NURS 6630 Discussion Factors Influencing Social Change For Psychiatric Mental Health
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Individuals with psychiatric mental health disorders are frequently stigmatized not only by society as a whole, but also by their friends, family, and sometimes healthcare providers. In your role, however, you have the opportunity to become a social change agent for these individuals. For this Discussion, consider how you might make a positive impact for your clients and advocate for social change within your own community.
The relationship between communities today is not the same as a decade ago. How nurses execute their roles at the community level has changed too. Contextually, social change is a concept that many people may not interpret correctly. As Dunfey (2019) explained, social change entails shifts in human interactions and relationships, transforming cultural and social institutions. Most of the changes occur over time, and their consequences in society are profound and long-term. To a significant extent, social change is adopting a new way of thinking, aiming at improving the current situation. It follows the ideology that doing things the same way for a long time is unhealthy for people and society.
Impact of Social Change
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Since social change denoted adopting new ideas, it usually changes people’s attitudes. For instance, community-based education on HIV/AIDS made many societies changed their attitude towards people living with the disease. They view them better and can live with them peacefully. Social change has been the foundation of social movements that champion civil and women’s rights and equal treatment of groups such as the LBGTQ community. Indeed, social change movements change people’s relationships, institutions, and cultural norms. Fortunately, they usually transform situations for the benefit of the larger populace.
As their professional mandate obligates, nurses are social change agents. If they remain committed to seeing healthy communities, nurses can play an instrumental role in improving public health by changing how people understand situations. Nurse practitioners should help to identify social problems through their experience. They are exposed through education, implying that they should be vocal when things are not happening as expected. Problem identification should establish the foundation of solution generation. In this case, nurse practitioners should play a leading role in proposing solutions for social problems through policymaking and community education. They can do it individually or collaboratively with other change agents.
Helping in Psychiatric Mental Health
Psychiatric mental health has become a real challenge in the community and hospital settings. Taking care of the mentally ill is challenging, and understanding their concerns can be burdening. A social change agent should help change attitudes towards the mentally ill at the hospital and society. People with mental health issues are usually victims of stigma. Families neglect them, and some health care providers isolate them due to their attitude towards such people (Knaak et al., 2017; da Silva et al., 2020). Their situations and extent of need are usually misunderstood. In the same case, people with mental health problems are a vulnerable population that requires more help. Besides the homeless, people suffering from mental illnesses are at higher risk of contracting COVID-19 (Ojha & Syed, 2020). A nurse practitioner’s role in such situations is helping families, communities, and colleagues understand psychiatric mental health better and become more conversant with what mental health entails.
As a social change agent for psychiatric mental health, my role would be raising awareness about mental health to change people’s perception of the patients. I would do so through participating in community health education. There are many groups in societies whose primary mandate is to improve the community’s health. As they educate people on environmental protection, family planning, and substance abuse, among other issues, I would join them to expound more on mental illness. Social media has also provided a huge platform for people to connect with others within and outside the community socially. I would use my social media platforms to teach people about mental health while concentrating on the most overlooked aspects such as stigma, resources for the mentally ill, and the mentally ill’s potential if supported.
Obsessive compulsive disorder is characterized by a group of symptoms such as preoccupations, intrusive thoughts, and compulsions. An obsession is defined as an intrusive thought or idea while a compulsion is a conscious recurrent behavior such as checking, cleaning, or counting (Pauls, Abramovitch, Rauch & Geller, 2014). The recurring obsessions result in severe distress to an individual, and the compulsive behaviors consume a lot of time and interfere with an individual’s normal routine, functioning and relationships (Öst et al., 2016). The present paper will review a case study of a child presenting with a mental disorder, come up with the most likely diagnosis, and formulate a treatment plan for his disorder. Further, it will explore some of the ethical considerations that a psychiatric mental health nurse (PMHNP) should observe and how they might impact the treatment plan.
Decision One: Differential Diagnosis
Obsessive Compulsive Disorder (OCD)
Reason for Selection
OCD is characterized by obsessions of thoughts such as contamination which result in compulsive behaviors such as frequent cleaning (Hirschtritt, Bloch & Mathews, 2017). The provider chose OCD as a differential since the patient, Tyrel, presented with excessive thoughts of hand washing and fear of germs on his hands that may make him get sick. The mother reported that the child was repetitively washing his hands with the fear that if he fails to, he will get sick from contamination of germs. Furthermore, the objective history revealed that the patient was preoccupied with thoughts of having dirty hands. The patient reported that he was scared of not having cleaned his hands well and only felt better after washing them.
The provider will expect that the final diagnosis will be OCD based on the presenting symptoms of obsessive thoughts on contamination that results in compulsive behaviors of frequent hand washing.
Differences between Expected Results and Actual results
The patient’s symptoms were most consistent with obsessive-compulsive disorder, which was also my main differential diagnosis. Therefore, no difference existed between the expected results and actual results.
Decision Point Two: Treatment Plan for Psychopharmacology
Begin Fluvoxamine immediate release 25 mg orally at bedtime.
