The service user experience

15 The service user experience





Case study 1: young male experiencing his first psychotic episode


This case study will focus on a young male who experiences a psychotic episode for the first time. When reading this case study, you should consider the following key areas of learning and think about how you would apply them to your own clinical practice, including how they help you to achieve your practice competencies to become a registered nurse:






11.30 a.m. Monday


You arrive at Christopher’s home with your mentor. Christopher’s mum opens the door. She has obviously been crying and does not look like she has slept. Your mentor introduces you both and you enter the house.



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The section on practicalities in Chapter 5 will help you with this one. There should also be a policy relating to this in your practice area which you should read before going out on home visits, even if you are with your mentor. You could also look at the communication section in Chapter 6 to help you consider how you might enhance your approachability when meeting Christopher’s mum.


Your mentor explains to Christopher’s mum that her GP has referred Christopher to the service and that you are both here to find out more about what has been going on in order to agree on the best way forward. His mum immediately appears relieved, bursts into tears and thanks your mentor for agreeing to help. You offer her a tissue from your bag which she takes and she smiles at you. Your mentor begins the assessment process.



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Chapter 8 on assessment will give you some ideas about how to work through this scenario. You may also have observed your mentor or other professionals in practice and learnt from their approach.


You learn from Christopher’s mum that he has been smoking cannabis on and off for the past 4 years. She tells you that although she doesn’t agree with it, it doesn’t seem to do him any harm and she appreciates that most of his friends are also doing it. Over the past month he seemed to be smoking more and she had a hard time getting him out of bed in the morning to go to his job in the local call centre. He had been late so many times that he got the sack and hasn’t made any effort to look for something else.


His Dad has been getting more and more frustrated with him and they have been arguing all the time. This led to Christopher retreating to his room and the smell of cannabis was constantly coming from his door. Last week Christopher’s mum convinced him to let her in to his room to change the sheets. She was shocked because all his electrical gadgets had been taken to pieces and were scattered all over the floor. Christopher told her that they were all malfunctioning because of aliens attempting to communicate with him through his TV, iPod and computer. She initially thought he was joking, but when she returned from home the next day he had also taken the microwave in the kitchen to pieces and made a start on the downstairs TV. His Dad was furious and that was when they went to see Dr Ascot at the GP surgery. She described things as going from bad to worse since then:




You and your mentor discuss your next steps and decide to try and talk to Christopher. You agree that two people may be intimidating so your mentor initially approaches him and you stay with his mum to provide comfort and reassurance. Your mentor returns after 15 minutes and tells you that Christopher hasn’t responded to her at all although she can hear him pacing in his bedroom.



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The document Keys to Engagement (1998) published by the Sainsbury Centre for Mental Health and Chapter 7 on forming therapeutic relationships might offer you some ideas on approaches to working with Christopher. You could discuss with your peers what risks are present in this scenario. Chapter 12 will also help you to identify the risks and possible ways of working with them in a way that is therapeutic.


You suggest to your mentor that you could try writing a note to Christopher telling him who you are and that you would like to speak with him about his worries and fears. You could say that you might be able to help and that you will come back this afternoon to see if he would like to speak with you. Your mentor agrees that this is a good option as Christopher may be suspicious of her motives and finding it difficult to trust her. His mum agrees with the plan and takes your contact details in case anything happens in the meantime.



3.30 p.m. Monday


You and your mentor return to the house. Christopher’s mum tells you that she has heard him continually talking in his room. Your mentor approaches his room again and he opens the door slightly. He is sitting on the floor and your mentor also sits down on the other side of the door. She introduces herself and they talk for some time. Christopher tells her in detail about his fears for his safety as the aliens will be coming for him at 6.30 that evening. He tells her that he would rather die than let them take him because they have told him what they will do to his brain. He is highly distressed, scared and speaking very quickly. Your mentor talks with him about going into hospital as a place of safety to get help with the thoughts and beliefs that he has. Christopher becomes angry with this and accuses your mentor of being part of the plot to get him out of his room. He slams and locks the door.


Feb 25, 2017 | Posted by in NURSING | Comments Off on The service user experience

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