Promoting Mental Health & Well being
Chung is a 35 years-old ma- le who move• d 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.
1 a) Using the case study provided, identify an urgent risk area. Ensure your answer details why you have identified this risk area including specific information about the client and current literature. (2 marks)
1 b) Identify one nursing / midwifery intervention you would undertake directly with your client to address the risk area noted in question 1 a and include a rationale for the intervention. (2 marks for the intervention and 2 marks for the rationale)
2a) Using the case study provided, identify a mental health concern. Ensure your answer details why you have identified this concern including specific information about the client and current literature. (2 marks)
2b) Identify one nursing / midwifery intervention you would undertake directly with your client to address the mental health concern noted in question 2a and include a rationale for the intervention. (2 marks for the intervention and 2 marks for the rationale)
3) Using current literature, identify and discuss (2) two legal, ethical or professional issues a nurse / midwife may need to consider when working with the client in the case study (4 marks).