Acute Care Assignment

Title of essay: Acute care assignment

Student number: 631514

Programme of study: Mental Health (Nursing)

Cohort: S14

Module lead: Sarah Tait (Swansea University)

Name of personal tutor: Keith Bradley-Adams

Module code: SHN278

Word count: 3992

Date of submission: 8th of April, 2016

Scenario 1: Bipolar Affective Disorder

Introduction

The purpose of this assignment is to provide a detailed discussion of a care and management journey of an acutely unwell person in response to a given scenario representing the field of mental health nursing. The assignment will be split into two sections. The first section will be entitled ‘what has happened so far’ which will include a brief interpretation of the presented situation and insight into the patient’s condition. Additionally, a case formulation (CF) will be conducted which will identify needs and present contributing factors that may have led to the patient’s current situation. The information gathered from the CF will inform practice through identifying the appropriate measures to maintain patient safety and reduce the risk of clinical deterioration in regards to the nurse’s responsibilities.

In the second section entitled ‘what action is required?’ a rationale will be set from the CF in order to make a plan of prioritised nursing action for the next two weeks using a structured care and treatment plan recognised in the field of mental health nursing. This in turn, will promote active nursing intervention to achieve best possible outcome for the acutely unwell patient. Additionally, for the purpose of this assignment, there will be a brief overview of the care and treatment plan (CTP) in order to further demonstrate prioritised nursing action.

Furthermore, the maintenance of confidentiality and anonymity will be necessary in order to adhere to the professional regulations of the Nursing and Midwifery Council and College Guidelines (NMC, 2015). No reference will be made or included in relation to any on-going legal health board or organisational investigations.

Section 1: What has happened so far?

Pen picture: Interpretation of patient’s situation

Jonathan is a 20-year-old male who has been referred to the Community Mental Health Team (CMHT) by his General Practitioner (GP) as an emergency as he appears to be at risk to himself and others and is suicidal. The GP claims that Jonathan is ‘climbing the walls’, is difficult to engage, will not sit down, talking very fast and incomprehensively which makes it difficult to make an adequate assessment.

Upon CMHT assessment, Jonathan is found not to be actively suicidal and has a mental health history of depression. His mother was present during assessment and claims that he has been misusing drugs occasionally, but does not believe this is problematic or the cause of Jonathan’s current presentation. She also states that he appears very irritable, cannot sit still and sometimes is awake all night. Additionally, he has lost interest in his usual activities such as watching television and has stopped going to college (he is studying for his A Levels). He has also changed in temperament as he is usually quiet but recently has been very talkative. Furthermore, she claims that he has received a poor diet for the last week. Jonathan has been complaining to his mother about not being able to think straight and having a racing mind. Both Jonathan and his mother state that he has recently split from his long-term girlfriend and subsequently failed an exam at college. Jonathan is not presently on any medication, although he has previously been prescribed some antidepressants. Jonathan is later diagnosed with Bipolar Affective Disorder (BAD) after being seen by a consultant.

Insight into the patient’s condition

Diagnosis is important as it can help guide interventions in mental health (Frances, 2013; Carddock & Myners-Wallis, 2014). However, this may be limited as it does not take into account the person’s individual experience of their disorder (Crowe, Carlyle & Farmar, 2008; Macneil, Hasty, Conus & Berk, 2012; Maj, 2011).

In the present situation, Jonathan has been diagnosed with BAD which is a potentially lifelong and disabling condition characterised by periods of depression and elevated mood (American Psychiatric Association (APA), 2013). It is evident from the information given in the scenario that Jonathan is currently experiencing an episode of mania. Mania is a mood disturbance whereby the individual experiences a distinct period of abnormally and persistently elevated, expansive or irritable mood and abnormally and persistently increased goal-orientated activity or energy, usually lasting for about a week in duration (APA, 2013). It is necessary that the person’s symptoms are significant and is noticeably different from their usual behaviour. For example, in Jonathan’s case, he experienced a decreased need for sleep; he was more talkative than usual; he had racing thoughts and appeared distracted; which is also consistent with criterion for mania (APA, 2013).

Moreover, when mania is diagnosed it is recommended that admission to hospital or intensive community management is a consideration (Goodwin, 2009). According to the National Institute for Health and Care Excellence (NICE) Guidelines (2016) regarding the management of mania and hypomania in adults, it is necessary to ensure that the person who is experiencing mania has access to calming environments and reduced stimulation, for example the home environment (NICE, 2016). Furthermore, people with serious mental illness often choose treatment options that make fewer demands on their behaviour and empower them to obtain help where and when they need it; this is often offered on a community setting such as the CMHT (Corrigan et al., 2012). Thus, in Jonathan’s case it would seem appropriate to be able to treat him from the community perspective. However, if it later transpires that Jonathan is a risk to himself or others an admission to hospital will be paramount to ensure his safety and the safety of others (Welsh Assembly Government (WAG), 2010).   

Identifying a comprehensive case formulation (CF)

The CF is a framework to inform mental health practice through creating a summary of problems and key points gained through assessment in order to make sense of the patient’s current presentation (Rainforth & Laurenson, 2014; Tarrier & Johnson, 2015). This is often done collaboratively with the patient in order to emphasise individual strengths to promote recovery (Goodwin, 2009; NICE, 2014; Skelley et al., 2013). This is consistent with the Mental Health (Wales) Measure (WM) 2010 legislation (WAG, 2012) which states that service users who find themselves in secondary mental health services have the right to play an active role in the development of their care and treatment plan.