Nsb204 Mental Health Self And Assessment Answers

This assignment aims to help you to begin to use your professional and clinical judgement and to think like nurses working in a mental health settings and/or in relation to the mental health needs of people regardless of the setting. Choose one of the four case scenarios below, of a person who is experiencing difficulties related to a mental health disorder.

1. Case scenario one: Mary- Depression
2. Case scenario two: Cormac- Schizophrenia
3. Case scenario three: Jayan- Risk of suicide
4. Case scenario four: Arnold - Mania

Description

This is an individual assignment of 1,700 words in two parts, each with several steps. Follow the steps for each part carefully. Related to the person in your selected case scenario your assignment will demonstrate your understanding of the following:

• Mental Status Examination (MSE)
• A clinical formulation including biopsychosocial history and your own MSE observations leading to the clinical formulation
• A nursing orientated handover
• Recognising and responding to the mental health needs of the identified person by identifying best practice nursing interventions
• How to engage a person in a therapeutic relationship
• The application of cultural safety
• The application of the recovery model/philosophy

You will need to justify your assignment points with reference to relevant literature. Students who plan to do well in this assignment, will read and use the unit readings as well as additional relevant evidence based practice resources.

Plan for Nursing Care

• Identify two (2) high priority problems /issues for the person and briefly justify why each is a high priority.
• Outline one (1) nursing intervention for each of the identified problems /issues and briefly explain how each is likely to positively contribute to care of the person with reference to relevant literature. Interventions must be nursing related, detailed, practical and within your scope of

practice.

The Therapeutic Relationship

• Explain how and why a therapeutic relationship will be established with the person in your care. This must not be a general description of  therapeutic relationships but demonstrate that you are applying therapeutic skills to this selected case and person. Then describe at least one (1) specific strategy appropriate for the development of a therapeutic relationship with this specific person and how it was applied in the nursing care interventions you described in Part 1.3.

Cultural Safety

• Describe the first step you would take to ensure that you deliver culturally safe care to this person. Then identify and describe one (1) issue that working with this person might present for you. Describe which of the principles of cultural safety you used in applying cultural safety in the nursing care interventions you described in Part 1.3.

Answer:

Part1: Holistic Assessment and Planning [903].

1.1 The Mental Status Examination for depression case. [248]

Table1: Showing Mental Status Examination of a depression case (Brannon& Schetzer, 2011).

1.2 Clinical Formulation Table. [198]

Table 2: showing representation of clinical for depression case adapted from standard templates (Selzer & Ellen, 2014).

1.3 Plans for Nursing Care [287]

In dealing with Mary’s case, the first priority is establishing nurse –patient relationship based on trust. I would ensure effective collaboration with other healthcare providers through development of effective working relations (Stovell, Morrison, Panayiotous, & Hutton, 2016). Promoting the clients’ self-worth, coping and problem-solving is another crucial intervention. A good communication skill is another priority. Communication in this context involves keeping a close watch to my emotions and reactions and ensuring safe care even after shift. This will ensure that those around her too monitor their emotions hence contributing positively to Mary’s case. My interventions should support her psychosocial dynamics of the case person under my care. Patient-centered care is another priority (Epner& Baile, 2012). I would drive to ensure my client’s wishing to recover quickly come first by reducing symptoms of psychosis. I will use available technology in management and treatment of my client such as mobile based applications for depression. This will help in treatment and recovery process (Paganini, Teigelkötter, Buntrock, & Baumeister, 2018). Self-care practices adherence during the care process is important in ensuring positive nursing experience. Educating the client on mental health disorder she is experiencing and the appropriate care process required will empower her to actively get involved in her care, promotes the client’s sense of self-regard and help sped up the recovery process (Wilson, Crowe, Scott & Lacey, 2018). Nursing care plan should ensure quality care, patient centered, informed care and recovery oriented. Evidence based nursing care is important practice hence I will ensure that all the client ’s information within my cope are available and a safe handover issued when my shift ends (Kathol, Perez, Cohen, 2010). My client will acknowledge for the quality service and satisfaction.

1.4 Clinical Handover [160].

Quality clinical handover is crucial for ensuring flow of information to other team responsible for the patient when my shift ends (Jason, Siefferman et al. 2012). Mental illness patient management requires clinical handover like other illness diagnosed by physicians (Malla, 2015).Safe handover ensures patient safety (Merten, 2017). The synthesized results for my case would be as follow:

 Mary is 41years old accountant. Her symptoms on admission are; quiet and brief, fells worthless and hopeless. She has a history of depressive mental disorder and genetically vulnerable to mental illness. Insomnia and loss of appetite has been reported. Currently, she is on leave and feels burdensome. Her physical health is good with history of low adherence to medication. She seems suicidal due to self-rejection and hopelessness with a family history of suicide under similar circumstances. Her coping strategies are good physical health and responsibility to her family. She speaks less often hence feels agitated when talked to.

