401013 Promoting Mental Health & Wellbeing 1
Question:
Case Study:
Focus on Chung, regardless of your status as a nursing or midwifery student.
Chung is a 35 years-old male who moved to Australia from China five years ago. His parents, older brother and younger sister still live in China. Chung visited his family in China once after a year of moving to Australia. He has not returned to China since, because of his long working hours and need to undertake additional study for promotion.
Chung is a doctor working in Accident and Emergency in a busy inner-city hospital. He is studying for promo-tion to ultimately become an emergency medicine consultant. Two years ago, Chung was under investigation by the hospital Human Resources department due to a drug error. He was very tired and had been on-call over-night with frequent call outs to see patients. The drug error resulted in an eight year-old boy being very sick, requiring intensive care admission. Chung used an intra-muscular medication to treat the boy but administered it intravenously. Chung was subjected to several work-place and medical board investigations and placed on practice supervision for 12 months.
Chung met his wife, Harriett, in Australia four years ago. Harriett is 30 years old. They married two years ago. Unfortunately, Chung’s parents and family could not attend the wedding due to the high costs of travel and his mother has severe arthritis in her hips, making travel very di?cult. Chung found their wedding day emotionally di?cult. He felt the ceremony lacked reference to his Chinese culture. On reflection, he feels that he wasn’t as involved in the wedding planning as he could have been, due to his long working hours. He simply agreed to the suggestions and plans made by Harriett and her family.
Chung and Harriett now have a three week-old baby girl, Charlotte. Charlotte was born by caesarean section, due to birth complications. Harriett has had an infection in the operation site since the birth, resulting in lots of pain, frequent dressings and di?culties moving around. Chung was o?work for one week after the baby’s birth. However, he has now returned to working shifts, often working through the night, where he may go without sleep for 20 – 24 hours. Harriett’s parents are staying with them to support Harriett while Chung is at work. However, he finds that Harriett’s parents are very involved with baby care even when he is home. Given this, Chung finds he gets very little time and space to be with his new daughter.
You are visiting the family in your capacity as a community nurse supporting Harriett with the caesarean section wound care or as a midwife undertaking a post-natal visit. During your visit to the family, you notice Chung looks flat in mood and tearful. His a?ect is sad and restrictive. He is slumped in his chair, with rounded shoulders and starring at the floor for long periods. You inquire about his health. He has very limited eye to eye contact with you. His speech is slowed and purposeful. On occasions, you need to repeat your question several times to get a reply. However, you do manage to obtain the following information from Chung. He has been feeling increasingly anxious during the past two months, given his continuing long hours, shift work, the high pressure of an Accident and Emergency department, Charlotte’s birth and his wife’s health. He has been having palpitations, chest pains and breathlessness for six to seven weeks. He asked a colleague at work, another doctor, to assess him for cardiac issues several weeks ago as he had been experiencing thoughts that he was going to have a heart attack and die. Chung has been feeling very low in mood for the past six weeks, experiencing sleeplessness, particularly initial insomnia and early morning wakening at 3am. He has lost five kilos in weight during the past month, due to reduced appetite and missing meals. He feels he is worthless and a failure at work within his medical role and he is letting his wife and new daughter down. He has been experiencing fleeting thoughts of suicide for the last week. He is aware of high lethality medications which he could take to overdose. Currently, he is hopeless and helpless and wants to die. He states he feels his situation is self-imposed and that treatments will not be of help at this time.
Tasks:
1.
1a) Using the case study provided, identify an urgent risk area. Ensure your answer details why you have identified this risk area including specific information about the client and current literature.
1b) Identify one nursing / midwifery intervention you would immediately undertake with your client to address the risk area noted in question 1a and include a rationale for the intervention.
2.
2a) Using the case study provided, identify a mental health concern. Ensure your answer details why this is an area of concern. Include specific information about the client and current literature.
2b) Identify one nursing / midwifery intervention you would undertake with your client to address the mental health concern noted in question 2a and include a rationale for the intervention.
3.
3) Using current literature, identify and discuss (2) two legal, ethical or professional issues a nurse / midwife may need to consider when working with the client in the case study
Answer:
1.
