Mental Health Portfolio

Mental Status Exam

Mental Status

Mental status exams (MSE) are preformed by a variety of health care workers, including nurses (Halter et al, 2019). During the mental status exam, the nurse "both observes and acts directly about the patients physical behaviour, nonverbal communication, appearance, speech patterns, mood and affect, thought content, perceptions, cognitive ability, and insight and judgement" (Halter et al, 2019). Mental status exams are very important, and "include general observations made during the clinical encounter, as well as specific testing based on the needs of the patient and physician" (Norris, 2016). The nurses primary source of information is the patient, although in Max's case, his mother might be of more assistance since he prefers not to interact with others (Halter et al, 2019). The MSE allows for nurses to "collect and organize objective data" (Halter et al, 2019). All patient health centers (both inpatient and outpatient) must have mental status nursing assessment forms (Halter et al, 2019). The MSE is not only used to gather data, but is cal also be used to build a therapeutic relationship with the client (Halter et al, 2019). The MSE takes place during the orientation phase of the client relationship, the nurse will often follow the mental status exam to get a better understanding on the patient's mental state and their possible needs (Halter et al, 2019). The mental status exam can also help determine patient safety.

The nurse will gather lots of information about a patient during the mental status exam, such as...

General Assessment and Motor Behaviour: How do they dress? What is their hygiene like? Facial expressions? Any tattoos or scars?

Speech Content and Process: The rate and volume of their speech? Are they slurring or stuttering? Are they mumbling? Disorganized?

Mood and Affect: Do they have a bland or flat affect? Angry? Is their affect appropriate to context?

Thought Process and Clarity: Are they coherent, disorganized, or thought blocking? Having flights of ideas?

Sensorium, Intellectual Process, Perception, Memory, Orientation and Concentration: Experiencing hallucinations/illusions? Is the patient mentally challenged? Are they forgetful? Clouded mind?

Judgement and Insight: Does the patient know how to act in an emergency? Are they aware of their behaviours?

Self-Concept: How does the patient view themselves? Do they have plans for the future? Are they aware of their abilities?

Roles and Relationships: How does the client interact with staff and other clients? Do they have any family relationships? Any romantic relationships?

Physiological and Self-Care Considerations: Is the client participating in activities they enjoy? Are they taking care of themselves?

Assessing A Child

Oftentimes when assessing children, one needs to collect data from various sources (Halter et al, 2019). The behaviour of the child is often observed from caregivers or the child's parents, meaning they may have better descriptions on the behaviour of the child (Halter et al, 2019). In Max's case, his mother has witnessed his behaviour, and heard about it from his school. He has been known to avoid school work, pick fights with other children, and his friends do not want to spend time with him anymore. These are all assessments from school staff that the mother has been informed of. Therefore, one of the main sources of data in Max's case is his mother.

In some cases during child assessments the nurse may ask the caregivers to exit the room if they feel as though the child is suffering from abuse (Halter et al, 2019). It does not seem like this is the case in Max's scenario, although it may still be a good idea to ask Max's mother to exit the room so that Max may feel more comfortable sharing his feelings.

As the nurse, it would be important to monitor Max's behaviour throughout the duration of the interview. Just keeping an eye on how Max responds when asked specific questions can tell a lot about how he is feeling. Children often show clues as to how they function through playing with toys, so providing Max with toys could give the nurse some indication as to what Max is feeling and how he acts (Halter et al, 2019). As mentioned in the case study, Max has been experience more aggression towards his toys. A technique nurses use to evaluate behaviour is providing children with toys to act out their emotions is often beneficial. This is often used with children as younger children can struggle to put their emotions or thoughts into words. This is something the nurse would watch for when Max is presented with toys.

Assessing Children

Psychosocial Assessment

The psychosocial assessment is similar to the MSE, although it is used to collect more subjective rather than objective data such as alcohol or substance abuse, the central or chief complaint, history of violence, suicidal behaviours, family psychiatric history, stressors and coping methods, personal background, support systems, weaknesses, strengths, and goals for treatment (Halter et al, 2019).

