NSB204 Mental Health For Self And Others

NSB204 Mental Health For Self And Others

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NSB204 Mental Health For Self And Others

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NSB204 Mental Health For Self And Others

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Course Code: NSB204
University: Queensland University Of Technology

MyAssignmentHelp.com is not sponsored or endorsed by this college or university

Country: Australia

Questions:
1. Identify two (2) high priority problems /issues for the person and briefly justify why each is a high priority.2. 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:
The Mental Status Examination

Appearance

The patient, Mary appears very clean and tidy. She is seen to wear fashionablet-shirts paired with jeans. She hasshort and dark hair. However Mary does not wear any makeup. However often she is also seen sitting wearing her dressing gown.

Behaviour

The behaviour of the patient apparently seems normal. However sometimes she has moments of despair and is tearful on some occasions.

Attitude

The patient often feels worthless and hopeless and she thinks that she will not be able to manage herself and carry on to the next day.

Level of Consciousness

The consciousness of the level of the patient is normal.

Orientation

Speech and Language

Her speech and language does not have any problem however she refuses to talk to others at times.

Mood

She suffers from mood swings. At times she is apparently normal, and at times she appears depressed and tearful. She lacks sleep and suffers from insomnia.

Affect

As a result of her mood, Mary often lacks the motivation to carry out simple activities like eating or dressing.

Thought Process/Form

She feels worthless and hopeless. She also suffers from thoughts like she will not be able to survive anymore and will not be able to make it to the next day.

Thought Content

Her thought content of the patient is that she will not be able to manage herself anmore and will not be able to survive.

Suicidality and Homicidality

Mary does not have any suicidal thoughts.

Insight and Judgment

Mary likes to spend time in the church and admits that she gets pleasure from her visits to the church.

Attention Span

The attention span of the patient is also reduced as she lacks concentration while doing simple activities even like eating and dressing.

Memory

The memory of the patient is normal as she remembers things from her past.

Intellectual Functioning

The intellectual functioning of the patient is apparently optimal. She understands that if she is admitted to the hospital again, she would be trouble her family members. She is now adamant that she needs to stay at home to take care of her children and her husband. 
Clinical Formulation Table 200

 

