Create a recovery focused nursing care plan for the mental health patien
Create a recovery focused nursing care plan for the mental health patient from case study 2
Order Description
no introduction and conclusion are required and that the word count is 1500 works with 20% over or under allowed
create 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 HONOs
One goal per page
Requiring 22 Referances, UK english
Discipline of Nursing
Complex Mental Health & Recovery 1
Recovery Focused Nursing Care Plan
DUE: Sunday 19th April 2015 by 23:59 [End of Week 6].
Title: Recovery Focused Nursing Care Plan
1500 [approx.] Word Assignment
25 %
Please see the Recovery Focused Nursing Care Plan Information Package
for full details of the Assignment.
This document provides all of the necessary details for Case Study 2.
Case Study 2: The Client with Schizophrenia
Clinician Role: Case Manager (Nurse): Community Case Management
Team.
Identifying Information: Bernard is a 25-year-old single male currently
residing as an inpatient mother in the local Mental Health Unit where he has
been a patient for the past 14/7. Prior to this admission you had been casemanaging
Bernard in the community for the past 9 months. He was admitted
with worsening psychotic symptoms over a 4/52 period in the context of
poor compliance with his oral medication that he puts down to due to
increased stress at home and work. He has been re-established on his
medication with good effect and you are seeing him today to review him and
discuss his discharge plan before he is discharged home in 2/7 time. Bernard
is not religious, works part-time as a labourer for his uncle (who is a brick
layer). Bernard lives with his parents and his younger sister in the family
home.
Presenting Complaint: Bernard reports increased paranoid ideation in the
preceding 4/52 stating ‘they’ are watching him, following him and talking
about him. When asked who ‘they’ are he refuses to identify them, stating
that if he does “they’ will come after you too”.
History of Present Problem: Bernard reports first being diagnosed with first
onset psychosis at the age of 22. He was studying Engineering at University
and was half-way through his final year leading up to mid-year exams when
he first became unwell. At this time he experience paranoid ideation and
Discipline of Nursing
Complex Mental Health & Recovery 2
heard voices of a commentary nature. He was treated by the local First Onset
Psychosis Team and made a good recovery over time in the community.
Eventually he was discharged to ongoing treatment via a private psychiatrist
and his GP and everything had been going well until 11/12 ago when he
experienced a full relapse of symptoms whilst on a family holiday overseas.
He had returned to Australia and had been an inpatient in the local Public
Adult inpatient Unit for almost 2/12 at that time and had subsequently been
assigned a Case Manager to oversee his progress following this episode. He
had initially made slow but steady progress in the community and had
started to work for his uncle as a labourer to earn some extra money. This
had initially gone well however some of the other workers on the building
site had started to make fun of him leading to his becoming increasingly
stressed and subsequently more disorganised in his thoughts and actions. He
also reported beginning to feel quite paranoid about his co-workers, and
began to suspect that they were planning to harm him or his family. He
reports that his poor compliance with medication was accidental and he did
not mean to not take them. Bernard states that although his paranoia has
receded over the past fortnight he has experienced increasing anxiety,
feelings of helplessness and worthlessness, as well as feeling overwhelmed
by 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 to
sleep as he tends to lie in bed worrying about his life and future. He denies
any middle-of-the-night or early-morning awakening. His appetite has
increased since recommencing medication and he report a weight gain of 4
kilograms in the past fortnight. He eats large meals and usually snacks on
top of this. Meals at home are usually prepared by his mother. Bernard had
been contributing to the running of the household prior to his relapse
however at present does not feel up to doing household chores. He has
become increasingly insular and has avoided social contact, tending to avoid
friends and family who have come to call: he states this is for fear of them
becoming targeted by the same people who were targeting him. Bernard
describes few interests or activities outside the home; he had been heavily
involved in the Drama and Soccer clubs whilst at University however he lost
contact 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 markedly
worse during the evening. He describes feeling disconnected from his life
and unsure of what he is doing. He says he had a clear plan of what he
wanted to do with his life but “that is all gone now” and he is struggling to
Discipline of Nursing
Complex Mental Health & Recovery 3
come to terms with the loss. He admits to occasional suicidal ideation in the
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”. He denies any alcohol
or drug abuse; he reports some experimentation with Cannabis and Ecstasy
at parties in first year Uni but did not like the feeling and has not tried
anything since.
