The presenting symptoms of Razzaq

Discuss About The International Journal Mental Health Systems?

Post-traumatic stress disorder (PTSD) is a disorder that develops in some individual after exposure to a threatening, dangerous, scary or shocking event. For instance, victims of war are likely to develop PSTD. This assignment is based on the case of Razzaq, a refugee from Iraq who lives in Australia and has been experiencing symptoms of PTSD. Firstly, it will discuss the symptoms of Razzaq and available help from an RN and other care providers. Secondly, the assignment will explore the mental health assessments required to examine Razzaq. Thirdly, it will discuss the interventions to manage Razzaq. Fourthly, it will examine the ethical and legal principles to required in patient-centred care. Finally, the paper will determine the cultural needs of the Razzaq and discuss culturally based care for the patient.

Razzaq presented with several symptoms, which are intrusion, avoidance, and hyperarousal symptoms. Intrusion symptoms are symptoms that cause a victim to re-experience traumatic events and might be uncontrollable and unintentional. Razzaq presented with intrusion symptoms including awful nightmares and flashbacks. According to the case study, the washing machine reminds him of the noises from war, which is a disturbing flashback. Flashbacks are disturbing because the event starts from what the victim regards to be the gravest point of their past trauma (Hirsch & Holmes, 2007). Avoidance symptoms cause a victim to avoid places or items that remind of their past trauma. Razzaq tends to hide away for days to avoid his family. Avoidance behaviour symptoms make it challenging for victims to engage in social functions and live a normal social life (Levin, Kleinman, & Adler, 2014). Hyperarousal symptoms include irresponsible behaviour, anger as well as angry outbursts. Razzaq presented with hyperarousal symptoms since he gets angry and yells at his wife and children. Also, he has hit his wife on various occasions due to anger.

An RN is in a better position to provide support for Razzaq because he has discussed his symptoms. The primary goal of the provider is to enable the victim and family to develop a sense of empowerment and attain control over their symptoms. The RN and other healthcare professionals should first understand how the symptoms make Razzaq feel for them to achieve this objective. They should then strive to develop a communicative and trust-based relationship with Razzaq to open up a pathway for recovery. The techniques that the nurse can use are listening, normalising responses and reframing. The RN and other healthcare professionals should be amenable and listen to Razzaq’s expressions of his feelings. As revealed through the case study, the Razzaq’s feelings are negative and include the expression of anger, shock and depression (Benson & Thistlethwaite, 2009). The nurse should allow Razzaq to express these feelings because the primary role is to listen without judging the victim. To normalise Razzaq’s responses towards the traumatic event, the RN and other healthcare professionals should endeavour to support the victim’s strengths in the face of the trauma. Razzaq should then be trained on coping techniques based on his strengths. The family should also be advised to accept Razzaq as a member of the family and help him fit in the social life. Family therapy that involves Razzaq’s wife and children might be helpful in this case. Approaching a victim based on their strengths and capabilities is more therapeutic than emphasising on their problems and shortcomings (Rumpler, 2008). Most importantly, the care provider should inform Razzaq that the traumatic event did not occur because he is a horrible person or deserved it.

Assistance from an RN and other healthcare providers for Razzaq and his family

The mental health assessments that are needed for Razzaq are PTSD symptoms, the severity of depression and the exposure to war. Cross-cultural sensitive and refugee adapted assessments that can be used for Razzaq are IES-R, Hopkins Symptom Checklist and Afghan War Experience Scale.

For Razzaq, the symptoms of PTSD can be assessed using the impact of events scale-revised (IES-R). The IES-R is a self-report scale that is widely used to assess PTSD symptoms. In the past, this tool has been used to measure the symptoms of PTSD in Afghan and Iraq refugees in Australia. This assessment tool has solid psychometric properties and a good internal consistence. One study was designed to test the diagnostic utility of the IES-R as an assessment tool for PTSD in individuals exposed to war. Two independent samples, n=854 and n=3313 were used for this study for this study (Morina, Ehring, & Priebe, 2013). Based on this analysis, the IES-R will be an appropriate tool for assessing the mental health status Razzaq.

The severity of depression symptoms will be a fundamental mental health assessment for Razzaq. The mental health assessment can be performed using the Hopkins Symptoms Checklist-25 (HSCL-25). This diagnostic tool is a 25-item questionnaire consisting of two scales for anxiety and depression symptoms (Rickels, Khalid-Khan, Gallop, & Rickels, 2009). The depression symptoms scale contains 15 items while the anxiety symptoms consist of 10 items. In the diagnosis of depression, the HSCL-25 portrays high internal consistency, test-retest reliability and good validity. Thus, the HSCL-25 is an appropriate assessment tool for Razzaq.

Razzaq should be assessed mentally to determine the level of exposure to war and violence. The Afghan War Experience Scale (AWES) can be applied to assess the level of exposure to war.  This assessment tool is a scale that asks candidates or victim whether they have been exposed to the indicated 17 war-linked experiences or loss or violence (Slewa-Younan, Yaser, Guajardo, Mannan, Smith, & Mond, 2017). There are three possible choices for participants including once (1), more than once (2), or never (0). The possible scores for a participant range from 0-34 (Yaser, Slewa-Younan, Smith, Olson, Guajardo, & Mond, 2016). A candidate who has a high score indicates that they have been exposed to war-related experiences.

