Could you please assist me with this one along with the reference.

Sandy’s Story
You are a nurse working in emergency and are allocated to work with Sandy for an evening shift. Sandy is a 41 year old lady with a diagnosis of borderline personality vulnerabilities. Sandy has history of childhood sexual abuse and has also been a victim of domestic violence. She is estranged from her family members and does not have any close friends. Sandy has been brought in by ambulance this evening at 1945 following an overdose of her prescription medication, Seroquel XR 100mg x 12 tablets. Sandy states that she called the ambulance after she panicked about dying and wondering who would look after her cat Tibby. The trigger for the overdose was having an argument with Alan whom she was in a long-term relationship (13 years) with until recently. Alan went to Wollongong two months ago to attend a residential rehabilitation program for his alcohol dependence and decided not to return to Canberra as he felt this would jeopardise his sobriety. Sandy feels ambivalent about the relationship breakdown. Although she recognises their relationship was turbulent, she feels abandoned and rejected by him. They continue to speak on the phone frequently and she had been drinking wine and became verbally abusive during their conversation which led to Alan terminating the call.

You have completed the following MSE after conversing with Sandy:
Mental state examination

Appearance and behaviour
Sandy presents as an obese lady with short brown hair which appears unwashed and is slightly malodorous. She is of Caucasian appearance and appears as stated age. She has blue eyes and no remarkable features. She is wearing gold hoop style earrings and a gold wrist watch on her right wrist. She is dressed in a hospital gown and has an intravenous infusion insitu and is lying in bed. She appears defensive in her posture with her knees drawn up to her chest and her arms crossed. She does not meet your eye when you introduce yourself. She has a red face and bloodshot eyes and it is apparent she has been crying. She is to remain in the acute observation for ongoing monitoring until her fluids are completed in 3 hours and will have repeat toxicology screen upon cessation of her infusion. She is currently tachycardic at 130 and her BP is 170/90. Her blood alcohol level is 0. Her temperature is 37 and her respiration rate is 23.
Mood and affect
Sandy rates her current mood as “shit” and her affect is sullen, congruent with her stated mood.
Speech
Sandy appears withdrawn and speaks in a soft voice which is difficult to hear. Her head is downcast and she mumbles
occasionally becoming irritable when asked to repeat what she has said.
Thought form
Her thought form is unremarkable and there appears to be no abnormality of thought form. Her speech is coherent and
follows a logical sequence.
Thought content
Sandy expresses fears of abandonment and further rejection from the few friends she has. She describes feeling worthless and that she cannot trust herself. She describes limited coping mechanisms.
Cognition/Orientation
Sandy no longer appears to be substance affected. She is oriented to time place and person. Her cognition was not formally tested.
Judgment
Sandy appears to have impaired judgment in the context of emotion regulation. She stated the overdose was impulsive yet she admitted to hoarding extra medications specifically with implied intent to overdose with them.
Insight

Sandy has limited insight into her difficulties in terms of the connection between her thoughts, feelings and behaviour. She finds it difficult to think beyond the moment and anticipate long term consequences of her actions.

Lifestyle/drug and alcohol:

Occupation
Sandy previously worked as a disability support worker 18 months ago. She resigned following an episode of bronchitis which required IV antibiotics. She states she has experienced some symptoms of chronic fatigue. When she did not return to work after 6 months she was presented with an option of reducing her hours or resigning, she chose to resign. She would like to return to work but has lost confidence. She used to attend an arts evening class on Mondays but says she lost interest and dropped out.

Activities of daily living
Sandy does not like housework and is not physically active. She says she doesn’t feel like getting out of bed some days. She relies on convenience foods mostly when eating alone. Her appetite is varied fluctuating between not eating for 2 or 3 days followed by binge episodes where she will eat 2-3 serves McDonalds eating until she feels sick. She denies inducing vomiting or other compensatory behaviours. She only leaves the house to buy groceries or go to the shop to buy wine. Sandy does not engage in any regular exercise at present. Sandy reports poor sleep at present with middle insomnia. She falls back to sleep around 5 am and wakes at 1pm. She
does not feel refreshed following sleep and reports recurring flashbacks and nightmares.
Sandy was drinking a bottle of wine daily when living with Alan. Since their separation 2 months ago she has managed to reduce her intake to one bottle every alternate night. Sandy is unsure how she feels about her drinking. She denies any other substance misuse.

Risks
Risk of self- neglect, risk of further suicide attempt/ self-injury (by means of overdose), potential misadventure
Sandy becomes verbally aggressive when asked by nursing staff if a friend can be contacted to take her home and stay with her once she has been medically cleared. Sandy denies having any medications at home to take however she says “I will soon sort that” and will not provide any further information when asked to clarify what she meant.
Sandy will not agree to come into hospital as she says, “it makes me feel worse.”
When asked about her ongoing safety she says “I don’t know.” She reports being glad that she called the ambulance this time but she feels like a ticking time bomb.” She is able to list some protective factors however she feels that what has worked for her before is not as effective as it was and that overdosing is her “coping mechanism.”

