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Case Study: Hemi

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rhoda musumba

on 24 May 2013

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Transcript of Case Study: Hemi

MSA 16 year old Maori boy.
Pulled out of the local river by the police.
Constable questioning Hemi became concerned about his behavior.
Crisis worker was called to talk to Hemi.
Hemi states that he can hear and smell his 'Koro' (Grandfather).
states his Grandfather is dead.
His parents are also called in the police station. HEMI Clinical
Formulation Maslow's Heirarchy of Needs Recovery Model Therapeutic Relationship Appearance & Behaviour How does the patient look?
How does the patient act? Young, teenage boy
Medium build and height
Well groomed (Neat, short, black hair)
Clothes are clean, functional (blue jumpsuit).
No visible jewellery or tattoos
Posture: leaning forward.
stooping (Shoulders hunched, body bent forwards)
Slow foot tapping.
Head was looking down.
Poor eye contact (darting eye contact)
appeared preoccupied (deep in thoughts).
Attitude was fearful and sadness (especially when talking to the crisis worker). Speech How does the patient talk? -Speech was slow (a few long pauses between speech).
Poverty of speech (restriction in the amount of spontaneous speech)
Hemi’s speech response was limited to questions asked by the crisis worker, and also remained quite when questioned by parents.
He was brief & unelaborated.
Hemi was having a non-social speech (whispering to self before the interview). Mood How does the patient describe their mood? Hemi does not really describe how he feels in the interview.
But “He stated that he tried to do what his Koro wanted”.
His mother also said that he told him he feel sad when he thinks of his grandfather. Affect What do you observe about the patient’s mood? low mood
Restricted (little variation noted).
Congruent References
• Arieli, D., Mashiach, M., Hirschfeld, M. J., & Friedman, V. (2012). Cultural safety and nursing education in DIVIDED SOCIETIES. Nursing Education Perspectives, 33(6), 364-8. Retrieved from http://search.proquest.com/docview/1269080064?accountid=13380

• Adamson, J., Warfa, N., & Bhui, K. (2011). A case study of organisational cultural competence in mental healthcare. BMC Health Services Research, 11(1), 218-218. doi:http://dx.doi.org/10.1186/1472-6963-11-218

• Buffum M. D., Buccheri R., Trygstag L., Gerlock A A., Birmingham P., Dowling G. A., & Kuhlman G. T. (2009). Behavioural management of auditory hallucinations: implementations & evaluation of a 10 week course. Journal of Psychosocial Nursing and Mental Health Services. 47(9) 32-40.

• Commonwealth of Australia. (2008). LiFE: A framework for prevention of suicide in Australia. [brochure]. Retrieved March 30, 2013 from http://www.livingisforeveryone.com.au/uploads/docs/LIFE-research-web.pdf

• El-Mallakh R. S., & Walker K L (2010). Hallucinations, pseudohallucinations (sic) & parahallucinations. Psychiatry: interpersonal and Biological processes. 73(1) 34-42.

• Hazelwood, Z., & Shakespeare-Finch, J. (2010). Let’s talk (listen, feel, think, act): Communication for health professionals. French’s Forest, N.S.W: Pearson Australia.

• Gardner, A. (2010). Therapeutic friendliness and the development of therapeutic leverage by mental health nurses in community rehabilitation settings. Contemporary Nurse : A Journal for the Australian Nursing Profession, 34(2), 140-8. Retrieved from http://search.proquest.com/docview/374988030?accountid=13380

• Hierarchy of Needs. (2009). In The Cambridge Dictionary of Psychology. Retrieved April 3, 2013 from http://qut.eblib.com.au.ezp01.library.qut.edu.au/patron/FullRecord.aspx?p=461152

• McMillan I. (2012) talking therapy trialled for command hallucinations. Mental health practice 15(5) 6-7.

• Mottaghipour, Y., & Bickerton, A. (2005). The Pyramid of Family Care: A framework for family involvement with adult mental health services. Australian e-Journal for the advancement of mental health, 4(3). Retrieved from http://www.auseinet.com/journal
• Price J. (2012). Cognitive behavior therapy: a case study. Mental Health Practice. 15(9). 26-31.

• Takian, A., Sheikh, A., & Barber, N. (2012). We are bitter, but we are better off: Case study of the implementation of an electronic health record system into a mental health hospital in england. BMC Health Services Research, 12(1), 484. doi:http://dx.doi.org/10.1186/1472-6963-12-484

• Waikari J. (2012). Drawing on the past to put whanau Ora into practice. Tiaki Nursing New Zealand. 18(3). 18-9.

