Discuss  on Clinical Reflection Report……………………

TABLE OF CONTENTS

1. INTRODUCTION…………………………………………………………………………………………………….3

1.1AUSTRALIAN MENTAL HEALTH STANDARDS AND PRACTICES……………………….3

1.2 IMPORTANCE OF STANDARDS……………………………………………………………………………..3

1.3 MENTAL HEALTH NURSING…………………………………………………………………………………..3

2. CLINICAL ASSESSMENT…………………………………………………………………………………………..3

2.1 CLINICAL OBSERVATIONS…………………………………………………………………………………..3

2.2 SIGNS AND SYMPTOMS OF DEPRESSION……………………………………………………………..3

2.3 ASSESSMENT DEFINATION……………………………………………………………………………………4

2.4 CHALLENGES WHEN ASSESSING………………………………………………………………………….4

2.5 HEALTH CARE CONCERNS……………………………………………………………………………………5

2.6 THERAPEUTIC COMMUNICATION SKILLS……………………………………………………………5

2.7 THERAPEUTIC SKILLS…………………………………………………………………………………………..6

3. RISKS AND MANAGEMENT……………………………………………………………………………………6

3.1 DUTY OF CARE……………………………………………………………………………………………………..6

REFFERAL PATHWAYS……………………………………………………………………………………………..7

4. CONCLUSION………………………………………………………………………………………………………..7

5. REFERENCES………………………………………………………………………………………………………….8

 

INTRODUCTION

AUSTRALIAN MENTAL HEALTH STANDARDS AND PRACTICES

The National Mental Health Education and Training Advisory Group was established by the commonwealth in August 2000 to develop standards for the mental health work force. These standards were intended for the professional disciplines in psychiatry, Nursing, Social work, Occupational Therapy and Psychology. The standards are centred on rights, responsibility, consumer care, assessment, mental health problems and mental disorders, evaluation and so on (Victorian Government health information, 2010). In 2007, the Australian College of Mental Health Nurses Inc. (ACMHN) undertook to review the Standards of Practice for Mental health Nurses in Australia through research and consultation process (Neville et al, 2010)

IMPORTANCE OF THE STANDARDS

These Practice Standards aim to provide the benchmark for mental health professionals and their employers. They provide a guide for education and training curricula and other professional development programs in mental health. This ensures an optimal mental health for the Australian population through ensuring high quality practice education and training in mental health.

MENTAL HEALTH NURSING

It focuses in meeting the mental health needs of the consumer, in partnership with family, significant others and the community (Hazelton, 1998). It also focuses on helping the consumers to manage their mental problems and bring them to the reality of life. The patients can be put into asylums or encouraging them to make their own decision about their health care while involving other family members. These patients are also assisted by the mental nurses to exercise the rights and responsibilities expected. In Australia, it is the Australian & New Zealand College of Mental Health Nurses which has undertaken the leading role in developing standards of practice. It incorporates the specialized skills, attitudes and forms of knowledge required for mental health nursing (Hazelton, 1998)

CLINICAL ASSESMENT

CLINICAL OBSERVATIONS

When Camira was placed in boarding school suffered from parental separation. She displays depression.

SIGNS AND SYMPTOMS OF DEPRESSION

Camira displays a loss of interest and enjoyment in everyday life, low mood and emotional and physical symptoms. She is unreactive to suggestions from the nurse and remains moody. Her behavioural and physical symptoms include irritability, social withdrawal, agitation and diminished activity. She has feelings of worthlessness, helplessness, suicidal ideation. She also has poor concentration and reduced attention and pessimistic. She also displays slurred speech. She characterises fear in social situations like work impacting her ability to function effectively in her daily life. She fears being judged by others, being embarrassed or being humiliated which leads to avoidance of social situations which impacted her educational and vocational performance. She displays blushing by poor eye contact.

The separation of Camira from her parents may have caused post-traumatic stress disorder. This caused her distress which significantly interfered with her social, educational and occupational functioning and also concentration problems.

ASSESSMENT DEFINATION

This is a process used for the collection of information from patients with mental problems in order to find out the type of disorder and the extend. Assessment is typically based on a Western framework and therefore has a significant impact when working with Aboriginal people (Drew et al., 2000). Historically, assessment with Aboriginal and Torres Strait Islander people, like research, was deeply rooted in the power differential between Aboriginal and Torres Strait Islander and non-Aboriginal people.(Drew et al 2000).

 

The goals of assessment include;

• Establishing a therapeutic alliance with the patient
• Collecting valid data pertaining to the patients mental state
• Develop understanding of the patients problems
• Develop a treatment or management plan in collaboration with the patient
• Decrease the impact of psychiatric symptoms to the patient

 

CHALLENGES WHEN ASSESSING

There are various challenges that a mental health nurse may face when assessing Camira. She may be unwilling to answer the questions posed to her by the nurse making it difficult for the nurse to evaluate her condition.

Secondly hostility towards the nurse is a common challenge where the patient feels that she is being bothered by too many questions which to her opinion will not help her.

Some patients do not want to admit that they are sick. They feel that they are normal and so do not need any treatment from the doctors. This makes it difficult for the doctor to treat them.

Camira may not be willing to follow up with the medication as directed by the doctor to help her with her situation. There may be less effort made on her part to help with the cure

Assessment that is based on phrases and words may present problems and consequently is a disadvantage to Aboriginal people. The unfamiliarity of the terminology used by the health nurse presents problems like misinterpretation or lack of communication between the health nurse an and the patient (Drew et al., 2000) Camira may fail to communicate well with the nurse and this impairs the assessment.

