NSB204 Mental Health Self And Others
Question:
Choose one of the four case scenarios below, of a person who is experiencing difficulties related to a mental health disorder.
- Apply principles of cultural safety and reflect on self to articulate the role of self in person-centred mental health care and therapeutic use of self.
- Demonstrate and apply knowledge of the challenges and factors that can compromise mental health for ourselves and others in order to promote positive mental health and wellbeing.
- Conduct a biopsychosocial and mental status assessment to create a clinical formulation, informed by the recovery model, to enhance the provision of consumer focused care.
- Describe key mental health issues and work with consumers and carers to address needs and promote recovery across the care continuum applying the Recovery Model.
- Explain and apply knowledge of the Mental Health Act and mental health standards for practice.
Answer:
The Mental Status Examination:
Level of consciousness:
Although Mary is orientated to time place and person, she is not that alert. She gives brief response when attempts are being made to engage her.
General appearance:
Mary appears well-dressed and well-groomed evidenced by her brushed hair and fashionable jeans and t-shirt with sandals.
Behaviour:
She avoids eye contact during the conversation and sits quietly with her hands clasped in her fingers.
Mood and affect:
The patient is dysphoric and conversation with her reveals that she is depressed. Her conversation also reveals feelings of worthlessness and hopelessness. She described many moments of despair when she is tearful thus suggesting that she is depressed (Pollard, 2018).
Speech:
Her speech is very slow and monosyllabic. She is not fluent during conversation and gives brief answer to questions.
Thought content:
Her thought content is considered logical as she has the understanding that she is physically well. She has also systematically described her treatment history related to diagnosis of depression three years ago and cessation of the drug one year later. Her description about her illness suggests that her thought pattern is coherent (Finney, Minagar & Heilman, 2016). There is no hallucination or false sensory perception.
Perception/insight:
Mary had poor perception about her illness. Although she reports about feeling hopeless and depressed and lack of motivation to complete simple activities, still she thinks any kind of treatment is not necessary for her. Hence, her insight about illness is poor.
Judgment:
Her current judgment is poor because she needs to be admitted to the hospital fro treatment of depression. However, she refuses it as she thinks looking after her children is important and she is in not in need of any medication (Finney, Minagar & Heilman, 2016).
Clinical Formulation Table
|
Presenting factor |
Precipitating factor |
Predisposing factor |
Perpetuating factor |
Protective factor |
|
Depressed mood, feelings of hopelessness and worthlessness, lack of interest in daily activities, poor personal hygiene and sleep difficulty |
Previous admission to hospital for depression, medical history of depression and loss of connection with friends and family |
Previous history of depression is a predisposing factor as evidence shows that depression is a lifelong disease where recurrent rate is high. Many patients who have half recovered or received treatment continue experiencing one or frequent episodes of depression (Suija et al., 2010). Hence, diagnosis of depression is a predisposing factor of current symptoms for Mary |
Mary has stopped visiting the church and responding to phone calls from friends. She has also stopped doing activities that she enjoyed such as visiting church. Hence, these perpetuating factor can increase the risk of depression |
Mary’s husband Jim and her children are protective factors that would help her recover from her illness |
Plan for Nursing Care
Based on assessment of Mary, two high priority problems that have been identified for Mary are lack of social engagement and lack of positive skills to deal with her depression. Lack of social engagement can be regarded as a nursing problem because isolating from friend and family can deteriorate her symptoms and worsen her depression. Social isolation can have negative effect on longevity as well as physical and mental health (Matthews et al., 2016). Hence, to reduce severity of depression, it is necessary to provide intervention that promotes social engagement for Mary. In addition, another high priority issue identified for Mary is that she has adapted negative strategies to deal with her depression. Instead of taking steps to distract herself from negative thought, she has taken the step to stay alone in the bed all time and be tearful during moments of despair. Hence, her coping skills need to be addressed to prevent future harm.
