Physical Care Reflective Essay
Critically analyse the physical care, well being and interventions used in a client in your care
Module: MHR4607
Physical Health and Wellbeing
‘Critically analyse the physical care, well being and interventions used in a client in your care’.
This reflective essay focus’s on a 54 year old service user who suffers from schizophrenia. Coinciding with her mental health illness she has a diagnosis’s of diabetes type 2, she is obese, and has chronic obstructive pulmonary disease (COPD). For the purpose of this reflective essay I shall be focusing on how her diabetes was managed during her time on an inner city psychiatric assessment ward. I will also look in to the correlation between diabetes and schizophrenia.
It is a fact that in today’s …show more content…
society those who suffer from mental health conditions, compared with those who are not mentally unwell, have a lower life expectancy and it appears this gap has widened through recent times (De Hert, Schreurs, Vancampfort & Winkel 2009).
Connolly & Kelly (2005) suggested this could be due to a purposeful avoidance of health services by those who are mentally unwell, or that during this time of their mental health crisis, many are suffering the effects of their illness such as positive symptoms, thought disorder, or the flat effects associated with schizophrenia, these experiences could make it harder for them to go to their appointments. Saha, Chant & McGrath (2007) state that the reason as to the exact cause of this gap is not known, however many theories have been suggested as to why it has occurred. Mc Creadie (2003) attributed this gap as lifestyle factors. In a study on people suffering from schizophrenia against those who were mentally well, there was significant findings that the individuals with schizophrenia ate poorer diets, consuming under half of the recommended guide lines of fruit and vegetable consumptions in a week, theey undertook substantially lower exercise than the comparison group and tended to have a higher body mass index. According to Gough & Peveler
(2004) current risk factors for people to suffer from diabetes are linked to issues such as eating unhealthy food and being inactive. Scheen &De Hert (2007) suggested that many who suffer from schizophrenia have certain lifestyle patterns that leave them at risk of developing diabetes, such as the lack of exercise they par take in, the unhealthy diet, being inactive and smoking. De Hert,et al (2009) concurred with this finding and found that the mentally unwell have a higher chance of being a smoker and being overweight, as well as developing diabetes. Leslie & Rosenheck (2004) argue that there is no conclusive evidence as to why many who are mentally unwell develop diabetes, however there is a strong occurrence between obesity and the current use of second- generation antipsychotic drugs. De Hert et al (2009) have also found that there is a correlation between the use of some anti psychotic medication and weight gain.De Hert, Winkel, Van Eyck, Hanssen, Wampers, Scheen & Peuskens (2006) suggest people suffering from schizophrenia do have a greater chance of suffering a metabolic defect. They suggested that metabolic defects are inbuilt to those with schizophrenia, this was raised due to people already having such defects when they are suffering their first psychotic experience. However there findings also indicated the anti psychotic medication has a direct impact on metabolic illness. When this data was weighed against those who were not unwell, and consistent in age bracket and sex, those suffering schizophrenia had significant higher rates of metabolic illness and diabetes. This evidence amplified as age and the length of their illness increased. This occurrence was seen to be at its strongest when a person had been suffering from schizophrenia for ten years and over. This research indicates that there is a link between either the illness and metabolic defects or a correlation between the illness and antipsychotic drugs.
Connolly et al (2005) suggest that the danger for the person with schizophrenia is the weight gain caused by the medication, this weight gain then increases the chances of the individual developing diabetes. It was suggested that a cause of the weight gain could be that the antipsychotic drugs have tranquillizing side effects. However other aspects should not be overlooked such as the individual may have low motivation to engage in exercise. Connolly et al (2005) also found that when a person is overweight this is connected with glucose intolerance and exercise can help combat this.
Looking in to the correlation of anti psychotic medication and diabetes a study was carried out by Miller & Molla (2005) assessing diabetes against people receiving a depot neuroleptic and found that those receiving the depot had a 19% higher chance of having diabetes against the general population.
