Understanding Depression: A Case Study of Ms Jessica and the Role of Nurses in Public Health Promotion

Introduction
Depression is one of the leading mental health issues across the globe (Vos, et al.,
2013). In 2013, depression was the second chief cause of years lived with a
disability worldwide, only followed by lower back pain. Depression was the key
cause of disability in 26 nations (Ferrari, et al., 2013). The sign and symptoms of
depression can vary from mild to severe. It can disrupt an individual’s routine life.
The clinical manifestations not only affects the mental state but also engulf the
physical sphere. In this essay case study of Ms Jessica to understand how the
clinical condition of depression affects a person’s overall life. Evidence of health
promotion are also used to discuss the nursing practice. Role of nurse in public
health promotion is also identified. Then the concept of communication related it to
nursing and nursing practice is defined. In addition, two areas of the communication
skills that that needs to be developed are also identified to inform an action plan for
future practice.
Case Study
Ms Jessica was brought in the psychiatry department through a referral by her GP
with suspected diagnosis of depression. She is a 52 year old lady who is employed
in a firm as an accountant. His husband died last year due to prostate cancer. She
now lives with three kids, a son in college and two daughters in school. A
psychoanalysis was conducted and her family were also enquired. On asking her
eldest son regarding his mother’s mental status, he got emotional and told that
since the death of his father, his mother has experienced increased physical and
mental stress because of enhanced responsibility and the loss of her constant
support. Jon was given time to compose himself and then he was made to
understand that it is natural of her mother to react in this way and she needs time
to adjust to the void that is created in her life. Jon also revealed that his youngest
sibling Jean was very close to her father and his mother found it very difficult to
manage her after his husband’s death. Her daughters informed that she kept
looking at a spot and doesn’t react to anything. On enquiring her kids, it was
concluded that they were a happy family and the trigger point of Jessica’s
depression was her husband’s death as she was finding it challenging to cope up
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with this incident. Since he suffered from prostate cancer, last few months of his life
were also very difficult for Jessica and the kids. So, she is living under physical and
mental stress from around last two years.
Notes from her GP enlisted multiple changes that were observed by him in Jessica’s
behaviour. Due to her constant absence at work, she left her job as an accountant.
She neglected herself. She even said once she has suicidal thoughts at times. On
one occasion, she left her house without informing anyone and didn’t return till late
night. She came back with injured hand and multiple injuries. She refused to come
to the hospital and asked her kids to stay away from her.
During the psychoanalysis it was found that Jessica and her husband spent their
savings in the treatment of his care and she is facing financial burden due to lack of
financial resources. It was found that she was very worried about the future of her
kids and that she has to fulfil their requirements. Her mental state also revealed
that she was overthinking about her kids and lack of father in their lives. During the
psychoanalysis also, she was reluctant to talk but didn’t look aggressive. However,
she cried three times in the entire session. She was consoled and given time to
relax herself. It was observed that Jessica was calm, cooperative but sometimes
unresponsive during the entire session. Jessica was neglecting her professional and
personal responsibilities. She also did not look after the home and her own hygiene
and looks.
Public health promotion to Jessica
Ms. Jessica faced the issue of suicide ideation which is considered as a key cause of
mortality in public mental health issues like depression. Two items of evidence one
quantitative, and one qualitative are chosen from the current literature that could
be used in helping to inform Jessica with regards changes to her life style. Summary
of both the articles can be found in appendix 1.
