Dealing with an Individual with Complex Mental Needs - Essay Example

Dealing with an Individual with Complex Mental Needs Section Aetiology Milane has a severe learning disability, Down syndrome, epilepsy and dementia which lead to self-injurious behaviour and is living within a care environment. All these complex health needs including his bio-psycho-social needs he experiences have a major impact in his daily living. His down syndrome is hereditary. People with Down’s syndrome experience a high prevalence of dementia later in life (Zaccara, 2009). His dementia is a result of his Alzheimer disease. Some possible causes of his seizures are: chest infection or urinary tract infection (UTI), Alzheimer disease and high fever. He has seizures which he experiences once in three months on different days. Some symptoms which could be associated to his seizures can be classified from the two main categories of seizure types. He falls under the generalised type of seizures. His symptom exhibits tonic-clonic seizures where he experiences stiffness and jerking, with sudden falls, grunting noises and foaming at the mouth. More so, deep breathing may be associated with convulsion and he usually gets confused about three minutes. Other possible seizure triggers are; poor drug compliance, medication changes, dehydration, change in sleep pattern, infections, example like chest infection, constipation, pain and discomfort. Epilepsy is a neurological condition that affects the brain. Epilepsy also affects different people in different ways and as a tendency to have recurrent seizures (Brown et al 1998). Epilepsy is a serious neurological condition which can affect anyone in the world. In UK alone people who have epilepsy are over 600,000 including at least 40 different seizure types (Joint Epilepsy Council, 2011). It has been stated by Epilepsy Action (2012) that 20-30% of people experience difficult treatment, for example, those who experience chronic epilepsy. The earlier a person is diagnosed with the right treatment and care, the number of epilepsy related death will be reduced. In 2009, epileptic related death was 1,150 in the UK alone. This makes Milane to be at risk of sudden unexplained death in epilepsy or SUDEP. It is estimated that about 500 people a year die of sudden, unexpected, un-witnessed, non-drowning death in patients with epilepsy in the United Kingdom (Epilepsy Action, 2012). Milane has been experiencing seizures which are attributed to Alzheimer’s disease. He takes anti-epileptic drug (phenytoin) which has been prescribed by his (GP) once a day to control his seizures. Milane has been admitted to a nursing care facility for a few years now under the supervision of his doctor and the nurses in the residential home. Section 2: Planned Intervention The World Health Organization (2011) defines health as "a state of physical, mental, and social well-being and not merely the absence of disease or infirmity" (p. 57). Without good health, an individual cannot participate in a wide range of activities and join society. The United Nations Convention on the Rights of Persons with Disabilities (CRPD, 2006) acknowledges and reinforces the right of persons with disabilities to be accorded with the highest standard of health care without discrimination (Article 25). Milane, no matter how complex his needs are due to his multi-disabilities is entitled to the best intervention there is to help him cope with his illnesses and improve the quality of his life. Person-centred approaches are recommended for him. Such approaches educate and support people like Milane who suffer from various disabilities, so they can manage their health better. Although Milane may seem to be unproductive, teaching him self-management skills with appropriate training and support as well as providing collaborative decision-making are believed to improve his health outcomes as well as lower health care costs (Meng et al., 2007). Multidisciplinary team efforts are meant to contribute to Milane’s wellness. This should involve the participation of Milane’s family and caregivers so that they, too, can learn about the therapeutic interventions being implemented for him and follow through on their own (Lindsey, 2002). Care coordination is essential in promoting a collaborative and interdisciplinary team approach which links people with disabilities to the appropriate services and resources for their special needs (Antonelli et al., 2009; Kroll & Neri, 2003). Although this may seem costly at first, in the long run, coordination is bound to improve the quality, efficiency and cost-effectiveness in the delivery of health care services for individuals with disability (Schillinter et al. (2000; Boling, 2009; Battersby, 2005). Since Milane is mentally incapable of making decisions for himself, his family was consulted if he can be the subject of this paper since the planned intervention will greatly benefit him. His mother gave her consent in behalf Milane and agreed to be cooperative and supportive in the intervention. The prioritized needs of Milane are the management of his epileptic seizures and Alzheimer’s disease in order for him to live a more productive life despite his condition. Epilepsy is a chronic condition involving episodes of involuntary seizures in patients. Usually, it has comorbidity with other diseases. In Milane’s case, it is Down’s Syndrome and Alzheimer’s Disease and these have caused other adverse bio-psycho-social symptoms that threaten his health and well-being. Zaccara (2009) offers that Alzheimer’s disease and other dementias have a 5- to 10-fold increase in risk of epilepsy and 10-20% of patients with such comorbid diseases have had at least one unprovoked seizure in the duration of their comorbid condition (Mendez & Lim, 2003) Since his seizures put him at risk of greater harm, this health care need will be one of the priorities in his planned intervention program. Add to that, the management of his Alzheimer’s disease which is a cause of his learning disability. Imfeld et al. (2013) contend that several studies consistently reported that patients with Alzheimer’s disease (AD) are more vulnerable to developing seizures or epilepsy than patients without dementia. Seizures put the patient at risk of accidents such as