Mental Health Nursing Essay Example

  • Category:
  • Document type:
    Case Study
  • Level:
  • Page:
  • Words:


Mental Health Nursing

Demonstrates an understanding of DSM-IV TR criteria of substance abuse disorder as exhibited in case study

Carol has a substance abuse disorder as she meets the DSM-IV-R criteria for the condition. Substance abuse disorder is a maladaptive pattern of using substances and this leads to distress or impairment in a clinically significant way (ABS, 2008). Carol meets the criteria in the following ways; — First, the substance use is recurrent and results in failure to meet important role obligations at school, work, or home, leading to absences, expulsions, or neglect of households. This is evident in the case, in which Carol’s frequent absenteeism from work leads to her termination. Second, there is recurrent substance use even in physically hazardous situations. Evidently, Carol drinks and drives as shown by the 0.15 PCA alcohol range in her system, her slurred speech, and alcohol-smell breathe, when she is rescued from the automobile accident. Moreover, it is not the first time that she is involved in a similar situation. The third criterion describes the continuous use of substance despite having recurrent and persistent interpersonal or social problems as shown by Carol’s continuous arguments and fights with her family and ex-boyfriend.

Presentation of the epidemiology, prevalence, possible causes, hospital rates and burden of disease related to Cannabis use in Australia.

Presentation of the epidemiology, prevalence, possible causes, hospital rates and burden of disease related to Cannabis use in Australia.

Cannabis, also referred to as Marijuana is one of the most commonly used illegal drug in Australia. Nevertheless, the incident rate has been declining since 1998 (Hall& Babor, 2000). Generally, the UNODC (United Nations Office on Drugs and Crime) reports a third (5.8 million) of Australians at the age of 14 and above have tried cannabis at least once and 1.6 million people have used it in the recent years. This makes it three times more than the world’s proportion. The NCPIC (National Cannabis Prevention and Information Centre) reports that 750,000 Australians use cannabis on a weekly basis while 300,000 use it on a daily basis. Majority of cannabis users in Australia fall in the age group of 14 and 64 years, and the use is most prevalent among males and females in the 20s (Hall& Babor, 2000).

The causes for cannabis use in Australia include self-generated reasons such as the need to get mood enhancement, cope with negative moods, facilitate socialization, conform to peer pressure, and expand the cognitive and perception (Hall& Babor, 2000). However, increased frequency in cannabis use leads to cannabis-related problems. In 2006, around 11,700 hospital cases of drug use among people aged 15 and 24 years was reported (ABS, 2008). More hospital cases have also resulted automobile accidents, self-harm, and suicidal tendencies, these being factors related to drug use. The death and disability levels from injuries and risk to health as a result of marijuana use have resulted to disease burden. Illicit drugs such as marijuana accounted for an estimate of 197,000 DALYs among people aged between 14 and 24 years in 2003 (ABS, 2008).

Discussion of the relevant causes and psychodynamic factors/influences affecting mental health, as per case study, is supported by relevant and current literature

Family factors such as a chaotic home environment, lack of parental attachment and nurturing, or ineffective parenting can be risk factors to substance abuse disorder (Amanda, 2011). According to psychodynamic theorists, people that are vulnerable to substance abuse have very powerful dependence needs and these can be traced to their early or childhood years. This is especially true when parents fail to fulfil the child’s nurturance needs, causing her to grow up depending excessively on outside support for comfort and assistance. The outside support includes peers, drugs, and alcohol, of which the affected person develops a relationship that can lead to substance abuse. This explanation well suits in Carol’s case. At 25 years of age, Carol abuses alcohol and marijuana and claims that they comfort her from negative life situations such as strained relationships with family and ex-boyfriend, and generally, a past difficult life. Moreover, most of her peers smoke marijuana and therefore she does not see any problem with the habit. Tracing back to her childhood, Carol describes it as terrible, because her parents always yelled at her and fought each other, always throwing punches and scaring the children. Carol’s case is that of substance abuse and dependence because she smokes about three to four joints of marijuana every three or four times a week. Moreover, she intoxicates herself with alcohol to the extent that she fails in major role obligations and causes accidents while driving her car. The 0.15 alcohol percentage in her body system after the accident shows that she is abusing alcohol by drinking off the limits.

Furthermore, according to the psychodynamic theory, certain people respond to their early nurturance deprivation by developing the substance abuse personality. This leaves them prone to drug abuse. According to Comer, (1999) people who abuse or depend on substances tend to be more dependent, antisocial, depressive, novelty-seeking, and impulsive as compared to other people. In the case, Carol is sad about her life but finds no problem with the habit of using marijuana, making it part of her lifestyle. Carol has been described as irritable and she is stubborn at cooperating during the assessment. Moreover, she exhibits low self-esteem and pessimism by describing her life as doomed just because her work, family, and love relationships have failed. However, it is not clear as to whether the abuse of substances leads to such personalities or such personality traits lead to substance abuse.

Other causes of substance abuse disorder include having poor social coping skills as well as poor performance in school. These are observed in Carol, who had to drop out of school at 15 years of age, because of poor academic achievement. Association with a peer group that is deviant also increases the chances of one adopting the substance abuse habit. Another cause involves the perceived approval of the drug abuse behaviour. One of the main reasons that Carol believes it is alright to puff marijuana is because her friends are also using it. Worth noting is that drug abuse has no single cause and various risk factors are involved. The factors can be categorized into include psychological, social, and biological dimensions.

Key major AOD/mental health problems or risks related to case study

  • Risk for self-directed harm as evidenced by suicidal desires, because of stressful life situations, e.g. relationship problems, and loss of job.

