Attitudes in Psychiatric Care for Overdose Patients

Introduction

Under psychiatric care, a positive attitude is needed by care providers for mental illness patients with paracetamol overdose. There are a number of factors ranging from patients attitude to working environments that influence a nurse’s attitude towards these patients (Rayner et al, 2019). Negative attitudes of discriminatory behavior in health professionals have constituted a major obstacle in psychiatric care. This has been pointed out as a key issue when working with mental illness patients. Severe mental disorders are characterized by disturbance of an individual’s cognitive and emotional behavior that cause a dysfunction of the psychological, biological and developmental processes that underlie mental functions (Cust et al., 2020). Currently mental illness is a severe disorder that accounts for more than 12 % of the global burden which has been projected to reach 20% by 2022. In United Kingdom, mental illness is a leading disorder than is non communicable comprising of 11% of the total burden (Joiner & Kaewchaloay, 2021). Considering the prevalence of the problem, the illness is currently gaining attention in UK almost outranking HIV/AIDs. Paracetamol self-poisoning is becoming more and more common in people with mental health. While paracetamol is a relatively harmless medicine at medicinal doses, liver necrosis is a life-threatening over-dosage complication. Under such conditions, paracetamol is usually extensively conjugated in the livery of the metabolism and subsequent renal excretion of the drug. Research in mental health care workers' attitudes towards people with mental health seems minimal. Culture is profoundly influenced by negative views and hostility to people with mental illness. There are several reports of stigmatization behaviors from mental health care workers toward these patients with paracetamol overdose. This complains have highlighted behaviors such as discouragement, rejection, negative remarks and negative attitudes. This has been the major issue which is being taken into account as a nurses attitude is a major determinant of the type of quality care these patients receive(Crust et al, 2020). Across the globe, there is a high prevalence of nurses’ attitudes towards mental patients with paracetamol overdose. Primary health care nurses with less training and minor exposure are reported to be intolerant of mental health patients with drug overdoses.

In order to provide a holistic care, it is important to understand a nurse attitude. These nurses are expected to provide essential health care which is universally accessible to individuals and families. Integrated mental services were implemented in 2014 with primary focus shifting towards primary health care (Rayner et al, 2019). This study will offer formative information and the perception of primary nurses towards patients with mental illnesses resulting from paracetamol overdose.

Background

Nurses engaging in mental health work face several challenges, such as the acuity of common patients, shorter hospital stays, and changing patient expectations, which can cause problems for nurses and in turn, affect the nature of care (Joiner & Kaewchaloay, 2021). Mental health nurses fight for corrective actions while working hard to ensure environmental safety. The progress of mental health management has an impact on the work and practice of mental health care. As Rey and Walter suggested, mental health experts have reported that mentally ill patients are truly desirable, nervous, and frustrating (Solberg et al., 2021). Incidents of hostility and substance abuse in institutional departments of psychiatry are considered normal and have caused widespread concern among mental health professionals. These growing demands require nurses to increase their mental health work. In mental health care, there is little information on the views of nurses on mental illness and patients with mental illness. Similarly, there is little information on the impact of nurses' mental health perspectives on the nature of thinking of patients with severe mental illness. Taking into account the opinions of nurses is essential for mental and socio-psychological health. Points of view include psychological domains full of feelings and behaviors controlled by modernization or openness to protest (Joiner & Kaewchaloay, 2021). In the mental health field, the nurse's opinion of mentally ill patients is considered a compelling element of the nature of the mental health care provided. Subsequently, due to the importance of encouraging behaviors in the face of mental illness, the United States, New Zealand, the United Kingdom, and India sent a delegation to change their negative perceptions of mental health problems (Turri et al., 2020). Mental health nurses have been found to often have a negative view of depressed patients, which generally occurs in patients with severe mental illness. Negative attitudes, therefore, affect nurse-patient communication and the nature of the care provided. Mental health management in the UK is not seen or understood everywhere, and many people in the UK need information on mental illness and medicine. Therefore, people still despise mental illness in the UK. This is one of the obstacles to seeking treatment in the competent foundation.

