Mental Health Disorder In Nursing Essay

4 page double space mental health disorder in nursing due 10/5/2020

1. Complete a search and find 2 journal articles related to Generalized Anxiety Disorder and posttraumatic stress disorder. After reviewing the articles, do a 2-page summary on the article and reference it according to APA. use the attached textbook and 2 other source. Mental Health Disorder In Nursing Essa

2. Go on to the NAMI.org website and find out what resources and treatment are available for the client with Anxiety Disorders. Choose one disorder and focus on available resource for Generalized Anxiety Disorder and posttraumatic stress disorder. Summarize your finding of the resource available for the disorders and what you found from the website. This will be a 1-page summary of what is available and a description of the resource- how to use it and any other information that is important. use the attached textbook and 2 other source.

3. Develop a one-page nursing Teaching Sheet, which will include 4 of the most important things to teach a client with an Anxiety Disorder and Social Phobia. Make sure to reference the source that you used- you many want to use the attached textbook and 2 other source. Mental Health Disorder In Nursing Essay

Auditory hallucinations for some people suffering mental disorder are frequently experienced as alien and under the influence of some external force. These are often experienced as voices that are distressing to the individual and can cause social withdrawal and isolation. Although auditory hallucinations are linked with major mental illnesses such as schizophrenia, it also occurs in people who have not been diagnosed with any mental illness (Coffey and Hewitt 2008). The annual incidence is estimated between 4-5 percent (Tien 1991), with those experiencing voices at least once, estimated between 10-25 percent (Slade & Bentall 1988).The standard professional response to voice hearing has been to label it as characteristic of illness and to prescribe anti-psychotic medication (Leudar & Thomas 2000). However, Romme and Escher (1993) view the hearing of voices as not simply an individual’s psychological experience, but as an interaction, reflecting the nature of the individual’s relationship with his or her own social environment. In this way, voices are interpreted as being linked to past or present experiences and the emphasis is on accepting the existence of the voices. However, the cause of schizophrenia is unknown; most experts deem that the condition is caused by a combination of genetic and environmental factors (Szas, 1988).

This dissertation will aim to discuss the experience and management of auditory hallucinations in schizophrenia looking into therapeutic relationship, helping approaches, and working towards the ending of a therapeutic relationship discussing discharge. Mental Health Disorder In Nursing Essay

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First chapter will aim to explain what schizophrenia is, the cause of schizophrenia, its symptoms and types with particular focus on auditory hallucinations. The chapter will then discuss what auditory hallucinations are in the diagnosis.

Therapeutic relationship between service user and the nurse is paramount in mental health nursing and is seen to prove long term outcome such as social functioning (Svensson and Hansson 1999). Chapter two will aim to discuss the building of therapeutic relationship in the management of auditory hallucinations using Peplau’s interpersonal relations model (1952).

The importance of holistic assessment using a variety of tools, scales and questionnaires that will identify symptoms, risks, management of risk and address the service users needs will be discuss in chapter three. Mental Health Disorder In Nursing Essay

Chapter four of this dissertation will discuss helping approaches. Gray et al (2003) states that pharmacological and psychosocial interventions have been heavily researched to find the most up to date literature and recommendations for the management of auditory hallucinations in schizophrenia with medication and Cognitive Behavioural Therapy (CBT).. The final chapter will aim to discuss the ending of the therapeutic relationship between the nurse and the service user looking into discharge planning process and conclusion. Mental Health Disorder In Nursing Essay

Chapter one
What is Schizophrenia and Auditory Hallucinations?
Introduction to chosen topic
Schizophrenia is one of the terms used to describe a major psychiatric disorder (or cluster of disorders) that alters an individual’s perception, thoughts, affect and behaviour. Individuals who develop schizophrenia will each have their own unique combination of symptoms and experiences, the precise pattern of which will be influenced by their particular circumstances (NICE 2010).

