401013 Promoting Mental Health and Wellbeing For Cardiac Evaluation
Questions:
2 Distinguish the mental health priorities in relation to meeting the needs of individuals and their families/significant others in the community.
3 Relate the principles of stress, mental health assessment, risk assessment and management in promoting mental health and wellbeing.
4 Explain the principles and skills of therapeutic communication and interventions related to caring for people experiencing alterations in thought, behaviour, and mood.
5 Apply ethico-legal implications in relation to the care of people with mental health concerns and/or illnesses
6 Develop an understanding of the lived experiences and recovery for individuals with mental health concerns and/or illnesses
Answer:
Case Study: Plans of Care
Urgent Risk area.
The first priority in dealing with Chung’s case is to identify the possibility of myocardial infarction. Chest pain is treated as an emergency concern (Roche, Gardner & Jack, 2017).This would be a cardiac evaluation precaution to allow early risk stratification of myocardial infarction following the vital signs of chest pain accurately (Ayerbe, González, Gallo, Coleman, Wragg, & Robson, 2016)).Identification of the urgent area is important owing that cardiac arrest is a life threatening condition hence requires urgent interventions (Steadman, 2010)
Nursing Intervention and Rationale
Following the warning signs on possible cardiac arrest, I would immediately asses for the characteristics of chest pain (PQRST) (Burman, Zakariassen, & Hunskaar, 2014), respiration and heart rate with each episode of chest pain. Causes of chest pain are many .An increase in chest pain happens as the body compensate to pain, which can lead to other serious complications Barnett, Prior, Kadam, & Jordan, 2017). I would obtain full description about the client’s medical history and details about the location, duration, and intensity of his symptoms and assist the client to quantify pain by comparing it to other experiences.
The rationale of this intervention is that pain is a subjective experience and must be described by the client. It provides baselines for comparison to help in determining effectiveness of therapy, resolution and progression of problem (Wilcox et al.,2015).I would also put into practice the consideration that some chest pain are non-cardiac (Campbell et al.,2017).
Mental health concern
The mental health concern in regards to the case client would be the possible harm to self. This is due to the risk factors upon assessment. The client admits the thought of harming himself (suicidal ideation) and would have higher access to means of carrying out the plan since the client is a doctor by occupation (De Choudhury, Kiciman, Dredze, Coppersmith & Kumar, 2016). The other area of concern would be depression due to anxiety.
Nursing intervention for the mental health concern and rationale
The risk of suicide or harm to self requires nurse intervention. Management of risks factors is a major intervention I would use. This will aim to reduce the risk behaviors such as the hopelessness, self-rejection and the suicidal ideation that influences the client to carry out the plan. The client also should be given leave at work to minimize access higher means of carrying out the suicidal plan (Tighe, Nicholas, Shand, & Christensen, 2018).
Legal. Ethical or professional issues of consideration
Working in mental health setting as a nurse present challenges dealing with legal and ethical issues. In my client’s case deciding on whether to maintain the right to confidentiality versus disclosure to enable intervention by mental health team present an ethical dilemma (Hiriscau, Stingelin-Giles, Stadler ,Schmeck, Reiter-Theil,2014) Mental Health Act provision requires detention for risk of suicide in order to reduce risk versus the clint’s right to consent treatment(autonomy) options present legal issue (Weimand, Sällström, Hall-Lord, & Hedelin, 2013). Chung’s self determination to harm -self versus my responsibility to prevent no harm or to ‘no harm’ poses an ethical consideration. (Attri et al.,2015). The decision whether to use coercion in practice when there is risk or not will be shaped by professional code of conducts shown in professional virtues of dignity, integrity and compassion (Nursing & Midwifery Council ,2015).
References.
Attri, J. P., Sandhu, G. K., Mohan, B., Bala, N., Sandhu, K. S., & Bansal, L. (2015). Conflicts in operating room: Focus on causes and resolution. Saudi Journal of Anaesthesia, 9(4), 457–463. https://doi.org/10.4103/1658-354X.159476
Ayerbe, L., González, E., Gallo, V., Coleman, C. L., Wragg, A., & Robson, J. (2016). Clinical assessment of patients with chest pain: A systematic review of predictive tools. BMC Cardiovascular Disorders, 16, 18. https://doi.org/10.1186/s12872-016-0196-4
Barnett, L. A., Prior, J. A., Kadam, U. T., & Jordan, K. P. (2017). Chest pain and shortness of breath in cardiovascular disease: A prospective cohort study in UK primary care. BMJ Open, 7(5), e015857. https://doi.org/10.1136/bmjopen-2017-015857
Burman, R. A., Zakariassen, E., & Hunskaar, S. (2014). Management of chest pain: a prospective study from Norwegian out-of-hours primary care. BMC Family Practice, 15, 51. https://doi.org/10.1186/1471-2296-15-51
Campbell, K. A., Madva, E. N., Villegas, A. C., Beale, E. E., Beach, S. R., Wasfy, J. H., … Huffman, J. C. (2017). Non-cardiac Chest Pain: A Review for the Consultation-Liaison Psychiatrist. Psychosomatics, 58(3), 252–265. https://doi.org/10.1016/j.psym.2016.12.003
De Choudhury, M., Kiciman, E., Dredze, M., Coppersmith, G., & Kumar, M. (2016). Discovering Shifts to Suicidal Ideation from Mental Health Content in Social Media. Proceedings of the SIGCHI Conference on Human Factors in Computing Systems . CHI Conference, 2016, 2098–2110. https://doi.org/10.1145/2858036.2858207
Hiriscau E.I., Stingelin-Giles, N., Stadler,C., Schmeck, K., Reiter-Theil ,S.(2014). A right to confidentiality or a duty to disclose? Ethical guidance for conducting prevention research with children and adolescents. Eur. Child Adolesc. Psychiatr,23(6),409–416. doi: 10.1007/s00787-014-0526-y.
Roche, T. E., Gardner, G., & Jack, L. (2017). The effectiveness of emergency nurse practitioner service in the management of patients presenting to rural hospitals with chest pain: A multisite prospective longitudinal nested cohort study. BMC Health Services Research, 17, 445. https://doi.org/10.1186/s12913-017-2395-9
Tighe, J., Nicholas, J., Shand, F., & Christensen, H. (2018). Efficacy of Acceptance and Commitment Therapy in Reducing Suicidal Ideation and Deliberate Self-Harm: Systematic Review. JMIR Mental Health, 5(2), e10732. https://doi.org/10.2196/10732
Nursing and Midwifery Council. (2015) .The Code: Professional standards of practice and behaviour for nurses and midwives. Retrieved September 20, 2018, from https://www.nmc.org.uk/globalassets/ sitedocuments/nmc-publications/nmc-code.pdf
Weimand, B., Sällström, C., Hall-Lord, M. & Hedelin, B. (2013). Nurses’ dilemmas concerning support of relatives in mental health care. Nursing Ethics, 20 (3), 285–299.
Wilcox, C. E., Mayer, A. R., Teshiba, T. M., Ling, J., Smith, B. W., Wilcox, G. L., & Mullins, P. G. (2015). The Subjective Experience of Pain: An FMRI Study of Percept-related Models and Functional Connectivity. Pain Medicine (Malden, Mass.), 16(11), 2121–2133. https://doi.org/10.1111/pme.12785
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