Assignment Guidance
4,000 word case study level 7
Bellow is a lay out, plan, and a lot of information already written down. Detailed explanation of what needs to go under each learning outcome!
Learning outcomes for this module: TO BE ALL RELATED TO BELLA CASE STUDY (PAGE 8)
1. Critically appraise elements of the therapeutic relationship.
2. Critically evaluate the evidence required to care for and support people with acute mental health conditions.
3. Examine a range of health assessment strategies and tools in order to develop a person-centred care plan.
4. Apply the principles of risk assessment and management that reflect positive risk taking in mental health care.
5. Critically integrate relevant principles of law, ethics and professionalism when delivering and evaluating care for people with mental health needs.
Written assignment 4000 WORDS LEVEL 7. Use the American Psychological Association 7th Edition (APA) referencing style Format for written assignment – Font Arial 11, 1.5 line spacing
• Subheadings can be used as they can help structure your work, include an introduction and a conclusion
• UK WRITING AND SPELLING. UK REFERENCES ONLY.
•
ASSIGMENT LAYOUT TO BE FOLLOWED STRICKLY
Case scenario – Bella
Introduction – 150 words as a guide
1. Set the scene for the reader
2. Explain your intentions
3. Refer to NMC –A MUST BE IN SENTENCE: The NMC sets out the standards for professional practice in the Code – the Code is underpinned by the law and for this reason, will be widely used within this paper. Can reword it. Apply it to a therapeutic relationship for a gentle move into LO1.
Summary of your service user – 100 words VERY BREAF
1. Provide a brief synopsis of the succinct summary – Paraphrase in your own words
2. If you must include a larger more detailed summary of the service user then place it in an appendix and refer to it
LO1 Therapeutic Relationship – 500 words as a guide
Writing from the perspective of an A&E team member (refer to case study) (3rd person) even though she left I can discuss how will I bring her back to strengthen the therapeutic relationship.
1. You MUST Critically appraise elements of the therapeutic relationship. (plan bellow with ready written information)
2. You SHOULD Apply your discussion to your case scenario including how you would engage with the service user. (plan bellow with ready written information)
3. You SHOULD consider person-centred care: NMC CODE OF CONDUCT TO BE MENTIONED HERE. Why is person-centred care important and why is it the recommended way of working and who recommends it. Explain why is important in Bellas case. Advantages and disadvantages and again relate it. (see below for ready info)
4. You SHOULD discuss communication theory/skills: discuss 1 communication model. Why is good communication important in mental health nursing; Communication – Albert Mehrabian (1967) 7-38-55, which highlights the importance of the tone of the voice (%38) and body language (%55). Apply it to Bellas case study. Then give Pros and cons and strengths and limitations. Non-verbal skills when engaging and why it’s important (you can say using the communication theory picked, mention how important and why nonverbal communication is and how can be as significant. Relate to Bella’s case scenario. How the communication can be approved having into account the case study?
5. You SHOULD consider discussing developing trust, empathy, validation, and touch: This can be a challenge as our initial responses might be more sympathetic rather than empathic. The key here is to be in tune and acknowledge Bellas feelings and emotions, the way they are experiencing a situation. Why is this important? If I was in your shoes, I would do this…It is more about… I am in your shoes and wow I can see that things are really tough for you. you may wish in the notes to refer to Mental health nursing / Patients. (Just think about broadening language) remember our audience is mixed criminal justice professionals so whilst we may discuss from our prof backgrounds, we need to also ensure it’s relatable. How is this going to affect the therapeutic relationship Relate to Bellas scenario by also saying what can be done better?
Notes for parts 1,2,3 that can be reworded or referenced USE FOR LO1:
Explain what therapeutic relation is. How and why we use it in mental health. Keep applying it to Bellas case. Apply Rogers communication model to Bellas case and how would improve the therapeutic relationship. What is good and what is bad about it and how this can be beneficial in establishing a therapeutic relationship with Bella. How can we improve it by looking at the case study? What can be done better in Bellas case?
