Although earlier, the mental health issues were not being given sufficient importance, in recent time, the medical health reports claim that an individual is as susceptible to get affected by mental illness, as by the usual physical illness, and in both the cases, if the illness is being neglected, the patient can encounter fatal consequences. While usually people seek medical attention only once they are being diagnosed with bipolar disorder and schizophrenia, depression, anxiety problem or paranoia are equally harmful to the patient’s mental well-being that need medical attention and proper treatment. In Australia, the mental health problem has emerged to be a crucial problem with approximately 1 out of every 5 Australians suffering from some sort of mental illness (Lee et al., 2016). Each year, it should be noted, that approximately 4 % of the Australians suffer from a major depression disorder, while 14% of the Australians suffer from major anxiety disorder (Loo, 2015). However, a large number of patients suffering from mental illness refrain from seeking treatment, simply because they are being stigmatized against gong to a hospital for a mental check-up, that invariable implies lunacy to them. In the present case study, it is observed that Angelina has been suffering from severe depression disorder, and yet she did not seek medical assistance, partially because of her stigmatized attitude towards mental disorder. However, as her parents rush her to the Mental Health Nursing centre of Australia it would be important to understand as to which therapeutic modalities would be offered to her, and what therapeutic engagement skills would be used by MHN for the restoration of Angelina’s mental health.
Angelina exhibited the most usual symptoms of depressions, such as the feeling of worthlessness, loss of interest, appetite and sleeping, suicidal thoughts as well as lack of meaning or purpose in life. However, what might have refrained her from seeking medical attention was her stigmatized attitude towards mental illness, which is still being equated with lunacy. She might have daunted by the thought of being referred to as “mad” by her friends, or might have also apprehended receiving similar response from her physician as well. In fact, a report by the Mental Health Council, Australia claims that 29% of the mental healthcare consumers claim that the healthcare experts they sought treatment from, exhibited an unnaturally and unacceptably stigmatized behaviour towards them, which in turn impeded their effective recovery, as their self-esteem were being hurt (Ziaian et al., 2012). However, once Angelina’s parents were able to identify the signs of her mental dysfunction, they rushed her to get admitted in a mental health centre (Dipnall et al., 2016).
Once admitted, the duty of a mental health nurse towards the patient can be considerably different from one who treats and helps in curing the physical illnesses. The early experiences of a consumer encountering his health expert leaves an indelible impression in his mind and the extent to which the nurse has a positive impact on the patient’s health largely depends on how active therapeutic engagement skills the expert possesses. It has been noted that much before she is being admitted, owing to depression disorder, Angelina has been suffering from a sense of social exclusion (Jackson et al., 2014). Hence, the MHN will first of all, need to ensure that unfair treatment or disrespectful and stigmatized behaviour is not being shown towards the patient that can hurt her dignity and sense of worth (Ibrahim et al., 2013).
In case of the therapeutic engagement process, first a rapport has to be formed with the client so that she can confide in her, followed by a process of setting out strategies to guide the self-healthcare practice. First of all, she will need to possess sound communication skills, backed by a friendly demeanour so that the patient like Angelina can come out of her shell and open up. The skill to empathize would also be required as there is no gain listening to the problem of Angelina unless the nurse can provide her moral support. It would also be important to posses the therapeutic skill to listen, as it would help the patient get the opportunity to express her pent up emotions, and yet feel understood and listened. A patient suffering from depression, usually feels ignored, and strives to seek attention, and thus he should be properly attended to, listened and understood. Even if the healthcare expert feels she is stating wrong facts, the nurse should not correct her during the initial hours of her treatment, as it can impede the communication flow, and hurt the dignity of the patient, discouraging her to open up further. Angelina’ circumstance, considering her age, sex or background, may be completely different from that of the nurse, yet she should mete out a warm and empathetic treatment to her, while also observing and taking note of her circumstances that might be considered to have contributed to her depression(Rickwood et al., 2014).
Considering the situation of Angelina, it has been observed that she does not suffer from major depression disorder, as the very common and usual symptoms such as insomnia, apathy towards activities and social isolation are found in her case. Hence, as she is being diagnosed with moderate depression disorder, the initial treatment modalities that would be offered to her would include pharmacotherapy as well as psychotherapy.
Since Angelina has not yet committed nay violent act, or has not exhibited acts of self-harm, her depression can and should be cured especially with the help of Psychotherapy. In case of Psychotherapy, Angelina will be encouraged to talk out about the problems that have been distressing her the most in the last few days (Colquhoun et al., 2013). However, during the counselling session, the patient will not be suddenly asked about the factors that are bothering her, but it would require, a systematically organized method of approaching the client hat would be followed by the gradual divulgence of the significant facts and issues of the client’s life. The recent death of a beloved relative, lack of career focus, a recent heart-break, major illness or any such major incident in the recent past of the client should be understood that might have affected the mental well-being of the patient, and altered the perception of her life. Psychotherapy treatment modality will help the patient cure not by seeking consolation, but by altering how she perceives the world or herself (Ditchter et al., 2015). The nurse will not only help her understand how frequently common depression is in her country or the world as well, and how she can look at the problem in a positive way, but will also teacher the coping strategies for the same (Mott et al., 2014).
