Create a recovery focused nursing care plan for the mental health patient from case study 2

Create a recovery focused nursing care plan for the mental health patient from case study 2 Order Description no introduction and conclusion are required and that the word count is 1500 works with 20% over or under allowed create a Recovery based nursing care plan for the patient in case study 2. the assignment is to be completed in the format provided in the attached document including completion of HONOs One goal per page Requiring 22 Referances, UK english Discipline of Nursing Complex Mental Health & Recovery 1 Recovery Focused Nursing Care Plan DUE: Sunday 19th April 2015 by 23:59 [End of Week 6]. Title: Recovery Focused Nursing Care Plan 1500 [approx.] Word Assignment 25 % Please see the Recovery Focused Nursing Care Plan Information Package for full details of the Assignment. This document provides all of the necessary details for Case Study 2. Case Study 2: The Client with Schizophrenia Clinician Role: Case Manager (Nurse): Community Case Management Team. Identifying Information: Bernard is a 25-year-old single male currently residing as an inpatient mother in the local Mental Health Unit where he has been a patient for the past 14/7. Prior to this admission you had been casemanaging Bernard in the community for the past 9 months. He was admitted with worsening psychotic symptoms over a 4/52 period in the context of poor compliance with his oral medication that he puts down to due to increased stress at home and work. He has been re-established on his medication with good effect and you are seeing him today to review him and discuss his discharge plan before he is discharged home in 2/7 time. Bernard is not religious, works part-time as a labourer for his uncle (who is a brick layer). Bernard lives with his parents and his younger sister in the family home. Presenting Complaint: Bernard reports increased paranoid ideation in the preceding 4/52 stating ‘they’ are watching him, following him and talking about him. When asked who ‘they’ are he refuses to identify them, stating that if he does “they’ will come after you too”. History of Present Problem: Bernard reports first being diagnosed with first onset psychosis at the age of 22. He was studying Engineering at University and was half-way through his final year leading up to mid-year exams when he first became unwell. At this time he experience paranoid ideation and Discipline of Nursing Complex Mental Health & Recovery 2 heard voices of a commentary nature. He was treated by the local First Onset Psychosis Team and made a good recovery over time in the community. Eventually he was discharged to ongoing treatment via a private psychiatrist and his GP and everything had been going well until 11/12 ago when he experienced a full relapse of symptoms whilst on a family holiday overseas. He had returned to Australia and had been an inpatient in the local Public Adult inpatient Unit for almost 2/12 at that time and had subsequently been assigned a Case Manager to oversee his progress following this episode. He had initially made slow but steady progress in the community and had started to work for his uncle as a labourer to earn some extra money. This had initially gone well however some of the other workers on the building site had started to make fun of him leading to his becoming increasingly stressed and subsequently more disorganised in his thoughts and actions. He also reported beginning to feel quite paranoid about his co-workers, and began to suspect that they were planning to harm him or his family. He reports that his poor compliance with medication was accidental and he did not mean to not take them. Bernard states that although his paranoia has receded over the past fortnight he has experienced increasing anxiety, feelings of helplessness and worthlessness, as well as feeling overwhelmed by his situation, saying “I did my best last time and it all just fell to pieces; what’s the point in trying now if that’s what’s going to happen?”. Bernard sleeps 6-8 hours per night, experiencing some difficulty getting to sleep as he tends to lie in bed worrying about his life and future. He denies any middle-of-the-night or early-morning awakening. His appetite has increased since recommencing medication and he report a weight gain of 4 kilograms in the past fortnight. He eats large meals and usually snacks on top of this. Meals at home are usually prepared by his mother. Bernard had been contributing to the running of the household prior to his relapse however at present does not feel up to doing household chores. He has become increasingly insular and has avoided social contact, tending to avoid friends and family who have come to call: he states this is for fear of