Case-based analysis with questions relating to clinical practice

This document is a case-based analysis with questions relating to clinical practice. It covers topics such as the meaning of paranoid, immediate priorities for nursing care, nursing interventions, legal considerations, PTSD, nursing strategies for addressing suicide risk, and the harm minimization approach.

Case-based analysis with
questions relating to clinical
practice

Contents
ASSESSMENT 1.............................................................................................................................1
1A Meaning of Paranoid..............................................................................................................1
1B. Two immediate priorities for Michael’s Nursing care..........................................................1
1C. Nursing interventions............................................................................................................1
1D. Legal considerations.............................................................................................................2
QUESTION 2..................................................................................................................................2
Question 2a What it means for person to have PTSD.................................................................2
Question 2b Justify two nursing strategies to address Aliah acute suicide risk..........................3
Question 2 b Two multi disciplinary interventions and why each one is important...................3
QUESTION 3..................................................................................................................................4
3A. harm minimisation approach................................................................................................4
3B How harm minimisation link with person centred care.........................................................4
REFERENCES................................................................................................................................5

ASSESSMENT 1
1A Meaning of Paranoid
Paranoid is a condition where a person is being suffering from mental disorder like paranoia.
In this patient is stuck with a feeling of extreme distrust, delusion and suspicion. In this condition
person have a false feeling that people are going to harm them. These thoughts and actions are
usually described a paranoid (Krzystanek, Krysta & Skałacka, (2017). It is one of major sign and
symptom of paranoid schizophrenia. Person usually have a sense of distrust on the other people
and they always feel like every individual is conspiring against them. Being paranoid means that
individual generally have suspicious thought and also patients feel that someone is conspiring
against them. In this way, it is almost always used negatively as a criticism of someone. Person
have a negative feeling, anxiety and they tend to always feel low.
1B. Two immediate priorities for Michael’s Nursing care
There are various non pharmacological interventions which can be used in order to enhance
health outcome of Michael. It includes the following:
Psychotherapy: From the case study it can be analysed that Michael is suffering from
paranoia and he feels like nurses will poison out his medication. Patient can be motivated to
engaged in psychotherapy. This is one of the best non pharmacological intervention which can
be used to enhance condition of patient. In this patient can be allowed to communicate with
psychiatrist. This therapy can support him in gaining control over his feelings, thoughts and
actions. Psychotherapy can be as effective as pharmacological treatment. This therapy can assist
Michael in having better understanding of under-lying issues which is causing social grief.
Cognitive behavioural therapy: As provided in case study Michael do not want to go
hospital as he feels like nurses will conspire against him. CBT can assist patient in changing their
thinking and behaviour which are harmful (Kalayasiri et.al., (2019). This therapy can replace this
type of behaviour with better thoughts and feelings. This can reduce down their negative
thoughts and feelings.
1C. Nursing interventions
In order to enhance health outcome of patient suffering from schizophrenia, nurses have the
most important role. Michael has negative feelings towards nurses and also he does not want to
be in hospital. For this proper interventions needs to be taken by carers. It includes the following:
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Ensuring safety: One of the most important intervention is that nurses needs to be engaged
in making sure that patients are in safe and secure environment. This is necessary because to
make sure no harm is caused to service user. Michael should be kept in observation as he is
suffering from paranoia and can cause self-harm and also can harm others. They must make sure
that no sharpened objects are kept near patient. A better and peaceful environment needs to be
provided to patient so that their well-being and quality of life can be enhanced (Jiang et.al.,
(2020).
Patient-centred care: Nurses needs to be engaged in providing Michael with holistic care.
For this they can make use of effective communication so that negative thoughts and feelings of
patients are reduced down. Holistic approach must also be used and nurses must make sure that
they do not judge patient because of their behaviour and should not possess negative feeling
towards them.
1D. Legal considerations
From the case study it has been summarised that Michael has been admitted to hospital
involuntary as he has a feeling that nurses will poisoned his medications. There are legal
considerations which needs to be followed (Dorofeikova et.al., (2018). Mental health act 2009
has provided that involuntary admission can only be given to patients while considering
statement of their rights. In this patients, carers and tribunals must be informed for the grounds of
detention. They can also be detained on basis of mental state examination. In MSE nurses can
understand about psychological conditions and functioning of patients. The law also provided
that for involuntary admission in hospital to treat patient with mental illness, they must be
