Nursing Foundations: Case Study Analysis

This case study analysis focuses on a patient with schizophrenia and discusses the problem, solution, and role of the nurse in providing care. It also covers assessment, treatment, communication, and ethical principles in mental health nursing.

NURSING FOUNDATIONS 1
Nursing Foundations
Student’s Name
Institutional Affiliation

NURSING FOUNDATIONS 2
PART 1: CASE STUDY
Magdalene, a 60-year-old lady, was first married when she was 22 years to Robert but after four
years she was divorced. After her divorce, she remarried severally and also had many informal
relationships which had not lasted for long. When Magdalene was 40 years old, she started
behaving strangely, walking around her village during the night shouting, self-talking together
with self-laughing. By this time she was living alone in a single mad walled room which was
grass thatched and very dirty since her relationship with another man had broken. Because her
behavior was a threat to the whole community her neighbors took her to a community hospital
where she was diagnosed with schizophrenia and since then she has been hospitalized several
times in acute care psychiatric facilities. It was also found that Magdalene’s mother suffered
schizophrenia when she was in her 50’s but died later as a result of cancer.
The last time to be admitted which was three years ago she was diagnosed with a
borderline personality disorder which might have resulted due to a pattern of varying moods as a
result of the many broken relationships. Magdalene has a 10-year-old son called Martial who has
been in and out of foster care homes, and she attends her school occasionally although she hates
it saying that she is stupid and the other kids are mean. They both live in a dirty motel room.
Two years ago which was her last separation and divorce Magdalene's clinical presentations
were more exaggerated. Up to that time, she had worked intermittently as a temporary clerical
employee via a local personnel agency, but when her overreactions to office stress and her
manipulation character became very pronounced, she was sacked and stayed jobless till now.
Magdalene presents herself in a hospital emergency room with both her body and clothes filthy.

NURSING FOUNDATIONS 3
Although the weather is rainy and freezing, she is not on any coat and meets one of the clinical
nurses, and they start conversing.
Nurse: Hello, my name is Elizabeth, but you can call me Lizzy and I wish to help. How can I
call you madam?
Magdalene: My name is Magdalene.
Nurse: Okay Magdalene, do you have any family or friends?
Magdalene: As for the family I don’t have any other relation around apart from my ten-year-old
son, Martial and I do not have any friend because there are no people who want to be friendly.
Nurse: Where is Martial at the moment?
Magdalene: Martial is in school today. I got scared and could not wait for him.
Nurse: It is okay Magdalene we will verbalize a proper plan for the care of Martial during the
time of your hospitalization and of friends I can be your friend. Now, how do you feel or how
can I help you?
Magdalene: There is a man down the street, and he says he is going to harm me that is why I
came here to seek admission.
Nurse: It is alright Magdalene. Do you know the man and did you do anything to him?
Magdalene: There are a lot of nasty and mean individuals out there only that you can’t get away
from them and you have got to let me in.

NURSING FOUNDATIONS 4
Nurse: (Wondering what kind of answer she has given to her but on looking at her leg she
notices that Magdalene has a giant leg ulcer) Magdalene, what happened to your leg?
Magdalene: My leg gets tired sometimes, and I can't remember when my leg got sore like this.
The nurse decides to examine Magdalene, and she finds out that she has medical issues of
a giant weeping ulcer of 5 cm in length of stage 3 on a swollen left ankle, a serum glucose level
of 263, respiratory rate of 22, heart rate of 98 and high blood pressure of 160/98. Magdalene
refuses to let the nurse take her temperatures and instead tells the nurse that she is starving and
tired. Since Magdalene is agitated, the nurse is not able to undress her. Consequently, the nurse
can feel protruding bones under Magdalene's clothes and her skin is dry and flaky with several
bruises, abrasions along with scars. Furthermore, her feet are cracked and calloused.
PART 2: CASE STUDY ANALYSIS
Describe and analyze the problem(s) presented in your case study. What occurred and
why?
The problem presented in the case study is Schizophrenia which is a mental disorder that
interferes with an individual’s capability of recognizing what is real, think clearly, communicate
and make judgments along with managing his or her emotions (Ashwini, Prasad & Kosgi, 2017).
Strange symptoms are associated with Schizophrenia-like hearing imaginary voices along with
believing that the sounds are controlling their actions and thoughts.
From the case study, Magdalene is seen behaving strangely such as shouting while
walking around her village at night; there is an indication that she laughs and talks to herself
which is not normal and she feels not safe around people to the extent that she does not have a

