CNA256 Mental Health


Janine’s mother reports that she made a serious attempt on her life four years ago by jumping in front of a bus. She is now left with a permanent limp and some chronic pain. However, she manages to get around okay most of the time. Janine works 10 hours per week with a consumer run supported employment initiative, and does gardening and house cleaning. She likes the work when she is doing it, although she usually needs a lot of encouragement to attend. She is picked up by one of the employment workers because she is not confident about using public transport. She also attends a community support facility two half-days per week for social activities, where she plays cards and participates in outings At other times, she mainly sits in her room or watches television at her accommodation. 
Janine has a case manager whom she sees each fortnight. The case manager’s main concern is the accommodation problem and Janine’s occasional use of cannabis with other residents at the supported accommodation. This causes Janine to withdraw more and becomes preoccupied with her delusions. The case manager says that Janine also needs regular supervision to make sure that she eats regularly, takes her medication and looks after herself. 
She often needs to be reminded to change her clothes and to maintain her personal care. However, she often appears untidy and poorly groomed. She always cooperates when reminded and is never irritable or aggressive. Janine says she is lonely having lost many of her friends when she became ill, and has not been able to make new ones. People at her work say that she is hard to relate to and often seems to be in her own world. She does not feel able to initiate any friendships and feels uncomfortable even starting a simple conversation. Janine is feeling low at the moment, and occasionally thinks about suicide as the only way out. 
1. Janine has a long history of mental illness and has been under the care of the local community mental health centre for six years. She has experienced several admissions to the psychiatric unit of the public hospital, the most recent being 12 months ago. 
Janine lives in a supported accommodation house run by a private accommodation provider where she feels threatened and intimidated by the manager. She claims that he constantly walks into her room uninvited, is always critical of her and does not give her full access to her benefit. Assessments by the Community Mental Health Team (CMHT) clinician have confirmed that these problems exist. The manager is a rather insensitive character, who appears to dislike Janine. He refuses to repair the heater in her room, and he watches the Nat high volume late into the evening. When Janine complains, he threatens to evict her. The CMHT clinician and care manager have been concerned for some time about the run-down state of the accommodation and the quality of its care, and have been investigating alternatives for Janine. 
When ill, Janine has become very disorganized in her thinking and experiences auditory hallucinations of people talking about her and laughing at her. She has not experienced these symptoms since her most recent acute episode 12 months ago. Although when acutely ill Janine’s thinking becomes very disorganized, at present she does not show any cognitive problems. However, she continues to have delusions that people living in her street are ASIO/Intelligence agents who are compiling a dossier on her, and watching and recording her every move. However, she does not act on these and is no longer greatly distressed by them.
Discuss how you would approach assessment and care:

1. Explain what is involved with developing a therapeutic relationship that is respectful of the patient’s choices, experiences and circumstances.
2. Outlines and nursing care consistent with the patient’s mental, physical, spiritual, emotional, social and cultural needs (as applicable).
3. Discuss therapeutic interventions which could be included in the patient’s care; include any appropriate collaborative multi-disciplinary involvement.
4. Discuss the existing risk factors for the patient. What questions might you ask to ascertain potential risk factors?
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