Assessment 3 – Case Study Using an Inquiry Based Learning Approach PDF

Assessment 3 – Case Study 2019
Using an Inquiry Based Learning Approach
Learning strategy
What you need to do
to critically analyse
the Case Study
Thought processes
What you need to demonstrate to your lecturer
in terms of your critical thinking about this
Case Study
Learning Outcomes Section
Demonstrate your learning in each section by presenting the
information that you have examined to improve your knowledge and
understanding of this particular Case Study
STEP 1 - CONNECT
Analyse each of the
case study documents
Think about what are some of the key issues or
information that you consider are important in this
Case Study?
Document what you consider are the key issues in this Case Study here.
Do not rewrite the case history from the case study documents.
Concerning and interconnecting issues are identified in this case and include;
the clear deterioration of Amanda’s health, noticed by bother her professional
and personal support network. But there is no evidence of psychological
community support to prevent further decline; the overdose and attempt of
suicide, are evidence of high risk to Amanda’s physical and mental health.
Letters from her mother indicate harm on family, friends and; the comment
made by the RN is worrying blah blah this doesn’t read smoothly.
According to the given case scenario of Amanda, the key issues consist one
of main factor that she want to kill herself as attempted for the same in past. It
includes her distressed mood which make her difficult to relate information.
However, she is suffering from initial insomnia due to having little sleep and
frequent waking up which is required to be maintained to stable her mental
status. Moreover, she has a poor appetite energy level is also very low as it is
difficult for her to sit still. It is necessary for mental care practitioner work on
motivation level to make her morally strong because is is very low and pre
occupied because of insufficient energy levels. She has weak thoughts due to
which trying to commit suicide and harming herself. The major issue is her
disturbed thoughts with low self esteem & self-worth that are responsible for
forcing to negative attempts in regards to self harm as well as suicide. Due to
past drug abuse and alcohol, it may impact on her mental state deeply which
develop extreme complicated problem with bipolar disorder and insomnia.
She needs moral support, counselling and effective medications in order to
gain stable psychological condition.
STEP 2 - QUESTION
What are some of the
questions about this
Case Study that you
Document your questions here
Derive questions from issues
1. What were the conditions of Amanda’s
CTO?
Provide a rationale - Why are these questions relevant to your learning
about this Case Study?
There are a number of key issues identified in this case that raise a number
of questions surrounding safety, support, workplace culture and stigma. that

want to know more
information?
Identify the additional
information you need
to know about so that
you can plan your
care
2. Is Amanda consuming illegal drugs?
3. What was done by all health professionals
involved in the case when they saw the
relapse signs? What did the case worker
do after receiving Amanda’s letter to
prevent the episode?
4. Is Amanda on 24hour watch?
5. Is the comment made by the RN a
thought shared by all workers in the
hospital? Was the comment heard by
Amanda?
could have prevented further decline, and consequently, attempt of suicide
In context of Community Treatment Order (CTO), it has been analysed that
case of Amanda was managed by local community MH team along with
having a private psychiatrist. The given information is relevant to learn about
past condition of Amanda that everything was going well but suddenly patient
started relapse but she had not voiced suicidal ideation at her last seen. It is
helpful to analyse that patient avoid her appointment which may responsible
for creating complications for her. However, it has been examined the issue
that she has missed her last week appointment which develop early
symptoms of mania (Chan and Lam, 2018).
It is relevant and important to understand about Amanda's habit of intake
illegal drugs because its is favourable to understand about the causes of her
current critical condition. According to the views of Amanda's flatmate, it has
been identified that patient has not taken any kind of drugs in illegal manner
but she intake Diazepam tablets to manage depressed condition on
prescription of a general practitioner. Meanwhile, it is necessary to learn
about her condition to become quite depressed after taking alcohol as she
become drunk everyday that helps to make accurate decision of providing
correct medication.
The information about attempt of health professionals is relevant to learn
about effective medications and treatment procedures which are suitable for
controlling situation of patient in given case. It helps to understand
appropriate method of conducting assessment of patient issues and needs
regarding bipolar disorder. Information about medications like Quetiapine
(100 mgs Mane and 300 mgs Nocte) and Lithium (600mg BD) is favourable to
analyse suitable treatment for Amanda to overcome with her condition.
It is relevant to understand about given case study regarding patient on 24
hours watch because it helps to analyse necessity of it in critical situation of
Amanda. According to the case study, the patient has been kept under
observation for 24 hours because of her violent mental state. It is favourable
to understand the important clinical attempt with similar patients as given in
present case study (Kranke and et. al., 2017). However, Amanda has attempt
to harm herself in the past and still have similar thoughts of commit suicide
due to which it is very important to monitor for 24 hours to save her from any
kind of of harm.
The RN has comment her thought about the patient in regard to efforts of
professionals for her well-being who want to destroy herself. It is favourable
to learn about critical condition of Amanda in given case scenario which helps
to understand regarding suicidal thoughts of patient.

