Medical Research


2809NRS Mental Health Nursing Practice

Trimester 2, 2017 Assessment Item Two

Case Study Essay

Aim: to understand the importance of a thorough biopsychosocial assessment to reliably

identify factors that will lead to diagnosis of a mental health issue and appropriate

nursing care management.


You are to write an essay which analyses a case study in order to discuss appropriate

biopsychosocial factors and nursing management or interventions relevant to that case.

Recent and relevant literature must be used to support your discussion.


1) Select a case study provided.

2) Use recent literature to support your discussion:

2.1) Discuss biopsychosocial factors that contribute to the development of the

selected disorder.

2.2) Discuss a nursing management or interventions appropriate for your

selected case study.

2.3) Discuss ethical implications for the selected case study.

Other elements:

 Always refer to the HEALTH Writing and Referencing Guide

 Ensure that you use scholarly literature (digitised readings, research articles, relevant Government reports and text books) that has been published within the last 10 years.

 Provide a clear introduction and conclusion to your paper.

 You may use headings to organise your work if you wish.

Assessment Type: Case Study Essay – Assessment Two

Word Count: 2,000 words

Due Date and Time: Monday August 28th at 1700

Weighting: 50%

 Unless otherwise instructed, write in the third person.

 Use academic language throughout.

 Refer to the marking guidelines when writing your assignment. This will assist you in calculating the weightings of the sections for your assignment.

 State your name, essay title and word count (excluding your reference list) on the Title page.


Your written assignment must be submitted as:

As an electronic file to the campus-specific “final” Turnitin portal available from the 2809NRS [email protected] site.

You must submit this assignment as instructed to be eligible for a passing grade in this course.

Marking Criteria Possible marks

1. INTRODUCTION - Assignment has as an opening paragraph that contextualises the assignment. - Clearly identifies the aim of the assignment


2. ANALYSIS : DISCUSSION OF BIOPSYCHOSOCIAL FACTORS - Clearly identifies and discusses biopsychosocial factors influencing the development of

the disorder in the selected case study.


3. ANALYSIS: DISCUSSION OF NURSING MANAGEMENT OR INTERVENTIONS - Clearly identifies and discusses nursing management or interventions appropriate for

the selected case study.


4. ANALYSIS: DISCUSSION OF ETHICAL IMPLICATIONS - Clearly discusses ethical implications appropriate for the selected case study


5. CONCLUSION - Has a concluding paragraph that summarises the overall argument in the assignment. - Does not introduce any new information or references in the conclusion.


6. RESEARCH AND REFERENCING - Identifies, analyses and uses good quality evidence to support the outlined relevant

points. Uses at least 10 relevant sources from the scholarly literature published in the last 10 years.

- Referencing as per APA Style 6th Edition - Separate page for reference list headed “References”


7. ACADEMIC WRITING - Conforms to the Assignment Presentation Formatting Guidelines.

 Correct word count (2,000 words). Uses academic language throughout.  Essay is well presented, with correct spelling, grammar, and well-

constructed sentence and paragraph structure.



Case study 1

Dorothy is 29 years old. She gave birth to her first child, Amy, four weeks ago. Dorothy

had a protracted labour. After 35 hours the obstetrician decided to perform a forceps

delivery. The birth was difficult, resulting in Dorothy requiring internal and external

sutures. Dorothy had a previous miscarriage when she was 24 years old. She

subsequently found it difficult to become pregnant and this pregnancy was a surprise to


From the time of Amy’s birth Dorothy experienced a lack of interest and “feeling” for her

new baby. She was only agreeing to hold the baby following encouragement from nurses

and pressure from her husband Alan, who is 30-year-old self-employed electrician. Alan

presents as intolerant of Dorothy’s lack of interest and affection for the new baby.

Since Dorothy’s daughter was born four weeks ago, Dorothy has been consistently

complaining of tiredness. She refuses to breastfeed the baby saying it was “gross,


Dorothy presents for admission to the postnatal unit with low mood. She displays

irritability and lack of interest and motivation. She also expresses a lack of connection

with her daughter and an inability to care or show affection towards her. Dorothy has a

low tolerance level, with frequent episodes of panic, screaming, and shaking. She finds

caring for Amy particularly distressing. She refuses to breastfeed her as she feels no

connection, attachment or affection for the baby. Dorothy states that all she wants to do is

to “shake her (Amy) until she stops crying.” Dorothy describes fantasising about shaking

Amy when she cries but to date she has never acted on her thoughts.

When alone, Dorothy appears subdued, sitting for long periods of time. She appears

disengaged from her baby, husband and mother-in-law, who is living with them to help

Dorothy care for the baby. Dorothy feels that her husband and his family are not

supportive of her. Since the birth of her daughter, Dorothy has experienced loss of

appetite with resulting weight loss. She is not sleeping well, maybe one to two hours a

night at the most, but she lies awake in bed thinking about her life.

Although Alan and Dorothy have been together for 6 years, their relationship has been

quite difficult. Alan sometimes drinks alcohol and often is angry and intolerant of

Dorothy, speaking dismissively of her emotional needs and other requirements.

Dorothy and Alan live in a 3-bedroom rental accommodation in a low socio-economic

working class suburb of Brisbane. Dorothy’s parents live in Gin Gin, where Dorothy

grew up. They are both estranged from Dorothy since her marriage to Alan following an

incident where they witnessed him shouting and pushing her around. She has 2 siblings,

who both live in Cairns and are not supportive to Dorothy. One of Dorothy’s siblings has

a history of depression.

