Mental Healths Nursing Analysis 2022

Running head: MENTAL HEALTH NURSING
MENTAL HEALTH NURSING
Name of the student:
Name of the university:
Author note

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Introduction:
Introduction:
The purpose of the essay is to develop an evidence-based nursing care plan to support the
recovery of a patient diagnosed with schizophrenia. In order to develop an effective patient-
centered care plan, this essay will consider evidence-based approaches and set goals based on the
patient needs and requirements to render high quality person-centered care (Morin and Franck
2017). It is very important that as a psychiatric intensive care unit nurse, it is very important to
facilitate communication with the subject in order to develop rapport for a better person centered
care (Martin and Higueras 2016). This paper will apply the knowledge of legal and ethical
concepts within the context of professional practice. This essay also aimed to analyses the
practice regarding drug administration and side effects of drugs, interaction and sensitivity in
order to provide patient psychoeducation and thus aims to creat awareness and insight into their
own illness (Lazzari et al. 2015).
All names mentioned are changed for maintaining confidentiality aligned with Nursing
and Midwifery Council Code of Conduct (NMC 2017) and the Data Protection Act (1998).
Discussion:
Description:
Tom is a 52 year old male, brought to the hospital by the police under section-136 to the
acute ward as he is creating tension in the traffic by trying to stop all the cars in the middle of the
traffic which may lead to the accidents. When he arrived ward, he appears restless, chaotic and
observed to have visible wounds on his feet. Tom visibly looks like he is completely neglecting
his hygienic care needs as he has got unexplained injuries, unkempt appearance and unpleasant

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body odor which can be due to hygiene issues. Tom believes that he hasn’t done nothing wTomg
and he thinks he is absolutely fine. Tom has been assessed by the Mental health team and been
decided by the team to admit him to the ward under section-2 of the mental health act 1983 for
his own safety and safety of others for his assessment and treatment purposes. Tom is refusing
his medications too as he believes that there is nothing wTomg with him. As a student nurse I
have taken the initiation to make him comfortable as he brought in police van it will be a
daunting experience so offered him drink and some food and eventually sat with him read his
initially section 136 rights and also when he got admitted to the ward as he is placed on section-
2. I have gone through the section-2 rights and ensure he understood them. Initially he was
nursed on the low-stimulus environment to keep him away from the loud noises and ward
environment.
According to the Maslow’s hierarchy of needs, I need to prioritize my goals, as the voices are
distressing to him. My main aim is to lower the distress caused due to voices and long term goal
is to terminate the voices. Other problem is self-care-deficit evidenced by poor personal hygiene
and lack of self-worth (Gage and Munafò 2015). In this essay I am going to focus on these two
problems and formulate a care plan with the patient to render effective care. My other focus will
be on psychological education which creates awareness and explain importance of taking
medication and to provide least restrictive recovery focused care.
As a psychiatric intensive care unit nurse, it is important that treat and care for Tom in a
very person centered way and take up a humanistic approach in order to heal and treat the
underpinnings of the problem from within. It is important that the behavioral modification is
done to the patient as a clinical or rather a psycho-social outcome and for that, building an
effective therapeutic communication with the patient is critical to the care process (Gage and

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Munafò, 2015). As per the NICE guidelines, the psychotic disorders such as schizophrenia,
schizophreniform disorder, delusional disorder. Schizoaffective disorder needs a specific type of
nursing care and I will follow the same to recognize, treat and manage the affective psychoses
associated with Tom’s case.
ANALYSIS
Hallucinations come in many forms and is a common feature of schizophrenia and related
disorders. Hallucinations are false perceptions of things that are actually not present and these
hallucinations are of different types – visual, auditory, olfactory, gustatory and even tactile
(Www.nhs.uk 2019). It can even be thermo-receptive, chemoreceptive and nociceptive. Hence,
in case of Tom, as a psychiatric intensive care unit nurse, I have to take care of the psychosocial
issue that has led to denial state in which Tom believes he has not done anything (despite the fact
he has created a scene in the traffic trying to stop other cars). Auditory hallucinations are very
common in schizophrenia which is the case with Tom. The subject in a psychosocial state of
denial and the state is very strong that is defending itself from within. Therefore, before changing
the behavioral pattern of the subject which is the second part of my nursing intervention – at
first, it is important that I talk to the patient politely with demonstration of compassion and
kindness and be humanistic while assessing his psychological and psychosocial state with
empathy (Www.nice.org.uk 2019). Empathy is a very important tool that can evoke a very strong
response in this case in order to know and understand the underlying hallucination, memory,
behavioral and emotional issues associated with Tom’s present mental state ( as per the NICE
guidelines ) (Richardson, Percy and Hughes 2015).
There are injuries in Tom’s body for which he do not have any logical reasons which can
be indicative of a deep seated amnesia underpinning the case as well. In my nursing assessment

