The case study of a client the author met during her placement period in one of the NHS trust. The WritePass Journal

The case study of a client the author met during her placement period in one of the NHS trust. Introduction The case study of a client the author met during her placement period in one of the NHS trust. IntroductionREFERENCESAPPENDICES     APPENDIX 1  PERSONAL HYGIENEINTEVENTION/ACTIONEXPECTED OUTCOMEAPPENDIX 2  SLEEP PATTERNINTERVENTION/ACTIONEXPECTED OUTCOMESAPPENDIX 3  MEDICATIONINTERVENTION/ACTIONEXPECTED OUTCOMEAPPENDIX 4MOODINTERVENTION/ACTIONExpected outcomeAPPENDIX 5SUICIDEINTERVENTION/ACTIONExpected outcomeTo prevent further relapseAPPENDIX 6SECTION 3 MENTAL HEALTH ACT (1983)INTRVENTION/ACTIONExpected OutcomeAPPENDIX 7  OBSERVATIONSINTERVENTION/ACTIONEXPECTED OUTCOMEAPPENDIX 8LESSON PLANOBJECTIVES Related Introduction This essay is based on the case study of a client the author met during her placement period in one of the NHS trust. Confidentiality will be maintained to protect the clients sensitive data as stated under Data protection Act (1998). Therefore, a pseudo name will be used and hospital name withheld throughout the essay. This is in collaboration with NMC (2008) Code of Professional Conduct. The author will discuss about assessment strategies used by the team to assess the client. The essay will develop by identifying factors contributing to client mental health concerns and in addition the author will look at agreed care plans. Discussion on own contribution and those of others in implementing and evaluating agreed care plan actions will be revisited as well. The author will also reflect on mental health education and practice carried out with the client and his family. In conclusion the author will summarise the case study by reflecting on how she experienced the procedures of her tr eatment from assessment throughout to recovery plan. Richard (pseudo name), is a 20 year old white male who was admitted in one of the NHS acute wards in England under Section 3 of Mental Health Act (MHA, 1983). He is known to the service since the age of 13 and has been diagnosed with schizophrenia. This was his sixth admission and he has been to a mental rehabilitation and recovery unit twice during his previous admissions and presently he is under care of Community Psychiatric Nurse (CPN). He is known to be escorted by police on all his hospital admissions. Richard grew up under the care of his mother who was single with different men coming in her house. She was unemployed and lived on benefits in a two bedroom council flat since Richard was two years. The area was crowded, multicultural with a high rate of drug, theft and violence crimes (UpMyStreet, 2011).   As he grew up, he played with friends raised from the same financial/economic and social background as his, in the Council Estate in which he resides. Drinking alcohol excessively and smoking any sort of cigarettes is common in his home and his neighbourhood. As a result Richard was easily influenced into excessive drinking and smoking. He began using the little money he was given by his mum to feed his habit. His friends smoked cannabis and all sorts of drugs and it did not take long for him also to join them in smoking it. According to Rausch and Young (1991, Pg 4) cannabis is â€Å"a depressant drug with hallucinogenic properties†.   This reality catches up with him as he increasingly gets accustomed to cannabis. Around the age of 14, he started using illicit drugs like Heroin and crack cocaine. According to Edlin and Golanty (2009, Pg 377) these drugs stimulates the nervous system. What this means is that when a person is under the influence of these drugs, even though it is a crime on its own, can easily go to the extreme of anything he/she is performing or have wrong judgements that may easily result into another crime. Richard had family history of Mental Health; both his grandparents died of Alzheimer’s Dementia. According to epidemiology studies people with family history of mental health have high risk of having mental health in future. Richard was admitted after the CPN and his mother were concerned about his behaviour, for example, walking naked around the house; not attending to his personal care; very withdrawal; laughing inappropriately; low moods; responding to voices and not taking his prescribed medication. They tried to bring him into Hospital informally but he refused as he had no insight into his condition, therefore, CPN informed the Approved Mental Health Professional (AMHP) who then arranged for mental health assessment and brought him formally under section 3 of Mental Health Act 1983 (MHA 1983). On admission, he was under influence of drugs and was not able to stand properly; therefore, he sat on a wheelchair to avoid risk of falling. He looked untidy with long uncombed hair, wearing dirty clothes and appeared to be in need of using the toilet. The author and other nurse took him to the toilet/bathroom and were able to get the urine sample which was sent for test and confirmed that illicit drugs were present. Whilst in the bathroom, he was assisted to have a bath and get changed into clean clothes. This also gave the author and other nurse opportunity to do Body map. He was responding to both visual and auditory voices. He could not maintain eye contact. Every time staff looked at him he puts his head down. During body map, it was found that his fingers and toes appeared purple with wounds. This was documented on Body Map Form (See Appendix 10a). The nurse said that the type of wounds is common to people who inject themselves with drugs. However, he sat on a scale to weigh him and his height taken as per assessment procedure. His weight was 48kg and height 1.78m (See Appendix 10b). According to Body Mass Index (BMI) Richard was 15.1 under weight. Understanding this from his lifestyle, it appears that he was living on a poor diet because most of his money went towards drugs instead of food, clothing and toiletries. Vital signs such as Blood Pressure, Temperature, and Pulse were taken and recorded (See Appendix 10c).   