NURS20158 portfolio Q & A

Portfolio activity 1

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Q1. What is the general practice that is arrived while patients are claiming about their medications?

Reflection

The major purpose of this study is to provide a piece of in-depth information about the effectiveness of medications on an individual’s normal lifestyle. Pharmacists, based on general practices, are providing a huge range of high-quality services to patients, like medication reviews and long-term health management services (Parker et al. 2020). As a result, it is assisting an individual in terms of leading a healthy and normal lifestyle. After being admitted to the healthcare organization, the client will be provided with a review regarding treatment and medication which is given to the patients. In addition, after admitting to the healthcare, the client must be included in the discussion of his or her treatment and medication, which will provide or will be provided to improve mental illness. Moreover, after giving the review to the patients after doctor’s visits, the main responsibility is to provide an accurate explanation regarding treatment and medication and those are highlighted below:

• After giving an explanation to the patient or client, the allocated health professional is restating the entire information and ensuring that the client is able to understand
• In case the client is unable to get the point of an allocated health professional, then it is the major responsibility of that nurse to provide information in front of the patient’s family members (Naik-Panvelkar et al. 2020). As a result, it is supporting the patient or client in terms of clarifying the query of the client.

Q2. Which kind of positive effect has been observed which is related to Psychotropic Medication?

Reflection

Psychotropic medication is not only an effective cure but also it helps in reducing the negative impact of a mental issue on an individual. As opined by Deeks et al. (2018), psychotropic medication is reducing the negative symptoms and preventing relapses of psychiatric disorders. In addition, it is assisting the clients in minimizing cravings and maintaining abstinence from addictive substances. Even after the psychotropic medication system has an intensive negative impact like drowsiness, psychomotor retardation, forgetfulness and extra-pyramidal effects. Moreover, it has several kinds of benefits for the client’s lifestyle, which is associated with the mental disorder.

The primary medications for psychotropics are used in reducing the negative impact of mental issues and those are basically neuroleptics, anti-anxiety disorders, necrotic analgesics, mood stabilizers and hypnotics.

Providing treatment and medication to the patients, I have gained positive experiences and it is helping me to improve my service provision skills and professional skills. In addition, I am the witness as the medication is reducing the psychotic symptoms, producing the effect of mood stabilizers and decreasing the thoughts of suicide or self-harm. Moreover, proper medication is reducing the negative impact of self-harm or anxiety on an individual’s lifestyle (Dykgraaf et al. 2021). As a result, it is assisting an individual in leading a healthy and normal lifestyle in the upcoming days. Moreover, the major necessity of Psychotropic Medication is providing proper treatment to mentally ill patients and providing proper medication for proper function. In addition, all those drugs or medication is working positively by balancing or changing the amount of the chemicals in neurotransmitters.

Portfolio activity 2

Brief Psychiatric Rating Scale widely used for the clinical purpose to collect information on potential possibilities of presence with the intensity of severity associated with psychiatric symptoms. As referred by Taylor et al. (2019), it helps in tracking psychological symptoms over time. This includes depression, anxiety and stress. I have taken a score rating of BPRS of one of my clients that ranges from 0 to 7, among which 0 indicates not assessed, 1 indicates not present, 2 indicates very mild, 3 indicates mild, 4 indicates Moderate, 5 indicates Moderately severe, 6 indicate severely, 7 indicates Extremely severe. However, my client obtained a total score of 45. The analysis has been done using de-identification of the documents so that the privacy of the client has not to hamper. This document process is significant in clinical research and in developing a psychological study. De-identification comes under the ethics of nursing professional practices.

I have done BPRS on the client as the client has been primarily diagnosed with Schizophrenia with a personality trait as a secondary with MBD- dependence Syndrome-Nicotine dependent and has been admitted to IPU. I found this tool effective in assessing the treatment effectiveness for those who have symptoms of moderate to severe psychosis. This rating allows the assessment of 18 psychosis symptoms that include hallucination, hostility, suspiciousness, and grandiosity. While performing this assessment, I took a random client with existing symptoms of psychosis who was very cooperative throughout the assessment. De-identification documents refer to the process that allows preventing the personal identity of someone from being exposed to the public. As stated by Chevrier et al. (2019), documenting de-identity includes redacting information that is followed by aggregating data with removing some variables and coding that is ended by one-way encryption. Henceforth, the analysis concludes that the client has still existing psychosis which reflects the accuracy of the tool. It simultaneously determines the clinical condition that has scored 45. The client has been prescribed extensive treatment followed by discharge planning. It is predicted that on undergoing a treatment plan, the score level lowers once the symptoms are subsidies. Hence, from this I concluded that BPRS tools are an effective tool to some extent as it helps in determining the client's mental health progression, therefore discharging plan can be formulated. Therefore this tool can be summarized as an effective tool for drafting the psychiatric symptoms among clients suffering from psychosis symptoms.

