HLTENN009 Implement and monitor nursing care for consumers with mental health conditions

Q1a

 

 

Mental Health Disorder groups

Mood disorders

  • Bipolar Affective Disorder
  • Depression

Anxiety Disorders

  • Obsessive Compulsive Disorder (OCD)
  • Panic disorder
  • Post-traumatic Stress Disorder
  • Social & Specific Phobias
  • Eating disorders  

Organic Disorders

  • Dementia
  • Delirium

Personality Disorders

  • Borderline Personality Disorder

Psychotic Disorders

  • Schizophrenia
  • Psychosis 

 

 

 

 

 

Using the table below, insert the mental health disorder group that matches the common signs and symptoms

 

 

 

 

Mental health Disorder group

Common Signs and symptoms (classification)

Anxiety Disorder

Obsessive thoughts, debilitating behaviours leading to decline in functionality

 

Racing thoughts, shaking, sweaty, feeling of choking, heart pounding

 

Flashback, nightmares, recurrent memory of traumatic event

 

Unable to attend social functions Intense anxiety around social functions, physical symptoms of anxiety

 

Increased weight loss, poor appetite, sleep, social isolation, purging, vomiting, binge eating. BMI below 15.

Personality Disorder

Fear of abandonment, unstable relationships, chronic feelings of emptiness, suicidal thoughts, Deliberate Self Harm, Poor self-image, impulsive, Angry.

Organic Disorder

Memory loss, Difficulty communicating, problem-solving, planning and organizing. Confusion and disorientation

 

Acute confusion/ disorientation. Anger irritability, anxiety, mood swings. Disturbed sleep.

Psychotic Disorder

Positive symptoms: Paranoid, disordered thoughts, Hallucinations, Delusions

Negative symptoms: Apathy social isolation, poor diet, ADL’s

Fixed false beliefs

substantially impair effective communication

Vivid, involuntary perceptions that are experienced as ‘normal’ and occur without an external stimulus

Usually experienced as voices that are perceived as distinct from the person's own thoughts

Mood Disorder

Elevated mood, manic, pressured speech, increased spending, lack of sleep, increased substance abuse.

 

Low mood, suicidal thoughts, poor sleep, no energy, Helpless / hopeless themes, poor appetite. Low energy.

 

 

 

 

 

 

 

 

 

 

 

 

 

Q1b.

 

For each of the mental health disorder groups below, provide two (2) treatment options (1 medication class and one therapy) and two (2) nursing interventions to manage the disorder group

 

Note: Please do not repeat any answers

 

Mental Health Disorder group

 

Therapeutic Treatment options

 

Medication Class

Therapeutic Treatment options

 

Psychotherapy

Nursing Interventions

 

Mood disorders

  • Bipolar Affective Disorder
  • Depression
  • Mood Stabilizers (e.g. Lithobid, Depakene etc.)

Interpersonal therapy

  • Follow organization policy and procedure to ensure safety of patient
  • Help patient verbalize their feeling and thoughts

 

Psychotic Disorders

  • Schizophrenia
  • Psychoses

 

Chlorpromazine

Counselling

  • Be confident do not panic, listen to patient feeling without judgment
  • Speak slowly and simply take support of mental health professional to care or the patient.

 

Anxiety Disorders

  1. Obsessive Compulsive Disorder
  2. Panic disorder
  3. Post-traumatic Stress Disorder
  4. Social & Specific Phobias
  5. Eating disorders 

 

Selective serotonin reuptake inhibitors

Cognitive behavioural therapy

  • Provide comfort and reassurance to patient
  • Educate and inform patient about the anxiety triggers using effective communication skills

 

Organic Disorders

  1. Dementia
  2. Delirium

Blood test

Biopsychosocial therapy

  • Use effective/therapeutic  communication skills to build rapport with patient
  • Check medical health record of the patient regularly to monitor the patient and deliver patient-centered care.

 

Personality Disorders

 

  1. Borderline Personality Disorder 

Selective serotonin reuptake inhibitors

Dialectical behaviour therapy

  • Be active in care, learn about the patient medical history
  • Validate their feelings, encourage responsibility.

 

 

 

 

 

 

 

 

 

Q2.

Clinical practice is guided by nursing theory. There are many different theories in regards to mental illness. Phil Barker is renowned for his Tidal Model which looks at the recovery journey.

