NURS1103 Preparation For Clinical Practice

Introduction

Clinical  practices  are  simply  guidelines  or  statements  that  are  intended  to optimize  patient  care  and  give  an  assessment  on  the  benefits  and  harms  of  a  particular  treatment  or  alternative  care  options. This  research on clinical practices is  about   a  client  by the name Lupe Guardiola suffering  from post  traumatic  stress caused due  to  a  road  accident  that  nearly  cost  him  his  life.  The  reports  contains  detailed  assessment  and  formulation  and  incorporates  a  bio-psycho-social  approach  while   providing  a  treatment  plan  for  him (Workowski & Bolan, 2015). Alternatively, It identifies potential interventions necessary during treatment. Basically  the  report  is  about  the  clinical  practices  required to  treat a trauma  patient  and  the  most  preferred  treatment  plan  for  such  a  patient.

Assessment and Formulation

An  assessment  in  clinical  terms,  is  a  way  of  diagnosing  and  planning  treatment  for  the  patient  while  clinical  formulation  or  a  case  formulation  is  a  theoretic  explanation  on   the  information  obtained  from  a  clinical  assessment. The clinical assessment and  formulation cannot be easily completed  if  a  bio – psycho – social  approach  is  not  taken  into  consideration  during  the  assessment  and  formulation  process. The  human  being  is  believed  to  a  psychological,  biological  and  social  being (Arnold & Boggs, 2015).  Thus  during  treatment  of  anyone  in  any  clinical  practice,  a  bio- psycho-  social  analysis  is  mandatory  to  ensure  that  all  the human  needs  are  met.  The above analysis is divided into three stages  (as  the  name  suggests)  i.e. biological, psychological, and social stages.

Biological  assessment  and  formulation

Biological  assessment  deals  mainly  with  the  entire  physical  body  of  the  client. As  in  our  case, Lupe Guardiola  was  involved  in  a  road  accident  that  almost  cost  him  his  life  thus the first biological assessment is mainly screening. Guardiola   is  screened  and  the  body  checked  to  see  if  there are any  injuries  that he  might  have  suffered  during  the  predicament. Screening  helps  to  detect  whether  there  are  fractured  bones  or  head  injuries  that  may  have resulted  to  the  patient  suffering  from  the  traumatic  stress (Boswell, Kraus, Miller  & Lambert, 2015).  After  the  screening  assessment, the physicians  then  provide a formulation  that  will help  to  treat  the  identified  problem. The  formulation  could  be  to  put  the  client (Guardiola) under  medication  and  regular  checkup  to  see  if  the  problem  is  getting  solved  and  see  if  the  treatment  is  working  for  the  patient. This formulation is done by the clinical officer. In our case Guardiola was found to have not incurred any physical injuries during the accident.

Psychological  assessment  and  formulation

Psychology  is  simply  the  study  of  the  human  mind  and  its  functions  in  relation  to  the  mental  and  attitude  characteristics  of  the  person. Psychological assessment simply means the process  of conducting   tests,  using  a  combination  of  techniques  to  arrive  to  a  person’s  behavior, personality,  and  personal  capabilities. During a psychological assessment the main means used in the initial testing stages of assessment is interviewing. The  information  obtained  is  then  used  to  build  a  hypothesis  and  help  in  the  selection  of  tests (Chow et al. 2015).  The  next  step  is testing  whereby  the  formulation obtained  after  the  results  are  analyzed  tested  then  a  report  is given  out.  In Guardiola’s case, the  interview helped to  identify  the  type  of  trauma  (whether complex or simple trauma) he is  suffering  from  and  then  using  the  data  given  a  formulation  is  developed  on  how  to  treat  the  patient  psychologically. After an interview it was evident that since the accident almost cost him his life, his psychology was greatly affected thus leading to a diagnosis of post traumatic stress leading to an intensive psychological assessment.

Social  assessment  and  formulation

Social  assessment  helps  to  assess the  social  state  of the  human  being  and  his  relationship  with  others   in  the  society. The assessment could range from questions of family  to questions about friends relatives and close brothers or sisters. In our case, the assessment could narrow down to questions about family or friends. This helps greatly to learn  if the family is contributing or helping in the social relationship of Guardiola. From the assessment it was evident that he became antisocial due to stress thus leading to him being isolated and left to stay by himself spending less time with friends and his family.  This therefore formed the basis for the formulation and treatment on the social aspect of the patient.

Treatment Plan

In order to treat the patient, a treatment plan is necessary. This  is  simply  a  guideline  which  shows  how,  when,  and  steps  to  be followed  when  treating  the  patient. It  outlines  the  best  medical  practices  that  would  be  highly  recommended  for  the  client  to  achieve  the  best  treatment  possible  and  help  in  curing  the  patients  trauma. The  process  starts  from  diagnosis  all the  way  to  social  treatment ( Friedberg & McClure, 2015).  Since  the  trauma  of  Guardiola is  complex trauma,  the  treatment  will  not  start  from  the  patient’s  past  history  but  dwells  mainly  on  the  current  state  of  the  patient  thus  calls  for  a  proper  and  well  designed  plan  to  ensure  that  the  client  is  not  overwhelmed. Revision  of  the  plan  is  very  necessary  to  ensure  that  every  procedure  adheres  to  the  optimum  treatment  of  the  patient.  In short the treatment plan is based on:

1. Strength  and  the   esteem of  the  client
2. The  mental  and  physical  triggers  that  affect  the  patient  presently  and in  the  future.
3. The  plan  should  not  neglect  the  past  events  but   work  on  them.

