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DEVELOPING AUTONOMOUS PRACTICE IN MENTAL HEALTH NURSING – PART 1 - ALCOHOL

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DEVELOPING AUTONOMOUS PRACTICE IN MENTAL HEALTH NURSING – PART 1 - ALCOHOL

Mon, 04/22/2019 - 20:45
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Autonomous Practice In Mental Health Nursing Introduction

This essay will discuss a specific client’s background till date, with whom I have worked with during my semester five clinical placement. I will explore this clients various needs and how to address them, using published therapeutic approaches and theories.

I will also endeavour to justify my reason for selecting the chosen approach for my client. The essay will continue to demonstrate how my chosen approach can be structured and used as a guide towards delivering holistic care for the client. It will conclude by exploring the therapeutic efficacy of the current clinical environment and its services where care is being provided. A look to consider an alternative service provision option will be discussed, while considering whether they may be more beneficial for my client. My clinical placement for semester five was working with a mental health community team. They are known as an Assessment and Share care Team. This team complies of a multi—disciplinary team of various health care practitioners. These included besides nurse practitioners, social workers, consultants and psychologist. Referrals to my team were made from other care services and also post discharge from the hospital for further psychiatric assessment for any mental health illness, and also for follow up for intensive input towards the patient’s recovery, which cannot be solely manage by primary care services but will need secondary care services. For the purpose of this work, my client’s identity will not be disclosed due to confidentiality and as per the Nursing & Midwifery Council (NMC) professional code of conduct (2009). I will refer to my client as James throughout the essay.

Mental Health Alcohol

Background and history to date.

James is a 49 year old white British man, currently unemployed. He last worked 3 years ago as a bricklayer. He was seen and assessed in a psychiatric inpatient hospital. He later discharged himself and went to see his GP, who then referred James our team.
 

Mode of referral

James was referred to the community assessment and shared care team from by his GP because he had expressed suicide ideation. James was reported to have dis-engaged and drank half a bottle of vodka of 40% alcohol against the rule of the detoxification treatment. This led to his discharge from that service. He said he was feeling rejected and frustrated, while waiting to be placed in a rehabilitation unit, despite five weeks stay in the detoxification unit. He subsequently returned home, after he could guarantee his safety. His GP referred him to an alcohol service locally and to our services thereafter. James has a diagnosis of Mental and Behavioral disorder due to alcohol dependence. He has a differential diagnosis of depression. He also has other physical conditions of Spondylitis, Arthritis and Osteoporosis.

 

History of alcohol problem

James reported drinking 34’2 units of cider every day prior to his admission at the alcohol detoxification unit. He reported incidence of fits, incontinence and self-neglect for five days prior to his detoxification. He also added he had been drinking on average 5.7 units of cider together with sleeping tablets, everyday with his friends in the park at age 14 years. He left school at 16 years with no qualification. He then worked as a handy man and later became specialized as a bricklayer at age 30. James uses a wheel chair following an accident of fall while drunk 4 years ago. He had been mobilizing with clutches. He was also diagnosed of spondylitis two years ago, and treated with prednisole 30mg. He was also diagnosed with osteoporosis five years ago, to which he is treated with Risedrouate Sodium 35mg daily. James also suffers from Rheumatoid Artaritis.

 

Alcohol Hangover

 

Exacerbating factors

James reported living at his girlfriend’s flat for 3.5 years. His ex—girlfriend has alcohol problem and cases violent towards him. He was often driven from the flat and have been going for shelter at the nearest pub and off license. He moved into a one bedroom council flat six months ago. He increased his use of alcohol to improve his mood and masked thoughts of his decreased family. His wife of ten years left him with their two children — age 18 and 16. He also has a 27 years old son with his ex-girlfriend, when he was 18 years old. He has lost contact with all of his children. He subsequently had to drink increased amount following his mobility problem and to avoid withdrawal symptoms.

 

Impact of problem on his life

He reported estrange relationship with his friends and close relatives because of his alcohol problem. He said to have accessed alcohol services prior to his admission for detoxification. He also reports rarely sleeping at night, especially prior to his admission. He would normally have a ‘cap nap’ and would go out of his house at early hours of the morning to the off license to buy some cider. He reports having tremors, sweats and anxiety prior to his first drink. Then he will spend the day smoking tobacco and drinking cider all day. Patient view of what is wrong

James reported his alcohol abuse to have a negative effect on his life. He initially started drinking alcohol to enjoy life but now he is unable to control his alcohol habit. James drank alcohol to escape the frustration but instead his situation was made worst and his physical health deteriorated. Current psychological, physical, social needs of the client and Therapeutic] theoretical approach Carl Rogers (1961) and Abraham Maslow (1970) both argue that human health comes from individual natural tendencies. The patient’s basic needs according to Maslow hierarchy of needs are paramount towards care. James’s current psychological needs are as follows; He is currently feels depressed and low in mood. He is also anxious about the effect of his alcohol intake and its effects of these to his other physical condition.

 

Donald Horton (1943) raises how in some culture, the primary function of alcohol is to reduce anxiety. Abuse would be more prevalent in societies with greater anxiety experience and where few alternatives present. This can explain why James will drink, to improve his mood but instead he feels frustrated all the time and has reported feeling angry for no apparent reason, with himself and others. He would sometimes be aggressive. Alcohol consumption may be either a cause or a consequence of depression. In relation to its causal role, some have suggested that alcohol is bi-phasic in its effects, initially producing a sense of euphoria which turns to feelings of depression as the blood alcohol levels falls. 

 

Problem drinking and dependence can cause a range of problems such as family conflict and disruption, job loss and financial problems that are likely in themselves to result in increased levels of anxiety and depression. Alcohol dependence is one of the main risk factors for suicide. ( Robert et al 2001).

 

He is also very emotional thinking of his children, whom he has no contact and also a great sense of loss being bereaved from his brother and mother. John Bowlby (1907 — 1990) a child psychiatrist and Psychoanalyst talks about the Importance of attachment in human development. He demonstrates in his studies how like young animals, humans have a need for a figure who provides a source of safety, comfort and protection in order to aid positive development overtime.

 

James would sometimes feels suicidal as he would mostly rely on others in attending to his personal hygiene and in preparing a meal for himself. As mentioned above, he also have other diagnoses of spondylitis two years ago, and treated with prednisole 30mg. He was also diagnosed with osteoporosis five years ago, to which he is treated with Risedrouate Sodium 35mg daily. James also suffers from Rheumatoid Artaritis. All the above conditions makes him prone to pain and fatigue. James will sometimes suffer from alcohol withdrawal symptoms of headache, nausea, vomiting, and sweating. Having physical health conditions have proven to have an impact on an individual’s mental state and their recovery. Mindout ( 2001). 

 

James has not been sleeping well. He reports not sleeping at all for 48 hours and has not eaten throughout that same period. As a result, he feels extremely weak, tired and appears to be dehydrated and prone to self neglect.  Beck A.T( 1991).

 

His social needs are due to being isolated by his friends, who have alienated him due to his drink problem. He also does not socialize with anyone nor take part in any social activities since he separated with his girlfriend. James remains in his flat all day and only goes to the shop to buy alcohol when he can afford it.

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