Detailed Mental Health Assessment and Care Plan: Marion Case Study

This report presents a comprehensive analysis of Marion's mental health assessment, based on a provided video case study. It details the application of the mental status examination (MSE) framework, assessing Marion's appearance, behavior, affect, mood, speech, thought process and content, perception, memory, orientation, concentration, insight, and judgment. The analysis identifies a key clinical issue: Marion's delusion of being a member of the UK royal family, categorized as a grandiose delusion, stemming from non-compliance with medication. The report outlines interventions, including creating a comfortable environment, encouraging medication adherence, and fostering a trusting relationship between Marion and healthcare professionals. Furthermore, it evaluates the positive and negative aspects of the nurse-patient interaction observed in the video. The overall aim is to provide a complete understanding of Marion's condition and the necessary steps for her care and well-being.

Running head: MENTAL HEALTH AND WELL BEIGN
MARION CASE STUDY
Name of the Student
Name of the University
Author note

1MENTAL HEALTH AND WELL BEIGN
Activity 1
Appearance
The client interviewed is Marion and the video showed that she is suffering
from some mental disorder and doctor is trying to find a way out to understand the
level of the disorder. The appearance of Marion seemed to be little clumsy (TEST -
Marion, 2020). Her top was dirty and was not buttoned properly. She was wearing
glasses and her hair was top knot. She did not have any signs of tattoos in her hand,
neck or face.
Behaviour
Her behaviour was little surprising. She was continuously restless. However, it
was noticed she was understanding the question asked even though the answer was
designed by her own thoughts and imagination. She was seated in the chair and was
continuous rubbing the hand with each other. It felt like she was fidgeting with her
fingers with a proper eye contact through the discussion process.
Affect
Her emotional response was flattened. There was not much emotional outbreak
and noticeable response from her side. All through her conversation her mood was
same, rather it was plain and normal like any other people.
Mood
The client however was having an imagination was she belongs to royal family
of UK; daughter of Charles and Camilea. Her expression was strong and intense while
expressing the thought as she mentioned that she wants to go and visit them as well as
planning to meet governor general of Australia to arrange for it.

2MENTAL HEALTH AND WELL BEIGN

3MENTAL HEALTH AND WELL BEIGN
Speech
All through the discussion Marion showed no variation in her speech. It was
constant all throughout. However, when she was asked about Royal family in UK her
voice sounded dominating and confident. Sometimes, even she was clearly telling her
thoughts but she fumbled at some places when she was asked if she requires to stay in
hospital.
Thought form
Her thoughts were illogical. She is assuming her to be a part of royal family,
daughter of prince Charles and Camelia. She also thinks that Diana used to know about
her (TEST - Marion, 2020).
Thought content
Her thought are variable. First she things that she is from Royal family,
secondly she felt that the medication, which she was under made her grow fat, third she
is not going to work for one week and she is not worried about it.
She Marion is having delusion, she is thinking to be a part of royal family of
UK, which she is not. They delusion can be categorised as grandiose delusion. Her
dreams her high and grandiose. She thinks that she is ready to go to UK royal’s and that
the reason she needs to meet governor general of Australia, to arrange this for her.
However, Marion is not at all having any suicidal or homicide thoughts. She is no harm
to others at present.
Perception
Marion is not having any hallucination; she was clearing mentioning that she
never hears voices or sounds. In the video, there was no mention that the client was

4MENTAL HEALTH AND WELL BEIGN
having a feeling that people standing around her. She is having some ideas that are not
real.
Memory
The nurse did not analyse her memory.
Orientation
She was having difficulty in concentration as she was finding difficulty in counting,
other than this nurse did not conduct analysis on orientation.
Concentration
She is having some difficulty in memory as she forgot about her job and she has
not been there for 1 week and she is okay with it. Moreover, when nurse asked her to
count from 100 minus 7 she was having difficulty in counting back which proved the
problem regarding concentration. Even though she was answering all the nurses
question however she was having difficulty in providing any suitable reasoning.
Insight
Marion do not think she is having any problem; she is confident that she is fine.
She herself said that she is better now and do not need any treatment in the hospital
even though she can discuss with a doctor however she denies to stay in hospital for
better treatment.
Judgement
The client does not have correct judgment. She thinks that she decision is
correct. She is lacking in understanding that she is suffering through some difficulty
and needs to be treated. Her refusal to stay in hospital and informing that she had
improved and she had stopped medication.

5MENTAL HEALTH AND WELL BEIGN
Four risk are as follows
 Risk of further deterioration- As she has stopped taking the medication, changes
are being observed in her behaviour. Moreover, Marion herself thinks that she is
fine and is not ready for further medication.
 Risk on non-compliance of medication- As observed in the video, Marion
thinks that due to medication she was putting on weight and hence she had
stopped it as she does not want to gain weight and wants to look good on gown.
Hence, she herself stopped the medication provided for her treatment (TEST -
Marion, 2020).
 Risk of financial difficulty- Marion has not been going to her workplace for 1
week. She might face financial difficulty, as there are chances that she might
lose her job.
 Risk of self-negligence- Marion is undergoing self-negligence, she is not ready
to do her treatment further as she rejects the proposal of staying in a hospital
and get treated. Hence, she might get more thoughts and it can become stronger
and affect her health more.
Activity 2
Clinical issue
In the video it is clearly understood that Marion is having a delusion. She thinks
that she belongs to the UK royals, daughter of Charles and Camelia. Patient is
expressing delusions due to non-compliance of medication. In the interview she clearly
mentioned her thoughts about being a part of royal family and was exerting her
thoughts to nurse interviewing her.