It is important to understand where someone is coming from when getting to know them. The psychological assessment provides the nurse with information about how the patient acts in a more social setting (Bradford & Rickwood, 2012).

Most development occurs in childhood and adolescence, which is why there is likely going to be many psychosocial issues addressed when a child or young adolescent is present in a mental health setting (Bradford & Rickwood, 2012). Max falls under this age category, as he is only 12. Based on his case study, there are quite a few concerns related to his psychosocial assessment that must be addressed during the interview stage of the nurse-client relationship.

When the nurse does a psychosocial assessment on Max, she will see that he is at risk for suicide, lost support systems, began smoking, lost his father, and possibly failing this school year. These are all things that the nurse will learn about during the psychosocial assessment, and it will be compared to the MSE so the nurse understands the clients situation.

Psychosocial Assessment

Building A Therapeutic Relationship

It is important to keep in mind that all behaviour has meaning. So, after looking into Max's case, the nurse should be considerate as to what is causing this aggressive behaviour to arise. Being able to aknowledge client behaviour is an important part of building a therapeutic relationship with clients (Halter et al, 2019).

There are three kinds of relationships that occur in life, these include therapeutic, social, and intimate (Halter et al, 2019). Depending on the situation, each of these relationships tend to come naturally. In the hospital setting, nurses must be aware of the relationship they are forming with their patient, to ensure it is nothing but therapeutic.

Each nurse-client relationship is unique, as not all nurses or patients are the same (Halter et al, 2019). The role of the nurse in the therapeutic relationship is to "maximize his or her communication skills, understanding of human behaviours, and personal strengths to enhance the patients growth" (Halter et al, 2019). Therapeutic relationships are developed through the use of trust, respect, professional intimacy, empathy, and power (College Of Nurses, 2006). The nurse should have a good understanding on each of these topics related to therapeutic relationships in order for the nurse-client relationship to show beneficial effects on health and wellness.

It may be a bit difficult at first for the nurse to build a therapeutic relationship with Max. Although Max has not yet been diagnosed with anything, he seems to show many signs of depression. Based on what is written in the case study, it seems as though he avoids interacting with others. This could make things challenging in the orientation and working phases of the therapeutic relationship, as the nurse could have some difficulty getting Max to communicate his thoughts and feelings.

Building a therapeutic relationship

Phases of the therapeutic relationship

Preorientation Phase: In this phase, the nurse is preparing to see their client for the first time, and they may be experiencing some thoughts or feelings leading up to their first interaction with the patient (Halter et al, 2019). This would give the nurse the opportunity to look into Max's background, and get a better understanding on what to expect when they meet for the first time.

Orientation Phase: During this phase, the patient and the nurse meet for the first time and conduct an interview. This phase may last more than one session, or until the nurse has gathered all the information needed to proceed. This phase will end likely after the nurse has established rapport, outlined the parameters of the relationship, created a formal or informal contract, and established confidentiality (Halter et al, 2019). In the case study, it is mentioned that max and his mother were given "the rules and orientation to the floor". Then, it was mentioned that they were given documents to sign. This is an example of the orientation phase of the therapeutic relationship.

Working Phase: The next phase in Max's interaction with the nurses would be the working phase, which is typically used to maintain the relationship, gather further data, promote the patients problem solving skills, facilitate behavioural change, and overcome resistant behaviours (Halter et al, 2019). In Max's case, all of these concepts will be important, although his biggest struggle seems to be behaviour. As he has had two suicide attempts and multiple bursts of anger since his fathers death, this relates to patient safety and therefore becomes the biggest concern of the working phase.

Termination Phase: The final phase of the therapeutic relationship is the termination phase. Although Max has not yet made it to this phase, he will reach the termination phase once there is an agreement between both the nurse and client, where they both feel termination is appropriate. Although the termination phase is the final phase, it is discussed throughout the orientation phase of the therapeutic relationship. This phase occurs when the patient is discharged, and able to discuss coping strategies, summarize the goals and objectives achieved in the relationship, and review situations that occured in the nurse-patient relationship (Halter et al, 2019). The termination phase can be difficult for both the nurse and the patient, and allowtose involved in the relationship to become emotional. This could be especially difficult for Max as he is a child, amd experienced the loss of a loved one 5 years ago. Therefore, forming a relationship with someone and later having to terminate that relationship could be difficult for him.

Phases of the therapeutic relationship

Active Listening

Communication is defined as "an interactive process between two or more people who send and recieve messages to one another" (Halter et al, 2019). During communication, it is important to participate in active listening so the other person does not feel as though they are not being listened to. It is common for people to "want the other person to be there for them psychologically, socially, emotionally, and spiritually" (Halter et al, 2019). There are many ways one could portray active listneing skills, such as....

- Observing the patients nonverbal behaviours

- Understanding and reflecting on patients nonverbal messages

- Providing constructive feedback about the patient of which they may not be aware of

- Leaning in and engaging in eye contact with client

- Restating things the patient has said

- Nodding or shaking head

(Halter et al, 2019)

Active Listening

Open/Closed Ended Questions

Open Ended Questions: The purpose of open ended questions is to allow for a more detailed and more prolonged response (Halter et al, 2019). Open ended questions are often used in the orientation stages of the interview phase in the therapeutic relationship. They allow for the nurse to gather more detailed information about the clients history and current situation (Halter et al, 2019). Some examples of open ended questions that could help the nurse get more information on Max's situation may include...

- "Tell me more about your relationship with your friends"

- "What are some things in your life that make you worried or upset?"

- "What kind of activities make you happy?"

Closed Ended Questions: Oftentimes closed ended questions only allow for a "yes" or "no" response, which is why nurses prefer to use open ended questions (Halter et al, 2019). Closed ended questions can although be very useful as well, more so in an intake interview or to gather "concrete data" (Halter et al, 2019). Using closed ended questions could be useful when interviewing a patient like Max, as it can help identify quickly if he is at risk for suicide, or if there are any major concerns before going into more depth (Halter et al, 2019). For example, some closed ended questions that may be asked in Max's case may include...

- "Have you recently been experiencing suicidal thoughts?"

- "Do you have access to the resources needed to harm yourself?

- "How many suicide attempts have been made?"

- "Have you ever been on medication in the past to help with depression?"

These questions are answered in the case study for the most part, but it is still important to ask the client in case they have answers different from what is written in the case study. Since Max is young, he may have trouble understanding some questions. So it is important to make sure Max understands the questions being asked.

Open/Closed Ended Questions

Verbal and Nonverbal Communication

Max seems to be expressing signs of depression through both verbal and nonverbal cues throughout the case study.

Nonverbal communication (cues) can be defined as "those messages expressed through directly observable behaviours such as physical appearance, facial expressions, body posture, eye contact, eye cast, hand gestures, signs, fidgeting, and yawning" (Halter et al, 2019). Tone of voice can also be a big indicator on how an individual is feeling. One may say they are feeling "okay", but express that they are feeling down through their tone of voice (Halter et al, 2019). Nurses must be aware of this, as oftentimes it is the "nonverbal behaviours that may be communicating the "real" message" (Halter et al, 2019).

Verbal communication "consists of all the words a person speaks" (Halter et al, 2019). Verbal communication, or talking, is something that connects the individuals of society. It is important to be mindful of some topics when communicating with patients verbally, as some topics my be sensitive to those patients. For example, a sensitive topic for Max may be his fathers death. Therefore, if this topic is brought up, it may be difficult for Max to speak about it.

Both of these communication techniques are highly effective, and happen to be used in our every day lives. Since people are more consciously aware of their verbal communication methods, they are more likely to lie about how they are feeling to avoid opening up (Halter et al, 2019). Nonverbal cues allow for the nurse to visually see the patients emotions, which the client is not as conscious of and therefore does not change (Halter et al, 2019).

