Care Plan for Auditory Hallucinations: A Case Study of Stephen

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Florence Nightingale Faculty
of Nursing, Midwifery & Palliative Care,
King’s College London
Assessment, Formulation & Management of Care
7KNIM730 2018/19
Practical Exam
Using the pro-forma overleaf you are required to write a care plan for ONE
identified or perceived need for either ‘Stephen’ or ‘Moyra’.
Here are the two links for the film assessment, student are required to do a care
Plan based on any these two film assessment
https://vimeo.com/fnsnm/review/73619905/38a2bb59cd
Stephen
https://vimeo.com/fnsnm/review/107799778/c34958480f
Moyra
You may review the assessments on the KEATS site for this module.
The care plan must include a clear statement about the perceived or identified
need and possible goal(s). It is expected to be a client-focussed, practical,
working document with specific, measurable, achievable, realistic, and timely
goals and actions, with an indication of how these will be evaluated. You are not
required to reference the care plan but you are expected to choose an
appropriate, evidence-based intervention relevant to the client’s needs.

Your brief commentary should describe your rationale for focussing on the
particular need identified; outline the strengths and limitations of your care plan
in practice; and discuss how you might promote collaboration in practice.
Candidate number:……………………………………………….
Chosen client: Stephen  Moyra 
(Please tick the box to indicate which client your care plan is about)
Plagiarism Policy for Students undertaking programmes in the Florence Nightingale School of Nursing & Midwifery.
I have read and understand the statement concerning plagiarism. I confirm that the work attached is my own and that
I will follow the College and university Regulations in respect of plagiarism or any other examination offence.
Candidate’s initials………… Date……………………..

Need identified:
Stephen complains “I have been hearing strange voices which I am unable to understand. The
voices are most prominently coming out of the Television and radio”
Goal(s):
The client hopes to achieve a stable life without any auditory hallucinations. Further, the care
plan aims to achieve adequate sleep, diet and refraining oneself from any form of abuse or
drug addiction.
Actions/Interventions:
S – Specific – The goals should be specifically orientated to control the extent of auditory
hallucinations for Stephen.
M –Measurable – The goals should also be measurable which means that scalable
improvement in terms of his symptoms’ relief should be recognized.
A – Achievable - The goals that are identified should be based as per an achievable timeframe
and should have an achievable matrix.
R – Realistic – The goals should also be realistic and set only if they have been achieved in
reality by the previous specialists.
T – Timely – The care plan goals should also be achievable within a specific timeframe and
the progress should be measured as per the daily targets.
Evaluation:
To evaluate this care plan, Stephen must be critically monitored during the 28 weeks period.
His general and detailed examination should include all the current situations and after the
care plan is being implemented, his health condition should improve in a phased manner with
the regular improvement of anxiety and auditory hallucinations (van der Gaag, et al., 2014).

Commentary:
Stephen was found to experience auditory hallucinations that may or may not be due to an underlying
mental health problem. This symptom is, however, most commonly found in patients having psychotic
disorders like schizophrenia.
The following interventions will help to form the care plan:
1. The environmental stimuli should be as low as possible so that the environment is quiet and it
decreases any triggering factor for increased patient anxiety (Thomas, et al., 2014).
2. While Stephen is being monitored continuously, the time when he hears the voices he should be
advised to tell the voices to ‘go away’. This directive should be repeated regularly to make a practice.
This, if guided within a trusting relationship, can especially help Stephen to avoid the strange voices.
3. In order to avoid multiple and confused thoughts that may provoke anxiety or auditory
hallucinations, the conversations should be kept as simple and short as possible.
4. Spending time with Stephen to identify the activities that can help to keep the patient engaged in
some sort of playful work and help to get distracted from the voices (Koops, et al., 2015).
While these are the possible interventions suggested the care plan still has certain strengths and
limitations. The strengths are that the plan is based on rationales and evidence that have been
extremely helpful in past cases. Also, these interventions are selected basis the most suitable care
plans according to Stephen’s symptoms. On the other hand, this care plan might not be most
appropriate because it includes the interventions that have been chosen as per the success rate of
previously identified case studies (Koops, et al., 2015).
While these nursing interventions will definitely help to prevent the hallucinations, however, this
effort should be a collaborative one with the involvement of multi-specialty team (that will include the
dietician, sleep therapist, motivational speaker, etc.) that can even improve the final result.

REFERENCES
Koops, S., Dellen, E.V., Schutte, M.J., Nieuwdorp, W., Neggers, S.F. and Sommer, I.E., 2015. Theta
burst transcranial magnetic stimulation for auditory verbal hallucinations: negative findings from a
double-blind-randomized trial. Schizophrenia bulletin, 42(1), pp.250-257.
Koops, S., van den Brink, H. and Sommer, I.E., 2015. Transcranial direct current stimulation as a
treatment for auditory hallucinations. Frontiers in psychology, 6, p.244.
Thomas, N., Hayward, M., Peters, E., van der Gaag, M., Bentall, R.P., Jenner, J., Strauss, C., Sommer,
I.E., Johns, L.C., Varese, F. and García-Montes, J.M., 2014. Psychological therapies for auditory
hallucinations (voices): current status and key directions for future research. Schizophrenia
bulletin, 40(Suppl_4), pp.S202-S212.
van der Gaag, M., Valmaggia, L.R. and Smit, F., 2014. The effects of individually tailored
formulation-based cognitive behavioural therapy in auditory hallucinations and delusions: a meta-
analysis. Schizophrenia Research, 156(1), pp.30-37.