Introduction
It is difficult to attain optimal spiritual, bodily, and mental health without the collaborative effort of nurses and patients (Webb, 2020). A therapeutic relationship is essential. The essay will describe a case study of a patient in my ward’s mental health unit for whom I was responsible for providing care and support as a healthcare provider. In this essay, I will evaluate the five components necessary for therapeutic care. They are: pharmacology, partnership, communication, patient safety, and self-evaluation. In accordance with the Nursing and Midwifery Council’s (NMC, 2018) mandate to protect the patient’s privacy and confidentiality, I will use the pseudonym name as Terrence O’Sullivan.
O’Sullivan is 78 years, and have severe cognitive impairment. When I engaged O’Sullivan in a conversation, he could not effectively communicate due to his delirium. He has memory loss and requires prompting and reassurance to engage his intentions. Mr. O’Sullivan is unable to weigh up any information or maintain information. Due to his delirium, he cannot concentrate long enough to process information and make a judgment. As a clinical syndrome, delirium most commonly affects the elderly. There is a disruption in attention, consciousness, and thought processes, and people experience difficulties maintaining concentration and switching tasks (Han et al., 2022). Also, O’Sullivan is known to the psychiatry unit, and he can be paranoid. In addition to delirium, O’Sullivan has pressure soars, is bed bonded, has limited strength, is peg fed, and requires staff to administer his feed and medications via bolus.
Communication
Communication is a vital part of nursing that improves the therapeutic relationship between patients and nurses due to its significance in recognizing the patient and allowing them to share their experience (Kourkouta & Papathanasiou, 2014). Mr. O’Sullivan lacks mental capacity and cannot communicate effectively when speaking. Due to his poor communication ability, Mr. O’Sullivan cannot fully communicate his physical and emotional needs. Delirious patients have problems producing spontaneous speech and speech content (Green et al., 2018). Since Mr. O’Sullivan is cognitively impaired, he cannot make complex decisions like staying in a nursing home or with his family.
Talking is only one part of communication. Ellie Collier (2021) highlights that multiple channels of communication, both verbal and nonverbal, can influence one another and the outcome. When a person is delirious and has trouble communicating verbally, body language and physical contact becomes more critical (NHS, 2018). In delirium, nonverbal communication is essential because it promotes compassionate treatment, trust, and positive benefits for the patients (McCorry & Mason, 2020). Further, it helps healthcare professionals assess the severity of the condition, provide emotional support, and enhance patient-centered care.
Although it was difficult, I managed a session with O’Sullivan and learned some physical and emotional needs he had. O’Sullivan talked slowly in a broken speech, but I listened carefully and gave him time to express how he wanted to be treated. By paying attention to O’Sullivan’s body language, such as his relaxed, open posture and lack of avoidance of eye contact, I got a better idea of what information the patient needed to communicate, but he was unable to (Ali, 2018). I encouraged O’Sullivan to communicate what he wanted however he could. Since people with delirium may not understand the question but reply according to their knowledge of its structure and non-verbal clues, it was essential to use closed-ended questions.
Additionally, I explained things to O’Sullivan in simple terms and gave him plenty of time to process the information before moving on to the next topic. They may take more time to process language, and if they understand a question, they may take more time to formulate a response or even forget before giving a response (NHS, 2018). Advocacy is an important aspect of healthcare, and it involves defending patients’ rights and ensuring that they have access to the care and support they need (Hamric, 2000). In Gregory’s case, the medical team recognized the need for reasonable adjustments to ensure that he can effectively communicate with his healthcare providers and receive the care he needs. Listening and giving O’Sullivan time assisted in building a trusting therapeutic relationship which made him communicate his emotional and physical needs. Using gestures, the patient could locate the painful parts of his body. Also, Mr. O’Sullivan could show signs that he is contented with the nurses’ care in the aspects of medication, nutrition, and helping in mobility.
Patient Safety
NHS England (2016) defines patient safety as preventing preventable incidents, errors, and injuries to patients throughout healthcare delivery. We will be looking a patient safety in mental health settings. Just as it is crucial to maximize the positive and minimize the negative in healthcare, so is the National Health Service’s (NHS) mission to ensure patient safety (NHS, 2021).
As several patient safety tools exist, we are based on “intentional rounding .”This approach involves meeting the patient’s basic needs by making ticks in the box. Through intentional rounding, nurses can assess continence, pressures areas, pain levels, and hydration (Kings College London, 2019). O’Sullivan expressed that he had stomach pain and could not feed himself. Since Mr. O’Sullivan is bedbound and cannot feed, I performed all his activities of daily living, from feeding and hygiene to toileting. Mr. O’Sullivan required full supervision during mealtime due to the risk of aspiration to food and drink. Delirious patients usually develop dysphagia, which predisposes them to a high risk of aspiration (Chen et al., 2021). From this view, I ensured O’Sullivan received nutrition and hydration via the peg tube.
Intentional rounding was helpful in this situation of O’Sullivan because it facilitated conversation, and led to the prompt identification of the problem (Kirk & Kane, 2016). Harris, Sims, and Levenson (2019) suggest that this safety tool oversimplifies nursing by emphasizing a prescriptive approach despite a lack of solid evidence about the effect of nurse-patient communication. The patient was given an antiemetic and analgesic for the pain and nausea. During the safety huddle, I filled out a datix incident form and reminded my colleagues of the need to provide close supervision at mealtimes to prevent aspiration. In addition, I ensured that the patient’s care was improved so that he or he was less likely to attempt to remove the PEG tube. O’Sullivan benefited from intentional rounding, a precursor to a more involved nursing intervention (Harris, Sims, and Levenson, 2019).
