Introduction and Setting the Scene
Mental health is among the most significant issues in healthcare in the United Kingdom. In accordance with the Parity of Esteem, a principle set by the NHS, mental health is to be valued to the same extent as the physical health of an individual (Panday 2016). As a result, it is critical to understand the problems affecting people living with mental health issues and respond to them correctly. This includes recognising the needs of people in emotional distress and using caring conversations to alleviate it. The present paper will analyse a case from practice by determining the factors that had influenced the caring conversation that took place.
Mental Health in the United Kingdom
Mental health has been brought to the forefront of healthcare in developed countries quite recently. Although the stigma around mental health issues persists in many societies, more and more mental health patients are now able to receive needed care and services. These developments are critical to the United Kingdom because a significant part of the population in the country lives with one or more mental health disorders.
According to the report by the Mental Health Foundation (2017), based on a representative sample, nearly two-thirds of the population in the UK have experienced a mental health problem. The most prevalent mental health issue in the country is depression, with over 40% of respondents admitting to having experienced it (MHF 2017). Depression, panic attack disorder, posttraumatic stress disorder, and other mental health issues have a significant influence on people’s wellbeing, and thus it is critical for the healthcare policy to reflect the needs of mentally ill persons.
Mental Health Policy
The NHS is the primary provider of healthcare in the United Kingdom, including mental health care. Under the Parity of Esteem, the goal of the NHS in this area is to ensure that people with mental health issues benefit from the same status in the healthcare environment as those with physical health problems (Panday 2016). As a result, the NHS seeks to address disparities that exist in mental health care by improving the quality of mental health services provided to the population (Panday 2016).
As part of the Five Year Forward View, the NHS is working to reduce waiting time and expand access to services for children, adults, and elderly persons. For instance, reports indicate that not all acute hospitals have mental health services in emergency departments, which restricts patients’ access to them (Parkin 2018). This issue will likely become among the priority areas for the NHS as part of its commitment to enhancing the mental health of the population.
Another piece of mental health policy that guides the actions of the NHS is the Mental Health Act 1983. The Act provides legislative foundations for people’s right to primary and secondary mental health services in the UK (Mind 2018). However, the Act is currently under consideration for reform due to concerns associated with detention and racial disparities (Parkin 2018). Reducing detention rates, particularly among black and minority ethnic groups, and expanding mental health patients’ rights is among the goals of the NHS that will be addressed in the reform (Parkin 2018). It is expected that more attention will be paid to enhancing secondary mental health services to fulfil these goals.
The shift from primary to secondary mental health care is also consistent with the Mental Health Act 2007. It required decision-makers to reduce the share of mental health patients treated in inpatient facilities, transferring them into community settings and providing social care alongside mental health care instead (Glover-Thomas 2013). The restructuring of the NHS under the Health and Social Care Act 2012 might support the process by establishing integrated care pathways. Under the 2012 Act, the number of mental health care providers has been increasing, making it easier for patients to find the required services (Glover-Thomas 2013).
However, the Act also poses some challenges to mental health patients. For example, the All Party Parliamentary Group on Mental Health (APPGMH 2013) states that the increased role of GPs in service provision could impair the quality of first-line mental health care. It is thus critical to equip all care providers with necessary knowledge on mental health, thus enabling them to provide assistance to patients in all care settings.
Emotional Distress
Emotional distress is a complex notion that is influenced by an individual’s experiences and their mental health state. According to the explanation offered by Ross and Mirowsky (2017), distress is an unpleasant state that can take the form of anxiety or depression. Anxiety is manifested through restlessness, irritability, tension, and fear, whereas depression causes a person to feel hopeless, lonely, fatigued, and sad (Ross & Mirowsky 2017). Another concept that is closely tied to distress is malaise, which concerns the physical manifestation of depression or anxiety. For instance, anxiety can cause a person to develop ailments, such as headache or stomachache, as well as shortness of breath, trembling, and dizziness (Ross & Mirowsky 2017).
Emotional distress is widespread in patients with mental health disorders, which is due to both psychological and sociological factors. People with mental health issues often experience alienation, which results in poor social support and leads to distress (Arvidsdotter et al. 2016; Ross & Mirowsky 2017). In addition, they are more prone to developing anxiety and depression as a result of stress, medications, or external triggers. Distress has a detrimental effect on a person’s wellbeing and their quality of life (Ross & Mirowsky 2017). Hence, recognising acute situations of emotional distress and addressing them promptly is a necessary skill for care providers, regardless of the settings of their work.
