Consumer Scenario For Mental Status Examination – Holistic Assessment And Planning

Holistic Assessment and Planning

Discuss about the Consumer Scenario for Mental Status Examination.

Adam, a15-year-old Caucasian man, tall but slim for his age. At the time of examination, he was not dressed well; hairs not combed properly and had dark circles. He was quiet and sullen throughout the interview. During the interview, he responded to most of the questions with yes or no. He was not making eye contact and had poor concentration level. It was observed that the patient was clasping his hands during the interview, looking down at the floor and was almost murmuring (monash.edu.au, 2016).

Slow speech: It was observed that he was with slow speech, almost whispering. He answered to all the questions, but at slower pace.

It was found that affect was depressed and the patient’s mood was low. When Adam was asked to rate his feeling, he rated 3 out of 10 and said he did not feel better that that ever (psychclerk.bsd.uchicago.edu, 2016).

Thought 
1.Stream 

It was found that the patient’s thought stream was decreased.

Form

Adam was observed with no formal thought disorders as he did not have disordered speech or unorganized thinking. He answered to all the questions precisely.

Content

Adam felt guilty and considered him a failure. It was clear from the mental status examination that Adam had other negative symptoms like self-harm.

Perception 

It was observed that Adam had normal perception. Symbols of misinterpretation, depersonalization or illusion were not observed.

Cognition 

Adam was aware and had no disorientation issues. He was conscious about time, place and persons. Besides, he had no difficulties in recollecting previous incidents. Moreover, he was capable of answering all the questions as evident from the medical status examination.

Suicidality

Adam was not observed with any suicidal ideation or tendency. However, the patient admitted that he had intention of self-harm. When the patient was inquired about suicidal thoughts, he denied and said he needed sound sleep and was tired of taking medicines. 

The patient was aware of his mental ailment and was opened to proper diagnosis and treatment. He cooperated with the mental state examiner. Adam showed compliance with the entire medical procedure and willing to get a speedy recovery (Greenham & Persi, 2014).

A Clinical Formulation Table

	Predisposing (Early life incidents)	Precipitating (Incidents that resulted in the ongoing crisis)	Perpetuating (Factors constantly contributing to the crisis)	Presenting (The crisis or problem which has occurred)	Protective factors (Coping skills and strength)
Biological determinants	The patient was on antidepressant treatment. He received extensive counseling for CSA. He was admitted to hospital for depressive episodes with suicidal ideation.	Adam’s parents suffered from marital problems.	The patient was reluctant to have food. He had low appetite. He was under medications and counseling. Hence, he was tired and restless.	Adam had dark circles	Adam was compliant to medication and the treatment procedures.
Psychological contributors	The patient, Adam became a victim of sexual abuse at an age of 6 years.	Adam’s uncle who was the perpetrator would be released from jail shortly. Hence, he was traumatized	Adam had low mood and loss of drive.  He was depressed and unhappy	Since, his doctors anticipated depressive episodes; hence, he might suffer from Major Depressive Disorder (MDD). He had ideation of self harm, considered himself responsible for his parent’s marital problems	Adam agreed for further treatment. He would be admitted in adolescent ward as a voluntary patient.
Social factors	He had a damaged family.	He believed that only his sister considered him to be normal.	Adam had stopped biking. He was not interested in preparing for the upcoming competition.	The patient ceased himself from biking and reluctant to go to school, confined himself to his home and stopped socializing.	Adam’s family was supportive, confident and optimistic about his recovery.

(Serobatse, Du Plessis, & Koen, 2014).

Using Maslow’s Hierarchy of Needs, there are mainly two needs that required to be prioritized in context of patients suffering from psychological disorder (Lee & Hanna, 2015).

1. Physiological needs
2. Safety needs

General Appearance and Behavior

Physiological needs are the first level of Maslow’s hierarchy. It is mainly concerned with the maintenance of human body. It comprises of the fundamental needs, which are crucial for existence. They are water, food, air, shelter and sleep.

The Physiological needs are prioritized, as it is a basic need in humans that need to be fulfilled for maintaining life processes (Lester, 2013).

Safety needs are the second level of Maslow’s hierarchy. It is mainly concerned with protection from harm. It comprises of safe shelter, security of job, health and safe surrounding (Datta, 2014).

The safety and security needs are prioritized as safety and security are primarily the two most important factors for a human being. If a person is not secured he would not be able to meet up other needs.

