Reference no: EM132381120

NSB204
Mental Health Self and Others

ASSESSMENT TASK 3

Assessment name: Case-based analysis with questions relating to clinical practice

Task description: This assessment requires you to answer a series of questions related to clinical cases provided (below), integrating relevant and contemporary literature to support your responses.

What you need to do:

• Refer to the questions below and prepare responses. Label each of your question responses clearly.
• All responses should integrate evidence using in text referencing with a reference list provided at the end of your document. As a guide at least 10 relevant and credible references should be used.
• Follow the word limit provided for each question response.
• Read the Criterion Reference Assessment for this task. This will help you to understand what is required of you and how this assignment will be graded.
• You do not require an introduction or conclusion section.
• Please carefully edit your work to keep within the word limit

Assessment Questions

Question 1

Refer to the video in NSB204 Blackboardsite, week 6 Online Module Assessment 3 tab.

This interview was undertaken by Petra Lawrence (RN) on 21st June 2019, with Geoff Corbett, Drug and Alcohol Coordinator at Clarence Street, which is a part of Mater Young Adult Health Centre.

In this interview Geoff talks about the therapeutic approach in working in the alcohol and other drugs (AOD) field, specifically building rapport using a harm minimisation model.

A. Briefly describe the nature of the therapeutic relationship and explain why building rapport is a key element of the nurse's role in mental health care and AOD contexts. [150 words]

B. Undertake a process of cultural self-reflection and then briefly discuss whether you support the use of harm-minimisation as described by Geoff Corbett, detailing the reasons you either support or do not support this. [150 words]

Question 1 cont.

Richard is a 19 year old man in the acute adult inpatient unit. Richard works as a garden laborer and has had the same job since he left school over two years ago. He loves gardening and has been saving to undertake studies in horticulture and landscape design.

Richard is the father of a two-year old son Joshua, as he and his young girlfriend opted to keep the child following an accidental pregnancy when they were in year 11 at highschool. The relationship broke down when their son was 1 year old but until now Richard has been able to maintain a close relationship with him. Recently the child's mother took up with another man and is preventing Richard from seeing his son while still expecting child support payments.

Over the past three shifts you have had difficulty engaging with Richard, he responds only with monosyllabic answers and avoids eye contact. Richard does not socialise in the common areas of the unit and prefers to spend time alone in his room. Richard was admitted seven days ago with a new diagnosis of major depression after a significant suicide attempt. A bystander in a car park noticed an exhaust hose coming into the window of his car. During his review with the psychiatrist today Richard reports feeling ‘fine'. He seems reluctant to engage with you and other members of his treating team as he walks away when approached or quickly ends conversation.

C. Discuss two strategies you would use to build rapport with Richard.[200 words]

Tip: This is not a general discussion of therapeutic relationship approaches. Demonstrate that you are applying therapeutic skills to Richard and the case context.

Question 2.

Case Scenario

Tom is a 46 year old bachelor and a sales manager for a brewery, who was admitted to an alcohol and drug treatment centre 24 hours ago. Tom has recently been charged with driving under the influence (DUI) and has entered treatment under legal orders. When asked "Are you worried about how much you drink?" he replies "I'm worried I'll lose my job if I lose my license. I don't drink any more than the other executives." When asked how much he drinks he says, "I drink about half a bottle of scotch in the evening. I have a couple of beers at lunch time and I like a few wines with dinner." When asked when he had his last drink, Tom says lunch time yesterday just before he came for admission. He lives alone, has no pets, and works long hours. The nurse reads in his chart that Tom started drinking when he was 13. The nurse asks more about this history and is told that his father, who has since passed away, was a heavy drinker and was often angry and aggressive toward Tom. Tom had a much older brother and sister who both escaped this tense environment when Tom was 12 leaving him to bear the brunt of his father's frustrations. He hasn't seen them for years. His mother, who he sees occasionally, was quiet and passive and avoided any confrontation with her husband. There was always alcohol around the house and Tom soon found that it relaxed him and he slept better. He was an average scholar and after school he took a job as a sales representative for a liquor company where drinking was the way to do business. His current job allows him to conduct business over lunch and drinking is encouraged. He keeps a well-stocked fridge in his office.

During your assessment Tom is unsettled and fidgety and his hand feels cold and damp when you shake it in greeting him. He appears anxious, is easily startled and says he feels "shocking". He glances constantly around the room and squints when his eyes encounter bright light. He has a slight tremor of the hands, which is noticeable only when he reaches for his cup of tea. Tom seems to find it difficult to concentrate on your conversation and has to ask you several times to repeat yourself. When you ask about his history he seems to have trouble recalling some events such as circumstances leading up to his DUI charge or what he was doing this time last year. Tom says that he usually feels nauseous and sometimes vomits in the morning and he has trouble sleeping. He has beads of sweat on his face and complains of feeling "full in the head." His vital signs are: pulse 92 bpm, temperature 38.20C, respiratory rate 20bpm and BP 170/100 mmHg and he is orientated to time, place and person. He is 187cm tall and weighs 73kg. Tom is prescribed diazepam 10mg every six hours for four doses, then 5mg every six hours for eight doses; a multivitamin; and daily thiamine.

A. Focusing on aspects of the person's recovery rather than symptoms management, discuss how you would apply one key principle of the recovery model in working with Tom. [200 Words]

Question 3

Calista is a thin 28-year-old woman who was brought in to the emergency department by police at 8 am today. She has bags and dark rings under her eyes and looks tired. Calista is clearly very distressed but is orientated to time, place and person and presents as intelligent. She often collapses into bouts of convulsive sobbing and at times swears loudly saying she wants to leave so she can go and kill herself.

Police were called to the home of John, Calista's ex-boyfriend, as she had arrived at 7am that morning and had broken several windows there and kept saying she wanted to die. Between sobs Calista says that her and John's relationship has broken down and that he is seeing someone else.

When admitting staff undertook a biopsyhcosocial assessment, Calista has tachycardia and an elevated blood pressure. She says she feels ‘like shit' and cannot remember when she last ate as she often feels nauseous. She has trouble sitting still and is not sure when she last slept. She has a dry mouth and blood on her clothes from multiple self-inflicted lacerations to her chest, forearms and upper thighs; some will require suturing. She is on a disability support pension and lives in a rooming house in New Farm. Calista has long been estranged from her abusive family from which she escaped as a young teenager. It is clear that Calista does not have a social support network.

She has been admitted many times to the acute mental health facility in the past ten years for self-harm [e.g. horizontal cuts on arms usually] and for suicidal ideation, suicidal threats and suicide attempts. As a result she has at times required treatment in the emergency department and surgical ward. Five months ago she made a potentially fatal suicide attempt. On that occasion a driver on the Story Bridge rang police and reported that there was a woman that seemed to be intoxicated and attempting to climb over the edge of the bridge. A nearby bicycle police officer quickly reached her and talked her into coming with him to the hospital where she was found to have ingested at least 50 x 50mg of Zoloft that she had saved up over the previous months.

Calista has had various diagnoses including Borderline Personality Disorder and Major Depression. She was prescribed Zoloft (Sertraline) 50 mg daily on an admission a year ago and her GP has continued this treatment until the present time.

A. Although suicide can be thought of as a very extreme form of self-harm, briefly describe how self-harm and suicide often differ. [150 words ]

B. Briefly discuss strategies you and the health care team would use for suicide prevention in Calista's situation? [150 words]