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Foundations of Mental Health Nursing

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Samantha, [pseudo name according to the nursing & midwifery council on patient confidentiality (Nursing & midwifery Council, 2009)] is a mental health patient; she has been under my care for the last 3 months in a therapeutic nursing setting. She has been dual diagnosed with personality disorder and substance abuse. A background check shows that she was married and divorced; hence she suffered from personality disorder after she was gang-raped as a teenager. In her marriage, Samantha underwent an abusive relationship with her husband. She has been exposed to psychologically damaging situations for the better part of her life.

She is a 45-year-old woman, who sought therapeutic help to conceal the effects of her addiction and mental status. In dealing with patients suffering from personality disorder, a nurse-patient relationship is not always clearly defined, but it improves with time as a result of the methods used to address the patients` underlying problems in a therapeutic context (Arnold, and Underman-Boggs, 2011).  I observed that her case was significantly pronounced; therefore, the extent and prevalence of her mental problems contributed to her attendance to daily therapeutic sessions in a day hospital, where people suffering from psychosis and depression could be treated and go home. Since her family could not adequately understand her problems, hence, they could not offer sufficient care for her. Samantha’s case demonstrates the dynamics involved in nurse-patient relationships and the effect a mental disorder has on the patient’s family, friends and the society.

I observed that she exhibited indications of borderline disorder. Her previous ordeals have made her to experience states of averted tension characterized by episodes of anger and depression. She is constantly illustrating destructive behaviour to herself and to others. These result from her perception of being victimized. Her interpersonal relationships are affected by her sensitivity and strong reactions to perceived mistreatment. Her moods are constantly changing from good to bad, while displaying high sense of alertness towards other people’s actions. Samantha’s addiction to alcohol influences the disorders` manifestation; therefore, her symptoms are significantly pronounced through impulsive behaviours and recklessness.

Her borderline disorder is different from a split-personality disorder, because it presents a regular and consistent nature of symptoms in behaviour. Split personality in some situations is a mental problem that affects an individual and leads to having two or multiple personalities. Samantha’s case follows a consistent and gradual change of personality for worse in terms of interpersonal associations, healthy living, marinating her temper, focusing on her life, maintaining hygiene, keeping friends, losing family, and finding purpose of living.

I observed that her borderline disorder symptoms and her alcohol abuse have critically influenced her lifestyle, especially her sleeping patterns. Disrupted sleeping patterns are caused by flashbacks of her traumatic experiences that took place during her youth. As a child, Samantha was sexually abused, and as a teenager she was gang-raped by two men. These experiences have influenced the extent of manifestation of her borderline disorder; hence her sleeping patterns are characterized by night terrors and insomnia.

Samantha’s borderline disorder has made her to be socially isolated, as she does not tolerate close contact with people; hence she alienates her family and friends. The psychological trauma, that she previously experienced, has critically derailed her trust in people and the ability for human interactions. Psychological effects of the rape and sexual abuse have distanced her from the rest of the world. On the other hand, her controlling marriage wrecked her ability to converse or communicate effectively.

On several occasions, she has tried to commit suicide in an attempt to end her problems, therefore, indicating the chronic nature of her borderline disorder. Suicide attempts are connected with the fact that she feels alone because of social isolation facing her. She also hears voices talking to her and sees things out of the corner of her eyes. These indications illustrate the extent of her borderline disorder.

At her age, Samantha is still within the active age-bracket in terms of providing for herself and anybody else who might appear in her life. In this case, the borderline personality disorder, from which she suffers, has pushed her to drugs and alcohol. The abuse of drugs is responsible for the loss of personal associations, since she has been disqualified in several situations as incompetent or unreliable. Since she has developed drug problems, it is hard for her to be employed or to run any form of business. This has affected her financial and social life, since she spends all her time drinking her savings away.