 

Outline three (3) principles of this theory (Reference)

First principle:  recognition of patent feeling, thoughts and need help in identifying medical necessity so that better care can be provided.

Second: respect the person wishes and their beliefs

Third: acknowledgment of the person goals is also helps in delivering quality care. 

 

Reference: Barker's Tidal Model of Mental Health Recovery - Nursing Theory. (2020). Retrieved 1 April 2020, from https://nursing-theory.org/theories-and-models/barker-tidal-model-of-mental-health-recovery.php

 

Q3

 

For each of the following possible causes of mental illness from a biopsychosocial perspective, state whether the causes are Biological, Social or Psychological

 

 

Biopsychological perspective

Possible causes

Psychological

Life experiences, low self-esteem, unintegrated sense of self, personality, lack of resilience.

Biological

Altered neurotransmitters levels, anatomical malfunction, acquired brain injury (ABI), substance abuse, infection, exposure to toxins, epilepsy, stroke, endocrine imbalance. Genetic factors – first degree relative, pre-natal infection, predisposition to mental illness, constitution

Social

Death, divorce, cultural, stress, housing, homelessness, exposure to violent behaviours, childhood trauma (verbal, physical, sexual), social isolation, childhood neglect and abuse, attachment problems, parenting issues, substance abuse, environment, grief and loss

 

 

Q4

Contemporary mental health services are based on the recovery-orientated approach. The web link provided to the national framework for recovery- orientated mental health services outlines the principles and practices that will assist with the following multiple choice questions

http://www.health.gov.au/internet/main/publishing.nsf/content/67D17065514CF8E8CA257C1D00017A90/$File/recovgde.pdf

 

After you have reviewed the above article there arefive fields of practice in relation to recovery-orientated practice and service delivery;

 

From the multiple choice questions below place an X beside the answer that relates to each domain

 

 

 

 

 

 

 

 

 

 

 

Domain 1: Promoting a culture and language of hope and optimism

 

  1. Putting people who experience mental health issues first and at the centre of practice and service delivery; viewing a person’s life situation holistically

 

  1. Personally defined and led recovery at the heart of practice rather than an additional task

 

  1. A service culture and language that makes a person feel valued, important, welcome and safe, communicates positive expectations and promotes hope and optimism

 

  1. Service and work environments and an organisational culture that are conducive to recovery and to building a workforce that is appropriately skilled, equipped, supported and resourced for recovery-oriented practice

 

  1. Upholding the human rights of people experiencing mental health issues and challenging stigma and discrimination

Ans- C

 

Domain 2: Person 1st and holistic

 

  1. A service culture and language that makes a person feel valued, important, welcome and safe, communicates positive expectations and promotes hope and optimism

 

  1. Putting people who experience mental health issues first and at the centre of practice and service delivery; viewing a person’s life situation holistically

 

  1. Personally defined and led recovery at the heart of practice rather than an additional task

 

  1. Service and work environments and an organisational culture that are conducive to recovery and to building a workforce that is appropriately skilled, equipped, supported and resourced for recovery-oriented practice

 

  1. Upholding the human rights of people experiencing mental health issues and challenging stigma and discrimination

ANS- B

 

Domain 3: Supporting personal recovery

 

  1. A service culture and language that makes a person feel valued, important, welcome and safe, communicates positive expectations and promotes hope and optimism

 

  1. Putting people who experience mental health issues first and at the centre of practice and service delivery; viewing a person’s life situation holistically

 

  1. Service and work environments and an organisational culture that are conducive to recovery and to building a workforce that is appropriately skilled, equipped, supported and resourced for recovery-oriented practice

 

  1. Upholding the human rights of people experiencing mental health issues and challenging stigma and discrimination

 

  1. Personally defined and led recovery at the heart of practice rather than an additional task

 

Ans- e

 

 

Domain 4: Organisational commitment and workforce development

 

  1. A service culture and language that makes a person feel valued, important, welcome and safe, communicates positive expectations and promotes hope and optimism

 

  1. Putting people who experience mental health issues first and at the centre of practice and service delivery; viewing a person’s life situation holistically

 

  1. Personally defined and led recovery at the heart of practice rather than an additional task

 

