Mental Health Nursing Report: Case Study, Care Plan, and Outcomes

This report provides a comprehensive analysis of mental health nursing practices, focusing on a case study of a 40-year-old male, John McDermott. It explores the application of the Ropers model of daily living to assess his physical and mental health challenges, including persistent cough and unemployment. The report outlines the role of a graduate mental health nurse, emphasizing their responsibilities in providing care and support. It discusses interventions such as Nicotine Replacement Therapy (NRT) and Cognitive Behavioral Therapy (CBT) to address John's smoking habit and psychological issues related to unemployment. The report also details a care plan for the patient, focusing on managing his physical symptoms and low mood. Furthermore, it examines the knowledge required for contemporary nursing practice, the importance of public health policies, and the role of mental health nurses in promoting public health, emphasizing the need for aligning care with regulatory standards and policies to improve patient outcomes and overall population wellbeing.

Running head: MENTAL HEALTH NURSING
Mental Health Nursing
Name of the student
Name of the university
Author’s name

1MENTAL HEALTH NURSING
Introduction
In various countries, during the beginning of the 21st century there were significant
amount of changes in the delivery of mental health services. The evolution of the nurses and the
mental care nursing had a positive effect on the way psychiatric treatment occurs in different
countries. Since the start of 21st century there have been a consistent amount of changes that have
occurred at an extraordinary frequency and also had a substantial influence on the type of care
delivered to the patients with mental health issues and also to those participating in service
delivery, especially, mental health staff members in acute inpatient setting, who have witnessed
firsthand the resultant chaos.
Discussion
The following article focusses on the case study of John McDermott who is a 40 year old
male. John is a bachelor, unemployed receiving universal credit and lives in a single bedroom
social housing flat on Green road in the Burroughs. As per the case study, he has no siblings and
his only relative is his mother who stays in another town. John is a sociable person and maintains
a healthy relationship with his neighbours in the block of flats where he stays. John has been
attending community mental healthcare centre for fortnight injection of Flupentixol Deconate
300mg. He has been complaining of being lethargic and apathetic. He has been unemployed for a
long time and has been searching for work. He was noticed with persistent cough and he did not
feel like to stop smoking. John has been facing many mental and physical challenges like low
mood, anxiety of finding a life partner, persistent cough, sexual health and more. Due to this
reason he requires a thorough assessment that will be done using the Ropers model of daily

2MENTAL HEALTH NURSING
living to contribute to a holistic assessment. To continue with the assignment, one physical
health issue that is persistent cough and one mental health issue which is lack of employment
will be discussed.
Role of graduate mental health nurse
In a healthcare system, there are various nurses among which there are mental health
nurses. Their responsibility is to plan and provide support and medical and nursing care to
individuals who have a range of mental health issue. They have the ability to work with the
patients in various places such as at home, community healthcare setting, specialist units,
hospital outpatients departments, and secure residential units (Hooper, Browne and O'brien
2016). They have the responsibility to assess and discuss about the problems with the patients
and discuss the best suitable strategy to tackle the problems. They guarantee the proper
medicines and injections are being provided. They deliver evidence-based individual therapy,
such as cognitive behaviour therapy for depression and anxiety (Hooper, Browne and O'brien
2016).
Ropers model of daily living
The Ropers model is a nursing theory which is based on the activities of the daily living.
This is a widely used model in the United Kingdom, used for the patient care assessment. It is
generally used to monitor how the health condition of the patient has changed the daily living of
the patient rather than as a means to plan for the freedom and improving the quality of life
(Williams 2017). This theory aims to define the meaning of life as it classifies the encounters
into actions of daily life via a thorough valuation that results in identifying different approaches
through which patient will supported by providing freedom in places where it will be challenging
for the patient to address alone. The main objective of Ropers model is to enhance and deliver