Her suicide attempts are significant in illustrating the nature of her life’s challenges in lieu of her past experiences and trauma. The constant reminder of her misfortunes makes her feel unworthy and rejected by society; therefore, it results in suicide attempts in a bid to end her painful existence. Hence, her unsuccessful suicide attempts are a demonstration of her dissociation with a society influenced by inhuman and cruel acts towards her, thus, in killing herself she intends to make her plight known to the world. Social isolation provides a means of distancing herself from people, therefore, averting any possible attack on her person. She attempts to shut the world out of her life, as demonstrated by her dissociative tendencies; however, the attempt is not successful as it leads to the deterioration of her health and a stressful life. The fact that she was raped and sexually abused only provided the basis of her disorder. Any other contributing factors are a result of the prolonged period without consulting medical personnel.

Samantha’s health and body image presents a suffering outlook characterized by feeble body structure as a result of poor nutritional care. Her diagnosed problems, that include borderline personality disorder and substance abuse, have significant influence to her health. Therefore, the levels of stress that she has to deal with have lowered her appetite. Low appetite is responsible for her deteriorated weight loss as well as vulnerability to diseases. The influence of alcohol abuse on her physical health is indicated by her prolonged periods of starvation and subsisting on alcoholic beverages. These aspects of her life have inherent health consequences which she either ignores or is oblivious of the resulting effects. Alcohol abuse combined with her traumatic experiences is the causative factor of her ulcers; hence alcohol abuse is a definite contributing factor to her pain and alienation.

Besides the fact that she was forced to engage in prostitution for 10 years, while taking drugs and alcohol sub-consciously, she understands that her destructive activities could cost her life. While in an attempt to be rehabilitated, Samantha was affected negatively by her addiction, as it was hard for her to quit drinking and taking drugs even during this therapeutic proliferation. It is easy to deal with some factors that affect her life. However, it is very hard to make efforts when a part of her mind is rooted to concoctions.

Borderline personality disorder is a mental condition that has significant effects in an individual's social and family life. The most affected individuals are the family members of a mental health patient. Given the dynamics of borderline disorders, the family members are faced with challenges in addressing the needs of the patient. For instance, in Samantha’s case, communication becomes a challenge, since the patient perceives actions of each family member as intended to cause her harm.  Therefore, all attempts to take care of her are met with resistance, suspicion and rejection. In some cases the patients result to violence and abusive behavioural tendencies. These make it difficult for family members to give appropriate care adequately.

The suicidal attempts have significant psychological effects on the family members as they contemplate on the possibility of losing a family member. Suicides are associated with dysfunctional family and personal settings; therefore, the patients` attempts to commit suicide have significant social effects on the family members. On the other hand, friends are afraid that they may lose a friend, hence giving them a sense of apprehension. The borderline patient’s actions are impulsive, as demonstrated by Samantha’s behavioural tendencies, and it is difficult to predict what danger she may pose to herself or others in the absence of supervised care. Therefore, it is critical that close supervision is availed. These duties are given to close family members or appointed care givers. However, these individuals are forced to change their lifestyles to accommodate the mental patient. Therefore, significant social and economic sacrifices are made by family members, friends and caregivers.

Borderline personality disorder from its name sets a boundary between a patient and people: these may be family or friends. In this case, since Samantha developed social isolation behaviour, it is hard for her to interact with other people, as she creates her own isolated world. Mostly, patients feel like they are self-sufficient and isolate themselves from other people, while others get engaged in violent activities, if their space is invaded. Besides pleas of the patient to be left alone, the family or friends are the first to suffer from it, since they are at the receiving end. Borderline disorder makes it difficult to create and maintain personal and social relationships; hence tension may escalate to the extent of threatening levels. For instance, if Samantha had children, it would be her duty to take care and provide them with everything necessary; however, given her borderline disorder this cannot be realized.

Friends are significantly distant from borderline personality patients in comparison to the family, while many of them may lack experience in dealing with the resulting effects of mental illness. Hence patients suffering from borderline personality disorder drive people out of their space, creating an isolated atmosphere which affects them significantly (Barker, 2009).

Where borderline personality disorder is diagnosed in an individual with a drug addiction, it imposes significant challenge to the family or caregivers. In a situation, where the family operates a business, the patient’s addiction may bankrupt the business.

