Psychiatric Nursing: Biopsychosocial Assessment

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Client Description and the problem being addressed

I am a worker at Bishop McGann-Mercy High School. My role is to work with clients, who are students, and ensure that they are comfortable at school. This task is quite challenging given that students come from various backgrounds. Currently, the student that I am working with is J.M. This client belongs to a family, and thus dealing with him concerns the family as well. The client’s family is comprised of the father, Mr. M; the mother, Mrs. M; and three siblings. The mother to J.M. is suffering from the bipolar condition, a fact that troubles my client very much (Healy, 2008). However, this is not the only problem that is affecting my client as he is showing deficiencies in various aspects of life.

J.M was recently transferred from being home-schooled to attend a private school. Though J.M reveals that he is enjoying public school life, he at times finds himself struggling in the social and academic aspects. In this case, J.M has made very few friends but he is determined to improve the situation. J.M has also revealed that he has difficulties in certain subjects. He would also want to improve on this though he has very limited opportunities. J.M. also experiences some family problems in which the mother is sick and there is no harmony in the family. This aspect seems to trouble J.M too much. This situation will require a bio-psychosocial approach to address the challenges facing J.M (McLaren, 2002; McLaren,1998).

Goals mutually agreed on between the worker and the client, and tasks to be performed to reach these goals

After having received information regarding various issues affecting the client, it was important to look for a way to resolve the problems. I was supposed to work closely with J.M to develop attainable goals. The goals were threefold. These include improving the social life of J.M.; improve J.M’s relationship with his parents, especially the mother; and helping J.M. to improve his academic performances. All these goals could easily be attained with the corporation from the client.

It was important to address the social problem that J.M was experiencing. This was a grave issue that needed to be addressed. J.M had indicated that he was willing to work out this problem. He had promised to get more friends at school. To make more friends, I suggested that J.M should get involved in as many activities as possible both at school and out of it. This will enable him to get acquainted with as many people as possible. By relating to as many people as possible, J.M. will be able to make many friends. This is because he will be forced to interact with many people thereby widening his social network.

Since J.M. had the will to improve his social relationships, he will be able to participate in various activities that will enable him to achieve his social goal (McKenzie, 2008). Apart from participating in various activities with colleagues, it was also important for J.M to spend time with friends during the weekends. I asked him about this but he revealed to me that he hardly spends time with friends at the weekends. However, he promised to try and I hope that this will be beneficial to his social life. This is because spending time with friends improves the bond and enhances friendship (McInnis-Dittrich, 2005; McKenzie, 2008).

The other problem that is being experienced by J.M is the family relationship. In this respect, J.M. is experiencing some problems in his family which at first he was not willing to share with me. However, upon talking to his father, Mr. M., my client admitted that indeed his family had been experiencing some turmoil in the recent past. This had affected and weighed him down. After talking to his father, it was revealed that J.M’s mother was suffering from bipolar disease and she had been in and out of the hospital on several occasions. This had far-reaching impacts on the family (Healy, 2008).

This is because, Mr. M. revealed that the Child Protection Services had been involved and that, there is currently a founded report on Mr. M and his wife for having failed to do enough to protect the children. During this while, J.M’s mother was in the hospital, but she was not taking her medication. It is not known when J.M’s mother would be leaving the hospital. All these aspects had detrimental effects on J.M. Therefore, it was important to talk to J.M to help him cope with the situation (Roberts and Watkins, 2009).

Talking to J.M., it was found that he initially believed that his father was the cause of his mother’s behaviors. However, now he understood that the mother was behaving in the manner that she did due to her health condition and failing to take medication. J.M. needed to understand the illness that was affecting the mother to know how to cope with the situation (Garcia and Mann, 2003). In addition, it was important to explain to J.M. about the job that was being carried out by the Child Protection Services. I explained that these people are working to ensure his and his siblings’ safety.

Since J.M’s mother’s condition was central to him, it was important to make him understand everything and have no doubts whatsoever (McInnis-Dittrich, 2005). In this case, I explained to J.M. about the possibility that his mother might fail to be home on Thanksgiving Day. J.M seems to have been well prepared for this as he said that though he hoped that his mother would be home, he was not sure about it. I suggested that in case his mother failed to be at home during Thanksgiving, he could take some photos of the event at home and write a letter to his mother about the days.

During Thanksgiving Day, J.M’s mother was at home and the family had a good day. J.M explained that his mother was taking her medication seriously and was doing quite well. However, J.M. revealed that he was depressed some times at the thought that his mother would never be the same. I talked to him about the condition and how he could cope with the situation. I told him that he was not the only one in this situation and that many people have been able to pull through. What is important is for him to accept the situation and know how to deal with it (Stiffman and Feldman, 1988).

The third goal was to help J.M improve his academic performance. J.M had an interest in joining the ‘Teens on the job’ and I explained to him that to achieve this, he would have to be good in his academic performance. J.M acknowledged that he understood this requirement. After discussing some of the difficulties that J.M was experiencing in certain subjects, I suggested that he should get some extra help to improve in these subjects. This was a challenge to him since there was no late bus to take him home and the idea of his parents picking him up was not an option. J.M explained that he could get some help in mathematics during lunch break or study time. After further deliberations on how J.M could get extra help, he said that he could get a tutor who would be coming home to coach him.

How the tasks are related to the clients’ problem

The first task was to work on improving the social life of J.M. For this to be achieved, J.M needed to participate in various activities either in school or while out of school. This would expose him to numerous people from which he would be able to develop acquaintances. Also, J.M needed to spend time with his friends during weekends. This would be critical in facilitating and strengthening the friendship between J.M and his friends. This can also serve to widen the social network in that J.M. may be able to meet new friends who would want to hang around with his group of friends. Friends will be useful in helping J.M improve his academic performance. This is because J.M can be able to interact and share with friends on various academic issues (Roberts and Watkins, 2009).

