Nursing Care Strategies for Managing Paranoid Schizophrenia and Substance Abuse

Introduction

The presence of proper nursing care is essential as it helps to treat physical health complications of the patients as well as their psychological needs. (Nash, 2014). In this assignment, the key purpose to determine the nursing care of John McDermont who is currently suffering from paranoid schizophrenia and substance abuse issues. In discussing the care, the physical issue of persistent coughing that hindered breathing and mental issue of unemployment or lack of meaningful activity is to be explored. The Roper Logan Care model is to be used for exploring the issues and needs of John. Moreover, discussion and assessment of nursing tools and techniques to be used for supporting John, in this case, is to be done.

Nursing Assessment

The nursing assessment is referred to the process of collecting information regarding a patient’s psychological, physical, social and spiritual needs with the help of the registered nurse (rcn.org.uk, 2017). The nursing assessment is beneficial for identifying health needs of patients as well as determines their current response to healthcare along with their social, psychological and spiritual needs (rcn.org.uk, 2018). This is evident as through nursing assessment of John where his health diagnosis is executed led the nurses to determine his physical, sexual and mental status regarding the present health conditions the person is suffering. The NMC Code informs that confidentiality of the patient is to be maintained so as to avoid any harm (nmc.org.uk, 2018). Thus, the pseudonym John is to be used for indicating the patient.

The data collected in nursing assessment is mainly objective as well as subjective health condition of the patients and it is gathered through effective interaction with the patients by the nurses (Mouko and Sullivan, 2017). This is because effective interaction with the patient helps nurses to determine their specific needs and probable cause that leads to the current complication that is to be discussed with health professionals to develop effective care for the patients. Thus, effective discussion through communication is one of the key aspects to be followed by the nurse for John to examine his health condition. As argued by Bennett et al. (2017), improper therapeutic communication in nursing assessment leads the nurses unable to develop rapport and show value towards the patients. Thus, effective communication in nursing assessment is required for John so that he develops proper rapport with the nurses and shares his key needs to be fulfilled by the nurses as well as make the nursing staff develop ease in offering care to him.

Framework to support needs of service users

The holistic assessment is the process of gathering information regarding the overall health condition of an individual (Mizen et al. 2019). In this study, the holistic assessment is to be done for John by using Roper-Logan-Tierney Model of Nursing. The Roper-Logan-Tierney Model of Nursing is a framework that is developed on the basis of activities of everyday living of individuals to ensure detailed care is offered to the patients by identifying their daily essential needs (Stonehouse, 2017). This is because fulfilling activities of living for the patients helps the nurses empower patients to live with independence and better health condition. The framework is to be used for assessing needs of John because it would help the nurses to empower John to live with independence. The benefit of the Roper-Logan-Tierney Model of Nursing is that it leads to create less conflict in offering care by the nurses as it supports holistic assessment of the patient to be executed (Wilson et al. 2018). Thus, the framework is to be used as it is going to allow nurses develop proper care plan for John to support his specific needs.

Physical Health Issue

The Roper-Logan-Tierney Model of Nursing informs that breathing is an essential physical process which is to be assessed for the patient to determine their ability to inhale and exhale air for living (Stonehouse, 2017). In case of John, it is seen that he has a persistent coughing tendency which is worse during the early morning. The persistent coughing often creates shortness of breath for the patient making them experience suffocation as well as it interferes with their performance in everyday life (Mahler, 2017). In this relation, breathing assessment of John is to be executed as per the mentioned model to determine the way it is interfering with his health. As asserted by Lee et al. (2017), often extensive coughing is experienced by individuals who are involved in smoking regularly. This is because coughing among smokers occurs to clear the airways from the deposition of chemical and substances done through cigarette or tobacco smoke. As argued by Josephs et a. (2019), extensive smoking leads development of chronic obstructive pulmonary disorder (COPD) or lung cancer that causes increased coughing tendency among smokers. This is because harmful agents in tobacco smoking damage the airways and air sacs along with lining of lungs creating trouble for the person to breathe and cough extensively to breathe in air. In case of John, he is found to be extensively related with smoking tobacco and cannabis which is evident as it is reported he smokes 40 cigarettes a day and takes £10 cannabis each week which is quite extensive. Thus, breathing assessment of the individual is to be done to determine the extent to which smoking has hindered his physical health.

The psychological aspect which may influence John avoid breathing assessment is his fear of being diagnosed with complex diseases such as COPD or lung cancer which requires high amount of financial support for their treatment as well as complex healthcare routine to be followed. According to the case study, John is found to be unemployed and pointlessness to be able to avoid smoking which in turn lead him to avoid compliance with the nurses in making the examination. This is because he understands that he is not going to leave smoking and therefore it is baseless to execute breathing assessment as it would expose diseases such as COPD or lung cancer and the treatment to be followed for which he would be made to avoid smoking which is not acceptable to him. However, through empathetic communication, the issues could be resolved by the nurses. This is because empathetic communication leads the nurses makes the patient feel valued and understood their pain is perceived by the nurses in turn leading to build a rapport with the nurses to show compliance in accepting care and assessment (Priebe et al. 2016).

