Nursing and Mental Health Services

This document discusses nursing and mental health services, including the stages of the transtheoretical model of change, treatment options, impacts of AOD and mental health issues, and ethical frameworks. It also provides insights into the role of counseling interventions and the importance of follow-up in the recovery process.

Running head: NURSING AND MENTAL HEALTH SERVICES
NURSING AND MENTAL HEALTH SERVICES
Name of the Student:
Name of the University:
Author note:

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Question 1
Considering the stages of the transtheoretical model of change by Prochaska and
DiClemente, Emma is likely in the stage of ‘Preparation’. This stage is characterized by the
concerned individual feeling the need to undertake changes in health behavior and shows
eagerness is participating health behavior change activities at the earliest. Emma can be placed in
this stage of change since it is observed that she expressed disgust over her detrimental habits
and hence, is eager to eradicate her drug addiction in order to be responsible parent.
Question 2
 Pharmacotherapy and Detoxification: Detoxification involves gradual withdrawal
from alcohol and drug consumption, in order to remove prolonged accumulation of
consumed substances over the years from the body system. Hence, considering Emma’s
prolonged history of drug and alcohol abuse, merely adopting withdrawal treatments may
result in relapses and hence, pharmacotherapy comprising of prescribed medications and
a nutritious diet will prove to be helpful.
 Counseling and Peer Support:Counseling involves establishment of direct
communication between the client and the clinician, where the counselor may use
psychotherapeutic strategies to help the concerned patient. Likewise peer support in the
form of self-help group engagement is proven to be beneficial in provision of assistance,
support and understanding to the patient. In Emma, considering her disruptive and
negative thought process of being a bad parents, counseling in the form of psychotherapy
will be beneficial in improving her thought process. Engaging her support groups with

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similar AOD patients, will allow her to gather the required mutual support which she had
lost upon being separated from her partner.
Question 3
In order to discuss the treatment options with Emma, a collaborative perspective will be
utilized which will involve a patient centered approach and result in direct discussion with Emma
in order to obtain her personal opinions. This will involve building an effective working
relationship with Emma where the counselor will discuss with her the available treatment
options, followed by obtaining her consent and decision. Successful collaborative approach will
be undertaken by actively involving Emma in the formulation of her treatment plan, which will
reflect her personal preferences.
Question 4
 Aggressiveness and Violence:Individuals with AOD issues are often susceptible to
projections of violent and aggressive behavior as symptoms of withdrawal and relapse
during adherence to their treatment. Hence, Emma may display outbursts of anger and
violence, resulting in increased risk of injuries to the health workers which must be
considered.
 Accidents and Injuries:As side effects of alcohol and drug abuse, AOD patients are
often susceptible to an unsteady movement and gait, resulting in susceptible to trips and
falls. AOD patients are often known to live in untidy homes due to their lack of interest
towards daily life, resulting in slips over objects or floors, which may occur in the
situation of Emma.

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 Compassion fatigue and Emotional Stress:Due to the detrimental emotional
consequences observed in AOD patients, health workers are often susceptible to stress,
emotional fatigue and burnout resulting in anxiety, depression and difficulty to sleep.
Question 5
Detoxification is the process by which individuals suffering from AOD issues are
engaged in gradually withdrawing or completely stopping the consumption of the concerned
harmful substance, in order to result incomplete removal of the same from their system. This
strategy is performed in order to eradicate the detrimental symptoms associated with
consumption of alcohol and drugs. In order to further mitigate the emergence of such undesirable
symptoms, the detoxification program may involve additional therapeutic approaches such as
consumption of a nutritious diet along with prescribed medications or nutritional supplements.
However, detoxification strategies have been associated with withdrawal and relapsing among
AOD patients.
Question 6
Signs and symptoms which can be estimated to be observed in Emma after detox include
withdrawal symptoms in the form of:
 Increased feelings of anxiety and irritability due to heroin withdrawal.
 Increased bowel movements resulting in physiological symptoms of diarrhea due to
heroin withdrawal.
 Withdrawal from alcohol may result in difficulty in sleeping and concentration, coupled
with seizures or hallucinations.

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Question 7
Emma’s AOD and Mental Health Issues due to alcohol and heroin consumption, may
lead to the following impacts.
 Loss of coordination and control in muscles.
 Development of long term organ damage, especially, the liver, brain and the nervous
system, further increasing susceptibility of neurodegenerative diseases such as
Alzheimer’s, depression and dementia.
 Increased conflicts in exiting social relationships resulting in social isolation, exclusion
and loneliness.
 Long term impacts of heroin include impaired cognitive functioning, constipation, drug
dependence, brain lung or liver damage, increased susceptibility to tetanus and sexual
dysfunction in males.
Question 8
 External trigger: Lack of social support or an avoidance to engage in social
relationships by Emma, may pose to be an external trigger resulting in her feeling lonely
and rationalizing her consumption of drugs and alcohol.
 Internal trigger: The prevalence of withdrawal issues in Emma due to her avoidance of
drug and alcohol consumption may result in symptoms of irritability, anger, distress,
insomnia, depression and hallucinations further triggering her AOD issue internally.

