Nursing Assignment: Analysing Self-Care Strategy For A Patient

Question

Task:
Case Study Scenario

Charlie is a 24 year old married female with a diagnosis of Bipolar disorder (Type I). Charlie has a history of physical abuse as a child and previous family violence from a long term relationship prior to her marriage. She currently lives in private accommodation with her husband and works full time in the banking sector. She is currently treated with medications as well as engaging in private psychotherapy.

Charlie has presented with a relapse of manic symptoms for the last 7 days including:

• Labile mood
• Overt sexualised themes at times
• Poor sleep and appetite
• Psychomotor Agitation

At times Charlie has been accepting of medications and is able to be managed in the least restrictive manner as a voluntary consumer in the community. Charlie has recently shown a relapse of her illness and has required an inpatient admission. This is due to an increase in psychosocial stressors and intermittent compliance with her medications. Charlie has been managed in the low dependency side of the inpatient unit as a voluntary consumer for 5 days. Julie (her primary nurse) has built rapport with Charlie through repetitive engagements and her husband through phone calls and discussions. Over the last 24 hours Charlie has declined substantially in her mental state with an exacerbation in her overt sexualised themes by disrobing in communal areas of the inpatient unit, making inappropriate sexualised comments to clinicians and is at significant risk to reputation and self. Charlie has also become increasingly irritable and aggressive making verbal threats to assault various staff and co consumers. She has also directed several personal abusive remarks towards Julie. She has said several times to Julie “how would you understand” and has become insightless regarding being unwell telling Julie “I am fine it is all you that are unwell I just want to go home”. She has also refused all medications and has not had any medications over this 24 hour period.

Due to Charlie’s current presentation and increase risks she has been placed under the Mental Health Act and transferred into the High Dependency Unit (HDU)/Intensive Care Area (ICA) during the morning. Julie has been allocated as the lead nurse in this section and is allocated Charlie for her shift in the afternoon. This is the first time Julie has nursed Charlie since being transferred to the HDU/ICA. Julie approaches Charlie at the commencement of her shift with the aim to have a discussion regarding what has been happening over the last 24 hours. Charlie escalates in behaviour further, resulting in Julie discussing the matter with the Nurse in Charge and the plan is made for Charlie to be taken to seclusion for the safety of herself and staff. Julie is allocated the role of communicator during the planned code grey.

On approach to inform Charlie of what is happening Charlie attempts to strike out at Julie requiring physical restraint whilst being transferred to seclusion. During this period Charlie continues to verbally abuse and threaten Julie and says “You know what I have been through and what has happened to me. How could you do this to me”.

Nursing Assignment Task:

1. During the physical restraint and seclusion Charlie screams at Julie that it is her fault she is being restrained and secluded and blames her for what is happening. This can be a confronting situation for nursing staff to experience whilst attempting to continue verbal engagement. By looking at self-awareness and therapeutic use of self, identify and explore a possible communication style Julie could utilise in this confronting and heightened situation.
2. Julie continues with her shift and returns home. Julie finds herself ruminating and unsettled regarding this incident. Julie is also experiencing negative self talk and concern regarding traumatisation to Charlie. Identify one (1) evidence based self care strategy that Julie could implement to manage what she is experiencing currently.

Answer

Introduction
Nursing incorporates collaborative and autonomous care of people of all families, ages, communities, and groups. Additionally, it includes health promotion, illness prevention, as well as care of dying, disabled and ill people. The purpose of this nursing assignment is to analyse a case study of an individual as well as providing self-care strategies to manage that individuals' health condition. At first, this assignment discusses appropriate communication style for confronting the issue of the selected patient. Then it identifies and analyses an appropriate self-care strategy so that the selected patient can manage the current situation.

