CLIENT CASE STUDY Graham 1

CLIENT CASE STUDY Graham 1

Client Case Study

General Information of Client:

Client Name: Jane (name changed for confidentially reasons)

Client Age: 21 years old

Client Gender: Female

Relationship to Client: Neighbor

Date of Assessment: November 2nd, 2015

Time of Assessment: 11am

Location of Assessment: RA Office – Balsam Hall

Area of Assessment: Stress management

Assessments Administered: Perceived Stress Scale, Patient Health Questionnaire (PHQ-9), Hamilton Anxiety Rating Scale (HAM-A)

Background Information:

Jane is a 21 year Caucasian female in her second semester of nursing school at Western Carolina University. Jane is from Greenville, North Carolina. She has a younger brother who also attends Western Carolina. Jane enjoys snowboarding, socializing with friends, watching movies, and listening to all types of music. She plans to graduate nursing school in the Fall of 2016 and hopes to work one day as a nurse practitioner.

Assessment Process:

I chose to access Jane because she is a friendly face in my building and I knew she would be up for taking any assessments. I initially met Jane during the SSI period, so she had opened up about her struggles this semester and things she had been going through. During the second SSI period for RAs I asked Jane if she would like to meet with me again to take the assessments and evaluate some areas in her life to set up some goals. She agreed to the meeting and found it to be a very considerate gesture that I asked her. Because Jane had time in her schedule, I went ahead and asked her the interview questions that I had previously prepared. After answering the interview questions, we agreed to meet November 2nd, 2015 at 11 A.M. in the RA office of Balsam Hall. Based on the interview questions and my prior knowledge on Jane, I decided to access Jane’s stress management skills.

Assessment Interview Questions and Notes:

Below are numbered questions that were asked of Jane and in quotations are her direct responses.

1. What is your age?

“21”

1. Where is your hometown?

“I am from Greenville, North Carolina.”

1. Do you have any siblings?

“I have a brother Josh. He goes here as well. I also have an older sister.”

1. Why did you chose to come to Western Carolina?

“Because they sent me an application that didn’t have an essay and I got into the Honors College. I also wanted to be far away from home.”

1. What do you do in your spare time?

“I don’t have a lot of free time because I am in nursing school, but when I do I like to watch Netflix, read, and snowboard in the winter.”

1. How are your sleeping habits?

“Awful. I find it really hard to sleep through the night. I wake up during the night. When I wake up in the morning, I still feel tired.”

1. How are your eating habits?

“I eat on-campus food, so not very good. I never eat breakfast - I forgot that was even a meal.”

1. How do you handle stressful situations?

“I lose all motivation to try and admit defeat when the stress is too overwhelming. I also cry. I cry and lay on my floor. I experience somewhat of an anxiety attack… I need someone else to talk me down, I can’t talk myself down.”

1. How often do you exercise?

“I like to exercise a couple times a week, but that doesn’t always happen because of my hair. My hair washing routine causes me stress.”

1. What are your plans after graduation?

“Hopefully I’ll be a nurse for 2 years and then I will go back to school to become a nurse practitioner. I also would like to have a family someday.”

1. Is there anything else you would like for me to know about you?

“No…

Interview Notes:

The assessment interview was administered November 1st, 2015 in the Balsam RA office around 9 P.M. Jane was in the office for a discussion with the RAs and also had to complete her SSI with me as well. After completing her SSI with her, I decided to ask her to participate in my project because she seemed like a good candidate. She agreed with me and said that she was available to take the initial interview right then. Overall, it was a pleasant and friendly meeting with Jane. Her SSI results were not too alarming, but it was evident she was under some stress because of exams and other school responsibilities. I started asking her the interview questions (knowing the answers to a few of them because of the SSI) and she opened up and shared with me even more. It was an easy, flowing interview. The assessment interview itself took about 10 minutes to complete.

Summary of Assessment Notes:

The first assessment administered was the Perceived Stress Scale. I obviously chose this assessment because I wanted to gauge Jane’s level of stress. Her answers to the questions mainly fell into the “Sometimes” and “Fairly Often” scales. Her total score for this assessment was 28. The highest score possible for this assessment is 40, so Jane fell above the median rate.

The second assessment administered was the Hamilton Anxiety Rating Scale (HAM-A). I chose this assessment because I wanted to assess the level of anxiety Jane was expressing due to the stress in her life. She rated mostly “mild” to “moderate” on her scales. The total score of her assessment was 18. These results on the (HAM-A) conclude that she has a mild to moderate level of anxiety.

The third assessment administered was the Patient Health Questionnaire (PHQ-9). I chose this as the third assessment because I wanted to determine if the stress in Jane’s life was contributing to any depressed thoughts or feelings. Jane scored a total of 18 on her assessment. The highest score possible for this scale is a 36, so Jane fell right in the median area.

Overall the three assessments identified the strengths in Jane’s life and the areas that need improvement. Jane’s assessments conclude that she has a moderate level of stress, anxiety, and depression in life, meaning that she knows how to cope with stress enough to not let it get out of control.