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Question 9
One of the key ethical and legal frameworks which must be considered in the treatment
of Emma’s AOD issues is the Mental Health Act 2013, which not only dictates the
responsibilities of workers to aid in the treatment of patients, but allows patients to engage in the
decision making process and practice self-capability in engaging treatments on their own. Hence,
Emma’s health workers must protect her privacy, respect her self-capacity in treatment
engagement and provide support in situations where she may be not be mentally sound
(Department of Health and Human Services Statewide Mental Health Services, 2019). Likewise,
in compliance to the Model WHS Act, the manager of the healthcare organization must exercise
duty of care to the health workers associated with the care of Emma resulting in providing
protection from harm due to possible patient aggression and provision of required compensation
during situations of employee injury .
Question 10
Out of the three intervention programs mentioned above, one of the key strategies which
will prove to be beneficial for the treatment of both AOD as well as mental health issues in
individual, are counseling interventions. Counseling involves one to one sessions of direct
discussion between the clinician and the concerned client, where the counselor may engage in
the usage of a variety of psychotherapeutic approaches for the purpose of management of AOD
and associated mental health conditions. Counseling strategies rely on the usage of multiple
methods which will prove to be beneficial for both AOD and mental health issues.
For the treatment of AOD in individuals, counseling interventions rely on treatment
models such as narrative approaches, family therapy and solution focused counseling methods.

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Such strategies prove to be beneficial for the management of AOD, since these allow the client
to freely explain their experience, develop new perspective, obtain family support and formulate
personal goals aimed at self-fulfillment and eradication of existing problems.
Counseling services will also prove to be beneficial for management of mental health
issues in patients due to their ability to regulate detrimental thought processes in response to
specific stimuli or traumatic childhood experiences by using cognitive behavioral and
psychodynamic approaches.
Question 11
After administration of treatment, health workers must continue evaluation and follow up
of Emma’s progress by recording her progress using direct communication strategies such as
conductance of phone calls and regular visits in her home. Likewise, Emma’s progress can also
be tracked by health worker’s usage of tools such as Alcohol Use Disorders Identification Test
(AUDIT), Alcohol, Smoking and Substance Involvement Screening Test (ASSIST), Mental State
Examination and Severity of Dependence Scale.
Question 12
Your Recovery Service: AOD and Mental Health issues, Counseling Interventions
Client: Emma
Health Worker
a) Available counseling services were communicated collaboratively to Emma using a

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patient centered approach where she was encouraged to actively participate in the
decision-making process concerning the formulation of her treatment plan. Upon
discussing the available therapies, Emma expressed interest in the usage of narrative
approaches for treatment. She also expressed her interest in undertaking solution focused
counselling treatments where she wanted to focus on achievement of her personal goal of
becoming a ‘good parent’ (Department of Health, 2019).
b) Upon conducting a person centered and recovery oriented approach, Emma expressed her
need to rekindle her social life and social interactions and hence, referrals were suggested
in the form of an AOD support group available in the local community center which
contained member with similar AOD issues (Turnbull & Standing, 2016).
c) Telephonic conversations where conducted where the health worker spoke on behalf of
Emma to the AOD support group service. No disclosure documents were then relayed to
the referral services in addition to Emma’s assessment reports. Upon admittance, Emma
undertook assessment procedures used by the support group, of which, copies were also
provided to our counseling service as evidence (Wilson et al., 2017).
d) Positive decision making was supported by collaboratively helping Emma on taking
decisions aimed at becoming a responsible and better parent for her children and by
avoiding negative or pessimistic goals which focused only on her avoidance of alcohol or
drug consumption (Modecki, Zimmer‐Gembeck& Guerra, 2017):
e) Alcohol and heroin abuse impacted Emma in the following ways (Vagenas et al., 2015):
 Increased alcohol consumption had affected mobility and decision-making skills
and resulted in feelings of anger, violence and aggression. Withdrawal symptoms
were later found in Emma in the form of insomnia, difficulty in concentration and

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hallucinations.
 Her AOD issues extensively affected her social life where she frequently engaged
in conflicts with her peers and preferred to socially isolate herself.
 Long term heroin usage negatively impacted Emma in the form of muscle aches
and weakness, depression, memory loss, insomnia, menstrual irregularities,
appetite loss and breathing difficulties.