The peak flow meter is to be used for initial breathing assessment of John on visiting the health professional. It is a portable and easy-to-use device which measures the efficiency of the lungs in expelling air ensuring proper breathing is maintained. The meter is marked green (stable, 80-100% of personal best), yellow (caution, 50-80% of personal best) and red (>50% % of personal best) (NHS, 2018). The benefit of using peak flow meter for breathing assessment is offered quick results to analyse the extent of breathing trouble being faced by the individual. However, the limitation of the meter is that vital and complex lung parameter which ensures presence of complex pulmonary diseases like lung cancer COPD cannot be examined by its use (Walker and Key, 2016). In case the peak flow meter shows, less than 50% personal best for breathing then further test are to be done for detecting presence of COPD or lung cancer.

The spirometer is to be used for assessing Forced Expiratory Volume/ Forced vital capacity (FEV1/FVC) ratio to examine the breathing efficiency of John. The spirometer mainly assesses the time taken by individual to inhale and exhale during breathing. The 70-80% FEV1/FVC ration indicates normal and less than 70% indicate possibility of presence of COPD (NHS, 2020). Since John is continuously coughing and facing breathing trouble that are key symptoms of COPD, the test is to be done. The benefit of using spirometer is that it helps to properly assess the lung capacity to breath in patients. However, the limitation of using the tool is that it cannot be used for infants and unconscious person (blf.org.uk, 2019). Since John is totally conscious, the limitation would not be faced with its use. The chest X-ray of John is required to be further performed to determine presence of COPD or lung cancer which is related to cause breathing trouble as seen in his case.

According to NICE guidelines, behavioural support, nicotine replacement therapy (NRT), bupropion, varenicline and smoking cessation advice is to be provided to adults who are required to quit smoking (nice.org.uk, 2018). This is because behavioural support helps individuals like John involved in smoking gradually make change in their behaviour to avoid smoking tobacco and other substances. Moreover, the NRT acts as therapeutic way to quit smoking and medication such as varenicline and others are effective to lower smoking addiction. Since John is found to be involved in extensive smoking tobacco and weeds, thus the services mentioned by NICE are to be provided to him. This is to ensure smoking cessation by John as it would result to reduce breathing issue and manage coughing caused due to extensive smoking habit and lower worsening of COPD condition if any. This is COPD worsens with increased smoking and smoking is the primary way to avoid progression of the illness.

Mental Health Issue

The Roper-Logan-Tierney Model of Nursing mentions that inability of the patients to perform work and play leads individuals to develop mental and financial issues due to feeling of non-productivity (Stonehouse, 2017). Thus, it can be determined that lack of employment is leading John to face lethargic and apathetic as he feels non-productive in life. The psychological condition of John that is paranoid schizophrenia acts as challenge for him to face social inequality. This is because paranoid schizophrenia patients are portrayed by the media and society with violent behaviour who cause harm to others. It promotes stigmatisation of the disease and instigating discrimination of individuals suffering from the disease (Bowen et al. 2019). Thus, it means social inequality and discrimination regarding schizophrenia would make John face difficulty in availing job which would in turn adversely affect his mood to show mental issues of depression and stress.

In the study of Cadge et al. (2019), schizophrenic people are mentioned unable to work continuously as they experience catatonia symptoms. However, people with adequately controlled schizophrenia through medication can work with intervals. The side-effects of schizophrenia medication include restlessness, drowsiness and others (NHS, 2020a). Thus, John present condition can affect him to be unemployed making him show mood disorder. The Mental State Examination (MSE) is regarded as structured assessment through which patient’s current state of mind, attitude, domain of appearance, speech, thought process, cognition and other are observed and described (bgs.org.uk, 2017, Soltan and Girguis, 2017). Therefore, to determine the mental condition of John as a result of unemployment and paranoid schizophrenia the tool is to be used.

The MSE tool assessed that John shows presentable appearance, proper behaviour, well-composed speech, effective cognition and perception. However, the mood and emotional condition of John is found to be disturbed. This is evident as John mentioned he feels apathetic and lethargic to live as well as expressed to have low mood of not being able to work because his schizophrenic state is going to act as barrier for him to find employment. The Rethink Organisation suggests that people with mental illness when wish to get back to work are to be offered appropriate nature of employment either full-time or part-time based on their health condition. This is to make them feel productive and control mental health condition in effective way through engagement at work (rethink.org, 2018). It indicated that John is required to provide support to find part-time employment so that his emotion and mood can be positively boosted that would ensure his better mental health state. This is because lack of productivity and lethargy make individuals gradually develops depression and thoughts of self-harm (Evans et al. 2020).

The risk assessment for John is also done to determine nature of risk present for the service providers or nurses as a result of his mental condition regarding unemployment and paranoid schizophrenia. This is because paranoid schizophrenia patients are found to at time cause harm to others as well as self during hallucinations and delusion that are acute symptom of the disorder (Rabe and MRPharms, 2019). However, risk assessment expressed that nurses have no risk of getting harmed by John during his assessment as he is seen to show steady mental health. This is evident as he has good relationship with his mother as well as takes services to control his mental health.

Conclusion

The above discussion informs that John is suffering from paranoid schizophrenia and associated disorder which has led his to experience persistent coughing contributing to breathing and unemployment which is hindering his mental health. The Roper-Logan-Tierney Model of the nursing framework is used for John’s holistic assessment. The peak flow meter and spirometer are tool used for John to assess his breathing efficiency. The Mental State Examination (MSE) is to be used for John to assess his mental health condition and risk assessment of self-harm by John is to be done.

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