ENHANCING MENTAL HEALTH NURSING PRACTICE THROUGH EFFECTIVE DECISION MAKING

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MH Case Study for Summative Assessment

You are to write a 3,000 word (+/- 10% excluding reference list) a care study. This can be based on  the scenario provided or you may select a patient(s) of interest from your practice experience and relevant to your field of practice. The essay will draw upon relevant theoretical concepts supporting decision making in the assessment planning and interventions to meet the patient’s / client’s needs. A systematic approach in assessment and care delivery must be evident with reference to national and /or professional guidelines to support shared decisions.

Schizophrenia

Service user:   Simon Evans, 32 has a diagnosis of schizophrenia

Present Situation: He still has some of the negative symptoms and still suffers from auditory hallucinations. He still lives in his mother’s home although he has little to do with his father. He has one brother who left home several years ago and now works as a teacher. His mother finds Simon’s symptoms and behaviour very difficult to cope with at times and has benefitted from family therapy and remains very supportive.

He often neglects his physical health and will stay up at night, chain smoking, will eat and drink erratically and neglect his personal hygiene unless constantly prompted by his mother.

History:

Simon was diagnosed with schizophrenia aged 20 following a deterioration of his mental health. Simon has a history of symptoms which include auditory hallucinations, disorders of perception, thoughts and affect.

His initial illness was followed by some deterioration in personal functioning which included memory and concentration problems, unusual behaviour and ideas, disturbed communication and affect, and social withdrawal, apathy and reduced interest in daily activities. This was then followed by an acute episode with hallucinations, delusions, and behavioural disturbances, which included agitation and distress.

Personal and social history:

He left school at 16 with no qualifications and has had several jobs in supermarkets e.g stacking shelves but found it difficult to hold down a job for long. He has not worked since his diagnosis.

He rarely goes out although when he goes out because of his bizarre dress he has been tormented by some local youngsters

Medication: He is now on Clozapine which he tolerates well but has gained weight

Assessment

After hospital admission for a further psychotic episode under the mental health act (2007) Following treatment and on discharge his assessment is:

Weight 16st 2lbs

BMI 30.5

ECG clear

Clozapine 500mgs per day

Urine Ketones detected

Blood test NAD

Family intervention to continue

Consider offering arts therapies, particularly to help negative symptoms of schizophrenia.

Has started CBT, in the inpatient setting which is to continue following discharge

His mother is still extremely worried about Simon’s behaviour but continues to be supportive and wants to be involved at every step of the care given.

Discuss how Simon’s on-going health needs will be met.

Following are the learning outcomes that need to be met::

Within the context of caring for patients/ clients you will be able to:

1. Apply in-depth knowledge which underpins clinical reasoning and decision making in the assessment, planning, delivery and evaluation of client centred care.

2. Utilise a systematic approach in gathering and interpreting data and respond appropriately where there are signs of deteriorating mental and /or physical health.

3. Critically evaluate available evidence in the selection of a range of nursing interventions contributing to improved outcome for clients with mental health problems.

4. Critically reflect upon individual clinical judgement and decision making and the extent to which this is informed by local/national policies and guidelines

ASSESSMENT

There is a single Summative Assessment demonstrating complexity of decision making in assessment, planning, intervention and evaluation of care. Although the major focus will be on a patient presenting with mental health difficulties, students will need to offer a biopsychosocial perspective demonstrate how the polarisation of physical and mental health has been avoided.

Students will select one of the patient journeys explored during the module and write a care study (3,000 words +/- 10% excluding references) focusing on care aspects relevant to their field. In the care study students will critically explore how effective critical reasoning and decision making contributes to meeting patient need and improving outcome. This will enable students to draw on some of the theoretical perspectives explored during the module so that the learning outcomes are met. The nurse’s role will be an important focus but students will need to demonstrate that they understand the importance of shared decision making in the assessment, planning, implementation and evaluation of care. Although symptom management is an important area additional dimensions are to be considered which can influence how well individuals cope. This will involve addressing psychosocial factors as well as reflecting on how policy in terms of service delivery can promote client centred care.

? Brief overview of epidemiological data relating to patient journey selected.

? Assessment issues
? Symptom presentation/control (with reference to national guidelines)
? Therapeutic interventions reflecting a biopsychosocial perspective (with reference to national guidelines)
? The complex interaction of symptoms, cognitions, emotions, behaviours and the significance of social support.
? Risk reduction through using evidence based interventions and standardised approaches to care where appropriate.
? The promotion of mental health
? Partnership and collaboration in decision making and care
? National and local policy promoting person centred care closer to home

You can write +10% of 3000 words.

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