Assessing the Problem Leadership
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Assessing the Problem: Leadership, Collaboration, Communication, Change, Management,
and Policy Consideration
Melissa Hughes
Capella University
NHS 4900
Professor Jaramillo
December 27, 2023
Assessing the Problem: Leadership, Collaboration, Communication, Change, Management,
and Policy Consideration
Mental illness has always been an issue worldwide. It has also been an illness that has not
been given many resources or has been portrayed so negatively that people do not seek care. The Center for Disease Control (CDC) shares that more than one out of five adults in the US are living with a mental illness, and one out of twenty-five adults in the US live with a serious mental illness like schizophrenia, bipolar disorder, or major depression (CDC, 2023). The mental
illness we will be examining closely is bipolar type I and II. Bipolar has been described as a chronic condition with episodes of mania and hypomania that alternate with depression (Jain & Mitra, 2023). Assess the Problem
Bipolar disorder (BD) is one of the top ten leading causes of disability in the world. It is such a complex disease that there are bipolar type I, type II, and cyclothymic disorder. Type I BD is diagnosed when an individual exhibits a manic episode for at least seven consecutive days.
A manic episode is defined by the following symptoms: inflated self-esteem, a decreased need for sleep, a need or feeling to be more talkative, racing thoughts, increased goal-directed activity,
increase in activities that have a high chance of painful consequences (Jain & Mitra, 2023). Type
II BD is diagnosed when an individual exhibits hypomanic episode or major depressive disorder without a manic episode. Jain & Mitra (2023) define a hypomanic episode as one that has a persistently elevated or irritable mood for three or four consecutive days. Type I and II are remarkably similar. The only major difference that should be noted is type I has more severe highs and could not have depressive episodes, while type II will have depressive episodes (Jain
& Mitra, 2023). Comorbidities of BD are known to be anxiety disorders, substance abuse, ADHD, and personality disorders (Crusey et al., 2020).
The etiology for which BD is derived from is still unknown but there are genetic, epigenetic, neurochemical, and environmental factors that contribute to the development of the mental illness. Genetically, it was first identified in 1987 as a “DNA marker” on the short arm of chromosome 11, this led to at least thirty more gene markers that have been targeted as increased
risk of the disorder. Environment factors were determined through a study where adult patients described experiencing one of the adverse events six months prior to their first episode. These adverse events can be emotional abuse, neglect, parent's divorces, disability, unemployment, and early parental loss. Neurochemicals that have been linked to BD are a lack of signals inhibiting dopamine and serotonin (Jain & Mitra, 2023). Define the Patient
For privacy purposes we will be using a fake name, Marcus is a twenty-three-year-old male who is five foot nine inches and weighs approximately one hundred and sixty pounds. He is
currently unmarried and living with his married parents in Temecula, California. Marcus is the oldest of two children with extended family ranging from four aunts and uncles and five cousins living throughout San Diego, California. Marcus graduated high school and began working for a trade company shortly after. His parents are college graduates in IT sales. Marcus lives a highly active life with a typical week beginning at four a.m. for work Monday through Thursday and ending at three thirty in the afternoon. After work Marcus spends his free time with friends drinking alcoholic beverages, smoking marijuana, and riding dirt bikes.
Marcus enjoys being surrounded by people and does not like to be alone. His diet consists of fast
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food and eating once or twice a day. No one cooks at home and most often the entire family survives on mac n cheese or cereal. Marcus has a long history of substance abuse tracking back to the age of nine, an aunt who is a recovering alcoholic and his parents drinking multiple times a
week. Marcus does not like to go to the doctors and when he does, he has admitted to not being completely honest. He has no formerly documented medical health issues other than a diagnosis of bipolar disorder type I and II with major depressive disorder. His parents also have anxiety disorder and major depressive disorder. His younger sister also suffers from major depressive disorder and ADHD. Marcus is currently on Lamictal 200mg and Abilify 7.5mg daily.
