Brian Sandman

Movie Assessment

GUIDE TO NURSING PROCESS PAPER- FAMILY ASSESSMENT AND CARE PLAN

Choose a movie from the lists. If you are in Section 01, choose one movie from the provided list
The data is to be collected on each member of the family and written in either a narrative format
or can be answered directly from in list form as outlined below. Whether by list format or
narrative be clear on answering the questions. List two possible appropriate nursing diagnoses
after each pattern section. Nursing diagnoses will come from illness and wellness data. At the
conclusion of the narrative section of the paper, select the top priority diagnoses to be addressed
in the care plan. State your rationale for selecting these diagnoses.
Student’s Name: ________________Brian Sandman________________________________
Movie Title: _____________________Patch Adams__________________________________
Each family member’s name and approximate ages:
-Patch Adams He is the oldest Medical student in the movie and I would say he is around 35 or
40 years old. (It did not specify)
-Truman (patch’s best friend in med school): about 25 years old.
-Carin (patch’s friend/crush throughout med school): about 25 years old.
These people are not related but Patch has no family that we know of and therefore these two
friends become his “family”.

NURSING ASSESSMENT DATA BASE (30 %) Functional health pattern assessment

provides the data base for forming nursing diagnoses. The following questions are guidelines for
assessment. Utilize your nursing judgment to assess the characters based on the following
questions. Answer as many questions as you can, given the
limitations of the movie. Please address each section (with the section headings), but you don’t
necessarily have to answer every question. Use your nursing judgment. The paper is to be typed
using a narrative format. Please double space using a 12 point font.

HEALTH-PERCEPTION--HEALTH MANAGEMENT PATTERN

The movie begins with a depressed, and suicidal man who checks himself into a mental

institution to “find what he’s been missing”. I know Patch had been being treated right away

because he had 10 different medicine containers in his bathroom behind the mirror. Patch is an

older man and I believe until he decides to go to medical school, he was not currently enrolled in

any institution. Patch didn’t seem to have any issues with alcohol or cigarettes, but he did have
an issue with prescriptions, as was apparent with the amount of pill bottles in his bathroom. A

benefit is that the client realized he needed help after his suicide attempt, as he voluntarily sought

help at the mental institution. Patch did seem alone and down while he moved into the institution

as well as when he first moved there. He was Still clean cut and “healthy” looking overall.

Not a lot of info was given about Truman and Carin. Carin is a loner and makes herself

clear that she is only in Medical school for studying and nothing else. She is one of only 8

women in their class and says she can not afford to goof around with Patch. Truman befriends

Patch immediately and they hit it off. Right away Truman and patch show signs of real

friendship. Corin takes some time to warm up to Patch and she learns that he is actually very

intelligent and not just a goof.

Nursing Diagnoses:
-Sedentary Lifestyle: Patch shows this in the few moments we see before committing himself to

the mental hospital. He is alone and does not venture outside of his home. He talks to no one and

this depression kept him that was because he seemed to have no available support system.

-Risk Prone health behavior: Patch’s depression is what made me decide this was a good

diagnosis. He had pills that he was abusing and attempted suicide. He was stressed and had a

lack of social support.

NUTRITIONAL-METABOLIC PATTERN

There was not a lot of scenes where our “family” was eating. Most of the time they went

to a diner called the “University Diner”. Patch and Truman became regulars at this place because

they become close with the waitress. The first time Patch and Truman go to the diner Patch is

eating french fries alongside a cheeseburger. We never get any insight on the dietary health of
each of them but with how many times they eat late at the diner, we can assume they have to eat

out a lot.

Nursing Diagnoses:

-Risk for Deficient Fluid volume: I chose this because I don’t believe we see Patch, Truman, or

Carin ever drinking any water, nor really any fluids at all.

-Risk for obesity: As I stated before our characters are only seen eating greasy food from a diner

late at night which is a poor diet exercise.

ELIMINATION PATTERN

There was only 2 scenes that involved a bathroom in this movie. The first was Patch

looking in the mirror and revealing his medications. And when Patch was in the mental facility

he helped his schizophrenic roommate get over his squirrel hallucinations and help him become

brave enough to go into the restroom. I did not notice any use of laxatives, nor any digestion

problems with any of our characters.

Nursing Diagnoses:

-Risk for Constipation: The only thing that leads me to this diagnosis is the poor diet we see our

family engaged in.

-Urinary Retention: This is the only diagnosis I could come across because of the lack of

bathroom breaks we see our family take.

ACTIVITY-EXERCISE PATTERN
 The most I saw these characters moving was walking around campus or walking to

Patch’s cabin in the mountains. Patch seems to be always on the move compared to Carin and

Truman who are always seated in the restaurant or in their rooms or studying in a classroom.

