Case Study of a Patient with Complex (Co)morbidities in Mental Health Nursing Practice

Introduction of the patient

Case study of a selected patient within mental health nursing practice with complex (co)morbidities and the role of social and pharmacological prescribing (2500 words) (50%)

Pretti is a 36-year-old woman who has been referred to you by the  GP .Pretti emigrated from Bangladesh to the UK  seven  years ago with her husband and his family, and gave birth to a baby girl one month ago.  You are doing a placement in a Community team, and she has been referred by the GP.

She comes to the appointment with her baby to see you. When her baby starts to cry, she becomes very tearful. She apologises and says she is very tired as the baby has not been sleeping well. She looks withdrawn and upset.  She complains of also having bad indigestion and has been buying medicine over the counter form a pharmacy to cope. She has been taking antacids to ease the symptoms, but the indigestion is not resolving, and she is worried about it.  She is also not sleeping and eating well. Several years ago, she was treated with antidepressants for postnatal depression, and anxiety when she had her first child, but has since stopped it. She also had cognitive behaviour therapy, but dropped it prematurely. 

Pretti said that the family have struggled with financial pressures. Her husband is very close to his mother, who advises him on all issues related to the baby. She is unhappy about the appointment with you as she feels this will bring shame to the family. She sees you with her husband Vijay, who acts as an interpreter. She says that her husband complains that she seems unhappy, and does not want to do anything. She is reluctant to get out of bed or to look after the baby, and complains of pain in her stomach constantly. She said that her mother in law thinks she is lazy because she is unwilling to do household chores. Pretti says that she and her husband have been arguing more lately and Pretti always seems to be crying. She said that she doesn’t normally drink, but has been having a glass of wine lately to sleep. She does not go out to meet her friends anymore, and does not look after herself or the home like she use to  The family have always lived in council accommodation and sometimes struggle to pay the rent. They have one other child: Seeta aged 10.  Pretti says that she would like to work to help the family out financially, but she does not have any skills. Pretti has type 2 diabetes and high blood pressure, diagnosed when she gave birth to her first child

Suggested format:

Introduction of the patient (250-300 words): 

• Name (anonymise)
• Demographic details (i.e. age, gender, marital status, significant others, culture, occupation),
• Background (why is this person in your care now)

Context: (250-300 words)

• Is there relevant previous history?
• What are the physical or other presentations/complaints of the patient?
• What objective and subjective evidence/data do you have for this patient?
• What medication and interventions are they taking or previously taken?

Diagnosis/Conclusion (150-200 words)

• Identify this.
• Indicate why this is complex (is it several independent pathologies/one consequence of a single pathology – either biological or psychological or both)

Marking Criteria

SOLO (Structure of Observed Learning Outcomes) taxonomy as a systematic way of describing how a learner’s performance grows in complexity when mastering tasks. Biggs and Collins (1982)

SOLO 1: Pre-Structural Level - The student does not have any kind of understanding, uses irrelevant information and/or misses the point altogether 

SOLO 2: Uni-Structural Level - The student can deal with one single aspect and make obvious connections. The student can use terminology, recite (remember things), perform simple instructions/algorithms, paraphrase, identify, name or count.

SOLO 3: Multi-Structural Level - The student can deal with several aspects but these disconnected. He/she is able to enumerate, describe, classify, combine, apply methods, structure, execute procedures, etc. 

SOLO 4: Relational Level - The student may understand relations between several aspects and how they might fit together to form a whole. The understanding forms a structure and may thus have the competence to compare, relate, analyse, apply theory, explain in terms of cause and effect.

SOLO 5: Extended Abstract Level - The student may generalize structure beyond what was given, may perceive structure from many different perspectives, and transfer ideas to new areas. He/she may have the competence to generalise, hypothesise, criticize or theorise