HI5019 Caring Conversation And Narrative

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HI5019 Caring Conversation And Narrative

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HI5019 Caring Conversation And Narrative

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Course Code: HI5019
University: University Of The Sunshine Coast

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Country: Australia

1. Develop an understanding of some common mental health issues and influencing policy and guidance.2. Analyse the factors that may influence a compassionate and empathic response to distressed and confused individuals.3. Demonstrate confidence and skills which enable the facilitation of caring conversations with those experiencing emotional distress4. Evaluate own professional development and strategies contributing to emotional resilience.

Introduction and Setting the Scene
The study aims to explore the various psychological disorders that are widely prevalent in the 21st century and as well the interconnection between psychological disorders and various other external factors like poverty and political landscape. Research has revealed that an increased number of mental health issues have been reported in low income communities, and the syndromes could include extreme mood disorders, schizophrenia, suicidal syndromes and other common mental illness like chronic anxiety that can be a consequence of long-term poverty and a constant feeling of frustration or disappointment.  As it is, there is an interconnection between mental and physical well-being of an individual, today clinicians are mainly focusing on achieving the mental and physical dualism to ensure an overall well-being of the individual.
However, a research has stated, the political conflicts and turmoil can have a significant impact on the mental and thereby physical well-being of a person (Santiago, Kaltman and Miranda 2013). People who have been periodically subjected under violent and compromising circumstances often reported to have gone through a phase of disorientation and rampant anxiety attacks which eventually result in memory loss.
This section will focus on the external factors that degrade the mental health and the correlation between mental and physical well-being of an individual.
After World War II, researchers emphasized that the mental well-being of an individual was the most essential element that one need to concentrate on. During or after a political conflict, the phase generally left a huge impact on the general and mental health of an individual. During these unpredictable political times common mental disorders like non-psychotic psychiatric morbidity is the result of a prolonged period of anxiety and depression that are generally the consequences of wars (Gold and Chrousos 2013). Another most rampant risk factor is suicidal tendencies which mainly occur as a result of repressed and untreated stress. Political turmoil and conflicts also wreck havoc on the entire community which gets reflected in the form of poverty, deprivation, lack of proper education and unemployment. Scientists have found that a majority of population suffer from psychiatric symptoms have been a victim of migration, unemployment, stiff competition which furthermore results in a sense of deep-rooted disappointment (Cockerham2016). These factors restrain an individual to ingratiate him/her into the normal life and the same affects their potential to participate in decision making process, active participation in productive activities or sustain social relationships (World Health Organization 2014).
Mental Illness is a disorganized state of mind that considerably hinders or affects the individual’s other faculties like emotional, cognitive or social abilities. Mental disorders can be identified in an individual by a number of symptoms or signs which can also restrain the proper functioning of the individual’s physical health (Heyward and Gibson 2014). A research conducted in Australia states that chronic physical conditions in an individual is significantly more noticeable with persistent mental illness. Studies show that people who are suffering from schizophrenia are 2.5 times likely to develop diabetes when compared to those who are not. NSW Health Commission has stated that there is a correlation between mental and physical health and has taken steps to implement primary physical and mental health care to ensure an all round development in an individual (Muehlenkamp et al  2012.).
Mental illness block the germination positive outlook in an individual and this distracts an individual which furthermore results on irregular intake of food and nutrition, hypertension, improper sleeping patterns, lower energy levels. The same can foster cardiovascular disease, musculoskeletal problems and obesity (Jorm 2012). Doctors have concluded that patients who were suffer from chronic pulmonary disease suffered from mild depression over prolonged period of time. To avoid a slow but steady degeneration of physical health one must ensure to get adequate amount of sleep, balanced diet, social participation as depression or other mental disorders are very much determinant of a person’s all round development (Van der Kolk 2017). In case of bipolar disorder, people suffer from manic behaviors and some of its physical effects include sleep disorders, extreme lack of sleep, and hyperactivity due to which the individual suffer from nervous agitation. These are potential hazards to maintain a healthy lifestyle as it results in absenteeism, improper functioning in daily life. The same can also end up creating a vicious circle of drug addiction, substance abuse. Therefore there is a strong connection between the physical and mental well-being which can be influenced by political and contemporary social scenarios (George, L.K., 2013).
Introduction to the case scenario
