Question 1: Describe the key interpersonal skills you would have used in this interview to engage with Amelia. Interpersonal skills are the effective communication and listening skills required by nurses to engage or interact with clients and formulate a therapeutic working relationship (Hungerford et al. , 2015; SteinParbury, 2013). In a client experiencing psychosis, the nurse must develop the therapeutic relationship to be able to engage with the client in effective communication (Dodd & Jeffs, 2014).
Some of the interpersonal skills the nurse would use to engage Amelia in the interview process would be active listening, using relevant questioning techniques, and showing empathy. Active listening is the act of listening attentively without allowing distractions to turn the focus away from the client (SteinParbury, 2013). When the nurse is actively listening, they will be facing Amelia, with no obstacles between them, and be assuming a relaxed and open posture.
Importantly they will be available and present in the interview shown by acknowledging what Amelia is communicating by verbally summarising Amelia’s narrative back to her or using words and gestures to prompt Amelia to continue. Using active listening in the interview enables the nurse to understand the message Amelia wishes to convey and facilitates trust and the building of a therapeutic relationship (Hungerford et al. , 2015) Relevant questioning technique is the use of differing types of questions to encourage the client to communicate their feelings or experiences and gain information pertinent to their care (Stein-Parbury, 2013).
In this scenario, open-ended questions would allow the interview to be structured as a conversation, taking the pressure off Amelia and ensuring the interview does not feel like an interrogation. If the nurse does require more information, using a focussed question will help Amelia to bring the conversation back to a specific topic (Stein-Parbury, 2013). Additionally, it is useful to paraphrase Amelia’s comments and repeat them back to Amelia.
This allows Amelia to confirm the message has been received correctly, as well as showing the nurse is attempting to understand Amelia’s experience (Hungerford et al. , 2015; Stein-Parbury, 2013). Empathy is the ability to understand or accept the client’s reality and the ability to accurately perceive the feelings the client may be experiencing, and responding appropriately (Stein-Parbury, 2013). The nurse can show empathy by acknowledging Amelia’s thoughts, emotions, and experiences allowing Amelia to feel validated and supported.
This validation and acceptance establishes a sense of equality between the client and the nurse and encourages the growth of a therapeutic relationship (Hungerford et al. , 2015). The use of all these interpersonal skills is important in building the therapeutic relationships and engaging Amelia in her diagnosis and health experience, in turn aiding the recovery process. Question 2: The doctor stated that Amelia has symptoms of a psychosis. Using correct clinical terms, describe three important signs and symptoms from the scenario that you agree would support the doctor’s clinical opinion.
There are many symptoms associated with psychosis and psychotic disorders, outlined in the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association (APA], 2013), however there are some key features of psychosis. These key features include delusions, hallucinations, disorganised thinking, and disorganised or abnormal motor behaviour (APA, 2013). Amelie is presenting with signs and symptoms of psychosis, three of them being auditory hallucinations, persecutory delusions, and disordered thinking.
Hallucinations are vivid and involuntary perceptions that are not prompted by an external stimulus, but are experienced as normal in the perception of someone experiencing psychosis (APA, 2013; Evans, 2017). Hallucinations can come in the form of visual or tactile experiences however the most common is auditory hallucinations, which is what Amelia is experiencing (Evans, 2013). This is evidenced by Amelia stating she hears voices telling her she is a bad person. No one else can hear these voices, however Amelia perceives them as real and that they make her nervous and scared.
Delusions are false beliefs that are fixed, therefore unable to be changed despite any logical evidence or argument. They are also inconsistent with social, cultural, or religious beliefs that the individual may hold (APA, 2013). Although delusions can come in various forms, Amelia is experiencing persecutory delusions. Persecutory delusions are characterised by the belief that the individual is being persecuted, spied on, conspired against, or in danger of being hurt (Evans, 2017). Amelia exhibits persecutory delusions by stating there are cameras in her house, and that she is being spied on.
Subsequently she is too scared to return home, and has started living in her car. Although to someone not experiencing psychosis this may not be logical, to Amelia this is a rational conclusion to make. Disorganised or bizarre behaviour is characterised by abnormal motor behaviour, change in clothing and appearance, and catatonia (Evans, 2017). This bizarre or changed behaviour can be the result of the individual acting on their altered thoughts and experiences associated with psychosis (Dodd & Jeffs, 2014).