them becoming targeted by the same people who were targeting him. Bernard describes few interests or activities outside the home; he had been heavily involved in the Drama and Soccer clubs whilst at University however he lost contact with most of the people he knew from them once he became unwell. He has been unable to establish a new social circle since then. The evenings are most difficult for Bernard — he feels increased anxiety, restlessness and finds that his pattern of negative rumination is markedly worse during the evening. He describes feeling disconnected from his life and unsure of what he is doing. He says he had a clear plan of what he wanted to do with his life but “that is all gone now” and he is struggling to Discipline of Nursing Complex Mental Health & Recovery 3 come to terms with the loss. He admits to occasional suicidal ideation in the form of a passive wish to be dead “because it would just be easier” however he denies a history of suicide attempts or current suicidal plan, stating he “could never do that to my Mum and Dad or Sister”. He denies any alcohol or drug abuse; he reports some experimentation with Cannabis and Ecstasy at parties in first year Uni but did not like the feeling and has not tried anything since. Current life stressors reported by Bernard include: · Co-workers on the building site where he has been working with his uncle making fun of him, calling him ‘freak’, ‘creep-show’ and ‘oddball’. He has caught them several times laughing at him as well; he knows it is directed at him because they stop when he gets within earshot. · His mother has recently been diagnosed with Diabetes and is having a hard time coping with this. Whilst she has begun to adjust to this Bernard is fearful that she will get unwell and might die in the future. · The loss of his intended life; he had been enjoying studying and had been doing extremely well in his course. He had begun to send out letters of interest to obtain an internship after he finished his degree. He had also begun to think about moving out of home into shared accommodation with several Uni friends and had been very excited about the impending change in his life. He reports feeling like a failure, stating that he feels “useless”. · Loss of her sense of role / structure that he had had whilst at Uni. Since then he had struggled to get some structure and routine in his life leading to him staying up late and then sleeping half the day. Past Psychiatric History: Bernard was diagnosed with 1st episode psychosis three years ago and initially responded well to treatment. When he relapsed 11/12 ago he was diagnosed with Schizophreniform psychosis which was revised and change to Schizophrenia during the current admission. The treating team are also questioning the possibility of a mood component given Bernard’s recent anxiety and depressive features. Pre-morbid Personality: Bernard describes himself as being creative, dramatic, funny and ambitious before becoming unwell. When asked further about Uni he says he was motivated, hard-working and really enjoyed the challenge of study though at times could be a little disorganised, putting this down to “being young”. He also reports a being very loyal to family and close friends, and has struggled with losing those friends who did not stay with him when he became unwell. Discipline of Nursing Complex Mental Health & Recovery 4 Medical History: Bernard’s only physical issue was a # L wrist sustained in a push-bike accident [when he was 17yo] that required surgery after it did not set straight initially. He has no known allergies. Family History: Bernard is the older of 2 children; the other being his younger sister Estelle [23yo] with whom he is very close. His parents are both alive and generally well; his father [Peter] suffers from high cholesterol and his mother [Janet] has recently been diagnosed with Type 2 Diabetes. Bernard reports that his father’s older brother [paternal uncle] had a ‘breakdown’ when his father was in his early 20’s and committed suicide; this is never spoken of in the family so Bernard knows nothing more about this. Social and Developmental History: Bernard is the older of 2 children. His mother’s labour was normal though he was delivered via caesarean section at term after the labour failed to progress. His early developmental milestones (talking, walking, etc.) were reached at normal age range. He denies any maladaptive behaviours or experiencing unusual stresses as a child. Academically, Bernard was a B grade student throughout his school years; he states that he could have done better but didn’t apply himself as much as he could have. He had many friends at school and as well as through various community groups [such as drama and various sports]. He had his first