Why Consumers Need Mental Health?

Requirement

Aim
The aim of this assignment is to help you to begin to use your professional judgment and think like clinical nurses in mental health settings and/or in relation to the mental health needs of consumers. In order to achieve this aim, everyone will be assigned a case scenario involving a consumer who is
experiencing issues relating to one of the various disorders commonly encountered in clinical practice.
Description
This is an individual assignment of 2000 words in two parts each with several steps. Follow the steps for each part carefully.
The piece will demonstrate a sound grasp of the following as they relate to your consumer and
include:
• a Mental Status Examination(MSE)
• a clinical formulation including biopsychosocial history and your own MSE observations leading to the clinical formulation
• a nursing orientated handover
• using Maslow’s hierarchy of needs to identity and prioritise consumer needs
• identifying nursing interventions and goals, timeframes and evaluation criteria for their achievement
• how to engage a consumer in a therapeutic relationship
• the application of cultural safety
• the application of the recovery model
You will need to justify your ideas with reference to relevant literature; students who plan to do well, read and use the unit’s required readings and additional items drawn from respected academic sources.

Solution

Mental status examination

This examination is required to find out the severity of the illness. The mental status examination involves many points. In severely ill patients like Cormac, these observations can be made. Cormac has schizophrenia.

  • The patients like Cormac are very suspicious and also socially awkward. Like , in this case, you can see him being suspicious about his boss. He is suspicious that his boss is taping his conversations with the customer and will utilise it against him.

  • The patient has many delusions or odd beliefs. Like , in this case, Cormac believes that he can talk to God. He sends messages to him through TV or radio. He also believes that he has conversations from the national spy agency. 

  • The patient does not show many emotions. In this case, Cormac is not responding to the nurse in a very positive way. He does not have an eye contact. His tone is monotonous and also his replies are brief. He shows very little emotion to his own story.

  • The patient admits that he responds to hallucination. Either auditory or visual. In Cormac’s case, he does admit that he can hear strangers talking about him. And for him these voices are real. They are not in his mind. He also laughs at their words. He is continuous talking to strangers while interviewing.

  • The patient shows thought to block . He takes long pauses. In this case, Cormac is not interested in answering what is being asked by the interviewer. Rather he is more interested in the other voices he is hearing. 

  • The patient does not have any insight into his own problems. In this case, Cormac is not aware of his own condition. He does not know that he is suffering from an illness. He does not have any concern about his appearance. His clothes are dirty and greasy. He has a beard. He does not even want to continue with medication. 

  • Usually, the patient is well oriented. In this case, also he is well oriented about his surroundings. He is aware of the fact that where is he. What is the particular date and time.

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The 5P mode in formulation

  1. Presenting problems- He is increasingly withdrawn, agitated and     irritable. He is threatening  towards his mother. He is irritable and not going to his work. He has also stopped his medications. He has become hostile and also he is smoking marijuana several times a day. 

  2. Predisposing factors- Cormac’s childhood was unremarkable. He never had a network of friends. His predisposing factor could be relationship breakdown which he had at the age of 20. He was taken to psychiatric hospital after that. He never had a strong relationship. A breakdown must have acted as a strong predisposing factor. He never has a network of friends.

  3. Precipitating factor- The Precipitating factors could be the cessation of medication. In this case, Cormac has not taken medicine for 6 weeks. Hence it has caused hostile behaviour in him. He was brought hospital by police. He has refused to go to work.

  4. Perpetuating factors-In this case it can be non-cooperation from the parent. As it has been mentioned that the parents are involved in conflicts. Four years of regular medication has not caused much relief. Cormac’s condition became worse. There is a possibility that he might not have received an adequate amount of support from society and parents.

  5. Protective factors- The protective factor is something which stops the individual from harming himself. For him, it is difficult to see that person in pain. In this case, Cormac is threatening  towards his mother. He cannot be called protective towards him mother. From the given case he is not found to be protective towards anyone.

Maslow’s Hierarchy of needs

It deals with providing motivation to people. As per him, people have certain motivational systems. People feels motivated to achieve certain needs. Once a basic level is achieved then progress towards next level is made. 

