Understanding Psychosis: A Case Study of Brian

Brian, a 34-year-old mechanic, was brought to the Psychiatric emergency services by his wife and has been diagnosed with psychosis. The key concern of Brian’s altered mental health will be identified and discussed. Also, this case study will identify and discuss interventions to address his inability to trust. Some potential impacts to him and his family will be discussed including the consideration of stigma and discrimination. Lastly, the relevant legal and ethical issues to this case study are discussed.

A key concern related to Brian’s altered mental health is his inability to trust others. It is evident that people who were diagnosed with psychosis often experience beliefs that are bizarre and absurd. Often they think that simple gestures and movements are

threatening to them.

They can also experience some auditory and sensory hallucinations just like when Brian claimed that he is receiving messages from Jesus Christ while watching television (Bucci, Startup, Wynn, Heathcote, Baker & Lewin, 2008, p. 326). Also, it was evidenced by his strange behaviours against his wife such as not trusting her, accusing his wife of cheating and poisoning his food. These behaviours may affect his interactions with the health professionals, as he may not believe that they are truly concern about him. Other than his wife, his family may also be affected by his inability to trust (Koivisto, Janhonen, & Vaisanen, 2003, pp. 225-227).

One of the nursing interventions that a nurse could use to address Brian’s inability to trust others is to build a therapeutic relationship with him. According to Stein-Parbury (2009, pp. 25-16), therapeutic relationship is when the nurse is able to maintain and establish a relationship with the patient. The nurse should be able to listen, explore and understand his reality. It allows him to share his thoughts and feelings freely without judgements, as he is highly suspicious to others and even to his wife.

The nurse should also interact with him in an honest and sincere way. The nurse should always let him know who the nurse is in case he forgets about the identity of the nurse and also, ask him for his own decision and choices (Videbeck & Schultz, 2013, p. 154). As a result, this will allow him to feel less suspicious and that he will feel that the nurse is genuinely concern towards him. Also, be cautious when making false reassurances as it may increase his inability to trust and hinder the development of the patient-nurse relationship (Dyson, 1998, p. 288). It may even result to completely damaging the relationship. Touching the patient’s hand may show threat and suspicions towards them because every actions of the nurse may perceive negative thoughts to the patient. The nurse should also be aware of asking for his consent and letting him know your actions so he would not be surprised (Townsend, 2011, p. 113). Also, let him know that he is safe and no one is going to hurt him in this place (psychiatric emegency services). He may feel more likely to be confident if he is aware of the real situation and knows the environment. The nurse can explain the procedures, routines and the rotating staff so he will not feel doubtful (Videbeck & Schultz, 2013, p. 148). Given these points building a therapeutic relationship with Brian will also help with his treatment and can improve his ability to trust others especially his wife.
Another intervention that a nurse could use to address Brian’s inability to trust others is to look over strategies and skills to help Brian feel that he can trust people around him. Koivisto et al. (2003, p. 223), suggest that letting them focus on their strengths by realizing that delusions are not real would be helpful. They may feel insecure, vulnerable, scared and can be aggressive. It was shown by his accusations that his significant other is spending all his money, cheating on him and trying to poison his food. However, the nurse must do this in a way that will not offend him by using “…reasonable doubt as a therapeutic technique” (Townsend, 2011, p. 118). For example, “I can see that you are certain about this, however I find it hard to believe it”, he nurse is neither denying nor arguing with his belief. There is no point of arguing with him because he would not change his belief and it may impact on the relationship between him and the nurse (Videbeck & Schultz, 2013, p. 148). Brian’s environment is also significant to his condition. The nurse should provide a low stimulus environment because highly stimulated surroundings could trigger his anxiety that contributes to his agitation and suspiciousness (Videbeck & Schultz, 2013, p. 149). Therefore, assisting Brian to focus on his reality and evaluating his environment can help Brian decrease his suspiciousness.