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Nursing Crisis Management - Case Study Example

Nursing Crisis Management

  • Subject: Nursing
  • Type: Case Study
  • Level: Undergraduate
  • Pages: 9 (2250 words)
  • Downloads: 2
  • Author: qtromp

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case study 4 1 a crisis in nursing


Mental Health Nursing

At a glance, grahame smith.

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Case Studies

Case 4: ellie.

Ellie is a 21-year-old woman who lives at home with her parents. Recently Ellie was assessed by the mental health crisis services after being referred by her GP. It was noted that since dropping out of university a year ago Ellie had become more withdrawn, preferring to spend most of her time in her room. When engaging with her parents Ellie would frequently become angry, accusing them of spying on her and on occasion she would threaten them with violence. On assessment Ellie admitted hearing voices; at times these voices were comforting and at other times quite threatening. Ellie also described feeling special, stating she could predict the future; she was also not sure that her parents were her real parents.

(a) How would the mental health nurse collect the required assessment information?

Show Answer

Correct answer: The nurse would ordinarily collect assessment information through formal assessments, which include checklists, questionnaires, rating scales, tools and structured interviews; and through informal assessment where information is collected through less formal and planned methods such as the nurse observing and interacting with Ellie. Both methods would provide the nurse with valuable information and both should have equal weight, though formal assessment tends to be viewed as being more objective and value free. The strength of using both methods is that information can be triangulated in a way that captures the whole clinical picture rather than just part of the picture. Assessment information that is effective should describe Ellie's situation, both generally and specifically; it should also identify the degree to which any identified problem has and is impacting upon Ellie's ability to function. To elicit assessment information the nurse would use a question approach that would use: open questions to scope the broad issues; probing questions to identify the specific issues; and closed questions to confirm that the nurse's understanding of the specific issues is correct.

(b) When assessing risk what factors should the nurse consider and how would they positively manage any identified risks?

  • Types of risk – self-harm, neglect, to others and from others.
  • How recent were the risk related incidents, how severe is the risk and what is the level of intent?
  • How frequent have the risk-related incidents been?
  • When do they happen, are there trigger factors, does the individual use drugs and alcohol at the same time?
  • What is Ellie's understanding of the identified risks, what is Ellie's present mental state like and does Ellie have capacity?

(c) Clinical risk management can at times lead to over-defensive practice. To ensure a positive approach is taken the nurse would:

  • actively listen to Ellie's views;
  • undertake action planning and make decisions collaboratively;
  • thoughtfully consider potential benefits and harms when deciding on actions;
  • implement decisions that involve an element of risk where the benefits outweigh the risk;
  • ensure that the risk management plan is fully communicated.

(d) Ellie is diagnosed with schizophrenia. How is schizophrenia diagnosed?

  • hallucinations
  • disorganised speech
  • catatonic behaviour
  • disorganised behaviour
  • negative symptoms.
  • thought disorders.

(e) When devising a care plan for Ellie, what types of psychological intervention should be considered?

  • establish a collaborative and therapeutic relationship;
  • normalise psychotic experiences;
  • reduce psychotic symptoms by modifying thought processes and enhancing coping strategies.
  • prevent social isolation;
  • promote social functioning;
  • focus on relapse prevention;
  • alleviate symptoms.

(f) Ellie is prescribed antipsychotic medication. On this basis what physical health issues might arise?

Correct answer: A specific issue within the field of mental health is the issue of weight gain. Service users treated with antipsychotic medication are more likely to be clinically obese than the general population. This in turn can increase an individual's chances of developing diabetes and coronary heart disease. On this basis once Ellie commences antipsychotic treatment it is important that Ellie's weight is monitored regularly and action is taken where there are concerns about weight gain.

Consider Chapters 6, 11, 12 and 15.

Initially Ellie agreed to take her antipsychotic medication and has been well for over a year. Over the last 6 weeks it has been noted that Ellie has become increasingly unwell exhibiting symptoms that were first highlighted on admission to the mental health service. Ellie has also stopped taking her medication.

Subsequently Ellie attacked her mother and a decision was taken to admit Ellie to an acute mental health ward. Ellie was admitted informally to the ward but since refusing to take any medication and also refusing to stay on the ward Ellie is now on a section 3 of the Mental Health Act 1983 (amended 2007).

(a) The ward organises care through a primary nursing approach. What other ways of organising nursing care could be used?

  • The task approach – the focus will be on delivering tasks such as administering medication or undertaking observations.
  • The service-user allocation approach – a nurse will be assigned to care for a specific number of service users.
  • The team nursing approach – a team of qualified and unqualified nurses will care for a specific group of service users.

(b) A key issue in deciding that Ellie needed to be placed on a section relates to the judgement that Ellie did not have capacity. How does capacity relate to an individual making their own decisions?

  • understand information relevant to the decision;
  • retain, use and weigh that information in the process of making that decision;
  • communicate that decision.

(c) During Ellie's admission there was an incident where Ellie was physically restrained and then placed on supportive observations – level 4. What are supportive observations?

