Mental Health Nursing - Sample Assignment

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Mental health nursing
Name of the student
University name
Author’s note

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Table of Contents
Issue on safety and legal responsibility......................................................................................2
Dilemma of providing information to carers.............................................................................3
Meaning of health related issues to the individual patients.......................................................5
5 R’s of reflection.......................................................................................................................6
References..................................................................................................................................8

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Issue on safety and legal responsibility
The current assignment focuses upon the nursing care practices adopted within a
mental healthcare setting. The nurses catering to the physical and mental health of the
patients possess a number of safety and legal responsibilities. As mentioned by Hunter,
Weber, Shattell & Harris (2015), abiding by the safety rules and guidelines helps in
improving the quality and standards of care. Thus following of the safety guidelines also
helps in preventing the occurrences of untoward incidents within an acute healthcare setup.
In the present study, an actual clinical setup could be taken into consideration where
the patient Mr. H is a 65 years old man with autism and lives with his foster parent. The
patient has reduced cognitive abilities and decision making power owing to his autism
spectrum disability, which makes him more dependent upon his foster parents and the care
service providers. Initially, Mr. H had been living in his own house along with his foster
parents. However, presently Mr. H had been reached the point of disagreements with his
parent where he wants to live on his own and travel alone. Mr. and Mrs. Kelvin who are the
foster parents of Mr. H had been worried about the well being of their foster son. Presently,
Mr. H had grown very irritable and violent and would often throw things around the house. It
has become increasingly difficult for his guardians to take care of him. Therefore, they
decided to send him to a day care centre.
Working as a reporting nurse within the day care centre, I had been provided with the
responsibility of looking after Mr. H. However, I had received insufficient cooperation from
the patient which made catering to his health requirements difficult for me. The patient had
been depicting an aggressive behaviour and insisted upon going out alone. However,
provided the reduced cognitive abilities of the patient, it would have been risky for the
nursing professional to allow the patient move out on his alone. Hence, I insisted that I

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accompany the patient or send someone along with him. This was done in order to reduce the
health risks and maintain the safety standards around the patient. This could be further
attributed to the standards 6 of the Nursing and Midwifery board (NMBA), Australia as per
which the enrolled nurse is entitled to provide timely direction and supervision to ensure a
safe and correct practice.
According to the standard 7 of the NMBA standards , the nurses are responsible for
communicating priorities, goals and health outcomes to the patients and their respective
families (Mårtensson, Jacobsson & Engström, 2014). Therefore, it was the legal
responsibility of the attending nursing professional to inform his family regarding his health
progress along with any untoward incident, which could endanger the safe keeping of the
patient. Therefore, hiding the relevant information from the patients as well as their families
could be a breach of the legal guidelines and invite strict action to be taken against the
community centres and healthcare units (Sercu, Ayala & Bracke, 2015).
Dilemma of providing information to carers
A number of dilemmas are faced by the health and support service providers within an
acute mental healthcare setting. Some of the challenges with respect to implementing a
person centred approach along with respecting the autonomy of the patient had been
discussed over here. As per the Mental Health Capacity Act , 2005 a person with reduced
cognitive abilities has equal rights in participating in important decision related to their
health and well being. As mentioned by Videbeck & Videbeck (2013), under no
circumstances the patient should be forced to agree with the healthcare professionals
regarding a certain plan of action. This could be encroaching into the basic rights possessed
by a patient within an acute healthcare setup.

