NSB204 Mental Health: Self And Others
Question:
Use information gathered from the MSE and the biopsychosocial assessment (history of presenting complaint, family and social history, current living situation, the person’s strengths and coping strategies, medical history) to complete a table under the headings of presenting, precipitating, predisposing, perpetuating and protective factors (5Ps) relevant to the clinical presentation of the person described in your case study.
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.
Answer:
Part 1
Response to question 1.1
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Appearance & behaviour |
Cormac has long beard and long blonde hair, which is greasy and matted. He used to take the washcloth on his head, which is very unusual. He also avoided the eye contact with the nursing personnel. Cormac was very interactive with the nurse as well. He did not think that he has any kind of disorder. |
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· Speech |
The answer of Cormac was very short and he replied in a very monotonous tone. Sometimes he replied with some irrelevant topics. |
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· Mood and Affect |
During the interview session, Cormac was very emotional during the statement of his own story. He thought he was completely fine. The nurses had observed that Cormac’s lips were whispering sometimes during the interview session. |
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· Form of Thought |
Cormac thought that the medication he was having was not safe for him and due to those medicines, he became restless. He thought that everyone thought of him as a bad person |
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· Content of Thought |
Cormac has the problem of delusions. He believed that He was a part of a god and he can interact with God by sending and receiving messages via radio and television. He also thought of himself as the member of the national spy agency and according to him; he had a regular conversation with them. |
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· Perception |
Cormac had been suffering from hallucination. He felt that he could hear someone’s voice and that voice was whispering in his ears. The voice was talking about him. He had also the thinking of that everyone had planned a conspiracy against him. |
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Sensorium and Cognition |
Cormac was almost attentive throughout the interview session but sometimes he went up from the chair and had a small walk to the window to see the outside area. He was aware of the place, time and as well as about the recent memory. He suspected himself as the messenger of God. |
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· Insight & Judgment |
Cormac was very aware of the situation and the place where he was. However, he was not in the condition to take a decision on his own and that is the reason he has stopped the medication. As a result, he became very aggressive to his parents. Marijuana is a promoter factor for Schizophrenia. Although he was taking marijuana twice a day. |
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· Risk Assessment |
As per the case study, Cormac had no history of attempting suicide. Nevertheless, he became a serious threat to his company’s sales and reputation. He tried to convince the entire customer not to buy the recording of that company. He was also sacrificing his family life by declining to join the work. |
Response to question 1.2
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Presenting factors
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The primary problem of Cormac in recent time is the schizophrenia and his aggressive behaviour is most threatening to his mother. He had also the problem of hallucination. He consumed marijuana twice a day and it would make the condition worse for Cormac. |
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Precipitating factors
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According to Cormac’s colleague’s he had stopped to take his medicines six weeks before and the made Cormac more aggressive. Cormac had refused to his office although his mother prompted him to go for his work. |
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Predisposing factors
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At the age of 20, Cormac had a history of hospitalization due to a relationship breakup. On that time he was first diagnosed with the schizophrenia. That mental trauma is mainly responsible for his disease. He was dropped out from his course due to his underperformance that is he did not submit his assignments on time. Even he had no trust in the feedback from his student. For this reason, he was dropped out. |
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Perpetuating factors |
Marijuana is another crucial substance for promoting schizophrenia. It is believed that smoking marijuana will increase the risk of schizophrenia. Cormac smoked marijuana twice a day. The detachment from medicine is another perpetuating factor for Cormac. |
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Protective factors
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According to the case study, Cormac had a bad working life because of his own behaviour. Moreover, he also a bad relationship with his parents. However, according to his mother is complain police had bought Cormac to the hospital. |
Response to question 1.3
The main problems which are related to Cormac are Hallucination that is talking with someone who is actually not there at all and then another one is a delusion that is Cormac thought that his phone was tapped by his boss in his office to make him wrong (Irmak,2014). Hallucination is a very common problem for a patient with Schizophrenia. In this case, study Cormac complained that he heard some voices and he claimed that those were real. This is really an alarming situation, as because this would be harmful to him. Moreover, the continuation of this process will cause severe damage to the health of Cormac. Delusion became very important in this case; as it was directly related to, his working life (Sass, 2014). Cormac had complained against his boss that he had disturbed Cormac’s privacy by tapping his communication with the customers. His hampered working life is a big threat to him. In presence of delusion, the nurses would show trusts to the matter that Cormac had told them. They should tell that Cormac was right and the nurse would keep the secret. Although they can ask for reasonable doubt about the condition. While feeding Cormac, nurses should be very attentive so that he cannot skip his medicines and food because Cormac thought that the medicines were harmful to him. The auditory hallucination is present in case of Cormac. Nurses should not touch Cormac suddenly because he may think of this as a threat. Nurses should show the attitude of acceptance towards the fact of hallucination. Distraction technique is another important technique to drive Cormac towards reality (Alderson-Day & Fernyhough, 2016).
