Recovery in Action: Challenges for Practice - Case Study Example

RECOVERY IN ACTION: CHALLENGES FOR ACTION due: Word count 3,357 The wellness Recovery Actionprogramme in mental illness is designed to observe distressing and uncomfortable signs and symptoms in organised reactions, minimising, eliminating or modifying the signs. The operations involved in creating this plan assist individuals to concentrate on their strengths and provide them an intense feeling of empowerment and responsibility (Brown 2002:127). The essay will explain on an encounter during placement with a service user that was admitted to a psychiatric ward of the community hospital. I will provide the case history of the service user as well as the actions taken to intervene in the course of care to the service user. I will highlight the recovery model used and the challenges experienced during the time the service user was admitted. The conclusion section will provide a reflection on the experience gained from care of the service user, the recovery process and the effect on my profession as a mental health nurse. The name of the service user and facility will be concealed as per Nursing and Midwifery code of (Nursing and Midwifery Council 2010:2). From this perspective Jones, a pseudo name will be utilised in this essay. Jones is a 25-year-old male of British origin who was born in whales. He resides with his father who is a prosperous farmer. Jones successfully managed the farm for three years before his mental illness. Jones was a committed Christian and despite his illness he attended Sunday services as usual and participated in church activities. Jones came into the community hospital accompanied by his father. They were referred by a general practitioner who suspected that he could be suffering from bipolar disorder. This was after Jones attempted to commit suicide by an overdose of antihistamines. He was rescued by his father who took him to the nearest clinic. He was treated with activated charcoal and observed for six hour before being discharged. He came to the hospital for further investigation and proper diagnosis. According to Hart, Brock & Jeltova (2014), further monitoring, intervention and evaluation is necessary to prove maniac or hypomanic symptoms (p.51). The signs and symptoms of bipolar disorder must be thoroughly examined because of the rate of conversion from unipolar to bipolar illness and people suffering from bipolar illness experience depressive symptoms in most of their life. It is also important because in the first episode that is reported in bipolar is depression (Hart, Brock & Jeltova 2014:51). A comprehensive assessment of the patient was carried out in the community hospital by two psychiatrists who are approved mental health professions (AMHPs) under the Mental Health Act 2007. The physical examination was done in the presence of his father who assisted the medical team with substantial information that helped in creating a clear picture of the situation that led to Jones current state. They were concerned with the level of negligence that the patient displayed, difficulty in concentration and visible aggressiveness. Jones was diagnosed with bipolar II disorder and agreed to be admitted to the community hospital where I was serving during my placement. He was detained for compulsory treatment for a period of one month after which he was to continue with his treatment in the community. As per section 3 of Mental Health Act 1983, an individual is needed to be admitted to the hospital for therapy. Under section 2 of the same law, the patient subject to section 3 is entitled to be given leave from the hospital to help with their slow rehabilitation in their community setting (Casey & Byng 2011:376). It was his first time to be admitted into the hospital because of bipolar illness. Jones has experienced low moods for a long time but has managed to live with the signs for one year. His behaviour within the one year changed because he became addicted to alcohol use. Jones got support from his general practitioner and community mental health teams (CMHTs). The DSM-5 is employed to define multiple conditions inside the bipolar spectrum. In reference to Barnhill (2014), for a diagnosis of hypomania or mania the patient must have three of the seven symptoms during the day (p.42). For a diagnosis to conclude maniac, the patient must have suffered from the episode for duration of at least one week. In hypomania, the episode persists for four days. Hypomanic is the principal feature of DSM-5 bipolar II disorder. Another requirement of DSM-5 to diagnose bipolar II disorder is one major depression episode (Barnhill 2014:42). As written by Hart, Brock & Jeltova (2014), bipolar disorder is presented by signs of depression, mania and hypomanic (p.1). The patients suffer from two extreme mood swings that are named mania and depression. The extreme emotional condition is referred to as mania. The patient suffering from mania displays the following signs poor judgement, high spirits, reckless driving and sexual behaviour. The patient may also have symptoms such as hallucinations, restlessness, aggressiveness towards others and themselves (Sue et al., 2014: 177). On the other hand, the low emotional condition is characterised by depression where the patient is inert and reclusive (Hearly 2010: 1-7). As stated by Beck & Alford (2009), people suffering from depression display symptoms of constipation, problems with concentration, pessimism, anxiety, retardation and self-criticism (Beck & Alford 2009:12). During the interview, Jones shared his view on the present incident, and this helped the medical team to form a treatment plan. Jones collaborated with the medical team that was in charge of assisting him during his stay in the hospital. During the interview, Jones avoided direct eye contact but could respond to questions without a problem. He was asked to narrate about his personal life. Jones said that he had lost his appetite; he did not want to take part in family activities and did not have any permanent relationships. He also experienced difficulties in falling asleep. It also emerged that Jones mother and father had divorced, and several months later his father died of an accident. Jones revealed that he drank alcohol as a way of lifting up his moods; because most of the time he experienced a low mood. He was asked to rate his mood on a scale of 1-10 and responded that he would score 1 out of 10 an indication of how depressed he felt. During the interview, Jones disclosed that he was worried about the farm he is managing. The business is not performing well, and there is a possibility of bankruptcy. The farm is under pressure from lending institutions that financed the farm operations. Jones said he attempted suicide because he was feeling hopeless, and did not have a reasonable statement to explain to his father about the current situation of the business. The stress diathesis model states that when individuals are exposed to stressful incidents in their lives may provoke mental illness symptoms. The model argues that a family form part of the patient’s environment. Several factors contribute to high levels of stress and include environmental events such as loss of job and events that a person encounters in the course of their life (Elder, Evans & Nizette 2009). Moreover, Adshead and Jacobs (2008), declare that individuals suffering from a psychiatric disorder underwent suffering in the course of their life (Adshead & Jacob 2008:22). Willmort and Gordon (2011), argues that most people suffering from bipolar disorder have a personality disorder. It is caused by change in mood from anxious to sad that increases the levels of emotions that can result to suicide attempts, self-harm and emotional dysregulation (Willmort and Gordon 2011: 15). Haycock (2010), suggests that bipolar disorder is triggered by genetic and environmental elements, stress, life experiences, social support and abuse (p. 63). The writer proposed that stress resulting from broken families; lack of sleep and from other illnesses makes an individual prone to bipolar disorder. Moreover, post-traumatic stress changes the neural circuits of the brain’s amygdala making it more prone to bipolar disorder (Haycock 2010:63). White and Preston (2009), further argues that genetic aspects play a significant role on how people encounter life events that are stressful. An individual with a family member or relative with bipolar disorder is at higher risk of acquiring the illness. These individuals express sensitivity to particular situations like substance use and traumas that cause bipolar signs (White & Preston 2009:88). In this case Jones was diagnosed with bipolar II disorder. The medical team also realised that Jones was alcohol dependent. The medical team recommended that the alcohol problem should also be treated for better health results. According to Macneil (2009), individuals with bipolar disorder have the greatest risks of substance dependence and abuse (p.120). He argues that the alcohol is the most abused substance, and bipolar patients are five times at risk of alcohol dependence in contrast to other individuals. Bipolar II treatment is based on the use of medicines and therapies. The recognised therapies include behavioural therapy, cognitive therapy, interpersonal therapy, psychoeducation; social rhythm therapy and family-focused therapy (Weiss & Connery 2011:21). The medical team and Jones agreed that drug treatment intervention would help to alleviate the symptoms of the illness. The drugs prescribed were lithium 0.6mEq/L to be taken two times daily and valproate 70µg/mL taken twice daily. Lithium is used to prevent the occurrence of new episodes, and valproate is used to treat mixed states of bipolar disorder (Suppes & Dennehy 2012:37). Through collaboration with a team consultant from the drug and alcohol, Jones alcohol history was reviewed, and the extent of dependence was determined. For alcohol problem, acamprosate medicine was prescribed as the treatment. The medication is used to treat alcohol reliance, and the dosage is 333mg three times daily (Koda-Kimble & Alldredge 2013:2048). The medication can be used together with other bipolar disorder medicines (Weiss & Connery 2011:15). Its contraindication includes mild diarrhoea that stops within a short period. The side effects caused by lithium include vomiting, nausea, drowsiness, tremor, dry mouth, cognitive impairment, thirst, increased urine output and weakness of muscles. The reactions from valproate consist of increased appetite and weight gain. Others may include reversible thrombocytopenia, reversible increase in liver function tests, loss of hair and sedation (Suppes & Dennehy 