Mental Health: Self and Others

This article discusses the mental status examination, clinical formulation table, plan for nursing care, therapeutic relationship, cultural safety, and recovery-oriented nursing care for a patient with depression named Mary. The article also includes references to studies that support the interventions suggested.

Running head: MENTAL HEALTH
Mental health: Self and others
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Part 1
1.1 The Mental Status Examination:
Level of consciousness:
Although Mary is orientated to time place and person, she is not that alert. She gives brief
response when attempts are being made to engage her.
General appearance:
Mary appears well-dressed and well-groomed evidenced by her brushed hair and
fashionable jeans and t-shirt with sandals.
Behaviour:
She avoids eye contact during the conversation and sits quietly with her hands clasped in
her fingers.
Mood and affect:
The patient is dysphoric and conversation with her reveals that she is depressed. Her
conversation also reveals feelings of worthlessness and hopelessness. She described many
moments of despair when she is tearful thus suggesting that she is depressed (Pollard, 2018).
Speech:
Her speech is very slow and monosyllabic. She is not fluent during conversation and
gives brief answer to questions.
Thought content:

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Her thought content is considered logical as she has the understanding that she is
physically well. She has also systematically described her treatment history related to diagnosis
of depression three years ago and cessation of the drug one year later. Her description about her
illness suggests that her thought pattern is coherent (Finney, Minagar & Heilman, 2016). There is
no hallucination or false sensory perception.
Perception/insight:
Mary had poor perception about her illness. Although she reports about feeling hopeless
and depressed and lack of motivation to complete simple activities, still she thinks any kind of
treatment is not necessary for her. Hence, her insight about illness is poor.
Judgment:
Her current judgment is poor because she needs to be admitted to the hospital fro treatment
of depression. However, she refuses it as she thinks looking after her children is important and
she is in not in need of any medication (Finney, Minagar & Heilman, 2016).
1.2 Clinical Formulation Table
Presenting
factor
Precipitating
factor
Predisposing
factor
Perpetuating
factor
Protective
factor
Depressed
mood, feelings
of hopelessness
and
worthlessness,
Previous
admission to
hospital for
depression,
medical history
Previous history
of depression is
a predisposing
factor as
evidence shows
Mary has
stopped visiting
the church and
responding to
phone calls from
Mary’s husband
Jim and her
children are
protective
factors that

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lack of interest
in daily
activities, poor
personal hygiene
and sleep
difficulty
of depression
and loss of
connection with
friends and
family
that depression
is a lifelong
disease where
recurrent rate is
high. Many
patients who
have half
recovered or
received
treatment
continue
experiencing
one or frequent
episodes of
depression
(Suija et al.,
2010). Hence,
diagnosis of
depression is a
predisposing
factor of current
symptoms for
Mary
friends. She has
also stopped
doing activities
that she enjoyed
such as visiting
church. Hence,
these
perpetuating
factor can
increase the risk
of depression
would help her
recover from
her illness

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1.3 Plan for Nursing Care
Based on assessment of Mary, two high priority problems that have been identified for Mary
are lack of social engagement and lack of positive skills to deal with her depression. Lack of
social engagement can be regarded as a nursing problem because isolating from friend and
family can deteriorate her symptoms and worsen her depression. Social isolation can have
negative effect on longevity as well as physical and mental health (Matthews et al., 2016).
Hence, to reduce severity of depression, it is necessary to provide intervention that promotes
social engagement for Mary. In addition, another high priority issue identified for Mary is that
she has adapted negative strategies to deal with her depression. Instead of taking steps to distract
herself from negative thought, she has taken the step to stay alone in the bed all time and be
tearful during moments of despair. Hence, her coping skills need to be addressed to prevent
future harm.
To reduce feelings of social isolation, the nursing intervention that is important is to
spend time with patient and encourage her to take part in activities that gives hope and
motivation. Prokofieva, Koukia and Dikeos (2016) give the evidence that establishing personal
rapport and showing positive regard to patient with depression is important to reduce social
isolation. By engaging in therapeutic relationship with patient, nurse can also assist Mary to
identify areas of changes and identify activities that can give her strength and pleasure. Social
connectedness is a part of treatment for depression and participation in social interaction can help
patients like Mary to improve social functioning and alleviate symptoms (Cruwys et al., 2014).