Concerning the family condition, it is important that J.M understands the condition of his mother and not blame anyone for what is happening. Understanding the condition from which the mother is suffering will help J.M know how to cope with it (Roberts and Watkins, 2009). This is because J.M seems not to have a clue regarding what the family is going through and this has weighed him down emotionally.

This has greatly affected J.M and that at times he gets depressed for what is happening (Stiffman and Feldman, 1988). It is, therefore, important that he understands and accepts the situation to get prepared to cope with it. J.M needs a lot of counseling on this aspect. Therefore, it is important to talk to him and hope that he understands the situation. This has proved to be successful as J.M seems to understand the situation after having talked about it with me. Psychological counseling is said to be useful in helping an individual cope with a stressful situation (Boyd &Lippincott Williams & Wilkins, 2008).

To improve his academic performance, J.M must get extra time for studying. This has proved to be a great challenge though there is a will on the part of the client. J.M could be willing to get extra time for tuition in school, but the school does not have a late bus to take him home. In addition, he cannot rely on his parents taking him home as this option is out of the question. Since he is determined to improve his academic performance, J.M can squeeze some time during lunch break or study time. In addition, after talking to his father, J.M talks of the possibility of hiring a tutor to help him improve on his academic performances.

Task Achievement Scale

Task	Rating (on 4 point rating scale)
Participating in activities	3
Spending time with friends	2
Psychological counseling	4
Finding extra time for tuition at school	2
Hiring a tutor	3

Task Implementation Sequence

From the above task achievement rating, the tasks that are effective in solving the client’s problems include psychological counseling, participating in activities both at school, while out of school, and hiring a tutor. The other two tasks including spending time with friends at weekends and finding extra time for study while at school are not effective. This is because of the challenges that are likely to be experienced. Psychological counseling is the most effective due to its positive and instantaneous results that it will have on J.M (Boyd &Lippincott Williams & Wilkins, 2008). Participating in activities both at school and outside the school is also effective in helping J.M build social relationships. Also, by hiring a tutor, J.M will be able to improve on his academic performance in the subjects that he needs improvement.

Steps

Enhance the client’s commitment to carry tasks

To ensure that J.M is committed to achieving the stated goals, it is important to ensure that all the stipulated aspects are strictly followed. In this case, I ensured that assistance was readily available to J.M whenever he needed it. To facilitate this assertion, I ensured that the supervisor was able to cover up for me if I was not available or held up somewhere. I also ensured that there was effective communication between me and J.M to create a comfortable working environment.

Planning the details of carrying out tasks

To carry out the tasks outlined above requires a clear plan. Therefore, I am required to sit down with J.M and talk about how the tasks are going to be achieved. We must agree on how we are going to accomplish the tasks at the right time.

Analyzing and resolving obstacles

Accomplishing the tasks can be challenging at times. For instance, for J.M to understand the role played by the Child Protection Service was not easy. This is because he believed that it was the parents who had the responsibility of taking care of their children. Nonetheless, J.M did not have a clear understanding of what was happening in his family. There is a time when he blamed the father for the abrupt change of behavior of the mother.

J.M’s family seems to have been broken down given that both parents have been accused of not doing enough to protect their children. I will advise that J.M’s family be referred to a family therapist who would guide them on how to live in harmony (Rasheed, Marley, and Rasheed, 2010). Another challenge is that J.M’s mother refuses to take medication which complicates the situation further. I will involve the community health workers to make a follow-up and ensure that she adheres to the doctor’s prescription.

Despite these challenges, I will sit J.M. down and talk to him about the situation. I will urge him to adopt a brave face and be able to cope with the situation. I will ensure that I spend quality time with J.M to help him overcome his problems. In this case, I will ensure that at no one time will J.M be left alone to deal with his troubles. I will ensure that everything that he needs is availed to him without many tussles.

Summary of the Plan

Ensuring that J.M participates in activities both at school and outside the school to improve his social life.
Conduct intensive psychological counseling to help J.M cope with the situation at home.
Encourage J.M to push for tutorials at home to improve on his academic performances.

References

Boyd, M.& Lippincott Williams & Wilkins. (2008). Psychiatric nursing: Contemporary practice. Philadelphia, Pa: Wolters Kluwer/Lippincott Williams & Wilkins.

Garcia, K., and Mann, T. (2003). From ‘I wish’ to ‘I will’: Social-cognitive predictors of behavioral intentions. Journal of Health Psychology, 8, 347-360.

Healy, D. (2008). Mania: A short history of bipolar disorder. Baltimore: Johns Hopkins University Press.

McKenzie, F. R. (2008). Theory and practice with adolescents: An applied approach. Chicago: Lyceum Books.

McLaren, N. (1998). “A critical review of the bio-psychosocial model”. The Australian and New Zealand Journal of Psychiatry, 32 (1): 86–92.

McLaren, N. (2002) “The myth of the bio-psychosocial model”. Australian and New Zealand Journal of Psychiatry 36 (5), 701–703.

McInnis-Dittrich, K. (2005). Social work with elders: A bio-psychosocial approach to assessment and intervention. Boston: Pearson.

Rasheed, J.M., Marley, J.A and Rasheed, M.N., (2010). Family Therapy: Models and techniques. ThousandOaks, California: Sage publications Inc.

Roberts, A. R. and Watkins, J. M. (2009). Social workers’ desk reference. Oxford: Oxford University Press.

Stiffman, A. R. and Feldman, R. A. (1988). Depression and suicide. Greenwich, CT: JAI Press.

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