Critical Appraisal of Care

This critical appraisal of care discusses the contemporary health care issues affecting the adult population, assessment and problem-solving processes for care management, and theoretical concepts underpinning adult nursing. It explores the prevalence of depression nationally and internationally, the assessment tools used for depression, and the role of nurses in providing care for patients with depression. The assignment also highlights the importance of problem-solving therapy in managing depression and the nursing interventions for treating depression in the adult population.

Critical Appraisal of Care

Table of Contents
Introduction......................................................................................................................................2
Part A Critically analyse the contemporary health care issues that affect the adult population,
nationally and internationally..........................................................................................................2
Part B: Evaluate the assessment and problem-solving processes that apply to the care
management of adult patients in relation to conditions, which include the contemporary
health targets............................................................................................................................5
Part C: Critically appraise the theoretical concepts underpinning adult nursing.............................7
Part D Devise appropriate evidence-based interventions to meet the diverse needs of the
individuals........................................................................................................................................9
Conclusion.....................................................................................................................................12
References......................................................................................................................................12
1

Introduction
This assignment is composed of evidence-based practice that will be supported by the critical
appraisal to provide care to patients suffering from depression.The reason for choosing this
health issue is that it is prevalent at the national and international levels. Moving forward this
assignment will provide the assessments as well as problem-solving techniques to overcome
depression. Moreover, underlining theories of critical appraisal in nursing will also be discussed
along with which suitable intervention to overcome depression will also be provided.
Part A Critically analyse the contemporary health care issues that affect the adult
population, nationally and internationally
The most commonly found healthcare issue in the adult population is depression both nationally
as well as internationally or globally. Depression is regarded as the consistent feeling of loss of
interest as well as sadness that persistently stops an individual from living life by performing
normal activities. However, in general, there are various classes of depression that range from
minor to severe. In common, this health care issue is not a result of one event or situation instead
it is raised due to multiple factors and mixed events. In addition, some of the major and
highlighted causes of depression are regarded to be personality(negative emotionality,
conscientiousness and positive emotionality), alcohol misuse, family history, trauma, health
issues, illness, medications, and other drugs (Robbins and Weidenbaum, 2017).
The adult population in the United Kingdom is reported to be suffering from depression at a
relatively high rate. According to (Mental health statistics: depression, 2022), about 19.7 per cent
of the UK citizens aged 16 and more than that shows symptoms of depression, this rate is
increasing on regular basis. However, this rate is higher among women (22.5 per cent) as
compare to men (16.8 per cent).These statistics in the rest of the countries are somehow shown
lower and others show the higher extent todepression. It is suggested that people with very low
esteem are easily affected by stress and other people being pessimistic are likely to experience
depression. Moreover, there are other environmental factors that prove to cause depression in
adult people such as abuse, neglect, exposure to violence, and poverty. Other physical conditions
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that are evident to cause depression among the adult population are hypertension, diabetes,
dementia, cancer, stroke, atrial fibrillation, and other chronic pain (Merikanto et al., 2015).
(Coronavirus and depression in adults, Great Britain - Office for National Statistics, 2021)
Depression is considered the most common illness or health issue globally with an estimated
population of about 3.8% of the impact population worldwide(Mental health statistics: older
people, 2021). Out of this ratio, about 5% are adults and the other 5.7% are adults that have
above 60 age(Mental health statistics: older people, 2021).. In addition, depression is a variant
from the common mood swings, in its worse condition it may lead a person to suicidal thoughts
(Mental health statistics: older people, 2021). About 75% adult population living in middle and
low-income countries do not receive any care treatment in regards to depression. In the United
Kingdom, about 85% of the adult population is suffering from depression out of which 22% are
male and the rest of the 28% are women(Mental health statistics: older people, 2021).
