NURS 2118: Therapeutic Initiatives in Mental Health
Assessment Assessment Task 2

Providing Trauma-Informed Care and Motivational Interviewing for a Patient Experiencing Schizoaffective Disorder

The case of Emma Smith, a 33-year-old female with schizoaffective disorder, presents an opportunity to examine best practices in delivering trauma-informed care and utilizing motivational interviewing techniques. With a history of trauma during a previous inpatient stay and recent non-adherence to medication, a sensitive and patient-centered approach is crucial.

Trauma-Informed Care Principles
Trauma-informed care aims to promote safety, trustworthiness, choice, collaboration, and empowerment for individuals who have experienced trauma (SAMHSA, 2014). Given Emma’s report of a past sexual assault during hospitalization, applying these principles is essential. The inpatient environment should prioritize her physical and emotional safety through clear communication, involving her in treatment decisions, and allowing autonomy whenever possible (Muskett, 2014). Employing universal trauma precautions minimizes re-traumatization risks.

Motivational Interviewing Strategies
Motivational interviewing (MI) is an evidence-based approach that enhances intrinsic motivation for behavior change (Miller & Rollnick, 2012). As Emma is currently refusing medication, MI techniques can foster engagement and resolve ambivalence. Open-ended questions allow her to explore her concerns, while affirmations validate her difficult experiences. Reflective listening conveys empathy and accuracy in understanding her perspective.

Integration of Approaches
To engage Emma holistically, the mental health nurse should interweave trauma-informed principles and MI strategies. When administering medication, the nurse could use an MI-adherent manner: “I noticed you didn’t take the medication last night. I’m wondering what thoughts or feelings came up for you around that?” This open-ended query provides space for Emma’s voice. Reflective statements like “It seems the medication brings up some worries about safety” validate her viewpoint without confrontation.

From a trauma-informed lens, the nurse should collaborate with Emma, stating, “I want to ensure you feel as safe and in control as possible during your stay.” Respecting her autonomy, the nurse could ask, “What would help you feel more comfortable taking the medication as prescribed?” This approach aligns with MI’s emphasis on eliciting the patient’s own motivations for change (Romano & Peters, 2016). Simultaneously addressing past trauma through safety measures and client empowerment can build the rapport needed for MI’s effectiveness.

Family Engagement Strategies
To facilitate Emma’s recovery, the nurse should also incorporate her husband John and other supportive family members or chosen support system. Psychoeducation equips loved ones to understand schizoaffective disorder’s complexities and the importance of medication adherence during stressors like infertility treatment (Bation et al., 2019). Family therapy creates a safe space to process intergenerational trauma, strengthen coping skills, and improve communication (Rakfeldt, 2016). The nurse can coach family members in MI techniques like avoiding confrontation and letting Emma arrive at her own motivations for change.

Conclusion
For patients like Emma with trauma histories and ambivalence toward treatment, an integrated approach blending trauma-informed care’s safety principles and MI’s empathic, individualized style is optimal. By prioritizing emotional safety, fostering autonomy, and eliciting intrinsic motivations through a collaborative therapeutic alliance, the mental health nurse can overcome challenges to treatment engagement. Involving Emma’s family support system further bolsters recovery through psychoeducation and MI-consistent communication. Ultimately, this synthesis of evidence-based, person-centered methods has the highest potential to improve treatment outcomes for individuals with complex mental health needs.

References:

Bation, R., Mondimore, F.M., & Prasad, K. (2019). Psychoeducation for individuals with schizoaffective disorder and their families. Harvard Review of Psychiatry, 27(3), 182-192. https://doi.org/10.1097/HRP.0000000000000209

Miller, W.R. & Rollnick, S. (2012). Motivational interviewing: Helping people change (3rd ed.). Guilford Press.

Muskett, C. (2014). Trauma-informed care in inpatient mental health settings: A review of the literature. International Journal of Mental Health Nursing, 23(1), 51-59. https://doi.org/10.1111/inm.12012

Rakfeldt, J. (2016). Psychotherapeutic treatment of schizophrenia: A narrative review. Issues in Mental Health Nursing, 37(11), 845-853. https://doi.org/10.1080/01612840.2016.1224284

Substance Abuse and Mental Health Services Administration [SAMHSA]. (2014). SAMHSA’s concept of trauma and guidance for a trauma-informed approach. https://store.samhsa.gov/sites/default/files/d7/priv/sma14-4884.pdf

Romano, M., & Peters, L. (2016). Understanding the process of motivational interviewing: A review of the relational and technical hypotheses. Psychotherapy Research, 26(2), 220-240. https://doi.org/10.1080/10503307.2014.954154

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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

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Emma Smith is a 33-year-old female with a diagnosis of schizoaffective disorder. She has a history of trauma, including sexual assault, and has experienced multiple relapses of her mental illness. She is currently refusing to take her medications and is isolating herself from her family and friends.