Introduction to Case Scenario
The case occurred during the first year’s placement at a renal unit of a hospital and involved a patient diagnosed with a mental health condition. In order to ensure compliance with the Nursing and Midwifery Council’s Code of Practice (NMC 2015), informed consent was obtained from the patient to share the case in the paper. The patient’s name will be kept confidential to ensure her privacy, and she will be referred to as Mrs P.
Mrs P. is a 68-year-old woman who was diagnosed with bipolar disorder and severe depression. She has one daughter who lives separately, although they maintain close contact through phone calls and visits. The patient has also been diagnosed with chronic kidney disease, which required her to receive dialysis treatment three times a week. As the unit is focused on renal diseases, it had a lot of dialysis patients.
On one day when Mrs P. came in for her treatment, the unit was hosting an event celebrating a dialysis wave. An informed consent form was signed by all patients willing to participate in the event, including Mrs P. The celebration involved music, singing, and making waves, during which the participants touched one another. Mrs P. was placed in a side room for her treatment while the event took place.
Because of her mental health condition, Mrs P. did not like to be in places where there is a lot of noise, as well as in crowded spaces. Increased sensitisation of the brain to external stimuli, such as noise, is a common symptom of many psychological disorders, including bipolar disorder, depression, and anxiety (Beutel et al. 2016; Ursin 2014). As a result, Mrs P. was triggered by the external environment, resulting in acute emotional distress. In this case, the patient exhibited symptoms of anxiety provoked by the noise. She started screaming and throwing objects from her table into the wall.
She appeared irritable and restless, which are both signs of severe distress (Ross & Mirowsky 2017). After witnessing Mrs P’s distress, the nurse ran to her mentor and asked them to turn off the music quickly. Then she read the patient’s file, which mentioned that noise and large groups of people cause Mrs P. to become anxious.
The caring conversation took place when the nurse returned to the patient and tried to resolve the situation. After the music had stopped, the patient was still showing signs of distress, including hyperventilation, restlessness, and incoherent speech. The nurse approached the patient calmly and asked about her daughter. From the file and prior communication with the patient, the nurse knew that Mrs P’s daughter was the person she felt most comfortable with during anxiety attacks. The nurse asked her daughter’s name, age, profession, and other details that brought Mrs P’s mind to her. The patient calmed down visibly after these questions, and the nurse served a cup of tea to help her recover from the symptoms of anxiety.
Mrs P. then asked the nurse to call her daughter on the phone and let them speak. The nurse used her phone to dial her number, and Mrs P. talked to her daughter for a couple of minutes. After that, she seemed to regain her composure fully and apologised to the ward for the situation. She also hugged the nurse and thanked her for the support. Other nurses in the unit were surprised to see the nurse resolve the situation so effectively, and her mentor praised the caring conversation that took place.
Influencing and Inhibiting Factors
As evident from the case scenario, there was a variety of factors that affected the caring conversation in the case. On the one hand, there were inhibiting factors, which contributed to the patient’s distress and affected the nurse’s response to it. These factors included the patient’s mental health status, the environment and poor knowledge of the patient’s needs. On the other hand, there were some influencing factors that contributed to the success of the caring conversation. These factors included communication, person-centred culture, and the therapeutic relationship. The present section will explore and analyse all of these factors to show their influence on the situation and the outcomes.
Inhibiting Factors
The environment
The primary cause of the situation described in the case was the patient’s reaction to the environment. The celebration planned by the unit included loud noise and activities and involved a large group of people. These factors triggered a response showed by Mrs P. due to her sensitivity to external stimuli. The environment also had an inhibiting influence on the caring conversation that took place. Worried about the patient, several nurses gathered in her room, which made her more uncomfortable even when the music had stopped. Once the nurses left to tend to other patients, Mrs P. was able to benefit from the caring conversation and the calm environment. After all the key stressors have been removed, the environment had a positive effect on the caring conversation, allowing the patient to relax and regain composure.
Mental health
The patient’s mental health condition clearly had a significant impact on the situation, as well as on the caring conversation that took place. Depression and bipolar disorder can be linked to behavioural changes if a patient is triggered by their surroundings. Research shows that both bipolar disorder and major depressive disorder are related to abnormal neural responses (Moon 2013).