Moreover, the estimated cost that is spent on treating and providing assistance to the people
suffering from depression in the UK is more than £9 billion out of which about £370 million is
the direct cost for the treatment of depression (Depression, 2021). According to the (WHO,
2021), the statistics for the people suffering depression globally is about 4.4% out of which it is
prevalent in females about 5.1%, and less in males about 3.6%. However, this prevalence differs
from region to region, about 2.6% of males reported to be affected with depression in the
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Western Pacific while on the other hand; about 5.9% of females are affected by depression in the
African region. Moreover, this prevalence also varies from age to age as this mental health issue
is most commonly found in older people. About 7.5% of females aged between 55-74 years
suffer from depression worldwide whereas, about 5.5% of males have to go through this health
issue. The estimated total population living with depression all across the world is 322
million(Depression, 2021).
(GBD Results Tool | GHDx, 2021)
However, this rate of depression is increasing day-to-day in the adult population as well as in
other people due to the current pandemic condition due to COVID-19(Depression in Older
Adults, 2021). In the most developed countries, this pandemic has caused great disturbance due
and many of the people suffering from depression either due to COVID-19 or because of any
other reason are being able to get adequate treatment. However, very few of them are able to
afford and treat depression (Depression in Older Adults, 2021).
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I am working as the Psychiatric mental health nurse in the renown healthcare of the UK. My job
role is to provide services to the patients suffering from mental and physical health problems and
also provide assistance and care to patients dealing with behavioural issues.In addition, these
nurses are also responsible to formulate and implement a care plan for the patients suffering from
mental health problems such as depression, dementia, anxiety, Parkinson's, schizophrenia, and
other relevant disorders. Moreover, to be an effective mental health nurse it is vital to have good
communication and personality skills as well as must equip adequate knowledge of mental health
problems and ways to put them into practice. Mental Health Act 1983 is the piece of legislation
that surrounds the treatments as well as assessments, and rights of people as well as
responsibilities of healthcare practitioners and mental health nurses in treating people suffering
from this disorder (Smith et al., 2020).
Part B: Evaluate the assessment and problem-solving processes that apply to the care
management of adult patients in relation to conditions, which include the contemporary
health targets.
The care providers are required to have awareness of the needs of patients. The term assessment
is referred to systematic process of determining qualitative as well as quantitative needs. Status
of patients and potential regarding psychosocial, physical and social functions are required to be
assessed. Such assessments further lead to details of limitations of patients and it further leads to
identification of service goals (Kroenke et al., 2016). It is evident that early assessment and
intervention of nurses can enhance recovery of psychological well-being of people with
depression and anxiety issues. All nurses are required to gain skills and knowledge in mental
health assessment, treatment and care to be aligned with their scope of practice. Role of nurses in
treating depression includes evaluation and support to therapeutic plan with evaluation of
response to treatment and communication with healthcare provider. During initial visits of
patients, nurses are more likely to evaluate the ability of patients to initiate treatment while
identifying challenges to comply and helping in resolving challenges. These aspects enables
nurses to detect the problems, analyse the interpret the information to fulfill the needs and
requirements of patients (Moise et al., 2018).
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It has been determined that the care management for the following mental condition called
depression comprises of a combination of monitoring and assessing the depression status of a
patient, identifying preferences, progress, and barriers, offering patient education along with the
development of self-management plans and treatment, maintaining communication with the
specialty clinicians and primary care, facilitating treatment adherence, and coordinating the care
of the patients with specialty clinicians and primary care (Moise et al., 2018).
New healthcare models have been integrated with self-assessment instruments in order to foster
person-centered care as well as to meet patients’ needs (Simon et al., 2016). Moreover, it has
been identified that the hetero-assessment and self-assessment tools used for depression have
almost identical and complementary clinical results. Hence, these must be implemented for
assessing the health outcomes (Moise et al., 2018). The anxious or depressive symptoms of an
individual are mainly assessed using scales such as Patient Health Questionnaire Depression
Scale (Kroenke et al., 2016). This is the most suitable assessment tool to evaluate the outcomes
reported by depressed people.
Unlike other scales used for depression, this scale involves 9 items that are grounded on the
Statistics and Diagnostic Manual for the Mental Disorders. The Questionnaire is usually a
questionnaire formulated of 3 pages and can be self-administered entirely by the patients (Simon
et al., 2016). The completed questionnaire is then scanned by the clinician and the positive
responses are verified. And the clinician then uses a diagnostic algorithm. 8 diagnoses are
assessed by the PHQ and divided into threshold disorders including bulimia nervosa, other
anxiety disorders, panic disorder, and major depressive disorder, as well as sub-threshold
disorders including probable alcohol abuse, other depressive disorder, binge eating disorder, and
somatoform (Kroenke et al., 2016).