Research question

What are the nurse’s attitudes towards mental illness patients with paracetamol overdose? Question framing tools are set out in order to provide answers to research questions. A good research question seeks to improve knowledge on an important topic and is usually narrow. The type of study conducted informs the research question.

Search terms

Paracetamol

Paracetamol is common pain killer used to treat aches and pain. It is also used to treat fever by moderating mild temperatures. It is also referred to as acetaminophen, in standard doses, paracetamol only slightly reduces body temperature; in this sense, it is inferior to ibuprofen and its benefit against fever is unclear (Callaghan, 2021).

Hepatotoxicity

It’s an injury in the liver that causes damage due to exposure to drugs. It is classified into hepatocellular cholestatic and mixed which are caused by alkaline phosphates which exceed normal limit. Medications, herbal supplements, chemicals, solvents, and alcohol are all possible causes of liver toxicity(Casey et al., 2020).

Deliberate Self-Harm

Intentional self-harm refers to actions that intentionally cause bodily harm without wanting to die. Intentional self-harm usually includes cuts (with a knife or razor), scrapes or bruises, and deliberate overdose (Oakes-Rogers, 2020).

Drug overdose

It’s an act of ingesting too much drugs as a result of prescription, illegal, legal or over the counter. This may be accidental or intentional which poses harmful side effects that may lead to medical complications such as death or mental illness (Oakes-Rogers, 2020).

Search strategy

The main search strategy I this research is a comparison of Meta data from different written literature nurses attitudes towards patients with paracetamol overdose. For this research literature was highly preferred as it contains already existing data from peer reviewed sources. Preferred Reporting Items for Systematic Reviews and Meta-Data Analysis (PRISMA) was used in searching and structuring of literature (Daly et al., 2020). Medline and CINHAL were searched for research of papers as they contained rich databases of scientific publication. To maintain focus towards the primary goal of this research, key words such as paracetamol, hepatoxicity and drug overdose were used together with Boolean expressions of “and” and “or”. The entire search strategy is limited to identifying observational studies, which can be found in other materials online. All relevant links for additional quotes have been verified. Due to the short-term follow-up of RCT study participants and the strict qualifications to participate in the study, evidence from randomized controlled trials (RCTs) is not considered a meaningful way to collect data, which means that it does not represent the general population (Callaghan, 2021) . Selection of articles for inclusion was also a limiting factor as only articles that were up to date, written in English and were from UK were used. Only research studies that evaluated the nurse’s attitudes towards patients with mental illness were included in this research. The excluded articles were those that were limited to subscription fee in order to access or those articles that were review more than 5 years ago. The inclusion and exclusion factors were important as they steered the research towards achieving the main objective.

Limitations

Of the eight descriptions used in the study, six have a negative attitude towards mental health nurses of patients with mental illness (Hayden, Kelly& McNicholas, 2020). Mental health nurses treat mentally ill patients as dangerous, immature, cold, harmful, and pessimistic patients with poor physical hygiene. The most negative attitude is related to the health of the patient. Approximately 50% of those interviewed consider that mental patients are adults and educated. This suggests that the patient may have taken a positive approach that the nurses believe is educated and mature. Another explanation is that nurses can overestimate the behavior and behavior of patients, thus paying more attention to positive behaviors than to negative ones. This can have a positive impact on the attitude of nurses and help them to positively understand patient courtesy and the attitudes of adults. Various techniques have been used to reduce paracetamol overdose in mental health patients. In 1998, the British government issued a regulation that removed restrictions on packaging size, storage space, and regulated packaging associations with ratings (Callaghan, 2021). This corresponds to a decrease in the frequency of paracetamol damage in the UK. Unexpectedly, we have shown that without such regulations, the incidence rate will decrease accordingly. Whether the "British Paracetamol Protocol Act" leads directly to a decrease in the overdose rate in the UK remains controversial. There may be occasional paracetamol poisoning in all four cases (Daly et al, 20202). The first is that when the patient takes a dose higher than the recommended dose, it is clearly believed that this will provide more pain relief, and paracetamol is a "protected" drug. The second situation is when the patient is taking different medications without knowing that they contain paracetamol. The third is young children, who inadvertently received an inappropriate dose of paracetamol due to their weight, or took paracetamol without the knowledge of their staff. The fourth situation is that patients who cannot eat due to illness take an effective dose of 4 g / day for several days(Callaghan, 2021). Under current circumstances, glutathione stores in the liver can be rapidly depleted and the result is that the digestive effect of paracetamol is transferred to the formation of Hepatotoxicity metabolites.

