Empirical Evidence Recovery Mental Health

Clinical Formulation Table using 5Ps

Discuss About The Empirical Evidence Recovery Mental Health.

Appearance: Looks younger than his age, long shaggy shoulder-length dark hair. He wears a cowboy hat, dusty jeans with a grubby long sleeve shirts and worn out riding boots. HE is very thin also. On all the fingers of his left hand, the word “LOVE” is spelled out on tattoos. On all the fingers of his right hand, “TESS” is tattooed.

Behaviour: At the initial stage, he was reluctant to speak to the nurse, speaks quietly with some monosyllables.

Attitude: Secretive, sad, thanatophobia which means, losing a loved one is also present in him, focused. While talking about his girlfriend, his eyes fill with tears. He has a phobia that his girlfriend will leave him.

Level of consciousness: Moody, fluctuating and depressed since his girlfriend moved to another place for studying.

Speech and language: volume is soft and weak; he spoke quietly to the nursing.

Thought process: Incoherent, loosing association, preserved. He thinks his girlfriend who has left to another city two months back for the purpose of studying won’t love him anymore.  

Suicidality: He told the nurse about his cousin who committed suicide a year ago and Jayan thinks his cousin was successful to find the way out. When he was asked that if he has any thought of killing himself he replied that he thought about this a lot and he believes he can do that also. SO, he is having high tendency to commit suicide.

• Jayan is facing many psychological issues but two of them have the highest priority. His mother asked a nurse to see Jayan and she also mentioned that Jayan doesn’t look at himself properly and drinking too much since his girlfriend has moved to another city to study two months back. This is alarming, because drinking too much can create serious healthcare issues and even it can endanger the life of that person also. So, it should be treated as one of the highest priorities. Another biggest issue is his suicidal tendency. He admitted to the nurse that he all the time thinks about his girlfriend and even he also specified that Michael, one of his cousins committed suicide by hanging himself and it was the best way of according to Jayan. He was asked by the nurse if he ever wanted to kill himself or not and he answered that he thought many times before and he is quite sure that he can do that also and according to Jayan it will make her mom free of concern about him too.
• Jayan was suffering from his childhood being aboriginal. So, first of all nurse should support his cultural safety before any intervention. Nurses can make many positive contributions in achieving healthcare outcomes by a range of intervention and one of them is alcohol screening test of the patient. One of the best screening tools for the patients of mental disorder is CAGE test (Wilkinson, Anderson & Wheeler, 2017). Screening test helps to find the reason of over-drinking after an in-depth analysis (Jacob & Patel, 2014).

Nurses play an important role in curbing suicide from the society. Jayan is having a tendency to commit suicide and nurse should directly talk to her about this matter. Understanding the main reason that is forcing a patient in acquiring suicidal behaviour is most essential. He should be motivated to his hobbies and likings in order to recover his depression.

From the case of Jayan it is clear that he was an aboriginal and in his childhood he faced many taunts and insult related to racism, again he was a talented football player, but as he was the eldest child of his family and his father died when he was only four, he has huge responsibility over his family and he could not go out to another place for playing football. He was only open to his girlfriend. When she left for another city for study purpose, Jayan felt broken. All these things created mental pressure. His present situation is making him depressed and he has found the solution is there only in committing suicide. One of his cousins committed suicide, and according to him it was the best way out to get rid of trouble.

Plan for nursing care

The therapeutic relationship

The therapeutic relationship is basically the alliance between the patient and the nurse that is helpful in bringing positive changes in the patients’ mind. Managing a patient of suicidal tendency is the primary responsibility of the nurse (LeFevre, 2014). Jayan is depressed and while talking about his girlfriend his eyes become teary. Apart from that, he is not looking at himself and drinking too much according to his mother. Along with this, he has set his mind to commit suicide and he admitted that too as he thinks it will also make her mom tension free about him. So, it is essential to introduce therapeutic relationship with this patient and the first priority is to stabilize him and to ensure his medical safety. Screening strategy will be the best therapeutic solution for this patient. The screening test will help to understand why the patient is depressed by asking some specific questions him. In the nursing care invention, the screening test can be applied by some questions like if the patient was asked that what drives him more to select the way of committing suicide (Newman, O’Reilly,  Lee & Kennedy, 2015)). In the CAGE questionnaire screening tool, applied in the nursing care intervention was, has he ever felt annoyed by the criticism on his drinking? Has he ever felt guilty about it? Has he ever thought to cut down drinking? Has he ever taken any morning eye-opener? All these questionnaires are the important part of screening test.

• Cultural safety

While providing assistance to any mental patient, cultural safety is one of the sensitive issues and it should be maintained with proper care by the nurses (Quinlivan et al., 2016). Jayan was an aboriginal, and due to this in his childhood he faced many taunts and insult from the mates in the school and if there was any fight in the playground only the aboriginal students were dragged into the principal’s house. So, while establishing treatment strategy, it was important to establish cultural safety in case of this patient. So, being a nurse I would say I am against racism and he can feel free to share his thoughts with me. As I am not an aboriginal, so it was quite difficult to convince him at the initial stage. Using the positive purpose principle from the 5 principles of cultural safety I would support the patient in building strength and will about the confidentiality also. It is important to avoid negative labelling also while talking to Jayan. So, this principle of cultural safety I used in applying cultural safety in the nursing care intervention.