Nonverbal/Verbal Communication

Listening and Communicating Empathy

Listening with Empathy

Nurses often feel empathy, but it is also important to ensure nurses are communicating empathy with the patient (Halter et al, 2019). It is said that to achieve the communication of empathy, one must "connect to the emotions, experiences, and thoughts of our patients" (Halter et al, 2019). It is not always easy to connect an experience from the nurse to the patient, as the patient is oftentimes suffering from the aftereffects of something tragic such as sexual abuse or the loss of a loved one. The nurse would better understand where the patient is coming from if they can "put themselves in the patients shoes" (Halter et al, 2019). This is overall the idea of being empathetic, but oftentimes nurses do not take the extra step to "practice relational competencies related to understanding the meaning and complexity of experience" (Halter et al, 2019). In the case study, it states that Max had lost his father 5 years ago. The nurse would be able to connect her experiences with the loss of a loved one to Max's experiences. Thus allowing the promotion of communication of empathy.

An example of a nurse listening and communicating empathy would look something like this in Max's case...

- "You feel ____ because _____.

eg. "you feel lonely because your mother is not home often and you are losing your friends?"

This allows clarification for the nurse as the patient will state whether or not the sentence is accurate to the patients feelings. Then, the nurse will continue to project empathy through communication to build on the therapeutic nurse-client relationship.

Empathy In The Therapeutic Relationship

Empathy is known as the "most important element in the therapeutic relationship" (Halter et al, 2019). Empathy is one of the main components of the therapeutic relationship. Studies have shown that by building empathy in a therapeutic relationship, it improves brain function through increasing the brains plasticity (Halter et al, 2019). By having an empathetic approach in the therapeutic relationship, the nurse is able to attentively listen and communicate with the patient in a non- judgemental way (Halter et al, 2019).

To help the nurse gain a therapeutic relationship with Max, they should listen to Max's actions, and approach the situation with an open mind and a non-judgemental attitude. This will allow the nurse to appear more empathetic toward the client, and allow them to feel more comfortable. Creating a comfortable environment through the use of empathy leads to the greater development of the nurse-client relationship. Therefore, it can help the nurse better understand where the client is coming from, and figure out how to better help them in treatment.

Empathy In The Therapeutic Relationship

Benefits Of Practicing Reflection

Benefits of Practice Reflection

- Improved critical thinking

- Empowerment

- Greater self awareness

- Personal and professional growth

Practicing reflective techniques will allow for nurses to better understand how to improve their nursing skills, and therefore provide better care for patients like Max (Kelly, 2021).

Some Reflexive Questions

Some Reflexive Questions

When practicing reflexivity, the nurse must ask themselves some questions after the experiences they have with their patients. By doing this, they will be able to improve their nursing skills in the future. Reflexive practice helps nurses understand and recognize the ways they must improve. Below there are some questions the nurse may ask themselves after an interaction with their patient.

- What was the goal of the interaction?

- Why did I respond as I did?

- What were the consequences for the patient?

- What were the consequences for me?

- How was the patient feeling? How did I know this?

- How did I feel?

- What influenced me to feel this way?

The Definition of Reflexivity

Definition of reflexivity

"A stance, being able to locate oneself within a structural picture, appreciating how one’s own self relates to the organization. Reflexivity relates to understandings of the complex relationships between individuals and social systems at micro and macro levels. That is, the capacity of the individual to position him or herself within the broader social and organizational causes of particular problems" (Kelly, 2021).

The Process of Medication Refusal

Patients must always be given the right to refuse medication, unless they are under a form that removes this right. In Max's case, his mother is worried about the long term effects of the medication prescribed to Max, and Max does not believe he is capable of taking this medication. It is understandable that Max wants to refuse the medication, as he has never been put on any medications before hand.

When dealing with medication refusal, it is important to "inform the client about the possible consequences of his decision in terms he can understand" (Smith, 2004). Be sure the client understands the consequences that could arise before moving on. The mother especially should be informed of how the medication could be beneficial for the client, and any side effects or long term effects it could have on her child. Max can also have a say on whether or not he accepts the medication, but the overall choice is within the mothers hands since Max is only 12. Ensure that both Max and his mother have all the answers before their decision to refuse or accept the medication. It is always important to ensure the client has no further questions before they make their decision (Smith, 2004).

