Case Study for Assessment 1 and 2 - Note: your student assessment work must focus on Chung, regardless of your status as a nursing or midwifery student.
Chung is a 35 years-old male who moved to Australia from China five years ago. His parents, older brother and younger sister still live in China. Chung visited his family in China once after a year of moving to Australia. He has not returned to China since, because of his long working hours and need to undertake additional study for promotion.
Chung is a doctor working in Accident and Emergency in a busy inner-city hospital. He is studying for promotion to ultimately become an emergency medicine consultant. Two years ago, Chung was under investigation by the hospital Human Resources department due to a drug error. He was very tired and had been on-call over-night with frequent call outs to see patients. The drug error resulted in an eight year-old boy being very sick, requiring intensive care admission. Chung used an intra-muscular medication to treat the boy but administered it intravenously. Chung was subjected to several work-place and medical board investigations and placed on practice supervision for 12 months.
Chung met his wife, Harriett, in Australia four years ago. Harriett is 30 years old. They married two years ago. Unfortunately, Chung’s parents and family could not attend the wedding due to the high costs of travel and his mother has severe arthritis in her hips, making travel very difficult. Chung found their wedding day emotionally difficult. He felt the ceremony lacked reference to his Chinese culture. On reflection, he feels that he wasn’t as involved in the wedding planning as he could have been, due to his long working hours. He simply agreed to the suggestions and plans made by Harriett and her family.
Chung and Harriett now have a three week-old baby girl, Charlotte. Charlotte was born by caesarean section, due to birth complications. Harriett has had an infection in the operation site since the birth, resulting in lots of pain, frequent dressings and difficulties moving around. Chung was off work for one week after the baby’s birth. However, he has now returned to working shifts, often working through the night, where he may go without sleep for 20 - 24 hours. Harriett’s parents are staying with them to support Harriett while Chung is at work. However, he finds that Harriett’s parents are very involved with baby care even when he is home. Given this, Chung finds he gets very little time and space to be with his new daughter.
You are visiting the family in your capacity as a community nurse supporting Harriett with the caesarean section wound care or as a midwife undertaking a post-natal visit. During your visit to the family, you notice Chung looks flat in mood and tearful. His affect is sad and restrictive. He is slumped in his chair, with rounded shoulders and starring at the floor for long periods. You inquire about his health. He has very limited eye to eye contact with you. His speech is slowed and purposeful. On occasions, you need to repeat your question several times to get a reply. However, you do manage to obtain the following information from Chung. He has been feeling increasingly anxious during the past two months, given his continuing long hours, shift work, the high pressure of an Accident and Emergency department, Charlotte’s birth and his wife’s health. He has been having palpitations, chest pains and breathlessness for six to seven weeks. He asked a colleague at work, another doctor, to assess him for cardiac issues several weeks ago as he had been experiencing thoughts that he was going to have a heart attack and die. Chung has been feeling very low in mood for the past six weeks, experiencing sleeplessness, particularly initial insomnia and early morning wakening at 3am. He has lost five kilos in weight during the past month, due to reduced appetite and missing meals. He feels he is worthless and a failure at work within his medical role and he is letting his wife and new daughter down. He has been experiencing fleeting thoughts of suicide for the last week. He is aware of high lethality medications which he could take to overdose. Currently, he is hopeless and helpless and wants to die. He states he feels his situation is self-imposed and that treatments will not be of help at this time.
Question 1 - 500 words - 10 marks Using relevant literature critically discuss the mental health status of the client in the case study. Your work should make reference to two (2) components of the Mental State Examination (MSE) related explicitly to the case study and the DSM V. (4 marks MSE, 4 marks DSM V, 2 marks for references)
Question 2 - 500 words - 10 marks Critically discuss two (2) factors which have contributed to the development of the client’s current mental health status. You should demonstrate your knowledge of the Stress Vulnerability Model. Your work should clearly identify the contributing factors; make reference to the case study and relevant literature. (2 marks for Stress Vulnerability Model, 3 marks for each contributing factor, 2 marks for references)
Question 3 - 500 words - 10 marks Respect, empowerment and hope are three (3) positive aspects of mental health recovery. Using relevant literature and the case study, critically discuss how these three (3) principles could positively contribute to the client’s journey of recovery. You should demonstrate your knowledge of recovery orientated mental health theory and practice. (2 marks for recovery orientated mental health theory and practice, 2 marks each for factors, 2 marks for references)
An APA reference list must be included with your work. Your work should include at least 10 different pieces of literature, no more than 5 years old unless it is seminal work
Hints and tips for assessment one – 401013
• Read the case study several times before doing anything else – ensure you have a good understanding of the client’s history, possible contributory factors, family situation, employment, current presentation, actual and potential risks to self, family and others.