However this vast amount of research regarding the correlation between schizophrenia and the increased risk of diabetes occurring seems irrelevant, when there is no pathway designed to assess individuals at risk, and as a result there is.no designs on how this risk could be handle successfully (Gough et al 2004).
Looking more specifically at the service user I am going to discuss, and will refer to as person W, it is evident that her current diagnosis of schizophrenia coinciding with being overweight and also receives a depot neuroleptic, all classify her as a high risk of developing the diabetes she suffers. The depot that Patient W was taking, dipoixol, has been classed as low potency and according to Connolley et al (2005) in relation to weight, the low potency drugs seem to be a strong indicator of responsibility as to this weigh gain. Miller et al (2005) also discuss the higher risk of having diabetes from being on depot neuroleptic and according to De Hert, et al (2009) having a severe mental illness increases you chances of being overweight and smoking, Patient W is both overweight, smokes and receives a depot neuroleptic. Being overweight itself is a risk factor to diabetes (Gough et al 2004). Thus Patient W falls into all the areas of high risk for someone to develop diabetes.
The NICE guidelines state that diabetes is a metabolic condition defined by having a high level of blood glucose concentration. Type two diabetes is known as non-insulin dependant diabetes mellitus. As a result of the high level of blood glucose people becoming insulin resistant.
Person W is a 54 year has a psychiatric diagnosis of schizophrenia, she currently resides in an acute assessment ward in an inner city. Person W has had this diagnosis for over twenty years, she has been a smoker since her teenage years and has had chronic health problems for over five years. In terms of physical health problems Person W has been diagnosed with chronic obstructive pulmonary disease (COPD) in the form of chronic asthma, Diabetes type 2 and is obese. Person W receives medication for her physical health and mental health problems. For her schizophrenia she is on a two weekly dipoixol 40mg depot injection and takes aripiprazole 15mg antipsychotic medication once a day 15mg. For her diabetes she takes Is on metformin 1g three times a day, for her type 2 diabetes. Kirpichnikov, Farlane & Sowers (2002)state that Metformin works by lowering the amount of cells that are resistant to insulin. This medicine appears to not only work on this metablic condition but also helps fight obesity. This drug is specifically aimed at those who are obese. Person W also takes Orlistat slimming tablets 120mg per day and simvastatin for cholesterol 40mg twice a day. Patient W has an inhaler containing Spiriva 18mg which she uses once a day for her asthma.
During her time on the ward, this patient received daily blood glucose level checks, this was done mainly at 8am before Patient W had eaten her breakfast. Patient W was advised healthy eating techniques and what food she should try avoid such as sweet food. The ward did not have any specific objectives and aims in place to help Patient W to control her diabetes. She was not referred to a dietician, which could of been to her benefit and the main intervention used was monitoring. It is reported in her care plan all Patient W’s physical health problems therefore all staff are informed of her specific needs.
Patient W blood pressure and oxygen saturation level are also monitored and if her oxygen saturation fell below 90%, she would use one litre of oxygen per minute. This was happening three times a day when she first came to the ward; however Patient W often refused this during her stay.
There are a number of other interventions that would benefit Patient W in regards to her diabetes and in turn her well being such as information regarding foot care, more about diabetes itself and lifestyle guidance.
It is important for people with diabetes to keep an eye on their feet. The Nice guidelines suggest that people monitor their feet on a daily bases looking out for any development of ulcers, the reasoning for this being that in people with diabetes an ulcer can quickly turn in to something more serious and result in the need of amputations. They should keep in regular contact with their health professionals and be taught techniques on how to protect their feet, such things as giving advice to wear well fitted shoes and look out for cracks or anything that deviates from what their feet are generally like.
This practise of awareness is vital in helping individuals keep on top of their physical health needs. Dickerson, Goldberg, Brown, Kreybnbuhl, Pharm, Wohlheiter, Fang, Medoff & Dixon (2005) suggested that those who are naive to diabetes and its effects of the body are those who will be overwhelmed by the impact of such a diagnoses and see it as troublesome. With this in mind it would be beneficial to educate people and this should in turn make people more understanding of their condition and the treatment they need to engage in.
