NURS2098 Complex Mental Health And Recovery

Question:

The purpose of this assessment is for you to demonstrate your ability to apply the knowledge you have acquired from this course to the case scenarios provided. NURS2098 Complex Mental Health And Recovery

Q1.

Part A: Identify and Describe two Key Concepts relevant to the Assessment of Suicide Risk as undertaken by MH Nurses in their practice .

Part B: Identify and Describe three specific Mental Health Nursing Interventions essential to the MH Nursing Suicide Risk Assessment of ‘Derek’. Your Response should describe the intervention itself and provide commentary on why and when it would be undertaken by the MH Nurse.

Introducing Derek

Derek is a 58yo married male (father of three grown children) who is currently an inpatient on your ward (day 7 of the admission). His wife and children are very supportive. NURS2098 Complex Mental Health And Recovery

He has a 5-year Diagnosis of Major Depression (MDD), Generalised Anxiety Disorder (GAD) (both of which occurred after he lost his job when his company was down-sized) and Post-traumatic Stress Disorder (PTSD) which was diagnosed following a serious motor vehicle accident (MVA) he had 10/12 ago).

He has a history of two previous admissions, the first 5 years ago when he was initially diagnosed with MDD and GAD, and the second 4 months ago following an overdose of his prescribed medications which he took in the context of feeling overwhelmed by flashbacks from the MVA. His current admission was precipitated by his youngest son moving to London to work.

He presents as low mood (states this is 3/10), restricted (congruent) affect, anhedonia, loss of energy, decreased motivation, poor selfcare (not showering / changing clothes), decreased dietary intake and very poor sleep in the context of reoccurring nightmares. In conversation he exhibits mild poverty of speech, and themes of hopelessness, worthlessness and guilt (associated with the belief he has been a poor provider for his family).

He has a history of attempted suicide x1 (4 months ago); he reported a gradual increase in the frequency and intensity of his suicidal ideation in the context of increasingly distressing flashbacks wherein he re-experienced the MVA (at which time he thought he was going to die). He is currently reporting fleeting suicidal ideation though is ambivalent about the frequency and intensity of the ideas). He stated on admission that he might overdose again but is now unsure about this.

Q2.

Q2 Part A: Identify and Describe two Key Concepts relevant to ONE of the three following therapy models Motivational Interviewing (MI), Cognitive Behavioural Therapy (CBT) or Acceptance & Commitment Therapy (ACT) as undertaken by MH Nurses in their practice (80 words / 2 marks).

Q2 Part B: Identify and Describe three specific Mental Health Nursing Interventions (specifically linked to the Therapy Model discussed in your Part A answer), that could be utilised in the care of ‘Alice’.

Your Response should describe the intervention itself and provide commentary on why and when it would be undertaken by the MH Nurse (120 words / 3 marks).

Introducing Alice

Alice is 27yo recently single female (her previous relationship of 3 years ended 7 weeks ago) who is currently an inpatient on your ward (Day 17 of the admission). She is an only child; her mother is very supportive but lives interstate and has been unable to travel to support her due to the CVOID-19 travel restrictions. Her father (with whom she was very close) died unexpectedly of a heart attack 2 years ago; she continues to struggle with the unresolved grief associated with his death

18 months ago she was diagnosed of Generalised Anxiety Disorder (GAD) and 12 months ago with Alcohol Dependence; she reports initially using 1-2 drinks to manage the increased anxiety associated with her father’s death however over time she ended up using up to 2 bottles of wine a night and not being able to control her drinking. She reports becoming increasingly belligerent and verbally hostile when intoxicated which was a major factor in her relationship ending and directly contributed to her losing her job (as a secretary) five weeks ago when she arrived at work clearly intoxicated and verbally abused a client and several colleagues. NURS2098 Complex Mental Health And Recovery

This is her first admission to a MH Unit. She was admitted after she was found heavily intoxicated, wandering in traffic on a road near her home late at night. She stated at the time she was ‘sick of living’ and wanted to ‘go and be with Dad’ though she has denied any suicidal ideation since citing her relationship with her mother as the main protective factor). She reported seeing a counsellor for a ‘few’ sessions after her father died to try help with her grief and again after she was diagnosed with GAD though in both cases she stopped going after a few sessions as she found them ‘to hard’, preferring to use Alcohol to help her cope instead. She Detoxed from the Alcohol over the first 10 days of the admission though continues to experience cravings when ‘stressed out’.