In the recent years, there has been difficulty in developing assessment tools which have validity and clinical usefulness in Aboriginal people (Drew et al., 2000) therefore in Camira’s case the appropriate tools for her assessment may not be there or be invalid for her. Example of an assessment tool that would be beneficial to Camira is NICE Depression guideline.

HEALTH CARE CONCERNS

There are several health care concerns that arise when dealing with Camira. These are;

• Suicidal intentions
• Lack of sleep or insomnia
• Eating disorders
• Drug and alcohol abuse
• Physical health problems development
• Development of physical illnesses such as angina, arthritis, asthma, diabetes (National Collaborating Centre for Mental Health, 2011) and others
• Development of other disorders e.g. anxiety disorder

THERAPEUTIC COMMUNICATION SKILLS

The useful communication skills that may be used to assess (Royal Australian college of General Practioners, 2011) Camira are as follows;

• Demonstrating appropriate respect for Camira and her family
• Establishing rapport and appropriate patient-doctor relationship boundaries
• Identifying relevant belief systems and cultural issues
• Managing emotionally charged encounters
• Managing the stigma associated with mental health and facilitate disclosure of her parents mental health
• Managing the emotional impact of mental illness on the patient
• Respecting her values, attitudes and beliefs

THERAPEUTIC SKILLS

The therapeutic self skills that I will use when dealing with Camira include giving her assertiveness training so that she can communicate clearly with others, psychotherapy, motivational interviewing, relaxation skills, Electroconvulsive therapy (ECT), social skills training, instilling hope in her, training her stress management, behavior therapy( Palmer, n.d.)  and many more.

The methods I would use to ensure that the therapeutic approaches will lead to her active participation include; following her up making sure that she follows the given instructions and also using telephone psychotherapy where I counsel her using the telephone

The first step I would take to ensure her safety is talk to her grandmother so that she watches over her since in order for her not to attempt committing suicide. I will also prescribe to her some medication which will reduce her depression for her.

Another step of ensuring her safety is contacting emergency services in case of any self harming incidents or referring her to appropriate professional care givers.

RISKS AND MANAGEMENT

Risk of suicide: This risk is managed by staff training to improve detection e.g. through improved questioning techniques and communication skills (National Collaborating Centre for Mental Health, 2011). The support level should also be increased for these patients. Other risks include drug and alcohol misuse and self neglect

Violence or aggression: Patient management of risk of violence or aggression involves liaison with other clinicians in devising an agreed plan of management issues to consider when assessing risk and developing a plan. The recommended tool is the Historical Clinical Risk 20 (HCR-20) (State Forensic Mental Health, 2009).

If a mental health patient displays a risk to themselves or others, they are referred to the emergency services.

The management of such risks is liaison with other health care team members to discuss risk factors and further information needed, investigations required and consultations with other services needed to plan comprehensive care (State Forensic Mental Health, 2009)

DUTY OF CARE

Duty of care is a legal obligation imposed on an individual requiring that they adhere to a standard of reasonable care while performing any acts that could foreseeably harm others. If the standards are not met then the act is seen as neglect and a lawsuit can be filed.

The duty of care to Camira would be that she has the right to an appropriate care, the right to confidentiality, the right to give or withhold consent and the right to information.

REFERRAL PATHWAYS

The referral pathways will include; individual facilitated self-help based on the principles of cognitive behavior therapy (CBT), computerized CBT, a structured group physical activity programme (NHS, 2011). These pathways are recommended since Camira displays sub threshold depressive symptoms or moderate depression. Camira also displayed post traumatic distress disorder and so she can be referred for a normal psychological intervention (trauma focused CBT or eye movement desensitization and reprocessing (EMDR) (NHS, 2011). Since Camira has slurred speech, speech therapy will be recommended.

CONCLUSION

Mental health problems are on the rise in Australia and urgent solutions have to be evaluated to curb this problem. This will include training of health nurses and general practitioners so that they given the standardized treatment to patients. If need be the standards of practice in mental health will have to be renewed again by the players in the health sector. With the proper treatment, Camira’s case will be a positive result given that she follows the direction given to her. In no time she will return back to her normal self.

REFERENCE

Christine, Palmer. (2011). Therapeutic interventions. Cambridge university. 426-448 (24).

Victoria’s Mental health Services(Victoria).(2011). Available from: http://www.health.vic.gov.au/mentalhealth/quality/practice.htm [Accessed 28th April 2012].

Neville, C. Eleg, D. Hangan, C. Weir, J. (2010) Standards of Practice in Australian Mental Health. Australian college of Mental Health Nurses Inc.

Royal Australian College of General Practitioners. South Melbourne.(2012). Available from www.racgp.org.au/gpmhsc [Accessed 28th April 2012]

Mike Hazelton. (1998) Mental Health Nursing. University of Tasmania. 5(1) 33-38.

National Standards for Mental Health Services. (Australian Government Department of Health & Ageing). (2010)

Neill Drew,Yolonda Adams and Roz Walker.(2011) Issues in mental health assessment with indigenous Australians. Aboriginal child health research.3 (1) 191-198.

Ministry of Health. (2011) Identification of common mental disorders and management or depression in primary care summary. NewZealand.

Western Australian-state Forensic Mental Health. (2009) Mental Assessment. (1) 4-5.

National Collaborating Centre for Mental Health. (2011) Mental health disorders. British Psychological Society.24-27

The Royal Australian College for General Practitioners. (2011). Royal Australian College for General Practitioners.

NHS. (2011) common mental health disorders. Australia. Available from www.Nice.org.uk/guidance/CG123 [Accessed 28th April

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