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As poor coping abilities has affected Mary’s ability to self-care and effectively deal with
depression, it is necessary to provide intervention that provides self-care support to Mary.
Attending to her hygiene and self-care needs and encouraging patient to increase responsibility
for self-care can strengthen independence of Mary and promote physical and mental health too
(Prokofieva, Koukia & Dikeos, 2016). As has adapted poor coping technique, resilience building
can be used as an intervention to increase Mary’s capacity to deal with episodes of grief. The
protective factors of patient can be used to increase resilience. Encouraging Mary to share her
worries with her husband would help her to get the required support during extreme events.
Shastri (2013) supports that the family plays a significant role in the development of resilience.
1.4 Clinical handover
The client Mary, a 41 year old woman is a patient with a history of depression and currently
suffering from recurrent symptoms of depression. Her current symptoms include lack of interest
in daily activities, poor personal hygiene, depressed mood, feelings of worthlessness, sleep
difficulty and lack of social engagement. Review of her family history shows she lives with her
husband Jim and three children. She works in large accounting form and Jim is a partner in the
legal firm. She is happy with her work too. Her family and children are protective factors of
illness. Her family history shows she was diagnosed with depression three years back suggesting
precipating factor behind depression.
The review of mental status examination has revealed that Mary is well-groomed however
has poor hygiene. She avoids eye contact and uses slow speech to express her concern. Although
she is orientated to place, however she has stopped taking part in activities like visiting church
and talking with friends. Not taking hypertensive medication and resistance to taking admission

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to hospital for treatment is also an issue. She had taken Citalopram for depression one year ago,
however no longer uses it now.
Part 2:
2.1 The Therapeutic Relationship
While providing care to Mary, establishing therapeutic relationship with Mary will be
important to facilitate positive nurse-patient experience and increase patient’s trust with care.
Therapeutic relationship building process can also act to enhance social support for Mary and
provide safe environment to her. Different types of skills such as communication skills, affection
and interpersonal skills enable nurse and other staffs to develop therapeutic relationship with
patient. Empathy is also an important skill that can be displayed by warmth, friendliness and
showing genuine interest towards patient problem (Clarke et al., 2017). Hence, empathy along
with friendliness can reduce level of depression for Mary and increase adherence to treatment.
One specific therapeutic skill that can be applied while engaging in therapeutic
relationship with Mary includes use of therapeutic listening skills. This skill is particularly
important during conversation with Mary because the main cause behind depressed mood is not
known. The assessment does not reveal about any event or stressors in life that has lead to
depression for Mary. Hence, therapeutic listening skill can be implemented by allowing space to
Mary to respond to her worries on her own will. Kornhaber et al. (2016) states that therapeutic
listening is a necessary component for data gathering and it acts a means for fostering positive
nurse-patient relationship too. Patiently listening to Mary’s concern can also help to identify her
unmet needs. Attentive listening, pausing and summarizing can help to achieve the purpose of
building therapeutic relationship with patient.

