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NSB204 Mental Health

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NSB204 Mental Health

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Course Code: NSB204
University: Queensland University Of Technology

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Country: Australia

Question:
Discuss about the Case Study of Samuel.
 
 
Answer:

Introduction
This assignment deals with the mental health study of a person named Samuel. He is 25 years old gay and single man who lived in a shared house. He works at his locality as a barber. He used to drink frequently at nights and smokes the weed regularly for reducing stress. He also went to gym at his leisure time for doing some workout.
Samuel is having some mental problems as he reports of feeling guilty of not being a typical son as everyone as he doesn’t want to marry and have children. His mother had a history of anxiety and depression. At his school level he became a victim of brutal assault in which he got a scar beneath the chin and his nose was broken which took 3 days to recover from the hospital (Akiskal, 2016).  During the past eight years he got some thought of self harm and anxiety and while diagnosis it was found he is suffering from Post Traumatic Stress Disorder. Before that he does not have any such issues. The doctor had prescribed him a low dose of antidepressant and had counselling sessions.
 
Mental status examination
Whenever a patient is admitted to a hospital the first step a nurse used to do is assessment. It is a process of collecting data, then organizing them for the evaluation and finally the documentation of the data of the patient. This assessment process is one of the important tasks for the health care experts as they must know the physical, mental and social status of a patient (Coombs, Curtis, & Crookes, 2013). An assessment is necessary to do for obtaining the information for creating the detailed history of the patient and distinguishing the problems so that a suitable diagnosis plan can be made.
The mental health status examination is a process that provides a structure about the condition of the mental health of an individual. The MSE deals with some key elements which are being addressed. They are:

Appearance
Behavior
Mood
Speech
Cognition
Pattern of thought
Consciousness level

Appearance & behavior

*        Appearance

Looks similar to his age, is friendly and co-operative, body is of moderate build as he goes to gym at his free time for doing work out

*        Motor behavior

Seems to be sad and have a guilt feeling

*        Attitude to situation and interviewer

Friendly to the interviewer

Speech form

*        Rate

Speaking very fast

*        volume

Volume is high

*        Quantity

While telling his problems his words are repetitive

Mood and affect

 

*        Mood

Sad, guilty

*        Affect

 

Form of thought

 

*        Excess, absence

Presence of various bad thoughts

*        Continuity of ideas

Nil

Content of thought

 

*        Delusions

Nil

*        Suicidal thoughts

Nil

Perception

 

*        Hallucinations

He is thinking that he was being by a gang.

*        Illusions

Nil

Sensorium and Cognition

 

*        Level of consciousness

Conscious

*        Memory

Having his past memories

*        Orientation

Nil

*        Abstract thinking

Thinking that he was being beaten by a gang

Insight and Judgment

 

*        Extent of individual awareness of the problem

Awareness of the extent of the problem is too much effective.

*        Can they make rational decision

No

Risk Assessment

 

*        Potential for harm to self

No

*        Potential for harm to others

No

*        Potential for absconding

No

Clinical Formulation Table
The clinical formulation is a process in which the patients information is explained which is obtained from clinical assessment. This process offers a hypothesis about the cause of the disease, its nature and the process of diagnosis.
The case formulation can be done by the 5P table:

5 P’s

Patient condition

Presenting factors

Post Traumatic Stress Disorder

Precipitating factors

Caused from a brutal assault when he was in school

Predisposing factors

It makes him remind of his past where he had been beaten and his nose was broken.

Perpetuating factors

It increased when he saw a television report on a school student being beaten by some others.

Protective factors

Samuel strength was the community case manager who helps him in the counseling and his habit of drinking alcohol together with smoking weed, which helps him to reduce stress.

Plan for nursing care
The plan of nursing care for the psychology patients mainly depends on the MASLOW’S HEIRACHY OF NEEDS. It is a motivational theory for the psychological patients which mainly depend on five different features generally shown by a pyramid (Tanner, 2016).  By this theory Maslow explained that people are having some basic needs and these needs sometimes become very important from the others.
In case of Samuel the two main prior needs are love needs and psychological needs. As Samuel is not so much attached to his parents he feels lonely and also he is having a feeling of guilty that he is unable to satisfy his parent’s demands. At this point if Samuel’s parents will give him love and support, then he can get recover himself from his guilt feelings. Also he can recover from his childhood trauma and will able to lead his normal life (Dallos, 2017).
 
One nursing intervention
PTSD is a mental disorder that leads to stress which causes life threatening nature of the patient. Cognitive behavioral therapy is being used for the management of PTSD. CBT has been proved as a safe and an effective treatment for both acute and chronic trauma.
As Samuel is suffering from post traumatic stress disorder, the cognitive behavioral therapy is the best intervention plan. PTSD is the most dangerous health hazard in a person’s life. Therefore, it’s very important to provide treatment as soon as possible so that the trauma of PTSD can be reduced from both the individual and society (Adam, 2017). From the studies it can be stated that the effects of PTSD from child abuse and fight are more harmful than the others.
CBT is the best and most widely used approaches for reducing stress, depression, sleeplessness, anxiety, relationship problems, and various other problems. Cognitive behavioral therapy can be done individually or in groups together with the people having similar problems (Ryu et al., 2016). It generally includes the learning process in which the mental health condition of a patient can be learned and to apply the techniques such as relaxation, stress management and assertiveness.
 
