Paper details:
This case study essay should critically examine the wider context of care management for a patient with complex circumstances
• Examine selected key pathological and/or psychological processes and critically debate these in relation to complex care.
• Justify and critically evaluate nursing assessment and care strategies for individuals with a range of complex circumstances.
• Analyse the clinical course of specific conditions and justify the nursing interventions required to meet the holistic needs of individuals with complex needs.
• Evaluate clinical decision making that informs care and service delivery for individuals and communities in a multi-agency arena
Additional Guidelines
• Critically analyse and utilise appropriate academic and e-based sources to support and provide rationale for reflective nursing practice
• Focus on one person to critically examine their complex circumstance/s
• Consider the underlying clinical condition and why this may be complex for this patient – is it a rare or specialist condition, is it the interaction with other circumstances that may include pathophysiological, clinical, social, psychological ethical, professional, legal, Health policy.
• Support your points with rationales explaining your reasoning
• What specific assessment and nursing care is required particularly focusing on the complex nature of the assessment and care
• Is the prognosis or progress of the clinical condition something that will affect how care is delivered
• You need to remember it is nursing assessment and care - not medical. It may be that liaison with other professionals is required or that a team approach is required for care delivery
• Consider the wider context of care management for a patient with complex circumstances
• Are specific resources or funding required that make care complex – what factors influence how care is managed
• Are family or careers involved that necessitate consideration in delivery of care
Question how nurse /s would lead clinical decision making in the context of multi-agency arena, caring for a patient with complex circumstances
• What is the nurse’s role in caring for the patient, what specific nursing decisions need to be made and how does this factor into the overall care provided for your patient
• focus on nursing actions (Nursing assessment/diagnosis/intervention), Risk Management, Medicine management, communication/reporting.
• Focus on one person to critically examine their complex circumstance
• Consider the underlying clinical condition and why this may be complex for this patient
• is it a rare or specialist condition?
• is it the interaction with other circumstances that may be clinical, social, psychological etc.
• support your points with rationale explaining your reasoning.
specific assessment and nursing care is required particularly focusing on the complex nature of the assessment and care?
What is the nurse’s role in caring for the patient, what specific nursing decisions needs to be made and how does this factor into the overall care provided for your patient?
What is needed in this piece?
Critical analysis, perspective and argument (with supporting evidence)
Language, grammar and expression
Introductions and conclusions
Structure
Presentation
Reading the relevant literature
Analysis of reading rather than description
Critical debate supported with appropriate literature
Following guidelines
New information
Referencing and references
There is a need for critical comment on the literature E.g. author A takes this view in contrast to author B – what they both fail to account for fully is… or – an alternative interpretation can be offered by … or this does not account for the problematic nature of x etc.
Questioning everything about what your reading, weighing up the arguments for and against
Examining in detail from different angles, is it logical, comparing points of view, checking for hidden agendas (i.e funders) and assumptions
Having considered all the literature - synthesis is about the ‘so what’.
So what does this mean in reality, how can it be applied, can you agree or disagree and if so why?
CASE STUDY
Jack a 48 years old man who has been living with schizophrenia for the past 20 years now and has received inpatient psychiatric treatment on several occasions when he became a danger to himself and others appear to be experiencing a relapse in his mental health. He lives alone in the community and has an intramuscular injection of Depixol fortnightly. Only that recently he has stopped accepting his IM injection because of claims of bad side effects he claims he has now developed from taking the medication.
Recently the death of his estranged mother could have tipped him over. More troubling for him was his sibling’s decision not to include him in her funeral arrangement as well as preventing him from attending the burial proceedings following the wish of their mum. He appears to be unhappy about their actions and he begins to slip into a relapse as a combined result of stopping his medication and the death of his mum. He expresses delusional ideas of having powers to bring the dead back to life and begins to think he could do that with his mum.
Angelina one of his sisters is the only one out for five siblings who tries to keep in touch with him. Long standing family conflict has resulted in his alienation from the rest of the family. The beginning of his alienation from the rest of the family began few years after the onset of his diagnosis. He appears misunderstood by family members as his actions, behaviours, and presentation during profound symptoms of schizophrenia could have been misinterpreted as him being bad. Jack and his mum seized to enjoy a close relationship from the onset of his mental illness. He had severely assaulted her several times and resulted in her being terrified of him. Jack grieves the passing of his mum and is more upset he could not make amends before her passing. He blames himself greatly and this appears to be affecting his current mental presentation.
Angelina one of his sisters who live about 2 hours away visits him few months after the burial of their mum to see how he was doing. She was surprised as to what she saw. Jack appears to be deteriorating in his mental health. His voice hearing experience is noticeably persecutory in nature. In addition, he is observed engaging with the voices in a really loud and aggressive tone. Occasionally he is seen agreeing to the voice’s assertion and begins to sob confirming with the voices how he is a most horrible child. He struggles to hold down a job and is currently unemployed. His living condition deteriorates, as his personal hygiene appears to suffer.
Of recent there appears to be concerns with his physical health. His sleep appears to be disrupted by his need to use the toilet several times during the course of the night. His thirst during the day has been unusual as well as occasional blurred vision he complains about. Jack could be having diabetes, which he might not be aware of, and this would need further investigation. This could be a side effect of his current medication which he has stopped having.
His voice hearing experience appears to have amplified and constantly exhaust himself engaging with them in an angry way. His next-door neighbour Max is concerned about the noise coming from Jack’s flat. Once, he came banging on Jack’s door to confront him about the constant noise from him, and there appeared to be rude altercation marked with verbal hostility and the threat of violence.
Jack claims he needs to prepare for a show down with Max, as he is occasionally seen shadow boxing. Max however is a boxing coach for the local amateur boxing club down the road and Angelina, Jack’s sister is worried that Jack could get himself seriously injured in any fight occurring between him and Max. There is strain in relationship as Max makes a truancy complaint about Jack to the property owner. Now he faces an eviction if things with Max his next-door neighbour do not get resolved.
Jack’s diet appears unhealthy, mainly full of junk food, fizzy pop and he appears overweight. He is a smoker but truly desires to stop because of huge cost to him but finds it difficult to give up his smoking habit.
Jack, who enjoys a daily routine of having walks around his neighbourhood, finds that he is no longer doing it. He now chooses to keep a very low profile, having no social contact.
Angelina becomes most worried when he said to her that he does not feel his life is worth living anymore and feels tired of waking up every day to a world that cares very little of him. Angelina reported concerns about his current presentation to his GP and his GP has now made a referral to the community mental health team.