NURS 2118: Therapeutic Initiatives in Mental Health

Posted: April 4th, 2019

NURS 2118: Therapeutic Initiatives in Mental Health
Assessment Assessment Task 2
Assessment Title and type Case Study-Application of trauma informed care and motivational interviewing in mental health
Word Count 1,500 words (+/- 10%)
Weighting 40%
Due Date 2nd April 2023 @ 2359hrs
Associated Learning Outcomes 1. Explore the significance and advantages of utilising psychotherapeutic approaches within mental health as well as delivery of trauma informed care.
2. Critically examine the use of motivational interviewing when working with people experiencing a mental illness.
3. Examine the use of various psychotherapeutic approaches when working with people and their families experiencing a mental illness.
4. Evaluate the application of psychotherapy within mental health settings.
Background Information:
Emma Smith is a 33-year-old female with a diagnosis of schizoaffective disorder. Emma was born in Queensland and is an only child and moved to Melbourne at age 20 to pursue a career in finance. Emma was diagnosed with depression at age 14 however at age 21 she was diagnosed with first episode psychosis after experiencing her first psychotic episode resulting in an admission to a public mental health unit. During this admission she reports that she was sexually assaulted by a co consumer and had multiple episodes of seclusion. Emma engaged with a private psychiatrist and psychologist on discharge and remained stable and compliant with medication management.
Emma subsequently married her current husband at age 25 and has experienced a significant relapse at age 29 in the context of self ceasing medications and disengaging with private supports after being concerned of the impacts her medication was having on her unborn child at approx. 8months pregnancy. During this prolonged admission to a public mental health inpatient unit then to a mother baby unit She was diagnoses with schizoaffective disorder and was discharged on Olanzapine 15mg nocte and Fluoxetine 40mg mane. She re engaged with her private supports.
Emma is now 33 years of age and has been brought to the emergency department by her husband John who has concerns regarding early warning signs of relapse after noticing Emma has been talking to herself, poor sleep and appetite and anhedonia. John also reports that two months ago they commenced IVF treatment. Whilst in the emergency department she is placed under an Assessment Order and then a Temporary Treatment Order and admitted to the public mental health inpatient unit.
Assessment Task:
You are Emma’s contact nurse for the afternoon at day 3 (Sunday) of her admission. Emma has been recommenced on her medication regime of Olanzapine 15mg nocte and Fluoxetine 40mg mane since arriving on the ward.
Emma has been isolating in her room since being admitted and at times has been heard responding to internal stimuli in a distressed manner. She is presenting as guarded and difficult to engage with regarding her mental state. You have gone to administer her nocte medication and she is refusing this stating “I don’t want it; I just want to go home and see my family. I don’t feel safe here.” She further states she has concerns regarding the safety of the medication but won’t disclose exactly what the concerns are. You also note that she refused the previous nights dose and has been refusing to engage with her treating team and nursing staff.
Details of the Task/Instructions:
– Your introduction should set the scene for the essay, provide context and the scope of what areas your essay would be discussing.
– Discuss how you would utilise the principles of trauma informed care and trans theoretical model of change and motivational interviewing to support Emma when it comes to her taking her medications as prescribed and engaging with services. Your discussion should be embedded within the available evidence-based literature around the concepts.
– You will need to demonstrate a good understanding of how to link/incorporate MI while providing trauma informed care.
– What strategies would you employ as a mental health nurse when it comes to working with Emma and her family to promote recovery?
Please note that this case scenario would also be used for your second written assignment so make sure you limit your discussion to only the relevant parts of the current assignment due to word limitations
Introduction:

The case study of Emma Smith highlights the complexities of mental illness and the need for appropriate therapeutic approaches to support recovery. Emma’s diagnosis of schizoaffective disorder and history of trauma, including sexual assault and seclusion, have resulted in a reluctance to engage with mental health services and comply with medication management. As Emma’s contact nurse, this essay will explore the application of trauma-informed care and motivational interviewing to support Emma in taking her medication as prescribed and engaging with mental health services.

Utilizing Trauma-Informed Care and Trans-Theoretical Model of Change:

Trauma-informed care is an approach that recognizes the impact of trauma on individuals and emphasizes safety, choice, collaboration, trustworthiness, and empowerment (SAMHSA, 2014). Emma’s history of trauma and seclusion highlights the need for a trauma-informed approach to care. As a mental health nurse, I would ensure that Emma feels safe and comfortable in her environment by respecting her boundaries and preferences. I would acknowledge Emma’s past experiences of trauma and validate her feelings and concerns about her medication.

Motivational interviewing is a person-centered approach to promote behavior change by exploring and resolving ambivalence (Miller & Rollnick, 2013). The trans-theoretical model of change is a framework that describes the stages of behavior change, including precontemplation, contemplation, preparation, action, and maintenance (Prochaska & DiClemente, 1983). Emma’s refusal to take her medication and engage with mental health services suggests she may be in the precontemplation or contemplation stage of change. Therefore, applying motivational interviewing and the trans-theoretical model of change can help Emma identify her readiness to change and address any ambivalence.

As a mental health nurse, I would employ the following strategies to promote behavior change and support Emma in taking her medication as prescribed and engaging with mental health services:

Express empathy: I would acknowledge Emma’s feelings and concerns about her medication and validate her experience of trauma. By expressing empathy, I can build a therapeutic alliance with Emma and establish trust.

Develop discrepancy: I would explore the discrepancy between Emma’s goals and her current behavior to promote insight and awareness of the need for change. For example, I would explore Emma’s desire to see her family and how taking her medication as prescribed can help her achieve this goal.

Roll with resistance: I would avoid confrontation and acknowledge Emma’s autonomy by respecting her right to refuse medication. I would explore Emma’s reasons for refusing medication and address any misconceptions or fears.

Support self-efficacy: I would promote Emma’s confidence and self-efficacy by highlighting her strengths and achievements. For example, I would acknowledge Emma’s previous compliance with medication management and how she has successfully managed her mental health in the past.

Strategies to Employ as a Mental Health Nurse:

As a mental health nurse, I would employ the following strategies to promote recovery and support Emma and her family:

Collaborative care: I would involve Emma and her family in the treatment planning process to promote shared decision-making and empower them in their recovery journey. By involving Emma and her family, I can tailor the care plan to their needs and preferences.

Psychoeducation: I would provide Emma and her family with information about her diagnosis, treatment options, and the importance of medication management. By providing psychoeducation, I can promote their understanding of mental illness and reduce stigma.

Multimodal therapy: I would consider the use of various psychotherapeutic approaches, such as cognitive-behavioral therapy, family therapy, and group therapy, to support Emma and her family in their recovery. By using a multimodal approach, I can address the complex nature of Emma’s mental illness and the impact it has on her and