Dorothy had lots of friends when she was young but she has lost contact with them since

meeting Alan. She does not work but stays at home caring for Amy. Currently she has

daily support from her mother-in-law whom Dorothy describes as “controlling” in her

approach to Dorothy. Dorothy has no social interaction or contact with any other adults.

Dorothy is concerned that she will never feel different and that she will always hate her

daughter. She worries that her parents will continue to be estranged from her.

Dorothy recognises she is in an abusive relationship. She can’t see a way out, and resents

the fact that Alan can escape from the baby when he goes to work or out with friends.

Dorothy is worried that Alan’s intolerance will result in escalating aggression towards her

and that she will have no one to turn to.

She hopes to have a break from the stress of living with Alan and his mother, so that she

can sleep. Dorothy is hoping that while she is in hospital, she will be able to contact her

parents and have them visit her without Alan and his mother knowing.

Case study 2

Susan is a 56-year-old woman who has presented for admission to a Moods Disorder Unit

in Brisbane. She has had numerous admissions to this facility in the past and has a

diagnosis of Bipolar Disorder. Her last admission was six months ago, when she

hospitalised for four weeks to have her mood stabilized and maintained.

Susan is an attractive woman, dressed in bright flamboyant colours, with long scarves

draped around her neck and vivid makeup rather heavily and theatrically applied. Susan

has been brought to hospital by her two sisters, who have advised the staff that she is

reluctant to be here. Susan’s speech is pressured and loud. She leans on the table to

engage with the nurse, patting her arm and calling her “Darling”. She frequently stretches

her arms and makes reference to her body shape.

Previous admissions have involved Susan being reinstated on a mood stabilizer

medication and being monitored for compliance with same. For the last few weeks Susan

has refused to take her medication, insisting she is “on top of the world” and does not

want to be “a zombie”. Historically Susan has periods of depression followed by “highs”

and whilst in the middle of a “high” does not want her mood to be levelled, because she

loses the feeling of exhilaration. Susan has not slept for more than a few hours over the

last week. She has started smoking again, after abstaining for one year.

Susan receives a disability pension due to her longstanding history of Bipolar Disorder.

Up until five years ago she was able to work part time in a newsagent’s shop, but as her

illness increasingly impacted on her work, she was no longer able to sustain her position.

Susan lives alone in a rented unit, and her two married sisters live close by. She has never

married, and was devoted to her mother who passed away two years ago.

She has several friends whom she meets regularly and enjoys going to a local club for a

meal with them. She is also a keen shopper, which causes friction with her sisters who

control her finances. When Susan’s illness is in a hypomanic stage, she overspends and is

very extravagant.

Susan’s brother also suffered from Bipolar Disorder and suicided 10 years ago.

Susan has been scheduled twice to a public hospital under the Mental Health Act.

In the last few days Susan has been ringing her friends in the middle of the night and

attempting to engage them in animated conversations, wanting to plan various trips and

outings which are not practical. She has also been disinhibited whilst interacting with

male neighbours. Susan is at risk of tarnishing her reputation and placing herself in a

vulnerable position. It is vital that she recommences her medication and has adequate

rest. She needs to be admitted to hospital and be monitored for compliance with


Susan is currently prescribed 250 mg Lithium in the morning and 500mg at night. She

also is prescribed 100mg Sertraline in the morning. Susan usually tolerates this

medication with no reported side effects. However, Susan has a history of medication


Case study 3

Steve is a 21-year-old man who has presented for a first admission to an acute psychotic


Steve is being assessed in an interview room by a registered mental health nurse. He has

recently been diagnosed with schizophrenia. Steve has gained some weight, which is

partly a side effect of his medication. He presents as unkempt, unshaven with soiled

clothing. His eye contact is poor. He is restless, moving around the room, at times

muttering to himself and nodding. He responds to questions in a monosyllabic fashion:

“Yes” or “No”.

Steve attended an elite private school, where he excelled academically, and was a popular

student. He commenced his Bachelor of Law last year. Four months ago Steve went

away for the weekend with a group of friends and experimented with a variety of illicit

drugs such as, ice, cocaine, and ecstasy. When he came home his demeanour was

markedly changed. He became suspicious and withdrawn. He refused to go to

university, and stated his parents were “imposters”. Since then he has attempted to attend

university only once, but was unable to last even half a day. He spends his days in his

room listening to music. Friends no longer come around because of his current mental

state. He has no social contact outside the family home.

Steve has been verbally aggressive towards his parents and younger brother, Andrew who

is 15 years old, causing the family great distress. His parents are fearful of having Steve

at home as they are frightened his verbal aggression may turn into physical violence

towards his brother or them.

Steve is observed responding to “voices” or auditory hallucinations. He tells his parents

the voices belong to a group of two men and a woman. The voices kept telling him that

he was “no good” and “everybody hated” him. Sometimes they told him to harm himself

and sometimes to harm other people. Steve also believes that he has special powers and

he is a spy working for the government. He is argumentative and sometimes becomes

aggressive. Steve also tells his parents that the “voices” don’t want him to take

medication because it is poison. Prior to this the family relationship was very good and

would be described as “loving and close”.

Steve’s doctor prescribed anti-psychotic medication for him approximately four months

ago, however Steve is not always compliant. He complains they make him put on weight

and make him feel “weird”. Typical “weird” feelings include tingling sensations and

fuzzy headedness.

Steve is currently on anti-psychotic medication: Olanzapine 20mg twice a day (BD)

Quetiapine 200mg twice a day. He is also prescribed Diazepam 10mg three times a day

which is a sedative. Steve knows exactly what medication he is supposed to take.