Identified Nursing Diagnoses
There are several diagnoses identified for the selected aggregate community, while the present care plan will concentrate only on two of them. The first is the actual diagnosis, which is a schizoaffective disorder characterized by hallucinations, delusions, fear of sudden death, and continuous depression. For the chosen aggregate, the severity of the schizoaffective disorder varies depending on the past clinical history of the patient and negative impact of the environment that contributed to the progression of mental issues. In the majority of cases, schizoaffective disorder became a culmination of the consistent feeling of depression and unsafety, eventually resulting into delusional behaviors and fear. In one specific case, it was a direct consequence of post-military PTSD. The depression was natural to the selected aggregate as African-Americans living below the poverty line in the Englewood area, constantly seeking for better life for their families and themselves, but mostly resulting in low-paid jobs and horrifying living conditions. Moreover, the cases of schizophrenia and delusions were poorly controlled by medical facilities because of significant budget cuts and the closure of mental care facilities. Finally, the aggregate often witnessed street violence and deaths of their family members and significant others, further worsening their mental conditions and increasing the frequency of the observed symptoms.
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The second is risk diagnosis, which is the high probability of committing suicide or homicide because of the schizoaffective disorder progression and lack of access to care to control such efforts. Luckhoff, Koen, Jordaan, and Niehaus (2014) reported that suicidal ideation is natural to more than 40% of the patients with schizophrenia, who have also demonstrated the presence of bizarre behavior, use of cannabis or alcohol abuse, as well as having previous suicide attempts. For the chosen aggregate, this risk is particularly evident considering their previous life events and violent environment surrounding their homes, which could eventually isolate them from receiving medical support on time and act as a catalyst to commit a suicide to ease the life burden. Schizoaffective disorder could also trigger the willingness to commit a homicide as an act of revenge for the street violence, which would eventually result in even more deaths unless prevented by police or community. Considering the ever-growing mortality rates and decreasing population in Englewood, both nursing diagnoses are worth considering in terms of equal access to care declared by Healthy People 2020 objectives.
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Strategies to Address Nursing Diagnoses
The first diagnoses relates to the confirmed fact of schizoaffective disorder and requires tertiary prevention and interventions performed in medical facilities or at home. Considering the case of Englewood, home-based interventions will be excluded since Englewood neighborhoods are places with high concentration of gun violence and a direct threat to the health of nurses. Hence, it is justified considering treatment of patients in the close proximity to Englewood, where the presence of mental health clinics is evident. A common strategy proposed for this intervention is to use the ‘first-generation’ antipsychotic drugs such as haloperidol, which has been recognized as the one characterized by the comparable antipsychotic efficacy and a comparator drug in clinical trials to identify other agents academically denoted as the second-generation antipsychotics (Dold et al., 2016). However, haloperidol remains a subject for the continuous research in terms of observed between-group differences in specific group trials; for instance, where nemonapride appears being more effective for a selected small trails in the results reported by Dold et al. (2016). Consequently, this strategy requires more attention with respect to the chosen population given the lack of sustainable observation over life habits, addictions, and family support, since African-American community in Englewood was never described as the one willing to share their worries and life concerns unless it comes to the critical barriers of treating mental issues in applied medical setting.
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The second diagnosis mostly refers to a community-based intervention and sustainable strategy to prevent acts of suicide and homicide even if the patient undergoes a regular treatment. Personal touch is an important aspect of developing the appropriate strategy in case of both suicide and homicide attempts as the consequence of schizoaffective disorder. First, it is advised to find a common understanding between family members, friends or other community supporters to perform regular screening of patient’s behavior. The case could be eased up when the patient from the aggregate has a responsible family caregiver who regularly arrives to the facility to check on the patient’s status and supports patient-centered service delivery by reporting on the particular behaviors. Family caregivers could be provided with basic training about the time to monitor delusional activities, administering appropriate psychotropic medications, and control or prevent the consumption of drug or alcohol substances in order to prevent mental condition worsening. Another approach is to engage into a faith nursing activities by identifying places of worship of the selected aggregate and communicate with conglomerate leaders about the opportunity to share information about the feelings expressed by the patients during confessions or spiritual talks, while not violating the confidentiality principles. Finally, it is worth considering collaborating with dedicated police units recently established in Chicago who are trained in basic mental support to the victims of gun violence, at least by collecting observed evidence of community feeling and the highest concentration of suicides and homicides in the area. This would eventually help to divert patients from the areas exposed to the violence in peak or night hours, considering possible delusional effects or drug and alcohol abuse.
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Disaster Management Planning
Considering the case of Englewood, it is a high risk of social and economic disasters that affect one on the regular basis and can eventually result in a significant healthcare issue. The first risk is associated with spontaneous acts of violence in the area, which could eventually lead to isolation and area blockade aiming to protect peaceful residents of Chicago, as well as initiation of police operations to neutralize gang activity. While the violence rates in the neighborhoods were decreasing for the last couple of years, the risk still pertains and can be a barrier for assisting chosen aggregate. The second risk emerges from the possible housing crisis because of the high concentration of foreclosure property in the area, which means that investors will not consider property in Englewood as the one as a subject for repairs or rent (Todman, Hricisak, Fay, & Taylor, 2012). It means that mentally ill patients will be cut off the public services and potentially emerging healthcare centers, further decreasing their odds for survival and basic needs such as water supply or electricity.
To date, there is no immediate or existing solution for managing such disasters, as the city government is rather weak in addressing South and West Side gun violence issues. Previously mentioned community initiatives such as faith nursing will likely not help the cause, as those will be banned from promoting their services as the community agencies were doing upon the increased violence rates back in 2015. Hence, sheltering with nurses serving as volunteers and community agents might be a temporary solution to fight back against the disaster, while one would require the strong involvement of the government to establish such shelters and revitalize the infrastructure of Englewood.