NUR258 Assessment 3: Clinical Case Study

Due date: Within 10 working days of completing your clinical placement

Length: 2000 words ± 10%.

Contribution to overall grade: 40%

Extensions: Extension requests to be made through the extension portal, with evidence.

Extensions will not be granted for work/study commitments or having back to back

placements. Requests must be made before the due date.

Learning Outcomes

1. Examine approaches to mental health practice including strengths-based and

recovery orientated approaches across the lifespan and in diverse contexts.

2. Demonstrate person centred mental health assessment, and design nursing care

interventions based on the person’s lived experience within their cultural context

drawing on best practice evidence.

3. Plan nursing care that includes safe medication management, addresses risk

assessment and demonstrates understanding of psychopharmacology.

4. Analyse ethical and legal concepts that inform nursing practice in mental health

settings and the implications for diverse populations.

Presentation Guidelines

● A minimum of 15 high-quality, credible references.

● 1.5 spaced using Arial or Calibri font in size 11 or 12.

● Use the template provided, including the subheadings.

● Use appropriate professional terminology.

● Do not use abbreviations or nursing jargon/shorthand.

● Write in an essay style and use academic English.

● Do not use dot points.

● You can write out assessments (the MSE, risk etc) using headings and short

sentences.

● Assessments that are more than 10% over or under the word count will incur a 10%

penalty of total grade.

○ Included in word count:

■ Subheadings

■ In-text citations

○ Not included in word count:

■ reference list

● Ensure the client is not identifiable. Pay particular attention to avoid a level of detail

about unique signs and symptoms or circumstances so that a person working with

the client, a friend or family, or community member, would be able to recognise

them.

Referencing

– Use APA 7th referencing style.

– A minimum of 15 high high-quality, credible references.

– The majority of your sources should be peer-reviewed journal articles.

– Do not use private websites, your health facility’s website, or information leaflets.

– Sources must be from 2012-2022 (maximum 10 years old).

– Plagiarism, including poor paraphrasing, may result in significant penalties and will

be recorded on the CDU system.

– Check the similarity report on learnline after submission. You can resubmit as many

times as you need until the deadline.

– Do not share your work with others.

Please complete the assessment task on the next page.

ASSESSMENT TASK

Your task is to write a clinical case study on a client that you meet on placement. You will do

so by using parts of the clinical reasoning cycle. The word count for each section is only a

guide and indicates how much information to provide. A brief example has been provided in

each section to help you. Do not copy this example.

There are a total of 5 steps to complete, and each step is numbered according to its place in

the clinical reasoning cycle.

Step 1: Consider the patient situation (100 words)

– Provide a brief overview of the patient’s situation

– Focus on why they have come in for treatment or review.

You can include their mental health diagnosis if there is one. If they have multiple diagnoses,

you are to focus on one. Ensure this diagnosis is one of the mental health conditions we

have studied in NUR258.

Example:

Jane Doe is a 27-year-old female who lives at home with her parents, and two siblings. She

was brought into the emergency department on 16/07/22 after she barricaded herself in

her bedroom and refused to come out. When her parents tried to enter, she threatened

them with a knife and stated that God had instructed her to stay in her room and pray.

Ambulance officers were called and had to restrain her and administer 5 mg of droperidol

to sedate her. Doctors are querying schizophrenia, but further investigation is required.

Step 2: Collect clues/information (500 words)

– Discuss your client’s relevant clinical history.

– Using evidence, outline why this history is relevant to their current mental state,

treatment, and/or outcomes.

– Identify one to two (1-2) priority nursing assessments that you conducted with the

client. You will lose marks if you discuss more than 2 assessments.

– Using evidence from your research, discuss these assessment results.

Example:

Jane Doe is a University student, and previously worked as a casual at a bar. Up until 6

months ago, she had a high level of functioning. However, in the last 6 months she has

started to withdraw from others. One month ago she quit her job, and began spending

more time in her room. She has also stopped going to class, and has become increasingly

superstitious and religious. Her parents report frequent mood swings and insomnia.

This decline in functioning is characteristic of the prodromal phase of schizophrenia (Jones,

2020). This phase is characterised by a decline in functioning, and changes in mood and

behaviour which precedes the onset of psychosis (Smith, 2019)….

Jane has a very supportive family… This is relevant because outcomes are improved for

people who have more supportive families (Jones, 2022). In fact, a study by Kaur et al.

(2016) found that people experiencing psychosis had a faster recovery and were less likely

to relapse, if they had a family who was involved in their care, and non-judgemental….

Assessment(s):

The first priority assessment was a mental state exam MSE and the results were as follows:

Appearance: Slightly dishevelled and wearing a large hoodie, despite the hot weather….

Behaviour:…..

The second priority assessment was a risk assessment. The risk assessment focused on risk

of suicide, self-harm, and harm to others. This is particularly relevant since Jane was hiding

knives in her room and threatened. The risk assessment looked at protective and risk

factors…

Step 6: Take action (700 words)

As per step 6 of the clinical reasoning cycle, you need to identify one to two (1-2)

recovery-focused nursing interventions. You will lose marks if you discuss more than two

interventions. You should:

– Identify the intervention.

– Discuss why you have chosen this intervention and the evidence for its use (i.e your

research findings).

– Discuss how it will help your client, and/or how it aligns to your client’s goals.

– Discuss how this intervention aligns to the recovery model.

– Take a critical view. That is, look at both the strengths and limitations of this

intervention.

Example:

The first intervention is cognitive behaviour therapy (CBT). CBT is an evidence-based

treatment which is beneficial for people experiencing symptoms of psychosis. According to

Jones (2022) CBT can…. CBT is especially relevant to Jane because… CBT is a

recovery-focused intervention because….

Step 7: Evaluate outcomes (200 words)

Provide a brief overview of your client’s outcomes. That is, discuss their progress, their

perspective, and their current treatment plan.

Example:

Jane remains an involuntary inpatient in the mental health unit. She has made some

progress and reports that she feels less paranoid and better able to cope with the voice

that she hears. She is currently taking quetiapine, but the Doctors are considering

changing her to olanzapine…

Step 8: Reflect on process and new learning (500 words)

Step 8 of the Clinical Reasoning Cycle requires you to critically reflect on what you have

learned and what you might do differently next time. You can use personal pronouns here.

You should discuss:

– What you did well with this client

– What you would do better next time, including research you need to undertake

– How caring for your client has challenged your assumptions or led to insights into

mental health

– Any legal or ethical issues you encountered

– Consider the impact of recovery orientated approaches on your client, and/or in

mental healthcare in general.

You can use the Gibbs Reflective Cycle to help frame your discussion if you wish to.

Gibb’s Reflective Model

How to use Gibbs Reflective Cycle

Gibbs' Reflective Cycle – Helping People Learn From Experience (mindtools.com)

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