Mental Health Nursing: Mary's Case Study and Management

This report focuses on the nursing management of a patient, Mary, a 65-year-old woman suffering from depression. It begins with an introduction to mental health illness and its impact, followed by a detailed assessment of Mary's physical, psychological, mental, social, and family conditions. The report highlights the importance of holistic care and the role of nurses in providing support and treatment, including cognitive and interpersonal therapies, medication management, and the use of evidence-based interventions. It emphasizes the significance of social inclusion, recovery, and relapse prevention, as well as the need for ongoing nurse-patient relationships and cross-disciplinary collaboration. The report also discusses the use of problem-solving therapy, healthy eating practices, and encouraging social activities to improve the patient's health outcomes. The case study underscores the importance of comprehensive care and the application of various therapeutic approaches in the treatment of depression.

MENTAL HEALTH NURSING

TABLE OF CONTENTS
INTRODUCTION...........................................................................................................................1
A PERSON LIVING WITH MENTAL ILLNESS.........................................................................1
Physical assessment....................................................................................................................1
Psychological assessment...........................................................................................................1
Mental assessment.......................................................................................................................2
Social assessment........................................................................................................................2
Family assessment.......................................................................................................................3
Ongoing management of the nurse person relationship with cross discipline context...............3
B. PERSONS NURSING MANAGEMENT...................................................................................4
C. CONSIDERATIONS MADE FOR SOCIAL INCLUSION, RECOVERY AND
PREVENTIONS OF RELAPSE......................................................................................................6
CONCLUSION................................................................................................................................8
REFERENCES................................................................................................................................9

INTRODUCTION
Mental health illness is a severe disease which hampers patient's ability to think and
react. It causes disturbances in thoughts and behaviour of an individual where the person is
unable to make necessary action to a certain situation. The disorder is one of the major cause of
concern for the nurses who have been provided the responsibility to cure depression.
Assignment has highlighted the nursing management of the patient. It will also demonstrate
considerations made for social inclusion, recovery and prevention of relapse of service users.
A PERSON LIVING WITH MENTAL ILLNESS
Mary, a 65-year-old lady is suffering from depression. During patient assessment it was
analysed that her husband died few years ago and she was living alone, away from her daughters.
The daughters meet her, once in a month. She has a habit of smoking cigars and also consume
liquor on regular basis. She has also tried to attempt suicide after the death of her husband. It was
noted that the patient has also weighted loss in the past years but still was very weak and
stressed. In addition, Mary remain very quiet and do not interact with family members or
relatives.
Physical assessment
The physical assessment of the patient denoted that because of the loss in appetite, her
body became weak. Moreover, care worker determined that she was a regular smoker and
alcoholic which can make patient at a risk of developing more problems like kidney failure or
cardiovascular disease. Depression is a disorder in which a patient is surrounded by the feeling of
intense sadness and hopelessness. The disease leads to mental, psychological and physical
changes which has been seen in Mary. The changes hamper the quality of life and decreases
service users' ability to manage their health. However, to cure patient suffering from mental
disorders, nurses are expected to manage and assess the holistic needs of service users who are
physically and mentally ill. Moreover, while providing treatment they focus on analysing signs
and symptoms of patient suffering from depression.
Psychological assessment
The psychological assessment shows that the patient is suffering from acute depression
which can be because of loneliness and isolation as she lives alone. Death of husband can also be
one of the major reason behind her depression (DiClemente, 2018). Treating depression is a vital
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concern for the health-care professionals as untreated disorder increase mortality rate, and
reduction in health quality of patients. Nurses are involved in assessing patients physical,
mental, psychological and family situations. This help them in developing better understanding
over the needs and demands of patient which support nurses in improving service users' health
outcomes.
Mental assessment
The mental assessment of patient shows that all the problems, Mary has been facing in
her life has negatively impacted the mental health condition of her. In order to treat depression
health-care professionals identify the signs and symptoms in patients which are the major cause
of change in behaviour (DiClemente, 2018). Assessment Eco-map tool can be used by nurses
while treating Mary. The assessment includes view of family members, friends neighbour in
order to provide physical and mental support to patient. For assisting Mary health-care
professionals will be involved in taking one to one interview to derive personal, social,
psychological and family history of the service user.
