A Nursing Care Plan For A Person With A Mental Health Disorder

Holistic Assessment and Planning

Part1: Holistic Assessment and Planning [903].

1.1 The Mental Status Examination for depression case. [248]

Appearance & Behavior	On admission Mary appears smartly dressed, fashionable, no make-up, clean and tidy. Motor behavior:  quite, feel Self-neglected, retardation, and adamant. Save Time On Research and Writing Hire a Pro to Write You a 100% Plagiarism-Free Paper. Get My Paper Posture: clasping labs, low level of alertness.  Facial expression: startled. Reaction to me: minimal information.  (Vares,Salum,Spanemberg,Caldieraro,& Fleck,2015) (Karyotaki et al., (2017).
Speech and language	Rate: slowed and hesitant. Poverty of speech: Brief, monosyllabic and impoverished. Volume: soft. (Recupero & Patricia, 2010)
Mood & Affect	Depressed, sad and hopeless. (Indicators of suicidal thinking.) dysphoria –hopeless, irritability. Internal mood: Sustained. Dysphonic mood: Hopeless and sad. Angry: Frustrated. Affect: full range and flat. (Mahli et al., 2015).
Thought content	The client has disordered perceptions characterized by  Anti-social urges and harm to self. Risks: The client seem in danger to herself due to suicidal idealation-hopelessness and with a family history of suicide.  (Vares et al., 2015)
Perception	Depersonalization- detached herself from friends. Dissociative- church and community functions. Illusion. (Athanasos, 2017).
Cognition	Observing the level of consciousness, attention and concentration; Mary’s cognitive functioning  on the time of assessment are as follows: Conscious and attentive. Intelligence: intelligent-The client’s occupation is an accountant on leave hence sense of intelligence.  (Mullahy,2010) (Recupero & Patricia, 2010).
Emotions	Neuro-negative signs: Struggling to sleep (insomnia). Lost appetite. (Silbersweig, 2015).
Insight and Judgment	Insight: insight into her illness, aware of her surrounding and responsibility. Judgment: Impaired. Risk assessment: Vulnerable to suicide. (Vares et al., 2015)

Table1: Showing Mental Status Examination of a depression case (Brannon& Schetzer, 2011).

1.2 Clinical Formulation Table. [198]

Factors	Biological	Physiological	Social
Presenting	Anxious Insomnia-struggles to sleep. Loss of appetite (Bolton,2015)	Clasping, Illusions.	Friends-kind and caring Feels worthless hopeless
Precipitating	Medication-anti depressants Personal hygiene: deteriorated   illness- previously diagnosed	Grief/loss Treatment Stressing events (Bolton,2015)	Work-on leave on medical grounds. Relationship-married.
Predisposing	Genetic Illness-past mental disorder, suicidal idealities. Medication-low adherence ((Fernando& Cohen, 2014).	Personality-stressful, Modeling- her mother past diagnosis. Coping strategy-conscious Self-esteem- low	Socio-economic status-poor Burdensome.
Perpetuating	Genetic-suicidal family history. Medication-low past adherence. (Bolton,2015)	Hopeless-feeling worthless (suicidal idealities). helpless	Self –isolation-detach from church and community functions.  Self-rejection-sense of self-disregard.
Protective	Physical health- Mary’s physical health is good hence protection from further illness.	Coping strategies: Mary is knowledgeable about her surroundings. Insightful-the need to take care of her family. Responsive-she briefly respond to  inquiries during the clinical interview Conscious- Awake hence can response during assessment and hence good during care process. Mindful-She expresses the need to recover and go back to undertake family responsibility. (Fernando& Cohen, 2014).	Social support-Friends and family are supportive to Mary. Concern family and Sense of belonging-The client’s need to undertake family responsibility. (Bolton, 2014).

 

Table 2: showing representation of clinical for depression case adapted from standard templates (Selzer & Ellen, 2014).