Apart from that, the problem solving applied to the care management of adult patients in relation
to depression includes problem-solving therapy (Kleiboer et al., 2015). It is generally a type of
psychotherapy that may help in the development of coping skills in order to manage upsetting
life experiences. As explained by Jain L et al. it is the notion of considering the problem or issue
at the moment in contrast to the psychodynamic therapy that stresses both the issue as well as the
underpinnings (Cuijpers et al., 2018).Problem-solving therapy is also referred to as short-term
therapy, structured problem solving, and problem-solving treatment. If an individual is diagnosed
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with this mental condition of depression, his physician might suspect that it stems from daily life
issues hence; they might suggest problem-solving therapy (Zhang et al., 2018).
The following therapy is helpful in terms of the development of strategies for resolving those
issues. In turn, it might relieve the symptoms of depression. In addition to this, PST can also help
in the management of other mental disorders such as anxiety, deliberate self-harm, unhappiness
at home or work, stress, and interpersonal relationship issues (Cuijpers et al., 2018). During
problem-solving therapy, the therapists teach the patients how to makeuse of the step-by-step
process including; problem identification, coming up with various realistic solutions, choosing
the most promising answer, developing and implementing an action plan, and assessing how
effective was the problem-solving attempt (Kleiboer et al., 2015). Moreover, the problem-
solving therapy is likely to include: psycho-education in order to teach the patients the skills used
for overcoming depression, exercises for interactive problem-solving, improving communication
skills, or motivation homework assignments (Gustavson et al., 2016).
Part C: Critically appraise the theoretical concepts underpinning adult nursing.
Since nurses are the entities that are seen by the patients the most throughout the entire day
therefore, their significant role in terms of dealing with depressed individuals does make sense
(Han, Park and Park, 2017). The majority of the things that nurses do, help a depressed person
not feel hopeless and unworthy and even help in lifting their spirits. Conversing with patients
suffering from depression concerning their feelings is an effective measure to deal with
depression. Moreover, showing empathy helps them to know that nurses understand their
patient's feelings rather than judging them, for how and what they feel (Han, Park and Park,
2017).
On the other hand, there are certain nursing accountabilities for caring for patients with
depression. For instance, when concerning nursing assessment, the subjective and objective cues
help them to assess the underlying condition of an individual (Kim and Kim, 2015). The
subjective cues include sleep disturbance, abuse of chemical agents, fatigue, verbalization of
incapacity to ask for help, emotional tensions, and disturbed appetite while, the objective cues
include inadequate [problem-solving, reduced social support use, incapacity to meet basic needs,
destructive behaviour, etc. Contrarily, the nursing diagnosis entails ineffective coping associated
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with the maturational or situational crises, hopelessness associated with long-term stress, and
fatigue related to anxiety and stress (Kim and Kim, 2015).
Mainly, the nurses take care of the depressed individuals with the aim of determining the degree
of impairment, assessing coping skills, and abilities, assisting patients to address the current
situation, promoting wellbeing, and providing for fulfilling psychological needs. Apart from this,
the nurses adapt certain effective interventions to treat or cure depression in the adult population.
They provide for the physical needs of the patients. In order to do so, they assist with personal
hygiene and self-care along with encouraging them to eat healthy. Nurses offer back rubs or
warm milk in order to improve sleep at bedtime (Lee and Chang, 2016).
On the other hand, they plan activities especially for the times when the individuals’ level of
energy is at a peak. Similarly, adult nursing interventions involve assuming an active role in
establishingcommunication. This is achieved by sharing the patient’s behaviour observation,
giving enough time for them to respond, speaking slowly, offering a structured routine, and
motivating them to write down or talk out their feelings. However, the other interventions
include educating patients regarding depression (Dunphy et al., 2019). The nurses explain to the
patients that depression can be overcome by involving in joyful activities and expressing
feelings. Also, they highlight the effective approaches that are available to relieve depression
symptoms. Moreover, they treat depression by asking patients whether they think about
committing suicide or death. Nurses play their active role by signaling an immediate need for
assessment and consultation. Also, the nurses stress the requirement for drug or medication
compliance together with reviewing adverse impacts with the patient (Lee and Chang, 2016).