Social assessment
The social assessment presents that Mary is not involved in any type of interaction with
her family members and is very quiet in nature. It can be one of the major cause of depression in
patient. They should ask questions about signs and symptoms related to the disease and
encourage them to express their mood and thoughts (Ross, Tod & Clarke (2015). Assessment
made by health-care professionals need to be patient centred. Raab (2014) says that patient
centred care consist of providing diagnosis according to the needs, preferences and values of the
service user. It includes listening, informing and engaging Mary and her family members in her
treatment process. If nurses are not involved in encouraging patient to share and express their
mood, they would not be able to analyse and evaluate the exact mental situation of service user
(Chukhraev et.al. 2017). Nurses can make use of the screening tools like rating scales which help
them in detecting the major reason behind the disease but on the other hand health-care
professionals focus on determining need for training by using tools like eco-map. There exists
an evidence that geriatric depression scale is a very useful self-rating tool which is used by
nurses for screening old age people suffering from psychiatric disorder (DiClemente 2018).
Effective communication need to be laid between service user and health-care provider
because it helps nurses in developing better understanding over holistic needs of patients. Also,
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nurses will focus on providing emotional support to Mary which will helps in motivating and she
will be able to share her feelings, thoughts and cultural values to nurses. For example, she will be
able to express about the problems going in her life. Ineffective interaction between patient and
experts hamper the growth of the service user. For example, if Mary will not tell about the signs
and symptoms related to disease, nurses will not be able to properly understand the situation.
Also because of this health-care professional would not be able to recognise the spiritual needs
of patient.
Family assessment
It was assessed that Mary was living alone and she is suffering from depression since
after the death of patient's husband. However, living alone and away from her family have made
Mary sad and depressed. Major cause of depression is isolation and loneliness, as she has to live
alone at her home and no one is there to take care. She does not interact with friends and does
not participate in social events. Holistic care needs to be provided by nurses to Mary. Further, it
is important for health care professionals that to recognise mental, physical health requirements.
In accordance it can be said that the best way to treat depression of Mary is to admit her in
shared care ward in hospital.
Ongoing management of the nurse person relationship with cross discipline context
Nursing patient relationship is bond of trust and mutual respect where focus of nurse is
on treating patient in best possible ways. However, patients are liable to coordinate with care
providers. In accordance with case, where Mary who is 65 years old and is suffering from
depression focus of nurse will be on keeping her involved with social activities. Patients
admitted in general wards have been seen with the better health outcomes. In this nursing
principle is to value the cultural beliefs, thoughts and religion of the patient (Galletly and et.al.
2016). They must follow the ethical principles which includes honesty, beneficence, and
autonomy. This means that all the decisions related to service user need to be made by patient.
Also, health-care professionals impart fair and equal treatment and does not involve in any type
of discrimination on the basis of caste, colour, gender and sex. However, the nurses are bound to
follow and practice ethical principles as not following approaches can hamper the growth of
patient (Thieme et.al. 2015).
The skills that are implemented by nurse while treating depression is the good
communication and cross-disciplinary practice. Nurse recognise the role of family in her life and
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will offer guidance and support to Mary accordingly. The focus of care providers will be on
involving Mary with other patients and cognitive therapies which are the best way for distracting
one’s mind and curing depression. Apparently, cross-disciplinary practice of nurse will be based
on perspective shared by multidisciplinary after assessing over health condition of Mary. Further,
working with multidisciplinary team will help the nurses in recognising the exact problem which
patient is facing. Health-care Professionals can use the evidence based interventions to improve
the health outcome of the patient. These therapies are highly structured and disciplined which
can help Mary in overcoming depressed state. Thus, the team will aim at preventing decline in
mental functioning of Mary.
B. PERSONS NURSING MANAGEMENT
As per the views of Le Boutillier et.al. (2015) cognitive therapy can be termed as an
effective method of cross discipline context as it helps in reducing negative thoughts and stress
among patients suffering from mental illness. This therapy consists of mental tool kit which is
used to challenge the change in behaviour. The cognitive therapy allows the depressive person to
talk about the views and thoughts which are going in their mind. This therapy is effective for the
individual suffering from mild to moderate depression.
According to views of Thieme et.al. (2015) nurses also adopt Interpersonal therapy
which is manual based treatment that helps the depressed individual in focusing on social
occasions and give them ability to fight against the diseases. On the other hand, Le Boutillier
et.al., (2015) stated that Electroconvulsive therapy is also implemented by care providers which
is mainly used for the patients suffering from severe depression. In this therapy the patient goes
through electrical impulses to the brain. Nurses use the evidence based interventions in order to
improve the health outcome of the service user. These therapies are highly structured which
helps patient in involving is learning and social activities which are designed to overcome
depression.
The patient suffering from depressive disorders, are given antidepressant medication
which has been prescribed to Mary by health-care specialists. Nurses are responsible for
monitoring service user while taking antidepressant as heavy dosage of these tablets can worsen
their condition. As per the view of Ross et.al. (2015) nurses also impart talk therapy where they
encourage or motivate patients to share their experiences of life, beliefs, thoughts and culture.
