Mental Disorders and Factors That Lead to Mental Disorders: Posttraumatic Stress Disorder

Introduction

There are different types of mental disorders and factors that lead to mental disorders vary as well. The effect of mental disorder on the patient depends on various things like treatment, environment, family, and support they get from family and friends (Susser, et al, 2006). A good support system and a good medical intervention ease the condition and facilitate healing (Marshall, Bell and Moules 2010, p.198). For the nurses to be able to plan a good intervention model they have to assess the condition by analyzing the whole situation. Some of the things to consider are a description of the event that led to the condition, and the feelings about the situation (Wilding 2008, p.723). From that point, the nurse will then be able to assess and conclude the situation. This paper will discuss the Gibbs cycle which will help in analyzing the situation and an intervention plan for a patient suffering from Post- Traumatic Stress Disorder (PTSD).

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Gibbs cycle

Gibbs cycle is a reflective cycle model which was published in 1998 which helps people to analyze a situation, event or a task in a systematic manner. It involves steps which are description of the task or event, feeling, evaluation, analysis and action plan. The above steps are discussed in details below.

Description

I met Hannah Gates when I was working as an intern nurse in the psychiatric care ward. Hannah Gates was around the age of 7 years and was accompanied by her aunt whom they were living with at that time. She was full of anger, resentment, fear, and hopelessness. She was admitted in the hospital involuntarily because she was very aggressive a behavior that posed a risk to herself and to others (Krippner, Pitchford and Davies, 2012). I had met patients with similar conditions but this case was different because Hannah was very young and to engage her was quite difficult. It needs a little adjustment to make a subjective assessment of the extent of the condition. Hannah's aunt could not communicate in English fluently which was another challenge. In such cases, most of the question should be directed to the aunt because Hannah was very young. The assessment would also involve extensive diagnosis because less information was availed to me.

Feeling

From the situation, I realized dealing with tender- age patients required a lot of adjustments like language use and even the tone of the language. This was to make it easy for them to understand, open up and give you the feedback (Sullivan, 2013). I realized that my mentor's verbal communication was accompanied by facial expressions and gestures. For example, when asking the child about her sleeping patterns, my mentor asked by closing his eyes and the aunt was able to respond. I realized that it was important to adjust according to the patients need and condition for quality assessment and effective communication. I felt I had let myself and my mentor down for failing to think critically. At first, I had also felt like if Hannah was too young to be in a mental unit not knowing that the mental disorders do not have an age limit, the difference was the ability to cope and deal with the situation (Fisher et al, 2012, p. 142).

Evaluation

This situation was challenging in two ways which were the age of the child and the language barrier which made it a bit hard for me to communicate with the patient. I was not sure who to ask the question and how to ask rephrase them for the child to understand. However, from my mentor, I learned that I should have directed the questions the aunt. On the issue of the language barrier I should have used clear and simple language and incorporate as many gestures and body language as possible.

Analysis

This experience taught me a few and important things. One, I learned that as a nurse I should always think critically to adjust according to the situation because the patients have a lot of trust in their doctors. The second thing is that I should learn to communicate effectively to people of different age groups by learning a few more languages and exposing myself to people of different nations. Also, I should learn to use body language as it enhances communication (Sullivan, 2013). Third I learned that when dealing with a child I should direct the questions to the accompanying adult.

Conclusion

This situation was challenging because the patient was very young and the communication needed a second person who was her aunt. However, creating a good rapport with Hannah herself was critical to be able to get fast hand information and exactly how she felt. This was necessary because assessing the psychological and physiological aspects needed her participation. Since her aunt could barely communicate in English there was a need to incorporate a translator to help in interpreting. The presence of a close person to the patient is very critical because it helps them to be relaxed hence easy for the nurse to get information from them.

Action plan

From this experience I have realized the need for learning more languages and expressing myself through gestures and body language and coping strategies in different cases. I plan to coach myself on communication skills and also I will place myself in more psychiatric clinics. This will help me to get to deal with different conditions and age groups.

Assessment

Assessment of the condition is a critical stage because it determines what treatment inventions should be incorporated (Giger, 2016). Snipes (2018) argue that people suffering from mental disorders have had a history of drug and substance abuse, physical and sexual abuse, interpersonal violence and homelessness. To assess the trauma I have to understand the causes of the trauma, the impact of the trauma, impact of the trauma to the individual, causes of the trauma whether it was an intentional or an unintentional and the time taken to process the traumatic event (SAMHSA, 2014).

