Bill is a 45 year old man 75kg brought into the Emergency Department by his sister after intentionally lacerating one arm and his neck while heavily intoxicated on alcohol.

Bill is a 45 year old man 75kg brought into the Emergency Department by his sister after intentionally lacerating one arm and his neck while heavily intoxicated on alcohol.

Bill is separated from his wife and children, he has a history of domestic abuse due to his alcohol consumption and often is verbally abusive to his neighbors. Bill is currently unemployed due to the recent loss of his driver’s license for Driving Under the Influence (DUI). His sister lives 4 houses away from Bill and seems to be the only person that he will talk to, she is often away and only sees Bill occasionally.

He is seen in the Emergency Department by the Mental Health Assessment Team (MHAT). Following assessment, Bill is admitted as a voluntary patient to the Mental Health Unit for assessment, observation and monitoring. Bill appears malnourished, dehydrated, and unwashed. He is flushed, ataxic and smells strongly of alcohol. His speech is slurred. He has a productive cough. He is given a provisional diagnosis of Major Depressive Disorder (MDD) and Substance Abuse (Alcohol).

A few hours later, Bill attempts to leave the Mental Health Unit without a medical review or authority. He becomes verbally and physically threatening toward nursing staff who are trying to persuade him to stay and be treated. Security is called and they physically restrain Bill when he lashes out at them and the nurses.

Following further assessment by the Medical Officer, Bill is placed on an involuntary Treatment Authority (TA) under the Mental Health Act 2016 (Qld). By this time, he appears physically exhausted, sobbing and stating that he wants to die.

1.To assist you with Bills issues and possible outbursts of aggressive behaviour who can you seek to obtain guidance or support?

2.Assessments are bound by time and context; that is, when you conduct an assessment, you are looking at the risk factors as they present in the current situation. While you do explore the client’s history and background, the main focus of risk assessment is what is happening for the client now. Bill is being admitted in a secured mental health ward due to being placed on an involuntary Treatment Authority (TA) under the Mental Health Act 2016 (Qld). Remember assessment is dynamic”.

You as the EN are on Duty the afternoon that Bill is admitted to the mental health facility, you would be working with a RN. Using the information from the case study you are to complete the following risk assessment tool, the RN will review your answers once you have completed it

(In this instance the RN will verify the marking of this paper)

a.Categories of risk identified

b.Detail any historical information that may indicate the potential for risk ( for example previous history or risk behaviours / threats )

c.What environment factors may contribute to risk ( for example, access to drugs alcohol, access to weapons)

d.Is there any current evidence to suggest “planned intent” to engage in risk – related behaviours

e.Are there any risk factors that indicate preferred staff allocation( for example danger to women, intimidation to men, need for 2 workers)

f.What strengths and opportunities can you identify, from the consumer and /or services as resources to support this plan.

3.Contemporary mental health services are based on the recovery-orientated approach. The Australian National Framework for Recovery-oriented Mental Health Services: Policy and Theory identifies five practice domains and capabilities.

a.List the five practice domains and capabilities in relation to recovery-orientated practice and service delivery.

b.Select one of the practice domains and explain how you could use the information when assisting with planning Bills nursing care.

4.Identify four key recovery principles that will assist the interdisciplinary team and yourself in planning care for Bill to maximise his health outcomes.

(Tick the correct answers)

Enable Bill to be in and connected to communities

Plan outcomes so that Bill feels like he is doing something worthwhile

Outlining to Bill that recovery is a cure

Plan ways for Bill to regain belief in oneself

Planning strategies for Bill to be aware of the principles of recovery and that it is an attitude, a way of approaching day-to-day challenges and being in control

Enabling Bill to understand that recovery has an endpoint and will solve his problems

Bill has remained in the mental health care facility for 4 days and there is now talk of possible discharge. A case management meeting has been arranged to discuss a plan for moving forward 

5.State which five members of the multidisciplinary team would possibly attend and why

6.Review Bills case study and name two possible community based service providers that the Multidisciplinary team members could include in the case meeting, as selected by Bill when he is discharged. Explain your role as an Enrolled nurse to liaise with these services and how can they help Bill towards recovery.

