Introduction
Parkinson’s disease (PD) is a degenerative disorder that results from the destruction of dopamine-producing neurons in the substania nigra and is likely to cause disability among individuals. It affects more men and women due to the X linkage of genetic risk factors. PD is the second most chronic neurodegenerative disorder after Alzheimer’s disease (Santa-Cecília et al., 2019). The condition affects 572 individuals aged 45 and above in every 100,000 in North America, and its incidence increases with age (Williset al., 2022).
Since the condition is degenerative, it must be managed appropriately to reduce its effects on the client’s quality of life. The following paper examines the components of a recovery-focused care plan for an individual suffering from the disease, drawing interventions from Gibson’s (2017) biopsychosocial approach. Moreover, the paper will discuss the role of a mental health nurse and the importance of early interventions for PD.
Gibson’s Model
In recent years, many approaches have been established to treat PD. The condition has been treated using contemporary techniques such as biomedical and neurological. These approaches have been beneficial but have yet to engage with patients with PD experiences. Such led to the introduction of a successful strategy for managing PD known as Gibson’s biopsychosocial approach. It involves assessing a patient’s psychological, physical, spiritual, and social needs for the creation of a holistic plan of care.
Assessment
Assessment is an essential component of caring for a PD patient. The nurse’s role is to assess the disease’s physical, social, spiritual, and psychological impact on the patient. Clinical manifestations of PD vary from one individual to another and are likely to include postural inability, bradykinesia, muscle rigidity, and tremors at rest. Other signs might include difficulty speaking, swallowing, depression, and anxiety. The symptoms are likely to be manifested differently due to the varying stages of the disease. Tremors are experienced first before other signs. In the latter stages, the condition displays fatal manifestations such as hallucinations and cognitive loss.
The nurse will likely use assessment tools such as the Parkinson’s Disease Questionnaire (PDQ) and the Parkinson’s Disease Activity Scale (PDAS). PDQ is a self-administered questionnaire with 39 items essential for evaluating a PD patient’s quality of life. It assesses how patients experience challenges across the eight dimensions of daily living, including communication, relationships, and social functioning. A nurse can use data from the questionnaire to assess the effectiveness of interventions and monitor the patient’s progress over time. Impulsive and compulsive behavior in Parkinson’s: monitoring and information tools are used when holding discussions between healthcare professionals and PD patients. The tool helps raise awareness of and monitor the patient’s impulsive and compulsive behavior.
PDAS is an assessment tool used to measure the severity of PD in diverse areas such as movement, cognition, swallowing, and speech. PDAS consists of three sections: motor symptoms, therapy complications, and daily living activities. The activities of daily living section an individual’s ability for self-care through examination of toileting, dressing, and undressing capacity. A nurse can use data from the motor symptoms section to evaluate the severity of symptoms such as rigidity, tremors, and bradykinesia. It is essential to note that the impulsive and compulsive behavior in Parkinson’s: monitoring and information tool, PDAS, and PDQ are not meant to replace clinical judgment but to help provide an objective view of the patient’s condition.
Case Formulation
Case formulation is essential to PD management since it involves understanding the presenting issues and their contributing factors. Several factors should be considered when formulating a case for PD patients, including the patient’s presenting problem, predisposing factors, precipitating factors, perpetuating factors, and protective factors. The presenting problem refers to the signs and symptoms manifested by the patient. Some of the symptoms that are likely to be related to PD affect the motor system and might include rigidity, tremors, and bradykinesia. Tremors are involuntary movements occurring when an individual is inactive and might indicate PD. They are likely to start in the hands and later spread to the rest of the body. They are prominent when an individual is stressed or anxious.
Rigidity occurs within the muscles, thus limiting one’s movement. The muscles will likely become tense and hard to relax, resulting in intense pain. Bradykinesia is common among PD patients and might lead to a decreased range of motion. The patient will likely take longer to accomplish simple tasks such as tying laces and buttoning a shirt. PD patients will likely manifest with a reduced capacity to maintain an upright posture. Such might result in devastating injuries from falls. Moreover, it is essential to consider psychological manifestations such as sleep disturbances, anxiety, and depression. Social and occupational impairments resulting from the disease include isolation, loss of employment, and changes in relationships with close people.
The cause of PD is unknown, but lifestyle, genetic, and environmental factors play a role in the condition’s etiology. In addition to the presenting problem, it is essential to consider the disease’s predisposing factors when formulating a care plan. Some predisposing factors include the patient’s history of physical illness, mental illness, family history of suicide, and mood disturbances. The disease is likely to develop among individuals with a family history of the condition. According to Cherian and Divya (2020), mutations involving genes such as PARKIN, SNCA, and LRRK2 are likely to result in the development of the disease. These mutations lead to the loss of dopamine-producing cells in the central nervous system, causing the condition. Moreover, environmental factors result in the development of PD.
