Question: Psychosocial Theories and Therapy: Case Study Analysis and Interventions

Psychosocial Theories and Therapy (see Videbeck chapter 3 as a resource)

Case study background
A newly-graduated nurse named Sarah is orienting to the hospital behavioral health unit. This is her first orientation shift. Kyle is the nurse who has been assigned to orient and help teach her about what is involved with caring for clients on the psychiatric unit.
During day-shift change hand-off report, Sarah reads the report sheet while listening to updates on the five clients she and Kyle will be caring for this shift. She makes note of questions she will ask Kyle about afterward.
The night-shift nurse giving report seems tired, and Sarah suspects she is not giving them all of the important information.
After shift change report, Kyle and Sarah make a plan for the care of their clients. Since it’s only her first shift orienting, Sarah will be following Kyle rather than taking her own clients.
Sarah asks him questions she identified during report. These are her questions and Kyle’s answers during their conversation.

Sarah: “About client A, does a history of abuse make a difference in the individual’s condition?”
Kyle: “Yes, in fact, a high percentage of our clients here have a history of abuse. We need to keep this in mind while providing care. For example, it’s crucial to explain what we are doing and always get the client’s permission if touch is required during our care.”
Sarah: “About client B, what exactly does it mean in the history where it says ‘male to female’? Does that mean that the client has physically transitioned surgically from male to female?”
Kyle: “This can refer to that, but it could also mean she is somewhere in that transitioning process. Or it may simply be that she identifies as female rather than male. Whatever the case, it doesn’t matter to our care, as we will treat her as whatever she identifies as. For example, we will use the pronoun ‘she’ instead of ‘he’ as the client prefers. Most important in caring for transgender clients is that we treat them with respect and kindness.”
The following is the report sheet Sarah and Kyle used while the off-going RN gave hand-off report. Following each client description is information Kyle and Sarah gained during their interactions with these clients.

Client A, Room 1
Client A is a 32-year-old female who is here for a suicide attempt via overdose of her medications at home. She called emergency services just after ingesting all of her medications, which she had recently refilled. She is still having thoughts of suicide (suicide ideation); however, she declines discussing her plan with staff. She has a history of abuse from ages 5 to 7 after which she was removed from her environment and placed in foster care until she was 18. She claims to have no memory of any abuse but knows it’s on her record.
After speaking with Client A this is what Kyle and Sarah learned.
Currently she has a steady job and stable housing, but indicates she has no support from family or friends. She has a flat affect. When asked about whether she is having current thoughts of suicide, Client A said, “I didn’t really want to die. I just couldn’t see any other way out of this severe depression.”

Client B, Room 2
A 21-year-old male to female who has been having increased depression over the past few weeks. She worries that she will harm herself so chose to seek help to avoid that happening. She identifies triggers of the anniversary of her best friend completing suicide one year ago, plus pressure from her parents and lack of support for her transgender identification.
After interviewing Client B this is what Sarah and Kyle learned.
Client B prefers to use the pronoun “she” which the nurses indicated they would do. The client is angry about her situation, saying, “People don’t understand. I would do much better in college if everyone would just accept me the way I am. I am not patient enough to wait until they come around. The college needs to do something now.” The client is having some obvious anxiety; wringing her hands and pacing in the room while the nurses are talking with her. She will answer their questions, but seems to have difficulty staying on topic.

Client C, Room 3
39-year-old female client feels overwhelmed. Stated, “I think I’m having a nervous breakdown.” She currently works two jobs including picking up extra shifts, hoping for acceptance from others. She has difficulty making choices. Although she is currently in an unhealthy relationship with her partner, she depends on him to make choices for her and is unable to contemplate leaving him.
After meeting and interviewing Client C, this is what Sarah and Kyle learned.
The client has no other friends or support than her husband. She stated, “He is very controlling. He doesn’t want me talking with other people outside of work. I can’t leave him, though. Then I would be all alone. It’s really not so bad, I can take it.”

Client D, Room 4
A 79-year-old male, recently widowed; shows symptoms of grieving. He came to the Emergency Department because he has been depressed and anxious. He lives alone.
After talking with Client-D, here is what the nurses learned.
The client feels guilty for trying to “move on” without his wife. He stated, “I feel kind of lost. I’ve been retired several years and she did so much for me. I should have done more to stay busy, because I’m feeling that now. I don’t want to think about losing her right now, though. I’m not strong enough. It makes more sense for me to just get help for my depression now and worry about going through the grieving process later.”

Client E, Room 5
A 25-year-old female with drug-induced psychosis. Besides drug use/abuse, she has a history of schizophrenia with periods of mania. Her family member reported to the staff that the client sometimes does not remember what she does during these manic episodes. They suspect that she has been using drugs as a way to self-medicate her condition rather than taking her prescribed medications.
After meeting and trying to interact with Client E, here are some observations the nurses made.
The client is unkempt and dirty, not appearing to have showered lately. She has been awake for a few days but resists efforts to try to get her to rest. She is constantly moving and appears quite anxious. She throws objects and hits her hand, tearing her hair, and tugging on clothes. When asked questions, she answers using a babyish, high voice with a lisp, sounding like a toddler. Her answers do not make sense, however.



Answer the following questions regarding the case study.

What important information would have been helpful to include in the night shift nurse’s hand-off report?
What are some ways that the previous nurse could have made sure to include all of the important information necessary for the next nurse to resume care
After talking with Kyle after shift report, what other questions do you think that Sarah might have about the other clients she didn’t ask him about (Clients C, D, & E)?
Using chapter 3, list at least three suspected issues, problems, or needs each client has and why you chose those. Read the definitions in the chapter to decide which to assign to each client. There could be several correct answers. Use the following tables and sections:
Table 3.1 Ego Defense Mechanisms
Table 3.3 Erikson’s Stages of Psychosocial Development
Table 3.6 Anxiety Levels
Pages 48 and 49 - Abraham Maslow’s Hierarchy of Needs
Sarah and Kyle attend group therapy with the clients. (See pages 55-56 Groups)
What are the seven therapeutic results that have been identified with group therapy in the mental health setting?
Considering these therapeutic results of group therapy, please give an example of how group therapy could possibly help one of your clients.