Allen et al (2010) define schizophrenia as a chronic and seriously disabling brain disorder that produces significant residual cognitive, functional and social deficits. Schizophrenia is considered the most disabling of all mental disorders (Mueser and McGurk, 2004), it occurs in about 1% of the world population, or more than 20 million people worldwide (Silverstein et al., 2006). Mental Health Disorder In Nursing Essay

The DSM -IV – TR (American Association of Psychiatry (APA) 2000) defines schizophrenia as a persistent, often chronic and usually serious mental disorder affecting a variety of aspects of behaviour, thinking, and emotion. Patients with delusions or hallucinations may be described as psychotic. However, Tucker (1998) argues that the system of classification developed by the DSM-IV does not actually fit many patients as a whole; the syndromes outlined in DSM-IV are free standing descriptions of symptoms. He said unlike diagnoses of diseases in the rest of medicine, psychiatric diagnoses still have no proven link to causes and cures; Tucker argues that there is no identified etiological agents for psychiatric disorders.

Schizophrenia is characterized by clusters of positive symptoms (e.g. hallucinations, delusions, and/or catatonia), negative symptoms (e.g. apathy, flat feet, social withdrawal, loss of feelings, lack of motivation and/or poverty of speech), and disorganized symptoms (e.g. formal thought disorder and/or bizarre behaviours). In addition, individuals with schizophrenia often experience substantial cognitive deficits including loss of executive function, as well as social dysfunction (Allen et al., 2010). It is estimated that nearly 75% of people with schizophrenia suffer with auditory hallucinations (Ford et al., 2009). Mental Health Disorder In Nursing Essay

It is suggested that one of the many symptoms of this disorder is hallucinations. It is put forward that hallucinations takes place when a person experiences a sensation in any form of sensory modality when there is nothing or nobody there to account for it (Green, 2009). There are several types of hallucinations olfactory, tactile, gustatory, cenesthetic, kinesthetic, visual and auditory (Kasper, 2003).

One of many forms of hallucinations is an olfactory hallucination, which relates to smells or odours. They can be particular scents like urine, or involve more general odours like a rotting smell (Blom and Sommer, 2011). Another is a tactile hallucination, which is characterised by a feeling of skin sensations, such as bugs crawling on arms and legs or electric shocks. This type of hallucination is rare in schizophrenia (Vidbeck, 2010). A different form of hallucination is a gustatory hallucination, these are concerning taste, were the sufferer either has specific taste in the mouth or a food tastes like something else (Campbell, 2009).

In addition there are also cenesthetic hallucinations, which are when the sufferer feels the physical functions that are ordinarily imperceptible like signals going to and from the brain (Sadock and Sadock, 2008). A further different form of hallucination is a kinesthetic hallucination, this is when a sufferer is motionless but reports that their body is moving, for instance floating off the ground, bed or chair (Thornhill, 2011). More commonly reported experiences are visual hallucinations which are when somebody sees something that is not there. Such as a person, object or commonly flashing lights (Kaufman, 2011). A further form of hallucination is an auditory hallucination; this is when a person experiences a sensation where they believe they can hear voices or noises. Sometimes these voices can be commanding and make the person suffering from the hallucination do things that are generally out of character (Joppich, 2009). Mental Health Disorder In Nursing Essay

The focus of this dissertation is the management of auditory hallucination in schizophrenia for more on schizophrenia see appendix 1.

Auditory hallucinations in diagnosis
Auditory hallucinations are often considered symptomatic of people diagnosed as suffering from schizophrenia (Millham and Easton, 1998). The American Association of Psychiatry (APA 1994, p.767) defines hallucinations as “a sensory perception that has the compelling sense of reality of a true perception but that occurs without external stimulation of the relevant sensory organ. Auditory hallucinations range from muffled sounds to complete conversations and can be experienced as coming either from within or from outside ones self (Nayani & David, 1996). However, Stanghellini and Cutting (2003) argue that APA definition of hallucinations is false, they believe an auditory hallucination is not a false perception of sound but is a disorder of self consciousness that becomes conscious. Hearing voices is not only linked to a person’s inner experience but can reflect a person’s relationship with their own past and present experiences (Romme and Escher, 1996). Beyerstein (1996) suggests that voices are anything that prompts a move from word based thinking to imagistic or pictorial thinking predisposes a person to hallucinating. Mental Health Disorder In Nursing Essay

Auditory hallucinations, or hearing sounds or voices are the most common and occur in nearly 75 percent of individuals diagnosed with schizophrenia (Ford et al., 2009). Auditory hallucinations are often derogatory or persecutory in nature, and can be heard in the third person, as a running commentary, or as audible thoughts. Some individuals with schizophrenia also experience useful or positive voices that give advice, encourage, remind, and help make decisions, or assist the person in their daily activities (Jenner et al., 2008).

