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


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Create a recovery focused nursing care plan for the mental health patient from case study 2Order Descriptionno introduction and conclusion are required and that the word count is 1500 works with 20% over or under allowedcreate 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 HONOsOne goal per pageRequiring 22 Referances, UK englishDiscipline of NursingComplex Mental Health & Recovery 1Recovery Focused Nursing Care PlanDUE: Sunday 19th April 2015 by 23:59 [End of Week 6].Title: Recovery Focused Nursing Care Plan1500 [approx.] Word Assignment25 %Please see the Recovery Focused Nursing Care Plan Information Packagefor full details of the Assignment.This document provides all of the necessary details for Case Study 2.Case Study 2: The Client with SchizophreniaClinician Role: Case Manager (Nurse): Community Case ManagementTeam.Identifying Information: Bernard is a 25-year-old single male currentlyresiding as an inpatient mother in the local Mental Health Unit where he hasbeen a patient for the past 14/7. Prior to this admission you had been casemanagingBernard in the community for the past 9 months. He was admittedwith worsening psychotic symptoms over a 4/52 period in the context ofpoor compliance with his oral medication that he puts down to due toincreased stress at home and work. He has been re-established on hismedication with good effect and you are seeing him today to review him anddiscuss his discharge plan before he is discharged home in 2/7 time. Bernardis not religious, works part-time as a labourer for his uncle (who is a bricklayer). Bernard lives with his parents and his younger sister in the familyhome.Presenting Complaint: Bernard reports increased paranoid ideation in thepreceding 4/52 stating ‘they’ are watching him, following him and talkingabout him. When asked who ‘they’ are he refuses to identify them, statingthat if he does “they’ will come after you too”.History of Present Problem: Bernard reports first being diagnosed with firstonset psychosis at the age of 22. He was studying Engineering at Universityand was half-way through his final year leading up to mid-year exams whenhe first became unwell. At this time he experience paranoid ideation andDiscipline of NursingComplex Mental Health & Recovery 2heard voices of a commentary nature. He was treated by the local First OnsetPsychosis Team and made a good recovery over time in the community.Eventually he was discharged to ongoing treatment via a private psychiatristand his GP and everything had been going well until 11/12 ago when heexperienced a full relapse of symptoms whilst on a family holiday overseas.He had returned to Australia and had been an inpatient in the local PublicAdult inpatient Unit for almost 2/12 at that time and had subsequently beenassigned a Case Manager to oversee his progress following this episode. Hehad initially made slow but steady progress in the community and hadstarted to work for his uncle as a labourer to earn some extra money. Thishad initially gone well however some of the other workers on the buildingsite had started to make fun of him leading to his becoming increasinglystressed and subsequently more disorganised in his thoughts and actions. Healso reported beginning to feel quite paranoid about his co-workers, andbegan to suspect that they were planning to harm him or his family. Hereports that his poor compliance with medication was accidental and he didnot mean to not take them. Bernard states that although his paranoia hasreceded over the past fortnight he has experienced increasing anxiety,feelings of helplessness and worthlessness, as well as feeling overwhelmedby 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 tosleep as he tends to lie in bed worrying about his life and future. He deniesany middle-of-the-night or early-morning awakening. His appetite hasincreased since recommencing medication and he report a weight gain of 4kilograms in the past fortnight. He eats large meals and usually snacks ontop of this. Meals at home are usually prepared by his mother. Bernard hadbeen contributing to the running of the household prior to his relapsehowever at present does not feel up to doing household chores. He hasbecome increasingly insular and has avoided social contact, tending to avoidfriends and family who have come to call: he states this is for fear of thembecoming targeted by the same people who were targeting him. Bernarddescribes few interests or activities outside the home; he had been heavilyinvolved in the Drama and Soccer clubs whilst at University however he lostcontact 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 