NRS222 Essential Nursing Care : Mental Health Nursing

Question:

Select a behaviour that is relevant to your consumer population and propose an evidenced-based approach to successful behaviour change. Consider- This is where you would select the behaviour of concern eg- Drug use or alcohol consumption

1.The rationale for focusing the behaviour change intervention with that specific population for this part, justify why this behaviour of concern was chosen, why is it a concern to the population that you work with/have chosen to write about and why have you chosen the specific intervention that you will present in the report, e.g. what does the research say

2.Critical review of theoretical perspectives that have been applied to supporting behaviour change in this population. For this part, review the research around behaviour change for this behaviour and critically analyse/justify why you have chosen the intervention you did

3.Any potential barriers at the neurophysiological, individual, interpersonal, organisational levels and how these barriers could be overcome. For this part, think about what barriers there might be to successful change from the clients perspective, from the practitioners perspective and through the system that surrounds them.

Specific details of the intervention are not required within this assignment and the focus should be on the justification of the theoretical approach and key areas of intervention.

Answer:

Introduction

Schizophrenia is a psychiatric disorder that is linked to a disabling of psychological. Cognitive and occupational functioning of the brain. (Hayes, Levin, Plumb, Villatte & Pistorello 2013). Evidence has revealed that behavioral change interventions can work towards increasing the changes of recovery and remission of the affected. Schizophrenia is majorly identifiable with cognitional and emotional disruptions that often lead to a progressive neglect of personal care and a failure to do well in social interactions in the affected people. (Herbert & Forman 2011). The narrow view that has been given towards tackling this mental problem have proved to be futile, and there needs to be ideas based on neurophysiology to approach behavior change in the affected individuals.

Psychopharmacological interventions that have been tried as mainstay approaches towards tackling these problem have not been very effective. The prevailing optimism that psychopharmacological interventions alone can lead to full recovery or reduce risks of this problem have all been futile and in vain. (Martin & Pear 2015). Studies that have been done on this problem in the recent years recommend that more knowledge on this problem should be provided and its treatment made aware to the public, and that personal/interpersonal interventions should be given to patients in order to increase their chances of recovering from the illness. (Ehde, Dillworth & Turner 2014).

Health workers should work hand in hand with patients and social workers so as to offer proper education, treatment, and psychological care in an environment that encourages hope and optimism in the affected people.

This review is a critical consideration of recent neurophysiological approaches in providing psychological interventions to people with schizophrenia. This review will give the summary some of the highlighted interventions that have need given towards solving this problem, and then look at the barriers that are hindering these approaches towards helping the individuals affected with this problem. This review will help to enhance the understanding of the most effective approaches towards a better management of the people affected by this problem.Cognitive-behavior technology Interventions for schizophrenia Patients.

Psychological Interventions

Current research shows that both psychosocial and pharmacological treatments can improve the prognosis of people with schizophrenia and other psychotic maladies. Albeit though, there has also been tremendous evidence that psychological interventions are most effective in relieving the patients’ symptoms of psychotic behavior and thus improving their functioning and relieving them. (Mennin, Ellard, Fresco & Gross 2013). Hence, allowing for providing alternatives to the traditional and conventional pharmacological approaches is key towards enhancing recovery of patients from schizophrenia. It is envisaged that psychological interventions towards treatment of schizophrenia can not only address patients’ needs but can also provide a more reliable an efficient intervention towards providing to people with schizophrenia, than does the prevailing conventional approached of dealing with the illness. (Espie 2009).

The following are five classes of psychological interventions that have been proved to work for patients with schizophrenia. With these interventions, there has been evidence of relieve of psychotic symptoms on patients with a good response on preventing relapses. These five categories are as follows:

i.Cognitive therapy
ii.Psycho education programs,
iii.Family intervention,
iv.Social coping skills
v.Training programs
vi.Case management

In addition to these identified approaches, there are also traditional approaches that have been incorporated in these psychological interventions. These include psychodynamic psychotherapies, Insight based psychotherapies and behavioral change techniques. These traditional approaches have also been proved to be effective in lessening the psychotic symptoms of patients with schizophrenia. Each of these identified classes of psychological intervention has its own goals and advantages and procedures of treatment. However, they have all been confirmed as effective in ameliorating various aspects of the individuals living with the problem.

Rationale of Psychological Interventions towards solving Schizophrenia patients

Psychological measures for schizophrenia patients involves family interventions and personal therapies with patients. (Mohr, Burns, Schueller, Clarke & Klinkman 2013). A good number of these in interventions directly apply principles of Cognitive-behavior technology (CBT) or they may derive their operational processes from the CBT principle. Although it is largely speculated that CBT –based interventions could promote positive results for schizophrenia patients, there is no much evidence to support that CBT could be more superior to other therapies. Currently, there have been good evidence on use of CBT related interventions for people living with schizophrenia. CBT researchers have really done a good work in researching for this intervention approach and thee is a good number of literature material on the approaches of CBT towards helping people with schizophrenia. (Mitchell, Gehrman, Perlis & Umscheid 2012).

