The aim of this essay will be to investigate the different therapies and psychotherapies that can be implemented by a community psychiatric nurse to help Adam, a service user who lives alone and suffers from bipolar disorder. It will also explain how bipolar disorder symptoms, such as long periods of depression can become a communication barrier between Adam and the nurse. Additionally, it will explain how the nurse can use different skills and knowledge to positively approach Adam and overcome any communication barrier.
Along the way it will also analyze how psychological and psychosocial issues can affect Adam’s physically and emotionally, perhaps contributing negatively or aggravating his mental health. It will offer an analysis about the importance of alliances between the psychiatric nurse and the multidisciplinary team on Adam’s health promotion and wellbeing.
This project will undertake an evaluation on how Adam’s mental disorder and disabilities can be related to some contributory factors such as: lack of self- awareness, lack of family support, social stigma and financial struggles. There is an indication that such issues as alcohol misuse, poverty, family problems and homelessness are constantly growing in the population of mental health disorders patients admitted at hospital.
Adam suffers from bipolar disorder and can be deeply affected emotionally, and physically. NIMH proposes that “Bipolar disorder (formerly called maniac-depressive disorder) is a mental condition that causes unusual shifts in mood, energy, concentration, and ability to carry out day- to -day tasks”. It affects significantly the cognitive function of the person, impairing the way one may listen to others, process emotions and recognise who could potentially help. If left untreated, bipolar disorder can cause destructive and violent behaviour, interpersonal dysfunction and substance abuse. Some of these symptoms can explain why Adam is feeling misunderstood, presenting aggressive behaviour and is consuming alcohol excessively.
He also diagnosed as suffering of long periods of depression a condition that is linked to bipolar disorder and it´s symptoms. According to WHO. “Depression is a common mental disorder that presents with depressed mood, loss of interest or pleasure, decreased energy, low self-worth and poor concentration”. It can be affecting his ability to communicate with other people, engage in social activities and making him feel hesitant or hopeless about his referral to a rehabilitation centre.
All the symptoms that Adam presents because of bipolar disorder are considerably causing a negative impact in his life. At this stage Adam is seeking help and support to be able to build up his self-growth, establish his wellbeing and achieve his life objectives. According to Maslow’s needs theory “the individual is ready to act upon the growth needs if and only if the deficiency needs are met” Maslow. The psychiatric nurse is one of the key professionals that can use different skills and knowledge to work on the promotion of Adam´s health.
In order to help Adam, the community psychiatric nurse will have to consider that symptoms such as mood swings and challenge behaviour that are caused by bipolar disorder, can become a big communication barrier between them. In order to overcome that barrier, the nurse must know how to deal with Adam’s extreme moods. To prevail over that, nurse can implement an active listening technique, a methodology inside therapeutic communication that will help the health care to fully understand Adam’s situation and build up a strong relationship with him. Arnold and Underman Boggs agreed that “It involves a range of behaviours, such as using prompts or phrases to encourage the other person to speak more and observation of a variety of verbal and non-verbal cues. It involves reflection on what being said and understanding the person perspective”.
Across this communication process there are different ways in which the nurse can approach Adam and help him. For example, using calm body language, open-ended questions, avoiding arguments and keeping eye contact with him. The nurse’s attention must focus on his emotions and on the validation of his feelings, that way he will feel valued. He can also be encouraged to create a routine and set manageable goals under the nurse’s supervision. These are step that will gradually help Adam to become more independent and feels that he is in control of his life. All these supportive attitudes will help Adam to comprehend that the nurse is truly listening to him and is present to help.
The nurse can also support Adam through his long periods of depression when he is feeling low, withdrawn and worthless. These symptoms can make any communication attempt from the nurse’s side very difficult. Therefore, the communication skills of the health care will be of great significance to stablish an interaction with him during this period. Although connecting with Adam can be challenging. It is recommended that the nurse come across Adam offering him respect, an empathic look, presenting a positive language and compassionate attitudes.
This caring attitude can be achieved with the nurse adopting a form of open and safe connection called therapeutic relationship. This ongoing approach is considered as a very effective and valuable form of communication between nurses and clients, since it integrates a valuable form of patient-centred care that is based on security, self-awareness collaborative agreement, empathy, and trust. By taking on this therapeutic method, the nurse will be able to develop an interpersonal relationship with Adam. Theorists have considered that “therapeutic relationship plays an important part in mental health nurse. This method supports the idea that every person can be accountable for their own choices, development and future”.
Adam’s mental disorder made him lose the ability to achieving his full potential and placed him in a very unfavourable position. His mindset can make him feel powerless and worthless not able to realize that in fact with the right help he can gradually improve his physical and mental Health. studies Jenkins et al reported that “The burden of mental disorder is substantial, and it arises from individual suffering, disability, premature death, loss of economic productivity poverty and family burden and leads to intergeneration cycles of disadvantages”.
