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1. Select a topic from the list below that will allow you to demonstrate your knowledge regarding mental health nursing:
Substance-related disorders
Schizophrenia
Mood disorders
Schizoaffective disorders
Anxiety disorders
Personality disorders
Eating disorders
Older adults with neurocognitive disorders
Childhood disorders
Crisis intervention, aggression, and violence
Describe a situation related to your chosen topic. The situation should:
Be written in chronological order
Include important background information
Describe people involved
Provide dialogue if needed
Present the situation without any attempt at analysis

Part 2: The Case Study Analysis (5 pages, double spaced)

Describe and analyze the problem(s) presented in your case study. What occurred and why?
Present solution(s) to the problem(s) and how they could be implemented. What would you do as a nurse in the case study?
Apply related knowledge to your analysis and solutions. Consider discussing the following topics if they are applicable to your case study:
Role of the maternity nurse
Assessment, DSM5, treatment
Communication and therapeutic nurse-client relationship
Legal and ethical principles related to mental health
Cultural competency related to mental health nursing
Teaching and learning principles and health promotion to the mental health client and family
 

Anorexia Nervosa: A Case Study of Rose

The report brings about the discussion on the aspects of mental health and the various issues or illness affecting the health of an individual. Mental health defines about the psychological well-being or the absence of the mental health issues, or illness. A satisfactory   level of emotional wellbeing and behavioural adjustment has been the elements which determine the mental health of an individual. The report will therefore discuss about one of the mental health issues, i.e. eating disorder with the help of application of case study. The rationale behind choosing the eating disorder, as the topic in mental health illness, is that it is widespread and prevalent in almost at every stage of the life of an individual. The case study of anorexia nervosa has been taken in this report, as it has been found as most common eating disorder amongst young people. Thus, the readers will gain an understanding of the various aspects of eating disorder through certain case studies.

The case study is based upon the fictional people and situations, and the person ‘Rose’ has been represented in the case. This is used for this case study to ensure the maintenance of privacy and protection of the patient’s personal information in accordance with the Privacy Act.  The patient is 19 years old who is currently suffering from Anorexia nervosa. She was very healthy as a child and possessed very normal bodyweight with respect to her age. When she grew up and became a teenager, she started to get fascinated by the idea of attaining a thin model like physical figure and continuously criticised all the natural flaws that she possessed. When she grew up to be 17 years old she began to put on a scarce amount of fat around her belly tummy but still was significantly healthy and had an appropriate body weight as well as BMI.  Because of the extreme wanting to achieve a thin perfect appearance she reduced her food intake drastically. At the beginning her parents did not consider the condition of the situation to be very critical and thought that she will get over this obsession with time and the fluctuating and sensitive emotions evident to happen to the girls of her age are the reason behind this scenario. However, eventually the situations began to get worse and she became extremely weak physically. Her body weight drastically declined in the following year that made her seem like she was devoid of any fat in her body. Other symptoms started to come into being which consists of insomnia, anxiety, and becoming conscious for own looks, and checking self in the mirror, avoid food intake, weighing herself every now and then etc. Even after she started to suffer from malnutrition and became under-weight she constantly complained about looking fat and that was a point of awakening for her parents and made them realise how serious critical her condition has become. She was immediately taken to the hospital after she felt unconscious on the floor as a result of not consuming any food or water for 5 days. This event took place 6 months ago.

Treatment Plan and Outcomes

After this incident intra-vinous injections and oral medicines were given to her in the form of direct nutrition in order to avoid any further worsening of her current condition. She was constantly given high dosage of medicines, and motivates for adopting healthy eating habits through a proper diet. The medications led to a negative impact on her body  an due to which  the natural food and diet has become more significant to attain recovery in her health  condition. Despite all these aspects, she constantly refused to eat food even after advised by her parents and health professionals.

Within 2 months of regular treatment the recovery was not significant and beneficial. After which I was assigned with the responsibility to take care of her and do my best to help with her recovery. I laid out plan to follow to make sure that I have a solid and determined set of guidelines, which will act as guidance for me to be able to take care of my patient and make sure she recovers fast and efficiently (Müller, 2016).

