Nursing Reflection on Complex Care in Mental Health

Introduction

Complex care can be referred as the person-centred approach that is designed to manage the symptoms of more than one chronic health conditions in a patient. In mental health nursing the complex care is widely used and most effective care approach that assists the mental health nurses to determine the complex care needs of mentally ill patients thereby meeting these needs by implementing appropriate care strategies in a nursing dissertation help department. This reflective care study will first introduce a case of a mentally ill patient who suffers from a complex health condition which pose adverse impacts on his overall mental and physical wellbeing. Then the study will critically reflect on how the APIE (assessment, plan, implementation and evaluation) tool is used by the mental health nurses to assess, analyse and meet the complex health needs of the patient in the case study. The study will reflect on nurse’s roles in promoting positive health and wellbeing of the patient in the case study. Then the study will discuss the importance of the partnership working in a complex care framework hereby reflecting on nurse’s roles to work in the interprofessional teams in association with the different health care agencies to promote the positive mental health and wellbeing of the patient in the case study. Finally, the study will draw a suitable conclusion in which the main aspects of the entire discussion will be summarized.

Case study:

Richard, the 75-years-old retired bank manager, has been admitted in the dementia ward of a local nursing home in which I practice as a student mental health nurse. Richard lives alone after the death of his beloved wife Jenny four years ago. He has a six years history of dementia which impacts adversely on his overall decision-making skill, thoughts, cognitive abilities and memory. He is also diagnosed with other chronic physical health conditions such as COPD, Type 2 diabetes and coronary arterial disease (CAD). The combination of all these chronic, mental and physical health condition enhances his vulnerability to the risk of mortality. While assessing personal history and background of Richard, it is seen that before his wife’s death Richard’s health condition was stable despite being diagnosed with the complex health condition. his wife used to take care of his health and wellbeing by serving him with the healthy as well as prescribed foods and guide him to follow the recommended clinical regiment which assisted Richard to manage the symptoms of this complex health condition. After his wife’s he suffers from severe mental and emotional distress that impact on his physical health condition. He uses to lead an irregular lifestyle with skipping meals and eating unheathy foods that easily raise his sugar level. He also skips going to the psychiatrist to undertake the weekly Cognitive Behavioural Therapy which deteriorates his mental wellbeing. As a result, the frequency forgets to take the prescribes medicines for COPD, CAD and diabetes. Most of the times he cannot remember where he keeps his medicines, foods and the water bottle. Moreover, the death of his wife leads him to face severe anxiety, frustration and loneliness that destroy his aspiration to live the life. The condition of his mental health deteriorates day by day due to the severe deterioration of his physical condition. He frequently suffers from breathing difficulties while doing any work. He also suffers from frequent urination and chest pain. The impacts of this complex health condition are so severe on Richard that he becomes hopeless about his survival.

Assessment of complex needs of the patient (APIE tool]:

Assessment of complex need:

The case study shows that Richard needs an effective health assessment tool to address his complex needs that would enables the mental health nurses to develop and implement an effective care plan in terms of meeting these complex needs. While working in the complex care setting in the interprofessional team I assist the senior nurses in using the APIE (assessment, plan, implementation and evaluation) tool to assess the complex needs of Richard

Assessment:

Physical health assessment:

As mentioned by Brenner et al (2017) while assessing the physical needs of a mentally ill patient who suffers from complex health condition, mental health nurses need to ensure that that effective and relevant diagnosis techniques are used to determine the physical heath of the patients. Under NMC (2019), mental health nurses need to ensure that they have the proper expertise and professional knowledge in carrying out the physical assessment of the mentally ill patients thereby ensuring the patient’s safety [NMC, 2019]. For determine the current physical needs of Richard, I have performed various tests such as:

High Resolution chromatography test (HRCT test), PFT test and the spirometry to determines the current lung condition of Richard.

Complete blood counts, Glycated haemoglobin test (A1C test), fasting blood sugar test and random blood sugar test, to check the blood sugar level and determine the level on insulin in the blood.