Gough et al (2004) go a step further than this and suggest that due to the vast amount of eviedence suggesting a correlation and schizophrenia it would be good practise for all those suffering from a diagnosis of schizophrenia to undergo diabetic screening tests. De Hert et al (2006) concurred with this finding. Similaly Miller et al (2005) felt that those who receive treatment for schizophrenia via a depot neurolptic glucose levels and weight are frequently checked, thus giving time for the right treatment to be used effectively. Gough et al (2004) suggests that the responsibility for this screening should lie with the general practitioners, and when an antipsychotic medication is being selected for patient the importance lies in finding a drug that will help the service user adhere to taking their medication and as a result of this improve the service users participation in undertaking diabetes awareness and coping approaches, this includes educating service user’s on healthy eating and exercise.
Connolly et al (2005) is in agreement with these findings again emphasising the importance for lifestyle changes to occur as well as monitoring, furthermore they suggest that if these changes are occurring it is advisable to re assess the medication to one which is not so associated with weight gain. On a final point Connolly et al (2005) highlight that a genetic biological link between schizophrenia and diabetes, although not confirmed, has proven significant findings and must be taken in to consideration.
To conclude, this reflective essay proves that more needs to be done for those suffering from a mental health illness and diabetes. It appears that although much theory is available suggesting the link there is not enough practical work that has been done for those suffering. More monitoring needs to occur earlier and lifestyle advice needs to become standard practise.
Word Count:1,911
References
Connolly, C., & Kelly, C., (2005) Lifestyle and Physical health in schizophrenia. Advances in Psychiatric Treatment, 11, pp. 125-132
Dickerson, F,B., Goldberg, R, W., Brown, C, H., Kreybnbuhl, J, A.,, Pharm,D., Wohlheiter, K., Fang, L., Medoff, D., & Dixon L, B., (2005) Diabetes Knowledge Among Persons With Serious Mental Illness and Type 2 Diabetes. Psychosmatics. 46 (5), pp. 418 – 424.
De Hert, M., Schreurs, V., Vancampfort, D., & Winkel, R, V., (2009) Metobolic syndrome in people with schizophrenia: a review. World Psychiatry, 8, pp. 15-22.
Gough, S., & Peveler, R., (2004) Diabetes and its prevention: pragmatic solutions for people with schizophrenia. British Journal of Psychiatry. 184 (47), pp. 106-111.
Kirpichnikov, D., Mc Farlane, S, I., & Sowers, J, R., (2002) Metformin: An Update”. Annuals of Internal Medicine, 37, pp. 25-33
Leslie, D, L., & Rosenheck, R, A., (2004) Incidence of newly diagnosed diabetes attributable to atypical antipsychotic medications. American Journal of Psychiatry. 161, pp. 1709-1711
Mc Readie, R, G., (2003) Diet, smoking and cardiovascular risk in people with schizophrenia. Descriptive study. British Journal of Psychiatry, 183, pp. 534-539
Miller, J., & Molla, P, M., (2005) Prevelance of Diabetes Mellitus in Patients Receiving Depot Neuroleptics or Clozapine. Archives of Psychiatric Nursing, 19 (1). Pp. 30-34
National Collaboration Centre for Chronic conditions (2008)National Institute of Clinical Excellence guidelines: Type 2 diabetes :The management of type 2 diabetes. http://www.nice.org.uk/nicemedia/pdf/CG66NICEGuideline.pdf Saha, S., Chant, D., & Mc Grath, J, A., (2007) A systematic review of mortality in schizophrenia: is the differential mortality gap worsening over time? . Archives of General Psychiatry, 64, pp. 1123- 1131.
Scheen, A., & De Hert, M., (2007) Abnormal glucose metabolism in patients treated with antipsychotics. Diabetes Metabolism. 33. Pp 169-175
The royal college of general practitioners (2000) National Institute of Clinical Excellence guidelines:Type 2 Diabetes: Prevention and management of foot problems http://www.nice.org.uk/nicemedia/live/10934/29242/29242.pdf
Module: MHR4607
Physical Health and Wellbeing
‘Critically analyse the physical care, well being and interventions used in a client in your care’.