  • Risk for injury as a result of internal and external environmental conditions which interact with the patient’s adaptive and defensive responses. This is as a result of substance intoxication, psychomotor agitation and panic level of anxiety characterized by feeling down, angry, sad, distressed, and irritable in response to crisis; specifically over the loss of job and failed relationships with ex-boyfriend and family. Carol says “Her life sucks”.

  • Risk of development of a negative self-worth perception in response to the current situation of losing boyfriend and job. This is related to loss of the capacity to remember things, and ineffective verbal communication; and evidenced by excessive irritability, and refusal to participate in therapeutic assessment.

Relevant nursing interventions THREE (3) for each mental health problem or risk identified previously

  1. Risk of self-directed harm

  1. The nurse will observe the patient’s behaviour during the patient care routine (Amanda, 2011).

  2. The nurse will carefully listen at suicidal attempts and observe any non-verbal indications of suicidal intent (Sawchuk & Olatunji, 2011).

  3. The nurse will ask direct questions and directly state phrases to determine the suicidal intent, the suicidal plan, and the means to commit suicide (Marydiyono, Songwathana, & Wongchan, 2011).

  1. Risk for injury

  1. The nurse will assess the patient’s level of disorientation to determine the exact requirements for safety (CRICO/RMF, 2011).

  2. The nurse will obtain an accurate drug history of the patient in order to determine the kinds of substances used, the last time of ingestion or intoxication and the amount used, the length and frequency of consumption, and the quantity used on a daily basis (Frisina, Guellnitz & Alverzo, 2010).

  3. The patient will be placed in a quiet and private room in which safety precautions are instituted. The nurse will achieve this by observing the patient’s behaviour on a frequent basis, and assign staff on a one-to-one condition as it warrants. The client will also be accompanied and assisted in long distances. Side rails will be pulled up when the client is on bed and mechanical restraints will be used where necessary to protect the patient in moments of hyperactivity and disorientation (Townsend, 2008).

  1. Risk of development of a negative self-worth perception

  1. The nurse will devise methods to assist the client with the problem of memory deficit. These include placing a large calendar that indicates a day at a time with the month, day, and year illustrated in bold print. Also, a daily schedule structure will be printed and one copy given to the client while the other posted on the unit wall (Amanda, 2011).

  2. The nurse will encourage the patient to express honest feelings in relation to the loss of the prior functioning level and support the client through the grieving process (Humphreys & Campbell, 2011).

  3. The nurse will encourage reminiscence and discussion of review of life. This can be in form of sharing joyful moments, pictures, and stories (Humphreys & Campbell, 2011).

Rationale for each nursing intervention related to the identified problems with reference to the literature. Total of 9 Rationale (250-300 words limit) (within the last five years

  1. Rationale

  1. Close observation of suicidal patient is necessary to prevent patient self-harm (Amanda, 2011).

  2. Non-verbal behaviours are very critical clues that regard the risk of self-harm (Sawchuk & Olatunji, 2011).

  3. The risk to commit suicide increases if the plans and means exist (Marydiyono, Songwathana, & Wongchan, 2011).

  1. Rationale

  1. The knowledge of the patient’s level of functioning is required to formulate the appropriate care plan (CRICO/RMF, 2011).

  2. The drug history will enable to come up with the most appropriate plan for care in the case of substance abuse and dependence. Moreover, the drug history may provide reliable information in regards to the client’s condition and the need for medication during the start of the detoxification period (Frisina, Guellnitz & Alverzo, 2010).

  3. Excessive stimuli can increase the patient’s irritability and agitation. Moreover, ensuring the client’s safety is a nursing priority (Townsend, 2008).

  1. Rationale

  1. Memory aids can assist the patient to function more independently, and consequently, increase self-esteem (Amanda, 2011).

  2. The patient is most likely fixed in the anger stage of the grieving process, and this can be turned inwards on the self, leading to a diminished self-esteem (Humphreys & Campbell, 2011).

  3. Reminiscence and review of life events can help the client to resume progression through the process of grief which is associated with disappointing life events. Moreover, successes are reviewed and self-esteem increased (Humphreys & Campbell, 2011).


Amanda, N. (2011). Instruments to detect alcohol and other drug misuse in the emergency department: A systematic review. Paediatrics, 128(1), 80-192

Australian Bureau of Statistics/ABS. (2008). “Australian social trends, 2008: Risk taking by young people,” ABS, Canberra, 4102.0

CRICO/RM . (2011). Optimizing physician-nurse communication in the emergency department: Strategies for minimizing diagnosis-related errors. Strategies Emergency Medicine Leadership, 1-9

Comer, R. (1999). “Substance abuse from the Freudian view,” Abnormal Psychology, 636- 896

Frisina, P., Guellnitz, R., & Alverzo, J. (2010). A time series analysis of the falls and injuries in the inpatient rehabilitation settings. Rehabilitation Nursing 35(4), 141-166

Hall, W., & Babor T.,F. (2000). “Cannabis use and public health: Assessing the burden”.

Addiction, 95(4), 485-490.

Humphreys, J.,& Campbell, J.,C. (2011). Family violence and nursing practice. UK: Springer Publishing Company, LLC

Marydiyono, M.,N., Songwathana, P., & Wongchan, P. (2011). Spirituality intervention and outcomes: Cornerstone of holistic nursing practice. Nurse Media Journal of Nursing, 1(1), 117-127.

Sawchuk, C., & Olatunji, B. (2011). Anxiety, health risk factors and chronic disease. American Journal of Lifestyle Medicine, 5(4)

Townsend, M. (2008). Psychiatric mental health nursing: Concepts of care in evidence-based practice, sixth edition. UK: F.A. Davis Company.