Leadership in Public Health

This essay explores the role of leadership in public health, specifically in the context of mental health nursing. It discusses the professional knowledge and evidence-based treatment for psychotic depression, as well as the importance of clinical reasoning and decision making. The essay also highlights the need for collaboration and therapeutic relationships in providing care for individuals with mental illness.

Leadership In Public
Health
1

Contents
INTRODUCTION...........................................................................................................................3
CONTEXT - SPECIFIC TO EUNICE’S CASE..............................................................................3
PROFESSIONAL/CLINICAL KNOWLEDGE AND EVIDENCE BASED TREATMENT........6
CINICAL REASONING AND DECISION MAKING..................................................................8
LEADERSHIP.................................................................................................................................9
CONCLUSION..............................................................................................................................10
REFERENCES..............................................................................................................................11
2

INTRODUCTION
Mental health nursing is also called psychiatric nursing which is the specialised area of
nursing practice that includes care of people who suffer from mental health disorder in order to
assist them to recover and enhance quality of life. The main role of Mental Health nurse is to
promote and support recovery of a person, assist them to live independently and fulfilling lives.
The role of nurses to develop effective relationship with individuals who utilize Mental Health
Services along with their families and carers (Brown, 2015). This is an essay report which is
based on the scenario happened in elderly functional unit where a patient 'Eunice' was admitted
to ward and presenting with psychosis symptoms.
This is a reflective essay in which I reflect on a scenario from the area of my nursing
practice, i.e., mental health nursing. In this, I critically explore my professional knowledge,
leadership skills and decision making skills which promote effective practice. It covers context
specific to the case of Eunice along with clinical or professional knowledge and evidence based
on the treatment of disease and disorder from which the patient suffered. Apart from this, clinical
reasoning and decision making is provided along with the leadership skills and qualities which I
applied on the case scenario. At last, a conclusion is provided which cover brief summary based
on the overall report.
CONTEXT - SPECIFIC TO EUNICE’S CASE
Mental health issue is the growing concern associated with public health and it is prevalent
not only in the United Kingdom, all around the world. It is one of the main cause of overall
burden of disease worldwide. Major depression is one of the leading cause of disability all over
the world and is main contributor to ischemic heart disease and burden of suicide. Psychotic
depression is also stated as major depressive disorder with some psychotic features (Callaghan,
and Gamble, 2015). It is a serious issue that needs immediate treatment as well as close
monitoring by mental health professional (Psychotic Depression, 2020). It is a very common
mental disease which can adversely influence many areas of life of an individual and impacts
mood, behaviour and physical function of a person involving sleep and appetite. Individuals with
depression often lose their interest in activities as well as face trouble in performing day to day
activities. Sometimes, they may even feel that life is not worth living. It is estimated that there
are around 20% of individuals suffering from depression also have psychosis symptoms.
3

In case of Eunice, she was present to Elderly Functional Unit symptoms of psychosis. She
was diagnosed with psychotic depression and was having chemotherapy as she was also
suffering from lung cancer. She started presenting with symptoms of aggressiveness and
Paranoia towards staff. She refused to take her medications as she believed that the doctors and
nurses were poisoning her. She constantly to be aggressive towards care professionals and was
take meditation multiple times.
There are some symptoms of psychotic depression including feeling sad, hopeless, no
interest in anything, fatigue, disturbed sleep, feeling worthless and guilty, thoughts of suicide or
death, changes in appetite, loss of pleasure in things. According to the National Health Services,
the cause of psychotic depression is not understood completely. There is no single reason of
depression and it may have many distinct triggers (Psychotic depression, 2019). For some
stressful events in life such as divorce, financial worries, bereavement or serious illness can be
cause. It is sometimes possible to determine the cause of psychosis disorder as a particular
mental health condition like bipolar disorder, schizophrenia and severe depression. It can also be
triggered by drug misuse, alcohol misuse, traumatic experience, physical condition like brain
tumour, stress and side effects associated with prescribed medicines. Apart from this, there are
several complications associated with psychosis including self-harm and suicide (Cleary, and et.
al., 2016).
Usually, treatment of psychotic depression is provided in hospital settings. The patient is
closely monitored by mental health professionals and different medications are provided to
stabilize the mood of an individual including antipsychotic medications and antidepressants. The
antipsychotic drugs influence neurotransmitters which enable communication between nerve
cells in brain areas which regulate ability of an individual to perceive as well as organised
information regarding world around them. In case of Eunice, she was given with lorazepam 0.5
mg which is an antidepressant medication in order to make her feel relaxed and calm.
According to a study, it has been found that around 80% of individuals with psychotic
depression present between age of 16 to 30 years. These people require treatment for first
episode psychosis. As per the Office National statistics, the prevalence of mental health in
children who are between the age of 5 to 16 years was 9.6% (Delaney, 2017). A Welsh study
found high incidence of psychosis in urban dwellers in comparison to the people living in rural
4

