NCS2102 - Mental Health and Illness - Nursing Case Study Assessment Answers

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This assessment is based on the following Case Scenario, and is designed to assess your understanding and application of the MSE, Risk Assessment, key areas of the Mental Health Act (2014), and potential hypotheses of presenting condition.

The case scenario:

Mr. Fred Robinson is a 24 year old man from Derby (2392 km from Perth) in the Kimberley Region of Western Australia. He has a supportive family, comprising of his father, mother, three brothers and friends. Fred is usually presented well, when found, he is disheveled, unwashed, wearing one shoe, a woolen jumper, beany, and boardshorts.

The police escorted him to the local public hospital after he was observed muttering to himself and pacing near the railing of a bridge next to the railway yard. They found a bag of ripped clothing and papers, a bible, wallet, and an unlabeled medicine bottle containing numerous coloured tablets near him.

Initially, Fred was uncooperative when questioned by the police and he accused them of trying to take thoughts from his head. He subsequently became aggressive and displayed violent behaviour by attempting to punch a police officer and shouting at the others. He was restless, overactive, singing loudly and it was difficult to calm him. Following scrutiny of his bag, Fred’s parents were contacted by the hospital staff and informed of his whereabouts. They reported that Fred had been missing for five days and they feared for his safety as he recently revealed to them that he had been hearing voices telling him to jump from the bridge that was located near the town.

Following examination by a doctor at the hospital, he was sedated and restrained and referred via the Royal Flying Doctor Service, with a nurse and police escort for admission to a medium security ward at an ‘approved hospital’ in Perth.

Based on the above case scenario, address the following questions:

1. An introductory paragraph:
2. Presenting information:

• Present a brief over view of the main presenting issues as outlined in the case scenario.
• Briefly describe what the psycho-social issues pertaining to this client are that needs to be taken into account by the nurses to ensure that Fred receives the most therapeutic care and outcome.
• You need to consider in your answer issues of safety, consumer (Fred) focus, and self?efficacy.

3. Mental Health Act:

• Describe the main aspects within the Mental Health Act (2014) as it relates to Fred’s situation.
• Explain the provisions that are in the Mental Health Act (2014) that can ensure Fred’s rights as a patient are protected when he is admitted to the ‘authorised hospital’ in Perth.

4. MSE:

• Gather the available information (evidence) from the case scenario, and document the client’s Mental State Examination in the form of progress notes (medical record) under the appropriate MSE headings (Present your information in the MSE format using the provided sequencing).
• Explain why the MSE is important in capturing a ‘picture’ of the patient at the time of the assessment.

• Provide a provisional diagnose(s) that could be made (based on the MSE) as to Fred’s possible presenting condition (s) in the way of a critical discussion.

5. Risk Assessment:

• • Based on your MSE of Fred’s presentation (in Derby) in the above case scenario, clearly list and briefly describe THREE potential risks (in order of priority) that Fred is likely to pose over the next 24 hours when admitted to the ‘authorised hospital’ in Perth.

• Describe Fred’s management plan based on your identified (3) risks within the 24 hours in the approved hospital in Perth.

6. Conclusion:

• Effectively and comprehensively summarises main points within the report – highlighting key areas.

Introduction

Mental illness is a major health issue in Australia. One in every five is suffering from some kind of mental health issues. Schizophrenia is one such mental disorder that impacts the thinking, feelings and behavior. Such people lose the touch with reality and have hallucinations and delusions. They often report that they are hearing voices. This kind of mental disorder is not very common and symptoms are found in one in millions. This is a chronic disease that can last of many years or may remains lifelong. The exact reason behind the occurrence of this mental disorder is not known, but it is believed that genetic, environmental and imbalances in brain chemicals are found to be responsible.

Information about the Case Study

The main issues in the case study are as follows: Fred Robinson is displaying a very aggressive behavior. He was found in a very disturbed condition. He was very violent towards the police. Controlling him was a very challenging task. He was continuously singing loudly and was overactive. Restlessness could be easily judged from his behavior and appearance. Hospital staff contacted Fred’s father, who came to hospital and informed that Fred was missing from home since last five days and he often complain that he hear a voice, which tells him to jump of the bridge. His aggressive behavior is the major problem, as he could hurt himself as well as others.

