Answer

Q1. Key interpersonal skills I will use to engage with Andrew

In mental health nursing, interpersonal skills form the foundation of every intervention. These skills are essential in facilitating the development of a positive patient-nurse relationship. As a nurse, I will use a wide range of effective and appropriate interpersonal skills when engaging with Andrew. Interpersonal communication skills that I will use include listening, probing, paraphrasing and summarizing skills.

Listening

In every practitioner’s experience, it is essential to always listen more and say less to a patient. Listening to Andrew will allow me to give him the space that he needs to speak his mind freely. Active listening to the patient has been proven to have productive therapeutic effects. Studies show that those who have used mental health services mainly value being heard and given the opportunity to tell their story (Stein-Parbury, 2013). Listening to Andrew will help him feel cared for, accepted, heard, respected, less isolated, and connected with others. It will enable him release tension and express emotions thus enhancing his participation in the planned care.

Probing Skills

This involves questioning the patient. I will use open ended questions since they are the most helpful type of questions. Such question will begin with ‘what’, ‘when’ ‘who’ ‘how’ or ‘where’ (Stein-Parbury, 2013). Asking Andrew such open ended questions will help invite full descriptive responses from his side. For instance, if I were to explore Andrew’s experience of hearing strange voices, some of the questions that I would ask include; “When did the voices start? What do the voices say? how do you feel during such episodes? Or who else knows you hear the voices?”  The other type of question which I may use in Andrew’s case include cognitive questions which would focus on his beliefs and thoughts. Also, behavioral questions relating to his actions and delusional behaviors may be significant.

Paraphrasing and Summarizing Skills

I will paraphrase Andrew’s message using my own words. As such, I will demonstrate to him that I have understood and believe him. This is essential since it would make him feel supported and cared for. This skill will involve giving Andrew a summary of information that he gave earlier. This will be effective since the information given by Andrew somehow need more synthesis. For Andrew, hearing the summary of what he told me will help assure him that he was heard correctly. Also, it will give Andrew the opportunity to elaborate further and correct any misunderstandings that may have accrued (Varcarolis, 2016).

Q2. Three important signs and symptoms that support the doctor’s opinion.

Patients suffering from psychosis usually have their own unique set of signs and symptoms depending on the surrounding circumstances. However, according to the case study, the three main symptoms that the doctor used to diagnose Andrew include hallucinations, delusions, and disorganized behavior and speech.

Hallucination

This refers to situations where someone smells, tastes, feels and sees things that do not exist in actual sense (Schimmelmann et al., 2015). Under sight, such patients usually see non-existent colors, people or shapes. For instance, Andrew frequently looked around or past me as if looking for something yet there was no one else in the room. They may feel touched when there are no people around them. Thirdly they can smell an odour that people around them cannot sense. Fourthly, such people can taste when there is nothing present in their mouth. And in the case of Andrew, he could hear people who are not actually around. When asked why he was restless, he responds that he can hear “them” talking about him.

Delusions

This is seen from a firm held idea that Andrew had about ASIO being after him despite obvious evidence that it was not true. This type of delusion is known as persecution delusion. It is the belief that other are out to get the patient. Such delusions normally have bizarre ideas of plots and conspiracy against the patient. This kind of delusion is evidently shown by Andrew as he tells implausible stories about different people in the university being ASIO spies. He also suffers from delusion of control in the sense that he beliefs his thoughts are being controlled by outside forces (Schimmelmann et al., 2015). He reports having “transmitter chip” that has been inserted into his brain to monitor his thoughts.

Disorganized Behavior and Speech

Andrew showed trouble maintaining and concentrating a train of thought that manifested itself in the way he spoke. He started sentences that were completely illogical and incoherent with each other. He had loose associations of his speech, rapidly jumping from one topic to the next without clear associations (Schimmelmann et al., 2015). For instance, he makes a number of loosely connected and implausible stories about different people in the university being ASIO spies. Additionally, he adds that other students have been discussing his activities with the lecturer to make sure he gets into trouble. He also suffers from disorganization in his behavior. This is evidenced by his Counsellor’s concern about a noticeable change in his general behaviour and a significant drop in his academic performance during the semester.

