Mental Health Nursing in Acute Care Assessment 5 - Written Assignment 2 Assessment Type Written Assignment Description This written assignment builds upon the work presented in Written Assignment 1. It provides the opportunity for you to demonstrate your ability to integrate your academic understanding as covered in this course into effective and evidence-based care for a person requiring acute care in an in-patient environment. When preparing this assignment, please insert the formulation developed for Written Assignment 1 at the commencement of the paper (this is not included in the word count). This assignment requires you to present: • The plan of care that you have developed for the person considering : − the environment in which the person is cared for − the priorities for care − psycho-social aspects of care − specific nursing interventions − and biological treatments • Provide a critical review of the experience of care: − From the perspective of both the person and yourself as a nurse − And of the outcomes of care NB: This will require that you discuss with the person their experience of mental health acute care as well as reflect upon your own and perhaps other’s experience of providing care in this environment. Weighting 35% Length 2000 words Due Date 26th April 2016 Submission Method Online - Submission via Turnitin Assessment Criteria Refer Appendix A Assessment 5: Assigment 1 A case study of DK admitted to our acute inpatient facility: DK was a 28-year-old male; initially brought in by Ambulance with suicidal and homicidal ideas in the context of an argument with wife in a volatile relationship, low mood, and substance abuse. Currently (NFA), unemployed on Newstart allowance, father of three children in the care of FACS. Reports numerous previous psychiatric diagnoses and treatments in the past, not currently on medication or receiving psychiatric input Currently homeless, No Fixed Address (NFA), couch surfing and staying with his wife recently. Lost his job one and a half weeks ago, as a scaffolder as he reports he had difficulty performing his work duties “'I was lazy.' Reports low mood since last September or October characterised by three-four (3-4) months ago, he states he tried to give himself a 'hot shot' with battery acid, methamphetamines and powder from inside a light tube. Had passed out, and woken with the syringe in his arm, thought about his children and stopped himself from injecting the substance and he has poor Sleep at night. Appetite poor due to substance use but today ate four sandwiches and two yoghurts during the assessment in triage, assessment centre. Some features of anhedonia but unclear. States he likes riding bikes but doesn't have his motorbike and therefore has to steal them which takes the enjoyment of the ride away. No other activities which he enjoys but states he is helping to seek for his children. Wants to work on the relationship with his wife despite the volatility but states 'she gets into my marrow like no one else' and that he can easily become enraged. He describes a pattern of his wife continuing to want to talk about issues when he would prefer not to, which leads to an escalation of verbal disputes. Today he states that he was at home with his wife and two friends and his wife was in a good mood. He states that she told him that she wanted to have sex with multiple men in front of him which led him to become angry and distressed, exacerbating his thoughts of wanting to die and wanting to kill his wife. Specifically, he wanted to stab her and then hang himself. He has also had ideas of taking methamphetamines and driving his bike into a tree/off a cliff. As a result, he has called the ambulance to seek help with his mental state or substance use. He has had 15ml vodka and one bong of tetrahydrocannabinol (THC) today. Dk reports a long history of help seeking, but when delays in access to services occur, he tends to use more substances in reaction instead. Past psychiatric history Patient has two previous suicide attempts at electrocution and one hanging attempt - reported father cut him down three-four months ago, he states he tried to give himself a 'hot shot' with battery acid, methamphetamines and powder from inside a light tube. Had passed out, and awoken with the syringe in his arm, thought about his children and stopped himself from injecting the substance (Lommen, 2009), No Deliberate Self-Harm (DSH) currently. Reports mother was heroin addicted, and he was also heroin addicted when born. Diagnosed with attention deficit hyperactivity disorder (ADHD) at the age of four by Paediatrician in one of South Eastern Local Health District. Managed on Ritalin and Clonidine. DK reports that