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This essay describes a case report of a young female, Angelina, who has recently been showing the signs and symptoms of depression and has been admitted in acute inpatient department for the treatment of same. The assignment briefly describes the overgrowing mental disorder (depression) in terms of its etiology, predisposing factors, signs and symptoms; it also explains the behavioural therapy carried out to help patients overcome the state of depression; lastly, it describes the therapeutic treatments and various other therapies which can be carried out for treating this disorder.
Depression can be defined as a state of low mood (feeling blue) or detestation towards activities which affects the person’s daily routine, behaviour and feelings. These people tend to get sad, angry and anxious at little reasons and have a feeling of disgust, worthlessness, helplessness and hopelessness towards themselves and towards their life (American Psychiatric Association, 2013). They start to lose interest in the activities which once they used to love & enjoy and feel guilty and helpless for themselves. Getting sad or feeling low may be a normal behaviour but it is considered as a mood disorder when it lasts for more than 2 weeks, however, it may also be due to any ailment in body or as a side effect of some medication.
Therapeutic Engagement Skills
Depressed mood may be a temporary situation caused due to any life event or as a reaction to drug or ailment, however if it lasts for 2 weeks or more, without any significant reason and the symptoms do not get better, it should seek medical attention. Prescribing antidepressants as a first line of treatment is not recommended in initial and mild forms of depression, but other therapies like therapeutic engagement and distractions should be used in order to elevate the patient’s mood and help him overcome the situation.
Therapeutic engagement is a relation between a nurse and a patient, different from both a social and an intimate relationship, which is intended to treat the patient and help him maintain a healthy psychological and cognitive health (Townsend, 2014).
Maintaining a healthy communication is a major prerequisite for a mental health nurse(Stuart, 2014); this not only builds a strong relationship between the patient and the mental health nurse, but also serves as a therapeutic agent or medication in itself in many of the cases. Depression is one such condition, in which “talking and listening” to the patient can serve as good as a medicine. Therapeutic relationships have been effective most of the times in treating mental and psychotic disorders. Therapeutic engagement consists of few important factors, which are developing rapport and building trust with the patient, improving the health care skills and techniques, developing strengths and overcoming the barriers.
Developing trust and rapport
It is the first and the foremost step in building a nurse-patient relationship. Having a trustworthy relation serves as a foundation between the nurse and the patient (Stuart, 2014). When a trustworthy foundation is laid between the nurse and Angelina, she would feel comfortable and safe sharing even her personal issues with the nurse which could help in finding out the core reason behind her depression.
Improving skills and techniques
Mental health nurse is the main care provider in cases of depression. The person with whom Angelina would share most of the things will be her nurse. Angelina would look upto her for getting solutions for her issues and thus the nurse should be updated with her skills and techniques to tackle the situation and resolve Angelina’s issues (Walker, 2014).
Overcoming the barriers
Depression now is a well known disorder by most of the people in the world; however, there are still few barriers which hinder in its recognition and in availing the treatment. The stigma about depression considering the patients as “mentally instable” or “crazy” is a significant factor which acts as a major psychological barrier (Heslop et.al., 2016). Ignorance and avoidance may be considered as another major cause for increased incidences of depression.
Techniques used for Therapeutic Engagement Skills
Asking of open ended questions to Angelina like asking about her thoughts, what she is going through, what she feels and how is she tackling the situation. This gives the patient to participate in her treatment and at the same time, may help understanding the root cause behind her depression. The mental health nurse tries to understand her point of view, reasons and suffering without any bias (Stuart, 2014). The ultimate goal of the questionings is to recognize Angelina’s life and the major stresses according to her, and to achieve this Angelina must be asked to narrate her life story and illuminate mainly on the things which depress her or those which can cheer her up. It is acceptable if Angelina does not open up completely at the first visit and thus a number of sessions may be needed to unveil the root cause, here the rapport which the nurse makes with Angelina plays an important role. The relation between Angelina and her nurse should be friendly and trustworthy, so that Angelina open up, the nurse at the same time should be a good listener as well as a keen observer, offering Angelina to have the control over the relation and giving the feeling of empowerment to her. Angelina here; should be treated with complete empathy and should be heard carefully. The key element of any therapeutic interview session is based on how the patient and the nurse interact and what assumptions can be made. Here, the nurse should not start advising or educating the patient but should only “listen” to the patient about her experiences and difficulties, trying to understand Angelina’s perspective. She should however, be “informed” about the solutions but main emphasis is given on the points which the she reveals. In the beginning, the therapist looks for the reasons for her depression, since when is she feeling that way and how is she coping with it? Both major issues like poverty and relationship and minor issues like stress at work, meeting deadlines etc are carefully observed and full empathy and support is provided to the patient. Next, the therapist explains the patient about the treatment modes available and seeks her view-points on the same like what kind of results she expects by the treatment. Complete understanding and compassion is given to her during the session. After a strong relation is build, education is given about her “stress”, its risk factors and how to overcome it. Lastly, barriers are assessed to seek the treatment which may be due to monitory issues, unsupportive family etc. efforts are taken to resolve the issues, if the patient remains ambivalent, the therapist does not force her and leaves the decision upto her (Videbeck, 2013 & Stuart, 2014).
