Thursday, January 19, 2017

The assessment procedure psychiatric emergencies

A. 1. Nursing assessment procedure for patients with psychiatric emergency
            Research has shown that certain psychiatric conditions cause severe or life-threatening harm to the patient and the family (Srebnik et al., 2014). Sudden disturbance in the patient’s mood or behavior may result to homicide or suicidal intent. Research has also shown that there are no premonitory symptoms that can be used to assess the intensity of patients’ condition (Wolf, Miller & Devine, 2003). In as much as initial assessment of the patient’s condition is deemed essential, psychiatric patients require prompt evaluation (Gordon, 2012). This is because a patient may present broad manifestations of the mental condition such as delusional communication, profound sadness, apathy, self injury, intense agitation and violence (Mundinger, Kane,Lenz & Totten, 2000). Most patients may depict low risk intentions. As a result, psychiatrists recommend intake of some medicine only for the patient to act lethal afterwards by poisoning, shooting or hanging.
            Therefore, for psychiatrists to handle such patients effectively and particularly in the assessment stage, high level skills and competencies must be applied (Srebnik et al., 2014). Statistics has revealed that there are very few qualified adult and children psychiatrists who are able to evaluate the patient’s condition before treatment procedures commence (Fontaine, Hudak & Gallo, 2005). In other words, evidence has shown that the assessment procedures for psychiatric patients have not been done well in the past.
Why the present process or procedure needs to be changed
            Wolf et al (2003) highlight that psychologists and other emergency physicians have been involved in the assessment process yet they are not qualified to assess and diagnose mental illness. Fontaine, Hudak and Gallo (2005) reiterate that poor assessment and diagnoses of psychiatric conditions adds pressure to the nerve-cracking situation. Upon a careful review of literature, Mundinger et al (2000) point out that distressed families and patients have fallen in the hands of several self-proclaimed psychiatrists. Moreover, these are merely unscrupulous personnel who propose to offer psychiatric services without proper qualifications (Srebnik et al., 2014). As a matter of fact, there is no particular test done to diagnose a psychiatric disorder. Therefore, there are recurrent underlying challenges while determining the measures to be applied for different patients. This might therefore compel the nursing assessment to be done continuously for weeks or months (Hopko, Lachar, Bailley & Varner, 2014). Evidences have shown that some patients decline accepting their predicament. As a result, they pose serious difficulties to the medical staff who are not able to restrain them forcefully. Hence, it is indisputable that assessment for psychiatric patients faces numerous challenges and flaws on a daily basis. This implies that changes need to be done in order to achieve successful outcomes such as increased patient satisfaction (Gordon, 2012).
2. a.  Explain who determined the basis for the current process or procedure in your practice setting.
            It is worth to note that there are medical experts who play an essential role in determining the basis to be used during the assessment procedure. Moreover, there is a medical team that offer support and attend to emerging psychiatric cases. The team has well spelt out procedures to be followed when assessing and treating psychiatric patients. Nevertheless, Gordon (2012) attests that the outcome of the treatment solely depends of the physician’s personality and competence. As a matter of fact, successful outcomes in the procedure entirely rely on the physician’s ability to reassure and calm agitated patients. At this point, there is a need to develop a trustful relationship between patients and therapists because it helps in improving acute symptoms. Srebnik et al (2014) highlight that there are basis of assessment that are not included in the current outline procedures. For instance, in order for a physician to administer appropriate psychotropic medication or recommend a final diagnosis, there is a need to study the patient’s emotional and social behavior. Patients also require supportive behavior and integrative therapies
b. Explain the decision makers’ rationale for instituting or supporting the current process or procedure.
            Though the current assessment procedure is not up-to-the-mark, decision makers have supported it for reasons that are very obvious. As mentioned earlier, assessing psychiatric conditions at times become tricky for physicians due to the numerous and varying manifestations of the symptoms (Hopko et al., 2014). The physicians may under-estimate the severity of the patient’s condition when administering medication and this may result to unsuccessful outcomes such as homicide, suicide and violence (Gordon, 2012).
c. Explain why the decision makers decided to implement the current process or procedure.
Although new strategies have been set to assess psychiatric cases, research studies indicate that decision makers have entirely decided to implement the current assessment procedure. This is because the current process is still effective and the outcomes of the process depend on the physician’s personality and ability to relate with the patient through integrative and supportive behavior therapy (Gordon, 2012).
3.  Recommend a practice change for the process or procedure you selected.
