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Nursing Mental Status Examination and Therapy Case Study

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Updated: Jul 1st, 2021

Holistic Assessment and Planning

The Mental Status Examination

  • Appearance & behavior
  • Appearance
  • Motor behavior
  • Attitude to situation and interviewer
Jayan looks younger than his actual age. He is thin and has long, shaggy, dark hair under the cowboy hat. He wears dusty jeans, a grubby long-sleeved shirt, and riding boots. The patient has two tattoos on his fingers on both hands (LOVE and TESS). He is not willing to talk and becomes teary.
  • Speech form
    • Rate
    • Volume
    • Quantity of information
  • Speech content
    • Disturbance of meaning
    • Disturbance of language
The patient speaks quietly and uses monosyllables. He does not share much information, and all its quantity is devoted to his ex-girlfriend or Michael, a cousin who committed suicide a year ago. The patient uses short declarative sentences (his awareness of the situation and plans) and interrogative sentences (his dissatisfaction with the current situation).
  • Mood and Affect
    • Mood
    • Affect
    • Congruency
A depressed mood is observed. Disappointment and grief can be discovered as soon as Jayan should remember the fact that his girlfriend left him several months ago.
  • Form of Thought
  • Excess, absence, quality of thought
  • Continuity of ideas
His thoughts are logically connected. He wants to know more about Tess and says that there is no point to raise other topics but his girl. Jayan has a problem and a solution (suicide) to it that is properly grounded.
  • Content of Thought
  • Delusions
  • Suicidal thoughts
  • Other
His suicidal thoughts are based on his problematic relationships with the girl and the attitude that there is no other option to find a way out.
  • Perception
  • Hallucinations
  • Illusions
  • Depersonalization/derealisation
He understands who he is but suffers from the derealisation that this life does not make sense without her.
  • Sensorium and Cognition
  • Level of consciousness
  • Memory:
  • Orientation.
  • Abstract thinking
He remembers past events and stays oriented and partially attentive during the interview.
  • Insight & Judgement
  • The extent of individual’s awareness of the problem
  • Can they make rational decisions
Jayan is aware of his problem but makes irrational decisions, wanting to kill himself.
Risk Assessment
  • Potential for harm to self
  • Potential for harm to others
  • Potential for absconding
The patient is not dangerous to others, but there is a potential for harm to himself.

Clinical Formulation Table.

Summarise the pertinent information from the case study
Presenting factors Jayan is dissatisfied and disappointed with the situation because his girlfriend went to another city and did not give any additional information. He uses suicide as the only way out of this situation. The patient wants to know more about Tess and is afraid that she does not love him anymore.
Precipitating factors Two months ago, his girlfriend Tess left him to study in another city.
Predisposing factors His father died suddenly of leukemia when Jayan was four. He was raised by his mother in the house with his three young sisters. One year ago, his cousin, Michael, committed suicide by hanging.
Perpetuating factors Jayan’s mother says he does not look after himself and drinks a lot. At school, he was the subject of racist taunts, and it was the reason why he did not like studying. He does not want to consider other options as the way out of this situation.
Protective factors Today, the patient is satisfied with the job he has. He adores horses and cattle, and the opportunity to work as a station hand is what makes him happy. When he was at school, he liked playing football but could not develop his skills in that field because of being the only man in the family. His love for family and mates did matter for the patient.

Plan for Nursing Care

The problem of being abandoned by dear people has a high priority in this case. A year ago, his cousin committed suicide, and although not much attention is paid to these relationships, it is possible to say that the patient was left by his cousin. When he was a child, his father left him when he died. Two months ago, his girlfriend left him to continue her education in another city. While she is not dead, she is not with him. Hospitalization is the main intervention during which he is not left alone. The nurse must communicate with the patient and encourage a safe environment. It is necessary to underline that suicide is a choice but not something hard to control. Its result is the end of human life, and there is no return from its outcome. The nurse should remind the patient about his family and his responsibilities as the only man there. He does not have the right to leave his mother and sisters but support and help them.