Literature Review

CBT has always been used in treatment of patients with cognitive disorders. However, this principle has not been fully implemented majorly due to the dominance and preference of pharmacological treatments or a deficiency in the understanding of the management of schizophrenia from a psychological and cognitive perspective. (Prochaska 2013). The use of psychotherapeutic treatments is fast growing as the knowledge of psychopathology is gaining dominance. (Olatunji, Cisler & Deacon 2010). Psychopathology of various diagnostic groups is widely being spread to people and general knowledge on schizophrenia is also growing fast. A lot has been researched and is available today on how to come up with an efficient ‘disorder mechanism’ psychological treatment of schizophrenia.

Schizophrenia is evidenced by its notable symptoms that include delusions and hallucinations, inconsistent breaking speech and behavior, indicative symptoms of discomfiture and a notable psychological dis-functioning. While often thought to be progressively hindering disorder of the mind, studies have revealed that schizophrenia has been found to be a varying illness, and its symptoms can vary and mutate between the common known behaviors to strange and unexpected ones that are majorly influenced by psychosocial interventions and the pharmacological treatment interventions that schizophrenia patients are often subjected to. Schizophrenia is usually characterized by difficulty in copying with changes in life, notable cognitive impairment, psychophysiological effects and chronic consistently debilitating cognitive failure. (Ryan, Lynch, Vansteenkiste & Deci 2011). The severity of the disorder is measure by the individual’s response of copying, and stress level.

With this condition, (schizophrenia), relapsed are normal occurrences. Relapses is one of the positive symptom of schizophrenia. This symptom has often been associated with prodromal symptoms and stressful events in life. Unfriendly interactions with family members, overstretching residential treatments and disappointments. Previous research has revealed that early interventions and prodromal signs can be potential factors in bringing down elapses. (Safren et al 2009).

There are also important phases in the treatment of schizophrenia that it is important to understand in order to avoid precipitating on de-compensations because of exerted efforts of rehabilitation. Many authors have noted that immense rehabilitation efforts contribute to precipitating of relapses within the first six months of treatment.

Findings of illness related deficits in this illness (schizophrenia) provide an empirical and conceptual foundation for development of CBT. Studies have highlighted a need for coping skills that will help clients to cope with situational stresses and to change the perception of events, lessen psychological arousals and put more focus on the interaction of the malady of the person affected. (Wetherell et al 2011).
CBT procedures that have been done in the past with schizophrenia are majorly focused on changing of delusions and hallucinations. Several studies show positive results with graded examinations based on evidence and the design of alternative methods to alter and lessen the power of hallucinations and increase management of symptoms. Other researchers view CBT as a way of offering adjunctive therapies in inpatient and residential settings. The Kingdom and Turlington study of 1991 and 1994 views CBT as a way of normalizing methodology to explain management of symptoms to clients. The result of this study suggests that these approaches led to a drastically reduced records of reduced cases of symptomatology and improved social interactions. In addition cases of hospitalization also appeared to have reduced drastically.
In a study by Bradshaw, a CBT study that involved a single subject with four individuals who had participated I outpatient treatment, it was found that there was a notable reduction in the symptomatology and hospitalization cases and a subsequent improvement in the functional psychological attainment objectives that set.

Viewed generally in this particular review, CBT can be useful with schizophrenia patients. However, many studies have been limited on this subject because of the methodological problems that that come during the time of clinical testing and experimental treatments. Most studies lack outcome measures which consequentially lead to meagre post-treatment data. Furthermore, there have been limited comprehensive use of CBT principles to schizophrenia clients over a long period of the illness.

Supportive Educational Interventions

Patients of schizophrenia have a right to get information of their disorder. Educational interventions are aimed at providing a well-organized process of feeding the schizophrenia clients and their care takers, a case that would otherwise be haphazardly done. Supportive approaches mainly involve efforts to help individuals to understand their condition and what they can expect. Clint education can take more than one forms, depending on the setting of the environment where the client is situated. For example, the process may be carried out in groups through discussions or by use of media such as pamphlets, and or videotapes or both.

Individual Psycho-educational Interventions

These programs are meant to address illness cases from various perspectives such as pharmacological. Social, biological and family perspectives. Patients are given support information and are acquainted with support methodologies. Recent studies have shown that educational programs can immensely lead to a reduction in relapses. Clients are also provided with programmed in life skills to help them cope with environmental changes that they may be going through. These programs may include running homes, personal care and or common skills. These programs are usually provided by trained health care professionals. (Bowler et al 2012).

