Assignment on Chronic Illness And Disability

Running head:CHRONIC ILLNESS AND DISABILITY
Chronic Depression Care Goals
Name of the Student
Name of the University
Author Note

1CHRONIC ILLNESS AND DISABILITY
Introduction
Chronic illnesses refer to conditions that need treatment for a prolonged period of
time such as over months. The duty of a nurse is to provide a care plan and desired goal for
the nurse via the clinical reasoning cycle. This essay is focused on the case study of an
older-aged woman who is suffering from severe depression and the aim is to come up with
specific care priorities and goals for her.
Background
The patient is a 66-year-old woman named Mrs Hemlock who is suffering from
severe depression. The background information able her life and illness was collected via a
telephonic interview over the course of half an hour. The patient reported of a feeling of
‘emptiness’ and ‘hopelessness’ in her day-to-day lives. She conveyed that she felt fatigued
while doing the simplest of jobs like washing her hair or brushing her teeth, and that simple
day-to-day tasks feel pointless to her. She reported of feeling ‘consistently lost’ since she
lost her father five years ago, but that her symptoms were not very severe and she
dismissed them as ‘normal sadness’. She has been separated from her husband for over a
decade and never had children by choice. She retired from her job as a teacher a couple of
years ago and has been living alone ever since. She has always been a smoker, and
reported of smoking half pack cigarette each day. She has no severe medical history to
speak of and no known allergies. She reported of sometimes having suicidal thoughts, but
they were never very serious and she has no plans of going through with it. She sometimes
suffers from insomnia, but not very often. She also mentioned that she has been ‘feeling
older’ as she has been losing her balance recently, and tripped out of nowhere twice the day
before. She has been prescribed Viibryd for her depression, however she sometimes forgets
to take it. She also claimed to have tried meditation, but getting ‘bored’ of it.
All these information was gathered from the patient and according to the clinical
reasoning cycle, it is critical that more information is collected about her family background
and physical history.
Following the clinical reasoning cycle, the information collected was analysed
(Utas.edu.au., 2020). It has been said that the patients has retired from her job couple of
years ago and has been living alone since. She is an elderly lady who is currently pretty
isolated and has no family to speak of. It is possible that these factors has aided in the
progression of her depression (Franck, Molyneux & Parkinson, 2016). Her insomnia may
also be an indicator of her depression. It has been seen that ageing adults often feel socially
isolated which makes them depressed and induces sleep disturbances (Cho et al., 2019).
This insomnia is a common occurrence in depression of elderly (Cheng, Malhotra, Chan,

2CHRONIC ILLNESS AND DISABILITY
Østbye & Lo, 2018). And It has also been seen that presence of depression in older adults
affects the severity of how much they experience fatigue (Kaplan, Leavitt & Miller, 2019). It is
also possible that her non-adherence to the medication is affecting the severity of the
depression and it is causing the symptoms to become more prominent (Holvast et al., 2019).
It is also possible that her smoking has adversely affected her depressive symptoms as it
has been observed that smokers are more likely to suffer from depression rather than non-
smokers (Smokefree.gov., 2020).
Discussion
The patients is suffering from severe depression, which is clearly affecting her day-
to-day lives. According to the information, she has reported of feeling fatigued by normal
things like washing her hair and brushing her hair (Crowe, Daly, Delaney, Carroll & Malone,
2019). This is seriously affecting her quality of living. She does not feel motivated to do
anything, and sometimes likely feels despair as it is very common in this stage of life,
especially compared with depression (Dezutter, Toussaint & Dewitte, 2019). She has no
family to speak of, and it is very possible that she has isolated herself from any friends or co-
workers she might have been close to. This stage of isolation has a profound effect on the
psyche of a person. She is also suffering from suicidal thoughts; which according to her, she
has no plans of actually carrying out. Even though she claims no actual intention of this, it is
still a reason for concern. She loses interest easily, as understood from her point of being
bored with meditation. She often ‘forgets’ her medications, which may also indicate towards
more serious underlying problems.
Following the R-L-T model of nursing care, it is known that the patient’s conditions
and symptoms must be analysed properly and the priorities and goals of the nursing
interventions must be planned accordingly (Williams, 2015). Here, the information was
collected via the interview and the assessment was made by connecting the symptoms and
her background. This was done by applying the clinical reasoning cycle which enabled the
healthcare professional to pin point the problems of the patient.
Care Priority and Goal Setting
Following the Roper Logan Tierney model, the patient priorities was set for the
nursing interventions meant for the patient. It is important that the interventions planned for
the patient tackles the problems and fulfil the goals. The care priorities must be planned
according to the patient’s immediate needs. They must be as follows-
Monitoring: The most critical point of the patient’s background is that she is having
suicidal thoughts. So it is the healthcare professional’s immediate priority to make sure she
does not harm herself in a moment of sudden hopelessness. For this, the patient should be

