Posted at 10.29.2018
On 9th March 2010, I used to be designated a 28years old male patient, at Karawan -e- Hayat. He was identified as having bipolar disorder. His present problems were aggression, anger and harming others. He lives in national B section of Karachi belongs to a middle income family. He was unmarried. Regarding patients relative his mother passed away of malignancy when he was four years old and his maternal aunty married to his father became her mother then at age of nine his father passed on on ship. Since that time he is staying with his grandfather who's is very tight naturally. Before he was accepted in Baqai Medical center. When I satisfied him for the very first time during interview I discovered his elated spirits and he was verbalizing that to get furious is normal. However my family thinks I want treatment for anger but I want to go back home. I promise i am going to not get furious want to work because people think I am not positive.
By making the conclusion of client verbalization, I then found out he needs help build a positive thinking in order to create wish and cope effectively with change and misfortune. Sacrificing a parent can be extraordinarily difficult due to the loss of support and characteristics which identify the position and role of your parent as being very special. Holds for children of individuals are an essential area of the grieving process and really should be linked to characteristics of children and people how they respond to such loss. As my client never got chance expressing his feelings. Eric Erickson's periods of psycho-social development with regards to the stage of "industry vs. inferiority. When a death of a mother or father occurs in child years or adolescents the kid might not exactly mourn effectively and this may create problems with depression and inabilities to keep up close connections with others (p. 159). During adolescents there's a quest to find ones "identity", and the father or mother is a job modeling figure then an adolescent may feel reliant, and even upset because of the death of these parental body. Mental health campaign in 2008 focus on building resilience plan. By concentrating on the positive aspect in life our mental resilience is strengthened, stress reduced and better mental well-being.
Introduction of Theory:
The idea of resilience has been interest to various professional teams for quite some time; however, it is only recently that the medical profession has begun to identify its potential contribution in diverse scientific contexts Most empirical studies of individuals and areas experiencing serious adversity, shows usually has negative repercussions on health. The reason to develop this concept as increasingly more youths are facing hard times, secondly not and then understand the defensive or risk factors also how to help these children to face these difficulties in an optimistic ways if the truth is that in today's time youths are facing many challenges due to global crises.
The founders of resilience Garmezy and Werner cited by McCarty. R (2006):
They emphasis on health problems or maladjustment among hazard-exposed organizations and towards advantages of risk-exposed individuals as well, both in conditions of adjustment final results and in conditions of characteristics that promote positive adaptation -- assets or protecting factors as well as 'liabilities' or vulnerability-enhancing ones. (p. 574)
Similarly if my patient possessed develop resilience in advance then he'd have never land up in maladaptive continum that is anger and agression. Relating to Examination of International Medical risk of diminishing that is resilience related to chronicity of crises as proof by patient angriness anticipated to loss of parents. There are various internal and exterior factors that stimulates resilience. Positive connections are with friends, family, problem resolving potential. Factors that drain resilience are unsupportive conditions, lack of connectedness to others. To build up resilience first we have to concentrate on anger anticipated to which he was admitted, if we control that then he'll have the ability to concentrate on his positive talents for which I gave educating on anger management through the use of different strategies. Lopper (2008), "In order to succeed, people need a sense of self-efficacy, have difficulties as well as resilience to meet up with the inevitable obstructions and inequities of life. " ~Albert Bandura. (p. 1)
Unfortunately, Pakistan is the united states where less work has been done in neuro-scientific psychiatry. Although there's a mental health legislation been develop in 2001 but there's a need to reevaluate it in order to safeguard the human protection under the law and establish the community based mental health services. Relating Kasi. P et. al (2007), research on long working time boosts stress and lowering performance and standard of living of individuals in post graduates trainees showed that the factors that donate to negative coping mechanism that is stress on post graduates raises the risk of patient's safeness. Khan, S. (1998) do studies on resilience and sociable support. Due to intimidation in the Pakistan, how cultural support system play role in building resilience promoting mental health. Now in my patient due to lack of understanding about mental health importance he being treated very negatively by the family because he had not been taking involvement in the studies, no one tried to learn why he is running from studies and conquering grandfather as well as people living in his vicinity. Mother got him to the doctor, who said that since child hood he loose trust relation ship went into low self esteem which he is compensating by conquering which negative coping device raises the chance of protection for self among others.
