Mental illness is defined as functional disorders in the cognitive structures that affect the patient’s ability to perceive, how he interacts with others and in his behavior towards life. The patient controls a set of unorganized patterns of thought that appear in the form of illusory and hallucinatory symptoms as manifested in self-directed aggressive behavior and others (Wykes et al., 2011).
Psychiatric nursing is one of the most important types of nursing specialties. The nurse faces many challenges in providing nursing care to mental patients. This reflection illustrates my experience in the mental health hospital and the benefits I learned from this experience.Description: The state on which the reflection will be based is a 48-year-old Saudi woman who has long been divorced. She has four sons, male and female, uneducated and uneducated.
She lives with her family and her siblings, but as a result of the patient suffering from bipolar disorder at the age of 26, she lives in tense relationships within the family as a result of the control of psychosis and illusions on the patient. The patient has a patient history and the patient has been admitted to more than one mental hospital. This is the seventh time that the patient has suffered a relapse and has been admitted to the hospital. Previously, she was admitted to Al-Fanatir Hospital in Dammam and the Mental Health Hospital in Taif. The sick brothers are the ones who were in her room in the hospital emergency department and they brought her and she refused to be admitted to the hospital.
The patient has breast cancer. Left breast mastectomy has been diagnosed with mood swings. She has been in a state of continuous depression and before the relapse; she has had severe aggressive behavior toward her brothers and sons with synchrony in increasing hallucinations and delusions.Feelings:I read the patient’s file and after reading the information, I found that the vital signs and symptoms that were recorded for the patient were a high blood pressure and decreased appetite and sleep disorders appear to be thinness, fatigue and insomnia, confirmed by the clinical examination of the patient. As the patient suffers from social isolation and morale is low has a fragmentation of thinking and lack of awareness of reality, where do not care about others do not pay attention to them, dominated by delusions that everyone wishes to get rid of them and death. I went to the patient who was diagnosed with bipolar emotional disorders. I knew that she was moody, but the enthusiasm and curiosity prompted me to establish a therapeutic relationship with the patient where she smiled and tried to show empathy to the patient but her looks were strange and she did not smile, the absent-minded looks scary and talk to themselves in an incomprehensible words. I tried to apply what I learned in my academic studies and went to her and told her that I want to help her looked at me a look that caused me fear and anxiety but I continued to talk to her even though I read in the file of the patient that she suffers from fluctuation in the mood.
I imagined that she would appreciate my interest and respond to me especially as I try to show her respect and I talk to her gently and suddenly I got angry and increased her anger and pushed me with her hand and the strength has returned to her despite her thinness and began to irritate and insult and she will not leave me has fallen to the ground and I rushed and left the room and I was very embarrassing because of this act I wished I had not spoken to her.Evaluation:I sat for a while thinking about the situation and what happened in order to assess the situation and identify the negatives and positives and after returning home I went to the internet and tried to get additional knowledge about bipolar emotional disorders. I knew the situation more and knew that it was negative that I did not have enough knowledge about the disease. The skill required to deal with the patient, especially that the patient suffers from mood swings and needs high and effective communication skills and that these patients have different behavior according to the personality of the patient, for example, eat greedily and others exposed to food to become thin. I have also rushed to establish a therapeutic relationship with the patient and the patient had been cut off from the drug treatment period and will not pay attention to this important observation. One of the pros that I have tried to show empathy and respect for the patient is the starting point for building confidence and establishing a successful therapeutic relationship.
Analysis:The patient who suffers from bipolar emotional disorders usually suffers from sleep disorders and becomes with time sluggish and unable to move and responds to the silence and the aggravation of the mind, and this is what happened with the current patient where she was lean and tired and sleep and then she was deceived in that and she did not perform anybehavior is aggressive and she will respond to my empathy and approach her (Rosenbaum et al., 2012). A patient with bipolar emotional disorders is always trying to commit suicide and self-harm as a result of low self-esteem. Sometimes the patient feels guilty about her-self and others and wishes death to get rid of depression and self-torture, which explains the current patient’s attempt to commit suicide and wishes death(Zachar and Kendler, 2007). Anti-insomnia and psychotropic drugs can control the patient’s condition within 24 hours of a relapse. This happened with the patient but was not fully controlled and the nurse had to wait for at least a week until the hallucinations that cause the disorders of thinking and mood swings were fully controlled of hallucinations that cause mood disorders and mood swings of the patient (Hanlonet al., 2014). Patients with bipolar emotional disorders need constant monitoring of the family and the nurse and the lack of sharp tools with the patient because it is permanent self-harm and suicide attempt, so the nurse must monitor the patient’s actions and expect to attempt suicide again and this can be controlled through regularity in medicine, especially during the first days of relapse (Cerimele et al.
