Mental Health Assessment 2023

Assessment Task 3: Case study – Mental Health
Introduction
Clinical reasoning cycle is the enhanced pathway to discover the actual nursing diagnosis,
nursing goals and the nursing interventions for the betterment of the patient. It also improves
the knowledge and skill of health professionals. Mr. Jim Gray is admitted in the mental health
unit with the history of failed suicide attempt who is diagnosed with major depressive
disorder. The nurse caring for Jim has to plan nursing care to ensure optimal nursing care for
him to recover and to prevent further complications. Aim of the assessment is to execute the
nursing care based on the eight stages of the clinical reasoning cycle. The assessment begins
with considering the patient situation, collection of health information, Identification of three
nursing problems, Establishment of nursing goals, discuss the nursing interventions with
rationale, evaluation of the nursing strategies, and the reflection of the person outcomes. The
assessment based on the clinical reasoning cycle helps the nurse to simplify the nursing
process and expect a better outcome.
Consider the patient situation
Mr. Jim Gray is the 28-year-old unmarried male admitted in the mental health unit with the
medical history of failed suicide attempt and he has been diagnosed with major depressive
disorder. He is from a rural community (Betz, 2016). The cause for depression is the financial
crisis due to recent drought in his village. Jim's present problems are lack of food intake, lack
of social activities, unwilling to speak to anyone, even with the health professionals, and
repeated suicidal thoughts (Cost, 2019). He needs to care for the physical bruising and broken
skin in his arms and legs. The nurse needs to consider various factors while planning nursing

care for Jim (Klemanski,2017). The nurse has to consider his literacy level, cultural safety
and respect, level of understanding, and persistent suicidal thoughts in the nursing practice
based on the clinical reasoning cycle (Betz, 2016). The patient is diagnosed with major
depressive disorder which needs close monitoring and well-planned nursing interventions for
the better outcome of the patient (Davis, 2017).
Collection of information
Collection of information helps the nurse to narrow the nursing goals and nursing
intervention. It helps to analyze the severity of the mental condition of the patient. Mr. Jim
Gray is a young farmer presented with the history of one episode of a failed suicide attempt.
He lives out of the city in a rural community, who was drastically affected by the
longstanding drought in his village. His family is in financial crisis and Jim was expected to
take over the family farm and his family since his Dad is no longer able to work (Betz, 2016).
His present situation and the loaded responsibilities significantly affect his psychological
condition which results in the depression. His signs and symptoms show that he is in severe
depression and he needs more attention and nursing care planned based on the causes of the
depression (Davis, 2017).
Processing gathered information
Processing the gathered information is the third stage of the clinical reasoning cycle, which
helps the nurse to gather the needed information to create an actual nursing diagnosis, nursing
goals, and nursing interventions. Jim is diagnosed with the severe depressive disorder;

treatment plan needs to be executed according to his physical condition and mental status
(Davis, 2017). He shows lack of interest in food and avoids the food intake, but his physical
condition is normal (Cost, 2019). His vital signs are stable and he has no signs and symptoms
of weakness due to decreased food intake. (Serin, 2018).Alarming signs and symptoms show
that he suffers from the persistent suicidal thoughts and there is chance of him attempting
suicide in the hospital environment (Betz, 2016). He is prescribed with Venlafaxine for
depression during the time of admission. The nurse has to plan the nursing care focusing the
persistent suicidal thoughts. He is from rural community, where people actively involved in
one-to-one activity and other social activities but Jim refuses the communication and social
activities which needs to be considered in nursing care (Kupferberg, 2016).
Identify the problem
Jim's present condition, his past medical and family history, and clinical manifestations help
the nurse to identify the actual psychological problem. Identification of the nursing problems
aids in the establishment of the goals, and implementation of the nursing intervention. Three
nursing problems are identified based on the present condition of the patient and his clinical
manifestations.
Nursing Problems
 Persistent suicidal thoughts
Jim is presented with the one episode of failed suicidal attempt and persistent suicidal
thoughts. This is the high priority nursing problem which may lead to self-harm. The nurse
has to find the root cause of the identified nursing problem to plan effective nursing care