Notes: Mention the ‘’the 3 core conditions (Rogeres,1957)’’, Carl Roger theory around the 3 core conditions required to develop a good therapeutic relationship are still relevant today despite his initial work being published in the 1960s. His approach has become a traditional approach to working in a therapeutic approach with patients/ clients and promotes a person-centred approach which is also the way of working in NICE guidance and NMC code of conduct and reference them.
Notes: Therapeutic engagement is the process of initiating clinical relationships with service users …expand on this. We need to reiterate that first impressions/introductions can influence how others behave towards us as professionals. Depending on the situation we meet them this might need to be done very quickly like in Bellas case. Introductions of yourself. When we approach patients, members of the public we should be demonstrating warmth and openness – a smile is a good starting point. Role – the importance of stating your role (I -Adam Jeewooth have often been mistaken for a doctor on mental health units- particularly when we didn’t wear uniforms). Building Trust and rapport – we need to think about how we build trust, the introduction will initially help with this, but we also need to establish some rapport. Finding common ground is always good for establishing rapport. If the person is distressed – reassuring the individual they are safe can help build trust. Undivided attention – When communicating make sure that you give your undivided attention to the service user, this will make them feel valued and like they are being heard. Be curious and ask questions – use non-verbal prompts-using eye contact, nods, and perhaps saying “right, yes, ok”. Be genuine- be the best professional you can be. Be open and honest whilst maintaining professional boundaries.
In Belles case and previously Bellas goes for the medical approach (shortly explain what medical approach with Reference UK) in the case study Bella specifically asks for Lithium medication but having in mind the overdose history is better if the practitioner takes a holistic approach (Explain shortly what is holistic approach) and this is going to strengthen the therapeutic relationship. Explain shortly the benefits or cons of using a holistic approach.
LO3 Health assessment strategies and tools – 800 words as a guide
1. You MUST examine a range of assessment strategies in relation to your case scenario/study – observation, history- timeline, records, family/ carers, Mental State Examination (MSE), interviewing, physical health. Starting up with what Is assessment in mental health and why do we assess use the following.
2. You MUST examine a range of appropriate assessment tools (at least 2) for my case study to relate it to the case study. Critique the use of tools/strengths vs limitations. Use the more suitable one. I recommend PHQ-9 assessment and ICD-10 Diagnostic criteria. You can say that because of the situation with Bella the assessment tools aren’t used however is there was an opportunity to use the most suitable one will be, and why? (Because of the risk of suicide and self-harm). The fact that the case study isn’t demonstrating the use of any assessment tools could potentially lead towards incorporation from Belles side based on poor communication and the lack of therapeutic relationship hasn’t been established. I AM NOT DIAGNOSING BUT HERE HAVE TO BE SAID THE FOLLOWING: BELLAS ISNT CURRENTLY DIAGNOSED WITH…. BUT BASED ON THE SYMPTOMS AND THE ASSESSMENT TOOL and diagnostic criteria (see apendix1) and having into account the results from the ICD-10 (diagnostic criteria), and what Bella is displaying as symptoms can suggest depression and mood disorder.
ICD-10 In the United Kingdom the ICD-10 (the latest edition) is the main reference guide to conditions for mental health practitioners and is an NHS standard. It is referred to alongside recommendations by the National Institute for Health and Care Excellence (NICE). As per ICD-10 Bella’s is displaying mood disorder (remember we aren’t diagnosing but reading the symptoms).
PHQ-9
Mention briefly
Talk about the chosen assessment tools: don’t forget to use Pros and Cons (especially) (critique) for the use assessments tools.
3. You SHOULD consider formulation and how this informs care planning and interventions: another form of assessment. There are different models there that drive the formulation I
What are formulations is another way of assessing. The formulation is a method of making sense of the information we collect in our assessments. Using ABC model formulation or biopsychosocial relate them to Bellas case because it helps you to see the bigger picture and helps you to create a care plan.