Night Staff reported that Richard becomes restless during the night asking to leave hospital. On doing this he turns to be aggressive presenting with threatening manners. Richard was reminded that he was under section 3 (MHA 1983) and nurses read his rights for him to rem ind him that he was not able to leave the ward without section 17 which requires Consultant’s approval (See Appendix 10d for patient’s rights). All these behaviour according to Patrice (1994) are drugs unforeseen effects. Through involvement with the Multi-Disciplinary Team (MDT), the author got an opportunity to participate in the assessment, for Richard’s needs, planning of his care, implementation and evaluation of the planned interventions. According to Ward (1992) assessment is a form that the nursing team use to measure what clients can do independently and their coping strategies. Walsh and Kent (2001 Pg 140) argued that assessment is about looking at a â€Å"patient as a whole† that is â€Å"physically, socially, biologically and psychologically†. During the assessment different assessment tools, approaches, observation techniques were used by different members of the team depending with their conceptual frameworks or models of practice. The team was comprised of the Author, Psychiatric Doctor, Physiotherapist, Occupational Therapist, Registered Nurse, Psychologist etc. However, all these were to fulfil holistic nursing care. Schultz and Vibeck (2002) views assessment as the initial step carried out during first stage of admission. Care Program Approach (CPA 1991) was used to assess Richard. According to The Sainsbury Centre for Mental Health (2000), CPA has a goal-achieving feature. It gives an efficient framework for a coordinated care provision and resource allocation. In this, a patient is allocated a key worker; a detailed assessment to each client’s needs is clearly stated and the client is involved in the recovery plan. However, interview was done, which involved Richard and his mother. They were assessed on their needs, for example housing, finance, physical and mental health status, past and current medication, education, sleep pattern and coping strategies. During the interview the author and other team members maximised their knowledge and skills, especially communication skill. According to Porritt (1984, Pg 3) communication is the main way by which human beings interact and can be view ed as a social process. It was witnessed that Richard was hallucinating; had paranoid ideas; restless; confused at times; presenting flat moods. He was denying to what was taking place at the same time avoiding eye contact and crying. All these were influenced by drugs he took.   Ross (2001) describes this as common to people who are depressed. The team was highly experienced and understood how to deal with these factors that might impinge assessment. Active listening skills were brought into use, for example: reflecting everything Richard had said and clarifying   with him; at other times paraphrasing and also asking him to summaries; speaking simple, clear and straight forward without use of jargon (Porritt, 1984). Good distance from him and sitting posture was maintained professionally for him to feel relaxed and engaged into the discussion (Egan, 2002).   When talking, they squarely faced him, with open gestures and smiling. Suitable questioning strategies were utilized, for example, open and close ended questions. One example of this type of questions he was asked was as follows: â€Å"What is your daily routine?† However, the author/student had limitations and boundaries to work on, therefore, during interview the doctor was asking questions and the author was documenting the answers on assessment form inst ead of asking questions as well. She had to maintain that and maximise understanding, acquiring skills and knowledge. According to McGuire and Priestly (1985, Pg7) â€Å"a knowledge of your own limit immense great benefit in itself and may be indispensable for solving some kinds of problems†. Literacy and numeracy skills were involved in the process when calculating points scored and lay down in a form of a scale. These were documented on assessment forms and the author’s mentor double checked to assess if they were well completed to the standard. These were to meet the NMC Code of Professional Conduct on documentation and record keeping (2008). It was concluded that the trigger for all His problems was substance misuse; therefore, he was referred to Drug Clinic for detoxification and was to be prescribed methadone depending on the level of drugs in the blood. Stopping drugs completely could result in death by acute causes ((Prof ) Jones,   2004).   