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Mental Health Assignment Analysing Case Of Psychological Health & Disease

Question

Task:
Mental Health Assignment Task:
The Case of Donna
Donna is a 52-year-old female who has presented for treatment. Donna is a short, stocky overweight woman with short grey curly hair. She has been married for 27 years in what she describes as a “companionable marriage” and has 2 children and 3 grandchildren. Donna reveals that she has arthritis in her knees and has recently been diagnosed with diabetes. Donna realises that exercise would be helpful for her weight, diabetes, mobility issues, and mood. However, she reports several barriers to becoming more physically active.

Donna recently presented to emergency at her local hospital worried about excessive heart palpitations, shortness of breath, and sweating. She was worried she was going to die and was convinced she was experiencing a heart attack despite medical evaluations revealing normal physical exam findings. She acknowledges she is in terrible physical shape but reports fear that she may have another attack or that she has heart disease. She is worried about her weight but fears she will only make her pain and arthritis worse with activity. This concern has led to her taking time off work and avoiding exercise or other activity that could elevate her heart rate (i.e., driving, coffee). Her sleep quality has declined, as has her mood. She reports feeling constantly tense, and that this feeling can be “really bad” and is sometimes accompanied by episodes of dizziness and crying. She says she gets overwhelmed easily and finds it difficult to think clearly about everything she needs to get done. She worries that may not live to see her grandchildren grow up.

Donna reports feeling “physically terrible”, that it hurts to walk, and that she is basically a couch potato. She has tried in the past to be more active and lose weight – and 15 years ago she lost 12 kilograms by “basically not eating”. But this weight loss was short-lived due to her tendency to binge eat and drink to avoid her emotions, and she put the weight back on, plus more. She says it hurts too much to walk on her treadmill, but that she can’t go swimming because she doesn’t want anyone to see her in her swimmers. She says when she considers walking into a fitness centre or pool, or even going for a walk around the block, she feels immense fear of embarrassment or humiliation. She says she conceals her worries about exercising or leaving the house by making up excuses or telling her husband she doesn’t feel like going out.

Donna says she would like to become more active and better manage her health. Her fear of raising her heart rate and ending up in hospital or dead, embarrassing or hurting herself because of her weight and appearance, and her reluctance to leave the house are preventing her from doing this.

Consider the above case study and to identify and describe the mental health concern, explain how the mental health concern may impact treatment, and describe the communication strategies you would use to effectively work with the client.

Part 1: Identify and describe mental health condition
Summary of case and presenting problem (approximately 200 words)
Your assignment should begin with a brief introductory paragraph that (a) describes the client and (b) their presenting problem. When describing the client, provide a summary of the relevant demographic information of the client (e.g., gender, age, health status). When describing the presenting problem, include:

  • A summary of the reasons the client has come for treatment
  • An overview of the current key symptoms/issues, history of the problem (i.e., when the symptoms began), and the impact of these symptoms on the client’s functioning or well-being (i.e., impact on relationships/job/quality of life etc).

When summarizing symptoms, DO NOT diagnose (i.e., state the client was “feeling anxious” or had “depressed mood” rather than declaring the client has “an anxiety disorder” or “major depressive disorder”).

Description of mental health condition (approximately 300 words)
Describe the identified mental health condition in relation to the following three aspects:

  • Epidemiology –prevalence, aetiology, and prognosis
  • Symptoms – outline the typical symptoms underlying the condition
  • Impact – in relation to social, relationship, or occupational functioning

You can discuss both diagnosed (i.e., major depressive disorder or generalised anxiety disorder) and non diagnosed (depressed mood or anxious mood) aspects of the mental health condition. Part 2: Identify client needs and develop an appropriate care plan

Explanation of how the mental health condition may impact treatment (approximately 400 words)
Explain how the mental health concern may impact your treatment approach, or what you would be trying to achieve with the client, in relation to:

  • Compassion and empathy
  • Establishing rapport
  • Therapeutic alliance

Do not provide a detailed treatment program for a specific musculoskeletal problem. Maintain the focus of the assignment on the mental health condition and broader treatment considerations and goals when working with a client with a mental health concern.

Description of care plan and communication strategies used to manage client (approximately 600 words)
Provide a care plan detailing the strategies you would use when communicating with, and managing treatment for, this client. The strategies you recommend must be evidence-based, and relevant to the personal details provided in the case study (e.g., active listening, non-verbal body language, open questioning etc). Each strategy and what it involves should be clearly described and a rationale given for how this strategy is relevant to the client. Include in your description a critical and thoughtful analysis of the potential advantages and disadvantages of each approach.

Answer

Part 1: Identification and description of mental health condition
Summary of the case and problem identified in this mental health assignment
The overall case study is based on a middle-aged female named Donna, who is 52 years of age and is short and overweight. She has been married for 27 years and has two children and three grandchildren. Due to being overweight, Donna was worried about diabetes, mobility issues and sudden mood swing and many other health issues and concerned about being paralysed in future.

However, due to excessive shortness of breath, heart palpitations and sweating, Donna was presented to emergency at her nearby hospital. After being diagnosed by the local hospital, her medical evaluations were normal, but Donna felt that she had a heart attack due to being overweight. Here, it can be said that Donna seems to have anxiety disorder about her overweight as she is not able to perform any exercise because of her pain and worse in arthritis. Thus, all these things have led Donna to overthink her worst situation rather than working on losing weight. In addition to this, it can be said that this has an impact on her social life and any other outdoor activity as she feels embarrassed to get out of home or go swimming or for a walk.

Description of mental health condition
As per the given case study, it seems that Donna is having a generalised anxiety disorder (GAD). Concerning the diagnosed mental condition of Donna in relation to the following three aspects has been discussed accordingly:

Epidemiology- As per the studies, it has been found that generalised anxiety disorder appears to be prevalent highly around the globe.

Prevalence- In Australia, more than 14% of the population, that is 1 in 7, experience an anxiety condition annually and it is projected that just under 3% experience generalised anxiety disorder. It has been found that more than 6% of the Australian population will experience generalised in their life and condition inclines to affect more to the women rather than the men (Nimh.nih.gov, 2021).

Aetiology- As with a number of mental health conditions, the GAD is likely to arise from a compound interaction of environmental and biological factors, which might involve variations in brain function and chemistry and genetics variations in the way threats are professed.

Prognosis- If the mental condition remains undertreated, then the prognosis is poor, and most patients will build an optional depression, needing medical help for the management. Thus, it can be said that with treatment, the prognosis is good, wherein the risk of developing the depression of secondary is reduced.

Symptoms
Some of the symptoms of GAD involve anxiety, overthinking, forgetting things in a short period of time, difficulty concentrating, and difficulty managing uncertainty (Llera & Newman, 2015).

Impact
GAD can worsen physical health conditions, such as bowel or digestive problems like ulcers or prickly bowel syndrome. It will lead to restlessness, muscle tension, irritability, fatigue and difficulty concentrating or sleeping. GAD will have a huge impact on the social life of the people as they overthink and embarrass to step out of their homes.

Part 2: Identification of client needs and development of an appropriate care plan
In order to overcome the mental health condition of the client and their needs and development of an appropriate care plan, the three factors have been taken into consideration on how the mental health condition may impact the treatment.

Compassion and empathy- For mental health clients, it is important to show empathy and compassion as it is highly powerful and effective that builds the trust of the patients, reduces anxiety, and progresses its health outcomes. Studies have presented that compassion and empathy to be related to the effective observance of medications, reduced malpractice cases, lesser errors, and boost patient satisfaction (Duarte et al., 2016). However, it is important to be a good listener and should respond to the mental health client to improve mutual understanding. Thus, it can be said that compassion and empathy shows a progressive impact as it encompasses an association and an understanding that involves the body, mind and soul and is powerful and highly effective as it advances humanism in healthcare.

Establishing rapport- Establishing rapport is important to maintain the mental health condition of the patient as it shows their progress. However, building rapport will take time, but it is imperative to be patient and not to hurry the process. Thus, in order to establish rapport effectively, it is important to be prepared for the session, listen to them without judgement, and use disclosure with care (Goldstein & Glueck, 2015). Also, it is significant to be conscious of the limits in experience and knowledge and is important to use empathy as well, which may have a positive impact on patient health conditions.

Therapeutic alliance- The nation of the therapeutic alliance is applicable in contemporary mental health care, as the recovery movement that led patients that promotes the progress of collaborative affiliations, and is emphasised on the individual patient concept of wellbeing. Here, it can be said that in order to have a progressive impact, it is important to use three important elements that focus on treatment goals, duties, and the individual development goal build-up of mutual positive feelings. In mental health conditions, it is important to use therapeutic alliance as it is a related concept that might contribute to the activation of the patient that the levels to which the mental health patient and provider are engrossed in collaborative and purposive work (Hillier & Mres, 2018). Here, the key goal of the therapeutic alliance and the patient shared the same goal and shows a positive impact with improvements and benefit from great change throughout the process.

