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NRNP-6660, WK6-Discussion, Initial Post (Treatment of Psychiatric Emergencies in Children Versus Adults)
When an individual’s behavior is out of control that the person is a danger to self and others, the situation is referred to as a psychiatric emergency. According to Newman and Ravindranath (2010), psychiatric emergencies entail situations in which individuals cannot refrain from putting themselves or others in danger. It is critical to recognize signs of psychiatric emergencies and be aware of how the situation can escalate if immediate actions are not taken to diffuse or address the situation. Signs of psychiatric emergency include agitation, screaming or yelling, throwing, or banging on objects, and lashing out.
The Case Selected
A psychiatric emergency that one witnessed was a dangerous situation. The patient is a 53-year-old African American female in a secured/locked down unit. The patient has a history of schizophrenia, Bipolar Disorder, Diabetes, and Hypertension. The patient is ambulatory with a walker.
For three days, the patient talked about going home, but her request was not granted. Her older sister, the only family member, refused to have the patient back home because she could not care for the patient. The patient got angry and refused to take her medications. The primary care physician and the patient’s sister were made aware. The primary care physician referred the patient for a psychiatric consult. By the time the psychiatrist saw the patient, two days later, it was too late. The psychiatrist witnessed the patient being aggressive. She was screaming and yelling. She hit her roommate in the face with her walker and attempted to hit staff. She was moving up and down the hallway attempting to hit anything and anyone in her way. She even tried to bite staff and spat at some of the staff. The police were called with a request for a backup. It took four police officers and four other staff members to restraint the patient. The patient was put on four-point restraint on the stretcher and was taken to the hospital for further evaluation.
How one Would Treat the Client Differently if he or she Were a Child or Adolescent
The patient could have been treated differently if she was a child or adolescent. The adolescent would have been assessed and determined that being in a lockdown/secured unit in a long-term care facility would not be the best option for admission. A comprehensive, integrated psychiatric assessment is required to diagnose emotional, behavioral, or developmental disorders. According to Johns Hopkins Medicine (2020), an integrated psychiatric assessment of a child, adolescent, or adult is conducted based on behaviors present and concerning physical, genetic, environmental, social, cognitive, emotional, and educational parts that may be affected by the result of these behaviors (Lawal, 2020). One of the challenges of adolescents’ psychiatric emergency assessment is that collateral data are often necessary to clarify the clinical picture (Gerson & Havens, 2015). With a comprehensive assessment, the adolescent patient would have been given the appropriate treatment in the right environment. According to Sadock et al. (2009), a comprehensive assessment is essential for making an accurate, culturally appropriate diagnosis and developing a specific, culturally sensitive, and effective treatment plan (Wheeler, 2014, pg. 96; Lawal, 2020).
Other than a comprehensive assessment, the child or adolescent’s parents would be involved in the treatment plan, be notified about getting the police involved, being retrained for safety, and transferring to the hospital for evaluation. The parents would be informed about the hospital that the adolescent patient will be transferred to, the information given to how they could have access to resources during the hospital stay and beyond.
Legal or Ethical Issues one Would have to Consider When Working with a Child or Adolescent Emergency Case
Confidentiality is one of the ethical obligations of every psychiatric mental health nurse practitioner. Confidentiality is the right to privacy of every client with specific statutes involving psychotherapist-client privilege (Lymberis, n.d; Lawal, 2020). While confidentiality could be achieved in long-term care facilities, it could be challenging with an adolescent patient who is 19 years old with parents involved in his or her care. The right thing to do would be to obtain consent from the patient before involving the parents in any care or decision-making.
Ethical decision-making is required for appropriate and compassionate clinical care. Therapists or counselors must identify and reflect on the ethical aspect of their practice. Therapeutic boundaries could be maintained by seeking consultations from experts when caring for clients who are challenging to treat or have complex conditions in safeguarding against danger in high-risk situations, and in endeavoring to understand more about mental illness, which are signs of professionalism and ensure ethical rigor in clinical practice (Yang, Schneider, Wynn, & Howe, 2017; Lawal, 2020). Therapists or counselors can effectively manage and resolve ethical dilemmas and challenges by understanding their clients’ ethical obligations and responsibilities.
Gerson, R., & Havens, J. (2015). The Child and Adolescent Psychiatric Emergency: A Public Health
Challenge. Psychiatric Times, 32, 11. Retrieved from https://www.psychiatrictimes.com/view/child-and-adolescent-psychiatric-emergency-public-health-challenge
Johns Hopkins Medicine. (2020). Comprehensive Psychiatric Evaluation. Retrieved from
Lawal, M. (2020). Legal and ethical considerations for group and family therapy. Unpublished
manuscript. Walden University
Lymberis, M. T. (n.d). Ethical and Legal Issues in Group Psychotherapy. Retrieved from
Newman, M., & Ravindranath, D. (2010). Managing a Psychiatric Emergency. Psychiatric Times, 27, 7.
Retrieved from https://www.psychiatrictimes.com/view/managing-psychiatric-emergency
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA: Wolters Kluwer
Wheeler, K. (Ed.). (2014). Psychotherapy for the advanced practice psychiatric nurse: A how-to-guide for
evidence-based practice (2nd ed.) New York, NY: Springer Publishing Company
Yang, S., Schneider, B., Wynn, G. H., & Howe, E. (2017). Ethical Considerations in the Treatment of
PTSD in Military Populations. The Journal of Lifelong Learning in Psychiatry, 15(4), 435-440. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6519518/
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