Other risk management strategies were ensuring a minimum 30-degree angle while feeding and one hour post strict fluid balance, close monitoring of hydration status by the urea and electrolytes team, and continuing to monitor bowels. Nonetheless, Mr. O’Sullivan is bed bond and has limited strength; two staff members assist him at all times for his mobility. Mr. O’Sullivan’s fall risk assessment is high, and the necessary precautions are in place to keep him safe. For instance, a full-body hoist should be required to be moved from the bed, and a bedrail risk assessment should be in place.
Pharmacology
Pharmacology is the study of how various medications interact with one another. It deals with the chemical and physical composition of the drug, absorption, mechanism of action, distribution, administration, circulation, elimination, clinical application, and side effects. (Flower, 2013). Mr. O’Sullivan requires trained staff to administer his medication as prescribed by his GP. His medication is administered via the peg. Medications should be taken as distributed by his doctor. Mr. O’Sullivan’s medication is used to control his medical condition. If he does not receive it, he will become unwell, potentially becoming life-threatening.
O’Sullivan was prescribed many medications, but for treating mental problems (delirium and paranoia), he was prescribed olanzapine. Olanzapine is broadly distributed, binds to plasma proteins, and can be given in various ways. O’Sullivan’s hypertension, diabetes, hyperlipidemia, and hypercholesterolemia can all be attributed to his use of olanzapine because it causes a dramatic rise in triglycerides and total cholesterol (Stern et al., 2008).
O’Sullivan’s prescription of olanzapine will be followed as recommended, and he will be monitored. However, the team has opted not to change it because there has been no significant weight increase. Medication adjustments may be made if neither the blood glucose level nor the patient’s symptoms improve. The most common reasons for discontinuing olanzapine medication were weight gain (9%) and metabolic side effects (9%). (Dayabandara et al., 2017). All nursing decisions must be made with the patient’s best interests in mind, as outlined in the NMC Code of Practice, which requires nurses to use their professional judgment (NMC, 2004). Working with O’Sullivan has also taught me the importance of continuing education to provide a competent, lawful, and safe practice without oversight (NMC, 2004).
Partnership
Through the partnership, nurses collaborate not just with the person seeking medical treatment but also with his or her loved ones and the community at large (Baillie, 2016). It is the primary goal of partnership and integrated care in healthcare to ensure that patients and their families are heard, encouraged to participate in their care, and given access to accurate information explained in terms they can grasp. Given the resources, they must participate actively and decide their treatment plans (Wolf et al., 2017).
Because O’Sullivan has many physical and psychological problems, I enlisted the help of other professionals to explore potential solutions for improving recovery as he stays in the hospital. By involving all the nurses and other multidisciplinary teams, I suggested that O’Sullivan be supported with all dietary needs and fluid intakes. Staffs are to ensure that blood sugar reading are monitored twice a week. Also, I requested that the patient be linked to one dietitian to supply weekly food supplements. Also, the dietitian would monitor the patient on his daily intake.
Considering that O’Sullivan is bedbound, it was necessary to link him with a physiotherapist. When an individual is impaired in their ability to move and function due to an injury, disease, or disability, physiotherapy can help. Also, it can help you avoid future health problems (NHS, 2017). The physiotherapist helped O’Sullivan maximize the function and quality of life across the aspects of emotional, physical, and social well-being. As all nurses and multidisciplinary teams collaborate, they should respect and maintain O’Sullivan’s privacy, dignity, and respect at all times.
Self-Reflection
Reflection motivates nurses to look honestly at how they care for patients and learn from their mistakes (Matshaka, 2021). According to the NMC Code of Practice, I ensured that my interactions with O’Sullivan were always respectful and never put him in a vulnerable position (NMC, 2018). After evaluating my knowledge and skills in O’Sullivan’s care, I consulted a physiotherapist and dietitian for collaborative management. I felt comfortable asking questions about O’Sullivan’s health whenever I thought it was necessary or acceptable because I greatly respected their skills, knowledge, and achievements (NMC, 2018).
Conclusion
My experience with O’Sullivan showed me the importance of a therapeutic person-centered approach in all aspects of patient care, including but not limited to interaction, engagement, and input solicitation. Patients must give their consent for each treatment they get. As all nurses and multidisciplinary teams collaborate, they should respect and maintain patients’ privacy, dignity, and respect at all times. I was able to establish a personal connection with O’Sullivan by taking into account my role and realizing how crucial it was for me to communicate in a way that was appropriate for individuals with delirium and paranoid disorders.
I have upheld professionalism by adhering to the NMC code through provision of a care that is client-centered, empathetic, and team-oriented (NMC, 2018).Patient care should be collaborative and involve all relevant professionals and family members. Further, it is necessary to consult any relevant professional to ensure the best receives whole and quality care. Although collaborative management is crucial, nurses should learn to manage patients independently because, on other occasions, it becomes challenging to find multidisciplinary support. The professional team should have adequate knowledge, including non-verbal communication, because patients with communication problems are multiplying, and advanced management is essential.
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