Mental Health Nursing: A Case Study of Post-Traumatic Stress Disorder

This report presents a comprehensive analysis of a mental health nursing case study focusing on a 32-year-old refugee, Jamilla, experiencing post-traumatic stress disorder (PTSD). The report begins with a detailed mental status examination (MSE) of Jamilla, examining her appearance, behavior, cognition, and communication. It then delves into clinical information, utilizing the 5Ps framework (precipitating, predisposing, perpetuating, and protective factors) to understand the root causes of her condition. A nursing care plan is developed, prioritizing interventions such as trauma-informed care training and addressing financial instability. The report also includes a clinical handover using the SBAT (Situation, Background, Assessment, Recommendation) approach. Furthermore, the report explores therapeutic engagement, emphasizing the importance of communication and the recovery model in patient care. Challenges like illiteracy are acknowledged, and strategies to overcome them are discussed, highlighting the crucial role of nurses in providing patient-centered care for individuals like Jamilla.

Running head: MENTAL HEALTH-NURSING 1
Mental Health- Nursing
Student’s Name
Institutional Affiliation

MENTAL HEALTH-NURSING 2
Part 1: Holistic planning and assessment
Mental status examination
A mental status examination is the assessment and description of a patient's general
behavior, appearance, and cognitive functioning (Asghar-Ali, 2018). During this assessment, the
psychiatrist does observation of the patient's psychological functioning, such as thinking,
cognition, emotion, and general appearance of the body at a specific point in time. For patients
suffering from post-traumatic stress like Jamilla in the provided case study, Mental status
examination is conducted to come up with the most appropriate and efficient treatment plan.
Below are the main essential components and domains of Jamilla's Mental Status Examination as
provided in the case study:
 Appearance: In this part, general knowledge and proper use of observation are used.
Posture, style of walking are significant parts (Finney, Minagar, & Heilman, 2016).
General body cleanliness, grooming, and type of clothes also worn aid during an
appearance assessment. In the case study, Jamilla is anxious and withdrawn. She is also
clean, tidy and well dressed in a grey headscarf and a long black dress. Her sitting
position is not only quiet but also still. Furthermore, she looks downcast with her hands
in her lap.
 Behavior: According to the case study, Jamilla's speech is normal since her response rate
is average (Zeanah, 2016). However, after talking about her past for a long time, her
facial expression and mood suddenly changed. When sitting, her hands are always in her
laps as she keeps facing the ground. Her eye contact is also appropriate, according to the

MENTAL HEALTH-NURSING 3
information in the case study. Additionally, when talking about her children, she can’t
control herself from smiling.
 Cognition: This is the process of mentally acquiring knowledge (Thomas, et., al, 2017).
From her speech, she is a determined woman who is focused on providing the best from
her family. By complaining about a study room for her children, she proves to be
knowledgeable. This is because she values education.
 Listening and communication: This refers to how a person receives and perceives and
thereafter interpret a piece of given information (Yong-Shian, et., al, 2016). The
information provided proves that Jamilla and the healthcare provider appropriately
exchanged information. Furthermore, this information is relevant, which proves that
Jamilla was in able to receive and interpret any information appropriately.
Clinical information
The clinical formulation is important since it identifies the root cause of the problem.
That is to say; it addresses all the factors such as social factors, economic or financial status,
genetic, personal, or any other biological problem that led to mental illness or depression. For
instance, Jamilla's clinical formulation explained below elaborates on the factors that contributed
to Jamilla's mental state, in reference to the 5Ps:
 Precipitating factors: These are either negative or positive situations or events, also
referred to as stressors (Kapoor, et., al, 2016). For instance, Jamilla’s precipitating factors
in the provided case study is evident when Jamilla complained of conflicts that exist in
her family. They have not been living in peace with both her husband and her two sons

MENTAL HEALTH-NURSING 4
named Mohammad and Mahir. They have also been running away from conflicts for
many years.
 Predisposing factors: These are factors that are contributed by our surrounding or general
environment and vulnerability around a certain population (Morrissey, 2016). In the case
study, it is clear that Jamilla and her family are refugees who have been on the run due to
conflicts in Afghanistan. Poor environmental quality among the refugees is a
predisposing factor.
 Perpetuating factors: This is general conditions that a community, family, or society are
surrounded by, that causes more problems to the people (McGrandles, 2016). Jamilla, as
a patient in the case study, faced a perpetuating factor of conflicts between her and her
husband. Financial instability is also another evident factor since she keeps complaining
of lacking enough money to cater to her needs.
 Protective factors: These are factors that express a person's area of interest. This can
include skills, experience, commitment, or knowledge (Ellrich, & Baier, 2017). In the
case study, Jamilla was committed and determined in educating her two sons and
providing standard and required care for them. She is also worried about her husband's
unemployment state.
Nursing care plan
All nurses and health care providers are always expected to develop appropriate and
efficient nursing care plans for all patients in the facility (Kallakorpi, 2019). This is because
nursing care plan helps to provide reliable information that guides the healthcare provider on the
most appropriate nursing care that a certain patient or community require. During the
formulation of a nursing care plan, all nurses are expected to identify the crucial primary health

