Clinical Reflection
This reflection will discuss my interaction with a mental health patient in the community and the reaction I experienced upon meeting any mentally ill patients for the first time. Through consideration of the theoretical perspectives and my own view points I will explain my feelings and attempt to interpret my reactions. I will suggest how my future behavior will be different as a result of this experience and my understanding of it.
We live in a time when mental health has been increasingly failing for many individuals. Many situations that are reflected in our societies today re increasingly convincing me, helping me to come to realize that mental health nurses matter, are essential healthcare providers, and will continue to be needed in the future. Mental health nurses are in the right position to grow in the understanding of mental health and to better identify the constructs and care practices that promote, strengthen, and protect the mental health of individuals and families.
Mental health can be a very challenging area to work in and as an experienced student nurse, I have a great admiration for the skills and commitment registered mental health nurses give. There are many qualities that a registered mental health nurse must possess. Personally, I feel that I have already developed some of these qualities given the time and experience that I have spent in the mental health field. To illustrate my capabilities, I will outline in the succeeding paragraphs the qualities that I have developed as well as the situations where I have applied them.
Mental and behavioral disorders are understood as clinically significant conditions characterized by alterations in thinking, mood or behavior, and associated with personal distress and/or impaired functioning. Mental and behavioral disorders are not just variations within the range of "normal" but are clearly abnormal or pathological phenomena. In order to be categorized as disorders, such abnormalities must be sustained or recurring, and they must result in some personal distress or impaired functioning in one or more areas of life. Mental and behavioral disorders are also characterized by specific symptoms and signs, and usually follow a more or less predictable natural course, unless interventions are made. Not all human distress is mental disorder; unless all the essential criteria for a particular disorder are satisfied, such distress is not a mental disorder. Similarly, culturally determined normal variations in thinking and behaving are not mental disorders ( 1996). These are aspects that must be considered when dealing with mental health patients.
While I was on my practice placement at a mental health clinic, I have experienced a lot of things and I have also learned many valuable lessons from those experiences. Being with the vulnerable population is an experience unlike any other I have come across. I had to make a lot of adjustments. As a student, my knowledge about behaviors of patients with mental problems is limited only to the books. And that also goes true for my knowledge on how to handle them, especially in unexpected situations. In my diary I have described my experiences during my student practice where I have learned a lot.
On my first day, I was assigned to take care of a male mental health patient and assist his needs. The next day, I was also assigned to another patient who is completely different from this one that I have previously handled. My third day patient is a 21 year old female with psychosis. She permitted me for an observation and I came inside and observed the interview and oral medication.
On that same day, we visited a schizophrenic patient. This patient was very depressed. Schizophrenia is found all over the world. The severity of the symptoms and long-lasting, chronic pattern of schizophrenia often cause a high degree of disability. Medications and other treatments for schizophrenia, when used regularly and as prescribed, can help reduce and control the distressing symptoms of the illness. However, some people are not greatly helped by available treatments or may prematurely discontinue treatment because of unpleasant side effects or other reasons. Even when treatment is effective, persisting consequences of the illness -- lost opportunities, stigma, residual symptoms, and medication side effects -- may be very troubling.
My job as a mental health nurse while taking care of the mental patients involve more than just giving them anti-depressant medications. What I was trying to achieve while I was the mental health nurse taking care of the mental health patients is to support them and relieve their feelings of hopelessness. I also wanted to show them that I care for them as a person and that everyone loves them and have time for them. I have learned that for a patient to fully heal, you have to also touch their hearts. I acted the way I did with my patients because they were obviously very depressed. I did not feel that I could just simply them her while they were in this state. I felt a need to help them develop positive attitudes for the future. I listened to everything they would want to say to me because I believe that it would help them minimize and overcome the depression that they felt from their situation. To reach out and encourage them was just one of the most natural things for me to do.
The need to remove the considerable barriers to health promotion for people who have mental health problems has long been recognized. In Australia there is commitment to community care and recognition of the importance of providing services that place the user central to service delivery. Whilst wide variations in the patterns of collaboration can be found between the health organizations and local government, it is possible to begin to identify key principles that underpin the delivery of coordinated services to the user that enhance quality of life irrespective of the particular structure through which they are delivered (2001).
Partnership is a fundamental theme in current government initiatives and is seen not only as the way to modernize statutory services but also as a catalyst to challenge the existing cultural mores within which our society operates. Within this, partnership is about developing and acknowledging our collective responsibility for the health and well-being of the community to which we belong (2001). Service users played a big part in determining how the partnership was set up. Brent is one of the few authorities nationwide to have a fully integrated learning disability service.
There are many personal factors which influenced the way I took care of the mental health patients. I believe that being able to listen and the application of touch are important skills in a nurse, as well as showing that you care for the patient. I also believe in my mental health patients as a person. Although I know that some of them are severely depressed, I also know that as the days went by, some of them are fighting hard to overcome it.
