NSB023: Mental Status Examination- Mental Health- Nursing Case Study Assignment
The aim of this assignment is to help you to begin to use your professional judgement and think like clinical nurses in mental health settings and/or in relation to the mental health needs of consumers. In order to achieve this aim, everyone will be assigned a case scenario involving a consumer who is experiencing issues relating to one of the
various disorders commonly encountered in clinical practice.
Colleen identifies as Aboriginal –she is a Birri Gubba woman from Mackay. Colleen was removed from her mother when she was 4 years old under a child protection order. Colleen then lived with a series of non-Aboriginal foster parents until she was 17. She ran away from the last family when her foster father sexually assaulted her and lived on the streets for some time. Colleen attended many different schools as she moved between foster parents and did not do well although she is literate and numerate. Since leaving school she has had numerous casual jobs as a waitress, kitchen hand and cashier in a supermarket but tends to leave jobs without notice. She has few possessions or friends and stays in various rooming houses.
Colleen has been seeing a counsellor in Mackay with whom she is still in touch. She has 3 children by different fathers and all are in care and she has chronic feelings of emptiness and despair and wants nothing more than to have her children and look after her family herself. Recently the counsellor encouraged her to find her mother and siblings and in January 2015 she left her current job and room and came to Brisbane to go to a Link-Up conference. She was brought to the RBWH ED by someone at the conference who found her in the toilets slashing at her wrists with nail scissors. She is admitted voluntarily to the adult open ward for further assessment.
Colleen presents as an attractive but sad and irritable woman who is bleeding slightly along her forearms where there are several superficial cuts, as well as numerous old scars. She has had many boyfriends since leaving school usually with men far older than herself. These tend not to last long and she tells you that the old scars were done after her many break- ups. Although her memory for recent events is intact she loses concentration at times and says that she hears a voice telling her that she is “rotten” and “no good”. She doesn’t recognise the voice as anyone she knows but says it is a male voice. She states “no-one wants me” and “I just want to end it.” She is reasonably cooperative with the assessment although she comes across as angry at times. Her vital signs are within normal range as is her weight.
Every night on the ward there is a problem as Colleen always wants to sleep in the lounge room with the television and lights on and she persists in dragging her mattress and blankets out. When back in her bed she says the thinks someone might hurt her and she is usually awake during the night shift ward rounds. She tends to have favourite nurses but a favourite one minute is discarded the next for a new person who comes on shift. When a current
favourite refused to allow her to smoke, she smashed a glass and began cutting her wrists with the broken piece.
Colleen is diagnosed with a Borderline Personality Disorder. As is often the case with this diagnosis there are disagreements amongst the ward staff -some don’t see Colleen as mentally disordered at all and say that she is “attention seeking”, that it is a “social admission” that she is too dependent and should be discharged immediately. Others say she needs to be in hospital, assistance in coming to terms with her social and cultural history and
support to contact her mother and stay in touch with her own children.
This is an individual assignment of 2000 words in two parts each with several steps.
Follow the steps for each part carefully.
The piece will demonstrate a sound grasp of the following as they relate to your consumer and include:
1. A Mental Status Examination (MSE)
2. A clinical formulation including biopsychosocial history and your own MSE observations leading to the clinical formulation
3. A nursing orientated handover
4. Using Maslow’s hierarchy of needs to identity and prioritise consumer needs
5. Identifying nursing interventions and goals, timeframes and evaluation criteria for their achievement
6. How to engage a consumer in a therapeutic relationship
7. The application of cultural safety
8. The application of the recovery model.
You will need to justify your ideas with reference to relevant literature; students who plan to do well, read and use the unit’s required readings and additional items drawn from respected academic sources
PART 1 Holistic assessment and planning:
This part does not require full paragraphs. Use appropriate templates/ tables to set out each part: EG: MSE, 5Ps as used in tutorials and the nursing care table as in the example below.
Ensure your work includes the name of the consumer and brief demographic data about them [e.g. Mary Citizen is an university educated 36 year old married woman and mother of a 14 year old girl]
1.1 The Mental Status Examination [350 words] Please see example of MSE attached.
A. Using the MSE format in your weekly tutorial guide provide a complete Mental Status Examination (MSE) of your consumer
B. Use specific examples from this case study to illustrate each part of the MSE
C. You must use and define psychiatric terms accurately (e.g. Instead of “talks fast” use the correct term “pressure of speech“, define it properly and cite your sources).
1.2 A Clinical Formulation Table [250 words] Please see the attached 5Ps table at last
A. Use information gathered from the MSE and the bio-psycho- social assessment (history of presenting complaint, family and social history, current living situation, the consumer’s strengths and coping strategies, medical history) to complete a table under the headings of presenting, precipitating, predisposing, perpetuating and protective factors (5Ps) relevant to your consumer’s clinical presentation.
1.3 Plan for Nursing Care [300 words]
A. Using Maslow’s Hierarchy of Needs, identify and prioritise the needs of your consumer
B. Select the two (2) highest priority issues identified and clearly indicate what they are and why they are highest priority
C. Outline your nursing care, focusing on one (1) nursing intervention for each of these needs and your rationale for each i.e. describe how the intervention assists your consumer to address or meet each need; interventions must be nursing related, detailed, practical and within your scope of practice.
Therapeutic engagement and clinical interpretation:
This part of the paper is to be written in properly constructed sentences and paragraphs under each subheading [not dot points] and is to provide further description and depth to the assessment and care planning identified in Part 1.
2.1 Clinical handover
Synthesise (consider together) the results of your MSE and clinical formulation to construct a paragraph describing the consumer and their main concerns that you could present at a clinical handover meeting.
Note: This is not merely a repetition of the case study material – it is an analysis and synthesis of the 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 consumer when you go home. Remember to keep a nursing focus.
2.2 The Therapeutic Relationship Explain how and why a therapeutic relationship will be established with your consumer. This must not be general description of therapeutic relationships but demonstrate that you are applying it to this person. Then describe at least one (1) specific strategy appropriate for the development of a therapeutic relationship with this specific consumer and how it was applied in the nursing care interventions you described in Step 1.
2.3 Cultural Safety Describe the first step you would take to ensure that you deliver culturally safe care to this consumer. Then identify and describe one (1) issue that working with this consumer may 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 Step 1.
2.4 Nursing Care and Recovery Model Consider the nursing interventions you developed in Step 1. Describe how these nursing interventions take the five (5) principles of the Recovery Model into account and relate these to your specific consumer’s recovery process.
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