NURS 4005 Discussion: Psychological Complications Resulting From Illnesses and Injuries
For this week’s post, I will discuss a case from my time working on an inpatient psychiatric unit. A patient had come to the ER after concerned family and friends urged them to do so. During the
assessment, the patient divulged having suicidal ideations and depression related to a terminal cancer diagnosis. The patient was admitted to our unit for these very reasons. The task of providing hope and
helping the patient heal became difficult. How do you discuss the importance of choosing life when you’re faced with death?
Our treatment team had to think. The psychiatrists and providers on the team decided to treat the depression and provide comfort. Discussions with nursing staff normalized death and touched on the
beautiful aspects of life the patient enjoys. Incorporating music the patient loved and the family that supported them was critical in finding peace for the individual. Psychiatric palliative nursing includes
interventions that form a support system for the patient and their family, affirms life, recognizes death as a normal process, and incorporates spiritual components into coping and treatment (Lindblad et al.,
2019). When offered specific medications to treat anxiety and depression associated with their cancer diagnosis, the patient would relay information about side effects and dissatisfaction with the mediation. As
a nursing staff, it was our job to ensure the patient adhered to a schedule to achieve therapeutic dosing. At the next day’s treatment team, we offered the patient’s medication preference as it comforted the
patient and assured compliance. The patient’s ordering providers well-received this. During shift assessments and follow-ups from the providers, however, the suicidal ideations did not dissipate.
The patient talked with staff about physician-assisted suicide (PAS), but this was not an option for our treatment team. PAS is illegal in Pennsylvania; however, California, Colorado, District of Columbia,
Hawaii, Maine, New Jersey, Oregon, Vermont, and Washington allow individuals that are deemed mentally competent to make this choice (2020). This decision and process leads to many ethical and legal
questions. Even the providers and psychiatric liaisons involved in PAS have uncertainties about establishing a patient’s competency regarding assisted suicide. 6% of psychiatrists felt they could determine this
competence after a single session with the individual requesting physician-assisted suicide (Kelly & McLoughlin, 2009). NURS 4005 4006 Discussion: Psychological Complications Resulting From Illnesses and Injuries
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While the patient’s chronic suicidal ideations would typically warrant intensive inpatient treatment, the patient’s discharge plan included palliative nursing care orders in the home. The treatment team felt
that inpatient psychiatric admission was furthering anxiety, as the patient felt certain aspects of their life were “passing by.” Through education and collaboration, a discharge plan was made. The patient felt
that with the medication regimen, identified coping skills, and family support, safety and treatment could be carried on at home. This discussion post made me reflect on difficult mental health nursing tasks
and how specialties in the nursing profession cross paths more often than I realized. It also brings thoughts of preparedness and education regarding this special patient situations. In the future, I would like to
have more informed treatment ideas for those suffering mental illness as related to terminal or debilitating illness/injury. NURS 4005 4006 Discussion: Psychological Complications Resulting From Illnesses and Injuries
References:
Kelly, B. D., & McLoughlin, D. M. (2009). Physician-assisted suicide and psychiatry. Psychiatry, 8(7), 276–279. https://doi-org.ezp.waldenulibrary.org/10.1016/j.mppsy.2009.04.011
Lindblad, A., Helgesson, G., & Sjöstrand, M. (2019). Towards a palliative care approach in psychiatry: Do we need a new definition? Journal of Medical Ethics, 45(1), 26.
doi:http://dx.doi.org.ezp.waldenulibrary.org/10.1136/medethics-2018-104944
Resources. (2020, March 17). Retrieved October 27, 2020, from https://www.deathwithdignity.org/learn/ NURS 4005 4006 Discussion: Psychological Complications Resulting From Illnesses and Injuries
Discussion – Week 3
COLLAPSE
I have an interesting relationship and experience(s) with a patient of mine. When I first graduated nursing school I started working on a Neuro/Stroke unit. I frequently cared for an elderly woman (above the age of 65), who was experiencing a significant number of falls, and subsequently resulting in traumatic brain injuries. This became suspicious to me and the other nurses on my unit due to the number of admissions this patient had over a short period of time. Oddly, once I left the hospital and moved to a private neurosurgery practice, the physician I work for is the same physician who operated on this patient and oversees her outpatient care. It’s interesting as a nurse to have seen her in the acute setting, but also in the outpatient setting as well. Elder abuse is something near and dear to my heart as I believe it is overwhelmingly occurring in the health care world. Elder mistreatment is defined as intentional actions that cause harm or risk of harm (even if unintended), or failure to meet the elder’s basic needs and to protect them from harm (Wangmo, T., Nordstrom, K., Kressig R.W., 2016).