Portfolio activity 3

Beck's depression inventory is a scoring scale that is used as the questionnaire. Respondents in this questionnaire have been asked to give a rating to each of the items determine accordingly to the severity of the symptoms. As opined by Chandradasa & Champika (2018), it ranges from symptoms absent to intense levels. This inventory has been constructed doe depression symptoms to measure the characteristics of depression symptoms and attitude. Rating of BDI has been done with 4 point scale that ranges from 0-3 which has a maximum score of 63. It has its significance of BDI in psychology studies and de for mental health professionals to screen the intensity of the depression that is followed by the behavioural manifestation. I found BDI as a useful screening tool for determining depression severity. Among depression disorders patients, psychometric properties can be evaluated using BDI.

The evaluation of depression, symptoms which include pessimism, sense of failure, mood, guilt, punishment, self-dislike, self-dissatisfaction, suicidal ideas, crying, self-accusation, irritability, indecisiveness, social withdrawal, work difficulty, insomnia, body image change, fatigability, weight loss, somatic preoccupation, loss of appetite and loss of libido (Upton, 2020). On performing the following exercise for myself, I scored 2, according to the BDI score, which has been in the limit of the normal range. In the same activity that I have performed on different people, I found facing challenges, though I received positive feedback from the others at the end.

BDI scoring and activity practice has involved in all question that is presented in the BDI formulated in a small language. It reflects the ease of understanding for the participants that overwhelmed the personal thoughts, promptly allowing the participants to answers that can deduce the mental health condition of the personal matter.

Beck's depression inventory has been highly appreciated by the other participants as it was found to be effective to analyse the mental health condition in analysing the problems that are not possible to be expressed in words. As mentioned by Anokye et al. (2022), BDI is conscious of 21 items, a basic self-report that has been performed to evaluate the characteristics that define the behavioural manifestation, and attitude on the basis of four response choices. Therefore, I found BDI effective on myself as it helped in drafting the prevailing issue that has been experienced by the world. Understanding the primary level of mental illness ensures effectiveness in self-evaluation and helps in integration.

Portfolio activity 4

Portfolio activity 5

ECT, or "Electroconvulsive therapy”, is a procedure that involves the passing of small sections of current to produce seizure-like episodes. As said by Li et al. (2020), clients who experience severe depressive symptoms are provided with this therapy. The client is provided general anaesthesia and exposed to this therapy under the supervision of the consultant psychiatrist. The small currents are sent to the brain to trigger the seizure-like sensations to reverse the symptoms of mental health issues. Besides severe depression, ECT might also be applied in the treatment of bipolar disorder, schizoaffective disorder, “neuroleptic malignant syndrome”, and catatonia (Sienaert et al., 2020).The reason why I would like to choose this as an alternative therapy in my career is that I have witnessed many clients being cured with this approach. The medication trials have been ineffective in some cases and have also displayed side effects, but ECT has been proven effective in most cases.

The administration of ECT is conducted in the morning before the client is provided breakfast. This is because the therapy is performed by providing general anaesthesia, after which it takes time to regain consciousness (Elias et al. 2021). I would like to administer a muscle relaxant to the clients before proceeding with the actual treatment. Followed by this, I would attach the electrodes to the skull of the client and allow current to pass. It is expected that the client would wake up in a confused state without the memories of the ECT event after recovering from the convulsion. I would repeat the treatment three times every week for each client, and this would be continued for a month. As mentioned by Porter et al. (2020), the number of treatments might vary depending on the client's condition, but the general range is six to twelve times. The clients would be recommended to maintain their medication routine after the treatment such that the chances of relapse are reduced.