  • Physiological needs- In this, it has been seen that Cormac is not taking care of himself. He is having a beard, his hair is long, blond hair is greasy and matted. He is having a washcloth on his head. Even his clothes are crushed and stained. He is very thin in his appearance. It is the duty of the nurse to explain to him that he needs to take of himself. He should maintain his personal hygiene. This will help him to develop a positive attitude towards life.

  • Safety needs- In this case, Cormac might be feeling insecure about his surroundings. He already suspects his boss that he wants to find a mistake in his work. It is the duty of the nurse to tell him that he is secure and safe and nobody is conspiring against him

  • Belongingness and love need- In this Cormac need to explain the importance of the relationship. And how parents are important. Also it important to have a friend group. So that he can have a healthy social relationship. It is important to have peer group

  • Esteem needs. This comes with certain accomplishments and achievements in life. Cormac has moved away from his job. It is necessary to encourage him to work. So that he feels motivated to go to his work. His small accomplishments must be admired. So that he is motivated to further.

  • Self Actualisation-Cormac should be motivated and told that he has enough potential. He needs to realise his talents. And focus on what he actually want to do. 

Clinical Handover

 Cormac is a 24-year-old single man. He is suffering from schizophrenia since 4 years. The condition was detected first when he was 20 years. It precipitated from a breakdown relationship. Recently it has been noticed by his parents that he has become increasingly withdrawn, agitated and irritable. He refuses to go to work. He has become threatening  towards his mother . He has quit his medications since six weeks and  says  that he is feeling  tired all day , has dry mouth and trouble passing urine.  His appearance is not good. He is very unhygienic. 
During the interview, it has been found that he is not very interested in telling about himself. He is unable to sit at one place for long. He is very flat and does not show any emotion. It has been noticed that he has been talking to himself. When asked he said that someone is speaking to him. The voices are real not in his head. Also, he says that the voices tell him that strangers are talking about him. Also, he suspects his boss. As per Cormac, the voices say that his boss wants to find mistakes in his work. Hence he is tapping his conversation with the customer. 

The Therapeutic Relationship

Adherence to treatment in schizophrenia is considered to be very important. It is regarded as the most important aspect of recovery. Most patients do not adhere to the treatment. This is a symptom of schizophrenia. Also, it is very difficult to treat them with this symptom. This causes a relapse of symptoms and hospitalisation (Bluhm, R. L., Miller, J., Lanius, R. A., Osuch, E. A., Boksman, K., Neufeld, R. W. J., ... & Williamson, P. 2007). As in the case of Cormac his non-adherence to the treatment has caused him hospitalisation. He has become very hostile and his symptoms have relapsed. ( Barkhof, E., Meijer, C. J., de Sonneville, L. M., Linszen, D. H., & de Haan, L. 2012).  The therapeutic relation between the nurse and the patient has been found very important. It helps the patient to be adherent to treatment. The first aim of therapeutic treatment is to ensure attaching the treatment with the patient.  Therapeutic relation helps in maintaining the quality of life of schizophrenia patients.  Therapeutic relation also helps in predicting outcomes of complex psychiatry treatment. Therapeutic relation helps in communicating with the patient. Through communication, it is easy to found out the symptoms which trouble the patient most. In the case of Cormac, it is important to make him feel secure. (Fusar-Poli, P., Papanastasiou, E., Stahl, D., Rocchetti, M., Carpenter, W., Shergill, S., & McGuire, P. (2015). It can establish by effective therapeutic relation. In this, he can be explained that there is no one to harm him. He need not be suspicious about other activities. Also he his having strong auditory hallucinations. Slowly and steady by effective medication and the therapeutic relation it is important to explain to him that there is actually no one. These things have to be done very patiently has any quick progress might aggravate the patient condition.( Keltner, N. L. 2013). 