Biological

Psychological

Social

Presenting

Acute illness

depression

Interpersonal problems

Precipitating

Sleeping disorder

psychosis

Social problems

Predisposing

stress

Cognitive problems

Work problems

Perpetuating

fatigue

Developmental problem

Healthcare factors

Protective

Chronic pain

Chronic addition

Cultural factors

Plan for Nursing Care
The two high priority nursing problems as perceived from the given case comprises of disturbed thought processes and impaired social interaction.
In order to justify the priority of the problem of disturbed thought processes, it should be mentioned that this is a symptom of major depression, where the individual is in a state when he or she experiences a disruption in cognitive operations and activities.
Similarly in case of impaired social interaction, this is another symptom of major depression where the patient suffers from inadequate ability if perform quality social exchange.
The nursing interventions that are needed to be carried out in order to address the problem of disturbed thought processes involves determination of the patient’s level of cognition function  that was present earlier. This can be done by collection of information from the patient, the family of the patient or the past medical records. This allows to establish a baseline data which helps the evaluation of the progress of the client. The interventions should allow the patient ample time to think about the made responses and to frame them appropriately (Van Bogaert, Kowalski, Weeks & Clarke, 2013). Hurry in such cases might increase anxiety in the patient. Through the interventions, the patient should be helped out to postpose the making of major life decisions. This should be done since making of major life decisions requires normal psychophysiological functioning. The interventions must ensure that the patient’s responsibilities are reduced. This helps to decrease the feelings of guilt, anxiety as well as pressure. The client must also be helped out to identify and address the persisting negative thoughts. This needs to be ensured so that the patient does not feel hopeless due to the negative thoughts. Such intervening might help to make the patient happier and healthier. The interventions should also ensure that the client is able to set structure in the family life in order to set schedules and predictable routines during severe depressions (Zarea, Nikbakht?Nasrabadi, Abbaszadeh & Mohammadpour, 2013).
In terms of interventions for the impaired social interventions, it should be ensured that activities are provided which require minimal concentration. This should be followed as most of the time the patients of depression lack memory and concentration. In cases, where the patient is in most depressed state, the interventions need to ensure that the patient is involved in one to one activity. These activities might help in relieving tension as well as elevating the mood. Interventions might also involve group activities that helps in socializing as it helps to reduce the feelings of isolation. In some cases the patient might also be referred to self-help groups in the community in order to help the client gain support from the experiences (Roldán?Merino et al., 2013). 
Clinical handover
The clinical handover follows the ISBAR method that comprises of:
Identification: The patient is Mary, who is 41 years old. She lives with her husband and three children.
Situation: Mary has been diagnosed with major depression.
Observations: The patient suffers from despair and fatigue. She suffers from sleeping disorder.
Background: Mary often talks of feeling worthless and hopeless and has made comments in the past that she can’t see how she will manage to get through another day.
Agreed plan: Evidence based interventions needs to be carried in respect of the nursing problems of disturbed thought processes and impaired social interaction.
Read back: The mental health care nurses need to be responsible for the patient and must establish a therapeutic relationship with the patient. 
The Therapeutic Relationship
Establishment of therapeutic relationship is a phenomenon that is multifaceted in nature, which mainly focuses on the alliance between the therapist and the patient. Therapeutic relationship should comprise of the following components that is development of therapeutic goals along with consensus on the necessary therapeutic tasks. It also includes the establishment of a positive affective bond between the patient and therapist.  A study by Rüsch et al., (2014), showed that a quality therapeutic relationship played a significant role in determining the therapeutic outcome of the patient suffering from depression. Development of such a high quality therapeutic relationship between Mary and her care giver, early in the treatment process will help in better predicting the treatment response. The care giver might be able to assess the symptoms which will show a reduction along with improved congenital functioning during the treatment period. The care giver should continue to maintain the relationship even during the follow-up period as the patient is suffering from major depression.
In relation to the interventions mentioned in the part discussing about the nursing care for the patients, the therapeutic interventions might include individual therapy that involves supportive and psychodynamic therapy. Group therapy is also involved which addresses the gender and the specific problems. It also identifies size, frequency and the safety issues. Behavioural therapy is also part of the therapeutic intervention that might be carried out by the patient (Wiger & Mooney, 2014). The patient can also be made to follow art therapy which will help Mary to express her context using different media.
Cultural Safety
In order to maintain cultural safety while providing care to the patients of depression, cultural competency is required to be maintained by the health professionals and care givers. The health care providers must be able to provide their service irrespective of the differences and comply with adeptness such as language, ethnicity, race, or culture. While working with Mary it should be ensured that health care provider is able to establish a sense of safety and security along with self awareness while providing care (Kang et al., 2016).
Working with the patient Mary it was perceived that she was a true Christian and she liked attending services at the church where she found solace. Therefore while working with her the care giver must keep this in mind and through maintenance of culturally competent mental health care, services should be provided. In order to do so, the caregiver needs to be well aware of the community structure and the community practices to which Mary belongs since the interventions involve making her involve in group activity intervention that involves the community. The delivery of the nursing care should also ensure that it is based on the cultural values of the patient along with her believes and behaviour. This will also affect the interventions like the supportive and the psychodynamic therapy in order to reduce social isolation of the patient (Chinman et al., 2014).
Recovery-oriented Nursing Care
The health recovery model takes a view of the person’s life through a holistic approach. The mental health recovery model compromises of the following:

Self-directed
Individualized and person-centered
Empowerment
Holistic
Nonlinear
Strengths-based
Peer support
Respect
Responsibility
Hope