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Ross et.al., (2015) Stated that health-care professionals include family members of patient while
giving this therapy. They can ask patient to spend some quality time with their close relatives.
This support nurses in changing the health status and mood of the service user and also this can
lead to positive impact on the mind of service user.
Brooks (2015) stated that evidence based practice includes multidisciplinary team which
is also used by nurses in order to improve patient health outcomes. Interdisciplinary workforce
includes psychiatric, psychologist, experts, dietician who can impart Mary with acute care which
can help her deal with the depressive symptoms. Dietician encourage service user to follow
healthy diet on regular basis. They have responsibility to make sure that patient is consuming
food which contains lot of fibre. This supports service user in gaining weight and improving their
health outcomes. In accordance with this, it can be said that if healthy eating practices are not
followed by Mary than it can make her immune system, weaker.
DiClemente (2018) says that Nurse has also made use of problem solving therapy which
help patient in learning skills which aim at identifying the signs and symptoms of disease faced
by service user. It also focuses on encouraging service user to share their problem with health-
care providers. This has assist in developing multiple solutions to the problem. For example, one
of the major issue faced by Mary was isolation and loneliness, for this nurse asked her to be
socially active and suggested her to join some friends club, yoga or any other activity which
interests her. Health-care professionals asked her to involve in physical activities like exercise,
aerobics, yoga which can make her feel refreshed. Nurse also suggested Mary to join art or craft
activities which are the best mode of distraction which can help patient in improving their health
condition.
As per the view of Ross et.al. (2015) For managing patient suffering from depression,
nurses combine pharmacotherapy and cognitive behavioural therapy. The combination of CBT
and pharmacotherapy is particularly powerful because it helps in fighting against the symptoms
of depression. Mary would be benefited by it as medicines target brain chemistry problems that
can impact mood. CBT steps in to provide a person with skills that they can use whenever the
patient feel depressed or sad.
Oldham (2016) says that managing patient suffering from depression, nurses combines
pharmacotherapy and cognitive behavioural therapy. Apparently, combining both the therapies
help service user in improving health outcomes. The combination of two therapies for the
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patient suffering from depression can help in recovering from disease faster. It has helped nurses
in developing better understanding over the disease and creating awareness among patient about
signs and symptoms related to depressive disorder.
C. CONSIDERATIONS MADE FOR SOCIAL INCLUSION, RECOVERY
AND PREVENTIONS OF RELAPSE
Mary is a 65-year-old lady who is suffering from depression. She lives alone and there is
nobody is to take care of her. After death of her husband she went into trauma which is the major
cause of her depression. If person experiences any kind of mental issues such as depression,
anxiety, etc. then nurses provide special care to these patients so that individual can feel happy.
This helps them in improving their wellbeing. Mary lives alone at her home and she is not
involved in any kind of social activities. She is unable to discuss own feelings with others which
is the major cause of her depression and can result into severe mental health concerns (Slade
et.al., 2014).
Social inclusion
Social inclusion can be defined as methods that are used by nurses to increase
involvement of patients. There are several methods of social inclusion such, increase
involvement of patients in social activities, interpersonal relationship, community participation,
etc. Hospital staff is responsible for monitoring activities of Mary in order to ensure that she is
spending time with other patients (Galletly et.al, 2016). Social inclusion therapies and plans are a
big support to clinical recovery of Mary. Use of simple and appropriate words is a nursing
technique to make patient comfortable with medication and treatment.
Maintain dignity and respect is another strategy that need to be implemented by nurses to
meet with the goal of social inclusion in case of Mary. If nurses give her respect and will treat
her equally as other patients, then this will enhance her confidence and involvement in social
activities (DiClemente (2018). Care providers focus on creating healthy environment to keep
service user comfortable and involved. Social isolation is the major cause of depression. When
person lives alone and feels that nobody is around them then individual starts developing feeling
of sadness and loneliness which depress them. However, in accordance with case study, nurses
will family members of Mary because if she will spend time with daughters then she will not feel
alone. Family support will raise confidence of Mary. (Thieme et.al., 2015). Social inclusive
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approaches are related with recovery oriented practices that concentrate on raising participation
of mental patient with their peer (Brooks, 2015).
Recovery
Medication programs need to be implemented by nurses in accordance with holistic needs
of patients. Nurses are required to take care of privileges of patients such as close monitoring,
right dose to right person at right time, etc. All these things help nurses in improving health
condition of Mary.
