Nursing论文模板 – Case Study Scenario One: Olga

Part One:

1.a.  Holistic Assessment and Planning 

Appearance and BehaviorAppearanceMotor behaviorAttitude to situation and interviewOlga is a 92-year-old polish widow dressed in oversized slacks, a t-shirt, and a cardigan. She appears underweight and slim built but with neat hair. She presents a welcoming and corporative appearance to the interview session.
Speech formRate VolumeQuality of information Speech content Disturbance of meaningDisturbance of languageOlga speaks with a slow and hesitant speech. Her hesitant speech causes disturbance in understanding her meaning.
Mood and Affect MoodAffectCongruencyOlga has a depressed mood with a flat affection. She also exhibits signs of anxiety and fear. In the interview, she reported feeling ‘down’ in the previous three weeks.
Form of ThoughtExcess, absence, quality of
thought Continuity of ideas
Olga exhibits psychotic thoughts, which are also enhanced by her failing eyesight. She is scared of leaving her house because of injuring herself over “objects on the ground.
Content of ThoughtDelusionsSuicidal thoughtsOtherOlga expresses signs of delusion, where she claims to injure herself by stabling over unreal objects if she gets out of her house.  
Perception HallucinationsIllusionsDepersonalization/derealizationOlga reports worry over going out in public lately due to the deterioration in her eyesight and fear of falling over an object she has not seen.
Sensorium and Cognition Level of consciousness MemoryOrientation Abstract thinkingOlga seems to have declining cognitive, which has rendered her into confusion and withdrawn.
Insight and Judgement Extent of individual’s awareness
of the problemCan they make rational decisions
Olga is aware that she has a problem and can thus make rational decisions regarding her treatment. She reports feeling ‘down’ and having problems waking up and sleeps more than eleven hours per night.
Risk AssessmentPotential for harm to selfPotential harm to othersPotential for abscondingOlga poses no danger to others but herself. She claims to miss her husband, hence may end up harming or killing herself in the effort of joining her husband.

       1.b. Clinical formulation

Presenting factors   Olga has a declining vision, yet she does want to tell her daughters. She has isolated herself and feels confused and anxious most of the time. A rational examination embracing calm Socratic discourse can assist in challenging her emotional responses to her daughter’s reactions and lose eyesight (Etoom and Ratnapalan, 2014, p. 112). 
Predisposing Factors Olga has had a traumatized past where she has lost friends and family members at a tender age. Such can be described as predisposing factors that put her at risk of worsening her mental state (Bogaers et al., 2020, p. 06).Despite her progressive poor health condition, Olga does not want to ask for assistance from her daughters. She prefers dealing with her condition on her own. Olga misses her husband, who died many years ago, and feels like she might be joining him soon.
Precipitating Factors Olga has had a challenging and traumatic past characterized by the loss of her home and family, and thus, she is scared of asking for help. She is also missing her husband deeply and wishes to be with him. Thus, addressing these issues may play a crucial role in improving her condition (Fahmy et al., 2016, p. 866).      
Perpetuating FactorsHer frustration is characterized by anxiety and fear of the unknown due to her deteriorating eyesight. Hence, she has canceled her appointments with healthcare providers, missing meals s missing meals, and is unable to tell her daughters about her health condition. Nil becomes determined, and this series acts again and again in the form of low mood and anxiety (Lang, 2019, p. 131)    
Protective Factors  Olga has a good relationship with her daughters and grandchildren. Such may prove essential when it comes to managing her house chores and food preparation. Also, she accepts that she has a problem and thus needs healthcare services, which is crucial in addressing her mental state (Chen, 2018, p. 754).

1.c. Plan for Nursing Care

       The first nursing intervention for Olga’s condition is cognitive-behavioral therapy (CBT). CBT is the most effective non-pharmaceutical treatment for a wide range of mental illnesses, including depression and anxiety (Sockol, 2015, p. 7). Olga is suffering from depression and also exhibits some traits of anxiety. With the integration of CBT components such as session structuring, creating a personalized case formulation, activity scheduling, scheme change technique, and thought record, there is a great healing chance for the patient (Chaves et al., 2017, p. 417). The method will help Olga identify and address her negative thoughts, such as not asking for assistance and missing her dead husband. In return, she will learn strategic self-help approaches to develop positive mental health thoughts to improve her mental condition. The approach will integrate a mutually agreed SMART goals setting. The goal for the CBT will involve reducing the time Olga spends thinking about her dead husband to as minimal as possible at the end of 2 weeks of therapy (Miller et al., 2021, p. 02). The therapy will develop emotional intelligence and self-awareness by teaching Olga to identify her emotions and define healthy from unhealthy thoughts. 
       The second intervention is interpersonal therapy. The approach addresses several aspects that enhance interpersonal relations (Dimaggio et al., 2017, p. 19). Olga has an unsatisfying relationship with people, including her close family members, where she does not ask for assistance. Thus, the focus of interpersonal therapy will thus involve improving Olga’s social functioning and interpersonal relationship (Centonze et al., 2021, p. 26). As a result, her mental distress level will significantly decline. Thus, she will develop a healthy mental status by interacting with people who will be helping her in several ways, including going to the market on her behalf. The SMART goals for this intervention will involve at least confiding in three people by the end of 2 weeks of therapy (Gao et al., 2012, p. 274). It will involve enabling Olga to effectively community with others by asking for assistance where required. Hence, addressing issues associated with her depression and loneliness.
       The long-term intervention for Olga will involve building and sustaining a strong social support network (Werner-Seidler et al., 2017, p. 1463). Such is because Olga will need an extended time to form a good relationship with friends and family. It will take time for her to develop positive thoughts as she interacts with family members and close friends, who will eventually help her manage her depression level. Thus, the approach will involve developing stronger ties over time with people around her, where she will learn to ask and appreciate their support. Their support over time will enable Olga to develop a healthy living habit that goes along with way towards eradicating symptoms of anxiety and depression.