hitting his body on hard or edged surfaces which may cause more damage. Anti-epileptic drugs (AED) may control such seizures but the consequences of strong seizures may affect language and/or cognitive skills (Mendez & Lim, 2003; Volicer et al., 1995). Milane’s complex needs need a team of specialists to help him. He is assigned to a social worker who assesses his care needs to know which resources or professionals he can be referred to be his part of his support system. She works closely with Milane’s family and carers, explaining to them the nature of Milane’s condition as part of the educative process (Community Care, 2012). The social worker first coordinates with Milane’s medical doctors to know the treatment interventions he was given over the years. Milane’s neurologist gave her the medication prescribed to him and told her that surgery was not an option for Milane. Since Alzheimer’s Disease is a mental illness, Milane needs a psychiatrist to oversee his progress. This doctor prescribes his medication and explains the symptoms he would usually manifest that might seem strange to people around him. The social worker also coordinates with a dietician to prepare a ketogenic diet which is rich in fat and low in carbohydrates. The special diet is believed to cause the body to break down fats instead of carbohydrates, and the process is known as ketosis (National Institute of Neurological Disorders and Stroke (NIH), 2014). Ketosis has been known to inhibit seizures by producing beta-hydroxybutyrate (BHB) (NIH, 2014). However, it is not an easy diet to maintain, requiring individuals to strictly adhere to a limited range of foods which are not usual in the market. Due to the components of the diet, it may cause side a nutritional deficiency and uric acid buildup in the blood resulting to the development of kidney stones (NIH, 2014). Hence, the dietician should know exactly the medical condition of the patient before she designs the diet for Milane. Milane’s anti-epileptic medication is Phenytoin. Its common side effects are jerking movements of eyes, decreased coordination, slowed thinking and movement, problems with memory, slurred speech, poor concentration, etc. (Epilepsy Foundation, 2014). More serious side effects of the drug are damage to liver or bone marrow, disease of the lymph nodes, depression and suicidal ideation. Milane does not present any of these side effects even if has been taking the drug for several years. The people who work with Milane on a consistent basis are the nurses in the nursing facility. Being diagnosed with Alzheimer’s Disease which is a progressive illness that is a form of dementia, care for such residents fall into two areas namely activities for daily living (ADLs) and their psychiatric and behavioural needs. These major areas can further be subdivided into physiological, hygiene, ambulation and psychiatric and behavioural symptoms which are all essential aspects of care for such residents like Milane, who are afflicted with dementia (Tilly & Reed, 2004). Section 3: The Proposed Intervention with Evidence Base Milane’s dementia, comorbid with his Epilepsy, truly needs a multidisciplinary team of professionals to help him cope with such complicated condition. Left on his own or just with his family and caregivers, it is likely that he will just deteriorate. He exhibits severe learning disability which becomes a hindrance from achieving a high quality of life. Learning disabilities affect an individual’s understanding of information as well as his communication skills. This implies that they struggle in comprehending new or complex information, learning new skills and/or independently coping with their daily functioning (NHS Choices, 2013). Milane’s condition of having epilepsy as well as Alzheimer’s disease limits him from expressing himself freely. Most of the time, he is just idle and prefers to be alone. However, group activities in the nursing home encourage him to socialize with others even if he does not converse with them. He is unable to join his peers at card games, Bingo, etc. because he does not comprehend nor follow the rules of the games. However, merely being in the company of others without any sign of anxiety benefits him socio-emotionally. In lieu of such group games, he gets to walk in the garden with one or two of his peers together with his attending nurse. He may not initiate social interaction, but most of the time, he would acquiesce to other people’s invitation for him to walk or sit with them. He may listen to their stories, but sometimes, he has this faraway look that people have no idea where his mind wanders. Confining him to a nursing care facility ensures that he is watched on a 24/7 basis. His social worker coordinates all the services he would need upon the supervision of his medical doctors. His neurologist and psychiatrist collaborate on his intervention to help him achieve a better mental health and well-being. They agree on the medication and dosage he needs to function properly. They prescribe the anti –epileptic drugs (AEP) as well as other medication for his health needs. Milane takes 100-milligram (mg) extended phenytoin sodium once a day for seizure prevention. He has been cooperative in adhering to the schedule of taking the drug. Perhaps because he experienced the unpleasantness of seizures one time when he failed to take his medication for a few days when he was not yet confined to the nursing care facility. His mother kept reminding him of that episode every time he refused to take his medicine that is why currently, he readily receives and ingests the capsule among other medications for his general health. The doctors also educate the nurses and caregivers as well as the family members on dealing with Milane’s psychiatric and behavioural symptoms. A dietician assesses his needs as she comes up with his ketogenic diet. She coordinates with the resident nutritionist of the nursing care home. Some of the foods may be difficult for him to accept and it is up to the family and caregivers to motivate him to eat. Examples are green beans, mushrooms and red peppers fried in flaxseed oil. Initially, he refused the foods, but as he was rewarded with something sweet every time he eats, he learned to tolerate the taste of his