Pseudonym to protect privacy and confidentiality †Free Sample

Question: Discuss about the Pseudonym to protect privacy and confidentiality. Answer: Introduction John (Pseudonym to protect privacy and confidentiality) was admitted voluntarily to a community care unit/psycho-social rehabilitation following a referral from the GP due to respite for parents. John was diagnosed with Schizophrenia (schizo-typal traits) and OCD, which was characterized by demotivation, low self-esteem, social withdrawal, anhedonia, negative view of self and ritualistic behavior. This case study presents, beginning with initial assessment, both subjective and objective data that were collected using mental state examination, following DSM-V and NANDA diagnosis. The preliminary findings were used to formulate a collaborative, evidence based recovery for future focused plan. The recovery plan is presented in a logical order: planning and implementation, expected outcomes of care, and finally evaluation and outcome measurements based on Johns objective data (Carey, 2016). Assessment In order to attain a holistic insight of Johns mental state, assessment was performed which included mental state examination, community risk and assessment plan, alcohol and other drug assessment, and behavioral and symptom identification scale (BASIS-32) (Dwyer, 2012). Johns current medication included Risperidone (Risperidol consta) 37.5mg IM injection depot for every two weeks. Although John was recommended to take ZOLOFT (OCD traits) tablets, he declined due to side-effects of the drug. Mental state Exam Being a Greek, the 34-year-old John was dressed in a color t-shirt and cargo pants with small stains on color appropriate for weather. John appeared to be thin, having poor personal hygiene, rigid posture, poor eye contact and greasy hair. John could be described as Im doing laundry and shower once every two days. He looked anergic and walked very slowly, while the psychomotor retardation was a times slow to initiate tasks. Johns speech was slow in rate, soft, audible and answered to all the questions in a polite manner. Throughout the conversation, John seemed to be inactive in the interview. Johns mood was euthymic, hyper vigilant, non-depressed and mildly anxious. His affect was blunted since he had a very low facial expression, anhedonia, reactive and inappropriate gestures and wanting to pinch his cheeks every time and then throughout the conversation. However, Mr. John did not present any formal thought disorder although he was obsessed with cleaning vegetables and checking loc ks frequently. He also had some persecutory delusions because he occasionally stated that someone is following when I go out. John was also isolated, self-neglected and stayed in his bedroom for many hours, socially withdrawn without any friends. He usually reported that he used to isolate himself in his room since he was alert and oriented in terms of person, place, time and the environment. This patient also experienced difficulties in performing day to day life routines, household responsibilities and thus he had to be prompted severally, in order to get on board. He was also not impulsive and hence did not present with any perception disorders. John was dependent on his parents and he was poor in solving problems and making decisions. Risk assessment The community and risk assessment plan was used to assess the general vulnerability, dynamic risk, statics and falls, and nutritional risk. The general vulnerability of Mr. John included a history of childhood trauma and a record of being bullied at school. Rumination on events resulted in significant self-neglect, poor self-care and social withdrawal. John was isolative and never received any social support including from friends and he reported I feel fear when I come out and I feel someone is following. John had also been charged by the police for removing license plates from a police vehicle. As a result of the persecutory ideas towards the police, John stated The police will be here at any time to take me away. However, this patient never had no known history of suicidal injury, deliberate self-harm or past attempts, and current thoughts of suicide or self-harm. Moreover, John was a non-smoker, non-alcoholic and non-drug abuser. Physical health The head to toe assessment was used to obtain the data, whereby Johns vital signs were found to be within the limits (100% SpO2, 18 breaths per minute, 70 beat per minute, blood pressure 120/ 70 mmHg, and temperature 36.4C). Additionally, John never experienced any pain, and the BMI was 22, and hence considered to be normal based on Reinders et al., (2015). He neither had any abnormalities in gastrointestinal, respiratory and cardiovascular systems, nor did he present any pressure injuries or wounds on the skin. Diagnosis By use of the Diagnostic and Statistical Manual of Mental Disorders, Johns presentation [Appendix-I], provided the requirement for diagnosis of schizophrenia disorder (American Psychiatric Association, 2013). John had this diagnosis for past 10 years, and was dependent on his parents since he was described as I hope to become more independent, because my parents are very protective and do things for me. He also expressed his desire to regain mental wellbeing and stated that I want to be more motivated and possibly take on another study course in future. John had some persecutory delusions and negative symptoms of schizophrenia since he was amotivated, and asocialite. He also had negative views about himself and others including anhedonia secondary to schizophrenia disorder, which could be related to childhood trauma. The Northern American Nursing Diagnosis Association taxonomy of nursing diagnoses 2015-2017 (Herdman Kamitsuru, 2014) was applied to the nursing process to identify one problem or issue in this patients. Social isolation was one of his problems and was evidenced by assessment, subjective and objective data. John