4. You SHOULD consider perspectives of mental health, pathophysiology, and alternative perspectives.
What, why, reference, critique
LO4 Principles of risk assessment, risk management and positive risk-taking – 650 words as a guide
1. You MUST include principles of risk assessment – structured professional judgement, actuarial risk assessment… Starting with what is risk assessment and why we use it and why important in mental health nursing: Risk assessment is a critical part of decision making in mental health settings and relates to decisions about Detention and discharge Institutional and community management Child protection Probation/MAPPA (the case scenario WILL NOT INVOLVE DETENTION). Structured, evidence-based model/tools preferable (with appropriate training as required) Check veracity of information and note information that is missing to follow up or take into consideration. Team compilation preferable, collaborative approach (as per NMC code of conduct). Share the assessment widely, review regularly and as appropriate i.e., when any changes occur. Awareness of limitations of the process i.e., that prediction is limited by the accuracy of the data, incomplete histories limit usefulness. It shouldn’t just end at risk assessment. We risk assessing evidence-based, using structural clinical judgment (risk factors using a blended approach, using tools, consider the law
https://www.gloucestershire.gov.uk/media/1517753/suicide-risk-assessment-in-primary-care.pdf
2. YOU MUST apply this discussion to your case scenario. Bellas last sentence leads towards a suicide attempt so follow the guidelines and contact the police to do a welfare check on Bella because she left.
3. You MUST include risk management concerning your case scenario/study the risk with belles is suicide, self-harm, and impulsivity. Base this on the assessment Bella’s what
4. You MUST consider positive risk-taking concerning your case scenario/study. What does it mean? Steps identify the potential harm (Bella’s self-harm and the positive risk-taking approach)
5. You SHOULD critically discuss what the evidence says about risk and risk assessment
6. You COULD consider reducing restrictive practices, service user perspectives. In the case of Bella, the danger of suicide is too high based on the assessment and the police must be called immediately and the practitioner should document everything. Even the this can affect the therapeutic relationship is a duty to safeguard. Gently relate this to the legal and ethical issues.
What, why, how, reference, critique
LO5 Critically Intergrade relevant legal and ethical issues when delivering and evaluating care – 800 words as a guide
1. You MUST critically integrate relevant legislation and/or legal issues related to your case scenario/study – Mental Health Act, Mental Capacity Act, Equality Act 2010, Deprivation of Liberty safeguarding, safeguarding vulnerable Adults, what/which one is applying to Bellas case and why
2. You MUST Critically integrate ethical issues that are relevant to your case scenario – beneficence, non-maleficence, justice, autonomy…
3. You SHOULD consider professionalism, accountability, competence – NMC Code 2018
4. You COULD consider discharge planning, clinical outcomes
Under the mental health act, a mental health nurse has the power to detain a person for up to 4 hours. However, in Bella’s case detention would be necessary even though the risk is high (based on the assessment, diagnostic criteria, and the risk assessment) detention can destroy the therapeutic relationship. However, the professionals have a duty of care and duty to safeguard so appropriate action must be taken (phoning the police to do a welfare check and documenting everything)
LO2 Evidence base required to care for and support people with acute mental health conditions – 850 words as a guide
1. You MUST Critically evaluate the evidence base underpinning care planning
2. You MUST critically evaluate the evidence base required to care for and support people with acute mental health conditions – focus on a few interventions/actions (3 max) relevant to your case scenario/study.
3. You SHOULD consider how you would, or did, engage the service user in the care planning process. SMART goals. Patient-centred.
