Mental Health Nursing Case Study 2022

Running head: MENTAL HEALTH NURSING CASE STUDY
MENTAL HEALTH NURSING CASE STUDY
Name of the Student:
Name of the University:
Author note:

2MENTAL HEALTH NURSING CASE STUDY
Scenario
Linda is a 21-year-old lady who was referred to the Community Mental Health Team(CMHT) by her GP
due to worsening depression. Linda had been diagnosed with clinical depression and attended her
assessment meeting accompanied by her mum as she does not feel safe leaving the house on her own
Linda lives with her mother and is a single child. She doesn’t see her father often since her parents
separated when she was 6years old. Linda has two close friends that she normally socialises with but
since the worsening of her low moods she has not been able to socialise with her friends as she normally
would. Her mum has a history of schizophrenia.
Linda reported that she was sexually molested when she was 8 years old by her mother’s then partner
and still has flashbacks of the incident. She had a 6months prior and her partner left her after that. She
stated that it is after their separation that she started having low moods, self-harming and having suicidal
ideation.Linda has been unable to return to work since her miscarriage. She has been neglecting herself
and would sometimes go for weeks without having a wash. She spends most of her time is her room. A
month before the appointment with CMHT, Linda wrote a suicide letter to her mum and called her to tell
her goodbye as she wanted to take an overdose. Her mum was on her way back from work and got to her
in time to intervene.

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Introduction
Nurses must demonstrate principles of ‘holism’ or ‘holistic care’ to ensure achievement
of comprehensive health outcomes across patients (Bester and Van Deventer 2015). A number
of nursing models and processes hence focus upon incorporating the concepts of holistic nursing
in order to guide future nursing professionals (Hani and Ahmad 2016). The following paper will
critically demonstrate concepts of holistic nursing care during care planning of Linda, the patient
inflicted with clinical depression, suicide ideation and insomnia. The nursing process can be
defined by the APIE nursing process, that is, Assess, Plan, Implement, Recheck and Evaluate
(Wilson, Woollands and Barrett 2018).
Assessment is one the first steps in nursing which nurses must adhere to and comprise of
usage of critical and evidence based thinking by nurses to collect data on existing patient
conditions, in terms of both subjective and objective details (Shen 2015). Indeed, as noted by
Barden, Conley and Young (2015) mental health assessment is essential for formulation of an
accurate scenario of a patient’s health conditions, since it provides a detailed structure on not
only experiences and symptoms of a patient, but also his or her actions, thoughts, feeling,
wellbeing, medical and family history, cultural perceptions, personal skills and strengths and
quality of relationships.
This paper will critically discuss on the strategies with which a comprehensive and
holistic assessment and care plan was conducted on a patient. The patient to be focused on Linda
– a 21 year old woman, who has been diagnosed with clinical depression along with the mental
health issues of self harm, suicide ideation and insomnia. The case study also highlights the past
trauma and lived experiences of sexual harassment which may have contributed to these mental

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health issues in Linda. The following paper will hence demonstrate holistic nursing principles in
the assessment of Linda, so as to explore the relevant biological, social and psychological factors
which may have contributed to her present condition of clinical depression, suicide ideation and
insomnia. This paper will also demonstrate a critical analysis of whether targeting Linda’s
symptoms of insomnia can improve her symptoms of depression and a critical analysis of the
strategies with which the nurse can contribute to treating Linda’s symptoms of depression
simultaneously with her symptoms of depression.
Background
The nursing process, as postulated by Yilmaz, Sabanciogullari and Aldemir (2015), is an
essential component which nurses must incorporate in their professional nursing practice and
comprises of a comprehensive tool and guidelines which aim to implement foundational nursing
knowledge into practice and hence, ensure enhance nursing care quality for the patient. The
APIE tool, in this regard, proves to be a comprehensive, structured and effective nursing model
which nurses can implement to ensure optimum achievement of health outcomes in the patient.
Hence, taking insights of the same, the nursing process and care planning of Linda was
holistically incorporated (Wilson, Woollands and Barrett 2018).
The clinical problem of concern for the case management of Linda is the treatment of her
clinical depression. The mental health condition of depression, alternatively known as clinical
depression or manic depressive disorder, is outlined by the Diagnostic and Statistical Manual of
Mental Disorders (DSM-5), as that which compels an individual to lose pleasure in desirable
activities, increased fatigue, negative perceptions regarding one’s worth and self-esteem, reduced
or delayed thinking or compromised decision making process and frequent preference or

