Integrative Health Care Approach: A Case Study

A visit to the emergency department (ED) is usually associated with negative thoughts by most people. It creates preconceived images of overcrowded waiting rooms and routine long waits for treatment (Jarousse, 2011). From 1996 to 2006, ED visits increased annually from 90.3 million to 119.2 million (32% increase). During this same time period, the number of EDs has declined by 186 facilities creating the age old lower supply and greater demand concept (Crane & Noon, 2011). There are many contributing factors that have led to an increase in ED visits. A few of these key drivers include lack of primary care access, rising of the uninsured population, dwindling mental health services, and the growing elderly

The study revealed several issues in this department. Voluntary emergency patients have to wait extended periods of time before being transferred to the appropriate department. The majority of those who have to wait are those seeking mental health assistance. Keeping people in the emergency department longer than necessary cause operational costs skyrocket, and worse, keeps the needs of patients from properly being met.

(Mann, 2014, p.2) These strategies include: broadening access to primary care services; focus on individuals who frequently utilize the emergency department (super-utilizers); and targeting the needs of individuals with behavioral health problems. (Mann, 2014, pp 2-4) Many resources and processes have been implemented in order to help decrease inappropriate emergency department visits. This paper is going to demonstrate some resources and processes that are in place to help individuals obtain health care at the appropriate health care setting.

The practice problem that this writer chose was psychiatric patients that are boarding in the emergency room that do not have a therapeutic environment. The website that this writer chose to use to research about the non-therapeutic environments for the psychiatric patients that are boarding in the emergency room is CINAHL complete. From this search of boarding psychiatric patient in the emergency room, eleven articles resulted. Boarding of psychiatric is all too common of an occurrence in the emergency room because of the decrease in inpatient psychiatric hospital beds. There has been a decreased in beds over the years in 1990 there was “3.7 beds per 1000 person” and in 2006, it decreased to “2.6 beds” (Nolan, Fee, Cooper, Rankin, & Blegen, 2015, p. 57). All of the article that were resulted from

As previously mentioned, it is thought that engagement and understanding are key elements involved in creating and maintaining a therapeutic relationship (Orlinskey et al 1994). Throughout the risk assessment I checked the patients

My experience in mental health clinical was very different from any other clinical I had before. In a mental health clinical setting, I am not only treating client’s mental illnesses, I am also treating their medical problems such as COPD, diabetes, chronic renal failure, etc. Therefore, it is important to prepare for the unexpected events. In this mental health clinical, I learned that the importance of checking on my clients and making sure that they are doing fine by performing a quick head-to toes assessment at the beginning of my shift. I had also learned that client’s mental health illness had a huge impact on their current medical illness.

Therapeutic relationship is defined as the collaboration and attachment between the client and therapist that focuses on meeting the health care needs of the client (Bordin, 1979). In this relationship, the therapist without prejudice shows Empathy, insight, understanding and acceptance of the client. Duan and Hill (1996) defined Empathy as “feeling into” the experience of the client. Over the years, the research evidence keeps piling up, and indicating a high degree of Empathy in a Therapeutic relationship is possibly one of the most potent factors in bringing about positive outcome in the therapy

The second recommendation for the above-identified weakness is for the hospital to have a holding unit staffed with a nurse and technician for the behavioral patient in the emergency department (ED) to prevent overcrowding in the unit. According to Mathur, Ms. ( n.d.), the extra wait time in the ED before receiving the mental health services delays the delivery of psychiatric intervention and increases psychological stress for patients.

While discussions of integrated care are not new in the United States, the research literature has largely been about blending mental and chemical health into physical health systems. Using a critical hermeneutic application of interpretive phenomenology, this study aims to address that gap by interviewing adults with serious mental illness about their experience receiving physical health services within a community mental health center. Nine individuals, five clients and four providers, interviewed for this study were selected using the critical case criterion in partnership with the community mental health center. Interviews were digitally recorded and transcribed. Data analysis was conducted within-case followed by cross-case analysis technique.

Despite the amount of time the therapist spends with the patient, she stressed the importance of developing a trusting relationship with the patient (IPEC, 1.6).

Members diagnosed with a severe mental illness (SMI) generally have a shorter lifespan than members that are general mental health. For many years behavioral health and physical health services have been provided separately. SMI members have a difficult time coordinating physical health care, resulting in unmanaged chronic illnesses that lead to death. The shift in healthcare focuses on the individuals whole health. Integrated health care seeks to close gaps in care to increase lifespan, reduce chronic illness, and focus on preventative healthcare.

Though the need for integrated health care continues to rise not all doctors are willing to consider the change. Critics have proposed that integrative medicine is “driven largely by market forces, as well as public fascination and demand for alternative treatments.” (Kam, 2009, para. 9) Tom Delbanco, M.D., a Harvard Medical School professor and physician at Beth Israel Deaconess Medical Center advises that in a national survey conducted amongst hospitals “implementing integrative care shows the most common barriers include physician resistance to change accounting for up to 54% of those surveyed, budget constraints (65%) and lack of evidence based research (39%).” (Kam, 2009, para. 10)

There are many variables that influence the success of therapy for the client, none more so than the therapeutic relationship. The therapeutic relationship is defined as the strength and collaborative relationship between the client and therapist that emphasises mutually agreed goals and tasks within the context of a strong affective bond (Horvath, 1994.) In the therapeutic relationship, the clinician offers care, touch, compassion, presence, and any other act or attitude that would foster healing, and expects nothing in return (Trout, 2013.) Some clinicians believe that the “therapeutic relationship is a precondition of change, others as the fertile soil that permits change, while others see it as the central mechanism of change itself” (Norcross, 2010.) This is not to devalue other variables that impact the success of the therapy such as client involvement and the treatment method.

First of all, therapeutic communication is the “ability to use one’s personality consciously and in full awareness in an attempt to establish relatedness and to structure nursing intervention” (therapeutic communication in psychiatric nursing, 2014). Nurses need to make changes in their own thought processes, and gain self-awareness and self-understanding to be able to apply effective therapeutic use of self (therapeutic communication in psychiatric nursing, 2014). The main point of maintaining therapeutic communication in nurse-patient relationship is to create a relationship that contains rapport, trust, respect, genuineness, and empathy (Therapeutic communication in psychiatric nursing, 2014). There are many aspects in communication that nurses need to consider important such as: values, attitudes, beliefs, culture, religion, social status, gender, age, developmental level, and the environment (therapeutic communication in psychiatric nursing, 2014).

In some cases, patients are advised to check with a psychiatrist or check into a mental facility.