7.Provide an example of one community service provider which Bill might select to assist him when he is discharged. Explain how this service can help to support Bill’s recovery.

8.Provide an example of one community service provider that facilitates recovery in a group based environment, which Bill might select to assist him when he is discharged. Explain how this service can help to support Bill’s recovery.

9.Explain the role of the Enrolled Nurse in liaising with service providers. Consider reporting relationships and enrolled nurse scope of practice in your response

10.What would your role as the EN be in this case meeting? Outline at least three possible roles

11.On discharge, Bills mental health care will predominantly be provided within a community-based setting. According to the aims of community-based service delivery, how could Bill be supported that will help him to build on his own strengths and to take as much responsibility as possible for decisions that affects his life when integrating back into the community?

ANSWER

Comprehensive Risk Assessment for Bill: Mental Health Unit Admission

Introduction

Conducting a thorough risk assessment is crucial when admitting a patient like Bill to a mental health unit. By evaluating various factors and identifying potential risks, healthcare professionals can develop an effective care plan to ensure the safety and well-being of the patient and those around them (McGowan, 2023). In this essay, we will analyze the risk factors associated with Bill’s case study and provide a comprehensive risk assessment using the provided tool.

Risk Assessment Tool

Categories of risk identified

Self-harm: Bill’s history of intentional self-laceration and expressed desire to die indicate a high risk of self-harm.

Aggressive behavior: Bill’s verbal and physical threats towards nursing staff and security personnel suggest a risk of aggressive behavior.

Substance abuse: Bill’s alcohol dependency poses a risk to his overall well-being and may contribute to impulsive and dangerous behaviors.

Historical information indicating potential risk

Bill’s history of domestic abuse and verbal aggression towards neighbors raises concerns about his potential for aggressive behavior (Rakovec-Felser, 2014).

His loss of a driver’s license due to DUI indicates a previous risk-taking behavior associated with substance abuse.

Environmental factors contributing to risk

Access to alcohol: Bill’s substance abuse issue is compounded by the fact that he has easy access to alcohol, which can exacerbate his behavior and impair judgment.

Lack of social support: Bill’s separation from his family and limited interaction with his sister may contribute to feelings of isolation and exacerbate his mental health issues.

Evidence of planned intent for risk-related behaviors

Bill’s self-inflicted lacerations and expressed desire to die indicate a significant level of planned intent to engage in self-harm.

Risk factors indicating preferred staff allocation

Given Bill’s history of domestic abuse, it may be advisable to allocate female staff members to ensure the safety and comfort of both Bill and the healthcare team.

Strengths and opportunities as resources

The mental health unit’s services can provide a supportive environment for Bill’s recovery and offer therapeutic interventions.

Bill’s sister, who occasionally visits him, can serve as a source of support and communication between Bill and the healthcare team.

Conclusion

Through a comprehensive risk assessment, healthcare professionals can gain insights into Bill’s current situation, identify potential risks, and develop an effective care plan. By recognizing the risk factors associated with self-harm, aggressive behavior, and substance abuse, the healthcare team can implement appropriate interventions and allocate resources accordingly (Rosen et al., 2018). Bill’s strengths and available opportunities, such as the support of his sister and the services provided by the mental health unit, can be utilized to support his recovery and improve his overall well-being.

References

McGowan, J. (2023, February 6). Risk Management Event Evaluation and Responsibilities. StatPearls – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK559326/ 

Rakovec-Felser, Z. (2014). Domestic violence and abuse in intimate relationship from public health perspective. Health Psychology Research, 2(3). https://doi.org/10.4081/hpr.2014.1821 

Rosen, M. J., DiazGranados, D., Dietz, A. S., Benishek, L. E., Thompson, D. R., Pronovost, P. J., & Weaver, S. J. (2018). Teamwork in healthcare: Key discoveries enabling safer, high-quality care. American Psychologist, 73(4), 433–450. https://doi.org/10.1037/amp0000298