Understanding Alzheimer’s and Care Needs

What skills could be implemented to provide person centered evidence based care for Dennis including an understanding of health promotion and recovery concepts. Your answer should refer to the case scenario and utilize appropriate supporting references.

As highlighted by MacGill (2018) Alzheimer’s disease is a neurological disorder which causes the death of the brain cells causing cognitive decline such as loss of memory and displaying unusual behavior. Patients suffering such neurological disorders are often placed on intensive care where care givers are capable of offering them help in performing tasks which they cannot effectively perform for themselves. Denis is such a patient, who suffers with as basic functions as mobility and as such require the assistance of a carer almost all the time. In addition to the sick and mentally challenged, care can also be provided to children, the elderly as well as individuals with physical disabilities of any kind that makes them incapable of caring for themselves. Alzheimer’s Association (2018) highlights a variety of symptoms related to Alzheimer’s disease including memory loss, challenges in planning and solving problems, difficulty in completing familiar tasks, confusion, misplacing things and many more, all of which directly point to the impact on the patients’ personal life. Denis therefore requires a personal carer who will regularly offer him assistance in his personal life to carry out the very basic of tasks. This requires a person centered care based on the available evidence Denis portrays about the things he needs assistance with in his life. Person centered care involves providing care that is responsive to individual personal preferences, needs and values and assuring that various patients values guide all the clinical decisions (Kim and Park, 2017). It is concerned with the empowerment of nurses, hospital or care home staff as well as care givers to cut through the various processes and systems and mainly focus on the needs of the patient and enhancing their experiences. As such, a range of significant and specific skills are a key requisition for care giver especially to helping patients such as Denis with a mental disorder and enabling their health promotion for aiding recovery (NHS.UK, 2018).

Among the skills as highlighted by the Royal Collage of nursing (2016) include the ability to adequately and appropriately communicate. In being able to provide a person centered care for Denis communication with him is fundamental in determining what he may need at whatever time. Given his condition which include fluctuating periods of Lucidity and confusion which render him immobile and incapable of proper thinking and communication the care giver needs to exhibit their ability of being able to use appropriate communication skills to encourage him to participate in his own care. This includes packaging information in a form that is acceptable and understandable to him at the time so as to help him with decision making. This includes patience and negotiation skills since coming to an agreement and a conclusion may take extra effort. The Health Foundation (2016) further highlights that it is essential for the carer to show compromise as a highly refined skill to be able to take care of such patients as Denis effectively. Given the mental state of Denis owning to Alzheimer’s disease, he is sometimes unable to do basic personal tasks such as bath themselves or clean up after biological calls, in fact helping themselves to the toilet may in certain circumstances be a problem due to immobility issues and confusion as displayed by Denis. As such, for the health giver to be effective, compromise and being able to bring themselves to assist Denis with such basic tasks, that may otherwise be quite embarrassing is a necessary skill. Perhaps the most basic of skills yet that could be implemented to provide person centered, evidence based care to Denis and include an understanding of his health promotion and recovery concept include caring. According to the Health Innovation Network (2017), a variety of underlying principles are important and impact on the outcome of person centered care, among them include; understanding the patient as a person and recognizing their individuality as well as a holistic approach in assessing an individual’s need. For a care giver to be able to carry out these functions of care then they have to actually care for their patient. This means having the Denise’s wellbeing, safety and comfort as the main priority, as well as his emotional and spiritual needs. This would specifically be important for Denise’s person centered care as he rarely gets in touch with his own children and grand children due to his illness. Continue your exploration of Understanding Alzheimer’s and Care Needs with our related content.

