Nursing Case Study: Psychiatric Patient Essay

The aim of this study is to provide a detailed account of the nursing care for a patient who is experiencing a breakdown in health. One aspect of their care will be discussed in relation to the nursing process. The model used to provide an individualised programme of care will be discussed and critically analysed.

The types of interaction with the clients are completely different between the professions. A psychiatric technician may or may not intervene with a client by themselves. Psychiatric technicians would probably alert a social worker, psychiatric nurse or who ever their supervisor is before they intervene with a client. For example, a psychiatric technician wouldn’t provide a one on one counseling session with the client because they are not permitted to provide treatment. However, they would listen to the client while they vent to help diffuse a situation, but not provide any mental health treatment. A Psychiatric Technician tends to focus more on direct care while clinical psychologist focus on treatment and diagnosing. In some states a psychiatric technician averages thirty-three thousand dollars a year compared to and average of seventy-five thousand dollars a year for a clinical psychologist.

Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing, at the Institute of Medicine

For the purpose of this assignment the student will be discussing and analysing the professional, legal and ethical issues that influenced how person-centred care was delivered to a patient in an acute psychiatric hospital where the student was working. In accordance with the Nursing and Midwifery Council (NMC) (2010) the patient will be referred to as Sarah to uphold confidentiality.

According to the Centers for Disease Control and Prevention, 8% of persons over the age of twelve reports being currently depressed, this includes 6% of the male population (2014). This literature also reports males aged forty to fifty-nine having higher rates of depression (7%), when compared to males sixty years or older (5%) (2014). In 2010 there were 63.3 million visits to primary care physicians, hospital outpatient units and emergency rooms attributed to mental health diagnosis (CDC, 2014). In the same year, there were 395,000 psychiatric inpatient discharges with major depressive disorder as the primary diagnosis. These individuals had an average stay of six and a half days (CDC, 2014). Inpatient and outpatient treatment is seemingly a revolving door. One article examines the growing number of people being diagnosed with depression, yet the declining number of people seeking outpatient care. This article reports 2.88 out of 100 people seek outpatient treatment for their depression (ScienceDaily, 2010). It is imperative for practitioners of group practice to understand that men and women experience depression differently and to then formulate treatment based on the individual’s unique needs (NIH, 2014).

Acute psychiatric inpatient nursing is primarily focused on the assessment and treatment of patients admitted in times of crisis. To effectively assess a patients needs a nurse requires an overview of the patient’s interactions with their external & internal environment. Fundamental to this been successful is the nurse patient relationship, forming a trusting relationship and maintaining this throughout the patient’s care. The nurse’s ability to listen, talk and understand are identified as key to positive patient experiences of feeling supported and cared for (Gilburt et al 2008).

Advanced Practice Nursing Nurses play an integral role in provision and maintenance of high quality health care and medical services in the any community. After completing their undergraduate studies, nurses can decide to pursue specific fields such as midwifery, anesthetics, and clinical nursing. According to the American Association of Colleges of Nursing (AACN), nurses who have acquired post graduate education like masters, post masters or doctorate degrees can perform medical tasks such as diagnosis and treatment of acute illnesses, as well as provide primary health care services to patients without the supervision of a physician. These advanced practice nurses have attained that capacity from years of educational training, skills, and experience. Different states may have different requirement for registering Advanced Practice Registered Nurses (APRN), but their functions, once registered are almost similar in all states in America, and other parts of the world.

1. Monitor the patient's oxygen saturation frequently (once per hour) at rest and after exertion on room air

Lily was a 65 year old lady with stage 5 CKD, she had recently begun hemodialysis treatment three times a week as an inpatient and had been responding well to treatment. During dialysis treatment on the morning of the first day, Lily’s observations showed that she was: tachycardic, hypotensive, tachypnoeaic, had an oxygen saturation level of 88% and was becoming confused and drowsy. It became apparent that Lily had become hypovolaemic. The hypovolaemic shock seen in this patient was of a particular critical nature due to the fact that her dialysis treatment had moved her rapidly through the first two stages of shock with her compensatory mechanisms failing very quickly (Tait, 2012). It was also much harder to identify the early signs of

Mr. R.T. was admitted to the unit due to increased dysphagia for the past two weeks and exacerbation of seizures. It was hard for me to find meaningful way of communication with him due to his serious developmental delay; however, the patient was sometimes able to express his preferences by telling “more, yes”. Health care providers in the unit were aware of, and some already experienced a behavioral aggression from Mr. R.T. When I tried to flush his Saline Lock, the patient suddenly hit me 2 times to my left hand. I never expected this and I was emotionally assaulted. Except for the pain in my hand, I also experienced psychological stress that could possibly affect my caring toward the patient. I perfectly understood that he was mentally disable; however, it took a lot of effort from me to remove the bias toward the patient. I did not demonstrate my emotional stress to the peers and Course Director but I felt depressed for the rest of the clinical day. Consequently, RN advised me to not continue providing any interventions for this patient except for basic care.

Bennett (2016) documents that new technologies, social media, changing measures of impact, easy access journals have influenced the way advanced practice nurses incorporate evidence-based research into their clinical practice. Stevens (2015) notes that clinical practice guidelines offer regulation in decision making relating to diagnosis, supervision, and treatment in particular areas of health care. Advanced practice nurses play a vital role in the evaluation and creation of an always-expanding evidence base and are of growing significance in aging societies with a high frequency of disease comorbidities, such as kidney disease.

The purpose of this essay is to reflect on a challenging situation I experienced during clinical practice as a student nurse. The essay will discuss my thoughts and feelings surrounding the situation and analyse the coping strategies I used in managing the situation, linking to relevant theory throughout in order to provide evidence for practice. The essay will also consider person-centred care and whether this was delivered to the patient. To conclude, the essay will discuss what I have learnt from the experience and how this experience will improve my future

The standards of practice describe a competent level of nursing care as exhibited by the critical thinking model known as the nursing process. This practice includes the areas of assessment, diagnosis, outcome identification, planning, implementation, and evaluation. The nursing process includes significant actions taken by registered nurses (RN) and forms the foundation of the nurse’s decision-making (“American Nurses Association,” 2010).

This is essay is going to examine the principles of nursing and health. In order to do this it must look at the concept of health then describe the dimensions that make up health. Secondly, an adult individual will be chosen in order to discuss the determinants that affect their health. It will then go on to explain the underpinning professional, ethical and legal principles that would be taken into consideration if the individual were to require nursing care. Finally, it will identify how carrying out this assignment has informed the writers personal concept of nursing.

Hurley (2009) designed a qualitative study to clarify the identity of the mental health nurse. The author defines the psychiatric nurse’s role as the role as exhibited in several behaviors. The behaviors include, being a generic specialist, adopting the patient’s focus, engaging in talking therapy, interacting with the patients, and engaging in a therapeutic use of self. According to Foster, McAllister and O’Brien (2006) a therapeutic use of self is