NURS 1021 Case Study: Managing Depression with Nursing Interventions

This case study examines the nursing care of a 45-year-old woman, Mrs. Kate, diagnosed with major depressive disorder following her mother's death. It delves into the patient's physical, social, and psychological symptoms, including loss of appetite, social withdrawal, and feelings of worthlessness. The study applies the APIE (Assessment, Planning, Implementation, Evaluation) model to guide the care planning process, emphasizing a holistic and patient-centered approach. It discusses the relevance of mental health policies, such as those in England, and explores the impact of ill-health on the patient and her family. Nursing interventions, including cognitive behavioral therapy, motivational interviewing, and social interventions, are detailed, alongside the use of the Beck Depression Inventory for assessment. The study also highlights the importance of trauma-informed care and the role of a multidisciplinary team in implementing the care plan. The goal is to reduce feelings of worthlessness, increase motivation, promote social inclusion, and improve the patient's appetite. The case study demonstrates how nursing theory can be applied to promote safe and effective nursing practice.

Running head: NURSING CASE STUDY
NURSING CASE STUDY
Name of the student:
Name of the university:
Author note:

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Introduction:
With the global burden of the disease, depression is a common psychological disorders
affected more than millions of individuals worldwide. The world health organization suggested
that approximately 800 000 individual die due to suicide every year where depression is one of
the common cause of depression (Www.mentalhealth.org.uk. 2020). The other common
symptoms of the symptoms such as low mood, loss of interest, enjoyment and reduced energy.
Hence, this essay aims to provide a detailed analysis of a scenario of a healthcare service user
who is suffering from a illness or a disability along with discussing how the care has been
managed with the help of a systematic, care planning approach. To deliberate the chosen case
scenario, this essay will identify public health policy as well as ill-health impose impact on bio
psychosocial health of the patients and family members. This essay will explore a range of
evidence along with rationale that underpin the knowledge as well as skills needed for safe and
operative nursing practice. Awareness of the problem-solving skills with the assistance of the
APIE model and holistic model will be incorporated in the essay. The nursing theory will be
used to demonstrate the awareness of the role as well as responsibilities to involve in safe
practice. For complying with the NMC Code of Conduct of confidentiality, the healthcare
service user to be discussed in this assignment will be referred to as Mrs Kate (Www.nmc.org.uk
2020).
Discussion:
Understanding of common physical and psycho-‐social health problems: (section 1)
Mrs Kate, 45 years of a woman is suffering from the major depressive disorder due to
sudden death of the mother. She is married and has two kids. Her husband stated that she has

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hypertension and exhibit anxiety when her mother was in death bed. She was close to her mother
after the loss of her father in a refugee camp. After the sudden death of her mother, she exhibited
loss of appetite, lack of motivation and significant weight loss. For the past three months, she
refused to talk to her husband and kids and frequently asked them to leave. Other symptoms
include worthlessness, low self-worth and depressed mood.
This condition is considered as the major depressive disorder that impacts the patients
physically, socially and psychological model. Stress vulnerability model helps in identifying the
mental health problem. According to stress vulnerability model, human being carries
predisposition and genetic factors of mental illness (Www.bhevolution.org 2020). In this context,
Mrs Kate lost her father when she was young and recently lost her mother that subjected her to
psychological distress. Consequently, the stress disrupted the normal function of
neurotransmitters (dopamine and serotonin) which resulted in an exhibition of various
symptoms. The physical impacts of the depression include weight loss, loss of appetite which
were exhibited by the patient. The social impact is the lack of interactions with the family
members and social exclusion. On the other hand, Mrs Kate exhibit various psychosocial impacts
such as worthlessness, lack of motivation and low mood.
Mental health policy in England is one such policy that supports the mental health and
wellbeing of individuals with mental illness. This policy is relevant since the policy designed by
NHS provide various mental health services such as access to care, quality of care, and allocation
of necessary resources to the mentally ill patients in order to achieve parity of esteem between
mental and physical health under the mental health act 1983 (Parkin and Powell 2020).
The family of the patients are highly impacted by depression since the patient reduce
interactions, communications. In this context, the family members are required to support by