Care Plan and Communication strategies
With the consideration of the case study, the care plan and communication strategy that can be used to manage clients are as follows:

Active listening and maintain a non-threatening manner- As per the case study, it can be said that Donna has been suffering from a mental health issue that has happened due to her overweight and lack of confidence in her own health. It is important that the carer must preserve a calm manner so that the patient feels familiar with the care plan. The rationale of this care plan is that generalized anxiety disorder is contagious and is transferable from the health care provider to the client and vice versa. Therefore, it is important for the care provider to develop a feeling of safety in the presence of a calm person (Nimh.nih.gov, 2019).

The advantage of this care plan is that the patient will be able to share her feelings with the care provider and that the existing mental health status can be properly diagnosed. However, the only disadvantage of this care plan is that the nature of the care provider might not be appreciated by the patient, and thus it can worsen her mental health. Therefore, these patients are more sensitive that require a high level of the care plan and hence the communication must be conducted in such a way so that the patient becomes friendly with the carer (Locke et al., 2015).

Build a trust relationship with the client- Another effective care plan and communication strategy for Donna is that the carer must work to build a level of trust and loyal relationship with the client so that she can rely upon the care provider for better mental health. Most importantly, a better level of communication is required as a care plan for Donna to make sure that she feels considered and understood. The carer can establish trust by showing affection, responding their questions openly, providing them with unreserved recognition and being accessible, as well as respecting the patient’s personal space. The main rationale of this care plan is that it is the most relevant ttherapeutic skill that requires to be conducted towards putting the client at ease in order to avoid the feeling of the patient that a stranger might lead to a threat to the highly nervous client. The advantage of this care plan is that when the nurse or carer builds a trust relationship with Donna, then she will be able to worry less about her body or her other health issues because she will feel confident about her body when a stranger consoles her. However, the only disadvantage of this plan is that the client might not easily trust a stranger nurse because Donna is already facing a problem socializing with any other person (Wayne, 2019).

Provide reassurance and comfort measures- The most important care plan that could be provided to Donna is that she requires reassurance and comfort level, and the care provider must assure her that her overweight will never affect her social life and her health issues will not lead her to face death. The nurse must make her sure that there is a various treatment that can bring her normal life back. These reassurances are important in order to pull her out of the generalized anxiety order. Therefore, the rationale of this plan is to help Donna relieve her anxiety and at least keep her happy throughout the day so that she does not overthink. The advantages of this plan are that Donna might start taking her body in a positive way and try to recover from her health issue. Whereas, the disadvantage of the same is that Donna might take the reassurances in a negative way because of her mental health issue and overthink more about her health issue and her over-weighted body (Vera, 2019).

References
Locke, A., Kirst, N., & Shultz, C. G. (2015). Diagnosis and Management of Generalized Anxiety Disorder and Panic Disorder in Adults. American Family Physician, 91(9), 617–624. https://www.aafp.org/afp/2015/0501/p617.html

Duarte, J., Pinto-Gouveia, J., & Cruz, B. (2016). Relationships between nurses’ empathy, self-compassion and dimensions of professional quality of life: A cross-sectional study. International Journal of Nursing Studies, 60, 1–11. https://doi.org/10.1016/j.ijnurstu.2016.02.015

Goldstein, F., & Glueck, D. (2015). Developing Rapport and Therapeutic Alliance During Telemental Health Sessions with Children and Adolescents. ResearchGate. https://www.researchgate.net/publication/283208980_Developing_Rapport_and_Therapeutic_ Alliance_During_Telemental_Health_Sessions_with_Children_and_Adolescents

Hillier, L., & Mres, B. (2018). Exploring the nature of the therapeutic alliance in technology-based interventions for mental health problems. https://eprints.lancs.ac.uk/id/eprint/127663/1/2018hilliermphil.pdf

Llera, S., & Newman, M. G. (2015). Generalized Anxiety Disorder. ResearchGate. https://www.researchgate.net/publication/313965781_Generalized_Anxiety_Disorder

Wayne, G. (2019, March 20). Anxiety – Nursing Diagnosis & Care Plan. Nurseslabs. https://nurseslabs.com/anxiety/

Vera, M. (2019, April 11). 7 Anxiety and Panic Disorders Nursing Care Plans - Nurseslabs. Nurseslabs. https://nurseslabs.com/anxiety-panic-disorders-nursing-care-plans/

Nimh.nih.gov. (2019, December 2). NIMH» Anxiety Disorders. Nih.gov. https://www.nimh.nih.gov/health/topics/anxiety-disorders

Nimh.nih.gov. (2021, August 26). NIMH» Generalized Anxiety Disorder. Www.nimh.nih.gov. https://www.nimh.nih.gov/health/statistics/generalized-anxiety-disorder

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