• Internal Code :
  • Subject Code : 401017
  • University :
  • Subject Name : Mental health

Case study 

Mental status examination

The mental status examination is one of the most important in the neurological examination and it forms a framework to understand the mental status of the individual (Grossman and Irwin, 2016).  Marion was a young lady and she was properly dressed with the messy hairstyle. She was alert during the conversation with the right sitting posture and cooperating the examiner during the interview (Appearance). During the conversation, she was openly explaining her issue and rubbing her hand that indicates little nervousness. She was able to maintain rapport during the whole conversation with the examiner (Behaviour).  She was having a normal mood during the conversation and she was trying to answer the entire question asked during the examination. She was using her hand very often during the conversation to explain the situation to the examiner (Affect).  She was worried about her increased weight and she raised concerned that she becomes uncomfortable when anybody notices her during the train journey. She also explained that she feels some ant in her brain that made her mood irrelevant (Mood). During the conversation, she was confused while choosing a word to convey her thought and her speed is also a little fast with little unclear tone. She was also taking random stuff during the conversation that indicates her distraction from the topic (Speech). During the conversation, she was a little disturbed about her thoughts and do not have a flow of thoughts. She was repeating one thing multiple times and some points are not relatable to reality (Thought). During the conversation she does nit complained about hallucination or any other issue she was only concern about her weight and financial issues (Perception). Marion was properly oriented during the conversation and she responds accurately about the date and month. She was having a good memory regarding her medicine and health status (Cognition and intellectual functioning). She was aware of her health status but she was lack understanding of her current health status. Judgement was not satisfactory as do not want to continue medicine as she thinks she is ok she only wants to reduce her weight (Insight and Judgement).

The four risk factor for Marion Includes 

Risk 1: The risk for harm to others due to delusions

Risk2: The risk for harm of reputation due to disorganized speech 

Risk3: The risk for self-due to hallucination 

Risk4: The risk for self-deterioration due to abnormal motor behaviour 

Care plan:

Schizophrenia is the disorder that develops due to behavioural and cognitive disturbance and this trigger cue to the genetic or environmental factor that disrupts brain development. It is considered to be one of the severe psychiatric disorders that directly impact an individual’s personal and social life (Qwen, Sawa and Mortensen, 2017).  After the video assessment, the interpretation can be made that Marion is at great risk of delusion that is visible in the video as she thinks she is the daughter of Charles and Camilla the royal family.

CLINICAL ISSUE: The individual with delusions always end up in depression, social life struggle, financial struggle and isolation. Marion is also having delusions that increase her risk to different complications

RATIONALE FOR CHOSEN ISSUE: the individual with delusion can imagine anything to be associated with him/her and this increase the chances of complication for the individual. The data presented by Feeney et al. (2017) describe that delusion is the false belief of the characteristics and the content for delusion is related to individual insecurity. The delusion increases the risk of the individual and causes further complication due to irrelevant behaviour of the individual toward a thing.

GOAL/S: After the intervention, the future goal is to improve the health status of Marion and reduce the effect of Delusions that can increase her complication. The intervention will be proposed according to the health status of Marion so that she can easily accept them and utilize them to improve her health status. To reduce the delusion of Marion will be the major goal of the intervention that will improve her mental status. 

Picture showing interventions and rationales Picture showing interventions and rationales Picture showing interventions and rationales

ACTIVITY 3  

The nurses are in direct contact with the patient that increases their credibility toward their health status. Effective communication is required to help the patient to express his/her issue without any fear and discomfort (Fakhr-Movahedi, 2016). Before starting the conversation examiner greeted the patient and introduces her that help to maintain rapport with the patient and it also put a step forward in trust development.  The article presented by Marshall et al. (2017) discussed the importance of ‘meet and greet’ in the primary care of the patient.  The article discussed that greeting the patient during meeting increase the confidence of the individual and increased his/her interest in the conversation. The greeting practises helping the patient to express an issue that helps the examiner to understand patients issue and these can be utilized to provide accurate care. During the communication, examiner utilized the open-ended question to increase the participation of the Marion in the conversation. The open-ended question provides the opportunity to the examiner to understand the patient and issue as the patient will be allowed to express her issue and his/her point of view a topic. The open-ended question increases the chances of the individual to express his/her feeling, attitude and understanding toward a topic. The article proposed by Weller et al (2018), discussed that open-ended question help to explore the topic in-depth and it increases understanding toward different perspective. Open-ended question help to understand the correlation of the issue with the individual’s situation. It helps to gather information regarding the individual that can be considered during the intervention. 

