Reflective Account On Mental Health Nursing Practice And Dementia Care

Nursing Student’s Perception of Mental Health Patients

Even though theoretical preparations are important, there is, however, no alternative for learning in a nursing profession like the practical aspect. Clinical experience is thought to be the key to nursing education. As a nursing student without prior experience in the field of mental health, I had this perception that the mentally ill are very dangerous people (Thomas, 2016). This is the same perception that is to the general public. Besides, I also thought that the mentally ill individuals are prone to violence, they are also unpredictable and to a further extent, they are responsible for worsening of their condition. At the beginning of the semester, I also felt much unprepared besides being anxious and stressed prior to the beginning of the mental health clinical (“Australian College of Mental Health Nursing 41st International Mental Health Nursing Conference – ‘Mental Health Nurses: shifting culture, leading change’,” 2015). A meeting with the clinical staff, however, gave me the required confidence and this also increased my satisfaction with the clinical experience. I did, however, note that with time, the course of clinical experience together with observation and active participation, I began to feel less anxious and more comfortable interacting with the mentally ill patients in the hospital.

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During the initial clinical days, I was very nervous hanging around patients suffering from mental illness characterized by stress disorder, anxiety disorder, mood disorder, psychotic disorder and so on. I did at some given point feel that one of the patients would hit me up especially after witnessing one patient who was right on the back of one of the students sniffing on her hair on the first day of the clinical placement. With time, however, I started feeling comfortable within the facility and being around the patients. Another fear, however, started developing. The fear to pick on the right words at the right situation. An example is where to pick a story from a patient who was hallucinating and only developed stories from the pictures of celebrities he could see in the magazines that were on the table. At this juncture, I felt that the theoretical aspect would not assist much and I did figure out how I could communicate with the patient. In this case, the only option was to listen to his stories by showing interest in them and then giving him some little feedback through nodding my head.

Many times I also became very emotional and had empathy especially towards younger girls who had been sexually assaulted by their family members. A good example was a girl who had been sexually abused by her grandfather and her mother knew everything but could not do anything to save her from the grievances. Another moving case was that of a young girl who had attempted suicide on several occasions due to lack of family support as her mother had died when she was only i5 years old. Her father, on the other hand, had another family in Jamaica and she had been sexually abused by her stepbrother.

Emotional Responses During Clinical Experience

As a nurse student however, I learnt that one has to separate between their feelings and the clinical setting so as to keep on responding to the needs of the patients in a more professional manner. The clinical set up was the best learning experience as I had that chance to see how the mentally ill patients behave first hand rather than the descriptive words from the psychology books. Miss J for example who was diagnosed with psychotic disorder, bipolar disorder, and final major depressive disorder was characterized by strange behaviors which I was really impressed with (Alzayyat, 2014). The particular patient would change from a very an initial strong personality to a later angry person. The patient could then change to an actor, laugh at a given time then cry and laugh moments later within a very few time. Furthermore, I felt that nurses and other staff did provide a good atmosphere to me and other students through answering questions and allowing us to interact and participate in staff meetings as well as group therapy counseling. In my opinion, I feel the attitude of the staff members towards students is a key component in the creation of a good clinical experience. In this scenario of my reflection, my patient will be referred to as Kate. However, note that Kate is not her real name. This is to ensure confidentiality of the patient in question as per the NMC codes of conduct.

Kate was a 70-year-old mother of three boys who retired from her job as a nurse twelve years ago. Since the unfortunate death of her husband seven years ago, she has lived alone though she has one son who is very supportive. The son visits her like two to three times a week. The patient was referred to the hospital by her doctor after she presented with an eighteen-month history of memory issues and it was decided upon that she should be attending the day healthcare facility for a duration of seven weeks so that she can be assessed and be involved in therapeutic activities while there as well.