communities. Patients with psychosis disorder usually require referral to Mental Health Care
professionals but some investigations are there which can be undertaken in practice. It is very
crucial to recognise as well as manage the psychosis correctly in initial episode as delay in
diagnosis may affect ultimate prognosis adversely. If there is an extrinsic cause such as
substance abuse, then it should be addressed properly. In many areas, family intervention is
available which is an evidence-based support program that assist in reducing the relapse rate of
patient with psychotic disorder early and late stages. The National Institute of Health and Care
Excellence focuses on requirement to treat the patient with psychotic disorder with respect
throughout their overall care plan, involving experience of compulsory hospitalization whenever
needed (Endsley, 2017). The main aim of the treatment of psychosis is to reduce the time
between symptoms appearance and starting therapy. It also makes use of psychological and
biological measures which assist in maximizing the ability of patient to get back into normal life.
PROFESSIONAL/CLINICAL KNOWLEDGE AND EVIDENCE BASED
TREATMENT
Professional knowledge is acquired by an individual through educational or experience,
practical or theoretical understanding of subject. The professional or clinical knowledge required
in the provided scenario is related to the area of Mental Health Nursing. According to the
viewpoint of Yolanda Smith, 2019, mental health nursing is a specialised area of nursing practice
that includes care of people with mental health disorder in order to assist them to recover and
enhance life quality. Mental health nurses possess advanced knowledge of diagnosis, assessment
and treatment related to psychotic disorder which assist them to administer specialised care.
Mental health nurses work alongside in a medical team with other healthcare professionals with
the aim to administer optimal outcomes for patient (Happell, and et. al., 2018). Mental illness can
affect people of any age, social economic status or ethnic origin. Due to this, it is required by
mental health nurse to work with different professionals from various backgrounds.
Psychotic depression is a major depressive disorder which cause individual to see, hear and
believe things which are not real. There are types of depressive disorder with psychotic
characteristics. Hallucinations and delusions are present in both but the affected people may
experience the depressive disorder with mood incongruent psychotic features or with mood
congruent psychotic features. The disease with mood congruent psychotic features means the
5

content of delusion and hallucination is consistent with depressive themes which may involve
feeling of worthlessness, personal inadequacy or guilt (Choi, and et. al., 2016). On the other
hand, the disorder with mood incongruent psychotic features means the delusion and
hallucination content do not include typical depressive themes. As stated by National Institute of
Mental Health, an individual with psychotic depression is away from reality. They may hear
voices or may have illogical and strange ideas. This people may get angry for no reason and
spend much of the time by themselves, staying awake at night and sleeping during the day.
The key types of psychotic disorder include affective psychosis and schizophrenia. 1 in 6
adults have suffered from common mental disorder such as anxiety and depression. It is found
from the data that men are more suffering from psychosis than women. It has been found from a
survey that the people reporting with major mental health symptoms increase from 7 % in year
1993 to over 9% in year 2014. Since year 2018, the number of suicide also have gone up in
Wales and England individual reporting self-harm goes up by around 62% between 2000 – 2014
(Mental health facts and statistics, 2020).
The evidence based practice approach that constantly ask care practitioner to mix up all their
knowledge sources collectively, their life experience, clinical experience as well as empirical
knowledge acquired through mental health nursing education. There are some standards of
practice which render practical benchmark to guide as well as measure how care is given.
According to the standards, the mental health nurse acknowledges cultural diversity, belief
system and values and ensure that their practice is non-discriminatory as well as promote self-
determination and dignity (Happell, and et. al., 2019). As a mental health nurse, it is very
necessary for me that while providing care to Eunice, I should treat the patient respectfully and
provide her with proper care and treatment without any discrimination based on belief system,
values and culture. Apart from this, the another standard is to establish collaborative partnership
which help in supporting individuals with mental illness to participate in all care aspects.
The another standard is developing a therapeutic relationship with patients and their families
which is respectful of the experiences, circumstances and choices of individual. According to
this standard, I need to building on strengths, improving resilience hand holding hope to promote
recovery (Happell, Wilson, and McNamara, 2015). As a mental health nurse, it is my
responsibility to collaboratively plan as well as administrator care which is based on ethics
consistent with emotional, physical, cultural, spiritual, social and mental needs of individual. In
6