Besides, the nursing interventions must be directly related to the psychodynamic strategies that can help the patient cope up with the problem of Depression. The nurse-led intervention process will consist of helping the patient learn the basic coping strategies. Angelina will be made aware of the symptoms of depression, and how to understand depression. She will be asked about her former depression experiences, and accordingly she will be informed about some of the common positive cognitive strategies she can practice at home. She will be encouraged to overcome depression as well as be made aware of the instructions of coping with depression, through face-to-face lectures. She will be made aware of the common medicines, such as mild anti-depressants that can solve her anxiety trouble or insomnia problem as well. The nurse will also need to share the useful tips about some of the common relaxation exercises that can relieve her mind of the stress and anxiety. Angelina will be informed about the depression related problems, such as dizzy head, apathy in doing work, a thought of detaching oneself from the world, suicidal tendencies and so on. With the help of the booklets, the nurse will require to make her aware of the the problem-solving strategies that can help her successfully deal with the problem. She will be made aware of the commonest breathing exercises, medication tricks and other distraction strategies that can help her overcome depression without resorting to medicines. The teaching is provided through standardized, non-individualized formats for each participant. The educational program based intervention would also be highly useful in helping Angelina get completely cured. The educational intervention would consist of six weeks, whereby one session would be taken in every 3 days (Fortinash & Worret, 2014). The nurse will also offer pamphlets to discuss about the common symptoms of depression, analyze the common symptoms associated with the disease, so that she can cope with it in a better way. Through the assimilation of information, the patient will be able to comprehend that she is not the only one to suffer from depression. The “Feeling Good” handbook will be handed over to her so that she can learn to appreciate life as it is, and understand the need to relax her mind.
It is important to diagnose the problem by talking to the family members and her roommates as well. This is why the Psychodynamic treatment modality should also be used for Angelina. In order to comprehend and analyze the unresolved and unconscious conflicts of Angelina, the Interpersonal Therapy for Depression will be used. Accordingly, the nurse will interact with the family members as well as the close friends including the roommates of Angelina to identify the presence and assess the significance of any life-changing event, such as relationship conflicts or social isolation or role transition that might have affected her emotional well-being.
However, it should be noted that merely educating the patient about the symptoms and coping strategies of depression may not resolve the problem of Angelina. Loss of sleep and appetite are the common symptoms of depression that cannot be eliminated without the help of proper medication, and yet the patient would fail to feel ‘normal’ unless she feels physically healthy and energetic. Usually, people suffering from depression, also suffer from anxiety disorders, and hence Angelina will be informed about the mild and commonly used anti-depressants that cool down the nerves, improves appetite and relaxes the mind (Stanners et al. ,2012). The antidepressant medication is usually suggested for patients who are unable to control their moods or change their feelings even after having attended a couple of counselling sessions. In case of Angelina, since she was being admitted, she should be made aware of the mild anti-depressant tablets that are usually prescribed for maximum 15 days, and not more than that, as these often cause undesirable hormonal imbalance (Fortinash & Worret, 2014). Since it is evident from Angelina’s case that she might be suffering from the problems of psychosocial stressors, interpersonal difficulties or intra-psychic conflict, she needs to be made aware of the meditations lasting for a couple of weeks along with which she will be referred to a professional psychologist.
Besides, in order to assess and examine the mental health status of the patient, the Mental Status Examination of Angelina will have to be arranged by the MHN professionals. It is very important to understand the extent to which she is suffering from depression, before prescribing any tip with her. With the help of this test, the usual behaviour and attitude of the patent, along with her speech, mood and motor skills can be examined to comprehend and analyze his mental state. The unkempt appearance or a careless attitude of Angelina must explain the extent to which she is depressed. Again, motor activities including her sense of withdrawal and apathy may be suggestive of her depression disorder and anxiety problems. Angelina will be asked any question and her though process will be measured. In case, Angelina is found to exhibit rapid thinking, also referred to as the flight of ideas, or disorganized though pattern, she will be sent for immediate counselling. Besides, the attention power or the concentration skills of the patient will also be checked by asking her t spell a word, such as “world” both forward and backward. Again, questions such as when was the last time did Angelina want to commit suicide, or had she witnessed a sudden loss of interest in her passion, can be beneficial in analyzing the cause of her depression, and offering necessary treatment for the same (Berk et al., 2013).
A risk assessment tools will also be used, considering the fact that Angeline has exhibited frequent symptoms of committing suicide, and hence to prevent any possibility of self-harm or violence in future, the risk assessment questionnaire will be given to Angelina asking her to fill up the same. A risk assessment questionnaire sample is being provided below to illustrate how the risk assessment is likely to be performed by the MHN professionals:
Questions to Assess Risks
Response Recorded (Yes/No)
Did you ever think of killing yourself in the last month?
Have any of your family members committed suicide?
Were you ever diagnosed with Anorexia Nervosa or Myocardial Infarction?
Did you recently get yourself in serious trouble with the law?
Did you exhibit any recent violent activity towards friends, animals or anyone you hate?
Did anyone close to you committed suicide in recent times?
In response to the answers recorded, the treatment to be chosen for Angelina would be communicated to her. She would be informed about her present mental health status. In case the risk is too high, the patient will be immediately sent for antidepressant medication, while in case of low risks, the patient can be discharged after a couple of days.
Although a very common mental disorder, depression required medical attention if it spans for more than a week. It not only can prove to be fatal, but can affect the productivity of an individual on a daily basis. Low energy, loss of sleep and appetite and lack of self-worth can not only impede the person from performing his daily activities, but it can also lead him to the path of self-destruction. Life itself becomes burdensome for a person who is depressed, and hence proper, effective and systematically organized healthcare service must be offered to patients like Angelina so as to ensure their speedy recovery.
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