NRSG370 Task 2: A Case Study on Mental Health and Suicide Attempts

This case study, prepared for NRSG370, examines a 28-year-old male patient from a rural agricultural background who attempted suicide due to major depressive disorder stemming from socioeconomic difficulties. The study follows the clinical reasoning cycle, detailing the patient's symptoms, diagnosis, and the application of interventions such as medication (citalopram), electroconvulsive therapy (ECT), and psychotherapy. The nursing care plan involved assessing the patient's emotional state, developing a therapeutic relationship, providing education on suicide and depression, and managing risk factors. The evaluation revealed positive outcomes, with the patient showing signs of recovery and improved communication after seven days. The study emphasizes the importance of clinical judgment in suicide risk assessment and the need for comprehensive care in mental health settings. The author reflects on the learning experience and highlights the need for improved communication skills in dealing with mental health patients.

1NRSG370 Task 2 Case Study on Mental Health
Case Study on Mental Health
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2NRSG370 Task 2 Case Study on Mental Health
1. Introduction
With the advancement of technologies, many diseases which were earlier not curable are
being cured. There are still some types of illnesses, especially mental problems; there is no
standard remedy for those diseases. The illness may be due to physical or mental imbalances.
In either case, the person cannot perform normal activities of life. Most of these diseases are
on account of socio-economic situation presently faced by common man where survival has
become difficult. Most of the cases reported about mental health problems are because of this
economic imbalance existing between people of different income groups (Stein, et al., 2010).
In this essay, the main objective is to study a patient suffering from mental illness which is a
result of socio economic imbalances. I shall be following the clinical reasoning cycle to
explain this case study (Levett-Jones, 2017).
2. Description
The term clinical reasoning (Pinnock and Welch, 2013) is used to explain the process by
which the medical professionals collect signs or symptoms, process the information,
investigate the patient issue or circumstance comprehensively , draw and apply an
appropriate intervention plan , assess the outcome, reflect and gain experience from the
entire cycle (de Beurs, van Borkulo and O'Connor, 2017). The clinical thinking cycle is
influenced by an individual’s attitude, preconception and philosophical point of perspective
(Tietze, 2018).
2.1 Description of facts, context, objects or people.
The admitted patient was a single man of 28 years who came from a rural agriculture
background and because of poverty, he attempted to commit suicide. The patient was
diagnosed with major depressive disorder.
2.2 Revision of the current information

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As indicated by the clinical thinking cycle, I need to analyse the present information
which includes delivery reports, history information of the patient, patient charts, results of
clinical tests and medicines applied recently and compile new information. Next, I have
applied my insight on pharmacology physiology, epidemiology, pathophysiology,
therapeutics, culture, attention setting, law and ethics to support the case (Lambert and
Hemingway, 2016). The patient was still in a condition of acute depression which was
evident from the fact that he avoided the morning breakfast and went to lunch reluctantly
when he was compelled to have it, yet he didn't eat anything and came back to bed quickly.
The patient did not take part in any of the activities like games within a small group or
individual activity. The patient had a rope mark on the neck. The rope was used by the patient
to hang himself. The rope got snapped because of the body weight of the patient and he fell
down in the process causing a few injuries and broken skin on the arms and legs. When I
went to introduce myself to the patient, I found him lying in bed with the raised lids. The
patient seemed reluctant to talk to me and was unhappy to survive from the attempted suicide.
2.3 Interpretation and analysis
The vital signs listed were blood pressure 125/75; Temperature: 36.30 C; Pulse 66 bpm;
Breathing 18/min. Venlafaxine and a multivitamin were given on admission.
Symptoms of depression The patient admitted with a mental disorder had the following
symptoms: hopelessness, frustration, loss of interest, tiredness and lack of energy, reduction
of appetite, feelings of uselessness, suicidal thoughts or attempts of suicide etc. (Cha et al.,
2017).
Cause of depression: It is very difficult to know the exact reason for the mental depression,
but it is a mental disorder and can occur due to the reasons mentioned below.

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Biological contrasts. Individuals with depression appear to have physical changes in the
brain. The significance of these changes is not certain, yet it can inevitably help in finding out
the causes (Batterham, Christensen and Calear, 2013).
Brain Chemistry: Neurotransmitters are natural brain chemicals that can assume a
significant role in depression. Current research demonstrates that changes in the function and
impact of these neurotransmitters and their interaction with the neuro-circuits that are
associated with maintaining mood stability can assume a significant role in the treatment of
depression (Kay et al., 2015).
Hormones Depression can be triggered due to changes in the balance of hormones in the
body.
Hereditary traits. Depression is found to be more frequent among people whose parents or
grandparents were affected by a similar disease. Researchers are trying to find out genes that
may cause depression (Alcafache, Figueiredo & Oliveira, 2011).
Risk factors for developing depression in this particular case include:
Unable to withstand the responsibility to support his family members due to the acute
financial crisis, and finding no avenue to come out of the difficulties.
2.4 Synthesis of facts and inferences Diagnosis: The diagnosis was done by the psychiatrist
based on a series of steps which include physical tests, lab tests like a complete blood count
or thyroid test.
2.5 Establish Goal: The patient had not yet recovered from his attempt to suicide. It was
evident from his behaviour. He was still in a state of hopelessness. The nursing goal is to
bring back self-confidence in the patient using psychotherapy, ECT and medications.
2.6 Action:
Electroconvulsive treatment otherwise called ECT is a technique carried out under general
anesthesia. In this procedure small electric current is allowed to pass through the brain,