She presents as anxious, with a reactive anxious (congruent) affect, increased levels of irritability and tension along with feeling unable to relax, poor selfcare (not showering / changing clothes), decreased dietary intake and very poor sleep in the context of constant anxious rumination about her sense of being a ‘failure’ and a ‘loser’ because she’s not been able to ‘get over’ her problems and cope with her anxiety. Since her partner left her, she reports feeling ’ugly’ and ‘unlovable’ stating ‘who could ever love a messed-up loser like me’, and says she struggles to distract herself from these ideas which happen ‘all the time’.

Q3.

Part A: Identify and Describe two Key Concepts relevant to Mental Health Nurses in working effectively with the Carers and Families of Mental Health Consumers (80 words / 2 marks).

Part B: Identify and Describe three specific Mental Health Nursing Interventions that are (specifically) informed by the principles of Family Sensitive / Carer Inclusive Practice that would be appropriate in the MH Nursing care of the Consumer ‘Sian’ and her Family.

Your Response should describe the intervention itself and provide commentary on why and when it would be undertaken by the MH Nurse (120 words / 3 marks).

Introducing Sian:

Sian is 28yo married mother of twin 3yo daughters; she has a supportive husband (Luke) and extended family, and is currently an inpatient on your ward (Day 25 of the admission).

She has 3-year history of BPAD and was admitted in the context of a depressive episode; she reports her mental state had deteriorated over a 6-8 week period in the context of feeling overwhelmed by the demands of caring for her daughters. This was, in particular, due to very poor sleep as her girls had been unwell with persistent chest infections and had been sleeping very poorly overnight. She described feeling increasingly sad, irritable and frustrated by the growing belief that she was a ‘bad Mum’ as she had struggled to cope with looking after her daughters when they were unwell. She reports themes of helplessness and worthless with clear feelings of guilt about her perceived shortcomings as a mother.

She is estranged from her older brother (Garth) who has had longstanding mental health and substance abuse issues but otherwise is very close to her parents (Mark and Esme) and her younger sister (Tamika). Luke has previously been very involved in the care of their daughters but he recently took on a new role at work which has meant that he has been working long hours, often seven days a week and has been struggling to cope with the new job and trying to support Sian. Her parents live close by however they only have a limited understanding of her mental illness; Sian reports they are loving but very ‘old fashioned’ and think she just needs to ‘pull her socks up and get on with it’; they report wanting to better support Sian but they’re not sure what to do. Tamika has been Sian’s closest support and was staying with Sian to help her with her nieces however she reports feeling ‘exhausted’ as she has been unwell herself and has often found herself the target of Sian’s irritability in the form of unpleasant criticism and ridicule. She states Sian always apologises after she calms back down and she knows that Sian ‘can’t help it’ but still finds it hurtful and struggles to cope at times.

Sian exhibits good insight about needing extra support at the moment but is very worried about how to try to get ‘everyone on the same page’, as her previous attempts to talk to Luke, her parents and her sister have gone poorly. She is asking for help to better support her family as well as helping them work together better.

Q4.

Part A: Identify and Describe three Key Concepts relevant to Trauma Informed Care as utilised by MH Nurses in their practice (120 words / 3 marks).

Part B: Identify and Describe four specific Mental Health Nursing Interventions that are directly informed by the principles of Trauma Informed Care, and that would be appropriate in the MH Nursing care of ‘Brie’. Your Response should describe the intervention itself and provide commentary on why and when it would be undertaken by the MH Nurse (180 words / 4.5 marks).

Introducing Brie:

Brie is a 42yo married female (mother of two adolescent children) who is currently an inpatient on your ward (day 5 of the admission). Her husband is very supportive though her children at times struggle to understand her MH issues and get upset that she is in hospital.

She has a 22-year Diagnosis of Borderline Personality Disorder (BPD), a 12-year history of Post-traumatic Stress Disorder (PTSD). She was the victim of severe childhood sexual abuse from the age of 7-12 perpetrated by her uncle. She disclosed this to her mother on several occasions but was not believed and was accused of being ‘wicked’ and deceitful’ though she suspects that her mother was aware of what was happening.

