Nursing Care Plan, Case Study of a Mental Illness Patient

This assignment defines and discusses the nursing interventions for a patient with a long term mental illness problem. The nursing process will be structured into several stages: the assessment stage, the planning stage, the implementation and the evaluation stage. The patient’s profile will be given in a detailed manner to enable the audience to understand the rationale behind the care plan.

NURSING CARE PLAN, CASE STUDY OF A MENTAL ILLNESS PATIENT 1
Nursing Care Plan, Case Study of a Mental Illness Patient
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NURSING CARE PLAN, CASE STUDY OF A MENTAL ILLNESS PATIENT 2
Nursing Care Plan, Case Study of a Mental Illness Patient
This assignment defines and discusses the nursing interventions for a patient with a long
term mental illness problem. To achieve that, a systematic approach in the nursing process will
be used while identifying all the roles played by mental health nurses in patient care. The
nursing process will be structured into several stages: the assessment stage, the planning stage,
the implementation and the evaluation stage. The problem-solving method will be used to plan,
organize and table all nursing interventions to be involved in the entire care plan. The patient’s
profile will be given in a detailed manner to enable the audience to understand the rationale
behind the care plan. Because it’s a mental health care scenario, mental assessment planning will
be addressed in a detailed manner as well. To ensure that the planning and interventions are
patient-centred, active client participation will be encouraged over the entire process. The client
profile will have a pseudonym (Benard). This is drawn from the Nursing and Midwifery Council
which encourages confidentiality when dealing with health-related information. The importance
of a Multi-Disciplinary Team in patient-centred care will be discussed to safeguard patient and
enhance the quality of the care.
Benard is an old man at the age of 70 years who was diagnosed with severe depression
and excessive intake of alcohol. According to section three of the mental health act of 1983,
Benard had been detained and admitted into a low secure unit 12 months ago with an offence of
attempted suicide and physical assault. The attempted suicide was to be done through an
overdose of his depression and insomnia prescribed medication. In the unit, Benard shares the
room with four men. He has been potentially active because he manages his daily chores and
attends his daycare sessions as expected. Benard recently turned reluctant as far as personal

NURSING CARE PLAN, CASE STUDY OF A MENTAL ILLNESS PATIENT 3
hygiene was concerned. The situation worsened when he started to skip bathing and washing his
clothes for a number of days. He stopped cleaning his room after some time which made it have
a bad odour especially because of his leg ulcers which he had initially denied Tissue Viability
Nurse to dress regularly
The odour in his room was as a result of denying the TV nurse to wash and monitor her
wound dressing for days. A previous meeting held to discuss issues surrounding his hygiene
revealed that his poor hygiene was hazardous to his own health as well as the health of the staff
members who frequently visited his room. When Benard did not attend the daycare sessions, he
could watch television the whole day. He also had a vast appetite which made him frequently ask
for additional food during the meal times. The other behaviour which proved his huge appetite is
the frequency in which he requested for tea and biscuits between the meal times. According to a
research by Järvholm et al (2018), frequent binging is a poor eating pattern, the eating pattern of
Benard could be seen as a poor eating pattern. During the review meeting, concerns were raised
about his fast weight gain. With time, Benard becomes very withdrawn and wanted to be alone
most of the times. In an interview he took place; he articulated that he was feeling useless and
helpless before the other people he was interacting with. He confessed to having a feeling that
his poor hygiene was the reason behind his peers looking down upon him.
Benard had been referred to the clinic where I was working during my nursing practice
for five days prior in order to facilitate his discharge. He was to undergo a psychosocial
assessment from the mental health nurse at my assigned ward and hence I took an active role in
the process. The psychosocial assessment was considered to be a good therapeutic to Benard
because it was his first chance to express different aspects of his problems. The psychosocial