Observational Notes:

The three assessments were given to Jane in the RA office of Balsam Hall on November 2nd, 2015 at 11 A.M. We were comfortably seated at the couch located in the office and had no interruption during the whole assessment interview. Jane was relaxed for the interview period and did well with making eye contact and understanding and answering each assessment question. She seemed to be giving thought into her answers because she took time in giving me her feedback. Jane stayed positive throughout her interview and was eager to continue on to each assessment. The assessments took about 15 - 20 minutes total to complete.

Treatment Plan:

Goals and Objectives:

1. Increase amount of hours of sleep.

Jane will increase the amount of hours of sleep she gets per night by going to bed by 11 P.M. at least 3x/week for 3 weeks.

1. Increase physical activity.

Jane will increase her physical activity by going to campus recreation center to run at least 3x/week for 30 minutes for 3 weeks.

1. Increase management of emotions/feelings

Jane will increase her management of her emotions and feelings by attending at least one 1 hour counseling session at CAPS per week for 3 weeks.

Action Plan:

1. Create a sleep schedule and sleep tracker chart with Jane, so she can prepare when she needs to go to bed and easily keep track of the amount of hours she sleeps per night.

Focus: To improve Jane’s sleep schedule.

1. Introduce Jane to the Campus Recreation Center, so she can start utilizing the facility. This includes introducing her to the upstairs track (8x = 1 mile) and the downstairs elliptical equipment.

Focus: To improve Jane’s physical activity.

1. Introduce Jane to the CAPS located on the 2nd floor of Bird building, so she can set up her appointments.

Focus: To improve Jane’s ability to communicate her feelings as well as identifying what the stressors in her life are.

1. Evaluate progress on November 25th, 2015

Mackenzie L. Graham, RT Student Nov. 2nd, 2015

Follow Up:

The follow up meeting took place on November 4th, 2015 at 11 A.M. in the Balsam RA office. Jane and I made ourselves comfortable with each other by making small talk and shortly catching up with each other. I started the meeting with her by expressing by gratitude for agreeing to take the assessments and meeting me for a second time to carry out an assessment overview.

I discussed the results of each assessment with Jane and then explained to her the treatment goals I had for her over the next few weeks to better manage her stress.

The first treatment goal was to increase the number of hours of sleep Jane was getting. She definitely agreed that this was something she needed to improve on because she reported her daily energy levels were low. She liked the idea of keeping a sleep journal and tracking the number of hours she slept each night. She was looking forward to tracking the energy levels of her days as she got more sleep.

The second treatment goal was to increase Jane’s physical activity. I explained that I chose increasing physical activity as an appropriate goal because Jane is a fairly active person and exercise is shown to combat feelings of stress. Jane agreed and stated that exercise does give her day a positive boost.

The third treatment goal was to increase Jane’s management of emotions and feelings. I explained to her that going to talk to someone at CAPS could benefit her in ways that she may not be able to see. I explained that talking to someone about her weekly frustrations might help her better identify the stressors in her life. Jane liked the suggestion of going to talk to someone at CAPS and said she had been there before as a freshman. She admitted that she had been meaning to go up to CAPS, but she simply had not made the initial move to go back.

Jane was not too surprised by the results of her assessments. She understood she was fell under the typical “stressed college student” profile and knew that she could stand to better manage her stress. She seemed to like all of the treatment goals and plans I had created for her. She did a good job expressing that she understood the areas that needed improvement in her life and what it was going to take to better manage her stress. Overall, the follow up meeting went very well and Jane easily listened to her results and my suggestions.

Observational Notes:

When the meeting started, Jane voiced that she was excited for her feedback. She made a good eye contact and nodded appropriately while listening to my entire presentation. She seemed to appreciate the treatment objectives I had wrote for her and said that she somewhat knew what activities would help her, but seeing them written down as objectives and listening them read out loud put a bigger importance to them and inspired her more to carry them out. Overall, it was a good meeting for the assessment overview.

Personal Reflection:

I learned quite a few more things during this assessment assignment as compared to the last. Administering three assessments compared to one is a lot more comprehensive and takes up a little more time. However, the three assessments gave me a larger scope on treatment goals and objectives for the client. Three different assessments give you the opportunity to get more information and knowledge about your client.

My strengths in administering assessments are that I am efficient at giving them while still being empathetic. I am good at making clients feel comfortable by throwing in some humor and small talk before and during the assessment process. I feel like because I am good at making clients feel comfortable, I am also good at make the clients feel like I am not judging them and that I am simply there to help. Also, I found that I really like to write treatment goals and objectives.

There is always room for improvement, so my improvement areas would probably be my planning for the assessment and my professionalism during the assessment I also could do a better job with planning the assessments. I feel that I need to write up an agenda for myself because I find myself questioning my next step or not knowing when to end the meeting. Sometimes I think I can be too open with clients when I am trying to earn their trust, so I need to learn to find that balance between friendly and professional.

Despite these areas I could improve in, I think this assessment went really well. Jane was a great client because she opened up to me and shared with me the juicy bits and pieces to her struggles with stress and anxiety as a college student. I cannot wait to improve on my assessment administering and become more confident as a RT in the field.