2012:35). The medical team together with Jones agreed that a combination of medication and therapy intervention would be of great help to Jones towards his recovery. Jones was put on integrated group therapy which was an evidenced-based treatment for patients with substance use problem and bipolar disorder. The therapy mainly focused on education on how to recognise symptoms to maintain emotion stability and how to prevent substance use dependence. He was also guided on how to avoid drinking alcohol and how to practice protective procedures such as hygiene, high-risk social conduct and sleep (Bhui 2012: viii). Jones was also guided on the importance of promoting other factors of life operations such as interpersonal connections. The integrated group therapy also included individual psychotherapy, group treatment, self-help support groups and pharmacological treatment of bipolar disorder. The particular mode of treatment is chosen because patients report better results compared to those who are given standard group substance abuse counselling (Weiss & Connery 2011:3). For the long-term intervention programme, Jones was expected to enrol in motivational interviews and public awareness campaigns that will build his personal commitment to abstain from alcohol. The medical team explained the importance of proper diet and physical activities for the physical well-being of Jones (Nash 2014: 127-150; Aiyegbusi & Kelly 2012:14). In maintenance treatment, the medical team told Jones that he will be regularly checked to make sure that he adhered to sleep hygiene and that he kept away from things that caused bipolar disorder. The primary trigger in this case is alcohol misuse that is prevented by the group therapy and medication (Oxford University Press 2014:135). In the daily maintenance plan, the medical team gave Jones an opportunity to explore his feelings and feel if he had the confidence in the programme. He confirmed whether it enclosed all his situations and interest to help him maintain his well-being. He was to look at how he is when he is not sick, what he is supposed to do to stay healthy and what he needs to do to be healthy. From the perspective of how he was before got sick, he was given the chance to make a list in a paragraph form. The activity reminded him of his positive attributes and strengths. He also identified taking his medication and getting enough sleep as some of the things that he must do to stay healthy. Jones also realised that bonding with his uncle and family would help him maintaining his wellbeing. In the triggers section, Jones was assisted by the medical team to describe events or things that caused extreme stress. Jones opened up and acknowledged that his loneliness was caused by the lack of parental love (Weinstein, 2010:15). The medical team assisted Jones to identify the early warning signs that are used to predict a relapse. They recognised symptoms of feeling anxious without a reason, avoiding social activities and loss of appetite. Jones agreed to participate in outdoor activities such as running, walking, or visiting his care provider to prevent these signs. The section for when things are breaking down section, Jones thought of times when he could not control his emotions and alcohol addiction. Jones noted that he felt so lost and withdrew from other family members. He realised that to avoid this it was good to seek help from a peer counsellor. It is very paramount because it helps the patient to avoid situations where he/she is not able to manage the situation. In the crisis plan, the patient was to consider the situation where despite utilising the wellness tools and plan they are not able to make decisions that are healthy and safe. Jones realised that he engaged in alcohol misuse, and he once tried to commit suicide. In the list of people, whom he considered would give him support, he nominated his uncle. In the post-crisis plan, Jones decided to reconnect with his existing family and continue with the group therapy. He also suggested looking at his wellness recovery action plan to find out areas that needed to be reviewed for more efficiency. Recovery is the procedure of restoration and healing. It is a feeling of equilibrium and well-being in times of crisis and stress. In this process, the medical team focused on the prevention of relapse, and creation of new and easy to adopt skills, change in lifestyle and healthy relationships that will make it possible for abstinence. The medical team then established boundaries to handle Jones’ case with the sensitivity it deserved and help him regain his ability to take care of his self. However, Jones had recurring mild episodes of depression where the medical team took time to establish the cause. They discovered that the challenge that hindered Jones from full recovery was loneliness and stress. The medical team took their time and engaged Jones in a discussion to find out his hobbies that could be used to reduce stress (Slade 2009:3). Jones loved reading all type of material; therefore, the medical team provided him with a patient workbook. The workbook contained psychoeducation material that Jones could refer to in order to strengthen what he learned in the course of his treatments. The workbook consists of forms and worksheets that are filled with in-session activities and at home tasks. The patient is supposed to