Clinical practice is guided by nursing theory. There are many different theories in regard to mental illness. Research Hildegard Peplau’s Interpersonal Theory, and briefly describe how these contribute to the importance of the therapeutic relationship between the person living with a mental health condition and their family and the health care worker, in shaping mental health care interventions. 

1. Clinical practice is guided by nursing theory. There are many different theories in regard to mental illness. Research Hildegard Peplau’s Interpersonal Theory, and briefly describe how these contribute to the importance of the therapeutic relationship between the person living with a mental health condition and their family and the health care worker, in shaping mental health care interventions.

 

 

 

 

 

 

 

 

 

 

 

 

 

1. In the table of biopsychosocial perspectives below, list three (3) possible causes of mental illness for each perspective (provide references from valid resources)

Biopsychological perspective	Possible causes
Biological
Social
Psychological

 

 

1. As and enrolled nurse you are required to identify common mental health conditions by classification and disorder, their treatment and management, as well be able to explain the key terms associated with mental health conditions.  Answer questions 3.1 – 3.3 .to demonstrate your knowledge in these areas of care to a person diagnosed with a mental health disorder.

3.1 Common mental health conditions are routinely classified under disorder groups. Below are eight (8) disorder groups as identified in your training package, with their most common related mental health conditions.

Please see further instructions below this table.

Mental Health Disorder groups
Mood disorders Bipolar Affective Disorder Depressive disorder   Anxiety Disorders Obsessive Compulsive Disorder (OCD) Panic disorder Post Traumatic Stress Disorder Social & Specific Phobias   Eating disorders    Anorexia nervosa Bulimia	Organic Disorders Dementia Delirium   Psychotic Disorders Schizophrenia Psychosis   Dual diagnosis (as stipulated in the training package, but also known as Substance use and Co-occurring mental health disorders)   Self-harm (as stipulated in the training package)

 

Using the table below, fill in the blank areas with the mental health disorder group and common mental health condition to marry with the appropriate signs and symptoms.

Mental health Disorder group	Common Signs and symptoms (classification)
Disorder group:
Disorder Sub-Diagnosis:	Racing thoughts, shaking, sweaty, feeling of choking, heart pounding
Disorder:	Unable to attend social functions Intense anxiety around social functions, physical symptoms of anxiety
Disorder:	Flashback, nightmares, recurrent memory of traumatic event
Disorder:	Obsessive thoughts, debilitating behaviours leading to decline in functionality
Mental health Disorder group	Common Signs and symptoms (classification)
Disorder group:
Disorder:                       Disorder	Memory loss, Difficulty communicating, problem-solving, planning and organizing. Confusion and disorientation
Disorder:                       Disorder	Acute confusion/ disorientation. Anger irritability, anxiety, mood swings. Disturbed sleep.
Mental health Disorder group	Common Signs and symptoms (classification)
Disorder group:
Disorder:                       Disorder	Positive symptoms: Paranoid, disordered thoughts, Hallucinations, Delusions Negative symptoms: Apathy social isolation, poor diet, ADL’s Fixed false beliefs Substantially impair effective communication
Disorder:                       Disorder	Vivid, involuntary perceptions that are experienced as ‘normal’ and occur without an external stimulus Usually experienced as voices that are perceived as distinct from the person’s own thoughts
Mental health Disorder group	Common Signs and symptoms (classification)
Disorder group:	The situation of a person experiencing two or more pathological or disease processes at the same time. It can refer to the co-existence of intellectual, developmental or physical disability with mental illness or widely describes in Australia as the experience of having a mental illness along with a substance abuse disorder. Invalid source specified.
Mental health Disorder group	Common Signs and symptoms (classification)
Disorder group:
Disorder:                       Disorder	Elevated mood, manic, pressured speech, increased spending, lack of sleep, increased substance abuse.
Disorder:	Low mood, suicidal thoughts, poor sleep, no energy, Helpless / hopeless themes, poor appetite. Low energy.
Mental health Disorder group	Common Signs and symptoms (classification)
Disorder group:	Underlying symptoms of anxiety, depression or psychosis, expressed personal distress or coping mechanism to manage feelings of abuse or trauma related to many varied reasons.
Mental health Disorder group	Common Signs and symptoms (classification)
Disorder group:
Disorder:	Increased weight loss, poor appetite, sleep, social isolation, purging, vomiting, binge eating. BMI below 15.
Disorder:	The person has patterns of bingeing and purging, causing emotional distress, preoccupation with body shape and weight, with the body weight often normal

 

3.2 Common mental health conditions are routinely classified under disorder groups. Below are eight (8) disorder groups as identified in your training package, with their most common related mental health conditions.

