Using an Inquiry Based Learning Approach | Report

Assessment 3 – Case Study 2019
Using an Inquiry Based Learning Approach
Learning strategy
What you need to do
to critically analyse
the Case Study
Thought processes
What you need to demonstrate to your
lecturer in terms of your critical thinking
about this Case Study
Learning Outcomes Section
Demonstrate your learning in each section by presenting the
information that you have examined to improve your knowledge and
understanding of this particular Case Study
STEP 1 -
CONNECT
Analyse each of the
case study documents
Think about what are some of the key issues
or information that you consider are important
in this Case Study?
After conducting in depth evaluation of the documents, it can be said
that the patient, Amanda citizen is suffering from bipolar disorder. While
considering her case scenario, several key issues are required to consider
for supporting her wellbeing and providing her with accurate
interventions for the recovery. The first issue observed in this case is
psychosis which can be the side effects of the drugs that she overdosed for
overcoming depressive episodes. The psychotic episodes can be the result
of the drug addiction she had exhibited manic episodes due to the bipolar

disorder which was manifested through aggression. The behavioural
issues such as aggression and violence can be the result of substance
abuse since the patient had a history of using marijuana and currently uses
other drugs to feel better. The third issue that is required to consider is the
tendency of self-harm and suicidal ideation which can be the reason due
to possible Diazepam abuse. The fourth issue is insomnia which can be
due to the stress and anxiety to which she subjected to. The fifth issue
observed in patient was delusion which can be due to the substance-
induced psychosis inpatient and cognitive impairment in patient. The
patient also had poor personal hygiene as her professionals highlighted
that her activity of daily living has been deteriorated which further
impacted the quality of life. The sixth issue of the patient is that the
patient is delusional which further impacted the quality of life. Since the
patient was experiencing manic or depressive episodes of bipolar disorder
where the disconnected thoughts and false beliefs are common in patients
as observed for this case scenario. The seventh issue, in this case, is
paranoia which is another key issue which was manifested as because of

the psychosis induced by the drug and alcohol. While all issues are
interconnected and mainly observed in the patient due to the relapsing
symptoms of the bipolar, possible substance abuse and alcohol
consumptions aggravated it.
STEP 2 -
QUESTION
What are some of the
questions about this
Case Study that you
want to know more
information?
Identify the additional
information you need
Document your questions here
1. Is patient subjected to past trauma in
childhood?
2. Is there any genetic disorder of Amanda or
her parents?
3. How is the family relationship of Amanda
1. According to stress vulnerability model, a human person carries
genetic and other predisposition to the mental illness (Wasserman
& Sokolowski 2016, p. 30). In this case, due to the presence of the
genetic and other genetic factors, when individuals are subjected
to the stress, the patient developmental disorders such as
personality disorder as observed in this case. Hence in this context
is required to gain the understanding of the trauma that whether
Amanda is subjected to any kind of trauma which further induce
bipolar disorder.
2. It is crucial to gather the history of a genetic disorder or mental
disorder of the patient and her parents to gain the idea of the

to know about so that
you can plan your
care
with her parents?
4. How is Her relationship with her peer?
5.
current bipolar disorder. As discussed above, according to the
stress vulnerability of the model, genetic factors and other
predisposition may induce the mental illness which can pass to the
next generation (Jongeneel et al. 2018, p. 82). In this case, it is
crucial to gain an understanding of whether Amanda has any
genetic disorder or not. In this context, it is crucial to gather the
understanding of whether her parents have any mental disorder or
genetic disorder to determine that possible cause of her bipolar
disease.
3. Loewy et al. (2016, p. 12), highlighted that family relationship
plays a crucial role in the development of personality in the
patient. Appropriate relationship with family member act as a
protective factor for improving mental health and physical health
since parents empower and encourage children to develop
autonomy and self-esteem. Hence, in this context, in order to
investigate the relapsing symptoms of the bipolar disorder, it is
crucial to gain the idea of the relationship with her parents such as

