Reference no: EM133677656
Assignment:
Evaluates a contemporary theory of nursing that can be used when caring for a patient with a mental illness.
Your Setting
A rural hospital in a mid-sized regional town. The hospital has an emergency department, a combined ICU/HDU/CCU, a general medical ward, a general surgical ward, a rehabilitation ward, a paediatric ward and a maternity unit. On the hospital campus is a small, voluntary mental health unit which also covers drug and alcohol. There is no secure mental health unit in your town.
Case Study
Your patient is Brian, a 33-year-old single, unemployed father of three who has a history of polysubstance misuse and recurrent depression, who has been attending an inner-city methadone maintenance programme in Sydney for the past two years. He has now moved to a rural town in an attempt at a fresh start.
He presented to emergency with a 10-week history of depression with biological symptoms, unresponsive to medication. He complained of low self-esteem and ideas of worthlessness. He had a pessimistic view of the future, stating: "I can't see anything ahead for me." He described a passive death wish but denied any active suicidal ideation. He is positive for hepatitis C and continues to misuse heroin and cocaine occasionally.
Due to a change in medication regime, he has been admitted to the medical ward of your hospital and you are the nurse looking after him.
Brian is compliant with all observations and interventions, including medication administration. He wears the same clothing around the ward each day, comprising of boxer shorts and a t-shirt, regardless of the temperature of the ward. He does attend to personal hygiene, but on occasion after prompting by nursing staff.
He is polite, but quiet, and his interaction with staff and other patients is always brief, and he mostly answers questions and greetings with one word responses. He does not appear to have issues with finding the correct words for responses, and is able to explain his treatment plan when asked.
On this occasion, he did not respond to a six-week trial of paroxetine 60mg daily, and so this was switched to venlafaxine 150mg daily which was titrated upwards over time. Medications were dispensed by the nurse and swallowed in front of the nursing staff to ensure maximum compliance.
Brian had a previous depressive episode two years ago and was hospitalised for four months. He responded to a full course of paroxetine medication. At that time, he also attended individual sessions with the team social worker and attended a few group therapy sessions on developing coping skills. However, he disengaged from both therapies after only a short period of time.
Brian is the youngest of five children. He denied any family history of psychiatric illness. Although he is very close to his elderly parents, he minimises his problems because he is afraid of worrying them. His parents appear to provide a secure base and somewhat buffer the interpersonal relationship problems he experiences with his siblings. He is close to one of his sisters but feels rejected by his other siblings and attributes this to his use of drugs and positive forensic history. He reports that they are successful; have good jobs, own their own businesses and are happily married with children. He describes himself as the "black sheep" of the family.
He was bullied throughout primary and secondary school. Academically, he had difficulties with maths and English and, although he received extra tuition in these areas, he was often punished and ridiculed in front of his classmates. He left school at the age of 14 years, after failing to pass any exams. At 15 years, his girlfriend gave birth to their first son. At 18 years, Brian commenced drinking alcohol and taking benzodiazepines monthly. He smoked cannabis regularly. At 21 years, he progressed onto heroin, injecting immediately. His three children currently live with their mother, and he rarely sees them.
Brian was considered for a trial of CBT because he was clinically depressed, had low self-esteem and failed to respond to an adequate course of paroxetine medication. He was quite bright, related fairly well to people and was moderately psychologically minded. Following discussion, he was keen to try another form of therapy, and he has asked for information from you about CBT.
Hi sister has rung the ward, and asked to speak to you as the nurse caring for Brian. His sister is against the idea of CBT, and has asked you to convince Brian it is not appropriate for him, and he should not consent to it. Brian's sister has Power of Attorney over his affairs, and also Enduring Guardianship.