1a) Using the case study provided, identify an urgent risk area. Ensure your answer details why you have identified this risk area including specific information about the client and current literature. (2 marks).
1b) Identify one nursing / midwifery intervention you would immediately undertake with your client to address the risk area noted in question 1a and include a rationale for the intervention. (2 marks for the intervention and 2 marks for the rationale)
Ensure the intervention includes who and when you would actually carry out the intervention.
Your rationale should state how and why you would carry out the particular intervention. Ensure literature is included.
- Before you answer questions 1 a and b, consider you are a health professional and have sat with your client to undertake a mental health assessment. You have gathered the information which is offered in the case study. What do you now see as the most urgent risk area to keep your client safe?
- Take care to ensure the risk area is focused on the client. You may identify risk areas for family members or members of the community, but this is not the immediate focus of your actual student assessment here.
- Identify the most urgent concern first in terms of immediate safety concerns.
- We want to see your understanding of the client’s issue, so avoid writing brief detailsabout the client such as: ‘the client has self-harm thoughts’. Expand on the detail of the concern ie. the client has presented with daily self-harm thoughts for 3 months, with intermittent / regular thoughts to cut his wrists using a razor blade. The client reports family contact as a possible cause of distress triggering self-harm thoughts which last for one hour daily immediately after seeing his family.
- You should then add in some literature about self-harm which has relevance to the case study ie. males and self-harm, incidence of self-harm. Remember 1a is only 2 marks, so the literature here doesn’t need to be expansive, but do make sure you provide some literature and provide details of the client’s main concern ie. safety concern.
- Identify one nursing or midwifery which you would undertake to address the concern you have noted in answer 1a. The intervention must be suitable for the concern you note otherwise it will not be awarded marks. For example: building a therapeutic relationship with your client; maintaining a safe environment; risk assessment; observations. You need to state exactly what you would undertake and how to gain marks. Ie. how would you build a therapeutic relationship with your client exactly? What approach would you take? What kind of language might you use? Who would be undertaken the activity ie. nurse / midwife on duty? Ie. the nurse / midwife will build a positive relationship with the client by meeting with them daily for 30 minutes using positive and recovery-based language to establish trust and rapport.
- Another example of a nursing / midwifery intervention: primary nurse / midwife to undertake a self-harm / suicide risk assessment with the client on initial contact and review on a continuous basis as new information is obtained or the client’s presentation changes.
- It must be a direct health professionals and client intervention not a referral to another service or practitioner.
- You should include a rationale with your intervention using literature and making reference back to the case study. Ie. why would you use recovery-based language when building a relationship with your client? Why would you undertake a risk assessment with your client?
2a) Using the case study provided, identify a mental health concern. Ensure your answer details why this is an area of concern. Include specific information about the client and current literature. (2 marks)
2b) Identify one nursing / midwifery intervention you would undertake with your client to address the mental health concern noted in question 2a and include a rationale for the intervention. (2 marks for the intervention and 2 marks for the rationale)
Ensure the interventions includes how, who and when you would actually carry out the intervention. Your rationale should state how and why you would carry out the particular intervention.
Ensure literature is included when you discuss the rationale.
- Question 2 a and b helps us to assess that you understand the difference between an urgent client concern ie. safety and a mental health concern. Question one was concerned with safety identification whereas question 2 is about mental health concerns ie. possibly low mood or anxiety.
- Again, avoid simply identifying the actual concern and writing in brief. You need to say something about the details of the client’s experiences using literature. Ie. the client has been experiencing low mood for one month, with thoughts of reduced self- esteem, worthlessness, hopelessness and suicide ideation. You should add in some literature in relation to low mood in males; anxiety in males for example. Again, it’s only 2 marks so doesn’t need to be lots of literature here.
- Try to avoid highlighting depression in your answer to 1a, as depression is an actual diagnosis with a collection of experiences as opposed to one concern. Better to term this as low mood as opposed to depression.
- Next identify an intervention which is suitable for the mental health concern in your answer to question 2a. Ie if you have identified low mood, what intervention can you do directly with your client to help / support them with low mood. Again, when writing the intervention think about who would carry out the intervention, when, how often, how exactly with details, actually describe what you would do.
- Again, a referral to another professional is not a direct face to face intervention, so please avoid this.
- You should include a rationale for the intervention you have offered in 2b. ie. why have you decided to carry out the intervention making reference to literature and your client?
3) Using current literature, identify and discuss (2) two legal, ethical or professional issues a nurse / midwife may need to consider when working with the client in the case study
- Question 3 helps us to determine your understanding of some of the wider issues in relation to a person’s presentation and care.
- Re-read the case study to identify possible legal, ethical or professional issues.
- For example: you might want to discuss the client’s presentation in terms of
legal issues such as: Mental Health Act; Privacy Act; Health Records Act;
ethical issues such as: the ethical principles such as building a relationship while undertaking risk assessment which may result in a client being scheduled under the Mental Health Act; asking the client lots of questions for mental health assessment knowing the client may find the actual questions distressing;
professional issues such as: confidentiality and maintaining public safety; being involved with a clinical relationship with a fellow health professional who may work within your place of work ie. hospital.