These abnormalities are believed to have an influence on the perception and processing of external stimuli by patients. For example, an article by Parker et al. (2017) describes that people with bipolar disorder can become hypersensitive to touch, smell, taste, and sound. Given the patient’s diagnosis, the event held in the unit could have triggered a sensory overload, which was the immediate cause of the patient’s emotional distress. Mrs P’s mental health condition also made it more difficult to hold a caring conversation because she was distracted by the noise and the people around her. Calming the environment and maintaining contact with the patient helped her to focus, thus enabling for the caring conversation to occur.
Poor knowledge of the patient’s needs
Since the case shows that the information about the patient’s triggers was in her file, poor understanding of the patient’s needs was also an inhibiting factor. Although the previous subsection illustrated that Mrs P’s response to the environment was justified by her mental illness, it is evident that the situation could have been prevented by the staff. While planning for a party, the manager should have checked the dialysis schedule to ensure that there were no patients who would be uncomfortable because of the noise and crowding.
This would have helped to prevent the situation and avoid the stress for patients and the staff working in the unit. In addition, better knowledge of the patient’s needs would have helped the team to respond to the situation more quickly. For example, monitoring the patient for early signs of anxiety would have been beneficial in this situation.
Poor preparedness
Another inhibiting factor evident from the case is poor preparedness to the anxiety attack. First of all, it appeared that Mrs P. did not have adequate knowledge of mechanisms to help her cope with anxiety. The anxiety attack experienced by the patient started abruptly, and the patient seemed to be confused about the situation afterwards. As mentioned by Arvidsdotter et al. (2016), it is essential to provide education about emotional distress to patients at risk in order to enable them to ask for help or calm down before anxiety or depression becomes too overwhelming.
The nurse’s response to the situation and the caring conversation were also limited by her knowledge of emotional distress and mental health conditions. Although the nurse managed to find the right approach to the patient due to various contributing factors, she was poorly prepared for the situation, too. Having more knowledge of bipolar disorder, depression, and emotional distress would have helped the nurse to prevent the situation and respond to it better.
Influencing Factors
Communication skills
Communication is among the most critical influencing factors that enabled the caring conversation to occur. Once the patient became distressed, the nurse’s communication skills helped her to reach out to the mentor and improve the environment to remove noise, which was triggering the patient. While talking to her mentor, the nurse was able to express her concerns and advice calmly and clearly, despite the chaotic nature of the situation. This skill is critical to nurses working in all settings since it improves the response to emergency situations (Abourbih et al. 2015).
The nurse’s communication skills have also assisted her in reaching out to the patient without increasing her stress. When a person has severe anxiety, they may be triggered further if the response is chaotic or if too many people try to approach them at once. In the present case, the nurse was the only person talking to the patient, and she did so in a calm and compassionate manner, which facilitated the caring conversation. Staying focused on the patient throughout our conversation helped the nurse to find the right words to say to reduce Mrs P’s disorientation and anxiety (Arvidsdotter et al. 2016). Therefore, communication played a critical role in influencing the caring conversation in the case scenario.
The therapeutic relationship
The concept of the therapeutic relationship applies to all areas of healthcare, but it is of crucial value in mental health care and psychiatric practice. As explained by Skodol and Bender (2018), a therapeutic relationship involves the partnership made between the patient and the care provider with the goal to achieve better patient outcomes. In mental health care, a therapeutic relationship helps care providers to understand patients and empathise with them, while also increasing patient autonomy and engagement in care planning (Farrelly & Lester 2014). As a result, forming a therapeutic relationship helps mental health providers to improve patients’ symptoms and achieve greater progress throughout treatment (Skodol & Bender 2018).
In the present case, the nurse was not the patient’s psychiatric care provider, which limited her knowledge of Mrs P’s condition and triggering and relieving factors. Nevertheless, the nurse has managed to form a therapeutic relationship with the patient because she came in for treatment regularly. While preparing Mrs P. for dialysis or checking up on her during the procedure, the nurse would ask about her well-being and the preferences regarding treatment, as well as about family, social support, and living conditions.
