Category: NSG 328 Posts

One thing I learned from this simulation is that it is very important to dig deeper and ask open ended questions to the patient. I found out that there is usually more to the story than just what the patient tells you. I also learned that it is very important to build rapport and trust with the patient, and that will make it easier to find out more information, and it will make it easier to help them. If the patient does not trust you, you will not be able to help them in the best way, and they may not even want to receive care.

One challenge my group faced was establishing a connection with the patient who had schizophrenia. I felt that we were able to get some background information on the patient, and what he was experiencing, but also felt that we got somewhat stuck in what to ask and look for.  I think we asked some good questions, but when we thought we had an answer, still could have followed up more. Overall, I feel like we worked very well together, and were able to bounce ideas off each other throughout the simulation.

I definitely learned more about the mental health process nursing through this simulation. One thing that stood up to me was the importance of follow up care. While we had relatively brief interactions with the patients, in a clinical setting we might see these patients every few weeks, or even daily depending on their diagnosis. Another thing I learned about the mental health nursing process is that it is important to reassure the patient that they have options regarding different treatment and medications. Simply telling a client about their medication and treatment, may make them more hesitant, versus making sure that the client has input on the type of care they are receiving. Overall, I feel more ready to address mental health issues in a clinical setting.

Throughout my time in both adult health and mental health clinical I have witnessed the complex connections between physical and mental health in many different patients. Being in any sort of hospital can be very difficult for any patient, as it is different from their usual routine, and they can end up being isolated from their family and friends. In the medical-surgical clinical setting patients are often in need of complex care, where their mental health needs might not be the priority. While these patients may not have been admitted for mental health reasons, their mental health may be affected, which is where I saw a patient with a very complex connection between their physical and mental health.

            The client I saw came in with a primary diagnosis of an ischemic stroke, and I encountered her in a rehab hospital setting. She had profound weakness on her left side, had some trouble eating independently, and was in a wheelchair. She also had some confusion about where she was, and who the nurses were but she was very talkative and friendly. The client was relatively mobile before her stroke, so not being able to move or eat by herself must have been very difficult. Stroke is also one of the main causes of depression in older adults, and she was diagnosed with depression separately before the stroke as well.  This client had a lot of up and down days; she was very social and loved to talk to everyone on the unit. She also had expressed to me how she was happy to have help to eat, and she was feeling better than she did when she first got there and showed me that she was able to move her left side much better.  However, some days she was extremely down and just wanted to sleep. One thing that was important to look into further was if she was feeling down and tired because of her recent stroke or if it was more due to her diagnosis of depression. She did have good insight into this and recognized that she was feeling more depressed than usual as she was in the hospital, and she hadn’t seen her family, since they were not coming to visit her.

            The client’s social domain was where I became most concerned in how she was dealing with her depression. She had been married; however, her husband had passed away. Her children and other relatives were not coming to visit her and were not involved in her care, so she was essentially stuck at that hospital with no support. As this patient was elderly and needed a lot of assistance in the hospital, not having a support system is very detrimental for both her physical and mental health. This aspect of the social domain was being continuously assessed with the providers and social workers, who were trying to figure out where they could place this patient next. This understandably, made the patient very sad, and when asked how often she felt depressed she said, “most of the time”.  The nurses and everyone on the floor did a really good job of providing a support system for her at the hospital and tried to spend a lot of time with her. However, I would be very concerned for her mental health when she got moved to another hospital and/or discharged.

            The main diagnosis for the client in the biological domain would be risk for falls. This client would try to be independent but was sometimes unaware of her physical limits and would try to get out of her wheelchair. The main priority for this patient would be to maintain safety and reduce falls. Some interventions for this include using a bed alarm, putting the bed in the lowest position, and keeping the side rails up. It would also be important for the room to be lit properly and making sure the floor was clear of obstacles. Since this patient had a stroke, physical and occupational therapy would be very important for her. Another nursing diagnosis for the patient’s biological domain could be risk for aspiration. This client had a left sided facial droop and was having trouble swallowing. She was put on aspiration precautions, her food was cut up into smaller pieces, and she was given thickened liquids to help her swallow easier. 

            The nursing diagnosis for the patient’s social domain would be ineffective family coping and social isolation. The priority nursing intervention would be to reduce the client’s isolation and hopefully get the family involved with the client’s care. A social worker could be used in this instance to involve the family more. The client often said how her family would be coming to visit later, but they didn’t, and that often made her very depressed. Since she was confused some of the time, it was hard to tell how much she knew about her family not being involved. This client ate her meals in the hallway out of her room as she was an aspiration risk, but this was also a good way for her to get some social interaction with the other patients and the nurses. The nurses did a good job of getting her up and helping her be more mobile, so she wasn’t stuck in her bed all day. She loved talking to the other patients and students that were on the floor and would perk up at mealtime. I was able to spend a lot of time with this client so I often played card games with her and would help her eat. Something that really stood out to me in the care that the nurses provided was how they helped the client feel better about herself. For example, one of the nurses had purple streaks in her hair and the client kept saying how she loved it and wanted her hair to look like that. That nurse was telling me how she was going to go get hair dye for the client and give her a haircut.        

            One nursing diagnosis for the psychological domain would be ineffective individual coping. The priority would be to see how to client is managing her depression. It would be important to have this client meet with a psychiatrist so they could recommend different strategies such as CBT and/or medication, while also taking her stroke into consideration. Post-discharge it would be very important to make sure the client is set up with good mental health care, especially if her family continues to not be involved in her care. If the client is not able to go home with her family caring for her, I think it would be beneficial if she was able to be in a rehab/long term care facility where she would be able to interact with the other patients. I think the nurses addressed this client’s mental health needs the best they could and were able to make her feel happier and supported. One big barrier to her treatment is the lack of family involvement, which is also one of the main factors contributing to this client’s depression. I believe that making the family known of what the clients care needs were and how their lack of involvement is a detriment to the clients mental and physical health would also help address the complex needs of this client. 

I think that there is so much stigma surrounding mental illness as there is a lack of understanding from many regarding mental health and mental illness. Mental illness is also stigmatized because you cannot physically “see it” like you could with someone who has a cast for a broken leg. People with a mental illness are often regarded as “crazy” or “insane” due to the stigma surrounding it. Many people don’t want to learn about mental illness or don’t believe mental health is equally as important as physical health, which further contributes to this stigma. People who are experiencing mental illness may be reluctant to get treatment or tell people about their mental illness as they may be labeled as “dangerous” or “unpredictable” if they are open about it with others.  Stigma surrounding mental illness is one of the biggest roadblocks to recovery for those experiencing mental illness.

            How people respond to mental illness can also be affected by their culture and religion. In certain cultures, mental illness is seen as a sign of weakness, so it is less common for people to get treatment. For example, Asian cultures traditionally do not acknowledge mental illness and it is seen as “unnatural” so treatment may not even be accessible. In Native American culture people may try herbal medicine first before seeking professional help or taking medication. Religion also plays a factor in the stigma surrounding mental illness. For example, some religions may view mental illness as the fault of the person experiencing it or as a sign of weakness. Some may try to use prayer to treat their mental illness as well. Cultural and religious stigma surrounding mental illness makes it much harder for people to understand and appropriately treat it. Continuing to not acknowledge mental illness can make people feel very isolated and discouraged when trying to seek help.