Care for a mental disorder&patient in acute care
Care for a mental disorder&patient in acute care
Order Instructions:
linked item M6A3: The comparison of collaborative care for a patient with a mental health disorder versus a patient with a medical disorder in the acute care setting Paper
Using APA format, write a six (6) to ten (7) page paper (excludes cover and reference page) that addresses the comparison of collaborative care for a patient with a mental health disorder versus a patient with a medical disorder in the acute care setting. The paper consists of three (3) parts and must be submitted by the close of week six. Each part must be a minimum of two (2) pages in length.
A minimum of three (3) current professional references must be provided. Current references include professional publications or valid and current websites dated within five (5) years. Additionally, a textbook that is no more than one (1) edition old may be used.
The following topics may be used for this paper:
Mental Health Disorders
Post traumatic stress disorder (PTSD)
Bipolar
Depression
Paranoid Schizophrenia
Anorexia
Attention deficit hyperactivity disorder (ADHD)
Alzheimer’s disease
Medical Disorders
Hypothyroidism
Addison’s Disease
Cirrhosis
Acute Pancreatitis
Chronic Renal Failure
Pylelonephritis
Type 1 Diabetes Mellitus
Part 1
Select one (1) mental health disorder and one (1) medical disorder covered within the modules of NUR212 as a basis for your paper. (It must be a disorder that is covered in the content of this course. Other disorders will not be graded.) Compare the two (2) disorders demonstrating similarities and differences.
Discuss how the efforts and resources required to manage the disorders compare to one another. Is the burden a patient with a mental health disorder endures comparable to the burden experienced by a patient with a medical disorder? Explain your response.
Identify two (2) issues that may arise for the patient and/or family when caring for the patients with the identified disorders. Provide two (2) descriptive examples.
Part 2
Identify ethical and legal implications the RN considers when caring for patients with a mental health disorder and medical disorder.
Discuss similarities and differences in the RN’s approach to address the identified implications.
Part 3
Based on the disorders chosen above, adress the following:
Provide an example of how the interprofessional team members can provide collaborative and continuous care in the acute care setting.
Discuss the role of the professional nurse within the team and provide three (3) examples.
Describe how to ensure adherence to medication regimen and follow-up visits – Provide three (3) examples.
What measures would evaluate the effectiveness of the interprofessional plan of care?
How does the RN evaluate the interprofessional team efforts and identify modifications that might be necessary?
Any topic chosen that is not covered within the context of this course, will not be accepted.
Compose your work using a word processor (or other software as appropriate) and save it frequently to your computer. Use a 12 font size, double space your work and use APA format for citations, references, and overall format. Information on how to use the Excelsior College Library to help you research and write your paper is available through the Library Help for AD Nursing Courses page. Assistance with APA format, grammar, and avoiding plagiarism is available for free through the
SAMPLE ANSWER
Part One
Diabetes mellitus is a lifelong condition that affects the patient ability to regulate glucose levels. When a person ingests food, the body breaks down the food into carbohydrates and glucose. The glucose is used to fuel the cell activity. This process requires the use of insulin in order for a cell to convert glucose into energy. With diabetes mellitus, the body does not secrete enough insulin or the receptors become faulty and are unable to absorb the insulin. This causes glucose to build up in the blood, which causes damage to the other parts of the body including kidney, eyes, heart and the nervous systems (Standards of Medical Care in Diabetes—2014, 2013). The signs and symptoms of diabetes mellitus include reduced appetite, increase urine output and general body weakness or fatigue. The diagnosis of this disease is done using glucose tolerance test and also testing of the glycosylated hemoglobin (Standards of Medical Care in Diabetes—2014, 2013).
According to NICE, patients diagnosed with diabetic are three fold likely to be diagnosed with depression. Depression is a mental disorder that affects a person’s health and their ability to self manages their healthcare condition. Research indicates that depression have great risk to suffering from episodes of diabetic burnout, which can effect their health adversely. Depression is the medical term that is used to describe people with the following symptoms. To start with, they have persistent anxiety, sadness and a prolonged feeling of hollowness. The patient feels helpless, powerless and hopeless. This makes them lose interests of activities that they perceived, insomnia, memory problems and weight changes (Ennis & Bunting, 2013).
The relationship between depression and other health complications is not fully understood. However, the rigors of managing the disease is not easy and could cause the condition to get worse, leading to more health complications. Depression can cause poor management of lifestyle decisions resulting to less exercise, drug use and binge eating. This affects the person abilities to perform their duties or even to perform their tasks as they used to. The non-therapeutic resources used to manage diabetes mellitus and depressions are similar. For instance the programs used to manage the two conditions include activities that will improve lifestyles, such as increase of fitness, weight management strategies, nutrition balance and exercises. These programs help the patient remain in good shape, which improves their self esteem and the patient diabetic condition (Ennis & Bunting, 2013).