Current life stressors reported by Bernard include:
· Co-workers on the building site where he has been working with his
uncle making fun of him, calling him ‘freak’, ‘creep-show’ and ‘oddball’.
He has caught them several times laughing at him as well; he
knows it is directed at him because they stop when he gets within
earshot.
· His mother has recently been diagnosed with Diabetes and is having
a hard time coping with this. Whilst she has begun to adjust to this
Bernard 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 had
been doing extremely well in his course. He had begun to send out
letters of interest to obtain an internship after he finished his degree. He
had also begun to think about moving out of home into shared
accommodation with several Uni friends and had been very excited
about 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 his
life leading to him staying up late and then sleeping half the day.
Past Psychiatric History: Bernard was diagnosed with 1st episode psychosis
three years ago and initially responded well to treatment. When he relapsed
11/12 ago he was diagnosed with Schizophreniform psychosis which was
revised and change to Schizophrenia during the current admission. The treating
team are also questioning the possibility of a mood component given Bernard’s
recent anxiety and depressive features.
Pre-morbid Personality: Bernard describes himself as being creative,
dramatic, funny and ambitious before becoming unwell. When asked further
about Uni he says he was motivated, hard-working and really enjoyed the
challenge of study though at times could be a little disorganised, putting this
down to “being young”. He also reports a being very loyal to family and
close friends, and has struggled with losing those friends who did not stay
with him when he became unwell.
Discipline of Nursing
Complex Mental Health & Recovery 4
Medical History: Bernard’s only physical issue was a # L wrist sustained in a
push-bike accident [when he was 17yo] that required surgery after it did not
set straight initially. He has no known allergies.
Family History: Bernard is the older of 2 children; the other being his
younger sister Estelle [23yo] with whom he is very close. His parents are
both alive and generally well; his father [Peter] suffers from high cholesterol
and 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 about
this.
Social and Developmental History: Bernard is the older of 2 children. His
mother’s labour was normal though he was delivered via caesarean section at
term after the labour failed to progress. His early developmental milestones
(talking, walking, etc.) were reached at normal age range. He denies any
maladaptive behaviours or experiencing unusual stresses as a child.
Academically, Bernard was a B grade student throughout his school years; he
states that he could have done better but didn’t apply himself as much as he
could have. He had many friends at school and as well as through various
community groups [such as drama and various sports]. He had his first
romantic relationship in Year 10 of secondary school and has had several
girlfriends since. His most recent was a girl he met in Uni however this ended
when he first became unwell. He states that he would like to meet someone in
the future but believes this is unlikely due to his illness. He has deferred his
studies at Uni and hopes to be able to return when well.
Bernard was raised in metropolitan Melbourne and has live in the family
home in Glen Waverly all of his life. He reports that the family has always
been very close and they all generally get alone quite well. He says his
parents and sister have been very supportive of him since becoming unwell
though 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 be
better off without him but states that he no longer feels this well and is
regularly reassured of his family’s support. Long term goals had involved
completing his degree, establishing his career, travelling and eventually
settling down and starting a family of his own. Bernard is no longer certain
about how he sees his future.
Discipline of Nursing
Complex Mental Health & Recovery 5
Mental Status Examination
General 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 is
mildly dishevelled in appearance [unshaven, malodourous] and he presents
with variable eye contact; in particular this drops when he is feeling anxious or
uncertain of himself.
Speech: Bernard speaks with a normal rate, tone and volume for the most
part. Occasionally his responses to questions are delayed however the
content of his conversation is logical, goal-directed, and appropriate to
situation and context. There is a noticeable increase in the rate [increased]
and tone [more excitable] of his speech when discussing content related to
his paranoid ideation.