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Therefore, looking after Mr. H I had come across a problem situation where the
patient was not convinced with some of the decisions taken by the healthcare professionals
looking after him. The patient here insisted upon having additional space and freedom for
making decisions relevant to his health and life in general like travelling alone. However, this
was not in the best interest of the patient. Hence, the nursing professional looking after Mr. H
had to restrict him from conducting some of the basic activities, which resulted in increased
resistance from the patient .This further, resulted in an ethical dilemma on the part of the
healthcare professional as they had to ensure safekeeping of the patient. On the other hand,
restricting the personal space and freedom of the patient could result in violation of the
person centred approach (Fortinash & Worret, 2014).
The safe keeping of the confidential patient details is one of the crucial aspects of
mental health care. As mentioned by Clement et al. (2015), the reporting nurse in charge of
the patient meeds to ensure that the patient confidentiality needs are respected while
dissemination of important details related to the patient. The violation of the privacy
standards can affect the standards and quality of the support care services (Tosangwarn,
Clissett & Blake, 2016). As per the standard 5 guidelines of the Mental health services
(MHS) , the mental health staffs need to comply with the relevant legislations, regulations and
instruments in relation to confidentiality and privacy of the patients (Phillips et al., 2015).
Some of the regulations formulated by the Australian government in this regard are- The
Australian health ministers mental health statement on rights and responsibilities, Australian
standards of medical records etc. The confidentiality and privacy standards further ensure
that the printed documents with the rules and regulations are available to the consumers in an
easy and understandable language. As commented by LoBiondo-Wood & Haber (2017), the
research or study conducted on the selected patient history is subject to a full ethical review
and clearance.

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Therefore, as a reporting nurse one often has to fall under pressure situations where
they need to be very careful regarding the amount of kind of information disseminated
regarding the patient (Higgins et al., 2016). Under no situations or circumstances can the
private or the confidential details be disclosed regrading the patient, as this will be a breach
of the standard 5 of the mental health nursing care (Anderson, Malone, Shanahan &
Manning, 2015). However, the private patient information and details could only be shred in
case informed consent has been received from the patient or else contraindicated by treatment
requirements. The mental healthcare services should be delivered in a manner where the
religious and spiritual beliefs of the patient are respected.
Meaning of health related issues to the individual patients
The perception of illness may vary from individual to individual. Some may define
illness as simply a state of not feeling well, whereas the others may define illness as a state of
alternation from the normal situations and conditions of life to which one may have been
used to earlier. However, the spectrum related to mental health issues are much larger where
the patient defines the situation of their health depending upon the symptoms experienced
(Fortinash & Worret, 2014). In the current study, the case study of Mr H had been taken into
consideration who had been suffering from autism spectrum disorder and had been handed
over to the community mental healthcare centre owing to difficult behaviour. Within the
community care centre, the patient experienced situations of withdrawal. He expressed little
joy or comfort living in the day care centre. As per the patient he would have been fine, once
he would have been sent back to his foster parents. Therefore, he felt that the withdrawals
symptom was more because of the emotional attachment he patient felt towards his family.
On proper clinical diagnosis, it was found out that the patient was suffering from depression
which increased the irritability factor within the patient.

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The dissemination of mental healthcare services to the patients often becomes
difficult, as they are not willing to accept the fact that they have been suffering from mental
health disease. Most of the times, the patients refute the presence of the diseases by relating
it to the present uncomfortable situations. However as argued by Manuel & Crowe (2014),
depression as well as other mental health disorders can affect the thinking and decision
making ability within individuals. As suggested by Durbin, Durbin, Hensel & Deber ( 2016),
mental illness is still stigmatised in the larger part of the world. Therefore, the people
suffering from mental health disorder often develop a feeling of shame in reporting their
illnesses, which often increases the gap in the time of reporting to the time of receiving the
services.
5 R’s of reflection
The aspect of reflection is very important for honing the nursing care skills. This
could be further done by focussing upon the 5 R’s of reflections which are- reporting,
responding, relating, reasoning and restructuring.
While dealing with the patient Mr. H I had come across a number of self realizations
some of which could be highlighted over here. With respect to reporting, I felt that
preserving the confidential and private details of the patient are very important. I felt that the
patient Mr. H suffered from low esteem owing to his dependence upon his foster parents ,
which could be attributed to his reduced cognitive abilities. Hence, I had to respond to the
patient in sympathetic and warm manner. As mentioned by Clement et al. (2015), using
therapeutic communication skills could help in relating with the patient.
Thus, dealing with the patient I also had to take into consideration his physical and
mental abilities while designing of the nursing care plan. I had to ensure that any stage I
could not force the patient to follow the instructions provided by the nursing care