Psychosocial treatment for the patient of Schizophrenia is very important for rehabilitation and management of this mental disorder (Mueseret al, 2013, p. 467). It involves, preventing acute episodes, preventing relapses and controlling symptoms. Psychosocial treatments related to the condition of the patient require problem specific psychosocial treatment, Family psychoeducation, vocational rehabilitation and educational opportunities, inpatient psychiatric care and management of vulnerability and stress (Lehman et al, 2010, 38). These are the ways that are required for the therapeutic treatment of Fred. Such treatment is required for the safety of the patient, as it ensure safe environment. It is also important to promote self-efficacy in patient (Jones et al, 2012, p. 20). Schizophrenia is a mental health disorder which can pose multiple disabilities in a patient and marked impairment can also be seen in the social role of the patient (Mueseret al, 2013, p. 468).

Mental Health Act 2014

Mental health act 2014 is the set of principles for the mental healthcare setting to make an effort of providing quality care to the mental health patients. The principles are based on facilitating recovery for the patients. The principles state that patient must be treated as an individual and healthcare services must respect the dignity, integrity and of the patient and must treat them with compassion (Mental Health Act, 2014). Every individual have fundamental human rights, these rights are in accordance to national and international standards. This act also states that mental health services must provide patient centered care and focus on the personal experiences, values, aspirations, skills, preferences and care support of the patient.

Mental health act states that patient with mental illness are vulnerable and conditions may risk their life, thus such patients require immediate and timely treatment. In the case of Fred, also he requires safe and immediate treatment, as he is suffering from severe mental problem and his life is at great risk. He can harm himself and also he is very aggressive. Thus, contemporary practices with quality care are required for his recovery (Mental Health Act, 2014). The rights of Fred are safeguarded according to principle 5 of Mental Health Act, which states that patient should be evolved in decision making and care plan. This principle also promotes self-determination in patient. For coming out of his mental health condition, Fred requires self-determination and supportive care (Mental Health Act, 2014). Privacy and confidentially of the patient is also important. The provision of information and rights includes the rights of the patient towards knowing legal rights. The legal rights of the patient includes that he must have the access to their personal information, as this will help Fred to understand his mental health condition and obtain essential care and support. The patient has all the rights like normal patients, thus they must be respected and cared (Mental Health Act, 2014).

When a patient is admitted to a mental healthcare setting, it is the duty of the professionals to provide safe environment and quality care. The mental health service must recognize various factors that may affect the mental health of the patient in positive or negative manner. These factors influence the mental health and well-being of the patient. Thus mental healthcare setting must recognize the factors associated with patient’s relationships, recreation, accommodation, financial circumstances, education and employment. The mental health service must also include patient’s family in the treatment, decision making in order to evaluate and improve treatment. According to the Mental Health Act 2014, the mental health services must be accountable and responsible towards providing continuous treatment and improvement in the patient’s condition. The problems must be solved in the collaboration with the people, who are involved in the treatment (Mental Health Act, 2014).

Mental State Examination

Appearance: found, he is disheveled, unwashed, wearing one shoe, a woolen jumper, beany, and boardshorts, he was observed muttering to himself and pacing near the railing of a bridge next to the railway yard. He was very uncooperative and aggressive. Fred was shouting and was very restless. He is tensely postured and underweight.

Behavior: When Fred was found by police, he was talking to himself. He displayed very aggressive behavior and tried to punch the policeman.

Speech: He is over reactive, loud and shouts. Rate, volume and pitch of the voice are very loud. It is important to test physical difficulty in vocalizing, repetition of words, and other oddities of speech.

Mood: He could not express his feeling properly and continuously display aggressive behavior.

Affect: He is emotionally very distracted. He talks to himself and continuously hears voices.

Form of Thought: He has the continuous idea of self-harm. He hears voices, which tells him to jump from the bridge. He does not have controlled form of thoughts.

Content of Thought: he has suicidal thoughts and also suffers from delusions and hallucinations. Thought process is marked by loose association of ideas.

Perceptual: He suffers from hallucination. Hallucinations are the sensations that patient face and experience without having any real stimuli. The intact reality testing is important for Fred. Fred appear to talk to imaginary figure, thus he suffers from hallucinations.

Cognition: His ability to process information seems to be weak. The cognition involves the level of understanding, consciousness, concentration, orientation and memory. Cognition is also important to find out if the patient’s condition is associated with any other medical problem or co-morbidities.

Insight: Insight is the level or the extent to which patient has awareness towards the illness. Fred also has poor insight and could not understand the level of his disorder.