the whether her parents are supporting her to overcome the issue
or not. It is also crucial to understand whether she used to exhibit
aggression to her parents and the reaction of her parents. It will
help to identify the root cause of the reason behind her low self-
esteem and relapsing symptoms of the bipolar disorder.
4. Many researchers highlighted that peer influence is one of the
crucial factors which shapes the personality of the individuals and
the development of the habit of psychosis (Aldinger & Schulze
2017, p. 15). In this current context, her mother highlighted that
during camp involved in alcohol consumption with the
involvement of her peers. In this case, it is crucial to gain an
understanding of the relationship of her peers with her in the past
so that understanding the reason for relapsing symptoms of
bipolar. In this current context, it is crucial to gain the idea of her
relationship with her current peers for understanding her mental
and physical health in depth.

5. Partner violence or distorted relationship with a partner is one of
the traumas that lead to personality disorders. Many researchers
highlighted that violent behaviour within an intimate relationship
may cause physical, psychological or sexual harm to those in the
relationship, including acts of physical aggression, psychological
abuse and controlling behaviors (Grande et al. p. 1570).
consequently, while some individuals can be subjected to
personality disorder due to stress, some of the individuals adapt to
the habit of substance abuse. Hence, in this context, the partner
violence or any other violence associated with the intimate
relationship is crucial to identify for supporting the wellbeing of
Amanda.
6.

STEP 3 -
INVESTIGATE
Review your current
knowledge about the
clients mental illness
in this Case Study
Answer the questions in the
Learning Outcomes Section on the right
After conducting in-depth research on the case study and the evidence-
based researchers, it can be said that Amanda citizen, the patient was
experiencing bipolar personality disorder. Grande et al. (2016, p. 1570),
Bipolar disorders are a type of mood disorders which comprise of one or
more manic with usually one or more depressive episodes. Bullock,
Murray and Meyer (2017), suggested that biochemical imbalances in the
brain such as low level of serotonin and dopamine can lead to the
development of the bipolar disorder. While some researchers argued that
bipolar disorder can be observed due to the stress or trauma individuals
are subjected to, some of the researchers argued that it can be observed in
individuals if the family have a history of the disorders (McElroy et al.
2016, p. 220). The risk factors for bipolar disorders are high stress, drug,
and alcohol abuse and parent or siblings with bipolar disorder (Samalin et
al. 2016, p.170). The clinical manifestations of the disease include manic

episodes with high energy, reduced sleep, delusion, depressive episodes,
and the tendency of self-harm and suicidal ideation. The patient tends to
feel hopeless, the sudden elevation of mood, sadness, lack of sleep where
substance abuse such as the use of alcohol or other drugs aggravates the
clinical manifestations as observed in this case study (McElroy et al.
2016, p. 220)..
The considering the common treatment for the bipolar disorder,
the common treatment for the reduction of suicidal thoughts and self-
harm tendency is dialectical therapy which is a cognitive behavioral
therapy is used for identifying and change negative thinking pattern in
order to bring positive changes in patient (Mayoclinic.org., 2019).
Interpersonal and social rhythm therapy is also considered as an effective
therapy which stabilizes the daily rhythm such as sleeping, walking and
healthy food management which provide benefit to the patients with
bipolar therapy. Psycho-education is another effective intervention for
providing education to the patient and the family members of the patient
for providing the best possible support to the patient (Mayoclinic.org.

2019). Apart from non-pharmacological treatment, Lithium carbonate is
also long term treatment given to the patient for 6 months for reducing
mania and depressive episodes. The antipsychotic and antidepressant can
be given to the patient where usually, Symbyax combination with
fluoxetine (antidepressant) and olanzapine (antipsychotic) are usually
given to improve the depression and mood stabilizers in patients (Malhi et
al. 2018, p. 220). Patients who have bipolar disorders and habit of doing
substance abuse usually refers to the substance abuse treatment to reduce
the impact of the disease. The family members of the patients usually
involve in the interventions for supporting the wellbeing.
STEP 4 -
CONSTRUCT
Using a recovery and
person-centred
Consider the NMBA Registered Nurse
Standards for Practice
You do not need to write anything here
 In order to support the wellbeing of the patient with mental
disorders, Registered nurse (RN) is required to
demonstrate a range of competencies and skills so that
patient can feel empowered and safe. In this case,

