In this case study, one day of care for a 28 year old, male patient on a low secure psychiatric unit will be examined and discussed. The main focus will be on implementation and evaluation of the nursing process. These areas will be covered under; physiological, psycho-sociological and pharmacological aspects of the patient’s care. Although, the case study is discussed using third person expression, the care discussed is what was implemented and evaluated by myself, a second year student nurse, under supervision from a qualified member of staff.
Having considered the physiological health complications, this case study now moves on to focus on the issues requiring psycho-sociological interventions.
Following the discussion about Rob’s possible diabetes diagnoses, he later complained of hearing voices and was becoming very aggressive and agitated. As the day went on, Rob was seen shouting to himself whilst wondering up and down the communal corridors. The strategies used to take control of the situation included, giving clear instructions for other patients to vacate the area and coaxing Rob into a quiet room as suggested by (Shinkwin et al. 2007). This is different from seclusion because the patient voluntarily removed himself from the situation (Davison, 2005). Once Rob was alone, an attempt to connect and reason with him was made. As recommended by NICE (2005), whilst ensuring the exit was close and risk assessment was mentally complete, Rob was approached in a calm sensitive manner, in a way which preserved dignity and respect, and was given the opportunity to express the reasons for his distress. When this did not help, a person centred approach was used to demonstrate an empathetic understanding of the possible diagnoses of diabetes, which was thought to have caused the outburst. The Royal College of Psychiatrists (2007), purpose that interventions used to defuse disruptive behaviour should be delivered in a person centred manner. However, whilst this intervention seemed to pacify Rob’s conduct, as he therapeutically discussed his worries, it was not long before his behaviour accelerated once again, the minute he was back on the ward.
Although de-escalation strategies were introduced, the behaviour escalated to him making inappropriate comments and becoming verbally abusive. This may have been due to the atmosphere felt, once out of the quiet area. Tensions were still running high with the other patients on the ward. In contrast to being on the open ward, where there was other patients to contend to, whilst Rob was on a one to one, he was made to feel like he was given undivided attention. An example of this is making eye contact, where necessary, and nodding along in understanding to what the client had to say in a none judgemental manner. According to Dufresne (2003), if people do not feel they are not being listen to, they may ‘up the ante’ in order to get the attention which they desire. It is possible that once...