Table of Contents
Challenges in Assessment Process 7
Importance of Therapeutic Relations 7
Nursing Role in Therapeutic relationships 8
Therapeutic Relationships in Jimmy and Jakes case 9
Factors that can damage Therapeutic relationships 10
Complexities of Therapeutic Relationships 10
Evidence-based plan of care 12
Collaborative nature of a Plan of Care 13
Goals Setting in Plan of Care 14
Interventions in Jimmy, and Jakes Case 14
Determining the Value of Care 16
Evaluation of Jimmys condition 17
Person-Centered Care: PTSD and ADHD
According to the World Health Organization (2018), Person-Centered Care (PCC) refers to the empowering of people through equipping them with vital knowledge to actively take care of their health rather than be passive recipients of the services. Person-centered care enables people to actively participate in their medical treatment by working in close cooperation with the healthcare providers. According to Perkins (2015, p 123), nurses are primary caregivers that help to treat patients, manage patients’ physical needs, prevent illnesses, and also offer advice to the masses on best health practices. With the changing social dynamics, the nurses’ roles have changed as people are now more aware of their physical body and health practices. The increased societal knowledge has led nurses to start adopting personal-centered care. In PCC, the nurses work in collaboration with the patients making sure the patients are aware of their condition and also the best health practices to adopt to prevent diseases.
Nurses who choose to practice PCC have a core obligation to show care to the patients as they form a trusting relationship that promotes self-caring behavior (Riddett, 2017, p. 33). In our case study, the PCC mode of treatment must be given for Jimmie to recover from the condition. Having suffered from childhood trauma, Jimmie requires to be shown a lot of care and understanding. The PCC approach is the best tool for such scenarios. This article is going to focus on how the PCC approach can be used for Jimmie’s mental health care and also in dealing with Jake’s mental case. This article will consider 4 major themes;
Plan of care and
According to (Janet Weber, 2017), nursing assessment is the process of collecting information on a patient’s psychological, physiological, or sociological status to come up with the best solution to help the patient. A nursing assessment is conducted b a registered nurse. The assessment process is usually the first stage towards the successful treatment of an individual. In this article, we are going to focus on pertinent issues regarding the assessment of Jimmie and Jake’s conditions.
In recent times, there has been a general rise in mental disorders including PTSD and ADHD (Crum-Cianflone et al., 2015, p. 587). Based on the case study, it is evident that Jamie suffers from complex PTSD and ADHD. The results of Jimmy and Jake’s case can be ascertained through a clinical assessment. According to (Crow et al., 1995; Janet Weber 2017), there are mainly 4 types of assessments; initial assessment, focused assessment, time-lapsed assessment, and emergency assessment.
To assess the actual condition Jimmie and Jake are suffering from, we will have to conduct an assessment of the condition. The assessment is part-specific only considering the mental health of the patients. To effectively assess Jimmies case, the following steps will be conducted;
This is the first stage upon a patient reaching a professional nurse practitioner. This stage helps the nurse determine the nature of the problem and thereby helping the succeeding stages of the assessment process. Accuracy is key in medical intervention and thereby this makes this process very thorough (Van Der Hart et al., 1995, p. 201). For Jimmies case, an interview will be conducted for Jimmie together with the parents (Jake or Kim). The interviewing process forms the basis of the entire assessment process.
It is quite important to disclose the history of childhood. Information such as a former diagnosis based on the CAMHS assessment should be disclosed the history of his traumatic experiences should also be made available to the nurse. In the interview, it is also crucial to disclose Jimmies attitude when interacting with professionals. Recent evidence has shown that there is a significant relationship between genetics and PTSD. Based on the available information, it is also crucial that Jake’s situation is first diagnosed and a further search is conducted to determine whether there is a family history of ADHD and PTSD both on Jake’s side and on the real father’s side immediate extended family.
After interviewing the child and also their parent, a focused assessment is conducted. The focused assessment focuses on the actual conditions the patient is suffering from such as pain (Todsen & Tolsgaard, 2016). In Jimmy’s mental health case, the following will be considered;
Coherence, insight, depression, mood, hallucinations (Hurst et al., 1991, p. 1446)
Response to verbal and tactile stimuli,
Level of consciousness, and alertness
At this stage, the nurse performs different operations to ascertain the real cause of the behavioral change shown in the initial stage.
This stage is quite crucial, especially in mental disorders. This type of assessment enables the nurse to evaluate how the patient (Jimmie) responds to an agreed treatment plan.