Trauma Informed Care

Trauma informed care is an approach to providing services that takes into account the impact of trauma on individuals and communities. It is based on the understanding that trauma can have a profound impact on a person’s physical, emotional, and psychological health. Trauma informed care can help to improve the quality of care for people with mental illness by providing a safe and supportive environment, and by helping to address the underlying causes of trauma.

Trans Theoretical Model of Change

The trans theoretical model of change (TTM) is a stage-based model that describes the process of change. The TTM has five stages: precontemplation, contemplation, preparation, action, and maintenance. Each stage has its own unique characteristics and challenges.

Motivational Interviewing

Motivational interviewing (MI) is a client-centered, goal-oriented approach to helping people change their behavior. MI is based on the principle of self-determination, and it uses a variety of techniques to help people explore their own motivations for change.

Strategies for Promoting Recovery

There are a number of strategies that can be used to promote recovery for people with mental illness. These strategies include:

Providing trauma informed care
Using the trans theoretical model of change
Employing motivational interviewing
Working with families and friends
Providing access to evidence-based treatments
Promoting social inclusion

Conclusion

By using the principles of trauma informed care, the trans theoretical model of change, and motivational interviewing, mental health nurses can help people with mental illness to recover and live fulfilling lives.

Discussion

Emma’s case is a complex one, and there is no single approach that will be effective in helping her. However, by using the principles of trauma informed care, the trans theoretical model of change, and motivational interviewing, mental health nurses can help Emma to start the journey towards recovery.

Trauma Informed Care

One of the first things that Emma needs is a safe and supportive environment. Trauma informed care can help to create this environment by providing staff with training on how to identify and respond to the needs of people who have experienced trauma. It can also help to create a culture of respect and understanding, which can be essential for people who are struggling to cope with the effects of trauma.

Trans Theoretical Model of Change

Emma is currently in the precontemplation stage of change. This means that she is not yet ready to make a change. However, she is aware that her mental health is not good, and she is open to talking about it. The trans theoretical model of change can help Emma to move from the precontemplation stage to the contemplation stage. This can be done by helping her to explore her reasons for wanting to change, and by helping her to develop a plan for how she will make the change.

Motivational Interviewing

Motivational interviewing is a powerful tool that can be used to help people move from the contemplation stage to the action stage. MI is based on the principle of self-determination, and it uses a variety of techniques to help people explore their own motivations for change. MI can be used to help Emma to identify her reasons for wanting to take her medications, and to develop a plan for how she will do so.

Working with Families and Friends

Emma’s family and friends can play a vital role in her recovery. They can provide her with support, encouragement, and practical help. They can also help her to stay on track with her treatment plan.

Providing Access to Evidence-Based Treatments

Emma needs access to evidence-based treatments. These treatments have been shown to be effective in helping people with mental illness. Emma’s treatment team should work with her to identify the most appropriate treatments for her needs.

Promoting Social Inclusion

Emma needs to feel like she is part of a community. She needs to have opportunities to connect with others and to participate in activities that she enjoys. Social inclusion can help Emma to feel more connected to the world around her, and it can help her to build a sense of purpose.

The principles of trauma informed care, the trans theoretical model of change, and motivational interviewing, mental health nurses can help people with mental illness to recover and live fulfilling lives.

References
Millard, David, Peter Agulnik, Neil Armstrong, Craig Fees, John Hall, David Kennard, and Jonathan Leach. “Innovation in mental health care: Bertram Mandelbrote, the Phoenix Unit and the therapeutic community approach.” History of Psychiatry (2023): 0957154X221142416.
Sreeram, A., Cross, W. M., & Townsin, L. (2022). Anti‐stigma initiatives for mental health professionals—A systematic literature review. Journal of Psychiatric and Mental Health Nursing, 29(4), 512-528.
Millard, David, Peter Agulnik, Neil Armstrong, Craig Fees, John Hall, David Kennard, and Jonathan Leach. “Innovation in mental health care: Bertram Mandelbrote, the Phoenix Unit and the therapeutic community approach.” History of Psychiatry (2023): 0957154X221142416.

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