Thought Content: Bernard describes themes of loss, worthlessness,
helplessness and hopelessness. There are some residual paranoia ideas
evident regarding his former co-workers though these are fleeting in their
nature and are less intrusive when they do occur.
Affect and Mood: Bernard describes his mood as variable; he reports period
of sadness, anxiety and uncertainty for the future. His affect is mildly
restricted, with diminished range and a generally sad quality though he is
responsive to humour at times.
Motor Behaviour: Posture is generally closed, and leaning forward though
his level of psychomotor activity increases when anxious.
Perceptions: Bernard describes persistent paranoid delusions regarding his
former co-workers though these are gradually softening and appear less
frequent and intrusive that prior to his admission. He feels some emotional
response to them [primarily anger] though firmly denes any plans to act on
same. He had initially felt he could hear others talking about him at work
though he know denies any such phenomenon; there is no other evidence of
hallucinations.
Suicide Potential: Bernard describes fleeting episodes of suicidal ideation in
the 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 Nursing
Complex Mental Health & Recovery 6
Concentration: Bernard describes a mild impairment in his concentration as
evidenced 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 on
TV or reading which frustrates him as he enjoys both of these activities.
Recent and Remote Memory: Bernard’s recent memory is intact, with three
of three objects recalled after 5 minutes. He is able to describe accurately
events from the past.
Insight and Judgement: Bernard has partial insight into his illness; he
accepts that he has a psychotic illness though he is unhappy with the
diagnosis of schizophrenia as he thinks it means he’ll never recover. He is
able to acknowledge psychotic Sx in retrospect though at the time has poor
insight. He has begun to trust his family’s opinion on his symptoms and will
often seek reality based reassurance regarding things that he is experiencing.
Formulation of Impression
Bernard is a 25 year old male with a Hx. of 2 previous episodes of psychosis
recently diagnosed with schizophrenia. He presents with a 4-6 week history
of re-emerging psychotic symptoms in the context of [unintentional] poor
compliance with prescribed oral medications. He experienced increasing
levels of stress, disorganised thinking and behaviour as well as paranoid
delusions about his co-workers suspecting that they were planning to harm
him or his family. Subsequent to his admission he has also exhibited mildly
depressed mood; increased anxiety; feelings of worthlessness, hopelessness,
and helplessness, suicidal ideation; withdrawn behaviour and impaired
functioning; decreased concentration. His symptoms are consistent with that
of Schizophrenia though the emerging affective component will need to be
closely monitored for further evidence of a co-morbid depressive or anxiety
related disorder. Bernard’s preoccupation with worthlessness, rumination
about the losses he has experienced, passive suicidal ideation, and his
marked functional impairment, all occurring in the context of his illness are
suggestive of a co-existing grieving process though at this stage this appears
to be appropriate under the circumstances.
Traditional Nursing Diagnostic Focus
The following nursing diagnoses for Bernard are derived from the
assessment data gathered:
· Altered Thought Processes.
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Complex 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 Scoring
Domain Results
1. Overactive, aggressive, disruptive behaviour. 0 1 2 3 4
2. Non-accidental self-injury. 0 1 2 3 4
3. Substance use and misuse. 0 1 2 3 4
4. Cognitive problems. 0 1 2 3 4
5. Physical illness or disability problems. 0 1 2 3 4
6. Hallucinations or delusions. 0 1 2 3 4
7. Depressed mood. 0 1 2 3 4
8. Other mental health issues [Anxiety]. 0 1 2 3 4
9. Relationships. 0 1 2 3 4
10. Activities of daily living. 0 1 2 3 4
11. Problems with living conditions. 0 1 2 3 4
12. Problems with occupation and activities. 0 1 2 3 4
Results Key: see Assignment Information package.