Using the table below, fill in the blank areas for each of the Mental Health Disorder Groups below.  Provide one (1) medication, one (1) therapeutic treatment  and two (2) nursing interventions with rationales for the management of each disorder group.

Mental Health Disorder group	1 x Medication  Include one (1) type of mental health medication for each of the mental health disorder groups listed in the first column. Provide a specific medication example for each disorder group.	1 x Therapeutic Treatment  e.g. ECG or rTMS or Psychotherapy, e.g. CBT	2 x nursing interventions and rationales for each disorder group
Anxiety Disorders, i.e. Generalised Anxiety Disorder Obsessive Compulsive Disorder Panic disorder Post Traumatic Stress Disorder Social & Specific Phobias
Mood disorders: Major Depressive disorder
Mood disorders: Bipolar Affective Disorder
Self-harm
Dual diagnosis (to training package) also known as Substance use and Co-occurring mental health disorders
Psychotic Disorders Psychoses
Psychotic Disorders: Schizophrenia
Eating disorders, e.g. Anorexia nervosa Bulimia nervosa
Substance use disorder: Nicotine

Substance use disorder: Alcohol
Organic Disorders: Dementia
Organic Disorders: Delirium

3.3 Below are key terms to the eight (8) disorder groups as identified in your training package. Provide an explanation of each of the key terms associated with mental health conditions. Using the table below and fill in an explanation of the key term next to the key term associated with mental health conditions.

Key term associated with mental health conditions	Explanation of the key term
Addiction
Affect
Mood
Insight
Judgement
Self-harm
Agitation also known as psychomotor agitation
Akathisia
Avolition
Anhedonia
Obsession
Compulsion
Hypervigilance
Intoxication
Dependence
Tolerance
Delusions
Hallucinations
Binge
Mania

Complete the table below.  For each of the common behaviours listed below, identify two (2) common effects on the person and two (2) common effects on others. Please ensure answers are referenced.

Common behaviours associated with mental health conditions	Effect of behaviours on the person	Effect of behaviours on others
Aggression and or agitation
Irrational, bizarre behaviour
Self-medication (prescription and non-prescription medication or illicit substances)
Self-harming behaviour, such as overdoses
Self-neglect
Somatic complaints, e.g. physical pain
Treatment refusal
Risk taking
Bullying
Physical health neglect

 

 

1. Australia’s National Standards for Mental Health Services 2010 underpin the national recovery framework. Of particular importance is that the Principles Of Recovery Oriented Mental Health Practice and the Supporting Recovery’ Standard (Standard 10.1) guides mental health practice.

Answer questions 5.1 – 5.2 

5.1 List the six (6) principles of recovery, underpinned by the Australian National Standards for Mental Health Service 2010

 

 

 

 

 

 

 

5.2    Explain how each of the listed principles identified in 5.1 is applied within contemporary evidence-based nursing practice that reflect recovery-orientated care for a person who has a mental health condition (Approx. 30 words per Principle)

Principle	Explanation

 

 

1. Australia’s recovery-orientated mental health services are guided by the National framework for Australian Government recovery-oriented mental health services (Australian Health Ministers’ Advisory Council, 2013).  The framework consists of 17 capabilities grouped into five dominant fields of practice known as practice domains.

Answer questions  6.1 – 6.3

6.1     List the five (5) practice domains to the Australian national framework for recovery-oriented mental health services

 

 

 

 

 

 

 

6.2 Describe three (3) values and philosophies to any of the 17 capabilities listed to the practice domains of the Australian national framework for recovery-oriented mental health services.

Practice Domain	Capability/Capabilities captured under the identified practice domain	Description of Values and philosophy underpinned by the practice domain
Domain 1:  Promoting a culture and language of hope and optimism is the overarching domain and is integral to the other domains.
Domain 2:  Person 1st and holistic
Domain 3:  Supporting personal recovery
Domain 3: Supporting personal recovery

Domain 4: Organisational commitment and workforce development
Domain 5:  Action on social inclusion and the social determinants of health, mental health and wellbeing

 

6.3  The Australian Commission on Safety and Quality in Health Commission (National Safety and Quality Health Care Service (NSQHC), developed national standard in health care, to protect the public from harm and to improve the quality of health service provision. The mental health standards of practice are developed to guide mental health services to practice within the Australian National Safety and Quality Health Care Service (NSQHC) Standards.