Diagnosis

The initial step of the treatment plan is diagnosis.  The treatment plan relies heavily on   diagnosis.  Diagnosis  helps  to  identify  the   underlying  problem  it  could  be  through  psychoanalysis  and  screening  to  determine  the  type  of    underlying  problem.  If  there  are  any  physical  injuries  the  treatment  administered  would  be  different  from  the  one  given  to  treat  the  patient’s  psychology.  Finally  a physical  exam  is  used  to  check  physical  symptoms  that  may  affect  the  patient(Meichenbaum, 2017).  The  criteria  used  to  carry  out  these  analysis  is  from  the   diagnostic  and  statistical  manual  and  mental  disorders(DSM-5).

To start with, Guardiola undergoes detailed protocol and since in our case the  patient  suffers  from  post  traumatic  stress  the  first  step  is  to  assess  the  ability  of  the  client  to  utilize  and  maintain  resources. These  could  be  events,  thoughts  or  people   who  had  been  of  positive him. Since  treatment  is  based  solely  on  therapy  the  first  person  to  create  a  feeling  of  serenity  and  security  is  the  therapist.   To  enable  and  identify  the  negative  belief  that  causes  trauma, Guardiola should be  taught  on  how  to   take  the  positive  side   of  life  and  relate  it  to  his  positive  cognition. All these  steps  should  be   followed  in  the  psychoanalysis  of  the  patient  by  the  psychologist (Carrot& Potter-Efron, 2014).

Treatment

The  treatment  given  is  to  help  the  patient  regain control over  his  life.  The  main  treatment  allowed  for  the  treatment  of  the Guardiola’s  trauma is  by  use  psychotherapy  and  sometimes  medication. These  combinations  helps to  address  his  symptoms,  cope  with  the  symptoms  if  they  arise  in  the  future,  and   also  help  to  treat  other  related  experiences  such  as    anxiety   and  depression (Youngstrom, Choukas-Bradley,  Calhoun  & Jensen-Doss, 2015).

Psychotherapy.

Psychotherapy forms the main treatment of the trauma.  There  are  many  types  of  psycho  therapy  which  ranges  from  cognitive  therapy  to  eye  movement  and  desensitization  processing(EMDR).  Firstly,  cognitive  therapy  helps  the  patient  to  recognize  their  way  of  thinking   and  develop  relations  between their  cognitive  behavior  and  their  environment. This therapy is commonly used along with exposure therapy. Exposure   therapy  always  works  on  the  behavior  so  as  to  help  the  patient  to  face  situations  that  make  the him face  memories  that  are  frightening   and  to  focus  on  the  best  memories.  These  memories  could  be  through  flashbacks  or  even  nightmares. Thirdly,  the  last  step  for  psychotherapy  is  eye  movement  desensitization  and  reprocessing  which  help  to  change  the  traumatic  memories  and  help our client Guardiola,  to  change  how  he  reacts  to  them. To  conclude  he should  be  taught  by  the medical  practitioner  on  how  to  handle  the  mental  health  and  to  develop  skills  that  could  help to  develop  stress  management  skills  and hence overcome  trauma ( Fife & Weeks, 2014).

Medication.

To ensure full recovery for the client, medications  are  necessary. The  first  form  of  medication  the  client  should  receive  are  antidepressants. These medications help  to reduce depression and anxiety.  They  also  help  to  improve his  sleep which  is  a  major  factor  in  treatment  of  post traumatic stress. These  medications include;  selective  serotonin  reuptake  medications  and  paroxetine   which  should  be  approved  by  the  drug  administration  for  treatment (American Speech-Language-Hearing Association, 2016). The  other  type of  medication  required  is  anxiety  mediations  to  manage his anxiety,  and  finally  prazosin  which help  to  suppress  nightmares that may occur while he is sleeping.

Social  support

Social  support  forms  the  final  part  of  the  entire  treatment  plan  for  the  client.  For best results the Guardiola must be socially involved.  The  first  important  aspect  of  the social  support  is  to  help  him follow  the  treatment  plan,  to  enable  the him  to  learn  more  about  the  disorder  and  finally  know how  to  take  care  of  himself.  In our case, Guardiola should  be  encouraged  to  spend  more  time  with  his  family  so  as  to  develop  good  memories  that  would  help  him to fully recover ( Miller & Moyers, 2015).