Principles of Assessment
In conducting an assessment of Jimmy’s condition, it is vital to follow the four principles of assessment. The principles of assessment include; reliability, accuracy, objectivity, and authenticity (McAlpine, 2002).
Interviews are quite crucial in the assessment of patients suffering from PTSD. Interviews enable the nurses to determine the possible illness the patients are suffering from (Burrows et al., 1995, p. 1121). When interviewing Jimmy, it is crucial to divide it into phases first assessing Jimmy with a parent and also interviewing Jimmy alone to ensure the nurse captures the actual feelings, emotions behaviors, and attitudes of Jimmy. There are various ways in which Jimmy could be assessed using interviews, these methods include;
Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) (Blevins et al., 2018, p. 180)
PTSD Symptom Scale Interview (PSS-I and PSS-I-5) (Ding et al., 2020)
Structured Clinical Interview; PTSD Module (SCID PTSD Module) (Ding et al., 2020)
Structured Interview for PTSD (SIP or SI-PTSD) (Blevins et al., 2018, p. 187)
Treatment-Outcome Posttraumatic Stress Disorder Scale (TOP-8) (Ding et al., 2020)
A self-report assessment is based on an individual assessment of the patient. Based on Jake’s assessment, she believes she has a bipolar mental disorder. It would also be crucial to subject Jimmy to an individual self-assessment using the following tools (Weiss, 2007);
Davidson Trauma Scale (DTS)
Impact of Event Scale-Revised (IES-R)
Mississippi Scale for Combat-related PTSD (MISS or M-PTSD)
PTSD Checklist for DSM-5 (PCL-5)
PTSD Symptom Scale Self-Report Version (PSS-SR)
Short PTSD Rating Interview (SPRINT)
For the nurse to help Jimmy deal with the mental disorder a priority assessment is vita. A priority assessment involves fast collecting of a patient’s information, determining the relative priorities of care.
In Jimmy’s case, priorities will be set based on the magnitude of the PTSD and ADHD. PTSD is more serious since it has quite a great effect on Jimm who is a teenager. It should thereby be dealt with to enable Jimm to live a normal life.
Challenges in Assessment Process
According to Daud & Rydelius, (2009, p. 190), there is a high correlation between ADHD and PTSD with the latter being a major cause of ADHD. Once an individual suffers from post-traumatic stress in an early stage, the brain development is affected especially having a huge impact on brain areas that deal with; consciousness, impulse control, and emotional regulation (Zylowska et al., 2009, p. 323).
Researchers define a therapeutic relationship as an interactive relationship between a patient and a healthcare practitioner (Haugh & Paul, 2008; Hill, 1994, p. 92). The therapeutic relationship is quite important and effective in dealing with mental disorders such as ADHD and PTSD. According to McCabe & Timmins, (2013), a therapeutic interpersonal relationship is where health practitioners depict caring, non-judgmental behavior, and a safe environment to create a conducive environment for the patients to share their feelings and get well in the process. Based on the assessment and available information, it is evident that Jimmy is suffering from a mental disorder Jimmy must be shown care and a conducive environment that will make him feel appreciated. The creation of a conducive environment for Jimmy will enable him to feel more at ease and thereby enable him to heal from PTSD.
Importance of Therapeutic Relations
In the nursing profession, there are quite numerous benefits that emanate from therapeutic relations. According to (Greenhalgh & Heath, 2010, p. 476), a good-quality therapeutic relationship improves the satisfaction of patients and offers professional fulfillment. In addition, there is evidence that having such a good relationship between the nurses and the patients will eventually save time in treatment and enable compliance of patients to the given medication. There is evidence that a good-quality therapeutic relationship improves both patient satisfaction and professional fulfillment, saves time, and increases compliance with prescribed medication. Research conducted by (Geller, 2020, p. 11), shows that in the therapeutic process, trust is key. For the therapeutic process to be successful, there must be complete trust between the health practitioners and the patients. Based on our case study, Jimmy has a problem with relationships with professionals it is thereby crucial that the approach is used cautiously to ensure that he feels appreciated and thereby cooperates with the treatment process.
In Jimmy’s case, the therapeutic relationship will enable him to feel at more ease. The relationship will also enable him to open up emotionally and share more details and concerns that may be affecting him. Through sharing more information, the nurse will now e in a better position to comprehend the actual situation of Jimmy’s problem. With a complete understanding of the problem, the nurse is better positioned to take corrective action or administer drugs that will help Jimmy with his condition.
