University Nursing: Mental Health Case Study Analysis and Report

This report presents a nursing case study focusing on a patient experiencing mental health challenges. The analysis begins with an assessment of the patient's mental state using the Mental State Examination (MSE), highlighting key observations related to appearance, behavior, affect, and mood, and linking these to diagnostic criteria for depression according to DSM-V. The report then applies the stress-vulnerability model to understand the patient's history and the factors contributing to their condition, including childhood experiences, loss of employment, and other stressors. Finally, the report discusses ethical nursing interventions, emphasizing respect, empowerment, and fostering hope to facilitate patient recovery. The interventions focus on building a therapeutic relationship, providing culturally competent care, and promoting patient self-management skills. The report also references relevant research articles to support its analysis and recommendations.

Running head: NURSING
Nursing: Mental Health
Name of the Student
Name of the University
Author Note

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Question 1
Two components of the mental state examination (MSE) that is related explicitly with
the case study include:
1. Appearance and general behaviour: The main variables of appearance and general
behaviour include the physical appearance of the person (apparent vs. stated age),
grooming (immaculate/unkempt), dress (subdued/riotous), eye contact (furtive/direct)
and posture (kyphotic/erect). According to MSE, the grooming of the person with
depressive disorder shows unkempt appearance (Mirza et al. 2016). The unkempt
appearance of Munny was not significant as he was dressed well. However, his
clothes were loose fit. Loosely fitted clothes is attributable due to his significant
weight loss In case of psychosis, the affected individuals fails to maintain proper eye
contact. The lack of proper eye contact is evident in case of Munny. When Munny
visited the centre, the nurse who greeted him noticed that he is refusing to make eye
contact. He is slumped in his own chair and was staring at the floor and this indicates
mannerism or stereotype posturing. Munny is also refusing the answer the questions
raised to him in full sentences, and is only nodding his head. His wife also
complained that Munny mainly orates in monosyllables and shows limited interest in
talking with others.
2. Affect and Mood: Emotions are judged based on the mood of the person and the
affect. The mood of Munny seems to be low as he was sitting with his eye sight
looking at floor. He is refusing to make eye contact and to indulge in effective
communication. He was mainly responding by nodding his head. Kaup et al. (2016)
are of the opinion that disinterest in communication, and refusal to make eye contact
indicates that an individual is suffering from severe depression or self-esteem. Overall

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mood and affect showed dysphoric attitude that is having significant indication of
depression, guilt and anxiety (Asghar-Ali & Boyle, 2018).
According to Diagnostic and Statistical Manual or Mental disorder V (DSM V),
relevant criteria for detection of depression include significant depressed mood for majority
of the day like a constant feeling of sadness, hopelessness and emptiness (American
Psychiatric Association, 2015). The appearance of Munny provides resemblance of
hopelessness, sadness and emptiness. Like though he was well-dressed with loose fitting
clothes. He was refusing to make eye contact, staring over the floor and was answering with a
nod or in monosyllabic words. His feeling of hopelessness further got highlighted when he
provided consent that he has thoughts about whether his life is worth living. Second criteria
for detection of major depressive episode in DSM V include significant weight loss,
markedly diminished interest in the pleasure or other daily living activities and loss of
appetite (American Psychiatric Association, 2015). Wife of Munny reported that he has lost
interest in food, showing the signs of decreased appetite with significant loss in weight. He
was also reduced his interest daily living activities like initially he love he spend time with
his children but at presented Munny showing less interest in communicative and rarely notice
children and take part in other daily living activities. He mainly keeps himself locked in his
room.
Question 2
The stress-vulnerability model was elucidated by Zubin et al. in the year 1977. This
model is extremely useful for identification and treating of the mental health complications.
According to this model, with the increase in the level of stress in life, the vulnerability of
developing stress and anxiety increases. A significant vulnerability threshold must be crossed
in order to experience high level of stress and anxiety.

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Problematic childhood
Munny has problematic child, he first experienced adverse living condition during his
early years of life when he along with his family was forced to move out from their home
towards the countryside (1975). This was followed by the death of his father with gunshot.
Then he and his mother escaped in the refugee camp in Thailand until they got Australian
visa in 1985. Hankin et al. (2015) are of the opinion that exposure of high level of stress, due
to sudden loss of parents at an early year of life and change in the surrounding living
condition increases the severity of post-traumatic stress disorder in the later stages of life.
Rehan et al. (2017) stated that childhood stress, anxiety and adverse conditions increase the
risk of subsequent depression and anxiety. Rehan et al. (2017) further stated that majority of
the neglected or abused individuals during their childhood did not show any significant
clinical levels of depression and anxiety. However, severe maltreatment of adverse living
condition during childhood increases the risk of developing psychopathology.
Loss of employment
After the death of his father he supported his family and his mother. Thus taking
responsibility for the family members was his principal concern behind this high level of
stress. If he is thrown out of job, his way of income will get zero, increasing the burden over
the family. Stolove, Galatzer-Levy and Bonanno (2017) stated that sudden loss of job is
associated with high vulnerability of developing depression. The severity of developing
depression increases with the experience of adverse living condition during the early
childhood. The severity of depression and anxiety upon job insecurity, increases further when
a person are the sole earning member of the family. De Witte, Pienaar and De Cuyper, 2016).
stated that job insecurity influence the mental and physiological well-being during the course
of time and thus increasing the level of stress

