This chapter explains three illustrative cases of psychiatric medication withdrawal in adults such as Angie: Medicated through her divorce and the death of her father, Sam: Withdrawing a patient who didn’t want psychotherapy, and George: Withdrawing a suicidal and delusional patient from medication. The person-centered collaborative approach starts with “the person”-the individual who seeks help. Because human beings are unique and enormously varied in their infinite qualities, every therapy and every withdrawal process will be unique and varied. The three cases involve circumstances hazardous enough to need a collaborative approach. Many patients in private practice, especially emotionally stable patients who have taken one drug for only a few months, will be much easier to withdraw from medication. Some will be much more difficult and even impossible on an outpatient basis, especially patients taking multiple drugs for many years while becoming increasingly impaired and dependent on others.
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This chapter describes how to talk with patients about religiosity assumes the purpose of the talk is for therapeutic purposes other than assessment. It provides guidelines that are vital to observe when talking with a patient about religiosity. The skills most appropriate for supporting a patient to explore religiosity are those of making restatements, open questions, and empathy that names feelings. It is possible for a religious nurse comforting a distressed patient with religious admonitions to instead cause hurt or harm. As every nurse learns, communicating involves not only sending verbal and nonverbal messages, but also receiving them. The chapter discusses how to make sense of messages nurses receive from the patient who is talking about religion. The nurse who wants to share personally helpful religiosity is given suggestions for when and how to make a patient-centered, therapeutic self-disclosure.
Prescribers and therapists who embrace a person-centered collaborative approach to therapy and to medication withdrawal will find it professionally gratifying and will help many patients and their families. Any time a prescriber determines that a patient is suffering from sufficient emotional distress to benefit from medication, that same patient should be encouraged to try counseling or psychotherapy. Prescribers can no longer assume the role of medical doctors or nurse practitioners working in isolation prescribing for patients who then depart the office to dutifully take their drugs. All psychiatric drugs have serious long-term adverse effects and tend to produce chronic brain impairment (CBI). The modern prescriber will best serve patients by working together with therapists, patients, and their significant others or families, especially during difficult drug withdrawals. Many patients and families feel wounded by their experience with prescribers and therapists. They feel they have been pushed into taking psychiatric drugs.
Asking anybody about his or her religion can be really tough. This chapter discusses various aspects of assessing religion and also explores techniques for improving a clinician’s comfort with asking patients questions about religiosity. The real issue is not whether religions and spiritual commitments improve patients’ health but rather whether physician inquiries into such commitments honor patients as persons. Religiosity is always considered an aspect of spiritual assessment in nursing literature on the topic. Although nurses play an integral role in assessing religiosity, it is important to remember that spiritual and religious assessments are ideally completed by various members of a health care team. Several clinicians offer clinical interview guides for spiritual and religious assessment, which cover a gamut of facets of religiosity. Spiritual care experts such as certified chaplains should be responsible for any comprehensive religious assessment.
The idea of “religious ritual” may conjure up images of poorly lit spaces, olfactory memories of burning incense, or sounds of chants or hymns. Experiencing a ritual’s symbols for beliefs and the accompanying emotions allows individuals to experience transformation, another major function of religious rituals. Nurses benefit from knowing about religious rituals for two reasons. First, the religious patient will be engaging in these rituals. Second, nurses can support patients who no longer can participate in their usual religious rituals to create religious rituals appropriate and meaningful during health challenges. The goal for many pilgrims is healing, although often a pilgrimage is made simply because it is a religious obligation or search to encounter the holy. Pilgrims may also need to be reminded to continue their usual medications and be educated about when to self-medicate.
One of the most trying aspects of training professionals to work with couples using solution-focused therapy is expecting professionals to go slowly and to develop a connection with their couples before moving on. In fact, the therapist is working to uncover the positive aspects of the couple’s life, and how they were living before their problem. Lipchik calls this process listening with a constructive ear probing for evidence of strengths, resources, and past success, learning what life was like before or without the problem, what the clients want, or anything at all that can be reinforced as a positive aspect of the client’s lives going forward. Every couple comes from a past when the relationship was working much better. The therapist listens for clues about how the relationship was built to understand what worked in the past and continues to work today.
Hospice and palliative care nurses work at the nexus of life and death on a daily basis. A thorough understanding of the features of grief and grief theories fosters therapeutic communication and the implementation of effective grief support. This chapter discusses the grief and bereavement experienced by patients and their families, along with appropriate support interventions. It helps nurses to identify typical and atypical grief reactions, assess grief responses in families, and provide age-appropriate grief and bereavement support. Hospice and palliative care nurses must be adept at identifying grief and providing support along with the interdisciplinary team. Patients facing death often experience denial, anger, bargaining, depression, and acceptance. Family grief is influenced by the relationship between the patient and each of the family members. Grief in children is manifested according to age and developmental level. After the patient's death, bereavement care should be offered for at least 12 months.
Advance care planning is a collaborative effort between healthcare providers, patients, and families through which the patient establishes his or her preferences for future medical treatments. Advance directives are used to guide care only when patients are unable to speak or make decisions for themselves. This chapter helps nurses to approach goals of care conversations with terminally ill patients and their families, establish hospice eligibility, and discuss hospice benefits, coverage, and eligibility. Hospice and palliative care nurses must possess expertise in discussing goals of care with patients and their families. Goals may need to be revised as the patient's condition changes. When goals are developed, they should be measurable and achievable. Hospice and palliative care services are covered by Medicare and Medicaid and by most private insurances. Patients should be advised to contact the hospice or palliative care social worker or their insurance company with questions about their benefits.
Often, clinicians carry subconscious expectations of patients and patient behaviors. The range of expectations can be broad, but individual expectations can also be subtle. These subtle expectations can act as a set of entitlements that, when violated by a patient or family, can impose a barrier to our being able to provide effective care. This chapter shows a clinical example of a thirty-year-old woman with cystic fibrosis and bilateral lower lobe pneumonia. Mindfulness practice provides the clinician with a set of principles for reconsidering the ‘should’. There are some situations in which all patient-centered efforts fail to achieve a workable relationship with a patient and family. In these cases, it is important for clinicians to convey clear expectations and limits and convey them consistently across disciplines. The purpose of limit setting is never so that clinicians can assume a position of power, or as a means of punishing patients.
Expert practice is characterized by increased intuitive links between seeing the salient issues in a situation and ways of responding to them. This is evident on observing the nurse in the situation and is partially captured in the following account of a situation where a patient who was hemorrhaging stopped breathing. The practice of the expert, like that of the proficient nurse, is characterized by engaged practical reasoning, which relies on mature and practiced understanding and a perceptual grasp of distinctions and commonalities in particular situations. The chapter shows a paradigm case for the nurse about an unusually close and lifesaving connection to a patient. It presents key aspects of the clinical world of expert practice like: developing involvement skill, managing technology and preventing unnecessary technological intrusions, and working with and through others. Response-based practice constitutes having a good clinical grasp and recognizing both familiar and individual patterns of responses.Source: