Siobhan Rice: S00237990

NRSG263: Principles of Nursing: Mental Health

Assessment One: Essay

Word Count: 2067

Siobhan Rice NRSG263 Assignment 1 Essay

A 2016 study conducted by the Australian Institute of Health and Welfare found that
34.8% of Australians aged over 14 have at some stage in their life used cannabis
and 6.3% of Australians will use amphetamines in their lifetime (Australian Institute
of Health and Welfare, 2017). This essay will identify a number of issues that impact
vulnerable individuals and can be influencing factors for subsequent substance
misuse. This will be done by examining the principles of trauma informed care and
using these principles in relation to a case study on a vulnerable individual named
Lisa. Lisa has a number of factors that have influenced her and her use of illicit
substances. These influencing factors include Stress, Family discord and her
psychotic illness that she has been self-medicating.

Trauma informed care requires the knowledge and understanding that all individuals
will experience trauma different and it will have a different impact on every
individual’s life (Kezelman, 2014). This requires careful and thorough consideration
of a person’s environment beyond the immediate care being provided and
acknowledgement of how their symptoms and presentations may be seen as a result
of trauma they have experienced and will be specific and individualised to them.
(Australian Institute of Family Studies, 2016). When acting in a way that
acknowledges and utilises trauma informed care it is important for the nurse to have
an awareness and sensitivity to the way in which the client’s presentation and
service needs can be understood in the context of their trauma history. When an
individual experiences trauma it is important to recognise the impact that this has
had on the individual’s life in special regard to their mental health as this can at times
be a factor that results in the individual experiencing severe anxiety, depression or
other such mental health diagnoses (Tello, 2019). There are three main principles of
Trauma Informed Care that will be explored throughout this essay include Safety,
Transparency and Trustworthiness, and Collaboration and Mutuality (Muskett, 2014).
For the safety principle to be met it is important to create a space where clients feel
as though their cultural, emotional and physical safety needs are met. Transparency
and Trustworthiness is vital for building a rapport with the patient, especially in the
mental health setting (Watson, Thorburn, Everett, & Raewyn Fisher, 2016). This is
done by providing full and accurate information about what is happening and the
likely future steps that will be taken. The final principle that will be explored
throughout this essay is Collaboration and Mutuality. This involves recognising the

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value of healing that can only occur with the family and her other support team being
involved in the decision making (Tello, 2019). In order for Lisa to have the best
possible care it is crucial for all of these principles to be met full as well as the other
principles which include choice, and empowerment.

Through an examination of Lisa, it is clear how important it is to understand and be

aware of the trauma she has and is facing in her life. Lisa has previously
experienced auditory hallucinations which can be traumatic, Lisa is also currently
trying to deal with the trauma associated with the large amounts of family discord
that she is facing in her current situation. Lisa has a past of psychotic illness which
she had previously been hospitalised and medicated for. Lisa is also a regular
Cannabis and occasional Amphetamine user. It is important to note that her
Amphetamine use had previously ceased but she has begun taking amphetamine
more frequently in the past two weeks. Lisa has also been experiencing a decline in
her mental health state. This is apparent through her decline in grooming standards
and she is also presenting as very anxious and agitated. Lisa is also experiencing
difficulty concentrating and during her consultation was unable to recall her new
residential address.

Stress has been found to be a key risk factor in addiction initiation, maintenance,
relapse, and subsequent treatment failure. When an individual is experiencing
stressful times in their life matched in combination with poor coping mechanisms this
can increase their risk of addiction through the intensification of impulsive responding
and self-medicating (Mustonen et al, 2018). The stress that Lisa has been
experiencing has resulted from her new environment, as she has recently moved
into a house with her boyfriend. Lisa is feeling unsafe in this new environment due to
her auditory hallucinations and her delusions and feelings of thought broadcasting
which are all causing her great amounts of stress. As Lisa is not feeling safe in her
home, she has resorted to sleeping with a knife under her pillow in the garden shed
which is meaning she is having many restless nights which is not helping to reduce
her stress levels. It is possible that Lisa is using the Cannabis as a relaxant to help
her to better cope with her stressful situation (Temple, Driver, & Brown, 2014). It can
also be assumed that due to Lisa’s already high levels of stress and past
Amphetamine use this has made her more susceptible to a relapse in addiction. With

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1 in 5 of the amphetamine users using the drug weekly or more often in 2016 it is
clear that it is an addictive agent and Lisa is not only experiencing a relapse in her
amphetamine use but is also experiencing symptoms of addiction as she has found
that her use of amphetamines have increased in the last few weeks (Australian
Institute of Health and Welfare, 2018). When understanding and assisting Lisa in her
stress and psychotic disorder and illicit substance abuse it is especially important to
implement the trauma informed care principles. By making sure that Lisa is feeling
safe and respected by her care provider she will be more willing and open to sharing
more information and accepting the help provided to her. This will also aid Lisa in
better managing her stress in her life at the moment. It is also vital that the care team
is transparent with Lisa as this will aid in building trust and rapport between Lisa and
her care team. It is also important for the clinicians to ensure that Lisa is involved in
the decisions as to where her meetings with the teams are to keep her feeling safe
and comfortable.