approach, explore the
issues raised in this
case study and how
you can support this
person during your
early shift
Consider the nursing interventions and
clinical skills that are required for this Case
Study
You do not need to write anything here
Consider the patient safety concerns related to
this Case Study
You do not need to write anything here
according to the standard 3 of Nursing and Midwifery
Board of Australia (maintains the capability for practice), a
registered nurse must responds in a timely manner to the
health and wellbeing of self and others and provides the
information and educations require to enhance the health
of self and others (Nursingmidwiferyboard.gov.au 2019) .
The registered nurse must involve in the profession and
seek help from other professionals when required. In this
context, as a registered nurse, the primary responsibility
would be communication with parents and other health
professionals regarding this case scenario until she
becomes conscious. An empowered and safe environment
would be created with the assistance of the first principle
of trauma informed care (physical and emotionally safe)
where other professionals and family members so that she
feels safe (Nursingmidwiferyboard.gov.au 2019). Her vital
signs and cognitive function is required to assess which

should be the prime priority of the registered nurse. Her
psychosis episodes are also required to assess and
appropriate support is required to provide.
 For stabilizing the mood of the patient, the patient can be provided
with a limited amount of Olanzapine 5-10 mg PRN for agitation
(Xu & Krishnaswamy 2018, p. 637)). With the collaboration of
other health professionals, when she will be conscious,
Interpersonal and social rhythm therapy can be given for
improvement of sleeping and healthy diet. The rationale behind
choosing this interventionist that it is evidenced-based treatment
designed to help people with bipolar disorder to improve mood by
understanding and stabilizing biological and social rhythms (Inder
et al. 2015, p. 130).
 The proper nutrition can be provided to her to improve her health
with the assistance of nutritionist.

 For improving the hygiene, the patient can be provided with the
interventions such as the activity of daily living because the
activity of daily living helps patients in the management of daily
activities such as bathing, toileting, feeding, and other activities
without proper assistance (Zhang et al. 2018, p.211). The psycho-
education can be given to her for improvement of the health
status and self-management.
 For improving self-harm, suicidal ideation and improvement of
the paranoia and delusion, the patient is required to provide with
dialectical therapy with the assistance of other health
professionals. It is a cognitive behavioral therapy is used to
identify and change negative thinking pattern in order to bring
positive changes in patient (Linehan & Wilks 2015, p. 100).
 Considering the safety of the patient, violence and aggression is
safety concern of the patient. The registered nurse must
incorporate her mother in the therapy and create an empowered
environment so that she feel safe and empowered. In order to

ensure her safety and reduce violence, the registered nurse must
engage the patient in the therapeutic communication for building
trust and being transparent to the patient according to the
standard 2.
STEPS 5 and 6
Reflect on the parting
comments made by
the night duty RN
STEP 5 - EXPRESS
Document your thoughts about these
comments made by the night duty RN below
“Parting comment given by RN”
I don't know why we are
wasting our time looking
after a woman who wants
to kill herself when there
STEP 6 - REFLECT
According to Hunter et al. (2015, p.32), Mental health nurses are
responsible for planning and providing recovery directed approach to the
patients who are suffering from a range of mental health issues. The
common practice in this area is that a registered nurse must provide safe
and responsive care to the patient for the best interest of the patient
according to the NMBA code of ethics beneficence and non-maleficence.

are plenty of sick people
out there who need hospital
beds".
Need TO DOCUMENT OUR THOUGHT
ABOUT THIS COMMENT .But ITS NOT
WRITTEN HERE Please INCLUDE
In this context, in my opinion, the comment on the registered nurse not
only impacted the nursing practice but also question the safety of the
patient. The registered nurse required to provide the best possible support
to the patient and provide additional support to the patient considering the
urgency of the situation. The comment of the registered nurse was the
reflection of her personal values rather than professional values which
further impacted her nursing practice. The registered nurse could be
empathetic towards Amenda and could provide best possible support for
her faster recovery. While other patients require nursing assistance, the
registered nurse must prioritize patients according to the severity and in
this current context, Amanda should be the priority
(Nursingmidwiferyboard.gov.au 2019). Hence, in order to improve her
practice, I believe the registered nurse must alter her professional values
through Johori window and involve training and workshops for evaluating
clinical practice so that her nursing values can be altered.