Patch on the other hand is running around campus or walking around his practice in the

mountains, or walking to the diner near campus. There is no real issue with transportation

because the characters live on campus and never seem to venture far from VCU. The most

“family activities” we see our characters engage in is studying or brainstorming over school at

all hours of the day. They are all in constant contact though. The dorm rooms are well kept by all

of our characters.

Nursing Diagnoses:

-Activity Intolerance: Patch, in the beginning of the movie was at risk for this because of his

sedentary lifestyle.

-fatigue: With the high stress that comes with medical school, all of our characters are at risk for

fatigue. With all the high pressure testing and the shear amount of information they are tasked

with learning.

SLEEP-REST PATTERN

While we do not see any of our characters being exhausted beyond belief, we can assume

with the high intensity of Medical School, we can assume they are going to show signs of

exhaustion. Truman Shows sign of this when he is spending all of his free time working at

Patch’s practice. While Patch is out wandering we never see him really in his bed other than a

scene with he and Carin waking up together. Patch seems to be well rested and relaxed, while
most of the other characters seem to be showing signs of tiredness in class. All of our characters

share the same style of rooms but have different roommates.

Nursing Diagnoses:

-Insomnia: Patch does not seem to sleep well in the first few nights at the mental institute. He

lies awake and has a roommate known for screaming and yelling at all hours.

-Sleep deprivation: Carin exhibits this because Patch keeps her up all night while they plan the

idea of a “free hospital”. This was only due to Patch’s excitement and her willingness to help

him.

COGNITIVE-PERCEPTUAL PATTERN

There are no impairments in our characters when it comes to vision or hearing. The level of

cognition is very high as well with our characters. They are all accepted into VCU’s medical

school and they are all getting exceptional grades as we see because they are all competing with

one another. Patch has a unique mind and is always thinking of ways to increase the

comfortability of the patients.

Nursing Diagnoses:

-Deficient Knowledge:Treatment: We see Patch not knowing how to effectively treat his

depression, and therefore he attempts suicide.

-readiness for enhanced communication: After his visit to the mental institution Patch shows us

that he is ready for treatment and ready to communicate with others about his problems. All

because he admits himself to fix himself.

SELF-PERCEPTION--SELF-CONCEPT PATTERN/ROLE RELATIONSHIP PATTERN

 With Patch we see a total transformation throughout the movie. He begins depressed

without hope. Then he finds meaning to life in the mental hospital when he realizes he wants be

become a Doctor to help people. He is amazing with patients and shows a whole new type of

communication between Doctor and Patient. He then falls back into depression after the loss of

his friend Carin. Truman tries his best to get Patch not to give up on all they had created and

achieved. He receives a sign and sure enough he becomes the Patch who only wants to help his

patients again. He has the most drastic transformation out of any of the characters. Truman and

Carin both have depressed moments as well as extremely happy moments, but it seems their

moods directly reflect Patch’s. Patch also has a large amount of problems with his roommate

who is jealous and suspicious of Patch’s grades and work ethic. This causes some stress between

them throughout the movie, but eventually they are able to work everything out, and are able to

work together.

Patch: generally relaxed: 1, assertive 3

Truman: generally relaxed 1, passsive 1

Carin: not nervous but not relaxed 5, assertive 5

Nursing Diagnoses:

-Chronic Low Self-esteem: This is only apparent before Patch gets treatment for himself, but it

seems to be chronic because of the depression and the hopelessness he must feel to attempt

suicide.

-Risk for loneliness: This one I picked for Carin. She rejected friendship and potential study

buddies at the beginning of the semester which could cause her to potentially continue shutting

everyone out of her life. This could leave her with no support system and make her feel alone.

SEXUALITY-REPRODUCTIVE PATTERN
 The only sexual encounters we see in this movie are between Carin and Patch after 3

years of medical school. Although we don’t see it, I believe it was implied that when Carin and

Patch woke up in his bed, they had slept together. Carin also opens up to Patch before this and

tells him about how she was raped as a young girl. There were no clear signs that they did or did

not use contraception when they slept together. And none of our characters have any children.

Nursing Diagnoses:

-risk for disturbed maternal/ fetal dyad: The only reason I could put this is because of the passing

of Carin.

-Impaired parenting: this would also be because of the death of Carin. If they had a child the

child would have never known his/her mother which can be detrimental to them.

COPING-STRESS-TOLERANCE PATTERN/VALUE-BELIEF PATTERN

There were no large changes in the “family” in the last few years other than the normal

problems they face in Medical School. The family seemed to be relaxed most of the time when it

came to relationships between themselves. As stated before the stressor of studying and striving

to become doctors did seem overwhelming at times for Truman and Carin, but never for Patch.