The manifestation of borderline disorder requires a systematic approach towards recovery; hence the application of adequate therapeutic principals is essential. Since, she has been exposed to various psychosocial challenges and dangers, the development of hope can be applied to build reassurance and give her a sense of belonging. In this case, despite her age, she has a lot to live for; hence this principle is aimed at building hope as well as developing the meaning in life. Samantha felt and may still feel like an outcast; therefore, this principle is aimed at correcting these perceptions and aligning her recovery with the need to live positively.

As a principle of the recovery approach, I have employed empowerment methods to show her that there is a need to be participative in therapeutic nursing: this is because she is the only major benefactor. Through empowerment, her problem with drinking and drugs will no longer hinder recovery (Wrycraft, 2009).

Her attempts to use drugs and smuggle drinks in the nursing setting were thwarted, thus, a need for addressing the problem through the application of coping skills was essential. Instead of drinking alcoholic beverages and abusing drugs, Samantha would read a book on the effects of substance abuse and watch medical documentaries on the subject. Through this recovery approach, she has been gaining an understanding of the implications of her past tendencies, while enforcing her sense of well-being (Rogers, 1975).

The reasons behind numerous suicide attempts include the lack of hope, insecurity and the lack of a sense of self. However, the principle of coping skills helped her mend her perceptions regarding her well-being and those of other people. This way, she has realized that every negative choice made effects on others, and will have significant effects on her well-being. At the same time, interpersonal sessions have helped to secure a base for her to talk about how she feels as well as what she thinks. This has created a sense of belonging and a supportive base.

Supportive relationships are taken as a principle of the recovery approach. Therefore, therapeutic nursing would be useless, if she did not build a relationship with a family member, nurse or a caregiver. The purpose of such relationship is to establish an interpersonal mechanism that will make her believe that she can trust the nurse or the caregiver. This principle works in terms of issuing instructions and giving guidelines to the patient.

Currently, Samantha is not in the position to hold office or to be employed. However, as a principle of the recovery approach, I have assigned her a task of helping me with checking on other patients as a method of social inclusion. Social inclusion deletes negative mentality in regard to the life of a mentally ill person and replaces it with a duty to engage the mind positively. As a critical tool, communication skills helped in decreasing Samantha’s anxiety and general misunderstanding. Therefore, I could control such outcomes as compliance with nursing ethics, pin emotional and psychological distress, and her general rate of recovery.

The therapeutic relationship is the engagement process between a therapist/nurse/caregiver and the patient. The engagement between the patient and the therapist in a clinical setting is a process, in which a variety of steps are involved. These steps do not symbolize a formula, but represent an approach, on the basis of which a patient and a nurse or a therapist can work together, to help the patient with his/her medical condition. The engagements provide the therapist with an opportunity to assess and understand the patient`s underlying problem, hence enabling them to create a progressive approach in addressing the patient’s problem. This helps in creating patient-therapist relationship, aimed at enabling the effectiveness and efficiency of the therapeutic session and environment.

The therapeutic relationship is a critical tool in medicine and nursing that predicts the level of treatment and its outcomes. Despite the fact that the patient and the caregiver meet in a clinical and professional setting, the creation of an interpersonal relationship is essential in establishing a basis for the therapeutic session. The level of connection affects both communication and involvement of the patient and therapist in the session. When the relationship is strong, then the outcome is bound to be positive.

The therapeutic relationship works as a process in which a patient’s progress is determined. This may be illustrated as progressive, where the patient demonstrates significant improvements or regressive where no significant changes can be determined. In the beginning of the relationship, a working alliance is built to define goals, tasks and extent of the therapeutic session. When the patient presents his or her problems in a clinical setting, he/she aims at achieving certain goals. To achieve these goals, tasks, which the patient and the therapist have to accomplish in ensuring that his/her goals are realized, have to be defined. When the patient and the therapist are working together , tasks are executed in mutual agreement; hence an atmosphere of trust is created. Therefore, an atmosphere where the client can trust the therapist creates a progressive therapeutic connection (Norman & Ryrie, 2009).

