Leonie has quite literally been through hell and back in the past decade. She lived an active and fulfilling life, but it all changed when her husband was diagnosed with cancer. She gave up her career to care for her husband, whose death left Leonie grieving and out of touch with her surroundings. Death is a symbolic manifestation of an intangible psychological loss, which can be equated to such a deep sense of loss that can leave people feeling deprived of someone that they valued ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"VboUviUM","properties":{"formattedCitation":"(Hamilton, 2016)","plainCitation":"(Hamilton, 2016)","noteIndex":0},"citationItems":[{"id":832,"uris":["http://zotero.org/users/local/0omESN17/items/NK4I5VU6"],"uri":["http://zotero.org/users/local/0omESN17/items/NK4I5VU6"],"itemData":{"id":832,"type":"article-journal","title":"Understanding grief and bereavement","container-title":"The British journal of general practice : the journal of the Royal College of General Practitioners","page":"523-523","volume":"66","issue":"651","archive":"PubMed","archive_location":"27688503","DOI":"10.3399/bjgp16X687325","ISSN":"1478-5242","journalAbbreviation":"Br J Gen Pract","language":"eng","author":[{"family":"Hamilton","given":"Ian J"}],"issued":{"date-parts":[["2016",10]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Hamilton, 2016). This is especially prevalent in case of the loss of a loved one, such as Leonie’s husband. Her grief has manifested itself in the form of an intense emotional as well as physical suffering which can cause her to experience fatigue, shock, confusion, and even the disbelief that their loved one has passed away. These situations can contribute to an individual feeling depressed, anxious and isolated ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"FQGach7B","properties":{"formattedCitation":"(Roberts et al., 2016)","plainCitation":"(Roberts et al., 2016)","noteIndex":0},"citationItems":[{"id":831,"uris":["http://zotero.org/users/local/0omESN17/items/X25UN366"],"uri":["http://zotero.org/users/local/0omESN17/items/X25UN366"],"itemData":{"id":831,"type":"article-journal","title":"Grief, bereavement, and positive psychology","container-title":"Journal of Counseling and Psychology","page":"3","volume":"1","issue":"1","author":[{"family":"Roberts","given":"Jesse E."},{"family":"Thomas","given":"Andrea J."},{"family":"Morgan","given":"James P."}],"issued":{"date-parts":[["2016"]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Roberts et al., 2016).
Three behavioral health risk factors (mental health risks)
In Leonie’s case, her grief has manifested in her isolating herself from society, loss of interest in activities she once loved and refusal to subconsciously accept that her husband had passed away. She is overweight and as someone in her early 70s, it is vital for Leonie to continue with the activities she loved such as spending time outdoors, go on walks and even visit her friends and family. Add in her refusal to cook her own food and keep her gardens as she once did, along with the weight gain in the past few months alone is alarming. Her refusal to continue living her life the way she used to can leave her worse off than she originally was. These factors are not only generating mental health risks for her but also increase the possibility of her requiring medical care for sudden onset of physical ailments ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"Kj4S6US9","properties":{"formattedCitation":"(Harris, 2018)","plainCitation":"(Harris, 2018)","noteIndex":0},"citationItems":[{"id":834,"uris":["http://zotero.org/users/local/0omESN17/items/G7FMXKD5"],"uri":["http://zotero.org/users/local/0omESN17/items/G7FMXKD5"],"itemData":{"id":834,"type":"article-journal","title":"The relationship between physical inactivity and mental wellbeing: Findings from a gamification-based community-wide physical activity intervention","container-title":"Health psychology open","page":"2055102917753853","volume":"5","issue":"1","author":[{"family":"Harris","given":"Marc Ashley"}],"issued":{"date-parts":[["2018"]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Harris, 2018).