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2.2 Cultural safety:
While providing any nursing intervention to patient, respecting their cultural preferences
and values is necessary to provide high quality care and enhance patient experience with care. To
provide culturally safe care to Mary, her dignity will be respected during assistance for self-care
and hygiene related activities. During dressing Mary or while assisting her during bath,
necessary permission will be taken from her. Any cultural habits related to cleaning and hygiene
will also be respected. In addition, while planning social activities for Mary, it will be necessary
to consider her cultural values. This is important because the patient may not like engaging in
activities that violates her cultural values. Hence, the cultural safety principle of respect and
acknowledgement of cultural differences will be applied to avoid any cultural conflict with
Mary. This would help to provide care in an environment that protects identity and well-being of
patient. Another advantage of respecting Mary’s cultural value during care is that it can promote
equity, social justice and a climate of safety for patient (Almutairi, 2015).
2.3 Recovery-oriented Nursing Care
The key nursing interventions that has been planned for Mary includes increasing social
support for Mary to reduce social isolation and build resilience and positive coping skills to deal
with depression. The nursing intervention of social support has been planned by engaging in
therapeutic relationship by building rapport and showing positive regard to Mary. The
intervention is in compliance with the principles of recovery oriented care because therapeutic
communication skills puts patient at the centre and respects uniqueness of the individual while
providing care (Chester et al., 2016). Hence, by engaging in the process of therapeutic
relationship building and providing social support to patient, the intervention will enhance social

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identity and purpose in life. While planning social activities, her cultural considerations have
been considered too. This enables delivery of care in a way which supports recovery of mental
health consumers. By respecting cultural preferences and giving patient autonomy, Mary can be
empowered to lead a better life. Active listening skills and acting after communication with
patient are positive attitude that respects right of patient and supports nurse to work in realistic
way with patient (Kidd, Kenny & McKinstry, 2014).
The nursing intervention of promoting resilience and positive coping skills has been
planned to increase motivation and interest towards recovery in patient. Positive coping
technique can address Marie’s poor perception towards her illness and motivate her to engage in
activities that distracts her from negative feelings. Resilience is a concept in mental health that is
directly linked to recovery oriented care because resilience is a skill that can help patients like
Mary to learn coping skills, gain competencies and increase their capacity to fight with mental
illness. Resilience can help to maintain equity in care and preserve rights of patients too as
resilience can be developed as a strength to avert mental illness (Howell & Voronka, 2012).

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References:
Almutairi, A. F. (2015). Fostering a supportive moral climate for health care providers: Toward
cultural safety and equity. NursingPlus Open, 1, 1-4.
Chester, P., Ehrlich, C., Warburton, L., Baker, D., Kendall, E., & Crompton, D. (2016). What is
the work of recovery oriented practice? A systematic literature review. International
journal of mental health nursing, 25(4), 270-285.
Clarke, S., Ells, C., Thombs, B. D., & Clarke, D. (2017). Defining elements of patient-centered
care for therapeutic relationships: a literature review of common themes. European
Journal for Person Centered Healthcare, 5(3), 362-372.
Cruwys, T., Haslam, S. A., Dingle, G. A., Haslam, C., & Jetten, J. (2014). Depression and social
identity: An integrative review. Personality and Social Psychology Review, 18(3), 215–
238.
Finney, G. R., Minagar, A., & Heilman, K. M. (2016). Assessment of mental status. Neurologic
clinics, 34(1), 1-16.
Howell, A., & Voronka, J. (2012). Introduction: The politics of resilience and recovery in mental
health care. Studies in Social Justice, 6(1), 1-7.
Kidd, S., Kenny, A., & McKinstry, C. (2014). From experience to action in recovery-oriented
mental health practice: A first person inquiry. Action Research, 12(4), 357-373.
Kornhaber, R., Walsh, K., Duff, J., & Walker, K. (2016). Enhancing adult therapeutic
interpersonal relationships in the acute health care setting: an integrative review. Journal
of multidisciplinary healthcare, 9, 537.

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Matthews, T., Danese, A., Wertz, J., Odgers, C. L., Ambler, A., Moffitt, T. E., & Arseneault, L.
(2016). Social isolation, loneliness and depression in young adulthood: a behavioural
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Prokofieva, M., Koukia, E., & Dikeos, D. (2016). Mental health nursing in Greece: Nursing
diagnoses and interventions in major depression. Issues in mental health nursing, 37(8),
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Shastri, P. C. (2013). Resilience: Building immunity in psychiatry. Indian Journal of
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