NURSING CARE PLAN, CASE STUDY OF A MENTAL ILLNESS PATIENT 4
assessment was also important because it would enable the development of a person-centred care
plan which would stabilize the condition of Benard and improve his quality of life. The most
effective care plans are those which take person-centred approach supported by recovery models
which are also person-centred because the medical practitioners are able to explore client
feelings, thoughts and lives to enable them to discover a more acceptable sense of self.
According to the Beck Depression Inventory, Benard indicated a high depression score of
19/21 which signalled that he might have been suffering from a depression disorder. However,
because of the high possibility of exaggeration and client under presentation of symptoms in this
score, the results from the inventory have only used a guideline (Townsend and Morgan, 2017).
Research by the Department of Health Australia revealed that active care management and
targeted assessment promoted the independence of older people through the prevention of health
deterioration and management of crises. Further, the research revealed that proper assessments
reduced demand for health services by ensuring that services remain appropriate to patient needs.
To address the depression disorder faced by Benard, the National Service Framework
(NSF) and the National Institute of Clinical Excellence (NICE) standards were used. NSF guides
medical practitioners on proper approaches when dealing with older adults while NICE focuses
on the general management of people with depression. The guidelines from the two research
institutes set clear proposals which can be used to promote partnership working, tackle social
exclusion, upholding high standards care and provision of safe, quick and supportive services to
depression victims (Petersen et al, 2016, p.30).
According to a research by Djukanović, Sorjonen, and Peterson (2015), it has been
revealed that depression disorder in elderly people is hard to detect because most of them

NURSING CARE PLAN, CASE STUDY OF A MENTAL ILLNESS PATIENT 5
mistake it to physical illnesses and other physical aspects of disease rather than the mood itself.
Also, they are not aware of the symptoms of depression. To add on this observation, De Winter
et al (2015) observed that most medical practitioners perceive depression as a normal stage for
ageing people hence they must be trained to make them recognize depression symptoms among
the elderly people because misdiagnosed depression may lead to serious issues as most of them
will remain untreated (Bohnenkamp Stephan and Bobo, 2015, p.720). The Department of Health
Australia (DOHA) has supported the observation above when they stated that mental illness
among older people is mostly undetected because of the nature of mental illness symptoms and
the fact that most of the older people stay alone. Following this observation, the case of Benard
required collaboration between different medical practitioners in order to examine the patient
from different perspectives.
Bernard’s engagement with different professionals like psychologists, psychiatrists and
counsellors revealed that Benard was suffering from depression. His depression became severe
when his wife died and lost his family house. According to the assessment fact sheet, Benard was
finding it hard to cope with the loss of his family house which made him move into a residential
house. He also expressed some feelings of loneliness by missing his family, wife and neighbours.
Compared to the symptoms of depression listed by the International Classification of Disease
(ICD), some of the symptoms of Benard like loss of interest, disturbed sleep, suicidal thoughts
and lack of concentration affirmed that Benard was facing depression.
In his assessments, Benard frequently explained how he considered ending his life as the
best option, although he did not elaborate on how he intended to achieve it when follow up was
made. This was listed among the most serious risks during the assessments (Gray and Brown,

NURSING CARE PLAN, CASE STUDY OF A MENTAL ILLNESS PATIENT 6
2017, p.32). Benard revealed that he had lost contact with the family because he saw their
unwillingness to associate with him under his mental illness. This was considered as mounting
evidence that people with mental health problems face discrimination from their community and
families.
According to a research by Manwell et al (2015), health has been defined as an aspect
that includes the dimensions of a normal human being such as social, biological, cultural and
spiritual aspects. Therefore, the nursing intervention in the case of Benard will entail not only his
health but also the promotion of his social well-being. When intervening in the care of Benard, a
problem-solving approach will be followed as emphasized by Bayindir Çevik and Olgun (2015).
Also, the four steps of the nursing process (assessing, diagnosing, planning and implementing)
will be used by the mental health nurse to facilitate Bernard’s nursing interventions.
To guide the mental health nurse in the care planning process, Maslow’s (1954) hierarchy
of needs will be used. Maslow’s hierarchy recapitulates all human health requirements. This
approach borrows from research by Lawrence et al (2016) which revealed that people’s needs
must be given the first priority in any care planning regardless of whether they are ill or well. It
is from this finding that Maslow provided considerable information on human needs to be
considered in care planning regardless of their health wellbeing.
Maslow’s hierarchy will be considered as the main assessment tool in the case of Benard
because of the Maslow approach on care planning that considers physiological needs as the first
priority. According to the assessment results, Benard lacked the ability to satisfy his
physiological needs and hence ended up depressed (Cree et al, 2015, p.208). Therefore, failure to
satisfy his physiological demands such as unhealthy eating and poor hygiene, he won’t be able to