The guidelines were as follows:

  • Informing her about her sickness and enabling her understand the importance of ensuring and leading recovery of her health condition and the ways she must take care of herself.
  • To put a check on her physical health condition, on a regular basis every morning, and then organising and managing the regular visits at clinic in order to ensure about her health condition, also to avoid any risks that arise.
  • To assist her in performing her day-to-day activities such as using the washroom, eating, bathing, cleaning and others activities.
  • Undertaking the responsibility of providing her regular medications and ensuring that they are given in the correct manner and dosage as per the prescription of the doctors.  
  • To make her learn about the intake of food in her diet and educating her regarding the intake of nutritious food and the role it plays in ensuring effective health.
  • To provide a plan or a diet-chart inclusive of all the necessary food items or vitamins, minerals, which will lead to building a physical health and ensure wellbeing? It also includes feeding her 6 times each day and motivating her to eat sufficient amount of the food required by her body. This can be done effectively by taking the support or help from dieticians.
  • It has been analysed from the discussion that her disease is related to her psychological wellbeing, as I developed a healthy and friendly relation with her, and encouraged her to love herself so that it would lead her towards self-improvement. In addition, it will also encourage her to become committed towards adopting healthy eating habits and embrace her weakness or flaws as they make her unique from others.
  • Ensuring best suggestions and care towards leading her mental wellness through conducting visits to the psychologists, and promoting happiness and peace through creating  a healthy and friendly environment.
  • To develop a sense of positive feeling towards the fact that healthy body and healthy mind leads to beauty and the flaws or shortcomings of an individual are what which makes the person unique and important.  
  • Involvement into efficacious activities and events like socialising and connecting with people, watching movies or TV series, and adopting the habits of reading books etc.
  • To indulge her into the daily walks or recreational activities in morning so that she can attain her physical and mental fitness through exercising.
  • Making her parents aware and informed regarding the improvements or pace of recovery in health condition, and also guiding them about their efficient role in the whole process.
  • Keeping a regular check through use of checklist and records maintenance system for effective monitoring or measurement of her recovery.  

Therefore, I followed all these guidelines and principle and witnessed the recovery process. Moreover, a gain in the body weight of Rose was observed within 6 months and recovered significantly.

The plan led to some of the positive outcomes which are listed below:

The eating patterns of the patient also became uniform and better and now she has been not dreading towards the idea of consuming food.

  • It has been also observed that there was a control on her hunger level which encouraged her to eat healthy food.
  • Furthermore, she became highly aware about the health condition and took determination to consume nutritious food and do regular exercise to attain health and fitness.
  • Moreover, it was more surprising to the doctors to learn or witness the improvement in her health and then, soon her medication was reduced.
  • To develop a personal relationship with her which helped me to better understand her case and take care of her in way that resulted in fast and effective recovery.
  • Afterwards, she undergone a change and became positive towards herself, and life and also learned to accept her body, and all other flaws.
  • In the process of helping her, she was motivated  enough to communicate about her thoughts and feelings with me, which helped me to take care of her in order to provide  cure to her  health issues.
  • The development of the close or healthy bond also led to an encouragement leading her to become positive or encouraged to take actions and listen to the health care services for working towards the effective or better health outcomes.

People involved 

People who were included in the process of the intervention were as follows:

  • Parents
  • Relatives
  • Doctors
  • Psychologist
  • Nurse (me)
  • Friends
  • Dietician

Part 2: The Case Study Analysis 
What occurred and why? 

My patient Rose was experiencing the issue of Anorexia nervosa which refers to an eating disorder that result in the low body weight at extreme levels along-with the excessive fear of weight gain (Treasure & Alexander, 2013). Patients of this disease put a lot of work in order to control and lessen their body weight and shape, they make use of dangerous methods that are life threatening. The case study mentions about the patient who is a teenager as like many other girls who belong to similar age became fascinated towards the skinny perfect appearance (Stice, Rohde, Gau, & Shaw, 2009). She was afraid of gaining any weight and continuously criticised her flaws because of this she began to make her diet confined to an extent which put risks to the life, causing extreme amount of weakness, weight-loss, as well as malnutrition. Under this case, I was appointed as her nurse with the aim to assist her recover and assisting her with regular nutrient rich diet, proper medication, and mental support and I was capable and successful in doing so fast and effectively. 

