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NRSG210 Mental Health Nursing Questions: Chung is a 35 years-old male who moved to Australia from China five years ago. His parents, older brother and younger sister still live in China. Chung visited his family in China once after a year of moving to Australia. He has not returned to China since, because of his long working hours and need to undertake additional study for promotion. Chung is a doctor working in Accident and Emergency in a busy inner-city hospital. He is studying for promo-tion to ultimately become an emergency medicine consultant. Two years ago, Chung was under investigation by the hospital Human Resources department due to a drug error. He was very tired and had been on-call over-night with frequent call outs to see patients. The drug error resulted in an eight year-old boy being very sick, requiring intensive care admission. Chung used an intra-muscular medication to treat the boy but administered it intravenously. Chung was subjected to several work-place and medical board investigations and placed on practice supervision for 12 months. Chung met his wife, Harriett, in Australia four years ago. Harriett is 30 years old. They married two years ago.   Unfortunately, Chung’s parents and family could not attend the wedding due to the high costs of travel and his mother has severe arthritis in her hips, making travel very difficult. Chung found their wedding day emotionally difficult. He felt the ceremony lacked reference to his Chinese culture. On reflection, he feels that he wasn’t as involved in the wedding planning as he could have been, due to his long working hours. He simply agreed to the suggestions and plans made by Harriett and her family. Chung and Harriett now have a three week-old baby girl, Charlotte. Charlotte was born by caesarean section, due to birth complications. Harriett has had an infection in the operation site since the birth, resulting in lots of pain, frequent dressings and difficulties moving around. Chung was off work for one week after the baby’s birth. However, he has now returned to working shifts, often working through the night, where he may go without sleep for 20 – 24 hours. Harriett’s parents are staying with them to support Harriett while Chung is at work.   However, he finds that Harriett’s parents are very involved with baby care even when he is home. Given this, Chung finds he gets very little time and space to be with his new daughter. You are visiting the family in your capacity as a community nurse supporting Harriett with the caesarean section wound care or as a midwife undertaking a post-natal visit. During your visit to the family, you notice Chung looks flat in mood and tearful. His affect is sad and restrictive.   He is slumped in his chair, with rounded shoulders and starring at the floor for long periods. You inquire about his health. He has very limited eye to eye contact with you. His speech is slowed and purposeful. On occasions, you need to repeat your question several times to get a reply. However, you do manage to obtain the following information from Chung. He has been feeling increasingly anxious during the past two months, given his continuing long hours, shift work, the high pressure of an Accident and Emergency department, Charlotte’s birth and his wife s health. He has been having palpitations, chest pains and breathlessness for six to seven weeks. He asked a colleague at work, another doctor. to assess him for cardiac issues several weeks ago as he had been experiencing thoughts that he was going to have a heart attack and die. Chung has been feeling very low in mood for the past six weeks, experiencing sleeplessness, particularly initial insomnia and early morning wakening at 3am. He has lost five kilos in weight during the past month, due to reduced appetite and missing meals. He feels he is worthless and a failure at work within his medical role and he is letting his wife and new daughter down. He has been experiencing fleeting thoughts of suicide for the last week. He is aware of high lethality medications which he could take to overdose. Currently, he is hopeless and helpless and wants to die. He states he feels his situation is self-imposed and that treatments will not be of help at this time.    1.Using relevant literature critically discuss the mental health status of the client in the case study. Your work should make reference to two (2) components of the Mental State Examination (MSE) related explicitly to the case study and the DSM V.   2.Critically discuss two (2) factors which have contributed to the development of the client’s current mental health status. You should demonstrate your knowledge of the Stress Vulnerability Model. Your work should clearly identify the contributing factors; make reference to the case study and relevant literature.   3.Respect, empowerment and hope are three (3) positive aspects of mental health recovery. Using relevant literature and the case study, critically discuss how these three (3) principles could positively contribute to the client’s (journey of recovery. Using the case study provided, identify an urgent risk area. Ensure your answer details why you have identified this risk area including specific information about the client and current literature.   lb) Identify one nursing / midwifery intervention you would immediately undertake with your client to address the risk area noted in question la and include a rationale for the intervention. Ensure the intervention includes who and when you would actually carry out the intervention. Your rationale should state how and why you would carry out the particular intervention. Ensure literature is included.  