The case scenario reflects the experiences of working as a community matron, alongwith patients who showed symptoms of mental health issue like depression and anxiety. One of the most essential skills which are required in order to become an efficient and capable matron is the ability to communicate effectively to the patients. Initiating a compassionate conversation with patience will ultimately generate an understanding with the patients. This will further be helpful in understanding their cause of distresses or the root cause of psychological complications that they are being confronted with. In this case I was told to carry a caring conversation with a patient named James (pseudonym) aged 22 who has been suffering from dissociative identity disorder and chronic bipolar disorder. The individual has also attempted various violent self-harm activities like piercing his skin with sharp objects and frequent intake of sleeping pills. What further aggravated his situation is lack of parental care and medical attention. I was instructed to carry on a conversation using a mild and compassionate tone to know in-depth about his childhood trauma and history of sexual abuse. He was placed under medical attention only for a brief period of time which failed to prove fruitful because he stopped consuming them midway. This interaction had also given me the opportunity to understand their progress after receiving medical attention.
The caring conversation narrative would later go on to give a proper shape to ideas and concepts that we generally relate with mental illness. It emphasizes on the ethics which are interrelated with a caring conversation which further becomes instrumental in making the reader aware of the root causes of complication and insecurities of a mentally ill or chronically depressed patient. Furthermore, I learnt one should respect the function of both the parties helpful in generating a caring conversation which gives a better hindsight into the problems or complications of a mentally ill patient for instance, somebody who is suffering from bipolar disorder. Bipolar disorder results in depression and mania which could be brought to the forefront with the help of caring conversation that encourages for more open conversation (Reeves, Parker and Konkle-Parker 2016). Researchers have stated that marginalized community gets little or no benefit of healthcare professionals and as a result they fail to address the steps necessary to improve the mental well-being.
The case scenario will also discover various aspects of depression and anxiety which result in self-harm and frequent suicidal tendencies. Consequently a manual will be developed based on the caring conversation that will be beneficent in dealing with the above stated issues.
Influencing and inhibiting factors contributing to the situation
The influencing factor that had an impact on the caring conversation narrative is empathy. Without empathy or the lack of it the ease that both the speakers share in between themselves would be hampered. Professional matron should make the patient realize that he/she is relaxed and solely concentrating in the conversation by asking counter questions (Van der Kolk 2017). Open questions should be asked to the patients to provide them with the opportunity to express them and to gather more information If the patient is suffering from self-destructive thoughts, extreme mood swings, insomnia, suicidal tendencies, they need to be provided with an empathetic and understanding nurse who can insinuate a feeling of trust and mutual warmth. This would be helpful to assess the extent of damage that the patient has undergone. If the individual is not being able to invest a degree of trust and mutual confidence with the listener, he/she may feel the uncomfortable in sharing meaningful conversations. Trust and confidence will help to carry a very candid conversation that helped them face with their trauma and insecurities. The objective of a caring conversation is to ensure that the patient is being provided with an effective and advanced healthcare planning (Ilic et al 2012).
  One of the other influencing factors is the need of well-established communication skills which are necessary for a caring conversation narrative to advance further. For a caring conversation to take shape there should not be any wall amongst the two individuals which would otherwise prohibit the individuals to open up in front of one another. Effective communication skills are one of the influencing factors in a caring conversation for the healthcare personnel to possess a complete map of the client’s mental health, personal life, insecurities and weaknesses. One should always consider the fact that effective conversation is one of the most crucial ways to treat self-harming tendencies. Action is always preceded by a complete understanding in order to develop an effective approach for the problems that the patient is facing. Intuitive ability to respond and counter the patients with relevant questions for the progression of the client’s treatment is necessary. The same would develop from an in-depth understanding of the client’s problems and with the help of languages and behavioral pattern as evident during the conversation, the healthcare professional will be able to interpret and design treatment policies.
Open questions should be exchanged in between each other in order to provide with the opportunity to express them and to gather more information. The lack of proper communicative skills could have also restricted the flow of information in between the speakers and would have meddled with the narrative of caring conversation. Effective communication skills are rather incomplete without the various aspects like listening, sparing adequate concentration and responding to the stimuli that the professional is receiving from his/her client. The most important factor to help a confused and distress individual is to show genuine support by listening to him/her and asking several open questions. The person should be made to understand that he can always ask of help whenever needed. Travelling with one’s emotional in order to comprehend the root cause of these emotions is imperative for the counselor (Erskine, Moursund and Trautmann 2013). The healthcare professional should have a clear understanding of his/her own self on the patient sitting across.
