NURS 324 Theories In Nursing Practice
Question:
Write a report on Needs of patients with psychotic disorder related to substance abuse.
Answer:
Introduction
Substance abuse is one of the main cause of the psychotic disorder in patients. Recent studies regarding the patient’s in their first episodes of psychosis have found a 74 % lifetime prevalence of the use of the substances (Van Dorn et al., 2012). Alcohol, nicotine, and cannabis are the major substances required abused by the patients with psychotic disorders. The main psychotic symptoms faced by the patients with substance abuse are hallucinations or delusions. Mental illness can cause various types of psychological problems that can decrease the quality of life of both the patient and their family. Some of the challenges faced by the patient himself and the caregivers are the remission of the drugs and disruptive and abnormal behavior exhibited by the patients. Patients with psychotic disorder often can show violence and can often engage in behaviors that can be frightening, disruptive and destructive for both the family and the patient (Thornton et al., 2012). The family members and the caregivers have to be in an optimal, social and psychological state in order to deal with the patients with mental disorders another important issue is the remission of the substance abuse. Hence this paper would provide a vivid plan of care regarding the issue of violence shown by the patients related to remission of the substance abuse.
Plan of care
Nursing care plan for substance abuse involves the provision of support to the patient and the family to prevent the substance abuse, manage any kind of violent behavior exhibited by the patients. The nursing interventions for dealing with such behaviors include conveyance of the attitude of acceptance, ascertaining the reason for beginning the abstinence or the involvement in the therapy (Byrne, 2007). This helps in providing insight to the willingness of the patient to commit to long term behavioral changes. It has to be remembered that denial is the most common and resistant symptom to substance abuse.
The family of the patients might be in vein due to the remission of drug abuse. Hence it is important to discuss the current situation and the actual impact if the substance abuse. The risk of relapse of the drugs is enabled by the family history of psychosis, residual disability and current substance misuse. This is because the first step in the denial is to see the relationship between personal problems and substance abuse (Volavka, 2013). Patient might deny but the credit lies in confronting and examining the denial and rationalization in peer group. Confrontation should be accompanied by caring. The patient should be encouraged to take his own responsibilities for his/her own recovery because denial action can be replaced with a positive reaction if the patient accepts his own reality.
Since families play a great part in the care of the patient it is important to determine the current situation and the methods of coping with the life problems. According to Ranahan, (2010, February), there had been significant deficits in the first aid skills of the mental health among the adult population for responding to the people or the adolescents in distress. The beliefs of the mental health disorders in the family and the caregivers plays a crucial role in the care of the patients with mental disorder to get rid of the stigmatized thoughts regarding mental illness (Iseselo et al., 2013). Mental stigma would bring a barrier in the care of the patient that may trigger disruptive behavior in the patients (Calatayud et al., 2012). There is a need for the awareness of the mental health symptoms and the effective treatment. The family members should be encouraged to be aware of their own feeling as some actions of the family members can perpetuate the problem of the addicts. In case of the violent patients more intensive case management is required with prolonged prophylaxis. It is necessary to keep the patient calm as the environmental stimuli such as minimal activity and low noise can decrease the potential for anxiety that might create violence. Any type of activities that can trigger violence such as using of restraints or forcing for medications should be avoided as restraint can generate mistrust and delusion in patients (Hawton, et al., 2012). It is necessary to engage the client in reality based activities such as writing, drawing, simple arts and craft of listening to the music, as redirecting the energy of the client to some activities can decrease the possibilities of violence in patients and help distract from hallucinations and voices. The therapist should be able to develop a trusting relationship with clients, such that the patient can express the frustration and the grievances verbally instead of just striking out. Proper cognitive behavioral therapy can be helpful in organizing the disruptive thoughts of the patient (Hawton, et al., 2012). It is necessary to guide the client to focus on only one idea at a time as thinking might become confused and the disorganized that can generate stress in the clients and can give rise to delusions and violence in patients. The functioning of the client can be optimized by healthy habits such as adhering to the medication regimen, maintaining a proper sleep pattern, self-care, reducing the drug intake. These all are vital in keeping the clients in remission. It is necessary to show empathy towards the feelings expressed by the clients and to reassure them about the care that has been provided. It is necessary to teach the client to cope up with the worrying thoughts and the urge for causing harm to others (Iseselo et al., 2013). Safety measures has to be utilized to protect the clients or the others as during acute phase the delusional feelings of the patients might instruct them to hurt others in order to remain safe. In case of extreme cases external controls might be required. The family and the caregivers may suffer from burnouts or stress while caring for the mental patients related to substance abuse. Counselling of the family members and the personal caregiver can be helpful in preventing the psychological burden on the family (Iseselo et al., 2013).
Conclusion
In conclusion it can be said that although violence in psychotic patients can be risky for both the patient and the caregivers, therapeutic relationship with the client, empathy, and adherence to medications can reduce the occurrence of destructive activities in the patient and reduce the psychological burden on the caregivers.
References
Byrne, P. (2007). Managing the acute psychotic episode. BMJ?: British Medical Journal, 334(7595), 686–692. https://doi.org/10.1136/bmj.39148.668160.80
Calatayud, G. L., Sebastián, N. H., García-Iturrospe, E. A., Piqueras, J. C. G., Arias, J. S., & Cercós, C. L. (2012). Relationship between insight, violence and diagnoses in psychotic patients. Revista de Psiquiatría y Salud Mental (English Edition), 5(1), 43-47.
Hawton, K., Saunders, K. E., & O’Connor, R. C. (2012). Self-harm and suicide in adolescents. The Lancet, 379(9834), 2373-2382.
Iseselo, M. K., Kajula, L., & Yahya-Malima, K. I. (2016). The psychosocial problems of families caring for relatives with mental illnesses and their coping strategies: a qualitative urban based study in Dar es Salaam, Tanzania. BMC Psychiatry, 16, 146. https://doi.org/10.1186/s12888-016-0857-y
Ranahan, P. (2010, February). Mental health literacy: A conceptual framework for future inquiry into child and youth care professionals’ practice with suicidal adolescents. In Child & youth care forum (Vol. 39, No. 1, pp. 11-25). Springer US.
Thornton, L. K., Baker, A. L., Lewin, T. J., Kay-Lambkin, F. J., Kavanagh, D., Richmond, R., … & Johnson, M. P. (2012). Reasons for substance use among people with mental disorders. Addictive Behaviors, 37(4), 427-434.
Van Dorn, R., Volavka, J., & Johnson, N. (2012). Mental disorder and violence: is there a relationship beyond substance use?. Social psychiatry and psychiatric epidemiology, 47(3), 487-503.
Volavka, J. (2013). Violence in schizophrenia and bipolar disorder. Psychiatria Danubina, 25(1), 0-33.
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