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purposefully, causing a short seizure. Symptoms of certain mental health conditions are
rapidly reversed and cured by using ECT that stimulates changes in brain chemistry. ECT
was applied to the patient for a brief period as he was not in a normal state of mental health.
The psychiatrist prescribed citalopram (Celexa) (Cipriani et al., 2012) to relieve symptoms of
severe depression. Celexa belongs to the category of selective serotonin reuptake inhibitors
(SSRIs). It is a comparatively safer drug in comparison to other types of antidepressants and
causes fewer side effects. Psychotherapy is a general term for treating depression when the
mental health professional talk with the patient to know about his problems and slowly and
slowly bring back confidence in the patient. Psychotherapy can help the patient in the
following ways ("Depression (major depressive disorder) - Diagnosis and treatment - Mayo
Clinic", 2019):
1. To be adjustable to a current difficult or crisis situation.
2. Negative beliefs and behaviour are to be identified and to be supplemented by a
healthy and positive attitude.
3. Positive interactions with others are to be developed.
4. Better approaches should be explored to adapt and tackle issues.
5. The issues that contribute to depression are to be identified and the factors that
aggravate depression should be controlled.
6. Realistic goals for life are to be set.
After I was posted as a psychiatric nurse to look after the patient, it was a challenge for me to
instil confidence in the patient and bring him back to normalcy. This was my first encounter
of such a patient.
1. My first task was to understand the patient’s emotional reaction to his suicide attempt.
Though initially, he was reluctant to speak, I played a role as if I was his well-wisher.

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2. I started developing and maintaining a collaborative, therapeutic relationship with the
patient by taking a sympathetic stance in relation to the patient and family. I narrated
stories and evidence to educate the patient about the suicidal mind, symptoms of
illness, and effectiveness of the intervention (Ali Alshowkan, 2016). I used to explain
the factors and motivation for suicidal thoughts and behaviour. I gave a lot of mental
courage to him by giving inputs on solving his present financial crises and his old
father another family members are dependent on him. He was young and could search
for alternate option if agriculture was a failure. Initially, he used to argue with me but
slowly and slowly he started realising his mistakes.
3. I used to collect accurate assessment information and document them and
communicated the risk factor to the treatment team and appropriate persons.
4. In the process, I had drawn a risk assessment plan and developed ongoing nursing
care based on continuous assessment,
5. I was aware of the lawful and moral issues concerning suicide. I knew state laws on
suicide, rights of patients, civil responsibility, isolation and advance directives for
mental treatment. I was sure about basic parts of chart documentation of suicide risk
evaluation, monitoring and interventions, keeping up patient records and rights to
security and privacy within HIPAA guidelines (Jones & Moffitt, 2016). I applied
ethical principles of self-sufficiency, non-maleficence, value, loyalty and justice in
relation to patients who are suicidal. The entire episode was documented accurately
and thoroughly including suicide risk.
3. Evaluation and Reflection
Because of my active involvement, the patient started recovering from the
trauma and after seven days he was communicating normally with all the healthcare
professionals (Sun, Long (Tsao & Huang, 2014). He also responded well to the

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medication given. His body language showed restoration of confidence and he started
taking food. This episode gave a great learning point to me how to save a young
person who lost self-belief and wanted to die. Since it was my first encounter, I was a
little nervous at the beginning but in future, I shall be more confident in dealing such
kind of cases. Moreover, I require improvement in special communication skills
particularly to deal with mental patients.
4. Conclusion
The assessment of suicide risk is different from the risk assessment for other types of
disease, there is a multitude of factors that should be considered without a clear
algorithm that exists or can be developed (Weber, Michail, Thompson & Fiedorowicz,
2017). This can be discouraging for many doctors without any template for risk
stratification from which appropriate management is adapted, but this process is no
different from many decisions that the doctor must take daily for which clinical
judgment is paramount. Similarly, suicide risk assessment requires the doctor to
exercise its clinical judgment and take into account the relevance of risk-based and
protection-based factors of evidence to assess the risk of a particular patient. A
number of researches have been published about the root cause of the mental problem.
Research has found out a protein which causes brain shrinking causing depression.
Similarly, bio-informatics studies are going on to know the proteins involved in
causing mood change. So it is not far off that the exact solution to this problem will be
found out.

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References
Alcafache, J., Figueiredo, M., & Oliveira, S. (2011). P03-435 - Characterization of patients
with suicidal behaviors. European Psychiatry, 26, 1605. doi: 10.1016/s0924-
9338(11)73309-0
Ali Alshowkan, A. (2016). Nurses Attitudes towards People with Mental
Illness. International Journal Of Mental Health & Psychiatry, 02(04). doi:
10.4172/2471-4372.1000131
Batterham, P., Christensen, H., & Calear, A. (2013). ANXIETY SYMPTOMS AS
PRECURSORS OF MAJOR DEPRESSION AND SUICIDAL
IDEATION. Depression And Anxiety, n/a-n/a. doi: 10.1002/da.22066
Cha, C., Franz, P., M. Guzmán, E., Glenn, C., Kleiman, E., & Nock, M. (2017). Annual
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Cipriani, A., Purgato, M., Furukawa, T., Trespidi, C., Imperadore, G., & Signoretti, A. et al.
(2012). Citalopram versus other anti-depressive agents for depression. Cochrane
Database Of Systematic Reviews. doi: 10.1002/14651858.cd006534.pub2
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Depression (major depressive disorder) - Diagnosis and treatment - Mayo Clinic. (2019).
Retrieved from https://www.mayoclinic.org/diseases-conditions/depression/diagnosis-
treatment/drc-20356013

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