Mirtazepine 15mg once daily, Zopiclone 7,5mg once at night and paracetamol 500mg three times daily was prescribed. Risk assessment was carried out using Threshold Assessment Grid Tool (TAG see Appendix 10e). According to DOH (2002), this tool assesses client potential risk to him or others, that is, looking at clients past history of violence; self harm or others; patient social network and neglect. TAG simply assesses the severity of service user’s mental health problems (Slade, 2000). It was noticed that Richard was at risk of blood transported diseases, for example, HIV and Hepatitis. Blood test was done and Richard was informed that the results were negative.   Advice was given that the blood test will be repeated again after six months as HIV studies refer this period of months as window period. Level three observations commenced, where the staff had to monitor him on one to one. Close monitoring was important on Richard because he was depressed and was on antidepressant medication, therefore, suicidal thoughts were most likely to affect him (Carolyn et al, 2008). Care planning is one of the requirements of CPA. According to Hogston and Simpsons (2002), care planning is a process that provides a â€Å"road map† to guide everyone involved with patients’ care. Richard and his mother participated in planning.   According toSeaback (2006) patient involvement make them feel empowered, valued and committed to goals sat out. However, Maslow Hierarchy of needs triangle indicates that basic, low level needs should be satisfied first. Following this triangle, needs to be met were housing, weight building, job, personal hygiene, sleeping pattern, compliance with medication and dealing with suicidal thoughts. Due to word limit of this assignment, three of these will be discussed and others written in appendix (1 to 9). Since the problem was triggered by substance misuse, this can be viewed as the umbrella of all other needs, thereby makes health promotion the top priority. A health promotion care plan was devised involving Richard and his mother. This was done according to DOH (2004) that, the care plan is to be individualised and tailored to meet each client’s needs . It involved educating Richard about his illness and researches about substance misuse. Richard and his mother agreed that he was going to attend Drug- Misuse-Team clinic to get more help on detoxification and how to quit drugs. Therefore, a referral was sent to Drug-Misuse -Team, who came to assess and take him on board. The author sort consent from the mentor (Richard’s key worker) to work collaboratively with them in order to achieve this assignment and get insight into planning and delivering a teaching session on substance misuse. According to Body Mass Index, Richard was under weight therefore, food and fluid chart were put out to record the intake (See Appendix 10f). Whitney and Rolfes (2008, Pg 579) suggest that, the prolonged use of drugs causes dehydration, loss of appetite which result in loss of weight which can lead to malnutrition and swallowing problems. Staff members were informed and communication book completed to make sure Richard has adequate diet and fluid. Weight chart was put in place for him to be weighed weekly (See Appendix 10g). Dietician was contacted to come and give advice on which foods to offer Richard. She came and carried out assessment with Richard and advised staff to offer him soft diet as he was likely to have problems with swallowing (Whitney and Rolfes, 2008). This was to be reviewed weekly during Multi-disciplinary Meetings. Food supplements in the form of fort sip, fort cream and Calogen were prescribed; this was in line with Stanfield and Hui (2009) who notes that these fo od supplements help building the body but they must be taken alongside with meal not as a substitute. To meet his social needs Richard agreed to work collaboratively with the Social Worker who planned to find accommodation in a different area from his friends. His care co-ordinator was to monitor him effectively whilst at home to prevent further relapse and discouraging him to associate with friends who abuse drugs. Welfare state benefits began to be processed whilst he was still in hospital. In the care plan Richard agreed to go back to college in order to achieve his goals because he wanted to find a job. According to Radomski and Latham (2007), education is the primary goal to dysfunctional people as it increase their self esteem, work experience, outdoor activities and prevent risk of exclusion. He also agreed to take some voluntary work whilst he was still in hospital and Occupational Therapist (OT) was to come and collect him twice weekly as soon as he was ready to start. During his community activities the consultant completed Section 17 Mental Health Act (1983) which was ther e to allow Richard to go outside the ward for four hours a day. These care plans were to be monitored daily and evaluated every now and then as Richard progressed. Within six weeks after admission, changes began to be noticed on his behaviour and appearance. Reflecting to progress, he began to put weight which proved that the supplements were working, therefore, weight care plan was changed from weekly weight to fortnightly. However, food and diet chart continued as it was still important to find out how much he eats and drink. The food supplements were discontinued after the Dietician’s assessment in which it was reported that he was progressing well and proper diet was encouraged. In the process, he was maximising the use of gym to build up his muscles. Evidence in progress was witnessed when he began to use his own initiative to attend to his personal needs independently; therefore, his care