Exposure to toxins such as herbicides and pesticides increases the risk of developing the condition. Injuries on the head predispose one to the disease since they involve loss of consciousness. Such might affect the functioning of dopamine-producing cells. The other predisposing factor is the age at which most people diagnosed with the condition are older adults. As individuals age, their body parts, such as the brain, lose functionality. Loss of dopamine-producing cells predisposes one to PD. The other predisposing factor to the development of PD is lifestyle. Sedentary lifestyles increase the risk of developing the condition. According to Paul et al.(2019), heavy alcohol consumption and intense smoking increase the risk of developing PD. Exercise is crucial since it is beneficial in reducing the risk of PD and helps keep brain cells healthy.
The other factors to consider are those precipitating the occurrence of the disease. These are conditions that trigger the development of PD symptoms. Such might include medication changes, changes in meal times, mood changes, and emotional trauma. The onset of PD might be precipitated by toxin exposure and infections. Perpetuating factors maintain and prolong the symptoms of PD. Some of the perpetuating factors of PD include financial strain, limited social support networks, poor lifestyle, and medication side effects. Such factors might be addressed through therapeutic measures such as lifestyle modifications and cognitive behavior therapy.
Protective factors provide the patient with resilience and are essential in recovery. Such factors include the creation of supportive relationships and engaging in enjoyable activities. According to Paul et al. (2019), protective factors for PD include moderate alcohol consumption, physical activity, and coffee consumption. They encourage patients to explore and participate in activities promoting joy and fulfillment for faster recovery.
Care Planning
Physical Interventions
The interventions for the management of PD should be patient-based and should focus on examining one’s cognitive, social, physical, and psychological functioning. It should consist of physical, medication, psychological, and support interventions. Physical interventions include physical therapy and exercise programs to improve mobility and strength. According to Mak and Wong-Yu (2019), exercise is essential to any PD treatment plan since it delays disease progression and improves symptoms. Exercises such as cycling and walking are likely practical since they help improve balance and cardiovascular blood flow and help regulate mood. Muscle strength training is likely efficient in preventing falls. Exercises incorporating virtual reality games are gaining popularity in managing PD patients. The intervention involves using computer-based games in a virtual reality environment and can increase patient motivation.
Another physical intervention for PD management is Nordic walking. Such involves using two special walking poles with rubber tips for walking. Nordic walking requires one to perform arm swings by applying effort on the poles as they move forward, similar to movements in cross-country skiing. An advantage of using the poles for walking is the promotion of postural adjustments and uncoupling of the shoulder, thereby facilitating improved gait patterns.
Occupational therapy can be valuable in aiding patients in achieving their independence. Occupational therapy can assist PD patients in carrying out everyday activities when they become challenging. For PD patients with mild symptoms, PD therapy might focus on enabling an individual to be more aware of how they move and perform different motor skills. Moreover, the treatment might focus on using auditory, visual, and auditory cueing techniques to improve the ability to move. Wood, Henderson, and Foster (2022) suggest that occupational therapy should incorporate coaching, cognitive behavioral, and self-management interventions in a multi-component treatment plan based on the patient’s goals. Occupational therapy might involve cognitive exercises that aid in attention and memory.
Physiotherapy is an essential component of the management of PD symptoms. A physiotherapist is responsible for designing an exercise program tailored to patients’ needs. Aerobic ability is impaired in individuals with severe PD. Moreover, compromised aerobic capacity among PD patients might be evident in reduced walking endurance on tests like the 6-minute walk test and elevated physiological costs associated with walking and performing activities of daily living (Pang, 2021).
Such issues might be addressed using aerobic exercises. Various modes of aerobic exercises, such as cycling on a stationary bicycle and walking on a treadmill. PD patients are likely to have limited muscle strength compared with those without the disease. Muscle mass loss and strength are likely to lead to the development of secondary osteoporosis. According to Pang (2021), a physiotherapist might introduce graded resistance training exercises to deal with the problem of muscle weakness. They might use resistance exercise training to strengthen respiratory muscles since PD patients are likely to experience respiratory dysfunctions due to respiratory muscle weakness.
Effective communication is an essential element in improving the quality of life of PD patients. Speech disorders negatively affect the quality of life for PD patients. The disorders result from poor muscle activation, decreased muscular strength, and poor sensory processing in the brain. Effective communication can be achieved through speech and language therapy. Some therapy options for PD patients include voice therapy, compensatory strategies, eating, drinking, and swallowing management. Moreover, other physical interventions are essential for PD management. They include acupuncture, dance, and massage therapies. Massage therapy is essential in managing stiffness and pain, whereas acupuncture aids in managing tremors. Patients will likely improve balance and reduce fall incidences by embracing dance therapy.
Psychosocial Interventions
Cognitive-behavior therapy (CBT) is a psychological intervention for PD management. CBT aids patients in modifying their thoughts, thought patterns, and behaviors and effectively coping with their symptoms. CBT aims to reduce the psychological symptoms related to PD. The therapy can effectively manage patients with anxiety, cognitive decline, and depression. CBT can help a patient improve their quality of life by providing coping mechanisms essential for managing PD symptoms. The other essential intervention for PD management is mindfulness training. Such involves concentrating on the present moment with an open mind and a non-judgmental attitude.