addition to this, the mental health nursing practice incorporate as well as reflects requirements of
common law, relevant statutes along with code of conduct and ethics associated with nursing
profession. As a mental health nurse, I also required to hold specialised qualification and depth
advanced practice, skills and knowledge integrating the standards competently as well as
modelling leadership in setting of care practice (Choi, and et. al., 2016).
It is hard to diagnose psychosis as many individuals with the disorder may be afraid of
sharing their psychotic experiences. Being diagnosed with psychotic depression means an
individual must have five or more symptoms including low energy levels, feeling of guild,
depressed mood, slow motor function or agitation, insomnia, thoughts of suicide, difficulty
concentrating, lack of interest and changes in weight or appetite. Apart from this, a person also
experiences symptoms of delusion and hallucination which are false beliefs and the things that
seem real but does not exist in reality (Harrison, Hauck, and Ashby, 2017). Currently, the
available treatment of psychosis disorder includes medications and electroconvulsive therapy.
According to International classification of diseases, the psychotic depression disorder is
considered to be the most severe depressive disorder. The healthcare professionals and
practitioners can misdiagnose depression along with psychotic features. This is often because of
lack of recognition about psychotic features. In order to diagnose the disorder, the mental health
care professionals perform physical examinations along with blood and urine test in order to rule
out another possible medical issues. If the individual has family history of bipolar disorder, then
the professional may screen main episodes. In case of Eunice, she was also suffering from lung
cancer and it can be diagnosed through initial tests, computerized tomography, chest X Ray, lung
function test and blood test (Hsiao, Lu, and Tsai, 2015). For confirming the diagnosis, the further
tests are conducted by the healthcare professionals including biopsy which involves
bronchoscopy, CT guided lung biopsy, mediastinoscopy, thoracoscopy, endobronchial
ultrasound etc. Molecular testing can also be performed for testing the genetic changes in Cancer
cells.
CINICAL REASONING AND DECISION MAKING
All the learning which I get from nursing practice help me in handling the case of Eunice
happened on elderly functional unit. The previous knowledge which I got from my practice help
me in interacting with Eunice. She was experiencing symptoms of psychotic depression and
7

behave aggressively at times. I was also knowing about my need to validate the feelings of
patient. It is an important approach in mental health nursing practice as it assists to individualize
the care and help me in trying to understand the reason of why the individual behaving in a
certain way (Hunter, Weber, Shattell, and Harris, 2015). As the scenario happened in elderly
functional unit, I was aware regarding various aspects associated with the situation including
current mental state of Eunice along with the circumstances in which she was able to access
healthcare services and support. As a mental health nurse, I was gained a certain level of clinical
knowledge regarding common acute situations as well as the way to identify deterioration.
The outlook in psychosis patient is not as bleak as it once was because of early intervention
policy as well as enhancement in drug treatment. However, it is very much necessary to keeping
in mind that psychosis disorder can lead to devastating consequences. It has been found in the
study that the factors which identified five-year prognosis after initial stage of psychosis
involved global assessment of functioning score in the year before mission admission, actual
global assessment of functioning score at first assessment, education level, Social network and
gender. Another found that around 20% of individuals were in symptomatic as well as functional
remission in 2 years and further study on that confirm the significance of education in
developing insight as a factor related to improved prognosis (Foster, and et. al., 2019).
When Eunice was admitted 2 ward under section 2, she was diagnosed with psychotic
depression and was also having chemotherapy as she was suffering from lung cancer. She was
put on one to one observation in order to keep her safe along with other service users safe as she
was aggressive towards care providers when they try to stop her from leaving. In such situation,
it is very necessary to handle the case appropriately and with patience. At that time, following
the nursing and midwifery council code of conduct help in promoting professionalism and trust
and preserving safety. The codes include treating people as individuals as well as uphold their
dignity. For achieving this code of conduct, it is very necessary for me as and mental health
nurse to treat Eunice with respect, kindness and compassion and ensure to deliver fundamentals
of care in an effective way (Kirkbakk-Fjær, Hedelin, and Moen, 2016). I also need to listen and
respond to the preferences and concerns of patient by working in partnership with her in order to
ensure that care is delivered effectively. The aggressive behaviour of Eunice and her refusal to
take medications can be the contributing factor of psychotic depression in case of Eunice.
8