plan pertaining to personal hygiene was reviewed and reduced to supervision. The Social Worker got him an apartment that was close to his mother and his benefits were processed. He began receiving weekly payments which he collected accompanied by staff. He was able to buy his toiletries, clothes and other foods preferred. When Richard started activities with OTs improvement on his capability and potential to do things better was witnessed. Initially, he required a wheelchair when going out because he was assessed as weak and at risk of falls, however, this was discontinued and a wheelchair was no longer needed to mobilise him. Richard was advised to increase his activities as he enjoyed participating. He got a place at the local college to study carpentry. His medication was reviewed and changed; Zopliclone and Paracetamol were to be given as per his request (PRN) because he was sleeping well at night and no more headaches as before. The author also reported progress on teaching session conducted with Richard as presented in the later part of this assignment. Analysing the introduction of receiving benefits weekly while in hospital, Staff members witnessed some incidences (although few) were service users smuggle drugs into hospital. Giving Richard money appeared to be a risk because he might use it for buying drugs. However, this was an issue dealt with in advance, in the Criminal Law Review (1992) Police have right to stop and search anyone in possession of controlled drugs under Misuse of Drugs Act 1971 which also gives hospital staff same powers to do stop and search to detained patients. Therefore, the stop and search use to be conducted by staff and police once every now and then and all drugs, alcohol, dangerous weapons found were to be confiscated. However, the reason for stop and search was always explained to patients to avoid breaking the therapeutic relationship between client and nurses which is build upon trust, respect, genuineness and empathy. On substance misuse care plan, all staff had a responsibility to educate Richard on health promotion. The author working collaboratively with the mentor planned the teaching sessions which focused on developing an understanding for Richard and family that drugs are detrimental to their health. The author put together session plan (see appendix 8). At this point the greatest dilemma was that, the author had no experience in teaching sessions of this nature. However, support was available from the mentor when needed Blais (2002) views teaching as a system of activities whereby learning occurs. Hinchcliffe (2005, Pg 63) added that, â€Å"learning is any event that brings about relatively permanent change in behaviour resulting from either experience or practice†. To achieve a meaningful session the author usually began by defining the purpose of the lesson to the group. Each and every individual were given chance to participate, contribute and criticise the session. Information   for teaching was gathered through current research, evidence based practice ideas,   clients experience and   other professionals as recommended by NMC Code of Professional Conduct (2008) that, one â€Å"has to keep his/her knowledge and skills up to date and deliver care based on current evidence†. According to Jarvis and Gibson (2001) rehearsing helps develop confidence and reduce nervousness, therefore, rehearsals were done with the mentor before the final session. This helped to boost confidence a nd to correct and polish work before presenting it to Richard and group. In implementing the teaching session, the author used the activist strategy, according to Nicklin and Kenworth (2000) this is a teaching theory that allows clients perform more activities to motivate themselves and enjoy the learning experience. These activities were group work that includes discussion, listing substances and identifying relapse signatures. To make this teaching theory effective some resources were used, for example, flip charts, simplified diagrams and video clips. All these helped to draw attention as some realised that the symptoms they were experiencing were similar to what they saw on the teaching resources. They responded by answering each other’s questions. This proved that they were listening to teaching session. At some point they debate which made the session more enjoyable.   Use of leaflets was avoided in the session because most of them including Richard got a lot of leaflet information teachings from drug misuse clinic. During the session, the author had to use skills such as maintaining the tone of average voice because lowering it was going to give wrong signal to clients that information given was questionable. Raising the voice could be associated with threatening manner or shouting (Porritt, 1984). Listening was a skill used a lot to attract clients into discussion. In doing this, the author avoided repetition of phrases; hesitation; was facing them and maintained eye contact in order to communicate effectively without reading from the script (Egan, 2002). At the beginning of the lesson, the author advised clients to maintain confidentiality in case some clients disclosed important information and at the same time encouraged them to maintain respect and dignity in line with NMC code of Professional Conduct (2008). An evaluation tool (see appendix 9) was designed by the author to get feedback from Richard and group. Some expressed that too much material was used, for example, flip chart and handouts. Some