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QUESTION
Title: Mental Health Case study
Case study:
Mick
Mick is a 19 year old man who lives in a small town about five hours travel from the
city. He lives with his mum, Angela and four younger siblings. His father died from a
workplace accident when he was 15 years old.
Mick left high school in Year 9 because he was unable to concentrate and focus on
his studies. He has had a disrupted employment history involving working as a farm
hand although h e successfully started work 12 months ago for a local mechanic.
Two months ago Mick began to hear voices that told him he was no good. He also
began to believe that his boss was planting small video cameras in the cars to catch
him making mistakes. Mick became increasingly agitated at work, particularly during
busy times, and began "talking strangely" to customers. Recently, a customer asked
when his car would be available and Mick indicated that it might not be available for
several days because it had "surveillance photos that were being reviewed by the
CIA".
A few weeks ago, Mick quit his job after yelling at his boss that he couldn't take the
constant abuse of being watched by all the cameras in the car yard and even at his
home. Mick has become increasingly confused and agitated. His behaviour has
recently become more disorganised and his mum and aunty have been concerned
about his erratic and volatile behaviour. They are particularly concerned over the
increase in his alcohol and cannabis use. He has been demanding money from them
and threatening to hit someone if they didn’t give him what he wanted.
Mick has a shaved head and has several tattoos on his arms. His teeth have not been
brushed for some time and he smells somewhat of perspiration. He is 185cm tall and
weighs 87kg. He is wearing jeans and a t-shirt with runners on his feet. He expresses
frustration that no-one believes that he is under surveillance. He angrily thumps his
fist on the desk and declares that it is so obvious; “why don’t you believe me?” Mick
has no previous history of mental illness and there is no family history of mental
illness. He has a few close friends with whom he socializes most evenings. They
usually drink alcohol and “smoke a few cones”.
Mick’s mother Angela reports that Mick has been physically well and has no medical
history of any note apart from a broken arm when he was seven years old. He is not
prescribed any medication. Angela points out that Mick has had two friends die from
suicide over the past three years.
| Subject | Psychology | Pages | 10 | Style | APA |
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Answer
Mental Health Case Study of Mick
PART 1 Holistic Assessment and Planning
- Introduction
Mental health problems affect one in every Australians and have thus become universal experiences across the lifespans of individuals. Knowledge of the significant mental health conditions as well as their signs and symptoms is key to ensuring early diagnosis and treatment (Evans, Nizette, & O’Brien, 2017). Clinicians should develop the skills necessary for the assessment as well as respond to mental health issues. Such capabilities include taking the history of the patients, mental health and risk assessment, as well as recovery which enhances both coping and resilience. According to Richardson, Yarwood, & Richardson (2017), in having any therapeutic engagement with mental health patients, healthcare practitioners should apply cultural safety and hence avoid providing treatment which infringes on the beliefs of the individual. Additionally, they should understand the role of the self in person-centered care as well as the application of therapeutic self (Townsend, 2014). This paper uses the case study of Mick who has a mental health condition to perform a mental status examination and formulates a nursing care plan. Finally, a therapeutic engagement and clinical interpretation of Mick’s condition will be provided.
- The Mental Status Examination
Mental health examination (MSE) is an assessment of the state of an individual with a mental health condition. Such an analysis is key to assisting healthcare providers in making decisions as to the nature and type of diagnosis (Townsend, 2014). Additionally, it aids in the understanding of the contributory factors towards the symptoms presented. Moreover, through MSE, the most appropriate treatment, as well as recovery, is determined for each of the patients (Arnold et al., 2016). Through an MSE, the strengths and areas which need support are identified and resilience promoted in the journey towards recovery (Evans, Nizette, & O’Brien, 2017). Nurses develop clinical formulation after conducting an MSE. As such, it is critical that it is done on Mick so that a clinical formulation and nursing plan can be created.