Importance of Mental State Examination

Mental State Examination is very essential to for the patients suffering with mental disorders. This helps the healthcare professionals to understand the level of mental disease and severity of the patient’s condition (Lehman et al, 2010, p. 120). This also provides the insight of the biopsychosocial history of the patient’s condition. The present condition of the patient is evaluated by mental state examination. The examination of behavior, mood, appearance, speech, though content, perceptual disturbances, impulse, cognition, insight and knowledge are included in the mental examination of a patient (Carniaux-Moran, 2008, p. 41). The healthcare professionals have to face many challenges, while providing quality care to the patient. This examination is a kind of holistic psychiatric assessment, which examines the psychological, physical, social, intellectual and emotional state of the patient.

Critical Discussion of Fred’s condition

The present condition of Fred is very disturbing and critical. The provisional diagnosis that could be made on the current condition of the patient states that patient is suffering from mental disorder. He has a very weak thought process and also suffers from hallucination. It is very important to review the coping skills of Fred. Coping skills is a kind of mechanism that help the patient to face internal and external conflicts (Carniaux-Moran, 2008, p. 42). According to the speech and though analysis of the patient, he has suicidal behavior or the self-destructive thoughts. He requires immediate attention of the mental health professionals and family members. Fred does not have impulse control over his emotions, which display the potential towards committing suicide. He displays the symptoms of acute schizophrenia. Thus, according to the mental health examination, the immediate action could be taken, specifically according to Fred’s condition.

Risk Assessment of Fred’s condition

Schizophrenia and suicide: The patients of schizophrenia are at highest risk of committing suicide. They are unable to have real understanding of the situation and also suffer from delusions and hallucinations (Pompili et al, 2007, p. 1). As in the case of Fred, he suffers from hallucinations and also display suicidal thoughts through the examination of his though content. Most of the patients suffering from mental disorder suffer from acute depression and have suicidal behavior. In some cases patients are even able to kill themselves (Kasckow, Felmet & Zisook, 2011, p. 130). If the disorder remains untreated for long time the risk of suicide and self-destruction increases.

Schizophrenia and Violence: According to some reports it is believed that patients of schizophreniaare more likely to display violent behavior. They are more violent and aggressive in comparison to sane people (Volavka, 2013, p. 25). They can display violence towards anybody, including family members, health care professionals and nurses. They could go to extreme dangerous level (Volavka, 2013, p. 25). According to the recent studies the people living with schizophreniaare likely to commit more violent acts and can potentially harm anyone. As in the case of Fred, he has also display violent behavior, when he tried to punch the police man.

Schizophrenia and Refusal towards Treatment: Another risk assessment associated with the condition of patient is that, they may not accept the treatment and medication. It could pose a ethical and legal dilemma for the nurses and physicians, if the patient refuse to accept medication. Fred display aggressive behavior towards people. He is also suffering from delusions and thus he may refuse medication (Barkhof et al, 2012, p. 10).

Management Plan for Suicidal Behavior: Within the first 24 hours of the patient’s hospitalization, it is important to monitor the potential self-risks abilities of the patient. Fred has displayed destructive thoughts and mental instability. He also displayed suicidal behavior, which could lead to complete suicide. Thus, it is important to provide safe environment to the patient (Kasckow, Felmet & Zisook, 2011, p. 140). Hospitalization of the patient is the safest way to reduce the risk of suicide. All the objects, by which patient can cause self-harm must be removed from the room, thus too ensure safe environment for him.

Management Plan for Violence: Violent behavior of the patient can be risky for the care providers and family members. Within the first 24 hours of hospitalization, the violent behavior of the patient can be controlled by providing sedatives. There are many atypical antipsychotics medications that can be used to reduce the violent behavior of the patient (Volavka, 2013, p. 30). There are some of the studies, which state that antipsychotic medication could not control the violent behavior of the patient. Thus, for such patient specialized cognitive behavioral treatment can be used. Fred can be controlled with the help of medication within the first 24 hours (Wehring & Carpenter, 2011, p. 877)

Management Plan for Refusal towards Treatment: The patients suffering from Schizophrenia may display no understanding towards their illness (Latha, 2010, p. 96). Also, they might not accept that they are mentally ill. They may refuse to take medication. Fred, can also display such condition, where he may refuse to take medication after his hospitalization. In such case it is important for the nurse to involve family members in the patient’s care and ask them to pursue patient (Barkhof et al, 2012, p. 10). If the patient’s condition is too severe, and at dangerous level than covert medication can also be given.

Conclusion

The report is based on the case study of Fred Robinson, who was found in much distorted condition. He was taken to the hospital by police when he was found muttering something near the edge of a bridge. He displayed very violent behavior and his parents informed that he has delusions and hears some voices. The reports provided the overview of the risk assessment associated with the condition of Fred, which includes risk of suicide, violence and non-adherence to medication. The report also provided the essential management plan for the risks associated with Fred’s condition.