Assessment:

 Part A: Written - Case Study

 Part B: Practical - Role plays
S/NS result given. A satisfactory result must be attained.

STUDENT INSTRUCTIONS: This assessment is a two (2) part assessment, as follows:

PART A: CASE STUDY: Questions 1-4.
 To be uploaded to blackboard, completed and assessed BEFORE the ROLE PLAY and
handed back to the student for the performance of the ROLE PLAY or as directed by your
educator.
 This is an individual assessment task.
 All tasks are referring to the one case study: Mr Riley, with multiple addits to his story.

PART B: ROLE PLAYS: Questions 5-9.

 Total time allocation = 25-40 minutes.
 Due to the complexity of the assessment requirements, there are three (3) role plays that
flow on after each other, as it would occur in real world, everyday practice.
 These role plays are to be performed as an enrolled nurse working within their scope of
practice when working with the multidisciplinary team approach to implementation,
planning and evaluation of care.
 This is an individual assessment task, performed in groups of 3-5 students, as determined by
your educator.
 Each student must participate as the Enrolled nurse. This is an essential component to this
unit.
 Each role play should take at least five (5) minutes and no more than fifteen (15) minutes.
Guidelines for timing have been given at the beginning of each role play.

REFERENCES:
 Clarke, L, Gray, S, White, L, Duncan, G & Baumle, W 2016, Foundations of Nursing –
Enrolled/Division 2 Nurses, Cengage Learning, Victoria.
 Evans, K, Nizette, D & O’Brien, A, 2017, Psychiatric and Mental Health Nursing, 4 th edn,
Mosby/Elsevier, Sydney.
 https://www.qld.gov.au/health/mental-health/understanding/index.html
 University of Nottingham, 2012, Psychiatric Interviews for Teaching: Mania, Viewed 27
February 2017, https://www.youtube.com/watch?v=zA-fqvC02oM
PART A: Written: Case Study
To be uploaded to blackboard, completed and assessed BEFORE the ROLE PLAY and handed back to
the student for the performance of the ROLE PLAY, or as directed by your educator.

CASE STUDY: Mr Riley – Analyse and Observe behaviours in the person with mental health conditions

Instructions:
STEP 1: Observe the video on a client; Mr Riley, by clicking here: Video on Mr Riley
STEP 2: Peruse the addit to Mr Riley’s scenario, as below, then answer question 1 - 4.
ADDIT 1 to Mr Riley’s case study:

You are an enrolled nurse working in an acute inpatient mental health facility. You have been allocated
a new client who has just been admitted into the ward.
History:
John Riley a 36 year old man presented to the psychiatrist this morning after being referred by his GP
clinic this morning. He was bought in by his mother who is concerned about his behaviour. He has had 2
previous suicide attempts, where his auditory hallucinations (God) told him to that the cure for cancer
would be discovered once he sacrificed himself. He overdosed on tablets and alcohol. He was behaving
the same way he is now and his mother is terribly concerned he might attempt suicide again. Mr Riley
has lost 7kg, refusing to eat because “he doesn’t need to, I’m too busy doing my important work”. His
strengths appear to be a supportive family (Mr and Mrs Riley) and he is quite intelligent, enjoys
problem solving the difficult mechanical issues at work.
The team requires you to, as a staff member, undertake the Mental Status examination and Risk
assessment, under the supervision of the RN, in preparation for the Multidisciplinary team meeting this
afternoon, where Mr Riley’s case will be discussed.
The psychiatrist diagnosed Mr Riley as presenting in a Manic episode of Bipolar Disorder. After
discussion, Mr Riley decides he is happy to be admitted as a voluntary patient. After you have
completed your assessment of Mr Riley, the Multidisciplinary team (MDT) will meet to discuss his case.
In preparation for the MDT, you, as an enrolled nurse are required to assist in developing the care plan
for Mr Riley.
The Registered Nurse has decided that there are three (3) nursing diagnoses that require immediate
interventions:
1) Risk of suicide related to delusions
2) Poor Sleep hygiene related to current Manic behaviour
3) Weight loss related to delusional belief he doesn’t need to eat and acopia
The psychiatrist prescribes Mr Riley Lithium 450mg bd on an increasing scale over the next few days.

Observe, analyse and document the behaviour of Mr Riley.

1. The Registered Nurse has delegated the task of analysing the observed behaviour (signs and
symptoms) that Mr Riley presents with and complete a Mental Status Examination (MSE) as per
Appendix A.

