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COMPETENCY APPRAISAL I

CASE ANALYSIS
Submitted To:

Prof. Cynthia Mendoza

Submitted By:

Espinosa, Melasel Gerdane Estacio, RM J-vee Carl Fajardo, Maria Patricia Fantinalgo, Keith Jan Flores, Cristine Joy

CASE NO. 2 A 15 year old girl who self mutilates by cutting is admitted to psychiatric ward for evaluation. Her family is anxious about her behavior and worried about her prognosis. A teacher who reported the incident is close to the girl and asked to speak to the attending physician. Describe how different nursing theories would direct the proper plan of care for this patient, her family and significant others? Individuals who are hurting emotionally think poorly of themselves and act in ways that will cause others to think poorly of them. As this cycle is perpetuated, they become more and more isolated and convinced of their worthlessness.... Options like reaching out and seeking help are rarely considered or are rejected outright, and as the depression evolves, the only option that promises to shut off the pain is suicideIt is typical for people with depression to perceive life in an almost totally (Source: Rudd, 2001)

A. SAFE & QUALITY NURSING CARE


Theory of Florence Nightingale Environment plays an important role in the care of a patient with suicidal ideation. The nurse should provide calm and a quiet environment. The nurse should deviate the patients attention on happy thoughts. The safety of the patient is considered in taking care of her. In this way, this would help the patient to forget about the suicidal thoughts she has. Theory of Virginia Henderson Avoid dangers in the environment and avoid injuring others and self. Communicate with others in expressing emotions, needs, fears or opinions. These two components play an importance in the patients plan of care. The nurse should encourage the patient to express her feelings and thoughts about suicide in order for others to know what is on her mind and be able to avoid dangers such as inflicting self with pain. In psychiatric nursing, Peplaus interpersonal Model is used in counseling women undergoing depression. Because of the maintained and strengthened nurse patient relationship, women were able to describe patterns that resulted from their negative thinking and independently bfound strategies to manage them. According to Hildegard Peplaus Interpersonal Theory, the counseling role has the greatest importance and emphasis in nursing. This role strengthens the nurse-patient relationship as the nurse becomes a listening friend, and understanding family member, and someone who gives sound and emphatic advises.

In the initial contact, the nurse and the patient are strangers to one another. As the nurse attempts to know the patient better, she must treat him with utmost courtesy, which includes acceptance of the patient as a person and due respect over his individuality. As the patient assumes the independent role, the nurses provides specific answers to her queries which include health information, advices, and simple explanation of the healthcare teams course of care. It is the responsibility of the nurse to appropriately change her responses to the patients level of understanding. As the interaction progresses, the nurse assumes the teaching role as she gives much importance for self-care and in helping her understand the therapeutic plan. In assuming this role, the nurse must determine how the patient understands the subject at hand. She must develop her discussion around the interest of the patient and her ability of using the information provided. Although dependent to the healthcare team over her care, the patient is still considered vital in deciding as to what course his plan of care would take. The nurse as a leader must act in behalf of the patients best interest and at the same time enable her to make decisions over her own care. This is achieved through cooperation and active participation. The patients dependency for her care gives the nurse surrogate role this creates an atmosphere wherein feelings previously felt. Some other relationships are reactivated and nurtured. The nurse must assist the patient to make sure that her surrogate role is different and only temporary.

B. MANAGEMENT OF RESOURCES AND ENVIRONMENT


Determines tasks and procedures that can be safely assigned to other members of the team. Ensure that all the equipment are functional Keep all sharps and other chemical substances in secure places, these can be used as a medium for suicide. Provide a stimulating environment like having different kinds of recreational activities that will utilize her time. Keep all medicines in secured places which the patient cannot easily access. Plan ahead of time to finish the work assignment on time.

C. HEALTH EDUCATION Teach folks the possible nonverbal behavoirs that maybe observe. Body behaviours such as posture, body movements, gestures and gait. For example, the client is slumped in a chair, puts her face in her hands, and occasionally taps her right foot.