Documentation of the medication refusal process is often next. When a patient refuses medication, the nurse must document that they have done an MSE on the patient, the results of the assessment, the information that was provided to the patient, the patient's response (in their own words), any additional written information given to the client, document any questions asked by client (Smith, 2004). Depending on the facility, there may be a specific form related to medication refusal, also known as a "refusal to consent" form (Smith, 2004). The patient must sign this form to prove they refused the medication.

Why Someone May Refuse Medication

There are various reasons as to why someone may refuse medication, "including religious beliefs, dietary restrictions, misunderstandings, cognitive impairment, desire to self-harm, or simple inconvenience" (Haskins & Wick, 2017). In Max's case, his mother is hesitant as she is unsure of the long term effects on her sons growth and development. This issue can be delt with by explaining to Max's mom the potential long term effects this medication could have on Max. Max refuses to take any form of medication as he states he is not able to take it. The nurse could attempt to explain to Max that many children his age take medication, or offer an alternate medication he feels more comfortable taking.

Just because Max refuses to take the medication now, does not mean he wont change his mind in the future. Oftentimes individuals who refuse their medication "revisit the issue as necessary" (Haskins & Wick, 2017). It is important for the nurse to check up every so often on Max's thoughts about taking medication to treat his symptoms of depression.

Why someone may refuse medication

Step 1: Call For Help

The first step in any crisis is to call for help. You should plan out how you and your colleagues are going to approach the situation, and ensure everyone is on the same page (Kelly, 2021).

Step 1

Step 2: De-Escalate Yourself

Step 2

The next step of the de-escalation process is to ensure you are calm and collected enough to handle the situation presented in front of you. When one is presented with an escalated situation, they often experience an adrenaline rush (fight or flight), and their thought processes are not as useful in the escalated situation as they could be. Therefore, the nurse and anyone else planning on stepping in should take some time to take a deep breath before attempting to de-escalate (Kelly, 2021).

The goal of the nurse when dealing with de-escalation is not to react but to respond. Therefore the nurse should be calm and reasonable upon entering this sort of situation (Kelly, 2021).

Step 3: Body Skills

Step 3

Keep in mind that there should only be one nurse speaking directly with the individual who needs help de-escalating. Distance should be maintained so if the patient moves toward you, you have the ability to withdrawal (Kelly, 2021).

In some situations, it is appropriate to use therapeutic touch as a calming technique. If the nurse decides to use this strategy, there should be careful thought put into it. This could be a major safety risk for the nurse if used in the wrong situation (Kelly, 2021).

Things to keep in mind...

- Do not stare, but maintain eye contact

- Do not clench hands

- Maintain distance so you can exit if necessary

- Maintain a relaxed, open stance

- Relax your face

(Kelly, 2021)

Step 4: Verbal Skills

People who are experiencing agitation may have a harder time processing things that are being said to them. Before asking the client any questions as an attempt to de-escalate, try...

- Introducing yourself

- Ask them what their name is and what they prefer to be called.

- Remain authentic and calm throughout the interaction while maintaining a soft tone of voice.

The next step should be attempting to get the patient to verbalize what they are feeling in a safe way. Try to get them to sit down and express how they are feeling through words rather than violence and aggression (Kelly, 2021).

Step 4

Step 5: Listening skills

Being able to listen to what the individual is trying to say without putting words in their mouth is an extremely important part of the de-escalation process. This allows the patient to share their feelings and feel as though someone is listening to them (Kelly, 2021).

The nurse should listen to the patient with a non-judgemental head space. The patient may be saying things that are "wrong" in your opinion, but it is the nurses job to realize that this is their truth and it must be aknowledged (Kelly, 2021).

Step 5

Step 6: Set Boundaries

Step 6

Ensure that the patient knows any sort of violence is unacceptable. This includes violence towards you as the nurse, themselves, or anyone else present in the environment (Kelly, 2021).

Boundaries should be set early on in the patient interaction, but not directed at the patient as if boundary setting is a threat (Kelly, 2021).

As mentioned previously, sometimes individuals who are in this sort of situation are not always able to comprehend what is being said to them. Therefore, boundaries may need to be repeated, but in a respectful manner (Kelly, 2021).

Step 7: If The Situation Continues to Escalate...

