Nursing Mental Health for Trauma- myassignmenthelp.com

Question: Discus about theNursing Mental Health for Trauma. Answer: Introduction Trauma has long lasting impact on the physical and the mental health of an individual. Trauma is recognised to be the major public concern in the area of mental health services. Therefore, strategies to address the clients history of trauma are increasingly drawing attention of the care providers and the care policymakers in different parts of the world (American Psychiatric Association, 2015). People with traumatic experiences can be benefitted if provided with emerging best practices in the traumatic informed care (Muskett, 2014). These practices involve both the clinical and the organisational changes that have the potential to improve the health outcome of the patient, patient engagement, and decrease unnecessary utilization of the health care resources (Wall, Higgins, Hunter, 2016). The paper deals with the case study of Amir Daud who has traumatic background experiences can and is experiencing anxiety disorder. In response to the case study, the paper discusses trauma informed care as a therapeutic approach from the nursing perspective. The response to the case study includes the prevalence of a history of trauma in mental health presentations and the neurobiology of trauma. The paper further provides the critique of the evidence base for trauma-informed care. The paper highlights how a trauma informed model of care would be implemented for Amir. Prevalence of the History of Trauma in Mental Health Presentations Mental health settings in any country are reported to have extreme prevalence of trauma cases. In Australia, two third of people visiting the inpatient and the outpatient mental health services have traumatic childhood (Slewa-Younan et al., 2014). They have experienced physical or sexual abuse in childhood. Other than that the major cases of complex trauma were found to be an outcome of neglect, emotional abuse, family violence, separation and loss, substance abuse, war, and refugee trauma (ODonnell et al., 2016). In Australia, five million adult people have experienced traumatic childhood. Most of the patients have multiple experiences with trauma. The indigenous population (both adults and children) in Australia are highly represented in the mental health services with experiences of trauma (Kraan et al., 2015). Trauma is recognised to be major public health concern. In a study examining, the charts of the psychiatric outpatients 50% of the cases were positive for the history of tr auma (Fulbrook Lawrence, 2015). In US, 90% of the clients in public mental health services have been exposed to trauma (Sise et al., 2014). The impetus for development of a trauma-informed care perspective in the development of the social service and the mental health service delivery originated from the growing recognition the wide prevalence of early traumatic events and their health consequences. Critique of the Evidence Base for Trauma-Informed Care Riebschleger et al. (2015) criticised that the clients traumatic history is rarely explored by the mental health practioner irrespective of the event that caused the trauma of the individual. In mental health setting, most patients are not screened or assessed or treated for their traumatic experience, which, may lead to adverse outcomes. Therefore, trauma informed care is important in addressing the impact caused by the trauma. According to Muskett, (2014) the trauma informed care refers to recognition of the prevalence of the trauma, its assessment and treatment, followed by laying focus on what has happened to the client and what is wrong with him or her. Trauma informed care is informed by current research. This type of care recognises that coercive environment cause re-traumatisation of the patient. This care it is considered as framework for human service delivery, since it is based on awareness and understanding of how trauma has influenced an individuals life and service needs. The core principles of the trauma informed care are-patient empowerment, collaboration, choice, safety, trustworthiness, cultural, historical and gender issues (Wall, Higgins Hunter, 2016). Huckshorn LeBel (2013) argued that Trauma informed care is an effective framework, which keeps the patient at the centre of his or her treatment. In this model or framework individual and the family are empowered. The service is delivered with the goal of wellness and self-management. Trauma informed care is transparent and open to outside parties and minimises the power control. The staffs in the trauma informed care is trained and understand the function of behaviour. This framework is highly preferred because it focuses on collaboration as per Knight (2015). In this form of care, the care providers do not engage in interactions that are disrespectful, demeaning, coercive, dominating, or controlling. Instead, the staffs respond to the disruptive behaviours through active listening skills, empathy, and by developing questions that help the patients to find solution to their crisis. In short, the trauma informed approaches could be described as strength-based framework, which is responsive to the effects of trauma (Coughlin, 2014). In conclusion, trauma informed care is the best therapeutic approach for patients with traumatic history. The effectiveness of this approach has been published in various studies. Trauma Informed Model of Care for Amir In the given case study, Amir has elements to his history that suggests distinct vulnerabilities and needs specific to his experience as a member of immigrant and refugee population in Australia. This section demonstrates as to how trauma informed model of care will be implemented to this case. Screening Trauma History Amir Daud is a 28-year-old refugee from Afghanistan. He is receiving supported accommodation with other refugees in Australia and have been referred to nurse for trauma counselling. Upon interaction with the client it was found that he has pleasant and cooperative behaviour but somewhat reserved in the general