Discuss about the Prenatal Depression and Prematurity.
Mental health nursing is a key domain in nursing profession, which is specialized for mental health and provides care services for people of all ages, experiencing mental illness, including mild symptoms like anxiety to as severe disease as schizophrenia and dementia. Mental health nurses need to deal with patients having mental disorders and each patient might have different types of symptoms; thus diagnosis of mental health issues re difficult and mental health nurses should consist some additional skills and competencies to provide effective care services to them (Townsend, 2014). In this context, the patients experiencing mental health issues need additional support and empathy, for which establishment of a therapeutic alliance or a strong therapeutic relationship is important.
In this essay, the key concern is the 18 years old teenager Angelina, who has been recently diagnosed with depression symptoms. Due to some depressive symptoms, Angelina is unable to complete her studies and normal life activities, causing a significant hindrance in both her future career as well as personal life. In this context, the essay has been focused upon the discussion on therapeutic engagement of Angelina and implementation therapeutic modalities appropriate for Angelina on the ward. There are more than one treatment modalities, which can be implemented for the improvement of Angelina’s mental status, which would be evaluated in this essay.
This essay focused upon the key mental health services, which should be provided by a mental health nurse to deal with Angelina’s case. Angelina’s has commenced her first year of nursing at a Melbourne university. She moved from Warrnambool at the start of the year and lives with two other female university students. There is no family history of mental illness or substance misuse and Angelina’s developmental milestones are all normal. She was a high achieving student and enjoyed sports with a good social network of friends. Over the last two weeks, Angelina’s roommates have been concerned with her mental state as Angelina has been displaying the following symptoms of depression: depressed mood most of the day and every day, feelings of hopelessness, helplessness and worthlessness., decreased interest in her nursing subjects and missing classes, weight loss of about 8kgs, insomnia, psychomotor retardation, fatigue, reduced concentration & attention with all the above symptoms leading to thoughts of suicide without suicidal intent or plan. At this situation, Angelia is unable to continue her studies and appeared in the university examinations. Her parents brought her to the emergency department for a mental health review.
In this context, the first priority of the mental health nurse is to establish a positive and strong relationship with Angelina. Establishing strong therapeutic relationship is the initial step of mental health care provision. In case of Angelina, as she was suffering from depression, she may feel uncomfortable in the health care settings and unwilling to provide information during assessment. In case of mental health nursing, mental health history is crucial to relate the past life consequences with the present symptoms (Videbeck, 2013). Thus, in this context, some key interventions should be implemented by the mental health nurse, in order to engage her in the therapeutic process, after which, upon which the appropriate intervention selection would depend.
Building trust is a key skill of mental health nurse, while dealing with a patient like Angelia, who is suffering from severe depression. Angelia has shown the symptoms of depression and isolation from the social connection, thus, while assessing her, she might not tell the nurse about her feelings, issues as well as actual needs; she might feel helpless and isolated in the new therapeutic environment. Thus, it is very important to build trust of Angelina towards the mental health nurse, so that Angelina can express her feelings and provide the nurse and other health care staff important information required for her therapeutic procedures. Fortinash and Worret (2014) suggested that without building trust, nurse-client relationship would not be established and interventions would not be successful. To build trust of Angelina, the mental health nurse should demonstrate some key behavioural traits including friendliness, caring, interest, consistency, understanding, good and polite communication, approachability, listening, honesty and suggesting her options, instead of telling to do something.
Empathy is the ability for entering into the life of another person, to communicate and understand client’s needs and to perceive client’s current feelings and their meanings accurately, as claimed by (Tansey & Burke, 2013). Accurate empathy involves more than knowing what the client is attempting to mean, by involving sensitivity to the patient’s current feelings as well as the verbal ability to interact and communicate this understanding in a language, which is familiar to the client. As Angelina is showed depressive symptoms and isolation, it may be difficult to understand her actual needs; in this context, empathy can promptly influence constructive learning and change. It is done by dissolving her feelings of isolation through connecting the patient with others. Sometime, people confuse between sympathy and empathy; however to build good nurse-patient relationship, nurse should show empathy, not sympathy. By sympathising the client, nurse may inhibit the expression of client’s feeling through projection of her own concern. Thus, in case of Angelina, the mental health nurse should empathy, thereby acknowledging her feelings, while allows her to talk and express her emotions, at the same time.