had difficulty in reality, establishing relationship, and false belief about the intension of other people on him. Planning Implementation In order to achieve Johns goals for his problem of social isolation, nursing interventions were required to make a plan using the SMART (specific, measurable, achievable, realistic and timely) approach (Revello Fields, 2015). It was evident that Johns mental state was greatly affected by childhood trauma and bullying at school. Social isolation is positively correlated with schizophrenia such as low self-esteem, anhedonia and asociality (ref). Based on Johns presentation, it was required that nursing interventions were to be collaborative with John, so that a recovery-focused wellness plan could be developed to keep him safe. Group activities The group activity used in this case was gathering, whereby John expressed that he would be interested in making friends and stated I want to see myself as a friendly person and show an interest in other people. Based on his preferences, group interventions with problem-focused and goal-oriented activities were suggested, in an effort to alleviate social isolation and loneliness (Henderson). This intervention was given by nurses in collaboration with occupational therapist and social workers (ref). The group activities were realistic, and thus John was encouraged to engage with other clients. He was therefore asked to participate in activities such as card games, group outings, community meetings, walking in groups and cooking a meal. John was prompted more to get on to board as he was a slow learner and took long time to initiate a task. John was thus required to be educated to improve significant social interactions by participating in group activities. He was also advised on how t o establish rapport and show positive regard towards other people and seek for help whenever he needed support in various activities (Prokofieva). Gardiner reported that group-based activities make clients to continue feeling safe and competent during interactions. Furthermore, on long term management, clients will demonstrate willingness and desire to socialize with staff and co-clients and voluntarily participate in group activities without prompt Ojengbede. Social skill training Social skill training is an education which teaches necessary skills for effective communication with others (ALLY). John was encouraged to attend social skill training which helped to learn adaptive social skills. John was to be trained in an environment that was free of any stimuli like loud noises and high traffic (lauren), to avoid deviation of his training. Initially, John would aim to learn simple basic behaviours like maintaining good eye contact, keeping appropriate distances, appropriate behaviour, effective communication and making simple decisions. This therefore encouraged John to do rehearsal and role-play the skills which involved practicing and positive reinforcement (ally). Moreover, John would adapt and function at a higher level in the society to improve the quality of his life. However, John took time to adapt these skills because of his negative symptoms of schizophrenia. Pfammatter reported that these skills increase self-confidence, self-esteem and positive resp onses from others. The outcome was that John improved social interaction with family, friends and relatives. Evaluation and expected outcomes Short term goal for John were to engage in one activity accompanied with trusted nursing staff and attend at least one therapy by the end of day within one week. He was also to maintain interaction with other consumer while playing, drawing or cooking a meal. Long term goal for John were to spend time with other clients voluntarily in various group activities to show interest in coping skills. He would also be comfortable in talking and avoid spending more hours in his bedroom. This goal is realistic and may be achieved within a period of six months to one year. The basis-32 and adult well-being scale would be assessed to find any improvements in behaviour or daily living activities. However, social skill training and group activities helped to improve Johns status more independently and lower asociality. Outcome assessment The main issue with John was social isolation and the combination of group activities and social skill training interventions helped him in developing interpersonal and social skills. Outcome assessment for these interventions were adult well-being scale and behavioural and symptom identification scale (BASIS-32), and recovery. The wellness plan and monitoring of mental change every month was necessary with an occupational therapist, social worker, psychologist and psychiatrist. John currently had little difficulty in performing day to day life activities, household responsibilities, relation with family members, and isolation/feeling of loneliness. He had improved in self-care and independent in performing tasks but needed to be prompted for once. John had recently enrolled in TAFE program, criminal justice and started working for four hours in his brother in laws warehouse. Finally, subjective data of recovery stated that I feel more confident doing house chores and cooking and I w ill remain active and try to pass my exams in future. Conclusion John was referred to a community care unit by treating team with a diagnosis of schizophrenia, where social isolation was a current issue. The nursing process involved assessments such as mental state examination, risk assessment and physical health to form a nursing diagnosis. Based on the John preferences, collaborative recovery-focused interventions such as group activities and social skill training were framed to achieve goals. To improve social interaction, alleviate social isolation and keep him safe, these evidence-based interventions were used. His intervention plan provided reasonable outcomes which had improved his wellbeing in the community.