Despite the availability of ethical codes of conduct and moral standard documents to guide care givers and nurses on ensuring fair, non-judgmental, non- prejudicial and respectful practices, a care giver as a matter of effective skills for the job should be respectful and have a sense of responsibility as a skill to be able to effectively and conveniently provide Denis with person centered care. The Royal Collage of Nursing (2016) emphasize that having a sense of responsibility and personal moral standards as a care giver ensures accountability and consequently provision of quality care. The Alzheimer’s society of Canada (2014) further highlights that personal engagement is a significantly important aspect in being able to deliver person centered care for patents. Developing and implementing skills of engagement with Denis help him to be able to engage more in activities and gain a better concentration, contrary to his current state, this could also help with minimizing the frequency of his episodes of confusion and align him towards health promotion and recovery. Nurses caring for Denis could therefore implement their skills in delivering appropriate patient engagement in the attempt to provide a person centered care for Denis. Denis like all other mental health patients are incapable of taking care of their own selves adequately at all times and as such, this necessitates the need of having a personal care giver at all times. In order to enable the promotion of their health and enhance a recovery process, then care must include the willingness of the patient which prompts the need for a person centered care. A nurse providing this has to among other many skills show good communication abilities, Understanding and compromise, Care as well as patient engagement.

References

Kim S. P. and Park M. (2017). Effectiveness of Person Centred care on people with Dementia: A systematic review and Meta analysis. Journal of Clinical Interventions in Aging. 12(1), pp 381-397

What assessments would need to be carried out to enable effective care planning for Susan? Your answer should refer to the case scenario and also demonstrate an understanding of health promotion and recovery concepts utilizing appropriate supporting references.

Patient assessment is one of the fundamental functions of all nurses regardless of their practicing field and being able to establish a proper assessment for patients is key in the developing of a treatment and care plan that promotes the patients health as well as enables their full and quick recovery (Jarvis, Forbes and Watt, 2011). While most of these assessments may be medical and require specialized medical equipments to carry out, some assessments are entirely physical and as such can be done through observation, listening, palpation and other physical activities that do not include any medical equipment. Given Susan being 22, she is a young patient suffering depression and mood disorders linked to her Urinary tract infection. According to Krans (2013), depression and other mood disorders could be the brains response to inflammation. Dumphy et al. (2015) further emphasizes that review of literature highlights a clear relationship between lower Urinary tract Symptoms and depression. However while the Urinary tract infection may be the cause of her depression, prolonged years of drugs and alcohol abuse may as well have turned her into an addict and interfered with her mental capacity and functioning causing her hallucination and hearing of voices. In order to be able to develop and schedule an effective care plan for Susan therefore a wide range of assessment ranging from her medical condition check up to her social status check up especially with regards to her drug problem, low moods and inability to socialize with others or even attending her piano lessons will be among the assessment practices to be carried out. Her prolonged periods of depression as well as the over reliance of alcohol and cannabis to keep her calm indicates the possibility of a mental health issue. And as such to carry out a proper care plan that includes her health promotion and recovery require a wide range of Assessments.

Cuijpers et al (2015) highlights that a variety of factors such as medical illnesses, disabilities, medication side effects, social isolation as well as abuse of drugs and alcohol contribute to raising the risk of depression. While sadness or a sore mood is not the only sign of depression and may actually not be a sign of depression depending on the circumstances, Bruce (2017) clarifies that mood disorders over long period of time is in fact a major sign of depression. Assessment of her medical conditions and history is among the major assessments to be carried out for the planning of an effective care plan. Despite Susan having a treatment plan with a practice nurse regarding her urinary tract infection, assessment on the period of treatment that she has been subjected to, the drugs and medication she has been using in her treatment, including the option that the problem may arise from a different source and as such lead to depression is necessary. Smith (2010) highlights that; continuous urinary tract infection may arise from structural problems with the Kidney or bladder which makes the patient susceptible to infection. In this case a treatment and care plan for the structural problem can then be adequately planned. Susan will also need a psychological assessment that includes an interview with the patient to determine the extent of the impact of her past experiences to her current mental health and status. Baldwin (2008) highlights that often depression and mood disorders can be triggered by ongoing life experiences as well as past traumatic experiences that leave patients stuck emotionally within the same scene and incident and therefore unable to process similar occurrences that may be due to everyday socialization and engagement with people as Susan is experiencing with her friends and her inability to further attend her piano classes.