6MENTAL HEALTH AND WELL BEIGN
Rationale
Delusion to think that she is a part of the royals would create a problem for the
client, if her delusion does not gets fixed. Slowly the delusion will increase and she
would become aggressive when people would not believe her, she might become
outrageous and harm others and mental state would deteriorate slowly (GOH et al.,
2016). On other hand, she had also stopped taking medication, that would make her rate
of delusion to increase and hence she would find it difficult to take self-care. Due to
this Marion might lose her job, face financial difficulty leading to social isolation. It is
responsibility of us to take patient’s choice as first priority. However, we need to see
that patient gets treated well, therefore it is necessary that she undergoes proper
diagnosis (Slemon et al., 2017)
Delusion would slowly make her refuse to eat causing to lose weight and errors
at work. This would further increase her anger.
Goal
The ultimate outcomes will be that –
 The patient would not be having any delusion,
 It would help Marion not to skip her work and hence reduce economic problems
 It would make the environment suitable for her stay in the locality
 It would also prevent for from doing any mistakes in the workplaces.

7MENTAL HEALTH AND WELL BEIGN
Interventions and Rationale
INTERVENTIONS RATIONALE
1. Making her feel comfortable, take
out for a walk, make her listen to her
favourite music and plays (Townsend
& Townsend, 2015). Making her work
in the section she wants to would make
her happy (Dreison et al., 2018).
1. It had also been see that excess stress
also creates health problem, making
Marion feel homely, taking her out for
walk, listening to favourite also reduces
pain and suffering. Sometimes music
therapy also helps in stress reduction
(Tobiano et al., 2015). Sometimes it has
also been observed that due unfavourable
work environment feels undergo mental
problems due to over stress. Sometimes it
had been noticed that patient loves
gardening, nurse might ask the patient to
help in gardening which would make them
feel satisfied (Sampaio et al., 2015).
2. Make her take medication as per the
course and stop her from compliance
of medicine.
2. This would help her faster recovery, as
every medication has a due course, if
anyone stops it in the middle it leads to
side effects. Hence, taking medication
properly is mandatory and requirement for
quicker improvement (Riahi et al., 2016)
3. The health professionals must create
a humble and soft bond with the client
3. However, development of better relation
between client and nurse would make

8MENTAL HEALTH AND WELL BEIGN
so that she feels happy to talk and
discuss her ideas with them (Butcher et
al., 2018). Marion must trust health
care people.
Marion feel comfortable and she can
understand her problem. Therefore, it
would be easy for diagnosis.
Activity 3
The positive interaction is followed in the video are-
 The nurse did not directly told Marion that she is having delusion, this is
necessary for a patient as it might turn her aggressive and violent.
 She was pausing at points and was allowing Marion to speak. This makes the
patient think and answer, and not feel that she is being rushed, which might
affect her brain more.
 Nurse maintained an eye contact with the patient, which is good because the
patient will be frank and get assured about the discussion that is being done.
 the nurse was an active listener, she never missed any point told by Marion
(TEST - Marion, 2020). She was continuously interacting which might made
Marion feel that people are listening to her, which is important for a patient.
The negative interaction observed are-
 The nurse was sitting very close to the patient, as per medical rules a slight
distance would be maintained between patient and nurse. Even though at
present Marion did not seem harmful however situation might change, hence it
is necessary to maintain a distance.
 Nurse was not writing down or recording the discussion that being done with
Marion. It is necessary to record the discussion because there would no chances
of missing the points told by the patient.

9MENTAL HEALTH AND WELL BEIGN
References
Butcher, H., Bulechek, G., McCloskey Dochterman, J., & Wagner, C. (2018). Nursing
Interventions Classification (NIC) - E-Book. Mosby.
Dreison, K., Luther, L., Bonfils, K., Sliter, M., McGrew, J., & Salyers, M. (2018). Job
burnout in mental health providers: A meta-analysis of 35 years of intervention
research. Journal Of Occupational Health Psychology, 23(1), 18-30.
https://doi.org/10.1037/ocp0000047
GOH, Y., Selvarajan, S., Chng, M., Tan, C., & Yobas, P. (2016). Using standardized
patients in enhancing undergraduate students' learning experience in mental
health nursing. Nurse Education Today, 45, 167-172.
https://doi.org/10.1016/j.nedt.2016.08.005
Riahi, S., Thomson, G., & Duxbury, J. (2016). An integrative review exploring
decision-making factors influencing mental health nurses in the use of restraint.
Journal Of Psychiatric And Mental Health Nursing, 23(2), 116-128.
https://doi.org/10.1111/jpm.12285
Sampaio, F., Sequeira, C., & Lluch Canut, M. (2015). Nursing psychotherapeutic
interventions: a review of clinical studies. Journal Of Clinical Nursing, 24(15-
16), 2096-2105. https://doi.org/10.1111/jocn.12808
Slemon, A., Jenkins, E., & Bungay, V. (2017). Safety in psychiatric inpatient care: The
impact of risk management culture on mental health nursing practice. Nursing
Inquiry, 24(4), e12199. https://doi.org/10.1111/nin.12199
TEST - Marion. (2020). [Image]. Retrieved 25 March 2020, from https://youtu.be/iIaqJ-
sMyII.

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Townsend, M., & Townsend, M. (2015). Psychiatric nursing. F.A. Davis.
Tobiano, G., Marshall, A., Bucknall, T., & Chaboyer, W. (2015). Patient participation
in nursing care on medical wards: An integrative review. International Journal
Of Nursing Studies, 52(6), 1107-1120.
https://doi.org/10.1016/j.ijnurstu.2015.02.010