When the therapist is attending to the patient, a close relationship creates cooperation during the session. Childhood memories and personalities that have influenced the patient are recreated by the therapist, thus creating a critical part of the treatment process. This is referred to as transference and relates to the childhood history of the patient. By assuming the role of a person who matters to the patient, the therapist creates an emotional connection with the patient.

The emotional support that the therapist shares with the client or the patient creates a counter transference atmosphere. This allows the patient and the therapist to connect emotionally in terms of feelings, understanding of pain and trauma, which the patient may be going through. This is the final step of building the therapeutic relationship; it determines the nature of future sessions. In instances, where the therapist is unable or has difficulties in establishing the therapeutic relationship, trust is limited and the resulting outcome has essentially negative responses to treatment (Neville, 2009).

Samantha’s borderline disorder made it difficult for me to build a personal therapeutic relationship; however, I used my acquired skills to develop one. I empathized with her situation while appealing to her sensitivity through identifying with her situation. This enabled the establishment of a rapport, through visual aids and reassuring music which she appeared to like.  However, it was difficult to establish a relationship at first; however, as time progressed she opened up to me. Initially I would engage her in conversations; however, she did not reply to my questions nor made any comments towards my observations. For instance, when I asked what her name was or why she was in therapy, she would stare at me blankly, and then began to hum nervously to herself.

Therefore, I noticed she would hum some musical tunes to calm herself, on occasion; I would join her in singing out loud the tune, this way she began to identify with me; I would suggest a different song, which she would nod, utter her agreement or refusal. Hence, she began to identify with me and started answering my questions, though, she began by using monosyllables at first; her utterances became coherent sentences as time went by. Thus, at the beginning of her daily therapeutic session I would play her favourite song on the music system, I realized this enabled her to feel at ease and to be able to communicate.

It is critical to ensure that the patient has the therapist undivided attention. Hence, while treating Samantha I observed the need for a personalized approach where the patient is made comfortable to express his/her feelings, fears, hopes and aspirations. In this case, I noted that Samantha indicated significant lack of self-confidence and faith. In this case, I provided Samantha with a non-judgmental environment that comforted her and encouraged more participative attention. Through this approach, I could get through to Samantha and have her express her feelings and needs (Nelson, 2006).

While considering the manifestation of her borderline disorder, it was critical to establish a personal relationship. This would be instrumental in making her to open up and voice her fears and concerns. It is essential that the patient is allowed to speak in a comfortable environment. However, the creation of a comfortable therapeutic setting should be complimented by the therapist’s demeanour. This will ascertain that the patient feels included in the recovery process, which is a critical factor of the healing process.  Since, Samantha’s borderline personality disorder was not the first case in my practice, I was careful to ensure that the therapeutic process did not alienate or blame her for her predicament. However, I found that it was essential to inform her regarding advanced effects, statistics and the mode of recovery. An honest, open and direct approach to her problem provided her with a basis in which she could weigh the disorders variables and commit to the program. In addition, her attitude was not very good at first, but as time progressed she illustrated modified positive behavioural tendencies. This indicates that she was more prepared to deal with the reality of her situation than before (McCabe, 2004).

The importance and application of the therapeutic relationship is to help the patients regain their normal life. The relationship results in trust and later presents positive outcomes, as the result of a personalized therapeutic relationship. In Samantha’s case, a spiritual approach was assumed, where we could pray between sessions. This helped to build a sense of self in Samantha and hope that she was going to attain her healing objectives through faith and self-motivation.

Samantha’s borderline personality disorder requires a therapeutic approach to be solved; however, at the start of the session or the nursing mission, several problems and challenges were encountered that affected the relationship. When Samantha presented her case, she could hardly provide a background check on her health or a recap on the origin of her problem. The problem that created a relationship surge was the fact that she did not have any family members, who could provide a foundation to start treatment (Freshwater, 2002).

