Mental Health Nursing for Clinical Reasonong Cycle


Describe about the Mental Health Nursing for Clinical Reasonong Cycle.



The report deals with the case study of John Gray who is suffering from mental health problems. It discusses the management of the patient focusing on the delivery of nursing care, using the Levett-Jone’s clinical reasoning cycle. It is the framework for clinical decision-making that assists in planning and evaluating the person-centered care. In this report, patient details and health information will be collected and processed. The primary health issues concerning Mr. John will be identified and treatment goals will be established prioritizing the health problems. It will be helpful in providing holistic care to the patient.

Patient details

Mr. John Gray is a single, 28-year-old male and lives in Brisbane. He is a son of a grazier and is expected to take over the family farm. The farm being affected due to longstanding drought caused severe depression in John, and he attempted suicide several times till he was finally admitted to the hospital a week ago.

Patient information

The information obtained in relation John’s condition includes severe depression, signs of withdrawal and disorientation. He skipped his breakfast and was reluctant to have lunch as well. He returned to bed almost empty stomach. Assessment of John’s vital signs showed blood pressure 125/75. His pulse rate and respiration rate were found to be 66 and 18 respectively. John has no serious injuries except some bruising and broken skin on his arms and legs and a rope burn mark around his neck which was a consequence of his attempt to commit suicide. John was prescribed to take Venlafaxine 75mg BD, Multivit I and Vitamin B Co I daily.

Processing information

I have communicated with John and his family to collect more accurate assessment information, to identify the risk factors and determine the level of risk of suicide. It will assist in gaining a broader perspective of patient’s condition. Severe depression destroys an individual’s behavior and thought (McElroy et al., 2014). When a person fails to cope up with an overwhelming life situation or crisis, it leads to frustration and depression. The depression makes the person feel that suicide is an ultimate solution to stop the pain and agony. It severely affects mental and physical state, and a person develops low self-confidence and self-esteem.  Depression is a mental illness that causes people to lose interest in life resulting in intentional self-harm such as punching the body, scratching skin or cutting wrists (Townsend, 2014). People punish themselves due to guilt and feeling of shame (Stuart, 2014). John’s vital statistics are normal. However, John as the result of his depression is not engaging in any social activity.

Identification of issues

After the completion of information collection, assessment, and its processing I have given the responsibility to identify the primary issues concerning John. As per my understanding, John is highly worried about his future as he is expected from his family members to take the responsibility of the family farm which is affected due to longstanding drought. He may have become anxious thinking that he might fail to fulfill his responsibility. He is too stressed thinking that how he will revive his farm after the drought (Kutney-Lee & Aiken, 2015). Caplan, (2013) demonstrated that depression is caused by personal criticism and low self-esteem and leads to decreased social participation.  According to Seo et al., (2015) feeling of worthlessness significantly increases depression. This, in turn, impairs concentration and leads to indecisiveness which is evident in John’s self-harm behavior. It is evident in John withdrawal from communication and social engagement that he has lost the interest and hope in life. Thus, it is important to maintain patient safety by minimizing self-harm, safe medication to increase positive outcomes.

Establishing goals

After John’s treatment was commenced, a set of goals care of patients were created which include-

To modifying the risk factors to assist the patient in preventing suicide and enhancing coping skills

Assess the patient’s capability to minimize or accelerate risk

Assessment of the environment to identify and reduce any hazard at the personal and the unit level such as belt, knife, ligature point, and any other object that may be the source of self-harm for John (Klainin-Yobas et al., 2012)

Monitor the level of use of preventive measures and patient’s adherence to medication

Monitor his mental status on a timely basis

Improve his emotional and physical well-being to control depression and reduce anxiety

Determine any improvement after using medication

Develop an evidence-based nursing intervention plan by collaborating with the patient, family and interprofessional team mainly focusing on John’s safety (Videbeck, 2013)

Nursing care of the person

Establish a therapeutic relationship with the client – Adams & Iseler, (2014) demonstrated that building the strong rapport with client help to gain more information about him. It will enhance John’s verbal expression.


Provide a person-centered care- Forbes & Watt, (2015) demonstrated that when a patient receives empathy and understanding he feel important and sense of connectedness. It fosters positive psychological balance in patients


To modifying the risk factors to assist the patient to prevent suicide such as keeping him in the positive atmosphere and avoid any depressing information related to his farm. Providing John with positive atmosphere will promote help-seeking skills in him and decrease self-harm behaviors (Happell & Gaskin 2013)


Family involvement– Engaging John parents in intervention and decision making  will reinforce his self-esteem by making him feel important


Motivate patient to enhance the use of preventive measures and strictly adhere to medication- Strict adherence to medicines will help John in easy recovery both mentally and physically (Robson et al., 2013). Motivation helps in instilling positivity and increase courage to overcome fear and worthlessness


Engage John in physical activity – According to Storm & Edwards, (2013), depression can be minimized to a great extent through intense exercise and physical activity such as swimming, walking, jogging, whichever enhances mood. It also allows promoting social connectedness