The inhibiting factors that could have its impact on the caring conversation narrative is the lack of mutual trust and respect. It is due to this crucial element that none of the speakers were perfectly comfortable to share their personal stories of trauma and pain with each other. Considering the fact the service user is suffering from depression and anxiety, various reasons can be stated for occurrence of depression, which eventually got associated with anxiety. The healthcare personnel or the nurse should be able to maintain standard professional ethics and should listen and respond to the client from a non-judgmental perspective. During the on-going of the caring conversation process, the nurse should ensure to respond from an undiscriminating frame of mind and thereby honoring the privacy and individuality of the client (Kross et al 2014.). A non-judgmental perspective will also vouch that any kind of personal opinions or stances are not intervening the caring conversation narrative.
Another inhibiting factor to the caring conversation narrative would be imposition on the part of the nurse. Instead of applying force or cohesion, the nurse should further ensure to foster within the client self-determination and responsibility. The same would ingratiate within the client the necessity of opening up in a candid manner and participate in the caring conversation with a degree of honest and straightforwardness (Heyward and Gibson 2014).  This would be instrumental in stimulating a feeling of confidence and credence towards the nurse conducting the caring conversation narrative. In addition, this will be imperative in making the client or patient feel cared and listened to. Without the incorporation of care and love, a nurse cannot attain even an iota of trust from the patient. Adhering to strict professional standards is often times inadequate to make the patients and their family members to express their concerns and burden (Bertolote and Fleischmann 2015).
The caring conversation narrative is therefore an important way to confront the thread of complexities that any mentally ill patient harbors within him or her. During a caring conversation, the nurse should keep in consideration the broader picture of society and contrasting values. This would also generate a client centric conversation narrative that would emphasize on the well-being of the patient. Mentally ill patients suffer from extreme vulnerability, therefore the nurse should also bear in mind the environmental factors that the patient is in (Hamza, Stewart and Willoughby 2012). during a caring conversation narrative a positive environment is a major factor the lack of which can inhibit the flow of information between the nurse and patient. Environment can act as a stimulant that can have a significant influence in the caring conversation narrative.
Analysis of factors that influenced or inhibited your caring conversation
Patients with borderline psychological disorders or patients who have clinical psychological disorders tend to suffer from aggression, hostility and desperation which pose as a major threat to their personal well-being and all round development (Brody 2017). Due to these reasons a number of mental healthcare institutes or perhaps the family members of the patients feel the urge to use coercive measures. This no doubt further aggravates the situation that the patient is already in. At this stage the patients may feel trapped when persuaded to take medicine or the assistance of psychologists (Dewar 2013). One of the main reasons for such practices is the fact that in many sections of the society, people tend to stigmatized mental disorders and develop absurd prejudices around the same. In many families, especially in the low income families, mental health becomes the lowest concern and due to which the symptoms take enormous shapes at the later phase of the victims’ life. The society tends to view mentally ill patients as potentially dangerous and consciously creates alienation from them. These stereotyped set of behaviors and public beliefs result in violent scenarios like crime and violence. According to WHO, 85% of people fail to receive treatment or diagnosis during the first year of mental turbulence ((Silverman, Kurtz and Draper 2016). Naturally this further jeopardizes the chance of steady recovery that the patient might have had. However, during my placement, I was provided with the opportunity to communicate with a patient named James, who was undergoing through severe Dissociative Identity Disorder which thoroughly affected his family, social and work life (Nathan and Gorman  2015). After continuing with the conversation, I came to understand that the root cause of the person’s syndromes was childhood trauma and abuse which now has resulted in exaggerated forms. The symptoms included memory gaps, a disoriented sense of identity. The fact that many people spare sparse attention to these cases and let the patient to lead a solitary life was evident in the case of James. After felicitating a prolonged conversation I came to understand that to cope o with his loss of reality, he had taken recourse to drugs and alcohol which had started to affect his mental health thereby increasing trauma and a feeling of helplessness. The boy was constantly deprived of parental care and supervision which made him go through a period of blank phrase, insomnia, anxiety and self-harming tendencies. Repetitive feeling of helplessness made him suppress his painful memories and finally resulting in dissociative amnesia. As a result, the individual starred performing bad in academia and his memory loss went beyond the parameters of normal memory loss. He entered into a dark phrase of anxiety and depression with the gradual loss of important information and personal details.
The conversation made me develop a compassionate attitude towards James and realize how he lacked the guidance that would have helped him to develop a feeling of self empowerment (Rogers and Pilgrim 2014). I put his picture in the broader spectrum and analyzed how family and society play a fundamental role in the patient’s recovering. The victims fail to take decisions independently during their vulnerable junctures and end up choosing detrimental lifestyle which castrates them from the community. As I progressed with the conversation I realized that James has developed bipolar disorder due to prolonged phrases of manic depression. He mostly replied to my questions in a detached manner and became extremely aware of his own vulnerabilities. With the help of his response pattern I got the cue that he is fatigue and extremely listless. It made me understand how essential it is for the doctors to enumerate a treatment plan and discuss the same with the patient for his/her own benefits. I tried to communicate with him in a non-judgmental manner and extracted details about his life as much as he remembers. He started to feel comfortable with me and shared with me a few personal details of his life which made me realize the extent of harm that isolation and lack of psychological help can result in a child. However, as it was my first experience, I was incapable of assessing his vulnerability and made him feel uncomfortable and conscious with my flow of questions. On diagnosing we came to know that he was feeling a sharp pain in his chest accompanied by palpitation and tremor.