Critical appraisal of literature

Critical appraisal also know as quality assessment is a scientific method that uses explicit, transparent methods , rules of evidence to assess the validity and rule adherence of the reporting standards of a research paper. This section forma the central part of systematic review process by using evidence based health care training to assist in making critical and informed clinical decisions(Mann& Gunja, 2020). The appraise the quality of study design for quantitative studies to asses for biasness. This process identifies strengths and weaknesses of a research article in order to assess the usefulness of the finding and weather it can be used to inform future research or not. In this case study, two article will be compared and evaluated in terms of their originality, importance, cohort groups included in the study, was the environment of study realistic or highly controlled, was the study design feasible, was the outcome appropriate and how was it measured, was the outcome tested against reliability and validity, was the collected data appropriate, were there drop out participants and was the research conclusive.

Article 1

In a study conducted by Chambers et al in 2016 on the nurse’s attitudes towards to mental illness patients, he compared differed samples of nurses from European countries. Mental illness is a serious concern n in Europe. Stigmatization and discrimination of patients has acted as a major barrier to the realization of good mental health and well being (Chambers et al 2016). The main objective of chamber’s research was to describe and compare attitudes of different registered nurses working in mental institutions, towards mental health patients from Europe. The research design was quantitative in nature as questionnaires were used to carry out the survey. A total of 72 inpatient wards and units and five community facilities in England (Finland, Lithuania, Ireland, Italy and Portugal) were selected for study. The participants were 810 nurses who were sourced from the wards and community mental facilities. The data was collected using the community attitudes towards mentally ill (CAMI) scale, which is a40-item self-report questionnaire. Using quantitative methods that emphasized objective measurements and statistical analysis of the data collected data was analyzed. Statistical data analysis methods such as graphs and statistical package for social science (SPSS) were used. After the comparison of data, the findings suggested that the nurses’ attitudes were mainly positive in Portuguese, Italy, Ireland and Finland with Lithuania nurses having the most negative attitudes compared to these other countries. Chambers and his colleagues concluded that European mental health nurses attitudes towards mental illness patients differ significantly across different countries, while in some countries they are largely similar. According to chambers, these observable differences and similarities are contributed by social, cultural and organizational circumstances that are encompassed by nursing practice.

Article 2

Similar to chambers work, Todorova and his colleagues in 2020 conducted a research on perceptions of ambulance nurses on their knowledge and competence when assessing psychiatric mental illness patients with paracetamol overdose. The main aim and objective of this study was to obtain the current perception of knowledge and competence of pre- hospital emergencies in attending to patients with mental illness (Todorova et al, 2020). Psychiatrist illnesses have increased with time as the population grows. Quantitative and qualitative techniques were used as research design methods in order to gain a deeper understanding of ambulatory nurses and their perception towards patients with mental illness. A total of seven ambulance nurses received questionnaires on the subject matter which they filled are returned. The nurses had commenced their employed back in November 2019. Follow up interviews were further conducted to explore their perceptions and knowledge on attending to patients with mental disorders. The surveys were analyzed using descriptive statistics which were then followed by content analysis for the interviews conducted. The finding of this research gave rise to three topics for discussion. The encounter of patients with mental illness, awareness of lacking knowledge about mental illness and the expectations for future pre-hospital emergency psychiatrist response teams. However much these nurses possessed basic knowledge on mental illness, it was not sufficient enough for appropriate care. They considered that combining the pre-hospital care and psychiatric care in emergency units would increase their in-depth knowledge on mental care, treatment options and alternative care delivery options.