ECG to determines the percentage of blockages in the coronary artery

After performing these tests, I receive test reports and hand over the report to the senior nurse. Based on the reports on these physical tests it is seen that Richard has severe infection in lung with 85% perforated lung wall that shows the sign of primary hung malignancy. On the other hand, the ECG report shows that Richard has 75% blockage in the coronary artery. The report of the sugar test shows that Richard has high blood sugar with fasting sugar level of 220 mg/dl. By assessing these test results, it is stated that, Richard needs an immediate complex treatment process which will cover all his physical and mental health needs such as the pulmonary condition, the heart condition, oxygen saturation level, lung function, and his dementia condition.

Mental health assessment:

While assessing the mental health needs of Richard I use the PEPSI COLA tool under the guidance of my seniors. I choose this tool under the instruction of the senior care professionals to assess the emotional, spiritual and psychological needs of Richard by evaluating his personal, professional and social life (Breton et al. 2017). Under Mental Health Act (2007), nurses who work with the mentally ill patients must ensure that the health assessment tool that is going to be use will not interfere with patient’s autonomy, dignity and self-esteem. By using the PEPSI COLA tool, I am able to determine the factors associated with the mental distress of Richard such as his wife’s death, lack of social support, presences of more than one health conditions and lack of effective health and social care (Correa, 2018).

Based on this assessment, an effective care plan has been developed for Richard, that included the medication, proper nutrition, good nursing care and promoting life styles change. Under NMC (2019), while providing complex care to a mentally ill patients, care professionals and nurses must ensure that care plan will cover all the physical and mental health needs of the patients thereby promoting the holistic wellbeing of the patients [NMC, 2019].

Implementation

Inpatient care:

Under this care plan I have played manifold roles while working in the inter-professional team to provide the inpatient care to Richard. I used to make regular observation of Richard’s physical health, his activities, behaviours and attitude. I immediately inform my seniors if I notice any deterioration of the physical health or appropriate changes in the behaviour, approaches and activities of Richard (Brenner et al 2017). Under the direction of my mentors I use the NEWS (National Early warning system) to evaluate the physical health status of Richard (de Vasconcelos et al. 2019). I am also assigned to develop empathetic communication with Richard to provide him with the mental and emotional support that will improve his overall mental wellbeing. Under Mental Health Act (2007), nurses must use the friendly, empathetic and supportive behaviour towards a mentally ill patients to promote the positive psychological wellbeing of the patients (Hyatt et al. 2018). Under NMC (2019), mental health nurses must listen to the complex need of the mentally ill patient and provide a fair and supportive care environment to the patient [NMC, 2019]. In the complex care setting, I use to discuss with Richard on how he feels about his health condition and what impacts these health condition have on his mental and physical state. I use to motivate Richard to undertake the Cognitive behavioural therapy and regular counselling by telling him the benefits of these therapies in promoting his mental and physical wellbeing (Gray et al. 2020). I am also assigned to ensure that Richard follows the guidelines regarding taking prescribed foods and the medicines on regular wise. I regularly check that whether the healthcare staffs provide the instructed meals to Richard that is enriched with proteins and low in fats and carbs (as Richard has diabetes and CAD).

Medication:

Under NMC (2019), while treating a mentally ill patients who suffers from complex health condition, medicine optimisation is important to ensure the usefulness of prescribed medicines to cure patient’s complex health condition [NMC, 2019]. While providing complex care to Richard, I am involved in checking that whether right dose of all prescribed medicines is administered to Richard. I use to check the health staff provides the right medicine to Richard in right time. Also, I check that whether there is any side effects in the physical health and behaviour of Richard after the medicined administration. As Richard has COPD, regular administration of SABA and LAMA is performed to improve his breathing condition as well as lung activity. Additionally, he also undergone the IV fluid administration to normalise his sugar level. I also check that whether Richard is provided with the ketogenic diet to reduce his sugar level. As mentioned by Hui et al. (2018), while meeting complex needs of a mentally ill patient, nurses need to consider the mental wellbeing of the patients along with the physical health promotion. For promoting the positive mental wellbeing, I use friendly and empathetic words towards Richard to motivate him about positive health and wellbeing, I discuss with Richard about his personal life and loss and provide the emotional support to assist him get rid of all these memories and follow the clinical regimen to have a healthy life.