pointed out that they could not keep in memory words used especially in flipcharts. Few of them believed that drugs have no effect on mental health despite all education they got; they still believed mental health comes like any other disease, for example, diabetes. Generally, most were good comments such as â€Å"It was informative, well taught, the session was well timed and of good length, the teaching was helpful in personal life, the session reflected real experience in life, etc†. According to authors’ work experience and opinion, giving up drugs is up to individuals not what clients are told. With the view of hospitals, there is a number of health care professionals who smoke cigarettes but they are quite aware of the effects. Mcdowell and Spitz (1999) argued that people give up on their own will as the substance misuse cycle is like any other recovery cycle and that varies depending on individuals. Reflecting to the whole case study, the author was impressed to see what she knew in theory put in practice, for example, individualised care. Hinchcliff (2005) argued that reflection is the way in which everyone revisits the events that happened and how these could have been done differently.   Therefore, the author hereby suggests that Richard would not have relapsed if the government’s welfare state system was fit for purpose. Evidence in the text shows that Richard grew up and lived in a community associated with poverty and social exclusion. It was also mentioned that the Social worker got an apartment for him in a better area. This means that the state is failing other places by inadequately supporting them. After detoxification the social input offered to Richard were sufficient enough to avoid his admission into hospital. That kind of social input and support was suppose to be given to Richard from birth to present. In short prevention is better than cure. Furthermor e, it is encouraging that Richard and family were involved in all aspects of care. Richard was able to take a lead which was useful because it encouraged him to work toward his goal. The only skill to endeavour apart from what the team used so far is Focus Solution Therapy (Simon and Nelson, 2007) as it also encourages clients to focus on their goals instead of the problem. Richard remained in hospital. REFERENCES Blais K (2002) Professional Nursing Practice: concepts and perspectives; Prentice Care Program Approach (1991) Department of Health 1090; Relapsing or Recovery: England Carol C.G, Baldwin R, Burns A (2008) Integrated Management of Depression in Elderly: Cambridge University Press Data Protection Act (1998) Department of Health: Record Management, The stationary office Department of Health (2002) Department of Health, Best practice in Risk Assessment: The stationary Office Department of Health (2004) The NHS Improvement Plan: putting people at the heart of public service: The stationary office. Edlin G, Golanty E (2009) Health and Wellness: Jones and Burtlett Learning Egan, G. (2002) The Skilled Helper a problem management approach to helping’. Brooks Cole Hinchcliffe, S. (2005) the Practitioner as a Teacher. 3rd Edition. The fractioned as a teacher. London, Churchill Livingstone. Hogston R and Simpson (2002) Foundation in Mental Health Practice. New York: Macmillan Jarvis, P. and Gibson, S. (2001) the Teacher Practitioner and Mentor: in Nursing, Midwifery, Health Visiting and Social Services, 2nd Edition. Cheltenham: Nelson Thorns Ltd. Jones R (Prof)(2004) Oxford Textbook of Primary Medical Care; Volume 2: Oxford University Press. Mcdowell. D. M, and Spitz, H. I, (1999) Substance Abuse from Principles to Practice, London, Brunner / Mazel. Mental Health Act (1983) Department of Health: Acts and Bills, England McGuire J, Priestly P (1985) Offending behaviour: Skill and stratagems for going straight; Batsford Academic and Education Nicklin, P.J. and Kenworth, N. (2000) Teaching and Assessing in Nursing Practice: An Experimental approach 3rd Edition. London: Brailliere Tindall. Nursing and Midwifery Council (2008). Code of Professional Conduct: Standard for Conduct, Performance and Ethics, London: NMC Patrice G (1994) An Introduction to pychology: Routledge Porritt L (1984) Communication: choices for nurses; Churchill Livingstone Seaback W. (2006) Nursing Process Concepts and Application 2nd ed London: Delmer, T. Learning. Schultz, M and Videbeck H (2002) Manual of psychiatric Care Plans Philadelphia: Lippincott Simon, J. K and Nelson, T. S. (2007). Solution-focused brief practice with long-term clients in mental health services: Im more than my label. New York: Taylor Francis Slade, M. (2000) What outcomes to measure in routine mental health services, and how to assess them – a systematic review. Australian and New Zealand Journal of Psychiatry, 36, 743 -753 Stanfield P, Hui Y. H (2009) Nutrition and Diet Therapy: Self-Instructional Approaches: Jones and Bartlet Learning Radomski M. V, Latham C. A. T (2007) Occupational Therapy for Physical dysfunction: Lippincott William and wilskins Rausch S, Young M (1991) Be a Winner: an educational programme to prevent drug abuse: University of Arkansas Press Ross A.J (2001) Coping when a parent is Mental ill: The Rosen Publishing Group The Criminal Law Review (1992) Law: Sweet and Maxwell The Sainsbury Centre for Mental Health (2000) Care Program Approach (Available at); http://sainsburycentre.org.uk(Accessed on 25April 2011) UpMyStreet (2011)B70 house prices, property crime rate, local neighbourhood and