Essay on Mental Health: Patient Behavior, Nursing Role, and Practices

This essay delves into the complexities of mental health care, focusing on the challenges posed by patient behavior and the crucial role of nurses in managing these issues. It examines the impact of challenging behaviors, which can range from verbal aggression to physical harm, on both patients and healthcare providers. The essay explores the intrinsic and extrinsic factors that trigger such behaviors, emphasizing the importance of risk assessment and the creation of safe environments. It highlights various intervention strategies, including de-escalation techniques, patient seclusion, and pharmacological interventions, while also acknowledging the ethical considerations and potential negative outcomes associated with each. The role of nurses in implementing these strategies, advocating for patient needs, and reflecting on their practice is thoroughly discussed. The essay also considers the consumer perspective, emphasizing the impact of challenging behaviors on families and the importance of compassionate, empathetic approaches. The essay concludes by discussing the implications for future nursing practice and the need for ongoing training and skill enhancement in mental health care.

Running head: ESSAY ON MENTAL HEALTH
Essay on mental health
Name of the student:
Name of the university:
Author note:

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ESSAY ON MENTAL HEALTH
Introduction:
Mental illness has been discriminated against and treated as one of the greatest social
taboos. Due to the advancements of the mental health care sector, the myriad of mental illnesses
have attained the status of an illness equivalent to other physical illnesses. However, there still
are a varied range of challenges complicating the mental health care delivery among to the
various different mental patients. One of the most important challenges that the mental health
nurses experience while handling the various different mental patients is the challenging
behavior and handling it affectively (Sallis, Owen & Fisher, 2015). Most of the burnout among
the mental health nurses have been attributed to the stress of handling challenging behavior
among of the mentally ill patients. Along with that, there is mounting evidence that in case the
mental health nurses are not able to handle the challenging behavior of the mentally ill in an
effective manner it can lead to considerable violent tendencies among the patients and can even
lead to physical harm as well. This essay will attempt to explore the current literature regarding
handling the challenging behavior among the mentally ill patient, the role of nurses, effective
practice models and protocols, patient perspectives and future nursing practice implications.
Challenging behavior can be described as any behavioral activity of an individual which
can potentially lead to physical or physiological harm to the mentally ill patient themselves along
with the other care individuals or family members. As mentioned by Price et al. (2015), the
behaviors of the mentally ill patients that can also destroy the property around them which can
also potentially hurt the mentally ill patients and those around them. The challenging behaviors
exhibited by the mental patients can be intentional or unintentional, however, in most cases, the
most devastating challenging behaviors expressed by the patients suffering from mental
disorders are unintentional and cause severe harm to their own health and safety. There is

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mounting evidence that indicates at the challenging behavior being one of the most important
contributing factor that restricts adequate care delivery for the mentally ill patients as well.
Exploring into this particular issue further, the extent of challenging behaviors act as a potential
barrier that restricts the care provider from being able to provide adequate care to the mentally
ill, in fact in most cases the mental health care providers are terrified of engaging with or
interacting with a mentally ill patient who is exhibiting the signs of challenging or violent
behavior (Iozzino et al., 2015).
One of the most important contributor to the unrest and disinterest among the mental
health care staff is the perception among the mental health nurses of their safety being
compromised along with other patients in the in-patient setting. However, it has to be mentioned
that challenging behavior puts the mental patients at extreme risk of both physical and emotional
harm and along with that, in case their challenging behavior is not adequately managed, it can
eventually lead to injuries for both the patient and others associated with them. Hence, it is
crucial for the mental health staff to develop protocols and guidelines to handle challenging
behavior effectively so that the harm can be minimized or controlled. However, research
suggests that it is crucial for the mental health nurses to focus on the extrinsic and intrinsic
factors that act as potential triggers of the challenging behavior among the mentally ill patients
(Fortinash & Worret, 2014).
More than 75% of the mentally disabled patients are associated with challenging behavior
and hence the mental health nurses are often subjected to a variety of different safety risks and
burnout. There are various best practice protocols available for use for mental health nurses to
handle the different challenging behaviors. First and foremost, the most of the guidelines direct
the nurses to focus on the extrinsic band intrinsic factors that trigger or facilitate the challenging