Response to question 1.4
According to the MSE table and the clinical formulation table, the main clinical issue if Cormac that should be presented in during the handover is the problem of hallucination, delusion, the aggressiveness of Cormac towards his family (Hasan et al., 2013). It should also be mentioned that he was detached from the medication from last six weeks and he had been consuming marijuana for twice a day. The medical history of being a schizophrenic patient also should be mentioned during the clinical handover. That documentation will help in the future medication of Cormac. The psychological trauma that Cormac had four years ago, also should be mentioned during the process of clinical hand over because it is a crucial psychological factor for Cormac’s disease. The medicines that Cormac had previously should be referred to in the clinical handover period (Sonntag et al., 2016).
PART 2
Response to question 2.1
Therapeutic relationship refers to the interaction of the patient and the nursing personnel and this interaction helps in building a healthy environment around the patient. In this case, the nurse of Cormac should understand the feelings of Cormac so that she can assess the condition of Cormac’ properly. Cormac had experienced hallucination and delusion and as a result, it is very important to drive him towards the reality. To establish a wonderful therapeutic relationship the nurse can apply the Peplau’s theory to Cormac (Senn, 2013). According to this nurse would aware of her responsibility to Cormac. Along with this nurse would face difficulty at first and in this situation, she will continue the process of understanding as well. Whenever Cormac establishes faith in his nurse, the nurse should start the process of resolving hallucination as described in section 1.3. The nurse should try to convince Cormac that he was living in an unreal world and the voices he was hearing were not real at all. Along with this, she would also continue medicines because Cormac thought that medicines were not good for them. As Cormac started to believe his nurse, he also will believe that the medicines that are given to the nurse cannot be harmful to him. The nurse will also attentively listen to Cormac so that he can be more comfortable in his diseased situation. They will also help in differentiating between real and unreal facts (Kvrgic et al., 2013).
Response to question 2.2
Cultural safety is a practice of effective nursing that gives proper care to a person who has come from a different culture. In this case, study a nurse should first ensure that she would not make feel Cormac that Cormac had some disease. Initially, the nurse should ensure the healthy environment to continue the treatment process (Best, 2014). While treating Cormac, the nurse should face the trust issue because Cormac thought that the medicines were not good for him. Initially, when the nurse will give medicine to Cormac, he might refuse those medicines due to lack of trust in the nurse. In this case, the first principle of cultural safety can be used (Stuart, 2014). According to this, the main aim of this principle is to provide better treatment for Cormac. To ensure better treatment, at first, the nurse should build a good relationship with Cormac so that he can feel free to the nurse. Then the nurse should give Cormac proper medicines to overcome this condition. As Cormac became very thin, consuming healthy diet is a crucial issue for Cormac to improve his health and it is associated with the principle of cultural safety. Cormac had a belief that he can interact with God. The nurse should ensure that his thought was not correct without hurting his religious belief (Procter, 2013).
Response question 2.3
As mentioned in section 1.3, to treat the delusion the nurse should trust Cormac and tell him that she will not disclose the secrets to anybody. This nursing intervention is correlated with the principle named ‘Real choices’ and according to this principle, the nurse should support the thought of Cormac. Another important intervention, that is to show attentiveness to Cormac, is another principle of recovery. According to the principle of ‘Attitudes and right’, the nurse should listen to the words of Cormac. The nurse will also help Cormac in maintaining a social life as Cormac is partly detached from occupational life, family life. In this case, the nurse would encourage Cormac to go back to his working life, there was no threat from his boss, and his boss was not spying on him. The nurse should also tell that Cormac should not behave aggressively with his mother (Warner, 2013). This intervention is also associated with the previous one. The nurse should also show respect to the Cormac so that he would not feel bad. According to the principle, named ‘Dignity and respect’ nurse should maintain a respectful attitude toward Cormac so that he can realize that he was not discriminated with others due to his disease. Another important nursing intervention to treat Cormac is Communication. It can be a crucial tool to treat Cormac. A proper communication will help nurses to know about Cormac in details and that will be very helpful for the treatment. Moreover, a healthy environment makes Cormac easy to cope up with the condition. Along with this proper interaction will make it easy for the nurse to make a partnership with Cormac. A good partnership can provide a huge support to Cormac to combat against these situations. Moreover, this nursing intervention is related to the principle of ‘Partnership and communication’ that says about the bonding between nurses and the patient (“Department of Health | Principles of recovery-oriented mental health practice”, 2018).