demeanour. This behaviour may be considered as strength that will help in building positive relationship with the client (Raja et al., 2014). He speaks Persian language and the lack of fluency in the host language is terrifying for him and adds to his frustration (Valibhoy et al., 2017). .Being a new comer in Australia, he has no awareness of the cultural and diversity in this new place. This has led to poor social connectedness. His childhood history shows a long experience of discrimination and persecution. He has also witnessed the murder of his family member. In the adult stage he has struggled fighting from Afghanistan. Further, discussion revealed that his years of detention were full of anxiety and uncertainty. He has witnessed self harm by his fellow detainees. It was found that he has no emotional support from his family who is still in Afghanistan and is facing persecution. This data indicates that Amir has limited control on his life and his confinement (Huckshorn, LeBel, 2013). He has a good physical health and poor mental health, which may lead to adverse health outcomes if unaddressed. He is suffering from poor concentration due to which he is unable to seek employment and he feels hopeless about his condition. It is indicative of lack of resources to pay for the services. He is demotivated about reunion with his family. His mind flashes back the negative experiences and keep generating negative intrusive thoughts, which are resulting in sleeplessness. It is indicative of anxiety disorder as per Tay et al. (2016). Delivery of Care During the delivery of the care, the nurse will use the strength of the client to empower him in the development of his treatment. It is needed because at present he might be feeling vulnerable due to history of violence and fear of further harm. Patient empowerment will help in building trust and ensure positive interaction with nurse (Brnhielm e al., 2014).The client is stressed with the socio-economic strain, loss of status, family separation and therefore needs empowerment. Therefore, the nurse will provide interventions that support the existing strengths. The nurse will incorporate traditional support mechanism and foster social agency. In order to empower client messages that focus on resilience and wellness will be delivered regularly to facilitate positive adaptation (Allan, 2015). The patients safety will be ensured by eliminating the barriers that may cause the underutilisation of the services. The cultural and the linguistic barriers will be addressed by recruiting the medical interpreters, cultural brokers and by assigning care assistant who is more culturally competent. It will prevent the language barriers and the possibility of the negative interaction (Raja et al., 2014). It is evident that the Amir being a newcomer do not understand the purpose of the programs and the laws and regulations governing them. Therefore, the nurse will inform him of various treatment options from which the patient can choose the preferred option. It will help assist in increasing the clients trustworthiness. This process will help in making the treatment goals clear, transparent and consistent. It also includes informing Amir about the time of the service delivery such as referrals, waiting list, fee structure, and different appointment system. Further, the nurse will assure the client of the confidentiality of the information that may reduce his anxiety related to fear of mistrust by the care professionals (Brnhielm et al., 2014). Giving different choices of the treatment will maximise the clients control. It is of high priority considering his experiences of prolonged detention in refugee camps. Giving choices will make him feel that he is controlling his life. It will d ecrease his anxiety related to the therapeutic intervention and prevent silence or withdrawal from the treatment fearing the diagnosis and future (McBride, Russo, Block, 2016). Hence, it is justified to maximise the clients control and choices by allowing him to determine the pace of disclosure. During screening and assessment no assumptions were made regarding trauma. Since the patient has no source of income he may be referred to cost effective community mental health services (Tay et al., 2016). While dealing with the client the patient is considered as partner in this approach to enhance collaboration. The nurse will attempt to learn about the clients cultural identity to ensure appropriate level of emotional expression. According to McBride, Russo, Block (2016) trauma education will help in power sharing. In this situation, the nurse will focus on trauma education, which is focused on normalizing the trauma experiences and symptoms. As a result of structural inequalities, it is evident that the Amir is experiencing significant distress while resettling in Australian society. He needs support in the form of counselling as he has complex needs that may not be adequately addressed through broader interventions (Slewa-Younan et al., 2014). In this situation the role of the nurse is to adequately attend to the influence of these inequalities. It includes attending to the impact on Amirs emotions and incorporate the model of practice which embraces this. The model of practice for counselling Amir in this case is the one that acknowledges deep interrelationship between structural inequalities and psychological well-being. It is also called a psycho-social approach suggested by Allan (2015). This approach of counselling involves understanding Amirs socially structured feelings. In this counselling the nurse. Incorporates the trauma recovery model and the social model of healing. In addition to counselling the nurse liaison initiative is important to provide clinical support, education, advocacy, formal and informal capacity building, and referrals (McBride, Russo Block, 2016). Conclusion To be trauma informed means to understand the impact of violence on the mental health consumer. The role of the nurse is to apply knowledge and understanding in delivery of care. 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