Amelia is observed exhibiting bizarre behaviour when she is seen staring at the ceiling and mumbling to herself. Additionally, fidgeting with her hair and clothes, and her scuffed and unwashed jeans are also signs of bizarre behaviour. These bizarre behaviours may be the result of the disordered thought process, Amelia’s thoughts may be confused and she may be unable to concentrate on completing cognitive tasks (Dodd & Jeffs, 2014). Together, these symptoms are in keeping with a clinical diagnosis by the doctor of psychosis. Question 3: The doctor prescribed 5mg olanzapine nocte’ for Amelia.
Describe the education you will need to provide to her before she leaves the clinic. Providing appropriate education of medication management to those experiencing psychosis is important, as often individuals lack insight into the correlation between medication and the improvement of their illness (Evans, 2017). In this scenario, Amelia has been prescribed five milligrams of olanzapine to be taken at night. The nurse should build on the therapeutic relationship with Amelia to provide appropriate education before Amelia starts her antipsychotic medication regime (Evans, 2017).
This education includes an appropriate explanation of why Amelia has been prescribed this medication, how to take this medication, and any side effects Amelia may experience. An appropriate explanation of why Amelia has been prescribed olanzapine, and how to taking her medication is important in the education process. The nurse could explain to Amelia the way the olanzapine will help to moderate the chemical in her brain called dopamine and serotonin, and this will help her to experience relief from the psychotic symptoms she has been experiencing (Boyle, Boyle, Fisher & McKay, 2014).
The nurse should then go on to explain that for the effects to take place, Amelia will need to take five milligrams of olanzapine every night, even if at first it feels that it is not doing anything. It is important she keeps taking the olanzapine as it can take some time for it to make an initial difference. The nurse should also explain that it is important Amelia does not suddenly stop taking olanzapine without talking to her doctor, as this could induce side effects such as vomiting, convulsions, or muscle cramps (Evans, 2017; Tiziani, 2013).
Finally, the nurse should explain to Amelia some of the short and long term side effects she may experience while taking olanzapine. Short-term, it is important that Amelia is aware she may experience some drowsiness or dizziness, this should go away in a few weeks, however it is important she does not drive during this time. Additionally, Amelia should not consume any alcohol at all, as it can interact with the olanzapine (Tiziani, 2013). Long-term its important Amelia is aware the most common side effects include significant weight gain, abnormal cholesterol levels, increased risk of heart disease, and development of diabetes (Ou et al. 2013).
Therefore, it is important the nurse stresses to Amelia the importance of making lifestyle modifications such as regular exercise and healthy food choices (Boyle, Boyle, Fisher & McKay, 2014; Evans, 2017). In the provision of appropriate education surrounding olanzapine and its potential side effect, Amelia gain enhance understanding of the importance of medication in her recovery. Question 4: Explain why you would need to ensure “adequate support” for Amelia before she leaves the clinic It is important to ensure Amelia has adequate support before leaving the clinic to ensure her treatment is effective as possible.
To ensure adequate support, the nurse should ensure Amelia has availability to a support network with family or friends, a safe place to live, and someone to talk to about her experiences. A strong support network of family or friends is important to those experiencing mental illness, such as psychosis. Studies have shown that the early inclusion of family in the recovery process often results in higher recovery rates for those with psychosis (Leggatt & Woodhead, 2016). However, it is also important that Amelia is in control of who is involved in her care, the nurse should not assume who Amelia will want to care for her.
Amelia mentioned her friend convinced her to see a doctor about her symptoms, no family is mentioned. The nurse should ask Amelia if there is someone she would like to contact and be involved in her care (Stanton, Tooth & Champ, 2017). It is important that Amelia can access a safe residence to live, to aid her recovery process. Individuals suffering psychosis and other mental health issues often have higher rates of homelessness (Mental Health Council of Australia, 2012). Amelia states she is currently living in her car, this not only poses a safety risk for Amelia, but also does not promote a supportive recovery environment.
If Amelia is unable to go to a member of her support networks home, the nurse may be able to provide information on specialist homelessness services agency which focus on preventing homelessness in those suffering mental illness (Mental Health Services in Australia, 2016). A support network Amelia can access, in addition to friends and family, especially in terms of understanding the mental health challenges Amelia is facing. Peer support workers are mental health workers who have had and recovered from mental health challenges themselves (Repper & Carter, 2011; Stanton, Tooth & Champ, 2017).
Amelia may find it beneficial to have access to this support network, as it promotes positive role models for her and foster her recovery process as well as decreases the risk of social isolation (Repper & Carter, 2011; Stanton, Tooth & Champ, 2017). There are many aspects of support Amelia will need during her recovery, however adequate support in the form of family and friends, safe housing, and access to a peer support network can be instrumental in the start of her recovery.