Developing Autonomous Practice in Mental Health Nursing

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This essay will focus on a case study of a patient with Schizophrenia, whom I cared for during my recent clinical specialist placement in a medium secure unit. The patient personal and psychiatric history would be given. The patient current psychological, sociological and physiological needs will be looked at by using published therapeutic approaches. In this case study a demonstration of how the therapeutic approaches chosen provide or guidance of the nursing care provided in the assessment of needs, identification of goals/aims, therapeutic nursing intervention and clinical review of the patient progress will be discussed. The therapeutic efficacy of the current environment where the care is being provided for the patient will be analysed in terms of possible alternative service provision where the patient could be nursed will also be considered. Finally a reflective conclusion would be drawn based on the previous care and interventions provided for the therapeutic efficacy of the model considered in improving the life of the patient’s suffering from schizophrenia.

My patient will be referred to as Judy for patient confidentiality in accordance with the Nursing and Midwifery council code of professional conduct, (NMC, 2004). Which require nurses to protect all confidential information concerning patients obtained in the course of professional practice, Judy is a 17 years old she was born and raised in a deprived council estate. Reports indicate that Judy had a normal birth with no obvious signs of problems during this milestone. Judy has one sibling, a brother who is the eldest her parents divorced when she was three years of age. Judy has a history of chronic bullying at school because of her excessive weight gain, abusive experiences within the home, and presented with mood instability, depressive mood, perceptual/ psychotic disturbances, aggressive behaviour, excessive alcohol intake, cannabis use, deliberate self harm and suicidal attempts.

Judy has four years history of paranoid schizophrenia. She was first hospitalised at the age of 12 under section 2 of the Mental Health Act (1983) for mental state assessment and treatment. She has had five previous hospital admissions due to her disengagement from the services for a period of 18 months after a suggestion of increase family involvement and for non compliance with her prescribed anti-psychotic medication Resperidone 4mg twice daily and anti- depressant medication Fluoxetine 10mg. Judy is an occasional user of cannabis and alcohol and has a history of self harming and unpredictable aggressive behaviour when unwell. As a result of Judy’s disengagement from services and poor compliance of her medications, she suffered recurrent relapses. Due to Judy’s deterioration in her mental state led to her transfer and detention under section 3 of the Mental Health Act ((MHA) amended 2007) meaning compulsory admission for treatment from an open adolescent psychiatric unit to a medium secure unit.

Judy has been observed to be hallucinating with command telling her to carry out self harming behaviour mainly by cutting. She has been observed to be expressing delusional beliefs that people are against her that the Nurses on the ward are secret agent of the police wanting to pass information to the police for her to be arrested. Since she been on the ward she has been isolating herself for fear of being attacked by other patient. Judy has been racial and verbally abusive towards staff and has physically attacked ten members of staff by, head butting acting on her delusional beliefs, when approached by staff she stated she did it to protect herself because staffs are part of the police conspiracy; she has been observed to be talking loudly to herself of late. She has been sleeping a lot during the day in her bedroom and becomes verbally abusive and aggressive when encouraged to join in the ward based activities. In the past weeks she has been in good concordances with her...
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