For effective planning of Susan’s care a physical assessment is also fundamental. According to Kyle and Carman (2008), a structured physical examination enables the nurse to obtain a complete assessment of the patient. Among the various techniques to be used in carrying physical examination on Susan include observation, percussion and inspection. These could be instrumental in being able to establish the physical manifestations of the impact of alcohol and drug abuse Susan having been involved in it for more than 10 years, thereby giving the extent of damage by alcohol and drugs. This could be quite significant in the design of rehabilitation programs and which drugs to use to curb withdrawal effects, as such planning of her care can then include promotion of her health and recovery from depression. The nurse will highlight clinical judgment of Susan’s shape and conditions in adequately determining which physical assessments are required. Given the lack of understanding at the time of what exactly is causing the low moods and sadness as displayed by Susan, it would be crucial to carry out a Focused Assessment in order to pinpoint the exact problem and therefore be capable of designing a treatment plan for Susan. Focused assessment involves a detailed nursing assessment of specific body system that relate to a present problem being experienced by a patient (Susan, 2012). In this case a neurological system assessment is significant in pin pointing whether Susan experiences low moods and sadness in addition to unsocial tendencies due to a mental disorder. Given these conditions the nurse can then organize for a person centred care plan that will ensure Susan is safely taken care of. The focused assessment will also include her other systems including the entire excretory system in a bid to determine what causes the re current of the urinary tract infection and as such enable the establishment of a care and treatment plan. Given her complicated condition, Susan’s low mood and sadness may as much root from her life experiences as they may from her medical conditions and history. It is prudent therefore for the assessment to include, physical, medical as well as focused assessments for the ultimate planning of an effective care and treatment plan which will not only promoter the wellbeing of her health and physical emotional state but also advance in her recovery.

References

Bruce M. L. (2017). Caring for depression in older home health patients. Journal of psychosocial nursing and mental health service. 53(11), pp 25-30

Dunphy C, Laor L., Te A., Kaplan S. and Chughatai B. (2015). Relationship between depression and lower urinary tract symptoms secondary to Benign Prostatic Hyperplasia. Journal of Urology. 17(2), pp51-57

Jarvis, C., Forbes, H., & Watt, E. (2011). Jarvis's physical examination & health assessment / Carolyn Jarvis ; Australian adapting editors, Helen Forbes, Elizabeth Watt: Chatswood, N.S.W. : Elsevier Australia

How would you establish and maintain a therapeutic relationship with Louise. How would you promote mental health and recovery with Louise? Your answer should refer to the case scenario and utilize appropriate supporting references.

Psychotherapy refers to a collaborative treatment process between an individual and a psychologist usually with the aim of helping the individual get through their personal emotional problems. According to the American Psychological Association (2018) A psychologist provides a supportive environment for individuals to be able to openly and truthfully talk about their emotional problems that may crop from different problems experienced within one’s life as well as past experiences and occurrences that are traumatic to the patient and as such difficult for them to manage on their own. While therapy is good and of actual significance to the patients, McRae (2013) highlights that most patients shy away from it after a few sessions due to the feeling that it is useless to them. This would explain the condition of Louise 28 who despite having attempted suicide twice at Just 28 has had to be transferred through different care homes and hospitals due to depression. Louise is young, suicidal and depressed, this crops out from traumatic experiences she has had in the past including sexual abuse from her uncle when she was a teenager. Further the depression is enhanced by a low self esteem and the feeling of being worthless derived from early childhood anger issues and being unable to stay committed to a single relationship. Basically, Louise has trust issues and to be able to establish and maintain a therapeutic relationship then trust between her and the psychologist must be first established. LaRowe (2004) highlights that the very first process of establishing a therapeutic relationship involves establishing an understanding with the patient that they are entering into a relationship that is confidential, reliable, consistent and with clear boundaries with a therapist. In the case of Louise, that would mean guaranteeing her confidentiality in matters concerning her life that she may choose to share, ensuring reliability for emotional support at any time which enhances her sense of self worth and esteem. It also involves guaranteeing consistency in being there for Louise in her various life problems and struggles as well as defining clear boundaries that will govern the relationship moving forward.

