Patient-Centred Healthcare: Analyzing Mr. Jim Gray's Case Study Report

This report analyzes the case of Mr. Jim Gray, a 28-year-old male admitted to a mental health unit after a suicide attempt and diagnosed with major depressive disorder. It utilizes the clinical reasoning cycle to demonstrate patient-centred care, considering his personal needs and goals. The report identifies key problems including suicidal ideation, social isolation, and physical injuries, proposing nursing interventions such as therapeutic communication, social support, and safety measures. It emphasizes the importance of evidence-based practices and patient involvement. The effectiveness of nursing strategies is evaluated, and the report reflects on the lessons learned, highlighting the challenges faced by individuals with depression and the significance of holistic, patient-centred care in promoting recovery. References to evidence based practices are included.

Running head: HEALTH CARE
Health care
Name of the student:
Name of the University:
Author’s note

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Introduction:
Person centred approach to nursing focus on consideration of patient’s personal needs,
desires and goal while implementing care to patient. This is based on components like being
responsive, fostering trusting relationship with patient, promoting physical and emotional
comfort and providing meaningful care (Ulin et al., 2016). Clinical reasoning skills enable
nurse to implement patient centred care. This paper utilizes the clinical reasoning cycle
framework to demonstrate patient centred care by analyzing the case study of Mr. Jim Gray.
It will process the health related information of the Mr, Jim, establish goals and nursing care
and evaluate the effectiveness of the nursing care strategies. A reflection on the patient’s
outcome will be provided too.
Consider the person’s situation:
Mr. Jim Gray is a 28 year old male admitted to the Mental Health unit 5 days ago
after a failed suicidal attempt. She has been diagnosed with major depressive disorder
(MDD). He is the son of a grazier and the family is suffering from financial crisis because of
longstanding drought conditions in the district.
Processing information
To assess and identify key problems in patient, it will be necessary to consider
subjective and objective information of Mr. Jim. The handover information of Mr. Jim
suggested that he was reluctant to have lunch and ate almost nothing. He returned to bed
immediately. The occupational therapist reported no interest of Jim in taking part in any
small group games. Based on this information, it can be interpreted that key symptoms of Jim
includes suicide ideation, low appetite, social isolation, little interest in activities. These
symptoms are similar to that of major depressive disorder (Draper & Tetley, 2013). However,

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the duration or persistence of these symptoms is not known. In addition, the vital signs of Jim
include blood pressure 125/75 (normal BP 120/80), temperature 36. 3 degree Celsius (normal
37.4) , pulse 66 bpm (60 to 100 bpm) and respiratory rate 18/min (normal 12 to 20 breaths
per minute). All the vital signs are within normal limit expect body temperature which is
lower than expected.
On assessment of the body, burn mark has been found on his neck due to breaking of
the rope during suicide attempt. Minor bruising and broken skin on arms and leg from fall has
been found too. These forms of self inflicted injuries are common during failed suicide
attempt such as strangulation and jump from a height. Hence, injury patterns must be
assessed to promote full recovery of patient (Siegl et al., 2017). The review of current
behaviour of Mr. Jim shows that he is not willing to talk with anyone. Currently he is turning
face towards the fall and stating that he just wants to die. This is high risk behaviour as he is
still having suicidal thoughts and it can increase suicide attempts in the future too. Interacting
with such patients can be challenging for nursing staffs too. Hence, nursing staffs must be
skilled in therapeutic interactions to effectively deal with patients who are suicidal (Awenat
et al., 2017).
Three nursing problem or issues:
Based on collection and processing of subjective and objective information of patient,
three major problems have been identified for patient. Based on the analysis of symptoms of
Jim during afternoon shift, one nursing problem identified is risk of suicidal thoughts or
suicide ideation. Suicide ideation includes thought about killing oneself or making plans to
end life. This is evidenced from the mark in the neck which is a sign of failed suicide
attempts and patient’s verbal expression of willing to die. Hence, addressing suicide ideation
is a major problem that needs to be prioritized by nurse as it can lead to future risk of self