A big challenge in the mental health sector is implementation of interventions that are evidence – based within their respective settings. Many implementation efforts have had major setbacks due to barriers that can be identified in each implementation level. (Beck 2011). At each level of the implementation of psychological interventions can be identified barriers. According to research that has been done, personal level, organizational and provider-level barriers. Personal barriers refer to challenges that clients face that are limited to their own personal affairs. Organizational barriers refers to the attributes of the environmental setting where the implementation is set to occur. (Persons 2012). The characteristics of the setting may be cultural or climatic. Intervention barriers refer to the characteristics of the interventions to be implemented. Neurophysiological barriers may include attributes of the principles and models that are to be used in implementing the interventions, in which the organizations and providers are situated. Below are some of the barriers that may be faced on various levels. Among the barriers to behavioral change among the individuals with schizophrenia is Stigma and discrimination in the interpersonal level. Stigma involves the prejudices and stereo types of people towards people with schizophrenia. Organizational barriers also contribute immensely to affect outcomes in the implementation of interventions to help people with schizophrenia, in this case. Many providers and settings have not yet fully implemented this principle in their programs of treatment although CBT is considered to be an effective evidence-based approach towards helping individuals in behavior change.

References

Beck, J. S. (2011). Cognitive behavior therapy: Basics and beyond. Guilford press.
Bowler, J. O., Mackintosh, B., Dunn, B. D., Mathews, A., Dalgleish, T., & Hoppitt, L. (2012). A comparison of cognitive bias modification for interpretation and computerized cognitive behavior therapy: Effects on anxiety, depression, attentional control, and interpretive bias. Journal of consulting and clinical psychology, 80(6), 1021.
Ehde, D. M., Dillworth, T. M., & Turner, J. A. (2014). Cognitive-behavioral therapy for individuals with chronic pain: efficacy, innovations, and directions for research. American Psychologist, 69(2), 153.
Espie, C. A. (2009). “Stepped care”: a health technology solution for delivering cognitive behavioral therapy as a first line insomnia treatment. Sleep, 32(12), 1549-1558.
Hayes, S. C., Levin, M. E., Plumb-Vilardaga, J., Villatte, J. L., & Pistorello, J. (2013). Acceptance and commitment therapy and contextual behavioral science: Examining the progress of a distinctive model of behavioral and cognitive therapy. Behavior therapy, 44(2), 180-198.
Herbert, J. D., & Forman, E. M. (2011). The evolution of cognitive behavior therapy. Acceptance and Mindfulness in Cognitive Behavior Therapy, 1.

Martin, G., & Pear, J. J. (2015). Behavior modification: What it is and how to do it. Psychology Press.
Mennin, D. S., Ellard, K. K., Fresco, D. M., & Gross, J. J. (2013). United we stand: Emphasizing commonalities across cognitive-behavioral therapies. Behavior therapy, 44(2), 234-248.
Mitchell, M. D., Gehrman, P., Perlis, M., & Umscheid, C. A. (2012). Comparative effectiveness of cognitive behavioral therapy for insomnia: a systematic review. BMC family practice, 13(1), 40.
Mohr, D. C., Burns, M. N., Schueller, S. M., Clarke, G., & Klinkman, M. (2013). Behavioral intervention technologies: evidence review and recommendations for future research in mental health. General hospital psychiatry, 35(4), 332-338.
Olatunji, B. O., Cisler, J. M., & Deacon, B. J. (2010). Efficacy of cognitive behavioral therapy for anxiety disorders: a review of meta-analytic findings. Psychiatric Clinics, 33(3), 557-577.
Persons, J. B. (2012). The case formulation approach to cognitive-behavior therapy. Guilford Press.
Prochaska, J. O. (2013). Transtheoretical model of behavior change. In Encyclopedia of behavioral medicine (pp. 1997-2000). Springer, New York, NY.
Ryan, R. M., Lynch, M. F., Vansteenkiste, M., & Deci, E. L. (2011). Motivation and autonomy in counseling, psychotherapy, and behavior change: a look at theory and practice 1ψ7. The Counseling Psychologist, 39(2), 193-260.
Safren, S. A., O’cleirigh, C., Tan, J. Y., Raminani, S. R., Reilly, L. C., Otto, M. W., & Mayer, K. H. (2009). A randomized controlled trial of cognitive behavioral therapy for adherence and depression (CBT-AD) in HIV-infected individuals. Health Psychology, 28(1), 1.
Wetherell, J. L., Afari, N., Rutledge, T., Sorrell, J. T., Stoddard, J. A., Petkus, A. J., … & Atkinson, J. H. (2011). A randomized, controlled trial of acceptance and commitment therapy and cognitive-behavioral therapy for chronic pain. Pain, 152(9), 2098-2107.

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