Hence, the two above mentioned basic needs of Maslow’s hierarchy had been chosen. 

Issue	Evaluation	Goal	Interpretation
Self- harming tendency	Good communication and trust between the patient and nursing staff	To ensure patient safety and security as well	Assess mental status of the patient
constipation related to medication side effects	consumer has 1 hour accompanied walk/day	Regular elimination established	Assess bowel elimination 1/24 hours
Lack of sleep	Regular exercises	To ensure that the patient has a sound sleep	Monitoring of the exercise schedule on daily basis
Lack of appetite	Physical activities like games, aerobics	To ensure that the patient is on proper diet	Maintaining diet chart for the patient and ensuring that the patient is on balance diet
Weight loss	Provision of nutritious food to the patient	To ensure improvement in patient’s weight and overall health	Regular monitoring of the patient’s improvement in weight

Therapeutic engagement and clinical interpretation

Adam is a 15-year-old Caucasian man male, tall but slim for his age. At the time of examination, he was not dressed well; hairs were not combed properly and had dark circles. He was quiet and sullen throughout the interview. During the interview, he responded to most of the questions with yes or no. He was not making eye contact and had poor concentration level. He was clasping his hands during the interview, looking down at the floor and was almost murmuring (Eggins & Slade, 2015).

The patient’s parents and family were concerned about his mental state. He was traumatized and confined himself to his home. He stopped biking and preparing for the upcoming event. Moreover, he abandoned going to school. He had low mood and a loss of appetite.

The medical state examiner and the clinical formulation table led to the derivation that the patient, Adam was suffering from Major Depressive Disorder. It was evident from the outcomes of MSE and clinical formulation table that he was traumatized and felt insecured outside home. He was terrorized as his uncle was released. He was terrorized with the thought that the perpetrator might harm him again and make him suffer from depression and pain. 

Therapeutic relationship is a relationship between a patient and a medical/ healthcare professional. It helps in recovery of the patient. Therapeutic relationship is a prerequisite for establishing an effective therapy in patients suffering from mental ailment. The therapeutic relationship is a vital part of nursing care and practices. The therapeutic relationship is central to all nursing practice. The fundamental elements of the therapeutic relationship include respect, empathy and validation. (Keltner, 2013).

Speech

Cognitive behavioral therapy is such an approach of treating patients with psychosis. It mainly emphasizes on establishing therapeutic relationship with patients. It is comprised of empathy, care, warmth, genuineness, positive attitude and active participation of the consumer (Nolen-Hoeksema & Hilt, 2013). 

The patient can be treated with cognitive behavioral approach, about eight to sixteen sessions over a period of four months. It is seen that in this type of therapeutic pattern, consumers get involved in activities, gain skills to improve social values. Moreover, in this kind of approach the consumer can recognize and reconstruct their behavioral patterns and eliminate their undetermined and self-defeating patterns that lead to mood depressions.

The cognitive behavioral therapy furnishes certain therapeutic goals. They typically include stress reduction, increase in acceptance and consideration, quality of life enhancement. It will help the consumer to focus on valuable objectives and directions. The meeting of consumer’s goal involves acceptance of the previous experiences and symptoms by the patient. Consumer’s acceptance and trust towards the clinician involved in treating the ailment is another major determinant in the effective treatment of depression (Mohr et al., 2013).

Cultural safety is an effective nursing practice of a patient by a person belonging to a different cultural background determined by the patient or the family. It can be referred to as a safe environment in terms of social, emotional and physical security (Ramsden, 2015).

The culturally safe practices involve recognizing and respecting the cultural integrity of the consumer, fulfill their necessities, and safeguard their rights (Stuart, 2014).

The patient, Adam is in his adolescence and had a abusive past. He was depressed and withdrawing from the society and friends. Hence, he must be provided proper care and safety. He confined himself to his family and reluctant to go outside. It is evident that he was insecured and had trust issues. Hence, the primary focus should be towards developing trust with the consumer. The third principle of culturally safe nursing care can be implemented in the interventions. It would help in building rapport with the patient, which would help the nursing care provider to collect more information about the patient and accordingly assess his mental state. It would supplement in providing better care to the patient. A critical assessment of the family and society influence on the victim should be made.  The patient had suicide attempts in the past and had self-harm ideation later. Hence, assessment of the patient’s activity, behaviour, mood changes and mental status is indispensable in this particular case. A respectful communication and considerate attitude towards the patient would be appropriate for provision of culturally safe care.

