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

Emma Smith is a 33-year-old woman with a diagnosis of schizoaffective disorder. She has a history of trauma, including sexual assault and a prolonged hospitalization during which she was seclude. She is currently refusing to take her medication and is isolating herself from her family and friends.

In this case study, I will discuss how I would utilize the principles of trauma informed care, the 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.

Trauma Informed Care

Trauma informed care is an approach to service delivery that recognizes 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 well-being. Trauma informed care organizations are committed to creating a safe and supportive environment for all clients, regardless of their history of trauma.

When working with Emma, it is important to be aware of her history of trauma and its potential impact on her current mental health status. I would begin by creating a safe and supportive environment where she feels comfortable sharing her story. I would also be mindful of the use of language and avoid triggering her trauma.

Trans Theoretical Model of Change

The trans theoretical model of change is a framework for understanding how people change. It was developed by James Prochaska and Carlo DiClemente in the 1970s. The model identifies six stages of change: precontemplation, contemplation, preparation, action, maintenance, and termination.

Each stage of change is characterized by different thoughts, feelings, and behaviors. People who are in the precontemplation stage are not aware that they have a problem or are not ready to change. People in the contemplation stage are aware that they have a problem and are considering making a change. People in the preparation stage are making plans to change. People in the action stage are actively changing their behavior. People in the maintenance stage are working to prevent relapse. People in the termination stage have successfully changed their behavior and are no longer at risk of relapse.

When working with Emma, it is important to assess her stage of change. If she is in the precontemplation stage, I would focus on raising her awareness of her problem and helping her to see the benefits of change. If she is in the contemplation stage, I would help her to weigh the pros and cons of change and to make a plan for how she will change. If she is in the preparation stage, I would help her to develop a specific plan for change and to make a commitment to change. If she is in the action stage, I would provide support and encouragement. If she is in the maintenance stage, I would help her to identify and manage triggers and to develop coping skills.

Motivational Interviewing

Motivational interviewing (MI) is a client-centered counseling approach that is used to help people change their behavior. MI is based on the principle of self-determination, which is the idea that people are more likely to change if they feel like they are in control of the change process.

MI is a non-judgmental and collaborative approach. The MI counselor works with the client to explore their reasons for wanting to change and to develop a plan for change that is tailored to the client’s individual needs.

MI has been shown to be effective in helping people change a variety of behaviors, including substance abuse, smoking, and weight loss.

Strategies for Promoting Recovery

In addition to utilizing the principles of trauma informed care, the trans theoretical model of change, and motivational interviewing, I would also employ a number of other strategies to promote Emma’s recovery. These strategies would include:

Providing psychoeducation about her mental illness and its treatment
Helping her to develop coping skills for managing her symptoms
Linking her with community resources, such as support groups and mental health services
Working with her family and friends to provide support and understanding