Voice hearers can work with their voices and either choose what to listen to or can completely ignore them (Romme et al., 1992). Sorrell et al (2009) states that some individuals experience positive voices which do not affect the way they function or go about their daily living, these hearers also find that their voices may offer advice and guidance. The hearer’s voice can be reported as a little distressful or some go on to report no distress at all (Honig et al., 1998). However Nayani and David (1996) argues that individuals who experience a constant negative voice found them difficult to control, they found the voice more powerful and attempt to ignore the voice often fail. Chadwick et al (2005) said that those who resist voices or feel the need to argue or shout back are seen as harmful/evil(exhibiting ill will), those who think voices are good and engage with them are seen as kind , they see voices are helping them so they tend to listen and follow advice. Mental Health Disorder In Nursing Essay

Not all auditory hallucinations are associated with mental illness, and studies show that 10 to 40 percent of people without a psychiatric illness report hallucinatory experiences in the auditory modality (Ohayon, 2000). A range of organic brain disorders is also associated with hallucinations, including temporal lobe epilepsy; delirium; dementia; focal brain lesions; neuro- infections, such as viral encephalitis; and cerebral tumours intoxication or withdrawal from substances such alcohol, cocaine, and amphetamines is also associated with auditory hallucinations (Fricchione et al., 1995)

There is also evidence that delusion formation may distinguish psychotic disorders from non clinical hallucinatory experiences. In other words, the development of delusions in people with auditory hallucinations significantly increases the risk of psychosis when compared with individuals who have hallucinations but not delusions. Auditory hallucinations may be experienced as coming through the ears, in the mind, on the surface of the body, or anywhere in external space. The frequency can range from low (once a month or less) to continuously all day long. Loudness also varies, from whispers to shouts. The intensity and frequency of symptoms fluctuate during the illness, but the factor that determines whether auditory hallucinations are a central feature of the clinical picture is the degree of interference with activities and mental functions (Waters, 2010) Mental Health Disorder In Nursing Essay

The most common type of auditory hallucinations in psychiatric illness consists of voices. Voices may be male or female, and with intonations and accents that typically differ from those of the patient. Persons who have auditory hallucinations usually hear more than one voice, and these are sometimes recognized as belonging to someone who is familiar (such as a neighbour, family member or TV personality) or to an imaginary character (God, the devil, an angel). Verbal hallucinations may comprise full sentences, but single words are more often reported. Voices that comment on or discuss the individual’s behaviour and that refer to the patient in the third person were thought to be first-rank symptoms and of diagnostic significance for schizophrenia (Schneider, 1959). Studies show that approximately half of patients with schizophrenia experience these symptoms (Waters, 2010). Mental Health Disorder In Nursing Essay

Waters (2010) says a significant proportion of patients also experience non verbal hallucinations, such as music, tapping, or animal sounds, although these experiences are frequently overlooked in auditory hallucinations research. Another type of hallucination includes the experience of functional hallucinations, in which the person experiences auditory hallucinations simultaneously through another real noise (e.g., a person may perceive auditory hallucinations only when he hears a car engine). The content of voices varies between individuals. Often the voices have a negative and malicious content. They might speak to the patient in a derogatory or insulting manner or give commands to perform an unacceptable behaviour. The experience of negative voices causes considerable distress. However, a significant proportion of voices are pleasant and positive, and some individuals report feelings of loss when the treatment causes the voices to disappear (Copolov et al., 2004).

The exact processes that underlie auditory hallucinations remain largely unknown. There are two principal avenues of research: one focuses on neuro anatomical networks using techniques such as positron emission tomography and functional Magnetic Resonance Imaging (MRI). The other focuses on cognitive and psychological processes and the exploration of mental events involved in auditory hallucinations. A common formulation suggests that auditory verbal hallucinations represent an impairment in language processing and, particularly, inner speech processes, whereby the internal and silent dialogue that healthy people engage in is no longer interpreted as coming from the self but instead as having an external alien origin. There is support for this language hypothesis of auditory hallucinations from neuro imaging studies. These show that the experience of auditory hallucinations engages brain regions, such as the primary auditory cortex and broca area, which are associated with language comprehension and production. This suggests that hallucinatory experiences are associated with listening to external speech in the absence of external sounds (Waters, 2010) Mental Health Disorder In Nursing Essay

