Case Scenario
Client name: Jane Doe
Age: 28
Gender: Female
Background:
Jane Doe is a 28-year-old female who was bought to hospital by ambulance when she was found running barefoot on a highway in the middle of the night. She has been admitted to the mental
health unit. She has no significant medical history and does not use any substances.
According to her mother in the last month there has been a sudden change in her behaviour. She
has been expressing paranoid beliefs and has begun staying in her room all day praying. The family
reports that she often talks to herself and will laugh or yell for no reason. She sometimes says things
as if she is speaking to someone. For instance, yesterday she yelled “I told you already! Leave me
alone!” When her mother asked who she was talking to, she didn’t respond.
She is also extremely suspicious of other people, including her own siblings and friends, but she still
trusts her mother. Jane states that the devil has possessed her family members and is trying to kill
her. During conversation, she often jumps from one unrelated topic to another, and it is very difficult
to understand what she is saying.
Her mother states that Jane has never behaved like this before. However, she does admit that over
the last 6-7 months, Jane has become increasingly superstitious and isolative, and that her mood has
been quite low. She has been showering less frequently and she also quit her job at ANZ bank,
stating that she felt overwhelmed and couldn’t keep up with the workload. About 5 months ago,
Jane stopped playing soccer, which she used to love, and she also stopped going out and seeing her
friends. She used to be very outgoing and social.
Jane’s mother is very religious and she believes that her daughter has been cursed by her exhusband. She would like a priest to perform an exorcism on her daughter, and is giving Jane holy
water to drink. She is very distrustful of medications and of Doctors, and doesn’t want Jane to stay in
hospital. She insists that her church can help Jane and the Doctors cannot. She is observed telling
Jane “just keep praying. God will save you”. Jane also wants an exorcism and states that the devil is
controlling her mind. She is refusing to eat or to take any medications, stating that she doesn’t trust
the nurses or Doctors.
Jane’s mother gave birth to Jane at the age of 40. She said it was a very difficult pregnancy and she
was born preterm at 32 weeks. Jane suffered abuse from her father up until the age of 11, when her
mother moved her and her siblings to Australia. She has not seen or spoken to her father since then.
Jane did well at school and started working at ANZ bank after high school. She always had a large
group of friends, but always suffered from low self-esteem and anxiety. She was always a
perfectionist. She has always had a strong faith in God and is a member of Hillsong, a large
evangelical church.
Questions:
1. Explain how Jane meets the criteria for schizophrenia in the DSM 5. Give details of the symptoms experienced (300 words)
2. Watch the video of an interview with Jane and write an MSE (300 words)
3. Choose one biological, social or psychological factor that may have increased Jane’s risk of developing schizophrenia. Use research to support your ideas (400 words)
4. Discuss 2 nursing interventions that will help Jane’s recovery. You should define the intervention and discuss why it will help Jane, including any limitations. Use research and the
case study to support your ideas (1000 words)
Frequently Asked Questions
Do I have to follow the word limit for each section?
No, this is a guide only. However, your word count should not be too dissimilar. For instance,
if you write only 300 words for question 4, and 1000 words for question one, you will likely
loose marks as section 4 requires a more detailed response.
In what format should I answer question 1?
You can write in a paragraph or using dot points. Refer to the video for information on this.
What do you mean by ‘nursing intervention’?
A nursing intervention is something that nurses do with patients. Think, what can the nurse
do that will help Jane in her recovery?
I want to suggest art therapy/CBT/ECT etc…. is that a nursing intervention?
Anything that the nurses can do or be a part of would come under nursing intervention. Your
focus should be on explaining the intervention, discussing the evidence for or against it
(research) and telling me why it is suitable for Jane.
I am feeling lost, what do I do?
Email your unit coordinator Sarah on NUR258@cdu.edu.au
I don’t know how to write an academic assessment and/or do referencing
Contact the library or the learning support service at CDU for help with academic writing and referencing.
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Explain how Jane meets the criteria for schizophrenia in the DSM 5. Give details of the symptoms experienced (300 words)
Jane exhibits several symptoms consistent with a diagnosis of schizophrenia according to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5). Specifically, she demonstrates delusions, as evidenced by her belief that her family members have been possessed by the devil and are trying to kill her. She also experiences hallucinations, such as when she yells in response to voices telling her what to do. Her disorganized speech is apparent from her mother’s description of Jane jumping between unrelated topics, making her difficult to understand. Significant decreases in functioning are evident in Jane quitting her job and isolating herself from friends and activities she previously enjoyed like soccer. These symptoms have been present for over six months, as her mother notes a gradual change in Jane’s behavior emerging about seven months ago (American Psychiatric Association, 2013).