2. Therapeutic Treatment Modalities
One of the Key factors in deciding the treatment plan for patients of depression is the “Severity” of depression. Patients like Angelina with only mild to moderate depression need medications for their recovery but also need generous amount of empathy and support. Actively listening to her story and past history helps to get clues regarding the cause and the ways through which she can recover from her illness.
Before getting admitted to the hospital Angelina must be facing great amount of difficulty in some area of her life which was making her feel helpless and worthless. As we know she maintains a good relation with her family, so family issues can be ruled out, leaving us with two major options, either she must be dealing with some complexity in her career or there must be some issue with her personal relationship. Few points which should be considered while treating Angelina, which are:
Angelina is showing mild to moderate symptoms of depression, monitoring her activities and progress/regress of symptoms will help the MHN to get a clear picture of her condition. It will make Angelina feel more understood and thus more comfortable talking and sharing with her.
Providing knowledge to Angelina regarding her features of depression, what damage it can cause and how can these be resolved will help her get over her depression faster. Explaining the dangers in simple language and how the damage can be controlled works miraculously in some cases of mild depression (Cleary, 2012).
Angelina has lost much weight since she has got into this illness; she now should be encouraged to have proper nutritious meals at regular intervals as lack of nutrients also increases the feeling of being tired and ruined. In addition, alcohol should be completely avoided even after she gets discharged from the hospital as it may also act as a depressant.
Angelina may also have a feeling of constant tiredness throughout the day which further increases the low and depressed mood. She thus, should be encouraged to take some form of exercise (walking, swimming etc.) and include it in her daily routine. Physical activities are considered as natural antidepressants, as during exercise, our body releases “endorphins” which are the “feel good” hormones and help in mood elevation (Farholm, 2016).
Major cause of depression is stress and anxiety and relaxation is the key to it. There are a number of ways for relaxation like listening to music, taking a walk, reading etc. Angelina should be encouraged to find her stress buster and see what works best for her. This will not only help her fight with the stress but also will work as a mood elevator.
Stress and depression often lead to sleep deprivation, which we know Angelina is already suffering from. Getting right amount of sleep will make her feel less tired and help her cope with the stressor in a better way. Some simple techniques may be taught to her for getting a proper sleep routine like setting alarm for going to bed and waking up at the same time each day, relaxing her muscles when she goes to bed, avoiding heavy meals or caffeine before going to bed etc (Kragh et.al., 2017).
Angelina during her illness may have a feeling of getting isolated or left out which can worsen the state of depression. This increases her negative feelings, feelings of hopelessness and worthlessness. She must be encourage to communicate and socialize with the people she likes to spend time with who may be her friends, relatives her sibling etc (Cleary, 2012). She may join a support group where she can find people undergoing similar phase and situations. This makes her realise that the problem of depression is universal and it is possible to recover through it.
Lastly but most importantly, emphasis must be given at the root cause of depression by talking about the problem, clarifying the doubts, setting up the goals and implementing on the appropriate solution.
Depression is a mood disorder which is more serious than the people think. Incidences of mood and anxiety disorders like depression are increasing day by day. Not only adults but also children and adolescents are getting trapped into this serious issue which affects their physical health, behaviour, psychology and may be their life. A mental health nurse can bring a huge amount of difference in helping patients recover from mental illness like depression. Listening to the patients, offering them advices and filling them with hope and self respect are the major outcomes of a work done by a mental health nurse.
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