During the conversation with the patient, examiner ensures the patient conversation will remain confidential between both of them and she can freely express a view without any fear of disclosure. The healthcare associates are expected to maintain privacy and confidentiality during the conversation with the patient and about his/her medical documents. The maintenance of confidentiality and privacy increase trust and improve patient satisfaction. Medical confidentiality set a rule for the healthcare associates to improve their working practise and provide care according to basic human right. According to Nursing and Midwifery Board (2017), discusses the Code of Conduct principle 3 states that nurses should maintain confidentiality and privacy of the patient and individual have equal right to expect that nurse will not be involved in any disclosure of the information. An individual should be provided by a proper private and confidential environment so that he/she can have alone time to think. During the conversation, the examiner uses her active listening power to communicate with Marion as it helps to increase understanding of the issue of the patient. Active listening helps the individual to understand the issue with the patient by listening properly. Active listening comprises removing distraction, listening carefully to the patient and showing feeling toward the issue of the patient. The article presented by Jahromi et al. (2016), describe active listening as one of the important skill of effective communication. The article discussed that active listening includes good body posture, facial expression, eye contact and attentive silence during the conversation. The nurses should utilize their active listening skill during the conversation with the patient to increase understanding of patients issue and provide equal opportunity to the patient to discuss the issue without any fear and discomfort. 

During the interaction, I realise that examiner utilized less therapeutic communication skill with the patient to increase understanding toward patient health issue. The conversation with the patient should be included with therapeutic communication so that examiner can analyse the patient condition and the issue she is facing. The article presented by Abdolrahimi et al. (2017), discussed that therapeutic communication is considered to be one of the key factors in communication with the patient. Therapeutic communication includes forming an interpersonal relationship with the patient to solve the patient issue and satisfy the psychological need. The health care associate can improve their therapeutic communication skill by theoretical education that will improve their understanding of different techniques and skill related to a therapeutic communication technique. It combines the nonverbal and verbal communication method to improve the patient experience.The video revealed that examiner was in a bad posture that can affect the behaviour of the patient. The bad body posture directly affects the patient interest in the conversation and bad body posture will decrease the interest of the patient for conversation. Our body posture says it all about us as it creates the first impression over the patient and directly affects the patient experience. The article presented by Berman and Chutka (2016), describes the importance of body posture and body movement during the conversation with the patient. The effect of body language and posture contribute to about 93% in communication and it has an important role in patient satisfaction. The body posture should be welcoming to increase the interest of the individual in the conversation and proper movement of the head should be done to improve communication. The body posture directly provide patient information regarding how the examiner is interested in communication and have empathy toward his/her issue  

References 

Abdolrahimi, M., Ghiyasvandian, S., Zakerimoghadam, M., & Ebadi, A. (2017). Therapeutic communication in nursing students: A Walker & Avant concept analysis. Electronic physician, 9(8), 4968–4977. https://doi.org/10.19082/4968

Berman, A. C., & Chutka, D. S. (2016). Assessing effective physician-patient communication skills: "Are you listening to me, doc?". Korean journal of medical education, 28(2), 243–249. https://doi.org/10.3946/kjme.2016.21

Falkai, P., Malchow, B., and Schmitt, A. (2017). Aerobic exercise and its effects on cognition in schizophrenia. Current Opinion in Psychiatry, 30(3), 171–175. doi:10.1097/yco.0000000000000326 

Feeney, E. J.,  Groman, S. M., Taylor, J. R.,  Corlett, P. R. (2017). Explaining delusions: reducing uncertainty through basic and computational neuroscience, Schizophrenia Bulletin, 43(2), 263–272, https://doi.org/10.1093/schbul/sbw194

Grossman, M., and Irwin, D. J. (2016). The mental status examination in patients with suspected dementia. Continuum, 22(2), 385–403. https://doi.org/10.1212/CON.0000000000000298Grossman

Marshall, E.G., Ogah, I., Lawson, B., Gibson, R. J., Burge, F.  (2017 ).‘Meet and greet’ intake appointments in primary care: a new pattern of patient intakes? Family Practice, 34(6), 697–701, https://doi.org/10.1093/fampra/cmx043

Nursing and Midwifery Board. (2017). Code of Conduct. Retrieved from: https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards.aspx

Owen, M. J., Sawa, A., and  Mortensen, P. B. (2016). Schizophrenia. Lancet 388(10039), 86–97. https://doi.org/10.1016/S0140-6736(15)01121-6

 Weller SC, Vickers B, Bernard HR, Blackburn AM, Borgatti S, Gravlee CC., Johnson, J. C. (2018). Open-ended interview questions and saturation. PLoS ONE 13(6), 1-18. https://doi.org/10.1371/journal.pone.0198606

Yadav, B. (2015). Efficacy of social skills training in schizophrenia: a nursing review. CURRENT NURSING JOURNAL. 2. 26 -34. 

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