Summary
Well-developed communication and relationships are the core mechanisms that ensure the effective delivery of quality treatment and care to sick persons by medical service providers, especially in psychiatry. Peplau made a significant contribution to developing this professional viewpoint, and many nurses nowadays follow this perspective. She perceived nursing as “an interpersonal process of therapeutic interactions between an individual who is sick or in need of health services and a nurse especially educated to recognize, respond to the need for help” (Gonzalo, 2021, para. 32). However, many mental disorders, such as bipolar disorder, are complex and long-lasting, and their mitigation and treatment require additional resources, including human ones.
Nurses work with family members of patients to make the treatment and supervision process continuous and uninterrupted. To enhance the overall impact, they apply “the Calgary Family Assessment Model (CFAM) and the Calgary Family Intervention Model (CFIM) developed in Canada by Wright and Leahey” to their collaborative relationships (Zimansky, 2020, p. 347). These two theoretical models provide nursing health specialists with analytical tools and practical frameworks for building and strengthening relationships with family units to better their physiological and mental welfare (Zimansky, 2020). The relationship triangle that nurses make has a dual effect.
One side of the said dual effect is healing, and the other side is damaging as patients’ problems, and nurses’ duties starting to affect relatives. It is especially prevalent in cases of the bipolar disorder mentioned above. It is because “the individual’s illness creates an ongoing burden for the family” (Tracy, 2022, para. 4). Negative consequences for family caregivers may include a general decline in health and the development of unhealthy coping techniques. The practice issue is that the inclusion of a patient’s immediate family as part of comprehensive bipolar treatment sometimes results in their health deterioration due to emotional and financial influences and, consequently, undermines nurses’ efforts.
Prevalence
Looking at the statistics, one can say that the given practice problem is almost at a crisis level. For example, experts report that 90% of all visits by families of individuals diagnosed with bipolar disorder to health care institutions are associated with the negative external influence of the condition experienced by caregivers (How bipolar disorder affects families, 2020). Only one-tenth of the appointments are directly related to patients with the discussed disease (How bipolar disorder affects families, 2020). The conclusion is that either a reformation of CFAM and CFIM or a new, better, and well-designed program to prepare families for a care provider’s role, duties and burden is needed.
National Data and Quality/Regulatory Expectations
The national data confirm the assertion from the upper section that the situation is approaching the scale of a local health crisis in the United States (US). According to medical professionals, “bipolar disorder affects approximately 5.7 million adult Americans, or about 2.6% of the U.S. population age 18 and older every year” (Bipolar disorder statistics, n.d., para. 1). Moreover, one should also consider that one in five adults in the US has experienced or has some psychological ailment (Mental health by the numbers, 2022). The overall picture of the well-being and functioning of families with individuals suffering from mental issues becomes increasingly frightening, as bipolar disorder is not a unique condition in terms of causing indirect adverse effects on familial caregivers.
In addition, many global organizations, such as the World Health Organization, have a pessimistic viewpoint. According to this entity, “mental health conditions are increasing worldwide” (World Health Organization, n.d., para. 1). Nevertheless, one should expect a slight improvement in the population’s mental health with bipolar disorder as new high-quality medicines emerge and high treatment satisfaction (Bipolar disorder statistics, n.d.). Another good news is that US regulatory bodies are focused on expanding economic and social access to services as they also foresee the upcoming catastrophe in the mental medicine area (Chemweno, 2021). Perhaps these measures can minimize the current methodological error in the practice of family caregiving for bipolar persons.
Impact on Patient, Family, and Healthcare System
Practice Issue and Patients
Evidently, the identified practice problem also affects the central figure of the triangle of caregiving relationships, namely the patient. Worsening of their diagnosed disorder, bipolar in this case, is one of them. Greater loss of agency, autonomy, and decision-making power is another thing that the patient experiences after initiating family care and the further development of indirect adverse effects on loved ones and relatives (Tracy, 2022). Patients may also begin to feel guilty about the idea that they are the source of new family hardships, resulting in aggressive behavior and even refusal to take medication and further care and treatment.
Practice Issue and Family
As noted above, the main negative consequence of the practical issue described is the occurrence of physical and psychological illnesses and harmful coping practices caused by various costs and difficulties in the course of home caregiving. Another is the development of feelings of guilt and aggression in family members, triggered by a diagnosed bipolar disorder in their relative and an untimely response (Tracy, 2022). Other negative changes in their emotional and psychological climate include fatigue, exhaustion, increased anxiety and depression, and a desire to isolate themselves.
Practice Issue and Healthcare System
From an institutional perspective, this problem of practice multiplies the number of sick people with conditions of physiological and mental categories and all types of severity. Moreover, it forces nurses to move away from including families in the care process and focus only on Peplau’s client-nurse relationship (Gonzalo, 2021). As one sees, the current dualistic approach overwhelms American health care facilities and leaves nurses operating almost alone in the realm of complex and lengthy mental treatment.
Financial Implications
The described practical paradox creates significant monetary problems for families with individuals who have bipolar disorder, US health care, and the country’s entire budget. For families, medical costs almost double, and their total spending triples due to the patient’s condition and the emerged side effects in relatives (How bipolar disorder affects families, 2020). The health institution is faced with finding significant resources and their balanced distribution for long-term multi-stage treatment of addictions and mental and physical ailments. The methodological problem of the dual effect of such nursing also leads the US government to allocate more money for the population’s health.
Other Implications
For the nursing culture, this paradox-created issue will lead to a shift away from family models of any kind toward a strict client-nurse approach to avoid harming family members in treatment and care. Left unresolved, it would force healthcare policymakers to give nurses more responsibilities, resources, and powers. However, if researchers and health professionals address the duality of this practice, it will lead to improved family models of care based on “effective communication” (Tracy, 2022, para. 26). As one can see, methodological and ethical paradoxes and conflicts already exist. The development of measures to improve the quality and safety of these models of nursing care through family caregiving in one direction or another is a question of time.
Problem of Meso-Systems
One can safely assert that the practice problem that has been shown here and its significance belongs to meso systems. It is because this issue exists in the field of health services, theory, and methodology, which promotes the care and well-being of such segments of the community as the family (Smith et al., 2019). Nevertheless, the topic discussed is also very close to the micro-healthcare level.
References
Bipolar disorder statistics. (n.d.). Depression and Bipolar Support Alliance. Web.
Chemweno, J. (2021). The U.S. healthcare system is broken: A national perspective. Managed Healthcare Executive. Web.
Gonzalo, A. (2021). Hildegard Peplau: Interpersonal relations theory. Nurseslabs. Web.
How bipolar disorder affects families. (2020). The Meadowglade. Web.
Mental health by the numbers. (2022). National Alliance on Mental Illness. Web.
Smith, T., McNeil, K., Mitchell, R., Boyle, B., & Ries, N. (2019). A study of macro-, meso- and micro-barriers and enablers affecting extended scopes of practice: The case of rural nurse practitioners in Australia. BMC Nursing, 18(1), 1-12. Web.
Tracy, N. (2022). Family considerations: Effects of bipolar disorder on the family. HealthyPlace. Web.
World Health Organization. (n.d.). Mental health. World Health Organization. Web.
Zimansky, M., Stasielowicz, L., Franke, I., Remmers, H., Friedel, H., & Atzpodien, J. (2020). Effects of implementing a brief family nursing intervention with hospitalized oncology patients and their families in Germany: A quasi-experimental study. Journal of Family Nursing, 26(4), 346-357. Web.