NURS2103 Mental Health Professional Practice

2.How might Justin’s cultural interpretation of mental illness be different from your own?

 

3.Identify how your own attitudes and values relating to mental illness may influence any communication with Justin?

 

4.How can partnerships with Justin and his immediate and/or extendedfamily be developed and maintained throughout his journey of

 

5.What are the social and cultural implications for Justin leaving his home and community for assessment and treatment in the city?

 

6.What needs to happen to ensure culturally safe care for Justin once he is hospitalised?

 

7.From the information in the Mental Health Assessment and Mental State Examination, what are the identified areas of concern and the priorities of care planning for Justin?

8.Read the 1:1 intervention notes and identify the communication skills/ strategies that are allowing the health professional to talk with Justin in a culturally safe

9.Review the discharge plan and 3 month review and consider how Justin can be supported to maintain his well-being when he has returned to his family and

10.After considering the issues for Justin, reflect on your own experiences of relating to people from different Consider what you have learnt fromJustin’s story and how your new knowledge might influence your practice.

The case study reveals the fact that Justin had been suffering from type 2 diabetes. This chronic disease has not only taken a toll on his physical conditions, but has also affected his mental health.

People with mental illness had always been susceptible to a lot of mental turmoil. Justin belonged to an aboriginal background and has already faced many problems due to his culturally diverse background.  He had faced school dropout, rejection in professional life. His background along with a lot more causes had been responsible for his present condition. Justin has been severely affected since the demise of his favorite uncle Reggie, who had always been his inspiration. According to Larson et al.(2007) dissatisfaction, frustration, not being able to share things with anyone can bring about depression and anxiety in adolescents. These entire factors have developed a sense of disgrace, discontent in Justin about his life. Justin is always invaded by the guilt that his family will suffer due to his condition and he could not find any meaning of life.

Aboriginal culture is mainly based on aboriginal spirituality is mainly generated from their connectedness with the land (National Aboriginal Health Organization  2008). Their religion is mainly totemistic and symbolical. Groups, communities, superstitions, rites and rituals form important spheres of their life (Vicary and Westerman 2004). According to the aboriginal belief mental illness is generally caused due to the effect of some bad omen or it affects those who have done some wrong deeds in previous life and is generally a condition that cannot be cured (Williams and Mohammed 2009). Justin has confessed this at the time of 1:1 interaction. Due to their superstition they never think of accepting the westernized model of care for treating mental problems. On the other hand I belong to a Hindu family from Nepal where mental health is considered as a serious issue which needs to be attended until situations turn worse (Kohrt and Hruschka 2010). According to Nepalese belief, mental illness can be caused as a result of social exclusion, social discrimination, racism, homesickness and probably due to limited job opportunities and lack of financial support (Luitel et al.2013). Mental health might be stigmatized in some communities but it has got nothing to do with bad omen and other superstitions. Unlike the aboriginals our culture believes that proper psychotherapy and medications can bring about moderate to higher rates of improvement.

I have already stated that my perception about mental health illness is quite different from that of Justin as we don’t share the same cultural background. Hence, It is necessary that a non-hostile environment is created between the client and the therapist. In order to deal with patients coming from a linguistically and culturally different background, the key principle that has to be followed is the acceptance to their culture (Mezuk et al.2010). In order to practice a care regimen that is culturally safe it is important to build a positive mindset towards their culture. It has to be remembered that a culturally safe practice is important to enhance the personal empowerment. It is important to listen and believe their culture carefully in order to help get rid of the fear of rejection. If Justin cannot share openly, his treatment will remain incomplete forever. As stated by Jorm et al.2012 (2012) gestures of avoidance from health care workers can create a sense of discontent among the aboriginal mental patient and decrease the rate of reliance on the western mode of treatment. As a nurse administrator I have tried to maintain a balance between professionalism and inter-personal relationship with the client (Williams and Mohammed 2009). I wish that that such an act would have increased Justin’s trust on me as his caregiver. As a nurse I have always strived on providing physical as well as spiritual support to a patient, as I have always believed that well being of a patient is integrated to physical, mental and spiritual care.

Collaborative care approach by involving the families of a mentally disturbed patient can be used to heal the severity of mental problems. It has to be remembered that most of the aboriginals are community centered and care should be taken, that no such procedures in the treatment plan loosen Justin’s tie with his culture and ethnicity (Hansson et al.2012). The aboriginal people had long been practicing traditional way of healing diseases; therefore his cultural ties should be maintained throughout his treatment. Justin’s attachment with his family will impose a positive therapeutic effect.

