Assessment Task 1: Integrating Practice Case Study - Ron's Scenario

This case study presents a scenario involving Ron, a 15-year-old boy exhibiting suicidal ideation and potential substance abuse. The assignment begins with a detailed account of Ron's background, including his parents' observations of behavioral changes and a description of an interview conducted by a nurse. The interview explores Ron's feelings, potential cannabis use, and physical symptoms. The analysis then applies the Levett Jones clinical reasoning cycle to Ron's case, including collecting cues (nervousness, red eyes), processing information (family dynamics, parental issues), identifying problems (suicidal ideation, depression), establishing goals (therapeutic engagement, behavior responsibility), taking action (drug remittance check, behavioral therapies), and evaluating the treatment's effectiveness. The reflection emphasizes the importance of communication skills, empathy, and creating a non-hostile environment when dealing with patients with disruptive behavior. The case study includes a list of relevant references, supporting the analysis with scholarly research on adolescent mental health and substance abuse.

Running head:INTEGRATING PRACTICE
INTEGRATING PRACTICE
Name of the Student
Name of the university
Author’s note

1INTEGRATING PRACTICE
Assessment task 1
Case scenario
Ron is a 15 years old boy, who has been brought to the mental health department, owing
to his recent suicidal ideation. As reported by his parents Ron had started to steal money from
their bags, in spite of getting enough pocket monies from his parents. Ron does not admit that he
intakes cannabis. However, as reported by his parents, Ron has been in his room for two days.
After two days, when Ron’s mother was about to enter his room, she found him sitting on the
edge of the bed with a sharp knife.
Interview
Before the conduction of an interview involving a psychiatric patient. Hence, as I entered
room I greeted Ron and asked him to sit comfortably.
Interview questions:-
Nurse: Hello Ron! Hope you are doing well. Do you mind, if we have a brief conversation?
Patient: Patient does not responds (he is staring at the ceiling)
Nurse: I heard you like playing video games, but I heard from your mother, that you have not
been playing that since past 5 days. Don’t you feel like going to school?
Patient: No, I hate studies, but I like going to school.
Nurse: Do you feel stressed out with the studies or you brother, since I have heard, you have a
close bonding with your sibling and often feel distressed and sad for him.

2INTEGRATING PRACTICE
Patient: Yea. I love my brother. I don’t like my fathers. They had been quarrelling day and night.
Nurse: So do you take cannabis in order to get relief for stress, or have you watched it from your
friends:
Patient: Uncomfortable and restless, had been avoiding eye contact.
Nurse: Its’ alright. How long had you been taking these drugs?
Patient: I used to take them, but I had stopped taking them since past 5 days. I feel anxious and
depressed, my exams are drawing near and I cannot study properly. I feel better when I am on
the cannabis. Otherwise I feel nothing is going to be right and that I feel like a useless person.
Nurse: do you experience any physical problems:
Patient: Yes I was having abdominal cramps yesterday.
Nurse: Well, I had done with the questions. Do you have anything to ask?
Patient: does not answer.
Interview analysis
Levett Jones clinical reasoning cycle
Considering the patient situation
Ron is a 15 years old adolescent boy, who had been brought to the emergency department
due to his recent weird and self-destructive activities. Ron is poorly groomed, his hairs are
disarranged, avoids eye contact, eyes were red, restless throughout session.