schools (Available at); upmystreet.com/b70.html (Accessed on 25 April 2011) Ward M. F (1992) The Nursing Process in Psychiatry: Churchill Livingstone Whitney E.N, Rofles S.R (2008 Pg 579) Understanding Nutrition: Cengage Learning; Hampshire APPENDICES      Appendices provided here are:  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Appendix 1  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Personal Hygiene- care plan Appendix 2  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Sleep- care plan Appendix 3  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Medication-care plan Appendix 4  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Mood- care plan Appendix 5  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Suicide-care plan Appendix 6  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Section 3 Mental Health Act- care plan Appendix 7  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Observation –care plan Appendix 8  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Lesson plan Appendix 9  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Evaluation Tool Appendix 10a  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Body Map- Assessment Tool Appendix 10b  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Body Index- Assessment Tool Appendix 10c  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Vital Signs- Assessment Tool Appendix 10d  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Section 3 Mental Health Act (1983) Patient’s Rights Appendix 10e  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Threshold Assessment Grid- Assessment Tool Appendix 10f  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Food and fluid Charts- Assessment Tool Appendix 10g  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Weight Chart- Assessment Tool Where information is deleted or omitted is done deliberately to protect confidentiality of the source APPENDIX 1   PERSONAL HYGIENE INTEVENTION/ACTION 1  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Richard to be assisted by one staff with his personal hygiene needs daily. 2  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Staff to encourage him to use preferable deodorant. 3  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Staff to encourage him to wear clean clothes daily. 4  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Staff to encourage him to shave every now and then. 5  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Staff to encourage him to brush his teeth and comb his hair daily when attending to his personal hygiene needs. EXPECTED OUTCOME 1 For Richard to be able to attend to his personal hygiene needs independently. 2 For Richard to look presentable all times. 3 For Richard to continue practising this skill when discharged. APPENDIX 2   SLEEP PATTERN INTERVENTION/ACTION 1   Richard to be commenced on sleep chart to monitor his sleep pattern. 2 Staff to offer him warm milk drinks before bedtime to help him sleep, but avoid caffeinated drinks 3 Staff to offer him warm bath priory to bed. 4 Staff to keep him occupied with activities during the day and discourages him to sleep until evening. 5 Staff to monitor any side effect of his current medication to his sleep pattern. EXPECTED OUTCOMES 1 For Richard to have long sleep hours. APPENDIX 3   MEDICATION INTERVENTION/ACTION 2 Richard to take all his prescribed medication. 3 Staff to educate him on importance of taking medication. 4 Staff to educate him on his prescribed medication. 5 Richard to discuss with the Doctors on other routes if he does not want oral medication. 6   Staff to monitor concordance with medication and observe for side effects and therapeutic effects. EXPECTED OUTCOME 1 For Richard to have knowledge on his prescribed medication. 2 To maintain recovery. 3   To prevent further relapse APPENDIX 4 MOOD INTERVENTION/ACTION 1   Staff to have one to one session with Richard once daily. 2   Staff to monitor his mood and document daily. 3 Staff to encourage him to participate in ward activities. 4 Staff to encourage him to interact with fellow peers. 5   Staff to use de-escalation skills when Richard becomes aggressive, restless or when he ask to leave. 6   Staff to use lock door policy when Richard threatens to leave the ward, document the incident and then inform the doctors. Expected outcome 1  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   For Richard to be able to ventilate his feelings and thought to staff. 2  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   For Richard to be able to interact with fellow peers and staff. 3  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   To maintain his safety and others APPENDIX 5 SUICIDE INTERVENTION/ACTION Staff to monitor Richard on one to one observations Staff to monitor side effects of depressant medication Staff to educate him on depressant medication Team to review his medication regularly Richard to have psychologist input To be referred to Therapy and Recovery Unit for CBT and Relaxation Expected outcomeTo prevent further relapse To prevent suicide or harm risk To help Richard achieve optimal function Richard to recover and maintain   treatment APPENDIX 6 SECTION 3 MENTAL HEALTH ACT (1983) INTRVENTION/ACTION Staff to read Richard’s right to him Staff to give him medication as prescribed Staff to inform him on lock door policy and observation levels Richard to have a signed Section 17 when he wants to go outside the ward. For the care plan to be reviewed weekly