Depression

This essay report includes topics like assessment, recovery concepts, the role of nurses to reduce the issues, essential therapeutic relationship and treatment strategies, intervention, the role of the nurses working with the multidisciplinary team and client participation.

Running Head: DEPRESSION
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Depression
Student name

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Depression
Depression is the most common but serious mental illness, which is characteristic by a
persistent feeling of sadness and a loss of interest in activities that a person normally enjoy. It
is determined as a person’s inability to do daily activities, normally for 14 days (World health
organization, 2018). Depression seems to affect everyone equally but females are more likely
to be depressed than man. This mental health issue is not the new concept for the world; it
has been affecting people for many years. Nearly 300 million people of all age groups suffer
from depression. It ranked as the single largest contributor to the international disability. It is
the major contributor to death by suicides and accounts for nearly 800000 deaths per year.
Sign and symptoms if this disorder includes depressed mood, reduced interest, weight loss,
insomnia, fatigue, feeling worthlessness, impaired ability to think, and loos of energy. In this
essay report, the topics like assessment, recovery concepts, the role of nurses to reduce the
issues, essential therapeutic relationship and treatment strategies, intervention, the role of the
nurses working with the multidisciplinary team and client participation will be included.
Assessing a patient with depression is quite difficult as most of the patient mention
low mood as the symptom of their physical health issues. Assessing the sign and symptoms is
the major contributor to provide a better health care and treatment to the patient with
depression, the nursing assessment should include assessing general appearance and motor
behaviors, mood and affects, the thought process and content, judgement and insight, roles
and relationship of the person with others, and using depression rating scale or tools like
Hamilton depression rating scale and Patient health Questionnaires-9 (PHQ-9). Hamilton
Depression Rating Scale is the multiple item questionnaires use to indicate depression, it was
designed for adults. The patients are rated by the clinicians on seventeen to twenty-nine items
scored on two different point scale; 3 points or 5 point scale. The original scale had only 17

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items but the new version contains 29 items. According to Olden, Rosenfeld, Pessin, and
Breitbart (2008), the Hamilton Depression Rating Scale is highly reliable and has concurrent
validity with the diagnosis of depression. PHQ-9 tool also has an excellent choice for
providers and researchers due to its brief nature and easy scoring method (Richardson,
McCauley, Grossman, McCarty, Richards, Russo, & Katon, 2010).
According to Vittengl, Clark, and Jarrett (2009), In clinical medicine area, the term
recovery has connoted the act of gaining the normal psychological health like before.
Remission is the related word that indicated a temporary abatement of the symptoms of
depression. Recovery occurs when the severity of the symptoms decreases below the
threshold used for defining the onset. Definition of remission term parallels the traditional
scientific concept of convalescence, the transitional stage of reintegration after the health
issue (Novick, Montgomery, Vorstenbosch, Moneta, Dueñas, & Haro, 2017). Therefore the
trajectory of the process is an important additional dimension which requires a longitudinal
consideration of the disease development, acute, residual and encompassing prodromal
symptoms. Recovery is not just about curing the symptoms associated with the disorder but
also achieving the complete mental health and returning the patient to his or her normal
condition. According to a study published by Stotland (2012), treatment of this health issues
considers adequate and successful when the patient’s function and the mood seemed to be
better after the treatment than before. The only measure of health improvement was that the
patient reports of function and the reduction in symptoms
The therapeutic nurse-client relationship is the basis, the very core, of all psychiatric
nursing treatment approaches regardless of the specific aim. The very first process between
nurse and client is to establish an understanding in the client that the nurse is entering into a
relationship with the client that essentially is safe, confidential, reliable, and consistent with

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appropriate and clear boundaries (Fonagy & Allison, 2014). It is true that disorders that have
strong biochemical and genetic components such as schizophrenia and major affective
disorders cannot be healed by therapeutic means. However, many of the related emotional
problems such as poor self-image and low self-esteem can be significantly improved through
a therapeutic nurse-client relationship (Sucala, Schnur, Constantino, Miller, Brackman, &
Montgomery, 2012).
Establishing a therapeutic alliance or relationship with a client takes time. Skills in
this area gradually improve with guidance from those with more skill and experience. When
clients do not engage in a therapeutic alliance, chances are that, no matter what plans of care
or planned interventions are made, nothing much will happen except mutual frustration and
mutual withdrawal (Zuroff,s Kelly, Leybman, Blatt, & Wampold, 2010). The nurse-client
relationship is often loosely defined, but a therapeutic relationship incorporating principles of
mental health nursing is more clearly defined and differs from other relationships. A
therapeutic nurse-client relationship has specific goals and functions. Goals in a therapeutic
relationship include the following: Facilitating communication of distressing thoughts and
feelings Assisting clients with problem-solving to help facilitate activities of daily living
Helping clients examine self-defeating behaviors and test alternatives Promoting self-care
and independence (Arnow et al., 2013)
With the modern therapies available, treatment of depression is highly successful.
People who are depressed should not hesitate to contact their GP, who may help them resolve
the problem or refer them to a mental health professional. The type of treatment depends on
the type of depression and its severity. Antidepressant drugs help to relieve the depression,
restore normal sleeping patterns and appetite, and reduce anxiety. They work by modifying
the activity of neurotransmitter pathways. There are a number of categories of

