PSYCHIATRIC MENTAL HEALTH NURSING
Personality disorders
Case Study
Background
Bozi is 23 years old and lives in the city with her mother and her brother, aged 14. Bozi was sexually abused by an uncle when she was nine, although her mother did not believe her at the time when she told her about it. As a result, Bozi started acting-out against her mother, who eventually accepted that the abuse had happened. Despite this, Bozi developed further behavioural issues (mood swings, self-harming) and had her first psychiatric admission to an adolescent unit. Around this time, she also started to be jealous of her brother, sometimes causing tension within the family.
Bozi grew up mostly with her mother. Her parents separated when she was seven and she has had little involvement with her father since then. She dropped out of school in 10th grade and has never held a job. She lives off of disability income. She enrolled in beautician school but could not cope with the commitment the course required. She likes music and going out clubbing. She has a history of polydrug abuse and uses alcohol, cannabis, XTC and speed, but she is not an IV drug user.
Bozi has been admitted to hospital after an episode of self-harming and aggressive behavior. She has made some friends among the other patients. Her mother is the only family member who visits her in hospital. On the ward Bozi usually wears headphones. She is morbidly obese and has told the nurse that she put on weight to make herself unattractive and that she finds eating a comfort. She says she hates the way she looks. She has multiple piercings in her ears, eyes, nose, chin, tongue, naval and arms; she also has tattoos of various patterns, one of barbed wire and others of Celtic bands. Bozi dresses as a Goth and is wearing heavy black clothes, make-up and nail polish, and has dyed her fair hair black. She tends to be flirtatious and sexually active on the ward.
a. Self-harm
Bozi?s arms, chest, stomach and legs are a mass of scars from cutting herself. She uses razor blades or broken tin cans, or will break a metal spoon and cut with that?she stashes these implements even when she is on the ward. They have been found in her bra, in her hair scrunchy, in the hem of the curtains around the bed, in the pillow case and in a cigarette packet. She says she cuts to feel something, as most of the time she does not feel anything.
Questions
1 Discuss possible reasons for Bozi?s self-harm behavior.
2 As a nurse, how would you manage prevention of self-harm when dealing with Bozi?
3 Self-harm behavior can be confronting. How would you manage your own position on this issue and your notions of being therapeutic towards your client?
b. Suicide risk assessment
Bozi frequently says that she wants to be dead but she usually tells someone when she takes an overdose. She tends to be impulsive and shows impaired judgement about her situation.
Questions
1 How would you go about assessing the risk of suicide in Bozi?s case? What questions would you ask?
2 Health professionals tend to have a negative attitude towards individuals with personality disorder. In what way would this interfere with making an accurate assessment?
c. Admissions
Bozi has been brought to the emergency department on multiple occasions. She has had frequent hospital admissions and is well known to the hospital staff. Usually her mother rings an ambulance or the police to take Bozi to hospital and she is admitted involuntarily.
Questions
1 Does involuntary admission under the Mental Health Act in your state or district infringe on the rights of the client, such as Bozi?
2 How can the nurse present involuntary admission in a more acceptable way for Bozi and her mother?
d. Team conflict
Bozi can be uncooperative with medication, and so sometimes has to be medicated by force. Her arrival in the unit can be a source of conflict among the nursing staff. Bozi tends to favor some staff over others, writing them thank-you notes about how nice they are to her. The favored nurses frequently end up feeling like a failure because they think Bozi is making progress but then she cuts herself again with some hidden object and the nurses become disappointed.
Team consistency is a significant problem in Bozi?s management and is sometimes undermined by Bozi?s words and behavior. For example, Bozi tells a nurse that she is allowed a day pass to see her mother, although it is clearly stated that she is not allowed to leave the unit as she will be able to access razor blades.
Questions
1 As a team member, how would you go about strengthening the team so that consistency in management is not problematic?
2 Usually, nurses find it difficult to work with people with personality disorder. How would you turn the situation around using a ?strength-focused model? as part of Bozi?s long-term recovery?
PLACE THIS ORDER OR A SIMILAR ORDER WITH NURSING TERM PAPERS TODAY AND GET AN AMAZING DISCOUNT