Appearance and Behavior
- Mick is a male adult of 19 years who is 185cm tall and weighs 87kg.
- He wears jeans and a t-shirt as well as runners on his feet.
- His head is shaved albeit with multiple tattoos on both arms.
- He usually drinks alcohol and smokes.
Speech –Rate, Quantity, and Volume
- He speaks too much in a rapid and loud manner.
- Mick shouts at his boss.
- He has perseveration as he gets stuck to the point that someone is surveilling him.
Mood and Affect
- He feels sad.
- Feels frustrated because nobody wants to believe him.
Thought –Form and Content
- Has an illogical connection between thoughts as for when a customer asks him about his care he responds that CIA is reviewing its surveillance.
- Obsessed with being surveilled which brings phobia.
Perception
- Experiencing a delusion as he believes that he is being monitored and that surveillance camera has been fixed everywhere around him.
Sensorium and Cognition –LOC, Orientation, Intelligence, and Memory
- Can remember past events.
- Has not lost memory despite the fact that he has false beliefs.
Insight and Judgment
- Does not have a cognitive decision and his behavior is terrible.
- Threatens his family members when they fail to give him money.
- Clinical Formulation Table
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Factor |
Evidence from Mick |
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Presenting Factors |
· Mick hears voices which tell him that he is not good enough. · He feels that he is being surveilled to be caught when making mistakes. · Mick is agitated at work especially at times when he is busy. · He has an erratic, disorganized, and volatile. |
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Precipitating Factors |
· Mick’s father died from a workplace accident when he (Mick) was aged 15. · Over the past three years, his two friends died. · He is usually taking alcohol and smoking. |
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Predisposing Fa
Creating a nursing care plan requires the identification of the needs of the individual (Healy, 2016). Maslow’s hierarchy of needs is a model which can be used to this effect. The model identifies needs based on five parameters. Physiological
Safety
Love/Belonging
Esteem
Self-Actualization
Based on the assessment of needs made using Maslow’s model, two high priority nursing care needs have been identified. One of those is safety, which includes health and wellbeing (O'connell & Dowling, 2014). In this requirement, Mick has become, and addict of alcohol whereas his smoking behavior is serial. The second high priority need is social belonging and in particular family and friendships. Mick’s mother and family are not supportive whereas two of his friends have died in the last three years. The nursing intervention for the nursing need of health and wellbeing is medical checkup. Having a checkup will ensure that healthcare practitioners identify any effects of alcohol and smoking on Mick’s body and provide the necessary diagnosis and treatment (Storm & Edwards, 2013). On the second need of lack of supportive family and friends, Mick should receive therapy from a psychologist. Specifically, Niemela & Kim (2014) assert that getting this advice will provide him with the necessary treatment to help him get over the death of his friends and change his attitude towards his family.