Evaluate three best-practice assessment tools used by nurses
While Leonie may not realize it herself, she is in immediate need of care and rehabilitation to return her to the way of life she once lived. It is the only way to maintain her physical health, while also ensuring her mental health and wellbeing is looked after as well. An effective tool that can be used by nurses to help Leonie is Global Mental Health Assessment Tool – The Primary Care Version (GMHAT/PC). It enables mental health professionals to detect and even manage mental disorders among patients in primary healthcare settings. It provides a computer-assisted diagnostic interview for nurses, which can then be used to treat the patient by correlating between GMHAT/PC assessment and a clinical diagnosis given by the patient to formulate a well-rounded approach of dealing with patient ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"fwhhOgPr","properties":{"formattedCitation":"(Sharma et al., 2008)","plainCitation":"(Sharma et al., 2008)","noteIndex":0},"citationItems":[{"id":835,"uris":["http://zotero.org/users/local/0omESN17/items/QDEQPIJZ"],"uri":["http://zotero.org/users/local/0omESN17/items/QDEQPIJZ"],"itemData":{"id":835,"type":"article-journal","title":"Mental health diagnosis by nurses using the Global Mental Health Assessment Tool: a validity and feasibility study","container-title":"The British journal of general practice : the journal of the Royal College of General Practitioners","page":"411-416","volume":"58","issue":"551","archive":"PubMed","archive_location":"18505618","abstract":"BACKGROUND: The Global Mental Health Assessment Tool-Primary Care Version (GMHAT/PC) has been developed to assist health professionals to make a quick and comprehensive standardised mental health assessment. It has proved to be a reliable and valid tool in a previous study involving GPs. Its use by other health professionals may help in detecting and managing mental disorders in primary care and general health settings. AIM: To assess the feasibility of using a computer-assisted diagnostic interview by nurses and to examine the level of agreement between the GMHAT/PC diagnosis and psychiatrists' clinical diagnosis. DESIGN OF STUDY: Cross-sectional validation study. SETTING: Primary care, general healthcare (cardiac rehabilitation clinic), and community mental healthcare settings. METHOD: A total of 215 patients between the ages of 16 and 75 years were assessed by nurses and psychiatrists in various settings: primary care centre (n = 54), cardiac rehabilitation centre (n = 98), and community mental health clinic (n = 63). The time taken for the interview, and feedback from patients and interviewers were indicators of feasibility, and the kappa coefficient (kappa), sensitivity, and specificity of the GMHAT/PC diagnosis were measures of validity. RESULTS: Mean duration of interview was under 15 minutes. The agreement between nurses' GMHAT/PC interview-based diagnosis and psychiatrists' International Classification of Diseases (ICD)-10 criteria-based clinical diagnosis was 80% (kappa = 0.76, sensitivity = 0.84, specificity = 0.92). CONCLUSION: The GMHAT/PC can assist nurses to make accurate mental health assessment and diagnosis in various healthcare settings and it is acceptable to patients.","DOI":"10.3399/bjgp08X299218","ISSN":"0960-1643","journalAbbreviation":"Br J Gen Pract","language":"eng","author":[{"family":"Sharma","given":"Vimal K"},{"family":"Lepping","given":"Peter"},{"family":"Krishna","given":"Murali"},{"family":"Durrani","given":"Shazia"},{"family":"Copeland","given":"John R M"},{"family":"Mottram","given":"Patricia"},{"family":"Parhee","given":"Rashmi"},{"family":"Quinn","given":"Bennett"},{"family":"Lane","given":"Steven"},{"family":"Cummins","given":"Anthony"}],"issued":{"date-parts":[["2008",6]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Sharma et al., 2008).
While GMHAT/PC is an excellent tool, holistic psychiatric assessment of the patient can also help examine the psychical, intellectual, psychological, and social, along with spiritual aspects of her life. This will relay a well-rounded assessment of the patient in an effort to gauge her ailments along with the right means of treating her. Furthermore, this can be supplemented with mental status examination for further assessment of her well-being ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"gwzUOD1K","properties":{"formattedCitation":"(O\\uc0\\u8217{}Brien et al., 2008)","plainCitation":"(O’Brien et al., 2008)","noteIndex":0},"citationItems":[{"id":838,"uris":["http://zotero.org/users/local/0omESN17/items/EQRJDNR2"],"uri":["http://zotero.org/users/local/0omESN17/items/EQRJDNR2"],"itemData":{"id":838,"type":"book","title":"Psychiatric Mental Health Nursing: An Introduction to Theory and Practice","publisher":"Jones & Bartlett Learning","URL":"https://books.google.com.pk/books?id=USg3_DbmyoQC","ISBN":"978-0-7637-4434-2","author":[{"family":"O'Brien","given":"P."},{"family":"Kennedy","given":"W. Z."},{"family":"Ballard","given":"K. A."}],"issued":{"date-parts":[["2008"]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (O’Brien et al., 2008).