suffering from it and also their must include a proof related to same. All these legal rules and
regulations needs to be followed by nurses so that the health outcome of patient can be
improved. Patient can be only being detained to hospital if two psychiatrist agrees upon that
service user is being suffering from mental heal disorder, if they do not agree then patient cannot
be detained.
QUESTION 2
Question 2a What it means for person to have PTSD
When a person suffers from PTSD it means that it is a mental health condition that is
triggered by a terrific event. So, a person has generally witness it or experienced. So, this highly
impact on person mental health as he is not able to overcome it. basically, most people who
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suffer from it find it difficult to adjust it. The symptoms of PTSD is nightmare, flash back,
anxiety, etc. this may continue for years. So, the symptoms cause problem in social life and
highly interfere on normal routine. PTSD are of 4 types that is intrusive, memory, avoidance and
negative change. Here, symptom can vary from person to person. similarly, in case study Aliah is
suffering from PTSD which she experienced in Syria. In this she is experiencing flash back of
her parent death several years ago (Cha, & et.al., 2018).
Question 2b Justify two nursing strategies to address Aliah acute suicide risk
It is necessary for nurse to reduce risk of suicide of Aliah. This can be done with help of
developing effective strategies. There are several strategies available in it but this depends on
patient that which is suitable Thus, here two strategies that can be used are as below
Nursing plan – This is a basic strategy that can be used in addressing suicide risk of Aliah. in this
nurse can develop a plan and include various levels of care. Alongside, nurse can interact with
patient relative , friends of Aliah and identify needs. This will make it easy to provide effective
treatment and then continuously evaluating it.
Using risk assessment technique – this is also a strategy that can be used by nurse to address
suicide risk. In this risk assessment can be done to identify patient act of self harm or suicide.
Moreover, in this MSE can be done to evaluate mental health condition of patient. Besides that,
all risk factors can be identified and on basis of that treatment strategy is developed. in addition,
outcomes can be assessed that it is useful in minimising risk of suicide or not (Asarnow & et.al.,
2017).
Question 2 b Two multi disciplinary interventions and why each one is important
Apart from treatment given to Aliah there is need to take multi disciplinary approach as
well. It is because it will be useful in treating her. Thus, two approach that can be taken are as
below
Therapeutic risk management- it is an approach in which risk of patient is managed, chronic risk
stratification is done and safety planning is applied. The model ensures that all bio, social,
psycho aspect of care is given to patient. Besides that the approach ensure that care is delivered
in effective way. Also, care is provided on with help of clinical decision making. It is important
in person centred care because it will focus on overall patient as it includes all aspects.
Nursing care plan- In this approach there are many teams which work together. A plan is
developed to provide safe environment to patient. Also, support system is created in it. There are
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3 types of plan developed in it like risk of suicide, ineffective coping and hopelessness. With that
treatment is given to patient. The intervention is important in person centred care as it focus on
suicidal behaviour and having close supervision in that (Mamun, Bodrud-Doza & Griffiths,
2020).
QUESTION 3
3A. harm minimisation approach
Harm maximisation approach is a policy that is used maintain behaviour related to
recreational drugs, alcohol use and sexual activity. In this needle exchange program has been
implemented which reduces down use of sharing syringes containing drugs and also using them
more than once.
3B How harm minimisation link with person centred care
As discussed above that it is policy to maintain behaviour so here a person is treated with
respect and dignity. Moreover, decision are take with regard to consulting patient about his
health. Furthermore, in case of sexual activity patient decision is respected. It is taken care that
what info is to be taken, etc. The gap is reduced and it is easy to provide effective treatment to
patient.
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REFERENCES
Books and Journals
Asarnow, J. R., Hughes, J. L., Babeva, K. N., & Sugar, C. A. (2017). Cognitive-behavioral
family treatment for suicide attempt prevention: a randomized controlled trial. Journal of
the American Academy of Child & Adolescent Psychiatry, 56(6), 506-514.
Cha, C. B., Franz, P. J., M. Guzmán, E., Glenn, C. R., Kleiman, E. M., & Nock, M. K. (2018).
Annual Research Review: Suicide among youth–epidemiology,(potential) etiology, and
treatment. Journal of Child Psychology and psychiatry, 59(4), 460-482.
Dorofeikova, M., Neznanov, N., & Petrova, N. (2018). Cognitive deficit in patients with
paranoid schizophrenia: its clinical and laboratory correlates. Psychiatry Research, 262,
542-548.
Jiang, M., Shao, X., Zhang, Y., Yan, Y., Hu, Y., Chen, H., ... & Wang, W. (2020). Family
relationships and personality disorder functioning styles in paranoid
schizophrenia. Personality and Individual Differences.109844.
Kalayasiri, R., Kraijak, K., Mutirangura, A., & Maes, M. (2019). Paranoid schizophrenia and
methamphetamine-induced paranoia are both characterized by a similar LINE-1 partial
methylation profile, which is more pronounced in paranoid schizophrenia. Schizophrenia
research, 208, 221-227.
Krzystanek, M., Krysta, K., & Skałacka, K. (2017). Treatment compliance in the long-term
paranoid schizophrenia telemedicine study. Journal of technology in behavioral
science, 2(2), 84-87.
Mamun, M. A., Bodrud-Doza, M., & Griffiths, M. D. (2020). Hospital suicide due to non-
treatment by healthcare staff fearing COVID-19 infection in Bangladesh?. Asian journal
of psychiatry, 54, 102295.
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