Watch the video of an interview with Jane and write an MSE (300 words)
Upon observing Jane’s interview, several findings emerge relevant to a mental status examination (MSE). In appearance, Jane appears disheveled with poor hygiene as described by her mother. Her behavior is agitated and restless. She is cooperative with the interview but her speech is disorganized and difficult to follow as she jumps between topics. Her mood is anxious and her affect is blunted. No current hallucinations are reported but she maintains delusional beliefs that her family wants to harm her due to devil possession. Her thought process is marked by tangentiality and thought blocking. She is oriented to person but not fully to place, having been found running on the highway, and demonstrates impaired judgment and insight in refusing treatment. Cognition appears impaired and concentration is poor. She reports poor appetite, sleep, and energy consistent with her symptoms (American Psychiatric Association, 2013).
Choose one biological, social or psychological factor that may have increased Jane’s risk of developing schizophrenia. Use research to support your ideas (400 words)
Research suggests that both biological and psychosocial factors likely interact to increase risk of developing schizophrenia. One factor evident in Jane’s case history is childhood trauma. A meta-analysis of 23 studies found that exposure to childhood trauma, especially sexual abuse, doubled the risk of later developing psychosis (Varese et al., 2012). Jane experienced abuse from her father up until age 11. Childhood trauma has been linked to both biological and psychological mechanisms that may increase vulnerability. Stress during critical periods of brain development can alter neuroplasticity and stress response systems implicated in schizophrenia (Read et al., 2014). Psychologically, trauma reduces sense of safety and control, impairing cognitive and emotional development in ways that may diminish later coping abilities (Read et al., 2005). For Jane, unresolved trauma from abuse could have increased susceptibility by affecting her biological and mental resilience when other risk factors emerged in early adulthood.
Discuss 2 nursing interventions that will help Jane’s recovery. You should define the intervention and discuss why it will help Jane, including any limitations. Use research and the case study to support your ideas (1000 words)
One important nursing intervention for Jane is psychoeducation. Psychoeducation involves providing patients and families accurate information about the nature and treatment of mental illnesses (Xia et al., 2011). For Jane, this could help counteract her mother’s misconceptions and increase willingness to engage in evidence-based care. Research shows psychoeducation reduces relapse rates by 30-50% in psychotic disorders by clarifying symptoms and management (Xia et al., 2011). It empowers patients and caregivers to better recognize warning signs of relapse and seek help. However, overcoming distrust of doctors will require a thoughtful, empathetic approach from nurses.
Another effective intervention is cognitive behavioral therapy (CBT). CBT aims to modify dysfunctional thoughts and behaviors associated with psychosis (National Institute for Health and Care Excellence, 2014). For Jane, CBT could target beliefs about devil possession and paranoia through logical analysis and reality testing. It may also help improve social and self-care skills given her isolation and withdrawal. Meta-analyses show CBT reduces relapses and rehospitalizations when combined with medication (National Institute for Health and Care Excellence, 2014). However, Jane’s current state may limit insight and engagement. Nurses can help establish rapport and a collaborative relationship to facilitate later CBT interventions.
Psychoeducation and CBT are evidence-based nursing interventions that can aid Jane’s recovery if implemented sensitively with her and her mother. While overcoming distrust poses challenges, taking time to understand their perspective and clarify misconceptions may build the trust required for Jane to fully engage in her care. Ongoing support from nurses can help empower Jane to better manage her illness.
References:
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
National Institute for Health and Care Excellence. (2014). Psychosis and schizophrenia in adults: Treatment and management. https://www.nice.org.uk/guidance/cg178
Read, J., van Os, J., Morrison, A. P., & Ross, C. A. (2005). Childhood trauma, psychosis and schizophrenia: A literature review with theoretical and clinical implications. Acta Psychiatrica Scandinavica, 112(5), 330–350. https://doi.org/10.1111/j.1600-0447.2005.00634.x
Read, J., Fink, P. J., Rudegeair, T., Felitti, V., & Whitfield, C. L. (2014). Child maltreatment and psychosis: A return to a genuinely integrated bio-psycho-social model. Clinical Schizophrenia & Related Psychoses, 8(3), 235–254. https://doi.org/10.3371/CSRP.REAF.081214
Varese, F., Smeets, F., Drukker, M., Lieverse, R., Lataster, T., Viechtbauer, W., . . . Bentall, R. P. (2012). Childhood adversities increase the risk of psychosis: A meta-analysis of patient-control, prospective- and cross-sectional cohort studies. Schizophrenia Bulletin, 38(4), 661–671. https://doi.org/10.1093/schbul/sbs050
Xia, J., Merinder, L. B., & Belgamwar, M. R. (2011). Psychoeducation for schizophrenia. Cochrane Database of Systematic Reviews, (6), CD002831. https://doi.org/10.1002/14651858.CD002831.pub2