Another excellent means of intervention, especially given Leonie’s mental state is through Swanson’s Caring Behavior. It serves as a cornerstone of healing for nurses and has been frequently used by nurses for effective rehabilitation of patients suffering from mental health issues. It not only comprises of intervention measures to rehabilitate the patients but also involves their family members in the caregiving process. It can be done by dealing with Leonie with empathy and giving an ear to her feelings of grief and loss if she is willing to talk. If not, the nurses would provide her with an environment where she can feel like being herself again, before opening herself up to care and understanding that what she is feeling is acceptable. Then, the nurse would emotionally connect with Leonie and give her a safe space to interact with her family and accept her care to return to her old ways ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"coV542zT","properties":{"formattedCitation":"(McKelvey, 2018)","plainCitation":"(McKelvey, 2018)","noteIndex":0},"citationItems":[{"id":837,"uris":["http://zotero.org/users/local/0omESN17/items/QY3RJECG"],"uri":["http://zotero.org/users/local/0omESN17/items/QY3RJECG"],"itemData":{"id":837,"type":"book","title":"Finding Meaning Through Kristen Swanson’s Caring Behaviors: A Cornerstone of Healing for Nursing Education","publisher":"Springer","ISBN":"1078-4535","author":[{"family":"McKelvey","given":"Michele M."}],"issued":{"date-parts":[["2018"]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (McKelvey, 2018)
Interventions
Person-centered interventions are needed to support Leonie’s mental health and behavior. According to Leonie’s sisters, she has been alone for almost a year and a year ago she was mentally and physically active. The change in Leon’s mental state is affecting her overall health by delaying her recovery. It is clear that Leonie needs help to cope with her health and state of mind. The interventions should be focused on three issues which are; Leonie is isolating herself, lately she is becoming lazy, and she is not coping well with the loss of her husband. Person-centered approaches are best for a person of her age, as it allows the patient to evaluate him/herself CITATION ACK16 \l 1033 (AC Kogan, 2016). As a first intervention, a therapeutic approach is recommended. The therapeutic approach for Leonie should be person-centered. In person-centered approach, the patient is given a lead in the discussion CITATION Rog01 \l 1033 (Rogers, 2001). This kind of approach will help the Leonie to identify the root cause of her health-related issues. The therapist should take Leonie in confidence and make her lead therapy session. In this way, Leonie will not only identify the reasons but also the solution to her problems. The concept behind person-centered therapy is that Leonie is an expert in understanding her problems. The second intervention involves her sisters and the nursing staff. As Leonie has no children and her only family member was her husband, she needs a supporting person to make her feel better in this hard time. This intervention is not as easy as therapeutic approach, because the key players in this intervention are not mental health professionals. Key players in this approach are Leonie’s sisters and the nursing staff, they require a plan and guidance from mental health professionals.
The main focus of both interventions is to listen to Leonie as much as possible and let her take lead in discussion to make her feel useful and needed. She should not be sent back home to live alone, instead her sisters should take her with them. At home, it is recommended to take necessary steps which allows Leonie to participate in household activities. Another option is that Leonie stays in hospital ward with nursing staff and her sisters visits her weekly. In this scenario, nurses have to get involved with Leonie by spending more time with her. One useful approach for mentally troubled people is to make up a problem and present it to him/her. The next step is to ask the patient for the solution to a make-up problem, this will make a patient feel useful. This approach can be applied to Leonie's case by the key players. In person-centered therapy, the therapist encourages the patient to speak out without giving any judgment or opinion to the matters. In person-centered approach, the therapist agrees with the patient and does not change the subject of the conservation. In case of Leonie’s care, therapist will ask her innocent question which is related to main cause of Leonie’s mental health problem. In this way, Leonie if comfortable enough, will talk about incident and mental issues. Leonie will eventually find a solution to her problems.