markedlyworse during the evening. He describes feeling disconnected from his lifeand unsure of what he is doing. He says he had a clear plan of what hewanted to do with his life but “that is all gone now” and he is struggling toDiscipline of NursingComplex Mental Health & Recovery 3come to terms with the loss. He admits to occasional suicidal ideation in theform of a passive wish to be dead “because it would just be easier” howeverhe 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 alcoholor drug abuse; he reports some experimentation with Cannabis and Ecstasyat parties in first year Uni but did not like the feeling and has not triedanything since.Current life stressors reported by Bernard include:· Co-workers on the building site where he has been working with hisuncle making fun of him, calling him ‘freak’, ‘creep-show’ and ‘oddball’.He has caught them several times laughing at him as well; heknows it is directed at him because they stop when he gets withinearshot.· His mother has recently been diagnosed with Diabetes and is havinga hard time coping with this. Whilst she has begun to adjust to thisBernard 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 hadbeen doing extremely well in his course. He had begun to send outletters of interest to obtain an internship after he finished his degree. Hehad also begun to think about moving out of home into sharedaccommodation with several Uni friends and had been very excitedabout 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 hislife leading to him staying up late and then sleeping half the day.Past Psychiatric History: Bernard was diagnosed with 1st episode psychosisthree years ago and initially responded well to treatment. When he relapsed11/12 ago he was diagnosed with Schizophreniform psychosis which wasrevised and change to Schizophrenia during the current admission. The treatingteam are also questioning the possibility of a mood component given Bernard’srecent anxiety and depressive features.Pre-morbid Personality: Bernard describes himself as being creative,dramatic, funny and ambitious before becoming unwell. When asked furtherabout Uni he says he was motivated, hard-working and really enjoyed thechallenge of study though at times could be a little disorganised, putting thisdown to “being young”. He also reports a being very loyal to family andclose friends, and has struggled with losing those friends who did not staywith him when he became unwell.Discipline of NursingComplex Mental Health & Recovery 4Medical History: Bernard’s only physical issue was a # L wrist sustained in apush-bike accident [when he was 17yo] that required surgery after it did notset straight initially. He has no known allergies.Family History: Bernard is the older of 2 children; the other being hisyounger sister Estelle [23yo] with whom he is very close. His parents areboth alive and generally well; his father [Peter] suffers from high cholesteroland 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 aboutthis.Social and Developmental History: Bernard is the older of 2 children. Hismother’s labour was normal though he was delivered via caesarean section atterm after the labour failed to progress. His early developmental milestones(talking, walking, etc.) were reached at normal age range. He denies anymaladaptive behaviours or experiencing unusual stresses as a child.Academically, Bernard was a B grade student throughout his school years; hestates that he could have done better but didn’t apply himself as much as hecould have. He had many friends at school and as well as through variouscommunity groups [such as drama and various sports]. He had his firstromantic relationship in Year 10 of secondary school and has had severalgirlfriends since. His most recent was a girl he met in Uni however this endedwhen he first became unwell. He states that he would like to meet someone inthe future but believes this is unlikely due to his illness. He has deferred hisstudies at Uni and hopes to be able to return when well.Bernard was raised in metropolitan Melbourne and has live in the familyhome in Glen Waverly all of his life. He reports that the family has alwaysbeen very close and they all generally get alone quite well. He says hisparents and sister have been very supportive of him since becoming unwellthough 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 bebetter off without him but states that he no longer feels this well and isregularly reassured of his family’s support. Long term goals had involvedcompleting his degree, establishing his career, travelling and eventuallysettling down and starting a family of his own. Bernard is no longer certainabout how he sees his future.Discipline of NursingComplex Mental Health & Recovery 5Mental Status ExaminationGeneral 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 ismildly dishevelled in appearance [unshaven, malodourous] and he presentswith variable eye contact; in particular this drops when he is feeling anxious oruncertain of himself.Speech: Bernard speaks with a normal rate, tone and volume for the mostpart. Occasionally his responses to questions are delayed however thecontent of his conversation is logical, goal-directed, and appropriate tosituation and context. There is a noticeable increase in the rate [increased]and tone [more excitable] of his speech when discussing content related tohis paranoid ideation.Thought Content: Bernard describes themes of loss, worthlessness,helplessness and hopelessness. There are some residual paranoia ideasevident regarding his former co-workers though these are fleeting in theirnature and are less intrusive when they do occur.Affect and Mood: Bernard describes his mood as variable; he reports periodof sadness, anxiety and uncertainty for the future. His affect is mildlyrestricted, with diminished range and a generally sad quality though he isresponsive to humour at times.Motor Behaviour: Posture is generally closed, and leaning forward thoughhis level of psychomotor activity increases when anxious.Perceptions: Bernard describes persistent paranoid delusions regarding hisformer co-workers though these are gradually softening and appear lessfrequent and intrusive that prior to his admission. He feels some emotionalresponse to them [primarily anger] though firmly denes any plans to act onsame. He had initially felt he could hear others talking about him at workthough he know denies any such phenomenon; there is no other evidence ofhallucinations.Suicide Potential: Bernard describes fleeting episodes of suicidal ideation inthe 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 NursingComplex Mental Health & Recovery 6Concentration: Bernard describes a mild impairment in his concentration asevidenced 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 onTV or reading which frustrates him as he enjoys both of these activities.Recent and Remote Memory: Bernard’s recent memory is intact, with threeof three objects recalled after 5 minutes. He is able to describe accuratelyevents from the past.Insight and Judgement: Bernard has partial insight into his illness; heaccepts that he has a psychotic illness though he is unhappy with thediagnosis of schizophrenia as he thinks it means he’ll never recover. He isable to acknowledge psychotic Sx in retrospect though at the time has poorinsight. He has begun to trust his family’s opinion on his symptoms and willoften seek reality based reassurance regarding things that he is experiencing.Formulation of ImpressionBernard is a 25 year old male with a Hx. of 2 previous episodes of psychosisrecently diagnosed with schizophrenia. He presents with a 4-6 week historyof re-emerging psychotic symptoms in the context of [unintentional] poorcompliance with prescribed oral medications. He experienced increasinglevels of stress, disorganised thinking and behaviour as well as paranoiddelusions about his co-workers suspecting that they were planning to harmhim or his family. Subsequent to his admission he has also exhibited mildlydepressed mood; increased anxiety; feelings of worthlessness, hopelessness,and helplessness, suicidal ideation; withdrawn behaviour and impairedfunctioning; decreased concentration. His symptoms are consistent with thatof Schizophrenia though the emerging affective component will need to beclosely monitored for further evidence of a co-morbid depressive or anxietyrelated disorder. Bernard’s preoccupation with worthlessness, ruminationabout the losses he has experienced, passive suicidal ideation, and hismarked functional impairment, all occurring in the context of his illness aresuggestive of a co-existing grieving process though at this stage this appearsto be appropriate under the circumstances.Traditional Nursing Diagnostic FocusThe following nursing diagnoses for Bernard are derived from theassessment data gathered:· Altered Thought Processes.Discipline of NursingComplex 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 ScoringDomain Results1. Overactive, aggressive, disruptive behaviour. 0 1 2 3 42. Non-accidental self-injury. 0 1 2 3 43. Substance use and misuse. 0 1 2 3 44. Cognitive problems. 0 1 2 3 45. Physical illness or disability problems. 0 1 2 3 46. Hallucinations or delusions. 0 1 2 3 47. Depressed mood. 0 1 2 3 48. Other mental health issues [Anxiety]. 0 1 2 3 49. Relationships. 0 1 2 3 410. Activities of daily living. 0 1 2 3 411. Problems with living conditions. 0 1 2 3 412. Problems with occupation and activities. 