This paper addresses two goals from Healthy People 2020 Mental Health and Mental Disorders affecting community and how nursing may assist in reaching these goals. It will also discuss the association between physical and mental health and the influence they have on each other. This paper will also discuss Trauma Informed Care and how nurses may utilize it to aid a trauma-affected child.
The two goals within the Healthy People 2020 Mental Health and Mental Disorders which my community are affected by are MHMD-12 Increase the proportion of homeless adults with mental health problems who receive mental health services and MHMD-11.1 Increase the proportion of primary care physician office visits where adults 19 years and older are screened for depression (Mental Health and Mental Disorders, n.d.). The goal of increasing the proportion of homeless adults with mental health problems who receive mental health services was selected because this is an unfortunate common issue in communities. The homeless population have an increased incidence of mental health disorders and substance abuse (Mental Health and Mental Disorders, n.d.). Providing them with mental health services opens the door to healing, restoration, and redemption. Nurses can help with this goal by assisting in community outreach fairs or free mental health clinics.
The outreach fairs may target the homeless specifically and offer various services, including mental health screening. The goal of intensifying the proportion of primary care physician office visits where depression screening for adults was chosen. This was due to the expected number of undiagnosed people in the community with depression. Many do not realize the reason for their mood swings, weight gain/loss, loss of interest, agitation, and more, may actually be depression. Patient’s may not ask for help for various reasons. If a depression screen is utilized routinely at primary care visits, it has the potential of catching it early so treatment can begin and have a better chance of being successful. Nurses are able to assist with this goal in several ways. They can assist with the development of the depression screening tool, they can ensure it is completed at every visit, and they can ensure the results are shared with the provider during the visit. For both goals, nurses can write to community leaders or elected officials to express their support (Mental Health and Mental Disorders, n.d.).
There is much evidence on the correlation between physical and mental health. This has been demonstrated repeatedly in various research studies with multiple disease processes. There are links between chronic illness and depression, depression and cardiovascular disease, trauma and adjustment disorder, obesity and anxiety, and many more. There are many factors which may cause the correlations, including isolation, social stigma, socioeconomic status, pain, and more. In cerebrovascular disease, specifically post-stroke, frequently there is a breakdown in mental health. Approximately one-third of stroke patients are diagnosed with depression and one-quarter with anxiety. Over one-half will be affected by depression at one point in their lives post-stroke. (Broomfield, Quinn, Abdul-Rahim, Walters, & Evans, 2014). Those who suffer with depression have a diminished ability to return to their activities of daily living (ADL’s). These patients report loss of independence, social isolation, and decreased contentment with life. Many times, they have physical restrictions and decreased participation in family events. Their quality of life is negatively affected (Bedi & Singh, 2014).
Trauma Informed Care is a way of acknowledging and comprehending patients with past trauma, such as violence, sexual abuse, natural disaster, child abuse, domestic violence, and crime and providing appropriate care to them. There are three “E’s” in Trauma Informed Care. Events, Experiences, and Effects. Events relate to the trauma itself. It may be one event or multiple. The event may be an individual event such as physical abuse or a community event such as a tornado or mass shooting. When these traumas occur in childhood, they are called adverse childhood experiences or ACEs. In children their brains may be rewired, which causes increased anxiety. Experiences relate to how a person responds to a trauma based on their maturity level and history. Therefore, an adult may react differently than a child to a trauma, as they have more experience in life. Communities with a history of persecution will react differently to an event than those who have not. Effects reflect how a person reacts to these events, both immediate and long-term. These effects may determine whether a patient is open to accepting help from healthcare professionals (Anonymous, 2018).
A part of Trauma Informed Care is avoiding re-traumatization. This can be avoided by being delicate about the persons current and prior trauma when interviewing them. There is no need to know every detail of a past trauma, as this may re-traumatize the patient. Six principles of Trauma Informed Care include providing safe surroundings for the patient, giving patients authority by allowing them to have a voice and ability to make decisions, being honest and translucent, offering opportunity to connect with others who’ve experienced similar situations, cooperation and reciprocity, and sensitivity to gender, cultural, and historical issues (Anonymous, 2018). There is a strong connection between ACEs and mental and physical health. Nurses may utilize Trauma Informed Care to help a child who has experienced trauma in several ways. Initially, recognition must occur. Trauma may not always be obvious, so being constantly aware and using a surveillance tool may be helpful. Listening and acknowledging their trauma provides collaboration and sharing (Harper, 2019). Educating the family or caregiver as well as the child is crucial. It is also important to remember that the family member or caregiver may have their own prior trauma. The nurse may provide resources to help the caregiver provide a nurturing home for the child (Harper, 2019).
Mental illness is found in every specialty of nursing and in every community. Nurses have the important role of continuously assessing patients and those in the community for opportunities to assist. The association between physical and mental health is very strong and must always be considered when caring for patients. Trauma is prevalent across the globe in various forms. Being proactive by providing Trauma Informed Care serves patients of all ages well.
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