Mental Health Exam Scenario: A Comprehensive Report

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MCL- MENTAL HEALTHY EXAM SCENARIO
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Table of Contents
Scenario 1...................................................................................................................................3
Scenario 2...................................................................................................................................7
Reference List............................................................................................................................9
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Scenario 1
A. Demonstrate a critical understanding and sensitive application of the key principles
of a mental health nursing assessment including screening for mental health problems,
risk assessment and care planning.
In mental health nursing, there are basic principles that need to be considered by a nurse
while dealing with patients. It is essential for the nurse to accept the patient as he/she is and
the nurse should be able to demonstrate a “non-judgemental” attitude. Further, it is also
crucial to be genuinely interested in concerns related to patients. After admitting the patient
in the care setting, it is necessary for the healthcare workers to behave sensitively towards the
needs of the patients and be careful while dealing with them because the patients suffering
from mental health conditions tend to be anxious more often. It is sometimes challenging the
nurses to change the behaviour of the patient; however, it is possible for the nurse to maintain
a realistic “nurse-patient” relationship by maintaining an emotional bond (Townsend and
Morgan, 2017). The term “self-understanding” can be utilised as a “therapeutic tool” because
nurses are supposed to have an ability to sense the patient’s needs without the patient being
vocal about it.
Mental health assessment involves the screening process, and it is considered crucial in the
entire therapeutic process. Screening is done at the beginning of the session, and several other
assessments such as tests or general measurements continue later. In real life application,
screening can help in making decisions, identifying common symptoms and examining the
progress of the patient (Healthyplace.com, 2019). The tools utilised for carrying out
assessment include rating scales, questionnaires and standardised tests. The screening process
by using assessment tools because it will help the practitioner to determine the success of
treatment. The process shall allow the professional as well as the service user to measure
progress.
Additionally, risk assessment in mental health nursing is essential because it allows the
professional to get an insight into the type of risk that the patient might be undergoing. The
patient might attempt suicide or cause self-injury. Due to constant anxiety, the patient might
behave violently towards others, and hence, it is essential for the mental health nurse to
assess the risks earlier. Lastly, care planning also plays a vital role because it acts as a
therapeutic tool and provides a legal record (Healthyplace.com, 2019). While preparing a
care plan, the professional is supposed to identify the key concerns or “mental health” needs
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of the patient. The treatment process is also outlined in the care plan. Based on shared
interests and goals, the professional and the client can precede the treatment process.
In the case of John, it has been observed that he is suffering from schizophrenia and has been
kept under observation of a psychiatrist several times; however, he often used to show
challenging behaviour. John’s treatment was completely based on medications, which in turn
would make him somehow less threatening. However, due to repeated hospitalisation, he
slowly became paranoid. It can be stated that in his case, the screening and care planning
process was not appropriate. Rather than providing him emotional support, the psychiatrist
focussed upon medication-based treatment only. This made him behave violently with friends
and family members.
B. Examine, contextualise and apply the principles related to physical care in mental
illness and be able to undertake basic skills in areas such as physical assessment,
homeostasis, diabetes, coronary heart disease, obesity, respiratory conditions, skin
complaints, sexual health and others.
The people suffering from mental illness often need physical care because these individuals
have certain “unmet” physical needs. In order to understand the needs of the patients, it is
essential for nurses to undergo training. The term “holistic care” is appropriate in this case
because the professional is supposed to provide both physical and mental care to the patient
(Cohen-Mansfield et al., 2015). Patients suffering from mental illnesses like schizophrenia,
bipolar disorder or various personality disorders might also have a negative impact on their
physical health. For example, certain metabolic diseases, cardiovascular illnesses and even
sexual dysfunction as observed in the case of John, are the impact of severe mental illnesses.
It can be stated that treatment factors as well as lifestyle factors often increases the risk of
physical illnesses. The people suffering from severe mental illnesses tend to have a low life
expectancy because of the consumption of poor diet or even side effects of certain anti-
psychotic medications like Olanzapine or Risperidone as observed in the case of John.
Certain physical illnesses like respiratory conditions, obesity, cardio-vascular diseases or
diabetes among others require individualised treatment plans. The treatment process of
coronary heart diseases mainly requires the patient to undergo major lifestyle changes and
undertake medications. The patients can be given medications like statins or certain beta-
blockers that can help in reducing blood pressure (Debra Rose Wilson, 2018).
In order to deal with diabetic patients, nurses need to possess certain competencies because
diabetic patients might also be suffering from severe mental issues like anxiety or depression.
For example, the nurse should have awareness regarding the patient’s needs, and he/she is
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supposed to report any noticeable changes so that medications can be delivered immediately.
