An extended essay demonstrating the candidate’s ability to evaluate how the application of theoretical knowledge gained during the course influences and effects the provision of quality nursing care as applied to a client with a mental health problem. The aim of this assignment is to explore the application of theory to practise with regards to a client with a mental health problem. In order to effectively care for clients, nurses need to regularly evaluate their knowledge and assess this knowledge increases the quality of mental health nursing care. The client chosen for this assignment was a female, 39 year-old suffering with agoraphobia.
She was a single Asian origin, but living in a council flat in London with her father and sisters. The duration of the clients’ illness was approximately nine years, since about 1987. For the purpose of the reader, this essay will be written in the first person, as it will make the assignment more coherent. I worked with the client in the community for the duration of my placement. Therefore, for two months I had regular contact with the client everyday.
The client needed nursing intervention because she needed help in coping with her agoraphobia. Due to this phobia she was reliably housebound and could not successfully carry out her activities of daily living. Her father did the shopping and housework. In addition to this the client’s functioning was impaired due to other physical problems. She suffered from epilepsy and she had a tumour growing in the left hemisphere, which affected her right-sided mobility.
“A phobia is a fear of a specific of a specific object or scenario” “A phobia is s persistent irrational fear of a specific object, activity or situation.” (Wilson and Kneisl 1996). The client’s usually identifies her phobia as unrealistic but she still perceives it as anxiety provoking. Agoraphobia is associated with a fear of open spaces. Clients fear leaving their homes and thus their social interactions are severely affected. (Wilson and Kneisl 1996).
The client I worked with also suffered from depression and in addition to her other problems. There are common features in clients with agoraphobia, (Wilson and Kneisl 1996). The client’s agoraphobia was triggered according to her by her epilepsy and mobility problems due to the tumour. She had suffered severe fits outside in public and from there had developed a fear of going outside. She became very anxious when thinking about or going outside her flat. Her anxiety symptoms that she experienced at the idea of confronting her phobia just served to reinforce isolation.
So; from these various problems the client identified four main needs: 1. Coping with her agoraphobia and anxiety 2. Accepting her tumour 3. Learning to manage her epilepsy 4. Learning to cope with her limited mobility. The occupational therapist that worked with me with the client helped the client with accepting her tumour, teaching her skills to cope with her epilepsy and anxiety management. She engaged in exposure and with the client.
The client had a psychotherapist who came to visit her once a week to help her with her mobility. My role was to work with the clients with her agoraphobia and anxiety. The client and I engaged in various techniques to help manage her agoraphobia using different theoretical areas from the course. Before discussing those techniques adopted it is important to look at the client’s perception of her illness, this is important as it helps to determine which areas the client wanted to work on. There would be little point in focusing on a need that is perceived by the nurse to be a problem but not to the client.
The client had remarkable insight into her problems. She accounted for her agoraphobia because she had experienced unpleasant anxiety symptoms while outside and this in addition to the fear of fitting added to the problems. She would often say “Well I would go out but I have never felt very well when I think about it so I stay indoors”. She also perceived that her illness limited her in her activities of daily living and this therefore lowered her mood and esteem regarding her abilities. She was also aware that because she had once been a fully functional young lady she was grieving a loss of these abilities. The client perceived her anxiety as physical because of how she felt. She felt “sweaty”, “dizzy”, “sick” and complained of a pounding heart and other unpleasant symptoms.