he has schizophrenia, bipolar, depression and anxiety but states no formal diagnosis, and couldn’t recall treating doctors. The patient had previous medications include Tofranil, Risperidone, Olanzapine, Quetiapine, Diazepam, and Mirtazapine. Prescribed Mirtazapine 45mg in 2016 by GP for depression. Took one box, at times multiple tablets to induce sleep. Was using methamphetamines simultaneously, not managed by a psychiatrist while in jail. One overnight MH admission voluntary, overnight in Hunter Health District. States he checked himself in after an allegation of sexual assault while under the influence of drugs but states that he was the one assaulted. Medical history DK has a history of Asthma – which he was non-compliant with an inhaler, No recent surgical history, and No Known Drug Allergies (NKDA), No regular medications. Substance use DK has been using Nicotine - 50/day, Ethanol, also called alcohol, ethyl alcohol, and drinking alcohol (ETOH) – occasional and tetrahydrocannabinol (THC) - daily. Three sticks/day Methamphetamines - fortnightly on the day of pay. 1.7 g smoked on each occasion. Doesn't consider himself dependent. Heroin - last use was over a two weeks’ period in 2016. Personal/Developmental DK was adopted by great uncle and aunt who he calls his parents, grew up in Young and has domestic violent (DV) at home. Child sexual assault (CSA) at age seven. Told his mother who said he was lying and never to disclose it. DK has a history of oppositional behaviours when young, and had sustained numerous incarcerations in his right wrist (Bonugli et al. 2010). He had in relationship with the wife for six years. Three children together in the care of FACS. They have visited. His wife also used substances and is currently pregnant. Physical assessment 28 years old male was weight 72kg, height 188cm, blood pressure, 133/78. Saturation level 96%, heart rate 84bpm, respiratory rate 17bpm and temperature of 36.4degree centigrade. Patient has body mass index of 21kg per metre square. Mental State Examination (MSE) Caucasian man of average build and height dressed in jumper and denim jeans and runners. Moderately kempt. A Large tattoo of 'Aussie' and 'Pride' on the right and left forearms respectively. Affect was reactive, with 'depressed' mood, speak in normal speech Thought form was logical, “Reports ongoing thoughts of wanting to kill himself and his wife with simultaneous desire to live and to work things out for his children (Barker 2009). 'I don't want to die' but states that he is worried that he will act on his thoughts impulsively as when he is acutely distressed 'I don't fear death'. He decided Seeking help through psychiatric admission. No delusions or grandiosity elicited and no perceptual disturbances. Patient has insight into mental health partially, denies any current disturbances. Patient alert and oriented to time, place and people (T/P/P). Impression 28 years old man presents with suicidal and homicidal ideation in the context of numerous psychosocial stressors, likely mood disorder secondary to substance use, and a long history of behaviours indicative of an antisocial personality structure (Hunt, 2012). Argument precipitates this presentation with his wife and his inability to return home. Due to the chronic substance use, it is difficult to elicit depressive features, but subjectively there is a deterioration in mood since late 2016. (Hunt, 2012). Plan Due to current presentation and a given previous history of aggression with aims of brief crisis admission, the patient was admission Voluntary to High Dependency Unit. Strict behaviour management agreement. The patient advised that if he becomes aggressive towards other patients or staff, he would be likely discharge home from the service. He has been encouraged to seek nursing staff if becoming anxious or agitated for assistance or medication. The patient has not been put on regular medication due to minimal evidence of a psychotic disorder; admitted voluntarily with close monitoring Medications as charted to ensure safety. DK was given the condition; he becomes aggressive, please notify the on-call psych registrar early for a review of the need to change voluntary status or discharge. Patient, need social worker input to help for accommodation, employment and Centrelink. Need also a referral to drug and alcohol for rehabilitation if mental state stable and agrees Discussion The nursing procedure does not completely depict the roles of psychiatric nursing, nursing models, existing exploration or specific psychotherapeutic models. It is a practical undertaking based on the administration of mentally aggravated, bothered and disarranged individuals (Bowers, 2005). This