Description and Justification of Intervention
Joseph is a 16 year old male residing in Wollongong. Joseph was presented to a security agency in an involuntary way about 13 months ago. The patient’s Juvenile Liaison Officer was faced with the obligation of arresting him following the community’s accusation of “possessing with intent to supply” drugs. Joseph was placed on probation for 12 months as he had no previous charges. Joseph confessed that his was the first treatment he had ever received. Upon examination, Joseph revealed substance dependency symptoms such as prolonged use of cannabis and alcohol.
On the other hand, Joseph depicts a family history of alcohol and drug usage; Joseph’s elder sister is undertaking a rehabilitation program aimed at fostering recovery from the abuse of opiates. The sister was an intense user of drugs such as heroin in her early 20s; a period that corresponds to Joseph’s early adolescence. Joseph presents multiple psychological conditions such as low self-efficacy, reduced impulse control and low self-esteem. Further, the patient stays for a long time in his room smoking cannabis; an aspect that reveals dysfunctional coping strategies. Most importantly, Joseph’s mother confessed that she experienced higher levels of alcohol intake during pregnancy; an aspect that reveals genetic loading towards addiction. Further, the patient depicts conflicting social networks as he is an active footballer despite the high levels of cannabis intake.
Description and Justification of Intervention
As a health professional, I applied Cognitive Behavioral Therapy (CBT) in exploring the negative automatic thoughts depicted by Joseph. According to Easton, Crane and Mandel (2018), CBT plays a crucial role in allowing a physician to advance individualized viewpoints concerning the patient under consideration; an aspect that allows for establishment of predictions of the difficulties encountered by the patient as treatment progresses. In my position as Joseph’s caregiver, I will work towards limiting the prevailing cognitive demands by ensuring that he patient is taken through multiple helpful behaviors aimed at fostering change. To achieve this goal, I will emphasize on adopting behavioral rehearsals aimed at emphasizing on a wide range of real-life case examples to enhance generalization.
I recommended a collaborative Cognitive Behavioral Therapy (CBT) as an intervention for Joseph’s case. Pachankis, Hatzenbuehler, Rendina, Safren and Parsons (2015) explain that the main aim of CBT is to act as a remedy to the coping deficits depicted by a client by managing the antecedents to drug use and abuse. According to Bowen, Chawla and Witkiewitz (2014), the CBT model considers drug use disorders as traits that are socially learned. Further, Dong and Potenza (2014) reveal that such behaviors may be modified through incorporation of factors aimed at fostering the interaction of factors considered to be triggers, sources of reinforcement and cognitions. Fernandez, Salem, Swift and Ramtahal (2015) explain that CBT adopts repetition based on the central role it plays in fostering learning, advancing proficiency and ensuring that the freshly acquired traits are practiced whenever they are required. To apply CBT on Joseph’s case, I asked the patient to identify the signals he would consider as high risk and demonstrate proper comprehension of his ability to comprehend the most effective moments to apply the coping skills gained.
My Role as a Health Professional
Gabrieli, Ghosh and Whitfield-Gabrieli, S. (2015) explain that the implication of applying ICF in fostering clinical interventions among patients depicting substance use disorders include laying an emphasis on the strengths and abilities of the affected individuals and assisting patients in their endeavors of becoming active participants in their societies. In Joseph’s case, ICF is applied in CBT by underscoring the contextual maintaining factors depicted by the patient. For instance, an assessment of Joseph’s social networks reveals that he is under influence of negative peer group (evidenced by intake of high doses of cannabis and involvement in criminal activities leading to arrest); contradicting social networks (revealed by his positive involvement in sporting activities such as football with negative peer influence); and damaging participation in the school system (evidenced by his inability to respond positively to the sources of authority).
CBT does not present serious risks both on the sides of the patient and the caregiver. However, the fact that the intervention presents the desired results within a longer period hinders its efficiency when dealing with individuals that are adversely affected by substance use disorders. On the other hand, Trockel, Karlin, Taylor, Brown and Manber (2015) reveal that anxieties and other psychological conditions need to be confronted in order to realize the desired results. Such confrontations make the patient develop a sense of nervousness for a short period. However, Easton et al. (2018) explain that patients get optimal benefits from this remedy if they are capable of tolerating such anxieties.