new food. Apart from the interventions of pharmacology and ketogenic diet, his ADLs also need attention. His physiological, hygiene, ambulation and psychiatric and behavioural needs all need to be addressed (Tilly & Reed, 2004). An occupational therapist can be called upon to train him with his activities for daily life such as bathing, brushing of teeth, eating properly, toileting, etc. Upon the assessment of the occupational therapist of Milena’s skills, the nurses and staff of the residential facility can provide Milena with productive activities even if it seems he does not understand or is not interested. Examples of such activities are gardening, dusting, sorting things according to its function or mixing food as part of food preparation. They should keep in mind that “the outcome of an activity is not as important as the person’s participation in it” (Alzheimer’s Association, 2009, p. 21). Both the temporal and physical environment in the residential facility should be well-planned to accommodate Milane’s complex needs. For example, for his temporal environment, he should have a predictable daily routine including sleep and toileting patterns. His physical environment should be kept safe from sharp edges in case he undergoes epileptic seizures all of a sudden. In addition, the psychological environment should be kept positive. The nurses and staff are trained to be positive in all their behaviours and attitudes towards the residents and patients of the home with the aim of contributing to their optimal functioning (Gable& Haidt, 2005). They all empower the residents to be more proactive and maximize their strengths instead of dwelling on their weaknesses and rid themselves of negativity which just brings about neuroses (Gates, 2006). The following chart summarizes the roles of the Intervention Team: Intervention Team Member Roles in the Intervention Social Worker Coordinates Milane’s system of support including his service providers, multidisciplinary team, family and caregivers Doctors: Neurologist & Psychiatrist Diagnose his mental condition and illness Prescribe the medication Monitor his general health and well-being Dietician & Nutritionist Collaborate on Milane’s kegogenic diet to help control his epileptic seizures Occupational Therapist Trains Milane to do activities for daily living (ADLs) which include addressing his physiological and hygienic needs such as bathing, oral care, eating, dressing, etc. Collaborates with nurses on productive chores/activities that Milane can participate in. Nurses Administer medication prescribed by the doctor Provide over-all care to Milane and implement his care plan Plan out productive activities for him to do and assist him with in carrying them out Bridge communication between Milane and his family Encourage Milane to socialize with his peers in the nursing home Help him with techniques to manage his learning disability such as giving him cues and reminders. Practice Positive Psychology Milane’s family Maintains contact with Milane by visiting him regularly. Provides moral support to Milane In addition to this intervention/ care plan is therapeutic massage which calms him down. He likes being massaged on his shoulders and back. It relaxes him and sends him off to a restful sleep afterwards. Section 4: Evaluation of the Proposed Intervention Taking care of Milane is a herculean challenge for his family, who is not appropriately trained to provide him with medical, psychiatric and behavioural interventions. His complex needs of being Epileptic, coupled with Down’s Syndrome and Alzheimer’s Disease makes him the best candidate for a residential facility that can address all his needs on a round-the clock basis. His social worker makes sure that the multidisciplinary team working with him is working together effectively to ensure his health and well-being. Having a multidisciplinary team working on his intervention is one essential component in helping him improve his quality of life, as each specialist provides expertise on a specific need (Lacey & Ouvrey, 1998). His medical team of a neurologist attending to his epilepsy and a psychiatrist attending to his Alzheimer’s Disease not only prescribe the necessary medication for him to keep his symptoms under control but also identify his patterns of behaviour for his family and caregivers to understand. Over time, his medication may change or faded out depending on the severity of his condition. In addressing Milane’s biophysical needs, an occupational therapist joins his multidisciplinary team to train him in developing skills to address his physiological and hygienic needs. Because a ketogenic diet has been evidenced to reduce the likelihood of epileptic seizures, the collaboration of Milane’s dietician and nutritionist from the nursing home to design a special diet for him is a significant component of his planned intervention. The residential facility’s nurses and staff implement his care plan and work with Milane to continue with the medication, special diet and activities implemented on him by his support team. Keeping reminders of things he needs to remember like notes on walls to remind him of the tasks he needs to do, sound cues for transition to routines or memory cues for her to remember the names of her peers in the nursing home become very useful to Milane. It all helps him become more functional as an individual despite his learning disabilities (Pawlyn & Carnaby, 2009). Together with his family, they all empower Milane to work towards his success despite his miserable condition. Milane may be viewed as an imbecile for his complex condition rendering him as a learning disabled and unproductive individual. However, with a dynamic team working with him, boosting his skills, there is always hope for him to be a somewhat productive member of society. He will learn to manage his seizures and learning disability and concentrate more on improving her relationship with others, leading to healthy relationships. In sum, with the collaboration of the intervention team, should the intervention team be successful in their goals for Milane, and if he fully cooperates with them, then his over-all health and well-being should be significantly improved. 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