Facial expression- such as frowns, smiles, grimaces, raised eyebrows, pursed lips, licking lips, and tongue movement. For example, the client grimaces when speaking to the nurse; when alone, the client smiles and giggles to herself. Eye cast- such as angry, suspicious, and accusatory looks. For example, the clients eyes are hardened with suspicion. Voice-related behaviours- such as tone pitch level, intensity, inflection, shuttering, pauses, silences, and fluency. For example, the client talks in a loud, sing- song voice. Observable autonomic physiological responses- such as increase in respiration, diaphoresis, pupil dilatation, blushing, and paleness. For example, when the client mentions discharge, she becomes pale, her respirations increase, and her face becomes diaphoretic. General appearance- such as grooming, dress and hygiene. For example, the client is dressed in a wrinkled shirt and her pants are stained, the clients socks are dirty, and she wears no shoes. Provide safety to the patient: Keep sharp objects and materials away from the patient. Always attend to the patient needs. Never leave the patient alone.

D/E. LEGAL & ETHICO-MORAL RESPONSIBILITIES


Respect the decision of the patient if he refused to any kind of procedure. Confirms information given by the doctor for informed consent. Checks the completeness of informed consent and other legal forms. Behave in accordance with the establish norms of conduct of the institution/organization. Reports unethical and immoral incidents to proper authorities. Practice beneficence Ensure patients privacy regarding her health information. Practice right of the patient to treatment.

Suggestions around Informed Consent Confidentiality and Release of Information As part of the intake process, obtain detailed contact information for the client, as well as contact information for family members or other significant others (e.g., friend, girlfriend/boyfriend).

The best defence against inappropriate breaches of confidentiality is a detailed informed consent procedure. Inform the client as to the limits of confidentiality. Indicate to client that you are ethically and legally obligated to release information in situations where you are concerned about the clients imminent wellbeing, and that this may include contacting their next of kin/significant other(s). The best defence against inappropriate breaches of confidentiality is a detailed informed consent procedure. Inform the client as to the limits of confidentiality. Indicate to client that you are ethically and legally obligated to release information in situations where you are concerned about the clients imminent wellbeing, and that this may include contacting their next of kin/significant other(s). Discuss and document other parameters around release of information (e.g., you may suggest that if the client no-shows for a session, that you will first try to contact the client, and if you cannot get a hold of him/her that you will contact their next of kin). Clinicians can understandably be concerned about liability issues arising from their work with suicidal clients. Clinicians have a duty to act in a reasonable and prudent manner to prevent the suicide of their clients (Berman & Cohen-Sandler, 1983). This is accomplished through adherence to sound, evidencebased clinical practice standards, including: caring for the client in alliance-based, non-defensive ways; focusing on the critical elements of clinically based risk-management; clearly documenting assessment, management and intervention approaches; and consulting with other professionals (Gutheil, 1999).

F. RECORDS MANAGEMENT
Maintains accurate and updated documentation of patient care -Completes the data of the patients accurately to avoid conflicts. -Updates the current condition of the patients and record if current status progresses. - Records all medications accurately that prescribed by the attending physician that have been given to the patient with correct medication, correct timing, correct dosage and correct route.

F. PERSONAL AND PROFESSIONAL DEVELOPMENT Evaluates or reflect own awareness of own self first Assess for understanding of patients case Attend on seminars or talks about how to handle clients with said condition

Read on articles, periodicals or journals containing the case of the patient

G. QUALITY IMPROVEMENT
Ask for feedbacks on the significant others on the interventions and quality care rendered to client Report important elements regarding the patients condition to the hospital Have an adequate knowledge about the case of the client

H. RESEARCH
Conduct Research on the interventions that should be done for patients with such case Conduct research on possible factors that cause the client to be on that state. Conduct research on other possible recreational intervention that would help the client

I. RECORDS MANAGEMENT
Records Outcome of the patient care -Records the condition of the patient on their chart or records for validity. Observes legal imperatives in record keeping -Observes confidentiality and privacy regarding patients condition and problem. -Not releasing records and other information without proper authority.