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Question 3
Respect
Showing respect to the needs and opinions of the healthcare service uses is one of the
prime ethics of mental health (Donoho, Riviere & Adler, 2017). Here respect will be given to
Munny by acknowledging and addressing his current mental, health issues, why he is
refusing to go to his worked field, that he used to love he most and spending time with his
children. Education given to the patients under utmost respect will help in the growth of the
therapeutic relationship with the patient and the nurses and thereby helping to improve the
outcome of care by increasing the therapy adherence. Development of therapeutic
relationship extends the provision to developing patient-centred care plan for the mental
health professionals and thus helping to promote speedy recovery. Culturally competent
nursing professionals will play an important role in giving respect to the client (Donoho,
Riviere & Adler, 2017). Munny was from Cambodia and then moved to Thailand in refugee
camp. The presence of culturally competent nurses under the community health care settings
will help in designing of the person-centred care plan while not hampering the rest of Munny
and thereby helping to improve the outcome of care (Donoho, Riviere & Adler, 2017).
Empowerment
Empowerment is termed as an important aspect of health care. Patient empowerment
deals with increase in the health literacy of the patient in order to improving the self-coping
skills, disease management skills and to take active part in the decision making process with
the healthcare professionals along with increase in the participation in the care plan. The
empowerment must be done by the mental health nurse. It would be the duty of the nurse to
educate Munny about his current mental stated and how can it negative affects his physical
health and well-being along with his family members. This health education will help to
increase the level of awareness in Munny such that he will work in the self-coping skills and

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disease self-management skills. Few of the self-coping skills about which Munny will be
empowered include increase in spending time with the family members and friends. Munny
also loves doing his job. Thus health empowerment will include motivating Munny to resume
his job role in a regular basis and at the same time tell Munny to work in the gaps of this
professional practice domain in order to improve his mental depressive state of mind.
Hope
Dowling and Rickwood (2016) stated that hope and expectations among the people
who are suffering from mental illness are two of most inter-linked non-therapeutic
interventions that help in promoting positive mindset. Low levels of high, high level of
psychological distress along with high expectations are the reason behind poor mental state
condition of Munny. The family members of Munny must increase the ray of hope in his life.
In this case, it would be his wife. Cheavens et al. (2016) stated that positive ray of hope
coming from the immediate family members help to reduce the sense of helplessness and
emptiness among the mental health patient who are suffering from severe depressive
symptoms. The role of the wife of Munny, Ary will be to educate him. Education will mainly
entail in the domain of developing of self-confidence. Improvement in self-confidence will
give Munny the proper boost to strive in the competitive market by finding a new job as per
his choice. This will help to reduce his level of anxiety and stress in Munny that is arising due
to the impending fear of losing the job and sitting unemployed at home. The ray of hope must
also come from the employer of the bakery in which Munny used to work. The duty of the
employer of Munny’s job will be highlight the flaws in Munny’s practice and thus helping to
provide scope for improvement.

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References
American Psychiatric Association. (2015). Depressive Disorders: DSM-5® Selections.
American Psychiatric Pub. Retrieved from:
http://www.medicaidmentalhealth.org/_assets/file/Guidelines/2017-
2018%20Treatment%20of%20Adult%20Major%20Depressive%20Disorder.pdf
Asghar-Ali, A. A., & Boyle, L. L. (2018). Mental Status Examination. In Psychiatric
Disorders Late in Life (pp. 75-77). Springer, Cham.
Cheavens, J. S., Cukrowicz, K. C., Hansen, R., & Mitchell, S. M. (2016). Incorporating
resilience factors into the interpersonal theory of suicide: The role of hope and self‐
forgiveness in an older adult sample. Journal of clinical psychology, 72(1), 58-69.
De Witte, H., Pienaar, J., & De Cuyper, N. (2016). Review of 30 years of longitudinal studies
on the association between job insecurity and health and well‐being: is there causal
evidence?. Australian Psychologist, 51(1), 18-31.
Donoho, C. J., Riviere, L. A., & Adler, A. B. (2017). The association of deployment-related
mental health, community support, and spouse stress in military couples. Military
Behavioral Health, 5(2), 109-116.
Dowling, M., & Rickwood, D. (2016). Exploring hope and expectations in the youth mental
health online counselling environment. Computers in Human Behavior, 55, 62-68.
Hankin, B. L., Young, J. F., Abela, J. R., Smolen, A., Jenness, J. L., Gulley, L. D., ... &
Oppenheimer, C. W. (2015). Depression from childhood into late adolescence:
influence of gender, development, genetic susceptibility, and peer stress. Journal of
abnormal psychology, 124(4), 803.

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Kaup, A. R., Byers, A. L., Falvey, C., Simonsick, E. M., Satterfield, S., Ayonayon, H. N., ...
& Yaffe, K. (2016). Trajectories of depressive symptoms in older adults and risk of
dementia. JAMA psychiatry, 73(5), 525-531.
Mirza, S. S., Wolters, F. J., Swanson, S. A., Koudstaal, P. J., Hofman, A., Tiemeier, H., &
Ikram, M. A. (2016). 10-year trajectories of depressive symptoms and risk of
dementia: a population-based study. The Lancet Psychiatry, 3(7), 628-635.
Rehan, W., Antfolk, J., Johansson, A., Jern, P., & Santtila, P. (2017). Experiences of severe
childhood maltreatment, depression, anxiety and alcohol abuse among adults in
Finland. PLoS one, 12(5), e0177252.
Stolove, C. A., Galatzer-Levy, I. R., & Bonanno, G. A. (2017). Emergence of depression
following job loss prospectively predicts lower rates of reemployment. Psychiatry
research, 253, 79-83.

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