Promoting mental health and wellbeing

| August 18, 2015

Promoting mental health and wellbeing

Scenario B – Tracey is a 35 year old woman who presents for assessment to the Emergency Mental Health Community Team. She is six months pregnant with her third child. Her other children, to her ex-partner, are aged three and five. Tracey is in a heterosexual relationship with her partner of one year, Peter. Peter moved in to live with Tracey and her children eight months ago. The children’s father is distressed about Peter moving in to live with his children. There is verbal hostility between Tracey and her ex- partner each time he visits to collect the children for a weekend visit. Her expartner frequently states he is making arrangements for court to have full time care of the children. Tracey and her current partner, Peter, are in $35,000 uncontrolled debt after a recent new joint business venture failed. A finance company calls weekly requesting payment. Tracey and her partner stopped making the mortgage repayments three months ago, with the belief that dealing with the uncontrolled debt would be a better option. Her parents are supportive but live in Queensland. Tracey is able to have face to face contact with them once a year. She does chat with her parents over telephone every week if possible. Tracey states she is worried about how she will cope with her two children and new baby. She reports low mood, weekly panic attacks and fleeting thoughts of suicide. During your meeting with Tracey, you note she is fidgety and restless, breathing rapidly, shaking slightly, sweating and tearful. She is not wishing to actively engage with the mental health services, for fear it will impact on her having care of her children, stating she will visit her General Practitioner (GP).

1)    Investigate and outline the prevalence/incidence of anxiety (depending on the scenario you have chosen) in Australia – Your answer needs to cover:  gender, age groups, specific risk groups, hospitalisations. 225 words

?    Please refer to ABS Australia 2007. ( Only Australia statistics)

2)    Using current literature discuss TWO (2) factors that may have contributed to the development of the client’s presentation and mental health concerns.  225 words

?    Contributed factors: Child custody issues, financial stress, Verbal hostility with ex husband

3)    Using current literature discuss TWO (2) ethico-legal issues related to your scenario. 225 words
The Mental Health Act (2007) is the legal construct used predominately for clinical care in the mental health services. Please ensure if you are using the Mental Health Act, you refer to the latest NSW version. However you may also wish to consider legal frameworks around access to health records, storage of health records or privacy. Professional nursing standards or ethics literature may also help guide your thinking.

For example you may wish to consider:

•    the professional boundaries around confidentiality
•    the use of the mental health act for when safety concerns are noted
•    a nurse’s role in assessment and engagement with a client knowing that they may have to activate resources to possibly schedule a person and detain them ( ie remove their freedom) due to concerns about their safety
•    You may also consider a person’s right to engage with mental health services when there are actual risks or potential risks to their safety or the safety of others
•    The ethics of a nurse taking no action if risks to self are identified or potential risks are noted
•    a person’s autonomy and right to choose
•    a nurse’s discussion with other health professionals ie. GP
•    a nurse’s involvement with family members when risks are noted versus a person’s right to choose no family involvement
•    a nurse’s professional and ethical role in child protection matters for risks or potential risks
•    non-maleficence; a principle to avoid harm. However assessment and interventions may cause distress to the person and their family

4)    Identify TWO (2) nursing/midwifery concerns / problems with evidence from your chosen scenario- Your risk identification should be focused on the next 1-5 days of nursing/midwifery care for your client. 100-150 words ( USE TABLE)
?    Symptoms of anxiety
?    Inability to cope
?    Fleeting thoughts to suicide
?    Reducing engagement in services

?    For each nursing / midwifery concern / problem you have identified in Question 4, outline and describe TWO (2) evidence based nursing / midwifery interventions (ie; what you would actually do as a nurse / midwife to support the person and how you would do it). Your interventions should be focused on nursing / midwifery care for your client over the next 1-5 days. They must be interventions which you would actually undertake directly with your client within your role as a nurse. You are also required to provide a clear rationale for each nursing  intervention (ie. Why have you chosen the particular nursing interventions? How will the interventions support the person or contribute positively to their current presentation or concern?)  Each intervention and rationale must be supported by current literature.   225 words (USE TABLE)

Positive nurse- client relationship with recovery based communication
?    Safety planning
?    Psycho-education to build hope and reduce stress
?    Sleep hygiene
?    Relaxation techniques
?    Behavioural scheduling and goal setting
?    Medications for anxiety

1)    Use a table to present your answers for questions 4 and 5.
2)    Ensure that your answers incorporate literature
3)    The total word count for assessment one is 1000 words. As a guide:
225     words for question 1, 2, 3 and 5.   100 – 150 for question 4.
4)    No introduction or conclusion to your work is needed.