For instance using communication strategies that are likely to gain her trust by making her feel comfortable and accepted will be the starting point of establishing the relationship with Louise after which its maintenance is key. Firestone (2016) highlights a research confirmation that maintenance of the therapeutic relationship itself is essential to the eventual success of the process. Skodol and Bender (2018) emphasize that the relationship between a clinician and a patient in psychotherapy plays a central role in alleviating symptoms and fostering character change and can potentially be a powerful vehicle towards enhancing patient improvement. To be able to ensure the maintenance of the relationship with Louise, I would then need to maximize on my communication skills and understanding of human behavior and personal strength as well as tap inter her specific problems so to be able to help with her growth and ensure it is visible for her to also witness it. Maintaining an effective therapeutic relationship includes achievement of specific goals and functions as highlighted by Skills for Health (2004) to include Facilitation of effective communication including distressing thoughts and feelings from the patient that they may otherwise not express, Assisting the patients with emotional problem solving to help them facilitates their activities of daily living, helping them to be able to examine alternative courses of action that may help ease their emotional pain and problems as well as promoting their self care and independence to enhance their full recovery. Other activities to help maintain the relationship would include demonstrating genuine concern for Louise’s welfares, facilitating the expression of her emotions by allowing her as much time as possible to enhance her processing, communicating clearly her roles and responsibility within the relationship, keeping track of her emotional, physical and behavioral responses and highlighting whether these may be communicating a subtext to be acted upon, showing empathy to her condition as well as recognizing her autonomy as a person and keeping well within the respect to her own personal boundaries.

Louise is undergoing emotional and mental stress which renders her mentally unhealthy and induces depression, low mood and sadness, lack of self esteem, loneliness all of which are inducing suicidal thoughts. Smith (2016) highlights that the function of a psychologist and support system, is to maximize the demonstration of empathy, this subsequently helps in the healing of painful experiences and letting go of traumatic experiences thereby leading to the recovery of the patient. In order to promote mental health recovery for Louise, then it is important to help her be able to understand herself more and appreciate herself. This includes helping her to attain employment if possible, reconnect with family and friends as well as be able to effectively commit to a relationship that is positive and fruitful. These activities will have the effect of helping Louise stay positive and optimistic. Further, to be able to promote Louise mental health and recovery, I would help Louise be able to view life in a different perspective and as such have much more to live and be happy for. McRae (2013) further highlights that therapy enables individuals develop a fresh insight to life from where they can be more appreciative of themselves. It also enables the patients to feel empowered and be able to improve on their relationships, which subsequently helps them to better handle their emotions and problems. To promote Louise mental health and recovery therefore I would help her in being able to identify patterns of anxiety and depression as well as the causes for these anxiety, self criticism and other unhealthy thoughts from where she can learn to control and process them correctly thereby significantly improve on her mental health. Psychotherapy is among the most common and main treatments of mental health problems especially as related to overwhelming emotional experiences derived from past traumatic experiences and will most definitely be effective to helping Louise solve her problems if approached correctly.

Identify the mental health condition that Kevin appears to be suffering with, outlining the following: aetiology, signs and symptoms. Your answer should also demonstrate an understanding of health promotion and recovery concepts and refer to the case scenario and utilize appropriate supporting references.

Kevin experiences and exhibits psychotic behavior that is consistent to an individual suffering from mental disorder. Some of these include; locking himself up and experiencing hallucination that are baseless and have no connection at all to him or the experiences that his life is about. While this may be a wide range of mental health disorders such as psychotic depression, Dementia or even Alzheimer’s disease, it appears Kevin might be suffering from Schizophrenia. According to WebMD (2018) individuals suffering mental disorders experience different symptoms that enables the nurse and doctors to be able to pinpoint exactly the illness they may have. Given Kevin’s hallucinations do not include any depressive qualities. According to Smith and Segal (2018) psychotic disorders characterized by depression or depressive disorder are highlighted by consistency in the delusions of self worthlessness. As such, patients suffering from depression or psychotic depression experience constant hallucinations that are related to how the view themselves as individuals and their ability to make a difference or a change within their own lives. This is inconsistent with Kevin’s experiences and as such leads to the condition of his probable mental health disorder being Schizophrenia. Smith and Segal (2018) further emphasize that Schizophrenia is a challenging disorder which often makes it difficult for an individual to distinguish between what is real and unreal, relate with others, manage ones emotions as well as think clearly. Nordqvist (2017) highlights that it is a mental disorder that usually appears in late adolescence and early adulthood and often proceeds to be a life time struggle among the patients who exhibit it. he further highlights that in some patients the illness may actually take a long period to manifest itself to the point where the patient will not even be aware when they started experiencing it while at the same time on others it may appear suddenly and develop to be full blown so quickly. While a variety of subtypes exist for Schizophrenia including Paranoid Schizophrenia and Schizoaffective disorder (NIMH, 2016) scientist and doctors no longer use this classification as the differences are not clearly distinguished.

