HS182- 4 – AP (Adult Nursing & Mental Health Nursing)
Scenario 1
Jake, 25, began working at a local gym 3 years ago following completion of his degree in Sport and Exercise. Work was going well, and he was taking on more responsibility until the Covid-19 pandemic enforced lockdown and the owners of the gym, like other businesses, applied for and placed the workforce on the furlough scheme. The loss of a proportion of his income is compensated by a saving on travel costs.
Jake lives alone in a bedsit and his family live some distance away in the midlands. He has friends whom he stayed in touch with via social media and began spending a lot of time in online gaming. At first, he enjoys the time away from work and not having to wake early to get himself ready and make the journey to the gym. There is a supermarket a fifteen-minute walk from home and, as permitted, he shops, observing social distancing rules.
As the weeks passed Jake became more preoccupied with gaming, lost the inclination to walk to the supermarket, opting instead to use the local shop three minutes away, and has generally adopted a more sedentary routine with little exercise and less healthy eating habits. Jake has become increasingly frustrated with lockdown and the inability to meet with friends and family.
When the gym reopens Jake’s manager notices his weight gain and more slovenly appearance. He is warned that this affects the image and good reputation of the gym and he must address this with immediate effect, otherwise his position is under threat. Jake arranges a telephone consultation with the practice nurse at his local GP practice for advice.
Essay Questions 1 (total 500 words)
- Explore the range of potential circumstances and factors, i.e. determinants of health, that may have impacted on Jake’s current experience of health and well-being.
- What are likely to be the main concerns as far as the practice nurse is concerned, and how may she support Jake in making the necessary changes?
Scenario 2
Gerry is 15 and currently living with his father and elderly grandmother. His grandmother has started to become muddled at times and Gerry feels increasingly stressed about her safety when on her own. His parents are separated following many years of a troubled relationship and his mother has returned to her family in the Philippines.
Gerry always remembers there being rows and, especially when his dad had been drinking, it was always safer to hide in his room before the physical fighting started and he learned it was best to keep out of the way. Gerry’s mum was very timid and had been kept under control herself by a very strict father, so she had taken a back seat in Gerry’s upbringing and had left him to his own devices. She would often stay in bed all day.
At school, concerns have been raised with the School Nurse about Gerry’s attendance and he is reluctant to communicate with staff or other students. There is evidence that Gerry is being bullied and taunted because of his shabby appearance, and he has begun to get involved in fighting. Gerry is also refusing to eat with others or get involved in sports at school, is wearing increasingly baggy clothes, and keeps his arms and legs covered at all times.
Essay Questions 2 (total 500 words)
▪ Describe the behaviours that suggest Gerry has experienced traumatic events in his life and explain what these events have been.
▪ Identify the principles of care in safeguarding Gerry as a vulnerable person and supporting his family.
Scenario 3
Yasmin is a 19-year-old woman who, until seven months ago, was living in the family home. She had a major falling out with her parents over her choice of partner (same sex relationship) and then moved in with her. This relationship has since ended; however, Yasmin has been unable to reconcile with her parents and had been ‘sofa surfing’ with a friend for two months but eventually felt that she had outstayed her welcome, leading her to sleep rough.
About six weeks ago Yasmin was approached by a man who seemed pleasant, gave her money for food and invited her to an abandoned property where others also lived. Shortly after moving in the same man began providing her with cocaine, unconditionally at first but after a while he sought sexual favours from her. Yasmin was uncomfortable with this and resisted initially but submitted soon after owing to her longing for the drug.
In the last two weeks the man has pressured Yasmin to have sex with other men, suggesting that he will provide her with money (as well as the drug). He adds that they will pay more if they do not have to wear a condom. Yasmin is again uncomfortable with this but also gives this consideration with the promise of money in her pocket.
During a visit to a food bank Yasmin was upset, and a visiting primary health care worker sat with her and listened sensitively whilst Yasmin confided in her about the events of the past seven months.
Essay Questions 2 (total 500 words)
- Discuss the determinants that affected Yasmin on her journey from the beginning to the close of the scenario, and the factors that increased her vulnerability on the way, including the health risks.
- How might Yasmin be supported in addressing possible health risks and concerns in a way that empowers her to act on this?
Scenario 4
Frank has been living alone with Alzheimer’s for many years, but his condition has deteriorated significantly enough over recent months, following a period in hospital after a fall, that his family decided that it would be safer and best for him to move to a nursing home for care. Before the move, Frank was visited daily by his granddaughter who used to help him get up and ready for the day and make sure he was able to get to the day centre twice a week.
Since the move, Frank has started to get out of bed as many as ten times during the night to visit the toilet and has started wetting his pyjamas on some nights. He ends up wandering, losing his way and pacing up and down the care home corridors. He spends much of his time during the day napping in his chair.
Frank’s family have noticed when they visit that he seems increasingly confused and distressed, especially in the evening and at night. He is sometimes verbally abusive to them and repeats the same phrases over and over. The care staff have reported that he has become very irritable for most of the time and has also started to lash out when approached and has refused care and help from the female staff.
Essay Questions 4 (total 500 words)
▪ What factors might explain Frank’s increasing agitation?
▪ What strategies might be useful in calming Frank and maintaining feelings of comfort and safety?