5)    Consider referring to the Australian Bureau of Statistics, Department of Health, Mental Health Commission websites for up to date information. You may also wish to refer to the DSM V.

6)    It may be helpful to consider the information you have about the Stress Vulnerability Model. This may assist you to think about vulnerabilities a person may have to developing mental health concerns.

7)    Question 3 refers to ethical or / and legal issues.
The Mental Health Act (2007) is the legal construct used predominately for clinical care in the mental health services. Please ensure if you are using the Mental Health Act, you refer to the latest NSW version. However you may also wish to consider legal frameworks around access to health records, storage of health records or privacy. Professional nursing standards or ethics literature may also help guide your thinking.

For example you may wish to consider:

•    the professional boundaries around confidentiality
•    the use of the mental health act for when safety concerns are noted
•    a nurse’s role in assessment and engagement with a client knowing that they may have to activate resources to possibly schedule a person and detain them ( ie remove their freedom) due to concerns about their safety
•    You may also consider a person’s right to engage with mental health services when there are actual risks or potential risks to their safety or the safety of others
•    The ethics of a nurse taking no action if risks to self are identified or potential risks are noted
•    a person’s autonomy and right to choose
•    a nurse’s discussion with other health professionals ie. GP
•    a nurse’s involvement with family members when risks are noted versus a person’s right to choose no family involvement
•    a nurse’s professional and ethical role in child protection matters for risks or potential risks
•    non-maleficence; a principle to avoid harm. However assessment and interventions may cause distress to the person and their family

8)    The nursing concerns should focus on mental health, associated risks, relationships, engagement with services, coping strategies, for example. Actual or potential risks within 1 – 5 days of your meeting with the person should be considered. Make sure they are risks which are identified or indicated within the case study so relate it back to your client.
9)     Ensure your interventions are suitable for the problem or nursing concerns you have noted. Be specific with the actual interventions you would offer. ie. describe how you will actually undertake the interventions, including times frames. The interventions are activities which you, as a nurse, would undertake directly with your client.
10)     (A note of caution: making a referral to another service or discussing with family members are consultation and not classified as nursing interventions for your assessment. )

Marking criteria

1 – Investigate and outline the prevalence/incidence of  anxiety  (depending on the scenario you have chosen) in Australia using current literature  10 marks    The details related to the prevalence/incidence of depression or anxiety are exceptional and of the highest quality. The answer is well supported by relevant literature
2 – Discuss using current literature TWO (2) factors that may have contributed to the development of Tracey’s presentation and mental health concerns.    Discussion consistently conveys evidence of analysis and synthesis showing exceptional understanding of the factors that may have contributed to the client’s presentation and mental health concerns. Sources used are exceptional to support work. Exceptional critical discussion noted
3 – Discuss using current literature TWO (2) ethicolegal issues related to your chosen scenario    Exceptional discussion related to the ethico-legal issues related to the scenario. Sources used are exceptional to support work. Exceptional critical discussion
4 – Identify TWO (2) nursing problems/risks with evidence from your chosen scenario
Exceptional identification of TWO (2) nursing/midwifery problems/risks with clear evidence and relevance to the case study chosen
5 – For each nursing/midwifery problem/risk  you have identified in Question 4, Outline and describe TWO (2) evidenced based nursing/midwifery interventions and rationales for each    Exceptional; clear concisely written relevant nursing/midwifery interventions. Sources used are exceptional to support work. Exceptional critical descriptions noted.
6 – Academic writing & referencing skills    Exceptional referencing: both in text and final reference list according to APA style. Extensive, relevant current academic reference list effectively utilised.  Publishable writing style and use of language

Please note: References should Not later than 5 years except ABS document which is 2007
Try to search references from Australia
For q1: Only Australia statistics.
APA style

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