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thoughts towards self-harm, suicide or suicide ideation (Fried et al. 2016). Indeed, as observed in
the case study, Linda along with depression is also inflicted with symptoms of suicide ideation
and a wish to end her life. Further, it has been evidenced that the simultaneous treatment of
depression along with symptoms of insomnia ensures comprehensive achievement of positive
health outcomes in the patient. Authors Manber et al. (2016), postulated in their research that
symptoms associated with disturbances in sleep, are one of the most prevalent and consistent
implications across patients with depressive disorders. The research by Murphy and Peterson
(2015), further denote that the hindrances in an individual’s regulation of sleep is not a resultant
illness of depression, but rather are preceding symptoms of the condition which continue to
persist long term and hence, it has been implicated that addressing sleep improvements in
depression patients will result in improved patient health outcomes. Practitioners and hence
mental health professionals specializing in psychological and sleep medicine are hence required
to demonstrate awareness and importance of sleep regulation while treating patients with
depression (Carney et al. 2017). The following paper will hence demonstrate the simultaneous
management of insomnia and clinical depression in Linda to ensure that she receives the best
possible and most comprehensive treatment.
As per the APIE framework, the nursing process used in the case management for Linda,
comprised of the steps of Assess, Plan, Implement, Recheck and Evaluate (Wilson, Woollands
and Barrett, 2018). In accordance to Standard 3 of the Nursing Code of Conduct postulated by
the Nursing and Midwifery Code (NMC), nurses are required to ensure that nursing processes
and patient care interventions incorporate the social, psychological and physical needs of the
patient (Nursing and Midwifery Council 2019). Hence, taking insights from the same, Linda
needs based on her health assessment was determined using holistic nursing principles, popularly

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postulated by the Jean Watson in her Holistic Nursing Theory (Willis and Leone-Sheehan 2017).
Additionally, a biopsychosocial mode of assessment will be considered, as recommended by the
NHS’s ‘Five Year Forward View for Mental Health’ (Humphries 2015.). Further, the NMC
Standard 2 necessitates nurses to partner with patients in the development of their care plans and
encouraging or empowering them to achieve the same (Nursing and Midwifery Council 2019).
Hence, to encourage the same, a comprehensive assessment comprising of the Patient Centered
Assessment Method (PCAM) tool was also be administered to explore Linda’s multifaceted
needs such of wellbeing, health, health literacy as well as service coordination (Maxwell et al.
2018). To further ensure that holistic principles of assessment were conducted throughout the
care plan of Linda, the primary assessment which was used was the patient assessment tool
developed by the Southern Health NHS Foundation Trust, which comprehensively screened her
on aspects of past psychiatric and physical health history, family history, prevalence of substance
abuse symptoms, risks and recommendations for care plans (See Appendix 1).
Taking insights from the APIE framework, the nursing processes of diagnosis, planning
and implementation will also be considered as per Linda’s condition of clinical depression,
suicide ideation and insomnia (Hill 2015). The guidelines on depression established by the
National Institute for Health and Care Excellence (NICE) will be used to critically explore the
interventions require to manage the mental health conditions of Linda (National Institute for
Health and Care Excellence 2019). However, the NICE guidelines emphasize on the combined
administration of pharmacological treatments for depression such as antidepressants and
Cognitive Behavioral Therapy (CBT), the effectiveness of which, for this case study, will be
critically evaluated in case of Linda (Taylor and Perera 2015). Further, taking insights from the
evidenced effectiveness of simultaneous treatment of insomnia with depression, additional