Critical appraisal of article 1 and 2

In article 1, the authors work was not an original piece. This work was informed by previous researchers who had conducted similar research to chambers and his associate’s piece of work. In 2015, Haddad and his colleagues conducted a similar research to chambers’ work on district nurses involvement and attitudes to mental health problems which were a three area cross sectional study (Hiddad et al, 2015). Chambers was an important addition to Haddad’s and his associates as he focused more on registered and working nurses from different countries in England unlike Haddad who only focused on district nurses. Chamber’s work was inclusive and the participants were selected randomly for study. No criterion was used in selecting neither these mental institutions nor the nurses. A total of 72 inpatient wards and five community facilities were selected in England. Participants were 810 registered working nurses in these mental institutions (Chambers et al, 2016). The environment of study was realistic and not controlled as the patients were interview using questionnaires that were mailed to them. No participant was taken out of their environmental setting. A quantitative study design was used in article 1 which was feasible as it was descriptive in nature. Subjects were assessed once using a questionnaire to establish the relationship between variables under study. Data was gathered using questionnaires that were structured and the results obtained were based on the small sample size the represents the lager population. The outcomes of Chambers research were measured using the CAMI scale and analyzed by statistical methods (SPSS). The authors’ conclusion reflects the findings of this study. However outcomes of this research were never measured for reliability and validity. The decision of the researcher was based on the data collected which could be biased at some point. The study also did not include information on participants who might have dropped out or failed to return the mailed questionnaires. For article 2, was also not an original piece of work but stemmed from different research conducted by scholars like (Zurlo et al 2018, Haddad et al 2015 and Pintar et al in 2020). Todorova’s work was an additional piece of knowledge to the already existing gaps in previous research. The first differs from the second article in terms of the findings, the type of research design used, the methods of data collection and data analysis. In article 2, quantitative and qualitative methods of data collection were used unlike in article 1 where only quantitative research was conducted. Like article 1, Participants in article 2 were randomly selected the was no specific criterion used to select participants. This research was carried out in nurses who work in ambulatory and psychiatric units in hospital. Like study 1, study 2 was also realistic but highly controlled. In both studies questionnaires were used to collect data but for study 2, follow up interviews were done in order to obtain a deeper insight and knowledge on ambulatory nurses. Appropriate outcomes were also chosen in study 2 and evaluated using descriptive statistical methods. The outcomes of case study 2 were measured for reliability and validity using the follow up interviews. Appropriate data was collected using interviews and questionnaires and analyzed using statistical methods such as SPPSS and graphs. However like study 1, study 2 also did not account for participants who dropped out of interviews and never filled their questionnaires. Another observable difference between study 1 and study 2, the conclusions of the findings in the first study matched the results obtained while for the second study, the objective study yielded three different findings (The encounter of patients with mental illness, awareness of lacking knowledge about mental illness and the expectations for future pre-hospital emergency psychiatrist response teams) which did not tally with the conclusive statement which focused on integrating pre-hospital and psychiatrist expertise in pre-hospital emergency units to increase in-depth knowledge on psychiatrist illnesses.

Recommendation for practice

In an effort to improve care provision to patients, the institute of medicine and Robert wood Johnson foundation in 2010 released a report with guidelines and principles that would improve the future of nursing. This initiative began in 2008 with the foundation committee to access and transforms the current nursing profession. These recommendations cover all areas of nursing care, with the gap identified in nursing care to mental health issues with Paracetamol Overdose the following practices are recommended:

Expanding opportunities for nurses to ensure they lead and diffuse information that will enhance collaborative efforts within nursing units. Collaboration between different departments in health care will improve the quality of care administered to patients.