0 1 2 3 4Results Key: see Assignment Information package.Discipline of NursingComplex Mental Health & Recovery 8DSM-5 Diagnosis for the Client with SchizophreniaThe DSM-5 diagnosis for Bernard is as follows:· Schizophrenia (295.9).PlanningThe Nursing Care Plan for Bernard illustrates how nursing diagnosesguide the development of goals and therapeutic interventions. Ideally, thenurse collaborates with the client in planning care.This can be difficult to do with the psychotic or depressed person who isfeeling 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 inempowering the client to begin the journey towards recovery.Equally the nurse’s communication of the firm belief that the client willfeel better with time can often be enough to engage the client in at leastgoing along with the care plan.Setting practical, reasonable, manageable, short-term goals that the clientcan accomplish without much difficulty is important in fostering a sense ofhope and improved self-esteem.The nurse should expect that with the amotivated psychotic client, earlyinterventions may need to be aimed at “doing for” the client [after accurateidentification of those abilities that remain intact vs. those that arecompromised].The care plan will also need to include consideration regarding theinvolvement/capacity of family, friends and other significant supportscare of her daughter], but the expectation should be that the client willgradually assume more independent functioning as their mental stateimproves.ImplementationNursing interventions are guided by the nursing care plan. For thepsychotic client, priority needs to be given to preventing self-harmthrough ongoing assessment of suicide potential and maintenance of asafe environment.Discipline of NursingComplex Mental Health & Recovery 9In addition, improving and maintaining physical health are importantfoci of care for the depressed client, who is likely to have an alterednutritional status and disturbed sleeping pattern.Monitoring for side effects of pharmacological treatments fordepression 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 thehospital unit will decrease his or her isolation and foster a sense ofself-worth.As the client’s symptoms of depression respond to thepsychotherapeutic and somatic interventions implemented, psychoeducationbecomes feasible.Clients and their Families should be educated about the type ofmental illness they have, as well as its possible causes.Specifically, the contribution of both neurobiological and psychosocialfactors to the onset of depressive illness should be discussed.Informing the client of the signs and symptoms of depression isimportant so that recurrence can be identified early.Education regarding the maintenance of medication regimens shouldbe conducted.EvaluationEvaluation of the client’s responses to nursing interventions should beongoing. In developing a Recovery Focused Care Plan for Bernard the nursemight ask the following questions to evaluate the effectiveness of the nursingprocess to ensure progress remains ongoing:· Does the client describe an improvement [reduction] in the frequency andintensity of paranoid thoughts?· Does the client describe an improvement in his level of organisation relatedto 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] ideasdiminished?Discipline of NursingComplex Mental Health & Recovery 10· Is the client initiating interactions with others?· Is the client initiating planning for his future taking into account theimpact of his mental illness?In asking these and other questions, the nurse reflects on his or her ownobservations; on the observations of other team members and the client’sfamily; and, of utmost importance, on the client’s description of his or herown experience.Discipline of NursingNURS2098: Complex Mental Health & Recovery 1Written Assessment TaskRecovery Focused Nursing Care PlanDUE: Sunday 19th April 2015 by 23:59 [End of Week 6].Title: Recovery Focused Nursing Care Plan1500 Word Assignment25 %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 ofscenarios. Please see the assessment information package for more information on thisassignment.Instructions:1. Choose 1 of the scenarios to use as the basis for your assignment [you will base your entireassignment on one of the case scenarios only]2. Read the Case Study and identify 5 Goals drawn from both the case study information andthe HONOs scale for the consumer in the scenario. Consider and adopt a Recovery Modelperspective in doing this.3. Having read the following case study, and familiarised yourself with the layout of thenursing care plan, you are to complete the Recovery Focused Nursing Care Plan for thisclient.