Reason for the Selection
Fluvoxamine immediate-release tablet was selected because it is a selective serotonin reuptake inhibitor (SSRI), and it enhances serotonin activity (Öst et al., 2016). The FDA approves fluvoxamine immediate release for the treatment of OCD in children above eight years and adults (Gerentes et al., 2019). Besides, it does not bind to cholinergic, dopamine, or alpha-adrenergic receptors and thus has fewer side effects. It will be highly likely that the patient will comply with the treatment. Moreover, Fluvoxamine has a favorable pharmacokinetic profile as well as minimal side-effects whose pattern may hamper a rapid escalation of its dosage, making it desirable as an intervention for OCD patients.
By prescribing Fluvoxamine, the provider hoped to achieve a reduction of obsessive thoughts and compulsive behaviors which would be evident by reports of less handwashing episodes (Öst et al., 2016). They also hoped to increase the patient’s social interaction and being more relaxed when he is around his friends and classmates. The provider expected that the mother would report that he has accepted to go to school.
Differences between Expected Results and the Actual Results
The client returned to the clinic after four weeks, and the mother reported that he had some decrease in his symptoms. She also stated that there was a decrease in the frequency of handwashing, and Tyrel appeared a bit more relaxed. However, the mother reported he had not entirely accepted to go back to school, but there was an improvement in his attendance. Tyrel’s mother stated that over the previous weekend, he had gone outside to play with his friends which he had not done for a while.
Decision Point Three: Treatment Plan for Psychotherapy
Augment treatment with cognitive behavioral therapy to help
Reason for Selection
The provider chose to augment treatment with cognitive behavioral therapy (CBT) to help the child to understand his disorder and develop approaches to identify problematic situations (Clark, 2019). Clinical studies have revealed that a combination of pharmacotherapy and CBT in the treatment of OCD symptoms in children have the best results. It has also shown significant improvement in patients aged 7-17 years than treatment with SSRI alone or CBT alone (Clark, 2019). It will further help Tyrel to manage anxiety and train home how to adopt approaches that will help him work with the anxiety in an effective and non-disruptive way.
By the end of the CBT sessions, the provider will expect the patient to have acquired techniques on anxiety management, such as relaxation and distraction. Anxiety management will be evaluated by the mother’s reports that Tyrel has entirely accepted to return to school, and he has no issues in school. Besides, the provider will expect him to have full control and learn to overcome senseless thoughts or fear, such as getting sick because his hands are dirty. Moreover, the provider will expect the patient to report a significant decrease in obsessive thoughts, anxiety, and the need to wash his hands after the CBT sessions.
Differences between Expected Results and the Actual Results
After four weeks, Tyrel’s mother reported that the frequency of handwashing had tremendously decreased and he only washed his hands when it was necessary. She stated that he had accepted to go to school and was playing with his best friend during his free time. On observation, Tyrel looked generally relax and playful. This is consistent with the expectations of the mother since the first intervention was augmented with CBT to address the social challenges that the child was facing.
Ethical Consideration That Might Impact the Treatment Plan
The PMHNP, in this case, will have to consider ethics such as the right to autonomy by obtaining informed consent from the mother before initiating treatment. The mother should be explained to concerning how the medication will be administered, its benefits, and possible side effects before signing the consent. However, if the mother refuses the prescribed treatment or declines to sign the consent, it will impact the treatment plan, and the PMHNP will have to consider another treatment plan (Hirschtritt, Bloch & Mathews, 2017). Another ethical consideration is on do no harm, and it should be observed to ensure that the treatment has no harm to the patient (Öst et al., 2016). The treatment plan may have to be altered if the mother reports that the drugs have major adverse effects.
Obsessive compulsive disorder presents with distressing and obsessive thoughts that cause distress and anxiety. An individual attempts to suppress the thoughts and anxiety with actions that result in having repetitive and compulsive behaviors. Treatment of OCD is best achieved with SSRIs in combination with psychotherapy such as CBT. In children, Fluvoxamine is the most preferred since it has fewer adverse effects as compared to other SSRIs, and this promotes compliance. Ethical considerations such as the patient right to autonomy and non-maleficence should be observed when treating patients with psychiatric conditions to avoid legal issues.
Clark, D. A. (2019). Cognitive-Behavioral Therapy for OCD and Its Subtypes. New York, NY: Guilford Press.
Gerentes, M., Pelissolo, A., Rajagopal, K., Tamouza, R., & Hamdani, N. (2019). Obsessive-Compulsive Disorder: Autoimmunity and Neuroinflammation. Current psychiatry reports, 21(8), 78.
Hirschtritt, M. E., Bloch, M. H., & Mathews, C. A. (2017). Obsessive-compulsive disorder: advances in diagnosis and treatment. Jama, 317(13), 1358-1367.
Öst, L. G., Riise, E. N., Wergeland, G. J., Hansen, B., & Kvale, G. (2016). Cognitive-behavioral and pharmacological treatments of OCD in children: A systematic review and meta-analysis. Journal of Anxiety Disorders, 43, 58-69.
Pauls, D. L., Abramovitch, A., Rauch, S. L., & Geller, D. A. (2014). Obsessive–compulsive disorder: an integrative genetic and neurobiological perspective. Nature Reviews Neuroscience, 15(6), 410.
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