I came to the realizations that many institutes and healthcare personnel today are unaware of the benefits that early treatment can have on the patients (Silverman, Kurtz and Draper 2016). Lack of timely treatment can foster a feeling of self-stigma in which case the patient starts to judge himself/herself with a slow decrease in self-respect and confidence. In such cases, even the result of treatment plans and procedure fail to be insufficient and can act as a catalyst in increasing the feeling of helplessness and disorientation.
 Educating oneself about various psychological disorders is necessary in order to help people with mental issues (Ilic et al. 2012). Considering the fact that effective conversation is one of the most crucial ways to treat self-harming tendencies, solve the violent behavioral patterns that the patient is showcasing and evaluate their approach at daily life. As evidence suggests, effective caring conversation is an effective way of making the patient cope with self destructive habits, overcoming fears and insecurities and help the individual to grasp the significance of maintaining an overall well-being.
Promoting interventions and healthcare promotion is pivotal in these scenarios. It should start with documentaries on the benefits of early treatment and care. The same would also be beneficial to eliminate the stigma and taboo associated with psychological disorders a mental illness. Early recognition on the part of the family plays a vital role in ensuring that the symptoms are not changing for the worst. Administration of healthy dosage of drugs like Fluoxetine, Sertraline and Citalopram can prevent further worsening of the symptoms. Various other measures like talk therapy, community support programs can also be effective in making the patients feel unburdened (Johnsen and Friborg 2015). The patients should be provided with protein food and a balanced life to help them deal with their rough patch.
A critical self-reflection on learning and professional development
My placement provided me with the amazing opportunity to evaluate my capabilities and skills as a nurse and identify and work on my short and long term goals. It also helped me to confront the prejudices and backward behavior that many section of the society still possess for those who are suffering from psychological fragmentation. After communicating with James I understood there is a prominent linkage between self-harm and depression. Individuals who have prone to anxiety and chronic depression are more vulnerable to suicidal activities compared to those who have never attempted self-harm. According to research, people who have recently undergone treatment for self-harming activities are 66 percent more likely to conduct suicide.
In some cases medication fails to be the sole effective treatment and the individual needs to be provided with other modes of care and treatment. Under such circumstances, social stigmatization and ostracization can make the situation extremely unfavorable for the patient (Hawton, Saunders and O’Connor 2012). In this respect the healthcare personnel should also implement steps in the direction of providing awareness and help the society get rid of preconceived ideas that the community at large holds for mentally unstable patients. There can be a number of ways to achieve the same for instance, seminars and speeches, video clips focusing on the importance of community participation and acceptance, educating the people about the possibilities of recovering and making them aware how dangerous can social isolation can be in victims’ lives.
My placement also helped me to understand my lacks and shortages that would be fundamental for me in becoming a better nurse to help people deal with their psychiatric problems. Apart from understanding the need for developing effective interpersonal skills, which would ensure that will destroy any kind of communication barrier with the patient. Interpersonal skills would also help me to increase my productivity within the hospital premises. Interpersonal skills will also help me to grasp the hints or body language of the patient and help me to understand his/her immediate problems. Since many mental illness symptoms are result of chemical imbalance in the brain, it can result in violent mood swings within the patients (Dewa and Lin 2000.). It is however, up to the responsibility of the matron to act on the same and assess the development of the patient on availing medicines.
As a nurse, it becomes also imperative on my part to acquire the skills of important decision making. I realized how critical it would be to handle delicate situations within the clinic. Decision making and critical skills would help to interpret data and information in order to provide better service to the patients (Silverman, Kurtz and Draper 2016).
I also understand the planned usage of using light humor as a therapeutic way of dealing with the patient. After all the usage of spontaneous humor can be beneficial in maintaining a light atmosphere, reducing the stress and fear of the patient. It can also help to develop a healthy relationship with the patient. Discrimination can stimulate the patient in taking extreme decisions and can sour the matron-patient relationship.
My placement also helped me to identify the fundamental elements that would determine a nurse-client relationship. Maintaining strict professional standards and a careful usage of body language, voice and touch are essential. Additionally, maintaining a non-judgmental stance is equally necessary to plunge deep into the patients’ problems and understand his core issues. This would also help me to work within an ethical framework and also develop a positive attitude towards the client.
Here are the learning objectives for year 2