She has a history of 10+ admissions in her late teens and early twenties usually in the context of a crisis often with associated suicidal ideation or deliberate self-harming behaviour; she rarely found them to be useful and reports getting discharged ‘worse off’ than she’d been when she was admitted. At the age of 30 she was attacked and sexually assaulted whilst walking home from a friend’s house late one evening and was subsequent diagnosed with PTSD due to recurrent nightmares, flashbacks and increasingly avoidant behaviour. She began seeing a Trauma Therapist which initially focused on the recent assault though over time began to include working on her childhood abuse as well. She has been seeing this Trauma Therapist for the past eight years. Her current admission was precipitated by her being unable to ‘protect’ her youngest daughter being bullied at school which has triggered her sense of hopelessness connected to her own trauma leading to increased suicidal thoughts (though denies plan or intent to act on same).

She describes her mood as being ‘all over the place’ with high levels of emotional dysregulation, increased irritability and poor tolerance in response to feeling out of control. She describes loss of energy due to very poor sleep, variable levels of motivation, decreased dietary intake. She reports her very poor sleep is in the context of reoccurring nightmares (that have re-emerged in the past 4-6 weeks). In interactions she appears hypervigilant and anxious and reports feeling unable to relax. She reports struggling to settle in the ward environment and finds herself worrying about the other consumers and ‘what they’re up to’. She had found some nursing staff very supportive though reports others seem to have ‘no idea’ about her reason for being there or what has happened to her in the past. She wants to ‘settle down’ enough to go home but feels like she’s ‘getting nowhere’…

Q5.

Part A: Identify and Describe three Key Concepts relevant to the Recovery Model of MH Care as utilised by MH Nurses in their practice

Part B: Identify and Describe four specific Mental Health Nursing Interventions that are (specifically) informed by the principles of the Recovery Model of MH Care, and that would be appropriate in the MH Nursing care of ‘Heintje’.

NURS2098 Complex Mental Health And Recovery

Your Response should describe the intervention itself and provide commentary on why and when it would be undertaken by the MH Nurse

Introducing Heintje:

Heintje is a 24yo single male who is currently an inpatient on your ward (day 41 of the admission).

He had his first episode Psychosis 18 months ago whilst in the 3rd Year of his Chemistry Degree which was characterised by hearing voices (voices of the Angels telling him that he has to save the world) and delusions of grandeur. He was treated with Olanzapine and responded very well to this initially however he developed some problematic side-effects over time (significant weight gain and associated loss of energy and diminished selfesteem) and so 2 months ago the decision was made to change his medication to Risperidone. This was initially undertaken in the community however Heintje’s mental state deteriorated as his dose of Olanzapine was decreased and did not respond to the commencement of the Risperidone. His hallucinations returned and became more pronounced and his behaviour became increasingly unpredictable and so eventually the decision was made to readmit him to review and optimize his medication regime. He was commenced on Lurasidone to which he has responded extremely well although he continues to hear occasional voices.

He now presents as euthymic in mood (states this is 8/10), with reactive (congruent) affect. He describes experiencing occasional voices which he identifies as being the ‘angels trying to upset him’ and persistent thoughts that he is ‘supposed to be healing the world’ though he is able to identify both of these as being symptoms of his illness and is able to ignore these when they occur. NURS2098 Complex Mental Health And Recovery

In 1:1 interactions he his reported feeling anxious about his future once he is discharged. He has had to take a leave of absence from his University studies due to his illness and as a result has lost contact with most of the friends he had made at University. He reports being an avid soccer player during his adolescence however he stopped playing when he became unwell though he still goes down to his local club to watch his old team play some weekends. He also lost his job working at his local K-Mart when he became unwell; he reports missing the money he earned there but reports that now he feels like he has nowhere to go and nothing worthwhile to do with his time. He would like to return to Uni and work but is very unsure about how to do this and very apprehensive that his ongoing symptoms mean he’ll be ‘no good’ to anyone anyway. NURS2098 Complex Mental Health And Recovery

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