Justin’s family can be helpful in preparing discharge plans for Justin and bringing him back to the normal pace of life from the darkness of mental illness.

While communicating with the families, it is necessary to maintain the cultural safety practice such that it becomes easier for them to understand the ways and the means of Justin’s treatment. Furthermore it will also help Justin to understand his own problem which can be considered as the initial step towards self care management (Parkar 2010).

The aboriginal background of Justin comes with a lot of implications. The ill effects of racism are still prevalent in the society even in these years of progressiveness. Due to their negative experiences of the past related to racism and western culture, they sometimes cannot fully rely on the westernized concept of medical treatment (Larson et al.2010). Again as mentioned earlier that community norms always played an important part in the life of aboriginals. Therefore the community might not find the involvement of western clinical practice in a positive way. The case study reveals that Justin shares a strong bonding with her mother. Her mother’s wants her son to recover soon, for that she is also ready to cooperate with the mental health clinic. She is also a bit stigmatized by the culture and hence fears that taking Justin to a city for the treatment might break the cultural bonds (Knifton 2012). In spite of all these facts, Justin and his mother could accept the westernized treatment plan by untying the cultural stigma and taboos (Brody and Galvin 2013). It is evident from the case study that Justin could fade away her stigmatized cultural concept and could actually accept the westernized concept of treatment and respond to the treatment plan set for him.

Justin’s culturally different background had already taken a toll in his life and had impacted his school life, professional life and social life. Justin. Justin has encountered racist behaviors for school which led to his school dropout. Lack of proper education has again affected his professional life as he could not achieve enough academic degrees to enroll for a quality job. Above all he has become the victim of type 2 diabetes and several other comorbities. In order to provide Justin with a comprehensive care, it is necessary to maintain a conducing environment in the mental health clinic (Lee et al.2014). A nurse should be able to understand the perception of Justine and would help him to develop the trust for the westernized type of care. A non -hostile environment can help Justine to respond and adhere to the necessary medicines. Patients with cognitive behavioral problems should be tried with talk therapy, which required through interrogation and interaction with the patient (Brody and Galvin 2013). It is necessary for the nurse to create an interpersonal relationship with the patient in such that Justin can be a part of the therapy and can interact freely with the caregiver (Hanson et al.2012). It is evident from the assessment report that Justin wished to be attended by a male nurse. Complying with his wishes by appointing a male nurse and providing culturally safe meals can also be an important part of the treatment plan.

Some of the most common issue associated with mental illness is depression, anxiety and the thought of self destruction. Justin finds his life meaningless and sometimes develops suicidal thoughts. According to McGough (2015) depression, anxiety, lack of purpose in life can lead to self destruction among depressed individuals like Justin. In order to deviate his suicidal thoughts Justin should be imparted with the thought that the issues that he is facing is just a regular one and he can easily recover from it by adhering to proper medications and adopting a healthy life style. Justin needs to be provided with some psychotherapies as well as recreational therapies. Recreational therapies would help to distract Justin’s mind from self destructive thoughts (Pitman et al.2012). After Justin has responded to these therapies he can be provided with some complementary therapies like meditation or yoga.  Furthermore as seen from the case study, Justin’s depression had worsened after the death of his beloved uncle Reggie and it seems that Justin still requires some counseling to recover from his grief.  One thing should be carefully noted that since Justin had already tasted the bitterness of racism, every possibility that can make Justin fell discriminated should be irradiated.

Culturally safe practice can be achieved by the adoption of following ways-

• A therapeutic relationship can be established between the client and the healthcare professional. The purpose of a therapeutic relationship can assist an individual to change his life for the better (Van Brakel 2006). A therapeutic relationship with the nurse would help Justin to share his intimate thoughts, emotions and beliefs. It is important to create a non -judgmental atmosphere and show empathy and kindness to the patient (Brody and Galvin 2013). A proper therapeutic relationship with Justin would help to speed up the recovery process by providing a complete understanding over the matter.
• A patient like Justin should be countered with open ended questions. An open ended question allows a patient to give vague answers or opening up in front of the therapists rather than answering by simple ‘yes’ or ‘no (Hannson et al.2012)’. Open ended question helps an individual to share things about his own life and gives an idea about their ways of thinking (McGough 2015). Open ended question would help Justin to share the stories of his life and would not confine his grievances into himself.
• In order to communicate with patients coming from a different linguistically different background it is necessary for the therapist to construct short and easy questions, for the easy understandability of the patients (Van Brakel 2006). The caregiver must have asked short simple questions to Justin, such that Justin does not cringe out of fear or faces difficulties in choosing words to answer the questions.