Research the National Safety and Quality Health Care Service Standards with the Mental Health Standards for Mental Health Services as outlined in the Map of the National Safety and Quality Health Services Standards (second edition) with the National Standards for Mental Health Service (NSMHS).

Compare the following two (2) National Safety and Qualify Health Services Standards (Second edition): Partnering with Consumers standards and Comprehensive care standard with the National Standards for Mental Health Services.

Using the table below, fill in the blank areas with the comparison between NSQHC standards: Partnering with consumers and Comprehensive care standard with National Standards for Mental Health Services.

Key concepts	No. of NSQHS Standard	National Safety and Quality Health Services Standards (second edition)	No. of MHS Standard	National Standards for Mental Health Services
Partnering with Consumers standards
Comprehensive Care Standard

1. The Congress of Aboriginal and Torres Strait Islander Nurses and Midwives (CATSINaM) facilitate the inclusion of Aboriginal and Torres Strait Islander Nurses and Midwives.

Answer questions 7.1.- 7.3   

7.1 Identify the Role of Congress of Aboriginal and Torres Strait Islander Nurses (mental health nurses to the context of this assessment task) and Midwives (CATSINaM)

 

 

 

 

 

 

 

7.2  Explain CATSINaMs cultural safety position statement by interpreting their position on cultural safety within mental health practise

 

 

 

 

 

 

 

7.3 Fill in the table below by listing two (2) priorities published in CATSINaM, THE CONGRESS OF ABORIGINAL AND TORRES STRAIT ISLANDER NURSES & MIDWIVES STRATEGIC PLAN 2018-2023 to facilitate the direction towards culturally safe health services to the Australian Indigenous population and provide one (1) rationale to each.

Priority	Rationale
Priority 1:
Priority 2:

 

 

1. Provide three (3) examples and rationale to the impacts of inter-generational trauma in the Australian multi-cultural population.

Examples x 3	Rationale x 1 for each example

 

1. Knowledge regarding the key features of mental health legislation is assessed to the Mental Health Act of the State or Territory you are practicing as an enrolled nurse.

Answer questions 9.1 – 9.7

9.1  Name the Mental Health Act to the State or Territory you are practicing as an enrolled nurse. (Note that your answer to this question will be used to validate all the answer related to the Mental Health Act of the State or Territory you have named)

Sate or Territory	Mental Health Act

 

9.2 Decisions of Least restrictive assessments and treatment ways in Mental Health recovery-orientate care are determined by the objective/object of the legislation, the person’s  capacity, where examinations and assessments can occur, the treatment criteria for care, to each state and territory mental health act.

Complete the table below.  The student must provide three (3) provisions to each of the features of the Mental Health Act to the  State of Territory of practice.

Features of the Mental Health Act	State three (3) provisions of the Mental Health Act to your state or territory of practice
Objectives/Objects of the Mental Health Act
Capacity
Criteria for involuntary care
Where can examinations and assessments occur
Recommendation for assessment
Less restrictive way regarding minors, a person with an Advance Health Directive, as well as a person with the consent of an attorney.
Criteria for involuntary care

 

9.3 Australia’s National Standards for mental Health Services (2010) and National Framework for Recovery-Oriented Mental Health Services: A Guide for Practitioners and Provider (2013) form the foundation of the Mental Health Act in all States and Territories of Australia regarding people supported to make and participate in decisions about their assessment, treatment and recovery.

1. Name the document which supports the person with mental health conditions to make and participate in decisions about their assessment, treatment and recovery

 

 

 

 

1. Who does this document apply to?

 

 

 

 

1. Explain the importance of the document in the admission process of a person to mental health care?

 

 

 

 

9.4 Mental health legislation in all Australian States and Territories protect and promotes the rights, dignity and autonomy of individuals with mental health conditions.

Answer questions 9.4a – 9.4c

1. Research the specific State or Territory’s Mental Health Act and name five (5) rights of a person living with a mental health condition

 

 

 

 

1. State two (2) Acts (legislation) which establish privacy and confidentiality regarding patient information in Mental Health Care as a basic human right.

 

 

 

 

1. Outline two (2) provisions in the Mental Health Act to your State or Territory, where private and confidential information of a patient can be shared without consent.