This reflective essay focus’s on a 54 year old service user who suffers from schizophrenia. Coinciding with her mental health illness she has a diagnosis’s of diabetes type 2, she is obese, and has chronic obstructive pulmonary disease (COPD). For the purpose of this reflective essay I shall be focusing on how her diabetes was managed during her time on an inner city psychiatric assessment ward. I will also look in to the correlation between diabetes and schizophrenia.
It is a fact that in today’s …show more content…
society those who suffer from mental health conditions, compared with those who are not mentally unwell, have a lower life expectancy and it appears this gap has widened through recent times (De Hert, Schreurs, Vancampfort & Winkel 2009).
Connolly & Kelly (2005) suggested this could be due to a purposeful avoidance of health services by those who are mentally unwell, or that during this time of their mental health crisis, many are suffering the effects of their illness such as positive symptoms, thought disorder, or the flat effects associated with schizophrenia, these experiences could make it harder for them to go to their appointments. Saha, Chant & McGrath (2007) state that the reason as to the exact cause of this gap is not known, however many theories have been suggested as to why it has occurred. Mc Creadie (2003) attributed this gap as lifestyle factors. In a study on people suffering from schizophrenia against those who were mentally well, there was significant findings that the individuals with schizophrenia ate poorer diets, consuming under half of the recommended guide lines of fruit and vegetable consumptions in a week, theey undertook substantially lower exercise than the comparison group and tended to have a higher body mass index. According to Gough & Peveler
(2004) current risk factors for people to suffer from diabetes are linked to issues such as eating unhealthy food and being inactive. Scheen &De Hert (2007) suggested that many who suffer from schizophrenia have certain lifestyle patterns that leave them at risk of developing diabetes, such as the lack of exercise they par take in, the unhealthy diet, being inactive and smoking. De Hert,et al (2009) concurred with this finding and found that the mentally unwell have a higher chance of being a smoker and being overweight, as well as developing diabetes. Leslie & Rosenheck (2004) argue that there is no conclusive evidence as to why many who are mentally unwell develop diabetes, however there is a strong occurrence between obesity and the current use of second- generation antipsychotic drugs. De Hert et al (2009) have also found that there is a correlation between the use of some anti psychotic medication and weight gain.De Hert, Winkel, Van Eyck, Hanssen, Wampers, Scheen & Peuskens (2006) suggest people suffering from schizophrenia do have a greater chance of suffering a metabolic defect. They suggested that metabolic defects are inbuilt to those with schizophrenia, this was raised due to people already having such defects when they are suffering their first psychotic experience. However there findings also indicated the anti psychotic medication has a direct impact on metabolic illness. When this data was weighed against those who were not unwell, and consistent in age bracket and sex, those suffering schizophrenia had significant higher rates of metabolic illness and diabetes. This evidence amplified as age and the length of their illness increased. This occurrence was seen to be at its strongest when a person had been suffering from schizophrenia for ten years and over. This research indicates that there is a link between either the illness and metabolic defects or a correlation between the illness and antipsychotic drugs.
Connolly et al (2005) suggest that the danger for the person with schizophrenia is the weight gain caused by the medication, this weight gain then increases the chances of the individual developing diabetes. It was suggested that a cause of the weight gain could be that the antipsychotic drugs have tranquillizing side effects. However other aspects should not be overlooked such as the individual may have low motivation to engage in exercise. Connolly et al (2005) also found that when a person is overweight this is connected with glucose intolerance and exercise can help combat this.
Looking in to the correlation of anti psychotic medication and diabetes a study was carried out by Miller & Molla (2005) assessing diabetes against people receiving a depot neuroleptic and found that those receiving the depot had a 19% higher chance of having diabetes against the general population.
However this vast amount of research regarding the correlation between schizophrenia and the increased risk of diabetes occurring seems irrelevant, when there is no pathway designed to assess individuals at risk, and as a result there is.no designs on how this risk could be handle successfully (Gough et al 2004).
