Prioritizing Patient Care And Safety In Mental Health Nursing: An Essay.

Urgent Risk Area: Prioritizing Patient Care

Questions 1a and 1b
1a) Using the case study provided, identify an urgent risk area. Ensure your answer details why you have identified this risk area including specific information about the client and current literature. (2 marks). 
1b) Identify one nursing / midwifery intervention you would immediately undertake with your client to address the risk area noted in question 1a and include a rationale for the intervention. (2 marks for the intervention and 2 marks for the rationale) 
Ensure the intervention includes who and when you would actually carry out the intervention. 
Your rationale should state how and why you would carry out the particular intervention. Ensure literature is included. 
Before you answer questions 1 a and b, consider you are a health professional and have sat with your client to undertake a mental health assessment. You have gathered the information which is offered in the case study. What do you now see as the most urgent risk area to keep your client safe?
Take care to ensure the risk area is focused on the client. You may identify risk areas for family members or members of the community, but this is not the immediate focus of your actual student assessment here. 
Identify the most urgent concern first in terms of immediate safety concerns. 
We want to see your understanding of the client’s issue, so avoid writing brief details about the client such as: ‘the client has self-harm thoughts’. Expand on the detail of the concern ie. the client has presented with daily self-harm thoughts for 3 months, with intermittent / regular thoughts to cut his wrists using a razor blade. The client reports family contact as a possible cause of distress triggering self-harm thoughts which last for one hour daily immediately after seeing his family. 
You should then add in some literature about self-harm which has relevance to the case study ie. males and self-harm, incidence of self-harm. Remember 1a is only 2 marks, so the literature here doesn’t need to be expansive, but do make sure you provide some literature and provide details of the client’s main concern ie. safety concern. 
Identify one nursing or midwifery which you would undertake to address the concern you have noted in answer 1a. The intervention must be suitable for the concern you note otherwise it will not be awarded marks. For example: building a therapeutic relationship with your client; maintaining a safe environment; risk assessment; observations. You need to state exactly what you would undertake and how to gain marks. Ie. how would you build a therapeutic relationship with your client exactly? What approach would you take? What kind of language might you use? Who would be undertaken the activity ie. nurse / midwife on duty? Ie. the nurse / midwife will build a positive relationship with the client by meeting with them daily for 30 minutes using positive and recovery-based language to establish trust and rapport. 
Another example of a nursing / midwifery intervention: primary nurse / midwife to undertake a self-harm / suicide risk assessment with the client on initial contact and review on a continuous basis as new information is obtained or the client’s presentation changes.  
It must be a direct health professionals and client intervention not a referral to another service or practitioner. 
You should include a rationale with your intervention using literature and making reference back to the case study. Ie. why would you use recovery-based language when building a relationship with your client? Why would you undertake a risk assessment with your client?  
Questions 2a and 2b
2a) Using the case study provided, identify a mental health concern. Ensure your answer details why this is an area of concern. Include specific information about the client and current literature. (2 marks) 
2b) Identify one nursing / midwifery intervention you would undertake with your client to address the mental health concern noted in question 2a and include a rationale for the intervention. (2 marks for the intervention and 2 marks for the rationale) 
Ensure the interventions includes how, who and when you would actually carry out the intervention. Your rationale should state how and why you would carry out the particular intervention. 
Ensure literature is included when you discuss the rationale. 
Question 2 a and b helps us to assess that you understand the difference between an urgent client concern ie. safety and a mental health concern. Question one was concerned with safety identification whereas question 2 is about mental health concerns ie. possibly low mood or anxiety. 
 Again, avoid simply identifying the actual concern and writing in brief. You need to say something about the details of the client’s experiences using literature. Ie. the client has been experiencing low mood for one month, with thoughts of reduced self- esteem, worthlessness, hopelessness and suicide ideation. You should add in some literature in relation to low mood in males; anxiety in males for example. Again, it’s only 2 marks so doesn’t need to be lots of literature here. 
Try to avoid highlighting depression in your answer to 1a, as depression is an actual diagnosis with a collection of experiences as opposed to one concern. Better to term this as low mood as opposed to depression. 
Next identify an intervention which is suitable for the mental health concern in your answer to question 2a. Ie if you have identified low mood, what intervention can you do directly with your client to help / support them with low mood. Again, when writing the intervention think about who would carry out the intervention, when, how often, how exactly with details, actually describe what you would do. 
Again, a referral to another professional is not a direct face to face intervention, so please avoid this. 
You should include a rationale for the intervention you have offered in 2b. ie. why have you decided to carry out the intervention making reference to literature and your client? 
Question 3
3) Using current literature, identify and discuss (2) two legal, ethical or professional issues a nurse / midwife may need to consider when working with the client in the case study (4 marks).
Question 3 helps us to determine your understanding of some of the wider issues in relation to a person’s presentation and care. 
Re-read the case study to identify possible legal, ethical or professional issues. 
For example: you might want to discuss the client’s presentation in terms of 
legal issues such as:  Mental Health Act; Privacy Act; Health Records Act; 
ethical issues such as: the ethical principles such as building a relationship while undertaking risk assessment which may result in a client being scheduled under the Mental Health Act; asking the client lots of questions for mental health assessment knowing the client may find the actual questions distressing; 
professional issues such as: confidentiality and maintaining public safety; being involved with a clinical relationship with a fellow health professional who may work within your place of work ie. hospital.
Clearly identify each issue in your work and then relate to the case study and use literature. If you are highlighting legal issues, you should relate to the Act directly and not secondary sourced literature. 
Make sure you refer back to the client in the case study and literature. 