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where I observed Tom’s body language and psychological state closely and found out that the
subject is very chaotic and restless which I clinically reasoned – to have occurred due to some
internal negative stimuli or rather a thought that is continuously troubling him and the
aforementioned ‘defense mechanisms’ is not allowing Tom to express the issue clearly. The
injuries are signs that something noxious might have happened to him. These can even be self-
harm behaviors that is typical of schizophrenia (Uhlmann, Pizarro and Diermeier 2015). The self
-harm behavior could have been triggered due to the auditory hallucinations. As a nurse, it is
critical I talk to him about that has been troubling him and who else are there in his family
(Oliveira, Carvalho and Esteves 2016.). If the communication with the patient works properly, I
would be able to ring over his family member to come to the PICU unit and help me with the
patient’s history and condition (Yong-Shian et al. 2016). Secondly, a very important part of my
nursing intervention with a humanistic approach will be helping Tom with self-help and personal
hygiene strategies for the self-deficit problem. The humanistic approach of nursing, will focus on
fulfilling the subject’s physiological, social, belonging, safety, esteem and self-actualization
needs in a step wise manner (Hayes et al. 2017). Reflecting on my nursing assessment and
humanistic intervention – I shall be able to understand that what level – lies the clinical or the
psycho social deficiency as any of the deficiency at any level can lead to further derangement or
extreme physical or behavioral outbursts in psychotic subjects like Tom.
I would incorporate the Stress vulnerability model, in my nursing acre plan in order to
decipher the genetic and socio psychological predispositions to the mental derangement in Tom.
Taking family history and knowing about would provide me with the information about the
genetic actor being involved in the case. Identifying the physiological intricacies is another
important or rather a vital nursing strategy to develop the care plan for Tom. There can be

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problems with working of the Hypothalamus – pituitary- axis and the neurodegeneration of the
hippocampus and memory consolidation areas can lead to behavioral suppression, apathy and
idiopathic anxiety in the subject leading to complex neuro psychological presentations and
related symptoms of amnesia, aggression, social detachment and social withdrawal,
hallucinations as well (Ulin et al. 2016). Hence comply with psychiatric nursing practice with the
stress – vulnerability model – I must closely follow the hematological and metabolic reports of
the patients in order to understand and diagnose the physiological underlying the case. My
nursing intervention will include making sure that the patient receives a proper diet, nutrition and
sleep that restores the distorted neuro biological rhythms leading to anxiety, chaotic and
restlessness in the patient (Bighelli et al. 2018). Promoting sleep, relaxation and adherence to
activities of daily life in Tom would help better his psychological and physiological state. My
nursing care plan should include fulfillment of the patient’s covert drives and needs – eating,
sleeping, social, socio cultural, emotional, belonging and psychosocial needs (Priebe et al. 2016).
Using he stress vulnerability model, the three important factors such as biological vulnerability
(the unfulfilled level at Maslow’s hierarchy of needs), the stress (that is disturbing the patient)
and the protective factors (the defense mechanisms such as ego, repression and outbursts) needs
to diagnosed and addressed very closely.
In order to manage the auditory hallucinations which is a chief symptom in Tom – I will
incorporating CBT and other procedures in the nursing management (Dellazizzo et al., 2018). At
first I will question the patient and show genuine interest in his auditory hallucinations (in order
to engage the patient). The second step would be to normalize the hallucination where I will ask
Tom whether he agrees with rationalized explanation acting behind the auditory hallucination
which can be sleep deprivation, AOD abuse, social isolation, stress and conflicting emotions and