Prior to her first known incident, she was known to have Alzheimer’s Dementia and lived at home with her husband, which she still does at this time. When she was admitted the first time, she had been wandering on the side of a highway and was hit by a truck. While she sustained several locations of brain bleeds, and then in turn Hydrocephalus, you can imagine the number of other injuries sustained as well. One of my first questions upon her admission was “why and how was she out on the main highway at night?” Turns out, this incident occurred while her husband was sleeping, and she escaped their home. So, we thought “no big deal, just a crazy accident.” However, we began to see more and more admissions over the period of 3-6 months. Every admission was something new (UTI’s, unstageable bed sores, gangrene, etc.) she continued to decline cognitively and physically and was every bit related to the care or lack thereof she was receiving at home. I will never forget one incident that resulted in her admission. She was a diabetic that suffered from diabetic neuropathy and was also blind. When she came into the hospital maggots were literally eating her feet. I’ve never seen anything like it.
Obviously, at this point in her inpatient care, there were a lot of team members involved such as social work and care management. They were our initial strategy in this situation as it was clear the patient was not being cared for at home. I’m not entirely sure of the intricate details of her situation, but her husband was an attorney and refused to place her in a long-term care facility. I remember discussing with the social worker how much disbelief I was that she was able to return home with him. I tried to advocate for her safety as she was unable to do so for herself. However, as a nurse in an inpatient setting, I felt our voices weren’t heard. Decisions at this level were made by physicians and social work. So then at that point, our focus shifted to educating the husband on her care, seeing if any other family members or friends could assist in the care, and having home health aide in care as well.
Fast forward, she hasn’t had any recent hospitalizations, but we often see her in our clinic. How she is still under the care of her husband is beyond me. Last week when she was in our office for a follow-up, she was pulled out of the back of a van where a newspaper laid underneath her. Her hair was matted, her face from her chin to her eyebrows was covered by her mask, she had obviously not been bathed, and had been sitting in feces. When she arrived at our office, we contacted social services. I am still unaware of what has come of this situation. I expressed my concerns to her husband for her safety, and our physician urged placement in a long- term care facility. NURS 4005 4006 Discussion: Psychological Complications Resulting From Illnesses and Injuries
According to research, elder mistreatment is defined by five types of abuse/neglect. These consist of physical abuse, emotional/psychological abuse, sexual abuse, financial exploitation, and neglect (Wangmo, T., Nordstrom, K., Kressig R.W., 2016). Shockingly, for every case of elder abuse and neglect (EAN) reported, 24 more cases remain unreported (Wangmo, T., Nordstrom, K., Kressig R.W., 2016). When examing elder abuse further and the statistics correlating with the abuse, 40% of Americans over the age of 65 experience some type of functional limitation (Zeranski, L., Halgin, R.P., 2011). It is also estimated that 13% of older Americans have a diagnosis of Alzheimer’s, and another 20% experience cognitive disabilities without dementia relating to issues such as depression, stroke, diabetes (Zeranski, L., Halgin, R.P., 2011). Research shows that older adults with the conditions as stated about are at much-increased risk of becoming victims of abuse and neglect and in turn, can experience significant issues with depression (Zeranski, L., Halgin, R.P., 2011). So, in examining my patient’s demographics and medical history, she easily falls into more than one of these categories and further explaining her risk of abuse.