The fact that he is unemployed, dropped out from formal education and suffers from a mental health disorder. Automatically place him in a position of social and economic disadvantage, causing him a series of socio-economic difficulties and financial struggle. According to (Boardman, 2003, p.327) “paid employment is very important in helping to maintain the good mental health of people and to provide a sense of identity for those who suffers mental health disorders”.
Adam’s life and mental health condition have also been affected by the lack of family support. He is living alone in an accommodation away from his family possibly because of his challenging behaviour. Several studies Chakrabarti et al., reports that “Bipolar disorder is a serious and chronic mental illness which imposes a substantial burden on both patient and patient´s relatives”. It is important to consider that Adam´s condition might improve significantly if he starts to receive more support from his family.
That help, can be through the implementation of a family psychoeducation about his mental health condition. The psychiatric nurse can guide and assist Adam and his family to cope with the symptoms and therapies. Rose states that “Family intervention and support on the decrease of symptoms and recovery of patients who suffer from serious mental health disorder is recognised as crucial”.
Another important point to consider in Adams’ situation is the way he sees himself and is perceived by society. It is a detrimental perspective that can cause him a lot of distress, anxiety and negative feelings towards himself. According to Thara “Stigma is a ubiquitous and universal experience of pain, discrimination and marginalisation cutting across all cultures and society”. Everyday mental health service users are excluded and branded by a social stigma that is very discriminatory towards people who suffers from mental health disorders. This type of discriminatory behaviour only increases the mental health problems of some people, stopping them from seeking help and aim for recovery.
Shame and discrimination can be the reasons why Adam is socially isolated. He doesn’t trust people enough to socialize or communicate, fearing that he will be misjudged because of his behaviour and mental health issues. In fact, Adam lacks on social interaction and community participation. He is not aware that he can find support instead of discrimination within his community and receive help with his health promotion and social engagement.
Florin & Wandersman agreed that “Active participation in community groups or partnerships is recognised as offering important opportunities for both personal and community empowerment”. The knowledge the community psychiatric nurse has about community services and alliances with different groups can be helpful to guide Adam to begin a community participation and introduce him to the resources and services he can benefit from engaging with his community.
People who suffers from mental health disorders like Adam can be optimistically presented to society through initiatives such as “The World Mental Health Day” promoted by the health education authority that supports social awareness about mental health and encourages social inclusion. Project like that contributes worldwide and locally to avoid prejudice among people who suffers from mental health conditions.
The lack of knowledge of some people in relation to mental health, causes a lot of misconception and social barriers; therefore, it is essential that the government and local authorities acts continuously to support and protect people with mental health issues. Moore et al., emphasized that “the action of advocating in benefit of a cause is assumed to influence and inspire social and public opinion. It can also help to promote changes in the community and governmental policies”.
Adam to find help and support for all psychological and psychosocial problems he faces from the multidisciplinary health team, social services and volunteer institutions. Two researches Hauf & Bond described that “Good collaboration both facilitates desired programme outcomes and supports the functioning and development of the people, organization and agencies committed to promoting mental health in their populations”. Services such as GP, psychiatrists, psychologists and social services would be essential on the establishment of Adam´s psychological and physical wellbeing.
The psychiatric nurse can advise Adam to attend the Alcoholic-Anonyms group support, to seek recovery from his excessive alcohol intake. He can also be advised to start systematic and continuous psychological therapy such as (CBT) cognitive behavioural therapy to work on how his feelings and thoughts are affecting his behaviour. According to CBT is a cognitive and behavioural therapy that aims to decrease symptoms and develop functioning of the affected person.
The nurse can recommend Adam to a wide range of social care, online services and platforms that offer adequate support for people with mental health disorders such as “Pals” that offers private advice, assistance and information on health- associated queries for service users suffering from mental disorders .
The aim of this essay was to analyse how a psychiatric nurse could assess Adam´s mental health and use different skills and knowledge to overcome the communication barriers caused by bipolar disorder and its symptoms. Additionally, it also investigated the link between Adam’s mental disorder and socio-economic, psychosocial and environmental factors. It also explored some essential concepts behind the prevention, implementation and practice of mental health therapies that could help Adam.
In conclusion it is valid to emphasize that part of Adam’s struggles in life are a direct result of different internal and external factors such as lack of family support, psychologic difficulties, cognitive dysfunction and social barriers. He needs long-term support and constant encouragement to recover and reach his life goals. For which reason, the role of the community psychiatric nurse will be essential to help Adam to go through this healing process, once he will be offered care, therapies, information and hope.
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