Anne (pseudonym), 31 years old now, was first diagnosed with depression disorder while she was fourteen years. This was triggered by the divorce of her parents. She defied, taking her medication any further; neither did she continue seeing the psychiatrist. Her conditions worsened with each passing year, and it was until her university years that the condition seemed contained. At 21 years of age, Anne was diagnosed with Bipolar I disorder. This was after she presented the risk of harming herself as well as others that saw her being sent to a psychiatrist. This study will focus on two care priorities: mood-stabilizing and patient and family education based on CRC and RLT model frameworks of assessment to reach an ultimate decision that suits the patient’s situation by assessing the problems/ needs of the patient.
Mood Stabilizing
Mood stability must be given priority while assessing care for patients with bipolar disorder. The fact that Anne has had a challenge with mood control necessitates her need to be given the care that will eventually stabilize her mood. Based on the Clinical Reasoning Cycle (CRC) framework, it is evident that 31-year-old Anne is having a challenge of mood control because of stress. The patient has had a history of depression, and her living and family conditions have been worsening the situation even further. Depression can be triggered by life events or certain illnesses ("Major Depression",, 2021). For instance, the patient has been denied a chance for personal space, neither has she been given time for resting; unfortunately, the patient only rests a day each month, and that is when she has gone for her regular visit to the psychiatrist, the family only treats her well whenever the situation worsens, especially when symptoms represent themselves. Even though Anne wishes to move out of the family to get a place of her own, lack of money has made her do nothing about it. With all these factors at hand, mood stabilization can help ease the patient's situation. This is vital with someone who has had a challenge with mood control, like our patient in this case. While assessing the patient, the caregiver should assess the patient’s independence on a continuum that ranges from absolute dependence to complete independence, and this helps in determining the interventions that can cause an increase in independence and what ongoing support is required to offset the still existing dependency. According to "Roper-Logan-Tierney's Model for Nursing Based on a Model of Living - Nursing Theory" (2021), Activities of daily living ought to be looked at "as a cognitive approach to the assessment and care of the patient, and not just on paper as a list of boxes but rather as an approach to the organization of care to be offered. This means that caregivers should put into consideration all the five factors that influence the activities of daily life (ADL), which are; psychological, biological, politico-economic, environmental and socio-cultural, (Holland & Jenkins, 2019).
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Since mood episodes, relapses and incomplete responses to treatment are common, especially for the depressive phase. Mood symptoms, psychosocial functioning, and suicide risk must, therefore, be continually reevaluated, and, when necessary, the plan of care must be adjusted during long-term treatment. Manic stages are normally destructive and can trigger the patient to engage in activities or rather do things that keep their lives or others' lives at risk since people who are manic can rarely notice when they are on the wrong side. Even though mania in bipolar disorder can at times make someone feel good, keeping a stable mood, however, in the long run, it makes an individual be more productive, happy, more successful and even healthier.
The main goal for prioritizing mood-stabilizing as a care priority is to ensure that mental well-being is promoted and enhances recovery. This goal can be realized with proper actions and interventions in place. For the case of mood stabilization, we are going to focus on two main intervention, namely, mood monitoring and medication management.
Mood monitoring
Bipolar disorder cannot be predicted, which eventually affects our judgements and alters our introspection into normal things. Bipolar Disorder needs continuous monitoring and speciality management (Matton, Mclnnis & Provost, 2019). Generally, mood monitoring should be a vital skill in bipolar disorder self-management (2021). Mood monitoring really assists individuals to be aware of their mood pattern, thus making it a key tool useful to the medical professions supporting individuals with bipolar disorder. Mood monitoring can be done using monitoring journals, mood charts and thankful to new technologies that have even integrated mobile apps for the very purpose. The logical reasoning behind mood monitoring is that it aids us to be able to predict our mood patterns. This triggers us to put strategies that minimize the risk of relapse in place. Furthermore, it helps to determine the causes of mood swings among the patients and thus paving the way for easy management in times of relapse. This helps to better the lives of patients (Saunders et al., 2017). Monitoring mood generates precious information over time that can be utilized fully in managing bipolar disorder to recovery through the crisis.
Medication management
A treatment plan should be agreed upon based on medications to be used, areas to be addressed as well as decision making in the treatment setting. This should be formulated with the patient's consent, caregivers, and any other stakeholder involved in the treatment team. Medication management options available for Bipolar Disorder can be classified as antidepressants, mood stabilizers, electroconvulsive therapy (ECT), antipsychotic medications, psychosocial intervention and adjunctive medications. Treatment options are used depending on the patient's phase of illness and previous history of treatment. According to "Treatment of bipolar disorder" (2021), medical management of bipolar disorder aims at dealing with symptoms whenever they appear and also limiting the occurrence of the symptoms.