The nurses should also carry out screening and early detection of diabetes as it will help in
describing several risk factors. Especially in the case of Type II Diabetes, the nurses need to
advise the patients to undertake physical exercises and make them understand the importance
of losing weight (Rcni.com, 2019). This, in turn, will also reduce the risk of obesity.
It has been further understood that in nursing assessment while treating severe skin
conditions, it is essential to conduct early assessment and diagnosis. The dermal infections
require timely management so that the infection does not spread into deeper tissues like
cellulitis.
C. Recognise, assess, monitor and manage the pharmacodynamics of psychiatric
medication including symptoms, side effects and non-concordance
Psychiatric medications are considered as licensed drug, and it is often utilised by mental
health care professionals in order to deal with patients suffering from severe mental illnesses.
It should be noted that a licensed professional could only give medications in a psychiatric
setting. Risperidone is one such medication, which is often prescribed by professionals to
patients suffering from schizophrenia or bipolar disorder. It is usually prescribed in order to
calm down the brain activities of patients. However, the common side effects include
tiredness, headache, restlessness, fatigue, stomach pain or insomnia (Risperidone, 2019). In
order to manage the side effects of Risperidone, it is essential for the patient to be vocal about
their concerns. The nurse should be able to understand the mood swings of the patient and
identify early signs of fever. It is also necessary for the patient to inform the doctor in case,
he/she is taking any other supplements or medications.
Additionally, Olanzapine is another psychotic medication prescribed by professionals in
order to treat patients who are suffering from mental conditions. It can help in treating
severely depressed patients. However, Olanzapine might have severe side effects that include
high cholesterol, weight gain, weakness, constipation or insomnia (Goldberg and Ernst,
2018). Especially while prescribing this medication to older patients; it is necessary for the
nurses to be cautious. Certain patients might also be allergic to this medication. Hence, nurses
are required to monitor the effects of the medication continuously. Older patients might suffer
from dehydration due to the severe effect of this antipsychotic drug. Constant monitoring of
temperature elevation is necessary in order to manage its side effects. Lastly, it should be
noted that patients should not take this drug with no consultation with the physician.
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In the case of John, it has been observed that he has been given Risperidone (six mgs) on a
daily basis and this antipsychotic medication has certain side effects. Although he became
less threatening and less confrontational at the beginning of the treatment, however, it has
been observed that he slowly became paranoid and decided to stop undertaking anti-psychotic
medications. Further, in his case Olanzapine has severe side effects, as he was unable to
engage in healthy sexual relationships. He gradually became paranoid and often used to
consider these medications poisonous.
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Scenario 2
A. Evaluate the main theories of communication and their application within a mental
health context.
Communication is an essential medium by which two or more people can express their
opinions. Various theories of communication can be considered while understanding the
importance and way by which communication is done. The Shannon-Weaver model is
considered an important communication model and it mainly involves ways by which
systems and sub-systems of communication can be broken down. The communication model
mainly includes six systems. These are “Source, Encoder, Channel, Message, Decoder and
Receiver” (Peoi.org, 2019). Here, communication is considered as a “one-way” process. The
message is transported from the source to the receiver (McPhee and Poole, 2016).
Further, Wilbur Schramm has devised methods of communication and pointed out the fact
that it is essential to examine the influence of a message on both the sender and the receiver
of the message. Communication essentially means that both the parties are receiving advice
from each other and each individual is participating actively in the communication process.
Information can be transferred by following semiotic rules. It mainly includes syntactic,
pragmatic and semantic. Syntactic primarily involves the usage of symbols or signs.
Pragmatic implies the relationship that exists between users and the expressions while
semantic implies the relationship that exists between representations of symbols (Koptseva et
al., 2015).
In the case of Mr. D, it has been observed that he was severely suffering from depression and
isolation. Communication with him has been difficult because he hardly maintained eye
contact and therefore could not build rapport with his interviewer. Due to his social isolation
and inability to communicate with others, he also lost his job. He remained unemployed for a
long time. He was admitted again. However, he has constantly shown signs of depression and
suicidal ideation. It can be recommended that while dealing with patients like Mr. D, it is
essential to build a rapport with the professional. He has attempted suicide several times,
therefore, it is important to understand that his communication needs remained unmet. His
mother is also mentally unstable according to him, and therefore he lacked an appropriate
support system. It is essential for mental health professionals to receive training in
communication (Papageorgiou et al., 2017). In this manner, the satisfaction levels of patients
will also improve. Similarly, in the case of Mr. D, the evidence-based practice would have
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been productive. The professional need to understand the moment the patient is unable to
decode a message and immediately take necessary actions.
