NRSG263: Mental Health – Stress – Anxiety and Depression – Case Study Assessment Answer

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 1AGJCJ
Code: NRSG263
Nursing Assessment Answer
Assignment Task: NRSG263
NRSG263 - Nursing
Marks case scenario – NRSG263
Stress, Anxiety & Depression and the undiagnosed mental disorder are the issues that I believe that contributed to the substance abuse in Marks’s case looking over Marks case. Mark has presented with
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Environmental influences which include exposure to the abuse or trauma that may be physical, emotional, access to addictive substances
According to the self-medication hypothesis of substance abuse, people develop substance abuse problems in an attempt to manage distress associated with the effects of trauma exposure and traumatic stress symptoms. This theory suggests that youth turn to alcohol and other drugs to manage the intense flood of emotions and traumatic reminders associated with traumatic stress or PTSD, or to numb themselves from the experience of any intense emotion, whether positive or negative.

Psychological factors:- Stress, anxiety, depression, personality and other psychiatric disorders, personality traits such as sensation, high impulsivity

According to Joanna, Melinda, Lawrence and Jeanne (2018) abuse of the substance and  mental health disorders are closely linked and people often abuse drugs and alcohol to comfort themselves from the symptoms of an undiagnosed mental disorder, to transform their mood temporarily or to muddle through though emotions. They believe that the abuse of substance and mental health disorders such as anxiety and depression are precisely related. According to the chronicles issued in the Journal of the American Medical Association of all the  people diagnosed with mental illness , 29 % of them are substance abusers
According to Witte et al. (2012), men have a greater predisposition of not knowing how to react to their own anguish, which may result in more prolonged and serious emotional responses to adversative life happenings like death. They barely communicate their feelings of despondency and possibly likely to show a forbearing assertiveness towards adversity.
-Isolation and Lack of support

Stress, Anxiety and Depression, Mental disorder and Trauma  using principles of trauma-informed care and practice – NRSG263

Mental Health Services Administration (SAMHSA)  states Trauma-informed care as ‘A program, organization, or system that is trauma-informed, identifies the widespread influence of suffering and recognizes  the potential pathways for recovery, distinguish the signs and symptoms of trauma in clients, families, staff, and others involved with the system and responds by fully participating in  knowledge about trauma into policies, procedures, and practices and most essentially seeking to actively resist re-traumatization.’ In trauma, a person’s usual coping mechanisms are often overwhelmed, in response to real or perceived threat. The experience of trauma and extremes of stress activate a ‘normal’ survival response, which is `fight’ or ‘flight’. When the threat can’t be escaped it leads to a ‘freeze’ or shut down response. NRSG263
Trauma frequently leads to a diversity of mental health as well as other types of co-occurring problems such as poor physical health, substance abuse problems, eating disorders, relationship and self-esteem issues and contact with the criminal justice system.  When a human service program seeks to become trauma-informed, every part of its organisation, management, and service delivery system is assessed and modified to ensure a basic understanding of how trauma impacts the life of an individual who is seeking services. Trauma-informed organisations, programs, and services are based on an understanding of the particular vulnerabilities and/or triggers that trauma survivors experience (that traditional service delivery approaches may exacerbate), so that these services and programs can be more supportive, effective and avoid re-traumatization. In Marks case,
Safety Throughout the organisation, the staff, and the young people and family/carers they serve, all should feel physically and psychologically safe; the physical setting is safe and interpersonal interactions promote a sense of safety.

