Still Alice by Lisa GHenova: Case Management Review
Introduction
Management of the client’s psychological needs is a critical practice that should be adequately addressed to achieve desired mental health. However, therapy needs amongst the clients accompanied by a host of socioeconomic factors could constrain service delivery. In this case, caregivers are caught in the epicenter of which ideal practice should be employed to guarantee their clients quality services. The book Still Alice by Lisa Genova lends itself to the topic as a compelling case to review in the appraisal of processes involved in managing diverse client situations. The book presents Alice's case, the main female character who suffers from early-onset Alzheimer's disease, and the family struggles to provide the support that should be best sufficed with family-centered intervention.
Issues to Review
The causes
Researchers have not yet agreed on the real causes of early-onset Alzheimer's. It is only suspected that two proteins get damaged, killing the nerve cells in the end. One of the damaged proteins develops into plagues while the other forms tangle (Kandimalla et al., 2016). These two features are noticeable almost in every person at the aging stage. In the beginning, plagues and tangles damage memory areas that are within the brain. In the long-run, the entire brain is attacked.
Etiology
On-set Alzheimer's is caused by old age and hereditary factors. Aging people are vulnerable to memory lapse and are most likely to suffer from on-set Alzheimer’s. In other cases, hereditary factors could be the cause of the condition. In this case, it can be noticeable in people aged as early as 30 (Bird, 2018).
Interventions that have tried and failed
On-set Alzheimer's is a condition that affects the health well-being of the patient. To combat the disease, doctors have tried to use pharmacological interventions such as Aricept, razadyne, Exelon, and namenda (Hung & Fu, 2017). However, these drugs are only meant to slow down the rate of memory lapses. In addition, psychotherapy interventions are deemed the best strategy to deal with related mental conditions, have been employed, but failed. The psychotherapy approach has been unable to correct the on-set Alzheimer's disease Alice is experiencing. The failure in psychotherapy is to manage adequately the condition due to the absence of widely defined guidelines for nurse psychotherapists.
The role of the family in providing care
Family members play a critical role in helping the patient cope with any health-related issue, particularly mental condition. For instance, as inferred to the case, Alice's family members are concerned about on-set Alzheimer's disease she is experiencing (Genova, n.d). However, whether they are doing all it takes to offer Alice full support alongside nurse psychotherapy remains unclear. As such, nurse psychotherapists should explain to Alice's members that they are responsible for helping their mother manage the condition.
Initial Assessment
Alzheimer's condition can be assessed in many ways. Observation and interview approaches are regarded as the appropriate approach. For instance, as revealed in the case, Alice has on-set Alzheimer's signs. These signs can be seen as she appears to carry out her daily activities and forgets about herself. Interviewing Alice by asking her simple questions, struggles to find appropriate answers. A nurse psychiatrist should structure these two approaches before commencing on a treatment plan action to help Alice manage the condition.
CM theory, models, how do these fit with your client?
The psychological health needs of patients are varying and complicated. Because of this reason, a nurse psychiatrist should tactically approach the case. A tactical approach will need a case manager to use a scientific case management framework and concepts. While referring to Genova case management, she explained in a structure that encompasses nine steps that should be used by case managers to guarantee quality psychological services (n.d). The effective psychiatric process's nine steps include screening, assessing, stratifying risk, planning, implementing, following-up, transitioning, communicating post-transition, and evaluating (Genova, n.d). Whichever the condition a client could be diagnosed with, the nine steps framework approach is deemed ideal. However, while these steps are suitable for psychiatrists, there are notable gaps in knowledge execution and delivery of services amongst case managers. These gaps in service delivery are attributable to the use of different concepts. For example, a psychosocial concept comprises knowledge touching on cultures, clients, social networks, and support teams play to enhance the client's health (Emery et. al, 2019).
