Symptom Cluster: A CASE STUDY

This presentation is made to develop an understanding of symptom clusters and the advanced nursing response in mental health care, as well as an appropriate model of care. Case study of Ms. Megan is selected. The presentation will have three sections, case introduction, case analysis and case critique.

Symptom Cluster
A CASE STUDY

Introduction
This presentation is made to develop and
understanding of symptom clusters and the advanced
nursing response in mental health care, as well as an
appropriate model of care. Case study of Ms. Megan is
selected. The presentation will have three sections,
case introduction, case analysis and case critique.

Case Study Introduction

Clinical presentation
 Ms. Megan, a 36 year lady married with a kid.
 Active and social
 One year back, lost his son in motor accident
 After death of his son, her physical and mental health deteriorated
 Left her job
 Neglected herself, house and husband responsibilities
 Unable to sleep
 Admitted of having suicidal thoughts
 GP diagnosed her of depression and referred to the psychiatrist
 One day she left house without informing anybody and came back late at night with multiple injuries
 Refused to come to hospital
 Denied treatment
 Has a history of diabetes mellitus

Symptom Cluster
Symptom cluster consists of multiple symptoms which are inter-
related and occur together. Symptom clusters are made of stable
groups of symptoms and can identify particular underlying aspects
of symptoms(Dong, Butow, Costa, Lovell, & Agar, 2014).
Symptom cluster in case of Ms. Megan include:
 Neglected herself, house and husband responsibilities
 Unable to sleep
 Admitted of having suicidal thoughts

WA Chronic Health Conditions
Framework 2011–2016
A theoretical framework is identified which can be used in delivering care to Ms. Megan’s case.
WA Chronic Health Conditions Framework 2011–2016 will help in delivering the right care at the
right time by the right team in the right place to Ms. Megan
Framework works on these principles:
 Collaboration and care coordination
 Interdisciplinary planning of care and case management
 Evidence-based and person-centered care
 Health awareness and self-management for chronic health disorders
Framework explains:
 Identification of priority areas
 Service provision elements within the range of care
 Recommendations for addressing care provision to Ms. Megan
 System enabler factors to gain care provision improvements.

Case study analysis and
Synthesis

Etiology of the symptom cluster
It is found that etiological models for depression are mainly diathesis-stress
models. As per these models, stressful experiences prompt depressive
syndromes in people who are vulnerable because of biological and
psychosocial traits and situations.
 Environmental stressors related to depression are acute life events,
chronic stress, and childhood exposure to adversity. In case of Ms. Megan,
the environmental stressor was the acute life event of death of her son.
 Personal susceptibilities related to depression are cognitive,
interpersonal, and personality elements.
Biological, environmental, and personal elements interrelate to contribute in
developing depression.

Diagnostic tools
There are certain diagnostic tools that can be used to assess Ms. Megan’s
symptoms of depression
 The Center for Epidemiologic Studies Depression Scale Revised (CES-DR)
This diagnostic tool is used often as it is self-report quantification of depressive
symptoms (Carleton, et al., 2013).
 25-Item Hopkins Symptoms Checklist (HSCL-25)
It is a self-rating scale derived from the SCL-90 which is a multidimensional
psychological test instrument for the assessment of psychological symptoms and
distress [18–20]. It has robust efficiency and reliability scores. HSCL 25 has been
widely used for evaluation among traumatised populations and used many times in
primary care(P. Nabbe, et al., 2018).

Diagnostic tools
 The Hospital Anxiety Depression Scale (HADS)
The Hospital Anxiety and Depression Scale (HADS) is a frequently used
self-rating scale developed to assess psychological distress in non-
psychiatric patients. It consists of two subscales, Anxiety and Depression
(Djukanovic, Carlsson, & Årestedt, 2017).
 The Physical Symptom Checklist in 51 Items (PSC-51)
(Warren, 2017)

Key preventive and management
strategies
Various preventive and management strategies can be adopted in
Ms. Megan’s case
 Psychotherapy sessions
 Antidepressant medications
 Enhancing her social participation in community
 Regular exercise
 Regular follow-up by the mental health specialist
 Evaluation of care plan

Overall goals of care for Ms. Megan
 Overall goal of care for Ms. Megan is effective
collaboration between mental health specialist, nurse
and Ms. Megan and her family so that advancement
of her depression can be stopped and she can be
recovered to normal daily life.

Case study Critique

Possible barriers and facilitators in
implementing WA Chronic Health
Conditions Framework 2011–2016
Barriers
 Poor communication between the professionals responsible for
delivering care to Ms. Megan
 Lack of knowledge of evidence-based practice among the
professionals
 Self-management by Ms. Megan
Facilitators
 Person-centered care focusing on Ms. Megan's needs and
preferences
 Interdisciplinary planning of care
 Prioritization of action areas.

My unique contribution in achieving
optimum outcomes for Ms. Megan
 I understood and fulfilled my roles and responsibilities as Registered
Nurse while delivering care to Ms. Megan
 I ensured that I develop a relationship with Ms. Megan so that she can
trust me and open up with me.
 I emphasized on each symptoms of the symptom cluster while care
planning.
 I communicated regarding the needs, preferences and progress of Ms.
Megan regularly
 I made efforts to educate Ms. Megan and her husband regarding
depression, its symptom cluster and self-management strategies.

Conclusion
The presentation provided an understanding of
symptom cluster in Ms. Megan’s case who was
diagnosed with depression. Etiology of the symptom
helped in understanding the underlying cause. The
model of care will provide her a comprehensive care
including the aspects of evidence-based practice, team
work, prioritization and enabling system.

References
 Carleton, R. N., Abrams, M. P., Robinson, T., Asmundson, G. J., Teale, M. J., Welch, P. G., &
Thibodeau, M. A. (2013). The Center for Epidemiologic Studies Depression Scale: A Review with
a Theoretical and Empirical Examination of Item Content and Factor Structure. PLoS One, 8(3).
 Djukanovic, I., Carlsson, J., & Årestedt, K. (2017). Is the Hospital Anxiety and Depression Scale
(HADS) a valid measure in a general population 65–80 years old? A psychometric evaluation
study. Health Qual Life Outcomes, 15.
 Dong, S. T., Butow, P. N., Costa, D. S., Lovell, M. R., & Agar, M. (2014). Symptom Clusters in
Patients With Advanced Cancer: A Systematic Review of Observational Studies. Journal of Pain
and Symptom Management, 48(3), 411-450.
 P. Nabbe, c. a., Guillou-Landreat, M., Beck-Robert, E., Assenova, R., Lazic, D., Czachowski, S., &
Stojanović-Špehar, S. (2018). One consensual depression diagnosis tool to serve many
countries: a challenge! A RAND/UCLA methodology. BMC Res Notes, 11(4).
 Warren, A. (2017, July 31). The 7 Most Effective Tools for Diagnosing Depression. Retrieved
from https://www.mdmag.com/medical-news/the-7-most-effective-tools-for-diagnosing-
depression