attend every meeting and bring along the book (Otto 2008:13). In order to minimise loneliness, the medical team delegated light duties to Jones such as assisting in arranging their office. The medical team organised a group that could provide a company to Jones. The team was met with the challenge of getting a perfect combination of patients suffering from the same signs and symptoms. Therefore, they conducted the selection by looking for patients with a reasonable level of heterogeneity and homogeneity (Ruiz, Strain & Lowinson 2011:577). The group must provide a platform where the patients will identify with each other in better results. Nevertheless, diversity promotes the abundance of the group encounters hence group members can have different ages, socioeconomic status, and educational standards, race, and gender as long as there is no odd patient. The group consisted of patients suffering from various substance misuses to prevent addictive illnesses. The medical team applied for a community treatment order (CTO) for Jones that contained the community-based care that he needed once he was discharged from the hospital. The community treatment order will enable Jones to receive his entire treatment at home. He was supposed to report to the community hospital at specific dates provided by the treatment order to continue with his treatment (Staunton & Chiarella 2012:345). During this placement, I employed Kolb’s experiential learning cycle to reflect on what I learned. The Kolb’s model declares that for learning to happen there is need for experience. One reflects on the experience and makes sense out of it. Finally, one implements the concepts learned in practice through planning how to go about things faced by a similar situation (Clifford & Thorpe 2007:20). On reflection, collaboration between the patient and the health professional is critical in recovery. It is evident in this case study where the wellness recovery plan puts into consideration Jones thoughts and emotions. Communication is imperative because it enables the bonding of the patient and the medical team and development of trust. Without trust, it is impossible to implement the wellness recovery plan. The therapeutic relationship is vital in creating an environment that promotes quick recovery. It also enables the patient to discuss any life challenges and get help on how to solve the difficulties. On reflecting on this case study, I learned that the seven steps of wellness recovery action plan are paramount in maintaining the mental well-being of the patient. These measures put into consideration the standards that must be retained after the patient is fully recovered. It helps to empower the patient with the information that helps him to manage and get full control of his personal life. The patient is also aware of the time when he needs help to avoid a crisis such as attempted suicide like in the case of Jones. Psychoeducation is important and all patients, families and caregivers should be enlightened to manage the mental illness as well. I have learned that the intent of the recovery is to assist the patients regain their dependent status and reinstate their physical and mental status. As a mental health nurse, I have learned how to use different therapies and medication to give care to a patient suffering from bipolar disorder. I have also discovered that patients suffering from different substance use can be put in a group to promote diversity and have excellent results. I have gained more experience and realised that the challenges encountered in mental recovery of mentally ill patients depends on the individual’s illness. In order to comprehend the mental disease one must perform a comprehensive examination of the individual’s psychiatric, forensic, medical, developmental, occupational and family history. Their personality framework is also crucial to understand the illness. It is also clear that the challenges encountered during recovery are problems that face the patient under care that vary from one patient to another. Such issues like lack of social support may hinder full recovery of the patients. Social support creates a feeling of security and love which is paramount to a mentally ill patient. In most cases, the patients are hopeless and need to build hope for them to live a meaningful life. From Jones case, I have learned that patients with bipolar disorder are in danger of substance use. In such a case one is supposed to treat both the disorder and substance use to achieve total recovery. From the case study, I have acquired knowledge that for a patient to maintain good health once discharged from the hospital; a follow-up plan is necessary where the patient’s health is monitored. To sum it up, I am empowered with the expertise and knowledge needed to give care to patients suffering from bipolar II disorder. Bibliography AIYEGBUSI, A., & KELLY, G. (2012). Professional and therapeutic boundaries in forensic mental health practice. London, Jessica Kingsley Publishers. ADSHEAD, G., & JACOB, C. (2008). Personality Disorder the Definitive Reader. London, Jessica Kingsley Publishers. http://www.123library.org/book_details/?id=2572. BHUI, K. (2012). Elements of culture and mental health: critical questions for clinicians. London, RCPsych. BENNER, P. E., & WRUBEL, J. (1989). 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