The patient was enthusiastic about engaging in conversation, which allowed the nurse to form a therapeutic relationship with her. This relationship, in turn, created a bond between the patient and the nurse, which contributed to the caring conversation. Even while in distress, the patient recognised the nurse and knew that she could trust her and that she was trying to help her overcome anxiety. The therapeutic relationship was essential in this case because being approached by someone unfamiliar could have contributed to Mrs P’s fear and anxiety, leaving no chance for the caring conversation to take place.
Person-centred culture
Person-centredness is an essential factor in nursing care, which helps to improve patient outcomes and satisfaction with services. In the context of mental health, a person-centred culture is critical as it brings patients’ experiences to the forefront of care planning and delivery. As explained by Borg and Karlsson (2016), person-centredness in mental health care settings is still an evolving concept that signifies the shift in values and goals of care.
Recovery and control of the symptoms used to be the primary focus of mental health care, and in this context, care providers had a limited understanding of patients’ feelings and experiences (Borg & Karlsson 2016). However, in recent years, patient satisfaction has become an important factor, and person-centredness evolved as a way of addressing these changes.
The hospital where the nurse worked in had a strong person-centred organisational culture, and thus nurses were taught to pay attention to patients’ feelings, emotions, and experiences. This helped the nurse to have a caring conversation with the patient in the case scenario by improving her understanding of Mrs P’s state and needs. For example, focusing on the patient made the nurse remember that she had a good relationship with her daughter, and led her to ask Mrs P. the right questions to ease anxiety. Thus, in the present case, the person-centred culture in the hospital facilitated the caring conversation.
Health Promotion and Potential Interventions
As explained in the previous section, Mrs P’s response to the event and her emotional distress were mainly due to her mental health condition. The primary recommendation for health promotion is thus to ensure optimal treatment of bipolar disorder and major depressive disorder to reduce symptoms and promote well-being. According to the National Institute for Health and Care Excellence (NICE 2017), bipolar disorder can be successfully managed by a combination of pharmacological and psychological interventions. Pharmacological interventions include the use of antipsychotic drugs during episodes of mania and antidepressants during bipolar depression (NICE 2017).
Psychological interventions include individual and group therapy, such as psychoeducation, cognitive behavioural therapy (CBT), interpersonal and social rhythm therapy, and other options (NICE 2017). A combination of appropriate medications and psychotherapy would assist the patient in managing the symptoms of bipolar disorder and depression. They should also reduce the patient’s anxiety and sensitivity to external stimuli, thus reducing the possibility of acute emotional distress in the future.
As part of the patient’s health promotion plan, it is also critical to provide education to Mrs P. and her family regarding the state of her mental health and the risks associated with it. This would help to ensure an adequate understanding of both conditions and motivate the patient to seek professional help (NICE 2017). The family should also receive education about emotional distress in bipolar and major depressive disorders so that they could warn other care providers about it and respond effectively in case Mrs P. becomes anxious. It would also be beneficial to refer the patient to a mental health specialist in the hospital so that she could obtain mental health care in the same facility as her dialysis treatment.
Critical Self-Reflection
On the whole, the case scenario showed that my response to the situation had both strengths and weaknesses that affected the caring conversation. I believe that I was successful in calming Mrs P. down and helping her to overcome anxiety. This was mainly due to the knowledge and experience I gained from the course and my professional practice. On the one hand, the course provided me with an understanding of emotional distress and its causes, which helped me to recognise the patient’s needs in this particular situation. On the other hand, my professional experience helped me to establish a therapeutic relationship with the patient and enhanced my communication skills, thus facilitating an effective caring conversation.
These skills and knowledge will have a positive influence on my future practice as they will enable me to build connections with patients and provide high-quality, patient-centred care in any work settings. I also believed that I showed a good level of emotional resilience in this stressful situation, which allowed me to focus on the patient and engage her in a caring conversation. Emotional resilience is critical for nurses and will help me in my future work by allowing me to respond to stressful or unexpected events quickly and effectively.
Nevertheless, the case scenario also highlighted some areas for improvement that should be addressed as part of my professional development plan. First of all, I was not completely prepared for the situation of emotional distress. While my response was fast and effective, I did not have enough experience working with patients who have mental health conditions. Therefore, I feel that I would benefit from developing a more in-depth understanding of the strategies and tools used to relieve emotional distress in patients. This would help me to be more confident in my knowledge and skills when dealing with similar situations in my future practice.