Frith (2005) says the reason these experiences are not perceived as self-generated facts is that individuals who have the hallucinations fail to distinguish between internal and external events. This arises because of deficits in internal self-monitoring mechanisms that compare the expected with the actual sensations that arise from the patient’s intentions. This abnormality also applies to inner speech processes and leads to the misclassification of internal events as external and misattribution to an external agent. However, Bentall and Slade (1985) suggest that individuals with hallucinations use a different set of judgment criteria from healthy people when deciding whether an event is real, and they are more willing to accept that a perceptual experience is true. This bias essentially involves a greater willingness to believe that an event is real on the basis of less evidence. Mental Health Disorder In Nursing Essay

According to the context memory hypothesis of auditory hallucinations, the failure to identify events as self-generated arises because of specific deficits in episodic memory for remembering the details associated with particular past memory events. These specific deficits in memory cause confusion about the origins of the experience (Nayani and David, 1996). Patients with auditory hallucinations tend to misidentify the origins and source of stimuli during ongoing events and during memory events (Waters et al., 2006). The lack of voluntary control over the experience is a key feature of auditory hallucinations, which might explain why self-generated inner speech is classified as external in origin (Copolov et al., 2003). Hallucinations are experienced when verbal thoughts are unintended and unwanted. Because deficits in cognitive processes, such as inhibitory control, are thought to render people more susceptible to intrusive and recurrent unwanted thoughts, studies have linked auditory hallucinations with deficits in cognitive inhibition (Waters et al., 2006). Mental Health Disorder In Nursing Essay

Recent advances in the neurosciences provide clues to why patients report an auditory experience in the absence of any perceptual input. Spontaneous activity in the early sensory cortices may in fact form the basis for the original signal. Early neuronal computation systems are known to interpret this activity and engage in decision-making processes to determine whether a percept has been detected. A brain system that is abnormally tuned in to internal acoustic experiences may therefore report an auditory perception in the absence of any external sound (Deco and Romo, 2008). Ford et al., (2009) suggested that patients with auditory hallucinations may have excessive attentional focus toward internally generated events: the brains of persons who have auditory hallucinations may therefore be over interpreting spontaneous sensory activity that is largely ignored in healthy brains.

Patients suffering from auditory hallucinations sometimes can not distinguish between what is real and what is not real, it is very important to build a trusting therapeutic relationship with the sufferer. This dissertation will go on to explore the importance of building a therapeutic relationship with a patient; To explore the extent of auditory hallucinations a patient may be experiencing it is important that an appropriate assessment and risk management are carried out, exploring the need for assessment and risk management in auditory hallucinations, It will also look into helping approaches discussing pharmacological and psychosocial approaches in the management of auditory hallucinations and how to end the therapeutic relationship between a service user and the nurse, looking into discharge planning. Mental Health Disorder In Nursing Essay

CHAPTER TWO
DEVELOPMENT OF THERAPEUTIC RELATIONSHIP
Development of the Therapeutic Relationship
Peplau’s theories laid the ground for ascendancy of the relationship as the key context for all subsequent interventions with patients (Ryan & Brooks, 2000). Although the idea of the relationship endures as the paradigm for psychiatric nursing (Barker, Jackson, & Stevenson, 1999a; 1999b; Krauss, 2000; Raingruber, 2003), it does not appear there is any universal consensus on exactly how to frame this relationship. The nurse-patient relationship can be defined as an” ongoing, meaningful communication that fosters honesty, humility, and mutual respect and is based on a negotiated partnership between the patient and the practitioner” (Krauss, 2000, p. 49).

Peplau describes nursing as a therapeutic interpersonal process that aims to identify problems and how to relate to them (Peterson and Bredow 2009). Forster (2001) defines therapeutic relationship as a trusting relationship developed by two or more individuals. However, Jukes and Aldridge (2006) says at first sight therapeutic nursing and the therapeutic relationship may seem relatively easy to define, but once we scrape the surface we find a complex range of ideas and concepts that stem from philosophies, ideologies and individual therapies. Sometimes there are difficulties in applying these definitions to our own work. Not least of these difficulties is the relevance of the concept of ‘therapy as healing’ to nursing. This begs the question of whether a therapeutic relationship always entails the use of a therapy, or whether there is something more universal and fundamental in therapeutic relationships. It seems important therefore to attempt a workable definition of the therapeutic relationship that has currency within nursing as a whole. Additionally, it seems that therapeutic nursing has two facets. The first of these, and probably the most apparent, is the emotional and interpersonal aspect, which we might call ‘therapeutic nursing as an art’. The second is the more logical and objective aspect, which we might call ‘The therapeutic nursing as a science’. Arguably, there is a synergy between the two that leads to a gestalt, and therefore a need to address both aspects if our nursing is to be truly therapeutic in a holistic sense. Mental Health Disorder In Nursing Essay