CBT is a kind of psychotherapy that intends to help victims realise negative thoughts, perceptions, feelings or behavioural pattern and consequently trains the victim how to replace the negatives with positives. This therapy identifies and modifies misinterpretations that cause patients to overestimate their current threat as well as interpreting their behaviours during the trauma (Bisson, Cosgrove, Lewis, & Roberts, 2015). Also, this psychotherapy teaches the victims on how to embrace healthy patterns. CBT will be useful and safe for Razzaq because it focuses on the symptoms of PTSD, depression and phobias. One study by Rhoads and colleagues found that CBT was helpful for patients and delivered good outcomes (Rhoads, Pearman, & Rick, 2007). This study revealed that even if a nurse has minimal training on CBT, she can be helpful to the patients.

Three mental health assessments required to assess Razzaq

Cognitive restructuring teaches the victims that negative thoughts occur due to unhealthy thinking. In turn, the patient experiences behavioural problems like poor social relationships and substance abuse. When the victim acknowledges the link between negative feelings and unhealthy thinking, they are in a position to identify and avoid the deleterious behaviours and symptoms (Rickwood & Bradford, 2012). This therapy is appropriate for Razzaq because he has harmful thoughts that need to be replaced with positive thinking.

In exposure therapy, a victim is exposed to a situation that is similar to their past trauma with the aim of teaching that negative symptoms happen due to their past trauma. Additionally, it aims to teach the patient that a potential trigger is controllable. A patient can be helped to confront their past trauma through verbal or written narrative, delineating the course of the traumatic experience (Bisson, Cosgrove, Lewis, & Roberts, 2015). Patients are trained through continuous exposure although some experiences might be unpleasant. Razzaq requires exposure therapy because of his past traumatic events. For instance, when the washing machine is turned on, he hears a car backfire.

The medication option for treating Razzaq is SSRIs. This class of medicines has been found to be effective in managing the symptoms of PTSD. Besides, the SSRIs have been assessed for a wide range of trauma types such as witnessing injury, physical abuse and compact (Sullivan & Neria, 2009). Sertraline and paroxetine are the two main drugs under this class of medicine (Rhoads, Pearman, & Rick, 2007). Sertraline will be the most effective medicine for Razzaq due to its effectiveness in improving hyperarousal and avoidance symptoms.

The nurse can train Razzaq on how to reduce anxiety and depression. Razzaq can be trained on relaxation techniques, breathing techniques as well as exercises that enhance social skills. Teaching the victim on the symptoms of PTSD can also be helpful because it will help him to identify detrimental symptoms. The nurse can also ensure that the victim takes prescribed medications correctly and assess the response to medication. The nurse can also refer Razzaq to other places for social support like community organisations. In this case, the patient will learn coping skills by participating in social activities.

When offering patient-centred care, the patient should be involved in decision-making towards their treatment plan (Thomas & Chaperon, 2010). The involvement of the patient is a fundamental aspect towards designing the treatment plan. The patient should then offer consent for the kind of treatment that will be administered. Thus, informed consent is important in patient-centred care.

The interventions to safely manage Razzaq’s PTSD

The healthcare provider should observe and promote human rights when offering patient-centred care. They should know that embracing the principles of human rights in health care, entails identifying, respecting, constantly enhancing and safeguarding the rights of the patient. Violation of these rights might result in severe health implications (Thomas & Chaperon, 2010).

The healthcare professionals should deliver holistic, safe as well as evidence-based care to realise the patient’s outcome. Any treatment, intervention or action that might harm the patient should be avoided (Brophy, Roper, Hamilton, Tellez, & McSherry, 2016). The patient should be monitored progressively to determine their outcomes.

Every patient should be respected regardless of their ethnic background. RNs should observe the ACSQHC recommendations. These recommendations support the need to practice cultural respect and diversity (Thomas & Chaperon, 2010). The patient should then be supported to realise better outcomes. 

Razzaq and the family require a comprehensive understanding of PTSD. Within the Iraqi community, a person who has a mental illness is viewed as “crazy” and might be stigmatised. Hence, knowledge of PSTD will be fundamental in addressing the issue of stigmatisation. Another cultural requirement is the assistance for cross-cultural communication. Razzaq is a refugee from Iraq and might have limited English skills (Guajardo, Slewa-Younan, Santalucia, & Jorm, 2016). He needs help to communicate to the registered nurse and other healthcare providers. Besides, the victim requires help to overcome the barriers to seeking professional care. Based on their Muslim belief, Iraqi refuges might prefer to read the Koran rather than seek professional assistance for mental health.

The culturally based care for Razzaq should include various pertinent principles which result in improved mental health. The care should be offered by a multidisciplinary team comprising of a psychiatrist, psychologist, registered nurse and culture-specific healthcare provider (mostly from Iraq). Due to language differences, the care should include an interpreter (Kirmayer, et al., 2011). Health care information on the symptoms of PTSD and importance of treatment should be included in Razzaq’s therapy. The victim’s beliefs especially the Muslim religion should be respected throughout the therapy. Razzaq’s family should also play a central role in advancing his treatment and offering social support. Finally, the provider should observe the legal and ethical principles when offering care.

Conclusion

Appropriate diagnosis and management of PTSD are important in helping the patient to lead a normal life. Registered nurses and other healthcare professionals play a fundamental role in diagnosing, treating and training the patients with PSTD how to manage their symptoms. As discussed in this paper, Razzaq requires support and empowerment to overcome the intrusion, avoidance, and hyperarousal symptoms. Due to his background, Razzaq requires culturally suitable treatment. This paper has proposed culturally suitable mental health assessments and treatments that can be used for Razzaq since he is a refugee from Iraq. Conclusively, culturally appropriate treatment should focus on meeting the cultural needs of the patient and their family.

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