Looking more specifically at the service user I am going to discuss, and will refer to as person W, it is evident that her current diagnosis of schizophrenia coinciding with being overweight and also receives a depot neuroleptic, all classify her as a high risk of developing the diabetes she suffers. The depot that Patient W was taking, dipoixol, has been classed as low potency and according to Connolley et al (2005) in relation to weight, the low potency drugs seem to be a strong indicator of responsibility as to this weigh gain. Miller et al (2005) also discuss the higher risk of having diabetes from being on depot neuroleptic and according to De Hert, et al (2009) having a severe mental illness increases you chances of being overweight and smoking, Patient W is both overweight, smokes and receives a depot neuroleptic. Being overweight itself is a risk factor to diabetes (Gough et al 2004). Thus Patient W falls into all the areas of high risk for someone to develop diabetes.
The NICE guidelines state that diabetes is a metabolic condition defined by having a high level of blood glucose concentration. Type two diabetes is known as non-insulin dependant diabetes mellitus. As a result of the high level of blood glucose people becoming insulin resistant.
Person W is a 54 year has a psychiatric diagnosis of schizophrenia, she currently resides in an acute assessment ward in an inner city. Person W has had this diagnosis for over twenty years, she has been a smoker since her teenage years and has had chronic health problems for over five years. In terms of physical health problems Person W has been diagnosed with chronic obstructive pulmonary disease (COPD) in the form of chronic asthma, Diabetes type 2 and is obese. Person W receives medication for her physical health and mental health problems. For her schizophrenia she is on a two weekly dipoixol 40mg depot injection and takes aripiprazole 15mg antipsychotic medication once a day 15mg. For her diabetes she takes Is on metformin 1g three times a day, for her type 2 diabetes. Kirpichnikov, Farlane & Sowers (2002)state that Metformin works by lowering the amount of cells that are resistant to insulin. This medicine appears to not only work on this metablic condition but also helps fight obesity. This drug is specifically aimed at those who are obese. Person W also takes Orlistat slimming tablets 120mg per day and simvastatin for cholesterol 40mg twice a day. Patient W has an inhaler containing Spiriva 18mg which she uses once a day for her asthma.
During her time on the ward, this patient received daily blood glucose level checks, this was done mainly at 8am before Patient W had eaten her breakfast. Patient W was advised healthy eating techniques and what food she should try avoid such as sweet food. The ward did not have any specific objectives and aims in place to help Patient W to control her diabetes. She was not referred to a dietician, which could of been to her benefit and the main intervention used was monitoring. It is reported in her care plan all Patient W’s physical health problems therefore all staff are informed of her specific needs.
Patient W blood pressure and oxygen saturation level are also monitored and if her oxygen saturation fell below 90%, she would use one litre of oxygen per minute. This was happening three times a day when she first came to the ward; however Patient W often refused this during her stay.
There are a number of other interventions that would benefit Patient W in regards to her diabetes and in turn her well being such as information regarding foot care, more about diabetes itself and lifestyle guidance.
It is important for people with diabetes to keep an eye on their feet. The Nice guidelines suggest that people monitor their feet on a daily bases looking out for any development of ulcers, the reasoning for this being that in people with diabetes an ulcer can quickly turn in to something more serious and result in the need of amputations. They should keep in regular contact with their health professionals and be taught techniques on how to protect their feet, such things as giving advice to wear well fitted shoes and look out for cracks or anything that deviates from what their feet are generally like.
This practise of awareness is vital in helping individuals keep on top of their physical health needs. Dickerson, Goldberg, Brown, Kreybnbuhl, Pharm, Wohlheiter, Fang, Medoff & Dixon (2005) suggested that those who are naive to diabetes and its effects of the body are those who will be overwhelmed by the impact of such a diagnoses and see it as troublesome. With this in mind it would be beneficial to educate people and this should in turn make people more understanding of their condition and the treatment they need to engage in.
