Principles of Nursing: Mental Health

This article discusses the principles of nursing in relation to mental health, specifically focusing on substance abuse and trauma-informed care. It analyzes a case study of a patient named Lisa who is struggling with substance abuse and explores the factors contributing to her problem. The article also highlights the importance of trauma-informed care and collaboration among healthcare professionals in providing effective treatment. Recommendations for specialized care, such as referring the patient to an occupational therapist, are also discussed.

Running head: PRINCIPLES OF NURSING
Principles of Nursing: Mental Health
Name of the Student:
Name of the University:
Author’s Note:

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Mental health illnesses had emerged as one of the most important issues that the
different individuals of the world are currently suffering from (Reeves, 2015). The problem
of substance abuse directly contributes towards different kinds of mental health issues that
the individuals commonly face and in some of the severe cases of substance abuse the
patients start to lose their sense of time and place as well (Quiros and Berger, 2015). Some of
the most important problems that the individuals with sustained substance abuse face are
hallucinations, depression, anxiety, a high sense of insecurity, paranoia and others (Isobel,
2015). These are precisely the problems that Lisa, a repeated substance abuser of cannabis
and speed faces in the video “Understanding the MSE – Lisa”.
There are various issues or causes which lead to substance abuse like genetics,
physical environment, mental health illnesses, peer pressure, trauma and others (Hall et al.,
2016). In the video under discussion here, Lisa is a patient who had been under medication
for quite some time however she again begins to use substances like speed and cannabis on
moving in with her boyfriend (DreamSchemaMedia, 2011). More importantly, she had
become psychotic and is afraid that the cameras in her home are watching and also her
boyfriend had placed a transmitter in her stomach so as to monitor her (DreamSchemaMedia,
2011). She becomes disillusioned and starts to sleep in the garden shed with a knife under her
pillow thinking that her boyfriend Jonah will hurt her. Three of the major factors which have
contributed towards her problematic substance use are peer pressure, environment and
trauma.
In the video, Lisa mentions to her counselor that her parents did not want her to move
out with her boyfriend and ever since she had moved out she had no contact with them
(DreamSchemaMedia, 2011). This in turn had created a feeling in her that she is being
neglected by her parents and in turn had added to the trauma which she feels at the house of
her boyfriend. Kirst, Aery, Matheson and Stergiopoulos (2017) state that trauma or neglect

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for that matter is one of the major issues or causes which propel the individuals to use drugs
like cannabis, speed and others. Another important issue which had caused the problem of
substance abuse which Lisa is presently suffering from is environment in which she lives. For
example, she is recently moved out of her parent’s home and is living with her boyfriend,
Jonah. The house of Jonah has security cameras which make Lisa uncomfortable and also
makes her think that she is being watched and the cameras are trying to say something to her
(DreamSchemaMedia, 2011). More importantly, this had made her to have hallucinations and
she thinks that her boyfriend is trying to harmful although she herself says that he had not
given any cause to her to make her think so or has not hurt anybody till now. Thus, in order to
cope up with these insecurities or safety concerns she resorts to the usage of cannabis and
speed to adjust to her present environment, that is, in the home of her boyfriend, Jonah.
Lastly, the factor of peer pressure is another important issue which has made her to resort to
the usage of drugs again after undergoing medication for the same. In this regard, it needs to
be said that while she was at her parent’s home, they made her to undergo proper medication
and also she did not feel the urge to intake drugs. However, the act of her parents not talking
to her after she had moved out of their house is another factor which could have contributed
in a significant manner towards her substance abuse problem. This had created a sense of
abandonment in her mind and in order to adjust the new reality of her life she resorts to the
usage of drugs once again.
The Department of Health Services had made it mandatory for the service providers
to use the “trauma-informed care and practice” principles for the delivery of effective as well
as quality services to the patients with different kinds of problems (Isobel & Edwards, 2017).
The six important attributes or principles of the concerned framework of care and practice are
safety, trustworthiness and transparency, peer support, collaboration and mutuality,
empowerment and choice, cultural, gender and historical issues (Bryson et al., 2017). The