The interventions mentioned in the first part of the paper deals with mainly two nursing problems of disturbed thought processes and impaired social interaction. The suggested interventions that might be implemented to address these problems involve the components of the health recovery model in the following way: the interventions are self directed as data is collected directly from the patient. The interventions ensure that patient is given ample time to think about their responses which involves the component of respect. It also ensures person centred care. The patients should be helped out to make major life decisions which helps to empower the patient. The interventions help to reduce the anxiety and the guilt of the patient. This involves a holistic approach of recovery. The client must also be helped out to identify and address the persisting negative thoughts. This shows that the element of strength is applied. The interventions also help to make the patient happier and healthier by reducing negative thoughts. This involves the element of hope in the recovery process. Interventions in terms of reducing social impairment involve the one to one activities that again help to empower the patient and provide responsibility and respect through which recovery can occur. Interventions might also involve group activities that help in socializing as it helps to reduce the feelings of isolation. This involves the element of peer support this helping inn recovery. In some cases the patient might also be referred to self-help groups in the community in order to help the client gain support from the experiences. This involves the non- linear and strength based elements promoting the recovery (Lloyd-Evans et al., 2014).  
References
Chinman, M., George, P., Dougherty, R. H., Daniels, A. S., Ghose, S. S., Swift, A., & Delphin-Rittmon, M. E. (2014). Peer support services for individuals with serious mental illnesses: assessing the evidence. Psychiatric Services, 65(4), 429-441. https://doi.org/10.1176/appi.ps.201300244
Kang, E. K., Jeong, H. S., Moon, E. R., Lee, J. Y., & Lee, K. J. (2016). Cognitive and language function in aphasic patients assessed with the Korean version of mini-mental status examination. Annals of rehabilitation medicine, 40(1), 152-161. Retrieved from: https://synapse.koreamed.org/
Lloyd-Evans, B., Mayo-Wilson, E., Harrison, B., Istead, H., Brown, E., Pilling, S., … & Kendall, T. (2014). A systematic review and meta-analysis of randomised controlled trials of peer support for people with severe mental illness. BMC psychiatry, 14(1), 39. https://doi.org/10.1186/1471-244X-14-39
Roldán?Merino, J., García, I. C., Ramos?Pichardo, J. D., Foix?Sanjuan, A., Quilez?Jover, J., & Montserrat?Martinez, M. (2013). Impact of personalized in?home nursing care plans on dependence in ADLs/IADLs and on family burden among adults diagnosed with schizophrenia: a randomized controlled study. Perspectives in psychiatric care, 49(3), 171-178. https://doi.org/10.1111/j.1744-6163.2012.00347.x
Rotella, F., & Mannucci, E. (2013). Depression as a risk factor for diabetes: a meta-analysis of longitudinal studies. The Journal of clinical psychiatry. Retrieved from: https://psycnet.apa.org/record/2013-13698-004
Rüsch, N., Müller, M., Lay, B., Corrigan, P. W., Zahn, R., Schönenberger, T., … & Rössler, W. (2014). Emotional reactions to involuntary psychiatric hospitalization and stigma-related stress among people with mental illness. European Archives of Psychiatry and Clinical Neuroscience, 264(1), 35-43. Retrieved from: https://link.springer.com/article/10.1007/s00406-013-0412-5
Van Bogaert, P., Kowalski, C., Weeks, S. M., & Clarke, S. P. (2013). The relationship between nurse practice environment, nurse work characteristics, burnout and job outcome and quality of nursing care: a cross-sectional survey. International journal of nursing studies, 50(12), 1667-1677. https://doi.org/10.1016/j.ijnurstu.2013.05.010
Wiger, D. E., & Mooney, N. B. (2014). Mental Status Exam. The Encyclopedia of Clinical Psychology, 1-5. https://doi.org/10.1002/9781118625392.wbecp104
Zarea, K., NIKBAKHT?NASRABADI, A., Abbaszadeh, A., & Mohammadpour, A. (2013). Psychiatric nursing as ‘different’care: experience of Iranian mental health nurses in inpatient psychiatric wards. Journal of psychiatric and mental health nursing, 20(2), 124-133. https://doi.org/10.1111/j.1365-2850.2012.01891.x

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