NURSING FOUNDATIONS 5
friend. Moreover, when asked a question by a health professional she does not respond
accordingly but provides an irrelevant answer.
The reason why this problem occurred is due to genetic inheritance. It is believed that if a
close relative ever experienced schizophrenia, there are higher chances that one close to her or
him might suffer the same (Maziade, 2018). From the case study, it is evident that Magdalene's
mother had had schizophrenia in her 50‘s and this demonstrates how Magdalene came across the
disorder. Furthermore, relationships triggered her present condition in the sense that the tension
she encountered from her several broken relationships affected her mental health resulting in
schizophrenia.
Present solution(s) and how they could be implemented. What would you do as a nurse in
the case study?
The current solutions for this condition include social skills training along with individual
therapy (Hodgkinson, Evans, O'Donnell, Nicholson & Walsh, 2017). Social skills training could
be implemented by involving Magdalene to interact with other people to improve
communication and improve the capability to engage in everyday operations. However,
psychotherapy could be applied to normalize thought patterns and learn to cope with stress.
During the first few hours as the nurse taking care of Magdalene I would concentrate on
lowering her anxiety for her to accept the needed care and to have the opportunity to make
contact with Magdalene I would meet her physiological needs like food and locate Martial at
school to inform him that he will not find his mother at home. It would be essential to discuss
with her on how to access benefits and programs for Martial's support and education by

NURSING FOUNDATIONS 6
discharge, and then I would bring him to the hospital to see his mother before taking him to an
emergency foster home.
Role of the nurse
Dealing with mental health problems like schizophrenia mental health nurses has a role in
organizing group therapy sessions including artistic along with social events to promote the
psychological recovery of his patient. Also, the mental health professional should build
relationships and replicating to their emotional together with physical needs while providing
adequate care (Gabrielsson, Sävenstedt & Olsson, 2016). Consequently, the mental nurse should
provide individual counseling to the patient to have a better understanding of the condition and
assist the patient in dressing along with taking their drugs correctly. Finally, psychiatric nurses
have to work closely with their treatment staff to develop an individualized plan which gives the
patient the total attention needed for the patient to live a productive life.
Assessment
Assessment involves an interview from a mental health nurse to a patient which includes
looking at the look of the patient, the mood and the way she speaks. Nurses will ask about
personal history, traumatic events encountered, religious belief and whether on drug use
(Henderson, 2017). Physical examination follows to exclude the physical causes of the current
mental health problems of the patient. Other medical tests might be used like lab tests if there
seems to be suspicious of specific reasons.
DSM5

NURSING FOUNDATIONS 7
Mental health professionals utilize the Diagnostic and Statistical Manual the fifth edition
(DSM5) when determining what a patient is experiencing, and the information obtained analyzes
the diagnostic features and symptoms, level of impairment, and the duration of symptoms
(Buckley, 2016). Using elements and symptoms DSM5 delineates five criteria; delusions,
hallucinations, disorganized speech, disorganized behavior, and negative symptoms and the
duration of the symptoms persist.
Treatment
Treatment of schizophrenia involves therapy along with medication to minimize the risk
of future psychotic episodes and enhance relationships. Various medications are used to treat
schizophrenia-like antipsychotic drugs which are proven to be useful in the treatment of acute
psychosis and minimizing the peril of future psychotic episodes (Kane & Correll, 2016).
Therapies such as electroconvulsive therapy are used by doctors to treat mental illnesses like
schizophrenia and psychotherapy which is a kind of talk therapy to help one understand and
control symptoms of schizophrenia (Nomura, Kishi, Ikuta & Iwata, 2018).
Communication and therapeutic nurse-client relationship
Mental health nurses utilize a wide range of effective communication strategies along
with interpersonal skills to correctively develop, maintain, re-establish and terminate the nurse-
client relationship (Rasheed, 2015). The nurse should introduce herself by name to the patient
and address the patient by her name. Also, he should give the patient time and opportunity to
explain herself listening to her with the intention to comprehend but not to diminish her feelings
or instantly providing advice. Moreover, the mental health provider should recognize that all

NURSING FOUNDATIONS 8
behavior has meaning and should seek to understand the cause of strange comment by the patient
(Stockmann, 2018).
To develop a therapeutic nurse-client relationship the mental health nurse should include
the patient in the care as a partner since the patient is the expert on her life and he should also
gain an understanding of the limitations and capabilities of the patient and needs associated with
her health situation. Furthermore, the nurse should show sensitivity along with respect for the
choices the patient makes together with committing to being available to the patient in the period
of care within the employment boundaries and role context.
Legal and ethical principles related to mental health
As per constitutional laws associated with mental health all patients should be regarded legally
competent till they have declared incompetent through legal proceeding and there should be
implied consent (Schulze, 2016). On the other hand, the ethical principles in mental health
comprise of autonomy, beneficence, nonmaleficence along with justice (Slade, 2017).
Cultural competency related to mental health nursing
Cultural competence in mental health nursing involves a set of processes or skills which
help mental health professionals to deliver services that are culturally appropriate for the diverse
populations that they serve. The critical elements of cultural competence include cultural
encounter, artistic skill, and cultural knowledge along with cultural awareness viewed by the
Culturally Competent Model of Care (Shen, 2015). It encourages nurses to see themselves as
always in the process of becoming culturally competent instead of being culturally competent.

