Depression is a common psychological illness, which affects an individual’s mental state, mood, and emotional responses and hence affects the activities of daily life (Butcher, Mineka& Hooley, 2013). This mental condition could have the intensity from mild to moderate and hence, be depending on its intensity it can alter physical and mental health conditions (Kumar, Jain & Hegde, 2012). As per the data of World Health Organization, more than 300 million people throughout the world is suffering from depression, however, more than 50% of these cases are not being reported or treated as the majority of the countries lack the trained staff and healthcare facilities (Hay et al., 2012). If the Australian perspective is witnessed, more than 3 million people are being affected with depression and are unaware of the fact that such condition is affecting their well-being, personal relationships and their working career and productivity (Melo et al., 2012). In this assignment, the depression condition of Amy (75) has been discussed who is suffering from depression after she came to know about her diabetic and hypertension-related condition. She lives in a retirement village as both of her daughters lives away from her home and hence, she cares for her won medication and interventions (World Health Organization, 2013). Further, the mental state of Amy is vulnerable as she feels worthlessness, hopelessness, and helplessness. Therefore, in this assignment, the biopsychosocial factors influencing the development of depression will be discussed with appropriate nursing management and interventions. Further, the ethical implications appropriate for the patient condition will also be discussed in this section.
Unlike other physical and mental disorders, depression is caused by two etiological perspectives such as psychosocial and biomedical aspect (Klainin-Yobas, Cho &Creedy, 2012). The Biopsychosocial perspective is the integrated form of etiological study for depression related condition as both of these factors are interdependent and interconnected in case of depression (Gilbert, 2013). Further using biopsychosocial analysis for the identification of the cause of depression is systematic and is dependent on possibilities depending on their biological, social and social factors. Few of these factors include the timing and course of depression, biological factors such as genetic, hormonal or neurological factors environmental stressors as well as personal vulnerabilities such as family or children related stress (Fortinash & Worret, 2014). Vingerhoets and Cornelius (2012) mentions that the age of depression diagnosis describes the severity and persistence of the illness. Amy 975) was first diagnosed with depression when she has identified with diabetic and hypertension ten years ago. This depression was associated with her physiological condition, however, she developed her depression after 7 years of depression onset as her husband passed away. This was her personal vulnerability as due to the loss of her husband, she was not eating anything or slept properly, hence environmental stressor also contributed to the development of such a depression condition. Further, she thinks that after the death of her husband she is unable to share her feelings with anyone and has become lonely (Bastian et al., 2014). After her mental condition worsened, she was admitted to the mental health hospital by one of her daughters for the fourth time (Stoppard, 2014). The personal traits determine her as a quiet and caring person who does not share her feelings with others. The biological factor in etiology can be determined from the fact that Amy’s mother was also a depression patient and due to the severity of her depression condition, she died 15 years ago. Her personal thoughts about her depression condition express the level of her negativity as she feels as a burden to her daughters (Sarafino & Smith, 2014).
After understanding all her biopsychosocial etiological factors for depression, it could be stated that the course of depression played an important role in increasing and expanding her depression condition. Her depression episodes were not inclusive of a single episode as it was the cumulative effect of several depressive stressors increasing her vulnerability to shock and stress of depression. As mentioned by Fortinash and Worret(2014), early onset of depression is always associated with genetic etiological factor and the progression depends on the neurological and successive episodes of environmental stressors that increase the rate of autonomous episodes of depression in the brain of the affected person (Katon et al., 2012). Further, this course of depression was also due to the course of life events that occurred with Amy and in her family that leads to onset such increasing depression condition (Stoppard, 2014). Therefore, through this analysis of the biopsychosocial aspect of onset of depression in Amy, it was determined that there were several genetic, social, biological personal and environmental factors that made Amy vulnerable to these stressor conditions and increased her course of depression (Klainin-Yobas, Cho & Creedy, 2012).
Role of nursing professionals and nursing interventions are crucial while caring for patients affected by depression as with increasing complexity, they might develop suicidal ideation and self-harm related thinking (Katon et al., 2012). Maximum of the healthcare facilities around the world depends on application of antidepressants for patients affected with depression however, it has been seen in the research conducted by Parsons et al. (2012) that in primary mental health care settings, nursing professionals and interventions is able to increase the effectiveness of antidepressants by reducing its non-adherent nature. Further, it was also seen in researches that smaller psychosocial interventions taken by nursing professionals are effective in increasing the efficiency of medication provided by the healthcare physician (Butcher et al., 2018). The meaning of adherence to the medication could be explained by the fact that with increased adherence to the medication, people show improvement in their health condition.