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including them in the care process. Richardson and Barkham (2017), suggested that family
members can be incorporated and encouraged to be emotionally supportive towards patients,
effectively communicate with the family members, and emphasize the patients and family
members.
Nursing model and intervention: (section 2)
To gain a better understanding of the problem-solving approach, APIE model as a
problem-solving approach to the care planning which uses development of access, planning,
implements and evaluate the nursing care process (Glasper 2020). The use of nursing models is
often required to ensure holistic wellbeing and a patient-centred approach to care. Therefore,
the APIE can be considered a valuable tool in the context of wider nursing models to facilitate
care planning and decision-making. This model enables the assessment of the patient through
asking questions to Mrs. Kate and family member of Kate, planning care interventions that will
manage symptoms of the depression experienced by Kate. During planning, these models help to
consider the lifestyle of the patient, values and influence of the family members. Anderson et al.
(2017), argued that implementation of care can be done through specific nursing interventions
where the principle of person-centred care is required to incorporate. At this context, nursing
interventions that were used for the patients include cognitive behavioural therapy, motivational
interview and recreational activities. The implementation also enables goal-setting of the patients
for prorating the care. The evaluation part of the nursing care enable nursing professionals to
monitor the mental health of Mrs Kate.
Assessment of the patient: ( section 3)
In order involved in nursing care, the bio psychosocial model of care was used to assess
the patient. Habtewold et al. (2016), suggested that bio psychosocial model enable nurses to

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consider psychical factors, biological factors and socio-environmental factors for planning the
care such as self-efficacy, relationship with family members, frequency of social activities and
other stressors that can lead to mental illness or physical illness. Taking a deep insight of the
situation, Mrs Kate exhibited various clinical manifestations after the death of her mother such as
low mood, lack of social interaction, effective communication which can be considered with the
assistance of biopsychosocial model. According to the third principle of NMC code of conduct
(2018), the nursing professionals must ensure that the physical, social and psychological needs of
the patients were assessed and responded to. Hence, at this juncture, APIE model was used to
plan the care and conduct the assessment of the patient. Mrs Kate was assessed with the help
of Beck Depression Inventory (BDI). The rationale behind using the Beck Depression
Inventory (BDI) was that it uses a serious of questions for measuring the intensity, depth and
severity of the depression (Www.ismanet.org. 2020). Hence, this Beck depression inventory was
effective in assessing the depression of the patient (Knaster et al. 2016). While assessing the
patient with the assistance of this Beck depression inventory, the mood of the patient, sense of
failure, loss of identity, the reason behind the social withdrawal, lack of motivations was
considered in order to identify negative cognitive distortions of the patient. After assessment
through this scale and in-depth observations, the symptoms exhibited patients were aligned with
DSM V criteria. According to the Diagnostic and Statistical Manual of Mental disorder V (DSM
V) published by the American Psychiatric Association (APA) major symptoms of depression
include depressed mood, lack of motivation for involving in the activities, feeling of
worthlessness, lack of communication with the family members along with the social withdrawal
(Wright et al. 2018). In this current context, after assessment and observation, the result
suggested that Mrs Kate exhibited all of these clinical manifestations where the loss of loved one

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might be the stressor behind the development of depression. Moreover, since the patient mostly
felt worthlessness, lack of motivations and social withdrawal, the psychosocial aspect of
assessment was given priority when planning the care process. Apart from the depression
assessment, the patient was involved in the effective communication in a form of interactions
where Mrs Kate was asked various common questions such as any thoughts of suicide, four to
five stressors, medical history, medical history, surgical history, drug and alcohol used (Kaser,
Zaman and Sahakian 2017). During the assessment, it is usually observed that patient lose their
independence, dignity. While assessing the patient, the principle of person-centred care was used
since it enables nursing professionals to maintain dignity by respecting their wishing as well as
treating with compassion as well as empathy. In order to promote the collaborative practice,
family members of Mrs Kate were involved so that other symptoms exhibited by Mrs Kate can
be obtained through the narration of the patient. Hence, after complete assessment, identified
priorities include social exclusion, lack of motivation and worthlessness, lack of
communication.
Planning of care: (section 4)
As discussed by Jones et al. (2018), while planning care for addressing the needs of the
patient, lifestyle, values, social factors are considered which will further influence the goal of
living a purposeful life. In order to develop the care plan, a direct goal was designed with the
collaboration of Mrs Kate and family members of the patient. At this juncture, the goal designed
includes, reducing the feeling of worthlessness, motivating patient, social inclusion and
improving appetite of the patient. In order
Reducing the feeling of worthlessness:

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As observed in the case study, Mrs Kate was close to her mother and after loss of her
mother she exhibited the symptoms of depression. LeBlanc et al. (2020), suggested that after the
loss of loved once leads to severe grief that resulted in a feeling of worthlessness. In this current
context, this might be the case that after losing mother she experienced grief which resulted in
feeling of worthlessness. At this juncture, Cognitive behavioural therapy is the most suitable
intervention to reduce worthlessness. NHS guideline of the United Kingdom suggested that it is
goal-oriented psychotherapy treatment with a problem-solving approach that changes the
thinking pattern of the patients. Hence Tallon et al. (2019), suggested it will enable nursing
professionals to assist the patient in improving emotional regulation, developing personal coping
strategies and alter negative thought process with a positive thought process. Hence, it was the
most suitable approach for Mrs Kate to replace the feeling of worthlessness with positive self-
worth. Moreover, involving the patient in effective communication during the therapy period is
effective in reducing low mood, maladaptive beliefs. Hence, cognitive behavioural therapy twice
a week was recommended for her for 1 to 2hours. It will also reduce the sleeping problem.
Motivating patient:
As discussed by DelDonno et al. (2019), lack of motivation in clinical depression often
observed when patients experiencing difficulties to cope with issues or life events that affect the
self-confidence. At this juncture, loss of mother might be the contributing factors behind the lack
of motivation that reduced her self-confidence as well. Mack et al. (2017), suggested that one
counselling approach that seeks to maximize the therapeutic relationship between client and
practitioner is the motivational interview. The motivational interview enables professionals to
reflect empathy through listening, support self-efficacy and optimism, avoid conflicts and

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support the personal recovery of the patient. In this current context, to motivate patient for living
a purposeful life, the motivational interview was recommended for once a week for 3 hours.
Social inclusion:
Social withdrawal is common amongst the patients of depression due to various stressful
life events as observed in the case scenario. At this juncture, social interventions can be effective
to reduce social withdrawal. Nagy and Moore (2017) suggested that social interventions such as
foster interpersonal interaction between community members, increased participation amongst
existing friends, creating a connection with the strangers improve communications, copping
skills and express suppressed emotions.
Improving the appetite of the patient:
Reduced or loss of appetite is common amongst patients with depression as observed in
this case scenario. At this juncture, a healthy diet is effective in reducing depression. Northstone,
Joinson and Emmett (2018), suggested that a healthy diet including fresh vegetable and fruits can
improve low mood and increase the appetite of the patient.
Implementation of care (section 5):
In order to implement planned care designed for the patient, the principle of trauma-
informed care will be implemented. The multidisciplinary team play a crucial role in
implementing care. During the implementing care, the multidisciplinary team included mental
health nurse, psychologist, nurse and nutritionist (Rycroft-Malone et al. 2017). The role of the
nurses in the multidisciplinary team was to coordinate the care process for ensuring that Mrs
Kate is receiving holistic care intervention in order to develop self-efficacy and live a purposeful
life. Moreover, involving Mrs Kate in social interventions for social inclusion was also part of

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the duty of care of the nursing professional. Mental health nurse was assigned to motivational
therapy, the psychologist was assigned to do cognitive behavioural therapy and the nutritionist
was assigned to ensure a healthy dietary pattern of the patient. Taking a deep insight into the
situation, in order to implement the care, safe space was created where the patient can feel
culturally, emotionally and physically safe according to the first principle of trauma-informed
care (Sweeney et al. 2016). The family members and each member of the multidisciplinary team
were involved in creating a comforting environment for the patients where the rights and
responsibilities of Mrs Kate were informed for complying with the second principle of trauma-
informed care. With the collaboration with Mrs Kate and her family members, the shared
decision making was done regarding the implementation of care (Sweeney et al. 2016). As
discussed by Gunter and Greenberg (2017), in the clinical setting, patients usually lose their
ability to participate actively in the care process. At this juncture, involving the patient as an
active role player in the care process and maintaining respectful boundaries with the patient for
complying with the third and fourth principle will restore the respect and dignity of the patient.
While implementing planned care, Mrs Kate was involved in the effective communication for
developing a therapeutic relationship with each member of the multidisciplinary team and with
the consent of the patient, the interventions were implemented in accordance with the fifth
principle of NMC code (2018) (Www.nmc.org.uk 2020). Considering the reaction of the patient,
Mrs Kate was slowly responding to the implemented care process, especially cognitive
behavioural therapy. Initially, she was agitated to do social interactions. However, after the
active involvement of her husband and her kids in each part of the care process, she responded to
the implemented care which was reflected in increased self-confidence, improved self-esteem
and improved mood. She interacted with her family members and her kids which she refused to