• Carefully consider the search terms and keywords in your literature search.
• Use journal search engines such as: Scopus, ProQuest or Google Scholar. With key words / terms such as: mental state examination; low mood; depression in males; post-partum depression for males; mood and new fathers; depression and medical staff; anxiety in males; depression or anxiety among Chinese migrants; Stress Vulnerability Model; mental health recovery.
• Try to have most of your references from research papers or policy papers.
• Websites such as: Department of Health; Mental Health Commission; Reach Out; Beyond Blue; Black Dog can be helpful as long as properly referenced in your work.
• There is no need for an essay introduction nor conclusion in your work for assessment one.
• You are required to use an academic writing style throughout your work using literature to support you.
• Please number each of your answers, 1,2,3, so the marker is clear which of your answers relates to which question.
• Each question is marked out of 10 and each answer should be 500 words. Avoid using 600 words for one answer and 400 words for another question, as this will reduce your opportunity for higher marks.
• Make sure each question relates back to the client in the case study and incorporates literature.
• Your work should extend more than description or discussion but should move towards critical analysis. One way to do this is to compare and contrast the ideas in the literature. For example: what are the similarities and differences from different pieces of research or noted in policy.
• It’s fine to use a few sub-titles if that helps you to structure your work.
• You should have one reference list which includes all the references from the 3 questions.
• An APA reference list must be included with your work. Your work should include at least 10 different pieces of literature, no more than 5 years old unless it is seminal work.
• Ensure you avoid cutting and pasting text. This will result in review under the Misconduct policy. It can also reduce your overall mark of your work.
Question 1
• You are asked to think about the mental health status of the client making reference to the Mental State Examination.
• Make sure you think about the Mental State Examination (MSE) here and not the overall mental health assessment structure. You will learn more about this in session 2. We want you to think about the present state / presentation of the client in terms of the components of the Mental State Examination such as: appearance and behaviours, affect, mood, thought form, thought content, perception, judgement and insight for example.
• We also want to see that you can think about the client’s presentation with reference to the DSM V. You can do this by thinking about the specific criteria for diagnoses. Show that you can consider the criteria and how they may be relevant for this particular client in the case study. For example: you might want to suggest the client has depression or anxiety so show you have considered the criteria for depression or anxiety which are relevant and how.
• We are expecting that you will have more literature other than the MSE and DSM V for question 1. You should also use other research papers.
• It’s a good idea to aim for 250 words for the Mental State Examination (MSE) and 250 words for the DSM V sub section.
• (4 marks MSE, 4 marks DSM V, 2 marks for references)
Question 2
• Asks you to show your understanding, using literature, of the Stress Vulnerability Model. It would be reasonable to use 100 words for this as the maximum marks for this is 2.
• You are also asked to think about 2 contributing factors where you should make reference to the case study and literature.
• You should use 200 words to identify and discuss, critically analyse the literature for each contributing factor.
• A good way to think about contributing factors are possible stressors which could have impacted on how a person thinks, feels and behaves. For example: having a new baby could be a contributory factor as it creates change in the couple’s relationship; may change the time a person has for themselves and their hobbies; may challenge a person’s sense of self; may increase anxiety; lack of sleep as a result of caring for a new baby can result in changes to a person’s energy and mood.
• (2 marks for Stress Vulnerability Model, 3 marks for each contributing factor, 2 marks for references)
Question 3
• Question 3 asks you to show your understanding of the mental health recovery model / theory and to relate the recovery principles of respect, empowerment and hope to the client in the case study.
• Ensure you relate your answer to the client in the case study and include relevant literature.
• Recommended use of words – 125 words for recovery model / theory and 125 words for each of the principles – respect, empowerment and hope.
• To help direct your thoughts for this question, you might want to ask ‘how can the health professional show respect or exercise a respectful to the client in this particular case study and how could this support his recovery?’ You might want to consider how his family can show a respectful attitude towards the client to better support his recovery or how could his employee be respectful give his current situation to support the client. Thinking about the wider community approach to mental health concerns may also be helpful here. i.e. how can the language used by members of the community support his recovery. ie non-stigmatising language. How can a health professional facilitate self-respect for the client?
• You may want to ask these questions in relation to empowerment also. ie. how can a health profession, family, employer and the wider community offer greater empowerment to the client to support his recovery? How can this be helpful and why?
• Also, how can hope be helpful for the client, particularly given his current presentation and concerns for self and possible self-harm and suicide? How can a family member, employer and community members support greater hope for this client and why?
• (2 marks for recovery orientated mental health theory and practice, 2 marks each for factors, 2 marks for references)