2a) Using the case study provided, identify a mental health concern. Ensure your answer details why this is an area of concern. Include specific information about the client and current literature.   b)Identify one nursing / midwifery intervention you would undertake with your client to address the mental health concern noted in question and include a rationale for the intervention.   Ensure the interventions includes how, who and when you would actually carry out the intervention. Your rationale should state how and why you would carry out the particular intervention. Ensure literature is included when you discuss the rationale.  3.Using current literature, identify and discuss (2) two legal, ethical or professional issues a nurse / midwife may need to consider when working with the client in the case study . Answers: 1: The Mental Health Status Of The Client Is As Follows- The mental state examination or MSE has indicated that, excessive work pressure, less time for family due to long hour work shift, past circumstances such as mistake in the workplace, inquiry and poor health status has affected the mental health status such as mood and affect of the client to an extent (Fernando & Henskens, 2014). In the session of MSE tearful eyes and flat mood has been detected. Sad and restrictive affect was also identified in the session. He has been feeling anxious due to long hour of working shift and excessive pressure from the accident and emergency department of the hospital. He was tensed due to the severe health status of his wife, but he was unable to provide adequate time to her, thus was regretting. Due to such situation his speech has become slow and purposeful as well and he has lacked eye contact. He has been suffering from palpation, chest pain and breathlessness that has created a fear of heart attack within him. Such health concern has led to sleeplessness or insomnia. It has been identified in the MSE that the increase in depression and anxiety has affected the thought process of Chung as well (Cameron et al., 2013). However, there is no direct process to measure the thought process, but according to his description his changed thought process has forced him to think himself as a failure in the workplace. Even after knowing about the high lethality of medication he has thought about overdose of medicines. He has been suffering from helpless and hopeless situation that has led to the suicidal thought at the end. The criteria of diagnosis mental disorder provided by the Diagnostic and Statistical Manual for mental disorder or DSM 5 has indicated that the patient has been suffering from depressed mood, thus he has lacked eye contact and found to be least interested in communicating with others (Regier et al., 2013). He has been experiencing guilt due to his mistake in the workplace that has created a feeling of failure. In addition the increased work pressure has forced him to spend less time with family. The level of depression has affected his physical health condition as well. The symptoms such as chest pain, breathlessness, loss of appetite, palpitation, weight loss and stress has led to the risk of heart attack. The DSM 5 assessment has identified that due to the tension of his own health and the severe health condition of his wife Chung has been significant mental distress. The DSM 5 criteria has indicated that such mental condition cannot be explained and psychotic disorder and such symptoms are not attributed to medical conditions (American Psychiatric Association, 2013).  In addition t has been found that the patient has been suffering from severe anxiety, thus has been facing sleeplessness. Thus, the DSM 5 has suggested that Chung has been suffering from severe depression and anxiety disorder and the level of such mental health issue is so high that it has led to the suicidal thought as well (Regier et al., 2013). 2: The Factors Contributing To The Development Of The Client’s Health Is Discussed Below- Stress vulnerability model is a useful tool that helps to identify the potential factors that contributes to the development of severe mental health issue. The model helps to understand the contribution of stress to the development of signs and symptoms of mental distress. The model mainly describe the potential factors through vulnerability factor, protective factor and environmental factor. Utilizing the stress vulnerability model it has been recognized that stress and having new baby have been contributed as the vulnerability factor to the development of mental illness of the client (McEwen & Morrison, 2013). Stress is one of the main vulnerability factors that has contributed to the poor mental health of Chung. It is the potential factor that could influence the symptoms of mental distress (Thoits, 2013). Stress is defined as the thought that occur as the response of critical situations and individual should have the ability to cope up with the stress in order to avoid the occurrence of mental distress due to stress (Olff et al., 2013). In this case the stress has arisen due to the excessive pressure in the workplace. After the birth of Chung’s daughter. His wife has been suffering from severe health condition and in this situation he has failed to support her due to long hour shift in workplace. Such situation has created guilt within the client and has contributed to the development of stress. On the other hand, the pressure of investigation by the human resource department of the hospital regarding the drug error has also responsible for the increasing stress within the client. Furthermore, poor health condition of Chung such as chest pain, breathlessness, palpitation and weight loss has also leads to the development of