Another significant aspect of the case includes suicidal thoughts and the real-life example the patient observed. Jayan talks about his plans to kill himself and stop his mother’s worries. Relationship breakups may contribute to suicidal ideation among students and adolescents (Brenner & Vogel, 2015). This patient is older than college students, and, in addition, it was not a breakup but a necessity to change a city for a study period only. Psychotic experiences may also increase the risks of suicide in patients who survived losses (Bromet et al., 2017). The intervention includes a nurse’s assistance in identifying positive thoughts and feelings. The nurse can explain the role of his family and work in this life. It is necessary to underline the options available to the patient. Evaluation of pleasant details and questioning all negative thoughts can help the nurse change the patient’s mood and reduce the risks of suicidal behavior.

Clinical Handover

The patient is upset with the fact that his girlfriend left him to study in another city. He suffers from the feeling of being abandoned by the people he loves. His thoughts and talks about suicide and his awareness of how to take this step along with his tears and quietness can be used by a nurse to explain that suicide is not the only option. Tess did not say that she broke up with him, just went to the city to continue her education. There is a chance to continue living together with time, and positive emotions should be identified for the patient. Jayan has a loving family and a good job where he can spend a lot of time with horses. Safety promotion and supportive care are the main interventions to be applied by nurses in this case.

Part II: Therapeutic Engagement and Clinical Interpretation

The Therapeutic Relationship

For many patients, the establishment of therapeutic relationships may be their first disclosure of trauma and mental health problems. It is not enough to inform a person about the care that must be offered because some suicidal patients do not feel understood by their caregivers and medical workers (Gysin-Maillart, Soravia, Gemperli, & Michel, 2017). It is important to stay clear with a patient and give all necessary explanations. Bryan, Rozek, Burch, Lesson, and Clemans (2018) found out that structured therapies could enhance task- and goal-oriented expectations between clinicians, including nurses and therapists, and patients. In this case, it is recommended to use emotional awareness as the main strategy for the development of therapeutic relationships, communication, and the identification of positive thoughts.

There are many reasons why this type of relationship can help the patient remove or, at least, reduce suicidal thoughts. Awareness helps the medical staff control their interactions and become active when new reactions are observed (McMain, Boritz, & Leybman, 2015). Emotion regulation is a significant part of any therapeutic relationship to promote environmental adaptations, problem-solving, and cognitive improvements in patients with depression and suicidal thoughts (Kiossess et al., 2015). Although depressed patients at risk of suicide lack emotions and hide their true intentions, this patient is ready to share his grief and desire to return to his girlfriend. Therefore, the task of a nurse is to focus on the best moments of his life, underline the role of a family, and create as many positive and kind emotions as possible.

Cultural Safety

When a nursing care plan is developed for mentally ill people, it is important to consider cultural safety. Cultural values about committing suicide vary; some people develop neutral attitudes to the idea of suicide, whilst other nations consider it as a disgraceful or purely private issue (Bolster, Holliday, Oneal, & Shaw, 2015). Despite the origins of the patient, care should be culturally safe and meet all the principles established by the government.

The first step in taking care of the patient should be the identification of his origins and learning statistics about his culture. In this case, a patient is an Aboriginal man with a culturally sensitive history, including the problems at school because of his roots. The studies show that suicide as the cause of death is observed among Aboriginal Pacific) people more frequently than among non-Aboriginal people with about 15% of the New Zealand population reporting serious suicidal thoughts (Cross, Ryan, Brebner, & Siaosi, 2017). The main issue in this care plan is his unwillingness to look at the situation from another perspective. Therefore, the principle of social and restorative justice through conversation with a client can be used as a part of a nursing care intervention.

