Mental health specialists have embraced the person centered approach as the best method of treating conditions such as bipolar disorder. The approach is instrumental in bringing long term improvement in the lives of the patients by embracing a philosophy that embraces partnership especially with the clients benefiting from the mental health services (Law, Baptiste and Mills, 1995). The approach is collaborative since it involves patients together with the care providers and the family thereby ensuring their expectations and needs are catered for (Lutz and Bowers, 2000). This essay will give a brief description of the person centered approach with particular interest in the assessment overall management of a bipolar patient while shedding light on documentation of care and professional decision making.
After gaining consent from the patient who was suffering from bipolar disorder, I identified aggressive behavior as the aspect of person centered approach to be addressed. Bipolar disorder is responsible for irregular and unusual mood swings, imbalances in energy and activity levels and the overly inability of undertaking daily chores. Management of aggression and violence was chosen due to its predominant nature in the patient. The male patient was overly involved in violent acts and quarrels with his peers. Majority of his friends shunned him due to his lack of understanding of common discussions. In addition, the understanding aggression aspect was imperative in coming up with a long term solution to the condition since addressing it would enhance his social interaction with other people. In order to ensure the involvement of the patient, family friends and care providers, the patient was admitted in a mental health unit whereby the family members are given unlimited access to the patient. The proximity to the hospital was imperative for close monitoring by the care providers while the family members provides the needed comfort thus assuring the patients and making him feel loved during the recovery period. The treatment and recovery period was undertaken within a period of one week before the patient was discharged. In addition, regular visits to the home were conducted once in a week in order to assess the progress towards fully recovery.
Nursing assessment is mainly interested in ascertaining the needs of the patients during the encounter in a nursing situation. Assessment delves in information regarding the nursing history of the patient with regard to the health status and the overall management of the illness. The psychological coupled with the social examination was carried out to ascertain the perceptions of the client and emotional health. A physical examination with the eminent to decipher the symptoms and signs is undertaken before the documentation of the assessment results is done in the patients’ records, which may be electronic or paper form. Utilization of evidence was imperative in the application of the theoretical knowledge into nursing practice. Knowledge on the nursing assessment was useful during the assessment since it offered guidance that was instrumental in spotting the symptoms and signs.
During the assessment, I was interested in knowing the stage of illness and the diagnosis in order to guide the care approach. Compliance, medication and the presentation of the illness were crucial during the assessment since were instrumental in ascertaining the progress during thee recovery process. Adoption of the person centered approach was heavily reliant on the effectiveness of the patient in observing compliance when taking medication. Increased tendencies of violent acts and high levels of aggression were essential in informing the decision to conduct a medical assessment of the patient. In this case, assessment was instrumental in informing the diagnosis and further probe particularly when the patient is kept at the centre since their needs and the clinical setting are taken into account.
Kemp et al (1996, p. 346) asserted that compliance is imperative in retaining the utilization of the treatment in psychotic patients. In this case, compliance was vital in order to help in the management of the presentation, which was the major issue of concern. Since the setting was overly similar to the home set up, the over stimulating environment may have made the patients to overreact thus giving the wrong information thus misguiding the course of treatment.
Communication plays a major role in the assessment of the patients since the effectiveness of the patient centered approach is overly reliant in deciphering of the correct information thus informing the recovery process. Involvement of the patient in the whole process by informing him the reasons a certain n treatment path has been selected is imperative to improve the efficacy of the treatment. Although the patient seemed keen on listening to the instructions given by the nurse, it was later observed that he failed to implement most of them (Alaszewski & Horlick-Jones, 2003, p. 245). On the other hand, the patient was overly reliant on information shared by friends while disregarding the family members and other close relatives. Disregarding the family members was mainly informed by the notion that they had failed to provide him with the necessary assistance during the period of suffering. More importantly, the patient found it difficult to share confidential information with persons whom a close relationship had developed. Inattention and disregard of information provided shortcomings to the care approach thereby leading to ineffectiveness in sustaining the change in the long term.
Moreover, it is essential to take into consideration the safety and privacy of the patient with regard to the information given. In tandem to observance of confidentiality, the recorded information was utilized for the purposes of the treatment only. The environment and manner of presentation was taken into account particularly when communicating risk or sensitive issues. Efficacy in communication is believed to influence the success of the treatment while giving assurances to the patient. More importantly, the patient should be given time to discuss his needs and preferences so that the nurse can incorporate them into the whole program (Bennett & Calman, 1999, p. 75). Furthermore packaging and the timing of the information is also paramount in enhancing its acceptability (Alaszewski, 2005, p. 65).