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During her routine hospital visits, she was closely assessed and was found out to have repetitive and obvious fabrication. Besides, she was also very disoriented and had very poor concentration. It was also noted that Kate had a very short-term memory. The concerned consultant then instructed psychiatric nurses to closely carry out mental tests on her. From the results, it was apparently clear that Kate was suffering from dementia. According to Newell and Gournay however, dementia is a condition characterized by the structural alterations of the brain that affects 10% of people with ages above sixty-five years.

Case Study on Dementia Care

Based on the findings from Kate, A multidisciplinary team was put in place with the sole aim of discussing the best form of care that Kate should be accorded so that she could live safely in her own home. It was the consultant who was the chair of that particular meeting and he brought to the attention of the team the medical history of Kate, the problems she was going through together with her son. The consultant did feel that Kate would definitely benefit from the medications that could help her memory problems.

The community psychiatric nurse then issued the concerns about Kate’s son. The son had informed the Community Psychiatric Nurse of the careless wandering of Kate that did happen at inappropriate times of the day and that she could only remember to eat. The son also complained of how she would forget to close the taps and other dangerous appliances in the house like cooking gas and electrical appliances. The son was particularly concerned about the health condition of her mother. It was, therefore, suggested that the occupational therapist visit her home so as to keenly assess the safety in her house concerning the mentioned issues. The social worker, on the other hand, did discuss the possibility of availing home caregivers. However, the mental health nurse was deeply concerned about this since Kate was rarely at home.

The social worker then proposed a meeting with the son to give him guidelines that would ensure that his mother takes her medication on a regular basis besides ensuring that she remains at home until the particular caregivers arrive. It was as well agreed upon that if this particular plan is not conducive for Kate and her son, the issue would be raised in the next Multidisciplinary Meeting.

The brain is constituted of billions of nerve cells. The functions of this nerve cells are to convey messages and this is simply how the brain controls whatever someone does or thinks about (Hayes, 2017). The largest part of the brain is known as the cerebrum also known as the cerebral cortex which is made up of four lobes called the frontal, temporal, occipital and finally the parietal lobes. The function of the frontal lobe is speech control, reasoning as well as judgment (Giebel et al., 2015). The parietal lobe, on the other hand, is responsible for interpreting information got from different senses, sequencing as well as spelling (Bonds, Lee, Whitlatch, & Lyons, 2017). The temporal lobe is used for short-term memory while the occipital lobe recognizes different colors, shapes as well as movements. When a lot of brain cells start to die, it results in a condition known as dementia.

Role of the Nurse in Dementia Care

According to statistics from the Alzheimer’s Society, about 800,000 people who live in the UK suffer from dementia. It should be however noted that dementia is not a disease rather the natural process aging (Giger, Schweinle, & Smallfield, 2015). It is a word that symbolizes a group of symptoms like loss of memory, diminishing coordination and movement and the deficiencies in communication, thinking and reasoning (Sontheimer, 2015). The condition is not discriminative in terms of race and gender. Anyone can be affected by the condition.

The role of the nurse, in this case, is to initially diagnose the patient and in case the tests are positive, the nurse has to give health education to the family. There are generally four nursing steps a nurse should always consider to provide the highest quality care to the patient living with dementia (Lorenz, Freddolino, Comas-Herrera, Knapp, & Damant, 2017). The processes start with assessment to determine how well the patient can function within the care. After the assessment is the planning process and this involves an outline of what can be achieved (Daly Lynn et al., 2017). After planning, it is the implementation process. Finally, it is the evaluation to find out if indeed the condition has improved or not.

Within that particular Multidisciplinary team, I did feel very comfortable and accepted. The environment was quite friendly and relaxed that everybody appeared to have something to contribute or offer. Each one of us was just motivated to participate and I felt that should I have known the patient better, I would have really given my contributions as well. I felt that the MDT would have really listened to me keenly were it not that I was a student. About communication, each of the MDT did communicate well with others and both of them had the best interests of Kate (Sreevani, 2016). The discussions went on until the best outcomes were achieved for Kate. This aspect did demonstrate the benefits as well as the importance of communicating within a team and how different contributions within meetings should be of value.