STEP 3 -
INVESTIGATE
Review your current
knowledge about the
clients mental illness
in this Case Study
Research this disorder further. Record the
references at the end of this template
Pharmaceutical and nonpharmceutical options
Answer the questions in the
Learning Outcomes Section on the right
Describe the disorder presented in this scenario and include in-text
referencing
Bipolar disorder (BD) is a heritable, lifelong, chronic and, in Amanda’s case
(and others), debilitating mental health condition (Skjelstad, Malt, Holte 2010).
It is the episodic disturbance of mood into both depression or elation
(Goodwin 2016). As “approximately 60% of patients with BD experience
onset before the end of their teens”, it is evidential that people who develop
BD suffer in their most vulnerable and formative years (Skjelstad, Malt, Holte
2010). The prodromal symptoms can be detected up to 10 years prior to its
full expression (Miklowitz 2019) but in the absence of clear-cut biological
features of psychiatric illnesses, doctors are dependant on subjective
assessments to fit patients into poorly defined categories (Anon 2011). This
can result in a lag of up to 10 years from onset of symptoms and to a correct
diagnosis (Skjelstad, Malt, Holte 2010), an issue with extensive implications.
(Gone off topic?)
What are the clinical manifestations associated with this disorder? Include in-
text referencing
There are several types of bipolar disorders, all involving episodes of mania
and depression at varying degrees. Bipolar I disorder (BDI) is defined by
mania (Goodwin 2016). It includes includes higher rates of both alcohol and
drug abuse or dependence, higher rates of hospitalisations and higher rates

of generalised anxiety disorder. Other predictors of BDI have included
unemployment, taking medications for depression, a history of a suicide
attempt and difficulties with responsibilities (Bega, S & Schaffer, A &
Goldstein, B & Levitt, A 2012). Bipolar II disorder is a milder form of mood
elevation, alternating between milder episodes of hypomania and severe
depression (Goodwin 2016). The symptoms and signs found in both
categories include sleep disturbances, poor judgement in relation to money,
work and driving, irritability and aggressiveness, racing thoughts,
hyperactivity, mood swings, inappropriate social behaviours and depressive
symptoms such as feelings of worthlessness and lack of motivation.
(Skjelstad, Malt, Holte 2010). It is crucial to note that every case is unique,
and patients may not fall into one particular category. – haven’t related back
to Amanda in this section?
What are the common treatment options for this disorder? Include in-text
referencing
Treatments for BD aim to improve overall quality of life by reducing the
severity and frequency of manic and depressive episodes. The condition
needs to be treated and managed long term, and reassessed respectively by
a range of professionals. Medications prescribed by a psychiatrist are often
taken every day and long term. Common medicines for BD include; mood
stabilisers such as; lithium, valproic acid, etc., antidepressants called
selective serotonin reuptake inhibitors (SSRIs) such as; Citalopram,
Fluvoxamine, etc., and antipsychotics such as; Clozapine, Quetiapine, etc.
(MIMS 2019). The doses and combinations of drugs are unique to each
individual and is a process of trial and error to find the right fit (Goodwin
2016). The most effective treatments are when pharmaceutical and
psychosocial interventions promote lifestyle advice, mood monitoring,
psychoeducation, medication adherence, detection of early warning signs of
relapse and learning the triggers (Stein 2015) are used together. When a
range of treatment options have been exhausted and symptoms are declining
rapidly, hospitalisation is recommended. As BD impairs occupational, social,
and family functioning, learning to live with the disorder and its treatment is
critically important (Miller 2011).
STEP 4 -
CONSTRUCT
Using a recovery and
Consider the NMBA Registered Nurse Standards
for Practice
You do not need to write anything here
Identify the appropriate NMBA Registered Nurse Standards for Practice
that would be applicable for you as an RN in supporting the person in this
Case Study
The Standards of practice for RN are given here. Firstly, it includes that thinks