Peplau’s theory focuses on the nurse, the patient and the relationship between them and is aimed at using interpersonal skills to develop trust and security within the nurse-patient relationship. Therapeutic relationships are the corner stone of nursing practice with people who are experiencing threats to their health, including but not restricted to those people with mental illness (Reynolds 2003). The relationship of one to one of nurse – patient has potential to influence positive outcome for patients. Hildegard Peplau interpersonal relations overlap over four phases namely: Orientation, Identification, Exploitation and Resolution. Mental Health Disorder In Nursing Essay

Peplau also identify that during the four overlapping phases nurses adopts many roles such as- Resource person: giving specific needed information that aids the patient to understand his/her problem and their new situation. A nurse may function in a counselling relationship, listening to the patient as he/she reviews events that led up to hospitalization and feeling connected with them. The patient may cast the nurse into roles such as surrogate for mother, father, sibling, in which the nurse aids the patient by permitting him/her to re-enact and examine generically older feelings generated in prior relationships. The nurse also functions as a technical expert who understands various professional devices and can manipulate them with skill and discrimination in the interest of the patient (Clay 1988).

The orientation phase is the initial phase of the relationship where the nurse and the patient get to know each other. The patient begins to trust the nurse. This phase is sometimes called the stranger phase because the nurse and the patient are strangers to each other (Reynolds 2003). Mental Health Disorder In Nursing Essay

Peplau’s (1952) suggest that during this phase early levels of trust are developed and roles and expectation begin to be understood. It is important that during this time that the nurse builds a relationship with the patient by gaining their trust, establishing a therapeutic environment, developing rapport and a level of communication expectable to both the patient and the nurse. During the orientation phase trust and security is supposed to be developed between the nurse and the patient. Mental Health Disorder In Nursing Essay

Co-ordination of care and treatment of patient while using an effective communication between the MDT is a nurse role. The nurse also acts as an advocate/surrogate for a patient and promotes recovery and self belief. Essential communication skills are deemed to be listening and attending, empathy, information giving and support in the context of a therapeutic relationship (Bach and Grant 2009). Building a therapeutic relationship needs to focus on patient -centred rather than nurse-task focus.

Bach and Grant (2009) say interpersonal relationship describes the connection between two or more people or groups and their involvement with one another, especially as regards the way they behave towards and feels about one another. Communication is to exchange information between people by means of speaking, writing or using a common system of signs or behaviour. Faulkner (1998) suggested that Rogers (1961) client centred approach conditions can be seen as important factors that contributes to a therapeutic relationship. Rogers (1961) three core conditions are: congruence, empathy and unconditional positive regards. Mental Health Disorder In Nursing Essay

Congruence means that the nurse should be open and genuine about feelings towards their patient. Having the ability to empathise with the patient would show that the nurse has the ability to understand the patient’s thoughts and feelings about their current problem. Unconditional positive regards is viewing them as a person and focusing on positive attributes and behaviour (Forster 2001). The orientation phase also gives the nurse the chance to asses the patient’s current health and once the assessment has been carried out the can then move the relationship forward to the identification phase. The identification phase is where the patient’s needs are identified through various assessment tools. Assessment will be discussed in detail in the next chapter. Butterworth (1994; DH 1994a; DH 2006a) says that during the identification phase the nurse and the patient will both work together discussing the patient’s identified needs, needs that can be met and those that cannot be met. They will also identify risks and how to manage the risks and aim to formulate a care plan. Butterworth said the care plan should focused on the patient’s individual needs, long and short term goals and their wishes, whilst being empowered at all times to make informed decisions and choices that matter in their care. Mental Health Disorder In Nursing Essay

Collaborative working between multi-agencies ensures the needs of the patient are being met through appropriate assessment and treatment under the Care and Treatment Plan (CTP). The Care and Treatment Plan is one of a number of new rights delivered by the Mental Health (Wales) Measure (2010). The Measure also gives people who have been discharged from secondary mental health services the right to make a self referral back for assessment and it extends the right to an Independent Mental Health Advocate to all in-patients. A care co-ordinator must ensure that a care and treatment plan which records all of the outcomes which the provision of mental health services are designed to achieve for a relevant patient is completed in writing in the form set out (Hafal, 2012).