A drug psychiatrist was considered as an alternative professional in fostering the treatments offered for Joseph. According to Carpenter (2018), psychiatrists play a significant role in the detoxification phase of treatment by ensuring that the affected individuals are adequately weaned off the drugs and substances that are considered to be life threatening. Further, Bowen et al. (2014) attribute the importance of a psychiatrist in offering CBT to the fact that most of the additions impose great negative effects on the neurochemistry of the brain. Similarly, psychiatric consultations coupled with behavioral therapies such as CBT and medication are used in a concurrent way with the co-occurrence of a psychiatric disorder and substance abuse.
Fernandez et al. (2015) explain that psychiatrists dealing with drug and alcohol addicts are offered with sub-specialty expertise in addiction. As a consequence, an addiction psychiatrist in clinical settings is highly capable of treating conditions such as drug dependency, alcoholism, sex and gambling addictions. In the inter-professional team adopted to foster Joseph’s treatment, a psychiatrist was included to underscore the patient’s history in drug use and abuse as well as ensuring dire detections in instances where early symptoms of trouble were prevalent. On the other hand, the physician played an influential role in establishing Joseph’s reasons for developing cannabis and alcohol addictions. Similarly, Trockel et al. (2015) reveal that at the time of need, psychiatrists play a helpful role in prescribing the most effective medications aimed at minimizing and controlling withdrawal symptoms and treating co-existing conditions.
Intervention
The psychiatrist adopted in the inter-professional team employed the WHO ICF checklist to assess the effects of environmental factors, activities and participation on Joseph’s condition. For instance, an assessment of the environmental factors revealed that the patient’s home settings played a crucial role in contributing to the current state. Joseph was raised in an environment in which both parents take alcohol and an older sibling who suffered opiate abuse. Further, the practitioner established that the patient’s move to engage in cannabis use and criminal activities was heightened by negative peer influence.
Professionalism in medical settings is a term adopted to justify a caregiver’s mode of behavior when attending to his patients and interacting with fellow colleagues Carpenter (2018). According to Tanaka, M., Taketomi, K., Yonemitsu, Y., & Kawamoto, (2016), professionalism is recognized through observations. The current section of the study seeks to undertake a critical analysis of ethics, competence and responsibility as aspects of professionalism when working with drug addicts.
Ethics
Nurses are faced with the obligation of ensuring that their practices meet certain set professional values and morals. According to Cho and Kim (2014), values in medical practice encompass the practitioner’s ability to appreciate what is important on their side when offering services and what is important on the side of the patient receiving the supposed care. Further, Tanaka et al. (2016) reveal that ethical professionalism upholds higher levels of moral respect for all stakeholders by revealing wholeness of character, integrity and dignity.
Competence
Competence in nursing practice underscores a caregiver’s ability to practice higher levels of professional excellence by focusing on the attitudes and activities put in place when handling patients (Tanaka et al., 2016). According to Cho and Kim (2014), competence vets the objectives, and procedures applied in nursing practice. On the other hand, Carpenter (2018) explains that nurses are obliged to reveal higher levels of professional competency based on the positions they occupy in watching their clients in their capacity as caregivers and on behalf of other physicians in their institutions.
Nurses reveal their standards of professional responsibility based on their abilities to foster collaborations with other stakeholders in the healthcare system, effectuating social changes and advocating for the interests of their patients (Carpenter, 2018). According to Tanaka et al. (2016), responsible caregivers consider the best interest of their patients as central compared to other concerns and points if bias. As a consequence, caregivers must play an advocacy role by protecting the patient’s legal and ethical rights.