It is also important to take into account Lisa’s family discord as it can be assumed
that Lisa previously had a strong connection to her parents. This has been severely
impacted by her moving in with her boyfriend which they did not approve of. This not
only would have impacted on Lisa’s stress level, but it also would have cut off a
support structure for Lisa in her treatment and rehabilitation. This is a perfect
example of why it is important to implement the Trauma informed Care principles to
give Lisa the sense of transparency and trustworthiness, and safety that she has
been craving in her personal life. By doing this not only will it assist in building
rapport between Lisa and her care team, but it will also provide a stable structure in
her life that she is more likely to come back to. When looking at her risk factors for
substance misuse it is important to take into account the family discord that Lisa is
currently experiencing. It is also important to also consider why Lisa began taking
illicit substances and if there is a family history of substance abuse. A 2016 study
conducted by Moeeni, Razaghi, Ponnet, Torabi, Shafiee and Pashaei found that
individuals who had less family support, such as Lisa, are more likely to relapse and
resume illicit substance abuse. By examining the effects that Lisa’s family discord
has had on her mental state it is clear that she needs her care team to make her feel
safe and as though she can trust them. This can be achieved by implementing the
safety, trustworthiness and transparency, and collaboration principles as outlined in

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the trauma informed care principles. This will make Lisa feel as though she is being
supported and fully cared for. This may also assist Lisa in accepting help from her
care team as she will find them a support structure and a stabilising factor in her
changing life.

Lisa’s history of psychiatric illness is a big risk factor for her and in regard to her
recreational drug use. Lisa has a history of psychosis and has previously been
prescribed anti-psychotic medications which she has subsequently stopped taking.
By Lisa choosing to stop her prescribed medications and instead self-medicating
with Cannabis and Amphetamine this can worsen the long-term symptoms of her
psychiatric illness. This will cause more issues in relation to treating her pre-existing
conditions as well as impacting the treatment and rehabilitation plan for Lisa in
relation to her drug addictions. In regard to assisting Lisa with her narcotic addictions
and the risks and complications already associated in the rehabilitations of an
individual who is experiencing withdrawal from addictions, especially highly addictive
substances such as Amphetamine and Cannabis. 2018 data from the National
Institute on Drug Abuse in America found that around 30 percent of those who use
cannabis may have some degree of use disorder (National Institute on Drug Abuse,
2018). There are a number of factors that can influence the chance of developing
this disorder, this includes the age at which the individual began their use of
cannabis, in Lisa’s case it is unclear how long she has been a regular cannabis user
(Stefanis, et al., 2014). It is possible that Lisa is self-medicating by regularly using
Cannabis as it is often used as a relaxant (National Institute on Drug Abuse, 2018).
However, it is also important to note that cannabis can also result in feelings of mild
anxiety or paranoia and insomnia, this is dependent on the batch or dose of the drug.
Amphetamine comparatively can increase an individual’s feelings of euphoria for
short times but can also result in hallucinations and paranoia (Harro, 2015). By Lisa
increasing her Amphetamine use this can make her pre-existing psychosis worse as
some of the common side effects of amphetamine use include, agitation, irritability
and can include psychosis. By Lisa having a history of psychosis and hallucinations
this can increase her chances of experiencing psychosis and hallucination as a
result of her substance misuse (Harvey, et al., 2016).

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When forming an individualised care plan for Lisa it is important to not only take into
consideration her medical history but also her past compliance. Lisa has been known
to be compliant to treatment previously as she was previously admitted to a mental
health hospital prior to her discharge with a prescription for anti-psychotic medication
which she filled and was compliant with. It is also important to note that Lisa was
accepting of the help from her drug councillor and agreed to a meeting with the rest
of her mental health team (Essock, et al., 2015). This shows that Lisa has
acknowledged that what she is experiencing is problematic and is not contributing
positively to the safety of her or her boyfriend. The care plan must also re-examine
the reasoning behind Lisa feeling the need to self-medicate and stop the diagnosed
medications. When forming Lisa’s care plan, it is also important to take into
consideration what health care workers will need to work together to get Lisa the
best possible care plan for her current situation (Supper, Catala, Lustman, Chemla,
Bourgueil & Letrilliart, 2015). In this case Lisa would benefit from collaboration with a
Mental Health Nurse, psychologist, social workers and occupational therapists as
well as continuing working with her drug councillor. By working closely with a wide
variety of health care professionals it is not only going to provide best care for Lisa
but also be a way to share a widen the scope of practice of the care team (Olfson,
Kroenke, Wang & Blanco, 2014). This will better aid Lisa in achieving the best
possible results for her.

Furthermore, it is clear that when caring for vulnerable individuals it is vital that
extreme care be taken when talking to and supporting them, this can be done by
implementing the Trauma Informed Care principles. It is also important to understand
the substance misuse is not always an individual’s first resort, but rather can be a
way of the individual trying to cope with their traumas and take control back over
their situations.

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