NURSING FOUNDATIONS 9
Teaching and learning principles and health promotion to the mental health client and
family
Teaching and learning involve providing information and training patients and their
families how to attain better health which is a typical role in nursing. Patients and their families
need to be educated to gain knowledge which would enable her to decide on a specific health
action and also to be motivated to accept a process of behavioral change via directly impacting
their beliefs, attitude systems along with values (Martin & Nahar, 2017).
On the other hand, health promotion involves social, political and economic change and
therefore patients and their families should be taught on how to ensure their environment is
conducive for their health. The nurse has a role in educating their patients about their health
needs and also tries to address the broader social and environmental problems that negatively
impact the health of individuals.
Nursing process and nursing metaparadigm
The nursing process is a problem-solving and interactive process which is a systematic and
individualized way to attain results of nursing care. It respects an individual's autonomy and
freedom to make decisions and be engaged in nursing care. The nursing process involves
assessment of the patient, nursing diagnosis, identification of the outcomes, planning,
implementation and evaluation (Doenges, Moorhouse & Murr, 2016).
In contrast, nursing metaparadigm is an overarching framework which provides a
comprehensive perspective of a discipline which serves to differentiate the profession
intellectually. The four metaparadigm of nursing are a person, environment, and health along
with nursing (Vonarx, 2016). Metaparadigm of person concentrates on the patient who is the

NURSING FOUNDATIONS 10
recipient of the care; the environment refers to the external and internal context or setting of an
individual’s social encounter. Metaparadigm of health refers to the extent of wellness and
healthcare access that a client has. Finally, the nursing metaparadigm refers to the nurse and how
he will apply his knowledge and skills when taking care of the patient.

NURSING FOUNDATIONS 11
References
Ashwini, R., Prasad, B. V., & Kosgi, S. (2017). Psychosocial Intervention Strategies for Patients
with Schizophrenia: In Chronic Mental Illness. In Chronic Mental Illness and the
Changing Scope of Intervention Strategies, Diagnosis, and Treatment (pp. 58-75). IGI
Global.
Buckley, P. F. (2016). Schizophrenia Spectrum and Other Psychotic Disorders: DSM-5
Selections. Journal of Psychiatric Practice®, 22(3), 257.
Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2016). Nursing diagnosis manual: planning,
individualizing, and documenting client care. FA Davis.
Gabrielsson, S., Sävenstedt, S., & Olsson, M. (2016). Taking personal responsibility: Nurses' and
assistant nurses' experiences of good nursing practice in psychiatric inpatient
care. International journal of mental health nursing, 25(5), 434-443.
Henderson, S. (2017). Clinicians and Bicultural Workers' Views on Coassessment to Improve
Mental Health Assessments in Multicultural Clients.
Hodgkinson, B., Evans, D., O'Donnell, A., Nicholson, J., & Walsh, K. (2017). The effectiveness
of individual therapy and group therapy in the treatment of
schizophrenia. Group, 1(14.31), 0-05.
Kane, J. M., & Correll, C. U. (2016). The role of clozapine in treatment-resistant
schizophrenia. JAMA Psychiatry, 73(3), 187-188.
Martin, B., & Nahar, V. K. (2017). Book Review: Theoretical Foundations of Health Education
and Health Promotion. Perspectives in public health, 137(6), 348.

NURSING FOUNDATIONS 12
Maziade, M. (2018). 7. retinal functions expressed in retinal imaging, contrast processing, and
electroretinography may decrypt early risk mechanisms and pathophysiology of
schizophrenia and mood disorders and accelerate translation to the clinic: schizophrenia
bulletin, 44(suppl 1), s10.
Nomura, I., Kishi, T., Ikuta, T., & Iwata, N. (2018). Statin add-on therapy in the antipsychotic
treatment of schizophrenia: a meta-analysis. Psychiatry research, 260, 41-47.
Rasheed, S. P. (2015). Self-Awareness as a Therapeutic Tool for Nurse/Client
Relationship. International journal of caring sciences, 8(1).
Schulze, M. (2016). Human rights principles in developing and updating policies and laws on
mental health. Global Mental Health, 3.
Shen, Z. (2015). Cultural competence models and cultural competence assessment instruments in
nursing: a literature review. Journal of Transcultural Nursing, 26(3), 308-321.
Slade, M. (2017). Implementing shared decision making in routine mental health care. World
Psychiatry, 16(2), 146-153.
Stockmann, C. (2018). Presence in the Nurse-Client Relationship: An Integrative Review.
International Journal for Human Caring, 22(2), 49-64.
Vonarx, N. (2016). The body in the nursing discipline: An essential to link the four concepts of
the metaparadigm. Recherche en soins infirmiers, (4), 8-15.