Subject : Mental health Self and Others
Deadline: 17 September
Topic: Case Study of a patient, Tom, schizophrenia
Tom is 52-year-old Caucasian male who currently lives in supported accommodation in an inner-city suburb of a metropolitan city and has a diagnosis of schizophrenia. Tom was diagnosed with schizophrenia in his mid-twenties following the birth of his daughter and the subsequent relationship breakdown between him and his daughter’s mother. Tom has a family history of mental illness – his mother was diagnosed with schizophrenia but died from a heart attack 15 years ago, and his maternal aunt has bipolar affective disorder. Tom has never met his father nor knows who his father is. Tom is supported by the National Disability Insurance Scheme (NDIS) and his care coordinator Julie from the local community mental health team as Tom is on a community Treatment Authority under the Mental Health Act 2016 (Qld).
Tom does not have any contact with his daughter, Amelia, who is now 28-years old, or any other family members. Tom has minimal social supports outside of his care coordinator and the NDIS, he is unemployed and spends most of his time at home listening to the radio. Tom has a history of substance use including amphetamines and heroin and reports his substance use was frequent in his twenties and last used methamphetamines 2 months ago. He reports sporadic use over the past 20 years. Tom has a cognitive impairment which is a result of trauma he experienced in utero, he is unable to read or write and he feels shame regarding this.
Tom was discharged from the mental health unit 2 weeks ago after a 2-month long admission for commencement of clozapine on the background of increasing auditory hallucinations which were commanding in nature. Tom commenced a new medication during this admission, clozapine, however he self-ceased five days ago as he reported it was giving him constipation and he was not sure why he was taking it.
Tom’s care coordinator Julie is a mental health nurse, and on her last home visit to Tom one day ago, she observed a deterioration in his mental health. Tom was wearing a stained black shirt and pants, Julie noted that Tom was wearing the same clothes as when she visited the week before and he appeared disheveled and has tattoos on his arms. Tom did not have eye contact with Julie and was sitting facing away from Julie during conversation. Julie noted Tom had a blunted and reduced range of emotions, it was difficult to have a conversation with Tom as he appeared distracted, often pausing mid-sentence, and requiring questions to be repeated on multiple occasions. Tom’s responses were monotone and often brief in conversation and did not directly relate to the question asked. Tom disclosed he was hearing voices that were commanding him to stay home and to not trust other people. Tom reported the voices were derogatory towards him, telling him he is “worthless” and “not good enough for other people”. Tom became increasingly withdrawn as he was asked more about his experience of hearing voices. Tom reported his mood to be low and that he was experiencing thoughts of wanting to end his life if he had access to the means to do this.
Julie discussed Tom’s deterioration in his mental state with the mental health team and Tom agreed to present to hospital for admission to stabilise mental state and review medication regime.
This assignment aims to help you to begin to use your professional and clinical
judgement to think like nurses working in a mental health setting and/or in relation to
the mental health needs of people regardless of the setting.
Relevant to the person in your selected case scenario, your assignment will
demonstrate your understanding of the following:
• Mental Status Examination (MSE)
• A clinical formulation using the biopsychosocial model
• Recognising and responding to the mental health needs of the identified
person by identifying best practice nursing interventions.
• How to engage a person in a therapeutic relationship
Please follow the steps outlined below to answer this assignment question.
1. The Mental Status Examination [250 words +/- 10%]
Using the mental state examination (MSE) format from your tutorial guide, complete
an MSE of the person from information provided in your selected case study.
Use health terms correctly (for instance, instead of “talks fast” use the correct term
“pressure of speech”)
The opening sentence must clearly state your chosen case study.
In text references are not required for this section
2. Clinical Formulation [250 words +/- 10%]
Using information provided in your selected case study complete a clinical
formulation identifying relevant indicators using the 5Ps framework: presenting,
predisposing, precipitating, perpetuating, and protective factors. Include
biopsychosocial factors relevant to the person in the case study.
You may choose to present the clinical formulation in a table or in paragraph format,
ensure responses remain in sentence form.
In text references are not required for this section
3. The Therapeutic Relationship [300 words +/- 10%]
The therapeutic relationship is an important part of the nurse’s role. Explain why the
provision of a therapeutic relationship would be a priority for the nurse when working
with the person from your selected case study. Select one strategy you would use to
develop the therapeutic relationship and provide a rationale for use adapted to
respond to the specific needs of the client in the case. You may consider the recovery
model, person centred care or cultural safety in developing your response.
Academic paragraphs integrating evidence-based literature are expected.
4. Nursing care plan [700 words +/- 10%]
Develop a nursing plan of care for the individual in the case study. Base your plan of
care on information identified in your mental state examination, including your risk
assessment and information identified in your clinical formulation.
- List 2 priority problems in your nursing plan of care
- For each priority problem, identify and describe one evidence-based (nonpharmacological) nursing intervention to address them. (Each intervention
must identify how it will address the priority care area within a recoveryorientated framework).
- Identify what assessment data would indicate the interventions are positively
impacting the individual in the case study.
Academic paragraphs integrating evidence-based literature are expected.
Length: 1500 words +/- 10% (word length includes in-text referencing and excludes your
reference list).
Estimated time to
complete task:
40 hours
NSB204 Assessment Task 2
Weighting: 40%
How will I be assessed: +/- 7 point grading scale using a rubric
Due date: See Blackboard site for details of due date and submission requirements.
Presentation
requirements:
Your assignment should be written in CiteWrite APA style and prepared as follows:
• Cover sheet with the assessment title, your name, student number, tutor
name (not necessarily the Unit Coordinator) and word count.
• Include a ‘footer’ on each page with your name, student number, unit code
and page number.
• 3 cm margins on all sides, double-spaced text
• Use single font, such as Times New Roman, Arial or Calibri; font size 12
• Referencing
o CiteWrite APA7 style referencing.
o It is a requirement that you include page numbers for all in-text
references. E.g. (Smith, 2020, p.34).
o Note: markers will be checking references to see that you have
accurately represented the source. Inaccurate citations or falsifying
your references is academic misconduct and will be reported.
• Headings can be used to structure your assignment logically e.g. The mental
State Examination
• You do not need an introduction or a conclusion
• Be written in academic style using full sentences and paragraphs unless
stated otherwise
• References should be no older than 7 years and should be peer reviewed articles