Nursing Assignment: Assessment of MR, Including Diagnosis and Plan

This report presents a therapeutic assessment of MR, a 68-year-old male, focusing on his demographics, education, and employment history. The assessment explores significant positive and challenging life events, including his marriage and career advancements, as well as the loss of his wife and the resulting psychological impact. The report details his coping strategies, strengths, and advice he would give to his younger self. The assessment incorporates findings from various tools, including the Geriatric Depression Scale, Fulmer SPICES Assessment, Mini Mental State Exam, and Patient Stress Questionnaire. The report also discusses MR's level of ego integrity versus despair, based on Erik Erikson's theory. Finally, the report recommends psychotherapy and psychopharmacology as diagnoses to improve his condition, alongside a detailed plan of care including patient education, quality patient care, and promoting a safe environment.

Nursing Assignment
Student’s Name
Institutional Affiliation

Introduction
Life is a long journey which encompasses both beneficial and challenging experiences. These experiences have
different impacts on our lives as well as other people’s lives. Some challenging moments and experiences may bring
about psychological disorders such as stress and depression. Wolf, Stidham and Ross (2015) claim that different coping
strategies can be adopted during stressful times, either consciously or unconsciously. However, when a person has a
severe adverse effect from some challenging experiences, various diagnoses can be adapted to improve the situation
(Townsend and Morgan, 2017). In this piece of work, I will give a report on the assessment of MR including his
demographic, educational, and employment history. Also, I will present the difficult and positive times of his life,
including his coping strategies and strengths, and hence provide a summary of the overall assessment. Finally, I will
propose two diagnoses which can be used to improve his condition.
Demography, Education and Employment
MR is a male American adult with an age of 68 years. He has been married for more than 30 years and has four
children, some of whom have married and have their kids. MR grew in Virginia since his childhood and went through
the American system of education. He is a graduate from the University of Virginia School of Engineering and Applied
Sciences. He graduated magna cum laude in Mechanical Engineering. On his completion of school, his family shifted to
Washington DC, where he was lucky to work with the Jacobs Engineering Group for more than ten years. Later, he
moved from this company and was employed as senior staff in AECOM. It is from this company where he got the
financial strength to manage several projects which enhanced his lifestyle significantly.
Significant Times
I conducted a therapeutic assessment interview in two sessions with MR, where he revealed that he had been
longing to have a companion in his life. Therefore, one of his most significant moments is when he got married to a
charming and beautiful woman. He had been lonely for so long after the demise of his father, and of course, was getting
bored with some household chores which her wife later came to relieve him from. He sees the marriage as a new
beginning in his life since there was a person to share his deepest secrets and difficulties, and would be supported in all
ways possible. He defines his wife as a very jovial and charismatic woman who was able to tell when he was being

disrupted by something in his mind, and she would romantically approach him and help him out. Although stress is an
aspect which we must pass through on different occasions, to MR, it would not last for more than an hour when his wife
was around. From the many scenarios which he narrates, it is clear that his wife has been his support, socially,
spiritually, and emotionally.
Another significant moment which he narrates in his life is the time when he got an employment opportunity
with the AECOM company. He said that in the Jacobs Engineering Group, many people were not social and minded
their own business and the salary was also low, although it was enough for most of the necessities. The AECOM
company offered him almost three times the salary that he got from his previous workplace, a transition which he claims
to have impacted his life and made it beautiful. The time when he moved out of the office from negotiating the pay with
his employer was his happiest moments. He narrated it as it was a dream to him, not believing how significant changes
would come in his life after commencing his new job. It is from this company where he got the financial abilities to shift
his mother to a new apartment. He also bought his family another apartment in Washington DC and also bought several
expensive cars. To him, the shift from the Jacobs Engineering Group to AECOM was a significant transition in the rest
of his life due to the enormous income which he got from it.
Negotiated Loss
However, in the past few years, a tragedy hit him hard when his beloved wife passed on. This was an experience
which tore him into pieces, not knowing what to do next, having his only significant treasure leaving him lonely. She
had been ailing from cancer which had got her hospitalized severally. He claimed that the disease was realized at a
severe stage which could be treated successfully. He developed psychological problems due to the death of his wife,
which led to a considerable deterioration of his general health. Stress became an occasional experience in his life since
his wife was there no more to comfort him. His children had got away from home, some being at school while others had
shifted to various places due to employment reasons.
Strengths and Coping Skills
However, MR argues that he had two significant strengths, one being the ability to accept his present situation
and the other being social. Although it took time to accept the demise of his wife, he finally partially recovered and was