Discipline of Nursing
Complex Mental Health & Recovery 8
DSM-5 Diagnosis for the Client with Schizophrenia
The DSM-5 diagnosis for Bernard is as follows:
· Schizophrenia (295.9).
Planning
The Nursing Care Plan for Bernard illustrates how nursing diagnoses
guide the development of goals and therapeutic interventions. Ideally, the
nurse collaborates with the client in planning care.
This can be difficult to do with the psychotic or depressed person who is
feeling 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 in
empowering the client to begin the journey towards recovery.
Equally the nurse’s communication of the firm belief that the client will
feel better with time can often be enough to engage the client in at least
going along with the care plan.
Setting practical, reasonable, manageable, short-term goals that the client
can accomplish without much difficulty is important in fostering a sense of
hope and improved self-esteem.
The nurse should expect that with the amotivated psychotic client, early
interventions may need to be aimed at “doing for” the client [after accurate
identification of those abilities that remain intact vs. those that are
compromised].
The care plan will also need to include consideration regarding the
involvement/capacity of family, friends and other significant supports
care of her daughter], but the expectation should be that the client will
gradually assume more independent functioning as their mental state
improves.
Implementation
Nursing interventions are guided by the nursing care plan. For the
psychotic client, priority needs to be given to preventing self-harm
through ongoing assessment of suicide potential and maintenance of a
safe environment.
Discipline of Nursing
Complex Mental Health & Recovery 9
In addition, improving and maintaining physical health are important
foci of care for the depressed client, who is likely to have an altered
nutritional status and disturbed sleeping pattern.
Monitoring for side effects of pharmacological treatments for
depression 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 the
hospital unit will decrease his or her isolation and foster a sense of
self-worth.
As the client’s symptoms of depression respond to the
psychotherapeutic and somatic interventions implemented, psychoeducation
becomes feasible.
Clients and their Families should be educated about the type of
mental illness they have, as well as its possible causes.
Specifically, the contribution of both neurobiological and psychosocial
factors to the onset of depressive illness should be discussed.
Informing the client of the signs and symptoms of depression is
important so that recurrence can be identified early.
Education regarding the maintenance of medication regimens should
be conducted.
Evaluation
Evaluation of the client’s responses to nursing interventions should be
ongoing. In developing a Recovery Focused Care Plan for Bernard the nurse
might ask the following questions to evaluate the effectiveness of the nursing
process to ensure progress remains ongoing:
· Does the client describe an improvement [reduction] in the frequency and
intensity of paranoid thoughts?
· Does the client describe an improvement in his level of organisation related
to 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] ideas
diminished?
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Complex Mental Health & Recovery 10
· Is the client initiating interactions with others?
· Is the client initiating planning for his future taking into account the
impact of his mental illness?
In asking these and other questions, the nurse reflects on his or her own
observations; on the observations of other team members and the client’s
family; and, of utmost importance, on the client’s description of his or her
own experience.
Discipline of Nursing
NURS2098: Complex Mental Health & Recovery 1
Written Assessment Task
Recovery Focused Nursing Care Plan
DUE: Sunday 19th April 2015 by 23:59 [End of Week 6].
Title: Recovery Focused Nursing Care Plan
1500 Word Assignment
25 %
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 of
scenarios. Please see the assessment information package for more information on this
assignment.
Instructions:
1. Choose 1 of the scenarios to use as the basis for your assignment [you will base your entire
assignment on one of the case scenarios only]
2. Read the Case Study and identify 5 Goals drawn from both the case study information and
the HONOs scale for the consumer in the scenario. Consider and adopt a Recovery Model
perspective in doing this.
3. Having read the following case study, and familiarised yourself with the layout of the
nursing care plan, you are to complete the Recovery Focused Nursing Care Plan for this
client.
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 One
lecture] remember to:
a. Rank the goal priority in the order in which the consumer would like to address
the issues listed [there are going to be different ways to do this depending on
what you see as being the highest priority]; this will require some critical
consideration on your behalf.
b. Make sure that language used on the RFCP is clear, encouraging and agreed by
consumer and clinician.