Many people have stigma against mental health illness. There is a lot of information regarding stigma in mental illness and the effect it has on health care workers’ attitudes towards their patients. Viewing stigma as a public health issue points to the ways in which stigma harms people with mental illness. Three are particularly notable: label avoidance, blocked life goals, and self stigma.
The public health approach to decreasing mental illness stigma largely relies on education programs dominated by the medical or disease model. Education is defined broadly in terms of any strategic format (that is, classrooms, public service announcements, magazine articles) that seeks to decrease stigma by informing the public about mental illness. One example is the National Alliance for the Mentally Ill's (NAMI) "Mental Illness is a Brain Disease" campaign, in which the organization distributed posters, buttons, and literature that provided information about the biological basis of serious mental illness. On a global scale, the World Psychiatric Association (WPA) is sponsoring its Open the Doors Global Program against stigma and discrimination focusing on schizophrenia. Now in its eighth year, the WPA information program educates the public about mental disease and corresponding treatment.
The public health approach may have some value in reducing label avoidance and limited impact on aspects of blocked opportunities and self-stigma. However, in other ways it may exacerbate stigma-related problems. What might we learn from other perspectives on stigma that will diminish its impact? When not discussing health disorders, generic ideas of stigma are typically defined as social injustice; this general definition rests on the idea of discredited difference ( 2001). Prejudice of any sort rests on human differences. Although the vast majority of human differences are irrelevant to prejudice--handedness, eye color, foot size--history shows some differences such as skin color and sexual orientation are salient and often paired with negative attributes.
There is also the problem of unequal treatment of mental health patients. The causes of this unequal treatment arise in part from deep-seated convictions, if not biases. Foremost is the belief that mental health and disorder are poorly defined. While few would argue today that mental illness is a myth, or maintain that mental illness is whatever psychiatrists treat, nonetheless there is a bewildering diversity of views about mental illness, ranging from biological accounts to social determinism. The nature of mental illness is often conceived as a dichotomy between mind and body, an unfortunate dualism that tends to minimize the physical suffering and disability associated with mental illness. Oddly enough, even within the mental health field there are those who wish to distinguish biological from nonbiological mental disorders and give priority to the former ( 1992).
I have learned that mental health nurses should focus on the wider needs of the patient, using their skills to improve physical well-being through better assessment and health promotion activities, and by providing more psychological therapies. Mental health nursing is at the heart of modern healthcare. Through the development of new roles, such as prescribing, and new skills in areas such as physical wellbeing, mental health nurses are at the forefront of changes in how services provide for the needs of people with mental health problems. All mental health professionals are having to rethink the part they will play in the services of the future. This report sets out an optimistic and ambitious vision of a confident and responsive nursing profession.
Mental health nursing should take a holistic approach, seeing services users as whole people and taking into account their physical, psychological, social and spiritual needs. This means that mental health nurses need to widen their skills to improve promotion activities and provide more evidence-based psychological therapies. Mental health nurses need training, supervision and managerial support.
From my research, I have learned that Integrated care, an emerging trend, offers much promise to clients and all healthcare workers (2001). Integrated care is the increased collaboration of mental health professionals within primary care settings. More specifically, integrated care is most effective when services are provided via co-location, that is, when mental health counselors work in the same offices with primary care physicians. In this type of integrated arrangement, primary care physicians and mental health professionals consult regularly throughout the day about clients' needs and will, in some situations, see a client together to help determine the most appropriate treatment plan.
For example, in one large health maintenance organization, primary care physicians and psychologists share offices. Consequently, the professionals are successfully identifying 90% of the primary care clients who need mental health services, and of those clients, 85 % are receiving treatment ( 2002). Reasons for this success include the collaboration between the two healthcare providers and more importantly, clients' following through with treatment, perhaps because primary care physicians can introduce clients to the mental health professionals on staff, instead of referring them to outside agencies (1990).
I have also reflected that the quality of mental health care or of health care for that matter also rests on other aspects. Quality of patient care is threatened by the acute shortage of nursing staff and at times a less than optimum mix of skills and experienced staff. The consequences are felt by patients or their families as well as nurses and have implications for clinical responsibilities and vulnerability to litigation.
Due to this experience I have gained insight and will adapt my attitude and action when encountering patients with mental illness in the future. What I felt about the experience with the mental health patients is a mixture of feelings. I was very supportive with them and with their families. I wanted them to really overcome their situations if it is possible and I want them to feel that they are still loved. Some of the patients are still so young and have so much to live for. Sometimes I would feel helpless when I couldn’t make them calm down or I couldn’t stop them from crying or simply couldn’t stop them from doing weird behaviors.
Overall, I feel better and grateful for the experience I had with the mental health patients. It brings me joy that somehow I was able to foster hope in them and in the process helped them through daily living and even get well. I will use the knowledge I have gained from this experience to apply to future situations and hopefully help other persons with mental problems.
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