The fact that ECT provides rapid and significant improvement is also another reason behind my considering this as an alternate therapy apart from its versatility. 80-85% of clients can benefit from this treatment, and the majority has reported to remain in good health in the following months (Gil-Badenes et al. 2020). The cellular changes triggered in the brain due to the chemical impulses make helpful changes in the molecules of the cells, causing depression. Besides, the health risks in this therapy are minor, for which I have considered it appropriate.

Portfolio activity 6

Definition of ECT

Electroconvulsive therapy is one kind of treatment process in which all small electricity is passed through and causes episodes (Thiruvenkatarajan et al. 2020). This effective process is conducted for anaesthesia and it is changing brain chemistry which is reversing the conditions of mental health.

Importance of recommending ECT

ECT is essential and recommended to the patient for treating all kinds of several mood illnesses, such as anxiety or depression. In addition, the major reason behind recommending this treatment to patients is that it is ineffective in reducing the negative impact of mood-associated disorders (Weiss et al. 2019). As a result, it is positively affecting patient health and assisting to lead a normal and healthy lifestyle.

Basically, ECT is playing an essential role in supervising mentally affected patients. In addition, it is involving to have general anaesthesia and it is associated with several risks. The reason behind this is several kinds of medical conditions like heart disease or other health issues.

ECT treatment preparation

The client is required fast, which is addressed as eating or drinking before 2 hours of treatment. Along with that, it required more consideration, such as

• Removing nail polish and accessories
• Not to bring any valuable things
• Wearing loose nightclothes

Consent

This kind of effective treatment procedure is required a written consent in which all kinds of medical procedures are explained in a proper way. In addition, all kinds of possible risks have been mentioned in this consent form (Wells et al. 2018). As a result, the patient is able to receive treatment and medication after getting the point of the effectiveness of this therapy. According to the guidelines of The “Mental Health Act 2016”, the “Review Tribunal” is required and approved ECT for clients in terms of improving their health status (Health, 2022). Thus, it has been stated that this therapy is beneficial and effective in improving patients’ health quality and the quality of care of health professionals.

After effects of ECT

• The client or patient is transformed in terms of recovering rapidly and monitoring after an aesthesia
• The patient must have a responsible healthcare professional to take care of the patient
• The client is required in avoiding driving and making effective decisions regarding legal documents
• Avoiding smoking, drinking alcohol

Impact of ECT if a patient is on medication

In case the client is on his or her medication, then the patient is taking them between 6.30 am to 7.30 am with a small amount of drinking water. Moreover, several kinds of medications are decreasing ECT efficacy.

Treatment day-Expectations

• The client or patient must inform the healthcare professional regarding recent health concerns
• Daily check of blood pressure, pulse and oxygen level of the patient
• After sleeping, the doctor is required to measure the client's brain with an electric stimulus. As a result, the patient feels to be fully controlled as well as monitored.
• After an aesthesia body must be moved, which indicates the activated body relaxant

Portfolio activity 7

The majority of the clients being admitted to inpatient units in my working area are in Depot. The rest of the clients are provided with a treatment team after they have been admitted. Depots are "long-acting antipsychotic injections (LAAIs)” that are mainly designed for clients suffering from long-term schizophrenia. These are mainly prescribed to patients who relapse after non-adherence to the antipsychotic medications they have been taking (Pacchiarotti et al. 2019). The non-compliance with their oral medications while being in the community is what makes clinicians recommend LIAA to clients. The most important requirement for a patient in the inpatient unit is to have trust in the treatment method, which mandates building a rapport with them. As a part of my responsibility as a nurse, I would like to obtain written consent from the clients so that they accept the treatment process they are about to undergo. Also, the vital signs of the clients would be checked before they are injected because that would point out whether they are physically prepared (Gannon et al. 2020). The client would be provided basic education on the benefits and consequences of the treatment in case they are being subjected to the treatment for the first time. The QLD website and medication leaflets would be the advised sources to the clients for gathering information.

The privacy of the clients would be respected before administering the Depot, and their dignity would be validated. Consent would be gathered for the administration site as well, and the two options that would be presented to them include Deltoid and Gluteal. The client would be under extreme supervision, and their vitals would be regularly monitored to detect adverse reactions and prevent side effects immediately. In case the client refuses to get administered with the Depot, the team leader would need to be notified. As said by Pacchiarotti et al. (2019), in the absence of a leader, the senior hierarchy might be consulted, and the other members might also be helpful. The training team might also be consulted in such cases, and their advice would be helpful. However, I would ensure the clients that they would not be forced to take the injection in any case. At the time when the injection is being administered, I would ask the client to stay still. I would also advise them to report to me in case they face even slight discomfort after the administration.

