Mental Health Case Study: Analysis And Interventions
Cultural Safety in Nursing Care Interventions
The report brings about the discussion on the mental health, of self and others throughout the life. An analysis of the mental health through the assessment of a case study given explains certain aspects of the healthcare. Discussion of the cultural safety and establishing and involving a person in a therapeutic relationship is an essential part of the report. In addition, an overall mental status examination of the person is to be carried, which further leads to the identification of problems or issues. The recovery model or therapies are formulated and implemented with respect to the case, to find remedies or solutions (Kinderman, 2014).
Mental State Examination or Mental Status Examination of a person is considered an essential part in the clinical scenario. It is an examination or a process which describes about the psychological functioning of a person or a patient at a particular given point of time, based on the grounds of certain aspects. These domains or aspects include appearance, attitude, behaviour, thought content, though process or way of thinking, mood at that time, speech, cognition, insight and the judgemental attitude towards self and others (Albanna et al., 2017).
The purpose of defining and conducting a MSE of the patient is to determine the comprehensive description of the person’s mental state, which helps a clinical psychiatrist to formulate a clinical treatment planning. This facilitates in effective diagnosis and solutions of the issues of the mental health of the patient. With respect to the case, it has been stated that the case study of “Mary: Depression” has been taken for the analysis, and the mental status examination has been also included. Mary, a 41-year old woman was in the state of depression, she had a husband and 3 children. She was at a responsible position in a reputed accounting firm, but with the passage of time she faced numerous health issues. There was a change in her behaviour; she became passive and withdrawn towards life, which led to a major concern for her family members.
The table below represents mental status examination, to identify the aspects of her psychological functioning and level of depression she was experiencing.
|
Client name : MARY |
Date : 12th September 2018 |
|
OBSERVATIONS |
|
|
Appearance |
Bizarre |
|
Speech |
Pressured |
|
Eye contact |
Normal |
|
Motor skills |
Restless, hopelessness |
|
MOOD : Depressed |
|
|
COGNITION |
|
|
Orientation Impairment |
Time, place and person |
|
Memory impairment |
Short-term |
|
Attention |
Distracted |
|
PERCEPTION |
|
|
Hallucinations |
Other |
|
Others |
None |
|
THOUGHTS |
|
|
Suicidality |
None |
|
Homicidality |
Aggressive |
|
Delusions |
None |
|
BEHAVIOUR : Withdrawn |
|
|
INSIGHT : Poor |
|
|
JUDGEMENT : Poor |
|
Base |
Description/clinical formulation |
|
Information from MSE |
Mental state examination of the patient, clearly defined and observed that Mary was suffering from the problem of depression, from a long time. For the same she was hospitalized also 3 years ago. She exclaimed her fear of unable to cope with the chores of daily life, hopelessness, and sleeplessness. |
|
Bio-psychosocial assessment |
Looking at the bio psychosocial assessment of Mary, it has been found that the history of the current problem was very severe. Mary has been admitted to the hospital for the same reason i.e. depression, three years ago for almost 5 weeks. Her husband, Jim has been supportive to her. Although she has been very effective in her work, she faced problems in getting over her fear of coping with stresses of life. |
|
5 Ps (Precipitating, predisposing, perpetuating and protective factors) |
There are number of factors that either contribute or prevent the mental illness of a person i.e. Mary. 5 Ps of clinical formulation in mental health include predisposing factors led to her present problem over years. Precipitating factor that triggered the onset of the illness which may be related to her behaviour a cause of her illness. Factors which maintained the negative symptoms i.e. willingness to not change herself, and negative approach towards life; known as perpetuating factors. Protective factors are those which can prevent the problem or the Mary’s behaviour in this case. For an instance, her children, and Jim, can prevent her from thinking negative, driving the hope towards a better life and get rid of depression. The “presentation factors” which discusses about the present symptoms of the patient when diagnosed (Wijma et al., 2016). |
According to the above analysis of the mental health condition of Mary, two priority issues were identified that were the lack of appropriate personal hygiene, passive behaviour towards life which might lead her to commit suicide. These issues of mental health are at priority because along-with mental illness, deterioration in physical health might cause her serious diseases in the future. This will affect her overall wellbeing and wellness, and hamper the quality of life. However, there are millions of people facing and suffering from this phase of depression, and mental illness. Therefore, there is an effective role of the healthcare or nursing to prevent such illness, and provide care to their patients (Anderson et al., 2015).
