Alcohol & Drugs Mental Health Case Study - Nursing Assignment Help

Assignment Task

Task
Opportunity to Reattempt Students will not be given the opportunity to re-attempt this assessmentASSESSMENT 3: WRITTEN ASSIGNMENT
Assessment 3: Written Assignment - Case study
Criteria Marks Score
Structure and cohesion of case study overall (10%) 0 marks
Structure and cohesion not apparent 1-3 points
Evidence of attempt to provide structure and cohesion to paper 4-6 points
Structure clear with solid attempt at ensuring cohesion overall 7-8 points
Structure clear, and concise with overall cohesion apparent 9-10 points
Well-structured paper, clear and concise, easy to read and well organised; a coherent and complete document /10
Brief synopsis of case study (10%) 0-2 points
Less than adequate synopsis. 3-4 points
Some evidence of attempt to provide a synopsis of case study. 5-6 points
Adequate synopsis of the case study. 7-8 points
Competent and succinct synopsis of the case study. 9-10 points
Focused, clear and concise synopsis of the case study demonstrating careful thought. /10
Overview of the therapeutic intervention, its rationale for use, skill development (10%) 0-2 points
Not attempted, or minimal attempt only. 3-4 points
Limited overview with key areas superficially covered. 5-6 points
Adequate overview with key areas addressed. 7-8 points
Succinct and competently structured overview with all key areas covered. 9-10 points
Focused and well-developed overview with all key areas covered  and clarified succinctly. /10
Synopsis of evidence base for use of the intervention (20%) 0 points
Not attempted. 1-5 points
Limited synopsis with minimal key evidence included. 7-10 points
Well-structured synopsis with key evidence clearly summarised. 11-15 points
Competent synopsis with key evidence clearly identified. 16-20 points
Clear, concise synopsis with key evidence succinctly summarised. /20
Constructive critique & analysis of therapeutic intervention
(25%) 0 points
Critique and analysis not attempted. 1-8 points
Limited critique with some reference to key literature. 9-14 points
Demonstrating some competency in critique & analysis with integration of key references. 15-19 points
Competent and comprehensive critique & analysis with strong integration of key references and concepts. 20-25 points
Demonstrates profound critique & analysis with sound justification of responses and defended integration of key references and concepts. /25
Ethical issues and concerns (10%) 0 marks
Not addressed. 1-3 points
Some attempt to address this aspect. 4-6 points
Adequate discussion of this aspect. 7-8 points
Competent discussion demonstrating careful thought. 9-10 points
Focused discussion demonstrating careful thought and depth of insight. /10
Use of evidence to support discussion (15%) 0-2 points
Discussion supported mostly by personal opinion. Very poor use of resource material and no APA referencing. 3-6 points
Limited sources cited, too few, or of poor quality, little evidence of scope and depth of reading – poor and limited APA referencing. 7-9 points
Sources cited showed relevance to the topic, but were limited in scope and/or quality – incorrect APA referencing. 10-12 points
Sources cited showed relevance to the topic and were developing in scope and/or quality. Mostly correct APA referencing. 13-15 points
Sources cited were relevant to the topic and showed scope and quality. Flawless APA referencing. /15
Mark /100
  FINAL MARK /40
Useful reference:
Please refer Geller & Greenberg text book /article for relevant information ;Referencing APA 7
Geller, S. M., & Greenberg, L. S. (2012). Therapeutic Presence: A Mindful Approach to  Effective Therapy, Ch 1 (pp. 17-35). Washington: American Psychological Association 
Agrawal, S. and M. Edwards (2013). "Upside down: The consumer as advisor to a psychiatrist." Psychiatric Services, 64(4):301-302.