Conclusion

I got to learn different new things about myself in the course of my clinical experience. I did manage to learn different counseling skills through the process of listening to the patient, empathizing with them, identifying the particular problem or issue and then finally providing the basic care to avert any future problem. I never knew that with just a few and simple words of encouragement and empathy can effectively calm down a very mentally ill patient. Besides, I learned that communication can enable the patient feel relaxed and be cheerful. A good example is the case of Miss H who I encountered at the facility after she had attempted to commit suicide on several occasions. Dementia is impairment of the brain as a result of aging. It should, however, be noted that it is not a disease.

Besides medication, one on one therapy together with group therapies can help mentally ill patients so much. This was as well exhibited during the case of Miss H . I also learned that supporting recovery needs a cultural awareness that is deeply rooted in both the visions of values and trust. This, therefore, means that working relationship recovery is a crucial process that places responsibility on promoting personal as well as a valuable process that places responsibility on the promotion of personal and professional growth as well as comprehend. I, therefore, hope to bolster my psychosocial as well as counseling skills as I soldier on with the journey of nursing.

References

Alzayyat, A. S. (2014). Barriers to Evidence-Based Practice Utilization in Psychiatric/Mental Health Nursing. Issues in Mental Health Nursing, 35(2), 134-143. doi:10.3109/01612840.2013.848385

Australian College of Mental Health Nursing 41st International Mental Health Nursing Conference – ‘Mental Health Nurses: shifting culture, leading change’. (2015). International Journal of Mental Health Nursing, 24, 1-49. doi:10.1111/inm.12172

Bonds, K., Lee, C., Whitlatch, C., & Lyons, K. (2017). DECISION-MAKING INVOLVEMENT AND CARE VALUES OF AFRICAN AMERICAN PERSONS WITH DEMENTIA. Innovation in Aging, 1(suppl_1), 1212-1212. doi:10.1093/geroni/igx004.4406

Daly Lynn, J., Rondón-Sulbarán, J., Quinn, E., Ryan, A., McCormack, B., & Martin, S. (2017). A systematic review of electronic assistive technology within supporting living environments for people with dementia. Dementia, 147130121773364. doi:10.1177/1471301217733649

Giebel, C., Sutcliffe, C., Verbeek, H., Zabalegui, A., Soto, M., Hallberg, I. R., … Challis, D. (2015). Depressive symptomatology and associated factors in dementia in Europe: home care versus long-term care. International Psychogeriatrics, 28(04), 621-630. doi:10.1017/s1041610215002100

Giger, J. T., Schweinle, W., & Smallfield, S. (2015). Non-wearable sensors to detect sleep efficiency in older adults with dementia: A pilot study. Alzheimer’s & Dementia, 11(7), P188-P189. doi:10.1016/j.jalz.2015.07.167

Hayes, N. (2017). Excellent Dementia Care in Hospitals: A Guide to Supporting People with Dementia and their CarersJames Jo Cotton Beth Knight Jules et al Excellent Dementia Care in Hospitals: A Guide to Supporting People with Dementia and their Carers 192pp £16.99 Jessica Kingsley 9781785921087 1785921088. Nursing Older People, 29(6), 15-15. doi:10.7748/nop.29.6.15.s16

Lorenz, K., Freddolino, P. P., Comas-Herrera, A., Knapp, M., & Damant, J. (2017). Technology-based tools and services for people with dementia and carers: Mapping technology onto the dementia care pathway. Dementia, 147130121769161. doi:10.1177/1471301217691617

Sontheimer, H. (2015). Aging, Dementia, and Alzheimer Disease. Diseases of the Nervous System, 99-131. doi:10.1016/b978-0-12-800244-5.00004-5

Sreevani, R. (2016). Chapter-01 Perspectives of Mental Health and Mental Health Nursing. A Guide to Mental Health & Psychiatric Nursing, 1-35. doi:10.5005/jp/books/12736_2

Thomas, S. (2016). Mental Health Nursing. Issues in Mental Health Nursing, 37(8), 621-621. doi:10.1080/01612840.2016.1203225