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This unit will contribute to completion of course level outcomes, Western Sydney University graduate attributes and the Nursing and Midwifery Board of Australia Registered Nurse Standards for Practice. Course level learning outcomes can be accessed on your Unit vUWS Home Page.

The Unit Name unit is part of Course Name(s). The unit provides the foundation for developing comprehensive,coherent and connected knowledge in the nursing discipline and introduces and develops interaction skills which will be required by graduates in their work environments.

Learning outcomes for the unit are outlined below.

1 Apply primary health care principles in the promotion of mental health & wellbeing in diverse settings.

2 Distinguish the mental health priorities in relation to meeting the needs of individuals and their families/significant others in the community.

3 Relate the principles of stress, mental health assessment, risk assessment and management in promoting mental health and wellbeing.

4 Explain the principles and skills of therapeutic communication and interventions related to caring for people experiencing alterations in thought, behaviour, and mood.

5 Apply ethico-legal implications in relation to the care of people with mental health concerns and/or illnesses

6 Develop an understanding of the lived experiences and recovery for individuals with mental health concerns and/or illnesses

Course level outcomes, Western Sydney University graduate attributes, Nursing and Midwifery Board of Australia Registered Nurse Standards for Practice

Answer:

Mental State Examination

The initial area of examination for a mental health patient is appearance which is the physical outlook of the patient. Health specialists can judge Mr. Chung's outlook from his sitting posture during the time of the observation and questioning. The patient is slumped in his chair with rounded shoulders and stares at the floor for a long time. The observed behavior also indicates that the patient has clinical depression since he is unable to maintain eye-to-eye contact with the community nurse. Depressed patients have a hostile and secretive attitude towards questioning on their conditions (Dowlati et al., 2014). Chung is stressed and restrictive towards the caregiver who is observing his mental status. The language and speech is another parameter of judging whether an individual is depressed or otherwise. Chung's speech is slowed and purposeful due to his sad state.

Affect, and the mood is two parameters that matter in the life of a depressed individual. Affect is the external manifestation of an individual's emotional status. The feeling is the internal state that predominates an individual at all time (Breukelaar et al., 2018). Chung has a low and tearful mood which has lasted for the past six weeks. He also has a sad and restrictive affect. Repeated suicidal thoughts are every day in persons undergoing depressive disorders. Chung has been having a fleet of suicidal thoughts for the last week. The patient also has low levels of concentration as the nurse has to repeat questions to get a reply. Therefore, the mental state examination indicates that Chung has a depressive disorder.

DSM V

Clinical depression has five significant symptoms; however, there are additional signs of the disease. An individual with the symptoms should seek psychological assistance. The first sign is a depressive mood that lasts for a day or a week. Chung has a low and tearful mood. He also has a sad and restrictive affect. Weight loss is the second significant sign in depressive patients (White et al., 2015). They lose weight due to the failure to eat or lose their appetite.  Mr. Chung has lost five kilograms of weight in the past week due to reduced appetite and missing meals. Depressed patients experience insomnia which is an inability to fall asleep or to remain asleep. Chung has been experiencing sleeplessness which started as initial insomnia and early morning waking at three A.M.

Clinical depression makes patients have difficulty in maintaining a still sitting posture. The patient also becomes restless and has a slowed speech (Kendler, 2016). Chung's has an unstill position as he is slumped in his chair with rounded shoulders. His speech is also delayed and purposeful. Depression also makes the patients feel worthless and guilty about several life issues. Chung feels worthless and thinks that he has let both his wife and children down. He also feels guilty of the drug error he committed at the emergency department. A depressed individual cannot concentrate as the condition interferes with memory. Chung is distracted as the nurse has to repeat questions to get a reply. He also has a fleet of suicidal thoughts which is a sign of depression.