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problems that patients face. For example, the leading high priority problems that Jamilla's family
and other refugees face, are provided below:
1) One of the main priority that refugees should be given during the provision of healthcare
services is the provision of sufficient training for parents like Jamilla and her husband on
the problems associated with trauma. For instance, Jamilla’s husband and her two sons
should be trained on how to relate with good patients suffering from post-traumatic
stress, like Jamilla. This is a priority concern, according to the provided case study since
people from vulnerable communities such as refugees are at a high risk of developing
post-traumatic stress. Therefore, they should be educated on how to relate with such
patients appropriately to avoid cases of stigma and discrimination. Jamilla's strength, in
this case, is that she is strong and stands firms to fight post-traumatic stress. This is
evident when she takes a step to seek medical intervention on the condition. However, the
main barrier is financial instability that is affecting her and her family.
According to an article by Lindert, 2018, representative studies on refugees psychological
and medical needs should be done in order to determine the main solution to chronic diseases
such as post-traumatic stress affecting the refugee community. Additionally, the hosting country
is responsible for providing the necessary medical and psychological care such as training the
community on how to relate with post-traumatic stress patients. In the case study provided, the
government of Australia is responsible for providing Jessica and her family with the necessary
training on how to relate with such people.
2) Another high priority care that post-traumatic stress patients from vulnerable parts need is
peace negotiations and agreements between nations (Joshi, 2015). This will help to avoid
violence and conflicts resulting from politics. Conflicts and violence have been the main

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contributing factor to the increasing number of refugees like Jamilla and her family. The
healthcare stakeholders should also be on the forefront in this matter since conflicts and
violence has led to an increasing number of patients with post-traumatic stress, such as
Jamilla.
Jamilla's strength as far as conflict is concerned, is that she has tried her best to form
conflicts and violence, together with her family. She finally found peace as a refugee in
Austria. However, the main barrier is that refugees are not given the required medical
care, yet they are vulnerable people in Australia.
Clinical Handover
Relevant and valid information that concerns the care of patients should be
communicated and delegated to ensure that the patients receive quality and safe healthcare
services (Mania, et., al, 2016). This is achieved by using a clinical handover. Below is a clinical
handover concerning Jamilla in the case study. This Clinical handover is based on SBAT
approach.
 Situation: Jamilla’s Temperature was recorded to be 37.50C, which is normal for a
healthy human being. Her pulse is 113bpm. Blood Pressure is 140/90, and RR is 21. She
weighs 77kgs after increases 4kgs in the last four months. Her BMI is 32.
 Background history: Jamilla was born in Afghanistan but had to flee to Australia due to
violence and conflicts. She became exposed to conflicts and violence at a very early age,
which has affected her psychological wellbeing. She also experiences family conflicts
between her sons and her husband.

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 Assessment: After properly assessing Jamilla’s case, it was identified that she if facing
problems that include social and economic problems. The social issues include family
and national conflicts, and poor living conditions in the refugee settlement places.
Financial instability is the main economic issue.
 Recommendation: It is therefore recommended that all refugees like Jamilla should be
given the right medical and psychological care. Training programs on how to relate to
people with post-traumatic stress should be initiated. Patients like Jamilla should also be
taken through psychological counseling by medical specialists.
Part 2: Therapeutic engagement and clinical interpretation
For effective nursing care, all nurses and healthcare providers must establish a positive
therapeutic relationship among patients and other people around them (Altimir, et., al, 2017).
They should also be on the forefront in eradicating the barriers to good and strong therapeutic
relationships. One of the best strategies to use is proper communication. Proper communication
between the doctors and the patients can help increase the therapeutic relationship between the
doctors and the patients. For instance, to properly understand Jamilla’s issues, the healthcare
provider had to employ proper communication skills. Efficient communication strengthens the
relationship and bond between different people.
The reason why I would also employ appropriate communication with a patient like
Jamilla is that it will help in obtaining meaningful information that can be used to solve her
healthcare problems (Kiani, 2016). Proper communication as a strategy will be applicable in the
nursing intervention I provided above of using representative studies to improve the health
condition of refugees like Jamilla and her family. To obtain meaningful information during these

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representative studies, healthcare providers must always use proper communication skills. This is
also necessary during data collection.
For the provision of patient-centered healthcare, nurses must always adhere to the
recovery guidelines provided in the recovery model. Recovery model has been the most
recommended standard model for patients with mental illnesses like Jamilla (Jacob, 201)5. This
model mainly emphasizes that recovery from mental illnesses is something that is possible. One
of the principles provided in the recovery model is that patient's recovery gives hope and faith to
both the patient and the healthcare provider. Also, the nursing intervention of developing
psychological counseling and training programs for the victims and families gives hope and faith
to the affected victims and their families. This proves that the recovery model and the provided
nursing intervention have a healthy relationship.
If I were the healthcare provider attending to Jamilla or other post-traumatic patients, I
would face many challenges and barriers. For instance, Illiteracy is one of the barriers that would
compromise with quality healthcare provision. With poor literacy levels, the provision of
healthcare services becomes difficult since explaining every detailed information concerning
care to the patient is difficult. However, I would ensure that efficient use of verbal
communication is upheld to pass every meaningful information to the patient.

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