References

Journals

• Anokye, R., Jackson, B., Dimmock, J., Dickson, J. M., Blekkenhorst, L. C., Hodgson, J. M., ... & Stanley, M. (2022). Psychological distress and quality of life in asymptomatic adults following provision of imaging results for prevention of cardiovascular disease events: a scoping review. European Journal of Cardiovascular Nursing. https://doi.org/10.1093/eurjcn/zvac047
• Chandradasa, M., & Champika, L. (2018). Commentary: Measuring depression in a non-western war-affected displaced population: measurement equivalence of the Beck Depression Inventory. Frontiers in Psychology, 9, 566. https://doi.org/10.3389/fpsyg.2017.01670
• Chevrier, R., Foufi, V., Gaudet-Blavignac, C., Robert, A., & Lovis, C. (2019). Use and understanding of anonymization and de-identification in the biomedical literature: scoping review. Journal of medical Internet research, 21(5), e13484. https://doi.org/10.1371/journal.pone.0261719
• Deeks, L. S., Kosari, S., Boom, K., Peterson, G. M., Maina, A., Sharma, R., & Naunton, M. (2018). The role of pharmacists in general practice in asthma management: a pilot study. Pharmacy, 6(4), 114. https://doi.org/10.3390/pharmacy6040114
• Dykgraaf, S. H., Desborough, J., de Toca, L., Davis, S., Roberts, L., Munindradasa, A., ... & Kidd, M. (2021). “A decade’s worth of work in a matter of days”: The journey to telehealth for the whole population in Australia. International Journal of Medical Informatics, 151, 104483. https://doi.org/10.1016%2Fj.ijmedinf.2021.104483
• Elias, A., Thomas, N., & Sackeim, H. A. (2021). Electroconvulsive therapy in mania: a review of 80 years of clinical experience. American Journal of Psychiatry, 178(3), 229-239. doi: 10.1136/bmj.k5233
• Gannon, J. M., Conlogue, J., Sherwood, R., Nichols, J., Ballough, J. R., Fredrick, N. M., & Chengappa, K. R. (2020). Long acting injectable antipsychotic medications: ensuring care continuity during the COVID-19 pandemic restrictions. Schizophrenia Research, 222, 532. doi: 10.1016/j.schres.2020.05.001
• Gerlach, L. B., Wiechers, I. R., & Maust, D. T. (2018). Prescription benzodiazepine use among older adults: a critical review. Harvard review of psychiatry, 26(5), 264. https://doi.org/10.1097%2FHRP.0000000000000190
• Gil-Badenes, J., Valero, R., Valentí, M., Macau, E., Bertran, M. J., Claver, G., ... & Vieta, E. (2020). Electroconvulsive therapy protocol adaptation during the COVID-19 pandemic. Journal of affective disorders, 276, 241-248. https://doi.org/10.1016/j.jad.2020.06.051
• Hu, F., Muir?Cochrane, E., Oster, C., & Gerace, A. (2019). An examination of the incidence and nature of chemical restraint on adult acute psychiatric inpatient units in Adelaide, South Australia. International journal of mental health nursing, 28(4), 909-921. https://doi.org/10.1111/inm.12591
• Kamble, A., Kennady, C. J., Badiye, A., & Kapoor, N. (2022). Detection of diazepam in spiked drink using thin-layer chromatography. JPC–Journal of Planar Chromatography–Modern TLC, 1-4. https://doi.org/10.1007/s00764-022-00208-x
• Li, M., Yao, X., Sun, L., Zhao, L., Xu, W., Zhao, H., ... & Cui, R. (2020). Effects of electroconvulsive therapy on depression and its potential mechanism. Frontiers in Psychology, 11, 80. https://doi.org/10.3389/fpsyg.2020.00080
• Lowton, K., & Chiba, G. (2021). Assessing the clinical utility of the severity dependence scale for benzodiazepine use disorder. South African Journal of Psychiatry, 27(1), 1-6. http://dx.doi.org/10.4102/sajpsychiatry.v27i0.1571
• Naik-Panvelkar, P., Norman, S., Elgebaly, Z., Elliott, J., Pollack, A., Thistlethwaite, J., ... & Seibel, M. J. (2020). Osteoporosis management in Australian general practice: an analysis of current osteoporosis treatment patterns and gaps in practice. BMC family practice, 21(1), 1-13. https://doi.org/10.1186/s12875-020-01103-2
• Pacchiarotti, I., Tiihonen, J., Kotzalidis, G. D., Verdolini, N., Murru, A., Goikolea, J. M., ... & Vieta, E. (2019). Long-acting injectable antipsychotics (LAIs) for maintenance treatment of bipolar and schizoaffective disorders: A systematic review. European Neuropsychopharmacology, 29(4), 457-470. https://doi.org/10.1016/j.euroneuro.2019.02.003 0
• Parker, B. L., Achilles, M. R., Subotic-Kerry, M., & O’Dea, B. (2020). Youth StepCare: a pilot study of an online screening and recommendations service for depression and anxiety among youth patients in general practice. BMC Family Practice, 21(1), 1-10. https://doi.org/10.1071/AH19078
• Porter, R. J., Baune, B. T., Morris, G., Hamilton, A., Bassett, D., Boyce, P., ... & Malhi, G. S. (2020). Cognitive side-effects of electroconvulsive therapy: what are they, how to monitor them and what to tell patients. BJPsych open, 6(3). doi: 10.1192/bjo.2020.17
• Sienaert, P., Lambrichts, S., Popleu, L., Van Gerven, E., Buggenhout, S., & Bouckaert, F. (2020). Electroconvulsive therapy during COVID-19-times: our patients cannot wait. The American Journal of Geriatric Psychiatry, 28(7), 772-775. doi: 10.1016/j.jagp.2020.04.01
• Taylor, P. J., Fien, K., Mulholland, H., Duarte, R., Dickson, J. M., & Kullu, C. (2021). Pilot service evaluation of a brief psychological therapy for self?harm in an emergency department: Hospital Outpatient Psychotherapy Engagement Service. Psychology and Psychotherapy: Theory, Research and Practice, 94, 64-78. https://doi.org/10.1111/papt.12277
• Tolbert, D., & Larsen, F. (2019). A comprehensive overview of the clinical pharmacokinetics of clobazam. The Journal of Clinical Pharmacology, 59(1), 7-19. DOI: 10.1002/jcph.1313
• Upton, J. (2020). Beck depression inventory (BDI). Encyclopedia of behavioral medicine, 202-203. https://doi.org/10.1007/978-3-030-39903-0_441
• Wang, L. L., Ren, X. X., He, Y., Cui, G. F., Liu, J. J., Jia, J., ... & Yun, K. M. (2022). Pharmacokinetics of Diazepam and Its Metabolites in Urine of Chinese Participants. Drugs in R&D, 22(1), 43-50. https://doi.org/10.1007/s40268-021-00375-y