Nursing Role in Therapeutic relationships
In the provision of healthcare, nurses play quite a fundamental role in forging relationships between themselves and the patients. These relationships go a long way in ensuring the nurses can get complete information on the patients and thereby maximizing the diagnosis and assessment process. In forging therapeutic relationships, nurses act in the following roles
In forging therapeutic relationships, nurses have to assume the role of a teacher (Brainkart.com, 2018). During working on the nurse-patient relationship, the nurse may teach the patient new coping and problem-solving techniques (DYSON, 1999, p. 284). To be an effective teacher, a nurse must be well-versed in the subject matter to instill trust and confidence in the patient.
In forging therapeutic relationships, the nurse assumes the caregiver role (Brainkart.com, 2018). The primary role of a caregiver is to build trust, explore feelings and also help the patients meet their psychological needs (Curley, 1997, p. 209). Physical care is also quite important and can be established through touch to encourage patients to let out their personal feelings. In this stage nurses also need to be as honest as possible to build trust with the patients.
Advocacy is the process of acting on a client’s behalf when they cannot act on themselves (Mallik, 1997, p. 130). In dealing with mental care, the advocacy role could be quite different from a medical-surgical setting (Brainkart.com, 2018). In dealing with a patient with PTSD, and their disorders, it is crucial to give the best advice based on the patient’s condition and mental state. The nurses should adhere to dignity and privacy when giving informed consent to the patients.
In some instances, it may be crucial for a nurse to assume the parental role through the choice of words and also nonverbal communication (Brainkart.com, 2018). The nurses have to maintain a nonjudgmental attitude and maintain communication as easygoing.
Therapeutic Relationships in Jimmy and Jakes case
A good therapeutic relationship between a patient and a nurse is built on congruence, trust, and respect. To have a good relationship with a therapeutic nurse, Jimmy must first assume the role of a teacher. In doing so, the nurse will educate Jimmy on his current condition, causing him to trust the nurse’s expertise in the field. It is also crucial to make Jimmy feel engaged since he is easily irritated. After educating Jimmy about his condition, it is critical to take on the role of caregiver and show care to Jimmy in his situation. Assuming the role of caregiver will allow Jimmy to feel accommodated and loved by meeting his psychological needs. After meeting Jimmy’s psychological needs, the nurse must take on the role of an advocate. In doing so, the nurse will provide Jimmy with informed consent, allowing him to feel involved while also preventing him from making poor decisions. Finally, the therapeutic nurse could assume the role of a parent. This can be achieved through the choice of words and also through nonverbal communication. The nurse should be accommodative enough and nonjudgmental thereby making the communication easygoing.
Factors that can damage Therapeutic relationships
When forging nurse-patient relationships, numerous factors could damage the therapeutic relationships. These factors include (“Therapeutic relationship,” 2014);
Nurses’ failure to uphold the nursing code of conduct on patient privacy
Intimacy between patients and the nurses
Preferential treatment of the individual patient
Inappropriate gift-giving between the nurse and patient,
A sudden increase in phone calls outside clinical hours between the nurse and the patient,
Complexities of Therapeutic Relationships
Therapeutic relationships are designed to be beneficial to the patients by creating a strong bond between the nurses and the patients. However, the therapeutic relationship may be faced with various complexities. First, client-nurse mismatch. In some cases, the nurse may fail to match the patient in terms of behavior or general mindset; this may subsequently hinder the therapeutic process (Finley, 2018, p. 1186). Secondly, the client’s attitude towards treatment. In some cases, the patient may have a negative attitude towards a treatment or even fear opening up to an outsider (“Therapeutic relationship,” 2014). The personal attributes of the patient could as well hinder the therapeutic process. Finally, there are the personal attributes of the therapeutic nurse. In some instances, the nurse may be incompetent or inexperienced enough to handle the patients effectively (Finley, 2018, p. 189). The inability of a nurse to conduct the process effectively leads to loss of trust among the patients and thereby leading to failure of the therapeutic process.
Based on empirical findings, the relationship between the patient and the health practitioner should be regularly checked to ensure it remains professional and objective (Therapeutic Relationships 2015)
Plan of Care
According to Card, (2017, p. 128), a plan of care is a nursing outline that shows all the needs of a patient and the means of meeting these needs. According to researchers, the main purpose of a plan of care is to facilitate evidence-based, standardized holistic care to patients. A plan of care usually involves the following processes; diagnosis, assessment, expected outcome, rationale, intervention, and evaluation.
