Q1. Munny has not been reacting normally from past many days. The mental health status of Munny is not normal as can be depicted from his behaviour. His behaviour is not normal with his family members and also with the medical staff of the community centre. The mental status examination assess the behaviour and cognitive function of the patient. According to the mental status examination, the patient’s appearance and general behaviour is disturbed. Appearance and general behaviour of the patient helps in examining the overall impression delivered by the patient (Clark & Kruse, 1990). Munny was well- dressed but the clothes were loose- fitted on the body. He looks at the floor continuously and had the hard time making the eye contact with others. He sinks in the chair and does not sit properly in it. The general behaviour of Munny was also not normal. He sits in a kyphotic posture and other pertinent observation made by the examiner is that the grooming was immaculate. Other component of mental status examination is the disturbed affect and mood of Munny. The affect and mood of Munny looks dysphoric that is he looks depressed. There have been series of events that happened in his life that has made him depressed.
Munny displays the restrict ted affect when asked about how he is and how is his mood. He says that he has no problems and avoids talking to anyone for long. From the look of the patient, he looks depressed because when he was greeted by the medical professionals of the community centre, he did not make eye contact and gave only mono-syllabic answers like fine or no problems. He preferred shaking his head over verbally answering the questions. Other observation made by the examiner is that when he was asked a question related to his family, he just shrugged his shoulders. The examiner’s reaction to the patient is that the patient is depressed because of the developing sense of dysphoria. The mental status examination describes the mental status of Munny as depressed, disturbed appearance and general behaviour and abnormal mood and affect. According to the Diagnostic and Statistical Manual of Mental Disorders, Munny is suffering from mood disorders.
Depressed mood can be diagnosed by assessing the criteria of loss of pleasure in life activity from last two weeks along with other symptoms such as diminishes interest in social life, work life and personal life (Centre for substance abuse treatment, 2008). Munny does not prefer talking to his wife for long and does not share his sufferings with her. His children were always his attention but now he does not even take their notice. He has become less communicative in the house and shows no interest in food. He only prefers speaking one word answers and always asks everyone to leave him alone. He is suffering from depressed mood disorder along with the symptoms such as significant amount of weight loss, depressed mood for maximum number of days, loss of interest in the everyday activities and diminished interest in the social, work and other areas of every day functioning.
Q2. The factors that have contributed to the current mental health status of Munny are his employer’s unsatisfaction from his work that made him realize that he may loose his job soon and his mother’s demise six months back. According to stress vulnerability model, the biological vulnerability and stress are the areas that are influenced by several factors that includes the stress, coping skills and alcohol and substance abuse, involvement in meaningful activities and social support (Hazelden Foundation, 2016). Munny lost his mother six months back due to cancer and he was really close to his mother after his father left them long back. He could not cope up from this trauma as described by his wife that since then he has not taken a day off from his work because he does not want to get involved in the thoughts of his mother. This sentence describes that he has not yet coped up and there is a need to develop coping skills in Munny. According to Mental Health Foundation, some patients experience post – traumatic stress disorder (PTSD) for years after the trauma has ended in which they did not get physically harmed (Mental Health Foundation, n.d.).
The most common symptoms of post – traumatic stress disorders are depression, re- experiencing the vent time and again, anger, avoiding the things that are associated with the trauma and so on. Munny is also experiencing post- traumatic stress disorder (PTSD) because he shows some of the mentioned symptoms such as avoiding things associated with the trauma that is he used to take off from his work to go to meet his mother but he no longer takes off and work every day. He is experiencing depression and shows the signs of mood disorders. Other traumatic factor that contributed to the current mental health status of the patient is his employer’s unsatisfcation from his work and his words that Munny may lose his job if he does the same work. This stress led to the mental health events that are not normal and after this event he became less communicative at home. There is a need to develop the coping strategies so as to help the patients with stress management and to reduce the negative effect on vulnerability.
The coping skills like the management of persistent symptom like depression, using relaxation techniques so as to relax from stress will help the patient to engage in interesting and rewarding activity in day to day life. The fear of job loss can have significant negative effect on the mental health of the person and the symptoms are the activity limitation, health status reported by the patient himself and so on (Schaller & Stevens, 2015). This stress of loosing job impacted the mental health of Munny in a negative manner. Stress is known to worsen the biological vulnerability and can even cause relapses. Munny’s mother died due to cancer six months back and he could not cope up with that trauma and the stress of loosing the job that he enjoys working worsened his state of mind. He was stressed with the working hours in the job but still he enjoyed working.
Q3. The recovery of mental health includes the recovery of internal conditions that a patient is experiencing that best describes the person in recover like healing, hope and empowerment and the external condition that facilitates the recovery such as the recovery- oriented services, implementation of human rights and positive culture of healing (Common wealth of Australia, 2010). The principle of recovery oriented practice of mental health is the uniqueness of an individual. The mental health practitioner should accept the recovery outcome as personal and unique for every individual and they should go beyond the normal practice to include the patient back in the social life and should be able to provide them the quality life. The three positive aspects of mental health recovery are hope, respect and empowerment. The empowerment should be encouraged by the mental health practitioner in which they should empower the people to make them recognize themselves as the centre of the care received by them. This step is very important because it helps in recognizing that recovery is not about the cure only but also about living a meaningful life and the life that is filled with purpose. The mental health practitioners should empower the patients to make the personal choices to acknowledge their choices.