Q.N 1 – NRSG263

According to the National Standards for Mental Health (2010), recovery in the prospect of the individual with mental illness means obtaining and maintaining hope, understanding of ones abilities and disabilities, engagement in an active life, personal autonomy, social identity, meaning and purpose in life, and a positive sense of self. The National Institute for Mental Health Excellence (NIMHE 2013) considers the belief of recovery- orientated practice and draw attention of all the health professionals including mental health nurses to approach positive  consumer-centered care. In addition the Nursing and Midwifery council (2010) also supports the principles of recovery -orientated practice , which sets out how all the health professionals including the mental health nurses can execute these principles , for instance considering and prioritizing the intervention the consumer want than what we or as a health professionals think is best for them
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Being a  health
professional, it is essential to think about all facets of a person’s life that their  health condition or illness affects (NMC 2010)
Based on the literature review by Lesse D (2014), the three most essential nursing characteristic theme emerged for the recovery-orientated practice is the hope, patient-centered care and consideration of the clients perceptions on care approach . Gestel- Timmermans, Den Bogaard, Brauwers E, Herth K (2010), found that there is a strong relationship between hope and superficial quality of life and health-related self- efficacy values which suggests anticipation (hope) could be significant to recovery. NRSG263
To achieve person-centered recovery,  to provide the person centered care is essential and is also beneficial for the effective outcome  as person-centered care assists the nurses and the professionals to consider the clients need and preferences and enable them to take informed  decisions regarding their own treatment and care along with the collaboration with the health professionals(National Institute for Health and Care Excellence, 2011). NRSG263
The recovery method offers a holistic sight of the client with mental illness that focuses on the client not only their symptoms. Recovery-oriented practice recognizes the importance of having a supporting circle of family, friends and community and the necessity to understand and address, as allies, the structural inequalities and barriers people face that bound their prospects and to discover the approaches jointly to build publics that are more comprehensive. This requires all professionals to work collaboratively across systems and with other services in order to improve service access and build partnerships that will expand opportunities and create welcoming communities that are free from stigma and discrimination. Addressing the attitudinal and structural barriers that limit the opportunity
According to the recent research by Meares (2012) the most effective approaches for supporting recovery from trauma are well-integrated psychological/therapeutic health services that also reflect the centrality of trauma in the lives and experiences of consumers.
In case of  client like mark, who is dealing with depression , bipolar disorder , anxiety and stress substance abuse , we get to see that how the late diagnosis of the mental health issues and the  unmanaged stress and anxiety that mark was going through his adolescence to adulthood , the grief of loss his father and his career lead his future until he get the help from his friend and the right support system that helped him to get over substance abuse and fight against the mental health issues . The case itself shows the power of collaborative care in the process of recovery.
Being a mental health nurse working collaboratively in the recovery process with the client with issues like Mark, I would focus on the following measures which is based on the current literature review by Eva E, Trijntje Y , Van Dar Voort (2015)
Creating a  safe and helpful environment:- where I  as a mental health nurse can provide support to him , by being there when the client need ,being empathetic, try to know the patient beyond illness but keeping the professional boundaries and maintaining the therapeutic relationship
Clarifying the confusing thoughts  and feelings :- that could be associated with the symptoms of depression, bipolar disorder or any other mental issues that he is experiencing, empowering and encouraging the client
Supporting the client to remain physically active :- collaborating in the planning and executing activities , assist the client by helping them to figure out the goals that they set up collaboratively.
It is also essential for a mental health nurse to establish an accommodating approach, adjusting to their attitude and take care of their needs , thereby generating a stability between the temporarily captivating their control and also encouraging the clients self- management.

Q.N.2 – NRSG263

As Marks nurse, I would carry out a suicide risk assessment at that time of contact which would aid in measuring his level of danger. By this, I would be asking specific questions related to the assessment to come up with a clear gauge of his risk. For example, his stressors, use of substances, medical history and his mental state assessment which would assist me to determine his capacity to function, among many other questions.(NSW GovernmentHealth,2016). After the assessment, I would plan for a continuous evaluation on him to ensure that I have details of any new changes.
As anxiety being one of the concerns in Marks case – NRSG263
According to Anxiety and depression in men (2018), Marks anxiety can be attributed to the fact that most men find it difficult to acknowledge their health complications and instead, tend to dismiss any form of assistance. They think they’re supposed to be strong, self-sufficient, and able to take charge of situations.
Meek (2018) states that many of those who have anxiety issues often experience low self-esteem. Feeling insignificant like in the case of Chung can worsen the anxiety condition in several mannerisms for instance, it can prompt a reflexive way of networking with others and nurture a terror of being adjudicated falsely. Low self-image could also result to poor performance at work, feeling shameful and pressure. In Marks case, I would built his self-esteem on daily basis for quicker results by encouraging him to explore some interests and hobbies and hold positive talks which can easily divert his worries. In addition, exercises which always produces positive effects due to the release of endorphins would reduce his anxiety greatly. NRSG263
As Marks’ nurse Under NSW Mental Health Act 2007, am required to uphold the most effective care and treatment to Chung in a minimum limiting environment. By this I would just visit him at home or anywhere he chooses to respect his choices. On the other hand am also entitled to show respect by providing a person centred care while considering his level of risk. NRSG263
According to Amer (2013), the legal ethical issue of informed consent is an essential component of respecting one’s self-rule. Therefore, Mark  has a right to give informed consent regarding his care since his mental capacity is not compromised which would otherwise impair his ability to give informed consent. As his nurse am obliged to provide all the necessary information beforehand, to facilitate with effective decision making.
Mental illness is common among people with substance abuse and addiction. Treatment and healing of mental illness associated with substance abuse requires collaboration and mutuality. A nurse should involve other health professionals for the full recovery of the client. NRSG263
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