Diagnosis of posttraumatic stress disorder is assessed using DSM-5 criteria (APA, 2013). The criterion assesses the exposure to a traumatic stressor, impairment in social and occupational functioning and development of a characteristic syndrome (Ali et al. 2012, p.235). The criteria will involve a structured interview which will be answered by Hannah's aunt. I will then give PSTD symptom scale-interview (PSS-I) to her. This scale interview contained 17 questions to answer the symptoms experienced by the patients (Blanco 2011, p. 50). The advantage of this criterion is that it has great consistency, good reliability of tests and retests and topnotch validity (Powers 2010, p.637). A cognitive triad of traumatic stress will also help me to assess the condition; it involves the cognitive aspects of the patient which are about their feeling about the future, their thought about the world and how they view themselves in regard of the cue of the trauma (SAMHSA, 2014).

There are many challenges can prevent proper diagnosis and assessment which can lead to misdiagnosis (Moss, 2016). According to Hathaway, Boals and Bank (2010, p. 120) patient may hind information of the past trauma for safety concerns, fear to be judged by the caregivers, the shame of victimization and lack of trauma. I will also pay attention to avoid misdiagnosis because the symptoms of PSTD overlap with those of drug and substance abuse, borderline personality disorder, antisocial personality disorder and attention deficit hyperactivity disorder (SAMHSA, 2014).

Planning

The information I will collect from Hannah will help me to decide on the best intervention that will suit her needs. I will set specific goals and objectives which will help us during the evaluation stage. Setting goals will also help us to be focused and the timelines will help us to meet the deadline. The overall things that I should consider are the safety of the client, providing preventing recurrent of the trauma and providing psycho-education (SAMHSA, 2014). This will help to normalize the symptoms.

Interventions

There are a few intervention programs that will help Hannah to cope with the disorder and reduce the symptoms. The intervention programs, when combined together, have a better outcome than when used as single therapies.

Cognitive behavioral therapy (CBT)

Cognitive behavioral therapy involves cognitive restructuring and exposure to reduce anxiety. According to Hofmann et al. (2010, p. 430), cognitive therapy behavior involves weekly sessions which takes 60-90 minutes. I will adjust the time for Hannah because of her age because she cannot concentrate for all those minutes, alternatively, I will break the sessions into the small session with breaks in between the sessions. The CBT can be administered either as a group or individual (Craske, 2010). Hannah will be subjected to this therapy as an individual but with time I will introduce her to other kids who are in the same program.

Exposure-based Therapy

Exposure-based therapy involved a confrontation with frightening stimuli and is administered until the anxiety reduces (Steenkamp et al. 2011, p.100). I will expose Hannah to imagery and scenes with fire incidences to reduce her fear for fires. The objective of this therapy is to reduce the conditioned response to the traumatic stimuli which helps the patient to overcome the fear that is caused by the stimuli and the effects it has on them (Strachan et al. 2012, p.560). The sessions of Exposure-based therapy takes about 8-12 weeks which are into sessions of 60-90 minutes.

Cognitive restructuring therapy

The cognitive restructuring therapy focuses on the interpretation of the event rather than the event itself which determines the mood of the patient. The aim of this therapy is to help the patient see things in a different way especially those that revolve around the event that led to the event (Thrasher et al. 2010, p. 200). It also helps the patient to change to more adaptive and rational reasoning. Cognitive therapy takes 8-12 sessions with around 60-90 minutes.

Coping skills therapy

Coping skills therapy includes many components like relaxation training and biofeedback which aims at managing the traumatic feeling corrected at the time of the event (Deblinger et al. 2011, p. 70). It may include muscle relaxation training, education, breathing techniques, and role-playing. When the patient is exposed to this therapy they are able to cope with the current situations. The session of coping skills therapy takes 60-90 minutes.

Evaluation

Hannah will be assessed every two weeks to monitor progress this is to ensure that the structured plan is working. If it is not then I will have to adjust a few things and continue with the intervention. The patient can show destabilizing effects such as increased aggressive behavior, difficulty following their commitments, isolation, and a decline in daily activities (SAMHSA, 2014). This is accepted and the symptoms decrease with time. If Hannah shows improvement we will plan to discharge and encourage her to attend some of the sessions from home. Some of the ways I will evaluate progress is by observing her behavior and assessing the symptoms. A decrease in the PTSD symptoms and positive behavior are indicators of progress.

Conclusion

Nurse need to understand the strategies to use in Trauma-Informed Care (TIC) to be able to apply the techniques for the patients. Trauma Informed Care can be used in patients with PTSD and other traumatic disorders. The nurses should include assessment and diagnosis after which they should incorporate an intervention plan according to the conditions of the patient. The therapist should also evaluate the patient to track for progress after which they are supposed to make...