You begin your morning shift as a registered nurse in a busy Emergency Department (ED).  After hearing the handover from the night shift nurses, you ensure that Ruby receives the best possible outcome for her mental health.

Discuss caring for a consumer with a mood disorder regarding planning for Ruby’s care. Discuss therapeutic relationship with Ruby, and carers using empathic and compassionate language. Describe how to support the rights of mental health consumer to lead their treatment and recovery process, and the rights of carers and significant others with the consumer’s consent, to collaborate in the treatment and recovery process.

Ruby`s story

Ruby is a 20-year-old woman who presented in Emergency Department (ED) due to changes in her mental health. She was brought in by her mother, Sylvia, who reported that she picked her daughter up from Melbourne and brought her back to Western Sydney after Ruby’s flatmate, Alicia, contacted her about the changes in Ruby’s mental health.

Ruby has been living in Melbourne for the past year, where she works as a shoe sale assistant on a casual basis. She planned to return to Sydney before the end of the year to start her teaching degree in 2024. This was cut short due to the changes in Ruby’s mental health. According to Sylvia, Ruby has been going out and drinking alcohol every night the past few weeks with friends she met recently. Ruby has not had much sleep the past few weeks as she comes home most mornings just sleep for 2 to 3 hours and have a shower before going to work for 9 am. The manager of the shoe shop where Ruby work has warned her that she will lose her job if she continues arriving to work late and smelling of alcohol. Ruby has admitted to her flatmate Alicia that she has been smoking marijuana and experimenting with other illicit drugs with her new friends. Ruby stated, ‘I don’t’ know what I’ve been taking, but it made me feel good.’

Lately, the two friends would get into a verbal altercation when Alicia tried to talk to Ruby about the changes in her behaviour. Ruby would become irritable and angry and would say to Alicia, ‘you’re just jealous that I have met other people and I am enjoying myself without you. I can’t help it if people love me more than they love you. I want to make the most of this before I start uni.’

A few nights ago, Ruby called Alicia at 3 am to pick her up from their local pub. Ruby explained that she felt unsafe to go home on her own because she thought that she was being watched and followed by a guy who was in love with her. When they arrived at their flat, Ruby ran to her room and locked her door. The next day, she did not go to work and did not contact her employer. The manager of the shoe store contacted Ruby and informed her that she is no longer required to work in the store. Alicia thought that she would be devastated by this news as this is her only source of income. But Ruby told Alicia that ‘I was too good for that job anyway. It’s their loss’.

Ruby did not leave the flat for the next few days. Alicia noticed changes in Ruby’s mood. She stayed in her room most of the time. She has not showered in days, ate little amounts of food, and had barely any sleep and would watch TV instead all night or watch YouTube videos on her phone. She stated to her flatmate that ‘I don’t want to sleep; I feel that something bad is about to happen’. One night, Ruby asked Alicia for help as she started to have thoughts of suicide, but with no plan of how she would hurt or kill herself. Alicia felt she had no choice but to contact Ruby’s mum, Sylvia, to ask her for help.

During the interview, Ruby sat next to her mother, slumped with her head on her hands. She would get up and pace while wringing her hands. Although she presented as well-groomed and neat, Ruby was wearing clothes that were big for her small stature. When her mother excused herself to go to the toilet, Ruby opened about her experience to the nurse. She stated that she did not want her mother to know. She told the nurse that she had been feeling unmotivated, loss interest in going to university (when all she wanted was to become a teacher) and has been having suicidal thoughts with no plan. She mentioned that her ‘heart has been beating 100 miles per hour and feels like something bad is about to happen. I don’t know why, and I will do anything to make it stop.’ She mentioned that she was commenced on 20mg of Paroxetine daily by a GP in Melbourne four weeks ago and asked if she should keep taking this medication.

Note: 2 academic refererences from 2018 to 2023

ANSWER

Providing Holistic Care to Ruby: A Case in Mental Health Nursing

Introduction

Caring for individuals with mood disorders requires a comprehensive approach that encompasses assessment, therapeutic relationships, respecting the rights of mental health consumers, and involving their caregivers. This essay delves into the case of Ruby, a 20-year-old woman with changing mental health, and discusses planning her care, establishing therapeutic relationships, and upholding her rights as a mental health consumer and those of her caregiver, Sylvia.

Planning Ruby’s Care

Caring for Ruby begins with a thorough assessment and care planning process. Given her presentation, the following steps can be taken:

1. Assessment: Conduct a comprehensive mental health assessment, including a detailed history of her symptoms, medical history, medication history (Paroxetine), and her current mental state. Identify any risk factors, such as suicidal ideation.

2. Interdisciplinary Approach: Collaborate with a multidisciplinary team, including psychiatrists, psychologists, and social workers, to formulate a holistic care plan that addresses Ruby’s mental health, physical well-being, and social needs.

3. Goal Setting:Establish clear, achievable goals for Ruby’s treatment and recovery, taking into account her desire to pursue a teaching degree. These goals should be person-centered and recovery-focused.

4. Medication Review: Review Ruby’s current medication, Paroxetine, and consult with a psychiatrist to assess its effectiveness and appropriateness. Adjustments to her medication regimen may be necessary.

5. Psychoeducation:Provide Ruby with psychoeducation about her condition, the effects of substance use, and the importance of adhering to treatment. Encourage open communication about her experiences and concerns.

Therapeutic Relationship with Ruby and Carers

Building a therapeutic relationship with Ruby and her caregiver, Sylvia, is pivotal for her recovery:

1. Empathy and Compassion: Approach Ruby with empathy and compassion, acknowledging her struggles without judgment. Use empathic language to convey understanding and support for her feelings and experiences.

2. Active Listening: Listen actively to Ruby’s concerns, allowing her to express her thoughts and emotions. Validate her feelings and experiences, creating a safe space for her to open up.

3. Collaborative Care: Involve Ruby in decisions about her treatment plan, respecting her autonomy and right to lead her recovery process. Collaborate with her in setting goals and selecting interventions.

4. Involving Sylvia: Engage Sylvia as a supportive caregiver, respecting her role in Ruby’s life. Encourage open communication between Ruby and Sylvia, while respecting Ruby’s confidentiality as appropriate.

Supporting Rights of Mental Health Consumers and Caregivers

Respecting the rights of mental health consumers and their caregivers is essential:

1. Informed Consent: Discuss treatment options with Ruby, ensuring she understands the benefits, risks, and alternatives. Seek her informed consent for any changes to her medication or treatment plan.

2. Confidentiality: Safeguard Ruby’s confidentiality while involving Sylvia in her care. Inform Ruby about the limits of confidentiality and seek her consent for sharing relevant information with her mother.

3. Collaboration: Collaborate with Sylvia with Ruby’s consent, ensuring she is informed and involved in Ruby’s treatment decisions, recovery plan, and support mechanisms.

4. Advocacy: Advocate for Ruby’s rights and preferences within the healthcare system, promoting a patient-centered and recovery-oriented approach to her care.

Conclusion

Caring for individuals like Ruby with mood disorders necessitates a holistic approach, encompassing comprehensive assessment, therapeutic relationships built on empathy and compassion, and the respectful upholding of their rights as mental health consumers. Involving caregivers like Sylvia in a collaborative and informed manner is essential for supporting the recovery process. By focusing on these aspects, mental health professionals can contribute to Ruby’s well-being and journey towards recovery.