Mental Health Nursing: Analysis, Diagnosis, Factors, Recovery and Plan of Care

This article provides an analysis of a case study on mental health nursing, including diagnosis, contributing factors, recovery-oriented practice, and a plan of care. It also discusses ethical issues related to autonomy and informed consent.

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

1MENTAL HEALTH NURSING
Analysis of the case study:
Question 1: The mental health status of the client is as follows-
The mental state examination or MSE has indicated that, excessive work pressure, less
time for family due to long hour work shift, past circumstances such as mistake in the workplace,
inquiry and poor health status has affected the mental health status such as mood and affect of
the client to an extent (Fernando & Henskens, 2014). In the session of MSE tearful eyes and flat
mood has been detected. Sad and restrictive affect was also identified in the session. He has been
feeling anxious due to long hour of working shift and excessive pressure from the accident and
emergency department of the hospital. He was tensed due to the severe health status of his wife,
but he was unable to provide adequate time to her, thus was regretting. Due to such situation his
speech has become slow and purposeful as well and he has lacked eye contact. He has been
suffering from palpation, chest pain and breathlessness that has created a fear of heart attack
within him. Such health concern has led to sleeplessness or insomnia. It has been identified in the
MSE that the increase in depression and anxiety has affected the thought process of Chung as
well (Cameron et al., 2013). However, there is no direct process to measure the thought process,
but according to his description his changed thought process has forced him to think himself as a
failure in the workplace. Even after knowing about the high lethality of medication he has
thought about overdose of medicines. He has been suffering from helpless and hopeless situation
that has led to the suicidal thought at the end.
The criteria of diagnosis mental disorder provided by the Diagnostic and Statistical
Manual for mental disorder or DSM 5 has indicated that the patient has been suffering from
depressed mood, thus he has lacked eye contact and found to be least interested in
communicating with others (Regier et al., 2013). He has been experiencing guilt due to his

2MENTAL HEALTH NURSING
mistake in the workplace that has created a feeling of failure. In addition the increased work
pressure has forced him to spend less time with family. The level of depression has affected his
physical health condition as well. The symptoms such as chest pain, breathlessness, loss of
appetite, palpitation, weight loss and stress has led to the risk of heart attack. The DSM 5
assessment has identified that due to the tension of his own health and the severe health
condition of his wife Chung has been significant mental distress. The DSM 5 criteria has
indicated that such mental condition cannot be explained and psychotic disorder and such
symptoms are not attributed to medical conditions (American Psychiatric Association, 2013). In
addition t has been found that the patient has been suffering from severe anxiety, thus has been
facing sleeplessness. Thus, the DSM 5 has suggested that Chung has been suffering from severe
depression and anxiety disorder and the level of such mental health issue is so high that it has led
to the suicidal thought as well (Regier et al., 2013).
Question 2: The factors contributing to the development of the client’s health is discussed
below-
Stress vulnerability model is a useful tool that helps to identify the potential factors that
contributes to the development of severe mental health issue. The model helps to understand the
contribution of stress to the development of signs and symptoms of mental distress. The model
mainly describe the potential factors through vulnerability factor, protective factor and
environmental factor. Utilizing the stress vulnerability model it has been recognized that stress
and having new baby have been contributed as the vulnerability factor to the development of
mental illness of the client (McEwen & Morrison, 2013).
Stress is one of the main vulnerability factors that has contributed to the poor mental
health of Chung. It is the potential factor that could influence the symptoms of mental distress

3MENTAL HEALTH NURSING
(Thoits, 2013). Stress is defined as the thought that occur as the response of critical situations
and individual should have the ability to cope up with the stress in order to avoid the occurrence
of mental distress due to stress (Olff et al., 2013). In this case the stress has arisen due to the
excessive pressure in the workplace. After the birth of Chung’s daughter. His wife has been
suffering from severe health condition and in this situation he has failed to support her due to
long hour shift in workplace. Such situation has created guilt within the client and has
contributed to the development of stress. On the other hand, the pressure of investigation by the
human resource department of the hospital regarding the drug error has also responsible for the
increasing stress within the client. Furthermore, poor health condition of Chung such as chest
pain, breathlessness, palpitation and weight loss has also leads to the development of psychotic
symptoms within the patient. Such increased stressful situation has identified as the potential
factor that has led to the suicidal thought as well (Thoits, 2013).
Having a new baby has been contributed as another vulnerability factor to the
development of the poor mental health of Chung. It is an important factor that leads to the
changes in the mental condition. Such change in life creates changes in the lifestyle of individual
as its effect brings changes in the relationship, hobbies, management of time and self-sense. Such
changes could lead to the anxious mood (Caplan, 2013). In this case it has been found that
Harriet, the wife of Chung has been suffering from severe infection and pain due to the operation
during the birth of the child. In this situation she need the support and care of Chung, however,
due to excessive work pressure and long hour shift he has failed to spend adequate time with his
wife and new born daughter. Such condition has led to restrictive and sad affect. Due to such
situation he has been suffering from anxiety and flat mood. It has affected his speech and has