Ensure the patient that if they are not able to calm down, they will have to be administered medication to help them do so. At this point in the interaction it is important to be sure everyone, including the patient, is safe. Safety is the main priority. Some of the options to help achieve safety could be...

- Moving the patient to a different, more safe environment.

- It may reqire chemical or physical restraints

- Involves a rapid, coordinated response

(Kelly, 2021)

Step 7

Step 8: Document and Debrief

In this stage of the De-escalation process, it is important to discuss the events that had occured with the other staff involved (Kelly, 2021).

The nurse must also document the events that had occured, and what was done in the de-escalation process. There may also be quotes and techniques used incorporated in the documentation procedure (Kelly, 2021).

Step 8

Mental Health First Aid (MHFA)

Mental health first aid is a trauma informed intervention that provides a person developing a mental health problem/crisis some assistance (Halter et al, 2019). MHFA is provided before appropriate treatment is discovered, just as regular first aid is given to the injured before medical treatment can be given (Halter et al, 2019).

The idea of MHFA revolves around providing the "skills and knowledge to help people manage developing mental health problems in themselves" (Halter et al, 2019). This approach teaches individuals to notice the signs and symptoms of their disorder, provide initial help, and guide an individual toward appropriate professional help (Halter et al, 2019).

The MHFA course can be offered both in person and online, and the process is very similar to regular first aid training courses.

Mental Health First Aid Approach

Counselling

There are various levels of care when it comes to counselling. These consist of primary, secondary, and tertiary care (Halter et al, 2019).

Primary Care: The purpose of primary care in counselling is to "promote mental health and reduces mental illness to decrease the incidence of crisis" (Halter et al, 2019). This can be accomplished through the use of...

- "Working with a patient to recognize potential problems by evaluating the patients experience of stressful life events" (Halter et al, 2019). In this case, the nurse would work with Max to identify his aggression, suicide attempts, and fathers death. They would identify these stressful life events and recognize future issues that could arise such as additional suicide attempts, self harm, or increasingly aggressive behaviour toward friends and family.

- "Teach the patient specific coping skills such as decision making, problem solving, assertiveness skills, medication, and relaxation skills" (Halter et al, 2019). By teaching Max coping mechanisms, he is less likely to act out or act on his suicidal thoughts. It would be beneficial for him to find other activities that allow him to interact with others, unlike his usual coping mechanisms (video games by himself).

- "Assist the patient in evaluating the timing or reduction of life changes decrease the negative effects of stress as much as possible" (Halter et al, 2019). Max seems to be experiencing some stress when it comes to school. He has no motivation to do his school work, but is stressed about failing. It would be important to help Max decrease the effects of stress by teaching him some effective coping mechanisms such as meditation or drawing. Not all coping mechanisms work for everyone so it is important to find one he will enjoy.

Counselling

Counselling Continued...

Secondary Care: "Includes intervention during an acute crisis to prevent prolonged anxiety from diminishing personal effectiveness and personality organization" (Halter et al, 2019). One of the main things to keep in mind as a nurse is that patient safety is the main concern. Therefore, information about patient safety will be reported and delt with first. The next intervention will be assessing the patients issues, their support systems, and coping styles (Halter et al, 2019). Secondary care often occurs in hospitals, emergency departments, clinics and mental health centres (Halter et al, 2019).

Max's mother has found a pack of cigarettes, and some disturbing images related to death in Max's room. This indicates one of his coping mechanisms is smoking, and the images of death could be related to his suicide attempts. The fact Max has attempted suicide in the past indicates he is at risk of self harm, making him a safety risk.

Tertiary Care: The purpose of tertiary care is to "provide support for those who have experienced a severe crisis and are now recovering from a disabling mental state" (Halter et al, 2019). Tertiary care can be discovered in rehabilitation centers, sheltered workshops, day hospitals, and outpatient clinics. The responsibilities related to tertiary care is to prevent future emotional issues from arising by helping people with more severe and prolonged mental health problems (Halter et al, 2019).