To reduce feelings of social isolation, the nursing intervention that is important is to spend time with patient and encourage her to take part in activities that gives hope and motivation. Prokofieva, Koukia and Dikeos (2016) give the evidence that establishing personal rapport and showing positive regard to patient with depression is important to reduce social isolation. By engaging in therapeutic relationship with patient, nurse can also assist Mary to identify areas of changes and identify activities that can give her strength and pleasure. Social connectedness is a part of treatment for depression and participation in social interaction can help patients like Mary to improve social functioning and alleviate symptoms (Cruwys et al., 2014).
As poor coping abilities has affected Mary’s ability to self-care and effectively deal with depression, it is necessary to provide intervention that provides self-care support to Mary. Attending to her hygiene and self-care needs and encouraging patient to increase responsibility for self-care can strengthen independence of Mary and promote physical and mental health too (Prokofieva, Koukia & Dikeos, 2016). As has adapted poor coping technique, resilience building can be used as an intervention to increase Mary’s capacity to deal with episodes of grief. The protective factors of patient can be used to increase resilience. Encouraging Mary to share her worries with her husband would help her to get the required support during extreme events. Shastri (2013) supports that the family plays a significant role in the development of resilience.
Clinical handover
The client Mary, a 41 year old woman is a patient with a history of depression and currently suffering from recurrent symptoms of depression. Her current symptoms include lack of interest in daily activities, poor personal hygiene, depressed mood, feelings of worthlessness, sleep difficulty and lack of social engagement. Review of her family history shows she lives with her husband Jim and three children. She works in large accounting form and Jim is a partner in the legal firm. She is happy with her work too. Her family and children are protective factors of illness. Her family history shows she was diagnosed with depression three years back suggesting precipating factor behind depression.
The review of mental status examination has revealed that Mary is well-groomed however has poor hygiene. She avoids eye contact and uses slow speech to express her concern. Although she is orientated to place, however she has stopped taking part in activities like visiting church and talking with friends. Not taking hypertensive medication and resistance to taking admission to hospital for treatment is also an issue. She had taken Citalopram for depression one year ago, however no longer uses it now.
The Therapeutic Relationship
While providing care to Mary, establishing therapeutic relationship with Mary will be important to facilitate positive nurse-patient experience and increase patient’s trust with care. Therapeutic relationship building process can also act to enhance social support for Mary and provide safe environment to her. Different types of skills such as communication skills, affection and interpersonal skills enable nurse and other staffs to develop therapeutic relationship with patient. Empathy is also an important skill that can be displayed by warmth, friendliness and showing genuine interest towards patient problem (Clarke et al., 2017). Hence, empathy along with friendliness can reduce level of depression for Mary and increase adherence to treatment.
One specific therapeutic skill that can be applied while engaging in therapeutic relationship with Mary includes use of therapeutic listening skills. This skill is particularly important during conversation with Mary because the main cause behind depressed mood is not known. The assessment does not reveal about any event or stressors in life that has lead to depression for Mary. Hence, therapeutic listening skill can be implemented by allowing space to Mary to respond to her worries on her own will. Kornhaber et al. (2016) states that therapeutic listening is a necessary component for data gathering and it acts a means for fostering positive nurse-patient relationship too. Patiently listening to Mary’s concern can also help to identify her unmet needs. Attentive listening, pausing and summarizing can help to achieve the purpose of building therapeutic relationship with patient.
Cultural safety:
While providing any nursing intervention to patient, respecting their cultural preferences and values is necessary to provide high quality care and enhance patient experience with care. To provide culturally safe care to Mary, her dignity will be respected during assistance for self-care and hygiene related activities. During dressing Mary or while assisting her during bath, necessary permission will be taken from her. Any cultural habits related to cleaning and hygiene will also be respected. In addition, while planning social activities for Mary, it will be necessary to consider her cultural values. This is important because the patient may not like engaging in activities that violates her cultural values. Hence, the cultural safety principle of respect and acknowledgement of cultural differences will be applied to avoid any cultural conflict with Mary. This would help to provide care in an environment that protects identity and well-being of patient. Another advantage of respecting Mary’s cultural value during care is that it can promote equity, social justice and a climate of safety for patient (Almutairi, 2015).