4. You SHOULD discuss recovery concerning your case scenario/study.
5. You SHOULD showcase skills in critical appraisal of primary literature related to your interventions/actions.
6. You COULD consider including an individualised recovery-focused care plan
What, why, how, reference, critique
Conclusion – 150 words as a guide
1. You MUST summarise the key themes that have emerged throughout the case file
2. You should offer what you have learned from this case study assignment
Appendix – specifically relevant to your written assignment – remember your appendix is not marked.
You include your summary of your case scenario/study
You COULD include a formulation you have developed for your case scenario/study
You COULD include an individualised recovery-focused case plan you have developed for your case scenario/study.
References -A guide – AT LEAST 10 references per 1000 words. APA 7 format – See referencing guideline
You are a member of the A&E liaison team and conduct an assessment with Bella.
Bella is a 24 year old woman. She lives alone in a small bedsit. Her parents live in the area, but she has only seen them a couple of times in the last year. Bella has a zero hour contract at a local cinema but manages to get enough hours to cover her expenses. This is the third job she has had in the space of 12 months. Bella has a brother who is two years older than her. He attended university and now as a junior management position in sales. Bella sees him occasionally. He is married and his wife is expecting their first child.
Bella was a generally good student and is a talented artist. She always wanted to become a tattoo artist; her parents were not keen. Bella achieved three GCSE’s and went to a local college but was asked to leave due to sporadic attendance and a number of verbal altercations with tutors and other students.
Bella is a little over 5 feet in height and slightly underweight. She has a number of tattoos and has a several visible piercings. She has a number of female friends and has had several intimate partners but no long term relationships. Bella enjoys watching films, drawing and “partying” with friends. She drinks alcohol to excess at least once per week and occasionally uses cannabis. Bella has become increasingly well-known at the local accident and emergency after incidents of self-injury. This has mainly related to cuts to her forearms. These generally require limited intervention, only needing sutures on one occasion. Bella has also attended after a reported overdose of unknown prescription medication. Bella typically reports feeling low in mood and anxious when she attends A and E.
Mental state examination – Bella is a 24 year old woman. On interview she was dressed in jeans and T-shirt with a slightly oversized leather “biker” jacket. She removed her jacket at the start of the interview. Bella has extensive tattoos to both arms with piercings to her ears, nose, eyebrows, and lip. There are multiple fine scars visible on both wrists (though significantly more to her left wrist). She is average height and looks slightly underweight. Initially she did not maintain eye contact and sat with slightly hunched shoulders with a fine tremor in her legs. Her eye contact improved during the interview. Bella’s initial responses were limited and at times she was hostile in her responses and would respond with an angry intonation in her voice. When asked to confirm her name and date of birth she said “well what’s yours? How do I know who you are?”. She states that her mood is all over the place, she feels “awful” then “anxious”. She stated that she is sure she has bi-polar disorder as she meets all the criteria on the internet. She stated that she needs anti-depressants and lithium and then she will be fine.
She was reluctant to discuss her self-injury in any depth but stated that it is the way she copes, and it is her choice so “that’s the end of that conversation”. She then reinforced that she needs medication and then she will not need to cut anymore. She denied ever taking an overdose but stated that if she wanted to, she could and that no-one could stop her.
She states that her family are “dickheads”, and her dad is the “master dickhead”. She states that they never visit her anymore because she told them she was sick of their “bullshit”. She stated that she knows they do not care about her and never looked after properly anyway. She describes her friends as “pretty flaky” and that she would not care if they all disappeared except for one friend. She has known this person for three months; she is called Amy and she was a friend of a friend. Bella describes her as her “soul mate” and that they could be sisters. She is the only person that Bella can trust and states “I don’t know what I would do without her”.
Bella then asked about medication and admission to hospital. She rejected suggestions that this might not be needed at the moment. She became upset and again hostile in manner, standing up and pacing the floor. She stated that this was a pointless assessment, and she might as well die as no-one cares about her anyway. At this point she left. When asked in the car park if she was suicidal, she stated “that’s for me to know, but you had better tell A and E to save me a bed!” She left at this point.