In case of Amy, it has been seen that as she takes care of her medication herself, she tends to skip her medication and hence, it has been seen that her adherence to the medication is decreased with every depression related episode (Hidaka, 2012). Hence, the first nursing intervention for Amy will be related to her medication management and hence, it will a part of nursing management. This will help Amy with proper consumption of medication and eventually her adherence to the antidepressant medication will be increased (Hay et al., 2012). On the other hand, with proper medication and nursing management, she will become less prone to the environmental or social stressors that increase her depression condition. Communication is an important mean for patients suffering from depression as Townsend and Morgan (2017) mentions that majority of the depression affected patients are unable to convey their thoughts and feelings to the carer or another individual because they have the fear of being judged or humiliated. Hence, the nursing professionals should possess effective communication skills so that while communication with them, the patient can share each grieve, agony, and happiness leading to decreasing the effect of personal and environmental stressors (Klainin-Yobas, Cho &Creedy, 2012). Hence, communication with Amy will be the second nursing intervention that the nursing professionals should implement in the care process as the patient herself confessed about her loneliness and companionless after the death of his husband (Hegney et al., 2014). The third intervention will be understanding the depression patterns for Amy as the specific intervention for a specific type if depression condition will help in increasing the adherence of medication and intervention (Butcher et al., 2018). Therefore, as an intervention, the multidisciplinary team should be included in the nursing management so that the multidisciplinary team is able to recognize the sign and symptoms of the depression condition and can decide the interventions and therapies could be applied to treat her depression condition (Parsons et al., 2012).
On the other hand, it is important to make the patient involve in several activities so that the negative thinking of the patient can be controlled so that such negative thoughts cannot lead her to generate suicidal ideations or commit self-harm actions (Hay et al., 2012). Therefore, the fourth nursing intervention that will be applied for Amy will be involving her constructive actions such as providing her educational sessions about her mental health condition and actions she can perform to reduce her low mood and isolation related feelings (Townsend & Morgan, 2017). Further, she will be involved in arts, crafts, and gardening related activities so that she can develop positive thoughts and keep herself busy in such constructive activities (Hegney et al., 2014). There is a major role of family and relatives in making people happy and satisfied as the family is the institution where people can behave like their real self. After the death of Amy’s husband, she had lost her companion and both of her daughters used to stay away from her house. Hence, such environmental stressor increased her loneliness-associated feelings. Therefore, the nursing professionals should involve her daughters in several nursing interventions, arrange communication sessions once or twice in the week so that Amy could be provided with a family-related support which will help her in gaining positive effects of the intervention (Hidaka, 2012).
Discussion on ethical intervention for depression is a topic of debate as a maximum of the healthcare facilities around the world determine depression or other mental disorder fatal and harmful for cohabited patients in that healthcare facility (Hegney et al., 2014). Townsend and Morgan (2018) mentions that autonomy is the major ethical strength which patients receive while receiving care from any healthcare facility. However, majority of the depression-affected patients are not provided with this ethical right of them as the healthcare physicians believe that providing such mentally ill patients with the right of autonomy will affect the environment of the healthcare facility. Therefore, it is a moral obligation for such healthcare professionals to provide the depression affected the patient with any of the ethical rights so that their treatment could be controlled by the healthcare facility. As mentioned by Burston and Tuckett (2013) healthcare physicians believe that patients affected by depression are unable to think positively for themselves or for others surrounding to them. Therefore they do not provide them with their ethical rights such as autonomy, non-maleficence, beneficence and veracity which works as a pillar for ethical nursing interventions. In case of Amy, therefore, she will be provided with all her ethical rights however, she will always be observed for her actions within the healthcare facility (Van der Meulen et al., 2014). It is an important factor as her reaction to the environmental and personal stressors could be violent despite her calm and composed behavior. The multidisciplinary team assigned for Amy and her depression condition will be monitoring her intervention as well as educational sessions so that the effectiveness of the drug could be assessed (Townsend & Morgan, 2018). Further, all the healthcare professionals and nursing staff working in the facility will be provided with a training so that while caring or communicating to Amy or any other depression affected patients, they can be calm and composed so that each of the patient’s doubts and queries could be answered (Burston & Tuckett, 2013). In this situation, all the nursing staff will be provided with a detailed patient condition and would be explained about the serious patient condition so that while caring for Amy, they can work on their strategy and increase the adherence of medications. Further, a monthly evaluation of the nursing professionals and staff will be carried out so that the compliance level of healthcare professionals to the ethical considerations can be properly understood (Fortinash & Worret, 2014). Further, while changing medication, activity related interventions, and educational sessions so that consent from the patient could be received and her autonomy related ethical could be protected. These are the ethical considerations, which will be taken care of while implementing the nursing management and nursing intervention strategies on Amy and her depression condition.
Conclusion
In the current world, depression is one of the major and prevalent disorders, which is being diagnosed in the majority of the world population. However, the adverse consequences lead to increased mortality rate because depression is one of the most underrated and untreated disorders around the world as the majority of the patients and healthcare facilities are unable to assess or diagnose such mental condition. In this assignment, discussion about depression condition of Amy was discussed as she is suffering from depression from past ten years and stressors of her depression condition involve psychological, environmental, genetic and biological aspects that contribute in the etiology of depression condition of Amy. Further, after discussing her biopsychosocial depression etiological factors, five nursing management, and interventions were discussed so that a holistic care approach could be used for depression condition of Amy. Ethical importance in caring such mental illness was also discussed with respect to Amy and it was said that autonomy and other ethical rights should be protected while caring for such mental illness related condition in healthcare facilities around the world.
References
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