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antidepressants, including u selective serotonin uptake inhibitors (SSRIs), (for example,
sertraline, paroxetine) u serotonin or noradrenaline reuptake inhibitors (SNRIs), (for example,
venlafaxine) u atypical antidepressants (for example, nefazodone and/or mirtazapine) u
tricyclic (for example, amitriptyline, doxepin) u monoamine oxidase inhibitors like
phenelzine and tranylcypromine (Menza, et al., 2009).
Electroconvulsive therapy (ECT) is a safe and highly effective treatment for the most
severe forms of depression. Many misconceptions remain regarding its use, possibly owing to
inaccurate depictions in the media (Kato, 2009). The procedure involves the use of short-
acting anesthesia, muscle relaxants and oxygen, and the person is carefully monitored
throughout the procedure and during recovery (Perrin et al., 2012). The aim is to induce a
highly modified seizure, which is thought to positively influence levels of neurotransmitters,
leading to improvement in mood or reduction of psychotic symptoms. ECT may be life-
saving for those at high risk of suicide or who, because of the severity of their illness, have
stopped eating and drinking and may die as a result (Tendolkar et al., 2013).
Nursing interventions are the primary or initial interventions that a patient received
from the health care system. Nursing interventions play a critical and vital role to achieve the
health goals already set for the patient with depression. Nurse’s interventions should be
provided to the patient according to the nursing diagnosis. In case of risk of suicide a nurse
should create a safe environment for the patient, he or she keeps close observation and make
a frequent round in irregular intervals. A nurse should make a verbal conversation in order to
reduce the suicidal thoughts form the person. If the patient developed symptoms like social
isolation, a nurse should show the unconditional positive regard, they should recognize and
reinforces the interaction positively with others (Pinto-Foltz, & Logsdon, 2009). Patient with
depression often face insomnia, in this case, a nurse should log total sleeping time in every

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shift, and he or she should assist the patient to maintain the healthy sleeping habits. If
necessary the patient should be administered sleep medicines. Another psychological issue
that might occur in case of depression is low self-esteem. In this case, a nurse should spend
time with the patient, focus on the patient's strength and accomplishment that are forgotten by
her or him. The person should be encouraged to participate in group activities and other areas
of their life that were once interesting to them. Imbalanced nutrition is the most important
issues that should be noticed by the nurses at the higher priority (Richards & Hamers, 2009).
The dietician and the nurses should work together and cooperate with each other to monitor
the healthy nutrition intake in the patient with depression. The body weight should be
monitored by making a meal schedule and staying with the patient during meal time
(Jefferies, Johnson, & Ravens, 2011). A nurse can educate and motivate the patient to
increase the responsibility for them. In case of hopelessness, the nurse should identify
stressors in the patient to express and explore feeling and their perception that may develop
the expression of hope. According to Kang, Choi, and Ryu (2009), Complicated grieving can
also be seen in case of depressed mood, in this scenario a nurse should develop the trusting
alliance with the patient and encourage them to express their anger and motivate them for
physical activates to emotional discharge. A nurse can use the touch method while talking
with the patient to make them believe that somebody care for them and they are not alone
(Konnert, Dobson, & Stelmach, 2009).
According to Bosch et al. (2009), A multidisciplinary team (MDT) should consist of
psychiatrists, clinical nurse specialists/community mental health nurses, psychologists, social
workers, occupational therapists, medical secretaries, and sometimes other disciplines such as
counsellors, drama therapists, art therapists, advocacy workers, care workers and possibly
others not listed. See below table for further description. Leontjevas, Gerritsen, Smalbrugge,
Teerenstra, Vernooij-Dassen and Koopmans (2013) stated that the different professions all