The Sainsbury Centre for Mental Health (Rose 2001) found that patients are often not involved in the care planning process and many service users were not even aware of having a care plan.

The exploitation phase is where interventions are implemented from the needs and goals set out in the identification phase which enables the service user to move forward, these interventions will assist in managing auditory hallucinations, whilst educating the patient and family members about the illness. Helping approaches will be discussed in detail in the next chapter looking at various up to date interventions available for the management of auditory hallucinations. Mental Health Disorder In Nursing Essay

A trusting relationship can help with recovery and during these interlocking phases is what the nurse and the patient are aiming for (Hewitt and Coffey, 2005). Building of a trusting therapeutic relationship is essential for nursing interventions to work (Lynch and Trenoweth, 2008). Nurses need to be sensitive, show compassion at all times and understanding to a patient’s needs. Nursing interventions needs to address physical, psychological and social needs; this involves having holistic approach (Coleman and Jenkins, 1998). Nurses need to work with the best evidence based therapeutic treatment available, this then being a positive approach to care (NMC 2008). The Chief Nursing Officer (CNO) review of the Mental Health Nursing (2006) noted that to improve quality of life, service users risks need to be managed properly, whilst promoting health, physical care and well being. However, Hall et al., (2008) argues that the CNO review does not take into consideration the great pressure nurses are under and also the complex needs of the service user. Mental Health Disorder In Nursing Essay

Therapeutic interventions are an important aspect of recovery (Gourney 2005). Recovery can be described as a set of values about the service user’s right to build a meaning life for themselves without the continuous presence of mental health symptoms (Shepherd et al., 2008). The purpose of recovery is to work towards self determination and self confidence (Rethink 2005). National Institute for Mental Health in England (NIMHE, 2005) described recovery as a state of wellness after period of illness. Nurse need to provide a holistic view of mental illness with a person centred approach that can work towards the identification of goals and offer the patient appropriate support through interventions like CBT, family therapy and coping skills, this will enable the patient to be at the centre of their own care, thus taking responsibility for their own illness and improve quality of life. Service user who have a full understanding and accept their illness can engage more with therapies and interventions with the necessary support from professionals, this then leads to self determination and better quality of life (Cunningham et al., 2005). However, Took (2002) says it is important to remember that with a service user experiencing auditory hallucinations, their mood and engagement can fluctuate and also the side effect of prescribed medication can affect this which may slow down the recovery process.

Early intervention is also recognised to improve long term outcomes of auditory hallucinations in schizophrenia (McGorry et al., 2005: NICE 2009). However, not all service users will seek advice when first experiencing symptoms, due to stigma attached to mental illness and fear of admission to hospital (French and Morrison 2004). Some service users have also complained that the hospital has a non therapeutic environment and that they also feel unsafe and in an orison like setting (SCMH 1998, 2005; DoH 2004b). Drury (2006) says that service users felt that some professionals lacked compassion. Mental health nurses are encouraged to adopt a client centre approach, some research suggests nurses lack empathy and have general uncaring attitude (Herdman 2004). Mental Health Disorder In Nursing Essay

The final phase of Peplau’s theory is the resolution phase. This is where the nurse and the service user will end their professional relationship. The relationship can end either through discharge or death. For the purpose of this dissertation the ending of the relationship that will be discussed at a later chapter will be discharge.