International Classification of Functioning, Disability and Health (ICF) Components targeted by the intervention
Person centered practice aims at offering healthcare services by placing the patient at the center of the treatment strategies adopted (Ahola, Hakanen, Perhoniemi, and Mutanen, 2014). Therefore, person centered approaches in nursing are based on principles such as knowing the patient, sharing responsibilities and power, proper coordination and integration of the services offered and cultivation of a conducive environment. The current section of the study seeks to analyze sharing responsibilities and proper coordination as the most effective strategies of advancing person centered practices.
Responsibility
Responsibility is a strategy aimed at fostering person centered practice by respecting other people’s preferences (Ahola et al., 2014). Therefore, a responsible caregiver depicts characteristics such as the innate ability to treat his/ her patients as key partners in the treatment process and when establishing the goals of treatment, making decisions concerning the interventions to be delivered and planning care. Further, Mauno, Mäkikangas, and Kinnunen (2016), explain that responsibility in nursing practice can be cultivated by building an environment that allows both the clients and their family members to act as key sources of advice in quality improvement.
Coordination and integration vet the ability of a caregiver to initiate teamwork. According to Mauno et al. (2016), proper coordination and integration allows practitioners and clients to work together with the central aim of minimizing duplication and availing individual patients with seamless services. Further, proper coordination does not only present patients with positive experiences but also maximize the desired outcomes. Such results can be attained by emphasizing on the importance of working as a team when offering services.
References
Ahola, K., Hakanen, J., Perhoniemi, R., & Mutanen, P. (2014). Relationship between burnout and depressive symptoms: a study using the person-centred approach. Burnout Research, 1(1), 29-37.
Bowen, S., Chawla, N., & Witkiewitz, K. (2014). Mindfulness-based relapse prevention for addictive behaviors. In Mindfulness-Based Treatment Approaches (Second Edition) (pp. 141-157).
Carpenter, M. (2018). The new managerialism and professionalism in nursing. In Health and the Division of Labour (pp. 165-195). Routledge.
Cho, H. H., & Kim, N. H. (2014). Relationships among nursing professionalism, nurse image, and core elements of nursing professionalism that nursing students perceive. Journal of Korean Academic Society of Nursing Education, 20(4), 548-557.
Dong, G., & Potenza, M. N. (2014). A cognitive-behavioral model of Internet gaming disorder: theoretical underpinnings and clinical implications. Journal of psychiatric research, 58, 7-11.
Easton, C. J., Crane, C. A., & Mandel, D. (2018). A randomized controlled trial assessing the efficacy of cognitive behavioral therapy for substance?dependent domestic violence offenders: an integrated substance abuse?domestic violence treatment approach (SADV). Journal of marital and family therapy, 44(3), 483-498.
Fernandez, E., Salem, D., Swift, J. K., & Ramtahal, N. (2015). Meta-analysis of dropout from cognitive behavioral therapy: Magnitude, timing, and moderators. Journal of Consulting and Clinical Psychology, 83(6), 1108.
Gabrieli, J. D., Ghosh, S. S., & Whitfield-Gabrieli, S. (2015). Prediction as a humanitarian and pragmatic contribution from human cognitive neuroscience. Neuron, 85(1), 11-26.
Mauno, S., Mäkikangas, A., & Kinnunen, U. (2016). A longitudinal person-centred approach to the job demands-control model. European Journal of Work and Organizational Psychology, 25(6), 914-927.
Pachankis, J. E., Hatzenbuehler, M. L., Rendina, H. J., Safren, S. A., & Parsons, J. T. (2015). LGB-affirmative cognitive-behavioral therapy for young adult gay and bisexual men: A randomized controlled trial of a transdiagnostic minority stress approach. Journal of consulting and clinical psychology, 83(5), 875.
Tanaka, M., Taketomi, K., Yonemitsu, Y., & Kawamoto, R. (2016). Professional behaviours and factors contributing to nursing professionalism among nurse managers. Journal of nursing management, 24(1), 12-20.
Trockel, M., Karlin, B. E., Taylor, C. B., Brown, G. K., & Manber, R. (2015). Effects of cognitive behavioral therapy for insomnia on suicidal ideation in veterans. Sleep, 38(2), 259-265.
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