psychotic symptoms within the patient. Such increased stressful situation has identified as the potential factor that has led to the suicidal thought as well (Thoits, 2013). Having a new baby has been contributed as another vulnerability factor to the development of the poor mental health of Chung. It is an important factor that leads to the changes in the mental condition. Such change in life creates changes in the lifestyle of individual as its effect brings changes in the relationship, hobbies, management of time and self-sense. Such changes could lead to the anxious mood (Caplan, 2013). In this case it has been found that Harriet, the wife of Chung has been suffering from severe infection and pain due to the operation during the birth of the child. In this situation she need the support and care of Chung, however, due to excessive work pressure and long hour shift he has failed to spend adequate time with his wife and new born daughter. Such condition has led to restrictive and sad affect. Due to such situation he has been suffering from anxiety and flat mood. It has affected his speech and has reduced his interest to communicate with others. Thus, it can be said that, the factor has effectively contributed to the development of psychotic distress within the client. 3: Recovery Oriented Practice And Using Respect, Empowerment And Hope Related Recovery Would Help The Patient In The Following Manner-   One of the most important recommendations to resolve the mental health issue is recovery oriented practice. It is the one dimensional approach of mental health research that represents specific model of care in order to facilitate the treatment of patient with mental illness. While the other treatment procedures focus to symptom relief, the recovery oriented practice provides priority to supporting patients with mental health issue in order to achieve meaningful and satisfactory life through the improvement of supportive relations, hope and social inclusion. Such process helps the patients in order to achieve their personal goals in an effective manner (Slade et al., 2014). Utilizing recovery oriented practice could help Chung to improve his involvement in the relationship and manage balance in the workplace thus, could increase support from the family. In this way it could help him to reduce his stress and induce him in a meaningful life by promoting hope. One of the important element that could utilize in the treatment of mental distress is hope. People that suffer from psychotic distress become hopeless, thus, lack interest in the treatment. Hence, introducing hope could help them involve in the treatment process in an effective manner and live a healthy life by maintaining mental well-being (Tudor, 2013). In this case due to stressful life and depression the client has become hopeless and has been suffering from suicidal thoughts. Inducing hope in the treatment process would help him to participate in the treatment process in an effective manner and help him to recover faster. It is important to provide hope related to the better involvement with the family, improvement in the workplace, accessing social support and successful future in order to reduce the stress of the client and encourage him to reduce the suicidal thoughts. Such improvement in mental health would help him to improve the physical condition as well (Fawcett & Karban, 2013). Another important criteria of treating patient with mental illness that helps to achieve positive clinical outcomes is introducing respect in the treatment (Tudor, 2013). In this case, showing respect by the colleagues would help Chung to recover from the thought of considering himself as worthless in the workplace thus, could help him to encourage to perform effectively in the workplace. Respect from the family for the his effort to take care of his family after involving in such a busy profession could help him to get rid of the guilt, thus could reduce his stress and depression. Utilizing respect in the treatment process could help him to provide importance to his life and utilize the treatment to recover faster (Wahlbeck, 2015). One of the crucial element of promoting mental health is empowerment. It is important to implement empowerment in the individual level and in society simultaneously. There are four dimensions of introducing empowerment in the treatment of mental illness, they are, dignity, self-reliance, participation in self decision and contribution in wider community (Fawcett & Karban, 2013). Utilizing empowerment in order to help Chung is useful as it could help him to recover from the thought of uselessness and powerlessness, thus, could increase self-determination. Empowerment could help him to develop sense of living meaningful life and survive in the stressful period of life (Wahlbeck, 2015). Plan Of Care: 1a: The Recognized Risk Area Is As Follows- The patient has been suffering from anxiety and depression due to the stress of long hour working in the hospital. He is tensed as his wife has been suffering from severe health issues and in this situation he is unable to spend time with his family. Thus, he has suffering from breathlessness, palpitations, chest pain and weight loss. It can be said that there is a risk of cardiac issues such as stroke or heart attack as the symptoms occur in the patient have similarity to the symptoms of such cardiovascular risks (Galatzer-Levy & Bonanno, 2014). 