References – Please include a list of all your references used in this case study

References:
Aldinger, F., & Schulze, T. G. 2017. Environmental factors, life events, and trauma in the course of bipolar disorder. Psychiatry and clinical
neurosciences, 71(1), 6-17.
Bullock, B., Murray, G., & Meyer, D. 2017. Highs and lows, ups and downs: Meteorology and mood in bipolar disorder. PloS one, 12(3),
e0173431.
Grande, I., Berk, M., Birmaher, B., & Vieta, E. 2016. Bipolar disorder. The Lancet, 387(10027), 1561-1572.
Hunter, L., Weber, T., Shattell, M., & Harris, B. A. (2015). Nursing students’ attitudes about psychiatric mental health nursing. Issues in Mental
Health Nursing, 36(1), 29-34.
Inder, M. L., Crowe, M. T., Luty, S. E., Carter, J. D., Moor, S., Frampton, C. M., & Joyce, P. R. 2015. Randomized, controlled trial of
Interpersonal and Social Rhythm Therapy for young people with bipolar disorder. Bipolar disorders, 17(2), 128-138.
Jongeneel, A., Pot-Kolder, R., Counotte, J., van der Gaag, M., & Veling, W. 2018. Self-esteem moderates affective and psychotic responses to
social stress in psychosis: a virtual reality study. Schizophrenia research, 202, 80-85.
Linehan, M. M., & Wilks, C. R. (2015). The course and evolution of dialectical behavior therapy. American journal of psychotherapy, 69(2), 97-
110.

Loewy, R. L., Corey, S., Amirfathi, F., Dabit, S., Fulford, D., Pearson, R., ... & Vinogradov, S. 2019. Childhood trauma and clinical high risk for
psychosis. Schizophrenia research, 205, 10-14.
Malhi, G. S., Outhred, T., Morris, G., Boyce, P. M., Bryant, R., Fitzgerald, P. B., ... & Porter, R. J. 2018. Royal Australian and New Zealand
College of Psychiatrists clinical practice guidelines for mood disorders: bipolar disorder summary. Medical Journal of Australia, 208(5),
219-225.
Mayoclinic.org. 2019. Bipolar disorder - Diagnosis and treatment - Mayo Clinic. [online] Available at: https://www.mayoclinic.org/diseases-
conditions/bipolar-disorder/diagnosis-treatment/drc-20355961 [Accessed 30 Sep. 2019].
McElroy, S. L., Crow, S., Blom, T. J., Biernacka, J. M., Winham, S. J., Geske, J., ... & Mori, N. 2016. Prevalence and correlates of DSM-5
eating disorders in patients with bipolar disorder. Journal of affective disorders, 191, 216-221.
Nursingmidwiferyboard.gov.au 2019. Nursing and Midwifery Board of Australia - Professional standards. [online]
Nursingmidwiferyboard.gov.au. Available at: https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-
standards.aspx [Accessed 28 Jul. 2019].
Samalin, L., de Chazeron, I., Vieta, E., Bellivier, F., & Llorca, P. M. 2016. Residual symptoms and specific functional impairments in euthymic
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Wasserman, D., & Sokolowski, M. 2016. Stress-vulnerability model of suicidal behaviours. Suicide. An unnecessary death, 27-37.

Xu, L., & Krishnaswamy, S. 2018. Switch-associated adverse events: focus on olanzapine. Australasian Psychiatry, 26(6), 635-639.
Zhang, L., Sun, L., Zhou, C., Ge, D., & Qian, Y. 2018. The relationship between difficulties in daily living and suicidal ideation among older adults:
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