Nursing Case Study Essay - Mental Health

This essay examines the biopsychosocial model in nursing through a case study of Amy, a 75-year-old woman diagnosed with depression, hypertension, and diabetes. It analyzes the biological, psychological, and social factors contributing to her condition and discusses evidence-based interventions like cognitive behavioral therapy and interpersonal psychotherapy. The essay also examines ethical implications for nurses in providing care to elderly patients.

NURSING-CASE STUDY ESSAY -
MENTAL HEALTH

Table of Contents
INTRODUCTION...........................................................................................................................1
MAIN BODY ..................................................................................................................................1
CONCLUSION ...............................................................................................................................5
REFERENCES................................................................................................................................7

INTRODUCTION
The bio-psychosocial model is that approach which consider all the factors related to
social, biological and psychological issues appearing in a human body. The bio-psychosocial
issues impact mental and physical well-being of people (Beronio, Skopec & Glied, (2014). The
clinical practice works with the help of various components which include trust, self-awareness,
use of evidence based practices, individual calibration, emotional aspects. Essay will outline
mental health condition of Amy, who is 75-year-old woman and has been diagnosed with various
diseases. The study will discuss about bio-psychosocial factors that are responsible for patient’s
condition and nursing care which is provided to service user in order to cure disorders.
MAIN BODY
Discussion of bio-psychosocial factors related to study
Bio-psychosocial factors are the reflection of creation of sickness which arise due to
complex interaction of biological element that include genetic, bio-chemical. Psychological
components consist of mood, behaviour, lifestyle, personality, belief and many more. Social
factors comprise cultural, family, religion and socio-economic (Markowitz & et.al. (2015). These
elements have severe impact on the mental and physical health of an individual. They can
hamper the growth of patient (MILLER & REYNOLDS (2014). These components can be better
understood by relating it to case study.
Biological factors
All these aspects have laid impact on the life of Amy who is been suffering from diseases like
hypertension and diabetes (Dagöö & et.al. (2014). Patient has also been diagnosed with acute
depression after the loss of her husband. Medical record has a shown that service user is living
alone, far away from her daughters which represent another cause of depression. Amy has no
physical and emotional support; she has been living in isolation from past many years.
Biological problems like hypertension and diabetes is faced by Amy due to unhealthy
dietary routine, advancing age and due to improper medications. Not managing all these
problems on time can lead to heart stroke or death (Miniati & et.al. (2014). Medical record of
Amy shows that she has lost weight (6 kg) in past two weeks and has lost her self-esteem.
Patient is also feeling tired, lost appetite and also feels herself as a burden on her
daughter. It was noted that service users have same character traits as her mother and she also
1

had a problem of depression. Further, it has been analysed that anxiety issues can be genetically
transferred into Amy. All these issues make a person weak and frustrated.
Psychological factors
Due to loneliness patient has also started feeling hopeless, restless and is least interested
in daily routine activities (Bishop & et.al., 2014). Service user has been diagnosed with fatigue,
exhaustiveness and insomnia. Amy feels worthless and is full of shame and guilt. There can be
various factors like biological, social and psychological factors like problems in personal life,
diseases faced by patient, stress factors which are responsible for clients present mental health
conditions (Bernecker & et.al., (2016).
Social factors
Bio-psychosocial approach can help in understanding the problems faced by patient.
Service user is suffering from depression because of social factors like Amy is living alone, no
one is there to support her (The bio-psychosocial approach, (2018). Also, there is no one with
whom Amy can share her thoughts beliefs. All these factors have a huge effect on users’ mind
due to which individual feels tired and sick.
The another cause of Depression is mental stress which individual faces in their personal
or professional life (Gu, & et.al., (2015). Case study shows that the kids visit patient only once
in a month, which can also be one of the major reason of patient feeling worthless, restless and
tired. This can also lead to individual being at a risk of developing various diseases. Patient is
also suffering from fatigue because she is sleep deprived. Further, lack of physical exercise, not
following healthy diet, ongoing grief, personal problems are the common issues which leads to
mental stress and disorder (Dietz & et.al. (2015). This sickness is a common sign for anxiety,
depression and mental illness. It can severely impact the human growth and can make a person
feel worthless and exhausted (Beronio, Skopec & Glied, (2014).
Depression in service user occurred due to loss of her husband. Death of loved ones or
any natural mishap in family increase the risk of mental disorder. This may also often lead to
change in person’s behaviour or alteration in working pattern. Also, it has been noticed that
patient is been living in a retirement village, far away from her daughters. The distance is another
reason which may affect relationship between Amy and her daughters which is another cause of
mental instability. This hampers the well-being and mental ability of an individual.
2