3MENTAL HEALTH NURSING
maximum freedom for the patient. The Ropers model involves various activities such as
sustaining a safe environment, eating and drinking habits, sleeping, communicating, breathing,
working and playing, and many more (Williams 2017). According to the Roper’s model of daily
living there are five key factors - biological, psychological, sociocultural, environmental, and
politico economic which influence the daily activities of living (Williams 2017).
The biological factor highlights impact on the overall health of an individual, current
health condition involving any physical injury and the possibility of person’s anatomy and
physiology (Williams 2017). As observed that John was suffering from persistent cough because
he was failing to leave his smoking habit. According to the psychological factor of the Roper’s
model, the biological factor can also be determined as the impact of emotion, feelings and the
ability to understand different scenarios (Williams 2017). In the case-study it was mentioned that
John was educated to university level graduation from Oxford University and he wanted to
complete a PhD and become an academic. But due to different circumstances he could achieve a
proper work. Thus, since John was unemployed and broken as failing in relationship he was
having different psychological problems which made him feel that smoking is better than doing
nothing (Peláez-Fernández, Rey and Extremera 2019). As smoking is injurious to health, it
impacted on his health thus having persistent cough (Bakri, Tsakos and Masood 2018).
In order to stop his smoking problem, Nicotine replacement therapy (NRT) can be used
and suggested to him (Hajek et al., 2019). This will help him to stop smoking and that will also
help in slowing down his persistent coughing. In the Nicotine replacement therapy (NRT),
patient is given nicotine in the form of a gum, spray or inhaler excluding the harmful chemicals
present in the tobacco (Morales, Domínguez, González, Ramírez, Sánchez and Muñoz 2019).
NRT helps the patient to get relief from physical withdrawal symptoms and thus it enables the

4MENTAL HEALTH NURSING
patient to focus on the psychological (emotional) aspects of quitting. After the problem of
smoking is solved, then John can be advised for Cognitive-behavioral therapy (CBT) (Hofmann
and Otto 2017). CBT is a very effective therapy for helping individuals who are suffering
psychological problems due to unemployment (Hofmann and Otto 2017). Generally,
unemployment can give rise to depression, anxiety, trouble while sleeping and various other
challenges. Another reason to take care of mental health of John is that NRT cannot alone help
him to stop smoking. It is also necessary assess the psychological needs of John in order to
prevent them from re-occurring; as if the mental health is not treated then it can again deteriorate
John’s condition for which he might again start smoking.
Care plan for the patient:
Mc. Dermott must be given water to keep his throat hydrated. He must be made educated
on the appropriate ways of breathing and coughing. The nurse must instruct him in taking a deep
breath and hold it for 2 seconds and then cough for two to three time consecutively. Coughing
helps in removing most secretions and thus, it is important that the patient is assisted while doing
this activity. Also, deep breathing helps in promoting oxygenation. It is also important to
encourage position changing frequently and deep breathing. In order to manage his low mood,
the nurse must communicate effectively with him and encourage him to express his feelings of
anger, depression or guilt and then engage in developing appropriate strategies addressing those
concerns.

5MENTAL HEALTH NURSING
Learning outcome- 2
Different types of knowledge supporting contemporary nursing practice by
developing knowledge of art and science of nursing
The practice of nursing is much more than a mere science. It's more than simply
knowing; it is to do. This skilfully connects care knowledge for patients. All the technology
applied of nursing is used to give the patient the utmost attention. For their practice, caregivers
use a wide range of practical and theoretical expertise. Over recent years, they have had to
provide doctors with a tremendous amount of new information (Kramer et al., 2017).
Nursing awareness is the way to achieve the overall purpose of taking care of patients
since it undermines what people really are doing. It describes people as caregivers rather than
related occupations like physicians or physiotherapists, allowing them to distinguish
themselves from lay caregivers or workers. Understanding is essentially what classifies us as a
career, since it is one of the aspects that distinguishes the occupation within culture to have a
“unique knowledge” (Reed and Shearer 2017).
Information from nursing can be obtained through various means, and information is
often recognized from its origins. Patients often use biological science expertise, including
biology, and social science information such as psychology. Nursing involves awareness of a
wide range of sources and is a combination of different kinds of information that allows
determining what nursing expertise truly is even more challenging (Reed and Shearer 2017).
They are eager to use the communication skills for the good of the patients. The health
care career is perhaps most reliant on communication skills and as healthcare professionals
communicate with patients when they are most insecure and often have to execute sensitive

