PSYN 4145 Final Project

1. Case Study
Presentation
Hanna Santos
PSYN 4145
Kwantlen Polytechnic University
July 31, 2022

2. Clinical Placement Overview
Beckman House
Beckman House (BH) is a licensed long-term care facility operated by the MPA Society in partnership
with Fraser Health Authority (MPA Society, 2012). The facility is staffed 24/7 by mental health workers
and licensed nurses that support the members' daily needs. This facility is one of three housing facilities
that create a mental health residential campus in Maple Ridge (Fraser Health, 2016).
Population
BH is home to 21 members living with mental health disorders, the most common diagnosis is
schizophrenia. Admissions to the facility are through two options of referral--the hospital and an existing
tertiary facility. The length of stay varies from person to person, one member has lived in the facility for
more than 20 years, and our most recent admission was three weeks ago.
Program Goals
MPA Society aims to support individuals living with mental health issues through a supportive,
respectful, and client-centered environment that empowers individuals to be resilient through a
strengths-based approach that helps them achieve their goals and live meaningful lives (MPA Society,
2012). Beckman House offers members "psychiatric support, transitioning to independent living, life-
skills enhancement programs, and aging in place" (MPA Society, 2012, Programming section).

3. Beckman House: Student Nurse Duties
1-on-1
I normally check-in with the
members during medication
administration as some
members often like to go into
the community after. 1-on-1s are
best done while utilizing the
Psychosocial Rehabilitation
(PSR) model of care to note of
any changes and initiate a timely
response.
Medication
Administration
Dispense scheduled and as
needed medications daily.
Most members need
support with their
medications and a few are
independent in taking their
own.
Activities
Most members enjoy activities
that involves ‘food outings’ where
they can use their own money to
buy food in the community. Some
also enjoy going for daily walks or
cooking their own meals with
staff support. Students can
perform off-site activities with
staff supervision.
Miscellaneous
When all of the above duties
are completed, I often help the
staff alleviate workload such
as meal prepping, prompt
members to complete house
chores, or assist with clerical
work.

4. Brief Overview: Patient Demographics
Diagnosis: Depressive disorder,
Schizoid Personality Disorder, Mild
Cognitive Disorder, COPD
Hair: Grey with facial hair
Eyes: Blue
Height: 5’9”
Weight: 135 lbs
K.N. 73 year-old male
Medical History
2012: Tylenol overdose
2017: Alcohol & Gravol misuse
Uses Marijuana & THC
Current Medications
Acetaminophen, quetiapine,
fluoxetine, pantoprazole
Inhalers: Atrovent nasal inhaler
& combivent respimat
Boost Nutritional Support
Fibre Laxative
Signs of decompensation
Agitation, feeling anxious,
refusing activities of daily
living (ADLs), isolating

5. Case Study
Patient History
KN is a 73-year-old male who has a current diagnosis of depressive disorder,
schizoid-personality disorder, mild cognitive disorder, and chronic obstructive
pulmonary disorder (COPD). Prior to his hospital admission, he managed well,
living semi-independently in his current long-term residential housing facility. KN
enjoys independently going into the community to purchase plants to take home
and place them in his room and around the facility. He was also independent in
performing and maintaining his activities of daily living (ADLs) and completing
assigned house chores while often only needing support with medication
management, specifically for his symptoms of COPD and mood stability. KN
typically seeks staff support when he is experiencing shortness of breath and when
taking more breaks than normal when he is ambulating around the house. The
client periodically uses marijuana and THC. He has stopped smoking following his
recent hospital admission but would normally smoke 1 pack a day.

6. Case Study (cont’d)
Patient History
Recently, staff has noticed changes in KN's behaviour and that he is
showing signs of mental health decompensation. Staff reports increased
agitation and anxiety symptoms as evidenced by the restlessness of his
hands and legs. KN has also been refusing ADLs, such as bathing and
eating meals, and increasing isolative behaviours. Due to changes in his
behaviour, KN has lost 8.8 lbs since last month. KN's health has been
deteriorating as he has needed the use of a 4-wheel walker or a
wheelchair to ambulate around the house, to which he has never
needed to ambulate until this time. Staff have also noticed poverty of
speech and requiring multiple prompts to answer simple questions and
participate in medication compliance. The client is admitted to your unit
as per his psychiatrist’s orders and due to “catatonic-like depression”,
as per residential care nursing staff.

7. Mental Status Exam
Client received into care at 0700 hours. Observed in their room, laying
awake in their own bed, respirations visible and regular. Writer approached
client for check-in, agreeable with same. Calm and cooperative upon
interaction. Client is A&O x 3, oriented to name, place, and time. Client
appears slightly older than stated age, has gray disheveled hair, unkempt
beard, and blue eyes. Wears own white shirt, distressed denim jeans, and
hospital socks. Client uses a 4-WW to ambulate in unit. Reports having poor
sleep and no appetite for meals. Client is noted to have poverty of speech,
answers by nodding head, and maintains poor eye contact. Observed to
stare at wall for long periods of time and needing multiple prompts to
engage in conversation. When asked about his mood, client responded by
shaking his head. Presents with a flat affect. Thoughts are currently difficult
to assess due to poverty of speech and client not forthcoming with
information. Does not appear to have delusional or paranoid thought
content. Client denies auditory, perceptual, and tactile disturbances. He
does not appear to be responding to internal stimuli. Client currently
denies suicidal, homicidal, and self-harm ideations. Agreeable to speak to
staff if concerns arise. Denies concerns at this time. As per MRP orders,
level 1 observation initiated, Q15 minute safety checks in place.

8. Nursing Diagnosis 1: Risk for self-directed violence
Assessment
1. Client presents with increasing isolative behaviours
2. Client appears to have worsening depressive symptoms such as anhedonia, hopelessness, and increased agitation
3. History of a Tylenol overdose in 2012
Goal/
Objective
1. Client will seek staff support when intrusive, suicidal thoughts arise throughout hospital stay
2. Client will not inflict harm to self or others throughout the duration of stay
3. Client will demonstrate ability to utilize effective coping skills to combat negative thoughts and emotions
Nursing
Intervention
Intervention Rationale
1. Complete a suicide risk assessment upon admission
and reassess suicidality through comprehensive
mental status exams (MSE) every shift.
2. Contract the client to safety and initiate level 1
observation, Q15 minute safety checks upon
admission and to be assessed every day.
3. Collaborate with client to assess existing coping
skills and its efficacy. Support client in learning new
coping skills if necessary.
1. Completing a suicide risk assessments provides healthcare
providers a baseline of the client’s risk to harm self or
others. It is essential to keep this as an ongoing
assessment to note of any changes and engage timely
interventions (Austin et al., 2019).
2. The client’s impaired thought processes and risk factors to
suicidal ideation may put him at risk to harm himself or
others. It is essential to contract the client to safety and
allow them to understand unit expectations before concerns
arise (Martin, 2022).
3. Collaborating with the client facilitates rapport and builds
on the therapeutic relationship (Austin et al., 2019).
Assessing the client’s existing coping skills can help
pinpoint areas that need support to foster resilience and
build on strengths.
Evaluation
1. The client will approach nursing staff if intrusive thoughts arise and will not act on same until discharge
2. The client does not exhibit behaviours of self-harm or harming others until discharge
3. The client is able to ‘teach-back’ chosen effective coping skills and utilize them when intrusive thoughts arise
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9. Nursing Diagnosis 2: Disturbed thought processes due to severe anxiety or depressed mood
Assessment
1. Client presents with low mood and flat affect
2. The client has poverty of speech and needing multiple prompts to answer simple questions
3. Impaired judgment, perception, decision making as evidenced by poor hygiene, weight loss, and poor sleep.
4. The client appears restless as evidenced by poor sleep
Goal/
Objective
1. Client will show improved mood as demonstrated by the Beck Depression Inventory by discharge (Martin, 2022)
2. The client will gradually show improved ability to engage in short conversations within a week from admission
3. The client demonstrates ability to challenge negative thoughts and increased concentration within 3-4 days of admission
Nursing
Intervention
Intervention Rationale
1. Complete a comprehensive mental status exam on
shift onset and a brief status updated noting any
changes Q4 hours after the initial entry.
2. Use language and communication skills that is
appropriate to the client such as using simple words,
allow time for responses.
3. Educate client on mindfulness exercises and skills to
reframe negative thoughts into helpful ones while
maintaining confidentiality and incorporating a
trauma-informed and culturally safe approach to care
(Austin et al., 2019).
1. To identify behaviours, cognitive abilities, and expressed
emotions that can increase or decrease the potential risk for
harm.
2. Comprehension and response may be impaired due to
client’s slowed thinking (Martin, 2022). It is essential to treat
the clients with respect, dignity, and patience while they are
struggling with their depressive symptoms.
3. Depression can increase negative ruminating thoughts that
add to feelings of hopelessness and anxiety (Martin, 2022).
It is essential to build on the client’s skills and strengths to
foster resilience and regain control (Austin et al., 2019).
Evaluation
1. Client reports any changes in mental status and reports any suicidal or homicidal ideations, intent, and plan.
2. The client engages in short conversations with staff or co-patients with ease or answer simple questions without
difficulties
3. Utilizing the ‘teach-back’ method, the client will teach nursing staff of skills they have learned and use them when needed
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10. Nursing Diagnosis 3: Self-care deficit due to anergia, severe anxiety, and cognitive impairment
Assessment
1. Client reports poor sleep
2. Neglected personal hygiene as evidenced by unkempt hair, beard, and presence of body odor
3. Client reports poor intake and no appetite
4. Collateral from residential care staff suggests an 8lb weight loss since onset of symptoms
Goal/
Objective
1. The client will complete ADLs with minimal prompting and help from nursing staff by discharge
2. The client will report better sleep and have consistent 4 to 6 hours of sleep by use of effective coping skills or
medications before discharge
3. The patient will have evidence of weight gain upon discharge through proper diet and nutrition
Nursing
Intervention
Intervention Rationale
1. Give client extra time in completing ADLs such as
eating, bathing, and dressing. Provide support in
performing ADLs when needed.
2. Monitor intake and output. Encourage adequate fluid
and food intake to promote proper nutrition and
elimination (Martin, 2022).
3. Educate client on relaxation measures to facilitate
proper sleep. Utilize medications for sleep if
relaxation strategies have no effect in sleep hygiene.
1. Since the client is exhibiting slowed movements and needs
multiple prompts to complete ADLs, allow for some time to
finish their tasks to avoid exacerbating the client’s anxieties
and worries.
2. Depression impacts the client’s ability to have adequate
intake and normal elimination (Austin et al., 2019). It is
essential to encourage adequate food and fluid intake to
improve the client’s nutrition.
3. Relaxation measures such as eliminating reducing
environmental and physical stimulants help induce sleep
(Martin, 2022). Sleep aids can be useful for clients that are
exhibiting restlessness after utilizing relaxation techniques.
Evaluation
1. The client will require less and less prompting each day and shows increased ability to perform ADLs independently
2. The client’s intake and output form will be filled out everyday to track changes and improvement in nutrition.
3. The client appears to be asleep on all checks throughout the night and wakes up timely during the day.
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11. KN’s Health Update
After being hospitalized, KN’s health has noticeably
improved and his functioning in the community is
nearing baseline levels.
• Resumed his daily
smoking habits
• Has returned to
smoking cannabis
in his room (drugs
are not allowed in
the premises)
• Reports feeling
“unwell” since
hospital stay
• Independently
ambulates at home
without the use of
mobility aids
• Completes ADLs and
attends to personal
hygiene with minimal
prompting
• Reports better sleep
• Remains visible in
common areas
• Engages in
conversation with staff
Challenges Improvements

12. Key Takeaways
Communicate effectively and appropriately
Consider the individual’s ability to process information. Speak slowly, address the
client with their preferred name, and give them time to answer questions (Austin et al.,
2019). Use age-appropriate language while maintaining professional standards and
confidentiality.
02
Treat individuals with dignity and respect
Clients may feel confused and anxious of the changes that they are going through that is out of their
control. Sometimes, they may be unable to voice these anxieties or frustrations when they occur.
Always treat individuals with dignity and respect, and incorporate a trauma-informed and culturally-
safe approach to care for all clients (BCCNM, 2020).
01
Collaborate with the client and help them make informed decisions
Utilizing a client-centered approach to care allows clients build resilience and regain control
over their life despite the challenges in their health and well-being. Engage in a therapeutic
relationship that promotes safety, builds trust, and create an empowering environment for
the client and their families (BCCNM, 2020).
03
Individuals have the right to live at risk
As nurses, we are used to helping individuals achieve overall health and well-being. Spending some
time in the community made me realize that clients can still choose to live at risk such as continuing
to use drugs and other substances. It is our duty to support the clients as best as we can while
maintaining their right to information and the right to live at risk (BCCNM, 2020).
04

13. References
Austin, W., Peternelj-Taylor, C. A., Kunyk, D. & Boyd, M. A. (2019). Psychiatric and mental health nursing for Canadian
Practice (4th ed.). Wolters Kluwer.
British Columbia College of Nurses and Midwives (BCCNM). (2020). Professional standards for psychiatric nursing. BCCNM.
https://www.bccnm.ca/Documents/standards_practice/rpn/RPN_Professional_Standards.pdf
Fraser Health Authority. (2016). Beckman apartments officially opens in maple ridge. Fraserhealth.
https://www.fraserhealth.ca/news/2016/Apr/beckman-apartments-officially-opens-in-maple-ridge
Martin, P. (2022). 9 major depression nursing care plans. Nurseslabs. https://nurseslabs.com/major-depression-nursing-care-
plans/6/
MPA Society. (2012). Licensed housing Vancouver: Beckman house. https://www.mpa-society.org/programs-
services/housing/licensed/beckman-house