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professional. Therefore, the autonomy of the patient needs to be respected along with
ensuring that the safety standards of the patient are maintained. Therefore, effective
reasoning and critical thinking skills needs to be applied by the nurses. This is further based
upon the decision making capabilities of the nurse, which is often guided by past experiences
and exposure to similar environments. I have often felt that I need to effectively judge the
clinical improvement depicted by the patient which will help me in restructuring the clinical
care plan, which will help me in meeting the requirements of the patient.

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References
Anderson, J., Malone, L., Shanahan, K., & Manning, J. (2015). Nursing bedside clinical
handover–an integrated review of issues and tools. Journal of clinical nursing, 24(5-
6), 662-671.
Clement, S., Schauman, O., Graham, T., Maggioni, F., Evans-Lacko, S., Bezborodovs, N., ...
& Thornicroft, G. (2015). What is the impact of mental health-related stigma on help-
seeking? A systematic review of quantitative and qualitative studies. Psychological
medicine, 45(1), 11-27.
Durbin, A., Durbin, J., Hensel, J. M., & Deber, R. (2016). Barriers and enablers to integrating
mental health into primary care: a policy analysis. The journal of behavioral health
services & research, 43(1), 127-139.
Fortinash, K. M., & Worret, P. A. H. (2014). Psychiatric Mental Health Nursing-E-Book.
London: Elsevier Health Sciences, 78-102.
Higgins, A., Doyle, L., Downes, C., Morrissey, J., Costello, P., Brennan, M., & Nash, M.
(2016). There is more to risk and safety planning than dramatic risks: Mental health
nurses’ risk assessment and safety‐management practice. International journal of
mental health nursing, 25(2), 159-170.
Hunter, L., Weber, T., Shattell, M., & Harris, B. A. (2015). Nursing students’ attitudes about
psychiatric mental health nursing. Issues in mental health nursing, 36(1), 29-34.
LoBiondo-Wood, G., & Haber, J. (2017). Nursing Research-E-Book: Methods and Critical
Appraisal for Evidence-Based Practice. London: Elsevier Health Sciences, 105-124.

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Manuel, J., & Crowe, M. (2014). Clinical responsibility, accountability, and risk aversion in
mental health nursing: A descriptive, qualitative study. International journal of
mental health nursing, 23(4), 336-343.
Mårtensson, G., Jacobsson, J. W., & Engström, M. (2014). Mental health nursing staff's
attitudes towards mental illness: an analysis of related factors. Journal of psychiatric
and mental health nursing, 21(9), 782-788.
Phillips, J. A., Holland, M. G., Baldwin, D. D., Gifford-Meuleveld, L., Mueller, K. L.,
Perkison, B., ... & Dreger, M. (2015). Marijuana in the workplace: Guidance for
occupational health professionals and employers: Joint guidance statement of the
American Association of Occupational Health Nurses and the American College of
Occupational and Environmental Medicine. Workplace health & safety, 63(4), 139-
164.
Sercu, C., Ayala, R. A., & Bracke, P. (2015). How does stigma influence mental health
nursing identities? An ethnographic study of the meaning of stigma for nursing role
identities in two Belgian Psychiatric Hospitals. International Journal of Nursing
Studies, 52(1), 307-316.
Tosangwarn, S., Clissett, P., & Blake, H. (2016). Psychiatric-Mental Health Nursing. Int J
Ment Health, 2(5), 27-35.
Videbeck, S., & Videbeck, S. (2013). Psychiatric-mental health nursing. Philadelphia:
Lippincott Williams & Wilkins, 45-65.

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