Causes of Schizophrenia

Schizophrenia is a gradual development of disorders within the human brain that cannot be completely explained by scientist yet how it occurs without notice. As such the causes of Schizophrenia are not fully known yet, however scientist suppose that it results from a complex interaction between genetic and environmental factors. While the illness has a genetic element within itself, scientist highlights that it is also triggered by some environmental elements.

According to NIMH (2016) some of the causes of Schizophrenia include:

Genetic inheritance

The risk of developing schizophrenia is at 10 percent for individuals who have closely related relative or parents who have been diagnosed with the illness. However the percentage is much lower at 1% if there is no genetic link in an individual’s family.

Environmental Causes

While inherited genes make an individual vulnerable to schizophrenia environmental factors act to trigger the disorder on the individual. Studies highlighted by Nordqvist (2017) show that Schizophrenia normally appears after an individual has gone through major psychological stresses and traumatic occurrences. As such environmental factors such as witnessing or being involved in stressful and traumatic occurrences often trigger Schizophrenia. Among these stress inducing factors could include: low oxygen levels during birth, exposure to a virus during infancy or at the early ages of body development, Early parental loss or separation, prenatal exposure to a viral infection as well as physical or sexual abuse as a child.

Drugs

On some instances drugs have been the inducers of schizophrenia. Certain prescription drugs such as steroids and stimulants are capable of causing psychosis which induces the onset of schizophrenia. Further NIMH (2016), outline that Marijuana and LSD are among the major drugs known to cause schizophrenia relapses.

Chemical Imbalance in the Brain

Another probable cause of schizophrenia includes chemical imbalances within the brain of an individual. Brain chemical such as dopamine and serotonin are among the chemical neurotransmitters identified and attached to the onset of schizophrenia. Scientist highlight that a imbalance in the complex and interrelated chemical reactions involving these neurotransmitters play a role in the development of schizophrenia .Further, the brain structure itself may be compromised during its development and lead to the development of schizophrenia.

Signs and Symptoms

Symptoms of Schizophrenia are largely classified into three categories: Positive, Negative and Cognitive symptoms. Positive Symptoms are Psychotic behaviors that are not generally seen in healthy individuals including Hallucinations, Delusions, Thought Disorder as well as movement disorders Negative symptoms on the other hand are symptoms associated with disruption of normal emotional sequences and behavior and may include; reduced feelings of pleasure and fulfillment in normal everyday life, difficulty in beginning and sustaining different activities, reduced speaking and active use of other senses as well as reduced expression of emotions. Cognitive symptoms on the other hand are symptoms pointing t the reduced level of intellect and cognitive abilities and may include: memory loss, poor executive functioning, trouble focusing and paying attention as well as problems with working memory. Other symptoms include social withdrawal, lack of motivation, unawareness of illnesses, thought disorder, strange body positioning, inability to sleep or concentrate, change of personality, extreme preoccupation with ideas such as religion, a cult or other social ideas. Kevin exhibits a wide range of the symptoms described above including lack of motivation which led to his stopping work, delusions and hallucinations about the government conducting experiments on him, excluding himself socially from friends and other people and choosing to stay indoors, hearing hallucinations of strange male voices and barking dogs. All of these symptoms are consistent to schizophrenia in addition his motor functioning and incoherence of speech have not been much affected. That would suggest otherwise moreover no abnormal moods were recognized further disqualifying depression of any kind.