It is evident from the three months plan that Justin has been showing improvement to the care plan. The 3rd week review of the Justin’s plan provides with the information that Justin is now eager to go to home, to see his families, to greet his loved ones, families and friends (Mezuk et al.2010). Although Justin had been discharged for the institution but he should be kept under continuous surveillance for some times. His parents are advised to keep a close watch and avoid the events that may trigger depression and anxiety in Justin.  A continuous support and love from the closed ones can actually encourage Justin to start a new life afresh (Lee et al.2014). The discharge plan set for Justin involved daily exercises and healthy diets, to manage his physical ailments. The discharge plan also emphasizes on the fact that Justin needed enough rest and needs to stick to the medications. Furthermore, Justin is encouraged to move on in his life and dream of a better life. Justin can assist a traditional healer and cater his life to the wellbeing of others or he could continue with his previous job. A patient like Justin requires a regular follow up in order to keep his diabetes and mental health manageable.

I have come across many patients in my professional practice, but the case of Justin would always hold a significant position in my professional career, as I have gained knowledge regarding several things that would help me in my future practice. Since, it was a culturally sensitive issue, I have gained immense patience have learned acceptance towards new culture or religion. I have understood that it is not always essential to ask for logical reasoning for all the rituals and the taboos they follow.   

I have learned that being nonthreatening to a person can help in building trust between the patient and the caregiver. I have learned that a caregiver should not practice any biasness towards their patients as racism is one of the biggest curses of the society. I have learned to embrace non-judgmental practice of care and have also gained efficiency in conducing talk therapy sessions. I have seen how the collaborative approach of Justin’s family has been successful in improving Justin’s quality of life.

References

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Jorm, A.F., Bourchier, S.J., Cvetkovski, S. and Stewart, G., 2012. Mental health of Indigenous Australians: a review of findings from community surveys. Medical Journal of Australia, 196(2), p.118.

Knifton, L 2012, ‘Understanding and addressing the stigma of mental illness with ethnic minority communities’, Health Sociology Review, vol. 21, no. 3, pp. 287-298, viewed 15 August 2016.

Kohrt, B.A. and Hruschka, D.J., 2010. Nepali concepts of psychological trauma: the role of idioms of distress, ethnopsychology and ethnophysiology in alleviating suffering and preventing stigma. Culture, Medicine, and Psychiatry, 34(2), pp.322-352.

Larson, A., Gillies, M., Howard, P.J. and Coffin, J., 2007. It’s enough to make you sick: the impact of racism on the health of Aboriginal Australians. Australian and New Zealand journal of public health, 31(4), pp.322-329.

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Luitel, N.P., Jordans, M.J., Sapkota, R.P., Tol, W.A., Kohrt, B.A., Thapa, S.B., Komproe, I.H. and Sharma, B., 2013. Conflict and mental health: a cross-sectional epidemiological study in Nepal. Social psychiatry and psychiatric epidemiology, 48(2), pp.183-193.

McGough, S.A., 2015. Facilitating equity in mental health outcomes for Aboriginal people within mainstream mental health services in Western Australia: A grounded theory study(Doctoral dissertation). Peters, R., 2017. Managing the Unmanageable. York University Criminological Review, 2(1), pp.68-90.

Mezuk, B, Rafferty, JA, Kershaw, KN, Hudson, D, Abdou, CM, Lee, H, et al 2010, ‘Reconsidering the Role of Social Disadvantage in Physical and Mental Health: Stressful Life Events, Health Behaviors, Race, and Depression’, American Journal of Epidemiology, vol. 172, no. 11, pp. 1238-1249, viewed 15 August 2016, https://aje.oxfordjournals.org.ezproxy.flinders.edu.au/content/172/11/1238.full.pdf+html.

 National Aboriginal Health Organization (NAHO) 2008, ‘Cultural competency and safety: A guide for health care administrator, providers and educators’, viewed 15 August 2016, https://www.naho.ca/documents/naho/publications/culturalCompetency.pdf.

Parker, R., 2010. Australia’s Aboriginal population and mental health. The Journal of nervous and mental disease, 198(1), pp.3-7.

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