1.3 Plans for Nursing Care [287]

In dealing with Mary’s case, the first priority is establishing nurse –patient relationship based on trust. I would ensure effective collaboration with other healthcare providers through development of effective working relations (Stovell, Morrison, Panayiotous, & Hutton, 2016). Promoting the clients’ self-worth, coping and problem-solving is another crucial intervention. A good communication skill is another priority. Communication in this context involves keeping a close watch to my emotions and reactions and ensuring safe care even after shift. This will ensure that those around her too monitor their emotions hence contributing positively to Mary’s case. My interventions should support her psychosocial dynamics of the case person under my care. Patient-centered care is another priority (Epner& Baile, 2012). I would drive to ensure my client’s wishing to recover quickly come first by reducing symptoms of psychosis. I will use available technology in management and treatment of my client such as mobile based applications for depression. This will help in treatment and recovery process (Paganini, Teigelkötter, Buntrock, & Baumeister, 2018). Self-care practices adherence during the care process is important in ensuring positive nursing experience. Educating the client on mental health disorder she is experiencing and the appropriate care process required will empower her to actively get involved in her care, promotes the client’s sense of self-regard and help sped up the recovery process (Wilson, Crowe, Scott & Lacey, 2018). Nursing care plan should ensure quality care, patient centered, informed care and recovery oriented. Evidence based nursing care is important practice hence I will ensure that all the client ’s information within my cope are available and a safe handover issued when my shift ends (Kathol, Perez, Cohen, 2010). My client will acknowledge for the quality service and satisfaction.

1.4 Clinical Handover [160].

Quality clinical handover is crucial for ensuring flow of information to other team responsible for the patient when my shift ends (Jason, Siefferman et al. 2012). Mental illness patient management requires clinical handover like other illness diagnosed by physicians (Malla, 2015).Safe handover ensures patient safety (Merten, 2017). The synthesized results for my case would be as follow:

The Therapeutic Relationship

 Mary is 41years old accountant. Her symptoms on admission are; quiet and brief, fells worthless and hopeless. She has a history of depressive mental disorder and genetically vulnerable to mental illness. Insomnia and loss of appetite has been reported. Currently, she is on leave and feels burdensome. Her physical health is good with history of low adherence to medication. She seems suicidal due to self-rejection and hopelessness with a family history of suicide under similar circumstances. Her coping strategies are good physical health and responsibility to her family. She speaks less often hence feels agitated when talked to.

Part 2.0 Therapeutic engagement and clinical Interpretation [800]

2.1 The Therapeutic Relationship [249]

A therapeutic nurse-client relationship is based on mutual trust and respect (Unhjem, Vatne, & Hem, 2018). The client have faith in me as a her case manager, requiring that I become sensitive of her care, nurturing her and assisting  with her physical, emotional, and spiritual needs. A caring relationship develops when we come together with my client, resulting in harmony and healing (Unhjem et al.,2018).The strategy I would use to establish good relationship with my patient is communicating effectively, being empathic and identify with her case. This will be important part of interacting with Mary and ensuring provision of care in a way that enable her involvement in her car to achieve wellness with respect to professional boundaries (Valente, 2017).I will introduce myself to the patient and use her name whenever I talk to her. During provision of care for mental illness privacy of the patient is important. Professional code of conducts and boundaries adherence underpinned by the standards of practice (Australian College of Mental Health Nurses, 2010). I would also create awareness on my client on her state of health and professionally make her develop interest on her care process and recovery (Crane & Ward,2016). I would implement self-care strategies to mitigate the effects of the work, and to have sustainable working experience with my client (Hunter, 2016). Therapeutic relationship with my client will be an invaluable tool throughout the care and recovery process. It will also be important during follow-up with the client.

2.2 Cultural Safety [213] 
Provision of culturally safe care by  reflecting on my own practice is a critical aspect of cultural safety practice. Working with the client present reflection on how my own beliefs and values may influence my relationship with the client (Koshy, Limb, Gundogan, Whitehurst, & Jafree, 2017). It is worthwhile to incorporate cultural factors that positively affect my client (Walker, St.Pierre-Hansen, Cromarty, Kelly, & Minty, 2010). Understanding my client’s culture is a step in championing culturally safe care. The issue worth identifying is stigmatization in relation to mental illness (Rossler, 2016).  I will focus on recognizing and responding professionally to my client’s deterioration in her mental state with reference to culturally safe care provision good practices (Australian Commission on Safety and Quality in Health Care, 2017). I will enlighten my client and her family and those around her on positive cultural practices that impact on her care. I will work together with the other team to discourage any form of labeling on my client in her social cycles and create awareness to reduce its impact on my client’s mental health. Maintaining my client’s autonomy and dignity during the care process and high level of privacy is an important practice.

