Barriers that facilitate the worsening of mental health conditions
I have not been able to perform any clinical hours yet for this quarter because my preceptor is out of town, but I performed practicum with this preceptor last quarter. During this experience, I noticed many patients present with mental health concerns such as anxiety and depression. One patient was in his mid 30s, and he ended up quitting his job due to not being able to manage his anxiety.
The patient stated his anxiety symptoms started about 4 months ago, and he tried to manage it independently; however, his anxiety continued to get worse. My preceptor started the patient on sertraline and also gave the patient a one month supply of buspirone to take while waiting for the sertraline to take full effect. Since this patient\’s anxiety symptoms have greatly impacted the patient\’s quality of life, we decided that a psychiatric referral was also indicated.
We discussed the referral with the patient and sent the electronic referral order; however, my preceptor later explained to me how difficult it is to get patients in to see psychiatric providers, and sometimes the waiting period for referrals is 6-8 months. The primary care clinic is in a rural area, so resources are limited.
Anxiety disorders are the most common psychiatric disorder, and they are often under-treated by primary care providers (Bandelow et al., 2022). While most primary care providers focus on preventive health and treating common chronic illnesses such as hypertension and diabetes, it is extremely important for primary care providers to recognize and adequately treat common psychiatric disorders that can be safely managed in the primary setting.
With approximately 43.6 million American adults experiencing some form of psychiatric illness, it is crucial for primary care providers to have a good understanding of mental illness to ensure patient safety (Colorafi et al., 2017).
Even when primary care providers recognize a patient with a psychiatric disorder, there are often barriers that prevent the patient from seeking mental health counseling, such as financial concerns and poor accessibility (Colorafi et al., 2017). During my time with the patient, I made sure to educate on support systems at home, relaxation techniques, meditation, music therapy, journaling, healthy diet, and exercising as ways to help manage anxiety.
Cognitive behavioral therapy is another form of treatment that can be implemented by primary care providers to treat anxiety. Cognitive behavioral therapy works by helping change the patient\’s thought process and reduce the amount of negative or fearful thoughts a patient experiences (Otte, 2022).
Mental health disorders as very complex, which is why it is a speciality of its own; however, many barriers prevent these patients from seeing a psychiatric professional. My action plan moving forward is to be more aware of the barriers for patients with mental health disorders and ensure that frequent follow-ups are implemented until the patient\’s symptoms well managed.
I will admit I have been waiting for a patient to come into the urgent care clinic where I am currently working for my last practicum with a laceration so that I could finally have the opportunity to stitch someone up. I have only stitched the “fake skin” most of us received a few quarters ago.
Someone came to my clinic in week one requiring stitches! So, I had to tell the patient that I was a student, and she said that she would still allow me to stitch up her finger! She used to be a registered nurse, and said that I “needed to learn somehow”. I was beyond thankful, and thrilled. I will speed ahead, and tell you that my stitches looked great according to the injured nurse, and the nurse practitioner (NP). However, my reflection post is not really about my stitches alone.
For more effective medical care like my patient’s laceration on her finger, a digital block is commonly used to block the nerves (Driscoll & Hassan, 2019). I used lidocaine to anesthetize her finger. Lidocaine is often used for local anesthesia, when \”combined with epinephrine the local vasodilatory effects of lidocaine are opposed\” (Beecham et al., 2021). Digital blocks avoid systemic complications (Driscoll & Hassan, 2019).
Adding epinephrine subcutaneously with lidocaine solution has positive effects like in plastic surgery to reduce intraoperative blood loss (Kim et al., 2020). However, conventional wisdom was clear: “Epinephrine should never be used in an end-arterial field (eg, digits, pinna, nose, penis) owing to the risk for necrosis” (Paauw, 2019). Due to this old body of evidence many continue to advise against the use of the lidocaine-epinephrine solution even though recent research debunks this as inaccurate (Driscoll & Hassan, 2019).
In fact, lidocaine preparations containing epinephrine cause demonstrable cardiovascular effects even if only given in small amounts (Kim et al., 2020). In a small randomized, double-blind trial, patients receiving lidocaine-only blocks experienced complications, whereas the group that received lidocaine plus epinephrine solutions had no complications (Paauw, 2019).
First, I want to do more research before I add epinephrine to lidocaine before suturing a patient. If I continue to find more evidence that states that adding epinephrine to lidocaine is beneficial then I will do so in the future. I believe medicine is always evolving, and we should always try to discover new and better ways to treat our patients.
Response to Post 1
#Name, your argument clearly explains the barriers that facilitate the worsening of mental health conditions, such as the failure of patients to accept early enrolment into mental health treatment and the unavailability of resources for managing the psychiatric disorders in primary health facilities. You have also elaborated on its prevention mechanisms, such as cognitive behavioral therapy, relaxation techniques, meditation, and counseling.
Therefore, to further support your argument, accessing the treatment is often challenging due to the unavailability of policies for coordinating and implementing the mental health services (Tristiana et al., 2018). Some countries have limited laws and regulations protecting the civil rights of such patients. Also, stigmatization hinders patients from accepting mental health treatment. It results from the fear of being secluded or discriminated against.
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Lastly, lack of education makes it challenging for individuals to recognize their mental health conditions and seek treatment. (Tristiana et al., 2018). Most individuals and families in developing countries lack knowledge about mental illness, hindering their potential and response to treatment. Henceforth, governments in those countries must introduce laws protecting the rights of mentally ill people and offer mass education about mental illness.
Response to Post 2
#Name, engaging more patients during your practicum hours is important in enhancing your experience. You have highlighted the use of digital nerve blocks in treating wound lacerations, including the concerns related to using lidocaine-epinephrine solutions during the process.
Henceforth, to add to your observations about the need to continue using lidocaine-epinephrine solutions, it is essential to note that epinephrine is still the most appropriate adjuvant for slowing bleeding and reducing anesthetic absorption. Sallum et al. (2022) observe that using epinephrine with lidocaine improves laceration treatment by improving the patient’s comfort and increasing the duration of action of the anesthetic agent. It also improves healing and outcomes of the treatment process.
Also, it leads to limited vascular diffusion, which ensures a higher, safer dose administration. Thus, you can continue using lidocaine-epinephrine during laceration treatment as long as its patient-tailored to consider factors such as comorbidity, catecholamine sensitivity, hemostasis, and duration of wound repair.
Sallum, Y., Fodor, L., Mărginean, G., & Bodog, F. (2022). Combined distal median nerve block and local anesthesia with lidocaine: epinephrine for carpal tunnel release. Heliyon, 8(3), e09119.
Tristiana, R. D., Yusuf, A., Fitryasari, R., Wahyuni, S. D., & Nihayati, H. E. (2018). Perceived barriers to mental health services by the family of patients with mental illness. International journal of nursing sciences, 5(1), 63-67.
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