After Samantha was diagnosed with borderline personality disorder and substance abuse, it was significantly difficult to communicate effectively with her, therefore, gaining her attention proved to be a challenge. For instance, when attempting to establish dialogue she would recoil into a corner where she would remain until the end of the session. Throughout the first week of interaction, Samantha showed no signs of cooperation; hence, it was hard to get through to her. Given the fact that she committed herself into the institution,  she proved to be a challenge in her attempts to continue abusing alcohol, given that it was an inherent contributor to her borderline disorder’s escalation. This created doubt in my mind towards her dedication, since I thought she was not serious about her recovery.

Her social skills were significantly impaired after having been in a controlling marriage and estranged social relationships. Hence establishing communication and therapeutic relationships proved to be a significant challenge. For instance, in the daily therapeutic sessions she would not utter a word for a week, making it difficult to understand her needs. It was difficult to determine whether after her daily therapeutic sessions she continued to live a precariously or she had adequate home care.   

After some form of relationship was created between Samantha and me, her first utterances were in demand of alcohol. However, I could not meet her demands, a fact she construed as an act against her person; hence, she considered me as a threat to her well-being. Samantha misinterpreted my refusal to supply her with drugs and drinks, hence, defying any further interaction with me for 4 days.

Borderline personality disorder is a mental issue, whose effects are observed in the social and professional settings. The health care justice ethics is an important factor that determines choices a nurse makes as opposed to a patient’s requests. Depending on the nature of medical condition, people suffering from borderline personality disorder are less socialized; therefore, when in a social settings, they tend to be violent and significantly controlling. This phenomenon affects the development of the therapeutic relationship, as patients attach very little importance to situations and activities that they do not have control of (Barker, 2009). Such psychiatric drugs as Xanax, Valium, and Ativan can be used to ease anxiety of patients (Healy, 2009).

In therapeutic nursing, mental illnesses require collaborative efforts of the nurse and the patient’s family. The patient’s family is important to assist in evaluating a patient both psychologically and socially. Unacceptable or strange demands made by patients should be attached to consequential variables; only family members can describe a patient’s history. A detailed background check helps practitioners identify actual causes of their mental condition and side effects of conditions that may develop into independent problems, e.g. substance addiction developing into criminal behaviour to facilitate the purchase of substances.

Borderline personality disorder is much pronounced in people, who have experienced an abusive childhood and have lacked adequate attention as a result. At their teen age, such people may not display any signs or symptoms of such a condition; however, as they enter into young adulthood, signs like the lack of concentration, obsession with death, careless sexual encounters, violent behaviours, and mood swings can be witnessed. In a therapeutic setting, such patients attain tremendous recovery results, if they are socially included. Boderline disorder indications of the problem originate from the part of the brain that stores memories in idle states. If the mind is kept busy with employment, participation in social events and campaigns, and other physically intensive activities, the negative effects that may lead to the manifestation of the borderline disorder are mitigated. However, in the absence of therapy, the patient can take Seroquel to reduce anxiety, depression, and stress.

Conclusion

Samantha’s mental illness is similar to other mental problems, but does not involve mixed and unsystematic actions and reactions. Having been sexually abused as a child and gang-raped as a teenager, she requires a professional approach that incorporates empathy, a high level of understanding, and provision of positive regard. Through these elements, a relationship between her and the people, who care about her, will be established; in return, she would be a benefactor as she recovers.

To effectively influence the rate and results of therapy, Samantha’s case involves a number of recovery approach principles. The importance of these principles is to enable a sustainable growth in terms of combating effects of borderline personality disorder and associated effects. The development of hope is one of the principles that help the patient in attaching significance to the arrangement. Empowerment is another principle that makes the patients appreciate the purpose of therapy. Coping skill gives the patient a different and healthy alternative to recurring problems. The provision of a secure base and a sense of self  aids the patient to develop trust and guarantees safety. Social inclusion provides patients, undergoing medical intervention, with opportunities to be engaged in social and mind engaging activities, hence, limiting negative outcomes.

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