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do during the depression. Moreover, she retrieved her identity and hope of living a purposeful
life that she failed to retrieve during the period of depression, indicating implemented care
process was successful in improving the mental and physical health of the patient. Moreover,
with the assistance of a nutritionist, she was involved in consuming health dietary pattern that
improved her mood.
Evaluation of care process:
In order to complete a holistic care process and success along with the efficiency of the
care process, evaluation stage of APIE model is one of the most crucial stages that will provide
an understanding of the efficiency of the implemented care. The information from this
assessment will allow the nurses to establish if the implemented care was comprehensive and
holistic. In order to evaluate the intervention of the patient, two types of assessment can be done
such as mental health assessment and physical assessment. In order to assess the cognition,
memory, flights of thoughts, attention of the patient, the mini-mental state was conducted.
Lawton et al. (2016), suggested that mini-mental state is observational evaluation tool that
contains various questionnaires to assess the thinking process of the patient, flights of thoughts
or distorted pattern of the thought, attention of the patient along with other memory of the patient
for providing an in-depth idea of the mental health of the patient. On the other hand, Giebel and
Challis (2017), suggested that Montreal cognitive assessment enable professionals to assess
diverse domain of the cognitive dysfunction such as concentration, memory, language, skills,
calculation and orientation. At this juncture, mini-mental state enables nursing professional as
well as a multidisciplinary team to gather an understanding of the improvement of mental health
of the patient and response rate to the care process. Additionally, Montreal cognitive assessment
was used to focus on the cognitive function of Mrs Kate as it is a common instance for the

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clinically depressed patient to have cognitive dysfunction. All these assessments suggested that
patient exhibited improved mood, increased self-esteem, increased confidence, positive outlook.
Moreover, with the assistance of a nutritionist, she was involved in consuming a healthy dietary
pattern that improved her mood.
On a different note, physical assessment of the patient was also conducted to identify the stress
response through facial features. Observation of the facial feature of the patient will provide the
idea that whether patients are agitated or not. In this context, the physical assessment was
conducted by incorporating observation of facial features. After the assessment, she exhibited no
sign of agitation and depression or low mood. These evaluation data suggested that the patient
was responding to the implemented care by improved self-efficacy, improved social inclusion
and improved self-confidence. However, in order to gain long term recovery from clinical
depression, the prolonged adherence to the implemented care can be an effective strategy which
will reduce stress and install a hope of living a purposeful life.
Conclusion:
On a concluding note, it can be said that depression is one of the most common
psychological disorders affected more than millions of individuals worldwide. The purpose of
the paper was to depth analysis of choose a case scenario of a 45 years patient who was suffering
from depression after the death of the mother. The exhibited symptoms of the patient include
weight loss, loss of appetite, feeling of worthlessness and social withdrawal. Stress vulnerability
model suggested that since Mrs Kate lost her father when she was young and recently lost her
mother that subjected her into psychological distress. The assessment was conducted using the
Beck Depression Inventory (BDI) which aligned with DSM v. The identified goal of the patient
includes reducing the feeling of worthlessness, motivating patient, social inclusion and

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improving the appetite of the patient. For reducing the feeling of worthlessness cognitive
behavioural therapy, for motivating patient motivating interview, for, social inclusion social
intervention and improving the appetite of the patient improved healthy diet was given. A
multidisciplinary team was designed where a mental health nurse was assigned to motivational
therapy, the psychologist was assigned to do cognitive behavioural therapy and the nutritionist
was assigned to ensure a healthy dietary pattern of the patient. The care process was
implemented through principles of trauma-informed care such as safety, choice, trustworthiness
and empowerment. The patient responded to the care process since she exhibited improved self-
efficacy, improved self-esteem and improved mood. Montreal cognitive assessment and mini-
mental state were used to assess the mental health of the patient which provided the idea of
mental health and recovery after assessment.