Decision making is one of the significant process in mental health nursing. It is very much
necessary for a nursing practitioner or other healthcare professional to take appropriate decisions
that help in providing appropriate care to the patient and ensure effective health outcomes. The
decision making or clinical judgement in nursing involves conclusion regarding the needs and
status of patient with determination of methods to execute to mitigate the needs of patient in best
way with determination of methods to execute to mitigate the need of patient involving
assessment of response of patient (McKeown and White, 2015).
In case of Eunice, the decision which I made while providing care to the patient influence
effectiveness in clinical practice and impact the experiences in life of patient with health care.
There are some steps which I considered at the time of taking decision. I first collected the
preliminary clinical information regarding the patient, developing tentative hypothesis regarding
the condition of Eunice, interpreting initially registered cues in light of hypothesis and weighing
decision alternatives prior to choose one best decision by considering evidence collected (Choi,
and et. al., 2016). The decision of providing lorazepam 0.5 mg to Eunice was a collaborative
decision making which was taken by the whole nursing team. The main reason of providing her
with the medication is that she was very aggressive towards the staff and in order to make her
calm, it was very necessary at that time to handle the situation in an effective way and make her
feel that she is safe in the ward along with ensuring the safety of other staff members (Oates,
Drey, and Jones, 2017).
LEADERSHIP
In the overall scenario, I have the opportunity as a mental health nurse to get good
experience from team working, different level of cohesiveness, leadership and different team
working styles. In the scenario associated with Eunice, interdisciplinary team working is the
crucial aspect that help in handling the situation in an appropriate way. The collaborative
working of specialised doctors with other healthcare professionals help in providing Eunice with
appropriate care. Foundation of trust and mutual respect help in delivering the care services
effectively. As a qualified mental health nurse, it is my responsibility to handle the situation
effectively and take a lead (Sercu, Ayala, and Bracke, 2015). As a nurse, I found that the issue
from which Eunice suffered is the complex issue. And it is very necessary at that time to develop
professional therapeutic relationship patient in order to develop trust and provide her with
9

appropriate care services. Apart from this, rather than challenging the norms and values of
teamwork, I adopt the values and norms with the thought that this lead in better and accepted
way (Choi, and et. al., 2016).
As per the nursing and midwifery council codes of conduct, a nurse must be act as an
advocate for challenging work practices, vulnerable and discriminatory attitudes as well as
behaviour associated with care. In the scenario on elderly functional unit, I felt pressure initially
which was not necessarily my nature. This was a challenge and something which I need to
develop as a mental health nurse (Townsend and Morgan, 2017).
In order to perform the mental health nursing role effectively, it is very much necessary for
me to have good qualities and skills of leadership such as ability to delegate the activities
effectively along with self-awareness, good communication, learning agility, empathy and
courage. In order to ensure good leadership, self-awareness is one of the inwardly focused skills
that help me in better understanding myself and improving my practice. Apart from this, learning
agility is the ability to know about what to do. Through effort, practice and experience, the
learning can be foster. Empathy is critical part of leadership effectiveness and emotional
intelligence and is also correlated with performance at work. In order to lead effectively,
empathy is important leadership skill (Kirkbakk-Fjær, Hedelin, and Moen, 2016). Treating
people dignity and respect very crucial things which a leader can do. In my practice of Mental
Health Nursing, I treat people with equal dignity and respect which helped me in effectively
handling the scenario.
CONCLUSION
As per the above mentioned report, it has been concluded that there are several
responsibilities which has to be performed by a mental health nurse in a professional setting.
Nurses are required to follow all the professional standards and codes of conduct in order to
perform roles and responsibilities effectively and ensure that high quality care must be delivered
to the patients which contributes in their healthy lives. There are some aspects of professional
knowledge, decision making skills as well as leadership qualities that help in promoting effective
practices in nursing care.
10