Relevancy of The Problem
Based on the clinical research and patient data collected, the patient has a genetic history of mental illness, predisposing him to developing one of his own. Marcus was diagnosed at an early age with bipolar disorder type I and II with major depressive disorder. He has had countless
hospitalizations due to him attempting suicide or having suicidal ideation (Miller & Black, 2020). Research has suggested that patients with BD are more likely to commit suicide than others. This makes learning more about what nurses can do to help prevent suicide and get the mentally ill patients the care they need is so important. This problem is relevant to my practice because often in the acute care setting nurses are treating the medical condition and ignoring the psychosocial and psychological health of the patient. Nursing care is a continuum of all aspects of a patient's health including their mental health. The Role of a Nurse
Nurses play a significant role in implementing care plans that will enable their patients to thrive and work towards compliance with their home medications and regular therapy sessions. Research has shown that systemic nursing has made improvements on the continuum of care for patients with bipolar disorder. This type of nursing model provides a round verse of care for patients systemically, integrally, and scientifically. It has been shown to improve unhealthy psychology of patients with bipolar disorder, specifically their manic episodes. Systemic nursing provides goes beyond conventional nursing because it rehabilitates the patients of their own disease but also nurses also care for the patient's psychology and cognition. Using health education, clean environments, mental health nurses, rehabilitation training, family and social support were all key components to improving the cognition of patients with BD (Wang & Yu, 2021). The nurse's role in policy making is vital to improving the safety and quality of care all patients receive but more specifically those suffering from mental illness. Unfortunately, very few nurses are involved in the policy making process. Nurses can change policies, laws, and regulations based on their experiences in the healthcare system. This is because they diligently work with the patients and are at the bedside more than any other professional in the healthcare industry (Hajizadeh et al., 2021). Analysis of The Evidence-Based Research
The evidence-based literature included in this paper is relevant to the effective care planning, self-management, and the nurse's role with effective self-management of BD. The articles identified the problem and the conducted studies showed promising results or positive patient outcomes with the interventions tested. There was a significant finding with the negative impacts on poorly managed diagnoses of BD. Multidisciplinary authors shared data and statics to
back their research and evidence based approaches to caring for individuals with BD. Determining the reliability of the data obtained for this paper can be determined by researching peer-reviewed articles from individuals with credentials in the field of which they conducting research on. Also, credibly sites like .edu, .net, and .gov are placed into the category of credible sources. Barriers to adequately caring for those with bipolar disorder can easily be shared as the stigma on mental illness, acceptance of insurance, shortage of providers for mental illness and the cost of accessing care (Crusey et al., 2020). Conceptual Framework A conceptual framework that consisted of a research team that included public health experts, psychiatrists, and psychologists to create an interpersonal relationship, a care environment, drug therapy, access and care coordination, respect and dignity, information, and psychological care. The interpersonal relationship focused on the patient and staff members relationship, the patients' relations with others and family involvement in care. A caring environment was one that was easily accessible, comfortable, and clean. Drug therapy focused on examining the history of what has worked and what has not and determining the health status and wellbeing of the patient as issues with medications are the main issue for patient compliance to care. Access and care coordination was an issue as there is a lack of providers, lack of timely responses, and flexible scheduling appointments. Information needed, many patients in a clinical study described a lack of understanding of their mental illness and the symptoms that manifest from it (Fernandes et al., 2021). Policies and Legislation
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Federal regulations that aid in mental illness is the mental health parity and addiction equity act that was established in 2008 that requires insurance companies to offer coverage for mental health or substance abuse benefits that are a comparable cost to the common medical coverage. Another policy is the affordable care act that aids those with mental illness get the care
they deserve, as many private insurance companies do not offer benefits for mental health or substance use disorders (
Laws and regulations, 2023
).
Leadership strategies
When effective leadership strategies are implemented satisfaction and wellbeing are promoted. The Duke Healthcare Leadership Model was designed to help create a framework of leadership for healthcare providers that offers high quality care, integrity, teamwork, critical thinking, emotional intelligence, and patient centered care (Hargett et al., 2017). Implementing this model into the scope of practice gives the healthcare provider the ability to be open, honest and perform therapeutic nurse-patient communication. This will improve the development of communication skills when nurses advocate for their patients.
Conclusion
In conclusion, bipolar disorder is one of the top severe mental illnesses around and is one of the top leading causes of suicide and substance abuse. Bipolar disorders can be diagnosed as type I or type II and are potentially linked to genetics, neurochemicals, and environmental factors. Acts that have been passed aid in mental health care accessibility and affordability. Nurses play a vital role in creating policies that can help assist those mental ill due to their extensive exposure with patients dealing with mental illness.
Reference
Centers for Disease Control and Prevention. (2023a, April 25). About mental health
. Centers for Disease Control and Prevention. https://www.cdc.gov/mentalhealth/learn/index.htm#:~:text=More%20than%201%20in%205,a
%20seriously%20debilitating%20mental%20illness.&text=About%201%20in
%2025%20U.S.,bipolar%20disorder%2C%20or%20major%20depression
.
Crusey, A., Schuller, K. A., & Trace, J. (2020). Access to care barriers for patients with Bipolar disorder in the United States. Journal of healthcare quality research
, 35
(3), 167–172. https://doi.org/10.1016/j.jhqr.2020.03.001
Hajizadeh, A., Zamanzadeh, V., Kakemam, E., Bahreini, R., & Khodayari-Zarnaq, R. (2021). Factors influencing nurses participation in the health policy-making process: a systematic review. BMC nursing
, 20
(1), 128. https://doi.org/10.1186/s12912-021-00648-6
Hargett, C.W., Doty, J.P., Hauck, J.N., Webb, A.M., Cook, S.H., Tsipis, N.E., Neuman, J.A., Andolsek, K.M., & Taylor, D.C. (2017). Developing a model for effective leadership in
healthcare: a concept mapping approach. Journal of healthcare leadership, 9,69-78. http://doi.org/10.2147/JHL.S141664 Jain A, Mitra P. (2023 Feb 20). Bipolar Disorder.
Treasure Island (FL). https://www.ncbi.nlm.nih.gov/books/NBK558998/
Laws and regulations
. SAMHSA. (2023, October 27). https://www.samhsa.gov/about-us/who-we-are/laws-regulations
Miller, J. N., & Black, D. W. (2020). Bipolar Disorder and Suicide: a Review. Current psychiatry reports
, 22
(2), 6. https://doi.org/10.1007/s11920-020-1130-0
Wang, X., & Yu, Y. (2021). Application of systematic nursing in patients with maniac access of bipolar disorder and its impact on treatment compliance and quality of life. American journal of translational research
, 13
(6), 6929–6936.
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