Steps in CBT

Identifying the condition of the patient – Firstly the nurse must identify the situation of problem in Samuel’s life. In case of Samuel the problems detected were trauma, stress, depression, anxiety, fear, tiredness and sleeplessness. His therapist Mary used to do his counselling (Johnstone, 2017).
To be aware of the thoughts for these problems – After the identification of the problems Mary asked Samuel to share his thoughts about the problems. During this session Samuel described that he feels like he was in the middle of the gang which was beating him and it is causing a fear inside him (McLeod, 2016).
Identification of negative thinking – Samuel told Mary that he is having the feeling of getting exhausted, feeling restless and speaks very quickly with tremble in his voice. He is also getting tired and becoming sleepless at nights (Adelufosi et al., 2017).
Reshape negative or inaccurate thinking – Mary asks Samuel to get engaged in the counselling process. In this process the person is told to view his situation of trauma, which might be difficult. But with practice and control over the behavior patterns will help Samuel to recover from his negative thinking.

Therapeutic relationship
The therapeutic relationship is referred as an alliance between healthcare expert and a patient. It is the way of therapy in which the professional tries to engage with the other and hopes that this engagement will bring a change which will be beneficial to the patient. This type of relationship is different from others and are valuable to the clients those who have problems in making good relationships with others. It is also beneficial to the patients, those who had experienced some traumatic events in the childhood. As Samuel is suffering from post traumatic stress disorder which has caused from his past incident of bashing, he is being treated by his case manager carefully.  The therapeutic relationship between Mary and Samuel is based on trust and respect between both of them.  As given in case study that when Samuel was suffering the most from the trauma he called for his case manager Mary and she as soon as possible appeared in Samuel’s house (Rizvi, 2016).
 
Cultural safety
While treating with CBT the nurse must look after the cultural safety of a patient. There are various ways which we will help to improve the sensitivity of culture and the usual features of CBT. There are seven steps to maintain patient safety:

To build the safety culture for the treatment
To support the patient and providing them the best ways of treatment
To incorporate the activity of risk management.
To help in promotion of CBT.
Getting involved with the patients by communicating with them
Learning and sharing of the safety lessons
For preventing harm of the patients, implementation of some strategies.

In case of a mental disorder a nurse or the care manager can think of different ways for generating a therapeutic treatment which includes the process of understanding the patient’s problem. In addition to this the care manager can also organize some counselling sessions and some process to reflect the problem of the patient (Cleary et al., 2017).
Recovery oriented nursing care
The recovery oriented nursing care is a type of care which is used to provide prevention to the disease by the help of screening, then the diagnosis is done, treatment is provided accordingly and then the patient is sent for the rehabilitation of posttraumatic stress disorder (PTSD) (Van der Kolk, 2017).
Three dimensions of access to PTSD care in Department of Defense (DoD) and Department of Veterans Affairs (VA) are considered—availability, accessibility, and acceptability.

Availability is used to measure the amount of resources a health care system has, such as manpower and technology for fulfilling the needs of patients. To make sure that an effective care is available to a PTSD patient (Coombs, Curtis, & Crookes, 2013).
Accessibility is referred to accumulating the needs of the patient, which will satisfy them for the treatment and their stay in hospital (Dallos, 2017).
Acceptability refers to the patient-centered care and diagnosed the patient, treating the health issues and other social factors which can motivate the patient’s needs and priorities for care.

 
References
Adam, S. (2017). Critical care nursing: science and practice. Oxford University Press.
Adelufosi, A., Edet, B., Arikpo, D., Aquaisua, E., & Meremikwu, M. M. (2017). Cognitive behavioral therapy for post?traumatic stress disorder, depression, or anxiety disorders in women and girls living with female genital mutilation: A systematic review. International Journal of Gynecology & Obstetrics, 136(S1), 56-59.
Akiskal, H. S. (2016). The mental status examination. In The Medical Basis of Psychiatry (pp. 3-16). Springer New York.
Cleary, M., Lees, D., Molloy, L., Escott, P., & Sayers, J. (2017). Recovery-oriented Care and Leadership in Mental Health Nursing. Issues in Mental Health Nursing, 38(5), 458-460.
Coombs, T., Curtis, J., & Crookes, P. (2013). What is the process of a comprehensive mental health nursing assessment? Results from a qualitative study. International nursing review, 60(1), 96-102.)
Dallos, R. (2017). Reflections on assessment, diagnosis and formulation.
Johnstone, L. (2017). Psychological Formulation as an Alternative to Psychiatric Diagnosis. Journal of Humanistic Psychology, 0022167817722230.
McLeod, S. (2016). Maslow’s Hierarchy of Needs. Simply Psychology Website.
Rizvi, S. (2016). The essential aspects of building a therapeutic relationship. Indian Journal of Positive Psychology, 7(3), 359.
Ryu, J. H., Kredentser, M. S., Bienvenu, O. J., Blouw, M., Sareen, J., & Olafson, K. (2016). Post-Traumatic Stress Disorder in Survivors of Critical Illness. Comprehensive Guide to Post-Traumatic Stress Disorders, 263-280.
Tanner, R. (2016). Motivation: Applying Maslow’s hierarchy of needs theory.
Van der Kolk, B. A. (2017). Developmental Trauma Disorder: Toward a rational diagnosis for children with complex trauma histories. Psychiatric annals

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