1.d Clinical Handover (SBAR Handover)

SituationOlga presents herself as feeling “down” in the last couple of days. She is spending much time in bed. She is having a problem recalling dates and also feels lonely. Her declining vision is making it hard for her to move around.  
BackgroundOlga had recently been diagnosed with mental issues characterized by low moods and anxiety. She has had a traumatic life experience where she has been a concentration camp survivor from World War II since she was only 13 years, and also lost her husband.
AssessmentOlga is suffering from depression and anxiety, which have been contributed by her past traumatic life, and also her lonely life. Also, her worsening vision and declining cognitive skills are contributing to her depression and anxiety.  
RecommendationI recommend that Olga be submitted to psychiatric treatment for anxiety and depression management plan.

Part 2:

2.a. Therapeutic Relationship and Protective Factors

       Olga has a poor relationship with people where she neglects sharing her thoughts even with her family member. She has been confined into isolation, where she is suffering in silence. Therefore, the therapeutic relationship will enable Olga to develop mutual trust with her friends and family. There will also be a general agreement on the set tasks and objectives of the intervention with shared decision making, which will be set between her and the therapist (Boyd and Luebbert, 2019). The practice will also include teaching Olga how to cope with distress, such as the thought of missing her dead husband, develop healthy personal attributes, and strong social support (Boyd and Luebbert, 2019). Close interaction with friends and family members will thus help her develop strong and healthy social support. Olga will be assisted in learning how to ask for support, particularly going to the store to buy food and talk to people about her problems. The practice will enable her to develop healthy coping skills for her low mood, depression, and anxiety situations.
       There are several strategies that an excellent mental health nurse can apply to enhance a quality therapeutic relationship with Olga while engaging in CBT and interpersonal therapy practices. They include showing understanding, compassion, and empathy, which convey and enhance the sense and the feeling of importance where active listening between the nurse and patient is acknowledged to enhance proper understanding of each other (Gunasekara et al., 2014). Secondly, the nurse needs to be attentive and engaged to aspects that matter most in improving Olga’s mental condition (Gunasekara et al., 2014). Thirdly, there is power-sharing between the nurse and Olga, even in a situation where critical matters are involved. Such an approach enables the patient to take charge of her well-being and hence improving the therapeutic intervention.

2. b. Cultural Safety

          The first step I would take as an excellent nurse to ensure the delivery of culturally safe care to the patient will involve a proper understanding of her cultural practice and how they may influence her healing process (Crawford et al., 2017). It will involve interacting with Olga’s entire family to learn their cultural practices. Cultural influences on the healing practicesare essential for well-thought-out functioning with varied beliefs in mental well-being. The traditional setting of the clienteles and the therapist are dominant in the counseling affiliation. The affiliation cannot afford labor minus cautious deliberation of the inferences of cultural assortment. Preferably, the counselor and clienteles might be from a similar culture, and certain drawbacks can be evaded.
       Working with Olga might likely present the issue with beliefs that affect her treatment plan. Individual beliefs can generate gaps within the treatment, hence implicating the treatment process (Guarnaccia and Rodriguez, 2016, p. 420). In exercise, there is a sturdy probability that psychotherapists might deal with clientele from diverse cultures and create examinations deprived of dialectal, intangible, and routine correspondence, tipping to numerous errors in the provision of services and making decisions. 
       In integrating the principle of cultural safety in the nursing care in CBT and interpersonal therapy, I will implement active conversation with Olga (Richardson et al., 2017). Since there might be a language barrier between us, an interpreter will include in the therapeutic practices. The interpreter will also help boost my understanding of Olga’s cultural needs concerning the treatment. Language is dominant in understanding any culture. In the scenario of Olga in Australia, the inclusion of the interpreter will promote cultural diversity, enhancing an effective and appropriate healing process while embracing the correct counseling aims. 

2.c. Recovery-Oriented Nursing Care

       Recovery-oriented nursing care is associated with Olga’s respect and dignity to effectively highlight the chances of their well-being or recovery (Happell et al., 2017, p. 01). The approach involves full utilization of self-management and self-determination to enable Olga’s family to appreciate their roles in supporting their loved ones in the healing process. For instance, Olga’s daughters can be integrated into the healing process of their mother. They may be advised and encouraged to provide support for their mother, such as helping her at home with going to the store to buy food, cooking, and providing the company she needs to avoid the loneliness that may trigger the feeling of missing her husband.
       While implementing the principles of the recovery model or philosophy concerning Olga’s case may involve looking at both short and long-term approaches. The short-term aim of counseling will be embracing workable therapeutic strategies for dealing with low mood and anxiety. It may involve self-determination where Olga may be encouraged to identify and implement her route to recovery, such as learning to open and letting her friends and family help her at home (Piltch, 2016, p. 77). On the other hand, the long-term technique aims to develop appropriate therapeutic strategies for dealing with loss. It should be noted that Olga has unresolved issues dealing with her father’s death and her beloved husband. For this aspect, an individualized and person-centered approach can be helpful as it will involve addressing Olga’s emotional needs due to her loss, preferences, strengths, and cultural background (Stanghellini and Mancini, 2017, p. 03).
       Furthermore, hope can be a fundamental approach in Olga’s healing process (Rafiey et al., 2017, p 243). For instance, she yawns to join her dead husband because she loses hope in living a lonely life. Therefore, presenting the issue with her loving daughters and grandchildren may restore her urge to live longer to continue interacting with her family. If all these aims are embraced in every counseling session, she will be able to find solutions to the issues at hand.


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