Therapeutic relationship is seen as paramount during these interlocking phases of peplau’s interpersonal relations theory, nurse’s needs to promote the service users independence whilst treating them with respect, privacy and dignity. By identifying treatment goals, implementing and evaluating treatment plans the service user can move on to interventions that will help them manage and cope with auditory hallucinations. Mental Health Disorder In Nursing Essay

Chapter 3
Assessment of a patient with Auditory Hallucinations
Assessment of Auditory Hallucinations
Assessment is the decision making process, based upon the collection of relevant information, using a formal set of ethical criteria, that contributes to an overall estimation of a person and his circumstances (Barker 2004). Hall et al (2008) described assessment as one of the first steps to the nursing process; it is also part of care planning and a positive foundation for building a relationship and forming therapeutic alliance. It is an ongoing process that enables professional to gather information that allows them to understand a person’s experience. Mental Health Disorder In Nursing Essay

Most assessments have similar aims. However, how assessments are conducted can vary enormously. Such differences are very important and can influence greatly the value of the information produced (Barker 2004). In Wales, Care and Treatment Plan (CTP) was introduced under the Mental Health (Wales) Measures 2010. CTP means a plan prepared for the purpose of achieving the outcomes which the provision of mental health services for a relevant patient is design to achieve and ensures service users have a care plan, risk assessment and a care co-ordinator to monitor and review their care (see appendix one). NICE (2010) suggest that assessment should contain the service user’s psychiatric, psychological and physical health needs and also include current living arrangements, ethnicity, quality of life, social links, relevant risk and other significant factors that may affect the service user’s quality of life. Mental Health Disorder In Nursing Essay

Assessment of a patient relies upon the collection of information through interviewing: the patient, member of their family, direct observation of the nurse, questionnaire, rating scales, and previous history (Previous records). However, Barker (2004) argues that despite the importance of the history, if relied upon as the sole method of assessment, not only may the final picture of the patient be of a doubtful accuracy but it may also lack the fine detail necessary for the planning of care or evaluating progress. Mental Health Disorder In Nursing Essay

Direct observation is an important assessment skill; during observation the nurse can identify a service user hearing or responding to voices, this would be observed through non-verbal communication and behaviours (Trevithick 2005). Lamph (2010) suggested that engaging with a service user who is experiencing voices maybe difficult due to them being preoccupied with the voices or suspicious of the nurse’s motive. It is understandably a difficult and distressing time for the service user; open ended questioning techniques can work towards holistic assessment. It is not only distress that is caused through hearing voices but additionally the beliefs the service user may hold about them (Chadwick and Birchwood 1994; 1995). A service user experiencing voices maybe thinking that the nurse does not understand what it is like to hear them, it is therefore essential for the nurse to empathise with them at all times throughout assessment. Mental Health Disorder In Nursing Essay

There are different types of tools and aid that can assist in identifying auditory hallucinations but before discussing them, the importance of risk assessment and risk management will be discussed first. These tools will also be related to assessment of risk as they should identify existence, content, and nature of voices that may have bearing on risk.

Risk can be defined as the probability that negative consequences will follow an action or as the likelihood of adverse outcome after a particular event (Woods 2001). Identifying risk is the ability to assess the likelihood of an event occurring, rate severity if event occurs and take appropriate action whilst evaluating the identified risk and re-assessing (Doyle 1999). However, Baker (2004) argues that risk assessment is driven by fear of litigation, or a professional or institutional obligation to abide by specific legislative requirements; what the behaviourist called negative reinforcement. He said the risk is that staff will become overburdened by paperwork, lose sight of the person, the vogue for using standardized risk assessments or checklist are but two examples of this unfortunate although, given the political climate, understandable shift in organizational priorities. Mental Health Disorder In Nursing Essay

Risk can include harm to self (deliberate or accidental), suicide, self neglect, harm to others, alcohol, substance related misuse and social vulnerability (DH 2007).

Risk assessment is an integral part of assessing, planning, reviewing the risk of patients and risk they may pose to other people (DOH, 2008). The Mental Health Policy Implementation Guide (DOH, 2007) specifies the importance of service user centred assessment of needs and risks carried out using established methods and procedures for measuring symptoms, risk and social functioning; Risk assessment should contain a full multidisciplinary assessment of the service user’s full history, needs, risk management, crisis and contingency planning. Risk assessment should also work within the Department of Health best practice guidelines (DOH 2007). Mental Health Disorder In Nursing Essay

Although there is no statutory risk assessment with the CTP, however there are many tools, variety of rating scales and interviews that can be used to assess the severity of auditory hallucinations, symptoms of psychosis, risks and how to manage them. Gamble and Brennan (2000) says questionnaires for psychotic symptoms have been developed through research and are seen as valid tools of measurement, however they said questionnaires should be used selectively and not primarily because they are there, if there is a particular need or symptom to assess then a relevant tool should be appropriately used.