Secondly, the case showed that some aspects of care coordination in the unit were ineffective. When treating a patient with mental health conditions, it is essential for the whole team of nurses and physicians to know the patient’s needs and triggering factors. In the present case, the nurses, including me, were unaware that noise and large groups of people could trigger acute emotional distress in Mrs P. Hence, it would be essential for me to learn more about care coordination in various settings of nursing practice to promote effective care coordination in my future practice.
Professional Development Plan
Based on the critical self-reflection, the first developmental objective is to gain more in-depth knowledge of evidence-based strategies used to relieve emotional distress in mentally ill patients. To achieve this, I will perform independent research for guidelines and research articles on the topic and create a list of strategies with detailed information about each. Success in this developmental area can be evaluated based on how quickly and effectively I respond to similar situations in future practice. No further learning needs in this area have been identified.
The second developmental objective for me is to improve the knowledge of optimal care coordination and apply it in my future practice. To fulfil this learning need, I will research care coordination practices in my workplace and compare them to best practices highlighted in guidelines or research studies. Then, I will approach my mentor or other nurse leaders in my workplace with suggestions on how to improve care coordination. Successful learning in this area will be evidenced by positive changes in care coordination practices and enhanced knowledge of mentally ill patients’ needs across my unit. Further learning needs in this area include developing leadership skills, which can be improved by learning various leadership theories and applying them to my work.
Reference List
Abourbih, D, Armstrong, S, Nixon, K & Ackery, AD 2015, ‘Communication between nurses and physicians: strategies to surviving in the emergency department trenches’, Emergency Medicine Australasia, vol. 27, no. 1, pp. 80-82.
All Party Parliamentary Group on Mental Health (APPGMH) 2013, Health and social care reform: making it work for mental health. Web.
Arvidsdotter, T, Marklund, B, Kylén, S, Taft, C & Ekman, I 2016, ‘Understanding persons with psychological distress in primary health care’, Scandinavian Journal of Caring Sciences, vol. 30, no. 4, pp. 687-694.
Beutel, ME, Jünger, C, Klein, EM, Wild, P, Lackner, K, Blettner, M, Binder, H, Michal, M, Wiltink, J, Brähler, E & Münzel, T 2016, ‘Noise annoyance is associated with depression and anxiety in the general population-the contribution of aircraft noise’, Plos One, vol. 11, no. 5, pp. 1-10.
Borg, M & Karlsson B 2016, ‘Person-centredness, recovery and user involvement in mental health services’, in B McCormack & T McCance (eds), Person-centred practice in nursing and health care: theory and practice, John Wiley & Sons, Hoboken, NJ, pp. 215-224.
Farrelly, S & Lester, H 2014, ‘Therapeutic relationships between mental health service users with psychotic disorders and their clinicians: a critical interpretive synthesis’, Health & Social Care in the Community, vol. 22, no. 5, pp. 449-460.
Glover-Thomas, N 2013, ‘The Health and Social Care Act 2012: the emergence of equal treatment for mental health care or another false dawn?’, Medical Law International, vol. 13, no. 4, pp. 279-297.
Mental Health Foundation (MHF) 2017, Surviving or thriving? the state of the UK’s mental health. Web.
Mind 2018, Mental Health Act 1983. Web.
Moon, MA 2013, ‘Abnormal neural responses to emotional stimuli found in bipolar, depression‘, Clinical Psychiatry News. Web.
National Institute for Health and Care Excellence (NICE) 2017, Bipolar disorder: the NICE guideline on the assessment and management of bipolar disorder in adults, children and young people in primary and secondary care. Web.
Nursing and Midwifery Council (NMC) 2015, The Code: professional standards of practice and behaviour for nurses, midwives and nursing associates. Web.
Panday, S 2016, Parity of Esteem: overview and report. Web.
Parker, G, Paterson, A, Romano, M & Graham, R 2017, ‘Altered sensory phenomena experienced in bipolar disorder’, American Journal of Psychiatry, vol. 174, no. 12, pp. 1146-1150.
Parkin, E 2018, Mental health policy in England. Web.
Ross, CE & Mirowsky J 2017, Social causes of psychological distress, 3rd edn, Aldine Transaction, Piscataway, NJ.
Skodol, A & Bender D 2018, Establishing and maintaining a therapeutic relationship in psychiatric practice. Web.
Ursin, H 2014, ‘Brain sensitization to external and internal stimuli’, Psychoneuroendocrinology, vol. 42, no. 1, pp. 134-145.