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 Onelecture] remember to:a. Rank the goal priority in the order in which the consumer would like to addressthe issues listed [there are going to be different ways to do this depending onwhat you see as being the highest priority]; this will require some criticalconsideration on your behalf.b. Make sure that language used on the RFCP is clear, encouraging and agreed byconsumer and clinician.Discipline of NursingNURS2098: Complex Mental Health & Recovery 2c. 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 andresources.6. You are allowed to ‘fill in’ details in the case study where you feel that it is important forthe completion of the RFCP. If you do this you must include all additional information inan 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 thatyou will need to locate references that support nursing and consumer interventions aswells as in identifying potential strengths [especially through the literature on theRecovery Model] as well as when identifying supports and resources and determiningtimeframes for review.8. Please post all questions up on the Course Discussion Boards as this will allow all studentsto benefit from the answers.9. In keeping with RMIT policy all assignments are to be submitted through the TurnitinPortal available via the course webpage.The assignment is due by 23:59 on Sunday night: the portal will remain open until thistime however after the portal closes you will not be able to submit your assignment soplease 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 tosubmit your assignment. You are allowed to submit it as many times as you would like upuntil 23:59; the assignment I will receive to mark will be the LAST one you submitted.Discipline of NursingNURS2098: Complex Mental Health & Recovery 3Constructing the Recovery Focused Nursing Care Plan:When constructing the RFCP you are required to submit he document using the following format:ConsumersPriorityIdentifiedGoals/IssuesThe consumer’sstrengths toaddress theseissues.Consumer andNursingInterventionsPerson/sResponsibleTimeframe– Include asuccinctstatementdescribingthe issue.– Rankaccordingto theconsumerspriorities.– Can be doneusing HONOS orbased upon theinformationprovided in thecase study– This section iscritical toensuring theplan has agenuinerecovery focus.– You need toask questionssuch as:– ‘What can theydo?’– Howcan they helpthemselves?– Includeagreedactions andexpectedoutcomes.– Considerwhat needs tobe done foreach Goal /issue andidentify whatthings theconsumer cando and whatthings thenurse needs todo.– Who isresponsiblefor thisinterventionoccurring?– Who will beassisting inthisintervention.– What sortof assistanceare theygoing to give.– This needsto be realisticanddevelopedwith theconsumer.– It alsoneeds toreflect thetime takenforinterventionsto effectchange in theconsumer’ssymptoms.So your final assignment will have the following structureConsumersPriorityIdentifiedGoals/IssuesThe consumer’sstrengths toaddress theseissues.Consumer andNursingInterventionsPerson/sResponsibleTimeframe#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 5Discipline of NursingNURS2098: Complex Mental Health & Recovery 4The 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 Issuesand then rank them according to consumer preference. It is included as part of the case study information.Domain Results1. Overactive, aggressive, disruptive behaviour. 0 1 2 3 42. Non-accidental self-injury. 0 1 2 3 43. Substance use and misuse. 0 1 2 3 44. Cognitive problems. 0 1 2 3 45. Physical illness or disability problems. 0 1 2 3 46. Hallucinations or delusions. 0 1 2 3 47. Depressed mood. 0 1 2 3 48. Other mental health issues. 0 1 2 3 49. Relationships. 0 1 2 3 410. Activities of daily living. 0 1 2 3 411. Problems with living conditions. 0 1 2 3 412. Problems with occupation and activities. 0 1 2 3 4Results Key0 = 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 ratingperiod [usually the last 72 hours].2 = Moderate problem during the rating period [usually the last 72 hours] causing passing periods of distress orimpairment during the rating period [usually the last 72 hours].3 = Significant problem causing persistent distress or impairment during the rating period [usually the last 72hours].4 = Severe problem causing constant distress or impairment during the rating period [usually the last 72 hours].Discipline of NursingNURS2098: Complex Mental Health & Recovery 5The Recovery Focused Nursing Care Plan Marking Guide.Student Name: _________________________________________Assessment Criteria MarkAllocationConsumer 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, pagenumbers, 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. . 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