Providing health education and training to help a patient understand the consequences of enhanced depression. Seo et al., (2015) Believes that health literacy is essential in decreasing adverse health outcomes. John will be informed about side effects of the medicine such as dizziness and fatigue


Medication- John is prescribed a smaller quantity of Venlafaxine for two weeks supplied with multivitamins and is monitored for mood change. He will be provided with good skin care regimen to decrease the chance of skin infection. Regular checkup of vital signs, weight, heart and kidney function will eliminate future risks (Kutney-Lee & Aiken, 2015)


Referral services- referring John to counseling sessions will help him and his family to cope up with drought-related worries. Additionally, they can be referred to drought relief campaigns which would (Caplan, 2013)

Evaluation of outcomes

After two weeks there was a mild change in Mr. Gray’s behavior. He was taking his meals regularly and was engaged in reading flyers provided earlier. He was more interactive with people than earlier. His attitude towards health was changing in a positive way. He showed compliance to his medication and participated in physical activity. He was responsive to any questions asked. It can be concluded from this positive change in Mr. Gray that if the above care plan is continued then, John will decrease his vulnerability and social alienation and prevent suicidal tendencies.

Reflection on the process

By dealing the case of John I have learned that developing effective communication skills is essential. John felt a sense of importance and being understood when information was conveyed to him effectively. The fundamental aspect of the mental health care is the establishment of interpersonal relations and interactions between the care providers and clients. I also realized the importance of demonstrating self-awareness. It helped me in finding out the best way to approach and interact with John. It is highly required to obtain information from patients with high psychological distress and develop the effective treatment plan.  By developing a therapeutic relationship with John the assessment process became easy and it led to a smooth establishment of goals. Patient-centered care is central to dealing with mentally depressed patients. It helped me in understanding John’s thinking, reasoning style, and the cause of the depression. This, in turn, fostered a sense of control over his symptoms.  It seemed to facilitate patients’ beliefs in own abilities. Up-skilling is necessary for mental health nurses to strengthen their professional skills and lead to more effective patient outcomes. A positive psychological balance was reinforced in John when he received understanding, support, and empathy. As I involved John’s family in the treatment process, it helped in decision-making and encouraged his recovery. I now understand that when a patient feels that their respect and dignity is maintained it allows them to be open and increase their verbal expression which improves the overall treatment.


Adams, K. L., & Iseler, J. I. (2014). The relationship of bedside nurses’ emotional intelligence with quality of care. Journal of nursing care quality,29(2), 174-181.

Caplan, G. (2013). An approach to community mental health (Vol. 3). Routledge.

Curtis, J. R., Back, A. L., Ford, D. W., Downey, L., Shannon, S. E., Doorenbos, A. Z., … & Arnold, R. W. (2013). Effect of communication skills training for residents and nurse practitioners on quality of communication with patients with serious illness: a randomized trial. Jama, 310(21), 2271-2281.

Forbes, H., & Watt, E. (2015). Jarvis’s Physical Examination and Health Assessment. Elsevier Health Sciences.

Happell, B., & Gaskin, C. J. (2013). The attitudes of undergraduate nursing students towards mental health nursing: A systematic review. Journal of Clinical Nursing, 22(1-2), 148-158.

Klainin-Yobas, P., Cho, M. A. A., & Creedy, D. (2012). Efficacy of mindfulness-based interventions on depressive symptoms among people with mental disorders: a meta-analysis. International journal of nursing studies, 49(1), 109-121.

Kutney-Lee, A., & Aiken, L. H. (2015). Effect of nurse staffing and education on the outcomes of surgical patients with comorbid serious mental illness.Psychiatric Services.

McElroy, S. L. (2014). Prescribing antidepressants for bipolar depression: what does the evidence say?. The Journal of clinical psychiatry, 75(9), 24-24.

Robson, D., Haddad, M., Gray, R., & Gournay, K. (2013). Mental health nursing and physical health care: A cross‐sectional study of nurses’ attitudes, practice, and perceived training needs for the physical health care of people with severe mental illness. International Journal of Mental Health Nursing, 22(5), 409-417.

Seo, M., Kang, H. S., Lee, Y. J., & Chae, S. M. (2015). Narrative therapy with an emotional approach for people with depression: Improved symptom and cognitive‐emotional outcomes. Journal of psychiatric and mental health nursing, 22(6), 379-389.

Storm, M., & Edwards, A. (2013). Models of user involvement in the mental health context: intentions and implementation challenges. Psychiatric Quarterly, 84(3), 313-327.

Stuart, G. W. (2014). Principles and practice of psychiatric nursing. Elsevier Health Sciences.

Townsend, M. C. (2014). Psychiatric mental health nursing: Concepts of care in evidence-based practice. FA Davis.

Videbeck, S. (2013). Psychiatric-mental health nursing. Lippincott Williams & Wilkins.


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