Max has experienced periodic depression throughout his life, meaning he will likely recieve tertiary care at some point in the future if he does not follow treatment. Tertiary care is meant to help individuals who are extremely susceptible to crisis. Max has had a traumatic life and he is only 12. I believe if he continues on the path he is on, and refuses medication/treatment, he will likely need tertiary care in the future.

Counselling Continued...

How to support the family

Before beginning to support the family it is important to extablish rapport with Max and his mother (Oates, 2021). At this time, the nurse will allow both Max and his mother to express any feelings they have in regards to the passing of Max's father. The nurse must maintain a non-judgemental attitude, and express an open environment (Oates, 2021). There is a support system that was created for nurses to help support families struggling with grief. This system is called "NURSE", and can be used by doing the following...

N (Name): Name the concerns they just mentioned. Eg. "You feel lonely"

U (Understanding): Ask if there is anything that can be done to help, as you see the patient is lonely.

R (Respect): Show respect for the patient by saying something along the lines of "I am very impressed with your ability to handle this grief".

S (Support): Show the client that you are there for them when they need, and verbalize this as well. Eg. "I will be here with you for the remainder of my shift"

E (Explore): Use open-ended questions (discussed previously in the presentation) to further develop an understanding on how the patient is feeling. Eg. "What would you say has been the hardest part?".

(Oates, 2021)

How to support the family

Stages Of Grief

Shock: If the death of a loved one is sudden and not anticipated, it can often result in a state of shock for the individual.

Denial: Denying the fact an individual will never see their loved one again is a commonly seen in the early stages of grief.

Anger: Those experiencing grief may feel as though they have been abandoned, which could result in anger. Anger could be directed at anyone present during the death of the loved one, including the Doctors, nurses, friends, family, or even God.

Bargaining: An example of bargaining when experiencing grief would be, "I will do anything if you take the pain away". Oftentimes individuals who experience this sort of thinking will experience guilt later on.

Depression: At this point in the stages of grieving, individuals begin to realize this situation is real, and it sends them into a depressive state. This is an apporopriate response to loss.

Testing: During this process, one will begin to rebuild their life in their new reality. For example, during this stage, Max's mother got another job and adjusted her life according to her husbands loss.

Acceptance: An individual may not be the same after experiencing the loss of a loved one. The stage of acceptance does not have to mean the individual has accepted the loss, but just accepted their new reality.

(Oates, 2021)

Stages of Grief

Interdisciplinary Health Care

Nurse: Oftentimes the patient will interact and see the nurse more than any other health care worker. The nurse is responsible for keeping an open mind and non-judgemental attitude that can allow the patient to feel comfortable with sharing their feelings and emotions. The nurse is also responsible for the initial interactions with the patient. They will document import information and determine which health care professionals may need to be included in the patient care plan. The nurse is an important health care worker to have in Max's plan of care, as the nurse is someone Max will see often and can build a therapeutic relationship with. This will allow him to open up about his feelings and the interdisciplinary team will understand more about his condition from the data gathered by the nurse.

Therapist: Therapists are known to have similar responsibilities as nurses when it comes to caring for the client and establishing rapport. The therapist will go into more detail on the patients thoughts and feelings, and analyze them to possibly establish whether or not the patient is suffering from mental health disorders. As Max has not yet been diagnosed with depression, it would be smart to let him see a therapist. He would also be able to express his feelings in a one on one environment.

Family Nurse Practicioners: These health care workers are responsible for providing the family with the knowledge needed to prevent further mental health issues from arising. They can be responsible for establishing treatment plans, as well as preforming tests and administering medications. Both Max and his mother have experienced a great loss in regards to their family. They would both benefit from seeing a family nurse practicioner in the sense it will provide them with the knowledge and skills to prevent further development of mental health disorders, such as depression.

Each of these health care professionals would be beneficial for both Max and his mother. Although Max is the main priority based on his risk for safety and events mentioned in the case study in regards to his aggression, Max's mother may also need to speak to someone about her emotions. Having a child who is experiencing mental health disorders can be very difficult for parents. Speaking or interacting with a nurse, family nurse practicioner, or therapist may be benificial for her as well (Halter et al, 2019).

Interdisciplinary health care