On the other hand, rehabilitation concepts are comprised of knowledge that touches on the client's occupational and physical health functioning (Frankel, Gelman & Pastor, 2018). As such, a case manager who uses either of these concepts will reveal an alteration in knowledge service delivery. Whichever way, the tactical approach case management, which requires a case manager to use scientific framework and concepts are ideal. For instance, the scientific framework provided steps for a high-level case management process ideal for managing related mental conditions such as Alice Alzheimer's case. It is worth noting that psychosocial and rehabilitation concepts provided many options for a case manager to choose from to develop an ideal treatment plan. In particular, major depression requires a treatment plan that has a combination of both the two concepts postulated in this paper.
Signs of onset Alzheimer’s
Signs of onset Alzheimer's vary depending on the psychological response of the patient. For instance, in Alice's case review, she presents the following symptoms; foremost, she loses her memory and cannot remember simple things about her life. Also, she cannot trace her home, located a few meters away from where she lectures. Loss of appetite is also another sign and is evidenced in Alice when she loses weight.
Guideline Questions
A nurse psychiatrist must ask his/her client questions to gather information, which should be used to implement a treatment plan. Some of the most probable questions include; how often have you felt depressed, down, or hopeless in the past two weeks? A client who expresses to having felt down for more than half the days or daily for over the past two weeks is a clear indication of onset Alzheimer's. Have you had suicidal thoughts? How is your sleep? How is your energy? Do you opt to stay at home or prefer to go out to do new things? Do you have any relatives who had been diagnosed with onset Alzheimer's? Do you have a family? How many children do you have?
Conclusion
In conclusion, this paper sought to review Still Alice, where Alice is the main female character. The book reveals that she has early-onset Alzheimer's disease and whom the family struggles to provide the support that should be best sufficed with family-centered intervention. In this regard, Genova advised that a nurse psychiatrist should employ a nine-step framework to guide a client through the treatment plan (n.d). However, the fact that nurse psychiatrists have employed the nine-step framework has some noticeable changes that constrain their service delivery. These changes have been mainly attributable to the use of psychosocial and rehabilitation concepts strategies. These two concepts provided many options for case managers to choose from to develop an ideal treatment plan. As a result, some nurse psychiatrists do not adequately stick to the two concepts' guidelines, thus compromising service delivery. Therefore, nurse psychiatrists should adhere to the framework and concept guidelines to enhance their service delivery.
References
Bird, T. D. (2018). Alzheimer disease overview. In GeneReviews®[Internet]. University of Washington, Seattle.
https://www.ncbi.nlm.nih.gov/books/NBK1161/
Emery Trindade, P. G., Santos, R. L., Lacerda, I. B., Johannessen, A., & Nascimento Dourado, M. C. (2019). Awareness of disease in Alzheimer’s disease: what do patients realize about their own condition?. Aging & mental health, 23(10), 1292-1299.
https://www.tandfonline.com/doi/abs/10.1080/13607863.2018.1488945
Frankel, A. J., Gelman, S. R., & Pastor, D. K. (2018). Case management: An introduction to concepts and skills. Oxford University Press.
http://www.amazon.com › Case-Management-Third-Introduction-Concepts
Genova., L. (n.d). Still Alice: Case management review. Retrieved on 7th, august, 2020 from < https://cmbodyofknowledge.com/content/introduction-case-management-body-knowledge>
Hung, S. Y., & Fu, W. M. (2017). Drug candidates in clinical trials for Alzheimer’s disease. Journal of biomedical science, 24(1), 47.
https://link.springer.com/article/10.1186/s12929-017-0355-7
Kandimalla, R., Manczak, M., Fry, D., Suneetha, Y., Sesaki, H., & Reddy, P. H. (2016). Reduced dynamin-related protein 1 protects against phosphorylated Tau-induced mitochondrial dysfunction and synaptic damage in Alzheimer’s disease. Human molecular genetics, 25(22), 4881-4897.
https://academic.oup.com/hmg/article/25/22/4881/2525916