  1. Service and work environments and an organisational culture that are conducive to recovery and to building a workforce that is appropriately skilled, equipped, supported and resourced for recovery-oriented practice

 

  1. Upholding the human rights of people experiencing mental health issues and challenging stigma and discrimination

 

Ans- D

 

Domain 5: Action on social inclusion and the social determinants of health, mental health and wellbeing

 

  1. Upholding the human rights of people experiencing mental health issues and challenging stigma and discrimination

 

  1. A service culture and language that makes a person feel valued, important, welcome and safe, communicates positive expectations and promotes hope and optimism

 

  1. Putting people who experience mental health issues first and at the centre of practice and service delivery; viewing a person’s life situation holistically

 

  1. Personally defined and led recovery at the heart of practice rather than an additional task

 

  1. Service and work environments and an organisational culture that are conducive to recovery and to building a workforce that is appropriately skilled, equipped, supported and resourced for recovery-oriented practice

 

Ans- A

 

Which domain is considered the overarching domain that is integral to all the others?

 

  1. Domain 1
  2. Domain 2
  3. Domain 3
  4. Domain 4
  5. Domain 5

Ans- domain 1 is overarching domain

 

The national framework for recovery-orientated mental health services is underpinned by extensive research, consultation and informed by lived experience. ( place a X beside the correct answer)

 

True (X)

 

OR

 

False

 

 

 

 

Recovery can be defined as which of the following

 

  1. Recovery is an group journey toward a new and valued sense of identity, role and purpose outside the boundaries of their mental illness or substance misuse problem

 

  1. Recovery is an individual’s journey toward a new and valued sense of identity, role and purpose outside the boundaries of their mental illness or substance misuse problem

 

  1. Recovery is an individual’s journey toward a healing inside the boundaries of their mental illness

 

Ans - B

Q5.

 

Briefly outline the key features for the following that relate to the Mental Health Act QLD 2016 – the following websites will assist (use the contents index in the website link if needed to locate relevant information) 

 

https://www.health.qld.gov.au/__data/assets/pdf_file/0031/444856/guide-to-mha.pdf

 

(Word limit for each point max 60 – 100 words and reference)

 

Main objectives of the act

The mental health act 2016 main objectives are to protect the right of people who are suffering from mental illness and this act certify that patient is provided care ensuring their safety and confidentiality, this act reinforce patient rights, also it permits health professional to admit the individual with the mental health problem without their consent if essential to ensure their safety and wellbeing.

 

Reference:Mental Health. (2020). Retrieved 1 April 2020, from Health Act 2016 | Queensland https://www.health.qld.gov.au/clinical-practice/guidelines-procedures/clinical-staff/mental-health/act

 

 

Who is an involuntary patient?

The involuntary patient who is suffering from mental illness and at risk of danger or harm to others or themselves will be taken into care in this a legal order that authorize the detention of a person suffering from mental problem after the order is made by the magistrate and mental health facility holds a power to increase the patient stay.

Reference:Mental Health Review Tribunal - Involuntary Patient Orders. (2020). Retrieved 1 April 2020, from https://www.mhrt.nsw.gov.au/civil-patients/involuntary-patient-orders.html

 

 

 

Rights of the patient?

Patient has the right to be involved in their treatment plan, have the right to attain/obtain the second opinion from counsellor or psychiatrist. The patient also holds a right to take legal advice and have permission to talk to their family and friends.  If the patient is not happy with the service provided they can complain about the treatment provided. 

Reference:Reference:Mental Health Review Tribunal - Involuntary Patient Orders. (2020). Retrieved 1 April 2020, from https://www.mhrt.nsw.gov.au/civil-patients/involuntary-patient-orders.html

 

 

Involuntary review processes (Forensic orders)

 

The involuntary review process involves a legal order that authorise the detention of a person suffering from mental problem after the order is made by the magistrate and mental health facility hold a power to increase the patient stay. A person who wants to apply for discharge can contact authorised medical officer, the carer of the person may decide if they want to appeal.

 

Reference:Mental Health Review Tribunal - Involuntary Patient Orders. (2020). Retrieved 1 April 2020, from https://www.mhrt.nsw.gov.au/civil-patients/involuntary-patient-orders.html

 

Use of Mechanical restraint, seclusion, physical restraint and other practices

Mechanical restraint is the limit of an individual by the submission of a device to limit individual body movement though this not include medical appliance. Seclusion might be used for an involuntary patient in an official mental facility who is subject to forensic order. Physical restrain use to restrict patient movement.