Mental Health Assessment and Clinical Formulation
Interventions of nursing care which might help improve the state of Mary, and improve overall health and wellbeing includes clinical treatment or therapies. There are multiple mental health needs of the person with depression, longing for help, social contacts, relief from daily life stress, which they want to be addressed (Chisholm et al., 2016).
It includes one of the interventions such as “Counselling and Social support”, and therapeutic relationships, relating to the problem in the case of Mary. Addition of counselling in the general clinical practice for the patients of recovery was found effective and solved number of cases. Depressive disorders are considered as major and serious public health issues especially amongst women. These lead to the severe diseases, disabilities, impairing quality of life, thus decreasing life expectancy of the person (Park et al., 2014).
The intervention strategy of Counselling stated about active listening and showing the behaviour of empathy towards the patient will help him/her in overcoming the problem of mental illness and depression. As every person wants to belong, and develop healthy social relationships with the people around. Therefore, involving the person in social groups, events, i.e. providing social support will majorly contribute in mental recovery of the person (Yesufu-Udechuku et al., 2015).
The term clinical handover refers to the common practice, incorporated in every healthcare setting in their administration. It is an exchange of the information between the clinical nurses stating about the condition of the patient and the other related aspects. It plays an important role in delivering effective services, in terms of quality and continuity of patient care. However, the quality of the clinical or nursing handover may differ with respect to the process, and quality content. The patient in this case, Mary was found with the same problem even after diagnosis and treatment years ago, might be due to the ineffective treatment and nursing care delivered to her 3 years before; which led to the same problem in the present (Olasoji et al., 2018).
Mental health illness and the patient suffering from the illness, needs mental, physical , social as well as emotional support. Therefore, establishing a therapeutic relationship is one of the interventions found to improve mental health of the person, here Mary. It refers to the nurse-client relationship incorporates principles of mental health nursing. With respect to the case, therapeutic relationship has an effective role in improving her mental state. As the nurse with Mary’s case, can maximize her skills of communication, and understand her patterns of behaviour, which could help in enhancing Mary’s growth. The role or the focus of the nurse is to identify the issues of the patient and organise an interview, taking information regarding the cause or the reasons behind her depression and hopeless towards life (Wang et al., 2018).
Interventions for Mental Health Needs
Strategy in the interventions to be used for Mary, for building therapeutic relationship is the application of ‘CBT’. Cognitive behavioural therapy states that negative emotions and harmful behaviours are the result of the dysfunctional thoughts and the cognitive distortions in the mind of the person. With the Mary’s case this therapy acts as psychotherapy which will help in identifying thought patterns to change her negative behaviour and mood; improving state of wellbeing (Johnsen & Friborg, 2015).
Cultural safety is considered as the outcome or the result of the nursing care education that includes the provision of the safe, appropriate, and acceptable services to the person who is receiving it. The guidance revolving around the cultural safety of the patients of mental health illness, in the codes of nursing clearly defines the behaviour and treatment generally expected from the nurses and midwives. It is a vital concept to improve the health outcomes and experiences of the applied treatment practices in the healthcare (McAndrew et al., 2014).
Australian healthcare system is well-equipped with the healthcare safety standards, which also focuses upon the maintenance of cultural safety of their patients. Delivering services as per the code of conduct of the nursing and healthcare practices in Australia is taken care (Duckett & Willcox, 2015).
Some of the principles identified and applied with the case of Mary include, establishing a power relationship between the services provider in the healthcare and the person receiving the services. This was also mentioned and clearly described by the therapeutic relationship between the nurse and clients. Other principles include a wide application of the cultural standards, ensuring the eradication of inequalities within healthcare (Pauly et al., 2015).
The recovery model of illness in mental health aims to identify the causes and develop solutions, i.e. to look beyond the mere survival and existence of the patient. The nursing interventions of the counselling, social support and the major therapeutic alliance or relationship effectively involves the applications of recovery model/philosophy. Therapeutic alliance is guided by the principles of recovery. These principles through therapeutic alliance explain that it adheres to the principles of increasing commitment, strictly and honestly following the therapy (Chan & Thomas, 2015).