patient has been conceded by and large for very express reasons identified with his requirements for respite, well-being, security administration, perception, evaluation, individual care and treatment (Bowers, 2005). The suggestions for the exercises of psychiatric medical attendants are that their part is not hazy and unclear by any means, but rather evidently focused on these assignments. This situation won't be brand new information to honing psychiatric attendants who are, all things considered, doing these errands consistently. Nonetheless, the new point of view conveyed to these errands, by a thought of the explanations behind confirmation of patients, highlights their focal significance. We give the bedrock to further definition of psychiatric nursing abilities, part, procedures and systems (Horsfall, 2010). The capacities and parts for nursing can be raised on top of these foundational undertakings, insofar as they blend with them, and don't reduce them. The seven capacities that have been identified infer what the centre part of intense psychiatric nursing is, notwithstanding, they don't put on what the full part could be, with further improvement (Bowers, 2005). The affirmation of patients with self-mind deficits implies that essential care and rehabilitative capacities can, and ought to be, a piece of the psychiatric medical caretaker's part and aptitudes. These corporate would shower individual for cleanliness and cleanliness, care of garments, arrangement and observe of the satisfactory eating routine of sustenance and fluids (Hunt, 2012). Be that as it may, it is just a piece of the bundle of nurture the customers concerned whose rehabilitative exercises should join extra master contribution from medication and liquor and develop far from the ward into the group to cover zones like settlement and business. The ward staff will be that as it may, keep up their contribution amid the confirmation time frame, and add to the evaluation of the patient's potential for self-hurt, which will decide the suitable convenience for the patient on release (Carter et al. 2016). Given that admission to healing facility can be an expert on the grounds of self-disregard and self-mind deficits, the suggestion for the part of ward staff is that they give that individual care, and later give recovery, re-instruction and preparing in self-mind exercises. Intercessions for lessening reiteration of DSH in populaces ought to be produced and assessed with nursing group pioneer and patient investment. In our ward, all patients ought to ask whether they recognise as where they originate from to guarantee that particular populace information that can be gathered for DSH and other exhibiting issues (Carter et al. 2016). Meditations for decreasing reiteration of DSH among by individuals exhibiting to mental ought to be created and assessed with authority to guarantee legitimate self - hurt administrations (Carter et al. 2016). Reference Barker, P. (2009). Assessment: The foundation of practice (Ch 9). In P. Barker (Ed.). Psychiatric and Mental Health Nursing; The craft of caring (pp. 67-74). London, Hodder Arnold. Bonugli, R., Brackley, M., Williams, G., & Lesser, J. (2010). Sexual abuse and posttraumatic stress disorder in adult women with severe mental illness: A pilot study. Issues in mental health nursing, 31, 456-460. Bowers, L. (2005). Reasons for admission and their implications for the nature of acute inpatient psychiatric nursing. Journal of Psychiatric and Mental Health Nursing, 12, 231-236. (Link) Carter, G., Large, M., Hetrick, S., Milner, A.J, Bendit, N., Walton, C., Draper, B., Hazell, P., Fortune, S., Burns, J., Patton, G., Lawrence, M., Dadd, L., Robinson, J., & Christensen, H. (2016). Royal Australian and New Zealand College of Psychiatrists clinical practice guideline for the management of deliberate self-harm Horsfall, J., Cleary, M., & Hunt, G. (2010). Acute inpatient units in a comprehensive (integrated) mental health system: A review of the literature. Issues in mental health nursing, 31, 273-278. Hunt, G., O'Hara-Aarons, M., O'Connor, N., & Cleary, M. (2012). Why are some patients admitted to psychiatric hospital while others a not? A study is assessing risk during the admission interview and relationship outcome. International journal of mental health nursing, 21, 145-153 Lommen, M., & Restifo, K. (2009). Trauma and posttraumatic stress disorder (PTSD) in patients with schizophrenia and schizoaffective disorder. Community Mental Health Journal, 45, 485-496. Lommen, M., & Restifo, K. (2009). Trauma and posttraumatic stress disorder (PTSD) in patients with schizophrenia and schizoaffective disorder. Community Mental Health Journal, 45, 485-496.