Pinecrest is a residential center that provides mental health services to adults (18 years and above). Pinecrest is located in Hamilton along the 2030 Princeton Road, and behind the Transitional Living Center. The purpose of this facility is to provide holistic care to individuals with severe mental illnesses, such as schizophrenia, bipolar disorders, and other psychotic conditions. This service admits patients from diverse backgrounds. The center has 14 patients (11 males and three females) currently. The individuals’ age ranges between 30 and 70 years with an average age of 56 years. The majority of the patients are Caucasian although the population also comprises of Hispanics, Blacks, and Asians.
The patients at Pinecrest have other comorbid conditions besides their mental illnesses. The most prevalent conditions include diabetes, chronic obstructive pulmonary disease (COP), and emphysema. Unhealthy eating habits and sedentary lifestyles constitute the underlying risk factors for these illnesses. In addition, tobacco smoking emerged as a common practice among the residents. For instance, one particular person spent approximately $119 to buy 20 packs of cigarettes. One of the managers indicated that the clients loved to go on outings because they give them an opportunity to purchase tobacco products. The patients also enjoyed watching television, as well drinking pop and chewing sheets.
The residents of Pinecrest have adopted a very organized way of performing their respective duties. In practice, the center has developed a strict schedule to guide the accomplishment of tasks. The first noticeable feature of the front door is a list that contains the responsibilities for every person. The scheduled times for administering drugs are 8am, noon, 4pm, and 8pm. The staff members are responsible for cooking meals, which they serve at 8am, 11am, and 5pm. The patients receive snacks at 7pm daily. Other planned activities include outings and therapy sessions. Organization has become an intrinsic aspect of the community’s way of life to the point that these clients have no objections to the strict timetable. In fact, the residents are always beginning their duties on time.
The most striking feature about the center is that it is very untidy with the exception of the kitchen. For example, cigarette buds and residues of tobacco are visible in virtually all the living areas. Nonetheless, the pictures hanging on the walls are enhancing the esthetic value of the center. The photos portray snapshots of the various activities that the clients have engaged in over the years. These depictions imbue a sense of pride in the patients because they were excited whenever they talked about these photographs. On the other hand, the walls contain reminders about crucial events and topics. For instance, the previous nursing students set up posters in the dining room, which provide information about table manners, healthy habits. We also added our pictures and essential information on the walls.
We met with Nurse Annette, the care coordinator, to gather additional information about the patients’ immediate needs. The effectual management of health and wellness emerged as a principal concern during the meeting. Annette acknowledged that the residents lacked internal motivation to gain self-confidence. In addition, the clients were living sedentary lifestyles, as well as having poor personal hygiene and table manners. The clients have an insatiable appetite for food, but the primary objective is not to use food as a motivation. Conversely, the main goal is to encourage these clients to become more social and active. It is imperative to ensure that the patients desist from consuming pop, tobacco and caffeine products.
Findings from the initial evaluation formed the basis for conducting a literature review. The aim of this analysis was to identify the needs of the population at Pinecrest using existing evidence. Socialization, isolation, motivation, emotional responsiveness, and movement emerged as essential themes. Rigby and Alexander (2008) have asserted that individuals with severe mental disorders manifest negative symptoms than positive ones. As such, these patients can benefit from cognitive behavioral strategies (Dogra et al., 2009; Galletly, 2009). These approaches include activity scheduling, self-monitoring and graded task assignments. According to Cimpean and Drake (2011), activity scheduling can increase an individual’s performance level gradually, as well as encourage social interactions.
Interactions with the clients revealed that they had the tendency of isolating themselves from group discussions. For instance, the residents were not conversing while playing bingo, watching the television or smoking. In another case, a female client was scared and suspicious when one of the group members greeted her. Although she responded to the greeting, she did not maintain eye contact or show any willingness to engage in a sustained conversation. Kilbourne et al. (2008) have argued that the engagement in organized group activities relieves distress from both the caregivers and patients. Although group discussions provide safety, some individuals may feel alienated because of negative perceptions (Moritz et al., 2010; Propst, 2010). The assessment has shown that patients rely on their colleagues to make decisions. Consequently, they lose the capacity to make autonomous decisions or describe their personal experiences (Wölwer & Frommann, 2011).
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Propst, A. (2010). The effects of cognitive therapy on hallucinations in patients with schizophrenia. MJM, 13(1), 55-63.
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Wölwer, W. & Frommann, N. (2011). Social-cognitive remediation in schizophrenia: Generalization of effects of the training of affect recognition (TAR). Schizophrenia Bulletin, 37(2), S63–S70.