6MENTAL HEALTH NURSING
operations, communication and interpersonal skills connect their philosophy with practical
knowledge. Knowledge acquirement brings awareness of personal and work responsibility and
work challenges. Information is what enhances treatment if the nurse knows the best information
or evidence to be used.
Learning outcome-3
Understanding public health through the key drivers influencing public health
policies and the public health role of the mental health nurse
In the UK, there are two aspects of ‘public health’, the first is ‘health of the public’ and
the second, as alighted on first by many public health professionals is the raft of health policies,
services and systems of public health. Looking into the history of public health, improvements
have been noticed over many years that occurred as a result of systematized social responses to
dreadful squalor, disasters, deprivation and emergencies. Public health, thus, refers to the art and
science of both protecting and promoting health and wellbeing by preventing illness and
extending life through a contributed and combined efforts of the society. Public health services,
policies and systems play a vital role in the promotion of public health (Middleton 2017).
Public health activities act as a collaborating centre that are underpinned by stakeholders
of the health systems, including a wide array of nurses and midwives holding strong research
background. Thus, while developing these policies and actions, a network of these clinical
leaders including public health nurse, mental health nurse, practice nurse and learning disability
nurse work collaboratively and bring their knowledge and expertise together for a shared goal.
Thus, public health role of the mental health nurses are influenced by the health policies, systems
and services that impact their practice and affect the quality of service provided by them.

7MENTAL HEALTH NURSING
While developing mental health policies for public health, it is important record
epidemiological data and identify the risk areas across population that will assist in designing the
intervention strategy addressing those concerns. It is also important to increase health literacy
rate among population in order to achieve an improved outcome. Mental health nurses have an
important role for enabling the provision of highest and optimum quality of care for a wide range
of population with their unique care needs. They must be focused in delivering an enhanced care
that will help promoting public health, increase health outcome and eradicate the risk of further
complications. Nurses must practice by aligning with the regulatory standards, the available local
and national policies and various care guidance encompassing the care of people with mental
health issues. Failure to engage in care that aligns with the policy context can lead to a
compromised care quality ultimately leading to a decreased patient health outcome and an
increased mortality rate of the patients. Therefore, each mental health nurses must practice
following the care standards and policies available in order to promote health and wellbeing of
the population. Policies and care standards provide nurses with information and care guidance
that will enhance the care quality and lead to an improved outcome (Arabi et al. 2014).
Learning outcome- 5
Factors impacting physical and mental health
Poor physical health is common among people with mental health problems. There are
certain lifestyle factors that can impact the mental and physical health of an individual
(Ohrnberger, Fichera and Sutton 2017). Physical activity is a lifestyle factor that has a positive
impact on both the mental and physical health of the individual (Farhud 2015). Physical activity
has the ability to activate the endorphin hormone in the brain which gives a good feeling. Diet is
another lifestyle factor that can have both positive as well as a negative impact on both the

8MENTAL HEALTH NURSING
mental and physical health of the individual. A good diet involves good nutrients which
influences the mental and physical health whereas a diet involving fast food can have a negative
impact on health (Meegan, Perry and Phillips 2017). Smoking is another lifestyle factor though it
has only negative impact on both physical and mental health of an individual (Velten et al.
2014). A nurse can safely assess the mental and physical needs of an individual through the
systematic collection of data as described by the patient and collecting the objective data as
measured by the nurse (Martin 2016). Current and future patient care requirements are defined
by treatment appraisal. It allows the identification of regular and irregular body physiology
(Ohrnberger, Fichera and Sutton 2017).
Conclusion
Mental health professionals are consistently changing adapting with the consistent
changes occurring in the community and through that it is changing its way of service delivery.
As the framework of the society changes, it gives rise to new nursing habits, beliefs,
responsibilities and with that comes in new knowledge in response to the changes in the society
and its health problems. There are several factors which are consistently driving the society and
the nursing profession such as the rising costs, rising number of chronic ailments, rising number
of patients and many more. To ensure a safe, effective, and efficient care it is necessary for the
nursing profession to keep on changing as per the needs of the growing community.