Clinical Handover

• Recovery-oriented nursing care

Patients’ recovery model is very much essential for the patients who are suffering from mental disorder. Recovery is not always about getting rid of the problems but also to go beyond it by recognizing and fostering the patient’s special abilities, interests and hobbies (Simon et al., 2016). Recovery can be the voyage of personal growth. The process of engaging patients into society or any other social activities is also a part of recovery model (Slade & Longden, 2015). Many factors are there that supports mental recovery and they are good relationship, cultural safety, confidentiality and security etc. The patient loves horses and he is working as station hand so he loves his work. While doing the screening test nurse asked about his personal special abilities and likings. Jayan loved football and once he was talent-scouted as a young footballer to join the city football club in his teenage. But, due to family problem he could not join the team. A mental patient who has a suicidal tendency decides to commit suicide because he cannot feel the worth of life and he is unable to find happiness in his life. Nurses always try to bring his special abilities into his attention so that he can get some life in those. All these were associated with his recovery because recovery means he will be getting some element of happiness which will inspire him to live for his own, or for his family. The main focus in recovery is to motivate the patient to come back into the main stream of society (Slade et al., 2014). While talking with the patient, nurse provides cultural support and with the assurance of nurse Jayan also expressed her mental thoughts and admitted he wants to commit suicide. Nurse understands the main reason of depression of the patient and ensures the confidentiality also (Varcarolis, 2016). All these nursing interventions which are applied in the treatment plan of Jayan, are directly associated with the principles of patients recovery model. 

References

Baer, R. A. (Ed.). (2015). Mindfulness-based treatment approaches: Clinician’s guide to evidence base and applications. Elsevier.

Boudreaux, E. D., Camargo Jr, C. A., Arias, S. A., Sullivan, A. F., Allen, M. H., Goldstein, A. B., … & Miller, I. W. (2016). Improving suicide risk screening and detection in the emergency department. American journal of preventive medicine, 50(4), 445-453.

Davies, B., Hughes, J., Sayce, K., Sullivan, J., & Wilcox, D. (2018). Implementing positive behavioural support in a forensic psychiatric intensive care unit: addressing the barriers. Mental Health Practice, 21(8).

Goldsmith, L. P., Lewis, S. W., Dunn, G., & Bentall, R. P. (2015). Psychological treatments for early psychosis can be beneficial or harmful, depending on the therapeutic alliance: an instrumental variable analysis. psychology medicine, 45(11), 2365-2373.

Huffman, J. C., Boehm, J. K., Beach, S. R., Beale, E. E., DuBois, C. M., & Healy, B. C. (2016). Relationship of optimism and suicidal ideation in three groups of patients at varying levels of suicide risk. Journal of psychiatric research, 77, 76-84.

Jacob, K. S., & Patel, V. (2014). Classification of mental disorders: a global mental health perspective. The Lancet, 383(9926), 1433-1435.

LeFevre, M. L. (2014). Screening for suicide risk in adolescents, adults, and older adults in primary care: US Preventive Services Task Force recommendation statement. Annals of internal medicine, 160(10), 719-726.

Newman, D., O’Reilly, P., Lee, S. H., & Kennedy, C. (2015). Mental health service users’ experiences of mental health care: an integrative literature review. Journal of psychiatric and mental health nursing, 22(3), 171-182.

Quinlivan, L., Cooper, J., Davies, L., Hawton, K., Gunnell, D., & Kapur, N. (2016). Which are the most useful scales for predicting repeat self-harm? A systematic review evaluating risk scales using measures of diagnostic accuracy. BMJ open, 6(2), e009297.

Simon, G. E., Coleman, K. J., Rossom, R. C., Beck, A., Oliver, M., Johnson, E., … & Rutter, C. (2016). Risk of suicide attempt and suicide death following completion of the Patient Health Questionnaire depression module in community practice. The Journal of clinical psychiatry, 77(2), 221.

Slade, M., & Longden, E. (2015). Empirical evidence about recovery and mental health. BMC psychiatry, 15(1), 285.

Slade, M., Amering, M., Farkas, M., Hamilton, B., O’Hagan, M., Panther, G., … & Whitley, R. (2014). Uses and abuses of recovery: implementing recovery?oriented practices in mental health systems. World Psychiatry, 13(1), 12-20.

Varcarolis, E. M. (2016). Essentials of Psychiatric Mental Health Nursing-E-Book: A Communication Approach to Evidence-Based Care. Elsevier Health Sciences.

Wilkinson, A., Anderson, S., & Wheeler, S. B. (2017). Screening for and treating postpartum depression and psychosis: a cost-effectiveness analysis. Maternal and child health journal, 21(4), 903-914.

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