NURS 2118: Therapeutic Initiatives in Mental Health

Background Information:
Emma Smith is a 33-year-old female with a diagnosis of schizoaffective disorder. Emma was born
in Queensland and is an only child and moved to Melbourne at age 20 to pursue a career in finance.
Emma was diagnosed with depression at age 14 however at age 21 she was diagnosed with first
episode psychosis after experiencing her first psychotic episode resulting in an admission to a
public mental health unit. During this admission she reports that she was sexually assaulted by a co
consumer and had multiple episodes of seclusion. Emma engaged with a private psychiatrist and
psychologist on discharge and remained stable and compliant with medication management.
Emma subsequently married her current husband at age 25 and has experienced a significant
relapse at age 29 in the context of self ceasing medications and disengaging with private supports
after being concerned of the impacts her medication was having on her unborn child at approx.
8months pregnancy. During this prolonged admission to a public mental health inpatient unit then
to a mother baby unit She was diagnoses with schizoaffective disorder and was discharged on
Olanzapine 15mg nocte and Fluoxetine 40mg mane. She re engaged with her private supports.
Emma is now 33 years of age and has been brought to the emergency department by her husband
John who has concerns regarding early warning signs of relapse after noticing Emma has been
talking to herself, poor sleep and appetite and anhedonia. John also reports that two months ago
they commenced IVF treatment. Whilst in the emergency department she is placed under an
Assessment Order and then a Temporary Treatment Order and admitted to the public mental health
inpatient unit.
Assessment Task:
You are Emma’s contact nurse for the afternoon at day 3 (Sunday) of her admission. Emma has
been recommenced on her medication regime of Olanzapine 15mg nocte and Fluoxetine 40mg
mane since arriving on the ward.
Emma has been isolating in her room since being admitted and at times has been heard responding
to internal stimuli in a distressed manner. She is presenting as guarded and difficult to engage with
regarding her mental state. You have gone to administer her nocte medication and she is refusing
this stating “I don’t want it; I just want to go home and see my family. I don’t feel safe here.” She
further states she has concerns regarding the safety of the medication but won’t disclose exactly
what the concerns are. You also note that she refused the previous nights dose and has been
refusing to engage with her treating team and nursing staff.
Details of the Task/Instructions:
– Your introduction should set the scene for the essay, provide context and the scope of what
areas your essay would be discussing.
– Discuss how you would utilise the principles of trauma informed care and trans theoretical
model of change and motivational interviewing to support Emma when it comes to her taking
her medications as prescribed and engaging with services. Your discussion should be embedded
within the available evidence-based literature around the concepts.
– You will need to demonstrate a good understanding of how to link/incorporate MI while
providing trauma informed care.
– What strategies would you employ as a mental health nurse when it comes to working with
Emma and her family to promote recovery?
Please note that this case scenario would also be used for your second written assignment so make
sure you limit your discussion to only the relevant parts of the current assignment due to word
limitations.