Mental Health Scenario 2 – Personality Disorder: Alison

Assessment Brief: Care Study

You are to write a 3,000 word (+/- 10% excluding reference list) a care study (essay). This can be based on either one of the scenarios provided or you may select a patient(s) of interest from your practice experience and relevant to your field of practice. The essay will draw upon relevant theoretical concepts supporting the shared decision making process in the assessment planning and interventions to meet the patient’s / client’s needs. You will include a critical review of the patient’s complex needs using a bio-psychosocial perspective and demonstrate how effective shared decision making may prevent deterioration/crisis, enhance coping and/or recovery or contribute to good end of life care. You will consider the nurse’s role where dependency levels change and where there needs to be care escalation, referring to the use of appropriate assessment skills to identify risk. In evaluating the planning and delivery of nursing care (including therapeutic interventions) you will need to discriminate between the research evidence available to support the care proposed. A systematic approach in assessment and care delivery must be evident with reference to national and /or professional guidelines to support shared decisions.

Service user:

Alison is 35 years old and has a diagnosis of Borderline Personality Disorder.

Present Situation:

Alison has been brought to A&E for the 3rd time in 2 weeks, this time following a serious overdose of 18x 500mg paracetamol and 14x 20mg citalopram. She had been found unconscious by her partner who called an ambulance. Her partner had unexpectedly finished work early so was home 2 hours earlier than usual.

The two previous visits were following an overdose of paracetamol of 12x 500mg tablets and then a self-inflicted laceration to her left wrist which required 3 stitches. Following the overdose Alison had collapsed in the street and a member of the public had called an ambulance. Following the laceration Alison called ambulance herself. On both of these occasions she left before the Duty Psychiatrist or Psychiatric Liaison Nurse saw her.

History:

Alison was diagnosed with a Borderline Personality Disorder 12 years earlier. She has had repeated short admissions to acute psychiatric services across the south of England, which resulted in her transfer back to local services. She has numerous scars on her forearms and thighs from self-inflicted injuries. After the last admission 4 ½ years ago she was engaged in therapy and had regularly outpatient appointments.

Personal and social history:

Alison left school at 16 with no GCSEs. She worked in a local hairdressers till she was 22years old when the hairdressers closed down, she has not worked since. Alison was sexually abused by her step-father from the ages of 5 to 14years. He was subsequently charged and imprisoned.

She met her current partner 3 years ago and they have lived together for the last 18months. Prior to this relationship Alison had had no significant relationship in her opinion.

Medical History:

Recurrent UTIs

Medication:

20mg citalopram OD

5mg diazepam TDS

Assessment:

Seen by A&E Psychiatric Liaison Nurse with Duty Psychiatrist before she was medically cleared. She has a fresh dressing on her left wrist and has been prescribed a course of antibiotics because the wound has become infected.

On assessment Alison is very distressed, she can’t believe she is alive. Alison is very angry with her partner for saving her life.

Alison knew exactly what medication she had taken and explained she had not taken any diazepam because she had no tablets left, but would have done if she had any.

Objectively & subjectively low in mood. Reports disturbed sleep for the last 3 weeks and using alcohol to sleep. She admits to sporadically taking her antidepressant, believing it’s not helping, and has been taking more than the prescribed dose of diazepam.

Alison disclosed that her psychodynamic counselling sessions finished 1 month ago.

The partner shared they had recently found out from Alison’s mother that the step father is due to be released on parole.

A referral is made immediately to the Home Treatment Team to discuss admission.