The major difference is in therapeutic management process. This is because diabetes mellitus is managed using glycemic control including drugs such as Biguanides, Thiazolidinediones (TZDs), Meglitinide derivatives and insulin’s among others. The management of depression takes time but it can effectively be managed. The common treatments includes the Cognitive behavioral Therapy (CBT), a type of psychotherapy that helps change the negative mentality, as well as lifestyles that contribute to depression. The use of Selective serotonin reuptake inhibitor (SSRI) is a therapeutic management that involves the use of antidepressants including the Celxa, Sertraline (Zoloft) and Prozac. Other types of antidepressants that can be used include the Serotonin and norepinephrine reuptake inhibitor (SNRI) among others (Ennis & Bunting, 2013).
Generally, mental health is more debilitating than the acute diseases. Research indicates that person diagnosed with depression is 50% likely to become disable than patients suffering from the chronic diseases angina, arthritis or even diabetes mellitus. This is because mental pain is real that and more severe than the physical pain. The hustle for mental illness is real as most of the mentally ill patients are not accessing care as compared to those with medical conditions. Approximately, three quarters of these individuals are not able to access care. This is especially so, because the NHS commissioners have not commissioned mental health appropriately. For instance, when people suffering from physical condition undergo treatment, their treatment usually include the treatment psychological therapy. Psychological therapy in physical treatment especially in chronic diseases is emphasized than in the mental disorders treatment (Standards of Medical Care in Diabetes—2014, 2013).
The main issues that arise during the management of these health disorders are financial burden. This is because diabetes and depression are long term diseases that require a lot of resources including attending of the lifestyle modification programs. This is a challenge considering that chronic disease and mental disorders are inadequately covered by the public medical covers. This could be costly to both the patient and the family (Ennis & Bunting, 2013). The other issue that could arise is lack of effective training on how to handle the patients. In most of the public hospitals, patients and the care givers are not trained on how to manage the transition from the healthcare facility. There are not told about what is available for their management of care and what is not. This miscommunication between the patients, caregivers/ families and healthcare providers is a huge challenge that must be addressed (Barr, 2010).
Part 2 Registered Nurse Ethical and legal implications
In these healths setting, the registered nurses have ethical and legal guidelines used during their practices. There are six ethical principles applied by RN when making ethical decisions about their care. These include respect for the patient. RN is expected to support the patient. This includes empowerment and respecting patient’s choice (Autonomy) (Perreault, 2011).
The decision made by the registered nurses must be with the aim of improving patient’s condition by doing well (beneficence) and with the aim of avoiding harm (nonmaleficence). The ethical decision must be made with fairness, truthfulness and equitably (justice). The registered nurse must remain veracious and faithful to their commitment. The registered nurse is expected to make their decisions during care as indicated by the American Nurses Association’s nurse’s code of ethics. These standards are delineated registered nurses across the settings (Barr, 2010).
Some of the ethical concerns that arises these care is balancing the nursing attitude care with compassion, and simultaneously recognizing as well as sustaining the patient-healthcare boundaries. Another ethical concern for registered nurses is to ensure that these patients can access care. The registered nurses have the responsibility of acting as patients advocates, especially in ensuring that their care directives are respected and also in elimination of the healthcare hindrances (Barr, 2010).
End of life care is also an ethical concern for the registered nurses. The registered nurses have the responsibility of ensuring that their patients die with dignity.
The legal implications of nursing include the issues of licensure as stipulated by the federal and states laws. These licensures have delineated registered nurse scope of practice as well as the public expectations. The nurse level of education and the licensure gives the framework by which the registered nurse is expected to practice. These frameworks are to ensure that their practice does not fall below the accepted and expected standards of nurse care, which could expose the RN to litigation (Perreault, 2011).
There are no differences in the ethical and legal implication for RN for the physical disorder (diabetes mellitus) and the mental disorders (depression). The basis for RN litigation is if the patient can prove that the nurse’s actions were due to negligence to perform what is expected of them by the ANA code of ethics and nurse practitioners standards. These includes acts of omission and commission could subject the RN to have their licensure reviewed and to litigation (Perreault, 2011). Regardless of the method or approach of care, the RN has legal as well as ethical obligation to respond to patient’s demands. This implies that the RN should attend to the patient, assess the patient’s demands and the magnitude of care demands. The RN should conduct the family health assessment and cultural health assessment to ensure that the care provided is culturally sensitive. Based on the data generated from the assessment of the patient, then the RN can determine the level as well as the type of interventions are required, develop a care plan and implement it. The RN should contact higher level of healthcare where necessary, including offering referrals (Barr, 2010).
