Sarah is 31 years, with a history of bipolar affective disorder with episodes of major depression from the age of 15.She was managing well on medica

Sarah is 31 years, with a history of bipolar affective disorder with episodes of major depression from the age of 15.She was managing well on medications before the pregnancy. Sarahs medications were changed during pregnancy.

Sarah had a few issues including gestational diabetes and high blood pressure during the pregnancy. Sarah had her baby at 35 weeks ( Boy, 2 kgs- no complications).

3 days later, Sarah began exhibiting, sleeplessness, debilitating labile mood and disorganised behaviour. Sarah appears very distracted and unable to care for her baby including feeding. The newborn baby was shifted to the nursery. Later Sarah disclosed that she feels the baby was not hers and that he is a total stranger. She continued, now she has no good feelings she had while she was pregnant. Sarah refuses to take medications too. Sarah has also verbalised ideas of suicide.

Sarahs food and fluid intake remain very low. Now Sarah is referred to the MH team. However, Sarah was not cooperating with the examination of the psychiatrist. The psychiatrist who consulted Sarah suggested compulsory treatment under MHA 2014 and shifting Sarah to a single room in the adult acute inpatient unit (within the hospital with a special).

Your perspectives can be from perinatal settings or MH settings

Does Sarah meet the criteria for an assessment order and how?

As a nurse caring for Sarah, what are your priorities here?(3 main considerations)

How would you ensure Sarahs rights are taken care of?

Emily is 22 years of age was referred to an early psychosis service after telling her GP that she was hearing voices. This happened after a very stressful month of final assessments and exams.

She is in her second year of university (Law degree) and the voices made her sleepless, worried about her future and became extremely anxious. Emily thinks her future career and dreams might end here. She was assessed as meeting the criteria for the first episode of psychosis. Emily is worried about antipsychotic medications and weight gain. At the same time, Emily wants to go back to her studies after 2 weeks of semester break.

Emily is very confused. You are the clinician doing her assessment in the community clinic (before she sees her psychiatrist today). Emily trusts you and became interested, started communicating when you mentioned you are also doing your post-grad/university studies.

What are the priorities here? What are the important aspects of shared decision making you will incorporate into Emily's care plan?

Discussion: Safe ward Model

Originating domains. Mental Health wards are social and physical locations, separate from patients normal residences, and provide 24/7 mental health care.

Staff modifiers are features of the staff as individuals or teams or how the staff act in managing the consumers or their environment, initiating or responding to interactions with patients that can influence the frequency of conflict and containment.

Patient modifiers are ways in which clients respond and behave towards each other, which can influence the frequency of conflict and containment and are susceptible to staff influence.

Flash points are social and psychological situations arising out of features of the originating domains, signalling and preceding imminent conflict behaviours.

Conflict collectively names all those patient behaviours that threaten their safety or the safety of others (violence, suicide, self-harm, absconding, etc.).

Containment collectively names all the things that staff do to prevent conflict events from occurring or seek to minimize the harmful outcomes (e.g. p.r.n. medication, remarkable observation, seclusion, etc.).

Case study

James is aged 35 years, has been admitted to a ward following an assault and abnormal behaviours in the workplace. He has a history of schizoaffective disorder, on medications which he ceased 3 months ago. He smokes 2530 cigarettes per day and is unable to smoke in the patient unit. He also smokes 2 grams of Cannabis daily. James refused nicotine replacement therapy (NRT) in the form of a patch. James is getting increasingly agitated in the ward. He had an altercation with a patient, and the contact nurse explained the consequences of unexpected behaviour, including transfer to AMA and seclusion. James is not settled. He was pacing through the corridor. James requested 20mg of 'Diazepam', and the nurse refused as he had the maximum dose for 24 hours.

Identify staff modifiers

Patient modifiers

Flash points

How can you best manage James following the 'safe ward model.'