J. COMMUNICATION
Establish rapport with the client and develop a trusting relationship with him. Observe clients verbal and non-verbal actions and be sensitive to his needs. Communicate with the client on what care modalities he would like to comply with. Have a therapeutic relationship with the client.

K. COLLABORATION AND TEAMWORK


Develop a trusting relationship with one another to ensure quality care upon the implementation of the treatment process Work hand in hand with the clients physician in treating the client and inform the physician immediately on any complaints if the client regarding his treatment regimen

PREVENTIVE
It is important to talk to a teenager about the suicide attempt to help them understand what has happened. Without support of family/friends, they may try to make sense of this confusing situation themselves. Sometimes teenagers blame themselves for something they may or may not have done. Teenagers may not want to talk directly about their worries or feelings. Instead, they may show them in other ways. They may isolate, or not tell their friends out of shame, uneasiness, or fear of being misunderstood or rejected. Listen: Stay calm. Dont be outwardly shocked, as this may put distance between you and the child. Dont assume the teen is just trying to get attention. Dont try to argue him out of feeling suicidal. Show concern. Encourage the child to talk to you or some other trusted person. Allow for the full expression of feelings. Dont give advice or feel obligated to find simple solutions.

Share feelings: Accept the childs feelings, letting him know that he or she is not alone. Discuss how you have felt when you were sad or depressed. Be non-judgmental. Dont debate whether suicide is right or wrong. Dont challenge the teen to go ahead and do it. It is possible that he or she might take your advice. Show interest and support.

Be honest: Talk openly about suicide. If the childs words or actions scare you, tell him or her. If youre worried or dont know what to do, say so. Simply being a witness to the childs pain can promote healing. Offer hope that alternatives are available. Reassure the teen that you know how to locate assistance.

Get help: Dont be sworn to secrecy. Professional help is crucial. Assistance may be found from a local mental health clinic, school counselor, suicide prevention center, or family physician. Take action. Remove means of self-harm such as guns or pills. Stay close to the person until he or she is under professional care. Avoiding alcohol and drugs (other than prescribed medicines) can reduce the risk of suicide.

In homes with children or teenagers: Keep all prescription medicines high up and locked. Do not keep alcohol in the home, or keep it locked up. Do not keep guns in the home. If you do keep guns in the home, lock them and keep the bullets separate. Many people who try to commit suicide talk about it before making the attempt. Sometimes, just talking to someone who cares and who does not judge them is enough to reduce the risk of suicide.

CURATIVE
If she have made a suicide attempt and is injured: At the emergency room, she'll be treated for any injuries. The doctor will ask a number of questions and may examine the patient, looking for recent or past signs of suicide attempts. Depending on the state of mind, the patient may need medications to calm you or to ease symptoms of an underlying mental illness, such as depression. The doctor may want the patient to stay in the hospital long enough to make sure any treatments are working, that she'll be safe when and that she'll get the follow-up treatment she need.

Psychotherapy. In psychotherapy, also called counseling or talk therapy, you explore the issues that make you feel suicidal. You and your therapist can work together to develop treatment plans and goals. Medications. Antidepressants, antipsychotic medications, anti-anxiety medications and other medications for mental illness can help reduce symptoms, which can help you feel less suicidal. Addiction treatment. Treatment for drug or alcohol addiction can include detoxification, addiction treatment programs and self-help group meetings. Family support and education. Your loved ones can be both a source of support and conflict. Involving them in treatment can help them understand what you're going through, give them better coping skills, and improve family communication and relationships.

PROMOTIVE
Educate the folks and significant others about the emotional behaviors expressed by the patient. Emphasize the importance of emotional support and assistance of the family and other support groups for the well-being of the patient. Educate the folks about the appropriate therapy for the patient (Individual Psychotherapy).

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