4MENTAL HEALTH NURSING
reduced his interest to communicate with others. Thus, it can be said that, the factor has
effectively contributed to the development of psychotic distress within the client.
Question 3: Recovery oriented practice and using respect, empowerment and hope related
recovery would help the patient in the following manner-
One of the most important recommendations to resolve the mental health issue is
recovery oriented practice. It is the one dimensional approach of mental health research that
represents specific model of care in order to facilitate the treatment of patient with mental illness.
While the other treatment procedures focus to symptom relief, the recovery oriented practice
provides priority to supporting patients with mental health issue in order to achieve meaningful
and satisfactory life through the improvement of supportive relations, hope and social inclusion.
Such process helps the patients in order to achieve their personal goals in an effective manner
(Slade et al., 2014). Utilizing recovery oriented practice could help Chung to improve his
involvement in the relationship and manage balance in the workplace thus, could increase
support from the family. In this way it could help him to reduce his stress and induce him in a
meaningful life by promoting hope.
One of the important element that could utilize in the treatment of mental distress is
hope. People that suffer from psychotic distress become hopeless, thus, lack interest in the
treatment. Hence, introducing hope could help them involve in the treatment process in an
effective manner and live a healthy life by maintaining mental well-being (Tudor, 2013). In this
case due to stressful life and depression the client has become hopeless and has been suffering
from suicidal thoughts. Inducing hope in the treatment process would help him to participate in
the treatment process in an effective manner and help him to recover faster. It is important to
provide hope related to the better involvement with the family, improvement in the workplace,

5MENTAL HEALTH NURSING
accessing social support and successful future in order to reduce the stress of the client and
encourage him to reduce the suicidal thoughts. Such improvement in mental health would help
him to improve the physical condition as well (Fawcett & Karban, 2013).
Another important criteria of treating patient with mental illness that helps to achieve
positive clinical outcomes is introducing respect in the treatment (Tudor, 2013). In this case,
showing respect by the colleagues would help Chung to recover from the thought of considering
himself as worthless in the workplace thus, could help him to encourage to perform effectively in
the workplace. Respect from the family for the his effort to take care of his family after involving
in such a busy profession could help him to get rid of the guilt, thus could reduce his stress and
depression. Utilizing respect in the treatment process could help him to provide importance to his
life and utilize the treatment to recover faster (Wahlbeck, 2015).
One of the crucial element of promoting mental health is empowerment. It is important to
implement empowerment in the individual level and in society simultaneously. There are four
dimensions of introducing empowerment in the treatment of mental illness, they are, dignity,
self-reliance, participation in self decision and contribution in wider community (Fawcett &
Karban, 2013). Utilizing empowerment in order to help Chung is useful as it could help him to
recover from the thought of uselessness and powerlessness, thus, could increase self-
determination. Empowerment could help him to develop sense of living meaningful life and
survive in the stressful period of life (Wahlbeck, 2015).
Plan of care:
Question 1a: The recognized risk area is as follows-

6MENTAL HEALTH NURSING
The patient has been suffering from anxiety and depression due to the stress of long hour
working in the hospital. He is tensed as his wife has been suffering from severe health issues and
in this situation he is unable to spend time with his family. Thus, he has suffering from
breathlessness, palpitations, chest pain and weight loss. It can be said that there is a risk of
cardiac issues such as stroke or heart attack as the symptoms occur in the patient have similarity
to the symptoms of such cardiovascular risks (Galatzer-Levy & Bonanno, 2014).
Question 1b: The nursing intervention is as follows-
In case of Chung, it is important to control his stress. In this regards, the patient need to
perform physical activities such as exercise and yoga to relax his mind and reduce stress. He has
lost interest in eating thus has been suffering from loss of appetite and weight loss. Such
condition may lead to low blood pressure. Thus, it is important to intake proper diet to manage
blood pressure. In addition he could undergo proper diagnosis such as ECG, chest x-ray, MRI
and exercise stress test to identify his health condition and could take proper medication
according to the recommendation of the doctor (Muntner et al., 2014).
Question 2a: The mental health concern is as follows-
The client has been feeling low mood and anxiety. The inquiry due to the mistake in the
workplace has created guilt within Chung. In addition due to long working hours he has failed to
provide adequate time to his family. Such condition has affected his mental health to an extent
and he has been suffering from insomnia. His mental condition has led to the thoughts of suicide.
From such observation it can be said that the client is suffering from severe depression, which is
a great risk for his mental health and well-being (Gilbert, 2016).
Question 2b: Intervention for depression is as follows-