1b: The Nursing Intervention Is As Follows- In case of Chung, it is important to control his stress. In this regards, the patient need to perform physical activities such as exercise and yoga to relax his mind and reduce stress. He has lost interest in eating thus has been suffering from loss of appetite and weight loss. Such condition may lead to low blood pressure. Thus, it is important to intake proper diet to manage blood pressure. In addition he could undergo proper diagnosis such as ECG, chest x-ray, MRI and exercise stress test to identify his health condition and could take proper medication according to the recommendation of the doctor (Muntner et al., 2014). 2a: The Mental Health Concern Is As Follows- The client has been feeling low mood and anxiety. The inquiry due to the mistake in the workplace has created guilt within Chung. In addition due to long working hours he has failed to provide adequate time to his family. Such condition has affected his mental health to an extent and he has been suffering from insomnia. His mental condition has led to the thoughts of suicide. From such observation it can be said that the client is suffering from severe depression, which is a great risk for his mental health and well-being (Gilbert, 2016). 2b: Intervention For Depression Is As Follows- In this case, effective psychotherapy could be helpful. It would help the client to adjust with the difficulties of current situation. Psychotherapy could help to reduce negative beliefs and thoughts regarding his failure and suicide. Psychotherapy would help to identify the major factors contributing in the depression and recognize effective ways to address them. A face-to-face session would help Chung to cope up with helplessness, regain control on his life and set proper goal. In this way an effective psychotherapy would help the client to practice healthy behavior and maintain mental health and well-being (Chukhraev et al., 2017). 3: Ethical Issues Include- Ethical issues related to autonomy and informed consent may occur. The reaction of the client during interaction has indicated lack of interest in communication, thus shown less eye contact and restrictive affect. In order to understand his concern questions have been repeated. The client may become irritate and ethical issue regarding his autonomy and interest in communication occur (Wolf, Annas & Elias, 2013). As the client is adult he has the right to take decision regarding his treatment. In order to provide psychotherapy to the client it is important to provide adequate information regarding the process and take his consent, otherwise ethical issue regarding informed consent may occur (Faden, Beauchamp & Kass, 2014). References: American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub. Regier, D. A., Narrow, W. E., Clarke, D. E., Kraemer, H. C., Kuramoto, S. J., Kuhl, E. A., & Kupfer, D. J. (2013). DSM-5 field trials in the United States and Canada, Part II: test-retest reliability of selected categorical diagnoses. American journal of psychiatry, 170(1), 59-70. Cameron, J., Worrall-Carter, L., Page, K., Stewart, S., & Ski, C. F. (2013). Screening for mild cognitive impairment in patients with heart failure: Montreal Cognitive Assessment versus Mini Mental State Exam. European Journal of Cardiovascular Nursing, 12(3), 252-260. McEwen, B. S., & Morrison, J. H. (2013). The brain on stress: vulnerability and plasticity of the prefrontal cortex over the life course. Neuron, 79(1), 16-29. Thoits, P. A. (2013). Self, identity, stress, and mental health. In Handbook of the sociology of mental health (pp. 357-377). Springer, Dordrecht. Olff, M., Frijling, J. L., Kubzansky, L. D., Bradley, B., Ellenbogen, M. A., Cardoso, C., … & van Zuiden, M. (2013). The role of oxytocin in social bonding, stress regulation and mental health: an update on the moderating effects of context and interindividual differences. Psychoneuroendocrinology, 38(9), 1883-1894. Caplan, G. (2013). An approach to community mental health. Routledge. Slade, M., Amering, M., Farkas, M., Hamilton, B., O’Hagan, M., Panther, G., … & Whitley, R. (2014). Uses and abuses of recovery: implementing recovery?oriented practices in mental health systems. World Psychiatry, 13(1), 12-20. Tudor, K. (2013). Mental health promotion: Paradigms and practice. Routledge. Wahlbeck, K. (2015). Public mental health: the time is ripe for translation of evidence into practice. World Psychiatry, 14(1), 36-42. Fawcett, B., & Karban, K. (2013). Contemporary mental health: Theory, policy and practice. Routledge. Galatzer-Levy, I. R., & Bonanno, G. A. (2014). Optimism and death: Predicting the course and consequences of depression trajectories in response to heart attack. Psychological Science, 25(12), 2177-2188. Muntner, P., Davis, B. R., Cushman, W. C., Bangalore, S., Calhoun, D. A., Pressel, S. L., … & Rahman, M. (2014). Treatment-resistant hypertension and the incidence of cardiovascular disease and end-stage renal disease: results from the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). Hypertension, 64(5), 1012-1021. Chukhraev, N., Vladimirov, A., Zukow, W., Chukhraiyeva, O., & Levkovskaya, V. (2017). Combined physiotherapy of anxiety and depression disorders in dorsopathy patients. Journal of Physical Education and Sport, 17(1), 414. Gilbert, P. (2016). Depression: The evolution of powerlessness. Routledge. Wolf, S. M., Annas, G. J., & Elias, S. (2013). Patient autonomy and incidental findings in clinical genomics. Science, 340(6136), 1049-1050. Faden, R. R., Beauchamp, T. L., & Kass, N. E. (2014). Informed consent, comparative effectiveness, and learning health care. N Engl J Med, 370(8), 766-768. Fernando, D. I., & Henskens, F. A. (2014, November). A case-based reasoning approach to mental state examination using a similarity measure based on orthogonal vector projection. In Artificial Intelligence (MICAI), 2014 13th Mexican International Conference on (pp. 237-244). IEEE.

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