  • Level 1, or general observation, is the minimum level of observations for all in-patients.
  • Level 2, or intermittent observation, is where the service user's location on the ward is checked every 15 to 30 minutes.
  • Level 3 observation is where the service user is kept within sight at all times.
  • Level 4 observation is where the service user is kept within arm's length of the observing nurse.

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A case study of a collaborative allied health and nursing crisis response


  • 1 Department of Rehabilitation, Royal Papworth Hospital , Cambridge, UK.
  • 2 Clinical Nursing, Royal Papworth Hospital , Cambridge, UK.
  • 3 Faculty of Health, Education, Medicine & Social Care, Anglia Ruskin University , Cambridge, UK.
  • PMID: 32935607
  • DOI: 10.1080/13561820.2020.1813093

The COVID-19 pandemic was declared by the World Health Organization on 11 March 2020. The rapid spread of SARS-CoV-2 required an equally rapid response from health-care organizations to find innovative ways to utilize the existing workforce to care for people with COVID-19. Using an evaluative case study, a unique insight into the collaborative allied health and nursing professions' response to COVID-19 at a specialist cardiothoracic hospital in the United Kingdom is presented. The aim of the case study was to evaluate how an interprofessional workforce from the wider organization could be supported to work in critical care as part of a crisis response. In identifying the key enablers to setting up an interprofessional Essential Care Team and learning from the lived experiences of those involved, t his case study has demonstrated that, in supported, interprofessional teams the wider organizational workforce can be facilitated to effectively and safely provide critical care services. The lessons learned from this study will support future pandemic responses and aid the identification of further opportunities for interprofessional learning and practice. Ultimately, the study highlights that by identifying and investing in the key enablers, health-care organizations can be better prepared to respond to a global crisis.

Keywords: Interprofessional Collaboration; case Study; co-operative Working; interprofessional Practice; patient-Centered Practice; team-Based Practice.

  • Allied Health Personnel*
  • Betacoronavirus
  • Cooperative Behavior*
  • Coronavirus Infections / nursing*
  • Nursing Care*
  • Observation
  • Organizational Case Studies
  • Patient Care Team
  • Patient-Centered Care / organization & administration*
  • Pneumonia, Viral / nursing*
  • United Kingdom
  • Section One: Introduction
  • Section Two: Learning and Teaching Resources to Support Integration of Mental Health and Addiction in Curricula
  • Section Three: Faculty Teaching Modalities and Reflective Practice
  • Section Four: Student Reflective Practice and Self-Care in Mental Health and Addiction Nursing Education
  • Section Five: Foundational Concepts and Mental Health Skills in Mental Health and Addiction Nursing
  • Section Six: Legislation, Ethics and Advocacy in Mental Health and Addiction Nursing Practice
  • Section Seven: Clinical Placements and Simulations in Mental Health and Addiction Nursing Education
  • Section Eight: Reference and Bibliography
  • Section Nine: Appendices and Case Studies

Section Nine

  • Case Study 1

Also in this section

  • Alignment between CASN/ CFMHN Entry-to-Practice Mental Health and Addiction Competencies and Sections in the Nurse Educator Mental Health and Addiction Resource
  • Process Recording
  • Criteria for Validation: Process Recording
  • Criteria for Phase of Relationship: Process Recording
  • Journaling Activity
  • Safety and Comfort Plan Template
  • Advocacy Groups for Mental Health in Canada
  • Tips for Engaging Lived Experience
  • Glossary of Terms
  • Case Study 2
  • Case Study 3
  • Case Study 4
  • Case Study 5
  • Case Study 6
  • Case Study 7
  • Case Study 8
  • Case Study 9

Teresa is a 32-year-old woman in your practice who frequently misses her appointments, and at other times shows up without an appointment, often in crisis. She currently uses alcohol and tobacco, and has started to use street drugs.

As you have developed a therapeutic relationship with Teresa, you learn that she grew up in a household with a violent father who frequently assaulted her mother, her siblings and herself. Although now estranged from her father, the impact of his violence presents itself on a daily basis as Teresa struggles to cope with the trauma she experienced.

Teresa left school early, has few marketable skills and has never been able to hold a job for more than three months. Teresa receives $606 per month from Ontario Works and has no money left for food or other essentials at the end of the month. She is currently in a relationship with a man whom you suspect may be violent

Student Questions

What are your next steps with Teresa? How do you go about providing trauma-informed care?

  • Is a crisis intervention required?
  • What are some other interventions you could take to improve Teresa’s health in this situation that include addressing health inequities and structural drivers of the conditions of daily life, such as the inequitable distribution of power, money and resources?

Educator elaborations

  • Assess Teresa’s mental status and history of mental health care; explore her substance use and whether it places her at high risk for self medication and suicide; explore issues of violence in her life, income support and her housing situation.

Discussion Topics

  • Cultural competency and mental illness
  • Trauma informed care
  • Crisis intervention
  • Social determinants of health
  • Printer-friendly version


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