The next principle of the recovery oriented mental health practice is the dignity and respect. In every interaction the mental health practitioner should behave with courteousy and in respectful manner with their patients. They should be sensitive and should respect each and every individual’s cultural belief, values and culture. They should not disrespect their racism and should challenge the stigma that exists in the community. According to the supporting recovery standards, the standard 10.1 states that the mental health service providers should always treat their patients and provide them the care with respect and dignity (Australian’s health Ministers’ Advisory Council, 2013). The mental health service should afford respect and safety to all the patients struggling from the mental health problems that are of many types. The practitioner should respect the diversity and should also treat the patients with respect and dignity always. Hope is the positive aspect of mental health recovery that would positively contribute to the patient’s journey of recovery.
Every mental health patient should be treated with the hope that they would soon get fine and recover fast from the mental disorder and would get engage back into their social life. The mental health patients come to the mental health practitioners with a hope that they will get their quality of life back. The model for recovery developed by Glove includes five recovery process that are from alienation to discovery, from hopelessness to hope, from other’s control to self- control, from passive sense to active sense of self and from disconnectedness to connectedness. Munny can be given hope that he will be fine soon and will get back with his children soon. He should be treated with respect and dignity and his current state of mind should be respected. The mental health practitioners should empower him to recover fast and get back to his normal life with the normal living.
Q1a. The urgent risk area is the stress that Munny has taken of his job that has led him to become depressed. The stress is an urgent risk factor because that has changed the behaviour of Munny and he has become less communicative in house. After he was told that he may lose his job, he stopped being his usual self and he has taken a lot stress. The risk assessment can be done by observing the following symptoms such as depression, eating less than usual, feeling of constant worry, mood swings and difficulty in relaxing (Mental Health Foundation, 2019). All these symptoms are seen in Munny so this describes he is extremely stressed.
Q1b. The nursing intervention that can be made to manage the stress in patients is the education of the patient on importance of rest, sleep and physical exercise (Papatyhanasiou et al., 2015). The nurse will educate the patient and the family members on the importance of rest and sleep and making them lie down in a comfortable position and easing their pain. The human body at rest retrieves the high levels of energy and this energy is very important for the mental health patients. This intervention is carried out so that the patient can relax with the mind that is not overthinking.
Q2a. Depression is a major mental health concern that is characterized by the depressed mood, low self- worth, poor concentration, disturbed appetite and loss of pleasure or interest from day to day activities (World health organistaion, 2019). It has become one of the leading cause of mental disability in males and females all over the world. Munny is also suffering from depression because he has lost interest from daily activities, he is suffering from poor appetite and wants to stay alone. Depression is a mental health concern that needs to be treated but most of the people in depression does not receive the proper treatment.
Q2b. The nursing intervention for depression targets the social isolation. Munny also faces the social isolation in which he does not prefer talking to anyone including his wife. The nursing intervention is to show unconditional regard towards the patient that is positive and building of personal rapport that offers the assistance at any hour of the day (Prokofieva et al., 2016). The nurses also encourage the voluntary interaction with others so that the person interacts with people that are present around him. Establishing the good rapport with the patient and offering the positive regards to the patients will help in getting them out of the social solace.
Q3. The ethical issues faced by the nurses in mental health care setting while taking cared of mental health patients is firstly to obtain the informed consent from the patient. The mental health patient might not be able to get involve in decision – making so getting an informed consent from the patient becomes difficult (Aydin & Ersoy, 2017). Other ethical issue faced by the mental health nurse is respecting the patient’s culture when the patient is not in a state to inform the same to the nurse. This creates a problem as they might hurt the sentiments of the patient.
Centre for substance abuse treatment. (2008). Managing depressive symptoms in substance abuse clients during early recovery. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK64057/
Clark, V. L., & Kruse, J. A. (1990). Clinical methods: the history, physical, and laboratory examinations. Jama, 264(21), 2808-2809.
Hazelden Foundation. (2016). The stress- vulnerability model of co- occurring disorders. Retrieved from http://www.bhevolution.org/public/stress-vulnerability.page
Mental Health Foundation. (n.d.). Impact of traumatic events on mental health. Retrieved from https://www.mentalhealth.org.uk/sites/default/files/the-impact-of-traumatic-events-on-mental-health.pdf
Schaller, J., & Stevens, A. H. (2015). Short-run effects of job loss on health conditions, health insurance, and health care utilization. Journal of Health Economics, 43, 190-203.
Common wealth of Australia. (2010). Principles of recovery oriented mental health practice. Retrieved from https://www1.health.gov.au/internet/publications/publishing.nsf/Content/mental-pubs-n-servst10-toc~mental-pubs-n-servst10-pri
Australian’s Health Ministers’ Advisory Council. (2013). A national framework for recovery- oriented mental health services. Retrieved from http://www.mhima.org.au/pdfs/Recovery%20Framework%202013_Policy_theory.pdf
Mental health Foundation. (2019). How to manage and reduce stress. Retrieved from https://www.mentalhealth.org.uk/publications/how-manage-and-reduce-stress
Papathanasiou, I. V., Tsaras, K., Neroliatsiou, A., & Roupa, A. (2015). Stress: Concepts, theoretical models and nursing interventions. American Journal of Nursing Science, 4(2-1), 45-50.
World Health Organisation. (2019). Depression – A global health concern. Retrieved from https://www.who.int/mental_health/management/depression/who_paper_depression_wfmh_2012.pdf
Prokofieva, M., Koukia, E., & Dikeos, D. (2016). Mental health nursing in Greece: nursing diagnoses and interventions in major depression. Issues in Mental Health Nursing, 37(8), 556-562.
Aydin Er, R., & Ersoy, N. (2017). Ethical Problems Experienced By Nurses Who Work in Psychiatry Clinics in Turkey. Journal of Psychiatric Nursing/Psikiyatri Hemsireleri Dernegi, 8(2).
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