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NSB 204 Mental Health Self and Others Assignment - Queensland University of Technology, Australia

Learning outcomes -

1. The development of professional therapeutic relationships with people with mental health issues and their carers and significant others.

2. The effect of sociodemographic and cultural factors on mental health.

3. To assess risks and strengths of the person with mental health issues, their carers and significant others, and to consider these while planning, developing, implementing and evaluating the evidence-based initiatives which promote mental health, facilitate recovery and promote wellbeing and resilience.

4. Supporting the rights of people with mental health issues to lead their treatment and recovery process, while also taking into account their carers and significant others. To collaborate (with consent) with others in the treatment and recovery process, while providing high quality care.

5. The use of empathetic and compassionate language, professional therapeutic relationships with mental health consumers, their carers, and significant others.

6. Contemporary models of care such as recovery-orientated practice, trauma-informed care, and social determinant approach.

Case Study Assessment - Task description: The aim of this assignment is for students to conduct a holistic assessment of a person's situation, using your professional and clinical judgement. Students are to gain a greater understanding of how to summarise assessment information in a way which is meaningful, and to gain practice in care plan development.

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Part 1: Holistic planning and assessment

1. Complete a mental status examination for your case study.

Answer - The mental Status Examination

The mental status examination encompasses information from 3 areas such as the clinical interview, behavioural observation, and rating scales (Tayloer, 2013; Williams et. al, 2011). The mental status examination consists of appearance, speech, mood, affect, thought form, thought content, perception, cognition, insight and judgement and risks (Cao et. al., 2012). First, with regard to appearance and behavior, Jayan is a 27 year old, Aboriginal man and looks younger than his age. His hair is long, shaggy, and a dark colour which reaches to his shoulders. He wears dusty jeans, a dirty long sleeved shirt and worn out riding boots with a cowboy hat. He has got tattoos of the word LOVE on each of the fingers of his left hand and on his right hand spell TESS, his girlfriend's name. He looks skinny as he says he has no appetite. He hesitates to speak to the nurse and says "What's the point anyhow?" In regards to speech, his speech rate is normal, volume is monotone, and the quantity is paucity, which is related to depression. In respect of mood, he implies suicide when the nurse asked him whether he has had any thoughts about suicide as he replies, "I've thought about it a lot. I know how to do it, too." His eyes often are filled with tears when he talks about his girl friend left to study in Brisbane and he says that he has no appetite. His mood rate is 1 out of 10 since he is very depressed to think about suicide. His mood is closely aligned with 'affect' as he is sad in quality and range of expressions is restricted. In relation to the form of thought, his answers are in monosyllables and show dull and depressed and thus, have disturbance of language or meaning. The content of Jayan's thought is full of suicidal thoughts, which implies a risk that should be managed. With respect to perception, the patient does not have any perception problems. With regard to cognition, he is oriented and conscious. In relation to insight and judgment, he does not have good insight into his mother's concern nor make good decisions. Lastly, with regard to risks, the patient's risk is self harm or suicide as he mentions that his cousin committed suicide and he has also thought about it many times.

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2. Clinical formulation - Use the information gathered from the case study to complete the clinical formulation under the headings of presenting, precipitating, predisposing, perpetuating, and protective factors (5Ps), in relation to biological, psychological, and social factors, relevant to the presentation of the person described in your case study.

Answer - A Clinical Formulation Table

3. Plan for Nursing Care - Identify two high priority problems/goals for the person and briefly justify which each is a priority.

Answer - Plan for Nursing Care

For Jayan, the most significant nursing care plan prevents his suicide and thus, the nurse should help him know that life is worth living. The nurse can persuade him to confess and find out a sign of suicide. The nurse can also explain to him that suicidal thoughts are just kinds of the illness. Demonstrating his thoughts is helpful as the nurse can do nursing interventions responding to his thought.

The nurse should talk with him in a slow, low and firm voice. In addition, the critical point of the care plan is to help him to express his feelings, thinking, and worries by using open-ended questions. With regard to posture, the nurse should keep a therapeutic distance and show open posture. When interacting with the patient, the nurse should make sure of showing empathy. In terms of his personal hygiene, when the patient is able to obtain his energy again to do work.

Secondly, in order to escape from depression, the nurse should tell him that feeling good can start when he also care about himself. The patient can be irritable or angry and hence, the nurse should show the calm and supportive attitude. Moreover, the nurse should encourage him to build relationships with loved ones. The nurse should also pay attention to his physical complaints and teach him about his behavior modification techniques. The nurse should examine his strengths and evaluate an activity achieved, and therefore, the nurse would help him improve. The nurse can ask the patient about what activities the patient is interested in. The activities should be productive and use his energy. It should be non-stimulating and also restrict in some way that it would not impact on the client emotionally.

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Part 2: Therapeutic engagement and clinical interpretation

1. Explain one specific strategy that you might use for the development of a therapeutic relationship with the selected person in the case study. Why is this important for that person? How would this apply to the nursing interventions you described?

2. Describe how the specific nursing interventions relate to the principles of the recovery model. What would be one issue that you may encounter while working with this person and how will you ensure that 'you' provide high quality care?