Some useful information BELOW from previous similar assignments from other Uni . Please don’t copy & paste it. I need similar method - the case study continuing as scenarios. Please send me any clarification or doubts, then I can also assist you FOR PERFECT COMPLETION OF MY CASE STUDY.
Sample assignment from utas
Mr. Thoms is a 35 year old man who presents to a public drug and alcohol treatment centre in NSW. On arrival, he is under the influence of alcohol, is teary and distressed, seeking treatment for an exacerbation in alcohol consumption. As a Registered Nurse within the centre, the author invites Mr Thoms to a private interview room for further discussion and completion of a drug and alcohol assessment. Within the course of the assessment, Mr Thoms discloses for the first time a history of childhood sexual assault. Mr Thoms states he is so overwhelmed by the experience, he drinks to ‘block it all out’. With alcohol use now impacting on his employment reliability, Mr Thoms expresses a desire to stop drinking.
It has been well established that people experiencing substance dependence also have experience of trauma. Historically, approaches to drug and alcohol treatment planning did not address trauma, for fear of compounding the lived experience (Brown et al., 2013). According to Moloney et al. (2018), recent developments have resulted in a paradigm shift, the incorporation of trauma informed approaches. To be trauma informed is to consider what happened to people, rather than what is ‘wrong’ with them (Minkoff and Cline, 2005, p. 16). Further, it is the application of a multi-dimensional approach that interprets the human experience as a product of internal and external influences (Harms, 2015).
The portrayal of safe and calm is foremost in promoting client engagement. Within the given example, ‘welcoming’ and body language are foundational to developing rapport. Harms (2015) acknowledges ‘welcoming’ as a sense of meeting the patient where they are – the clinician unbiased, non-judgemental and accepting. In this instance, Mr Thoms was greeted, offered a private space, and listened to. The clinican consciously maintains open posture, leaning in to express interest, maintain eye contact, and be relaxed ((Egan, 2014, in Harms, 2015). As early as 1987, Selye (in Harms, 2015) reports non-verbal cues as a base survival instinct to read safety. With 80-85% of communication cues received non-verbally (Harms, 2015), the behaviours enacted by the clinician promote a sense of safety and security. In addition to these fundamental non-verbal cues, the author offers reassurance and validity. Reassurance is multi-dimensional and should encompass words of comfort, allow Mr Thoms to feel believed, and include providing options for Mr Thoms to consider ‘next steps’ -reassurance meaningful help is available.
Key indicators of Mr Thoms’ engagement are foremost, his continued presence. As described by Rosenberg (2011), it is impossible to help a client who is absent. Non-verbal cues such as posture and eye-contact indicate ‘presence’ within the encounter. The content of Mr Thoms speech will indicate motivation and intentions for treatment – the clinician is then patient driven in response and intervention (Redko et al., 2017). Treatment decisions must be patient driven, supported by information and knowledge from the clinician.
The experience of substance use and trauma are both stigmatising. Professionals can reduce the impact of stigma, a very real and complex problem, through the power of words. Choosing words that focus on people, rather than define them by their substance use. According to the Alcohol and Drug Foundation (no date), the right words have the power to improve health outcomes. Substance use is a public health issue, and should be treated as such, rather than framed as a moral failing (Worley, 2017). The clinician utilising a strengths-based approach contributes to rapport, trust development, and relationship building.