able to move on with his life. This required significant self-acceptance and make strategies to cope with the absence of
his wife. Being social, MR was able to move out, meet friends, interact even with new people and have joyful moments.
This helped him get rid of many thoughts, which would have the potential of leading to more severe psychological
problems. He also involved himself in a busy schedule where he would be left with a very little time with nothing to do.
This was a coping strategy which included other activities after workplace hours such as engaging in exercises and
playing games in casinos.
Fictional Advice
I inquired from MR the advice which he could have considered to apply if he was taken back to the stressful
experience. He said that he would have brought started healthy practices in terms of the meals they took daily. This
would include high amounts and varieties of fruits which could have reduced the chances of his wife developing cancer.
Additionally, he could have developed a routine of health check-up in the entire family to ensure that any potential
diseases are identified early enough and hence take the right measures to suppress the condition. However, he said that
he was going through health check-ups, but it was not as regular as it is recommended. Moreover, on the demise of his
wife, he could have hired a personal doctor who would take care of him at times when his psychological problems would
be higher. The private doctor would also develop a plan or a strategy which would be healthy and hence suppress any
potential psychological problem. Although this advice seems to be somehow healthy to him, none of them had been used
even some years after his wife's death.
Findings from Assessment Tools
From the various assessment tools which he completed, MR had some problems which are related to his
psychological state. For example, he had sleeping disorders where he would sleep for approximately 3 hours at night and
sleep would disappear completely. Also, he had problems with appetite and would not consume food at a fast rate. He
would take even an hour eating a very small amount of food. He also had trouble with maintaining concentration on one
aspect such as watching television for long. He was also insecure feeling that his life was not completely at peace. He
also had reduced energy since he could not engage in most activities he used to make himself busy with in the past.
Erickson’s Ego Integrity Versus Despair

From the perspective of Erik Erickson’s argument on the development of ego integrity and despair, it was evident
that MR was not regretful of his life. Although he had already retired and had lost her wife, he was glad that he took care
of his children and had made them stable. He is happy that he can still stay at home peacefully, visit friends, and have a
little fun regardless of the losses he has had. However, sometimes, he is overwhelmed by the death of his wife though
this does not happen occasionally. It only comes along when he gets to remember the happy moments that he enjoyed
with her. By using Likert’s scale, the level of ego integrity versus despair regarding MR is 7. This is an estimate since he
is happy with his past accomplishments, although the death of his wife strikes him.
Diagnosis
For MR to recover from this stressful feeling resulting from the death of his wife, I would recommend two
diagnoses, including psychotherapy and psychopharmacology. Psychotherapy involves closeness and interactions with
family members or friends. Dinnen, Simiola and Cook (2015) argue that this is the most efficient method of suppressing
such symptoms as anger, stress, sleep disorders, and sadness, evidenced by several research studies. Therefore, MR can
have one of his children staying with him to increase interactions and socialization. Through psychotherapy, the victim
feels loved, cared for and can empty his thoughts to other people who can provide comfort (Horowitz, 2018). On the
other hand, psychopharmacology involves intake of medicine (Birur, Math and Fargason, 2017). This diagnosis will be
adopted if the psychotherapy is not possible to put in place. Psychopharmacology has several medicines which can be
administered to MR for suppression of symptoms of psychological problems. These medicines can include sertraline,
paroxetine, and prazosin, among others (Aitchison et al., 2017). These medications help in preventing the re-
experiencing of stressful thoughts, as well as suppressing mood disorders (Behere, Das and Behere, 2019).
Plan of Care
Educating the Patient
Through educating the patient, relevant advice, suggestions, and enlightenment will be fed on MR. This will
involve letting him be aware of some of the risky behaviors which can worsen his condition. Additionally, I will help
MR to understand the various interventions which can be taken to improve his psychological health (Redfield et al.,
2016). The benefits and risks of each intervention would be well explained to him.