romantic relationship in Year 10 of secondary school and has had several girlfriends since. His most recent was a girl he met in Uni however this ended when he first became unwell. He states that he would like to meet someone in the future but believes this is unlikely due to his illness. He has deferred his studies at Uni and hopes to be able to return when well. Bernard was raised in metropolitan Melbourne and has live in the family home in Glen Waverly all of his life. He reports that the family has always been very close and they all generally get alone quite well. He says his parents and sister have been very supportive of him since becoming unwell though he worries about the impact the ‘stress’ might have upon them all. When first unwell he went through a period where he though they would be better off without him but states that he no longer feels this well and is regularly reassured of his family’s support. Long term goals had involved completing his degree, establishing his career, travelling and eventually settling down and starting a family of his own. Bernard is no longer certain about how he sees his future. Discipline of Nursing Complex Mental Health & Recovery 5 Mental Status Examination General Appearance: Bernard is a 25 year old male who appears of stated age. He is of medium build, has short brown hair and is appropriately dressed. He is mildly dishevelled in appearance [unshaven, malodourous] and he presents with variable eye contact; in particular this drops when he is feeling anxious or uncertain of himself. Speech: Bernard speaks with a normal rate, tone and volume for the most part. Occasionally his responses to questions are delayed however the content of his conversation is logical, goal-directed, and appropriate to situation and context. There is a noticeable increase in the rate [increased] and tone [more excitable] of his speech when discussing content related to his paranoid ideation. Thought Content: Bernard describes themes of loss, worthlessness, helplessness and hopelessness. There are some residual paranoia ideas evident regarding his former co-workers though these are fleeting in their nature and are less intrusive when they do occur. Affect and Mood: Bernard describes his mood as variable; he reports period of sadness, anxiety and uncertainty for the future. His affect is mildly restricted, with diminished range and a generally sad quality though he is responsive to humour at times. Motor Behaviour: Posture is generally closed, and leaning forward though his level of psychomotor activity increases when anxious. Perceptions: Bernard describes persistent paranoid delusions regarding his former co-workers though these are gradually softening and appear less frequent and intrusive that prior to his admission. He feels some emotional response to them [primarily anger] though firmly denes any plans to act on same. He had initially felt he could hear others talking about him at work though he know denies any such phenomenon; there is no other evidence of hallucinations. Suicide Potential: Bernard describes fleeting episodes of suicidal ideation in the form of a passive wish to be dead “because it would just be easier” however he denies a history of suicide attempts or current suicidal plan, stating he “could never do that to my mum and dad or sister”. Orientation: Bernard is oriented to person, place, and time. Discipline of Nursing Complex Mental Health & Recovery 6 Concentration: Bernard describes a mild impairment in his concentration as evidenced by an inability to do Serial 7’s accurately past a digit span of 5 [93, 86. 79. 72, 65 x, x, x,). He gives the example of struggling to concentrate on TV or reading which frustrates him as he enjoys both of these activities. Recent and Remote Memory: Bernard’s recent memory is intact, with three of three objects recalled after 5 minutes. He is able to describe accurately events from the past. Insight and Judgement: Bernard has partial insight into his illness; he accepts that he has a psychotic illness though he is unhappy with the diagnosis of schizophrenia as he thinks it means he’ll never recover. He is able to acknowledge psychotic Sx in retrospect though at the time has poor insight. He has begun to trust his family’s opinion on his symptoms and will often seek reality based reassurance regarding things that he is experiencing. Formulation of Impression Bernard is a 25 year old male with a Hx. of 2 previous episodes of psychosis recently diagnosed with schizophrenia. He presents with a 4-6 week history of re-emerging psychotic symptoms in the context of [unintentional] poor compliance with prescribed oral medications. He experienced increasing levels of stress, disorganised thinking and behaviour as well as paranoid delusions about