Increasing the number of nurses working in mental health care institutions. Due to fatigue and routinely work, these practitioners may develop attitude and hence impacts negatively on these patients. An extra pair of hands are recommended which can only be achieved if the number of nurses with doctorates and doubled.

Building an infrastructural collection of data in health care work force enhances the operability of these systems. Data collection and analysis forms a backbone in care management, this ensures all patients within the system are accounted for and hence accountability is assured incase of neglect.

Training and education programs

Training nurses equips them with new skills are knowledge that is applied in care provision. Well trained nurses are able to cope with the ever changing technology and in situations where digital backing up of data is needed they are able to deliver. Factors such as the nurse's preparation and the work environment affect the nurse's performance. This shows that continuing education and project preparation will help change the negative attitude of nurses, promote the development of nurses, and improve their corrective ability to communicate with patients. Another issue that affects the quality of mental health care is the nurse-to-patient ratio. Health leaders and professionals must emphasize the importance of focusing on mental health and supporting interdisciplinary work to form a key readiness for change in mental health in the UK. Another important area that needs more attention is nursing education at the university and graduate levels. Professional views and practices should be emphasized and incorporated into nursing education programs to reflect public and global principles related to the care of patients with mental illness. When formulating strategies and conventions for mental health care and nursing testing, you also need to focus on mental health testing. Future reviews of the educational and preparedness needs of nurses in the mental health field can help reveal information about the nature of the field in which nurses should be best equipped to provide mental health. Nurses should monitor the intake dose or plasma concentration of acetaminophen and the time elapsed since ingestion, as well as whether there are risk factors. Patients who are introduced within 8 hours after ingestion, in each case should be fixed with plasma paracetamol 4 hours after ingestion, in order to use the paracetamol treatment table to solve the risk of liver damage. Depending on the situation, the concentration of acetaminophen administered through the "normal" or "very dangerous" line of treatment determines the need for treatment. Paracetamol ​​should be started within 8 hours of ingestion to achieve maximum safety.

Conclusion

Findings identified in the 'Nurses' Perspectives on Mental Health and Mental Health of People with Mental Illness' indicate that mental health care in the UK is facing challenges and requires major change (Schafer, wood & Williams, 2011). The results show that nurses have negative opinions about mental illness and patients with mental illness. Mental health patients are considered at risk, seriously ill, adolescents, calluses, injuries, and poor integrity. This raises the question of the nurses' sense of security at work (or not). This information disturbs the sense of security in the work area and during nursing tests. Given that 60% of nurses have a negative attitude towards patients with mental illness, they mentioned the quality and needs of the care provided to these patients. Although actual cleanliness is the responsibility of the nurse, it is clear that the actual cleanliness of the patient's nurse is very poor(Mullins, Yeager& Freeman, 2020). Similarly, people believe that the level of demand for mental illness is lower than actual illness, that verbal communication is not required, that the cause of mental illness is negatively and illogically legalized, and that people with mental illness they consider themselves weak and suffering. Monitor your behavior and express yourself clearly (Cremonini et al, 2018). These views can interfere with the nature of care transportation, and as a result, people with mental illness may not be able to receive adequate care. Since this test is the first in the UK, no correlation test was allowed in previous research. In any case, this global survey emphasizes the importance and connection between nurses' perceptions of mental illness and nursing services. The specialist noted that mental health nurses' perceptions of stable mental health will affect the nature of mental health care and, in turn, the nurse-patient relationship. This survey is linked to the following objective: Negative perceptions of mental health nurses in the UK will affect the nature of care and in turn the nature of mental health care (if any). The clarification may be related to the social disadvantage of mental illness among the British population; this is comparable to the consequences of the previous public investigation(Mansfield et al., 2021). In this particular situation, the nurse may be affected by her lifestyle and harass her mentally ill patients in this regard. Sartorius said that the stigma of mental illness is considered the biggest obstacle to the development of sustainable mental health care. Due to the lack of training of nurses in the mental health field, further clarifications can be determined.

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