Introduction. Patient’s Background Information
- 65 years old, Hispanic male
- Recently divorced
- History of admissions due to mental health illness and heart attack
- Poor adherence to medication
- History of smoking o History of self-harm when unwell
- Family history of schizophrenia History of aggression and harm to family members and others when unwell o Informal patient on this in-patient admission – voluntarily consented to his admission and care.
Key Facts
Schizophrenic patients often manifest positive and negative symptoms (Living with Schizophrenia, 2021). The patient’s symptoms are as highlighted below.
Epidemiology
About 1% of the world’s population suffers from schizophrenia (Poole, 2018) About 0.7% of the UK population suffers from schizophrenia (National Institute for Health and Clinical Excellence, 2020) Schizophrenia can manifest any time from early adulthood onwards, but rarely when a person is below 10 years (Poole, 2018) Schizophrenia makes 25% of all psychiatric hospital admissions.
Aetiology
Genetic Factors: Schizophrenia present in family, increased risk (Barber etal., 2019).
Stress: Patient reports work-related stress.
Family Relationships: Stressful or emotional life events are triggers of schizophrenia (Ian, 2020). Therefore, the patient’s divorce could have led to the reoccurrence of the condition.
Biochemical Factors: Patient has a history of smoking, which is linked to schizophrenia (National Institute for Health and Clinical Excellence, 2020.
Case Conceptualization
The 5Psframework, integrates the perspectives of healthcare service providers, patients, and researchers when analysing one’s healthcare experiences (Kappelle, 2019). It is applicable to the patient’s condition as shown below 5Ps Framework.
Medication History
Patient has been using Chlorpromazine irregularly to treat schizophrenia. The drug is associated with mood regulation (WebMD LLC, 2021) He has experienced some side effects, including nausea, shakiness, vomiting, and dizziness, which are associated with medication use (WebMD LLC, 2021) Side effects have made it difficult to adhere to medication Patient has been using Rivaroxaban (Xarelto) to treat heart condition, as doctor prescribed. It is used to prevent heart attacks by thinning blood (American Heart Association, 2021)
Physical Health
Although patient has suffered a heart attack, his condition is stable but requires monitoring (American Heart Association, 2021) Establish patient’s sleep patterns, diet, and dependency on smoking to assess risk on treatment plan.
Assessment
- The patient’s uncooperative and aggressive behaviours inhibited proper assessment Section 5(4) of the MHA will be relevant in guiding the conduct of healthcare staff in an in-patient setting (Barber, Brown, & Martin, 2019)
- Patient’s capacity to consent assessed on how well he understands, retains, and weighs information (Delemos & Omland, 2017)
Risk
Patient was threatening to kill his ex-wife, staff and patients (Current Risks) o Patient once was violent to his wife when feeling unwell o He once threatened to commit suicide during a psychotic episode. This behaviour is consistent with studies which show that schizophrenic patients are likely to have suicidal ideation at least once during their illness (Poole, 2018; Living with Schizophrenia, 2021) o Aggressive behaviours demonstrated through breakage of wall cabinets in the ward (Current Risks) o Patient was shouting, kicking, and banging doors, thereby threatening the safety of other patients in the ward (Current Risks)
Immediate Therapeutic Interventions
Guided by the recommendations of Ian (2020), patient was informed of healthcare staff support, his rights, preferences, options, and support to be offered by an Independent Mental Health Advocate (IMHA) in a format he understands. Patient informed of the potential consequences of his leaving the hospital due to his presentation but he was uncooperative, insisting on leaving to go and smoke. Verbal de-escalation occurred by reassuring patient of his safety and available. Nicotine Replacement Therapy (NRT) options for his smoking but this did not pacify him and he remained mentally disordered By considering the diverse needs of the patient, family support was sought to seek his cooperation, as advised by Jackson and Erving (2020) to no avail. Doctor immediately informed of patient’s responses and his history of violence and presentation of aggressiveness were documented and provided justification for holding him.
Interventions for Risk Management
Section 5(4) of the MHA will be invoked as a last resort to protect the patient and others from harm before the doctor’s assessment. The patient’s agitation and aggressiveness, which were demonstrable through shouting, banging on doors and threats to kill provided the justification for doing so The MHA is relevant in guiding a nurse’s conduct in an in-patient setting and allows them to detain patients for a maximum of 28 days or a minimum of 6 hours (Barber, Brown, & Martin, 2019). The minimum time will be used because the patient was informal Patient will be placed on close observation to minimise physical harm to others and himself.
Interventions for Therapeutic Engagement
Interventions for therapeutic management will be aimed at rehabilitating the patient Due to his lack of cooperation, he will be supported to be part of the treatment plan Guided by the recommendations of Kappelle (2019), family support will be involved if patient is uncooperative A male nurse will be assigned to cater to patient’s needs because it is culturally appropriate to do so (Larson, Mathews, Torres, & Lea, 2017)
Conclusion
Holistic interventions proposed from patient’s historical information, family input and patient’s nurse. o Interventions governed by Mental Health Act o There is a need for regular review, continuous monitoring, and evaluation of patient’s presentation, risks assessments, and care plan.
References
American Heart Association. (2021). Types of heart medications. Web.
Barber, P., Brown, R., & Martin, D. (2019). Mental health law in England and Wales: A guide for mental health professionals. SAGE. Delemos, J., & Omland, T. (2017). Chronic coronary artery disease: A companion to Braunwald’s heart disease e-book. Elsevier Health Sciences.
Ian, C. (2020). Mental health services and community care: A critical history. Policy Press. Kappelle, R. V. (2019). Addiction: How we get stuck and unstuck in compulsive patterns and behavior. Wipf and Stock Publishers.
Larson, K., Mathews, H. F., Torres, E., & Lea, S. (2017). Responding to health and social needs of aging Latinos in new-growth communities: A qualitative study. Health Services Research 17(601), pp. 342-366.
Living with Schizophrenia. (2021). Schizophrenia and dangerous behaviour. Web.