his co-workers suspecting that they were planning to harm him or his family. Subsequent to his admission he has also exhibited mildly depressed mood; increased anxiety; feelings of worthlessness, hopelessness, and helplessness, suicidal ideation; withdrawn behaviour and impaired functioning; decreased concentration. His symptoms are consistent with that of Schizophrenia though the emerging affective component will need to be closely monitored for further evidence of a co-morbid depressive or anxiety related disorder. Bernard’s preoccupation with worthlessness, rumination about the losses he has experienced, passive suicidal ideation, and his marked functional impairment, all occurring in the context of his illness are suggestive of a co-existing grieving process though at this stage this appears to be appropriate under the circumstances. Traditional Nursing Diagnostic Focus The following nursing diagnoses for Bernard are derived from the assessment data gathered: · Altered Thought Processes. Discipline of Nursing Complex Mental Health & Recovery 7 · Sensory-perceptual Alterations. · Anxiety. · Mood Disturbance · Risk for Self-directed Violence · Self-esteem Disturbance · Self-care Deficit · Social Isolation · Sleep Pattern Disturbance [minor]. HONOs Scoring Domain Results 1. Overactive, aggressive, disruptive behaviour. 0 1 2 3 4 2. Non-accidental self-injury. 0 1 2 3 4 3. Substance use and misuse. 0 1 2 3 4 4. Cognitive problems. 0 1 2 3 4 5. Physical illness or disability problems. 0 1 2 3 4 6. Hallucinations or delusions. 0 1 2 3 4 7. Depressed mood. 0 1 2 3 4 8. Other mental health issues [Anxiety]. 0 1 2 3 4 9. Relationships. 0 1 2 3 4 10. Activities of daily living. 0 1 2 3 4 11. Problems with living conditions. 0 1 2 3 4 12. Problems with occupation and activities. 0 1 2 3 4 Results Key: see Assignment Information package. Discipline of Nursing Complex Mental Health & Recovery 8 DSM-5 Diagnosis for the Client with Schizophrenia The DSM-5 diagnosis for Bernard is as follows: · Schizophrenia (295.9). Planning
The Nursing Care Plan for Bernard illustrates how nursing diagnoses guide the development of goals and therapeutic interventions. Ideally, the nurse collaborates with the client in planning care.
This can be difficult to do with the psychotic or depressed person who is feeling hopeless, helpless, and unmotivated.
The nurse’s communication of the firm belief in the client’s capacity, ability, resourcefulness and potential for recovery is critical in empowering the client to begin the journey towards recovery.
Equally the nurse’s communication of the firm belief that the client will feel better with time can often be enough to engage the client in at least going along with the care plan.
Setting practical, reasonable, manageable, short-term goals that the client can accomplish without much difficulty is important in fostering a sense of hope and improved self-esteem.
The nurse should expect that with the amotivated psychotic client, early interventions may need to be aimed at “doing for” the client [after accurate identification of those abilities that remain intact vs. those that are compromised].
The care plan will also need to include consideration regarding the involvement/capacity of family, friends and other significant supports care of her daughter], but the expectation should be that the client will gradually assume more independent functioning as their mental state improves. Implementation
Nursing interventions are guided by the nursing care plan. For the psychotic client, priority needs to be given to preventing self-harm through ongoing assessment of suicide potential and maintenance of a safe environment. Discipline of Nursing Complex Mental Health & Recovery 9
In addition, improving and maintaining physical health are important foci of care for the depressed client, who is likely to have an altered nutritional status and disturbed sleeping pattern.
Monitoring for side effects of pharmacological treatments for depression is equally important to maintain biological integrity.
The psychotic client is often socially isolated and withdrawn. Involving the client in individual and group interactions in the hospital unit will decrease his or her isolation and foster a sense of self-worth.
As the client’s symptoms of depression respond to the psychotherapeutic and somatic interventions implemented, psychoeducation becomes feasible.
Clients and their Families should be educated about the type of mental illness they have, as well as its possible causes.
Specifically, the contribution of both neurobiological and psychosocial factors to the onset of depressive illness should be discussed.
Informing the client of the signs and symptoms of depression is important so that recurrence can be identified early.