Learning outcomes for the unit

 Question 2

Stress Vulnerability Model

The model explains the reasons behind the varying stress levels in different individuals. Vulnerability refers to a person's susceptibility to psychological disorders (Calvete, Orue, & Hankin, 2015). The major determinants of an individual's vulnerability are childhood experiences and genetic make-ups. Certain medications also affect the vulnerability of an individual to mental infections. Additionally, the use of addictive drugs and alcohol increases the susceptibility to stress. Stress is a general term for the numerous challenges that an individual faces during a lifetime. Proper social support and coping skills reduce the levels of stress. Engagement in useful activities also helps individuals to deal with stress and anxiety.

The contributing factors to the stress-vulnerability model are biological vulnerability, stress, and Protective Factors. Biological susceptibility traces back to an individual's genetics (Gunnar, & Vazquez, 2015). Therefore, a family history of stress vulnerability makes the offspring to have high chances of suffering from the mental condition. The case study does not indicate a depression history from Chung's parents. However, the fact that the mother has hip arthritis and could not attend his wedding is a possible origin of stress. The condition of the wife and child are also a biological source of depression to the patient. The wife gave birth through a caesarian section due to birth complications. Harriet (Chung's wife) is under a lot of pain due to the operation at the birth site.

The level of stress susceptibility differs from one individual to the other. The severity of depressive symptoms also varies among people. Biological factors such as viral infections can intensify an individual's stress levels (Saadat, Behboodi, & Saadat, 2015). However, the case study does not indicate whether the patient had a childhood infection or otherwise. Drug abuse and alcoholism elevate the amounts of stress in an individual. However, Chung's stress has increased due to other factors; since he is a non-alcoholic.

Stress is the other contributing factor to the vulnerability model. Stressful conditions lead to the beginning of a psychological infection or elevate the symptoms.  Stress is a problematic response to situations in life that need a person to change or to adapt (Dunn, Nishimi, Powers, & Bradley, 2017). An individual who can manage a stressful situation cannot develop a psychological condition. However, a person who cannot handle stress suffers from mental disorders such as depression. Major life stressors are stressful life events. Chung's long working hours and additional study for a promotion hinder him from visiting his parents. The inability to see an individual's parents is stressful and only a few people can deal with it.

Mental State Examination

Another stressful event is the drug error that Chung committed in the accident and emergency department. The medication mistake worsened the condition of the eight-year-old patient. Chung administered medication through intramuscular means instead of intravenous administration. His wedding was emotionally tricky since it lacked a Chinese reference and the parents did not attend the event. The condition of the wife and the child are also stressing the patient. He feels guilty and worthless due to the pain of the wife (Harriett). The wife is in pain due to infection at the birth site.

Question 3

Mental Recovery Model

The model supports and emphasizes an individual's process of recovery. Researchers believe that sufficient encouragement can help an individual to recover from a psychological condition. Recovery is a long journey that requires a personal commitment and belief that one can overcome whichever situation (Rosellini et al., 2018). An individual with a mental disorder needs respect to hasten the process of recovery. Health stakeholders and family members should also empower the patients to make them recover from cerebral infections. The patients should also be hopeful that their symptoms can diminish and they retain normalcy once again. Mr. Chung should positively view his symptoms and work towards minimizing their severity. Therefore, the recovery model discusses the three pillars that help one to overcome depression and other mental illnesses.

Respect towards the patient help to hasten recovery from mental diseases. The government, health stakeholders, and family members should respect the opinions of patients (Harvey, & Davidson, 2016). The psychological specialists should listen to the patients and prescribe medications that are in line with the choices of patients. The family members of Chung should make his wish to reduce his depressive symptoms. Harriett's parents should allow the patient to have time with his new daughter after returning from the hospital. The family should also organize for another wedding that involves both Harriett and Chung's parents. The wedding should have both Chinese and Australian reference to reducing the levels of the patient's stress. The hospital administration should obey the opinion of the patient on working hours and shifts.

