Case Study Analysis: Nursing Intervention To Prevent Suicide And Manage Depression And Anxiety

Identified risk area and mental health concern

Chung is a 35 years-old male who moved to Australia from China five years ago. His parents, older brother and younger sister still live in China. Chung visited his family in China once after a year of moving to Australia. He has not returned to China since, because of his long working hours and need to undertake additional study for promotion.

Chung is a doctor working in Accident and Emergency in a busy inner-city hospital. He is studying for promo-tion to ultimately become an emergency medicine consultant. Two years ago, Chung was under investigation by the hospital Human Resources department due to a drug error. He was very tired and had been on-call over-night with frequent call outs to see patients. The drug error resulted in an eight year-old boy being very sick, requiring intensive care admission. Chung used an intra-muscular medication to treat the boy but administered it intravenously. Chung was subjected to several work-place and medical board investigations and placed on practice supervision for 12 months.

Chung met his wife, Harriett, in Australia four years ago. Harriett is 30 years old. They married two years ago. Unfortunately, Chung’s parents and family could not attend the wedding due to the high costs of travel and his mother has severe arthritis in her hips, making travel very di?cult. Chung found their wedding day emotionally di?cult. He felt the ceremony lacked reference to his Chinese culture. On reflection, he feels that he wasn’t as involved in the wedding planning as he could have been, due to his long working hours. He simply agreed to the suggestions and plans made by Harriett and her family.

Chung and Harriett now have a three week-old baby girl, Charlotte. Charlotte was born by caesarean section, due to birth complications. Harriett has had an infection in the operation site since the birth, resulting in lots of pain, frequent dressings and di?culties moving around. Chung was o? work for one week after the baby’s birth. However, he has now returned to working shifts, often working through the night, where he may go without sleep for 20 – 24 hours. Harriett’s parents are staying with them to support Harriett while Chung is at work. However, he finds that Harriett’s parents are very involved with baby care even when he is home. Given this, Chung finds he gets very little time and space to be with his new daughter.

Nursing intervention to prevent suicide

You are visiting the family in your capacity as a community nurse supporting Harriett with the caesarean section wound care or as a midwife undertaking a post-natal visit. During your visit to the family, you notice Chung looks flat in mood and tearful. His a?ect is sad and restrictive. He is slumped in his chair, with rounded shoulders and starring at the floor for long periods. You inquire about his health. He has very limited eye to eye contact with you. His speech is slowed and purposeful. On occasions, you need to repeat your question several times to get a reply. However, you do manage to obtain the following information from Chung. He has been feeling increasingly anxious during the past two months, given his continuing long hours, shift work, the high pressure of an Accident and Emergency department, Charlotte’s birth and his wife’s health. He has been having palpitations, chest pains and breathlessness for six to seven weeks. He asked a colleague at work, another doctor, to assess him for cardiac issues several weeks ago as he had been experiencing thoughts that he was going to have a heart attack and die. Chung has been feeling very low in mood for the past six weeks, experiencing sleeplessness, particularly initial insomnia and early morning wakening at 3am. He has lost five kilos in weight during the past month, due to reduced appetite and missing meals. He feels he is worthless and a failure at work within his medical role and he is letting his wife and new daughter down. He has been experiencing fleeting thoughts of suicide for the last week. He is aware of high lethality medications which he could take to overdose. Currently, he is hopeless and helpless and wants to die. He states he feels his situation is self-imposed and that treatments will not be of help at this time.

The identified risk area detected from the case study is the suicidal tendency of the patient. Chung that is patient is seen to be flat in appearance. He appears to be very anxious and suffering from insomnia. He is felling low and has reduced body weight due to lack of sleep and lack of appetite. He also had wandering thoughts of suicide recently. He is contemplating to take an overdose of the lethal medicines in order to end his life (Bandura, A. (2014).1b) Identify one nursing / midwifery intervention you would undertake directly with your client to address the risk area noted in question 1a and include a rationale for the intervention. (2 marks for the intervention and 2 marks for the rationale)  

Rationale for the nursing intervention

Ensure the intervention includes how, who and when you would actually carry out the intervention. Your rationale should state why you would carry out the particular intervention. Ensure literature is included.

One intervention that can be implemented in this situation in order to prevent the patient from committing suicide includes suicidal risk assessment along with the modification of the physical factors of the patient. This will help the patient to understand the situation and thus prevent the occurrences of the suicidal thoughts (Resnick, 2017). A number of psychosocial factors are also associated with risk for suicide and suicide attempts.  These include recent life events such as losses. Psychological states of acute or extreme distress are often present in association with suicidal ideation, planning and attempts. While not uniformly predictive of suicidal ideation and behavior, they are warning signs of psychological vulnerability and indicate a need for mental health evaluation to minimize immediate discomfort and to evaluate suicide risk.

The most evident mental health concern of the patient, Chung is severe depression and anxiety disorder (Wepa, 2015). . He appears to be very anxious and suffering from insomnia. He is felling low and has reduced body weight due to lack of sleep and lack of appetite. He also had wandering thoughts of suicide recently. He is contemplating to take an overdose of the lethal medicines in order to end his life.

Ensure the interventions includes how, who and when you would actually carry out the intervention. Your rationale should state why you would carry out the particular intervention. Ensure literature is included when you discuss the rationale.

One of the interventions in order to manage depression is the cognitive behavioural therapy which is the talking theory. This helps to manage the problems of the patient. It is most commonly used to treat anxiety and depression, but can be useful for other mental and physical health problems (Wepa, 2015). The implementation of cognitive behavioral therapy is advantageous since it tends to be short in duration. Cognitive behavioral therapy can be considered of as a combination of psychotherapy and behavioral therapy. The psychotherapy mainly focuses on the importance of personal meaning that we place on the things around us. The behavioural theory on the other hand, is involved in paying close attention to the relation existing between the problems along with the behaviour and the thoughts.

The ethical issue that a nurse needs to consider in this situation mainly involves confidentiality of the situation since the patient himself is a doctor by profession. The issue of confidentiality is one of the ethical principles of health care. Any breach in the confidentiality might lead to a reason for disciplinary action. Any issues related to confidentiality might be brought to a clinical ethics committee or a group in the form of individual cases or in considering hospital policies. 

Additionally the professional issue here might be cultural safety since the patient here is suffering from problems related to his culture (Resnick, 2017).

References

Bandura, A. (2014). Social cognitive theory of moral thought and action. In Handbook of moral behavior and development (pp. 69-128). Psychology Press.

Bertolote, J. M., & Fleischmann, A. (2015). A global perspective in the epidemiology of suicide. Suicidologi, 7(2).

Bolton, J. M., Gunnell, D., & Turecki, G. (2015). Suicide risk assessment and intervention in people with mental illness. BMJ: British Medical Journal (Online), 351.

Resnick, L. B. (2017). Toward a cognitive theory of instruction. In Learning and motivation in the classroom(pp. 5-38). Routledge.

Segal, Z. V., Williams, M., & Teasdale, J. D. (2018). Mindfulness-based cognitive therapy for depression. Guilford Publications.

Wepa, D. (Ed.). (2015). Cultural safety in Aotearoa New Zealand. Cambridge University Press.