Affect and Mood

The word ‘Recovery’ refers to regaining and retention of hope. In context of mental illness recovery can be considered as regaining of an individual’s hope, zeal of life and become active. It also involves ways of gaining capabilities, engagement in day to day life, promoting consciousness, regaining identity and optimism. Recovery focused approach means an approach that focuses more on supporting an individual’s own potentiality to recovery (Caplan. 2013).The recovery model has six principles (Norman & Ryrie, 2013).

      The results from a particular recovery approach is unique to an individual, it varies with people..It focuses more on quality life and social behaviour

1. Own choice

Focus on supporting individuals to make their own choice. It helps in balancing duty and care

1. Authority and power

      Focus on individuals, identifies the requirements and act accordingly. Safeguards human rights and takes care of legal and ethical aspects

Focus on being respectful to individuals, their beliefs and ideas. It emphasizes on freedom of individuals and helps in removing discriminations.

Recognizes that individual is themselves having the best understanding of their life and well-being. It gives values on individual’s opinion and decisions.

Individuals assess their own improvement.

It reports on recovery outcomes on the basis of their mental, spiritual, financial and social issues (Mendoza et al., 2014).

The patient was detected with lack of sleep and appetite. Moreover, he suffered from mood swings, had poor concentration, low on speech and had self -harming tendency. The medications prescribed to him often had side effects of constipation.
The interventions for the issues of the patient were ensuring daily elimination of bowel, some physical activities, games are recommended, delicious yet nutritious food was given to the patient. Hence, the consumer made his own choice, his freedom and respectability was maintained. The interventions recommended comply with the recovery models, as the patient was involved actively in the entire treatment procedure. The food, diet and exercises were scheduled as per the patient’s choice. The patient was dealt with empathy. A rapport was built so that the patient could communicate with more ease. Hence, inter-communication and cooperation is maintained in providing nursing care to Adam. Patient specific nursing care is crucial for patients suffering from depression, trauma or other mental disorders. The interventions considered for providing patient specific nursing care are for the betterment of the patient.

Reference:

Caplan, G. (2013). An approach to community mental health (Vol. 3). Routledge.

Datta, Y. (2014). Maslow’s hierarchy of basic needs: An ecological view.Oxford Journal: An International Journal of Business & Economics, 8(1).

Eggins, S., & Slade, D. (2015). Communication in clinical handover: improving the safety and quality of the patient experience. Journal of public health research, 4(3).

Greenham, S. L., & Persi, J. (2014). The state of inpatient psychiatry for youth in Ontario: results of the ONCAIPS Benchmarking Survey. Journal of the Canadian Academy of Child and Adolescent Psychiatry, 23(1).

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

Lee, J. M., & Hanna, S. D. (2015). Savings Goals and Saving Behavior From a Perspective of Maslow’s Hierarchy of Needs. Journal of Financial Counseling and Planning, 26(2).

Lester, D. (2013). Measuring Maslow’s hierarchy of needs. Psychological reports, 113(1).

Mendoza, J., Wands, M., Hackett, M., & Najlepszy, L. P. (2014). Recovery oriented consumer focused practice: Emerging critical success factors in establishing a culture of collaboration to support our most vulnerable community members. International Journal of Integrated Care, 14(9).

Mohr, D. C., Burns, M. N., Schueller, S. M., Clarke, G., & Klinkman, M. (2013). Behavioral intervention technologies: evidence review and recommendations for future research in mental health. General hospital psychiatry, 35(4).

Nolen-Hoeksema, S., & Hilt, L. M. (Eds.). (2013). Handbook of depression in adolescents. Routledge.

Norman, I., & Ryrie, I. (2013). The Art And Science Of Mental Health Nursing: Principles And Practice: A Textbook of Principles and Practice. McGraw-Hill Education (UK).

Ramsden, I. (2015). 1 Towards cultural safety. Cultural Safety in Aotearoa New Zealand, 1.

Serobatse, M. B., Du Plessis, E., & Koen, M. P. (2014). Interventions to promote psychiatric patients’ compliance to mental health treatment: A systematic review. Health SA Gesondheid (Online), 19(1).

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

www.monash.edu.au,. (2016). Retrieved 20 September 2016, from https://www.monash.edu.au/lls/llonline/writing/medicine/psychology/3.1.xml

www.psychclerk.bsd.uchicago.edu,. (2016). Retrieved 20 September 2016, from https://psychclerk.bsd.uchicago.edu/mse.pdf