 

 

 

 

9.5 The Mental Health Act in your State or Territory, outline the importance of comprehensive care and support options that are responsive to individual needs of the person with mental health condition/s.

State three (3) provisions to the Mental Health Act in your State or Territory, regarding comprehensive care and support options that are responsive to individual needs of the person with mental health condition/s, as voluntary patients and patients treated under an authority or order.

 

 

 

 

 

 

9.6 The Mental Health Act to the different States and Territories recognises and promotes the best interests to wellbeing and safety of children, or also referred to as minors, receiving mental health treatment and care. Under the Act, a minor is an individual who is under 18 years of age and is presumed not to have capacity to give their own consent with a parent to provide consent for their treatment.

Answer questions 9.6a – 9.6d

1. Provide three (3) examples of who is considered to be a parent, to the Mental Health Act of the State or Territory you are practicing in?

 

 

 

 

1. Explain how you as and enrolled nurse can ensure wellbeing and safety of children and young people are protected and prioritised.

 

 

 

 

1. When can a Recommendation for Assessment be made for a child or adolescent (minor) to protected and prioritised wellbeing and safety of children and young people.

 

 

 

 

1. Name the public official (only the position and not a name of a person) which is appointed by the Mental Health Tribunal or Supreme Court of the State of Territory of practice, and must be informed when mechanical restraint, seclusion or physical restraint is required in the care and treatment of a patient who is a minor in an AMHS.

 

 

 

 

9.7 The Mental Health Act to your State or Territory provide clear guidelines to how carers (also known to be a family member or a nominated support persons) are recognised and supported regarding their roles and responsibilities to decisions about treatment and care of a person with a mental health condition.

Answer questions 9.7a – 9.7b

1. Explain what role carers (family member or nominated support person) play in decisions about treatment and care of a person with mental health conditions

 

 

 

 

1. What rights and responsibilities do a carer (family member or nominated support person) have in decisions about treatment and care of a person with mental health conditions.

Case study

Take note that this is a progressive case study involving the admission and in-patient care. Ensure that your answers are within the context of the scenario. Steve is a 30-year-old Maori gentleman who has been reluctantly brought into the Emergency Department by his brother Joe, after intentionally lacerating one arm and his neck while heavily intoxicated on alcohol. Steve is currently unemployed due to the recent loss of his driver’s license for Driving Under the Influence (DUI).  He lives with Joe in an apartment and Joe seems to be the only person that Steve will talk to but is often away as a FIFO worker and only sees Steve fortnightly. Steve is not participating in support programs and has historically refused referral to community support services. He is seen in the Emergency Department by the Mental Health Assessment Team (MHAT).  Following assessment, Steve is admitted as a voluntary patient to the Mental Health Unit for further assessment, observation, and monitoring with preliminary diagnoses of Major Depressive Disorder, with Alcohol Abuse Disorder and commenced on Sertraline 25 mg as initial treatment. Steve appears malnourished, dehydrated, and is significantly lacking personal hygiene. He is flushed, ataxic and smells strongly of alcohol.  His speech is slurred, and he answers assessment questions hesitantly in a monotone voice. He is unable to provide information re. how much alcohol he has consumed, since when he started drinking or when he last had a meal. Steve can share his full name and address, as well as that Joe brought him to the hospital for treatment, during admission.  He describes himself as being tired most of the time and unmotivated to plan or perform any personal care.  He has a productive cough. He is given a provisional diagnosis of Major Depressive Disorder (MDD) and Substance Abuse (Alcohol) Disorder.

 

1. Steve could feel highly impacted by his preliminary mental illness diagnosis of major depressive disorder, with substance dependency disorder.  Explain how the possible impact of racism, stigma, discrimination, as well as cultural and belief systems, has potentially contributed to Steve’s reluctant presentation to mental health care.

Consumer and carer perspectives provides vital information in evidence-based mental health care.  Consult the National Framework for recovery-oriented mental health services: policy and procedure and explain the importance of the consumer and carer perspective as sources of information when planning evidence-based care delivery

 

 

 

 

 

 

 

1. Assessing a person’s mental status and risk to self or others is known to be the two most important strategies in managing an individual’s wellbeing during engagement with mental health services (in-patient or community settings).

In the table below apply the ten (10) main elements of the Mental Status Examination (MSE) to the case study material and describe Steve’s mental state, then list two (2) general categories of risk as identified in your assessment of Steve’s presentation on admission, against the major categories of risk in a mental health context.