Providing Quality Patient Care
This is a significant aspect of nurses in their interactions and experiences with patients. The medical history of
the patient would be recorded accurately to identify any related health problems that can worsen his general health (Song
and Lindquist, 2015). Additionally, in case of any adverse event of psychological problem, quick action would be taken
to offer medical assistance (Mercer et al., 2016). Also, the patient would have a phone number through which he can
access health practitioners in case of emergencies (Jahromi, Javadpour, Taheri and Poorgholami, 2016). A helper would
be assigned, either from the family or a friend to ensure that he is always safe, and any assistance in his daily activities is
offered.
Promoting a Safe Environment
Some helpers can be assigned and eventually worsen the psychological condition of the patient. Therefore, the
character and moral principles of the helper, either a friend or a family member, would be observed critically to ensure
that there are no expected risks (Holden and Card, 2019). Additionally, a clean environment would be provided through
the hiring of a worker who will always ensure that the floor is clean and that most of the items handled by the patient are
tidy and free from germs. Also, all elements that contribute to MR's psychological problems would be taken from him
entirely or placed in places which he can hardly come into contact with them.
Conclusion
MR is at the age of 68 years and is a graduate from the University of Virginia. He has worked with Jacobs
Engineering Group, as well as AECOM. His life has been impacted positively by his marriage and shift of his job to
AECOM company. However, he has faced psychological problems due to the death of his wife. He is tolerant and has
coping mechanisms such as playing games and interacting with friends. There are two interventions which can improve
his condition, including psychotherapy and psychopharmacology. The plan of his care would involve educating him on
healthy living, providing care at the right time, and ensuring a safe environment.

References
Aitchison, K. J., Baldwin, D. S., Barnes, T., Hall, J., Howes, O., McAllister-Williams, R. H., ... & Young, A. (2017).
Use of licensed medicines for unlicensed applications in Psychiatric practice: Psychopharmacology Committee.
Behere, P. B., Das, A., & Behere, A. P. (2019). Upcoming Medicines. In Clinical Psychopharmacology (pp. 175-177).
Springer, Singapore.
Birur, B., Math, S. B., & Fargason, R. E. (2017). A review of psychopharmacological interventions post-disaster to
prevent psychiatric sequelae. Psychopharmacology bulletin, 47(1), 8.
Dinnen, S., Simiola, V., & Cook, J. M. (2015). Post-traumatic stress disorder in older adults: A systematic review of the
psychotherapy treatment literature. Aging & mental health, 19(2), 144-150.
Holden, J., & Card, A. J. (2019). Patient safety professionals as the third victims of adverse events. Journal of Patient
Safety and Risk Management, 2516043519850914.
Horowitz, M. J. (2018). Formulation as a basis for planning psychotherapy treatment. American Psychiatric Pub.
Jahromi, M. K., Javadpour, S., Taheri, L., & Poorgholami, F. (2016). Effect of nurse-led telephone follow ups (tele-
nursing) on depression, anxiety and stress in hemodialysis patients. Global Journal of Health Science, 8(3), 168.
Mercer, S. W., Fitzpatrick, B., Guthrie, B., Fenwick, E., Grieve, E., Lawson, K., ... & Watt, G. C. (2016). The CARE
Plus study–a whole-system intervention to improve quality of life of primary care patients with multimorbidity in
areas of high socioeconomic deprivation: exploratory cluster randomised controlled trial and cost-utility
analysis. BMC medicine, 14(1), 88.
Redfield, C. S., McGuire, A. P., Lin, T. C., Orton, V. J., Aust, M., & Erickson, T. M. (2016). Shifts in Attitudes,
Knowledge, and Social Goals in Nursing Students Following Structured Contact With Community-Dwelling
Older Adults. Journal of Nursing Education, 55(10), 569-573.
Song, Y., & Lindquist, R. (2015). Effects of mindfulness-based stress reduction on depression, anxiety, stress and
mindfulness in Korean nursing students. Nurse education today, 35(1), 86-90.

Townsend, M. C., & Morgan, K. I. (2017). Psychiatric mental health nursing: Concepts of care in evidence-based
practice. FA Davis.
Wolf, L., Stidham, A. W., & Ross, R. (2015). Predictors of stress and coping strategies of US accelerated vs. generic
baccalaureate nursing students: An embedded mixed methods study. Nurse Education Today, 35(1), 201-205.