Gough et al (2004) go a step further than this and suggest that due to the vast amount of eviedence suggesting a correlation and schizophrenia it would be good practise for all those suffering from a diagnosis of schizophrenia to undergo diabetic screening tests. De Hert et al (2006) concurred with this finding. Similaly Miller et al (2005) felt that those who receive treatment for schizophrenia via a depot neurolptic glucose levels and weight are frequently checked, thus giving time for the right treatment to be used effectively. Gough et al (2004) suggests that the responsibility for this screening should lie with the general practitioners, and when an antipsychotic medication is being selected for patient the importance lies in finding a drug that will help the service user adhere to taking their medication and as a result of this improve the service users participation in undertaking diabetes awareness and coping approaches, this includes educating service user’s on healthy eating and exercise.
Connolly et al (2005) is in agreement with these findings again emphasising the importance for lifestyle changes to occur as well as monitoring, furthermore they suggest that if these changes are occurring it is advisable to re assess the medication to one which is not so associated with weight gain. On a final point Connolly et al (2005) highlight that a genetic biological link between schizophrenia and diabetes, although not confirmed, has proven significant findings and must be taken in to consideration.
To conclude, this reflective essay proves that more needs to be done for those suffering from a mental health illness and diabetes. It appears that although much theory is available suggesting the link there is not enough practical work that has been done for those suffering. More monitoring needs to occur earlier and lifestyle advice needs to become standard practise.
Word Count:1,911
References
Connolly, C., & Kelly, C., (2005) Lifestyle and Physical health in schizophrenia. Advances in Psychiatric Treatment, 11, pp. 125-132
Dickerson, F,B., Goldberg, R, W., Brown, C, H., Kreybnbuhl, J, A.,, Pharm,D., Wohlheiter, K., Fang, L., Medoff, D., & Dixon L, B., (2005) Diabetes Knowledge Among Persons With Serious Mental Illness and Type 2 Diabetes. Psychosmatics. 46 (5), pp. 418 – 424.
De Hert, M., Schreurs, V., Vancampfort, D., & Winkel, R, V., (2009) Metobolic syndrome in people with schizophrenia: a review. World Psychiatry, 8, pp. 15-22.
Gough, S., & Peveler, R., (2004) Diabetes and its prevention: pragmatic solutions for people with schizophrenia. British Journal of Psychiatry. 184 (47), pp. 106-111.
Kirpichnikov, D., Mc Farlane, S, I., & Sowers, J, R., (2002) Metformin: An Update”. Annuals of Internal Medicine, 37, pp. 25-33
Leslie, D, L., & Rosenheck, R, A., (2004) Incidence of newly diagnosed diabetes attributable to atypical antipsychotic medications. American Journal of Psychiatry. 161, pp. 1709-1711
Mc Readie, R, G., (2003) Diet, smoking and cardiovascular risk in people with schizophrenia. Descriptive study. British Journal of Psychiatry, 183, pp. 534-539
Miller, J., & Molla, P, M., (2005) Prevelance of Diabetes Mellitus in Patients Receiving Depot Neuroleptics or Clozapine. Archives of Psychiatric Nursing, 19 (1). Pp. 30-34
National Collaboration Centre for Chronic conditions (2008)National Institute of Clinical Excellence guidelines: Type 2 diabetes :The management of type 2 diabetes. http://www.nice.org.uk/nicemedia/pdf/CG66NICEGuideline.pdf Saha, S., Chant, D., & Mc Grath, J, A., (2007) A systematic review of mortality in schizophrenia: is the differential mortality gap worsening over time? . Archives of General Psychiatry, 64, pp. 1123- 1131.
Scheen, A., & De Hert, M., (2007) Abnormal glucose metabolism in patients treated with antipsychotics. Diabetes Metabolism. 33. Pp 169-175
The royal college of general practitioners (2000) National Institute of Clinical Excellence guidelines:Type 2 Diabetes: Prevention and management of foot problems http://www.nice.org.uk/nicemedia/live/10934/29242/29242.pdf