NSB204 Mental Health: Self And Others Assessment Task 2 Answer

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NSB204 MENTAL HEALTH: Self and Others ASSESSMENT TASK 2

Assessment Task 2

Assessment name:
Case Study

Task description:
This assignment aims to help you to begin to use your professional and clinical judgement to think like nurses working in a mental health setting and/or in relation to the mental health needs of people regardless of the setting.
Choose from one of the four case scenarios below. Each case study is a person who is experiencingdifficulties related to a mental health disorder.
  1. Case scenario one: Olga
  2. Case scenario two: Sonia
  3. Case scenario three: Callum
  4. Case scenario four: Graham
Description
This is an individual assignment of 1,800 words broken into two parts, each with several steps.
Related to the person in your selected case scenario your assignment will demonstrate your understanding of the following:
  • Mental Status Examination (MSE)
  • A clinical formulation including biopsychosocial history and your own MSE observations leading to the clinical formulation
  • A nursing handover
  • Recognising and responding to the mental health needs of the identified person by identifying best practice nursing interventions
  • How to engage a person in a therapeutic relationship
  • The application of cultural safety
  • The application of the Australian mental health recovery model
You will need to justify your assignment points with reference to relevant literature. Students who plan to do well in this assignment, will read and use the unit text and readings as well as additional relevant evidence-based practice resources.

What you need to do:
Please follow the steps outlined below to answer this assignment question.
PART 1: Holistic assessment and planning: (1000 words +/- 10%) Part 1 does not always require full paragraphs.
Use appropriate templates/tables to set out the Mental Status Examination (MSE) and Clinical formulation-5Ps.
No introduction or conclusion required.
The opening sentence must clearly state your chosen case study.
1.a The Mental Status Examination [250 words +/- 10%]


  • Using the MSE format from your weekly tutorial guide, provide a complete MSE of the person, linked to the data from your chosen case study.
  • Use health terms accurately (e.g. Instead of ‘talks fast’, use the correct term ‘pressure of speech’).
  • In-text references are not needed in this section.

Clinical Formulation Table [250 words +/- 10%]

  • Use information gathered from the case study to complete a Clinical Formulation under the headings of Presenting, Precipitating, Predisposing, Perpetuating and Protective factors (5 Ps).
  • Relate this to biological, psychological, and social factors relevant to the presentation of the person described in your chosen case study.
  • Support your responses with in-text peer reviewed references.

Plan for Nursing Care [400 words +/- 10%].

  • Identify two (2) priority nursing interventions (non-pharmacological) for the person and briefly justify why each is a priority, drawing from peer reviewed evidence.
  • Identify one long-term intervention that may be indicated for this person’s long term goals. Justify selection by drawing on peer reviewed evidence.
  • Convert your two nursing interventions into a SMART goal framework.

** NOTE: In part two you will be explaining how you would develop and use a therapeutic relationship with this person, and how cultural safety and the Australian recovery model influenced your nursing care and choice of interventions.

Clinical handover [100 words +/- 10%]

  • Synthesize the results of your MSE and clinical formulation using SBAR format post admission for next shifts clinical handover.
  • No intext references required.

Note: This is not merely a repetition of the case study material – it is an analysis and synthesis of the case study material and the MSE to produce the clinical formulation that answers:- ‘why this person, why now, why with this presenting situation’. This is the information your colleagues need to know so they can continue working with the person when you go home. Remember to keep a nursing focus.

PART 2: Therapeutic engagement and clinical interpretation of your case study (800 words +/- 10%)

Part 2 builds on your work in Part 1. Use academic writing style for this section. Sub-heading are permitted.

The Therapeutic Relationship [250 words +/- 10%]

  • Explain how and why a therapeutic relationship will be established with the person in your care. This must not be a general description

of therapeutic relationships but demonstrate that you are applying therapeutic skills to this selected case and person.

Then describe at least one (1) specific strategy appropriate for the development of a therapeutic relationship with this specific person and how it was applied in the nursing care interventions you described in 1.c
  1. Cultural Safety [200 words]
    • Describe the first step you would take to ensure that you deliver culturally safe care to this person. Then identify and describe one (1) issue that working with this person might present for you. Describe which of the principles of cultural safety you used in applying cultural safety in the nursing care interventions you described in Part 1.3.
  2. Recovery-oriented Nursing Care [350 words]
    • Consider the nursing interventions you developed in Step 1. Describe how these nursing interventions take the principles of the Recovery Model/Philosophy into account and relate these to your specific person’s recovery process.
There is no requirement for a conclusion for this assignment.