Part 3
The inter-professional teams refer to the collaborations between the various healthcare staffs, with the aim of attaining the common goals of delivering quality and safe care. This is beneficial as the healthcare staffs divide their chores according to the scope of their practice. This reduced the events that the healthcare staffs become burnout. Additionally, inter-professional team facilitates the sharing of information. This coordination and supports ensures that the interventions proposed are ethical and legitimate (Axon et al., 2008).
Inter- professional team faces many barriers. This includes lack of understanding of the major roles, which reduces respect between the healthcare team. The nurses have a key role in collaborating between the healthcare inter-professional team. They are required to possess facilitation skills to ensure that they work collaboratively with the patients and the healthcare staff. This is to ensure that the teams have updated information about the patient and their preferences. For example, the nurses are the healthcare professionals who spend most time with the patients. Therefore, the nurses are expected to deliver around the clock care and record the observations (Pope & Casarett, n.d.).
The nurses are also responsible in ensuring that the physician’s directives are implemented. These include administering of medications and assessment of patients responses to the treatment plan. The nurses is also responsible for the evaluation of the patients medical plan efficiency and safety. They should interpret patient’s information to help the healthcare providers to make the appropriate decisions. Therefore, the nurses roles in the inter-professional team is to assess patient psychological, social, cognitive as well as spiritual needs , and to advocate for the patients wellness as well as facilitating optimal health for the patient. They are also responsible for patient education (Axon et al., 2008).
Through patient education, the patient understands the importance of adherence. There are five interacting factors if medication adherence that have been described by the World Health Organization (WHO). These include factors related to therapy, patient’s behaviors, socioeconomic factors and medical condition factor. Evidence based research identifies strategies to improve the medication adherence. The social and economic factors that can be addresses include lack of health literacy, communication barriers, low socioeconomic status and lack of medical cover. The nurse must learn the cultural beliefs to ensure that they can assist the patients (Axon et al., 2008).
Therapy related factors include complexity in therapy such as mastery of various techniques such as use of inhalers or injections. The unpleasant benefits, prolonged use and interferences are other causes of poor medication adherence. The patient related factors include the cognitive impairment and swallowing difficulties. The nurses need to address psychological issues such as confidence in following treatment, as well as making the patient understand the benefits of medication. Empowering the patient improves their confidence as well as the ability to follow their treatments despite the perceived risks (Pope & Casarett, n.d.).
Evidently, team effectiveness questionnaire is a tool that can be used to evaluate the effectiveness of working as a team. This tool consists of about 25 items which evaluates the effectiveness of the interprofessional team I relation to four main dimension including communication, organizational efficiency, healthcare practices such as staff development, EBP and patient centered care. The interprofessional collaboration scale may also be used to assess the interprofessional’s perceptions including the nurses, physicians and the other relevant healthcare professionals. This tool is a 13 item scale that is adapted from the Nurses Opinion Questionnaire. Other evaluative techniques include the evaluation of quality healthcare indicators such as readmission rates, patient’s falls, hospital acquired infections and the length of hospitalizations. These strategies will help identify the gap in inter-professional team, leading to effective interaction between the healthcare staff (Axon et al., 2008).
References
Axon, A., Hassan, M., Niv, Y., Beglinger, C., & Rokkas, T. (2008). Ethical and Legal Implications in Seeking and Providing a Second Medical Opinion. Dig Dis, 26(1), 11-17. http://dx.doi.org/10.1159/000109379
Barr, H. (2010). Understanding Interprofessional Working in Health and Social Care. J Interprof Care, 24(4), 470-471. http://dx.doi.org/10.3109/13561821003761465
Ennis, E., & Bunting, B. (2013). Family burden, family health and personal mental health. BMC Public Health, 13(1), 255. http://dx.doi.org/10.1186/1471-2458-13-255
Perreault, K. (2011). BOOK REVIEW Interprofessional Teamwork for Health and Social Care. Scott Reeves, Simon Lewin, Sherry Espin and Merrick Zwarenstein, Wiley-Blackwell (2010), 191 p. Physiotherapy Theory And Practice, 27(8), 595-596. http://dx.doi.org/10.3109/09593985.2011.599052
Pope, T., & Casarett, D.(n.d.). Ethical and Legal Obligations of Hospice Staff When Their Patients Receive Aid in Dying. SSRN Electronic Journal. http://dx.doi.org/10.2139/ssrn.2338095
Standards of Medical Care in Diabetes–2014. (2013). Diabetes Care, 37(Supplement_1), S14-S80. http://dx.doi.org/10.2337/dc14-s014
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