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Introduction: NURS20157 Mental Health Nursing Assessment and Formulation
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The present research analyses a case study of a 39-year -old whose is ASDF. She has always battled mental illness, and in 2015, the schizoaffective disorder was identified as her condition. She has finally bounced back from it. Despite the fact that the case study shows that she is still dealing with a mild mental disorder that may reappear at any time. In the first portion, the paper examines the history of ASDF. The paper also discusses how to formulate a treatment utilising the 5p model. Predisposing factors, protective factors, precipitating factors, presenting issues, and perpetuating factors are the 5Ps that are used. Additionally, the study includes an analysis of the women's mental states. Finally, the study offers a few takeaways and lessons for the nurses that are mentioned in this case study.
Case study formulation
The 39-year-old case study of ASDF is the focus of the current investigation. She has struggled with mental illness her entire life, and in 2015 schizoaffective disorder was d as the cause of her symptoms. Finally, she recovered from it. Even if the case study demonstrates that she continues to struggle with a slight mental condition that could reoccur at any time. Her illness has persisted since 2011. She has been seen to be part of the “Logan and IPU”. She has been on medication. She had no illness from her birth but later on, she started growing with this mental illness. She conceived when she was 14 and gradually she started having panic attacks and mental illness.
Formulation using the 5p model
Predisposing Factors: ASDF has encountered serious incidents that have added to her mental trauma in her early life. One example that can be aligned with predisposing factor includes the fact that she has been raped several times by different males when she was under the influence of abusive substances (Majothi et al. 2020). Besides, she got pregnant at the age of 14 and has undergone several miscarriages. Also, she has been in unstable relationships with several partners and has been engaging herself in sexual acts.
Protective Factors: ASDF has been polite in interacting with her colleagues, which points out that she has chosen to keep her distress to herself. Her colleagues might be suggested to behave the same with her to ensure that her mind is diverted from her mental issues.
Precipitating Factors: ASDF has mentioned in her mental assessment that a lot has been going on in her life. The main reason behind her frustration is her hospitality which she refuses to take. Besides, she gets angry at times when her psychotic symptoms are being explored by the staff.
Presenting Issues: ASDF behaves pleasantly with her colleagues but she gets angry and is easily frustrated. However, giggling has been observed in certain scenarios and she has been fatuous. She has also been observed to be talking to herself several times ((Majothi et al. 2020). She complains about the medications being provided to her and disagrees with the fact that she has been kept in the ward.
Perpetuating Factors: The most significant perpetuating factor in the case of ASDF is her habit of excessive substance abuse. She has been in prolonged consumption of cannabis and amphetamine, which she started to take at the age of 14 ((Majothi et al. 2020).
Mental state examination
The case study that is presented shares a mental state examination of ASDF. It is found that she dresses well. She is well-spoken. She has been noticed as a person who makes proper eye contact. This shows that a person who suffers from a mental disorder can control their behaviour and behave normally if treated well (Cabarkapa et al. 2021). She has no involuntary behaviour that can be mentioned as abnormal. This means that she has no sign of “rigidity tremors or dyskinesis”. Her speech is observed as very normal and polite. She does not show any “pressure of speech, neologisms, clang associations etc”. Her mood is noticed as having “ups and downs”. Although she said that she has been going through depression but at times she feels extremely “elevated”. Her thoughts are assessed and claimed as normal but she \has been seen to be highly “disorganised and tangential”. Her power of judgement is assessed to be fair. With time her speech, though and the streaming of the disease has improved. However, her attention to detail has been seen as normal, although, she also has exhibited delusions at several times. She has also said that she is not having any suicidal symptoms but she has seen to live in a place to light small things (Espeland, Hjelmeland & Loa, 2021). These showed she is mentally unfair in taking decisions. She denied that she had hallucinations but her colleagues informed her that she hallucinated a lot. On the contrary, she has good assessment power. Thus, it can be stated that she is mentally normal and physically fit to meet others and stay with them.
The risk assessment helps to identify the threats and drawbacks that can lead to severe damage. Also, assessing the impact and likelihood of the risk helps us to understand the severity of each risk involved in this scenario that is given. Thus, it can finally help to mitigate with the strategy that can be executed and improve the situation. In this case study, there are seven risks identified. The severity of each risk is determined in lower, moderate and higher risk levels in the group of impact (Graney et al. 2020). These impacts give an insight into the likelihood of their presence. The significance of the risks results in the right strategies to implement and implicate for solving the problem. Thus finally the mitigation strategy helps in resolving the issue with suitable approaches. The table of risk assessment is provided in this study [refer to appendix 1]. Based on the case study of the 39-year-old woman, the risk is generated from her mental illness.