Education regarding the maintenance of medication regimens should be conducted. Evaluation Evaluation of the client’s responses to nursing interventions should be ongoing. In developing a Recovery Focused Care Plan for Bernard the nurse might ask the following questions to evaluate the effectiveness of the nursing process to ensure progress remains ongoing: · Does the client describe an improvement [reduction] in the frequency and intensity of paranoid thoughts? · Does the client describe an improvement in his level of organisation related to both his thinking and his behaviour overall? · Does the client describe an improvement in mood and energy level? · Has there been any change in / worsening of his suicidal ideation? · Has the client learned new, more effective ways of expressing feelings? · Has the verbalisation of self-deprecatory [worthless/hopeless] ideas diminished? Discipline of Nursing Complex Mental Health & Recovery 10 · Is the client initiating interactions with others? · Is the client initiating planning for his future taking into account the impact of his mental illness? In asking these and other questions, the nurse reflects on his or her own observations; on the observations of other team members and the client’s family; and, of utmost importance, on the client’s description of his or her own experience. Discipline of Nursing NURS2098: Complex Mental Health & Recovery 1 Written Assessment Task Recovery Focused Nursing Care Plan DUE: Sunday 19th April 2015 by 23:59 [End of Week 6]. Title: Recovery Focused Nursing Care Plan 1500 Word Assignment 25 % Assignment Number 1: 25% Developing a Recovery Focused Nursing Care Plan [RFCP]. - A Recovery Focused Nursing Care Plan based on the care of a consumer described in one of scenarios. Please see the assessment information package for more information on this assignment. Instructions: 1. Choose 1 of the scenarios to use as the basis for your assignment [you will base your entire assignment on one of the case scenarios only] 2. Read the Case Study and identify 5 Goals drawn from both the case study information and the HONOs scale for the consumer in the scenario. Consider and adopt a Recovery Model perspective in doing this. 3. Having read the following case study, and familiarised yourself with the layout of the nursing care plan, you are to complete the Recovery Focused Nursing Care Plan for this client. 4. Each RFCP must include 5 full Goals/Issues with each section fully completed. 5. In keeping with the Recovery Model principles [as conveniently discussed in the Week One lecture] remember to: a. Rank the goal priority in the order in which the consumer would like to address the issues listed [there are going to be different ways to do this depending on what you see as being the highest priority]; this will require some critical consideration on your behalf. b. Make sure that language used on the RFCP is clear, encouraging and agreed by consumer and clinician. Discipline of Nursing NURS2098: Complex Mental Health & Recovery 2 c. Keep in your mind at all times the importance of this being a ‘shared document’ that aims to maximise the consumer’s strengths, capacity, abilities and resources. 6. You are allowed to ‘fill in’ details in the case study where you feel that it is important for the completion of the RFCP. If you do this you must include all additional information in an Appendix which should be cited in text wherever this information is relevant. 7. You must support your work with references. In particular this means that his means that you will need to locate references that support nursing and consumer interventions as wells as in identifying potential strengths [especially through the literature on the Recovery Model] as well as when identifying supports and resources and determining timeframes for review. 8. Please post all questions up on the Course Discussion Boards as this will allow all students to benefit from the answers. 9. In keeping with RMIT policy all assignments are to be submitted through the Turnitin Portal available via the course webpage. The assignment is due by 23:59 on Sunday night: the portal will remain open until this time however after the portal closes you will not be able to submit your assignment so please make sure that it is submitted by 23:59. The Turnitin portal will open 2 weeks prior to the assignment due date to allow you to submit your assignment. You are allowed to submit it as many times as you would like up until 23:59; the assignment I will receive to mark will be the LAST one you submitted. Discipline of Nursing NURS2098: Complex Mental Health & Recovery 3 Constructing the Recovery Focused Nursing Care Plan: When constructing the RFCP you are required to submit he document using the following format: Consumers Priority Identified Goals/Issues The consumer’s strengths to address these issues. Consumer and Nursing Interventions Person/s Responsible Timeframe - Include a succinct statement describing the issue. - Rank according to the consumers priorities. - Can be done using HONOS or based upon the information provided in the case study - This section is critical to ensuring the plan has a genuine recovery focus. - You need to ask questions such as: - ‘What can they do?’ - How can they help themselves? - Include agreed actions and expected outcomes. - Consider what needs to be done for each Goal / issue and identify what things the consumer can do and what things the nurse needs to do. - Who is responsible for this intervention occurring? - Who will be assisting in this intervention. - What sort of assistance are they going to give. - This needs to be realistic and developed with the consumer. - It also needs to reflect the time taken for interventions to effect change in the consumer’s symptoms. So your final assignment will have the following structure Consumers Priority Identified Goals/Issues The consumer’s strengths to address these issues. Consumer and Nursing Interventions Person/s Responsible Timeframe #1 Goal/Issue 1 Strengths 1 Interventions 1 Responsibility 1 Timeframe 1 #2 Goal/Issue 2 Strengths 2 Interventions 2 Responsibility 2 Timeframe 2 #3 Goal/Issue 3 Strengths 3 Interventions 3 Responsibility 3 Timeframe 3 #4 Goal/Issue 4 Strengths 4 Interventions 4 Responsibility 4 Timeframe 4 #5 Goal/Issue 5 Strengths 5 Interventions 5 Responsibility 5 Timeframe 5 Discipline of Nursing NURS2098: Complex Mental Health & Recovery 4 The HONOs and the Recovery Focused Nursing Care Plan: The HONOs scale is completed as part of the assessment data and can be used to identify the key Goals and Issues and then rank them according to consumer preference. It is included as part of the case study information. Domain Results 1. Overactive, aggressive, disruptive behaviour. 0 1 2 3 4 2. Non-accidental self-injury. 0 1 2 3 4 3. Substance use and misuse. 0 1 2 3 4 4. Cognitive problems. 0 1 2 3 4 5. Physical illness or disability problems. 0 1 2 3 4 6. Hallucinations or delusions. 0 1 2 3 4 7. Depressed mood. 0 1 2 3 4 8. Other mental health issues. 0 1 2 3 4 9. Relationships. 0 1 2 3 4 10. Activities of daily living. 0 1 2 3 4 11. Problems with living conditions. 0 1 2 3 4 12. Problems with occupation and activities. 0 1 2 3 4 Results Key 0 = No problem at all during the rating period [usually the last 72 hours]. 1 = Minor problem / occasional issues causing occasional periods of distress or impairment during the rating period [usually the last 72 hours]. 2 = Moderate problem during the rating period [usually the last 72 hours] causing passing periods of distress or impairment during the rating period [usually the last 72 hours]. 3 = Significant problem causing persistent distress or impairment during the rating period [usually the last 72 hours]. 4 = Severe problem causing constant distress or impairment during the rating period [usually the last 72 hours]. Discipline of Nursing NURS2098: Complex Mental Health & Recovery 5 The Recovery Focused Nursing Care Plan Marking Guide. Student Name: _________________________________________ Assessment Criteria Mark Allocation Consumer Priority: · Prioritisation logical and appropriately organised. · Reflects the information in the case study. · Reflects consumer preference. · Prioritisation reflects a commitment to the key concepts of the recovery model. /3. Identified Goals/Issues: · Congruent with client needs. · Reflects the information provided in the case study. · Clear, succinct and relevant. /3. Consumer’s strengths to address these issues: · Realistic, sensible and possible strengths identified. · Relevant and connected to the Goal/Issue. · Strong person focus. /4. Consumer and Nursing Interventions: · Appropriate for outcomes. · Feasible and realistic. · Consumer interventions relevant & appropriate. · Consumer interventions act to maximise consumer ability and capacity. · Nursing interventions based on sound evidence/research. · Nursing interventions Consumer oriented [not nurse / system oriented]. · Nursing interventions act to do only what the consumer cannot. /4. Persons Responsible · Relevant, appropriate and realistic. · Person and role clearly identified. · Roles allocated to maximise consumer, carer and community involvement. · Seeks to maximise consumer / carer involvement. /3. Timeframe · Reflects the Goals / Issues as outlined. · Feasible, Realistic & Measurable. · Specific to the consumer and their strengths / resources / barriers and overall situation. /3. Style & Presentation: • Including use of word limit, double-spacing, use of header & footer, section headings, page numbers, and size-12 Times New Roman font. · Spelling, grammar and paragraph structure meets academic standards. /2. Referencing: • Utilises relevant and contemporary references to support the discussion in each response • In text referencing used throughout. • Referencing formatted in accordance with APA requirements. • Includes at least 12+ current references (books and journal articles) /3. TOTAL: /25. PLACE THIS ORDER OR A SIMILAR ORDER WITH US TODAY AND GET AN AMAZING DISCOUNT :)