The ability to ‘hear the story’, rather than simply the presentation, is the essence of empathy. The understanding people are more than their substance use – substance use often a response to the traumatic experience. Empathy, as an outcome of warm, genuine and positive professional relationships, is fundamental to healing (Harm, 2015).

Summers and Barber (2003) recognise the strength of the collaborative relationship between patient and professional as crucial. This idea is further supported by Harms (2015) through the concept of ‘use of self’ – how to centre the client-professional engagement, and respond contextually. The skills and knowledge of the professional then facilitate growth and accomplishment (p. 80) for the patient. It has been shown how essential helping skills, qualities and attributes such as active listening, being authentic, present, positive and patient focused are fundamental to the therapeutic process. The expertise of the clinician is pivotal – a potential limitation given the subjective variables, when considering ‘use of self’ (Vanderplasschen et al., 2019).

Some extra points to add if needed.
Assessment of clients presenting to outpatient community-based drug and alcohol services presents many challenges, one of which is engagement. Client presentations range from actively seeking treatment and ready for change to those coerced by external pressures (such as family or criminal justice system) and still precontemplative to change. Many clients also present with significant history of trauma in their lives, a factor that has been shown to have long term negative health outcomes (Brown, Harris & Fallot 2013; Drabble, Jones & Brown 2013). Loxton et al. (2019) found that women who experienced adversity in childhood had higher primary, allied and specialist healthcare costs in adulthood as compared to those who did not experience adversity in childhood. Childhood trauma has been shown to change neural structure and function whereby the individual is more susceptible to cognitive deficits, psychiatric illnesses and substance use disorders (Khoury et al. 2010). Given the high rates of clients with history of trauma accessing drug and alcohol services, it stands to reason that services should adopt trauma-informed systems based on “principles of client choice, empowerment, collaboration, safety and respect, resilience, and goal to minimize organizational retraumatisation” (Drabble, Jones & Brown 2013 pp.93).
The “use of self” is an important concept and influencing factor in developing therapeutic relationships. Harms (2015) describes the “use of self” as being the application of emotional intelligence and social intelligence in relationships with others (pp.78). The “use of self” can refer to direct use of our own personal feelings, views and experience or more broadly to our conscious actions during an encounter (Harms 2015). The “use of self” is not a static concept but rather changes and adapts over time and different contexts. To build and enhance a therapeutic relationship it is important to critically reflect on one’s “use of self” and how it can be best utilised for the client.
A client, for the purpose of this essay will be named Annie, presented to our community-based service seeking assistance with cannabis use. Annie was mid 50s and had experienced multiple traumas in her life including child sexual assault, domestic violence and failed medical interventions which had left her with significant physical scaring and cognitively impairment. Annie had never sought out treatment for her substance use previously and was overwhelmed with anxiety and shame. It quickly became evident that Annie needed a safe, secure, non-judgemental and low-pressure environment in order to tell her story. Given time pressures in the workplace for assessments to be completed this was not a simple task. As in many cases the balance between providing client-centered or client-directed care and engagement against time pressures of the service is a challenge. Harms (2015) describes “use of self in context”, that being how one develops the therapeutic relationship within the constraints of the organisation and the environment or setting. These factors were important to consider and overcome as the interview room is very clinical in nature and not very conducive to empowering the client and promoting inclusion. Being conscious of body language or “use of physical self” helped to overcome some of these environmental challenges (Harms 2015).
As this was Annie’s first time in contact with drug and alcohol services, I felt it was important to establish not only a positive relationship with myself but also with the service as a whole. When clients have negative experiences of services or clinicians when seeking help, it can hinder their engagement in treatment at the time and also future contacts. Throughout the assessment, I was conscious to convey a non-judgemental, empathic, warm approach to foster a safe and trusting relationship important in trauma informed care (Brown, Harris & Fallot 2013). I used an open communication style and active listening, acceptance and unconditional positive regard (MacLaren 2008). Annie responded well and after being initially guarded in her responses for fear of judgement, she became more open and offering further information and insight into her life. In responding to information disclosed, I was conscious of managing my own emotional response, particularly when Annie became tearful and distressed at times. Being aware of the language I used and reflecting the client’s own vocabulary assisted in fostering open communication.
Mentha and Thomson (2012) discusses four components to the spirit of engagement under the framework of Motivational Interviewing; partnership, acceptance, collaboration and evocation (pp.11-14). In my practice I adopt a strengths-based approach to work with the client to identify their treatment goals and plan. This ties in with therapeutic emotional use of self as I aim to “walk with” the client through being empathic and authentic while remaining client focused (Harms 2015). In Annie’s case, by utilising self and showing empathy and remaining client-focused she was engaged in the assessment process and felt empowered to make decisions regarding her treatment plan.