Clinical handover entails the transfer of not only professional responsibility but also accountability for significant aspects of care from one person to the other or an expert group to the other (Cowan et al., 2017). Based on the results of the mental status examination and clinical formulation, various concerns have been identified. Mick is frustrated and aggressive. He has not showered for some time, and his clothes are dirty. He has an altered perception which makes him think that he is being monitored. The main concerns are that the client might be aggressive especially he feels that he is not being listened to and that nobody believes in him. Additionally, the client might make demands which might not be fulfilled such as asking for money for alcohol. Moreover, another issue of concern is that he might say things which do not make sense and which necessitates taking of measures to change his altered perceptions. PART 2: Therapeutic Engagement and Clinical Interpretation 2.1. The Therapeutic Relationship A therapeutic relationship, also referred to as working alliance, helping alliance or a therapeutic alliance, is a correlation between a healthcare provider and the patient. It involves the two engage each other to effect beneficial change in the patient (Kidd, Kenny, & McKinstry, 2015). The relationships requires components such as transference which is a friendly and affectionate feeling. Additionally, it entails having a working alliance which is to say; combining the patient’s reasonable side and therapist’s analyzing aspects (Storm & Edwards, 2013). In the current case, therapist offering to counsel will use therapeutic relationship to convince Mick to be cooperative and hence use skills to advise him. Additionally, the link will be crucial in the preparation of a mental status examination as Mick should corporate in the exercise. The strategy to be used in the development of a therapeutic relationship with Mick is the client-driven approach. Specifically, Mick will be allowed to use stop hand sign or “panic button.” This strategy will not only be respectful but also empowering to the client. Mick will have control over the pace of the therapy and assessment being made. Additionally, he will have the ability to disengage from the treatment at any time and re-engage when he feels ready. This client-driven approach is vital as the patient has the power to dictate not only the frequency and length but also the pace of the sessions. Additionally, Mick will be in control of what he shares and at what speed. Such a strategy will make him have control over the therapy session and hence have freedom and not feel intimidated. 2.2. Cultural Safety Cultural safety is defined by the Nursing Council of New Zealand as the effective practice of a nurse to a person from another culture or family (Harding, 2013). In this case, the nurse has to first reflect on his/her own cultural identity and, therefore, assess the impact of this/her personal culture on professional practice (Doutrich et al., 2014). To ensure that I deliver safe healthcare, the first step that I will make is reflecting on my cultural identity and comparing it with that of Mick. I will then go ahead and assess the impact of my personal culture on Mick. In providing therapy to Mick, one of the issues that cultural safety might bring about is that of the clash of personal cultures (Best, 2014). In this regard, our cultures might not align, and we might, therefore, have different beliefs and customs. In applying cultural safety to Mick, I used principle 4.4 which states that cultural safety has a close focus on the understanding of the effect of the nurse’s own culture, history, attitudes, as well as life experiences on other people (Cox & Simpson, 2015). Such a principle guided me in doing a reflection and understanding that my culture might conflict with that of Mick and hence applying measures to ensure that such a conflict does not occur. 2.3. Recovery-oriented Nursing Care The principles of recovery hold that recovery is a journey, an ongoing process, and not an event. Additionally, it is a personal responsibility of the patients to make a decision that they want to recover. Moreover, Welsh & McEnany (2015) state that recovery is about empowerment as people must have the power to act on the decisions which are in tandem with their personal goals. Indeed, Shepherd et al. (2014) add that recovery is about the restoration of hope as patients look forward towards their future with the belief that they will have continued satisfaction despite any life limitations that they may face. Recovery should be based on the idea that patients should understand why they need to recover and not be forced in a process that they have no idea of its intentions (Pincus et al., 2017). Recovery is a process by which patients rebuild and connect with themselves, their families, and others within their environments (Slade, 2009). Indeed, recovery is not only a complex but also a non-linear journey which requires patience and commitment. Such principles should be observed when implementing any interventions in nursing care so that clients can have a holistic recovery (Guerrero & Alicata, 2016). The nursing interventions which were used for Mick are psychological therapy and medical checkup. These two responses took into account the principles of recovery. Specifically, during therapy, Mick was given the power and control of the sessions as he could stop the meeting and continue with them anytime he deemed appropriate. Such actions were meant to reinforce the principle of personal responsibility. Before the start of the therapy, Mick was explained about the nature of the recovery process and the challenges that they may face in the course of that journey. Additionally, explanations were made to the point that recovery will restore his hope of a good life and hence ensure that he is better connected with his families and communities (Cox & Simpson, 2015). Applying such principles in Mick’s recovery process provides that he understands the process, takes it as his personal responsibility, and undertakes steps to overcome challenges which occur during the recovery journey.ctors |
· The death of Mick’s father has hit him (Mick) very hard. · His disrupted employment history has not been helpful. · Increased alcohol and cannabis use has been the cause of confusion and aggressive behavior.
· The death of his two friends has brought him a lot of stress as he has not seen a counselor. |
References
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