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usage of this care and practice in the particular case of Lisa and the problems that she is
facing would reveal insightful information. For example, as per the first principle, that is,
safety, Lisa does not feel comfortable or safe in the house she is presently residing in. This is
perhaps one of the major reasons why she sleeps in the garden shed with a knife under her
pillow. On the other hand, as per the second principle, that is, trustworthiness and
transparency, it is seen that Lisa had developed trust issues with her boyfriend and thinks that
he had transplanted a transmitter in her stomach to detect her inner thoughts and movements.
More importantly, Lisa is not getting adequate amount of support from her peers and as a
matter of fact they have stopped interacting with her after she had moved-in with her
boyfriend, Jonah. Furthermore, there is no mutuality or collaboration between Lisa and Jonah
and this becomes apparent from the trust issues that she had developed. Moreover, Lisa feels
that she does not have adequate choice or empowerment in her current situation and in order
to empower herself she resorts to the usage of a knife. Lastly, Lisa had issues of substance
abuse in the past as well and the net result of this is that when in present situation she faces
challenges she once again resorts to the usage of the same.
The collaborative practice of care had emerged as one of the most important ones
within the framework of the contemporary healthcare industry and the counselors are not
only required to collaborate in an effective manner with their patients but also with the other
healthcare authorities or bodies so as to offer the best quality services to them (Harden et al.,
2015). This even becomes apparent from the case of Lisa and her counselor in the video
under discussion here. For example, it is seen that the counselor of Lisa tries to analyze the
issues which Lisa is facing presently that had led to her substance abuse problem and also the
symptoms that she is manifesting so as to offer a more personalized care for her personal
recovery. The net result of this is that she takes the help of “Mental State Examination”
framework to analyze her present condition. In this regard, it needs to be said that Lisa

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appears to be disjointed since she normally looks very smart and although she shows no sign
of depression yet she is paranoid and seen to be responding to some unseen external stimuli
(DreamSchemaMedia, 2011). More importantly, she is disillusioned and not much attentive
during the entire course of the session while showing signs of restlessness and agitation
(DreamSchemaMedia, 2011). Furthermore, although she is not suicidal yet she thinks that she
might harm Jonah if he enters the garden shed in which she sleeps at night. Lastly, even in
her present state of mind she is agreeable and is willing to accept the help that her counselor
had to offer her by referring her to the mental healthcare authorities (DreamSchemaMedia,
2011).
The counselor of Lisa have been able to identify these symptoms that Lisa had been
facing not only on the basis of the MSE tool but also through an effective analysis of the
issues that had led to her present state of mind. This is important from the perspective that the
effective identification of the issues which caused the substance abuse and other problems
that Lisa was suffering enabled her to objectively understand her present state of mind of
condition in an effective manner. More importantly, this also helped her to gather adequate
information from Lisa for conducting the risk assessment and thereby to analyze the actual
state of Lisa. This in turn enabled to decide whether or not she needs specialized care for
speeding up the process of her personal recovery and also to ensure that she does not cause
any significant amount of harm to herself or for that matter those around her.
The nurses while applying trauma informed care principles need to take into effective
consideration the fact that negative impact of trauma could have lasting impact on the mental
health of the patients (Goodman et al., 2016). The nurses while administering trauma
informed care to the patients need to take the help of various tools like patient engagement,
clinical as well as organized care and others to ensure the wellness of the patients (Levenson,
2017). Basically, the nurses are required to follow various steps for administering effective

5PRINCIPLES OF NURSING
trauma informed care services like identifying the root issues of the symptoms or problems
that the patient is having, take the help of the MSE and risk assessment tools to analyze the
extent of threat or danger that these problems present and lastly to recommend specialized
care if the situation demands (Carello & Butler, 2015). An important member of the mental
health multidisciplinary team to whom the mental health nurses can recommend patients like
Lisa is the occupational therapist. The occupational therapists are the qualified professionals
who assess the mental condition of the patients in an objective as well as subjective manner
and thereby devise recovery plans through which the patients can recover from the mental
problems that they are facing (Berliner & Kolko, 2016). This is important because the
majority of the counselors lack the technical skills to administer effective recover process to
the patients and thus the patients often find it very difficult to recover from the mental health
issues that they are facing (Raja et al., 2015). More importantly, the occupational therapists
are specially trained to handle the cases of patients who suffer from the problem of substance
abuse, hallucinations, pose a significant threat to their surrounding people and others (Hall et
al., 2016). In addition to these, the care administered by them is not only in synchronicity
with the requirements or stipulations stated by the healthcare services department of the
national government but also follow the ethical or moral code of counseling as well (Bryson
et al., 2017). On the basis of these, it can be said that recommending or referring Lisa to an
occupational therapist would be the best decision on the part of her counselor.
To conclude, the trauma-informed care and practice had emerged as one of the most
important ones within the framework of the contemporary care methods which are being used
by the healthcare professionals for administering treatment services to them. More
importantly, the counselors or the healthcare professionals taking the help of this framework
are not only required to comply with its different principles but at the same time identify the
different issues that have led to the present condition of the patients. In addition to this, the

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counselors are also required to take the help of the MSE framework for analyzing the present
condition of the patients and thereby determining whether they need advanced care or not.