The plan of care has greatly changed over time. In the 1970s a plan of care was considered activity-based; the plan of care a patient received was entirely dependent on the medical procedures that were to be undertaken (Dreeben, 2010). Today, the plan of care has greatly changed and mainly focuses on individual needs (Schluter & Sinasac, 2020). In modern times, nurses have to first conduct an individual assessment before making a plan of care. The initial assessment ensures that the care plans are individualized and that they achieve a patient-centered approach for care (Pianarosa et al., 2021). The documentation process of the nursing plan of care has also changed immensely over time with the rise in technology. Today, their nurses used computerized nursing care plans which record the care plans in a digital device rather than the conventional handwritten care plans. The computerization of care plans has been quite instrumental in bringing accuracy, accessibility, and ease in documentation as compared to the traditional handwritten plans of care.
Objectives of Plan of Care
Promote holistic care,
Promote evidence-based nursing care,
Measure care, and
Ensure psychological support and reduce anxiety in patients
Evidence-based plan of care
Evidence-based practice is a fundamental measure of initiatives and performance as documented in the HITECH Act. EBP plays a vital role in improving the quality of care, enhancing patient safety, and also in reducing costs related to errors in adverse events. According to Mantzoukas, (2007), EBP involves making in-depth research all over the world to determine the best solution to a problem and as well identifying what could be different in the case of the individual patient. According to the Duke University Medical center, EBP is defined as an integration of clinical expertise to patient values and expertise through determining the best research evidence into the decision-making process for patient care (Forrest & Miller, 2009, p. 61).
Implementation of EBP involves 4 major steps first, framing clear questions based on the clinical problem (Melnyk et al., 2010, p. 51). This allows the nurse to identify the possible condition a patient could be suffering from. Secondly, the nurse searches for relevant evidence in the literature and also the internet. This is aimed at the nurse getting a deeper understanding of the situation they are dealing with. Thirdly, the nurse appraises the validity of the contemporary research (Melnyk et al., 2010, p. 52). This is meant to ensure that the findings of the research are valid and consistent with the patient’s condition. Finally, the nurse then applies the findings to clinical decision-making (Melnyk et al., 2010, p. 52).
Numerous benefits emanate from the use of EBC. These benefits include; superior nursing skills; lower cost of care and improved patient outcome. Despite the numerous benefits of EBC, the process also has various limitations. The limitations of EBC include; oversight of common sense, lack of adequate literature, difficulty to find credible evidence, and consumes a lot of time.
Based on Jimmy’s case, it would be quite crucial for the nurse to conduct a detailed EBP to determine the possible mental condition Jimmy could be suffering from. The EBP could also help giving possible alternatives which could then allow the nurse to narrow down to a specific condition. EBP will be quite fundamental in Jimy’s case since it brings about accuracy in the diagnosis of a health condition.
Collaborative nature of a Plan of Care
According to Smith et al., (2008), a collaborative plan of care entails a nurse collaborating with other professionals to eliminate redundancies, deficits, and errors. Collaborative Care Planning (CCP) is based on a thorough multidisciplinary evaluation of the bio-psychosocial factors that are affecting the person’s distress, followed by multidisciplinary case formulation and care planning. A collaborative plan of care should be aimed at giving the best possible care to a patient through embracing a patient-centered approach.
A collaborative plan of care process aims at encouraging positive change and changing the outlook of patients based on their mental state. The CCP plays a fundamental role in encouraging patients to take charge of the recovery process. According to (Seligman, 2012), collaborative care and support planning recommend a flexible, proactive, and tailored approach to care that recognizes an individual expert in their care.
Goals Setting in Plan of Care
In dealing with mental disorders such as PTSD, goals are set with the collaboration of the nurses and the patients. According to Robinson et al., (2008, p. 604), goal setting enables the nurse to focus on the health outcomes that are most important to the patient. The goals set should be patient-centered and as well follow the SMART guidelines. Nurses also have to document and communicate the outcomes of the goal-setting discussions.
Interventions in Jimmy, and Jakes Case
Based on Jimmy’s case, a plan of care must be made with the collaboration of the parent, Jimmy, and the Nurse. Making a plan of care will be fundamental in ensuring that Jimmy recovers from the condition. The plan of care should also be collaborative to make Jimmy feel appreciated and included in the entire process. In addition, the treatment of Jimmy’s condition should be evidence-based. The nurse should first collect data from the assessment to narrow it down to a specific mental condition based on the evidence available. The nurse should also consult with other practitioners, such as more experienced therapeutic nurses, to see if Jimmy’s condition is similar and, if so, to determine the actual mental disorder Jimmy is suffering from.