Identification and application of selected theoretical communication
In this assignment, the selected case scenario is based on Charlie, who is a 24 year old married woman and suffering from Type-1 Bipolar Disorder. In order to treat Charlie effectively as well as establish an efficient communication with her, Julie needs to find an appropriate communication style. In this regard, research has found that patients with bipolar disorder (BD) require collaborative care approaches that involve psychiatrists, social workers, nurses, therapists, doctors, and different support for managing patients’ illness (Iennaco & Carbray, 2016). In this context, Stubbe (2015) elaborated that “participatory or collaborative communication style” between patients and nurses has a huge positive impact upon medication and treatment adherence. This particular communication style encourages mutual exchange of information amongst nurses and patients as well as highlights listening to each other’s perspective and considers treatment partners to solve problems and resolve conflicts. Moreover, this communication style emphasises active participation of patients in order to treat their treatment procedure. Since Charlie made inappropriate sexualised comments towards clinicians, the collaborative communication style would help to build a strong connection between nurse and patient and would help Charlie to understand using sexualised comments to co-patients and clinicians is not an appropriate behaviour.

The collaborative approach defines incorporating clinicians and nurses into primary healthcare setting so that nurses can improve patients’ mental and physical health (Cusack et al., 2016). In terms of treating patients with bipolar disorder, nurses considers collaborative care so that they can closely follow the symptoms of patients and based on that, offer appropriate treatment approaches. Since Charlie has a behavioural issue as she use abusive words, and became aggressive towards doctors, nurses and other co-patients, thus, collaborative care would be beneficial to integrate behavioural healthcare into the primary healthcare setting. The selected communication style allows patients to in their treatment process as well as life goal programs, where, nurses help to improve self-management skills of patients with the help of psycho education (Iennaco, & Carbray, 2016). In addition, it allows nurses to provide active outreaching care when patients are at huge risk of contact with the mental health workers.

Chakrabarti (2018) explained that collaborative communication styles allow nurses or healthcare providers to establish a strong communication with their patients and with help of this communication style nurses can come to the patients’ illness more readily and that is why patients felt confident to cope with the illness. Additionally, because of this style, patients can feel less ashamed and angry about their health issues as well as patients are more probable to adhere towards their medication routine. The scholar has also elaborated that collaborative and effective patient-nurse communication improves patients' health outcomes (Chakrabarti, 2018). Based on the information it can be discussed that Charlie was also going into a severe mental health condition and that is why she was being aggressive, impulsive and abusive towards staff, doctors, nurses and co-consumers. Therefore, collaborative communication style can be helpful for her and Julie can consider it while handling Charlie. Since Charlie was not taking medication for more than 24 hours, therefore, collaborative communication can help to take her medication on time because Julie can interact with her and highlight the significance of trust and honesty by specifying areas of choice, safety management plans confidentiality and treatment approach.

Chakrabarti (2018) and Cotrena et al. (2020) stated that collaborative communication for collaborative patient relationships is one of the great facets of treatment of bipolar disorder. Additionally, Fisher et al. (2018) stated that a trusting, collaborative and positive therapeutic relationship appears for enabling patients for accomplishing patients’ treatment and involvement preferences. The reason patients are more comfortable in collaborative communication style, is that nurses can build trust and allow patients to make decisions on their treatment process. Studies have found that when patients are allowed to make decisions regarding their treatment, they feel more comfortable and allow their nurses to take care of their health (Ryan et al., 2015). Conversely, when the therapeutic relationship between patient and nurse is precarious and patients tend to report poor outcomes such as poor adherence, lower preference-based decisions, and reduce decision-making autonomy.

Thus, based on the above discussion it can be discussed that in order to appropriately treat Charlie, Julie can consider “collaborative communication style” and manage her aggressive and abusive behaviour with help of continuous collaboration and communication.