Side effects:

Under NMC (2018) while administering any medicine to a patient, nurses must ensure that they are aware of the side effects of the medicine. Nurses must have strong knowledge on managing the side effects of medicines while administering them into patient’s body to ensure that the patients will free from any health risk. While administering SABA and LAMA into Richard’s body, I ensure that there must be the rights dose is given to this patient to protect him from any kind of serious health issues. The common side effects if bronchodilators such as SABA and LAMA are mild headache, nausea, cold symptoms, stomach upset and migraine headache. After administering these two medicines to Richard, I notice for 24 hours that if there are any side effects is visible on case of Richard. I also ensure that there us proper arrangement to provide the immediate clinical support to Richard if he suffers from any side effects of medicines.

Services provision:

Under NMC (2019), while working in complex care setting, mental health nurses need to ensure that they work under their level of professional knowledge and competence to ensure the safety of patients through the care delivery [NMC, 2019]. In this context, I always ensure that I would behave and act in right way in my workplace that not only assist me to determine the complex needs of Richard but also enable me to maintain my professional integrity and accountability. Under Mental Health Act (2007), I always ensure that the rights, autonomy and preferences of Richard are respected throughout his care delivery. According to Hyatt et al. (2018) to promote the positive mental and physical health in a patient suffering from complex needs, nurses need to ensure that they adhere to all the healthcare legislation in terms of treating each patient in fair and right way. Under Mental Health (discrimination) act (2013), mental health nurses must protect the mentally ill patient to provides the effective complex care (Kuluski et al. 2017). I follow all the guidelines of this provision to ensure that Richard would be free from any kind of bias or discrimination in accessing the health and social care support.

NICE guidelines:

Under NICE (2019), mental health nurses need to implement the right as well as appropriate care plan in terms of promoting the physical and mental health and wellbeing of patients in complex care setting [NICE, 2019]. I always follow the NICE guidelines to ensure that, Richard will not be subjected to any kind of maltreatment or discrimination on meeting his complex needs due to his physical and mental disability. Under NICE (2019), mental health professionals must provide the fair and bias free treatment as well as care to mentally ill patients irrespective of their disability health condition, ethnicity, race and religion. Moreover, the NICE (2019) guidelines suggest that, mental health practitioners and nurses must provide the over protectives environment to the vulnerable people who suffer from menta illness to protect them from any kind of harm and abuse. During the care delivery to Richard, I ensure that Richard will receives a fair and transparent care delivery in which his preferences, autonomy and dignity are protected. I also ensure that Richard is free from any kind of abuse and maltreatment such as discrimination, bully, harassment, mental and physical torture.

CPA (Care Programme Approach):

Care Programme Approach or CPA is highly effective initiative that is widely used by the mental health nurses and practitioners in the UK to improve the mental and emotional wellbeing pf patient. Through conducting COPA, mental health nurses are able to determines the metal health needs of a patient and thus develop effective care plan-based ion these need to implement effective care strategies to meet these needs. During care delivery to Richard, I have conducted effective CPA which assist me to develop self-management skill and stress management ability in him. Additionally, through appalling CPA I am able to improves the decision-making skill, cognitive skill and problem-solving ability in Richard.

ICD 10 (International Statistical Classification of Disease and Related Health Problem):

ICD-10 works under the World Health Organisation and sets the standards for the care professions to provide the high-quality healthcare services to clients. During care delivery to Richard, I try my best to meet all these standard set by OCD-10 to ensure that fair, transparent and effective healthcare services provided to Richard to promote his positives health and wellbeing.

Nursing roles:

In a complex cere setting, the mental health nurses play manifold roles in terms of providing the high-quality care to a mentally ill patients thereby promoting their positive mental and physical health (Janssen et al. 2019.). While delivering complex care to Richard, I perform many tasks as an assistant practitioner under the guidance and instruction of my seniors.

Evidence based approach:

I use to implement the evidence-based approach under the assistance of my seniors to determine and meet the physical, mental and emotional needs of Richard. Under NMC (2019), mental health nurses need to use the evidence-based process to meet the complex needs of a mentally ill patient thereby promoting his or her holistic needs [NMC, 2015]. Here I use to discuss every information regarding Richard’s current mental and physical health to the different care professionals before taking any care strategies (Jeffs et al. 2017). After implementation of each care strategy, I also check that effects of the strategies on the health and wellbeing of Richard to ensure his overall safety.