by the team. Mental Health Coordinator to be informed of Richard section status as well as family Expected Outcome For Richard to be able to understand his rights For Richard to follow the section guideline at all times For Richard to be in a position to get support and guidance in appealing if they is a need. APPENDIX 7   OBSERVATIONS INTERVENTION/ACTION Staff to maintain Richard’s observation level Staff to increase observation level if appropriate Staff to record appropriate observation Staff to inform MDM of any change as appropriate No one should observe for longer than two hours at any one time EXPECTED OUTCOME Staff to provide information for ongoing behavioural and risk assessment including specific behaviours and triggers Staff to monitor all changes in behaviour Staff to enhance the safety of Richard’s behaviour at risk including: suicide attempts;   harm to others; self injury; risk of absconding and   potential risk of neglect APPENDIX 8 LESSON PLAN TOPIC: Substance Misuse and Mental Health Target audience: Patients, Staff, Family Date: 20 / 05 / 2010  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Time: 14.00 hrs Venue: Meeting Room  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Expected Duration: 1Hour OBJECTIVES To enable clients to: a) Understand what the meaning of the terms â€Å"substance misuse†. b) Understand the difference between the benefits of prescribed medication and the intoxication of illicit drugs c) List the different types of substances likely to be abused d) Discuss the effects of substance misuse on mental health e)   Identify their own relapse signatures f) Identify ways of getting help. TEACHING RESOURCES  Ã‚  Ã‚  Ã‚  Ã‚     Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  ACTIVITIES Handouts  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Discussion Flip Charts  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Group Work Overhead projector  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   watching a Video Television and video player  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Lesson Evaluation Video tape APPENDIX 9    EVALUATION TOOL Circle the appropriate answer 1) Objectives clear.  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Yes / No 2) The teaching material was useful.  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Yes/ No 3) The teaching material was easy to understand.     Ã‚  Yes / No 4) Discussions and group activities were useful.  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Yes / No 5) The language used was easy to understand.  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Yes / No 6) The presenter was speaking clearly.  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Yes / No 7) The subject well researched.  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚     Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Yes / No 8) The subject brought new things I did not know.  Ã‚  Ã‚   Yes / No

49 Tips on How to Cheat at College

49 Tips on How to Cheat at College 49 Tips on How to Cheat at College Do you remember that frigging fear, when you enter your class to take a test and understand that you remember nothing on the subject? You may have missed the classes or spent a previous night out, so there wasn’t enough time to study. Or you just wanted to relax and spend your time in a better way. In all such cases, you may want to cheat to save yourself and not to worsen your grades. We have collected 49 tips on how to save you from a disastrous test and help to sleep better at night. If you think that you are the only one to cheat, relax! According to the latest study, over 60% of all the students cheat in the class. Ask a friend. This one is probably the most popular way of cheating and only requires a reliable friend, who will be willing to assist you. Provide him with all the necessary notes and make sure he has internet connection to be able to get all the information fast. You will only need to text him a message with a question and wait for an answer; Use an earpiece. If you like spy movies, you will definitely like this method. Just buy an earpiece with a Bluetooth and record lectures beforehand. You will be able to listen to them and extract all the necessary information; Take a bottle with you. Make small notes and put them inside the wrapper. You can open them any time and no one will understand that your bottle is not for drinking! Classical method. You can make notes on any item you are allowed to take to the test. This can be a calculator, a ruler or an index card. You can use it any time you need and your professor won’t suspect anything; Order online. This type of an assistance is applicable for written tests, like essays or reports. You can hire an online writing company and give them all the details of the task. Then you will only need to check it on plagiarism to make sure it is original and memorize the paper before the test; Use your arms. You can make notes on your hand and a forearm, covering them with a sleeve. In such a way, no one will notice it and you will easily get access to the information any time you need; Take a mechanical pencil with you. This one is a simple trick: write down the notes on a tiny sheet of paper, roll it and put inside the barrel; Look at your neighbor’s work. Make sure he has excellent skills on the topic, as you may fail if rewriting answers of someone, who is also not good at the subject; Search online. If you can pull out your smartphone in the