Importance of Communication, Cultural Competence, and Nursing Metaparadigms

  • One of the issues was that she refused sharing her emotions and feelings with anyone. This further made the whole process of treatment quite complex.
  • The medications were given to the patient, in order to ensure that it would prevent risks but, because of her physic and under-nourished body, the medications were highly prone leading to the negative effects on the health.  
  • Feeding her was not easy as she is a grown up and caretakers were not also not able to force her to eat (Lock, et al., 2011).
  • To provide her psychological treatment this ensures about professional level emotional help with the aim to motivate her to become more expressive of her emotions.
  • Planning a diet-chart which will lead to the fulfilment of the nutrition requirements of her body.
  • Educating her about the importance of eating and taking a healthy diet. Implementation of Solutions
  • Fixing up a visit to the psychologist for  the purpose of emotional counselling
  • To take help  or consult a dietician for making a suitable diet chart (Ozier & Henry, 2011)
  • A talk session can be undertaken through the way of taking a lesson which represents the aspect of importance of eating.
  • Being with Rose during her visits to the psychologist for encouraging her towards speaking about her thoughts, and ideas in her mind and also giving information related to her mental being to the psychologist about all other relevant facts.
  • Informing the dietician about the preference of Rose in eating and all the other aspects or issues of her physical health condition, to help follow a  effective diet-chart and then actively feeding Rose.
  • To note down the essential points about the relevance and importance of eating and also highlights the harmful effects of reduced calories or avoiding food. This is required to stating to the patient in a manner that it motivates her to take  proper diet. 

Nurses must make use of many types of communication strategies along with interpersonal skills in order to appropriately maintain, develop, re-establish and terminate the relationship between the nurse and the client (Mathias & Pullen, 2010). The bond motivates the patients to become effectively able to share their thoughts and feelings, which is important for the nurses to become aware of. It is due to the reason that they need to establish suitable criteria for providing care and treatment for the particular patient (Ontario, 2019). For this purpose, in this  discussion,  it was necessary to develop healthy relation with Rose in order to promote her to love herself, body and also ensure healthy eating (Schmidt et al., 2015).

  • Autonomy: giving respect to the other’s right to take  their own decisions ( NGUI, KHASAKHALA, NDETEI, & ROBERTS, 2010)
  • Beneficence: benefit others
  • Veracity: communicate truthfully (Sriram, 2006)
  • Justice: Ensuring equal distribution of resources
  • Fidelity: commitment and being loyal towards patients
  • Patients’ rights- A patient’s Right to treatment, and refusing the treatment and it must oblige to the right of informed consent (WHO, 2019).
  • Privacy of the patient should be maintained.
  • Voluntary involuntary, emergency or temporary Admission to the Hospital.
  • The rights must be obeyed in relation to the admission.
  • Civil rights and Due Process

It has been found that nurses in healthcare are obliged to treat every patient in an equal manner without taking into consideration their cultural background and ensure effective care and support to them in order to make sure that efficient and fast recovery is achieved ( Monteiro & Fernandes, 2016). During the time of providing treatment to the patient the only factor that must be considered is the extent of their sickness for formulating treatment plans for them to make sure it is effective or appropriate and lead to benefits ( Nardi, Waite, & Killian, 2012). 

A nurse is considered to perform the responsibility of educating and informing the patient and their family properly as about their sickness in depth to make sure that they all are well informed and aware of the patient’s health situation and condition to provide them adequate knowledge of treatment that will be carried on. This will help them to stick to their responsibilities in the process of the treatment to ensure fast and efficient recovery. The patients family at times becomes disheartened and sad when they see the person that they love so much in a terrible health state, as a nurse I must provide them emotional support and encourage them to stay strong.
The process of Nursing and nursing Metaparadigm 

Nursing metaparadigms comprises of:

  • Environment: the factor of environment includes both internal and external, as they are equally associated with the patient. This may include the interaction of the patient with visitors or support members (Thompson, 2019).
  • Person: It refers to the patient who is provided with the health care services, and includes the components, like the culture, spirituality, friends, family, and the socio-economic status (BRANCH, DEAK, HINER, & HOLZWART , 2019).
  • Nursing: It states about the role of nurses, and their capability to his/her ability to utilise their skills and knowledge representing their attributes (Francis, 2017).  
  • Health: The aspect of health depicts about the wellness and quality of patient’s health condition, and also states  about the  admission of the client/patient to the hospital or healthcare ( Nikfarid, Hekmat, Vedad, & Rajabi, 2018).

It is essential for every nurse to oblige to all the metaparadigms in their process of nursing during the process of care and treatment they provide to the patient (Dupree, 2019).