2. The Registered Nurse has delegated the task of undertaking a risk assessment of Mr Riley, using the
recognised risk assessment in Appendix B.
 Plan the health care of Mr Riley

3. Identify one (1) of the nursing diagnoses, listed above and decide on how you will implement one
(1) nursing intervention, related to your nursing diagnoses.
E.g: Nursing Diagnosis: Poor oral hygiene related to erratic behaviour. Nursing Intervention:
working with the client, develop a routine in attending to oral hygiene.
4. The National Framework for recovery-oriented mental health services provides guidelines on how
we should work with the person with a mental health condition. This framework assists with
maximising health outcomes for clients and in building the clients own strengths and level of
responsibility.

In supporting the person as a valued member of the community and in applying the recovery
domains/principles to your chosen intervention, identify which capability applies and explain how it
applies.
Domain/Principle 3: Supporting personal recovery
 Capability 3A Promoting autonomy and self-determination
 Capability 3B Focusing on strengths and personal responsibility
 Capability 3C Collaborative relationships and reflective practice
• Poor Sleep hygiene
• Risk of suicide
• Weight loss
NB this must be handed in and assessed BEFORE the Role Play.
 o ROLE PLAY 1 – QUESTION 5
 an Enrolled nurse,
 a Registered nurse
 Community mental health nurse

Role Play 1 – Continuing to plan the health care of Mr Riley (5-10 mins) – MDT meeting
o Participants needed are:
 An Enrolled nurse
 A Registered nurse
 Community mental health nurse

5. Participate in the MDT meeting as the Enrolled nurse, by handing over your findings from Mr
Riley’s MSE and Risk assessment results. During this handover, you explain how you will
develop a prioritised plan on implementing the one (1) nursing intervention, you decided on in
question 3.
Support actors instruction:
The support members of the MDT meeting are to provide input in the context of their role.
E.g: mental health nurse will address home concerns and observed behaviour from last visit,
where it was obvious he was becoming more erratic in his behaviour.
Appendix A

MSE
Date and Nursing Entry
time
. .20__ Appearance and General Behaviour:
hrs
Mood:

Affect:

Thought content:

Thought rate:

Thought disturbance:

Speech: (Rate/volume/content):

Perception:
 Attention/Concentration:

Sensorium and cognition:

Insight/Judgement:

Signs and Symptoms of reduced physical health:

Strengths:

Student signature (surname) EN

Appendix B

SURNAME: Riley UMRN:12354 SEX:M

APPENDIX B
FORENAMES: John BIRTHDATE:25.3.19xx
BRIEF RISK ASSESSMENT
PATIENT’S ADDRESS:

SOURCE OF INFORMATION  The consumer  Immediate carer (parent, spouse, child)

  Other informants (family, friends)  Previous  Assessing clinician’s knowledge of consumer’s
clinical records past behaviour/current clinical presentation

 Police/ambulance/other agencies  Other (please specify)

SUICIDALITY Yes No Not Dynamic (current) risk factor Yes No Not

Static (historical) factors (1) (0) Known (2) (0) Known
Previous attempt(s) on own life Expressing suicidal ideas
Previous serious attempt Has plan/intent
Family history of suicide Expresses high level of distress
Major psychiatric diagnosis Hopelessness/perceived loss
of coping or control over life
Major physical disability/illness Recent significant life event
Separated/Widowed/Divorced Reduced ability to control self
Loss of job/retired Current misuse of drugs/alcohol
PROTECTIVE FACTORS (describe) :

LEVEL OF SUICIDE RISK (total score): LOW (<7) MODERATE (7-14) HIGH (>14)

AGGRESSION/VIOLENCE Ye N Not Dynamic (current) risk factor Ye No Not

Static (historical) factors s o Known s (0) Known

Recent incidents of violence (1) (0) Expressing intent to harm others (1)

Previous use of weapons Access to available means

Male Paranoid ideation about others

Under 35 years old Violent command hallucinations
Criminal history Anger, frustration or agitation
Previous dangerous acts Preoccupation with violent ideas
Childhood abuse Inappropriate sexual behaviour
Role instability Reduced ability to control self
History of drug/alcohol misuse Current misuse of drugs/alcohol
PROTECTIVE FACTORS (describe) :

LEVEL OF VIOLENCE RISK (total score): LOW (<7) MODERATE (7-14) HIGH (>14)

OTHER RISKS IDENTIFIED (AND RISK FACTORS)

RISK MANAGEMENT ISSUES (please ensure alerts are noted here)

(To be completed by assessing clinician)

PRINT NAME: DESIGNATION: SIGNATURE: DATE:

(Where appropriate, management plan to be acknowledged by requesting medical practitioner)

PRINT NAME: DESIGNATION: SIGNATURE: DATE: