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.
Assessment Question 1
Michael is a 46-year-old man who is being treated in an adult inpatient unit. He was brought into hospital by Police after he was found in Queen St Mall – he was shouting the “bikies are out to get me” and appeared to be distressed and afraid, running aimlessly and often looking behind. He was not wearing shoes, and his only clothing was a towel wrapped around his lower body. He appeared to be very disheveled, his hair was matted and dirty, as were his hands and feet. There were multiple cuts to his hands, some of them deep. When the Police approached Michael, he was challenging to engage, not re-directable, speaking out of turn, intrusive and looking all around him with a startled expression. He also appeared to be paranoid about hospital staff being “undercover bikies”. He told Police he did not want to go to hospital as he feared the nurses would poison his medication and be able to “read his thoughts”. He very reluctantly agreed to attend hospital for assessment.
Background information: Michael has a diagnosis of Paranoid Schizophrenia, which was diagnosed when he was 19. Michael finished year 12 although found it very challenging to maintain concentration and often lacked motivation to engage with study, his family, and his peers. He started using cannabis as a way to “sleep and relax” and has been using this ever since that time. Michael moved out of his parent’s home when he was 20 and has been living in shared accommodation since. Michael is currently homeless as he was evicted from his shared unit as he did not pay his rent. Michael has in the past worked as a labourer in construction, however ceased this after becoming unwell. He has been unemployed for the past two years and receives DSP (Disability Support Pension).
Michael has had multiple admissions for the care of his illness (the last one was 1.5 years ago). He has been prescribed multiple anti-psychotic medication, with limited effect. The last medication he took was Olanzapine (oral). He self-ceased this medication about three months ago, states “it made me fat and did not do anything for me, anyway”
Michael’s parents try to remain in contact (they also live in Brisbane). However, this is hard as he does not have a phone. Michael has a younger brother and they see each other when Michael goes home for a few days at Christmas. Michael’s grandfather also had schizophrenia and completed suicide aged 50.
Michael had a long-term partner however she died of an overdose five years ago. They had no children.
You meet Michael for the first time on the day following his admission. You introduce yourself to him and take him to a quiet place to have a conversation. He appears confused and tells you he does not know why he is in hospital, saying: “there is nothing wrong with me, it is all the bikies’ and the nurses, you are all out to get me”. He is not aggressive towards you however he is not happy to be in hospital. He tells you he has not slept well for a few days as he is “worried about the bikies’ finding him”. He also appears very thin. His cuts have been cleaned and bandaged.
Question 1a. Define and describe what it means to be Paranoid.
Question 1 b. Identify and justify two immediate priorities for Michael’s Nursing care. (Priorities should be- non-pharmacological)
Question 1c. Discuss two Nursing interventions to address each of the above priorities, drawing on peer-reviewed evidence.
Question 1c. Linking to the MSE component of “insight”, identify the legal considerations for Michael’s admission?
Read the following case study and answer the questions below.
Aliah is a thin 28-year-old woman who was brought into the psychiatric emergency department by her husband yesterday, after he experienced concerns, about her safety and wellbeing.
Background: Aliah was born in Syria and came to Australia as a refugee six years ago with her husband Khalid. Aliah’s background is traumatic, and she witnessed both her parent’s death in Syria when she was young. She has no siblings. She has been married to her husband Khalid for the past eight years. They have no children. Aliah has been attending University to become a teacher. However, has deferred the present semester as she feels low and unable to concentrate on her studies. Aliah has two close friends but has not seen them for the past three months. She is not linked with any transcultural services in the community.
Aliah has suffered from depression since the loss of her parents ten years ago. She has also been diagnosed with Post-Traumatic stress disorder (PTSD), and she experiences distressing flashbacks to her parent’s death. She attempted suicide by overdose some years ago (this led to a short medical admission and an admission to an acute psychiatric unit, for stabilisation of her mental state and mitigation of risk). When Aliah feels low, her sleep is often limited to 5- 6 hours per night and her appetite is poor. She has been taking ant-depressant medications for the past six years and Khalid states her GP also referred her to a psychologist who specialises in trauma. She has attended several sessions but stopped going about three months ago, after the 10th anniversary of her parent’s death. Khalid tells staff on admission that she “does not talk to him much anymore” (relationship was good until three months ago). He is concerned about her risk for suicide and suspects she may not be taking her antidepressant medication.
Aliah does not drink or smoke and is otherwise in good health.
You meet Aliah in her room the morning after her admission the previous day. She presents as withdrawn, her replies are limited, and she looks at the floor as you speak. When you ask whether she feels safe to assess suicide risk she looks down and says, “what is the point anyway, Khalid will be better off without me, he can meet someone else and be happy”. She is unable to confirm her safety on the ward. She confirms she has not taken her medication for four months and says she feels low “all the time”
Question 2a. Define and describe what it means for a person to have PTSD
Question 2b. Discuss and justify two Nursing strategies you would use in addressing Aliah’s acute suicide risk.
Question 2b. Discuss and justify two possible multi-disciplinary interventions or referrals (interventions should be non- pharmacological). In your answer identify why each intervention or referral is important in order to achieve person centered care?
Refer to the video in NSB204 Blackboard site, 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.
Question 3a. Discuss your understanding of the harm minimisation approach, supporting your points with peer-reviewed evidence.
Question 3b. Discuss how the harm minimisation approach links in with person centered care, drawing from peer reviewed sources.