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behavior in the patients. Elaborating more, intrinsic factors are the personal feelings, thoughts,
emotions, along with the health status of the mentally ill patient. On the other hand the extrinsic
factors that facilitate the challenging behavior in the patients are the environment and the other
people around the patient that can also trigger the challenging behavior in the patient as well.
The recommendation in this case is to assess the patient for the signs of these factors developing
the chances of challenging behavior in the patients. Along with that, the authors have
recommended the mentally unstable patients to be provided the aid of a comfortable and reliable
environment so that it can minimize the risk of challenging behavior exacerbating. As opined by
Heckemann et al. (2015), providing the assistance of activity rooms and spaces where the
mentally unstable patients can interact and have therapeutic communication, it has been
successful in managing the impact of challenging behaviors more effectively.
On a similar note, risk assessment of the mentally ill, patients is also a very useful and
excellent method to ensure better management of the challenging behavior among the mentally
ill. As mentioned by mental health authorities, training and educating the mental health nurses
with adequate skill enhancement and briefing of carrying out challenging behavior risk
assessment for the mentally ill patients have been described as one of the most significant
measures to prevent and better manage the occurrence of challenging behavior (Baer, 2015). One
a more elaborative note, these risk assessment procedures have been reported to aid the patients
with predicting the pattern of challenging behaviors that the mentally ill are prone to and the
extrinsic or intrinsic factors that trigger the exact pattern of challenging behavior so that the
optimal management strategies can be designed to manage the challenging behavior. Along with
the more popular and abundantly used techniques of patient risk assessment, de-escalation has
also emerged as another very common technique opted by the mental health nurses to handle the

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challenging behavior of the mentally ill patients. This particular technique helps in preventing
the challenging behavior of the mentally ill patients from turning violent and up-sitting. This
technique involves verbal communication with the patient, the care providers have to offer
undivided attention and nonjudgmental approach focus while handling the patient. Patient
seclusion of the mentally ill patients that are extremely prone to violent challenging behavior has
also been proven to be successful as well, however it is also associated with negative outcomes
for the patient as it has the possibility of affecting the dignity and integrity of the patient. Lastly,
the implementation of pharmacological intervention is also used in certain cases to manage
challenging behavior, however it has been contraindicated in most cases. On a more elaborative
note, Thornicroft et al. (2016) have mentioned that each drug is associated with individual risks
and adverse effects which can affect the condition of the patient as well. Along with that, it has
to be mentioned that the sedating medication that is used to manage the challenging behavior of
the mentally ill patients should be used very carefully so that there are no added risk to the safety
and efficacy of the patients.
While administering the above mentioned approaches to manage the challenging
behavior of the mentally ill and unstable, the role of the nursing professionals is an essential
element. It has to be mentioned that nurses are the first point of contact for the mentally ill when
seeking out care, and the mental health nurses are the care providers that are entasked with the
responsibilities of handling the patients and safeguarding the best interests of the patients at all
costs. According to the standards of registered nurses as per NMBA as well, the nurses are
expected to provide safe and effective care to the patients and advocate their care needs
effectively all the while ensuring the safety and wellbeing of the patients
(Nursingmidwiferyboard.gov.au, 2018). Along with that, the NMBA standards also recommend

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the nurses to prioritize the best interest of the patients above everything else and ensure optimal
cultural safety while addressing to the needs of the patients. Hence, for mental illness scenario,
while handling the challenging behavior, the mental health nurses are also required to abide by
these protocols and guidelines as well. It has to be mentioned that all the best practice strategies
mentioned above that has been recommended in literature for use to better manage the
challenging behavior has to be administered by the nurse and hence administering these
interventions correctly also is a very important roles of the mental health nurses. As mentioned
by Hallett and Dickens, (2015), the de-escalation and patient risk assessment is the first in line
responsibility of the mental health nurses while encountering challenging behavior such as
irrational response, agitation, confusion, and delusions. However, when the nurses are subjected
to violence and uncontrollability from the mentally ill patient seclusion and sedation can be used
by the nurses, however care to be taken to avoid these extreme measures until the challenging
behavior has the potential to injure the patient or the care provider. On the contrary, although the
primary purpose of the nurses hike managing the challenging behavior of the nurses is to
minimizing physical and emotional that can be caused by the challenging behaviors exhibited by
the patients, the learning from reflecting on practice is a very important aspect of professional
roles and responsibilities of the mental health nurses. On a similar note, Brophy et al. (2016)
have mentioned that following a serious event of challenging behavior exhibited by the patients
where there had been instances of physical or actual harm to either the patient himself or the care
provider there is need for post-incident review studies here the nurses involved are needed to
reflect on the experience and learn new insights that can help inform future practice.
The consumer perspective of the challenging behavior exhibited by the mentally ill is a
very important aspect in the mental health care scenario. It has to be mentioned that for the

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varied range of different mentally ill patients, the cost of the challenging behavior, such as
agitation, irritation and confusion or delirium has a much more influential impact of the family
members off the patients. Elaborating more, as discussed by Chan (2016), the most delimiting
impact of the challenging behavior on the family members is of violence. In the most cases, the
patients that are going through a svere mental illness and experience violent and risky
challenging behavior are often secluded and sedated to control. In the past, physical restrain has
also been one of the most abundantly used technique for managing challenging behavior and
containing the patients exhibiting those challenging behavior. This has had a profound impact on
the lived experience of all consumer groups. Including patients and their family and loved ones.
The struggle and grief of watching their loved one going through such pain and uncontrollable
bouts of challenging behavior and then be restrained or secluded as only options has been
depressing, distressing and overall a negative experience for the family members (Burns & Rose,
2013). Although the practice of using physical restraints to contains mental patients at risk of
challenging behavior is significantly reduced in the last few years, the impact of seclusion or
sedation as the measure for challenging behavior has also been reported to be a great deal of
discomfort and psychological distress for the patient families. However, there is mounting
evidence that indicates at de-escalation and pre-incident risk assessment are the most favoured
approaches for the families. The empathetic and compassionate approach represents a much
more personal and merciful techniques in the perception of the family members of the mentally
ill, hence there is need for better training and skill enhancement in the mental health nurses to
enhance the use of these techniques for managing challenging behavior (Ross, Campbell & Dyer,
2014).