Empowerment is the second pillar of the mental recovery model. Everybody around Mr. Chung should create an enabling culture to hasten his recovery. The health facility and the family members should support the patient in every aspect of his life (van Grieken et al., 2015). The government should ensure that doctors have an appropriate living apartment that provides a comfortable experience. The hospital administration should offer competitive packages to health workers. The sufficient earnings can help Chung to seek proper medical attention for his ailing mother and wife. The government should build a particular depression management unit in all health facilities in the country. Medical care from the specialized units should be cheap and accessible to all psychological patients. The family members should help Chung to conduct his chores such as washing his clothes and cooking for him.

DSM V

Hope is also a necessary tool in the path to recovery. The relevant stakeholders should help Chung to find hope in life since he is hopeless and helpless and wants to die.  The family members should support the patent to nurture the hope since it reduces the symptoms of depression. Chung should develop a sense of belief in self and tolerate the setbacks and uncertainty of dealing with clinical depression. Hope usually begins at a turning point or starts slowly and develops systematically (Biringer et al., 2017). The road to discovery is full of failure and disappointment. Therefore, the patient should persevere and work hard towards recovery. The psychologists should also ensure that patients remain hopeful.

References

Biringer, E., Davidson, L., Sundfør, B., Ruud, T., & Borg, M. (2017). Service users’ expectations of treatment and support at the Community Mental Health Centre in their recovery. Scandinavian journal of caring sciences, 31(3), 505-513.

Breukelaar, I., Erlinger, M., Harris, A., Boyce, P., Malhi, G. S., Hazell, P., ... & Williams, L. M. (2018). S124. Differences in Cognitive Control Brain Activation Between Euthymic Bipolar and Remitted Unipolar Depressed Individuals. Biological Psychiatry, 83(9), S395-S396.

Calvete, E., Orue, I., & Hankin, B. L. (2015). A longitudinal test of the vulnerability-stress model with early maladaptive schemas for depressive and social anxiety symptoms in adolescents. Journal of Psychopathology and Behavioral Assessment, 37(1), 85-99.

Dowlati, Y., Segal, Z. V., Ravindran, A. V., Steiner, M., Stewart, D. E., & Meyer, J. H. (2014). Effect of dysfunctional attitudes and postpartum state on vulnerability to depressed mood. Journal of affective disorders, 161, 16-20.

Dunn, E. C., Nishimi, K., Powers, A., & Bradley, B. (2017). Is developmental timing of trauma exposure associated with depressive and post-traumatic stress disorder symptoms in adulthood?. Journal of psychiatric research, 84, 119-127.

Gunnar, M. R., & Vazquez, D. (2015). Stress neurobiology and developmental psychopathology. Developmental Psychopathology: Volume Two: Developmental Neuroscience, 533-577.

Harvey, M. A., & Davidson, J. E. (2016). Postintensive care syndrome: right care, right now… and later. Critical care medicine, 44(2), 381-385.

Kendler, K. S. (2016). The phenomenology of major depression and the representativeness and nature of DSM criteria. American Journal of Psychiatry, 173(8), 771-780.

Rosellini, A. J., Liu, H., Petukhova, M. V., Sampson, N. A., Aguilar-Gaxiola, S., Alonso, J., ... & De Jonge, P. (2018). Recovery from DSM-IV post-traumatic stress disorder in the WHO World Mental Health surveys. Psychological medicine, 48(3), 437-450.

Saadat, M., Behboodi, Z. M., & Saadat, E. (2015). Comparison of depression, anxiety, stress, and related factors among women and men with human immunodeficiency virus infection. Journal of human reproductive sciences, 8(1), 48.

van Grieken, R. A., Kirkenier, A. C., Koeter, M. W., Nabitz, U. W., & Schene, A. H. (2015). Patients' perspective on self?management in the recovery from depression. Health Expectations, 18(5), 1339-1348.

White, M. A., Kalarchian, M. A., Levine, M. D., Masheb, R. M., Marcus, M. D., & Grilo, C. M. (2015). Prognostic significance of depressive symptoms on weight loss and psychosocial outcomes following gastric bypass surgery: a prospective 24-month follow-up study. Obesity surgery, 25(10), 1909-1916

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