• Worden, W. J. (2009). Grief counselling and grief therapy: A handbook for the mental health practitioner (4th ed.). New York, NY: Springer Publishing Company Form of thought How quick, logical and coherent is the patient? Thought pattern was illogical
Correct words being used. Content of Thought What is the patient thinking about? •Preoccupied with thoughts of deceased grandfather.
•Has expressed that he had no intention of self harm.
Experiencing Hallucination. Perception Is the patient experiencing illusions, hallucinations or other perceptual disturbances? Hallucination: auditory and olfactory Cognition Is the patient alert and orientated to time and place? Clouded (lack of clear mindedness to his situation)
Oriented to time, place and person
His abstract thinking was impaired. Insight Does the patient have an understanding of the situation or illness? Partial insight
Attempted to part and cross the river.
He isolated himself from other instead (friends, family).
He was able to recognize that he did not want to cause harm to himself. Judgement Can the patient make sound, reasonable decisions? He was unable to seek help from friends or family.
Able to recognize that he did not want to cause harm to himself.
He was able to acknowledge that his grandfather was in fact dead. Predisposing Factors Precipitating Factors Protective Factors Perpetuating Factors Presenting Factors . Pulled out of the local river by the local police Finds himself preoccupied with thoughts of his Koro.
His sleeping pattern has changed .
He has change in behaviour.
He is becoming more isolated.
Lack of communication.
Change of living conditions. Death of his Koro. Hallucinations (olfactory & Auditory)
Lack of insight to his situation.
Lack of knowledge of services & people to help.
overwhelmed with emotions (grief & sadness).
Lack of communication. Has supportive relationship.
Has the capacity to utilize therapy offered.
Has no desire to harm himself.
No evidence of AOD. Basic/ physiological needs provided:
He is living at home, has a bed, access to food, clothing etc.
However, Hemi has change in his sleeping pattern. Safety/ security needs:
He has no intentions on harming himself.
However, he acted on the his deceased grandfather's voice- poses safety issues.
Assistance in grieving process. Love & belonging (social) needs:
He has a supportive and loving family.
His teachers are also show concern about him.
Overwhelmed with grief emotions and has communication difficulties.
He might be feeling loss of love & belonging when he lost his grandfather. Esteem needs:
Experiencing mild self-esteem
Has loss of accomplishment
He needs self-confidence and a sense of achievement.
Self-esteem is a protective factor for reducing risk of self-harm. 7 Other related problems with Hemi’s Nursing Priorities
1. Gain skills of communicating.
2.Improve his relationship with his parents.
3. Repair social relationships.
4. Improve his sleeping patterns 1. Assist Hemi with his emotional grief.
2. Assist him in recovering from the hallucinations. Help Hemi find emotional stability Help Hemi stop Hallucinations. Hope Sense
of Self Discovery Connectedness Personal
Responsibility Hemi experiencing hallucinations Behavioural course for self-management Mood improves
Increases sense of hope.
Becomes more positive about the future HOPE Problem Intervention Rationale Efficacy Hemi a mild loss of self-confidence Cognitive behavior therapy Gets Involved in his own recovery.
Improved self-confidence More confident
Now & in future
build self-esteem
Stop isolation
get involved in his own recovery Sense of Self Problem Intervention Rationale Efficacy 2,6 Unable to move past his grandfather's death Engage in Maori tradition Personalised recovery Ability to set own goals.
achieve aspirations.
Takes ownership of his life Discovery Problem Intervention Rationale Efficacy Hemi discovery of sense of purpose Holistic care Help him overcome his emotions.
Help him express his emotions
Acceptance of death as part of life. Increase communication with family.
engage in his own recovery.
overcome his emotions.
become sociable.
participate in going to school Personal Responsibility Problem Intervention Rationale Efficacy 11 Loss of connectedness Help him get involved in his daily activities, school, friends & family Eliminate barriers will increase Hemi's communication skills, leading to a better chance of overcoming his grief. Hemi has a place in society. feels a sense of belonging. Connectedness Problem Intervention Rationale Implementation Efficacy Cultural Safety and Hemi How to Establish a Therapeutic Relationship with Hemi What is a therapeutic relationship?

Focus on client
Specific goals and functions to assist the client back to wellness
Professional boundaries How to developing a therapeutic relationship:

Friendliness (Eye contact, Positive regard, Positive attitude)
Active listening
Cultural safety
Reflective practice Be aware of cultural identity through reflective practice.

Your attitude
Coping skills
Perceptions Each nurse is different but examples of possible differences are:

Expectations of family support
Expectations about Hemi's age & experience
Expectations about Hemi's goals Teach Hemi about his symptoms .
Engage him in activities and strategies.
Help Hemi deal with death of grandfather and hallucinations. Implementation Implementation focussing on:
spiritual, physical, family and mental well being (holistically). 5 Help him go back to school.
Help him communicate with his parents or friend or teachers.
Help him get involved in sports again. Counseling
Group therapy Self-actualisation
-The person has reached self-actualization state where they focus on themselves
- Build their own image.
- self-confidence or by accomplishing a set of goals. Empowering
Encourage self management.
Helps him communicate.
Helps cope with grandfather's death. Working with a therapist-Exploring
cycles of his thoughts and behaviour. Focus on:
Physical health
spiritual health
Family health.
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