Cultural Safety

2.3 Recovery-Oriented Nursing Care [322.]

Recovery is an individual process that cannot be controlled but can be supported and facilitated at individual, organization and system levels (Schon, Svedberg & Rosenberg, 2015).It is evident that persons with serious mental health illness can recover to normal. As literature searches reveals the need for understanding process of recovery, the case person under my care will be supported in recovery through clinical interventions outlined earlier. Recovery process of my client needs support from all healthcare team in the continuum of care. Providing safe care, maintaining favorable nurse-client relationship, patient-centre care and evidence base care will speed up recovery process. A guiding principle to recovery that emphasize on hope and a strong belief that develops enhancing environment for quick recovery is my central focus (Jacob, 2015). I will use both traditional and recovery models to ensure my client recovers quickly from the mental illness (Snow, Meadus, Marie, Budden, Kirby, Reid, 2014). The traditional model on mental health care focuses on diagnosis, compliance, the eradication of symptoms and illness and reducing risk while recovery model focuses on the client’s lived experience, choices and self-determination on achieving dreams and on encouraging positive risk-taking (Snow et al., 2014). Understanding the client’s lived experience with shared decision making make her the expert in her own care and make it possible to tame behaviors such as low adherence to medication that may undermine recovery process. The practice of my professionalism the case will be based on dignity and respect for the patient under my care. It will recognize the possibility of recovery and wellness, self-determination and self-management of mental health and also helps families to understand and support their loved one (Cavanaugh, 2014).The recovery approach acknowledges that individual expectations about themselves have a strong influence on behavior and outcomes hence worth applying in respect to my client. Using this model in the care process will ensure quick recovery for my client.

References

Australian College of Mental Health Nurses (2010). Standards of Practice in Mental Health Nursing, Australian College of Mental Health Nurses, accessed August 12, 2018 at https://www.acmhn.org/publications/standards-of-practice 

Australian Commission on Safety and Quality in Health Care. National Consensus Statement: Essential elements for recognizing and responding to deterioration in a person’s mental state. Sydney: ACSQHC; 2017.

Athanasos, P. (2017). Mood disorders, in K. Evans; D. Nizette and A. O’Brien (eds.), Psychiatric and mental health nursing, (pp. 370-390). Chatswood: Elsevier.

Bolton, J. (2015). How to integrate biological, psychological, and sociological knowledge in psychiatric education: a case formulation seminar series. Academic Psychiatry, 39(6), 699-702. Available at: https://link.springer.com/article/10.1007%2Fs40596-014-0223-7 [Accessed 10 Sep. 2018].

Clinical Formulation Table

Brannon, G.E., & Schetzer, A.D. (2011).History and mental status examination. eMedicine. June 29, 2011.Accessed August 10, 2018 at https://www.medicine.medscape.com/article/293402-overview

Cavanaugh,S. (2014).Recovery-Oriented Practice, Accessed august 16,2018 at https://www.canadian-nurse.com/articles/issues/2014/september-2014/recovery-oriented-practice.

Crane, P.J., &Ward, S.F. (2016).Self-Healing and Self-Care for Nurses.AORN Journal, 104(5),386-400.Availabe at https://www.clinicalkey.com/nursing/#!/content/playContent/1-s2.0-S0001209216306391

Vares,E.A.,Salum,G.A.,Spanemberg,L.,Caldieraro,M.A.,& Fleck,M.P.(2015).Depression Dimensions: Integrating Clinical Signs and Symptoms from the Perspectives of Clinicians and Patients,10(8),eo136037.Availabe at  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4552383/

Fernando, I., Cohen, M. (2014).Case formulation and management using pattern-based formulation (PBF) methodology: Clinical Case 1.Australas Psychiatry, 22(1),32-40. Available at https://journals.sagepub.com/doi/abs/10.1177/1039856213511674?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub%3Dpubmed&

Hunter,L.(2016).Making time and space: the impact of mindfulness training on nursing and midwifery practice.A critical interpretative synthesis. Journal of Clinical Nursing, 25(7-8), 918-929. Available at https://onlinelibrary.wiley.com/doi/full/10.1111/jocn.13164

Jacob, K.S. (2015).Recovery Model of Mental Illness: A Complementary Approach to Psychiatric Care. Indian J Psychol Med, 37(2), 117-119. Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4418239/

Jason, W., Siefferman, Emerald, L., Jeffrey, S.F., (2012).Patient Safety at Handoff in Rehabilitation Medicine. PubMed, 23(2), 241-257. Available at https://linkinghub.elsevier.com/retrieve/pii/S1047-9651 (12)00011-3

Karyotaki E, Riper H, Twisk J, et al. (2017). Efficacy of Self-guided Internet-Based Cognitive Behavioral Therapy in the Treatment of Depressive Symptoms: A Meta-analysis of Individual Participant Data. JAMA Psychiatry, 74(4), .351–359. Available at https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2604310

Kathol, R.G., Perez, R., Cohen, J.S. (2010) The Integrated Case Management Manual: Assisting complex patients regain physical and mental health. New York, NY: Springer Publishing Company, LLC, 2010.