B. Explore and debate relevant ethical and legal issues and consider their application to
mental health care.
Ethics is considered as a “philosophical belief” that differentiates right from wrong.
Similarly, in healthcare, the term “bioethics” holds relevance for healthcare practitioners.
Ethical issues might occur when practitioners deal with patients suffering from mental
disorders because the patients lack the capability of making their own health-related
decisions. Therefore, the professional is supposed to follow certain principles ascertained in
bioethics. The principles mainly include beneficence, justice, autonomy, fidelity and
veracity.
It is often difficult for professionals to start the process of treatment without the client’s
consent. Here, the question of “freedom of choice” appears. In certain cases, mental health
patients cause self-harm, and they are likely to become a threat for themselves. Further,
practitioners face difficulty or ethical issues because of the huge costs involved in the
treatment of mental illnesses. Further, while conducting clinical evaluations, the professionals
are bound to face problems. For example, healthcare professionals might have to conduct a
clinical evaluation of a patient because someone might have requested the practitioner to do
so (Molewijk et al., 2015). Here, it is important to note that the patient’s consent is not taken.
Hence, the practitioner has to evaluate the patient carefully. Patient-centred care is necessary,
and therefore, the practitioner needs to highlight the importance or need of an evaluation to
not only the patient but also their family members.
Additionally, it should be noted that every professional should remain within his/her arena of
competency and should understand the consequences of particular treatment processes (CL,
2019). Here, the professional is supposed to show respect to the rights of the patients and
make the patients aware regarding the issues related to involuntary or voluntary admissions.
Lastly, in every care setting, it is necessary to set up an ethics committee. The committee
shall be responsible for addressing various ethics-related issues.
Similarly, in case of Mr. D, it has been observed that he was continuously receiving
medications like minor tranquillisers and fluoxetine; however, he did not receive “cognitive
behavioural therapy” or CBT, which would have been more effective in his case. It would
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have been appropriate to take the patient’s consent before prescribing them certain anti-
psychotic medications as it can have multiple side effects.
Reference List
CL, M. 2019. Rights and respect. Legal and ethical issues challenge today's mental
healthcare professionals. - PubMed - NCBI . [online] Ncbi.nlm.nih.gov. Available at:
https://www.ncbi.nlm.nih.gov/pubmed/10109227 [Accessed 30 Apr. 2019].
Cohen-Mansfield, J., Dakheel-Ali, M., Marx, M.S., Thein, K. and Regier, N.G., 2015. Which
unmet needs contribute to behavior problems in persons with advanced dementia?. Psychiatry
research, 228(1), pp.59-64.
Debra Rose Wilson, C. 2018. Coronary heart disease: Causes, symptoms, and treatment.
[online] Medical News Today. Available at:
https://www.medicalnewstoday.com/articles/184130.php [Accessed 30 Apr. 2019].
Goldberg, J.F. and Ernst, C.L., 2018. Managing the side effects of psychotropic medications.
American Psychiatric Pub.
Healthyplace.com. 2019. Mental Health Assessment and Screening Tools | HealthyPlace.
[online] Available at:
https://www.healthyplace.com/other-info/mental-illness-overview/mental-health-assessment-
and-screening-tools [Accessed 30 Apr. 2019].
Koptseva, N.P., Liia, M. and Kirko, V.I., 2015. The Concept of “Communication” in
Contemporary Research.
Molewijk, B., Hem, M.H. and Pedersen, R., 2015. Dealing with ethical challenges: a focus
group study with professionals in mental health care. BMC medical ethics, 16(1), p.4.
Papageorgiou, A., Loke, Y. and Fromage, M. 2017. Communication skills training for mental
health professionals working with people with severe mental illness. Cochrane Database of
Systematic Reviews.
Peoi.org. 2019. Theories of Communication . [online] Available at:
https://www.peoi.org/Courses/Coursesen/mass/mass2.html [Accessed 30 Apr. 2019].
Rcni.com. 2019 . Roles and responsibilities | RCN. [online] Available at:
https://rcni.com/hosted-content/rcn/diabetes/roles-and-responsibilities [Accessed 30 Apr.
2019].
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Risperidone, G. and Risperdal, B. 2019. Common Side Effects of Risperdal (Risperidone)
Drug Center - RxList. [online] RxList. Available at: https://www.rxlist.com/risperdal-side-
effects-drug-center.htm#overview [Accessed 30 Apr. 2019].
Townsend, M.C. and Morgan, K.I., 2017. Psychiatric mental health nursing: Concepts of
care in evidence-based practice. FA Davis.
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