Analysis of Qualitative Case Studies in Nursing Research

This assignment involves analyzing qualitative case studies in nursing research, focusing on data analysis and methodology. It includes a review of relevant literature, such as Cronin's (2014) use of case study research as a rigorous form of inquiry, Heggestad and Slettebø's (2015) study on dignity maintenance in people with dementia, and Oh et al.'s (2015) meta-analysis on simulation-based learning. The assignment also covers essential elements for recognizing and responding to deterioration in a person's mental state, as well as guidelines for nursing assessment and psychiatric/mental health nursing. It provides a summary of the best practices for conducting and publishing qualitative research in nursing.

NURSING CASE STUDY
ANALYSIS

TABLE OF CONTENTS
INTRODUCTION...........................................................................................................................1
MAIN BODY...................................................................................................................................1
1. Recognising Signs of Deterioration in a Person’s Mental State.........................................1
Signs of deterioration ............................................................................................................1
Ways of obtaining and communicating baseline information about John’s current mental state
................................................................................................................................................1
Aspects of comprehensive mental health assessment ...........................................................2
2. The Bio Psychosocial Model of Care in Mental Health Practice.......................................3
John’s feeling of depression with reference to the bio psychosocial model of assessment...3
b. Address why this approach is deemed ‘the best practice’ in mental health care...............4
3. Identifying and Managing Risk in the Clinical Setting...............................................................4
Risk assessment and management strategies for John, while maintaining positive relationships
with him and his family..........................................................................................................4
Rationale whether John would be deemed low, moderate or high risk based on predisposing,
perpetuating and precipitating factors....................................................................................5
Ways used by nurse to manage these risks............................................................................6
Potential duty of care (legal/law) versus individual rights conflict as an ethical dilemma that
may arise concerning John’s mental state..............................................................................6
CONCLUSION................................................................................................................................6
REFERENCES................................................................................................................................8

INTRODUCTION
Nursing is considered as one of the important healthcare profession. Nurses play an
essential role in healthcare industry as their practices are primarily focused on patient care. They
work in a variety of specialities to prevent and heal illnesses and injuries. This is a profession
which focused on providing care to individuals, families, and communities which helps them in
managing quality care services in society. Present report will study about a John who is 47 year
old male suffering from mental illness. The report will outline his signs of deterioration and will
evaluate feeling of depression with the help of bio psychosocial model.
MAIN BODY
1. Recognising Signs of Deterioration in a Person’s Mental State
Signs of deterioration
In the given scenario, John is a 47 year old male who was admitted in medical ward for
chronic back pain. He was also diagnosed with depression which is known as severe mental
illness. Possible signs of deterioration can be evaluated by identifying physical symptoms as well
as his mental state. Recognising and responding to clinical deterioration is a clinical priority
which assist in improving health of people. First immediate possible identifier about John's case
is that he suddenly stopped talking to everyone. During diagnosis nurse evaluated that initially
cheerful and chatty when he was presented in hospital. There are various ways through which
signs of deterioration are identified, such as, by communicating with people who are close to
John, studying his behaviour, etc (Al‐Sagarat, et.al., 2016).
In accordance with the case, it can be stated that John's mental state was disturbed due to
various reasons, like he was recently retrenched from his job as a horticulturalist which gave him
a huge shock. According to him, he was fired because of his bad back, which and him depressed.
Through clinical deterioration, monitoring of John;s vital signs and other physiological
parameters helped in assessing his mental state receptively. Identifying issues related to mental
stability of patient help nursing staff in providing treatment according to patient requirement.
Regular monitoring over signs of deterioration will help the nurse to examine John's daily
routine and which can help in extracting all the information that is related to John (Essential
elements for recognising and responding to deterioration in a person’s mental state, 2017.).
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Ways of obtaining and communicating baseline information about John’s current mental state
In the given nursing case, it is mentioned that John was also diagnosed (2 weeks ago) by
his local general practitioner with depression and commenced on antidepressant medication as
well. He was being cared in a single room and after shifting him they notice some injuries' oh his
hand which is expected to be a self harm situation done by him. When John got admitted he was
very happy but in the last 24 hours he was behaving miserably and was in extreme pain. These
were some early signs that has concluded that he might suffering from depression.