(a). From the point of view the most urgent risk area is suicide since Chung show the symptoms of depression which drives an individual towards committing suicide His suicidal thoughts are manifested through frequent withdraw from the family members, flat in moods and undergoing lack of sleep. In addition, Chung experiences difficulties in concentrating and feels worthless, hopeless and helpless as well as bad about himself and his life. He thinks mostly about his failures like not having enough time with his wife and daughter and on top failing to organize his wedding the way he wanted. Studies show that many men terminate their lives through suicide due to their unlikelihood to consult friends and families when undergoing through struggles (Franklin et al, 2017).
(b). Best intervention strategy a nurse can opt to is Dialectical Behavioral Therapy (DBT) to help the client get out of the suicidal thoughts (O’Connor & Nock, 2014).The nurse teaches the client skills that help him/her to endure and control their emotions. Nurses can achieve this via meeting the client regularly so as to get chance to motivate and precisely incorporate the relevant knowledge and skills. What Chung in this case study is I need of is the advice on how to control his feeling.
2.
(a). Chung is experiencing a feeling of low mood and sleeplessness which affects the mind and these are signs of anxiety. This anxiety is also manifested through Chung’s palpitations, poor concentration and shortness of breath. The symptoms of anxiety make a person feel helpless, out control and uncomfortable. Anxiety could be due to continuous long working hours, lack of time with his parent, his wife’s health and lack of involvement in his daughter’s life. Chung is also losing weigh due to changes in his appetite brought about by his anxiety condition. Current research about anxiety shows that it increase the risk of getting cardiovascular diseases like heart attack. It can also result to loss of memory.
(b). Nurses can help the client by treating him with respect and encouraging him to continue adhering to the recovery strategies that are being incorporated to him. The client can also be taken to psychologist experts who can help in recovering through counselling and guidance. Consistently visiting the client to know how he is doing with therapy can be of great impact (Cabassa et al, 2018). This can help Chung to improve quality of life and become well all-round. Cognitive behavioral therapy (CBT) is an intervention practice that can help get off with anxiety (Ehde Dillworth & Turner, 2014). CBT helps a person to get rid of anxiety via applied relaxation and change the perception of things.
3.
In agreement with the Nursing and Midwifery Board Association (NMBA) the nurse/midwife must value esteem and compassion for self and others. The ethics ensure that the nursing profession identifies the general human rights such as confidentiality and the ethical responsibility to safeguard the essential dignity and equivalent value of everyone. The nurses should acknowledge and admit the critical affiliation between health and human right (Åstedt?Kurki et al, 2018).
Nurses/midwifes must value excellence nursing care for all people and be aware that a client is entitled to self-rule and is at liberty from any external restrictions that might hinder him/her from exercising it. This is to ensure the every individual despite of the social positions is given treatment and care of high quality. The nurse/midwifery should provide care to all people depending on their need without discrimination (Silva et al, 2018).
References.
Åstedt?Kurki, P., & Kaunonen, M. (2018). Ethics in nursing research and research publications. Scandinavian Journal of Caring Sciences, 32(2), 449-450.
Cabassa, L. J., Manrique, Y., Meyreles, Q., Camacho, D., Capitelli, L., Younge, R., … & Lewis-Fernández, R. (2018). Bridges to Better Health and Wellness: An Adapted Health Care Manager Intervention for Hispanics with Serious Mental Illness. Administration and Policy in Mental Health and Mental Health Services Research, 45(1), 163-173.
Ehde, D. M., Dillworth, T. M., & Turner, J. A. (2014). Cognitive-behavioral therapy for individuals with chronic pain: efficacy, innovations, and directions for research. American Psychologist, 69(2), 153.
Franklin, J. C., Ribeiro, J. D., Fox, K. R., Bentley, K. H., Kleiman, E. M., Huang, X., … & Nock, M. K. (2017). Risk factors for suicidal thoughts and behaviors: A meta-analysis of 50 years of research. Psychological Bulletin, 143(2), 187.
O’Connor, R. C., & Nock, M. K. (2014). The psychology of suicidal behaviour. The Lancet Psychiatry, 1(1), 73-85.
Silva, T. N. D., Freire, M. E. M., Vasconcelos, M. F. D., Silva Junior, S. V. D., Silva, W. J. D. C., Araújo, P. D. S., & Eloy, A. V. A. (2018). Deontological aspects of the nursing profession: understanding the code of ethics. Revista brasileira de enfermagem, 71(1), 3-10.
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