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On a concluding note, challenging behavior is an umbrella term which encompasses a
number of different elements associated with the altered mental state of the patient. The
challenging behavior is undoubtedly one of the greatest barriers to adequate care service delivery
and recovery. Furthermore, it must not be ignored that the challenging behavior, regardless of the
fact that it is intentional or unintentional, is a restrictive element that deteriorates and
complicates the quality of life for the patients and their family members. Hence, the importance
of adequate management of the challenging behavior is extreme and along the years there have
been any changes that have been brought forward in the techniques of managing challenging
behaviors,. The essay has successfully identified the challenging behavior management strategies
in place in the present mental health care scenario, the nurse’s role and the consumer
perspectives regarding the methods that have been used and is being used presently. It has been
discovered that merciful techniques such as de-escalation and risk assessment are preferred
option for not just the consumers but also the nurses due to the lesser moral distress associated
with it. Hence, there is need for more research on the more merciful and compassionate
techniques of managing challenging behavior exhibited by mentally ill individuals.

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References:
Baer, R. A. (Ed.). (2015). Mindfulness-based treatment approaches: Clinician's guide to
evidence base and applications. Elsevier.
Brophy, L. M., Roper, C. E., Hamilton, B. E., Tellez, J. J., & McSherry, B. M. (2016).
Consumers’ and their supporters’ perspectives on barriers and strategies to reducing
seclusion and restraint in mental health settings. Australian Health Review, 40(6), 599-
604.
Burns, T., & Rose, D. (2013). How can the service user voice be best heard at psychiatric
meetings?. The British Journal of Psychiatry, 203(2), 88-89.
Challenging behaviour strategy :: SA Health. (2018). Retrieved from
http://www.sahealth.sa.gov.au/wps/wcm/connect/Public+Content/SA+Health+Internet/
Clinical+resources/Clinical+topics/Challenging+behaviour+strategy
Chan, J. (2016). Challenges to realizing the Convention on the Rights of Persons with
Disabilities (CRPD) in Australia for people with intellectual disability and behaviours of
concern. Psychiatry, Psychology and Law, 23(2), 207-214.
Fortinash, K. M., & Worret, P. A. H. (2014). Psychiatric Mental Health Nursing-E-Book.
Elsevier Health Sciences.]
Hallett, N., & Dickens, G. L. (2015). De‐escalation: A survey of clinical staff in a secure mental
health inpatient service. International journal of mental health nursing, 24(4), 324-333.
Heckemann, B., Zeller, A., Hahn, S., Dassen, T., Schols, J. M. G. A., & Halfens, R. J. G. (2015).
The effect of aggression management training programmes for nursing staff and students

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working in an acute hospital setting. A narrative review of current literature. Nurse
education today, 35(1), 212-219.
Iozzino, L., Ferrari, C., Large, M., Nielssen, O., & De Girolamo, G. (2015). Prevalence and risk
factors of violence by psychiatric acute inpatients: a systematic review and meta-
analysis. PloS one, 10(6), e0128536.
McSherry, B. (2013). The legal regulation of seclusion and restraint in mental health
facilities. Journal of law and medicine, 21(2), 251-254.
Nursing and Midwifery Board of Australia - Home. (2018). Retrieved from
https://www.nursingmidwiferyboard.gov.au/
Price, O., Baker, J., Bee, P., & Lovell, K. (2015). Learning and performance outcomes of mental
health staff training in de-escalation techniques for the management of violence and
aggression. The British Journal of Psychiatry, 206(6), 447-455.
Price, O., Baker, J., Bee, P., & Lovell, K. (2018). The support-control continuum: An
investigation of staff perspectives on factors influencing the success or failure of de-
escalation techniques for the management of violence and aggression in mental health
settings. International journal of nursing studies, 77, 197-206.
Ross, D., Campbell, J., & Dyer, A. (2014). Fostering trauma-free mental health workplace
cultures and reducing seclusion and restraint. Social Alternatives, 33(3), 37.
Sallis, J. F., Owen, N., & Fisher, E. (2015). Ecological models of health behavior. Health
behavior: Theory, research, and practice, 5, 43-64.

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Thornicroft, G., Mehta, N., Clement, S., Evans-Lacko, S., Doherty, M., Rose, D., ... &
Henderson, C. (2016). Evidence for effective interventions to reduce mental-health-
related stigma and discrimination. The Lancet, 387(10023), 1123-1132.