Pamphlet

• Health, (2022). About the Mental Health Act 2016. Retrieved on 21st November 2022. Retrieved from: https://www.health.qld.gov.au/clinical-practice/guidelines-procedures/clinical-staff/mental-health/act/about#reports
• Thiruvenkatarajan, V., Dharmalingam, A., Armstrong-Brown, A., Weiss, A., Waite, S., & Van Wijk, R. (2020). Uninterrupted anesthesia support and technique adaptations for patients presenting for electroconvulsive therapy during the COVID-19 era. The journal of ECT. https://doi.org/10.1097%2FYCT.0000000000000707
• Weiss, A., Hussain, S., Ng, B., Sarma, S., Tiller, J., Waite, S., & Loo, C. (2019). Royal Australian and New Zealand College of Psychiatrists professional practice guidelines for the administration of electroconvulsive therapy. Australian & New Zealand Journal of Psychiatry, 53(7), 609-623. https://doi.org/10.1177/0004867419839139
• Wells, K., Scanlan, J. N., Gomez, L., Rutter, S., Hancock, N., Tuite, A., ... & Halliday, G. (2018). Decision making and support available to individuals considering and undertaking electroconvulsive therapy (ECT): a qualitative, consumer-led study. BMC psychiatry, 18(1), 1-9. https://doi.org/10.7748/mhp2013.04.16.7.22.e769