Case Scenario
Mr. Lewis Sandy lives in Miranda Heights, which is a residential home for the elderly located in Huntington, California. Mr. Sandy has increasingly become delusional, and he has been complaining of constipation regularly. Mr. Sandy has indicated that FBI secret agents have been searching through his room for drugs and weapons. According to Mr. Sandy, these agents want to kill him because they think that he has leaked classified information to the Soviet forces. Mr. Sandy has asserted further that the cleaners at the residence have been giving him the wrong medication since they are conspiring to end his life with the FBI.
Mr. Sandy is not only famous, but he also commands respect and affection from everyone at the residential home. Mr. Sandy is a well-informed individual who has an interest in international politics and foreign affairs. As such, he spends much of his time reading newspapers and political commentaries. Mr. Sandy was born in Poland before his parents relocated to the United States in 1953. Mr. Sandy is a war veteran who participated in the Vietnamese war. Mr. Sandy became a prisoner of war for three years. He experienced torture throughout this period of servitude before his companions rescued him.
Mr. Sandy’s only son (31 years old) is living in Sydney (Australia), and he is married with two children. The younger son (28 years old) relocated to Perth, Australia where he is living together with his gay partner. Mr. Sandy has not seen his children for the past 15 years. His wife relocated to Australia with the children after their painful divorce. His children rarely call him because the accuse him of having neglected them. Mr. Sandy was diagnosed with psychotic depression three years after the divorce, and he has undergone treatment for the post-traumatic stress disorder (PTSD) successfully.
Client’s Information
Mr. Sandy is a 72-year old Polish man who is both divorced and widowed. The case manager has referred him to the Mental Health Clinic because his hallucinations have increased in scope and intensity. Mr. Sandy has not been getting enough sleep because he has been wondering throughout the night. The case manager is worried that Mr. Sandy may stroll away and meet an unspecified accident. The patient’s physical health is also deteriorating. First, he is becoming anorexic because he has not been eating well. Second, Mr. Sandy started smoking again although he had given up this behavior three years ago.
Mr. Sandy’s main problem is the hallucinations. It is essential to identify and treat the underlying risk factors. This process will entail conducting an assessment to measure the level of depression using the most appropriate scale. Townsend (2010) has identified the Geriatric Depression Scale (GDS) as a crucial tool for measuring depression among older patients. Mr. Sandy’s desire to meet and reconcile with his children is a fundamental aspect of the evaluation. This issue will be critical to establishing its effect on depressive symptoms (Probst, 2009). Other areas of need include nutrition, sleep, increased socialization, and smoking cessation.
The majority of patients with mental disorders lack the capacity to make informed consent (Dimond, 2007). In essence, Mr. Sandy has the right to make autonomous decisions regarding the choice of care plans and medications. Nonetheless, Fullbrook (2007) has underscored the need for educating these individuals to ensure that they understand the benefits and consequences of their preferences. Mr. Sandy should make choices that are independent of his case manager’s desires.
Intervention Plan
Mr. Sandy’s hallucinations will not only affect his quality of life but will also intensify the depressive symptoms. According to Kilbourne et al. (2008), the main effects of illusions include isolation (mild) and violence (severe). The primary goal is to develop patient-centered relationships, which will enhance socialization. Cimpean and Drake (2011) have argued that social interactions improve clinical outcomes among patients with mental disorders. The formulation of a multidisciplinary team will facilitate the delivery of holistic care. The interdisciplinary approach will play a crucial function in ensuring the continuity of care after discharge (Crimpean & Drake, 2011).
The strengths-based approach in social work plays a fundamental role in empowering individuals to become resilient or cope with adversity adequately (Probst, 2009). Mr. Sandy is a very social man considering that he is popular, and everyone at the residential home loves him. Kilbourne et al. have acknowledged the significance of social and group support in the management of the psychotic disorder. The strong bond between Mr. Sandy and his colleagues will facilitate the successful implementation of the care plan. Townsend (2010) has noted that these interactions and supportive systems assist patients to cope with their depressive symptoms efficiently.
Mr. Sandy has other underlying challenges besides the delirium. First, a health education and promotion program will be necessary to encourage Mr. Sandy to cease from smoking (Kilbourne et al., 2008). Secondly, a dietary plan that is rich in fiber and nutrients will address the challenge of constipation. Third, an exercise regime will also be critical to deal with both constipation and sleeplessness (Cimpean & Drake, 2011). The latter problem requires adherence to the prescribed medications and the development of a plan that mandates Mr. Sandy to sleep at predefined times. The active involvement of the caregivers and case managers in the decision-making processes will be indispensable to enhance positive outcomes (Probst, 2009).
Evaluation of Interventions
The main objectives of these interventions are to reduce the exacerbation of the depressive symptoms and prevent the development of other conditions. Townsend (2010) has posited that monitoring of the interventions is crucial to ascertain if the different players are fulfilling their mandates successfully. First, the evaluation process will measure the key components to determining if Mr. Sandy and his caregivers are meeting their goals. Second, getting timely feedback from all the participants will be necessary to determine if Mr. Sandy is responding positively (Kilbourne et al., 2008). Third, the staff at the residential home will facilitate the effectual implementation of the interventions. Consequently, it will be of the essence to find out if these professionals have the capacity to meet their mandates efficiently (Probst, 2009).
Next Session Plan
The next session plan will involve visiting Mr. Sandy at the residential home to determine if he can perform everyday tasks independently. The homework for Mr. Sandy will include the following components. First, he will have to cooperate with the caregivers in following the smoking cessation, dietary and optimal sleeping plans (Probst, 2009). Secondly, Mr. Sandy will practice new skills that will enable him to cope with his depressive symptoms efficiently. Thirdly, Mr. Sandy will outline his goals for recovery, including techniques he will use to achieve these aims (Cimpean & Drake, 2011). Finally, Mr. Sandy will identify how he will use the identified strengths to overcome his weakness (Townsend, 2010). The next session will focus attention on the successes and challenges that Mr. Sandy will have encountered.
References
Cimpean, D. & Drake, R. E. (2011). Treating co-morbid medical conditions and anxiety/ depression. Epidemiology and Psychiatric Sciences, 20(2), 141–150.
Dimond, B. (2007). Mental capacity and decision-making: Defining capacity. British Journal of Nursing, 16(18), 1138-1139.
Fullbrook, S. (2007). Best interests. An holistic approach: Part 2(b). British Journal of Nursing, 16(12), 746-747.
Kilbourne, A. M., Post, E. P., Nossek, A., Drill, L., Cooley, S., & Bauer, M. S. (2008). Improving medical and psychiatric outcomes among individuals with bipolar disorder: A randomized controlled trial. Psychiatric Services, 59(7), 760–768.
Probst, B. (2009). Contextual meanings of the strengths perspective for social work practice in mental health. Families in Society, 90(2), 162-166.
Townsend, M. (2010). Nursing diagnoses in psychiatric nursing: Care plans and psychotropic medications. New York, NY: Routledge.