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Role Play Part A
Documentation (As designed by the Author)
Your Recovery Service: Alcohol and Cannabis
Client: Cliff
Health Worker:
Services Provided: For the management of Cliff’s AOD issues, counseling services were
provided where the health worker engaged in a direct, interpersonal communication with the
client in order to obtain and insight into his personal experiences and AOD history. For
successful performance of counseling service, the health worker used psychotherapeutic
procedures of Cognitive Behavioral Therapy (CBT). The CBT procedure involved helping Cliff
to regulate his negative responses (in the form of AOD engagement) to stimuli such as ‘the
absence of Polly’.
In addition to the above, referral services in the form of support group therapy and nutrition
therapy. The local community health centre was contacted since it was beyond our scope to
provide for the above services. The dietician in the health center was contacted followed by a
community peer support group in the vicinity. A nutritious diet helps in the eradication of the
detrimental physiological effects exerted by alcohol and drugs. Peer and social support in the
form of social support groups hastens the process of recovery due to provision of mutual support
and expression of share experiences.
Decisions-made: Decisions were arrived at by using a collaborative and patient-centered
approach. This required directly involving Cliff in the decision making process of his recovery
plan where the health worker explained him the principles of nutrition therapy and CBT for the

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eradication of his symptoms. Cliff agreed to same but expressed his desire to engage in social
support, following which a social support group was contacted. Before engaging in referral
services Cliff’s consent was obtained in order to maintain privacy and confidentiality. The health
worker also collaborated with Cliff to allow him to set up his own personal goals and health
objectives.
Follow up actions: Cliff was regularly contacted over telephone followed by weekly visits by
the health worker to his home. The referral services were contacted in order to know Cliff’s
adherence to the nutrition plan and social support group meetings. Cliff was asked to engage in
monthly visits to our AOD service for follow up.
Scenario Part B
Question 1
For debriefing, the health worker after communicating with Cliff engaged extensively in
a self reflection in order to evaluate the personal experiences encountered. Hence, for debriefing
with the supervisor, the health worker firstly, communicated the problems Cliff presented to the
services and the new strategies used for mitigating the same, such as motivational interviewing
and referring to peer support. Likewise, debriefing also involved the health worker
communicating his or her experiences, feelings and coping capability considering Cliff’s health
scenario. As a response, the supervisor guided and counseled the health worker about coping
and resilience strategies, which may help to reduce burnout and compassion fatigue in the health
worker.

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Question 2
As observed from the Cliff’s case, his external triggers include: social isolation, lack of
social support and possibilities of disconnecting with Polly. The information about his custodial
time resulted him in perceiving a possibility of losing all social and familial support due to
which, he felt that engagement in the wellness plan was pointless and hence, reverting back to its
AOD behaviors seemed plausible. Likewise, internal triggers could be his feelings of anxiety,
agitation, fear, sadness and negativity, resulting him in relapsing back to his AOD condition.
Internal triggers may also include his symptoms of withdrawal, which further compelled him to
relapse back into excessive alcohol and drug use.
Question 3
One of the ways in which the supervisor can support the health worker to manage similar
situations is by educating and providing information on various coping strategies. Emotion
focused coping strategies will require the health worker to engage in mindfulness and self
reflection where he or she must identify negative feelings and engage in positive thinking.
Likewise, the supervisor may conduct resilience programs in order to reduce stress and burnout
in the health worker. Further, the supervisor can support the health worker by training him or her
in problem focused strategies where the health worker can identify the risks of injuries from
violence or aggression, as well as the health risks he or she may face while being in the vicinity
of clients like Cliff who are engaged in heavy alcohol and drug use.
Question 4
If Cliff is not calm, the health worker must remain calm and engage in a calm, patent and
empathetic conversation with Cliff. He or she must assure Cliff that the health worker is there to
provide him any form of assistance if needed. In such a situation of violence or aggressiveness,

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the health worker must visit Cliff with a colleague and not alone, in order to better manage
personal threats of acquiring injury. The health worker must used safe guarding procedures and
engage an emergency or personal protection team who would monitor Cliff and act accordingly
during any situations of emergency.
Question 5
Once known about Cliff’s plans of self harm, the health worker must be patient and
communicate patiently and empathetically with Cliff in order to calm him and assure him that
the health worker is always there for any help or assistance. Likewise, the health worker must
adopted a systematic approach as pet the WHS Act of 2011, where Cliff’s risk of self harm must
be managed by identifying triggers of his self harm, outline the responses towards such triggers
accordingly and hence, develop the required options of contingency and harm minimization.
Such strategies can involve safeguarding Cliff by using relevant governance of the service such
as employment of an emergency medical team.
Question 6
During making a referral to a relevant service, the health worker must most importantly,
obtain consent from Cliff concerning his permission and views on using a referral service.
Further, the health worker must clearly communicate every information and clinical
characteristics of Cliff’s case to the referral services and also relay the relevant medical
documents such as medications, symptoms, case history, assessment and screening data. The
health worker must also attach ‘no disclosure’ documents when communicating with the referral
service in order to maintain Cliff’s confidentiality. A collaborative, patient centered approach,
should be adopted where Cliff will be directly involved in formulation of his wellness plan with
both the health worker and the referral service.

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Question 7
After engaging Cliff in the peer support referral program, the health worker will engage
in visiting Cliff weekly or engage in telephonic conversations with him every week, in order to
follow up the effectiveness of the services and ask Cliff about his feelings. Likewise, within a
week after attending the referral service and every week after that, the health worker must also
communicate with the staff at the peer support group service in order to obtain information on
Cliff’s performance, progress and level of engagement with the service. Likewise, the
collaborative, patient centered approach can also be adopted involving discussions with Cliff, the
health worker and supervisors of both the AOD and peer support service, so that Cliff can share
his personal experiences, views, progress and needs.