Collecting or identifying baseline information plays a crucial role in medical field. It
helps in assessment of deterioration in a person's mental state. To obtain baseline information it
is very important to have effective communication with the respective patient. This help in
understanding patient issues more precisely. It is reported that baseline information can be
obtained from multiple sources, such as, his carers, emergency service professionals and
healthcare providers who were taking care of John (Almutairi, Gardner & McCarthy, 2014). In
the given case scenario, baseline information will be obtained by directly communicating with
John.
This will help medical staff to know the actual state of his mind. Through effective
communication it will be easier for the nursing staff to interpret the base issue of John's problem.
Baseline information is necessary for obtaining information regarding patient's history with
respect to health issues. The value of obtaining additional baseline information needs to be
weighed against various factors, for example, mutual understanding of nurse with the patient. All
gathered information should be evident and correct, etc.
In accordance with assessment of John it has been analysed he had no past history of
mental illness. However, from the evaluation it has been determined that main reason was that he
got fired from his job due to which he started to feel low and depressed. Other reasons which can
be included in this information is that John does not sleep at night which made him de-motivated
and he also stopped to socialise with other people, which is a major initial sign of getting
depression (Cronin, 2014).
From the baseline information gathered, it can be communicated that he was not sleeping
properly at night which has affected his mental state and health as well. From the obtained
information for John's scenario, it can be commented that factors like, his experience related to
his job and some health issues can be a major issue which has resulted in depression.
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Aspects of comprehensive mental health assessment
According to given case scenario, it can be stated that John was suffering from serious
mental issue that is depression. It occurs due to various factors, like, mood disorder characterized
by low mood, a feeling of sadness, etc. It is considered as comprehensive aspect of mental health
assessment because John was undergoing through numerous signs and symptoms due to changes
in his daily routine activities (Heggestad & Slettebø, Å., 2015).
However, the motive behind choosing depression as priority in this case is because of
change in his attitude and behaviour which was analysed on the basis of baseline information.
Like, when he got admitted he was very chatty and happy but within 24 hours his behaviour
changed completely. Other issues related to John which was monitored by the nurses includes, he
was not taking care of his personal health, i.e., he rejected to take medicines and even he did not
sleep on night due to depression only. (Lewis, 2015).
2. The Bio Psychosocial Model of Care in Mental Health Practice
John’s feeling of depression with reference to the bio psychosocial model of assessment
Bio Psychosocial model or BPS model is an approach which states that biological,
psychological, and social factors play a significant role in the identification of disease cause and
treatment. This model helps in evaluating mental health issues from different perspective and
entirely in new way. This is useful model in analysing the mental state of John. With the help of
this model, nurse can build a healthy relationship with John by communicating with him about
his past, present and future health needs which will be helpful in evaluating John's biological
(physical), psychological (mental health) and social domains (Nursing Assessment, 2016).
This Bio Psychosocial model helps in evaluating the problems on the basis of three
different factors, such as, in biological aspect which includes information related to neuro
biology, medicines, etc. Other than these factors, family background can also be a major issue
for his mental illness. For example, there can be chance that his father or mother might have the
same issue with them. In psychological factor it includes personality development, emotional
aspects, etc. All these factors were studied carefully in John's case to get all the required
information correctly. With the help of this Bio Psychosocial model or BPS model, it will make
their work easier in order to identify all the issues.
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This will help in assessing and evaluating John's condition by personally communicating
with him and getting all the information’s which can be helpful in providing him the best
treatment (Schenker, et.al., 2016).
b. Address why this approach is deemed ‘the best practice’ in mental health care
This is the best model or method which can be used in the case of John to resolve various
issues his mental health care. This model has been chosen to evaluate factors that promotes
mental illness on the basis of three core elements. These three factors, i.e., biological,
psychological and social helps in analysing John's conditions more accurately. From the final
outcome of this model it will be easy for the nurses to take care of John (Mosby's Pocketbook of
Mental Health, 2018).
In biological factors, it will be very helpful in analysing his family background which
will help in studying whether his family member were from depression before. As there are so
many chances to get such disease through hereditary (Houghton, et.al., 2015). Psychological
factors includes components like, personality, emotional and interpersonal issues which is
helpful in analysing John's personal issues related to his life. And in social factor of BPS model
will assist in providing information related to his past.