Part 2.0 Therapeutic engagement and clinical Interpretation [800]

2.1 The Therapeutic Relationship [249]

A therapeutic nurse-client relationship is based on mutual trust and respect (Unhjem, Vatne, & Hem, 2018). The client have faith in me as a her case manager, requiring that I become sensitive of her care, nurturing her and assisting  with her physical, emotional, and spiritual needs. A caring relationship develops when we come together with my client, resulting in harmony and healing (Unhjem et al.,2018).The strategy I would use to establish good relationship with my patient is communicating effectively, being empathic and identify with her case. This will be important part of interacting with Mary and ensuring provision of care in a way that enable her involvement in her car to achieve wellness with respect to professional boundaries (Valente, 2017).I will introduce myself to the patient and use her name whenever I talk to her. During provision of care for mental illness privacy of the patient is important. Professional code of conducts and boundaries adherence underpinned by the standards of practice (Australian College of Mental Health Nurses, 2010). I would also create awareness on my client on her state of health and professionally make her develop interest on her care process and recovery (Crane & Ward,2016). I would implement self-care strategies to mitigate the effects of the work, and to have sustainable working experience with my client (Hunter, 2016). Therapeutic relationship with my client will be an invaluable tool throughout the care and recovery process. It will also be important during follow-up with the client.

2.2 Cultural Safety [213] 
Provision of culturally safe care by  reflecting on my own practice is a critical aspect of cultural safety practice. Working with the client present reflection on how my own beliefs and values may influence my relationship with the client (Koshy, Limb, Gundogan, Whitehurst, & Jafree, 2017). It is worthwhile to incorporate cultural factors that positively affect my client (Walker, St.Pierre-Hansen, Cromarty, Kelly, & Minty, 2010). Understanding my client’s culture is a step in championing culturally safe care. The issue worth identifying is stigmatization in relation to mental illness (Rossler, 2016).  I will focus on recognizing and responding professionally to my client’s deterioration in her mental state with reference to culturally safe care provision good practices (Australian Commission on Safety and Quality in Health Care, 2017). I will enlighten my client and her family and those around her on positive cultural practices that impact on her care. I will work together with the other team to discourage any form of labeling on my client in her social cycles and create awareness to reduce its impact on my client’s mental health. Maintaining my client’s autonomy and dignity during the care process and high level of privacy is an important practice.

2.3 Recovery-Oriented Nursing Care [322.]

Recovery is an individual process that cannot be controlled but can be supported and facilitated at individual, organization and system levels (Schon, Svedberg & Rosenberg, 2015).It is evident that persons with serious mental health illness can recover to normal. As literature searches reveals the need for understanding process of recovery, the case person under my care will be supported in recovery through clinical interventions outlined earlier. Recovery process of my client needs support from all healthcare team in the continuum of care. Providing safe care, maintaining favorable nurse-client relationship, patient-centre care and evidence base care will speed up recovery process. A guiding principle to recovery that emphasize on hope and a strong belief that develops enhancing environment for quick recovery is my central focus (Jacob, 2015). I will use both traditional and recovery models to ensure my client recovers quickly from the mental illness (Snow, Meadus, Marie, Budden, Kirby, Reid, 2014). The traditional model on mental health care focuses on diagnosis, compliance, the eradication of symptoms and illness and reducing risk while recovery model focuses on the client’s lived experience, choices and self-determination on achieving dreams and on encouraging positive risk-taking (Snow et al., 2014). Understanding the client’s lived experience with shared decision making make her the expert in her own care and make it possible to tame behaviors such as low adherence to medication that may undermine recovery process. The practice of my professionalism the case will be based on dignity and respect for the patient under my care. It will recognize the possibility of recovery and wellness, self-determination and self-management of mental health and also helps families to understand and support their loved one (Cavanaugh, 2014).The recovery approach acknowledges that individual expectations about themselves have a strong influence on behavior and outcomes hence worth applying in respect to my client. Using this model in the care process will ensure quick recovery for my client.

References

Australian College of Mental Health Nurses (2010). Standards of Practice in Mental Health Nursing, Australian College of Mental Health Nurses, accessed August 12, 2018 at https://www.acmhn.org/publications/standards-of-practice 

Australian Commission on Safety and Quality in Health Care. National Consensus Statement: Essential elements for recognizing and responding to deterioration in a person’s mental state. Sydney: ACSQHC; 2017.

Athanasos, P. (2017). Mood disorders, in K. Evans; D. Nizette and A. O'Brien (eds.), Psychiatric and mental health nursing, (pp. 370-390). Chatswood: Elsevier.

Bolton, J. (2015). How to integrate biological, psychological, and sociological knowledge in psychiatric education: a case formulation seminar series. Academic Psychiatry, 39(6), 699-702. Available at: https://link.springer.com/article/10.1007%2Fs40596-014-0223-7 [Accessed 10 Sep. 2018].

Brannon, G.E., & Schetzer, A.D. (2011).History and mental status examination. eMedicine. June 29, 2011.Accessed August 10, 2018 at https://www.medicine.medscape.com/article/293402-overview

Cavanaugh,S. (2014).Recovery-Oriented Practice, Accessed august 16,2018 at https://www.canadian-nurse.com/articles/issues/2014/september-2014/recovery-oriented-practice.

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Kathol, R.G., Perez, R., Cohen, J.S. (2010) The Integrated Case Management Manual: Assisting complex patients regain physical and mental health. New York, NY: Springer Publishing Company, LLC, 2010.

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