Patch is also the main problem solver of the group. He has wisdom beyond the others and he is

more mature, in a way. Other than the passing of Carin, I believe the other two main characters

in this group got everything they wanted out of life, simply with the outcomes of friendship and

becoming Doctors. I can not tell if any of these characters are religious, but a “sign” that Patch

receives from seeing a butterfly could be suggestive that Carin is watching over him after she

passed away.
Nursing Diagnoses:

-Grieving: Truman and Patch are crushed with the passing of their friend and now much grieve

her loss.

-Rape-Trauma syndrome: Carin had a traumatizing event with rape. She then had to deal with the

stress that came with that event and had to deal with the personality changes that came with it. It

changed the way she trusted amongst other personality changes.

Healthy People 2020 Assessment (35%)

Mental Health

-The first goal that I believe applies to our main character, Patch, is the aspect of mental health.

Healthy people made this goal to improve mental health by preventing and giving easy access to

quality mental health services. Patch, with having gone through depression and attempted

suicide, he could have benefitted from counseling, or perhaps seeing a psychiatrist. We don’t

really know if he had tried these options but they are much less drastic than committing yourself

to a mental hospital for treatment. Now people have more access to mental health professionals

on campuses or even in outpatient clinics.

Substance Abuse

-Substance abuse can go hand in hand with mental health. This goal is supposed to help reduce

substance abuse among all ages, and improve the overall quality of life. We see Patch with 10

different medications in the beginning of the movie and it was not working for him. He used

these to attempt suicide and for a lot of people it doesn’t go unsuccessful as it did for Patch. It is

important to get substance abuse under control for mental health reasons as well as controlling

deaths from suicide.

Nutrition and Weight Status

-The goal is to promote healthy lives and reduce chronic diseases from unhealthy diets. While

none of our characters are really overweight in appearance, I believe this goal applies to the poor

nutrition we see them eating often. We see Truman and Patch really only eating at a greasy

University Diner. There are many problems that can arise with a high fat diet like fast/ fried

foods. The potential for diabetes, heart disease, heart attack, stroke, and high blood pressure

increases as one continues eating these unhealthy foods.

Occupational safety and Health

-This goal is for the Safety of people at work through prevention and education. With our

“family” becoming doctors, they will be put in the line of many communicable diseases. They

will work first hand with the most ill of patients and will need to know how to protect themselves

from being infected with these diseases. Along with diseases, they may be around a lot of X-ray

and heavy equipment that could cause health hazards as well.

Educational and Community-based programs

-Another goal that was basically achieved by our family was a community-based program or

hospital. This goal is supposed to increase the effectiveness and education of community based

programs. Patch starts up his “free clinic” in the woods and provides treatment for people outside

of the hospital. He made it affordable for anyone and patient-focussed. Which is what a lot of our

community-based programs do now such as Planned Parenthood. They helped the availability

and cost for the community.

-The top priorities for my family would be Mental health assessment, communication, and

education for substance abuse and depression. Along with the suicide attempt by Patch, we see

Carin struggling with intimacy issues because of a traumatic past event in her life. I believe she

could benefit from a mental health assessment as well as Patch. As they become doctors I believe
they need the information to educate patients who are suffering from depression and substance

abuse, as well as family communication problems as the family seemed to grow up with.

Nursing Care Plan (35%)

I believe chronic low self-esteem would be my top priority with this family. The issues that arise

in this movie primarily began with some sort of depression or low self esteem. Patch attempted

suicide, and Carin was abused as a young girl, and Truman and Patch have to overcome

depressing times as they mourn for the loss of Carin. The subjective data we can get is when

Patch is in the mental hospital telling the Doctor how he feels or the reasoning for his depression.

Our objective data is what we can observe, how he communicates with others and his vital signs

they take while in the hospital. If I were to see Patch pre-mental hospital I would give him a

short term goal of visiting a counselor at least once before discharge, and setting up at least 2

followups with a counseling center to see if behavioral therapy could help him. I would set a

long term goal of continuing the medication the Doctor prescribed for at least 8 weeks so we

could see if he would be reacting to the new medication. This was the medication would have

kicked in by then for depression and we could adjust his healthcare plan accordingly. The family

was actually brought together because Patch was able to channel his depression into helping

others. He coped by helping other people with their problems instead of focusing on his own.

And after he became depressed again he was able to refocus back on his patients after a little

“meditation” or conversation with what he believed was God. Patch was able to fix his nursing
diagnosis by his coping mechanisms and his drive to help people. Seems very little medical

intervention was actually needed to cure him!