1,800 words +/- 10% (word length includes in-text referencing and excludes your reference list and appendices)
Estimated time to complete task:
50 hours
Weighting:
40 %
How will I be assessed:
7-point grading scale using a rubric
Presentation requirements:
This assessment task 2 requirements are:

  • Cover sheet must be included as the first page of your document.
  • Assignment to be submitted as a word document, pdf documents will not be marked.
  • Use Times new roman, 12-point font.
  • Use double line spacing.
  • Include page numbers.
  • Be written in academic style using full sentences and paragraphs.
  • Have headings to guide your work. (if appropriate)
  • The assignment word count includes any words in the body of the assignment, including headings, in-text references, and quotations. It does not include the title page, reference list.
  • Include a reference list on a new page using QUT Version X APA referencing


Case study scenario one  Olga

Olga is a 92-year-old Polish widow who lives independently and has recently been referred to the mental health team by her GP due to concerns over her low mood and anxiety.

Olga is a concentration camp survivor from World War two. She migrated with her mother and brother to Australia post the war in the 1950s for a new start, her father passed away in the war when Olga was 13. Olga has two daughters and three grandchildren. Olga’s husband, Ivan, passed away thirty years ago from cardiac arrest and Olga has been living alone ever since.

Her daughters, Lena and Jude, have expressed concerns over their mother’s worsening vision and cognitive decline as Olga has been increasingly withdrawn and confused (normally about what day of the week and month it is) when they visit her. Lena and Jude also worry over Olga living independently and being isolated. When Olga presented to the clinic, the mental health nurse observes Olga to be dressed in oversized slacks, t- shirt and cardigan, with neatly presented hair, slim build and underweight with Olga looking her stated age. She reports difficulty getting out of the bed in the morning and sleeping for 11+ hours a night, she reports feeling ‘down’ over the past couple of months with a notable increase in this feeling over the past three weeks. Olga is often slow and hesitant in her speech however was engaged during the interview. Olga could agree with her GP that she may need some help with her low mood however was apologising to clinicians for taking up their time. While Olga often takes long pauses in her speech her thought form appears to be in contact and she was able to recall recent memories.

Olga had to give up her driver license two years ago and has expressed frustration at needing to rely on others for things, such as grocery shopping, when she has been doing this independently for so many decades. Olga reports worry over going out in public lately due the deterioration in her eyesight and fear of falling over an object she has not seen, and a result has been avoiding going outside and cancelling her appointments with her care worker to go grocery shopping. This has resulted Olga missing meals due to not having food at home with her reporting to have one meal a day on average, she states she does not have much of an appetite and suits her fine.

Olga loves her grandchildren and is so proud of them. She wishes her husband were able to have seen them grow up, Olga reports missing her husband deeply and hoping to be reunited with him again before long. Olga has never told her daughters how much she misses their father or how she is feeling, she does not wish to worry them or be burdensome on them.

Case scenario two:Sonia

Sonia is a 37-year-old female of Indian descent, and a new mother to Anaya a 8 week old baby. Sonia who has been referred to the perinatal wellbeing team for a mental health after a review from her GP due to concerns for her sleep and mood.

When you meet Sonia, you notice she is slightly unkempt in her appearance, observing creased clothes with stains and hair is greasy and pulled back in a ponytail. She is slight in build, appears slight older than her stated age and is observed to be fidgeting with her nails throughout the interview. Sonia appears tired and has dark rings under her eyes, she has intermittent eye contact throughout the interview. She reports that her mood is ‘great’ however on observation Sonia has limited facial reactivity or expression. Sonia is brief in her responses during conversation and is soft in speech. During your assessment, you notice that she is not responding to her baby when she cries out, and only stares at her. Despite this, Anaya looks well cared for.

Sonia reports trying for several years for a baby and using IVF to conceive Anaya. Sonia reported a challenging pregnancy experiencing hyperemesis for a significant portion and some trauma in the birth as it did not go according to the birth plan – Anaya required medical intervention after she was delivered, and Sonia found it difficult to bond with her. Anaya had difficulty breast feeding and therefore bottle feeds and Sonia feels Anaya is awake all night. Sonia reports poor sleep herself, averaging 2 hours a night. Sonia mentions that she feels overwhelmed by the responsibility of caring for an infant and does not have a lot of energy.

Sonia’s husband works long hours and often comes home late into the night due to the demands of his job. He expects that because Sonia is home all day the house to be clean and tidy, and when it is not conflict arises between the two. Sonia was expecting her parents to help with the newborn however due to the Covid19 pandemic her parents have not been able to travel from their home in India to help support Sonia. As a result, Sonia rarely leaves the house.

