Mental Health Reflection Essay

Throughout this semester as a nursing student, I have had the privilege of meeting a wide variety of patients with varying diagnoses. One patient in particular that stood out to me this semester I met through my mental health clinical. This patient had a history of suicidal ideation which was the reason for his admission to the behavioral health unit, but he also had suffered a traumatic brain injury. This patient’s TBI caused many impairments in physical and social functioning that also impeded on the patient’s mental health. This patient’s resilience inspired me, because he never gave up and always wanted to continue working towards his goals.

This client’s TBI was caused by an attempted suicide. The client doesn’t remember much of his accident, but he was using LSD when he jumped off a two-story building in his suicide attempt. The client now suffers from chronic pain, impaired emotional regulation, and unsteady gait due to his TBI. This has caused an immense amount of frustration for the client, leading to anger and depression. The client has experienced depression and anxiety for the majority of his life and was extremely upset with his father just before his suicide attempt. Since the client doesn’t remember this event, he doesn’t have much insight into the connections between his physiological impairments and his psychological ones. Upon my assessment at the behavioral health unit, the client denies ever having suicidal thoughts, plans, intent, or means. The client does not consider his accident resulting in a TBI a suicide attempt, even though evidence from his injuries and behavior points to this. 

Since the client does not remember his suicide attempt and is not experiencing suicidal ideation, his care plan revolves around coping strategies to manage frustration and anger. Some strategies that have been implemented include de-escalating techniques when the client becomes frustrated, walking away from the situation, and CBT to reframe negative thoughts. For example, the client became very frustrated about a comment that my clinical instructor made and began yelling in group in my last clinical. My client was very frustrated because my clinical instructor suggested he set an easier goal for the day that he would be able to meet successfully. To de-escalate the situation, my clinical instructor allowed the client to leave group so he could calm down and gather his thoughts. Later on, my clinical instructor went into the patient’s room and was able to have a productive discussion with the patient. 

Many aspects of this patient’s social history were assessed during the patient’s stay on the behavioral health unit. Due to this client’s TBI, he is unable to work. This causes some financial stress for the patient which is a part of his care that we weren’t able to address. The patient also has impaired family functioning and has a lot of anger directed towards his father. This is often the root of the patient’s anger, since he believes his relationship with his father has caused immense stress and depression in his life. This patient has never been married, and does not have any children, so he relies on his siblings for support. The patient’s sister is very supportive of his diagnosis and involved in the patient’s plan of care. Lastly, the patient currently is homeless, but this problem has been addressed since he has secured a spot in a TBI living facility where he will receive the care he needs. A meeting with the social worker to discuss his financial options is a necessary intervention before he is transferred to his new facility.

There are many nursing diagnoses applicable to this patient’s biological, psychological, and social domains. Regarding the biological domain, the patient’s greatest concern is Impaired Pain Management. Since the patient has chronic pain resulting from his accident, he requires pain medication daily. He also requires non-pharmacological pain management treatments such as decreasing stimuli and improving sleep. The patient is also at risk for Disturbed Sleep Pattern because he perseverates on his frustrations when he becomes agitated. Encouraging the patient to return to bed is a reasonable intervention, but sometimes PRN medications are required to relieve the patient’s agitation. This patient is also at Risk for falls because of his impaired balance. The patient should walk slowly and use his walker whenever possible to help prevent falls. 

The patient also has many applicable diagnoses in the psychological domain. This patient is at Risk for Impaired Coping, due to a previous history of depression and anxiety. Since this patient has a previous suicide attempt, it is imperative that we manage his coping mechanisms, and help him recognize which coping skills are healthy and which aren’t. Examples of healthy coping mechanisms for depression include journaling, attending therapy, encouraging proper hygiene, and maintaining a routine. This patient is also at Risk for Substance Abuse Disorder since he has a previous history of LSD and marijuana use. The patient currently states that he would never use drugs again, but this has the potential to change if the patient’s depression worsens. Education about the effects of substance abuse would be beneficial to this patient.

Pertaining to the social domain, the patient is at Risk for Ineffective Self-Care/ADLs. This patient has a difficult time showering and maintaining other forms of personal hygiene. An intervention the behavioral health unit has been implementing for this patient is encouraging showers weekly. The patient has a specific day when he is supposed to shower each week, so he maintains good hygiene. This patient is also at risk for Spiritual Distress. The client is deeply religious and considers God an extremely important part of his life. It is essential as a nurse to ensure this patient is able to pray, attend services/see a priest, and is respected in his spirituality. Finally, this patient is at Risk for Impaired Family Functioning. The facility the patient is being transferred to is further away from his family, which requires more support from his siblings and father. If the patient doesn’t receive the support he needs, the nurse may need to assist the patient in finding other supports such as friends and professionals. 

Through meeting this patient and learning about his diagnoses, I also learned a lot about myself. I learned that I have great empathy for mental health nursing and the patient’s it encompasses. The value of a patient’s overall wellness does not just rely on the patient’s physical being, but their emotional, spiritual, and mental well-being as well. It is essential as a nurse in any field to advocate for your patient’s wellness, and not just their physical health. After my clinical experience, I have earned even more respect for mental health professionals and the patients who have the courage and patience to continuing improving in their diagnosis.