PCC evaluation is a critical assessment process that entails rigorous procedures aimed at assessing whether they fulfill their objectives. Aspects of healthcare that can be assessed include;
There are mainly two types of health care evaluation. First, formative evaluation. Formative evaluation is conducted on a continuing healthcare program. Secondly, a summative evaluation. Summative evaluation is an assessment conducted at the end of the entire nursing personalized care (Lee et al., 2007, p. 162). Evaluation of the PCC could either be conducted prospectively or retrospectively. Prospective evaluation is quite crucial since it reduces the degree of uncertainty of the success of a program. On the other hand, a retrospective evaluation seeks to focus on the end project and assessing whether it meets its intended goals.
Evaluation is usually the last step in PCC. Evaluation ensures that the end goals of the healthcare program are met through a predetermined set of metrics (Lee et al., 2007, p. 167). Summative evaluation only kicks in after the patient has been considered healed through the PCC approach. The summative evaluation process differs from the formative approach which requires constant monitoring of the goals.
In Jimmy’s case, a formative evaluation will be adopted. This will be based on the patient-nurse goals that have been set. The formative evaluation process will entail constant evaluation of the objectives to determine whether the PCC process has met its intended goals. The major goal of this PCC approach is to ascertain the mental disorder Jimmy is suffering from and then implementing effective measures to control the PTSD and ADHD disorders.
Determining the Value of Care
Porter defines the value of healthcare as, “health outcomes achieved which matter to patients relative to the cost of achieving those outcomes.” According to Reid et al., (2010, p. 837), high-value care goes beyond containing costs to focus on improving health outcomes, patient satisfaction, and safety. According to the National Academy of Medicine, high-value health care in a timely, safe, efficient, effective, equitable, and patient-centered means of providing healthcare services to patients (AHRQ, 2021).
The value of care is measured by dividing outcomes, service, and safety by the total cost of patient care over time. Value= Quality/Cost.
In measuring the value of mental illness treatment in the case of Jimmy, it could be quite difficult to assess the quality of healthcare and thereby difficult to get a good measure. The value of healthcare is a qualitative measure that is determined through the help of predetermined metrics.
In PCC, there is a great interaction between the nurses and the patient. This enables the formation of strong bonds and a constant flow of communication. At the end of the PCC, the nurse could solicit verbal feedback or ask the patient to complete a questionnaire rating the services. Patient feedback is an important tool for assessing the efficacy of the entire treatment process. Nurses can identify their strongholds as well as their weaknesses, which they should work on to provide better services, through feedback. According to Jug et al. (2019, p. 247), feedbacks can provide healthcare practitioners with direct insights into what is working well and what needs to be improved to improve how care is delivered.
Evaluation of Jimmys condition
Having established a plan of care to assist in treating Jimmy’s condition, it is then crucial to evaluate whether the set goals and objectives have been met. A formative evaluation will be of great use in this scenario. The formative evaluation will enable the nurse to check whether previously developed goals have been met. It is also crucial to measure the value of care for Jimmy’s treatment. The value could be calculated by dividing the quality of healthcare by the total cost incurred in healthcare. Feedback is also a crucial tool in the evaluation of the treatment process. The nurse handling Jimmy’s case could offer a short questionnaire that Jimm could fill based on his satisfaction with the entire process.
Person-centered care plays quite a fundamental role in the treatment process of patients with mental disorders such as ADHD, and PTSD. The primary role of PCC is to show care to patients through person center treatment. Jimmy is currently suffering from complex ADHD and PTSD as per a current diagnosis. Fundamentally, the PCC approach is used in his treatment. The approach is quite effective especially when dealing with Jimmy’s case. One of the prerequisites of treatment is also to ensure that the patients feel cared for and appreciated through informed consent; this will in turn lead to Jimmy opening up to the nurse and thereby maximizing the chances of being treated for complex ADHD and PTSD.
In the PCC approach, assessment, forming therapeutic relationships, plan of care and evaluation are the four major themes that play a crucial role in ensuring that patients receive maximum benefit from the PCC process. The assessment process enables the nurses to determine the actual illness the patient is suffering from. Forging therapeutic relationships enables the nurse to forge a formidable bond with the patients and allowing them to trust the nurse and thus share more information. Thirdly, the nurse and patient must collaborate and develop a plan of care upon which will indicate the goals of the treatment process. Finally, evaluation should be conducted on the entire process to determine whether the process meets its desired goals.
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