Author: Amanda Eymard, Co-Author: Linda Manfrin-Ledet,
Title: Associate Professor
Institution: Nicholls State University College of Nursing and Allied Health
Evidence-Based Practice, Informatics, Patient-Centered Care, Quality Improvement, Safety, Teamwork and Collaboration
<p class="MsoNormal" style="margin-bottom: .0001pt; line-height:
normal; mso-layout-grid-align: none; text-autospace: none;”>This unfolding case study was designed to provide opportunities for nursing students to make decisions regarding a patient diagnosed with schizophrenia. There are KSA safety questions, teamwork questions (especially involving the use of SBAR), medication questions (including safety), a math problem, a video to illustrate schizophrenia, quality improvement questions, and also theory bursts are included.
The strategy is an unfolding case study involving a man diagnosed with schizophrenia. It begins with him encountering the police and evolves as he is transported to the emergency department and then to a psychiatric facility, and ends with his discharge. His family is involved in the patient-centered care scenario. Restraints, medication use, delegation, teamwork, communication, reflection, assessment, and laboratory/diagnostics are all included. It is designed to be an interactive, engaging exercise with students enrolled in a mental health nursing course. Questions and scenarios are posed, and then the next slide provides the answers. Theory bursts are also included.
<p class="MsoNormal" style="margin-bottom: .0001pt; line-height:
normal; mso-layout-grid-align: none; text-autospace: none;”>This unfolding case study is presented in the classroom to senior level nursing students enrolled in a mental health nursing course. The students are encouraged to participate by answering questions and collaborating regarding their answers. The students responded this semester with much enthusiasm; they were very engaged. They initially struggled with the SBAR activities when asked to notify a physician or other team member. This activity has been identified as a weakness in many new grads and was included in the case study for this very reason. As the case study progressed, the students became more confident with making the phone calls.
By DeepDiveAdmin, Wed, December 02, 2015
Sample Case Studies and Diagnoses
Following are four examples of patient descriptions with a link to the corresponding diagnosis.
These sample case studies are for illustration only. They should not be used to make a diagnosis. If the symptoms sound similar to those that you (or a loved one) are experiencing, please contact your primary physician or a mental health professional for an evaluation as soon as possible.
Case Study 1
Jessica is a 28 year-old married female. She has a very demanding, high stress job as a second year medical resident in a large hospital. Jessica has always been a high achiever. She graduated with top honors in both college and medical school. She has very high standards for herself and can be very self-critical when she fails to meet them. Lately, she has struggled with significant feelings of worthlessness and shame due to her inability to perform as well as she always has in the past.
For the past few weeks Jessica has felt unusually fatigued and found it increasingly difficult to concentrate at work. Her coworkers have noticed that she is often irritable and withdrawn, which is quite different from her typically upbeat and friendly disposition. She has called in sick on several occasions, which is completely unlike her. On those days she stays in bed all day, watching TV or sleeping.
At home, Jessica’s husband has noticed changes as well. She’s shown little interest in sex and has had difficulties falling asleep at night. Her insomnia has been keeping him awake as she tosses and turns for an hour or two after they go to bed. He’s overheard her having frequent tearful phone conversations with her closest friend, which have him worried. When he tries to get her to open up about what’s bothering her, she pushes him away with an abrupt “everything’s fine”.
Although she hasn’t ever considered suicide, Jessica has found herself increasingly dissatisfied with her life. She’s been having frequent thoughts of wishing she was dead. She gets frustrated with herself because she feels like she has every reason to be happy, yet can’t seem to shake the sense of doom and gloom that has been clouding each day as of late. [Click here for Diagnosis]
Case Study 2
Kristen is a 38 year-old divorced mother of two teenagers. She has had a successful, well-paying career for the past several years in upper-level management. Even though she has worked for the same, thriving company for over 6 years, she’s found herself worrying constantly about losing her job and being unable to provide for her children. This worry has been troubling her for the past 8 months. Despite her best efforts, she hasn’t been able to shake the negative thoughts.
Ever since the worry started, Kristen has found herself feeling restless, tired, and tense. She often paces in her office when she’s there alone. She’s had several embarrassing moments in meetings where she has lost track of what she was trying to say. When she goes to bed at night, it’s as if her brain won’t shut off. She finds herself mentally rehearsing all the worse-case scenarios regarding losing her job, including ending up homeless. [Click here for Diagnosis]
Case Study 3
Josh is a 27 year-old male who recently moved back in with his parents after his fiancée was killed by a drunk driver 3 months ago. His fiancée, a beautiful young woman he’d been dating for the past 4 years, was walking across a busy intersection to meet him for lunch one day. He still vividly remembers the horrific scene as the drunk driver ran the red light, plowing down his fiancée right before his eyes. He raced to her side, embracing her crumpled, bloody body as she died in his arms in the middle of the crosswalk. No matter how hard he tries to forget, he frequently finds himself reliving the entire incident as if it was happening all over.
Since the accident, Josh has been plagued with nightmares about the accident almost every night. He had to quit his job because his office was located in the building right next to the little café where he was meeting his fiancée for lunch the day she died. The few times he attempted to return to work were unbearable for him. He has since avoided that entire area of town.
Normally an outgoing, fun-loving guy, Josh has become increasingly withdrawn, “jumpy”, and irritable since his fiancé’s death. He’s stopped working out, playing his guitar, or playing basketball with his friends – all activities he once really enjoyed. His parents worry about how detached and emotionally flat he’s become. [Click here for Diagnosis]
Case Study 4
Martin is a 21 year-old business major at a large university. Over the past few weeks his family and friends have noticed increasingly bizarre behaviors. On many occasions they’ve overheard him whispering in an agitated voice, even though there is no one nearby. Lately, he has refused to answer or make calls on his cell phone, claiming that if he does it will activate a deadly chip that was implanted in his brain by evil aliens.
His parents have tried to get him to go with them to a psychiatrist for an evaluation, but he refuses. He has accused them on several occasions of conspiring with the aliens to have him killed so they can remove his brain and put it inside one of their own. He has stopped attended classes altogether. He is now so far behind in his coursework that he will fail if something doesn’t change very soon.
Although Martin occasionally has a few beers with his friends, he’s never been known to abuse alcohol or use drugs. He does, however, have an estranged aunt who has been in and out of psychiatric hospitals over the years due to erratic and bizarre behavior. [Click here for Diagnosis]
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