Furthermore, the concept regarding the nursing evaluation of depression entails evaluating the
individuals’ potential to accurately assess the contemporary situation and their capacity to
determine consequences and ineffective coping attitudes (Janssen et al., 2017). Additionally, the
adult nurses verbalize the awareness of their own coping skills as well as of feelings
corresponding to the conduct. Also, the evaluation is by the assessment of met psychological
needs as evidenced by suitable expression of feelings, resources utilization, and options
identification. Besides, the nurses are required to be competent in the area of written and verbal
skills, sensitivity and empathy towards patient’s concerns and needs, observation skills,
teamwork, organisational skills, attention to detail, good hygiene, good fitness and health,
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leadership and managerial skills, and the potential to deal in emotional situations (Dunphy et al.,
2019).
Grand theories of nursing reflect generalized concepts pertaining nature and goals of professional
nursing. These theories are synthesis of scholarly research with professional experience from
theoretical pioneers. One of the grand nursing theory was depicted by Dorothea Orem in 1950s
revolving around ability of a person to practice self-care. This theory is based on self-care,
nursing systems and self-care deficit. Another grand theory named as Roy Adaptation Model
states the purpose of nursing to increase the life expectancy. Nurses through this theory eliminate
the ineffective coping processes to generate favourable results (Janssen et al., 2017). Adapatation
is the process through which thinking and feeling use awareness and choice to develop human
and environmental integration. Also, Neuman Systems Model by Bettey Neuman uses a system
approach focusing on the needs of protection and relief from stress for people. Neuman believed
that the reasons of stress can be resolved and identified through nursing interventions. She also
focuses on the need of people for dynamic balance that nurses can provide with the help of
identification of problems with mutual agreement on goals and use of prevention as intervention
(Dunphy et al., 2019).
Part D Devise appropriate evidence-based interventions to meet the diverse needs of the
individuals
The term intervention is regarded as the actions that are adopted to enhance or improve the
symptoms of a disease or any other medical disorder. Depression is the most common health
issue in the world through which a number of people suffer from depression. In addition, it is
treatable only when it is diagnosed or symptoms related to it are identified. Moreover, the
treatment of cure for depression varies from person to person and age to age. The adult
population suffering from depression needs to follow some tips, get treatment as well as
assistance and funds to get over this disease (Barth, et al., 2016).
In order to provide adequate treatment for treating adult people suffering from depressionit is
needed to have enough knowledge to diagnose the cause of this mental disorder it may either be
an environmental factor, personality, drugs, medications, and others. The severity of this mental
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disorder is also a factor that requires intense treatment (Cristea, Kok, and Cuijpers, 2015). The
adult population finds it difficult to approach the best therapy and most of the time adequate
support as well as the right treatment. Sometimes the severity of this disorder increases due to
the long-term use of medicines or anti-depressants. However, exercise and the right therapy may
help in lowering the cause and symptoms of this disorder.
As being a mental health nurse the first suggestion to the patients suffering from this disorder is
to change the way they are living or in other words changing their lifestyle. It covers that people
suffering from depression must exercise regularly as it may boost the endorphins and serotonin
and other chemicals in the brain that may allow them to feel happy and fresh. As it is quite
difficult for adult people to do difficult exercise for this they are suggested either to go for yoga
or walk regularly. Social support for such people from their family, friends, and caretakers is also
very important (Abas, et al., 2016). Controlling the diet of such people may also cause a positive
impact as consuming a healthy, well proportioned, and balanced diet results impart a positive
impact on both mental and physical health.