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harm. The risk factor of self harm increases in patient with psychiatric illness (Singhal et al.,
2014). As history of self injurious thoughts and behaviour is the strongest predictor of future
suicidal behaviour, taking steps to prevent suicidal thoughts and behaviour is most important
for safety of patient (Ribeiro et al., 2016).
The second high priority nursing problem for patient is social impairment evidenced
by Jim’s lack of interest in taking part in social gathering. Jim avoided taking part in any
activities of small group games or one on one activity. Neither did he choose to talk with the
nurse. Impairment in social functioning or distress is a major problem for patient with major
depressive disorder. Mr. Jim was diagnosed with MDD and some of the primary symptom of
MDD includes depressed mood, diminished interest in activities of pleasure, weight loss,
insomnia, fatigue, feelings of worthlessness, recurrent thoughts, indecisiveness and suicidal
attempts (Zimmerman et al., 2015). The significance of improving social functioning is that it
is imperative for human well being and survival. Frequency of social activities and frequency
of perceived social support is important in people with depression as it gives a protective role
to patients (Saris et al., 2017). As impairment in social functioning is commonly seen in
patients with depressive disorder, priority this as a major nursing problem for Jim is
important. While deciding the choice of intervention, the focus should be to identify
perceived social disability in patients.
The third problem identified for Jim is injuries and minor bruises in the skin. Hence,
caring of the injured areas in the arms and legs is necessary to provide physical comfort to
patient. Addressing the above three problems will help to address mental, social and physical
health outcome of patient. The priority is to implement the values of patient centred care to
provide relief to patients.
Goals for priority of nursing care

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One of the key elements of patient centred care is to emphasize partnership between
patient and health care professionals and acknowledge patient’s preferences and values while
delivering care. The goal is to deliver holistic and patient centred care by addressing the
above identified nursing problems (Delaney, 2018). The key goal of care is to address
suicidal thought, reduce symptom of social isolation and provide appropriate care for self
harm related injuries.
Nursing care of the person
To address the issue of suicidal thought, it is necessary to implement multiple
interventions consisting of modifying the health environment of patient and engaging in
therapeutic talk with patient. As Mr. Jim has already attempted suicide very recently and he is
still having the same thoughts to die, it will be necessary of nurse to regularly observe or
supervise patient. The significance of clinical supervision is that it will aid in creating a
supportive environment for patient and promptly identify or respond to safety or self harm
issues (Snowdon et al., 2016). This is necessary as part of patient safety practices. The
evidence by Hodgson (2016) explains that skills in mental health training are critical to
ensure that nurses respond positively to patients with self harm. This needs to be considered
during supervision process too.
In addition, creating a safe environment for Jim is critical to safeguard patient during
suicidal and impulsive behaviour. This is necessary to promote safety and quality during care
delivery. According to the NSQHS standards, ensuring safe environment is critical to reduce
risk for patient. Furthermore, to promote recovery, it will be critical to engage in therapeutic
communication. This will be done by utilizing the concept of holism, recovery and
therapeutic alliance during communication with patient (Lees, 2013). Evidence based
intervention suggest that treatment protocols for patient should prioritize proactive

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therapeutic communication intervention to identify psychosocial issues and implement
appropriate behavioural interventions (Awenat et al., 2017). In addition, psychosocial
assessment is necessary to identify the reason behind suicidal thoughts and relation between
self harm and current psychosocial status. The advantage of risk assessment is that it can lead
to assessment of three categories of self harm. This includes assessing the characteristics of
self harm, psychological attributes of the person and collecting data related to social class,
physical illness and social relationship of patient. Some standardized risk assessment tools
include Suicide Assessment Checklist, Hopelessness Scale and Edinburgh Risk of Repetition
Scale. This tool can be used to identify risk and tailor interventions for the patients based on
their particular circumstances (Carr et al., 2016).
To address the second problem of social impairment and little interest in taking part in
group activities, it is necessary to provide social support intervention. This is necessary to
address risk of social isolation. The key advantage of social support is that social inadequacy
and negative self statements is seen in patient with depression. Loneliness is the main risk
factor that leads to development of depression (O'Rourke, Collins & Sidani, 2018). Hence,
addressing this factor is critical to reduce loneliness and increase social engagement in Mr.
Jim. Evidence by Mohd et al. (2019) indicates that social support is associated with reduced
depressive symptoms. In addition, care needs to be provided for treatment of bruises and
rashes caused due to failed suicide attempts. This will involve application of antiseptic in the
area and assessment of airway, breathing and circulation. Mr. Jim sustained injuries during a
failed strangulation attempt. The assessment will help to ensure the effect of the injury on
airway and breathing function of patient. This treatment will ensure resolution of all issues
for patient.
Evaluation of nursing care strategies:

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The success or effectiveness of the nursing care strategies implemented can be
evaluated by assessment of suicidal thought in patient using one evidence based tool.
Reduction in self harm score and lack of suicidal thoughts will be indicative of recovery of
patient. In addition, social support intervention will ensure reducing social isolation and risk
of progression of MDD. Mr. Jim’s preference will be considered while planning social
support intervention. Jim’s engagement in daily life activities and increase in appetite will
also be indicative of normal mental functioning.
Reflect on the person’s outcome:
From the evaluation of Mr. Jim’s care, many lessons have been learnt regarding the
key challenges faced by people diagnosed with depression. The experience of providing care
to Mr. Jim revealed that suicide ideation and social impairment is a high risk behaviour in
such patient and controlling these behaviour is crucial to promote recovery. The analysis
suggests use of patient centred care approach by addressing both physical and mental health
outcomes of patient. Use of evidence based assessment tool is critical to engage in right
assessment too.
Conclusion:
From the evaluation of key problems and nursing care plan for Mr. Jim using the
clinical reasoning cycle, clinical judgment and nursing knowledge helped to process patient
information and detect three major problems in patient. As part of patient centred care,
several interventions like suicide harm assessment, therapeutic communication, social
support intervention and assessment of self harm injury was proposed to promote holistic
recovery of patient. Throughout the care, both physical and mental health needs of Jim were
considered.

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References:
Awenat, Y., Peters, S., Shaw-Nunez, E., Gooding, P., Pratt, D., & Haddock, G. (2017). Staff
experiences and perceptions of working with in-patients who are suicidal: qualitative
analysis. The British journal of psychiatry : the journal of mental science, 211(2),
103–108. doi:10.1192/bjp.bp.116.191817
Awenat, Y., Peters, S., Shaw-Nunez, E., Gooding, P., Pratt, D., & Haddock, G. (2017). Staff
experiences and perceptions of working with in-patients who are suicidal: qualitative
analysis. The British journal of psychiatry : the journal of mental science, 211(2),
103–108. doi:10.1192/bjp.bp.116.191817
Carr, M. J., Ashcroft, D. M., Kontopantelis, E., While, D., Awenat, Y., Cooper, J., ... &
Webb, R. T. (2016). Clinical management following self-harm in a UK-wide primary
care cohort. Journal of affective disorders, 197, 182-188
Delaney, L. J. (2018). Patient-centred care as an approach to improving health care in
Australia. Collegian, 25(1), 119-123.
Draper, J., & Tetley, J. (2013). The importance of person-centred approaches to nursing
care. Retrieved December, 2, 2015.
Hodgson, K. (2016). Nurses' attitudes towards patients hospitalised for self-harm. Nursing
Standard, 30(31).
Lees, D. B. (2013). Therapeutic engagement between people experiencing suicidal crisis and
mental health nurses (Doctoral dissertation, University of Tasmania).

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O'Rourke, H. M., Collins, L., & Sidani, S. (2018). Interventions to address social
connectedness and loneliness for older adults: a scoping review. BMC
geriatrics, 18(1), 214. doi:10.1186/s12877-018-0897-x
Ribeiro, J. D., Franklin, J. C., Fox, K. R., Bentley, K. H., Kleiman, E. M., Chang, B. P., &
Nock, M. K. (2016). Self-injurious thoughts and behaviors as risk factors for future
suicide ideation, attempts, and death: a meta-analysis of longitudinal
studies. Psychological medicine, 46(2), 225–236. doi:10.1017/S0033291715001804
Saris, I., Aghajani, M., van der Werff, S., van der Wee, N., & Penninx, B. (2017). Social
functioning in patients with depressive and anxiety disorders. Acta psychiatrica
Scandinavica, 136(4), 352–361. doi:10.1111/acps.12774
Siegl, K., Luedi, M. M., Vassiliu, P., Kauf, P., Schneider, R., Degiannis, E., & Doll, D.
(2017). Injury patterns and emergency department mortality after unsuccessful
suicide. A descriptive study of a consecutive case series. International
Surgery, 103(5), 280-286.
Singhal, A., Ross, J., Seminog, O., Hawton, K., & Goldacre, M. J. (2014). Risk of self-harm
and suicide in people with specific psychiatric and physical disorders: comparisons
between disorders using English national record linkage. Journal of the Royal Society
of Medicine, 107(5), 194–204. doi:10.1177/0141076814522033
Snowdon, D. A., Hau, R., Leggat, S. G., & Taylor, N. F. (2016). Does clinical supervision of
health professionals improve patient safety? A systematic review and meta-
analysis. International Journal for Quality in Health Care, 28(4), 447-455.

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Ulin, K., Olsson, L. E., Wolf, A., & Ekman, I. (2016). Person-centred care–An approach that
improves the discharge process. European Journal of Cardiovascular Nursing, 15(3),
e19-e26.
Zimmerman, M., Ellison, W., Young, D., Chelminski, I., & Dalrymple, K. (2015). How many
different ways do patients meet the diagnostic criteria for major depressive
disorder?. Comprehensive psychiatry, 56, 29-34.Mohd, T. A. M. T., Yunus, R. M.,
Hairi, F., Hairi, N. N., & Choo, W. Y. (2019). Social support and depression among
community dwelling older adults in Asia: a systematic review. BMJ open, 9(7),
e026667.