Qualities for Professional Development

Planned development Activity



Future Usefulness

Interpersonal Skills

Taking professional classes from nursing schools and interacting with individuals as a practical learning method. Reading manuals and practicing workbooks can be counted as an effective measure as well.

The resources that would be needed for this purpose are colleagues and manuals on interpersonal skills and development.

Can be evaluated by communicating via effective verbal communication. The same can also be useful to understand non verbal communication.

Interpersonal skills will help in face to face communication and for developing a better understanding in between matron and patient.

Critical Thinking Skills

Fieldwork activities and real life situations can be helpful.

Practical Scenarios from the clinic can be helpful to develop critical thinking skills. The individual needs to place himself/herself to work on his/her critical thinking skills.

The success can be evaluated by my capabilities in helping to make decisions at important junctures.

Effective implementation of ideas and taking better decisions for the treatment of patients. The same would also involve a careful consideration of the consequences resulting such ideas and measures.

Sense of Humor

Reading books and leading a stress free and friendly conversation with the patient which would leave a scope for light humor.

The resources can be watching televisions.

The success can be evaluated based on the patients’ reactions and recovery rate.

To maintain a light ambience or atmosphere that would help the patients in communicating in a candid manner.

My learning and professional development goals would hopefully help me to overcome the obstacles and help me to function better as a nurse.
Reference List:
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Calear, A.L., Batterham, P.J. and Christensen, H., 2014. Predictors of help-seeking for suicidal ideation in the community: risks and opportunities for public suicide prevention campaigns. Psychiatry research, 219(3), pp.525-530.
Cockerham, W.C., 2016. Sociology of mental disorder. Taylor & Francis.
Dewa, C.S. and Lin, E., 2000. Chronic physical illness, psychiatric disorder and disability in the workplace. Social science & medicine, 51(1), pp.41-50.
Dewar, B., 2013. Cultivating compassionate care. Nursing standard, 27(34), pp.48-55.
Dilillo, D., Mauri, S., Mantegazza, C., Fabiano, V., Mameli, C. and Zuccotti, G.V., 2015. Suicide in pediatrics: epidemiology, risk factors, warning signs and the role of the pediatrician in detecting them. Italian journal of pediatrics, 41(1), p.49.
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