In their own workplace setting people reported with mental health issues and particularly
depression are treated through experimenting best suitable therapy. Some of the most common
therapies and interventions adapted to treat people more particularly the adult population
suffering from depression in the NHS, UK are CBT (Cognitive-Behavioural Therapy) and
MBCT (Mindfulness-Based Cognitive Therapy). CBT is the therapy that mainly focuses on the
inter-winding of thoughts, behaviours, and feelings in daily life and how bringing change in any
of it can result in causing improvement in other (Luik, et al., 2017). This therapy is mainly
proposed to alter the helpless thinking as well as behavioural patterns that can impair normal
functioning. These changes can result in enhanced regulation of emotions and are provided for
about 6-20 weeks. It is best suitable for adults suffering from depression. This therapy can give
these people a sense of differentiation among their feelings and thoughts and control their
feelings by inquiring about their beliefs and suppositions. As being a mental health nurse,
provide patients with the methods and tips to decrease the symptoms of depression and enhance
brain functioning. Furthermore, patients or adult service users are advised to fill the “mood
diary” in which writing down the situations that triggered them every day.
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MBCT is inclined to assist and teach patients to be familiar with helpless or disturbing thoughts
as meagre mental events and outline them impartially in a manner that is kind and caring for one.
This therapy takes about 8 week’s sessions one each week of about 2 hours in the group format.
It is best used in NHS for the treatment of depression in adults. People suffering from depression
usually compare the situation between how it should be and how it is. This therapy allows adults
to focus on their thoughts regardless of the predictable ways the brain may meander. Through
practising this therapy such adults may modify their thoughts allow them to be in the present
situation and avoid getting stuck in negative thoughts (Rycroft-Malone et al., 2019). In this
therapy, people are taught to attend and to live in the moment and also involve mindful eating,
body scanning, and sitting as well as breathing practice. Other exercises such as “affect
labelling” are also suggested to these patients. Service users are also provided with the
homework after every session which allows them to practice what has been taught to them.
It has been determined that the use of patient entered care plans has been evident across different
studies (Hagen,Knizek and Hjelmeland, 2017). Moreover, establishing goals and following up
with the depressed patients regarding progress towards aims and objectives had been discussed
and the nurses' CM will support the patient in determining and addressing barriers to
accomplishing their goals(Pilgrim, 2019). On the other hand, Morgan et al., 2013 discussed
monitoring particularly of the physical measures, referral follow-up, as well as lifestyle risk
factor review in their nurse CM check-ins whereas, Katon et al., 2010 presented exercise and
diet components of depression care plans (Hagen, Knizek and Hjelmeland, 2017).
Additionally, the mental health nurses are typically based on the community or hospitals as these
places are where the major mental healthcare facilities are offered. Whereas the nurses work,
they do shifts in order to offer round-the-clock care (Shaw and Sandy, 2016). In fact, mental
health nurses are among the most demanding yet rewarding career choices. Thus, the role
requires supporting the individuals through their worsening mental health conditions thereby
enabling them to have increased engagement in and control over their mental condition (Shaw
and Sandy, 2016).
However, the responsibilities in the delivery of nursing care in case of treating depression
include assessing patients through discussing their mental condition with them(Pilgrim, 2019).
The studies highlight the significance of providing treatment to the patients while ensuring that
11

the medicines are being administered correctly (Pilgrim, 2019). It has been found that the adult
nurse serves their role by conducting one-on-one therapy sessions and risk assessments of the
patients. They are involved in preparing records of the patients and effectively maintaining
them.The studies have also addressed the importance for the adult nurses to ensure that all
statutory requirements are complied with (Shaw and Sandy, 2016).
Conclusion
Therefore, it concludes that depression is the prevailing health issue that is affecting number of
adults not only in the United Kingdom, throughout the world. However, it is evident that early
assessment and intervention of nurses can enhance recovery of psychological well-being of
people with depression and anxiety issues. Moreover, Grand theories of nursing reflect
generalized concepts pertaining nature and goals of professional nursing, this allows the nurses
to gain skills that may help in providing satisfying care to the patients suffering from depression.
CBT is the therapy that mainly focuses on the inter-winding of thoughts, behaviours, and
feelings in daily life and how bringing change in any of it can result in causing improvement in
other.MBCT is inclined to assist and teach patients to be familiar with helpless or disturbing
thoughts as meagre mental events and outline them impartially in a manner that is kind and
caring for one.
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