NRSG370 – Clinical Integration - Speciality Practice Case Study 2022

Unit Title: NRSG370 – Clinical Integration - Speciality Practice
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Introduction
A major depressive disorder is a mental health complication that potentially impacts
the health-related quality of life (including eating, working, and socialising behaviours of the
affected individuals (Gohil & Shah, 2015). The presented mental health case study is based
on the reported suicidal ideation and severe depression of a 28 years old male patient (Mr.
Jim Gray) who exhibits clinical manifestations including loss of appetite, bed
confinement/social isolation, and self-harm tendency. Mr. Jim pertains to an impoverished
rural family affected with the financial burden in the context of longstanding drought across
their farmland. The case study assessment, accordingly, discusses Mr. Jim’s health issues,
prioritised problems, nursing goals, and interventions in the context of Levett-Jones clinical
reasoning cycle (Gummesson, 2018). The case study assessment also provides an evidence-
based reflection of Mr. Jim’s clinical condition while recommending realistic, meaningful,
ethical, legitimate, holistic, and person-centred measures for improving his psychosocial
outcomes.
Patient Situation
Mr. Jim’s presently reported situation is based on his major depressive disorder
(MDD), failed suicide attempt, self-harm desire/suicidal ideation, loss of appetite, non-
participation in activities (i.e. social isolation), bed confinement, communication deficit, and
impoverished rural status. Mr. Jim is also affected with inappropriate health-related
behaviour and reduced health-related quality of life.
Cues’ Collection
Mr. Jim’s MDD manifestations are based on vegetative symptoms, cognitive function
deterioration, diminished interests, and depressed mood. Mr. Jim’s MDD complications
reveal his deteriorated affective salience network, cognitive control system, overstressed
brain circuits, hippocampus dysfunction, and disfigured regional brain volumes (Otte et al.,
2016). Mr. Jim’s MDD manifestations also elevate his risk of immune system disruption,
hypothalamic-pituitary-adrenal axis deterioration, and neurobiological stress-response system
disturbance. These complications substantiate the requirement of administering a blend of
pharmacological, psychotherapeutic, and nursing interventions in the context of improving
Mr. Jim’s mental health outcomes and recovery phase. The nurse in the presented context

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will require undertaking Mr. Jim’s MSE (Mental Status Exam) for the systematic assessment
of his visuospatial proficiency, thought processes, thought content, prosody, praxis,
orientation, memory, language, gnosis executive functioning, and attention span (Norris,
Clark, & Shipley, 2016). Furthermore, the nurse will also require engaging Mr. Jim in his
health person-centred and holistic care interventions through the establishment of a
therapeutic relationship (Percival, Kessler, & Turner, 2017). This will not only improve Mr.
Jim’s treatment compliance but also enhance his trust and confidence in the recommended
therapeutic strategies.
Information Processing
Mr. Jim’s MDD manifestations reveal his ineffective coping (based on disrupted
mental processes, anhedonia, and disorientation), impaired social interaction (based on low
self-esteem, social isolation, diminished verbalisation, and withdrawn behaviour), and self-
care deficit (based on ineffective feeding pattern). Mr. Jim also experiences an elevated risk
of insular region hypoactivation based on his appetite loss (Simmons et al., 2016). This
outcome could potentially deteriorate Mr. Jim’s physiological state to an unprecedented level.
Mr. Jim’s suicidal tendency potentially elevates his risk of prospective suicidal attempts and
resultant hospital readmission or loss of life (Li et al., 2017). Mr. Jim’s psychosocial isolation
and bed confinement potentially elevate his risk of self-care deficit and cognitive decline.
Accordingly, the nursing care interventions must effectively focus on enhancing Mr. Jim’s
strength, self-esteem, physiological functioning, social engagement/relationship maintenance,
community-based support, and psychomotor activity.
Problem Identification
Ineffective Coping
Mr. Jim’s ineffective coping substantially reduces his ability to overcome his stressful
circumstances, negative thoughts, and suicidal ideation (Bazrafshan, Jahangir, Mansouri, &
Kashfi, 2014). Mr. Jim’s reduced coping is also based on his inability to utilise family
support and other significant resources to overcome his mental health deterioration.
Social Interaction Impairment