Leadership:

Although I work under the assistance of the senior nurses in the interdisciplinary team, many times, I act as an appropriate leader to take the right decision regarding effective complex care delivery to Richard (Kuluski et al. 2017). For example, while checking whether Richard is administered with the right medicines or whether the health care staffs follow the doctors’ instruction in serving the right foods to Richard, I use my autocratic leadership style, to maintain the disciplined activities of the subordinate healthcare staffs thereby ensure the high-quality care to Richard.

Health education:

I act as the mentor and guide of Richard to provide him with the health education and healthcare information under the instruction of the senior nurses. Here I provide Richard with proper health information about his health conditions, the impacts of these health conditions on his mental and physical wellbeing, the importance of following proper lifestyles and medicines to manage the complex health condition and the benefits of the right behavioural and psychological changes in avoiding the risk of mortality.

Policies:

While providing complex care to Richard I ensure to adhere to all the healthcare legislation and policies to provide high quality care to this patient. I follow the guidelines of the Health Act (2006), to ensure that effective care plan is implemented in case of Richard to promote his positive physical and mental health. I follow and implement the guidelines of the Disability Discrimination act (2005) and Mental Health Act (2007) to ensure that Richard is provided with all the health and social care facilities irrespective of his mental and physical disability (Larsson et al. 2017).

Partnership working in interprofessional team

I work in the inter-professional team in which I work in partnership with the senior nurses, different care professionals and healthcare staffs. In partnership working I use the effective communication which assists me to transfer all the updates regarding Richard’s health to the care professionals (Lewis et al. 2019). I act as the mediators in the interprofessional team between the Richard and care professionals thereby maintaining an effective transparent information delivery system between them. I also assist nurses and care professionals to maintain effective medicine management, heath records keeping and medicines optimisation that enhance the quality of the complex care delivery to Richard. In this interprofessional team, I work closely with care professionals and the nurses to discuss care related issues, the follow up treatment process for Richard and expected outcomes of the implemented care plan that help the care professionals to develop an innovative approach to promote the holistic wellbeing of Richard (McCrory, 2019).

Evaluation:

In the evaluation of the care plan, I have done a follow up of the implemented treatment process of Richard to evaluate that whether the treatment is useful in meeting the complex needs of Richard.

Conclusion:

From the above-mentioned discussion, it can be concluded that, in mental health nursing, nurses play crucial roles in meeting the complex care needs of patients. Complex health condition is the health condition in which a patient suffers from more than one health conditions that impact adversely on patient’s physical and mental health. Through effective assessment of the complex need and implementation of an effective care plan nurses can meet these complex needs thereby promoting positive health and wellbeing of patients.

Reference list:

Beima-Sofie, K., Begnel, E.R., Golden, M.R., Moore, A., Ramchandani, M. and Dombrowski, J.C., 2020. “It's Me as a Person, Not Me the Disease”: Patient Perceptions of an HIV Care Model Designed to Engage Persons with Complex Needs. AIDS Patient Care and STDs, 34(6), pp.267-274.

Brenner, M., Connolly, M., Larkin, P.J., Hilliard, C., Howlin, F. and Cawley, D., 2017. Adaptation of a voice-centered relational framework to explore the perspective of parents who have transitioned to home with a child with complex care needs. Comprehensive child and adolescent nursing, 40(4), pp.285-293.

Breton, M., Gray, C.S., Sheridan, N., Shaw, J., Parsons, J., Wankah, P., Kenealy, T., Baker, R., Belzile, L., Couturier, Y. and Denis, J.L., 2017. Implementing community based primary healthcare for older adults with complex needs in Quebec, Ontario and New-Zealand: describing nine cases. International journal of integrated care, 17(2).

Correa, Z.M., 2018. Reappraising the Psychosocial Needs of Patients With Uveal Melanoma. JAMA ophthalmology, 136(4), pp.363-364.

de Vasconcelos, P.F., de Freitas, C.H.A., Jorge, M.S.B., de Carvalho, R.E.F., de Sousa Freire, V.E.C., de Araújo, M.F.M., de Aguiar, M.I.F., de Oliveira, G.Y.M., Dos Anjos, S.B. and Oliveira, A.C.S., 2019. Safety attributes in primary care: understanding the needs of patients, health professionals, and managers. Public health, 171, pp.31-40.