From the final outcome from this model it is considered to be the best model which can
help nurse to treat John. It will be very beneficiary for the nursing staff as this model takes into
account all relevant determinants of health and disease and that supports the integration of
biological, psychological and social factors of John's life in the assessment, prevention and
treatment of his mental issue (Stacey, Pollock & Crawford, 2015). This model will cover all the
essential areas that are mandatory to treat a mental illness effectively.
3. Identifying and Managing Risk in the Clinical Setting
Risk assessment and management strategies for John, while maintaining positive relationships
with him and his family
The development of nursing interventions exhibit the link between nursing actions and
patient outcomes which is a high priority for health care practices. Nursing interventions are
management strategies which are used by the nurse for assessing risk. This process of nursing
intervention will help in analysis of John's health more precisely. It can be achieved by various
ways, such as, by applying approach to physical assessment which will consider all the factors
that are present and which led John to get depressed (Oh, Jeon & Koh, 2015).
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Information achieved from the analysis of patient’s history, such as, history of current
illness/injury (i.e. reason for current admission), relevant past history, allergies and reactions,
medications, immunisation status, implants and family and social history. This also includes
patients’ overall physical, emotional and behavioural state. From the information which is
obtained from nursing intervention, it will be very useful for the nurse in assessing risk
assessment and management strategies that will assist in treating John and maintaining good
relationship with John and his family (Psychiatric & Mental Health Nursing, 2012.).
In physical assessment nursing intervention helps them in getting all the information
related to its daily routine which will include its living standard, eating habits, etc. Assess for
mood, sleeping habits and outcome, coping strategies, emotional state, comfort objects, support
networks, etc. Play an essential role in the healthcare for the assessment of risk assessment and
management strategies that can be used in keeping a positive environment for John to make him
feel good about life (Heggestad & Slettebø, 2015).
Rationale whether John would be deemed low, moderate or high risk based on predisposing,
perpetuating and precipitating factors
There are various factors on the basis of which it can be stated that John was at risk.
These factors are predisposing, perpetuating and precipitating factors. These plays an important
role in treating any health issue effectively. Predisposing factor is a condition or state in which
an individual or patients are at more risk or are susceptible to get some disease. This can include
age, gender, heredity, etc. Perpetuating factors are those that helps in retaining the negative
symptoms of an illness or disease. Whereas, precipitating factors are those factors which triggers
any disorder, illness, accident and behavioural response.
On the basis of all these three factors, it can be stated that John can be considered
perpetuating as if he wants than he can recover from his mental illness (Oh, Jeon & Koh, 2015).
All the problems which he had has made him de motivated and sad. But if he ignores all these
issues he can recover easily from depression.
Ways used by nurse to manage these risks
It is very important for the nurse to handle such risk situation in order to understand the
mental state of the patient accurately and to provide him the best treatment. On the basis patient
assessment, nurse will plan risk assessment strategy to deal with it. Such as, she can organize
activities which she can include John so that he could make interaction with other patients as
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well. This will help in boosting his confidence and will make him happy. Such as, my making
him to meet similar patients who are suffering from the same problem but are more positive than
him. This will boost his confidence. They can take John out from the medical ward to interact
with people. All these activities will be very helpful for John in getting better (Cronin, 2014).
Other methods which can be used by nurse to manage risk is effective communication
with John to get back him from depressive mental state by making him confident and positive
about life.
Potential duty of care (legal/law) versus individual rights conflict as an ethical dilemma that may
arise concerning John’s mental state
Health care is one of the most regulated sectors and it is very crucial for them to follow
all the legal regulations that are necessary for them to implement. The Nursing and Midwifery
Board of Australia (NMBA) undertakes functions as set by the Health Practitioner Regulation
National Law, as in force in each state and territory (the National Law). The NMBA regulates
the practice of nursing and midwifery in Australia, and one of its key roles is to protect the
public. All these laws help in minimizing the impact of nursing malpractices. There should be no
sign of assault, ill-treatment, etc with the patient in the care home (Clinical Care Standards,
2017). Healthcare should follow standards of care and communicating with them.
