Faculty of Health | School of Nursing, Midwifery & ParamedicineNRSG 263Week 8 Virtual Tutorial OutlineLearning outcomes:1. Develop an understanding of the mental health services meeting the needs of people who live in regional and remotecommunities.2. Describe the knowledge needed to Implement the components necessary to safeadministration of psychotropic and other medications.3. Discuss the principles of trauma informed care and consider the role in managing effortsminimise restrictive practices in the clinical setting. ActivityActivity DetailNotesTime(minutes)Activity 11. Overview ofWeek 8 tutorialand tutor torecord classattendance.2. Students toidentify any takehome messagefrom the lectures.Tutor to introduce self and compete theroll. Students are reminded to checkannouncements and ‘Ask the LIC’.Students to identify take home messagefrom the lecture10Activity 2Whole class to view thevideo.Mental Health Services inrural South Australia(6:40mins)when assessing people who live in regionaland remote areas identify questions youwould ask factors that impact health andwell-being like -transport to larger regionalhealth care facilities, costs of transport andaccommodation to attend regional orurban health care facilities, the emotionalcost of being separated from family whenadmitted to larger regional and urbanhealth care facilities.30minutesActivity 3Students: Students are torefer to the case studydocument ‘Tony’, lectureslides and the requiredtext to prepare responsesto the topics listed below.Working in groups,students will investigatean allocated topic andpresent their findings tothe class. Be sure to usethe correct terminology.Please note students areencouraged to completenotes on all the topics inthe list during the classdiscussion.1. Identify incidents in Tony’s life thatare known to cause trauma for peoplewhen they areadmitted to an inpatient mentalhealth unit and describe how thesehave impacted his life.2. Tony is worried about being made‘involuntary’. What is the differencebetween ‘voluntary’and ‘involuntary’ treatment in thecontext of mental health legislation inyour state orterritory?3. Identify the psychotropic medicationprescribed for Tony, for the treatmentof the symptoms of schizophrenia andconsider the importance of effectivemonitoring, consumer experiences(side effects) and safety factors;Include nursing responsibilities when5015minutesin groups35minutesreportback Faculty of Health | School of Nursing, Midwifery & Paramedicine administering a LAI medication andinclude specific knowledge aboutincreased risk factors for a persondiagnosed with schizophrenia.4. Using the Clinical Reasoning Cycle‘Collect Cues/Information’ identifycues/information that would indicateTony may be depressed and notexperiencing an acute exacerbation ofschizophrenia or delirium?Self-ReflectionWhat are my firstimpressions and how arethey influenced by priorassumptions andpreconceptions of olderpeople diagnosed withschizophrenia.As a registered nurse your personalattitudes and beliefs will impact yourwords and actions.5 Case study ‘Tony’.Today Tony arrives at the Community Health Centre to see Jenna, the mental health nurse. Jennahad been his case manager several years ago, before he was transferred to GP care. He hadasked for an appointment because since his mother passed away six months ago, he finds hefeels sad all the time and does not want to join his cousins in the machinery shed. He is worriedhe will end up in hospital again. On arrival he noticed how noisy the waiting room was with peoplecrowding around the reception desk, people yelling and phones ringing. When it came to his turnto speak, he was told that he had missed his appointment and his doctor couldn’t see him. Theperson at reception said they were booked out and if he couldn’t be on time, that was too bad, andhe would have to wait till the next available time. But he said was sure he had the right time andhe said so, using a profanity in Italian. He fumbled in his pockets for the card with the appointmentdate, but she crossed her arms, raised her voice, and told him to ‘go away and learn to speakEnglish and if he didn’t move away from the desk, she would call security’. Tony could feel himselfstarting to shake, his face feeling hotter and hotter, and clenched and unclenched his fists. He wastrying so hard to keep control and he knew if he didn’t move, he might do something he’d regretand end up in seclusion again. Just then Jenna, the practice nurse came through the door. Shemade eye contact and smiled and said ‘Hi Tony, I’m glad you made it. Come inside and let’s havea chat.’Faculty of Health | School of Nursing, Midwifery & ParamedicineMedications: paliperidone palmitate 100mg IMI monthly; Amlodipine (Atorvastatin) 10mg oral bd;Metformin XR oral 1500mg daily, Panadol Osteo 665mg oral TDS.HistoryTony Rossi is 73 years old man living in regional NSW. His is part of a large Italian community thatestablished itself in the area mid last century. His family are farmers and Tony as always workedin the family business, planting and harvesting crops. These days he keeps himself busy helpinghis cousins maintain the farm machinery. Tony never married and now he lives on his ownfollowing the death of his mother, six months ago. His cottage is fifteen kilometres out of town,located near the home of his older sister and her husband.Tony was diagnosed with schizophrenia when he was 19 years old. He has always beensupported by his family, and he has not had an admission to for almost fifteen years. Over theyears he has been case managed by community mental health nurses at the community healthCentre. Now he sees his GP once a month for a depot injection. He has been offered hismedications as oral tablets, but he has always preferred the depot injection. He fears becomingunwell, and then made an involuntary patient under the State Mental Health Act and spending timein seclusion. After his first admission to a large regional psychiatric hospital in 1968 heexperienced periods of long inpatient admissions until a community mental health team was set up atthe new community health center in the early 1980’s. For many years Tony could not talk abouthis experiences in the hospital where his treatment included long periods of seclusion and physicalrestraint, and several treatments of Electroconvulsive Therapy. However, later in his 60’s heshared his story of hope and recovery from the trauma of his time in the hospital, to a local groupsupporting young people who were known to the juvenile justice system.Tony sees his GP every month and is currently being managed for schizophrenia, diabetes type 2,hyperlipidaemia, chronic obstructive airways disease and arthritis in his left hip. He is reluctant toagree to a hip replacement because he does not want to be admitted to hospital. He does notdrink but does report smoking ten cigarettes a day.
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