The principles of mental health recovery also include motivating patient to participate and involve themselves in the treatment and rehabilitation programs. Another principle of increasing the correlation of the strength between the therapeutic relationship and improved overall functioning of the person. In addition, it focused enhancing the level of community to reduce the presence of severity of such symptoms leading to serious illness affecting wellbeing of a person (Jacob, 2015).
Clinical Handover and Therapeutic Relationships
Conclusion
To conclude the above discussion on the mental health illness and identification of their mental health needs. Depression is major health disorder in the public, therefore has to be treated with effective care and concern. These issues are identified and interventions are formulated to improve the mental health and wellbeing of such patients. Therapeutic relationship has been found to be a major contributor which facilitated in fast recovery of the patient. Compliance to the cultural safety health standards, a plan for effective nursing care should be implemented in every healthcare. Hence, an effective plan for nursing care must be implemented to treat and help such patients recover from mental illness.
References
Albanna, M., Yehya, A., Khairi, A., Dafeeah, E., Elhadi, A., Rezgui, L., … & Al-Amin, H. (2017). Validation and cultural adaptation of the arabic versions of the Mini–Mental status examination–2 and Mini-cog test. Neuropsychiatric disease and treatment, 13, 793.
Anderson, J., Malone, L., Shanahan, K., & Manning, J. (2015). Nursing bedside clinical handover–an integrated review of issues and tools. Journal of Clinical Nursing, 24(5-6), 662-671.
Chan, F., & Thomas, K. R. (2015). Counseling theories and techniques for rehabilitation and mental health professionals. Berlin: Springer.
Chisholm, D., Sweeny, K., Sheehan, P., Rasmussen, B., Smit, F., Cuijpers, P. & Saxena, S. (2016). Scaling-up treatment of depression and anxiety: a global return on investment analysis. The Lancet Psychiatry, 3(5), 415-424.
Duckett, S. & Willcox, S. (2015). The Australian health care system. 5th ed. United Kingdom: Oxford University Press.
Jacob, K. S. (2015). Recovery model of mental illness: A complementary approach to psychiatric care. Indian journal of psychological medicine, 37(2), 117.
Johnsen, T. J. & Friborg, O. (2015). The effects of cognitive behavioral therapy as an anti-depressive treatment is falling: A meta-analysis. Psychological Bulletin, 141(4), 747.
Kinderman, P. (2014). A prescription for psychiatry: Why we need a whole new approach to mental health and wellbeing. Berlin: Springer.
McAndrew, S., Chambers, M., Nolan, F., Thomas, B. & Watts, P. (2014). Measuring the evidence: Reviewing the literature of the measurement of therapeutic engagement in acute mental health inpatient wards. International Journal of Mental Health Nursing, 23(3), 212-220.
Olasoji, M., Plummer, V., Reed, F., Jacob, S., Shaw, L., Shanti, M. & Cross, W. (2018). Views of mental health consumers about being involved in nursing handover on acute inpatient units. International journal of mental health nursing, 27(2), 747-755.
Park, M. M., Zafran, H., Stewart, J., Salsberg, J., Ells, C., Rouleau, S. & Valente, T. W. (2014). Transforming mental health services: a participatory mixed methods study to promote and evaluate the implementation of recovery-oriented services. Implementation science, 9(1), 119.
Pauly, B. B., McCall, J., Browne, A. J., Parker, J. & Mollison, A. (2015). Toward cultural safety. Advances in Nursing Science, 38(2), 121-135.
Wang, J., Simmons, S. F., Maxwell, C. A., Schlundt, D. G., & Mion, L. C. (2018). Home Health Nurses’ Perspectives and Care Processes Related to Older Persons with Frailty and Depression: A Mixed Method Pilot Study. Journal of community health nursing, 35(3), 118-136.
Wijma, A. J., van Wilgen, C. P., Meeus, M. & Nijs, J. (2016). Clinical biopsychosocial physiotherapy assessment of patients with chronic pain: The first step in pain neuroscience education. Physiotherapy theory and practice, 32(5), 368-384.
Yesufu-Udechuku, A., Harrison, B., Mayo-Wilson, E., Young, N., Woodhams, P., Shiers, D. & Kendall, T. (2015). Interventions to improve the experience of caring for people with severe mental illness: systematic review and meta-analysis. The British Journal of Psychiatry, 206(4), 268-274.