2.1. Clinical handover

Jayan is 27 years old and Aborigine and has been hospitalized in a rural area by the community nurse since he is at risk of suicide. As his father died owing to leukaemiawhen Jayan was 4 years old, he lived with his mother and his 3 younger sisters. During his school days, he was bullied and subject to racist tease. They had to fight with other students who teased them and were dragged up to the Principal's office. Today, Jayan works as a station hand and he loves his work. His mother said that Jayan did not look after himself appropriately and drank. In addition, she also represented him as gloomy since his girlfriend Tess left to study in Brisbane about two months ago. The community nurse confirms that Jayan is depressed. As the result of the mental status examination, even though he looks younger than his age, his clothes are not clean and he has got tattoos in his fingers and his right hand. He hesitatedto talk to the nurse and looked very sad when he was asked to talk to his girlfriend who he talks most easily and said that he fears that she will not love him. He said that he thought about suicide and also talked about his cousin's suicide. Therefore, the next shift needs to monitor him and encourage him.

2.2. The Therapeutic Relationship

In order to build a quality therapeutic relationship in mental health nursing, understanding is a key element. The ability of a mental health nurse is to show understanding. Delivering understanding is significant as it inspires patients with a sense of significance (Cadefroy et al., 2016).Particularly, when the nurse understands the patient, the nurse can help him understand himself, allowing him to impact on his treatment. Subsequently, knowing the patient facilitates customized care.

Active listening is taken account as the key elements of understanding. In order to perfectly convey understanding, the mental health nurse should not only listen to the patient but also be attending and attentive. Research shows that when a mental health nurse shows adequate attention and interest, patients feel understood (Tew et al, 2011).

Furthermore, interpersonal and communication techniques such as summarizing, clarifying, reflecting, and providing eye contact are taken into account to understand and relate to the patient. Along with the skill of listening to understand the patient correctly, the mental health nurse should find out problems and situation of the patient.

In order to truly understand the uniqueness of Jayan's situation, the nurse should go beyond what is expected of most other health professionals to achieve a personal knowledge of the patient. The mental health nurse should look beyond the obvious and make efforts to understand and attribute meaning to the behavior.

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2.3. Cultural safety

Jayan is an Indigenous Australian and thus, cultural awareness is essential to understand different. Some researchers criticize that cultural awareness develops the stereotype of cultural groups (Douché, & Carryer, 2011). Cultural sensitivity makes the health professional walk one step further in the level that realities and experiences accept legally (Douché, & Carryer, 2011). It indicates the start of the process of self-exploration in understanding how personal attitudes and experiences affect their patients. Where cultural awareness and cultural sensitivity help nurses know their personal attitudes and prejudices in a clinical context, cultural safety encourage patients' participation in order that patients can insist power and manage their own health and wellbeing. In particular, cultural safety is crucial in indigenous health. In terms of the power between patient and health professional, an authentic partnership is required between the nurse and the patient and cultural groups engaged in health care. In addition, the nurse should aware Aboriginal health and wellbeing in the respect of policy, history and culture. Further, cultural competence is to associate culture with health in order to enhance health and wellbeing. As a result, cultural competence is appreciated at all levels of health care system as behaviours, attitudes and policies constitute health care system. Cultural competency enables healthcare professionals and system to work effectively in the diversity of culture. Cultural competency makes Aboriginal people to access health care equitably and gain health outcomes.

2.4. Nursing care and recovery model

For Jayan, the two priority issues identified are preventing suicide and change his mood. In order to prevent suicide, the nurse should make him recognise the worth of living. Therefore, the nurse should encourage him to confess and find a suicidal tendency. In addition, the nurse can explain to him that a person who thinks suicide is a bad person but it can be the illness. In order for the nurse to do something, describing his thought is helpful in nursing care.

The nurse induces him to describe his feelings, thought and worries when the nurse asks him with a slow, low and stable voice. At the time, it is significant for the nurse to show empathy in his word. With regard to his personal hygiene, the nurse should encourage him to do tasks when he also cares about himself.

The second priority is recovering his mood, which means that he escapes from depression. Jayan is in the sadness and irritability and thus, the nurse should demonstrate the calm and supportive attitude. The nurse can help him to build relationships with loved ones. The nurse should also watch his physical health and educate him about his behavior modification techniques. The nurse should find out his strengths and examine an activity achieved, and thus, the nurse would promote his improvement. The nurse should find out what activities he is interested in and support productive activities for him. It should be non-stimulating and also constrain in some ways that would not affect the client emotionally.

Nurses play a key role in patient recovery since they work in all respects of health service, and they have responsibilities for delivering and coordinating care. The professional nurse should be in the center in the development and implementation of any action plan including patient recovery. Nurses are in the centre of the recovery movement based on the standards of nursing practice, composing the natural recovery process. The five elements for the recovery process embrace hope, active sense of self, discovery, connectedness and personal responsibilities (Leamy et al, 2011; Clossey, Mehnert, & Silva 2011). Jayan will have hope during the process of nursing intervention as the nurse gives hope to him when she talks to him. Hope is transferring from hopelessness and despair to hope. Now his is in despair since his girlfriend left him to Brisbane and thus, the nurse can help him to expand possibilities and know new options, rather than giving up everything. In addition, Jayan will recover his active sense of self through the process where the nurse finds out his strength and weakness and improves his development and achievement. Through holistic approach, correct assessment, intervention, and evaluation are implemented and nursing care approaches the patient within a health-oriented and cooperative care delivery model. With regard to the connectedness, the interaction with the patient is based on warmth, nurturance empathy, and caring and centred in an individual. A Mental nurse is building a good relationship between the patient and a nurse who acknowledges and responds to the individual's need for help. With a cooperative relationship, the recovery of the patient is achieved. In terms of personal responsibility, the nurse should help Jayan to develop adaptive and positive self image and be reborn with a meaningful existence.

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