Nursing management or interventions for the case study
Elderly aged people suffering from disease like depression needs extra care and attention
from health-care professionals as well as their family member (Bishop & et.al. (2014). This
increases the burden of caregivers who are responsible to look after older adults suffering from
diseases (Clement & et.al., (2015). Research shows that majority of the senior people are
suffering from anxiety issues because of informal care-giving procedures (Corrigan, Druss &
Perlick (2014). Patients stated that they are not satisfied with the treatment individuals are
receiving. It has been analysed by health-care professionals that the service user requires a lot of
time from their family members which indirectly result into rise of societal economic cost. This
impacts their quality of living severely (Gu & et.al. (2015).
Various sicknesses that are common in elderly aged people are known to be linked with
depressive symptoms. Old adults are at high risk of developing a disability related to depression
when they live alone or feel isolated. (Holmes, Craske & Graybiel, (2014). Disease like
hypertension are directly associated with depression. This can be developed because of reduced
physical activities and due to improper diet. Stress may also be one of the major reasons for
anxiety (Olfson & et.al. (2014). It can be due to problems faced by service user in their personal
life. Amy was also diagnosed with diabetes, this sickness can occur in a human body because of
genetic disorder. For providing effective care to patient suffering from issues like anxiety,
fatigue or depression nurses need to properly understand the pathophysiology related to
particular diseases. (Slade & et.al., (2014). Health-care professionals also take help of bio-
psychosocial approach which can support them in better understanding of factors which are
responsible for the mental condition of service user (Smith (2014).
Conditions that have been occurred depression are associated with patient mental
instability. It is the situation where service users feels low, exhausted, sleep deprived, restless
and hopeless. All these signs and symptoms were common in condition of Amy. It can be
because of advancing age or because of living alone. Multiple losses, physical-mental decline,
family history of depression are the various risk factors that increases patient's chance of
developing a depressive disorder (Slade & et.al., (2014). Symptoms of instable mental health
includes mood swings, loss of interest in activities, loss of weight, insomnia, fatigue, feeling of
worthlessness, suicidal tendencies or ongoing grief.
Evidence-Based practice
3

In order to cure Amy nurses can make use of evidence based practice that can helps in
improving the health outcome of service user. They can also involve multi-disciplinary team
which consists of dietician, psychiatric, psychologist which provides support to patient in every
possible situation (Thornicroft & et.al., (2016). Nurses will plan meal and can also encourage
Amy to involve in physical activities like exercise, yoga or aerobics (Lemmens & et.al. (2015).
Cognitive behavioural therapy
Health-care professionals can provide service user with cognitive behavioural therapy.
This theory has been developed in order to improve mental health conditions of patient. It helps
service users to fight against depression and overcome it. This process support and motivate
patient in sharing their thoughts, beliefs to nurses, which also helps health-care professionals in
better understanding the user (Markowitz & et.al. (2015). It helps patients in overcoming their
negative thoughts and allow user to believe that their problem can be cured and has a significant
solution. The therapist will assist Amy in changing her thinking pattern and will provide ways to
alter thoughts and behaviour (MILLER & REYNOLDS (2014).
Interpersonal psychotherapy
Interpersonal psychotherapy can also be provided by nurses to Amy in order to cure
depression. Therapist uses various methods to impart relief to patients (Dagöö & et.al. (2014).
They use techniques like role playing which helps service user in adjusting to the world. Apart
from depression, this model is also used in curing diseases like anxiety, chronic fatigue, eating
disorder, social phobia post-partum sadness. It also helps in building motivation of individual
and supports them in re-developing self-confidence. This process also enhances service user to
share their views or thoughts with therapist (Miniati & et.al., (2014).
Antidepressant medicines
In order to control mental health disorders of Amy that is hypertension, diabetes,
depression health-care professionals can encourage her to participate in art and craft group
activities (Bernecker & et.al. (2016). Health-care professionals can also make use of
pharmacology In this they can provide antidepressant medications to old age people (Olfson,
Kroenke, Wang & Blanco, (2014). Consumption of these medicines can support them in
overcoming feeling of guilt, tiredness and hopelessness. Health-care professionals can also
encourage them to have healthy diet and take their drugs on time. Depression can also be cured
by advising family members of patient to spend more time with them. Nurses can help Amy by
4

providing her emotional support and making her believe that she is not alone in the world. They
can enhance patients to share their thoughts and beliefs with them. All these can help in building
a positive relationship between health-care professionals and users. It will help in improving
well-being of patient (Dietz & et.al. (2015).
Ethical implications
Health-care professionals and care providers are responsible to follow ethical practices
when providing care to old age people (Bishop & et.al., (2014). Ethical considerations which
health-care providers should follow are that they should not be involved in any judgemental
practices. Patient must not be discriminated on basis of age colour or sex (Bishop & et.al. (2014).
Health-care professionals must follow autonomy which means that all the decisions related to
patient should be made by user himself. Also, while treating old aged adults nurses should avoid
obscurity of expression, ambiguity and unnecessary verbosity (Clement & et.al., (2015). Ethical
implications of nursing practice are considered in association with three issues competence,
honesty and obedience. All these factors can help nurses in building a relationship of trust with
users. Also, nurses must have a knowledge about patients needs, and care should be provided in
accordance with that (Gu & et.al., (2015). Health-care professionals should never talk
controversial things before old aged persons.They must not be engaged in asking any personal
questions to Amy which can hurt her sentiments.
Ethical considerations by nurses also include justice. All the service users must be treated
by them equally and fairly (Olfson & et.al., (2014). For example care providers who are
responsible for treating Amy must not judge her on the basis of age or disease (Clement & et.al.,
(2015). Health-care professionals must be involved in taking positive actions to support old aged
people and follow practices which provides benefits to others. They must also take suggestions
from entire person while making decision relating to treatment and diagnosis of patients in order
to adhere with the principle of totality and equality (Slade & et.al., (2014). Nurses should follow
competent practices and must report suspected abuse to senior management. They should also
actively listen and monitor the vital sign of change or behaviour in the patient (Thornicroft &
et.al. (2016). Often it has been noticed that nurses are involved in discriminating older aged
people as they are exposed or vulnerable to the possibility of being attacked. Health-care
professional should maintain the confidentiality of the information related to patients. They must
maintain the privacy and legacy. Also, it will support them in building the relationship of trust.
5