Further, professionals prescribe medicines to patients on the basis of their mental
condition thus, in case of Mary, nurses have to ensure that she get prompt medical care. Nurses
are liable to monitor health progress of Mary, they have to discuss progress of Mary with senior
doctors so that she can recover soon from her illness (CBR and mental health, 2018). Nurses will
focus on identifying early warning signs in Mary which will helps in making alteration in
recovery plan.
Prevention of Relapse
Relapse prevention methods ensure that patient is getting continuous care. In the case of
Mary, nurses need to implement various strategies so that she can recover soon from her illness.
Various Relapse prevention methods are described below:
 In the case of Mary, nurses have to give proactive reaction to Mary so that she can raise
her confidence. If she receives positive reaction from surrounding people, then she will
be able to recover from depression and will reduce the chances of relapse.
 Close monitoring is the best prevention way through which nurses can minimise issue of
relapse in case of Mary as she is very quiet in nature and has also attempted suicide.
 By creating healthy atmosphere nurses are able to improve well-being of mentally ill
person (Slade et.al., 2014). These prevention techniques help individual in recovering
from trauma. In the case of Mary, doctors will focus on changing medication regularly in
order to avoid the chances of relapse. They have to ensure safety of Mary by maintaining
dignity of patient.
Nursing practices are focused on dietary needs of each patient as per prescription. Care
providers ensure that Mary is in taking healthy diet and is not ignoring medication. Apart
from this, it can be said that regular work out, medication support patients in fast recovery.
Exercise is very helpful in improving wellbeing of patients suffering from mental illness
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(Galletly et.al., 2016). Nurses will ensure that Mary is involved in inclusion therapies and
physical activities which are specifically organised for old aged people suffering from mental
illness. Yoga, meditation aid in gaining mental relaxation. This gives positive energy to
individual. Further, nurses will focus on organising regular yoga session for her, this will support
in improving health condition of Mary. Cognitive behaviour therapy needs to be considered by
nurses, as it is most essential approach which increases interest of patients and enhance their
involvement in daily routine activities. Music and art activities are relaxing activities which helps
the nurse to improve condition of Mary (Thieme et.al, 2015). Thus, close supervision,
involvement of family and social participation would be considered by nurses (Brooks, 2015).
CONCLUSION
From the entire report, it has been summarised that in order to treat patient suffering from
mental health illness, nurses first need to have a keen assessment of patient health by assessing
their social, psychological, physical and mental condition. Further, report have included use of
various therapies like cognitive, behavioural which can support nurse in improving the health
outcome of the patient. It has also highlighted that how assessment tools like eco- map tool
involves family members, friends in the treatment process which results in positive impact on the
mental health condition of patient. Report has also discussed importance of effective
communication between service provider and user which helps nurses in developing better
understanding over patient’s situation. Assignment has also presented the need of social
inclusion in changing the mood and behaviour of patient suffering from depressive disorders.
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REFERENCES
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examination of individuals' experiences transitioning from an inpatient research facility
providing rehabilitation treatment to the community (Doctoral dissertation).
Chukhraev, N., Vladimirov, A., Zukow, W., Chukhraiyeva, O., & Levkovskaya, V. (2017).
Combined physiotherapy of anxiety and depression disorders in dorsopathy
patients. Journal of Physical Education and Sport. 17(1).414.
DiClemente, C. C., 2018. Addiction and change: How addictions develop and addicted people
recover. Guilford Publications
Galletly, C., Castle, D., Dark, F., Humberstone, V., Jablensky, A., Killackey, E., ... & Tran, N.
(2016). Royal Australian and New Zealand College of Psychiatrists clinical practice
guidelines for the management of schizophrenia and related disorders. Australian & New
Zealand Journal of Psychiatry.50(5).410-472.
Le Boutillier, C., Slade, M., Lawrence, V., Bird, V. J., Chandler, R., Farkas, M., ... & Shepherd,
G. (2015). Competing priorities: staff perspectives on supporting
recovery. Administration and Policy in Mental Health and Mental Health Services
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Oldham, J. (2016). Person-centered care. Future Hospital Journal.3(2). 85-86.
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review of the literature. Journal of health care chaplaincy.20(3). 95-108.
Radfar, M., Ahmadi, F., & Fallahi Khoshknab, M. (2014). Turbulent life: the experiences of the
family members of patients suffering from depression. Journal of psychiatric and mental
health nursing.21(3).249-256.
Ross, H., Tod, A. M., & Clarke, A. (2015). Understanding and achieving person‐centered care:
the nurse perspective. Journal of Clinical Nursing.24(9-10).1223-1233.
Thieme, A., Wallace, J., Meyer, T. D., & Olivier, P. (2015, July). Designing for mental
wellbeing: towards a more holistic approach in the treatment and prevention of mental
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