Discipline of Nursing
NURS2098: Complex Mental Health & Recovery 2
c. 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 and
resources.
6. You are allowed to ‘fill in’ details in the case study where you feel that it is important for
the completion of the RFCP. If you do this you must include all additional information in
an 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 that
you will need to locate references that support nursing and consumer interventions as
wells as in identifying potential strengths [especially through the literature on the
Recovery Model] as well as when identifying supports and resources and determining
timeframes for review.
8. Please post all questions up on the Course Discussion Boards as this will allow all students
to benefit from the answers.
9. In keeping with RMIT policy all assignments are to be submitted through the Turnitin
Portal available via the course webpage.
The assignment is due by 23:59 on Sunday night: the portal will remain open until this
time however after the portal closes you will not be able to submit your assignment so
please 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 to
submit your assignment. You are allowed to submit it as many times as you would like up
until 23:59; the assignment I will receive to mark will be the LAST one you submitted.
Discipline of Nursing
NURS2098: Complex Mental Health & Recovery 3
Constructing the Recovery Focused Nursing Care Plan:
When constructing the RFCP you are required to submit he document using the following format:
Consumers
Priority
Identified
Goals/Issues
The consumer’s
strengths to
address these
issues.
Consumer and
Nursing
Interventions
Person/s
Responsible
Timeframe
– Include a
succinct
statement
describing
the issue.
– Rank
according
to the
consumers
priorities.
– Can be done
using HONOS or
based upon the
information
provided in the
case study
– This section is
critical to
ensuring the
plan has a
genuine
recovery focus.
– You need to
ask questions
such as:
– ‘What can they
do?’
– How
can they help
themselves?
– Include
agreed
actions and
expected
outcomes.
– Consider
what needs to
be done for
each Goal /
issue and
identify what
things the
consumer can
do and what
things the
nurse needs to
do.
– Who is
responsible
for this
intervention
occurring?
– Who will be
assisting in
this
intervention.
– What sort
of assistance
are they
going to give.
– This needs
to be realistic
and
developed
with the
consumer.
– It also
needs to
reflect the
time taken
for
interventions
to effect
change in the
consumer’s
symptoms.
So your final assignment will have the following structure
Consumers
Priority
Identified
Goals/Issues
The consumer’s
strengths to
address these
issues.
Consumer and
Nursing
Interventions
Person/s
Responsible
Timeframe
#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 5
Discipline of Nursing
NURS2098: Complex Mental Health & Recovery 4
The 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 Issues
and then rank them according to consumer preference. It is included as part of the case study information.
Domain Results
1. Overactive, aggressive, disruptive behaviour. 0 1 2 3 4
2. Non-accidental self-injury. 0 1 2 3 4
3. Substance use and misuse. 0 1 2 3 4
4. Cognitive problems. 0 1 2 3 4
5. Physical illness or disability problems. 0 1 2 3 4
6. Hallucinations or delusions. 0 1 2 3 4
7. Depressed mood. 0 1 2 3 4
8. Other mental health issues. 0 1 2 3 4
9. Relationships. 0 1 2 3 4
10. Activities of daily living. 0 1 2 3 4
11. Problems with living conditions. 0 1 2 3 4
12. Problems with occupation and activities. 0 1 2 3 4
Results Key
0 = 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 rating
period [usually the last 72 hours].
2 = Moderate problem during the rating period [usually the last 72 hours] causing passing periods of distress or
impairment during the rating period [usually the last 72 hours].
3 = Significant problem causing persistent distress or impairment during the rating period [usually the last 72
hours].
4 = Severe problem causing constant distress or impairment during the rating period [usually the last 72 hours].
Discipline of Nursing
NURS2098: Complex Mental Health & Recovery 5
The Recovery Focused Nursing Care Plan Marking Guide.
Student Name: _________________________________________
Assessment Criteria Mark
Allocation
Consumer 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, page
numbers, 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.