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In addressing the legal and ethical issues with elder abuse and the reporting of such abuse, there are laws requiring investigation of these reports in all 50 states. However, each state has its own definition of elder abuse, and who is protected by these laws varies as well. (Zeranski, L., Halgin, R.P., 2011). Looking beyond the actual legal implications of elder abuse, there are a lot of ethical issues arising from this as well. Reporting elder abuse is keeping with ethic codes of beneficence and nonmaleficence, and respect for the patient’s rights and their dignity (Zeranski, L., Halgin, R.P., 2011). When looking at my patient’s situation specifically, she lacks the capacity to make her own decisions due to her medical issues. Her Dementia diagnosis alone creates an argument for lack of competency as it relates to her care. It is obvious that she is not being cared for adequately but, a nurse should examine the “cultural beliefs and patterns of adaptation of family members who neglect an elderly person’s personal and environmental health requirements rather than consider it a pathological finding” (Saghafi, A., Bahramnezhad, F., Poormallamizra, A., Dadgari, A., Navab, E., 2019). NURS 4005 4006 Discussion: Psychological Complications Resulting From Illnesses and Injuries
References
Wangmo, T., Nordstrom, K., & Kressig, R. W. (2016, December 23). Preventing elder abuse and neglect in geriatric institutions:Solutions from nursing care providers. Elsevier. https://reader.elsevier.com/reader/sd/pii/S0197457216303111?token=5A239EB7C8AAFEFD10A10DFAFE842DE0D5F209EAB9390786083CFF20CE18AD0BE3D7634F6F4A9F77D20FE7EB661EA8DC
Zeranski, L., & Halgin, R. P. (2011). Ethical issues in elder abuse reporting: A professional psychologist’s guide. Professional Psychology: Research and Practice, 42(4), 294–300. https://doi.org/10.1037/a0023625
Saghafi, A., Bahramnezhad, F., Poormollamirza, A., Dadgari, A., & Navab, E. (2019). Examining the ethical challenges in managing elder abuse: a systematic review. Journal of medical ethics and history of medicine, 12, 7.
Discussion: Psychological Complications Resulting From Illnesses and Injuries
The nurse’s role goes far beyond that which is expected. Nurses are the main communicators between patients, doctors, and family, and they care for more than just physical ailments. Often, nurses are presented with difficult situations where being an advocate becomes paramount to the healing of the patient. One of the issues that patients with acute and chronic illnesses or extended hospitalization face is a tendency to become depressed. The nurse’s role in this situation requires more than just attention to the physical problem. Another situation where a nurse may need to shift his or her care is when a patient presents with a suspicious injury or illness. In addition to considering the legal and ethical responsibilities of the nurse, he or she must consider the psychological undertones that may be present. NURS 4005 4006 Discussion: Psychological Complications Resulting From Illnesses and Injuries
For this Discussion, you will consider delicate situations that nurses often face and analyze the implications of these situations. Reflect on a patient care situation in which you have encountered one of the following:
- A suspicious illness or injury
- Depression resulting from illness or injury
Then, locate at least one scholarly journal article related to your patient care situation that offers strategies for managing the circumstances.
By Day 3
Respond to the following:
- Explain your patient encounter, highlighting the challenges the situation presented, and briefly summarize the contents of your journal article.
- What strategies did you employ to help handle the situation? What other strategies could you have used?
- How did you advocate for the patient in the situation?
- What are some of the legal and ethical implications that need to be considered when providing care for patients with depression resulting from illnesses or injuries or suspicious illnesses or injuries? NURS 4005 4006 Discussion: Psychological Complications Resulting From Illnesses and Injuries
Note: Avoid using personal information (e.g., names, facility name, etc.) in your post.
Support your response with references from the professional nursing literature.
Note Initial Post: A 3-paragraph (at least 350 words) response. Be sure to use evidence from the readings and include in-text citations. Utilize essay-level writing practice and skills, including the use of transitional material and organizational frames. Avoid quotes; paraphrase to incorporate evidence into your own writing. A reference list is required. Use the most current evidence (usually ≤ 5 years old).
By Day 7
Read two or more of your colleagues’ postings from the Discussion question (support with evidence if indicated).
Respond with a comment that asks for clarification, provides support for, or contributes additional information to two or more of your colleagues’ postings.
Post a Discussion entry on three different days of the week. Refer to the Discussion Rubric found in the Course Information and Grading Criteria area.