7MENTAL HEALTH NURSING
In this case, effective psychotherapy could be helpful. It would help the client to adjust
with the difficulties of current situation. Psychotherapy could help to reduce negative beliefs and
thoughts regarding his failure and suicide. Psychotherapy would help to identify the major
factors contributing in the depression and recognize effective ways to address them. A face-to-
face session would help Chung to cope up with helplessness, regain control on his life and set
proper goal. In this way an effective psychotherapy would help the client to practice healthy
behavior and maintain mental health and well-being (Chukhraev et al., 2017).
Question 3: Ethical issues include-
Ethical issues related to autonomy and informed consent may occur. The reaction of the
client during interaction has indicated lack of interest in communication, thus shown less eye
contact and restrictive affect. In order to understand his concern questions have been repeated.
The client may become irritate and ethical issue regarding his autonomy and interest in
communication occur (Wolf, Annas & Elias, 2013). As the client is adult he has the right to take
decision regarding his treatment. In order to provide psychotherapy to the client it is important to
provide adequate information regarding the process and take his consent, otherwise ethical issue
regarding informed consent may occur (Faden, Beauchamp & Kass, 2014).

8MENTAL HEALTH NURSING
References:
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders
(DSM-5®). American Psychiatric Pub.
Regier, D. A., Narrow, W. E., Clarke, D. E., Kraemer, H. C., Kuramoto, S. J., Kuhl, E. A., &
Kupfer, D. J. (2013). DSM-5 field trials in the United States and Canada, Part II: test-
retest reliability of selected categorical diagnoses. American journal of
psychiatry, 170(1), 59-70.
Cameron, J., Worrall-Carter, L., Page, K., Stewart, S., & Ski, C. F. (2013). Screening for mild
cognitive impairment in patients with heart failure: Montreal Cognitive Assessment
versus Mini Mental State Exam. European Journal of Cardiovascular Nursing, 12(3),
252-260.
McEwen, B. S., & Morrison, J. H. (2013). The brain on stress: vulnerability and plasticity of the
prefrontal cortex over the life course. Neuron, 79(1), 16-29.
Thoits, P. A. (2013). Self, identity, stress, and mental health. In Handbook of the sociology of
mental health (pp. 357-377). Springer, Dordrecht.
Olff, M., Frijling, J. L., Kubzansky, L. D., Bradley, B., Ellenbogen, M. A., Cardoso, C., ... & van
Zuiden, M. (2013). The role of oxytocin in social bonding, stress regulation and mental
health: an update on the moderating effects of context and interindividual
differences. Psychoneuroendocrinology, 38(9), 1883-1894.
Caplan, G. (2013). An approach to community mental health. Routledge.

9MENTAL HEALTH NURSING
Slade, M., Amering, M., Farkas, M., Hamilton, B., O'Hagan, M., Panther, G., ... & Whitley, R.
(2014). Uses and abuses of recovery: implementing recovery‐oriented practices in mental
health systems. World Psychiatry, 13(1), 12-20.
Tudor, K. (2013). Mental health promotion: Paradigms and practice. Routledge.
Wahlbeck, K. (2015). Public mental health: the time is ripe for translation of evidence into
practice. World Psychiatry, 14(1), 36-42.
Fawcett, B., & Karban, K. (2013). Contemporary mental health: Theory, policy and practice.
Routledge.
Galatzer-Levy, I. R., & Bonanno, G. A. (2014). Optimism and death: Predicting the course and
consequences of depression trajectories in response to heart attack. Psychological
Science, 25(12), 2177-2188.
Muntner, P., Davis, B. R., Cushman, W. C., Bangalore, S., Calhoun, D. A., Pressel, S. L., ... &
Rahman, M. (2014). Treatment-resistant hypertension and the incidence of cardiovascular
disease and end-stage renal disease: results from the Antihypertensive and Lipid-
Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). Hypertension, 64(5),
1012-1021.
Chukhraev, N., Vladimirov, A., Zukow, W., Chukhraiyeva, O., & Levkovskaya, V. (2017).
Combined physiotherapy of anxiety and depression disorders in dorsopathy
patients. Journal of Physical Education and Sport, 17(1), 414.
Gilbert, P. (2016). Depression: The evolution of powerlessness. Routledge.

10MENTAL HEALTH NURSING
Wolf, S. M., Annas, G. J., & Elias, S. (2013). Patient autonomy and incidental findings in
clinical genomics. Science, 340(6136), 1049-1050.
Faden, R. R., Beauchamp, T. L., & Kass, N. E. (2014). Informed consent, comparative
effectiveness, and learning health care. N Engl J Med, 370(8), 766-768.
Fernando, D. I., & Henskens, F. A. (2014, November). A case-based reasoning approach to
mental state examination using a similarity measure based on orthogonal vector
projection. In Artificial Intelligence (MICAI), 2014 13th Mexican International
Conference on (pp. 237-244). IEEE.