Ethically it is very important for the nurse to treat John with calm and patience as he is a
mental illness. Another area of ethical concern is the nurse’s responsibility for ensuring that
every patients is getting proper care. Ethical implications for nursing practice are considered in
relation with three issues, i.e., competence, honesty and obedience. In case of John it plays a
crucial role to deal with him carefully as his mental state was not stable as he was suffering from
depression (The need for a new medical model: a challenge for biomedicine, 2016.).
CONCLUSION
From the above report it can be concluded that nursing plays an important role in health
care sector as it helps in treating patient. From this study, it has been analysed that John was
suffering from mental illness, i.e., depression and also explained the reasons behind this. It also
discussed about the various methods that has been used in collecting all the information related
to John, such as, through baseline information, nursing intervention methods, etc.
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REFERENCES
Book and Journals
Al‐Sagarat, A. Y., Hamdan‐Mansour, A. M., Al‐Sarayreh, F., Nawafleh, H., & Moxham, L.
(2016). Prevalence of aggressive behaviours among inpatients with psychiatric disorders:
A case study analysis from J ordan. Nursing & health sciences. 18(2). 172-179.
Almutairi, A. F., Gardner, G. E., & McCarthy, A. (2014). Practical guidance for the use of a
pattern‐matching technique in case‐study research: A case presentation. Nursing & health
sciences. 16(2). 239-244.
Cronin, C. (2014). Using case study research as a rigorous form of inquiry. Nurse Res, 21(5), 19-
27.
Heggestad, A. K. T. & Slettebø, Å. (2015). How individuals with dementia in nursing homes
maintain their dignity through life storytelling–a case study. Journal of clinical nursing.
24(15-16). pp.2323-2330.
Houghton, C., Murphy, K., Shaw, D., & Casey, D. (2015). Qualitative case study data analysis:
An example from practice. Nurse Researcher (2014+). 22(5). 8.
Lewis, S. (2015). Qualitative inquiry and research design: Choosing among five approaches.
Health promotion practice. 16(4). pp.473-475.
Oh, P. J., Jeon, K. D. & Koh, M. S. (2015). The effects of simulation-based learning using
standardized patients in nursing students: A meta-analysis. Nurse education today. 35(5).
pp. e6-e15.
Schenker, N., Gentleman, J. F., Rose, D., Hing, E., & Shimizu, I. M. (2016). Combining
estimates from complementary surveys: a case study using prevalence estimates from
national health surveys of households and nursing homes. Public Health Reports.
Stacey, G., Pollock, K., & Crawford, P. (2015). A case study exploring the experience of
graduate entry nursing students when learning in practice. Journal of advanced nursing.
71(9). 2084-2095.
Online
Clinical Care Standards. 2017. [Online]. Available through:
<https://www.safetyandquality.gov.au/our-work/clinical-care-standards/>
Essential elements for recognising and responding to deterioration in a person’s mental state.
2017. [Online]. Available through:
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<https://www.safetyandquality.gov.au/wp-content/uploads/2017/08/National-Consensus-
Statement-Essential-elements-for-recognising-and-responding-to-deterioration-in-a-person
%E2%80%99s-mental-state-July-2017.pdf>
Mental health nursing : dimensions of praxis / edited by Karen-leigh Edward, Ian Munro,
Anthony Welch, Wendy Cross. 2016. [Online]. Available through:
<https://trove.nla.gov.au/work/37186304?selectedversion=NBD59969082>
Mosby's Pocketbook of Mental Health. 2018. [Online]. Available through:
<https://www.elsevier.com/books/mosbys-pocketbook-of-mental-health/muir-cochrane/
978-0-7295-4190-9>
Nursing Assessment. 2016. [Online]. Available through:
<https://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/Nursing_assessment/>
Psychiatric & Mental Health Nursing. 2012. [Online]. Available through:
<https://www.elsevier.com/books/psychiatric-and-mental-health-nursing/evans/978-0-
7295-4098-8>
The need for a new medical model: a challenge for biomedicine. 2016. [Online]. Available
through: <https://www.ncbi.nlm.nih.gov/pubmed/847460>
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