(Betz, 2016). The major cause for the persistent suicidal thoughts is because Jim was
overloaded with financial responsibilities. He needs to take over the farm and also his family
since his father is unable continues the farming. The nurse needs to consider the cause of the
clinical issue and plan the nursing interventions for better outcomes.
 Unwilling to take food
Jim shows lack of interest to take food and he was prescribed with multivitamin tablets which
shows that he is eating pattern is significantly disturbed due to the disease condition of the
patient (Cost,2019). A potential cause for the altered eating patterns can be low-self esteem,
feelings of unworthiness, lack of interest in food and hopelessness. The nurse has to consider
the causative factors while planning the nursing intervention to improve his eating pattern
(Lohman, 2016).
 Lack of social interaction and activity
The nursing assessment shows that the patient avoids one-to-one communication and social
activities. Lack of social interaction and activity is the critical clinical manifestation which
hurdles the health professional in finding thoughts of the patient. Social interaction and
activity help the nurse to assess the patient’s condition and the progress. Lack of social
interaction is the alarming sign that forbid the patient from expressing his thoughts. The nurse
has to plan nursing care with the support of evidence-based literature to help the patient to
overcome severe mental disorder.
Establishment of goals

Establishment of goals is the essential aspect of the nursing care plan. It motivates the nurse
plan and achieves the goal for the benefit of the patient (Otte, 2016). Nursing goals also helps
in evaluating nursing interventions and improve learning with evidence-based literature.
Three nursing problems were identified based on the priority of the patient.
 Persistent suicidal thoughts
Nursing goals for persistent suicidal thoughts are executed to prevent self-harm. He interacts
about his family and works after the nursing care for 48 hours (Valente, 2016). He maintains
eye contact and there are no statements about suicide after the nursing care for 24 hours. He
speaks about the future plan and the crops he is going plant on his farm after the care of one
week (Lam, 2016).
 Unwilling to take food
Nursing goals for the unwillingness to take food helps the patient to improve food intake and
prevents complications like the nutritional deficit. He interacts about the food choice within
72 hours of nursing (Cost, 2019). He takes three meals a day within 48hours of nursing care.
The doctor stops the multivitamin tablet within one week of nursing care
 Lack of social interaction and activity
Nursing goals for lack of social interaction and activity helps the patient to improve social
interaction (Linde, 2015). He interacts about his friends and relatives in his village within 48
hours of nursing care. He interacts with the other patients, nurses, and doctors within the

nursing care of 72 hours. He actively engages in social activities within one week of nursing
care (Vancampfort, 2017).
Nursing Interventions
Nursing interventions are implemented considering the ethical, legal, evidence-based, holistic -
person-centered approach.
 Persistent suicidal thoughts
The nurse needs to ensure a safe environment for Jim. The continuous assessment has to done
to rule out the suicidal thoughts. The nurse has to repeatedly orient the patient to the name of
the person and the place. The nurse needs to encourage the patient to speak and listen to the
patient (Lam, 2016). Encourage him to co-operate for the nursing procedure. If the patient
wanted to cry, the nurse has to allow him to cry and express his feelings.
 Unwilling to take food
The nurse needs to assess food intake continuously. Ask the patient about his food choices.
Allow the patient to choose the food and quantity as per his wish. The nurse should not tell
the patient about the consequences of not eating the food properly to make him eat. Present
the food in an appetizing manner (Cost, 2019). Encourage the patient to do some activities
which induce the appetite. Appreciate him if he has taken three meals a day (Wolfe,2016).
Lack of social interaction and activity

The nurse has to initiate a one-to-one conversation which improves the patient’s mood and
concentration (Santini, 2015). Encourage the patient to speak about his past experiences and
future goals. The nurse presents simple questions and is a good listener (Linde, 2015). The
nurse needs to maintain eye contact during interactions with the patient. Encourage him to
speak about his village and maintain cultural safety and respect in the interactions.
Evaluation and Reflection
Jim was clinically improved after the implementation of the nursing intervention. His suicidal
thoughts were reduced and he speaks about future plans. He is taking three meals a day and
has no significant health issue. He is actively interacting with other patients and health
professionals. Refection in this case study includes the patient centered and family-centered
care could have been implemented for the better outcome of the patient. I will involve family
members in the care of patients with mental illness in the future.
Conclusion
Critical analysis of the case study using the Clinical reasoning cycle helps the nurse to plan
and execute efficient nursing care for Mr. Jim. Using Clinical reasoning cycle inpatient care
promotes the health of the patient and prevents complication. Eight steps of the clinical
reasoning are implemented for the execution of the treatment for Mr. Jim Gray. This
presentation helps in improving the clinical knowledge and importance of focusing on the
need of the patient. Patient history collection, establishment of goals, planning the nursing
strategies and evaluating the outcome are executed according to clinical reasoning cycle. It
helps in improving the decision making capability of the nurse in the mental health nursing
for the wellbeing and speedy recovery of the patient.