As a registered nurse, it is their duty to provide health care to the patients CITATION Maz05 \l 1033 (Maze, 2005). Proper health care includes both the physical and mental health of a person. It is clear that the main reason for Leonie’s poor health is that she has stopped caring for herself. In this low time, Leonie needs help and support from people around her. Following the ethics of medical science, a registered nurse has to make the patients feel comfortable. Nurses have to care for patient's emotions and should involve with their patients to gain their confidence CITATION BMc06 \l 1033 (B McCormack, 2006). If Leonie is taken back home, she may also require the assistance of a professional nurse. One of the main reason for Leonie’s declining health is that she has been lonely. According to modern studies on health care, ethics in healthcare plays an important role in the treatment of a patient CITATION ELB02 \l 1033 (EL Bandman, 2002). Mostly elderly patients are the victim of elderly abuse in healthcare units. This is because the elder population is not able to raise their voices and the cases are mostly ignored by the people who have ability to take action against elderly abuse CITATION Per08 \l 1033 (Perel-Levin, 2008).
Conclusion
The overall health of a person includes mental health along with his/her physical health. Leonie’s behavioral issue depends on her loneliness, laziness, and not coping with her husband’s loss. To address a mental health-related issue that Leonie is facing, person-centered interventions are necessary. Healthcare interventions depends on therapist, nursing staff, and Leonie’s sisters. The therapist will use his/ her psychological expertise to find the solution for Leonie’s poor health. Remaining two players have to use an ethical approach to make Leonie feel needed and useful. It is the responsibility of a registered nurse to treat their patients without any discrimination. Nurses who are working in elder homes or in the hospital wards with aged patients should be extra careful about providing overall health care.
AC Kogan, K. W. L. M., 2016. Person‐centered care for older adults with chronic conditions and functional impairment: A systematic literature review. Journal of the American Geriatrics Society.
B McCormack, T. M., 2006. Development of a framework for person‐centred nursing. Journal of advanced Nursing.
EL Bandman, B. B., 2002. Nursing ethics through the life span. s.l.:Prentice Hall.
Hamilton, I.J., 2016. Understanding grief and bereavement. Br. J. Gen. Pract. J. R. Coll. Gen. Pract. 66, 523–523. https://doi.org/10.3399/bjgp16X687325
Harris, M.A., 2018. The relationship between physical inactivity and mental wellbeing: Findings from a gamification-based community-wide physical activity intervention. Health Psychol. Open 5, 2055102917753853.
Maze, C. M., 2005. Registered nurses' personal rights vs. professional responsibility in caring for members of underserved and disenfranchised populations. ournal of Clinical Nursing.
McKelvey, M.M., 2018. Finding Meaning Through Kristen Swanson’s Caring Behaviors: A Cornerstone of Healing for Nursing Education. Springer.
O’Brien, P., Kennedy, W.Z., Ballard, K.A., 2008. Psychiatric Mental Health Nursing: An Introduction to Theory and Practice. Jones & Bartlett Learning.
Perel-Levin, S., 2008. Discussing screening for elder abuse at primary health care level by Silvia Perel-Levin, s.l.: World Health Organization.
References
Roberts, J.E., Thomas, A.J., Morgan, J.P., 2016. Grief, bereavement, and positive psychology. J. Couns. Psychol. 1, 3.
Rogers, C., 2001. Client-centered/person-centered approach to therapy. Voprosy Psikhologii.
Sharma, V.K., Lepping, P., Krishna, M., Durrani, S., Copeland, J.R.M., Mottram, P., Parhee, R., Quinn, B., Lane, S., Cummins, A., 2008. Mental health diagnosis by nurses using the Global Mental Health Assessment Tool: a validity and feasibility study. Br. J. Gen. Pract. J. R. Coll. Gen. Pract. 58, 411–416. https://doi.org/10.3399/bjgp08X299218