CONCLUSION
This is to summarise that the essay is based on case study where Amy is suffering from
various diseases like depression, hypertension and diabetes. Bio-psychosocial approach has been
used by health-care professionals in order to understand the factors responsible for patient’s
conditions. Various therapies like cognitive behavioural, interpersonal psychotherapy are being
used in essay. These procedures can help Amy to overcome depression and fight against
disorders. Further it includes ethical implications which needs to be followed by nurses in order
enhance morale practices in nursing staff. It shows that health-care providers must treat each
patient equally and fairly. They must not be discriminated on basis of colour, gender or age.
Also, nurses must be honest and obedient while treating old aged people.
6

REFERENCES
Books and Journals
Bernecker, S. L. & et.al., (2016). Attachment style as a moderating influence on the efficacy of
cognitive-behavioral and interpersonal psychotherapy for depression: A failure to
replicate. Psychotherapy.53(1).22.
Beronio, K., Po, R., Skopec, L. & Glied, S. (2014). Affordable Care Act will expand mental
health and substance use disorder benefits and parity protections for 62 million
Americans. Mental Health.2.
Bishop, T. F. & et.al., (2014). Acceptance of insurance by psychiatrists and the implications for
access to mental health care. JAMA psychiatry.71(2). 176-181.
Clement, S. & et.al., (2015). What is the impact of mental health-related stigma on help-seeking?
A systematic review of quantitative and qualitative studies. Psychological
medicine.45(1).11-27.
Corrigan, P. W., Druss, B. G., & Perlick, D. A. (2014). The impact of mental illness stigma on
seeking and participating in mental health care. Psychological Science in the Public
Interest. 15(2). 37-70.
Dagöö, J. & et.al., (2014). Cognitive behavior therapy versus interpersonal psychotherapy for
social anxiety disorder delivered via smartphone and computer: A randomized
controlled trial. Journal of anxiety disorders.28(4). 410-417.
Dietz, L. J. & et.al.,(2015). Family-based interpersonal psychotherapy for depressed
preadolescents: Examining efficacy and potential treatment mechanisms. Journal of the
American Academy of Child & Adolescent Psychiatry.54(3). 191-199.
Gu, J. & et.al., (2015). How do mindfulness-based cognitive therapy and mindfulness-based
stress reduction improve mental health and wellbeing? A systematic review and meta-
analysis of mediation studies. Clinical psychology review.37.1-12.
Holmes, E. A., Craske, M. G., & Graybiel, A. M. (2014). A call for mental-health
science. Nature.511(7509).287.
Lemmens, L. H. J. M. & et.al., (2015). Clinical effectiveness of cognitive therapy v.
interpersonal psychotherapy for depression: results of a randomized controlled
trial. Psychological Medicine.45(10).2095-2110.
7

Markowitz, J. C. & et.al., (2015). Is exposure necessary? A randomized clinical trial of
interpersonal psychotherapy for PTSD. American Journal of Psychiatry.172(5).430-
440.
MILLER, M. D. & REYNOLDS III, C. F. (2014). Interpersonal psychotherapy.
In Psychological therapies with older people(pp. 121-145).
Miniati, M. & et.al., (2014). Interpersonal psychotherapy for postpartum depression: a
systematic review. Archives of women's mental health.17(4).257-268.
Olfson, M. & et.al., (2014). Trends in office-based mental health care provided by psychiatrists
and primary care physicians. The Journal of clinical psychiatry.
Slade, M. & et.al., (2014). Uses and abuses of recovery: implementing recovery‐oriented
practices in mental health systems. World Psychiatry.13(1). 12-20.
Smith, K. (2014). Mental health: a world of depression. Nature News.515(7526), 180.
Thornicroft, G. & et.al., (2016). Evidence for effective interventions to reduce mental-health-
related stigma and discrimination. The Lancet.387(10023).1123-1132.
Online
The bio-psychosocial approach. (2018). [Online] available through:
<https://www.urmc.rochester.edu/medialibraries/urmcmedia/education/md/documents/
biopsychosocial-model-approach.pdf>
8