I first met Serena when I did my clinical placement in the Psychiatry of Old Age (POA) department in Eccles Street over a year ago where she attended as an out-patient once weekly. My preceptor and I have both agreed that Serena would be a suitable client for me to work with as we feel that knowing her from a previous work experience have provided me with an advantage to easily establish an effective therapeutic relationship with her. Also, Serena’s required interventions are within the scope of practice of a Level 3 student nurse under the An Bord Altranais guidelines.
Serena is an 82-year old woman who lives in her north inner city Dublin home with her husband Dan. They ...view middle of the document...
The CMHN also talks to Serena providing one-on-one support. The CMHN then reports all the gathered information back to the consultant psychiatrist and the said psychiatrist comes in to the nursing home to talk to Serena and to evaluate her thoughts, feelings, perceptions, and any developments made. Serena’s relationship with her CMHT is also considered as one of her support systems.
The main health concern for the CMHT and the nursing staff from the nursing home was the risk of suicide Serena posed and thus, becoming the priority of her care. She took an overdose a few months before her admission to the nursing home. “I feel no hope, like I’ve nothing to look forward to,” as she would justify her action. This attempt to end her life was the very reason why she was referred to the said long-term care facility. The other health concern that needs to be addressed was Serena’s presentation of a more depressed state leading to her ineffective coping behaviour. Serena attends the dialysis clinic in the Mater Hospital three days per week and being on dialysis has put her on a great amount of stress. “This shouldn’t happen to a lady of my age, I’m not fit for it,” she would often complain. Serena reported that after her ESRF diagnosis, she’d find it difficult to get an 8-hour sleep. Her husband would also report that while at home on a weekend pass, he’d notice her not eating, feeling really low and showing no interest with doing any of the activities she used to enjoy doing. Nursing staff from GLC have also noticed episodes of agitation, becoming easily upset when demands are not met.
Videbeck (2009) explains that an assessment is an ongoing, tentative and transparent process undertaken with the support of documentation wherein the nurse engages collaboratively and therapeutically with the client to develop an agreed plan of care. GLC developed Serena’s care plan and all of the other residents in a way that their mental health needs are appropriately addressed to as well as effectively managing their physical illness at the same time. The CMHT focuses primarily on Serena’s psychosocial needs, while the nursing staff of GLC responds to both her psychosocial and physical needs but primarily focuses on her physical status and reports of pain or discomfort.
According to Cutcliffe (2003), some people suffering from a mental disorder may be at risk of committing suicide or otherwise seriously harming themselves hence, the need for a clinical risk assessment. Clinical risk assessment is an established tenet of psychiatric treatment concerned with the nature of risk and the types of harm that might occur which in turn, threatens an individual’s health as well as life (Gamble and Brennan 2003).
Barker (1997) suggested that much of the data that is needed to gage the probability of a person committing suicide can be obtained from interviews only, but a combination of scales and interviews enhances suicide risk assessments. I used the SAD...