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kept under constant surveillance. However, since the patient does not have any immediate
family she can rely on, the primary priority should be to make alternative arrangements. This
may include admitting her in a nursing home to monitor her or convince her to keep a nurse.
Either way, the priority is to monitor her activities and ensure her safety (Kim, Liu, Tan &
Chu, 2017). The monitoring aspect must also include making sure that her medications are
taken regularly to reduce the side effects irregular antidepressants may cause.
Motivation and Support: The second priority of care is to make sure that the patient
has a reason and aim to her. Majority of elderly patients face depression and hopelessness
because they feel like they are no longer needed. This is a serious problem and the priority
is to make her feel important. This will also include educating the patient in regarding what
she should or should not do to help her condition such as encouragement to reduce her
smoking habit.
The interventions may include many aspects. However, they should be planned in
such a way that it fulfils the goals of the care plan. The aim of NSQHS Partnering with
Consumers Standard is to create healthcare organisations and result beneficial effects for
the patients as well as the healthcare professionals (Safetyandquality.gov.au., 2020). The
goals must be discussed with the patient in order to ensure that the patient and the
healthcare professional is on the same page. The healthcare professional must come up
with a care plan that is personalized for Mrs Hemlock and she has given her informed
consent to co-operate. This discussion must be done in a open and comforting way so that
the patient does not feel judged and is ready to collaborate effectively with the nursing
professional. The communication between the nurse and the patient must be clear, and the
nurse must be sensitive to the fact that her words may have psychological effects on the
patient. It is essential that she agrees to all the goals and works towards achieving them.
This is a partnership that must communicate on a personal level, i.e. the nurse and the
patient. Then, Mrs Hemlock must trust their work (service level). Finally, Mrs Hemlock must
trust the healthcare organisation to take care of her fully. Only then, she can trust them
enough to let them help her.
With the help of NSQHS Partnering with Consumers Standard, the goals that have
been developed with the interviewee are as follows-
For short term goals, it must be made sure that the patient is not having suicidal
thoughts or self-harm thoughts anymore. It is critical that she does not harm herself in any
way.
As for long term goals, the patient’s depression should be brought under control so
that she can function as a healthy member of the society and not isolate herself. This entails

4CHRONIC ILLNESS AND DISABILITY
a holistic approach towards healthy life and thus it is also desired that she reduces her
smoking habit or any other such vices (Fluharty, Taylor, Grabski & Munafò, 2016). This will
enable her to have a better quality of life.
Conclusion
From this essay we can conclude that the patient is suffering from chronic depression
and specific priorities and goals were set to combat them in order to enable her to lead a
better quality of life. This was done with the help of R-L-T model, following the Clinical
Reasoning Cycle. The priority is to monitor and motivate her. The goals include short term
goals of getting rid of her suicidal thoughts. The long term goal consists of combating her
depression in order to give her a better quality of life.

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Reference
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Cheng, G. H. L., Malhotra, R., Chan, A., Østbye, T., & Lo, J. C. (2018). Weak social
networks and restless sleep interrelate through depressed mood among
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Cho, J. H. J., Olmstead, R., Choi, H., Carrillo, C., Seeman, T. E., & Irwin, M. R. (2019).
Associations of objective versus subjective social isolation with sleep disturbance,
depression, and fatigue in community-dwelling older adults. Aging & mental
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Crowe, E., Daly, M., Delaney, L., Carroll, S., & Malone, K. M. (2019). The intra-day dynamics
of affect, self-esteem, tiredness, and suicidality in Major Depression. Psychiatry
research, 279, 98-108. Doi: https://doi.org/10.1016/j.psychres.2018.02.032
Dezutter, J., Toussaint, L., & Dewitte, L. (2019). Finding a Balance Between Integrity and
Despair: A Challenging Task for Older Adults in Residential Care. Journal of Adult
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Kaplan, N., Leavitt, M., & Miller, J. (2019). A-63 The Fatigue Severity Scale and Depression
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Appendix
The patient’s consent form has been included.
CONSENT FORM
 I have understood the purpose of this interview and have agreed to participate with
my full. Yes - No -
 I fully understand that my participation is completely voluntary and that I am free to
withdraw and this interview at any time without giving a reason. Yes - No -
 I understand that I will not be identified by name and the information from the
interview will be used for study purpose only. Yes - No -
 I agree that information obtained from me in this interview will be used for the
assignment and I am comfortable with it. Yes - No -
 I hereby consent to this interview process.
Name- ………….. Signature- …………….. Date- ……………