- Clearly identify each issue in your work and then relate to the case study and use literature. If you are highlighting legal issues, you should relate to the Act directly and not secondary sourced literature.
Being a community nurse, I am undertaking a post-natal visit to Harriet for her wound care due to caesarean delivery of a child. While visiting the patient I noticed, Chung, her husband looked extremely sad as well as unmindful and his physical appearance also revealed that he was frustrated somehow. As a healthcare professional, I talked to him and managed to obtain some information during the conversation and the main risk was disclosed, when Chung presented his self-harm thought and he stated that he is aware of h
igh lethality medications which he could take to overdose as he wants to die. Many cases are there where a frustrated person commits suicide, to get over all the tragedies of life which is extremely dangerous (Ferrey et al., 2016).
Suicide is a common concern for the patients with mental disorder due to stress or frustration (Dunster-Page, Haddock, Wainwright & Berry, 2017). Building a close relationship with the suicidal patient is the main duty of the nurses (Hagen, Knizek & Hjelmeland, 2017). Establishing a therapeutic interpersonal relationship during a stressful period of the patient can be extremely useful intervention in this case (Kornhaber, Walsh, Duff & Walker, 2016). This is generally embedded in a safe environment which helps to provide a supportive, caring as well as non-judgemental behaviour to the patient (Kornhaber, Walsh, Duff & Walker, 2016). Listening carefully to the patient’s problem is helpful in the development of interpersonal alliance (Kornhaber, Walsh, Duff & Walker, 2016).
Considering the case study of Chung, the main mental health concern has been found and it is low mood with hopelessness. He was frustrated due to the failure in his work life and also he considers himself worthless. Mental health disorder affects the physical well-being of a person (Supnet, Crow, Stutzman & Olson, 2016). This stress is affecting the health of Chung as well. He is developing insomnia and also cardiac disease. During past couple of months he has been feeling extreme anxiety also. Apart from that, he lost weight, suffering from breathlessness and other physical hazards due to this. He also thinks that medical treatment will not help him to overcome the issue.
Nurses’ intervention works well in managing the mood fluctuation of a patient. Here in this case, nurses can encourage Chung to express his feeling of sadness and come up with some alternative and useful ways such as listening music to handle the frustration (Supnet, Crow, Stutzman & Olson, 2016). They should build trustworthy relationship and provide support to Chung to talk freely about the reason of his sadness (Hagen, Knizek & Hjelmeland, 2017). While being open during the discussion with nurses, Chung will be able to throw out the disappointment. This will help the patient in learning the alternative ways in order to deal with the emotions as well as to gain a sense of self-control.
While dealing with the client, nurses might face some ethical as well as professional issue. It is very common to face ethical issues while working with mental patients (Preshaw, Brazil, McLaughlin & Frolic, 2016). Asking many personal questions to the patient for the purpose of mental health assessment, can be difficult as patient might feel it distressing and he will try to avoid saying all the facts in detail. Professional issue is also a barrier while dealing with mental patient (Preshaw, Brazil, McLaughlin & Frolic, 2016). Keeping the confidentiality as well as maintaining the safety of the patient is quite challenging. Nurse can face these two issues while dealing with the issues of Chung.
Dunster-Page, C., Haddock, G., Wainwright, L., & Berry, K. (2017). The relationship between therapeutic alliance and patient's suicidal thoughts, self-harming behaviours and suicide attempts: A systematic review. Journal of affective disorders, 223, 165-174. Doi: https://doi.org/10.1016/j.jad.2017.07.040
Ferrey, A. E., Hughes, N. D., Simkin, S., Locock, L., Stewart, A., Kapur, N., ... & Hawton, K. (2016). The impact of self-harm by young people on parents and families: a qualitative study. BMJ open, 6(1), e009631. Doi: https://doi.org/10.1136/bmjopen-2015-009631
Hagen, J., Knizek, B. L., & Hjelmeland, H. (2017). Mental health nurses' experiences of caring for suicidal patients in psychiatric wards: an emotional endeavor. Archives of psychiatric nursing, 31(1), 31-37. Retrieved from: https://www.sciencedirect.com/science/article/pii/S0883941716301480
Kornhaber, R., Walsh, K., Duff, J., & Walker, K. (2016). Enhancing adult therapeutic interpersonal relationships in the acute health care setting: an integrative review. Journal of multidisciplinary healthcare, 9, 537. Doi: https://dx.doi.org/10.2147%2FJMDH.S116957
Preshaw, D. H., Brazil, K., McLaughlin, D., & Frolic, A. (2016). Ethical issues experienced by healthcare workers in nursing homes: Literature review. Nursing ethics, 23(5), 490-506. Doi: https://doi.org/10.1177/0969733015576357
Supnet, C., Crow, A., Stutzman, S., & Olson, D. (2016). Music as medicine: the therapeutic potential of music for acute stroke patients. Critical care nurse, 36(2), e1-e7. Doi: https://doi.org/10.4037/ccn2016413
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