Koshy, K., Limb, C., Gundogan, B., Whitehurst, K., & Jafree, D. J. (2017). Reflective practice in health care and how to reflect effectively. International Journal of Surgery. Oncology, 2(6), e20. Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5673148/

Mahli, G. et al (2015). Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders. Australian and New Zealand Journal of Psychiatry, 49(12) 1-185. Available at https://journals.sagepub.com/doi/abs/10.1177/0004867415617657?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed

Malla, A. (2015).Mental illness is like any other medical illness: A critical examination of the statement and its impact on patients care and society. Journal of Psychiatry and Neuroscience, 40(3), 147-150.Availabe at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4409431/

Merten, H. (2017).Safe Handover. The BMJ. October 09, 2017.Accessed at https://www.bmj.com/content/359bmj.s4328.full.doi:https://doi.org/10.1136/bmj.j4328

Recupero, Patricia, R. (2010).The mental status examination in the age of the internet. Journal of the American Academy of Psychiatry and the law, 38(1), 15-26.Accessed August, 10, 2018 at https://www.jaapl.org/content/38/1/15.full

Rossler, W. (2016).The Stigma of Mental Disorder: A millennium-long history of social exclusion and prejudices. EMBO rep, 17(9), 1250-1253.Available at https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/27470237/

Schon, U.K., Svedberg, P., & Rosenberg. (2015).Evaluating the INSPIRE measure of staff support for personal recovery in a Swedish Psychiatric context. Nordic Journal of Psychiatry,69(4),275-281.Available at https://www.tandfonline.com/doi/abs/10.3109/08039488.2014.972453?journalCode=ipsc20

Silbersweig, D.A. (2015).Bridging the brain-mind divide in psychiatric education: The neuro-bio-psycho-social formulation. Asian J Psychiatr, 17(1), 122-123.Availabe at

https://www.clinicalkey.com/#!/content/playContent/1-s2.0-S1876201815002105?returnurl=null&referrer=null

Snow,N.,Meadus,R.,Marie,A.A.,Budden,F.,Kirby,B.,Reid,A.(2014).The Benefit of Using an Interprofessional Education Model in an undergraduate Mental Health Course, Canadian Collaborative Mental Health Care Conference,2014 retrieved from https://jultika.oulu.fi/files/isbn9789526218571.pdf

Stovell, D., Morrison, A.P., Panayiotous, M., & Hutton, P. (2016).Shared Treatment Decision-Making and Empowerment-Related Outcomes In Psychosis: Systematic review and meta-analysis. The British Journal of Psychiatry, 209(5), 23-28.Availabe at https://doi.org/10.1192/bjp.bp.114.158931

Unhjem, J.V., Vatne, S., & Hem, M.H. (2018).Transforming nurse-patient relationships-A qualitative study of nurse self-disclosure in mental health care. Journal of Clinical Nursing,27(5-6),e798-e807.Available at https://onlinelibrary.wiley.com/doi/full/10.1111/jocn.14191

Valente, S.M. (2017).Managing Professional and Nurse-Patient Relationship Boundaries in Mental Health. Journal of Psychosocial Nursing & Mental Health Services, 55(1), 45-51. Availabe at https://dx.org/10.3928/02793695-20170119-09

Paganini, S., Teigelkötter, W., Buntrock, C. & Baumeister,H.(2018). Economic evaluations of internet- and mobile-based interventions for the treatment and prevention of depression: A systematic review.Journal of Affective Disorders, 225(1), 733-755. Available at https://linkinghub.elsevier.com/retrieve/pii/S0165-0327(17)30355-5

Walker,R.,St.Pierre-Hansen,N.,Cromarty,H.,Kelly,L.,Minty,B.(2010).Measuring cross-cultural patient safety: Identifying barriers and developing performance indicators. Healthcare Quarterly, 13(1), 64-71.Availabe at https://www.longwoods.com/content/21617

Wilson, L., Crowe, M., Scott, A. and Lacey, C. (2018).  Psychoeducation for bipolar disorder: A discourse analysis. International Journal of Mental Health Nursing, 27(1),349-357.Availabe at https://onlinelibrary.wiley.com/doi/full/10.1111/inm.1232