These risks are categorised in seven ways. They are - the risk of self-harm, the risk of getting aggressive towards others, the risk associated with misadventure, the risk associated with vulnerability and the risk of future appointments in the community for the medication of non-compliance (Thapa et al. 2020). The other risks of absenteeism are seen without any approval and the risk of abuse through substances. These risks are categorised as lower and higher based on their impact. By regularly monitoring her, the risk can be kept at bay. Additionally, it might be done on a regular basis to check on her mental health because she has a mental disorder. By acting appropriately around her and avoiding any conflicts, the risk can be kept at bay (Zaidi et al. 2021). Until she receives treatment, this risk of misadventure can be reduced by putting her in an elevated location where she won't come into contact with anything that could endanger her or others. The risk can be reduced by enrolling her in a high-level mental health programme because it has been discovered that she is acting inappropriately around her male co-clients and co-workers.
According to reports, she has also engaged in sexual activity within a unit, raising the risk level for others as well. She needs mental health treatment to get rid of the anxiety and depression that are making her act wrongly. By giving them the right mental care and counselling, the risk can be reduced. Vulnerability carries a significant danger that needs to be reduced (Fitzpatrick, Drawve, & Harris, 2020). By giving her authoritative treatment and keeping the manager assigned who looked at her case, this problem can be resolved. The possibility of missed community appointments for medication noncompliance can lengthen wait times (Lopez-Morinigo et al. 2018). Thus, it can be lessened by talking to her to lessen the psychological trauma that she experiences when she is placed in a large crowd at work.
The utilisation of mental health nursing skills in all aspects of case
The primary skill that would be required to deal with a patient with mental issues is effective communication. Considering that mental health is visually inaccessible, the only way to allow people to convey their distress is through communication (Smith & Applegate, 2018). Communication skills are the most important interpersonal skill that would be extremely necessary for dealing with ASDF. The other main requirement would be empathy which is important in responding to the patient’s needs. The professionals are required to build an environment of support and trust to facilitate positive outcomes for the patient. The other important skill required in mental health counselling is judgment skills. This implies the idea of deciding right and wrong and it does not mean that the opinion of the patient has to be suppressed. As said by O’Rourke et al. (2018), the professional has to demonstrate the ability to take firm decisions without imposing the ideas of the patient. The ideas and opinions of the patient have to be validated and yet it has to be maintained that the own judgment is not being outweighed.
The professionals being allocated to patients with mental issues are expected to display critical thinking skills. This would include the ability to decide on a solution for a crucial problem of the patient. Critical thinking provides the ability to decide plans against the problem a patient is displaying (Park & Conway, 2018). This would also include predictive skills, which means the professionals are expected to have a generalised idea of what the outcomes might be on applying a strategy against a potential problem of the patient.
Identified lessons from this study
The symptoms that a person suffering from schizoaffective disorder is likely to show have been well-defined in the case study. The case of ASDF provides a most important lesson that trauma experienced in early life might affect the future of an individual. Besides, substance abuse can have a serious impact on both physical and mental health. The case of ASDF has pointed out that it can be a serious factor that has the potential to spoil the whole life of an individual. Besides, behavioural changes are certain in the presence of substance abuse because it plays with the thinking ability of the person. It has been evident that a person is likely to perform various activities under the influence of substance abuse that they would not perform otherwise. The mental state examination of ASDF has pointed out the reasons behind each symptom she displays and the potential risks she carries have been identified.
Skills that are crucially required by a nurse or care provider, to deal with patients having serious mental issues, have been identified in this assignment. The major role of communication, empathy, understanding and other personal skills have been shed light on. The requirement of judgment skills and the ability to think critically has been well evident in this assignment. This has pointed out that the opinion of the patient has to be validated in the case of designing their treatment plan. Also, the factors that have led to the deterioration of their mental health have to be prioritised by the professional based on which the treatment approach is to be designed.
The study summarises the case study of a 39-year-old woman, whose is ASDF. She has been suffering from mental illness for a long time and has been diagnosed with a schizoaffective disorder in the year 2015. Finally, she has recovered from it. Although the case study presents that she is still undergoing minor mental illness and it can be relapsed at any time. There are many risks that are identified in this study which have an impact if not mitigated rightly. Also, there are a few risks that are identified as lower risk but still need to be maintained to validate any mishap. This study offers the utilisation of mental health nursing skills in all aspects of the case. The study analyses the background of ASDF in the initial section. Further, the study covers the formulation of the treatment using the 5p model. The 5 ps that are utilised are “Predisposing Factors, Protective Factors Precipitating Factors, Presenting Issues and Perpetuating Factors”. In addition to this, the research offers a mental state examination of the women. And lastly, the research provides few take-home lessons for the nurses that are identified in this case study.
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