Q3. Andrew asks you why he has a prescription for medication. Briefly discuss how you would respond.

The most important tool that I will deploy to ensure our discussion is effective is by treating Andrew with respect while explaining to him the need for his prescription. This is because, making Andrew feel heard and respected will prompt him to be respectful in return. He will thus consider what I will explain to him and take it into consideration. I will make eye-contact with him, minimize any distractions and watch out for any contradictory messages that may arise from my explanations as we discuss (Nieuwlaat et al., 2014).

Understanding the importance of medication helps every patient to adhere to such prescription. First I will explain to Andrew why that prescription is critical in ensuring that the voices in his head can disappear. This will help boost his perception about the significance of the medication prescribed in relation to his condition. I will explain to him that to avoid being hospitalized, he must take the prescription given. Studies show that medication adherence is higher among patients who are aware of the need to take medication to relieve them of the negative effects of the disease (Nieuwlaat et al., 2014). Andrew will understand that taking the prescription will alleviate his psychotic episodes thus improving his willingness to take the prescription.

Secondly I will explain to Andrew the consequences of not adhering to the prescription. I will explain to him that failing to adhere to such prescription would lead to terrible health outcomes. I will make him understand that ignoring the prescription will lead to relapse of his psychosis and more disturbing symptoms. This is because studies indicate that psychosis recurrence rate occur on averagely 77% of patients who stop taking their medication (Nieuwlaat et al., 2014). I will elaborate to him that he needs the prescription to avoid the risk of being rehospitalized after being discharged. Also, I would explain to him that he needs the prescription to prevent extension of his stay in the hospital.

Thirdly, I will help Andrew make informed choices about the prescribed medication. I will provide him with the information on options for the administration methods such as oral or injection. Also, I will explain to him the mechanism of the drug’s action, and its significance in ensuring that the psychotic episodes are completely eliminated (Nieuwlaat et al., 2014). Lastly, I will encourage him to ask me for help any time he feels uncomfortable with taking the medication. 

Q4. Monitoring Plan

My monitoring plan will revolve around holistic assessment of Andrew. This assessment will serve as the basis for accurate application of best services to the patient.

Components of the Assessment

First I will conduct a face to face interview in combination with mental state examination of Andrew during every appointment. Secondly, I will take his full history from the notes previously taken and collaborate it with face to face conversation regarding his physical health and trauma. This will help determine his risk level both to himself and to people around him. Thirdly, I will occasionally conduct psychometric assessment on him to monitor his cognitive thinking capability with time (Thompson et al., 2015). I will also seek advice and information from other experienced nurses and practitioners to help relate with the patient in a more positive and productive way.

Inquiry on what might Encourage Psychotic Episodes in his life

First I will identify any problems that Andrew might be experiencing, difficulties from such experiences and what he is willing to change, for instance some daily activities. Secondly, I will sought out Andrew’s view of why such psychotic episodes are happening to him. Thirdly, I will inquire about his personal life situations. These include his accommodation, leisure activities, and his relationship with family members and friends (Thompson et al., 2015). I will also inquire about his areas of difficulties, skills or abilities to help in working out the best management plan for his condition. I will also confirm if Andrew had such episodes before. If so, I will determine what worked or did not work in the past to help with current treatment plan.

Assessment of Risk to Self and Others

Due to the psychotic episodes that Andrew experience, it is imperative that his capacity for dangerousness to others and to himself be assessed during the monitoring period. Variables that are of great consideration here include his violent thoughts, anger, and hallucinations. High levels of such variables strongly relate to violence (Stuart, 2014). Additionally, I will encourage Andrew to make a list of formulated needs. Understanding of such a list would help Andrew to develop an individualized action plan detailing goals and focus of intervention.  Such an action plan may include therapy referral and other treatment plans, for instance, vocational advice in times of distress. Some of the components of the list include strengths and copping assets, potential triggers for the psychotic episodes, and factors that maintain current situation.