Therapeutic Engagement and Mental State Examination for Mr. Mussa Ahmed

QUESTION

NUR137 Assessments 3 Scenario 2: Information for the Patient role
Mr Mussa Ahmed
MRN: 145060
AGE: 48 YRS
Address: Garden Close, Bridgetown TAS 7248
Mussa is 48-year-old married man who lives with his wife and 2 (aged 6 and 2 years)
young children. Although Mussa does not have a formal psychiatry history, Mussa
reports that his journey to Australia, 5 years ago, was reported to be painful and
traumatic.
Mussa’s wife, Amina, describes how lately Mussa has become increasingly quiet and
reclusive, which is out of character for Mussa. Amina, reports that this behaviour, has
brought shame on her and their family. She has tried to make him happy and at times,
possibly forcefully, but nothing seems to work.
For the last month, Mussa has been so scared of the police saying that they were looking
for him. Whenever, he hears an emergency siren he panics and tries to hide. Mussa
reports that he has put cameras in the house to ‘protect’ himself from the police and so
that he can see them when they come. Amina, reports that as far as she is aware, he was
not wanted by authorities, nor has Mussa committed any crimes in Australia or Iraq.
Background Information
Mussa has been living in Australia for 5 years since he, and his family were granted
refugee status. Although speaking English was a challenge at the beginning, Mussa
managed to obtain a Certificate 3 in Building and Construction and has been working
for a building company for the 3 years. They struggle financially but are getting by ok.
Upon interview
Mussa reports to the nurse,
• That he is suspicious of the police alleging that they are looking for him. He has
installed CCTV to ‘protect’ himself and panics when he hears these sirens.
• That when he was in Iraq, he was arrested for protesting the government and
was subsequently beaten. Whilst he was in custody, he was injured from a
Grenade attack on the police vehicle he was in, with substantial physical injuries
from shrapnel. Although he was not the target, Mussa blames the police and
authorities for his injuries.
• That he thinks that he is unwell due to the constant harassment from the police.
• Although, his wife Amina is supportive she is exhausted and thinks that this
illness brings shame to her and their entire family.
If the nurse/health worker asks you relevant questions, please provide the
following information:
• Mussa should be avoiding eye contact, looking dishevelled and unkempt, act in
a manner which would be untrusting and suspicious of the nurse and the line of
questioning.• How the experiences of seeking asylum may have triggered stress and
presenting characteristics, symptoms, and behaviours.
• As the conviction grew that Mussa was in danger, he installed CCTV to protect
himself and his family. The sound of sirens has begun to make Mussa panic.
• How the arrest in Iraq, the injury from the grenade attack and injuries sustained
from shrapnel, police beatings, and the overall experience of seeking asylum
has impacted on Mussa current mental health. These experiences made him
suspicious and untrusting. He also felt in imminent danger constantly.
• The situation at home with his wife Amina, who is supportive, but states that
she is exhausted and thinks that this ‘illness’ or situation, has brought shame to
her and their entirely family.

NUR137 Assessments 3 Scenario 2: Information for the nurse role
Mr Mussa Ahmed
MRN: 145060
AGE: 48 YRS
Address: Garden Close, Bridgetown TAS 7248
For the purpose of this exercise, you will need to perform the role of the student nurse
on placement.
You are a student nurse on an afternoon shift in an acute mental health ward. You are
working with a RN and your first task for the shift is to admit an new person to the unit.
Mr Mussa Ahmed is a new admission to the ward via the emergency department (ED).
Background Information
Mussa is 48-year-old married man who lives with his wife and 2 (aged 6 and 2 years)
young children. Although Mussa does not have a formal psychiatry history, Mussa
reports that his journey to Australia, 5 years ago, was painful and traumatic. Mussa’s
wife Amina, describes that Mussa has lately become quiet and reclusive. Amina reports
that this behaviour, has brought shame on her and their family. She has tried to make
him happy, but nothing seems to work.
The referral letter from the ED team stated the following:
• No history of contact with mental health services or psychiatric illness
• Arrived in Australia as a refugee from Iraq five years ago.
• Mussa has been saying that the police are looking for him. Whenever, he hears
an emergency siren he panics and tries to hide. Amina reports that as far as she
is aware, Mussa is not wanted, nor has he committed any crimes in Australia
or Iraq.
Past medical history:
Surgery to his leg to remove shrapnel from a grenade attack when in Police custody in
Iraq.
Mussa is a new presentation, and this is the first time you are seeing him, therefore
requires initial engagement and mental state examination to help inform further
recovery-oriented service provision. In your interview (video) you need to:
• Therapeutically engage with Mussa.
• Perform a Mental State Examination (MSE), and
• Document a summary of the MSE using accurate professional expression.

ANSWER

 Therapeutic Engagement and Mental State Examination for Mr. Mussa Ahmed

Introduction

This essay explores the initial engagement and mental state examination (MSE) conducted by a student nurse on placement for Mr. Mussa Ahmed, a new admission to an acute mental health ward. The focus is on building a therapeutic rapport with Mr. Mussa and performing an MSE to gather relevant information for recovery-oriented service provision.

Therapeutic Engagement

Building Trust and Rapport: As the student nurse, the first step is to establish trust and rapport with Mr. Mussa. Approach him in a non-threatening manner, maintaining a calm and empathetic demeanor. Show active listening and validation of his feelings and experiences.

Cultural Sensitivity: Recognize that Mr. Mussa is a refugee from Iraq, and his experiences may have cultural implications. Show respect for his background and beliefs, ensuring a culturally safe environment.

Validation of Feelings: Acknowledge Mr. Mussa’s fears and concerns about the police and his traumatic journey to Australia. Let him know that his feelings are valid and that you are there to support him.

Mental State Examination (MSE)

Appearance and Behavior: Observe Mr. Mussa’s appearance, noting if he appears disheveled or unkempt. Pay attention to any unusual behavior, such as avoidance of eye contact or signs of suspicion.

Mood and Affect: Assess Mr. Mussa’s emotional state and expressions. Note if he appears anxious, fearful, or sad. Evaluate his affect for appropriateness and intensity.

Thought Process: Inquire about Mr. Mussa’s thoughts and whether they are coherent and logical. Be alert to any signs of racing thoughts or delusions.

Perception: Ask about any perceptual disturbances, such as hearing voices or seeing things that others cannot.

Cognition: Assess Mr. Mussa’s cognitive functioning, including memory, attention, and orientation. Observe for signs of confusion or disorientation.

Insight and Judgment: Inquire about Mr. Mussa’s insight into his current mental state and the appropriateness of his decision-making.

Summary of MSE

During the interview, Mr. Mussa appeared disheveled and avoided eye contact, displaying signs of suspicion. He expressed fear and panic whenever he heard emergency sirens, indicating heightened anxiety. He reported being suspicious of the police, installing CCTV cameras in his home for protection. There were no perceptual disturbances noted during the MSE. Mr. Mussa showed limited insight into his mental state, attributing it to constant harassment from the police. His wife, Amina, is supportive but expresses exhaustion and shame due to his current condition.

Conclusion

The initial engagement and mental state examination with Mr. Mussa Ahmed are essential steps in providing recovery-oriented mental health care. By building trust, showing cultural sensitivity, and conducting a comprehensive MSE, the student nurse gains valuable information to inform the patient’s care plan. Recognizing the impact of his traumatic experiences and understanding his current mental state are crucial for tailoring effective interventions and support for Mr. Mussa’s well-being.