References
Betz, M. E., Arias, S. A., Segal, D. L., Miller, I., Camargo Jr, C. A., & Boudreaux, E. D.
(2016). Screening for suicidal thoughts and behaviors in older adults in the emergency
department. Journal of the American Geriatrics Society, 64(10), e72-e77
https://onlinelibrary.wiley.com/doi/abs/10.1111/jgs.14529
Cost, J. J., Mehler, P. S., FAED, C., & Center, E. R. (2019). Level of Care Considerations for
Severe and Extreme Eating Disorders. Eating Disorders Review, 30(1)
https://eatingdisordersreview.com/wpcontent/uploads/2019/02/nl_edr_30_1print.pdf
Davis, C., & Lockhart, L. (2017). Not just feeling blue: Major depressive disorder. Nursing
made Incredibly Easy, 15(5), 26-32
https://journals.lww.com/nursingmadeincrediblyeasy/fulltext/2017/09000/
Not_just_feeling_blue__Major_depressive_disorder.7.aspx
Kupferberg, A., Bicks, L., & Hasler, G. (2016). Social functioning in major depressive
disorder. Neuroscience & Biobehavioral Reviews, 69, 313-332
https://www.sciencedirect.com/science/article/pii/S0149763415302487
Klemanski, D. H., Curtiss, J., McLaughlin, K. A., & Nolen-Hoeksema, S. (2017). Emotion
regulation and the transdiagnostic role of repetitive negative thinking in adolescents
with social anxiety and depression. Cognitive therapy and research, 41(2), 206-219
https://link.springer.com/article/10.1007/s10608-016-9817-6

Lam, R. W., McIntosh, D., Wang, J., Enns, M. W., Kolivakis, T., Michalak, E. E., ... &
Milev, R. V. (2016). Canadian Network for Mood and Anxiety Treatments
(CANMAT) 2016 clinical guidelines for the management of adults with major
depressive disorder: section 1. Disease burden and principles of care. The Canadian
Journal of Psychiatry, 61(9), 510-523
https://journals.sagepub.com/doi/full/10.1177/0706743716659416
Lohman, M. C., Raue, P. J., Greenberg, R. L., & Bruce, M. L. (2016). Reducing suicidal
ideation in home health care: results from the CAREPATH depression care
management trial. International journal of geriatric psychiatry, 31(7), 708-715
https://onlinelibrary.wiley.com/doi/abs/10.1002/gps.4381
Linde, K., Sigterman, K., Kriston, L., Rücker, G., Jamil, S., Meissner, K., & Schneider, A.
(2015). Effectiveness of psychological treatments for depressive disorders in primary
care: systematic review and meta-analysis. The Annals of Family Medicine, 13(1), 56-
68 http://www.annfammed.org/content/13/1/56.short
Otte, C., Gold, S. M., Penninx, B. W., Pariante, C. M., Etkin, A., Fava, M., ... & Schatzberg,
A. F. (2016). Major depressive disorder. Nature Reviews Disease Primers, 2, 16065
https://www.nature.com/articles/nrdp201665?draft=collection
Santini, Z. I., Koyanagi, A., Tyrovolas, S., Mason, C., & Haro, J. M. (2015). The association
between social relationships and depression: a systematic review. Journal of affective
disorders, 175, 53-65
https://www.sciencedirect.com/science/article/abs/pii/S0165032714008350

Serin, Y., & Şanlıer, N. (2018). Emotional eating, the factors that affect food intake, and
basic approaches to nursing care of patients with eating disorders. Journal of
Psychiatric Nursing/Psikiyatri Hemsireleri Dernegi, 9(2)
https://www.journalagent.com/phd/pdfs/PHD-23600-REVIEW-SERIN%5BA
%5D.pdf
Vancampfort, D., Firth, J., Schuch, F. B., Rosenbaum, S., Mugisha, J., Hallgren, M., ... &
Carvalho, A. F. (2017). Sedentary behavior and physical activity levels in people with
schizophrenia, bipolar disorder and major depressive disorder: a global systematic
review and meta‐analysis. World Psychiatry, 16(3), 308-315
https://onlinelibrary.wiley.com/doi/full/10.1002/wps.20458
Valente, S. M., & Saunders, J. (2016). Screening for Depression & Suicide: Self-Report
Instruments that Work. Journal of psychosocial nursing and mental health
services, 43(11), 22-31 https://www.healio.com/psychiatry/journals/jpn/2005-11-43-
11/%7B19daa25b-4ab5-4617-a9b5-6b9bfc4430ad%7D/screening-for-depression--
suicide-self-report-instruments-that-work
Wolfe, B. E., Dunne, J. P., & Kells, M. R. (2016). Nursing care considerations for the
hospitalized patient with an eating disorder. Nursing Clinics, 51(2), 213-235
https://www.nursing.theclinics.com/article/S0029-6465(16)00007-4/abstract