person-centred
approach, explore the
issues raised in this
case study and how
you can support this
person during your
early shift
Consider the nursing interventions and clinical
skills that are required for this Case Study
You do not need to write anything here
Consider the patient safety concerns related to
this Case Study
You do not need to write anything here
critically and analyses nursing practice. Secondly, it is necessary to engages
in therapeutic and professional relationships. Thirdly, it consist to maintain the
capability for practice. However, it is essential to comprehensively conducts
assessments (Maughan, Duff and Wright, 2016). Moreover, it includes to
develops a plan for nursing practice. Additionally, it is important for nursing
staff to provides safe, appropriate and responsive quality nursing practice.
Furthermore, it is required to evaluate outcomes to inform nursing practice.
Provide an outline of how you would support this person during your shift
In my opinion, it is necessary to provide her medication to stable the mental
condition which make her calm and conscious. However, it is essential to
determine cause of suicidal thoughts to prevent them with the help of
appropriate medicines and counselling for supporting Amanda. Moreover, I
will utilise effective communication to establish mutual understanding with her
and analyse her problems that cause the unstable psychological situation. It
is favourable for care practitioners to provide correct treatment for achieving
patient better heath (Dang and Dearholt, 2017). Moreover, I will support her
by completing her medical needs and supporting her morally in increase her
internal strength to become healthy.
Provide justification for your chosen interventions
The selected intervention of providing medication with counselling is
favourable for Amanda because combination of counselling therapies and
medicines work together then her condition with suicidal thoughts can be
recover in proper manner (Maloney, 2016). It is very important to make her
mentally stable for analysing actual cause due to which medicines should be
used to identify cause of her psychological condition. Meanwhile, effective
communication is helpful to create a trust factor of patient for carers which is
favourable to determine about her actual reason of committing suicide.
Additionally, this information plays an important role to make accurate
decision making regarding appropriate treatment and medication for maintain
her stable psychological health condition.
Identify the safety concerns for the patient in this Case Study
Risk to self and others
Considering safety of mental health patient in given case study, it has been
analysed that number of related issues are required to be focussed including
suicide & self harm, violence & aggressive nature, restraint use & seclusion
and absconding (Harper and Maloney, 2016). Meanwhile, these factors
should be concerned in order to save Amanda while dealing with her to
improve the psychological condition. However, it is necessary to appoint 1:1

nurse to focus on patient and make sure that she will not attempt to harm
herself. It is essential to remove overall items from her ward from which she
can harm herself or others. Moreover, technology should be used to monitor
her 24 hours without visiting her ward that is favourable for nursing staff and
avoid her discomfort due to presence of staff nearby her.
STEPS 5 and 6
Reflect on the parting
comments made by
the night duty RN
STEP 5 - EXPRESS
Document your thoughts about these comments
made by the night duty RN below
The comment made by the RN is saddening. It
denotes the lack of education and how far society
still has to come to really understand the effects
that psychiatric illnesses have on individuals. It
raises questions and concerns around the care
MH patients may be receiving when admitted to
hospital. The detrimental impact that stigmatised
language can have on the culture of the
workplace, influence on other employees, the
patient’s MH and recovery, and the effects on
their families.
STEP 6 - REFLECT
Provide a justification for your thoughts using the professional literature to
support your argument here. Include in-text referencing
The adverse consequences of stigma towards those with mental illness have
been well documented (Ellison, N & Mason, O & Scior, K 2013). It is a social
injustice that goes hand in hand with prejudice and discrimination, a result of
misconceptions about mental illness (Hawke, L 2013). Family members of
individuals with mental illness have also reported that the social stigma of
mental illness extends to them. Feelings of being ignored, blamed, isolated
and criticized, not only by family, friends and colleagues but even by MH
providers (Shamsaei 2013). Unfortunately, stigmatising attitudes are not
uncommon among MH professionals (Horsfall 2010). Stigmatisation leads to
numerous negative consequences for people with mental illness including low
self-esteem, hurt and anger, lack of progression and hope for the future,
social withdrawal, relapse, delayed healthcare seeking, unemployment and
reduced income (Bonnington 2014). Need to talk about the impact on work
place and other employees.
Considering thoughts in society, I have analysed that negative thoughts of
people regarding a person is responsible for developing metal illness and
relevant complications. As per views of Chen and et. al. (2017), it consist the
factor inequality, neglect, isolation and blaming for specific aspects may
impact deeply on mind of an individual due to which they may gain unstable
psychological condition. Thorough my personal observation and analysis, it is
observed that negative behaviour of society create mental complexities
whereas their positive attempt & support towards a mental patient favourable
in improve their condition. Moreover, I have evaluate that there are several
factors like poor economic condition, delayed care services, limited income or
death of loving one is responsible for generating severe mental illness that
leads to complications due to negative behaviour of society.

