Reference no: EM133506316 , Length: word count:2000

Nursing Therapeutics - Mental Health

Case Study : Details

Task description:

This assessment will assist you in using 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.
In doing so, you will demonstrate your understanding of the following:

Stigma and principles of cultural safety.
How to engage a person in a therapeutic relationship. Provision of trauma informed care.

Case Scenario
Presentation to the emergency department - June 18th, 2023 1800hrs

Renae has presented to the emergency department you are working in. She is 28 -weeks pregnant and complaining of dizziness, shortness of breath, nausea and vomiting and pain in the upper abdomen.

Renae is a 21-year-old female who looks older than her stated age. She appears underweight, wearing a singlet and denim shorts and you observe her clothes have notable stains on them. Renae has long brown hair, which is slightly matted at the back; she has scars on the inside of her left forearm.

During your assessment, you observe Ranae presents as anxious. She is biting her nails, often looking around the room, and is difficult to establish rapport with. Renae disclosed to you she presented to emergency as she thought the baby was coming. She has not seen a doctor since conceiving so was not sure what to expect. You learn Renae has been couch surfing for the past three months and currently has no fixed address after she lost her casual employment and could no longer afford to pay rent on her rental property. She reports she does not know who the father of her baby is. As Renae is disclosing this information you observe her to become increasingly anxious and is now asking if she can have some pain relief and something to help her sleep until the doctor comes as she reports she, "...does not like being in hospitals; they have only ever made things worse for her".

You have completed her vital signs which indicate hypertension (160/95), tachycardia (118bpm) and self-reported pain scale of 7/10. Renae is orientated to time, place and person and her memory appears to be intact.

You are currently awaiting a doctor review for Renae. You note your colleagues are dismissive of her concerns and refer to her as that 'homeless mother'.

What you need to do:
Read the case scenario and address the 3 questions that follow. Case Scenario
Presentation to the emergency department - June 18th, 2023 1800hrs

Renae has presented to the emergency department you are working in. She is 28 -weeks pregnant and complaining of dizziness, shortness of breath, nausea and vomiting and pain in the upper abdomen.
Renae is a 21-year-old female who looks older than her stated age. She appears underweight, wearing a singlet and denim shorts and you observe her clothes have notable stains on them. Renae has long brown hair, which is slightly matted at the back; she has scars on the inside of her left forearm.
During your assessment, you observe Ranae presents as anxious. She is biting her nails, often looking around the room, and is difficult to establish rapport with. Renae disclosed to you she presented to emergency as she thought the baby was coming. She has not seen a doctor since conceiving so was not sure what to expect. You learn Renae has been couch surfing for the past three months and currently has no fixed address after she lost her casual employment and could no longer afford to pay rent on her rental property. She
reports she does not know who the father of her baby is. As Renae is disclosing this information you observe her to become increasingly anxious and is now asking if she can have some pain relief and something to help her sleep until the doctor comes as she reports she, "...does not like being in hospitals; they have only ever made things worse for her".
You have completed her vital signs which indicate hypertension (160/95), tachycardia (118bpm) and self-reported pain scale of 7/10. Renae is orientated to time, place and person and her memory appears to be intact.
You are currently awaiting a doctor review for Renae. You note your colleagues are dismissive of her concerns and refer to her as that 'homeless mother'.

History

Renae's chart notes the following: she has a twin brother, her parents separated when she was 10 years old and she was exposed to domestic violence between her parents prior to their separation. Renae's mother remarried when she was 15. Renae left home at 17 years old after experiencing sexual assault by her stepfather. Renae has found it hard to maintain employment to financially support herself and, over the past 4 years, has experienced several periods of homelessness.

You note Renae's medical history shows previous presentations to this hospital. The most recent was for accidental overdose of heroin (1 year ago) where Renae was offered the option to see the Alcohol and Other Drug Brief Intervention Team; however, she self- discharged prior to this being facilitated.
The other presentation was a mental health admission when Renae was 16 for depression with suicidal ideation. You see in Renae's notes she found this admission traumatising due to interactions with the treating team, as she perceived they were dismissive towards her after she disclosed to them her sexual assault. Renae had a history of self-injury prior to and during this admission however you note she has not self-harmed since she left home at 17.

Assessment Questions

1. Stigma and cultural safety

From the information provided in the scenario above, identify and briefly explain what stigma Renae is likely to be experiencing, or be concerned about experiencing, when seeking medical support for her pregnancy i.e. seeking help.
You are the nurse allocated to Renae. Considering the importance of self-awareness and minimising stigma, explain what the nurse can do when providing care to ensure Renae receives culturally safe care that is therapeutic to her mental health.

2. Therapeutic relationship

Discuss why developing a therapeutic relationship is a priority in caring for Renae. Identify and discuss strategies for developing the therapeutic relationship with Renae.

3. Trauma informed care

Given Renae's history of trauma and feelings of dis-trust with the healthcare team, identify what trauma informed care principles would benefit Renae's care. For each give an example of how the nurse can practise these.