REFERENCES
Books and Journals
Brown, A.M., 2015. Simulation in undergraduate mental health nursing education: A literature
review. Clinical Simulation in Nursing, 11(10), pp.445-449.
Callaghan, P. and Gamble, C. eds., 2015. Oxford handbook of mental health nursing. Oxford
Handbooks in Nursing.
Choi, H., and et. al., 2016. Clinical education in psychiatric mental health nursing: Overcoming
current challenges. Nurse education today, 39, pp.109-115.
Cleary, M., and et. al., 2016. Hope and mental health nursing. Issues in mental health
nursing, 37(9), pp.692-694.
Delaney, K.R., 2017. Psychiatric mental health nursing advanced practice workforce: Capacity to
address shortages of mental health professionals.
Endsley, P., 2017. School nurse workload: A scoping review of acute care, community health,
and mental health nursing workload literature. The Journal of School Nursing, 33(1),
pp.43-52.
Foster, K., and et. al., 2019. Resilience and mental health nursing: An integrative review of
international literature. International journal of mental health nursing, 28(1), pp.71-85.
Happell, B., and et. al., 2018. Nursing students’ attitudes towards people diagnosed with mental
illness and mental health nursing: An international project from Europe and
Australia. Issues in mental health nursing, 39(10), pp.829-839.
Happell, B., and et. al., 2019. Changing attitudes: The impact of Expert by Experience
involvement in Mental Health Nursing Education: An international survey
study. International journal of mental health nursing, 28(2), pp.480-491.
Happell, B., Wilson, R. and McNamara, P., 2015. Undergraduate mental health nursing
education in Australia: more than mental health first aid. Collegian, 22(4), pp.433-438.
Harrison, C.A., Hauck, Y. and Ashby, R., 2017. Breaking down the stigma of mental health
nursing: A qualitative study reflecting opinions from western australian nurses. Journal
of Psychiatric and Mental Health Nursing, 24(7), pp.513-522.
Hsiao, C.Y., Lu, H.L. and Tsai, Y.F., 2015. Factors influencing mental health nurses' attitudes
towards people with mental illness. International Journal of Mental Health
Nursing, 24(3), pp.272-280.
Hunter, L., Weber, T., Shattell, M. and Harris, B.A., 2015. Nursing students’ attitudes about
psychiatric mental health nursing. Issues in Mental Health Nursing, 36(1), pp.29-34.
Kirkbakk-Fjær, K., Hedelin, B. and Moen, Ø.L., 2016. Undergraduate nursing students’
evaluation of the debriefing phase in mental health nursing simulation. Issues in mental
health nursing, 37(5), pp.360-366.
McKeown, M. and White, J., 2015. The future of mental health nursing: are we barking up the
wrong tree?. Journal of Psychiatric and Mental Health Nursing, 22(9), pp.724-730.
Oates, J., Drey, N. and Jones, J., 2017. ‘Your experiences were your tools’. How personal
experience of mental health problems informs mental health nursing practice. Journal of
psychiatric and mental health nursing, 24(7), pp.471-479.
Sercu, C., Ayala, R.A. and Bracke, P., 2015. How does stigma influence mental health nursing
identities? An ethnographic study of the meaning of stigma for nursing role identities in
11

two Belgian Psychiatric Hospitals. International journal of Nursing studies, 52(1),
pp.307-316.
Townsend, M.C. and Morgan, K.I., 2017. Psychiatric mental health nursing: Concepts of care in
evidence-based practice. FA Davis.
Online
Psychotic Depression, 2020. [Online]. Available through:
<https://www.webmd.com/depression/guide/psychotic-depression#1>
Mental health facts and statistics, 2020. [Online]. Available through:
<https://www.mind.org.uk/information-support/types-of-mental-health-problems/
statistics-and-facts-about-mental-health/how-common-are-mental-health-problems/>
Psychotic depression, 2019. [Online]. Available through:
<https://www.nhs.uk/conditions/clinical-depression/psychotic-depression/>
12