Reference:Mental health services in Australia, Restraint - Australian Institute of Health and Welfare. (2020). Retrieved 1 April 2020, from https://www.aihw.gov.au/reports/mental-health-services/mental-health-services-in-australia/report-contents/restrictive-practices/restraint:

 

Treatment authorities

Treatment authority is lawful authority give legal consent of the care and treatment of an individual who is suffering from mental health problem without consent of the individual or their family because of person is at risk of harming themselves or others.

Reference: Kisely, S. R., Campbell, L. A., & O'Reilly, R. (2017). Compulsory community and involuntary outpatient treatment for people with severe mental disorders. Cochrane database of systematic reviews, (3).

 

Treatment in the community

Under the mental health act 2016, the treatment in the community is to support the patient recovery switching the patient to live in the community where suitable care and treatment can be provided.  Basically, the treatment the community applied to forensic order or authority thus, an authorized doctor may decide the patient category for treatment or community. 

Reference: Kisely, S. R., Campbell, L. A., & O'Reilly, R. (2017). Compulsory community and involuntary outpatient treatment for people with severe mental disorders. Cochrane database of systematic reviews, (3).

 

 

Capacity to consent

The capacity of consent refers to the ability of understanding and using the information to make an effective decision and review the decision made, in many case person is unable to decide because of mental health issues thus, it is done by experienced health professionals to recommend the treatment who will investigate that patient is in condition to make the decision for themselves or not, then they will decide who will make the decision for the patient or the health care professional may refer to court.

 

Reference: Day, A., & Elliot, M. (2018). Capacity and consent. The Beginner’s Guide to Intensive Care, 21.

 

 

Privacy and confidentiality

People with a mental health problems have the right to privacy and confidentiality, the carer must ensure they keep their patient information private and can only be used when essential. If a person can understand and give consent about information sharing then the carer must obtain informed consent when sharing information, if the patient is unable to make consent then the carer must seek advice from the attorney or guardian.

.

Reference:Kelly, B. D. (2017). Confidentiality and privacy in the setting of involuntary mental health care: What standards should apply? Ethics, Medicine and Public Health, 3(1), 90-97.

 

 

Admission procedures- what must happen immediately after the client has been admitted to an authorised mental health facility?

 As soon as client admitted to mental health faculty nurse will document if the admission was voluntary or involuntary, investigation, documentation of purposes, ensure patient privacy, nurses male checklist of patient need, verify the patient data, examine the patient, make the proper observation of patient condition, etc. document everything in the hospital health record.

 

Reference:Brown, R. (2019). The Approved Mental Health Professional's Guide to Mental Health Law. Learning Matters.

 

 

 

Role of the authorised mental health practitioner

 

The role of authorised mental health practitioners is to provide treatment, support, care, etc. or refer the client suspected to be suffering mental health issues for examination to another health professionals who can support patients in better treatment. By following the rules and regulations stated in the mental health act 2016 the health professional has an ethical responsibility to take a decision in favour of patient health and wellbeing.

 

Reference: Stevens, M., Manthorpe, J., Martineau, S., Steils, N., & Norrie, C. (2019). An exploration of why health professionals seek to hold statutory powers in mental health services in England: considerations of the approved mental health professional role. Journal of Mental Health, 1-7.

Q6.

 

Mental health nursing is a regulated profession that occurs within a legal context and within a framework of professional standards and ethical principles and values. In Australia, nurses who hold current nursing registration, even without a mental health qualification, can work in mental health

 

http://www.acmhn.org/publications/standards-of-practice

 

Please answer the following multiple choice questions (placean X beside correct answer)

 

  1. How many standards of practice are there according to the Australian College of Mental Health Nurses?

 

  1. 5
  2. 7
  3. 9 (X)
  4. 3
  5. 2

 

 

 

  1. Imagine you are working in the mental health area, which one of these standards do you think would assist you in your work practices to help with understanding the values and philosophies of mental health nursing? (Word limit max 80 – 100 words and reference)

 

National practice standard for the mental health workforce 2013 will help understand the value and philosophies of mental health nursing as this act provides the clear procedure of managing patient and their information through different rules and regulations. This standard planned to balance the discipline-specific practice standards or capabilities of health care professionals and to discourse the mutual skills and knowledge obligatory when functioning in the mental health environment. Thus, this is a vital standard that will assist in understanding the values of mental health nursing.