Clinical impression
Sandy continues to present as a moderate risk of harm to self-due to her current self-care deficit, possible symptoms of depression and risk of impulsivity due to emotion regulation issues and ongoing alcohol consumption.

Please complete these questions after reading Sandy’s story and Mental State Examination (MSE):
1. 1A. Considering Sandy’s MSE, does she meet the criteria for Emergency Detention (ED3) under the Mental Health Act 2015 (ACT)
Yes or No?
1B. Based on the case study, what is the evidence that supports this action?

2. If Sandy was to be considered for Emergency Detention, which health professional would need to complete the ED3? (see section 85 of the Mental Health Act 2015 (ACT) to provide support to your answer)

3. Using the ISBAR format, write a nursing note for handover to night staff including any follow up actions to be completed by oncoming staff.
4. Describe three different communication strategies you will use to develop rapport with Sandy.

5. Using the “Recovery Principles” describe four (4) ways, you the EN, would demonstrate dignity and uniqueness
to encourage Sandy to make decision and contribution towards her own plan of care.

6. List four (4) attitudes that might impact the therapeutic relationships between Sandy and the Healthcare Professionals looking after her?

7. List 3 Primary Health and Community Resources and/or Opportunities that might be helpful to Sandy after her safe discharge

ANSWER

Comprehensive Assessment and Care Planning for Sandy

Introduction

Sandy’s case presents complex challenges, with a history of borderline personality vulnerabilities, childhood trauma, substance use, and recent self-harm behavior. As a nurse working in the emergency department, it is essential to assess Sandy’s condition comprehensively, considering the Mental Health Act 2015 (ACT), and develop a care plan that addresses her immediate needs and long-term well-being.

1A. Emergency Detention Criteria (ED3)

Based on Sandy’s Mental State Examination (MSE) and clinical impression, she does not meet the criteria for Emergency Detention (ED3) under the Mental Health Act 2015 (ACT).

1B. Evidence Supporting the Decision

The evidence supporting this decision includes Sandy’s ability to provide some protective factors, her cooperation with the medical team, and her willingness to engage in conversation regarding her emotions and impulses. While Sandy exhibits self-care deficits and emotional distress, her presentation does not indicate an immediate risk of severe harm to self or others necessitating emergency detention.

2. Health Professional for ED3

If Sandy were to be considered for Emergency Detention, a psychiatrist or authorized mental health practitioner, as defined in Section 85 of the Mental Health Act 2015 (ACT), would need to complete the ED3.

3. ISBAR Nursing Note for Handover

I**dentification: Sandy, 41-year-old female
S**ituation: Sandy was admitted following an overdose of Seroquel XR, triggered by an argument with her estranged partner, Alan.
B**ackground: Sandy has a history of borderline personality vulnerabilities, childhood trauma, and alcohol use. She presents with self-care deficits, depressive symptoms, and risk of impulsivity.
A**ssessment: Sandy’s current vital signs are stable, but she displays emotional distress, poor sleep, and alcohol consumption.
R**ecommendation: Ongoing observation, psychiatric consultation, and support for her emotional well-being.

4. Communication Strategies to Develop Rapport

Active Listening: Engage in empathetic and non-judgmental listening to understand Sandy’s emotions and concerns.
Empathetic Responses: Show empathy by acknowledging her feelings and validating her experiences.
Open-ended Questions: Encourage Sandy to share her thoughts and feelings by asking open-ended questions that promote conversation and reflection.

5. Demonstrating Dignity and Uniqueness

Respect for Autonomy: Involve Sandy in decision-making regarding her care plan, empowering her to make choices.
Person-Centered Care: Tailor interventions to Sandy’s unique needs, preferences, and goals.
Non-Stigmatizing Language: Use respectful and non-stigmatizing language when discussing her condition and treatment options.
Empowerment: Support Sandy in developing a sense of control and self-efficacy in managing her well-being.

6. Attitudes Impacting Therapeutic Relationships

Empathy: Demonstrating empathy fosters trust and connection.
Non-Judgmental Attitude: Avoiding judgment creates a safe space for open communication.
Patience: Being patient is essential when dealing with individuals facing complex challenges.
Respect: Showing respect for Sandy’s autonomy and choices enhances the therapeutic relationship.

7. Primary Health and Community Resources

Mental Health Services: Referral to local mental health services for ongoing therapy and support.
Support Groups: Connecting Sandy with support groups for individuals with borderline personality vulnerabilities.
Social Services: Accessing social services for housing support, if needed, and linking her to community resources for emotional and practical assistance.

Conclusion

Sandy’s case underscores the importance of a holistic and empathetic approach in nursing care. While she does not meet the criteria for Emergency Detention, her complex needs require ongoing assessment, support, and coordination with mental health professionals and community resources. Building rapport, respecting her dignity, and maintaining a therapeutic relationship are essential in helping Sandy on her path to recovery and well-being.