, 2013). The patient has disorders of perception and is controlled by hallucinations and interprets situations and events accordingly. Hence the nurse’s initiative to show empathy and respect for the patient may be misinterpreted from the patient as a kind of irony, and this is what happened with the patient and made her scream and go over her (Culpepper, 2010).
While acknowledging the importance of following the ethical behavior emphasized by the Code of Ethics for the practice of nursing, but it must take place in a somewhat advanced step after controlling the disorders of the conscience of the patient and after the drugs have been effective and then the nurse built a therapeutic relationship based on respect and sympathy and privacy and maintain the confidentiality of information so that it can overcome the challenges facing the establishment of this relationship and that the nurse has the skills of effective communication and skill, experience and knowledge to deal with the patient bipolar emotional disorder (Geddesand Miklowitz, 2013)Conclusion:After the situation, I became more interested in Bipolar Disorder, which made me read more references to the best practices of health care and found that the patient needs full control and regularity of medication so that emotional fluctuations can be controlled by self-reduction and self-harm(Chien et al., 2013). After a week of patient regularity in the drug interventions, the nurse should start establishing a therapeutic relationship with the patient and his / her family in order to gain a deeper understanding of the patient’s condition and increase the trust between the patient and the nurse and use this therapeutic relationship in the application of treatment strategies based on cognitive behavioral therapy and try to increase self-confidence in the patient (Kurtz and Richardson, 2012). Cognitive behavioral interventions seek to overcome low self-esteem of the patient by improving self-image for himself and bear responsibility and respect for self and others, and the desire to increase the life and then the patient to think about his future life positively begins (Velligan et al.
, 2010).Action Plan:After examining the evidence for best practices of nursing care for the patient, and after matching this information with the current patient information and individual needs, the nursing care plan should aim to reduce anxiety and depression in the patient, reduce sleep disorders, provide comfort to the patient and improve nutrition for the patient who suffers from Thinness in addition to controlling hallucinations and illusions improves the patient’s image to control low self-esteem within 72 hours. Nursing care interventions are based on the evidence-based practice confirmed by Higashi et al., (2013) regularity in the drugs of depression and insomnia, the attempt to relax the patient and the opportunity to sleep for longer periods and this will improve the condition of the patient significantly. After confirming the control of symptoms and complications through drugs, cognitive behavioral strategies are presented to improve the patient’s self-image, try to accept the disease and interact positively with others, and improve the patient’s future image in an attempt to control the idea of ??elation, hope and love of life (Morrison et al., 2014).
Comprehensive clinical examination of the patient, physical recovery and health care of the patient with respect to other physical illnesses he / she suffer from. The symptoms are monitored regularly and the patient’s malnutrition is treated(Weiser, 2011). Such as the patient Ms. X, who suffers from breast cancer and malnutrition that caused the thinnest patient.The family has a role to play in promoting therapeutic interventions by educating family members and the patient about positive and social interaction, improving the patient’s self-perceptions and changing the lifestyle that leads to a decrease in the self-concept of the patient. The role of the family should be enhanced through their involvement in CBT interventions, increased visits to the patient and psychosocial support (Balaji et al., 2012).
One of the most important goals of the nursing care plan is to reduce the patient’s re-admission as a result of the relapse. Therefore, health education for the patient’s family and their participation in the health care interventions and their prior planning to create a supportive environment for the patient is one of the tasks of nursing care(Collins et al., 2011).
The nursing care plan is designed to monitor the patient’s condition, the effectiveness of pharmacological and non-pharmacological interventions, evaluate the success of the care plan and provide appropriate interventions in case of individual patient need (Eack, 2012).This reflection of my experience at the mental health hospital has increased my acquaintance and nursing skills in dealing with the patient. I have learned patience in dealing with the patient, showing empathy for the patient, providing health education to the patient’s family to accept the disease, providing support to the patient, psychological, and that the interventions of health care through drugs first and then cognitive behavioral interventions to improve the patient’s awareness and increase self-confidence and others.