According to Zarotti et al. (2021), mindfulness interventions will likely reduce PD symptoms such as anxiety and depression. Patients can manage their stress and regulate their emotions through mindfulness intervention. Other psychological interventions essential for managing PD include peer counseling and support groups. Such interventions facilitate social interactions and improve patients’ access to support networks that aid in coping with the condition. The interventions make the patients feel less isolated and burdened by the disease symptoms. Support groups help patients improve their emotional well-being.
Recovery-focused, co-produced care plans for PD patients should be based on their assessment and be tailored to their needs and goals. It should incorporate evidence-based interventions and therapies that support an individual’s well-being, quality of life, and general well-being (Lidstone, Bayley, and Lang, 2020; Rajan et al., 2020). Moreover, it should include interventions that promote autonomy and patient involvement in their care. The recovery-focused care plans should focus on the need for support and collaboration with other professionals, such as physiotherapists, to ensure a comprehensive approach is designed and implemented.
Medical Intervention
There is no cure for PD, but medical intervention might include a prescription of dopamine agonists such as levodopa. The drug is absorbed in the small bowel and converted to dopamine through DOPA decarboxylase. This might occur in peripheral circulation and the nervous system after crossing the blood-brain barrier. The drug might be used in combination with others, such as Carbidopa. Such is likely since it aids in preventing levodopa breakdown before reaching the brain.
Role of Mental Health Nurse
The mental health nurse plays a crucial role in managing PD patients. They are responsible for the assessment of the mental status of PD patients. The disease is likely to affect a patient’s mental well-being, resulting in anxiety and depression. Nurses can use mental scales to evaluate an individual’s mental health status and create a comprehensive care plan. They can identify signs of depression and provide supportive therapies. A nurse’s other role in managing PD is patient education. The nurse must educate the client and caregiver about PD and available management options. Patients and caregivers will likely need to be more informed about the condition, which will result in poorer outcomes. Patient empowerment through education is crucial and affects their ability to make informed decisions concerning their care. Therefore, the nurse should provide understandable and precise information about the condition and the available therapies.
Nurses play a role in the management of PD through the dispensation of drugs. Such is done according to the rights of medications, such as dose, client, time, route, and the correct drug. The medications dispensed to the patient might have side effects impacting their mental health. In such a case, the nurse’s role is to monitor and manage dose-related side effects. Moreover, they can monitor clients’ medication use and manage symptoms of adverse reactions such as hallucinations. The mental health nurse can also act as a care coordinator for PD patients. The management of the condition requires a multidisciplinary approach from all healthcare team members, such as occupational therapists, physiotherapists, and neurologists. The nurse can aid in care coordination, thus ensuring the client receives high-quality holistic care. Moreover, the nurse is responsible for assessing the risk of suicide among PD patients. Therefore, they should assess them for suicidal thoughts regularly.
The Importance of Early Interventions
Early interventions are essential for PD patients since they reduce their impact. Such might be achieved through a multidisciplinary approach to care that will likely involve speech therapy, medication, occupational therapy, CBT, and physiotherapy. Early interventions are essential for preserving the function of neurons, reducing the symptoms, reducing the cost involved in acquiring treatment, and slowing the disease progression. The patient is likely to maintain their independence through active engagement in implementing the therapies.
Early treatment is dependent on early diagnosis. As a result, early diagnosis and management of the condition might be difficult due to the problematic nature of diagnosing PD. By the time motor manifestations are felt by an individual, significant neurological and destructive harmful changes are likely to have occurred. Diagnosing the condition based on conventional means tends to identify a disease that has advanced, and the possibility of slowing its progression is unlikely (Ugrumov, 2020). A significant impact of early intervention is the reduced need for invasive procedures and surgeries. In the advanced stages of the disease, deep brain stimulation surgery might be the recommended management mode. In contrast, early interventions are likely to eliminate the need for surgery.
Early interventions might help manage psychological symptoms such as depression, sleep disorders, and anxiety. These symptoms negatively impact an individual’s life and can result in other physical complications. Moreover, early interventions are essential since patients can participate in research studies and clinical trials. Such might be beneficial for the improvement and better understanding of the condition. Through patient participation in research, the clients can access novel treatments, resulting in improved outcomes.
Conclusion
PD is a degenerative disorder that manifests with physical, social, and psychological impairments. Mental health nurses might use various assessment tools in association with clinical judgement to diagnose the condition, create recovery-focused, co-produced care plans that improve patient outcomes. The Gibson’s biopsychosocial approach is essential in effective management of the condition. If diagnosed early and interventions initiated, there is a likelihood of reduced disease’s impact and limited need for invasive procedures and surgeries.
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