NURSING CARE PLAN, CASE STUDY OF A MENTAL ILLNESS PATIENT 7
restore his self-esteem. During the assessments, Bernard’s priority needs were identified to be
poor hygiene, poor eating habits, suicidal thoughts and excessive alcohol intake.
Bernard’s care plan will utilize Roper, Tiemey and Logan‘s model which advocates for
daily living activities. A model is an artifact that provides growth for new identified ideas. In the
nursing field, it has been defined as a collection of mental images which provides the directions
of achieving predetermined nursing goals. Roper, Tiemey and Logan‘s model was chosen
because of its systematic approach to health care planning to support Maslow perception on
physiological needs as the first priority when dealing with human beings (Bee et al, 2015,
p.1840). Health promotion was incorporated in the plan in order to improve the health of Benard
and prevent further deterioration of his health. Health promotion entails all the activities which
are meant to prevent diseases and illnesses and improve the well-being of a person.
Prior to any assessment, Benard would always be informed and explained what to expect.
This followed the four ethical principles in the nursing field which require a patient to be given
the choice and autonomy where possible to express their opinions or make their own decisions
(Newman et al, 2015, p.180). The assessment was strictly guided by the four stages of
assessment tabled by the Roper, Tiemey and Logan‘s model. The four stages included; a
collection of information about Bernard, review of the collected data, identification of Bernard’s
problems then the classification of the problems in the order of their priority.
According to a research by Sudore et al (2017), care planning has been defined as all the
activities involved when a nurse is making a decision on the necessary actions to meet the client
or patient needs. This research also warned that effective care planning must have aims, goals
and objectives tabled down to act as a guideline. In the case of Bernard, the aim of care planning

NURSING CARE PLAN, CASE STUDY OF A MENTAL ILLNESS PATIENT 8
was to help him understand the importance of proper dieting to avoid the consequences of his
weight. Another aim of the plan was to help him comprehend the importance of maintaining
good hygiene. In regard to the plan goals, the first goal was to encourage him to adopt a healthy
lifestyle through healthy eating while the second goal was to encourage him to prevent illnesses
through good hygiene.
In regard to the care plan objectives, they were tabled as per the objectives guideline
which requires them to be specific, measurable, achievable, realistic and time-bound. The main
objectives were: making Bernard eat a reasonable amount of food to have a healthy body and
mitigate the risk of diabetes, make him avoid unhealthy binging between meals, make him bath
daily, make him change his socks daily and wash his own clothes.
The implementation of the care plan focused on the way Bernard carried out his activities
in order to minimize disruptions. To empower Bernard with knowledge and confidence, he was
given some teaching and written information which enabled him learns the basics of normal
behaviour like hygiene and healthy eating (Liu et al, 2017, p.30). Time to time, sessions were
arranged to encourage Bernard on the importance of healthy eating. In other times, Bernard
would be referred to a dietician to learn about his fast increasing weight. To complement the
dietician guidelines, educative leaflets were provided to Bernard to make it easier for him to
follow up when alone. Whenever Bernard deviated from the routine or the healthy practices, one
on one session would be held to correct and encourage him. In such cases, the medical
practitioners tried to politely encourage Bernard instead of forcing him (Kigozi et al, 2016, p.45).
Person-centred care was also exhibited in this case by consulting Bernard to give his personal
opinions; this helped the nurses to work around and effectively encourage him.

NURSING CARE PLAN, CASE STUDY OF A MENTAL ILLNESS PATIENT 9
According to Kruger et al (2018), the evaluation process has been defined as the process
of determining the extent to which care plan goals have been achieved. Also, it’s defined as a
judgement which is based on careful and critical appraisal of a given circumstance, which must
have a sensible conclusion and useful proposals. It is hence an important aspect of health
promotion because it helps judge the quality of an activity. The process addresses the reactions
and perception s of the participants as far as health promotion approaches are concerned to
support the activities involved (Järvholm et al, 2018, p.350). In Bernard’s care plan, evaluation
of his health promotion activities involved; checking his body weight using a mass index to
check if there were changes in his body weight, checking his personal hygiene standards,
confirming if he had adopted healthy eating habits and then getting feedback from Bernard,
dietician and other staff members. They will be required to respond to several questions on how
the process went as well as what could have been done differently in order for the nurse to
improve the quality of the care in future.
In summary, the essay has scrutinized the different aspects of health care planning. Also,
it has emphasized on the role of mental health nurse when dealing with patients who face mental
problems. This has its support from the NMC which states that nurses must put efforts to identify
and minimize the health risks of patients. The entire care plan has revealed that nursing care
entails so many aspects rather than the assumed treatments. It has also emphasized the important
role of nursing collaboration to achieve effective care. Lastly, the paper has emphasized the
importance of patient-centred care which entails the strict considerations of patient opinions and
decisions in the care plan.

NURSING CARE PLAN, CASE STUDY OF A MENTAL ILLNESS PATIENT 10
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