Allchin-Petardi 1999) Thus this point helps me to understand retrospectively that though psychiatric disorders have a name common they vary that each ptient is different and they have the right to choose their own way of treatement. “Various options are available for the patients, as the patient reviewed the choices, the patient automatically short listed some options and rejected the rest (Allchin-Petardi 1999). The initial idea of Mitchell’s study is the anticipating limitation. The patient explained to his family unit and the caregiver, the numerous restrictions experienced by him, such as the necessity to walk with a cane and many other restrictions (Mitchell 1995). Parse theory stipulates that structuring implies the simultaneous creation of reality through valuing and imaging in a multi dimensional manner. (Parse 1995). The second idea outlined by Mitchell is the unencumbered self-direction. This idea is interrelated to the concepts of freedom and choice, the individual is free to do whatever he wants and is not accountable to anyone (Mitchell 1995). Parse’s concept of transcendence is vital to the nursing (Parse 1995). The last idea outlined by Mitchell is the idea of Yielding to change fortifies resolve for moving beyond. The patients mentally accepted their limitations and learned to accept their reduced functionality and loss of activities. Mitchell(1995) has remarked about the ability of the affected persons to take their loss in their stride and even attempt the occasional humor. This is in line with the Parse’s method which deals with the simultaneous creation of the various similar samples to relate to life (Parse 1995). “The restriction-freedom experience has been specified as anticipating limitations with unencumbered self-direction while yielding to change fortifies resolve for moving beyond. These were actually the guidelines or was the target I had set for the patient to achieve. This state I tried to achieve by making the patient and members to talk out in the presence of psychotherapist. After a stage I could feel that it was the patient who steered the direction of treatement that I could later be convinced that, on application of the theory I could feel that patients have the right to choose and they are individual entity. Thus the role of nurses in patients recovery is in stages: Medication and ECT Initial psychotherapy that helps the patients mostly, the effect of which lies in the hands of the practitioner who steers the direction of the talk. They also require the nurses to do some homework- the interaction with patient to break up useful information, interacting with the family members to know the nature and background. Interpersonal and cognitive therapy Psychodynamic therapies Follow-ups after the sitting to maintain the outcome of the treatment. (Lebowitz etal, 1997) The main disadvantage I felt with the parse theory was that it provides a holistic or generic approach for patients but disregards the importance of patients generic, race , sex, class and societal behaviour unconcerned,. The application of which I feel would still help us understand the patients better and offer them a better treatment. (Cody and Mitchell, 1992) (Drevdal, 1999) Conclusion This paper examines the Parse method of nursing with respect to a depressive patient.The theoretical basis for Parse theory is examined in brief. Its application to this scenario is studied in detail. The Parse Method is suitable to be used in this scenario. References Robins LN, Regier DA (Eds). 1990 Psychiatric Disorders in America, The Epidemiologic Catchment Area Study, ; New York: The Free Press. Blehar MD, Oren DA.,1997 . Gender differences in depression. Medscape Women's Health, 1997;2:3. Revised from: Women's increased vulnerability to mood disorders: Integrating psychobiology and epidemiology. Depression, 1995;3:3-12. Ferketick AK, Schwartzbaum JA, Frid DJ, Moeschberger ML,2000. Depression as an antecedent to heart disease among women and men in the NHANES I study. National Health and Nutrition Examination Survey. Archives of Internal Medicine; 160(9): 1261-8. Frank E, Karp JF, Rush AJ (1993). Efficacy of treatments for major depression. Psychopharmacology Bulletin, 1993; 29:457-75. Parse, R. R. (1995). Research with the human becoming theory. In R. R. Parse (Ed.), Illuminations: The human theory in practice and research (pp. 151-158). New York: National League for Nursing Press. Parse, R. R. (1995). The human becoming theory. In R. R. Parse (Ed.), Illuminations (pp. 5-8). New York: National League for Nursing. Parse, R. R. (1995). Theoretical conceptualizations within the human becoming theory. In R. R. Parse (Ed.), Illuminations (pp. 5-8). New York: National League for Nursing Press. Hickman, J. S. (2002). Theory of human becoming: Rosemarie Rizzo Parse. In J. B. George (Ed.), Nursing theories: The base for professional nursing practice (5th ed., pp. 427-461). New Jersey: Prentice Hall. Steve Brown a; Nick Bass,2004. The psychiatric intensive care unit (PICU): Patient characteristics, treatment and outcome , Journal of Mental Health, Volume 13, Allen J.G. & Coyne L. Dissociation and vulnerability to psychotic experience. J Nerv Ment Dis 1995;183:615-622 Fava M, Bless E, Otto MW, Pava JA, Rosenbaum JF: Dysfunctional Attitudes In Major Depression. Changes With Pharmacotherapy. Journal of Nervous & Mental Disease 1994; 182(1):45-9. Welner A., Liss J.L. & Robins E. A systematic approach for making a psychiatric diagnosis. Arch Gen Psychiatry 1974;40:877-883 Lebowitz BD, Pearson JL, Schneider LS, Reynolds CF, Alexopoulos GS, Bruce MI, Conwell Y, Katz IR, Meyers BS, Morrison MF, Mossey J, Niederehe G, Parmelee P,1997, Diagnosis and treatment of depression in late life: consensus statement update. Journal of the American Medical Association, ; 278:1186-90. Watkins JT, Leber WR, Imber SD, Collins JF, Elkin I, Pilkonis PA, Sotsky SM, Shea MT, Glass DR: Temporal Course Of Change Of Depression. Journal of Consulting & Clinical Psychology 1993; 61(5):858-64. Hollon SD, Shelton RC, Davis DD: Cognitive Therapy For Depression: Conceptual Issues And Clinical Efficacy. Journal of Consulting & Clinical Psychology 1993; 61(2):270-5 Kendler KS, Kessler RC, Neale MC, Heath AC, Eaves LJ: The Prediction Of Major Depression In Women: Toward An Integrated Etiologic Model, Journal of Psychiatry 1993; 150(8):1139-48 Mitchell, G. J. (1995). The lived experience of restriction-freedom in later life. In R. R. Parse (Ed.), Illuminations: The human becoming theory in practice and research (pp. 159-195). New York: National League for Nursing Press. Cody,W,K. and Mitchell.G.J,1992. Parse’s theory as model for practice: cutting edge. ANS Adv NUrs Sci , 52- 65 Drevdahl, Denise RN,1999,. Nursing Theory for the 21st Century. 21(4):1-13, Advances in Nursing Science. Read More