Case Study: Elderly Stroke Survivor with Depression (NURS8707)

This case study examines an 85-year-old male stroke survivor experiencing depression. The analysis begins with an introduction to the issue of depression in the elderly population, particularly those with co-morbidities like stroke. The study applies evidence-based practice, focusing on the Geriatric Depression Scale and a comprehensive mental health status examination. Miller's Functional Consequences Theory is used as a framework for nursing assessment, emphasizing a holistic approach. The assessment considers age-related changes and risk factors contributing to negative functional consequences. Nursing interventions include activities to improve focus, addressing physical health, and wellness-focused strategies. The study also explores the theory of Impaired Social Interaction, identifying factors contributing to the patient's depression, and highlights the importance of nurse-patient relationships, collaboration with colleagues, and resource management in providing effective care. The conclusion emphasizes the prevalence of depression in elderly populations and the need for coping strategies.

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Introduction
Depression is becoming extremely common across the Australian population (Chan,
Chan & Mok, 2010). Elderly patients with associated factors such a personal loss or physical
illnesses are more likely to experience depression. It has been estimated that between 10 and 15
percent of older people experience depression with 10% of people experiencing anxiety. In the
current case study, an 85-year-old man Mr. Peter Wilson is in the transitional care unit room and
is a first-time stroke survivor. His middle-aged children discuss their father's return from
rehabilitation therapy. They find out that a psychiatrist at the center, who had been called for
referral figured their father was suffering from depression. However, his daughter is unable to
realize the cause of depression of his father, as she states that he had lived a good life.
Evidence-based practice
A nursing care plan for the patient with depression, need to first determine the degree of
impairment and assess the ability to cope. Then the patient needs to be assisted to deal with the
current situation through the meeting of psychological needs and promotion of health and
wellness (Aylaz, Aktürk, Erci, Öztürk & Aslan, 2012). The functional consequence theory has
provided the primary guide to the analysis and comprehension of nursing care for this case. In
order to provide appropriate nursing interventions and support to the elderly patient, evidence-
based assessment tools need to be adapted. The evidence-based tool used was the Geriatric
Depression Scale. The scale includes a simple answering of questions to understand the level of
depression existing in the patient. This scale will take minimum time to be filled out and then the
condition of the patient can easily be understood.
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Moreover, a comprehensive mental health status examination (MSE) would be conducted
to understand the behavior, mental and overall condition of the patient (O'Connor, Whitlock, Beil
& Gaynes, 2009). An MSE is a tool that can reflect the overall mental health status of the patient.
Functional Consequences Theory
A nursing assessment of mental health for the patient needs to be conducted. The nursing
assessment will encompass a holistic approach that includes the individual, mind, body, and
spirit along with the whole person and the environment. Miller's (1990) Functional
Consequences Theory provides a framework for nursing assessment and managing care for the
elderly patient (Le Roux & Kemp, 2009). According to the theory, acute confusion has been
identified to be common complications amongst elderly hospitalization which impacts usage of
health care resources and the functional status amongst individuals. In order to cater to optimum
nursing care to the patient, the nurse needs to possess the capability to differentiate acute
confusion from other common conditions prevalent amongst elderly patients, such as depression.
Secondly, the nurse's ability to figure out the factor that contributes to the condition has to be
identified and applying of interventions such that impacts of various factors can be reduced on
the patient needs to be identified. The theory allows nurses to diagnose the risk factors that are
associated with the development of this condition.
Applying this model, the nursing model that has been identified is the Geriatric
Depression Scale, which diagnoses depression amongst elderly patients in hospitals. The scale
has 15 items that are used in the informant report (Schoenmakers, Buntinx & Delepeleire, 2010).
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When the scale measurement was applied, then the overall status of the individual was
adequately ascertained.
The age-related changes and risk factors that contribute to the negative functional
consequences are lowliness. Reduced physical movements, fear of rejection, and feeling of
worthlessness are some contributing factors. The patient lacked support in his old age which adds
to the detrimental effect on his mental and physical conditions.