            Past research studies expound that assessment procedure for psychiatric patient is unique for every patient and requires high-level expertise. I therefore recommend that not any physician should be allowed to handle psychiatric patients. Instead, only those that are highly competent and are specialized in handling psychiatric cases should be involved. As a matter of fact, quality delivery of care should be a priority area for the medical staff.
4.  Explain the clinical implications your recommended change might have on patients, based on the relevant and credible sources you listed in part A3a.
            Increased specialization and involvement of qualified physicians in emergency psychiatric cases lead to successful outcome of the diagnoses and treatment. Besides, uncompromised assessment helps in the process of administering appropriate psychotropic medication and eliminate diagnosis crisis (Gordon, 2012). Patients who are not diagnosed appropriately may not receive the much-needed treatment regime that is in tandem with their conditions.
5.  Explain the implications your recommended change might have on the practice setting, based on the relevant and credible sources you listed in part A3a.
            Successful outcomes will foster trustful relationship between patients and therapists (Gordon, 2012). If the latter is done in the most professional manner, it can cultivate personal satisfaction whereby physicians feel that they have delivered their best to save patients from psychiatric disorders. Outbreaks of mental disease may be handled even though relapses are to be expected. The outbreak can last a few days or up to several years. Little is known about the factors that bring recovery, but the convulsive therapy and psychotropic drugs have been used very successfully in the treatment of these patients. ECT has been the treatment of choice in cases of mental depression and also has good results in cases of agitation. This can be treated preferably by psychotropic drugs. Worsening of new outbreaks can be avoided by making up the patient understands his or her case, know to recognize the signs of relapse and be able to seek medical advice as soon as possible. This disease does not cause permanent damage to the mind or the personality of the patient.
Involving key stakeholders in the decision to change the process or procedure or to comply with the recommended change
In order to actively draw attention to all the stake holders, I would write a formal report that is well researched and contain tangible evidences addressing it to them in order to influence their decision to change or comply with the new recommended changes.
B.  1.  Discuss the specific barriers you may encounter in applying research to processes and procedures in your practice setting.
            One of the potential challenges includes insincerity especially when responses have to be obtained from psychiatrists through interviews. Moreover, the other challenge is biasness since the target respondents might tend to be subjective in their responses.
2.  Identify at least two strategies that you and your team could use to overcome the barriers you discussed in part B1.
            To overcome the aforementioned barriers, wide range of sources will be used to collect data. For instance, both primary and second hand information will be equally considered during the analysis. To overcome biased responses, the researcher may use closed-ended questionnaires to get direct-to-the point answers unlike the case with face-to-face interviews.
3.  Explain how you would implement your recommended process or procedure based on research findings.
            Being a psychiatrist, I would advocate for specialization within the medical team in order to ensure that physicians are assigned tasks related to their expertise. Moreover, I would influence the stakeholders to formulate new policies that are geared towards improving the current procedures. Some of the new policies may include motivating or appreciating physicians who record high rates of successful outcomes while handling psychiatric cases and accelerating capacity building and training among the medical staff handling psychiatric patients. In addition, implementing the recommended processes also demand the establishment of surplus centers and facilities where psychiatric patients can be restrained and probably attended to without a lot of interruption. When it comes to motivating physicians, availing adequate and functional facilities for use at workplace may play the much-needed role.

Fontaine, D. K., Hudak, C. M., & Gallo, B. M. (2005). Critical care nursing: a holistic approach. Philadelphia: Lippincott Williams & Wilkins, Inc.
Gordon, J. T. (2012). Emergency department junior medical staff’s knowledge, skills and confidence with psychiatric patients: a survey. The Psychiatrist, 36(5), 186-188.
Hopko, D. R., Lachar, D., Bailley, S. E., & Varner, R. V. (2014). Assessing predictive factors for extended hospitalization at acute psychiatric admission. Psychiatric Services. 1(2), 12-14.
Mundinger, M. O., Kane, R. L., Lenz, E. R., & Totten, A. (2000). Primary care outcomes in patients treated by nurse practitioners or physicians: a randomized trial. Jama, 283(1), 59-68.
Srebnik, D. S., Rutherford, L. T., Peto, T., Russo, J., Zick, E., Jaffe, C., & Holtzheimer, P. (2014). The content and clinical utility of psychiatric advance directives. Psychiatric Services. 1(1), 8-12.
Wolf, Z. R., Miller, P. A., & Devine, M. (2003). Relationship between nurse caring and patient satisfaction in patients undergoing invasive cardiac procedures. MedSurg Nursing, 12(6), 391-396.

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