Gray, C.S., Tang, T., Armas, A., Backo-Shannon, M., Harvey, S., Kuluski, K., Loganathan, M., Nie, J.X., Petrie, J., Ramsay, T. and Reid, R., 2020. Building a Digital Bridge to Support Patient-Centered Care Transitions From Hospital to Home for Older Adults With Complex Care Needs: Protocol for a Co-Design, Implementation, and Evaluation Study. JMIR research protocols, 9(11), p.e20220.

Hui, D., Hannon, B.L., Zimmermann, C. and Bruera, E., 2018. Improving patient and caregiver outcomes in oncology: Team‐based, timely, and targeted palliative care. CA: a cancer journal for clinicians, 68(5), pp.356-376.

Hyatt, R., Dean, J., O'Neill, M., Patel, N., Abu-Rabia, M. and Taylor, J., 2018. The frailest of the frail? Addressing the palliative care needs of frail older patients. Future healthcare journal, 5(1), p.10.

Janssen, D.J., Boyne, J., Currow, D.C., Schols, J.M., Johnson, M.J. and La Rocca, H.B., 2019. Timely recognition of palliative care needs of patients with advanced chronic heart failure: A pilot study of a Dutch translation of the Needs Assessment Tool: Progressive Disease–Heart Failure (NAT: PD-HF). European Journal of Cardiovascular Nursing, 18(5), pp.375-388.

Jeffs, L., Kuluski, K., Law, M., Saragosa, M., Espin, S., Ferris, E., Merkley, J., Dusek, B., Kastner, M. and Bell, C.M., 2017. Identifying effective nurse‐led care transition interventions for older adults with complex needs using a structured expert panel. Worldviews on Evidence‐Based Nursing, 14(2), pp.136-144.

Kuluski, K., Gill, A., McKillop, A., Parsons, J., Peckham, A., Sheridan, N., Upshur, R. and Wong-Cornall, C., 2017. The unmet needs of patients and carers within community based primary health care. International Journal of Integrated Care, 17(3).

Kuluski, K., Peckham, A., Gill, A., Arneja, J., Morton-Chang, F., Parsons, J., Wong-Cornall, C., McKillop, A., Upshur, R.E. and Sheridan, N., 2018. “You’ve got to look after yourself, to be able to look after them” a qualitative study of the unmet needs of caregivers of community based primary health care patients. BMC geriatrics, 18(1), pp.1-11.

Larsson, L.G., Bäck-Pettersson, S., Kylén, S., Marklund, B. and Carlström, E., 2017. Primary care managers’ perceptions of their capability in providing care planning to patients with complex needs. Health Policy, 121(1), pp.58-65.

Lewis, C.L., Moore, E.P. and Selwyn, C.N., 2019. Identifying Unmet Mental Health and Emotional Palliative Care Needs in Patients with Ehlers Danlos Syndrome.

McCrory, V., 2019. An overview of the role of the district nurse caring for individuals with complex needs. British journal of community nursing, 24(1), pp.20-26.

Samir Abdin, M., Grenier‐Gosselin, L. and Guénette, L., 2020. Impact of pharmacists’ interventions on the pharmacotherapy of patients with complex needs monitored in multidisciplinary primary care teams. International Journal of Pharmacy Practice, 28(1), pp.75-83.

Webster, F., Rice, K., Bhattacharyya, O., Katz, J., Oosenbrug, E. and Upshur, R., 2019. The mismeasurement of complexity: provider narratives of patients with complex needs in primary care settings. International journal for equity in health, 18(1), pp.1-8.

Wild, B., Heider, D., Schellberg, D., Böhlen, F., Schöttker, B., Muhlack, D.C., König, H.H. and Slaets, J., 2019. Caring for the elderly: A person-centered segmentation approach for exploring the association between health care needs, mental health care use, and costs in Germany. PloS one, 14(12), p.e0226510.

Wilson, L., Biery, N., Benner, L., Frutos, B. and Dostal, J., 2017. Moving Primary Care Forward to Meet the Complex Care Needs of Older Adults.

Take a deeper dive into Nursing practitioners and health practitioners manage with our additional resources.