NRSG264 Mental Health Reflection: Alison Case Study and Cycle Analysis

This paper presents a student's reflection on the case study of Alison, a 38-year-old single mother diagnosed with clinical depression. The reflection analyzes Alison's situation, considering financial struggles, job performance, and relationship stressors, while acknowledging her supportive family. The assessment utilizes a biopsychosocial approach, emphasizing the importance of the Mental Status Examination (MSE). The student applies the Clinical Reasoning Cycle, detailing Alison's diagnosis based on DSM-5 criteria and risk assessment findings. A recovery-oriented treatment plan is proposed, integrating biological, psychological, and social interventions. The student emphasizes patient-centered care, interdisciplinary collaboration, and SMART goal setting for evaluating clinical outcomes. The reflection highlights the significance of a biopsychosocial approach in mental health assessment and management, emphasizing the need to address patients' unique needs. The student's learning experience and how it will inform future practice are also discussed.

Nursing
Student name:
Institutional name

CLINICAL REASONING CYCLE
ALISON CASE STUDY
This paper intends to provide a reflection upon a case study of ‘Alison’ a 38-year-old single
mother of two, with a current working diagnosis of Clinical Depression. In consideration of her
current situation, financially she is not well off and is also struggling to perform her job. There
are significant stressors being feeling so low and also have two children who depend on her.
Moreover, her relationship is not really that good and is also significant that it is becoming a
major stressor to her. However, there are some protective factors include the fact that she has
supportive sisters.
There are many areas to assess as the aetiology of mental health issues has been linked to a range
of factors. As a clinician, you need to know what areas these are and the rationale for
incorporating them. The assessment of Alison requires a biopsychosocial approach. The
biopsychosocial approach involves looking into the person’s biological, psychological and social
factors (Atkins, Colville, & John, 2012). The three dimensions build to the fact that a person
suffers as a whole and not as isolated organs. A key feature of this is the mental status
examination (MSE), that is, a biopsychosocial approach cannot be complete without MSE
(Evans, Nizette, & O’Brien, 2017). In Alison's case, this was undertaken by the GP. A summary
of the findings was that her general appearance was that she was well kempt and dressed
decently. She, however, could not maintain direct eye contact. Her behaviour demonstrated
syndromes of unilateral spatial neglect. Cognitively she was… Her speech was spontaneous and
soft as the patient could relate the questions to answers that yield much useful information. The
thought process was logical and goal oriented. Thought content was devoid of any classical
delusional themes however contained cognitive distortions of derealization. Her affect was
dysphoric. Mood state was depressed and Perception indicates that there was no response to or
report of hallucinations and delusion. Her level of insight was normal with judgment being
normal.
By analysing the available data from this broad approach and more specifically from the MSE,
her diagnosis of Depression can be described by the DSM-5 as a persistent feeling of sadness and
hopelessness and lose interest in the activities which they usually or once enjoyed (Paris, 2013).
In a review of the risk assessment findings, she is currently feeling hopelessness and has lost

interest in activities that she used to enjoy such as watching soap. She is also having a depressed
mood most times of the day and get fatigued easily. Those are some of the factors considered in
making a diagnosis according to DSM-5.
Alison’s current financial situation coupled by her current level of functioning may impact upon
her two children aged and Her relationship with Dave is also deteriorating and are not in good
terms.
In the process of establishing a treatment plan, mindful of a Recovery-oriented approach, the
plan is to handle Alison’s depressing in a psychosocial approach considering all the three
dimensions, that is biological, psychological and social factors that alter her well-being. The
biological aspect will include the use of medications while the psychological deals will
emotionally support. The other aspect of sociological factors deals with the general aspects of
social interactions and relationship with the environment.
When an individual under treatment presents with symptoms of depression, with compounding
financial and personal issues, as a nurse would need to consider the patient as a whole. My care
should be patient-centered, in that I would address the patient according to the individual needs
(Mezzich, et.al, 2013). As I nurse, I would also have to educate the patient as regards the
underlying condition (Dougherty, & Lister, 2015). Patient education helps a lot in ensuring that
the patient's anxiety is alleviated as well as her increased cooperation throughout her
management. Moreover, as a nurse, I would need to initiate the interdisciplinary approach
towards the management of Alison. It will be my role in making sure that she is connected to all
the members of the multidisciplinary approach.
In order to evaluate clinical outcomes, I may need to discuss at a later date with the individual
the mutual set goals. Other means of evaluation could be a set of goals with a specific dateline
then after the set timeline, I can look at the outcome and compared it my expected outcome. I
believe that the set goals should be ‘SMART' (Hammond, Keeney, & Raiffa, 2015). This
implies; Specific, Measurable, Achievable Realistic and Timebound. Such a goal is easily
achievable and can be evaluated well. This is because one can clearly measure as per the aspects
mentioned above. Clinical outcomes should also be always evaluated after the set time and
further adjustments made where need be.

Through the case study and assessment of Alison, I have learned that a person with depression
needs a biopsychosocial approach. I have also learned that it is important to consider a patient as
and the whole individual and address the patient unique needs. In so doing, I will achieve
patient-centered care My broader learning around mental health assessment was that it is one of
the most vital assessment and it is required in order to achieve a biopsychosocial approach. I
believe that in my future practice this will be still part of the assessment and management of a
client with a mental health issue. Therefore, my understanding will help me in my future
practice.
This paper embedded steps of the Clinical Reasoning Cycle (ref) for the purposes of reflecting
upon the scope, nature, and rationale for assessment of the client in this case study. I have
addressed the client scenario following all the steps of Clinical Reasoning Cycle. It ensures that
all aspects of reflections are addressed comprehensively.

References
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