Potential Interventions during Treatment

Interventions  are  attempts  made  to  make  a  person  to seek  professional  help  to  address a  particular  problem.  It  may  also  refer  to  an  act  of  using  similar  technique  to  offer  therapeutic  treatment.  At  individual  level Guardiola  could  intervene  during  treatment   by  ensuring  that  he  strictly  sticks  to  the  medical  plan  and  ensuring  that  he  takes  the  therapeutic  treatment  with  uttermost  seriousness.  At  cultural  level, he should  engage  in  social – cultural  activities  that  would  enhance  his  treatment.  Finally  systemic  interventions  refers  to  a  pattern  in  which  an  event  occurs  during  treatment  and  have  their  own  effect  on  the  client  these  systems  range  widely  from  medication  to  therapy  (Duncan, 2014).   For  example  the he  could  volunteer  to  take  part  as  a  social  worker  to  try  and  enhance his social  skills  by  engaging  in  community  work  such  as  counseling  and  also  giving  advice  to  others  in  the  community  who  might  be  suffering  from  a  similar  predicament.

To  justify  the  above  statement,   Guardiola  could  work  as  a  counselor. Becoming  a  counselor  exposes  him to  different  types  of  people  and by  interacting  with  them  he  could  learn  to  understand  how  to  cope  with  the  various  challenges  that  he  may  face  during  therapy  sessions.  The  client  could  also  become  mediator  and  help  in  solving  wrangles  between two  people.  This  would   greatly  help  him to  become  conversant  with  the  various  social  set up  and  thus helping  him  to  develop  legit  conflict  resolution  skills  that  would  come  in  handy  to  help  him    overcome  self  conflicts  and  condemnation and to develop a high self esteem (Medalia & Bowie, 2016).

Theoretic model that supports the intervention

A theoretical  model  is  simply  an  assumption  about  a  system  or  object.  These  theories  can  then  be  used  to  fulfill  the  function  of  explanation and  derivation  of  principles.  In   our  case  the Guardiola  is  engaged  in  social  work as a therapist . The health  belief model, consists  basically  the  following  core  rules: cues  to  action, and  self  efficacy.  For  example,  if  the he  engages  in  social  work,  using an example of a therapist, the rate  of  exposure  to  different  types  of  minds  is  possible  thus  it helps him to  correlate  between  the  trauma  he  is  suffering  from  and  the  various  problems  people  encounter  during  their  social  life  such  as  stress  and  depression. This greatly helps  since by providing  solutions  through counseling to  the  various problems of his clients, he  is  able  to  apply  it  in  his  everyday  life  thus  overcoming  the trauma  in  the  long  run (Barlow, 2014), leading to a successful treatment.

References

American Speech-Language-Hearing Association. (2016). Scope of practice in speech-language pathology.

Arnold, E. C., & Boggs, K. U. (2015). Interpersonal Relationships-E-Book: Professional Communication Skills for Nurses. Elsevier Health Sciences.

Barlow, D. H. (Ed.). (2014). Clinical handbook of psychological disorders: A step-by-step treatment manual. Guilford publications.

Boswell, J. F., Kraus, D. R., Miller, S. D., & Lambert, M. J. (2015). Implementing routine outcome monitoring in clinical practice: Benefits, challenges, and solutions. Psychotherapy research, 25(1), 6-19.

Carruth, B., & Potter-Efron, R. (2014). Shame, guilt, and alcoholism: Treatment issues in clinical practice. Routledge.

Chow, D. L., Miller, S. D., Seidel, J. A., Kane, R. T., Thornton, J. A., & Andrews, W. P. (2015). The role of deliberate practice in the development of highly effective psychotherapists. Psychotherapy, 52(3), 337.

Duncan, B. L. (2014). On becoming a better therapist: Evidence-based practice one client at a time. American Psychological Association.

Fife, S. T., & Weeks, G. R. (2014). Couples in treatment: Techniques and approaches for effective practice. Routledge.

Friedberg, R. D., & McClure, J. M. (2015). Clinical practice of cognitive therapy with children and adolescents: The nuts and bolts. Guilford Publications.

Medalia, A., & Bowie, C. R. (Eds.). (2016). Cognitive Remediation to Improve Functional Outcomes. Oxford University Press.

Meichenbaum, D. (2017). Stress Inoculation Training: A preventative and treatment approach. In The Evolution of Cognitive Behavior Therapy (pp. 117-140). Routledge.

Miller, W. R., & Moyers, T. B. (2015). The forest and the trees: relational and specific factors in addiction treatment. Addiction, 110(3), 401-413.

Pardeck, J. A. (2014). Using books in clinical social work practice: A guide to bibliotherapy. Routledge.

Workowski, K. A., & Bolan, G. A. (2015). Sexually transmitted diseases treatment guidelines, 2015. MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports, 64(RR-03), 1.

Youngstrom, E. A., Choukas-Bradley, S., Calhoun, C. D., & Jensen-Doss, A. (2015). Clinical guide to the evidence-based assessment approach to diagnosis and treatment. Cognitive and Behavioral Practice, 22(1), 20-35.