More points
ntroductionResearch has recognized the importance and benefits of clinician’s interpersonal skills to support the safety, enhance communication, involvement, and a sense of calm through a consumers recovery process. The numerous advantages within the recovery process for consumers is well documented in scientific literature such as Harm (2015). It has become evident that clinicians play a major role within the recovery process, and as such their involvement in the consumer’s recovery process should be encouraged.
The concept of self and the role of self is an important tool within professional practice, it enhances a clinician’s ability to identify changes that need to be made, as well as identify the broader issues and consequences of situations (Crookes 2017). Using Borton’s developmental model (1970) and Rolfe, Freshwater and Jasper’s (2011) framework levels of reflective practice, this discussion will explore what is required to contribute towards positive change within practice. This is achieved through undergoing a reflective process within personal practice and developing a deeper understanding of the situation, actions and consequences of those actions.
This discussion also aims to highlight the benefits and importance of clinician’s involvement within the recovery process.
Overview
I will be focusing on a situation I had experienced as a Registered Nurse Specialising in Mental Health. My consumer has a traumatic history that contributed to Drug Induced Psychosis and Self Harm, she was admitted to a Mental Health inpatient unit after an attempted suicide. For the purpose of this reflection, I will be naming the consumer Anny. Anny had been admitted to the unit on a care level 3 (half hourly observations and engagement’s). During my engagement and observation round I found Anny wrapped in a blanket on the bedroom floor curled up in the fetal position rocking. When I approached her and asked her to remove the blanket she did, but she has a bed sheet wrapped around her neck.
Interpersonal skills used to reinforce Anny's safety, and sense of calm during the assessment processIn order to provide effective care for Anny I needed to establish a strong rapport with herself as it benefits her throughout her care (Edward K, et al, 2014, pp. 357-360). I had been Anny’s nurse for 3 days at this point and we had developed a good rapport by discussing common interests and shared some natural supports like art and music. By using effective communication and encouraging collaboration, I was able to create a stable environment for her. When I found Anny I asking her to give me the sheet, pillow case and blanket, removing all bed linen and calling the Nurse in Charge to assist. I also lowered Anny’s care level to a two (15-minute observation and engagement) and locked dangerous easily accessible items such as colouring in pencils and towels away, so she could not access them.
When I found Anny, I started to experience negative feeling of self-doubt and my ability to care for consumers with dual diagnosis. However, I quickly came to the realisation that I needed to de-escalate the situation as quickly as possible to ensure no harm came to either one of us (Cutler, N 2017). Given my duty of care for Anny, the first action I took involved preventing her from self-harming by removing the sheet and bed linen (Preventing and Managing Violence in the Mental Health Workplace 2018). This then allowed me to quickly escalate the situation to a more experienced staff member, which meant my involvement in the situation was more supported (NMBA 2006, P.7).
Clinical indicators
Anny’s recovery depended on her individual needs, and I tailored her care plan to be specific to her needs. After the incident I sat down with Anny and included her through her care plan construction. By including Anny in her care plan. I was able to empower Anny and gave her more opportunity to take control over her own life and helped develop strategies to manage the effects and symptoms of her illness (NSW Mental Health Commission 2014, pp.4-118). As supported by the Mental Health Act (2007), a consumer’s quality of life is increased when they are involved in their plan of care. When the healthcare team works collaboratively with a consumer, it enhances a therapeutic relationship and partnership allowing for better communication between all parties involved within the care (Fisher J, 2011.PP. 63 - 64).
Another advantage of including Anny in her care was the development of her ability to set her own goals, which in return gave her a sense of empowerment and maintains their dignity (Edward K et. al, 2014, pp.91 - 102). By providing a consumer with dignity and respect, a health care professional can assist the consumer to enhance their recovery through their own health care goals (Edward K et.al, 2014, pp.91 - 102).
Essential helping qualities, attitudes and skills that are critical to the experienceI believe that self-advocacy when appropriate assists the consumer to establish achievable goals and reduces the risk of hospitalisation as they can then create a clear understanding of their illness and how to manage it in a less invasive environment (Edward K et.al, 2014, pp.91 - 102). By Including Anny throughout her recover process, I created a safer and more consistent environment for her resulting in better treatment and overall care (NSW Mental Health Commission, 2014).

 

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