As in this situation I have reviewed, need to guide positive attitude towards life, this maladaptive tendencies can drop his mental health. As long earlier as 1948 the planet Health Organization focused on a renewed demand attention to positive health and well-being by the WHO Western european Office for Investment for Health and Development (IHD) has given climb to a pioneering give attention to assets rather than deprivation, on advantages alternatively than deficits. For example, women become resilient because they build strong, caring relationships with others, while kids develop resilience by learning how to problem-solve. Unbridled thoughts often take people to a point of which life's obstacles simply overwhelm them. Dr. McCarty, R (2006) said "Increasing resilience can help prevent as well as erase several emotional gridlocks". In order to know how we think, it's important to look more directly at the relationship between functionality and health. Experts found fast and effective way to generate and store resilience is through coherence. Coherence is the heart, mind and emotions are balanced and working in sync and the immune, hormonal and nervous systems function in lively coordination. Before you bring your heart, mind, emotions and other inner systems into balance, you must override the stressors and negative behaviour that caused them to escape sync.
One of the most common factors behind imbalance is the damaging feeling of anger. It impairs ram, impairs mental function. Dr. McCarty (2006) implies that these are the typical physical ramifications of anger, reduced amount at work, college or home. When you are angry for more than a few moments and cannot step back, you are in a state of incoherence. An individual who has had a wholesome childhood will be better able to endure in future. Referring to my patient he said I was unable to go away my B. com exam because I was not able to maintain whatever I read cannot concentrate on my studies. Regarding to mom patient had not been taking involvement in the studies and was exhibiting laziness and choose to sit and watch television set although he have few programs. Another research study done on resilience among adolescence targets what people can't do rather then what they can do. It is important to note that both positive and negative patterns can be brought on by significant, incidents that are powerful in impact to improve their lives directions termed as "turning point opportunity" (Howard and Johnson 2006).
Another international article on resilience written by Kappler. S (2010), innovator of Fort Jackson Institution in Pennsylvania wide open by the military personnel in Fort Jackson at forefront. This article is how the program benefits soldiers, young families, civilians and the army all together, it is just a long-term effort to boost emotional, sociable, family and spiritual strength in troops. The program, which was initiated in Oct 2008, is quickly growing and will be a symbol milestone with the starting of the Get good at Resilience Training college this will gain the soldiers to maximize their performance.
Resilience idea or Basch's developmental model (2008) emphasizes on coping reservoirs can help promote well-being and minimize burnout (anger and hostility). This model also helps a person with mental disease to identify risk factors that impact resilience as in my own patient the inner and external factors were parents perished when he was really small and didn't get enough support from the relatives and buddies, his own coping style because of this he could not analyze as he couldn't remember and concentrate and solve problem reduced coping reservoir. Although my patient was educated but anticipated to circumstances he was unable to perform as a healthy person while this model was used previously for medical students wellbeing and stress coping called as coping tank, It entails person head biology, personal frame of mind and environment which show and inhibit the symptoms. There isn't a single factor responsible for maladaptive tendencies; my patient used his coping skills in a poor course that is anger or burn out. On the other hand there is a protecting factor which isn't only helps to protect a person from suffering a relapse because we spend less time on health promoting pursuits like exercise and socializing. The coping reservoir is drained and loaded consistently as person confront the countless competing demands for their, cognitive and psychological resources, ability to recognize when to rest and recharge.