Sonia feels guilty about not working and leaving the financial responsibilities to her husband. She enjoyed her job as research assistant and misses her colleagues and the work. Sonia becomes teary when she discloses to you how she feels she failed at giving birth and breastfeeding her baby, that she is a terrible mother and wife. She loves her daughter and worries about her all the time, but at the same time resents her for causing so much change. She feels guilty that she has not bonded with Sarah the way a ‘normal’ person would with their child.

Case scenario three: Callum

Callum is a 19-year-old male who had an unremarkable childhood. After completing high school last year Callum decided to take a gap year as he did not know what direction he wanted for his future. Callum has picked up casual work at a local takeaway restaurant and currently lives at home with his parents.

Callum’s brother, Andy, passed away three years ago during an incident when they were both camping. Callum has expressed on several occasions how he believes his parents wish it were him and not his brother who passed away and that he feels guilty for what had happened.

Callum had a small group of close friends in high school, however, has lost contact them since school finished. In high school Callum started taking ecstasy at social events and smoking marijuana, he reported this helped his to stop thinking about Andy. Since school finished, he has increased his intake using substances on most days and by himself.

Callum’s parents have reported concerns for his behaviour over the past three months as he has become increasingly withdrawn and irritable, often dismissive, and argumentative with his parents. They report Callum has been calling in sick frequently to work and rarely leaves him room and will go days without seeing his parents, even though they live in the same house.

Callum’s parents have organised for a community nurse to meet with him for further assessment of his physical and mental health. When you meet Callum, you note he is a slim build, tall male, brown unkempt hair, unkempt facial stubble, and strong body odours (giving the impression he has not showered or tended to oral hygiene for several days). He has no obvious scar or tattoos and is wearing black jeans and black hoodie, with the hood up. Callum has poor eye contact and faces away from the nurse, often checking the window, and is reluctant to engage in conversation, he does not understand why you are there as ‘there is nothing wrong me’. Callum reports he has important work to attend to for Elon Musk, tesla and the space mission and does not have time for you, this project is important to find a ‘solution’. He reports that he cannot disclose any information to you as he cannot trust you, ‘the CIA are everywhere and are watching his every move’ and he attributes this to not leaving his room for days a time. When asked how he has come to know this information Callum tells you he has been receiving communication through YouTube videos. Callum appears preoccupied and often requires prompting to respond to a question, he is monotonous in his tone. Callum reports his mood as ‘fine’ however you note his affect to be restricted in its range, his memory appears intact as he is able to recall events.

Case scenario four: Graham

Graham is a 53-year-old male who has a diagnosis of bipolar affective disorder. Graham was diagnosed in his mid-twenties and has been managing well with his diagnosis with a combination of medication therapy (sodium valproate, a mood stabiliser), social supports and regular contact with his GP. Graham has a family history of mental illness - his maternal aunt had bipolar, and his father has depression and passed away from suicide when Graham was 22 years of age.

Graham has one son and is recently separated from his wife, Suzan, who he maintains an amicable and supportive relationship with. Graham owns and operates a small printing company however as a result of the Covid19 pandemic has seen a significant downturn in business, which has placed considerable stress on him financially. Graham has started to use alcohol to help manage his stress consuming 2 bottles of wine per night. Graham has presented to the emergency department for a mental health review after his ex-wife raised concerns over his wellbeing. Suzan reports Graham has been awake through most nights over the past week, as he has been calling her several times throughout the night. When she tries to talk to him Graham talks so fast and loudly that she finds it hard to respond to anything he is saying before he quickly moves on to the next topic, she states Graham is like a ‘thought machine’ at the moment, verbalising everything that passes through his mind even though they are not connected. Suzan has also noticed that Graham has had large spends on his credit card, which is out of character for him and has not been paying their son’s school fees and has missed his past two mortgage repayments.

When the nurse meets with Graham, they observe him to be Caucasian male of stated age, slightly overweight, wearing a business suit, short brown hair and facial stubble. Graham is initially cooperative with the interview and has good eye contact however quickly becomes impatient and informs you he has many business meetings today with multi-million-dollar companies to help his printing company go global which will then help to find a cure for the Covid19 pandemic. In amongst talking about the business, he talks about the three dams project in China, the destruction of the orang-utan’s rain forest in Southeast Asia and the economic impact of Brexit. When Graham speaks, he talks quickly and at times is difficult to understand as he trails off. Graham is not entirely sure why he needs a mental health assessment as he is feeling “great, the best I’ve ever felt, I feel unstoppable”, but does admit that he ran out of his sodium valporate medication a week ago and is asking for a script for this.

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