References
Alderson-Day, B., & Fernyhough, C. (2016). Auditory verbal hallucinations: social, but how?. Journal of Consciousness Studies, 23(7-8), 163-194.Retrived from https://www.ingentaconnect.com/content/imp/jcs/2016/00000023/F0020007/art00008
Best, O. (2014). The cultural safety journey: an Australian nursing context. In Yatdjuligin aboriginal and Torres Strait Islander nursing and midwifery care (pp. 51-73). Cambridge, Melbourne,Australia. Retrieved from https://books.google.co.in/books?hl=en&lr=&id=4I9xBAAAQBAJ&oi=fnd&pg=PA51&dq=Best,+O.+(2014).+The+cultural+safety+journey:+an+Australian+nursing+context.+In+Yatdjuligin+aboriginal+and+Torres+Strait+Islander+nursing+and+midwifery+care+(pp.+5173).+Cambridge,+Melbourne,+Australia.&ots=aiGffnglvr&sig=Qw0_wh49nB6zi7EFWpXH3i2RCL8#v=onepage&q&f=false
Department of Health | Principles of recovery-oriented mental health practice. (2018). Retrieved from https://www.health.gov.au/internet/publications/publishing.nsf/Content/mental-pubs-i-nongov-toc~mental-pubs-i-nongov-pri.
Hasan, A., Falkai, P., Wobrock, T., Lieberman, J., Glenthoj, B., Gattaz, W. F., … & WFSBP Taskforce on Treatment Guidelines for Schizophrenia. (2013). World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for biological treatment of schizophrenia, part 2: update 2012 on the long-term treatment of schizophrenia and management of antipsychotic-induced side effects. The world journal of biological psychiatry, 14(1), 2-44.
Irmak, M. K. (2014). Schizophrenia or possession?. Journal of religion and health, 53(3), 773-777. Retrieved from https://link.springer.com/article/10.1007/s10943-012-9673-y
Kvrgic, S., Cavelti, M., Beck, E. M., Rüsch, N., & Vauth, R. (2013). Therapeutic alliance in schizophrenia: the role of recovery orientation, self-stigma, and insight. Psychiatry Research, 209(1), 15-20. doi.org/10.1016/j.psychres.2012.10.009.
Procter, N., Froggatt, T., Hamer, H. P., McGarry, D., & Wilson, R. L. (Eds.). (2013). Mental Health. Cambridge University Press. Retrieved from https://books.google.co.in/books?hl=en&lr=&id=sQepCgAAQBAJ&oi=fnd&pg=PA21&dq=Procter,+%26.,+Froggatt,+T.,+Hamer,+H.+P.,+McGarry,+D.,+%26+Wilson,+R.+L.+(Eds.).+(2013).+Mental+Health.+Cambridge+University+Press&ots=N1_TNfopDB&sig=8Wyva_0brl3BDYgUuDzGefXSQ2s#v=onepage&q=Procter%2C%20%26.%2C%20Froggatt%2C%20T.%2C%20Hamer%2C%20H.%20P.%2C%20McGarry%2C%20D.%2C%20%26%20Wilson%2C%20R.%20L.%20(Eds.).%20(2013).%20Mental%20Health.%20Cambridge%20University%20Press&f=false.
Sass, L. A. (2014). Delusion and double book-keeping. In Karl Jaspers’ philosophy and psychopathology (pp. 125-147). Springer, New York, NY. Retrieved from https://link.springer.com/chapter/10.1007/978-1-4614-8878-1_9
Senn, J. F. (2013). Peplau’s theory of interpersonal relations: Application in emergency and rural nursing. Nursing science quarterly, 26(1), 31-35. DOI:10.1177/0894318412466744
Sonntag, O., Plebani, M., Della, P., Jones, D., Steward-Wynne, E., Walsh, J., & Lee, M. (2016). Effective communication in clinical handover: from research to practice(Vol. 15). Walter de Gruyter GmbH & Co KG. Retrieved from https://books.google.co.in/books?hl=en&lr=&id=JJrUCwAAQBAJ&oi=fnd&pg=PR5&dq=Sonntag,+O.,+Plebani,+M.,+Della,+P.,+Jones,+D.,+Steward-Wynne,+E.,+Walsh,+J.,+%26+Lee,+M.+(2016).+Effective+communication+in+clinical+handover:+from+research+to+practice(Vol.+15).+Walter+de+Gruyter+GmbH+%26+Co+KG.&ots=tsQUqWS-HT&sig=f8D65jGPMClUepTUXY2Mvy-YLoI#v=onepage&q&f=false
Stuart, G. W. (2014). Principles and Practice of Psychiatric Nursing-E-Book. Elsevier Health Sciences. Retrieved from https://books.google.co.in/books?hl=en&lr=&id=ivALBAAAQBAJ&oi=fnd&pg=PP1&dq=Stuart,+G.+W.+(2014).+Principles+and+Practice+of+Psychiatric+Nursing-E-Book.+Elsevier+Health+Sciences.&ots=pEI3MpjZp1&sig=EbXFcNkEY9mjVhTk-PFaO7pdOuw#v=onepage&q=Stuart%2C%20G.%20W.%20(2014).%20Principles%20and%20Practice%20of%20Psychiatric%20Nursing-E-Book.%20Elsevier%20Health%20Sciences.&f=false
Warner, R. (2013). Recovery from schizophrenia: Psychiatry and political economy. Routledge. Retrieved from https://www.psychiatry.ru/siteconst/userfiles/file/englit/Richard%20Warner%20(Author)%20-%20Recovery%20from%20Schizophrenia%20Psychiatry%20and%20Political%20Economy.pdf.
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