Reference no: EM133658958
Claire Smith
Claire Smith is a 33-year-old female with a diagnosis of emotionally unstable personality disorder. Claire is currently being cared for by your team in the community, although she is well known to both community and inpatient mental health services. Claire has an extensive history of admissions to inpatient mental health units and has had both informal and formal admissions between the ages of 16-29 years. Claire has not had an inpatient admission in the last 4 years but has remained under community mental health services.
Claire has a history of non-suicidal self-injury, most notably through making cuts to her arms and legs with a blade, swallowing batteries, and using an aerosol or lighters to burn her skin. Claire reports that the function of non-suicidal self-injury for her is to alleviate emotional distress and feelings of "emptiness". Claire also has a history of taking overdoses of both prescribed and non-prescribed medications and tying ligatures to cut off her airway. Claire reports that the intention with these behaviours is to end her life.
Claire struggles to manage her emotions and reports that she experiences emotions very intensely, but that her emotional experiences can also change very rapidly with little warning. These intense emotional experiences have resulted in difficulties for Claire in maintaining her relationships with others, and she describes patterns of falling out with friends and family, and then making up with them again. Claire reports that 'fallings out' often result in low self-esteem and feelings of worthlessness that lead to feelings of suicidality.
Claire grew up in a household that she described as 'volatile' and reports witnessing emotional and physical abuse between her parents. Claire also reports that she has experienced sexual abuse from a family member at a young age. Claire does not have a relationship with either of her parents but is very close to her younger sister who also has a history of contact with mental health services. Claire lives with her younger sister and their pet cat in a rented flat in the city centre.
Although your team have been supporting Claire in the community for the last 4 years. Claire's engagement with your service has been inconsistent over this time. Claire often misses appointments and does not reschedule or cancels last minute. When Claire does miss an appointment, she often does not return phone calls that day. Claire has recently split up with her partner and this has resulted in an increase in self-harming, and Claire has been to A&E three times in the last week following episodes of self-harm. Most recently Claire was treated at hospital following taking an overdose of paracetamol, and in her most recent appointment with the team she has spoken about thoughts of ending her life.
Questions:
Overview and Background
Summarise the case study using a handover model for structure.
Therapeutic model
Identify your chosen therapy and use the literature to provide a rationale for your application to this case study. Provide an overview of the therapy to identify the key principles and explore how these can be used to identify and prioritise Claire's challenges.
Making interactions person-centred
Consider how the value of therapeutic relationships in nurse-patient interactions and explore how you will use the evidence-base for good communication to develop this. Identify Claire's goals, strengths, and current support needs.
Treatment
Use the evidence-base and your therapeutic approach to explore the next steps for treatment and provide justification and rationale for these. Consider how other therapeutic interventions might complement your therapeutic approach and consider how you can engage with psychoeducation and multidisciplinary teams.
Risk management
Identify the present risks for Claire. Explore your chosen therapies approach to risk management and identify how you can use positive risk taking and other nursing interventions to manage risk.