The actual and potential health problems for interventions in the case study include the
inability of the patient to concentrate. Generally, depressed people lack memory and
concentration, hence there is a minimal opportunity where the patient would put himself down,
so simple tasks has to be first initiated (Underwood et al, 2013). Failure to involve the patient in
gross motor activities, though such activities allow to elevate mood, yet it was not possible to
relieve the tension of the patient. Another major problem for this case in providing nursing
intervention was the physical health status of the patient where he had survived a stroke. He was
in a lot of pain and was unable to concentrate or focus on the activities for mental nursing
interventions.
Wellness focussed interventions;
NURS8707 Nursing care of
older people with complex
health needs
Goals for wellness
outcomes
Nursing interventions
Nursing evaluation
Indulge in activities that
require minimum
concentration, e.g. drawing
Gradually developing focus of
the patient
Good development of focus of
the patient
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Involving the patient in one-
to-one activity, when he is the
most depressed state
Relieving tension and
elevating mood
Ability to get out of the
depressed mood
Referring the patient to self-
help groups in the community
Gaining support from sharing
other people’s experience
Understanding the importance
of the issue
Learning Experiences
The current case study analysis provided tremendous insights into various theories and
concepts in nursing care. The theory that has primarily been applied to resolve this case is
Impaired Social Interaction, where there is the insufficient or ineffective or excessive quality of
social exchange (Karakaya, Bilgin, Ekici, Köse & Otman, 2009). The theory states that
depression can be triggered by various factors such as the feeling of worthlessness, fear or
rejection, altered thought processes or due to lack of support system or self-concept disturbance.
In this case, the patient's condition can be related to most of the factors except for self-concept
disturbance. It is evident that the patient had dysfunctional interaction with his family members
as they were old and busy in their individual lives. He felt secluded from the rest of his family
members.
The theory-informed practice has enabled me to undertake appropriate diagnosis and
identify the possible desired outcomes for the patient (Watson, Zimmerman, Cohen & Dominik,
2009). Moreover, the theory enabled me to recognize the potential factors that had contributed to
the current situation of the patient. It was possible to enhance the nursing interventions based on
the rationale provided in the theory.
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With the assistance of the theory, I partnered with the patient as well as significant others
present in the healthcare center to develop and implement adequate nursing interventions. With
professional communication and team collaboration, I was able to effectively collaborate with
the patient (Tsai, Tsai, Wang, Chang & Chu, 2010). This partnering approach allowed
enhancement of care outcomes for the patient, as he was able to confide in me his needs and
preferences. The nurse-patient relationship is crucial and a major aspect in rendering patient-
focussed care. I was able to provide him support and assistance as and when he required.
Moreover, I was able to convince him of the medication he was not willing to take an altered
some medications according to his preferences as well.
I collaborated with my colleagues, which included others from varied disciplines as well
to enhance work-related outcomes for the patient (Lamers et al, 2010). For example, I worked
with the physician, who was responsible for his physical wellbeing, to know if we are not
providing any contradictory medications to the patient. This collaborating relationship enhanced
physical along with mental health outcomes for the patient.
There was need of tremendous resources and management support for the nursing
intervention that needed to be provided to the patient. Resources needed to be appropriate
medication, availability of room for the patient, whereas management permission was required to
collaborate with people from other departments and specialization areas. Strategies that were
applied to get these resources and management support was forming a formal report to be
submitted to the departmental head for nursing interventions (Andreescu & Reynolds, 2011).
Moreover, I had to discuss with my senior authorities regarding the possibility of outcomes with
such interventions. This enabled the sustaining of well-focused and high-quality care for the
patient.
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Conclusion
The rates of depression amongst people living in residential aged-care are estimated to be
as high as 35%. Elderly people are hesitant to share their experience of depression and anxiety in
comparison to others. The case study reveals that the patient had ignored symptoms for long
periods prior to seeking professional help and was diagnosed when he was admitted with a
physical ailment. Nurses need to provide coping strategies such that the patient is able to cope
with the current depression levels as it has already been diagnosed.
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