References – Please include a list of all your references used in this case study
Anonymous 2011, ‘Simple tools to diagnose mental illness should not be offered without sound support evidence’, First do not harm, vol. 469, p. 132.
Bega, S & Schaffer, A & Goldstein, B & Levitt, A 2012, ‘Differentiating between Bipolar Disorder Types I and II: Results from the National Epidemiologic
Survey on Alcohol and Related Conditions (NESARC)’, Journal of Affective Disorders, vol. 138, pp. 46-53.
Goodwin, G 2016, ‘Bipolar disorder’, Evidence-based guidelines for treating bipolar, vol. 44, issue 11, pp. 661-663.
Miklowitz D 2019, ‘Early intervention for youth at high risk for bipolar disorder: A multisite randomized trial of family‐focused treatment’, Early Intervention in
Psychiatry, vol. 13, pp. 208-216.
MIMS Australia 2019, Citalopram, viewed 10 October 2019, https://www.mimsonline.com.au/Search/Search.aspx
- Clozapine, viewed 10 October 2019, https://www.mimsonline.com.au/Search/Search.aspx
- Fluvoxamine, viewed 10 October 2019, https://www.mimsonline.com.au/Search/Search.aspx
- Lithium, viewed 10 October 2019, https://www.mimsonline.com.au/Search/Search.aspx
- Quetiapine, viewed 10 October 2019, https://www.mimsonline.com.au/Search/Search.aspx
- Valproic acid, viewed 10 October 2019, https://www.mimsonline.com.au/Search/Search.aspx
Skjelstad, D & Malt, U & Holte, A 2010, ‘Symptoms and signs of the initial prodrome of bipolar disorder- a systematic review’, Journal of Affective Disorders,
vol. 122, pp. 1-13.
Stein, B 2015, ‘Psychosocial Treatment of Bipolar Disorder: Clinician Knowledge, Common Approaches, and Barriers to Effective Treatment’, Psychiatric
Services, vol. 66, pp. 1361-1364.
Tse, S 2014, ‘Exploring the recovery concept in bipolar disorder: a decision tree analysis of psychosocial correlates of recovery stages’, Bipolar disorder, vol.
16, ppg. 366-377.
Miller, B 2011, ‘Hospital admission for schizophrenia and bipolar disorder’, British medical journal, vol. 343, pp. 571-594.
Bonnington, O 2014, ‘Exploring stigmatisation among people diagnosed with either bipolar disorder or borderline personality disorder: A critical
realist analysis’, Social Science & Medicine, vol.123, pp. 7-17.
Hawke, L & Parikh, S & Michalak, E 2013 ‘Stigma and bipolar disorder: A review of the literature’, Journal of Affective Disorders, vol. 150, pp.181-191.
Ellison, N & Mason, O & Scior, K 2013, ‘Bipolar disorder and stigma: A systematic review of the literature’, Journal of Affective Disorders, vol. 1 , pp.806-819
Shamsaei, F & Kermanshashi, S & Vanaki, Z & Holforth, M 2013, ‘Family Care giving in Bipolar disorder: Experiences of Stigma’, Iranian Journal of Psychiatry,
vol. 8, pp. 188-194.
Horsfall 2010, ‘Stigma in Mental Health: Clients and Professionals’, Mental Health Nursing, vol. 31, ppg. 450-455.

Chen, M.D., Jung-Hsuan, I., Pellegrini, C.A., Tang, T.C. and Kuo, C.C., 2017. A qualitative exploration of facilitators and barriers to physical activity
participation in people with severe mental illness in Taiwan. Mental Health and Physical Activity, 13, pp.100-107.
Chan, K.K.S. and Lam, C.B., 2018. Self-stigma among parents of children with autism spectrum disorder. Research in Autism Spectrum Disorders, 48, pp.44-
52.
Kranke, D., Weiss, E.L., Gin, J., Der-Martirosian, C., Constantine Brown, J.L., Saia, R. and Dobalian, A., 2017. A “culture of compassionate bad asses”: A
qualitative study of combat veterans engaging in peer-led disaster relief and utilizing cognitive restructuring to mitigate mental health stigma. Best Practices in
Mental Health, 13(1), pp.20-33.
Maloney, P., 2016. Nursing professional development: Standards of professional practice. Journal for nurses in professional development, 32(6), pp.327-330.
Harper, M.G. and Maloney, P., 2016. Nursing professional development: Revision of the scope and standards of practice. Journal for nurses in professional
development, 32(3), pp.171-173.
Maughan, E.D., Duff, C. and Wright, J., 2016. Using the framework for 21st-century school nursing practice in daily practice. NASN School Nurse, 31(5),
pp.278-281.
Dang, D. and Dearholt, S.L., 2017. Johns Hopkins nursing evidence-based practice: Model and guidelines. Sigma Theta Tau.