1(a). An Urgent Risk Area (Prioritizing Patient Care)

The urgent risk area for Chung is the experiencing of fleeting thoughts of suicide. This has been identified because patients experiencing depression usually have tendencies of being suicidal and hence immediate care is needed so that these people do not commit suicide. He has developed suicidal thoughts due to depression which has resulted due to his continuing long hours, night shift work, the high pressure of an Accident and Emergency department, Charlotte’s birth as he feels that he is not involved in her upbringing and his wife’s deteriorating health. The signs of depression he has to include; anxiety, insomnia, low in mood, fear of a heart attack and suicidal thoughts (Franklin et al. 2017).

(b). Interventions To Address Suicidal Thoughts Due To Depression (Terms Of Safety Management)

Patient To Be Given 24 Hour Care

The nurse should ensure that Chung can receive help 24/7 and this can be done by giving the patient a 24-hour hotline emergency phone number and direct how and when to use it. This will ensure that the patient can get help when needed to avoid suicidal thoughts or attempts and depression.

Help The Patient To Identify And Solve The Underlying Reason For Suicide And Depression

The nurse to help the patient to identify the cause of depression which leads to his suicidal thoughts. This can be through the identification of feelings, thoughts and behaviours that leads to Chung wanting to commit suicide (Townsend & Morgan, 2017). 

2(a). Mental Health Concern (Less Urgent Issue)

The mental health issues that Chung has is depression. This concern has been identified as Chung has signs and symptoms of depression which include; anxiety, insomnia, low in mood, fear of a heart attack and suicidal thoughts (Kendler, 2016).

(b). Nursing Intervention To Address Depression

Active Listening and Presence

The nurse should listen to the reasons that make Chung be depressed which include; lack of active involvement in his own wedding, demanding job, scrutiny by the medical board due to the error he made and his wife’s deteriorating health and advise him on how to deal with these emotions. Listening is caring hence Chung will feel loved hence eradicate negative feelings.

Family And Other Social Group Involvement

Chung family should be included in his management by arranging crisis counselling to reduce depression. Chung should also be encouraged to join self-help groups. Depressed persons need a network of resources so as to reduce the feelings that lead to depression. This will help Chung since it encourages him to express his feelings of anger, guilt and sadness which is the first step in overcoming depression (Townsend & Morgan, 2017). 

3. Legal, Ethical/Professional Issues

Confidentiality

The nurse treating Chung should ensure the confidentiality of the information that he shares on medical treatment and records. This principle is so important since in the field of mental health patients should be assured the information they share is for treatment only (Tribe & Morrissey, 2015). 

Informed Consent

Informed consent is the process in which all the information about treatment options, alternatives as well as risks are shared with patients (Tribe & Morrissey, 2015). Therefore, the nurse caring for Chung should provide him with an informed consent to ensure that he makes informed wise decisions. 

References

Franklin, J. C., Ribeiro, J. D., Fox, K. R., Bentley, K. H., Kleiman, E. M., Huang, X., ... & Nock, M. K. (2017). Risk factors for suicidal thoughts and behaviors: A meta-analysis of 50 years of research. Psychological Bulletin, 143(2), 187.

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.

Townsend, M. C., & Morgan, K. I. (2017). Psychiatric mental health nursing: Concepts of care in evidence-based practice. FA Davis.

Tribe, R., & Morrissey, J. (Eds.). (2015). Handbook of professional and ethical practice for psychologists, counsellors and psychotherapists. Routledge.