Educating patient and family
Educating patient and family is a key care priority since care and treatment of the bipolar disorder is more effective in a multidisciplinary setting involving the patient, caregivers and family (Baruch, Pistrang & Barker, 2018). Considering Anne's situation, it is evident that her family has greatly influenced her medical situation. For instance, Anne is only spoken to and treated well when she starts to exhibit the symptoms, aside from that, her mother relies on information from either the doctor, nurse or from the television only, also despite Anne's willingness to acquire social support from the government, she has no time to join the support since she lacks time even to relax. Educating patient and family can greatly contribute to a mutual understanding (Dell'Osso et al., 2017), that will help both the patient and family to have a clear view of the illness and can further enhance compliance by the patient and the ability of the family to create a serene and supportive environment. Education approach provides data that assists the patient and her family deal with hospitalization experiences and understanding of the disorder, for better collaboration with staff during the treatment process and support from the group that promotes a sense of feeling as well as an increased expression of competence since they help and learn from each other ( Fitriani & Suryadi, 2018) . Individual counselling, family therapy and other forms of group therapy can be utilized methods of treatment. The patient’s and family ability to integrate information will determine a method to be used at any given time. Based on the R-L-T model of nursing, in the dependence/ independence continuum, the patient's level of performance engagement should be determined to depict her extension of independence. Anne, just like any other individual, will normally execute every activity of living with increasing independence. Her illness has, however, influenced her level of activity. Thus, since Anne has Bipolar I disorder, to void her situation from getting worse, family support and patient education should be the priority needs for care.
Depending on the individual illness nature and how the illness is managed, the family and even the patient are affected in various ways. Living with bipolar disorder patient requires that one learns how to cope with challenges that accompany the symptoms, ensuring that the patient gets the required support and coming up with effective ways to cope with the situations. For instance, in mild mood swings, the family might be in distress and not knowing what to do. Without proper patient and family education, most needs in the management of the patient will not be met. Also, patient adherence would most likely turn out to be ineffective hence paralyzing the treatment management process.
Educating patient and family is a vital care priority whose main goal is recognizing that multidisciplinary working with the patient and her family in understanding the disorder and its treatment can promote the patient’s compliance and ability of the family to provide an environment that is supportive. Stress management and dealing with Anne's condition are among the actions that can be taken to help us actualize this goal.
Dealing with Anne’s condition
Aggression, social withdrawal, lack of motivation and poor grooming, to mention but a few, are the residual symptoms a patient can experience after the treatment process of Bipolar I disorder. It is, therefore, important for the family to identify what Anne is able and not able to do. High expectations that are not realistic might cause tension, frustration and relapse; at the same time, expectations that are too low will eventually lead to increased periods of symptoms as well as depression in the patient (Merrikangas, et al., 2019) . It is, therefore, advisable to provide a supportive environment by resuming the regular duties of the patient. The responsibilities can be taken back to her as she recovers with time, but this should be done at her comfortable pace.
Stress management
Since the level of stress is the key determinant of the seriousness and how regular the patient’s illness can occur, coming up with avenues to reduce stress becomes an inevitable priority in Anne's family dealing with bipolar I disorder. According to Murray (2018), Setting up structures and expectations that are clear within the family is important to manage stress. It requires that family schedules be altered to accommodate the patient's needs. The following can be done by the family while trying to manage the stress of the patient; adopting regular schedules that clearly defines what the patient is expected to ease the recognition of the sick person thoughts, emphasis should be stressed on ensuring that each member of the family is given an opportunity to take stock of her own lifestyle while pursuing interests of her own. Stress management helps the family to cope with the threat of suicide that is often brought about by stress. However, all the above expectations should be done in the best favour of the patient.
Conclusion
Bipolar I disorder is a lifelong condition whose treatment is based on managing the symptoms. Care and treatment plan should be incorporated such it addresses key care priorities. As discussed above, mood-stabilizing and educating patient and family are vital to care priorities in containing the symptoms of this disorder. Even though coping with bipolar I disorder can be challenging, interventions like monitoring the mood, medication management, dealing with the condition and stress management can improve the conditions. These interventions have far proved to improve the efficacy of managing patients with bipolar disorders.
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