Assessment 1 – Second Generation Antipsychotic Medications & Physical Health
Introduction:
Walsh and Grey (2019) assert that Māori already have a lower life expectancy than the general population in New Zealand. Despite this, Māori are more likely to be prescribed antipsychotics and at higher doses compared to other ethnicities (Burness et al., 2021). Further, the rate of antipsychotic prescribing for Māori is increasing much faster than other ethnicities: a 60% increase in 7 years (Wilkinson & Mulder, 2018), arguably leaving Māori the most susceptible to their metabolic side effects. This is extremely alarming, given that Māori are already disproportionately affected by cardiovascular disease (Miner-Williams, 2017), as well as experiencing higher rates of multi physical morbidity compared to the general population (Aminisani et al., 2020). Adding a diagnosis of schizophrenia for tangata whenua could mean a premature death up to 25 years earlier than the general population (Laursen et al., 2012). In life years this means that some people will not live past their 57th birthday (Te Pou o te Whakaaro Nui, 2021).
Purpose /Aim:
• To understand the relevance of the principles of Te Tiriti o Waitangi to contemporary mental health nursing practice.
• To understand how applying the principles of kawanatanga, tino rangatiratanga, and oritetanga can reduce the necessity for second generation anti-psychotics (SGA’s) as well as the use of coercion to administer them.
• To analyse a real-life scenario with a tangata whaiora and for the student to critically evaluate and reflect on their approach to the situation.
• To understand and appraise the many non-pharmacological alternatives to medication as first-line treatment.
• To understand the physical risks to tangata whaiora with the use of SGA’s and to increase student’s confidence in managing these risks.
• To prepare students with strategies to use when they are confronted with difficult discussions with colleagues in their workplace.
Method: Complete all three parts of the following assignment.
Part 1: Māori principles and the use of SGA’s
One ethical dilemma that arises for mental health nurses is that we must respect Māori rights as tangata whenua, but at the same time, part of our role involves enforcing treatment with SGA’s, when the Mental Health (Compulsory Assessment and Treatment) Act 1992 is being used.
1. Using relevant academic literature, critically discuss how using the Māori principles of kawanatanga (governance), tino rangatiratanga (self-determination), and oritetanga (for health professionals and Māori to maintain the mana of the other) might reduce the need for nurses to administer SGA’s by coercive means. (500 words)
2. Critically discuss examples from your nursing practice integrating the Māori principles above. If you do not have much nursing experience at this stage, draw from the academic literature for your examples. (500 words)
Part 2: Scenario
3. Use the following scenario best suited to your workplace and critically analyse one or two of the non-pharmacological options that could be implemented before medication. Use the academic nursing literature to articulate your holistic ideas for nursing practice in your chosen scenario. (500 words)
o Inpatient Nursing
4. With reference to one or two social and political influences, critically discuss the wider context of the tāngata whaiora’s experience of mental distress in your chosen scenario. (750 words)
Inpatient Nursing Scenario:
Shane is a Māori man who has whakapapa to Whakatōhea and is immersed in his Māoritanga. He has been admitted to the mental health unit under the Mental Health (Compulsory Assessment and Treatment) Act 1992, and you are his allocated nurse. This is his first presentation to mental health services. He was admitted after he had an argument with his girlfriend. His responsible clinician suspects he is experiencing drug-induced psychosis. Shane is mildly overweight and has a family history of diabetes and heart disease. Following a mental state assessment, the responsible clinician tells you that Shane is ‘floridly psychotic and irritable’ and has commenced him on olanzapine 5mg mane, 10mg nocte, with PRN olanzapine up to 10mg available for agitation, PO or IMI. In your interactions with Shane, you find him really engaged. He tells you he’s extremely reluctant to take the olanzapine.
Part 3: Advocating for Change
Tangata whaiora experience multiple physical risks when taking SGAs, and the nursing role involves understanding these risks, implementing holistic interventions, and advocating for change within the wider team.
5. Critically discuss, with support from the literature, what your concerns would be for Shane (the person in your chosen scenario in Part 2) when they are started on an SGA. Discuss the nursing interventions you will implement to try and mitigate any physical health risks. Use the academic nursing literature to support your actions. (750 words)
6. A month after commencing the medication, the tangata whaiora approaches you, distressed about several unwanted effects they are experiencing. You decide it is the right thing to do to advocate for a change of medication, however, the senior nurse refuses to address this with the responsible clinician. Critically discuss your nursing role and responsibilities to successfully advocate for this person and use nursing academic literature to support your discussion. (500 words)
References to be USED:
Aminisani, N., Stephens, C., Allen, J., Alpass, F., & Shamshirgaran, S. M. (2020). Socio-
demographic and lifestyle factors associated with multimorbidity in New Zealand. Epidemiology
and Health, 42, 1-7. https://doi.org/10.4178/epih.e2020001Links to an external site.
Burness, C., Corbet, C., Beyene, K., Webby, C., Nankivell, C., Cabasag, P., Hari, K., Fraser, A.,
Gray, S., Harrison, J., & Chan, A.H.Y. (2021). Factors predicting high-dose and combined
antipsychotic prescribing in New Zealand: High-dose antipsychotic prescribing. Psychiatry
Research, 302, 113996. https://doi.org/10.1016/j.psychres.2021.113996Links to an external site.
Laursen, T. M., Munk-Olsen, T., & Vestergaard, M. (2012). Life expectancy and cardiovascular
mortality in persons with schizophrenia. Current Opinion in Psychiatry, 25(2), 83-88.
Mental Health (Compulsory Assessment and Treatment) Act, 46 N.Z. (1992)
Miner-Williams, W. (2017). Racial inequities in cardiovascular disease in New Zealand. Diversity
and Equality in Health and Care, 14(1), 23-33.
Te Pou o te Whakaaro Nui. (2021). Equally Well: Physical health. Te Pou o te Whakaaro Nui.
https://www.tepou.co.nz/initiatives/equally-well-physical-healthLinks to an external site.
Walsh, M., & Grey, C. (2019). The contribution of avoidable mortality to the life expectancy in
Māori and Pacific populations in New Zealand – A decomposition analysis. The New Zealand
Medical Journal, 132(1492), 46-60.
Wilkinson, S., & Mulder, R. T. (2018). Antipsychotic prescribing in New Zealand between 2008 and
2015. NZMJ, 131(1480), 61-67.
Rubric
Ass 1 Marking Rubric
Ass 1 Marking Rubric
Criteria Ratings Pts
This criterion is linked to a learning outcomePresentation
University of Auckland guidelines for presentation including font, size, spacing, margins, and ID number are followed. Excellent spelling and grammar, recovery focused language evident. Appropriate use of professional language and presentation throughout. 15 pts
This criterion is linked to a learning outcomeStructure
Sentences and paragraphs are well structured enhancing succinct flow of ideas. Definitions provided. Focus/argument/thesis is developed 15 pts
This criterion is linked to a learning outcomeScope
All areas of the question covered
Relevance to practice is obvious.
Analysis demonstrates a positioning of ideas to ensure comprehensive exploration with sound critical commentary and synthesis. 40 pts
This criterion is linked to a learning outcomeLiterature
Accurate and detailed reference list and in-text citations follow APA 7th Edition requirements. Integration of literature regularly supports key themes/points discussed. 30 pts
Total points: 100