Recovery-oriented Nursing Care
The key nursing interventions that has been planned for Mary includes increasing social support for Mary to reduce social isolation and build resilience and positive coping skills to deal with depression. The nursing intervention of social support has been planned by engaging in therapeutic relationship by building rapport and showing positive regard to Mary. The intervention is in compliance with the principles of recovery oriented care because therapeutic communication skills puts patient at the centre and respects uniqueness of the individual while providing care (Chester et al., 2016). Hence, by engaging in the process of therapeutic relationship building and providing social support to patient, the intervention will enhance social identity and purpose in life. While planning social activities, her cultural considerations have been considered too. This enables delivery of care in a way which supports recovery of mental health consumers. By respecting cultural preferences and giving patient autonomy, Mary can be empowered to lead a better life. Active listening skills and acting after communication with patient are positive attitude that respects right of patient and supports nurse to work in realistic way with patient (Kidd, Kenny & McKinstry, 2014).
The nursing intervention of promoting resilience and positive coping skills has been planned to increase motivation and interest towards recovery in patient. Positive coping technique can address Marie’s poor perception towards her illness and motivate her to engage in activities that distracts her from negative feelings. Resilience is a concept in mental health that is directly linked to recovery oriented care because resilience is a skill that can help patients like Mary to learn coping skills, gain competencies and increase their capacity to fight with mental illness. Resilience can help to maintain equity in care and preserve rights of patients too as resilience can be developed as a strength to avert mental illness (Howell & Voronka, 2012).
References:
Almutairi, A. F. (2015). Fostering a supportive moral climate for health care providers: Toward cultural safety and equity. NursingPlus Open, 1, 1-4.
Chester, P., Ehrlich, C., Warburton, L., Baker, D., Kendall, E., & Crompton, D. (2016). What is the work of recovery oriented practice? A systematic literature review. International journal of mental health nursing, 25(4), 270-285.
Clarke, S., Ells, C., Thombs, B. D., & Clarke, D. (2017). Defining elements of patient-centered care for therapeutic relationships: a literature review of common themes. European Journal for Person Centered Healthcare, 5(3), 362-372.
Cruwys, T., Haslam, S. A., Dingle, G. A., Haslam, C., & Jetten, J. (2014). Depression and social identity: An integrative review. Personality and Social Psychology Review, 18(3), 215–238.
Finney, G. R., Minagar, A., & Heilman, K. M. (2016). Assessment of mental status. Neurologic clinics, 34(1), 1-16.
Howell, A., & Voronka, J. (2012). Introduction: The politics of resilience and recovery in mental health care. Studies in Social Justice, 6(1), 1-7.
Kidd, S., Kenny, A., & McKinstry, C. (2014). From experience to action in recovery-oriented mental health practice: A first person inquiry. Action Research, 12(4), 357-373.
Kornhaber, R., Walsh, K., Duff, J., & Walker, K. (2016). Enhancing adult therapeutic interpersonal relationships in the acute health care setting: an integrative review. Journal of multidisciplinary healthcare, 9, 537.
Matthews, T., Danese, A., Wertz, J., Odgers, C. L., Ambler, A., Moffitt, T. E., & Arseneault, L. (2016). Social isolation, loneliness and depression in young adulthood: a behavioural genetic analysis. Social psychiatry and psychiatric epidemiology, 51(3), 339-348.
Pollard, C. W. (2018). Fundamentals of the Psychiatric Mental Status Examination: A Workbook. Canadian Scholars.
Prokofieva, M., Koukia, E., & Dikeos, D. (2016). Mental health nursing in Greece: Nursing diagnoses and interventions in major depression. Issues in mental health nursing, 37(8), 556-562.
Shastri, P. C. (2013). Resilience: Building immunity in psychiatry. Indian Journal of Psychiatry, 55(3), 224–234. https://doi.org/10.4103/0019-5545.117134
Suija, K., Aluoja, A., Kalda, R., & Maaroos, H. I. (2010). Factors associated with recurrent depression: a prospective study in family practice. Family practice, 28(1), 22-28.
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