class, just type the request in your browser and get all the information you need. You can also go to the bathroom and find all the data; Stretch a rubber band and write down all the notes you may need. When it gets back to its usual size, there won’t be any trace of the notes and you will only need to stretch it again if you need help; Ask for a sample. If your friend or any other student is holding a test before you, ask him to make a photo of the test. You will be able to prepare the answers or learn them by heart before starting the test on your own; Buy a smart watch. You can make all the notes on your smartphone and simply link it with a smart watch. In such a way, you can ‘check the time’ and get all the information you may need; Make a hole in your eraser and put notes inside; Take a bigger eraser and write all the answers on it. If professor is approaching, simply erase the answers with a smaller one; Learn while sleeping. Play an audio version of the lectures, while you are asleep. Scientists say that you will remember all the information and will be able to use it any time you need; Print a mini-book. Type all the notes, print them and cut small squares, making a sort of a booklet; Take an mp3 pen, which contains all the information you may need; Just put all the notes you need to the inside of the hat; Write down the notes on the inside of your hat and put it on your table. Consult your hat any time you need assistance; Use a rubber part of the shoes to make all the notes and use it, when you need to get the answers; Get a partner. Cooperate with another student and share answers. Two heads may be much better than one! Look for clues. Look around as if you are thinking about something and try to search for the answers. There may be posters with diagrams or data on the walls of your classroom; Go to the bathroom. Excuse yourself as if you need to pee and simply use your phone or consult a friend to get all the answers you need; Put your thighs together and place all the notes between them. Your professor will never suspect that you are holding notes there! Use the ‘sneezing system’. Partner with a friend, who can make sneezes with the answers. For example ‘be-choo’ for an answer ‘B’; Learn one half of the test and leave the second one to your friend. Sit near to each other on a test and share the answers. This is a great way to get excellent grades without spending too much time over books; Use gestures with a friend to share the answers. You may even learn a basic sign language; For advanced students, there is a ‘morse code’. For example, one tap goes to the answer ‘A’, two taps for ‘B’ and so on; Wear a tie and use its back to hide all the necessary notes; Take a gum with you and put the answers inside of its wrapper; A belt buckle calculator. Yes, you heard it! If you are not allowed to take a calculator to the class, you may use the one, which is hidden in the buckle of a belt; Write down all the answers you need on a bookmark, placed in your textbook. Replace it with the next one if necessary; Pretend that you are using a calculator on your smartphone and consult the notes instead; Light inks. Use them to make notes on the index cards and your tutor won’t see them; Replace the tests. This one is quite tricky but guarantees that you will get the highest grade. Ask your friend to take a photo of the test, print it at home and fill in all the answer to pass at the classroom; Consult Wikipedia. You can download their app or simply enter the website from your browser. It is a perfect place to get brief information on a subject; Another favorite trick for all the lovers of spy movies is to buy an ink for a black light and take it with you to the class; Use a skirt. Hide all the notes under your skirt and your tutor won’t be able to check whether you have any hidden answers. Unfortunately, this is an option only for the girls; Buy a see-through pen and put all your notes inside of it; Make all the notes on a small sheet of paper and put them inside the case of your calculator. Any time your professor is approaching, close the case; Take an electronic dictionary, which contains all the notes you need. Most professors mistakenly take such dictionaries for a calculator; Make pictures of the study materials and open them on your phone at the class or while you are in the bathroom; Use an invisible ink to make notes on your desk. Any time you need answers, you will only have to use an ultraviolet light and no one will suspect anything; Put a blank sheet of paper over the one, which contains the answers. Put it aside if you need access to the notes or return to its place if the tutor is approaching; Contact anyone, who is online via various messaging apps or social media and ask for help. It will be even better if you can do it in a hall or in a bathroom; Buy spyglasses, which play the video of the notes or a textbook. This is quite a costly option but definitely one of the coolest ones; Reproduce your ‘cheat sheet’ with a laser pen. However, you should be sitting on the back row of the class; If you are assigned to complete a written assignment but you are running out of time, you can artificially increase the margins, fonts, spaces and so on; Learn! Of course, cheating in the class is much simpler but you can take some time and study to get the highest scores without any harm. Use an appropriate and the most suitable way for a particular situation and you will surely get high grades and save your time to prepare for the test.