Conclusion 

To conclude the above discussion it has been analysed that the mental health illness is one of the serious health issue at different stages of life.  The report has described well about the issue of eating disorders, impacts, relevance, and importance of communication and other aspects. Eating disorder has been illustrated well with the case study, i.e. in context to the anorexia nervosa. The findings of the case about the patient has led to the positive impacts or implications on her health, and represented improvement in her health condition, and maintenance of weight. Hence, the overall discussion and study of the eating disorders has been described in the report leading to the health promotion and wellbeing of the patient in the case.  

Conclusion

References

Monteiro, A. P., & Fernandes, A. B. (2016). Cultural competence in mental health nursing: validity and internal consistency of the Portuguese version of the multicultural mental health awareness scale—MMHAS. BMC Psychiatry, 16(149).

Nardi, D., Waite, R., & Killian, P. (2012). Journal of Psychosocial Nursing and Mental Health Services. Establishing Standards for Culturally Competent Mental Health Care, 50(7), 3-5.

NGUI, E. M., KHASAKHALA, L., NDETEI, D., & ROBERTS, L. W. (2010). Mental disorders, health inequalities and ethics: A global perspective. Int Rev Psychiatry, 22(3), 235–244.

Nikfarid, L., Hekmat, N., Vedad, A., & Rajabi, A. (2018). The main nursing metaparadigm concepts in human caring theory and Persian mysticism: a comparative study. Journal of Medical ethics and History of medicine, 11(6).

BRANCH, C., DEAK, H., HINER, C., & HOLZWART , T. (2019). Four Nursing Metaparadigms . Nursing, 124- 131.

Dupree, D. (2019). Four Basic Metaparadigm Concepts in Nursing. Retrieved February 1, 2018, from Career Trend: https://careertrend.com/13373959/four-basic-metaparadigm-concepts-in-nursing

Francis, I. (2017). Nursing Informatics and the Metaparadigms of Nursing. Online Journal of Nursing Informatics, 21(1).

Lock, J., Brandt , H., Woodside, B., Agras, S., Halmi , W. K., Johnson, C., et al. (2011). Challenges in conducting a multi?site randomized clinical trial comparing treatments for adolescent anorexia nervosa. International Journal of Eating Disorder, 45(2), 202-213.

Mathias, T., & Pullen, R. L. (2010). Fostering therapeutic nurse-patient relationships. Nursing Made Incredibly Easy!, 8(3), 4. 

Ontario, C. o. (2019). Therapeutic Nurse-Client Relationship, Revised 2006. Retrieved February 1, 2019, from Practice Standard: https://www.cno.org/globalassets/docs/prac/41033_therapeutic.pdf

Ozier, A. D., & Henry, B. W. (2011). Position of the American Dietetic Association: Nutrition Intervention in the Treatment of Eating Disorders. Journal of the American Dietetic Association, 111(8), 1236-1241.

Sriram, T. G. (2006). Ethical and Legal Issues for Mental Health Professionals: A Comprehensive Handbook of Principles and Standards. Journal of the American Academy of Psychiatry and the Law, 34(4), 566.

Stice, E., Rohde, P., Gau, J., & Shaw, H. (2009). An effectiveness trial of a dissonance-based eating disorder prevention program for high-risk adolescent girls. Journal of Consulting and Clinical Psychology, 77(5), 825-834.

Thompson, C. J. (2019). What is the Nursing Metaparadigm? Retrieved February 1, 2019, from Nursing Education Expert: https://nursingeducationexpert.com/metaparadigm/

Treasure, J., & Alexander, J. (2013). Anorexia Nervosa A Recovery Guide for Sufferers, Families and Friends. London: Routledge.

WHO. (2019). MENTAL HEALTH CARE LAW: TEN BASIC. Retrieved February 1, 2019, from WHO: https://www.who.int/mental_health/media/en/75.pdf 

Müller, H. L. (2016). Craniopharyngioma and hypothalamic injury: latest insights into consequent eating disorders and obesity. Current opinion in endocrinology, diabetes, and obesity, 23(1), 81.

Schmidt, U., Magill, N., Renwick, B., Keyes, A., Kenyon, M., Dejong, H. & Watson, C. (2015). The Maudsley Outpatient Study of Treatments for Anorexia Nervosa and Related Conditions (MOSAIC): Comparison of the Maudsley Model of Anorexia Nervosa Treatment for Adults (MANTRA) with specialist supportive clinical management (SSCM) in outpatients with broadly defined anorexia nervosa: A randomized controlled trial. Journal of consulting and clinical psychology, 83(4), 796.

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