Recovery-Oriented Nursing Care

Interpersonal communication and the identification of positive thoughts and feelings in a patient are the interventions that may be chosen by a nurse in the case under consideration. These steps should help explore the patient’s knowledge about the situation and past events that lead to his suicidal thoughts. In addition, a nurse may observe and identify the patient’s recent behavioral and cognitive changes, drug reactions, and general state.

Recovery-oriented mental health models in Australia are usually highly valued compared to the models with traditional physical health outcomes. The concept of recovery for many mentally ill people includes the necessity for a patient to stay in control of his life rather than supporting elusive state and depressive thoughts (Jacob, 2015). Among the existing variety of recovery models and philosophies, the principles of the Collaborative Recovery Model (CRM) are chosen. They include the recognition of meaningful life directions and the establishment of goals (Crowe & Deane, 2018). In addition to the obligation to talk and report on any changes, clinicians are responsible for discovering risks to the patient and his current attitudes to his family, his personal affairs, and his suicidal attempts. The recovery model includes three main pillars: personal attitudes, including hope and well-being, knowledge attitudes, including literacy and social integration, and housing, including work and family responsibilities. The collaboration of all these duties and tasks cannot be ignored and has to be properly underlined for the patient.

Being already emotionally challenged during his school age, Jayan was able to cope with social difficulties and racial judgments relying on love for his family and football. This time, the recovery process should also include discussions about the role of his family in this life and the relationships he has already developed. Jayan has already achieved the goal that not many people can do. He has a job that makes him happy and that he adores. His girlfriend is alive but not dead or with another person, but instead of giving hope to the patient, the task of a nurse is to discover new opportunities and reasons for self-improvement and development.

References

Bolster, C., Holliday, C., Oneal, G., & Shaw, M. (2015). Online Journal of Issues in Nursing, 20(2). Web.

Brenner, R. E., & Vogel, D. L. (2015). Measuring thought content valence after a breakup: Development of the positive and negative ex-relationship thoughts (PANERT) scale. Journal of Counseling Psychology, 62(3), 476-488. Web.

Bromet, E. J., Nock, M. K., Saha, S., Lim, C. C. W., Aguilar-Gaxiola, S., Al-Hamzawi, A.,… McGrath, J. J. (2017). Association between psychotic experiences and subsequent suicidal thoughts and behaviours: A cross-national analysis from the World Health Organization world mental health Surveys. JAMA Psychiatry, 74(11), 1136-1144. Web.

Cross, W., Ryan, K., Brebner, A., & Siaosi, T. (2017). Mental health and wellness in Australia and New Zealand. In K. Evans D. Nizette, & A. O’Brien (Eds.), Psychiatric and mental health nursing (4th ed.) (pp. 199-221). Chatswood, NSW: Elsevier.

Crowe, S., & Deane, F. (2018). Characteristics of mental health recovery model implementation and managers’ and clinicians’ risk aversion. The Journal of Mental Health Training, Education and Practice, 13(1), 22-33. Web.

Gysin-Maillart, A. C., Soravia, L. M., Gemperli, A., & Michel, K. (2017). Suicide ideation is related to therapeutic alliance in a brief therapy for attempted suicide. Archives of Suicide Research, 21(1), 113-126. Web.

Jacob, K. S. (2015). Recovery model of mental illness: A complementary approach to psychiatric care. Indian Journal of Psychological Medicine, 37(2), 117-119. Web.

Kiosses, D. N., Rosenberg, P. B., McGovern, A., Fonzetti, P., Zaydens, H., & Alexopoulos, G. S. (2015). Depression and suicidal ideation during two psychosocial treatments in older adults with major depression and dementia. Journal of Alzheimer’s Disease, 48(2), 453-462. Web.

McMain, S. F., Boritz, T. Z., & Leybman M. J. (2015). Common strategies for cultivating a positive therapy relationship in the treatment of borderline personality disorder. Journal of Psychotherapy Integration, 25(1), 20-29. Web.

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