 

Reference: Coombs, T., Burgess, P., Dickson, R., & McKay, R. (2017). Routine Outcome Measurement and the Development of the Australian Mental Health Workforce: The First 25 Years of Implementation Are the Hardest. In Workforce Development Theory and Practice in the Mental Health Sector (pp. 302-316). IGI Global.

Q7.

 

According to the Mental Health Statement of rights and responsibilities 2012 http://www.health.gov.au/internet/main/publishing.nsf/Content/E39137B3C170F93ECA257CBC007CFC8C/$File/rights2.pdfthere are many rights for the mental health consumer –as a nurse you are to support these rights when practicing.

 

In the table below for each of the rights listed, state if they are true or false

 

Right

True / False

Once a patient is in a mental health facility they no longer have the rights to privacy and confidentiality

False

Patients like to be respected and their wishes taken into account

True

Patients have the right to have their lived experiences ignored

True

Patients should be able to continue to live, work and participate in the community to the fullest extent possible without discrimination, stigma or exclusion

True

Patients are unable to make a complaint regarding any facet of their assessment, support,

care, treatment, rehabilitation and recovery

False

Patients have the right to be considered capable of making a decision (by the service orperson providing care)

True

Patients should be treated in the most facilitative environment with the least restrictive or intrusive response or treatment

True

Patients may have families, carers and support persons involved in their assessment, support, care, treatment, recovery and rehabilitation to the extent requested by them

True

Patients do not need to have their sexual orientation, gender and gender identity taken

into consideration in their treatment

False

 

 

 

 

 

 

 

 

 

 

 

 

Q8.

 

For effective evidence based practice in mental health nursing a variety of sources are used, one of these is the client and carers perspective, discuss why this is important

 

(Word limit max 80 – 100 words and reference)

It is vital to include client and carer perspectives in mental health service as it supports the relationship between the communities and service. Patient and carer engagement specifically in the initial stage of care plan improves the quality of care and support in the quick recovery of the patient. Also, it helps in identifying medical goals, procedures, needs so that ambiguity can be avoided and quality care can be delivered to meet the decided goals.

Reference: Easter, A., Pollock, M., Pope, L. G., Wisdom, J. P., & Smith, T. E. (2016). Perspectives of treatment providers and clients with serious mental illness regarding effective therapeutic relationships. The journal of behavioural health services & research, 43(3), 341-353.

Q9a

 

Place an X beside the correct answer for some of the common myths, stigmas or aspects of discrimination that may be associated with a person with a mental health condition

 

  1. All people with mental illness are violent.

 

True

 

False (x)

 

  1. People living with a mental illness are more likely to be victims of violence than other people

True (X)

            False

  1. People with mental illness never get well.

True

False (X)

  1. People with a mental illness are brain damaged.

True

False. (X)

  1. There is  no link between mental illness and creativity

           True

           False. (X)

 

 

 

  1. The majority of people with mental illness have the ability to work

True (X)

            False.

b. Outline 4 ways that you as the nurse can ensure that your own interactions with a person experiencing a mental illness is therapeutic and positive

(Word limit max 80 – 100 words and reference).

 

Effective communication skills: using effective communication skills both verbal and non-verbal help in ensuring that a person experiencing mental illness feel comfortable which key step in providing quality care.

 

Active listening: this also helps in understanding patient thoughts, feeling and discomfort that is helpful in providing therapeutic care.

 

Checking: considering the medical health record of the patient help in understanding the medical need of patient more effectively which crucial step in delivering patient-centered care.

 

Confirming: confirming the messages or information with the patient and other staff members is always supportive in delivering positive care to the person with medical illness and avoid ambiguity or medical errors.

 

References:Lederman, R., Gleeson, J., Wadley, G., D’alfonso, S., Rice, S., Santesteban-Echarri, O., & Alvarez-Jimenez, M. (2019). Support for carers of young people with mental illness: design and trial of a technology-mediated therapy. ACM Transactions on Computer-Human Interaction (TOCHI), 26(1), 1-33.

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