Managing Patients with Severe Persistent Mental Illnesses Discussion Paper
Reflecting on my practice, my most significant concern centers around ensuring comprehensive, coordinated care that addresses the specific needs and concerns of care. The complexity of severe persistent mental illnesses (SPMI) necessitates a multifaceted approach that addresses the psychiatric condition and complications and integrates social, psychosocial, and individualized needs (Isaacs & Eleanor, 2024). The challenge is navigating the fragmented healthcare system, overcoming stigma, and ensuring continuous engagement with the healthcare processes. Additionally, my most significant concern in providing this kind of care arises from the existing challenges in providing culturally and spiritually competent healthcare services that attain the best healthcare goals. Managing Patients with Severe Persistent Mental Illnesses Discussion Paper
TeamStepps offers a practical framework designed to optimize team function and improve communication among healthcare professionals, enhancing patient outcomes. Among the TeamStepps concepts, the SBAR (Situation, Background, Assessment, Recommendation) communication technique is particularly relevant to my future practice as an Advanced Practice Nurse (APN) in mental health settings. SBAR provides a standardized method for communicating critical information that requires immediate attention and action, making it an invaluable tool in managing the complexities of SPMI care. Managing Patients with Severe Persistent Mental Illnesses Discussion Paper
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Utilizing SBAR in Managing a Crisis Situation in SPMI
Alex is a 35-year-old client diagnosed with schizophrenia ten years ago. Over the past months, he has been attending his routine clinics and taking medications according to his treatment plan. During the visit, the APN notices that Alex appears unusually agitated and paranoid and reports hearing voices commanding him to harm himself. Recognizing the acute exacerbation of psychosis and the potential risk of self-harm, the APN decides to employ the SBAR technique to communicate with the psychiatric crisis team. Managing Patients with Severe Persistent Mental Illnesses Discussion Paper
Situation: My name is Blair. I am calling from the Bristol outpatient mental health clinic. I am with Alex, a 35-year-old male client with schizophrenia. Alex is experiencing an acute exacerbation of schizophrenia symptoms, including severe agitation and auditory hallucinations with self-harm commands.
Background: Alex has a history of schizophrenia, which was diagnosed ten years ago. Over the past few months, Alex has been attending follow-up clinics and he has adequately managed his psychotic features with Fluoxetine 20mg every morning. Alex denies recent changes in medication and has no known triggers for his psychotic features. Managing Patients with Severe Persistent Mental Illnesses Discussion Paper
Assessment: Alex’s condition has worsened, and he is currently exhibiting hallucinations with suicidal ideations. Alex is currently under observation in the clinic. However, his condition is escalating requiring more effective strategies to promote Alex’s safety.
Recommendations: I recommend that we activate the psychiatric crisis intervention team to assess Alex immediately. Considering the risk of self-harm, we should admit Alex to the psychiatry unit to provide around-the-clock monitoring and support. Can we arrange for transportation and an immediate assessment? Managing Patients with Severe Persistent Mental Illnesses Discussion Paper
Reflection
Krisher et al. (2024) assert that by employing the SBAR technique, the APN communicates critical information efficiently and effectively, facilitating prompt intervention by the psychiatric crisis team. This scenario demonstrates how TeamStepps concepts, specifically SBAR, can be utilized in real-life situations to enhance communication, ensure patient safety, and improve outcomes for individuals with SPMI. As an APN, integrating TeamStepps strategies into my practice will be instrumental in addressing the complexities of mental health care, fostering collaboration among healthcare professionals, and, ultimately, providing holistic and patient-centered care. Lazzari (2024) indicates that the SBAR approach enhances collaborative and coordinated efforts that ensure the healthcare team implements appropriate interventions to help the client cope with the underlying needs. Thus, incorporating the resources within the electronic health record decision-making strategies will be critical in enhancing individualized patient care. Managing Patients with Severe Persistent Mental Illnesses Discussion Paper
References
Isaacs, A. N., & Eleanor, E. (2024). Mental health integrated care models in primary care and factors that contribute to their effective implementation: A scoping review. International Journal of Mental Health Systems, 18(1). https://doi.org/10.1186/s13033-024-00625-x
Krisher, L., Boeldt, D. L., Nicksic, C. A., Rimel, S. E., & Newman, L. S. (2024). Pragmatic approach to the assessment and use of digital mental health interventions for health workers. American Journal of Public Health, 114(S2), 171–179. https://doi.org/10.2105/ajph.2023.307505
Lazzari, C. (2024). Implementing the verbal and electronic handover in general and psychiatric nursing using the introduction, situation, background, assessment, and recommendation framework: A systematic review. Iranian Journal of Nursing and Midwifery Research, 29(1), 23. https://doi.org/10.4103/ijnmr.ijnmr_24_23 Managing Patients with Severe Persistent Mental Illnesses Discussion Paper