In comparison, when the individual gets family support, psychosocial support the tank replenished, the natural procedure for resilience can blossom. An evaluation of the patient internal point out and coping reserve-and how these may be impacting resilience or burnout-is needed by using range. Again referred the individual scenario, the patient will not use any protecting factor that's the reason patient came up again due to relapse (anger and aggression). Patient must get the resources and opportunities to be more alert to their own health insurance and well-being during training and develop lifelong skills to keep their reservoirs full. By considering Basch's developmental model, we have been better in a position to start to see the fluidity of the reservoir model. By conditioning the internal composition, and promoting resilience and personal expansion. ( See Appendix A).
As much as nursing process is concern, referred to patient scenario the whole above article described the internal and external factors that helps to build resilience my first step was to build relationship which was necessary to start resilience then indicate him his own feelings that is anger.
In planning, and execution period my goal was to make him learn positive thinking and socialize after reading literature although from the long-term goal. I had developed plan according to your cultural context that can benefit the patient and the mental doctor as well. Matching to Mayo Center. com article of (2007). Some individuals are in a natural way more resilient than others, probably because of a propensity to be positive thinkers. But most of us can figure out how to become more resilient with practice. Life experience will show us that the majority of the negatives of life are transient. We lose a romance, but enter into a much better one. But study from it and make better choices in the future initially, at specific level, I designed for counseling time. Thus giving a person chance to speak through every day issues. Patient able to verbalize his emotions and work collaboratively to solve his problems. For evaluation i used anger size (happy, sad, upset, angry and rage) The goal of repeating this to see what's the actual reason behind anger that exercise help him to echo after himself, so he can identify his own positive features. Firstly, I used resilience scale to evaluate how resilient he's? Corresponding to Dr. Gail Wagnild, co-inventor Resilience Range User's Guide (2006), said if your resilience level is low but this won't mean you have zero resilience (p. 2). Everyone is resilient to some degree my patient rating was 127 which is low, can improve a resilience by doing so will make a significant positive change in one's life. Secondly I asked him to create an essay on "Myself" which he did then next step I asked him to write a letter of forgive and forget for his family additionally, arranged a present wrapping activity to socialize and bargain by managing anger. All together he indulges himself in group activities as well.
Another strategy used was yoga and guided imagery with help of a community sociable worker and doctors of Karwan-e -e Hayat which he started doing and was being self-confident by doing gentle strengthening exercise. Thankfully, talk to his mom on cellphone how family support helps him, arranged family ending up in senior Psychiatrist. Lastly, I asked him to continue practice of religious beliefs which is also a helpful strategy for building resilience in mental health. In this article Role of Trust compiled by Dr Niaz (2006), prayer used as an integral coping way of appearing out of the problems. The balance of faith appears to contribute more resilience than vulnerability. A great many other experts support this fact. I m glad the result family and doctors were happy to start to see the patient motivation improving and family also eager to support. Further, there's a need to make support group, which will serve as a system, helps the individual to ventilate their disappointment. For government part I plan to publish in media paper about why people have maladaptive behaviors when it comes to mental health.
Own thinking/ prejudices and learning:
Journey of mental health was very interesting and hard as a health care professional to help patient to build resilience at individual, family, and community which I was not aware of. Furthermore, we cannot change the health policy of the united states rather we can take initiative to provide awareness programme by educating the family and personnel if my patient family acquired this information earlier they would have helped him to live a normal life without stigmatization of being mentally ill. Through literature I realized idea of resilience applied not and then mentally sick but healthy person also. Likewise I m using the same idea of resilience in my senior citizen rotation as well. During this rotation we are organizing instructors of the trainee program at institutional level plus community level to promote mental health.
Conclusion and Summarization:
I conclude that Medical is a technology concerned with promoting the physical and mental health, learning new reasons for having yourself and the exterior world, nurturing your self-confidence and self-esteem so you feel strong, ready and self-reliant and hopeful. If this awareness gets by the folks of Pakistan then you will see a great decrease in volume of mental health issues in the country. An understanding of the concept will better put together nurses to enhance well being and better away.