Main elements of the Mental Status Examination (MSE)	Description of Steve’s mental state
MSE: Element 1: Appearance and behaviour
MSE: Element 2: Mood and affect
MSE: Element 3: Speech
MSE: Element 4: Thought: Process (form) and content
MSE: Element 5: Perception
MSE: Element 6: Cognitions: Orientation and memory
MSE: Element 7: Consciousness and sensorium
MSE: Element 8: Insight and judgement
MSE: Element 9: Impulsivity and risk factors
MSE: Element 10: Cultural factors
Mental Health Risk Assessment:  List two (2) categories of risk as identified in your assessment of Steve’s presentation on admission, against the major categories of risk in a mental health context:

 

 

1. Steve was commenced on Sertraline 25 mg as pharmaceutical treatment to his preliminary diagnosis of Major Depressive Disorder.  Answer the questions in the table below.

Identify two (2) oral health issues related to medication (Sertraline)
Identify two (2) adverse effects of Sertraline
Identify and provide a rationale to two (2) possible causes of oral issues to demonstrate the interplay between mental health and physical states when commencing treatment

 

During your 15-minute visual rounding, as the enrolled nurse, you found Steve watching TV in the TV room restlessly flicking through the TV channel during visiting hours.  He appears agitated, argumentative, anxious, and sweating. On assessment, he has a score of 5 in the Alcohol Withdrawal Scale (AWS), and his wound dressings are intact, and his pain is reported 3/10.  He refuses any medication to manage his symptoms.

 

1. Steve is displaying challenging behaviour.

Answer questions 14.1 – 14.3

14.1 Outline two (2) possible triggers that you as the enrolled nurse recognise to the added case study information, which could contribute to Steve’s agitation and refusal of medication (Approx 50 words)

 

 

 

 

 

 

 

14.2 Describe six (6) nursing interventions you, as the enrolled nurse, may use to deflect triggers causing agitation and refusal to medication management. Your answer must include at least two (2) active listening skills, two (2) observation skills, two (2) communication interventions.

Active listening skills (2 skills)

Observation skills (2 skills)

Communication skills (2 skills)

 

14.3 Challenging behaviours can occur at any time during Steve’s hospital stay.  From whom can you as the enrolled nurse seeking expert assistance to manage Steve’s challenging behaviour?

 

 

 

 

 

 

 

A few hours later, Steve attempts to leave the Mental Health Unit without a medical review or authority. He becomes verbally and physically threatening toward nurses who are trying to persuade him to stay and be treated. Security is called and they physically restrain Steve when he lashes out at them and the nurses. He is placed in emergency seclusion. Following further assessment by the Medical Officer, Steve is placed on an involuntary Treatment Authority (TA) to the Mental Health Act, appropriate to your jurisdiction of care (e.g. Mental Health Act QLD 2016; Mental Health Act NSW 2007; etc.).  By this time, he appears physically exhausted, sobbing and stating that he wants to die.

 

 

1. Steve is experiencing severe distress and crisis when he attempts to leave the Mental Health Unit without a medical review or authority.  You as the attending enrolled nurse try to persuade him to stay.

Answer questions 15.1 – 15.5 

15.1 Steve has demonstrated aggression and continues to be threatening to staff and patients.  Consult the case study information and describe two (2) possible causal factors to Steve’s presentation of aggressive and threatening behaviour.

 

 

 

 

 

 

 

15.2 Select three (3) identified communication principles from the table below, to follow during de-escalation, and provide one (1) example for each as  to how you as the enrolled nurse will implement each identified principle.

Principles	How You Could Do This
Establish contact early in escalation
Non-provocative engagement
Identify wants and feelings
Active listening
Display empathy
Be concise
Agree or accept
Offer choices and optimism
Self-control/remain calm
Non-judgemental approach
Self-reflection
Is it safe to intervene?
Here and now
Escalating aggression

 

15.3 Provide three (3) examples to how you, can safely address the possible causal factors to Steve’s presentation of aggressive and threatening behaviour.

 

 

 

 

 

 

15.4 Who can you seek to obtain guidance or support from to assist you with de-escalating Steve’s outbursts of aggressive behaviour?

 

 

 

 

 

 

15.5 As enrolled nurse, working in the mental health unit, you will be expected to de-escalate any person’s risky behaviours during a crisis.  Outline four (4) ways you can prepare yourself in managing your personal safety and prevent violence against you, during Steve’s aggressive outburst.