APPENDICES
Appendix 1: Hour Log
Community Health Nursing Project Hour Log
Use this form to document practice hours & activities for the
Community Health Nursing Project Assignment
Date Activity Location & Contact
(as appropriate)
Hour(s)
26th June,
2019
Therapeutic Assessment Interview USA 3
27th June,
2019
Filling of assessment tools USA 21/2
Total
I acknowledge and attest that my practice hours log and documented activities adhere to the Aspen University standards of academic authenticity and
may be subject to random audits of my logged hours, documented activities and contacts.
Student Name Student Signature Today’s Date
Appendix 2: Geriatric Depression Scale
Geriatric Depression Scale (Short Form)

Patient’s Name: MR Date: 27/6/2019
Instructions: Choose the best answer for how you felt over the past week. Note: when asking the patient to complete
the form, provide the self-rated form (included on the following page).
No. Question Answer Score
1. Are you basically satisfied with your life? YES 0
2. Have you dropped many of your activities and interests? NO 0
3. Do you feel that your life is empty? NO 0
4. Do you often get bored? NO 0
5. Are you in good spirits most of the time? YES 0
6. Are you afraid that something bad is going to happen to you? YES 1
7. Do you feel happy most of the time? YES 0
8. Do you often feel helpless? NO 0
9. Do you prefer to stay at home, rather than going out and doing new things? NO 0
10. Do you feel you have more problems with memory than most people? NO 0
11. Do you think it is wonderful to be alive? YES 0
12. Do you feel pretty worthless the way you are now? NO 0
13. Do you feel full of energy? NO 1
14. Do you feel that your situation is hopeless? NO 0
15. Do you think that most people are better off than you are? YES 1
TOTAL 3
(Sheikh & Yesavage, 1986)
Scoring:
Answers indicating depression are in bold and italicized; score one point for each one selected. A score of 0 to 5 is normal.
A score greater than 5 suggests depression.
Appendix 3: Fulmer Spices Assessment
Fulmer SPICES: An Overall Assessment Tool for Older Adults
Patient Name: MR Date: 27/6/2019
SPICES EVIDENCE
Yes No
Sleep Disorders Few sleep hours
Problems with Eating or Feeding Loss of appetite

Incontinence No problem evidenced
Confusion Poor in interpretation
Evidence of Falls Irregular steps while
walking
Skin Breakdown No evidence
Appendices 4: Patient Stress Questionnaire
Patient Stress Questionnaire*
Name: MR
Date: 26/6/2019 Birthdate 12/6/1951
Over the last two weeks, how often have you been bothered by any of
the following problems?
(please circle your answer & check the boxes that apply to you)
1. Little interest or pleasure in doing things 0 1 2 3
Total
2. Feeling down, depressed, or hopeless 0 1 2 3
3. Trouble falling or staying asleep 0 1 2 3
4. Feeling tired or having little energy 0 1 2 3
5. Poor appetite 0 1 2 3
6. Feeling bad about yourself or that you are a failure or
have let yourself or your family down 0 1 2 3
7. Trouble concentrating on things, such as reading the
newspaper or watching television 0 1 2 3
8. Moving or speaking so slowly that other people
could have noticed 0 1 2 3
9. Thoughts that you would be better off dead, or
hurting yourself in some way 0 1 2 3
(10)
add
columns:
5 4 0 9
Not
at all Sev
eral
d
a
y
s
More
than
half
thed
a
y
s
Ne
arl
y
Every
day

1. Feeling nervous, anxious or on edge 0 1 2 3
Total
2. Not being able to stop or control worrying 0 1 2 3
3. Worrying too much about different things 0 1 2 3
4. Trouble relaxing 0 1 2 3
5. Being so restless that it is hard to sit still 0 1 2 3
6. Becoming easily annoyed or irritable 0 1 2 3
7. Feeling afraid as if something awful might happen 0 1 2 3
(8) add
*adapted from PhQ 9, GAD7, PC-PTSD and AUDIT 1/24/11 columns: 5 4 0 9
Provider: Please also complete back side