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have different areas of expertise; so that they can combine, their skill sets if necessary to
tackle complex and challenging mental health conditions. The multidisciplinary team meets
regularly to discuss their work with individuals so that each patient has a care plan best suited
to their individual needs. Some details on the most common MDT members are set out
below. A nurse has an important role in a multidisciplinary team cares for the person with
depression. Establish the supportive role of the patient's environment through their
counseling by the multidisciplinary therapeutic team. Mental health nurses work in a highly
specialized field, caring for people with many different types of mental illnesses or disorder.
The mental health nurse's primary focus is to work alongside people and their carers to
overcome the symptoms of their illness, commence, and continue their personal recovery.
Responsibilities include protecting the rights of their consumer and supporting the
consumer’s families and carers. The nurses have opportunities to interact with a diverse
group of people from all backgrounds experiencing a range of mental illness and disorders
including psychosis, depression and bipolar disorder (Gaul et al., 2011). Mental health nurses
work within a multi-disciplinary team that may include psychiatrists, social workers,
psychologists, and GPs. The mental health nurse plays a central role in the planning and
delivery of care for people experiencing mental illness or disorder. Their main tool as a
mental health nurse will be the strength of the patient’s own personality and communication
skills. Nurses need to empathize with the people, engaged with and show warmth and care
about them. Regrettably, there is still some stigma attached to mental illness. Combating this
and assisting the individual and their families deal with the complex nature of mental illness
and disorder is a key part of the mental health nurse’s role (De Man‐van Ginkel, Gooskens,
Schuurmans, Lindeman, Hafsteinsdottir, & Rehabilitation Guideline Stroke Working Group,
2010).

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According to Jungbluth and Shirk (2009), including the patient and their families in
decision-making for the treatment process of the patient is a proven idea for achieving good
health outcomes. Client-centered therapy is known as person-centered therapy. During client-
centered therapy, the therapist will not focus on providing specific interpretations or
guidance. Rather, they will offer empathy, acceptance, respect, and unconditional support.
This may help the nurses to feel empowered and capable of finding solutions to patient’s own
problems. An accepting and empathic relationship with the therapist may help the nurses to
become more self-aware and self-reliant (Bohart, & Tallman, 2010). During client-centered
therapy, the therapist does not subject the patient’s feelings and behaviors to analytic
interpretation. Participation of the patient in the treatment process might help the nurses and
health practitioners to achieve the good health recovery. Including the family member may
help the treatment to boost recovery. A patient with depression might feel low or alone and
he or she should be given time to meet with their families so that they can recover fast
various it has conducted on involving the family members and friends in the treatment proves
(Graven, Brock, Hill & Joubert, 2011). Most them have found that this can be a good idea to
develop must the patient and their families related to the treatment process and the health care
system as various patient families seemed to feel unsafe when it some to the health of their
loved ones. According to a study conducted among 761 patients by Bolkan et al. (2013) in
multivariate regression analyses, lower depression severity and better medication adherence
over time were significantly linked to higher satisfaction with limited efforts by clinicians to
involve families in care. This method of therapy is meant to be adapted to each patient
(Tandon, Perry, Mendelson, Kemp, & Leis, 2011).
Depression is considered as the most common but severe mental illness, which is
often characterized by a persistent feeling of depression and loss in favorite activities or

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interest. It is determined as the inability to do the daily tasks. The epidemiological data has
shown that nearly 800,000 people suffer died per year due to suicides. Nursing assessment
should include assessing sign and symptoms, mood and affects judgment and insights. He or
she should use the Hamilton depression rating scale and patient health questionnaires to
assess the patient health condition. The recovery concept in the treatment of the patient with
depression is gaining and returning the patients previous health conditions. Recovery can be
achieved when the patient becomes healthy like before. To achieve health recovery a nurse
should make a therapeutic relationship with the patient is the most important aspect to deliver
a good and goal-oriented approach. It helps the patient to express their thoughts and feeling
with the nurses. Treatment strategies for depression include medication and ECT. An
antidepressant may help the patient to relieve with depression and restoring sleeping patterns
and appetite. Electroconvulsive therapy is considered as the safe and highly effective
approach to treat most severe forms of depression. Nursing interventions beneficial in this
health condition are creating a safe environment, administration f sleep medication,
monitoring weight, encouraging the patient to perform physical activities, and motivating
them to take responsibilities. In a multidisciplinary team, a nurse plays a key important role.
They establish the supportive role of the patient's environment through their counseling by
the multidisciplinary therapeutic team and report the coercing clinicians regarding the
patient's health condition. Client participation in the treatment decision can help the nurses to
develop trust in the patient for the nurses and the healthcare system.

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