Auditory Hallucinations Rating Scale (AHRS) (Haddock 1994, appendix two) is an additional questionnaire used by professionals during assessment primarily designed to identify voices individuals are experiencing over a period of time, frequency, duration, loudness and amount of distress or intensity are discussed including the number of voices a person maybe experiencing. Mental Health Disorder In Nursing Essay

Another tool to aid assessment of person hearing voices is the Beliefs about voices Questionnaires revised (BAVQ-R) (Chadwick and Birchwood 1994, appendix three). The BAVQ-R is an assessment tool used in reviewing what the service user thinks about the voices they experience. During the assessment the service user is questioned about their belief on the voice they are hearing and the information gather from the service user is used to get an accurate picture of the voice they hear. Chadwick and Birchwood (1995) suggests that this tool causes the least distress with voice hearers when engaging with them and it improves communication with the professional as the questions are not so intrusive and challenging.

The KGV scale (Krawiecka, Goldenberg and Vaughan Manchester 1977) (appendix four) is another tool used to aid assessment of auditory hallucinations; it is a structured interview that focuses on fourteen areas of symptoms to discuss ranging from symptoms that includes hallucinations, anxiety, depression that is measured on a scale ranging from 0-5 from absent to severe.

Another tool to aid assessment is the Psychiatric Symptom Rating Scale (PSYRATS) (Haddock et al., 1995, appendix five) is a tool that measures severity and intensity of dimensions in auditory hallucinations. It comprises of 11 items on hallucinations and 6 items on delusions. They are rated on a scale 0-5. Drake et al., (2007) says that this scale is commonly used in psychiatry and can review outcomes of interventions; it is also well tested for validity and well researched. Mental Health Disorder In Nursing Essay

The Positive and Negative Syndrome Scale (PANSS) (Kay et al., 1987 appendix six) this scale can be used to assess the severity of auditory hallucinations. The scale has 30 items that includes 7 positive and 7 negative symptoms and 16 general psychopathology items; these are then scored on a 1-7 point severity scale, 1 being absent and 7 being severer (Kay, Opler and Lindenmayer 1989).All the tools mentioned are the most common ones used in the aid of assessing auditory hallucination but there are many others too.

Through good communication and interaction service user can begin to work towards common goals and that through these interactions, an agreement can be made which assists in achieving these goals (Lafferty and Davidson 2006). Once all necessary assessments have been carried out a CTP can be formulated. Assessment is a constant process and has become an important part of clinical practice (WAG 2005). Harrison et al., (2004) says plan of care will have to be regularly evaluated to identify a change in needs. Care plans should also indicate who was responsible for implementing the treatment required within a specified time frame.

Townsend (2007) said assessment tools can be used to re-assess the level of voices an individual is experiencing; this will then identify whether there has been a reduction in voices and whether current care plans in place are effective. Nurses have a responsibility to deliver care on the best available evidence or best practice (NMC 2008). For a care plan to be effective there needs to be relevant evidence based treatment and interventions to assist in alleviating auditory hallucinations. The purpose of treatment is to improve the service the service user’s quality of life and prevent relapse (APA 2000). Mental Health Disorder In Nursing Essay

My interview is with a 27 year old male nurse by the name of Ryan Eads who has had experience with the mental health for the past 10 years. Eads is currently employed in Rockford IL, at Swedish American Hospital. Prior to our interview I researched online just what questions to ask and familiarize myself on basic terms to better understand what Mr. Eads would be informing me of.
While researching I found that Psychiatric nursing encompasses a fully holistic care model. A Psychiatric mental health (PMH) nurse must assess and integrate a patient’s medical, physical, social, cultural, socioeconomic, etc. considerations with his /her mental health concerns. Psychiatric nursing is equal parts knowledge, compassion, and intuition leveraged by experience. Psychiatric nurses deliver care with a planned emphasis on addressing the very areas of health and the mind that other nursing and medical disciplines view as an afterthought or footnote to the priority of physical/biological care. Psychiatric nurses, by helping a client to improve and positively progress in their mental health, can impact that client’s ability to maintain healthy lifestyles, medical regimens, employability, community integration and productivity. Psychiatric nurses are essential to the real-time enhancement of their client’s quality of life.
Q. Mr. Eads what does a PMH nurse do on an average day?
A. An average day as a PMH nurse consists of report and rounds with my fellow nurses. Talking with/assessing each Mental Health Disorder In Nursing Essay