Identification and analysis of selected self-care strategy
Since Julie experience verbal abuse and aggression, she finds this incident unsettling and ruminating and she was experiencing negative self-talk as well as being concerned about traumatisation to Charlie. Therefore, in order to cope with this situation, Julie needs to implement one self-care strategy. According to Hofmeyer et al. (2020) clinical teams for mental health treatment are more effective when nurses' morale is high as well as the patient satisfaction is high. Regarding treating a patient with bipolar disorder, nurse experience several issues, for example, patients’ aggression and verbal abuse. In order to cope with this situation, nurses need to have compassion and empathy within the healthcare cultures. Since Julie has considered collaborative communication style for treating Charlie, therefore, improvement of self-awareness ability can be an effective evidence-based self-care strategy for Julie. Lown (2018) stated that self-awareness is the capability of focusing on self and analyse in which ways own thoughts, actions and emotions align with internal standards. By developing self-awareness ability, nurses can confidently manage the challenging situations as well as provide patient-centric care from various orientations. Additionally, it can help nurses to build a strong and trusting connection with their patients who are experiencing mental health issues, especially patients with bipolar disorder (Vachon, 2016). When nurses improve their self-awareness capability, they can effectively create an environment that helps them to promote interpersonal relationship with patients. This again helps to understand patients’ situation, which can reduce the risk of experiencing aggressive and abusive behaviour from their patients.

Additionally, Vachon (2016) has stated regarding an effective self-care strategy, nurses need to understand “self-other” distinction, as well as they need to develop the ability for distinguishing between others and their own emotion so that they create a protective “self-other” boundary. By developing this self-awareness capability, nurses can nurse can get to know about their own self as an individual as well as understand how their belief, behaviour and attitude influence others. Hofmeyer et al. (2019) stated that inappropriate emotion regulation could lead to people being unable to tolerate their distressing emotions when they are confronted with others’ suffering. For example, some nurses can easily understand and evaluate own emotions and feelings and some requires conscious effort and time to develop their self-awareness capability. Therefore, it can be discussed that when nurses can develop self-awareness ability, they can easily understand their own and patients’ emotions and problems. It would again help to interact with patients and make a strong attachment with them (Mills et al., 2018). During this capability, nurses can effectively handle the situation, which again does not make a negative impact on their mind regarding this kind of situation.

Cusack et al. (2016) has stated self-awareness capability helps nurses to easily engage with “perspective taking” that contributes towards better psychological health as compared to ruminating about issues. Regarding improvement of self-awareness, nurses can consider meditation because it will ease their distress and strengthen attachment and resilience with patients (Berinato, 2020). According to the case study, when Charlie used abusive words against Julie as well as accused her because she secluded Charlie, Julie experienced negative self-talk that is why Julie felt demotivated. Therefore, during this type of situation having mindful awareness is important, because lack of self-awareness behaviour of nurses can result in self-judgement, isolation, self-criticism and over-identification. If Julie regularly experiences this kind of negative situation, it can affect her everyday lives, which would lead to failure, inadequacy in offering nursing care and personal suffering.

Therefore, from this entire information it can be discussed that Julie can improve her self-awareness capability because it would work as an effective self-care strategy. With the help of this care strategy, Julie can improve the bonding with Charlie, which again mitigates the risk of experiencing aggression and verbal abuse.

Conclusion
This nursing assignment aimed to analyse the case study of Charlie, who is suffering from bipolar disorder. This assignment has identified an appropriate communication style that Julie can use for confronting this situation. Additionally, it has offered an evidence-based self-care strategy for Julie for managing the negative issues she experienced during the treatment of Charlie. Thus, from this whole discussion, it can be concluded that a collaborative communication style would be beneficial to treat Charlie because this communication style would allow Julie to effectively build a trusting relationship with Charlie. Additionally, in order to manage this kind of negative situation, Julie needs to develop her self-awareness ability so that in future, if she encountered this kind of situation, she can easily cope with it.

References
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Chakrabarti, S. (2018). Treatment alliance and adherence in bipolar disorder. World journal of psychiatry, 8(5), 114. https://dx.doi.org/10.5498%2Fwjp.v8.i5.114

Cotrena, C., Branco, L. D., Shansis, F. M., & Fonseca, R. P. (2020). Predictors of quality of life in bipolar disorder: A path analytical study. Psychiatry Research, 285, 112846. https://www.sciencedirect.com/science/article/pii/S0165178119313770

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