3INTEGRATING PRACTICE
Collect cues
Ron is nervous, anxious and restless. His eyes were red. Red eyes, changes in behavior
such as depression, paranoid thinking and restlessness and being anxious, unable to concentrate,
avoiding eye contact are some of the clinical symptoms of substance abuse disorder. Espelage&
Holt, (2013) have found that adolescent children taking drugs are likely to miss schools or work
or generate a sudden disinterest in studies or school activities which can be related to Ron’ s
condition.. Dysfunctional gaze in eye substance abuse disorder can be common in drug addict’s
representation a fluctuating state of emotional and cognitive dysregulation (Berchio et al., 2016).
Process information
It was observed Ron had two working parents and a sibling, who suffers from autism
spectrum disorder. The adolescent involves a number of developmental transitions and the
parent’s non-working schedule might lead to risky behaviors in adolescents, such as alcohol use,
drug use, cigarette smoking and delinquency (Carr, 2014).Espelage, D.L., & Holt, 2013). Again,
Ron has also stated his depression and anxiety because of the abusive relation between his father
and the mother. The risky behavior of the adolescents is heavily influenced by the family context
and the parent –child relationship (Han, Miller &Waldfogel, 2014). Busy work schedules restrict
the children from getting the close the parents and articulate their grievances.
Identify the problem issue
 Suicidal ideation (Hartz et al., 2016).
 Depression and anxiety
 Abdominal cramp (Hartz et al., 2016).

4INTEGRATING PRACTICE
Establish goals
 To engage the patient in therapeutic program
 To encourage Ron to verbalize the acceptance of the responsibility for the own behavior.
 To prevent the remittance of the drugs
Take action
The prime action that has to be taken is to keep a check on the remittance of the drug.
Patients might suffer from different withdrawal symptoms, hence specific behavioral therapies
and “detoxification” can be helpful to manage the withdrawal symptoms (Miller, Esposito-
Smythers&Leichtweis, 2015). Relaxation exercises and engaging Ron in constructive activities
might keep him distracted from the environmental stimuli (Abuse, US& Office of the Surgeon
General, 2016, Zschucke, Heinz&Ströhle, 2012).
Evaluate
The evaluation of the treatment can be made by regular follow up. Urine test kits are
available to screen that the patient is under the influence of the drugs anymore. A mental health
examination can be made to evaluate the effectiveness of the treatment.
Reflect on process and new learning
This encounter has helped me to understand that ways of communicating with a patient
suffering from disruptive behavior. I have understood that, dealing with these patients requires
patience yet one has to be alert about some cues like bodily gestures, eye movements. In many
the cases the interview questions can be sensitive; hence as a nurse I should be acquainted with

5INTEGRATING PRACTICE
the skills to disclose sensitive questions cleverly. Furthermore, I should be able to uphold
compassion or empathy and form a non-hostile environment.

6INTEGRATING PRACTICE
References
Abuse, S., US, M. H. S. A., & Office of the Surgeon General (US. (2016). EARLY
INTERVENTION, TREATMENT, AND MANAGEMENT OF SUBSTANCE USE
DISORDERS.
Berchio, C., Piguet, C., Michel, C. M., Cordera, P., Rihs, T. A., Dayer, A. G., &Aubry, J. M.
(2017). Dysfunctional gaze processing in bipolar disorder. NeuroImage. Clinical, 16,
545-556. doi:10.1016/j.nicl.2017.09.006
Carr, A. (2014). The evidence base for family therapy and systemic interventions for child‐
focused problems. Journal of family therapy, 36(2), 107-157.
Espelage, D. L., & Holt, M. K. (2013). Suicidal ideation and school bullying experiences after
controlling for depression and delinquency. Journal of Adolescent Health, 53(1), S27-
S31.
Han, W. J., Miller, D. P., &Waldfogel, J. (2014). Parental work schedules and adolescent risky
behaviors. Developmental psychology, 46(5), 1245-67.
Hartz, S. M., Pato, C. N., Medeiros, H., Cavazos-Rehg, P., Sobell, J. L., Knowles, J. A., ...
&Pato, M. T. (2014). Comorbidity of severe psychotic disorders with measures of
substance use. JAMA psychiatry, 71(3), 248-254.

7INTEGRATING PRACTICE
Miller, A. B., Esposito-Smythers, C., &Leichtweis, R. N. (2015). Role of social support in
adolescent suicidal ideation and suicide attempts. Journal of Adolescent Health, 56(3),
286-292.
Zschucke, E., Heinz, A., &Ströhle, A. (2012). Exercise and physical activity in the therapy of
substance use disorders. The Scientific World Journal, 2012.