Appendix 1 Summary of two items of evidence
Lifestyle psychosocial interventions are linked with severe mental illness, and
suicidal tendency in recent times. Patients with mental health issues have increased
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mortality rates, inferior health states, and increased suicide tendency as compared
to the general population like in case of Jessica. Lifestyle conduct are responsive to
change by adopting particular psychosocial interventions, and numerous
approaches have been used. This evidence offered a detailed review of the
literature on lifestyle interventions, mental health, and suicide risk in the general
population and in patients with mental health disorders. Multiple factors can provide
rational for the link between lifestyle behaviors and suicide. First, several studies
have found that certain lifestyle behaviors and its results (sedentary lifestyle,
cigarette smoking underweight, obesity) are related cardiometabolic risk factors
and with poor mental health. Second, several lifestyle behaviors may lead to social
isolation, limiting the development of social networks, and remove individuals from
social interactions; boosting their likelihood of occurrence of mental health issues
and suicide. Jessica must be encouraged to have an active lifestyle by going back to
her job and looking after the kids and home. She must also be encouraged to build
social networks by meeting new people or contacting her old friends (Berardelli, et
al., 2018).
A study was conducted to evaluate if brief intervention and contact is useful in
decreasing subsequent suicide mortality among people who have tendency of
suicide in low and middle-income countries. It was found that substantially fewer
deaths from suicide took place in the brief intervention and contact as compared to
in the treatment-as-usual group. The inexpensive brief intervention can be a
significant part of suicide prevention programmes for people who are facing
financial issues like Jessica. The brief intervention and contact indicated that
universal and selective suicide prevention strategies must be supplemented by
indicated strategies. Focus must be laid on Jessica by offering her psychosocial
counselling and supportive ongoing contact as it can substantially decrease
mortality because of suicide. One of the chief benefits of brief intervention and
contact is that it needs little training, as compared to the high-skill training that is
typical of more advanced psychotherapeutic treatment like cognitive-behavioural
therapy. Since it is low cost, it can be performed with minimal resources of space,
equipment and personnel (Alexandra Fleischmann, et al., 2008).
Nurses have a vital role to play in public health promotion. Mental health nursing is
a specialised area of care practice which promotes mental health through
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assessment, diagnosis and management of individuals with mental disorders. The
mental health nurses have several roles to play in contemporary mental health
nursing (Thomas, 2016). They are required to have a clinical competence based on
interpersonal strategies and nursing process (Cleary, et al., 2012). They are
expected to be a resource person who can provide all the required information
regarding health to the patient like Jessica and her family must be accurately and
adequately informed about her condition by the nurse. They are also supposed to
be a teacher who can assist the patient in learning and growing in the healthcare
setting. They are also expected to be leaders who can lead Jessica in the right
direction and guide her to participate in the process (Cleary, et al., 2015). They also
act as counsellor by helping the Jessica integrate facts and emotions linked with an
experience into her quality of life. The mental health nurses also need to perform
the emotional labour apart from the physical work. Mental health nurses are
expected to deal with patient’s attitude, mood and their perception of reality. They
also explore patient’s conflicting and disturbing emotions. The nurse-patient
partnership includes several aspects of a mental health nurse’s role in the
healthcare system. They need to acknowledge the advocacy needs of patients and
their families. They are also required to be responsible and sensitive to the social
environment (Powell, et al., 2015). They need to understand the thorough
consideration of the legal and ethical dilemmas that a mental health nurse faces
frequently during practice. They should be skilled in interprofessional collaboration
based on mental health nurses’s clinical competence, professional self-assertion
and a clear understanding of the cost of mental health care and mental health
nursing (Zugai, et al., 2015) 249-257. Direct care, communication and management
are the three primary domains of the contemporary mental health nursing. These
three domains involve the roles of teaching, coordinating, delegating and
collaborating functions (Morrissey, et al., 2011). These are the responsibilities that a
mental health nurse is expected to fulfil to perform the job well. The emotional work
is associated with the stress from interaction with the patients and from routine
daily tasks. The mental health nurses are expected to have certain intrinsic belief
like treating everyone with respect and dignity, protecting autonomy and self-
actualisation, potential of change, equal opportunity, non-discrimination and non-
judgemental conduct. The nurses are expected to communicate hope in the Jessica
and her family (Cleary, et al., 2016). They are expected to build a personal
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