7PRINCIPLES OF NURSING
References
Berliner, L., & Kolko, D. J. (2016). Trauma informed care: A commentary and critique. Child
maltreatment, 21(2), 168-172. Retrieved from
https://journals.sagepub.com/doi/abs/10.1177/1077559516643785?journalCode=cmxa
Bryson, S. A., Gauvin, E., Jamieson, A., Rathgeber, M., Faulkner-Gibson, L., Bell, S., ... &
Burke, S. (2017). What are effective strategies for implementing trauma-informed
care in youth inpatient psychiatric and residential treatment settings? A realist
systematic review. International journal of mental health systems, 11(1), 36.
Retrieved from https://doi.org/10.1186/s13033-017-0137-3
Carello, J., & Butler, L. D. (2015). Practicing what we teach: Trauma-informed educational
practice. Journal of Teaching in Social Work, 35(3), 262-278. Retrieved from
https://www.tandfonline.com/doi/abs/10.1080/08841233.2015.1030059
DreamSchemaMedia, (2011). Understanding the MSE - Lisa [Video]. Retrieved from
https://www.youtube.com/watch?v=83i2MWMqph8
Goodman, L. A., Sullivan, C. M., Serrata, J., Perilla, J., Wilson, J. M., Fauci, J. E., &
DiGiovanni, C. D. (2016). Development and validation of the Trauma‐Informed
Practice Scales. Journal of Community Psychology, 44(6), 747-764. Retrieved from
https://onlinelibrary.wiley.com/doi/abs/10.1002/jcop.21799
Hall, A., McKenna, B., Dearie, V., Maguire, T., Charleston, R., & Furness, T. (2016).
Educating emergency department nurses about trauma informed care for people
presenting with mental health crisis: A pilot study. BMC nursing, 15(1), 21. Retrieved
from https://doi.org/10.1186/s12912-016-0141-y

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Harden, T., Kenemore, T., Mann, K., Edwards, M., List, C., & Martinson, K. J. (2015). The
Truth N’Trauma Project: Addressing community violence through a youth-led,
trauma-informed and restorative framework. Child and Adolescent Social Work
Journal, 32(1), 65-79. Retrieved from
https://link.springer.com/article/10.1007/s10560-014-0366-0
Isobel, S. (2015). ‘Because That's the Way It's Always Been Done’: Reviewing the Nurse-
Initiated Rules in a Mental Health Unit as a Step Toward Trauma-Informed
Care. Issues in mental health nursing, 36(4), 272-278. Retrieved from
https://www.tandfonline.com/doi/abs/10.3109/01612840.2014.982842
Isobel, S., & Edwards, C. (2017). Using trauma informed care as a nursing model of care in
an acute inpatient mental health unit: A practice development process. International
journal of mental health nursing, 26(1), 88-94. Retrieved from
https://onlinelibrary.wiley.com/doi/full/10.1111/inm.12236
Kirst, M., Aery, A., Matheson, F. I., & Stergiopoulos, V. (2017). Provider and consumer
perceptions of trauma informed practices and services for substance use and mental
health problems. International Journal of Mental Health and Addiction, 15(3), 514-
528. Retrieved from https://link.springer.com/article/10.1007/s11469-016-9693-z
Levenson, J. (2017). Trauma-informed social work practice. Social Work, 62(2), 105-113.
Retrieved from https://doi.org/10.1093/sw/swx001
Quiros, L., & Berger, R. (2015). Responding to the sociopolitical complexity of trauma: An
integration of theory and practice. Journal of Loss and Trauma, 20(2), 149-159.
Retrieved from https://www.tandfonline.com/doi/abs/10.1080/15325024.2013.836353

9PRINCIPLES OF NURSING
Raja, S., Hasnain, M., Hoersch, M., Gove-Yin, S., & Rajagopalan, C. (2015). Trauma
Informed Care in Medicine. Family & community health, 38(3), 216-226. Retrieved
from https://doi.org/10.1097/FCH.0000000000000071
Reeves, E. (2015). A synthesis of the literature on trauma-informed care. Issues in mental
health nursing, 36(9), 698-709. Retrieved from
https://www.tandfonline.com/doi/abs/10.3109/01612840.2015.1025319