Communication of risk is a sensitive issue which must be handled with due care by taking into account the condition of the patient. As earlier stated, the rational method is imperative in ensuring that the knowledge is effectively shared to the patient and the care providers. In this case, sharing of information is achieved through consideration of the close family members’ sentiments and incorporating it together with the patients account (Bennett & Calman, 1999, p. 65). While the risk knowledge was found to be high in the patient and the family members, its utilization in informing the decision making was poor. It is therefore worth noting that scientific knowledge and collaboration from other source or persons are pivotal in improving the utilization of knowledge during risks. Furthermore packaging and the timing of the information is also paramount in enhancing its acceptability. In this case, the patient disregarded information from the relatives due to its late timing while acknowledging that provided by the doctors since he believed the doctor owing to their lack of partisan interest in the patients’ health (Alaszewski, 2005, p. 65). In addition, the social context of the patients is imperative in determining the way the risks are handled.
During the management of the aggression in the patient, risk identification was found to be a major concern. In this case, the risk was assessed by presentation. Management of the risks was emphasized in order to avoid the watering down of the progress made in the recovery. Alaszewski (2005, p. 65), asserted that experts overly focus on the obvious and measurable components in the risks while disregarding the uncertain circumstances that are not easily quantifies. Assessment of the risks was essential in helping remove the barriers that impeded the recovery. A risk assessment tool was utilized was applied thereby guiding the delivery of healthcare (Sud & Gorman, 2008, p. 27). A general health questionnaire that delved on all aspects of patient care such as communication, relationships and risks was imperative in enhancing the recovery process. In addition, other risks such as the utilization of the lavatories and alarms were taken into account, considering the aggressiveness of the patients. In view of this, remedial measures were put in place to avert any unnecessary happenings in the care setting. The high stimuli environment in the care setup influenced the occurrence of risks mainly due to the state of patients. Duff (2003, p. 45), asserted the need to effectively utilize risk knowledge by improving the manner of presentation or communication of the risks related to different treatments.
Nurses and care providers must ensure that documentation of the patient history of care is overly documented in order to track any improvements in their health. Documentation of care should be emphasized from the point the care providers has first contact with the patient. In a bid to ensure the information recorded is accurate, it is important to receive firsthand experience with the patient while corroborating it with the accounts given by the family members and other care providers (National Ageing Research Institute, 2007, p. 6). Confidentiality and ethical guidelines must be maintained at all times (Zur Institute, 2010, para. 5). Accuracy in recording in the nursing care must be in tandem with the laid down guidelines. Personal details of the patients, taking into consideration his mental health condition, should be ascertained by the close relatives to ensure that only genuine particulars are entered in the registry thereby enhancing easy retrieval of the records on follow up visits (Ford & McCormack, 2000, p. 67). Owing to the manner of the approach, the documentation process may take a lengthy period due to the authority given to the patient to direct the process.
Person centered approach has resulted in far reaching changes in the roles of professionals in patient care. Various studies have denoted the dissolution of power bestowed upon the professionals. In this case, the care providers lose the professional autonomy they have on the patient in terms of directing the management of violence and aggression during the hyper manic stage (Ford & McCormack, 2000, p. 67). The decision making power of the nurses and doctors is challenged since it must respect the values and expectations of the patient. Cultural values and reliance on efficacy in the communication with the patient takes centre stage in the overall therapy process hence limiting the autonomy exhibited by the care providers in the traditional approaches (McCormack, 2000, p. 418).
More importantly, there is lack of adequate clarity on the components of the approach. In the case of the schizophrenic patient, difficulties such as constraints at the institutional level which impede the efficacy of delivery of mental health services were experienced. In addition, the doctors and nurses must observe caution when dealing with the clients since they must abide by the institutional policies and professional ethics. Nevertheless, the decision making was positively influence by the diagnosis and the past history of the patient where issues of compliance with medical and referral were overly discussed. Availability of empirical research findings informed the management particularly when communicating the risks and persuading the patient to embrace the care approach. The person centered approach borrowed heavily from articles in journals.
Person centered approach has provided a useful approach that is essential in the management of violence and aggression during the hyper manic stage. The appropriate incorporation of communication, risk management and documentation in tandem with the approach is imperative in enhancing the overall improvement of the patient. It is therefore essential to integrate the person centre approach concepts in nursing care in order to improve the efficiency in mental health delivery.
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