9MENTAL HEALTH NURSING
References
Arabi, A., Rafii, F., Cheraghi, M.A. and Ghiyasvandian, S., 2014. Nurses’ policy influence: A
concept analysis. Iranian journal of nursing and midwifery research, 19(3).
Bakri, N.N., Tsakos, G. and Masood, M., 2018. Smoking status and oral health-related quality of
life among adults in the United Kingdom. British dental journal, 225(2).
Fackler, D., Fuchs, M., Hölscher, L. and Schnabel, C., 2019. Do Start-ups Provide Employment
Opportunities for Disadvantaged Workers?. ILR Review, 72(5).
Farhud, D.D., 2015. Impact of lifestyle on health. Iranian journal of public health, 44(11).
Franck, L.S. and O'Brien, K., 2019. The evolution of family‐centered care: From supporting
parent‐delivered interventions to a model of family integrated care. Birth defects
research, 111(15).
Hajek, P., Phillips-Waller, A., Przulj, D., Pesola, F., Myers Smith, K., Bisal, N., Li, J., Parrott,
S., Sasieni, P., Dawkins, L. and Ross, L., 2019. A randomized trial of e-cigarettes versus
nicotine-replacement therapy. New England Journal of Medicine, 380(7).
Hofmann, S.G. and Otto, M.W., 2017. Cognitive behavioral therapy for social anxiety disorder:
Evidence-based and disorder specific treatment techniques. Routledge.
Hooper, M.E., Browne, G. and O'brien, A.P., 2016. Graduate nurses' experiences of mental
health services in their first year of practice: An integrative review. International journal of
mental health nursing, 25(4).

10MENTAL HEALTH NURSING
Kramer, M., Brewer, B.B., Halfer, D., Hnatiuk, C.N., MacPhee, M., Duchscher, J.B., Maguire,
P., Coe, T. and Schmalenberg, C., 2017. Impact of professional nursing practices on
patient/nurse outcomes: testing the essential professional nursing practices instrument. JONA:
The Journal of Nursing Administration, 47(5).
LaRocco, S.A., 2018. Nursing History for Contemporary Role Development.
Martin, C.T., 2016. The value of physical examination in mental health nursing. Nurse education
in practice, 17.
Meegan, A.P., Perry, I.J. and Phillips, C.M., 2017. The association between dietary quality and
dietary guideline adherence with mental health outcomes in adults: a cross-sectional
analysis. Nutrients, 9(3).
Middleton, J., 2017. Public health in England in 2016—the health of the public and the public
health system: a review. British medical bulletin, 121(1).
Millar, S.L., Chambers, M. and Giles, M., 2016. Service user involvement in mental health care:
an evolutionary concept analysis. Health Expectations, 19(2).
Morales, M.P., Domínguez, C.E., González, M.M., Ramírez, I.M., Sánchez, M.M. and Muñoz,
A.A., 2019. Characteristics of patients treated with nicotine replacement therapy (NRT)
prescribed during hospitalization.
Ohrnberger, J., Fichera, E. and Sutton, M., 2017. The relationship between physical and mental
health: a mediation analysis. Social Science & Medicine, 195.

11MENTAL HEALTH NURSING
Peláez-Fernández, M.A., Rey, L. and Extremera, N., 2019. Psychological distress among the
unemployed: Do core self-evaluations and emotional intelligence help to minimize the
psychological costs of unemployment?. Journal of affective disorders, 256.
Reed, P.G. and Shearer, N.B.C., 2017. Nursing knowledge and theory innovation: advancing the
science of practice. Springer Publishing Company.
Velten, J., Lavallee, K.L., Scholten, S., Meyer, A.H., Zhang, X.C., Schneider, S. and Margraf, J.,
2014. Lifestyle choices and mental health: a representative population survey. BMC
psychology, 2(1).
Williams, B.C., 2017. The Roper-Logan-Tierney model of nursing. Nursing2019 Critical
Care, 12(1).