Cultural Safety

Ensuring cultural safety in patients with schizophrenia is very important. Cultural safety includes improvements in health status. Emphasis on health gains and positive outcomes. In the case of Cormac, he is not maintaining a basic hygiene. He is having dirty clothes, his approach is bad, he is not maintaining his hair or clothes. It is important to tell him the importance of basic care. It will help him gain better state of health. It will help him to develop a positive attitude towards life. Cultural safety also ensures that Cormac receives proper care and attention as per his condition. There should not be any distressful trigger around him. He should be able to follow his medicinal schedule properly. Cultural safety also ensures the challenges which come across during employment. Like in Cormac’s case he is suspicious that his boss wants to find mistakes in his work and hence he has been tapping his voice. It is necessary to address Cormac’s insecurities and treat them. These insecurities if left untreated can cause many problems. Also in cultural safety is important to balance a relationship with every consumer. So that every consumer receives an equal amount of care and attention. It is important to ensure that no consumer should have a biased feeling. There should be equal care given at all levels.

Recovery Model

The recovery model needs to focus on many aspects

  • Self-direction- The individual must be self-directed. He should be given a positive goal with motivation. His goals designed should be unique for him. In the case of Cormac, there can be a goal of completing his electronics study. He had dropped out of this. (Stuart, G. W. 2014). Completing studies will give him a lot of positive influence and motivation in life.

  • Individual and person-centered- There are multiple pathways to recovery. It is based on individual strength. For Cormac, his education can be his strength for recovery. 

  • Empowerment- Through empowerment, there can be the ability to take an own decision.  The consumers will collectively join each other and speak to each other.  In this, there is a value given to life. As the person won’t feel worthless. Employment gives a specific direction to life. 

  • Holistic-Recovery is not merely getting rid of schizophrenia . It is wellness of entire mind, body and spirit.  Recovery should be expressed in all aspects of life.  This should include the society, family and friends.  This should be reflected in social networking and communication. (Elis, O., Caponigro, J. M., & Kring, A. M. 2013)Cormac is not communicating with anyone. He has cut himself from the society .  Also, he is not maintaining his physical appearance. It is important to make him understand that his participation in the society is important and required. He needs to get out from his hallucinations and participate in social activities. He should communicate with people. The more he will communicate the more chances are of having a peer group.

  • Strength-based-  There is a focus on building multiple capacities. There should be a focus on individual talents and skills. The coping abilities also need to be checked. At times schizophrenia patients don’t respond well to changes. There coping ability need to be monitored. They need to be taught skills to engage their time. There should be the development of hobby to keep their mind occupied. So that unwanted thoughts don’t come to their mind. (Bowen, M. 2013).

  • Peer support- Support from peers and family is very much required in the recovery process, the patients feel positive. The feeling of being worthless as in the case of Cormac will not be there. 

  • Responsibility- There should be a sense of responsibility for their own self-care and further journey of life.

 

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References- 

  • Fusar-Poli, P., Papanastasiou, E., Stahl, D., Rocchetti, M., Carpenter, W., Shergill, S., & McGuire, P. (2015). Treatments of negative symptoms in schizophrenia: meta-analysis of 168 randomized placebo-controlled trials.Schizophrenia bulletin, 41(4), 892-899.

  • Bluhm, R. L., Miller, J., Lanius, R. A., Osuch, E. A., Boksman, K., Neufeld, R. W. J., ... & Williamson, P. (2007). Spontaneous low-frequency fluctuations in the BOLD signal in schizophrenic patients: anomalies in the default network. Schizophrenia bulletin, 33(4), 1004-1012.

  • Elis, O., Caponigro, J. M., & Kring, A. M. (2013). Psychosocial treatments for negative symptoms in schizophrenia: current practices and future directions. Clinical psychology review, 33(8), 914-928.

  • Keltner, N. L. (2013). Psychiatric nursing. Elsevier Health Sciences.

  • Stuart, G. W. (2014). Principles and practice of psychiatric nursing. Elsevier Health Sciences.

  • Barkhof, E., Meijer, C. J., de Sonneville, L. M., Linszen, D. H., & de Haan, L. (2012). Interventions to improve adherence to antipsychotic medication in patients with schizophrenia–a review of the past decade. European Psychiatry, 27(1), 9-18.

  • Bowen, M. (2013). Family Psychotherapy with Schizophrenia in the Hospital and in. Intensive family therapy: Theoretical and practical aspects, 213.

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