Genuineness of s mental health nurse indicates that the nurse is an honest, sincere and open-minded person, who is actively involved in nurse-patient relationship. This trait is the opposite of self-alienation. Showing genuineness would help Angelina to feel secure and safe in the therapeutic environment, which also influences the development of trust towards nurse as well as the health care system (Andersson et al., 2012). If the nurse lacks this particular attribute, the patient would not be able to show openness, personal freedom and self-acceptance, making the relationship week, which will in turn make Angelina to feel unsafe and unable to share her needs for therapeutic purposes.
When a patient is shown unconditional positive regards, the patient starts to feel valued, which influence the patient to express her feelings and current health needs. Thus, it is important to show unconditional positive regards to maximize her involvement in the therapeutic practice (Ward, 2011).
In the following section, the therapeutic treatment modalities suitable for Angelina would be discussed.
Cognitive behavioural therapy is one of the key evidence-based psychological treatment that recognizes the cognition and behavioural attributes of a person. Several evidences have identified CBT as the most effective psychological treatment for depression, while it has been found to be useful for a wide range of ages, including children, adolescents, adults and older people (Dobkin et al., 2011). In this therapeutic modality, the mental health nurse would assist the psychotherapist to identify the thoughts and behaviour patterns, which are making Angelina more likely to become depressed or hindering the way of her betterment, while experiencing depression. In this context, in a holistic, team based and client-centred approach, therapist and MHN would attempt to understand the reason behind her depression, as it has not been identified in the case scenario. Once professionals successfully identified the key reasons, they attempt to change her thoughts and behaviour by teaching her to think rationally about common difficulties, the consequences, thereby helping her to shift negative or harmful thought patterns as well as reactions to a more positive, realistic and problem-solving approach (Beck, 2011). This therapy would help her to cope the strategies for modifying her depressive thoughts into positive thoughts.
As Angelina is suffering from severe depression along with insomnia, psychomotor retardation, fatigue, reduced concentration, attention, weight loss along with suicidal thoughts, only psychological therapy, like CBT may not work successfully, in this context, she can be prescribed with antidepressant medications to reduce the severity of her psychological symptoms (Keltner, 2013). Several studies have suggested that a combination of both psychotherapy and pharmacotherapy has a more significant outcome, compared to the implementation of only one of them.
Angelina may prescribe with medications for one or a combination of mood stabilisers, antidepressants and anti-psychotic drugs. However, the dosage and type should be confirmed by the psychotherapist. However, antidepressant can only make her feel better, but cannot change the personality or work for all the time. Thus, combining psychotherapy is important to eliminate the causes of depressive symptoms from the root. In addition, there are also some side effects. The mental health nurse need to encourage Angelina to adhere to her therapeutic procedures, provide her medication on proper time and motivate her positive thinking, while understanding and acknowledging her current holistic needs (Ciraulo & Shader, 2011). The MHN should also be accountable for monitoring improvement in Angelina’s behaviour and elimination of depressive symptoms. In addition, monitoring side effects are also responsibility of the MHN.
In addition to the two key modalities, i.e. psychotherapy and pharmacotherapy for Angelina’s treatment, there are other alternatives, which could improve the outcomes. One of this is development of self-management skills along with adaptation of relaxing techniques, which will help to reduce depressive symptoms. In this context, health promotional sessions has been shown to improve self-management skills of client. Health promotional session would help to improve awareness of Angelina and would promote her ability to cope with her own situation, thoughts and beliefs, thereby improving her self-management skills. In addition, relaxing techniques, like yoga, meditation and acupuncture are the key conventional methods of relaxation (Field et al., 2012). She can be engaged with different types of relaxation training, including muscle relaxation and breathing regulation. In addition, music is one of the key conventional relaxation techniques, which bursts out stress and promote positive thinking. These techniques have been proved their efficiency in reducing stress, anxiety as well as depressive symptoms. MHN would help Angelina to understand the importance of these techniques and monitor her improvement, while undergoing these conventional alternative therapeutic approaches.
The fourth intervention is also alterative processes for improving Angelina’s psychological heal outcomes. In this context, the mental health nurse can provide her referrals of support groups, where she will have an opportunity to connect with others, who are undergoing similar experiences and symptoms; it would make her socialize as well as attempt to eliminate her feeling developed for isolation. Once Angelina starts to feel valued and understand the challenges of her life, she would be influenced to modify her own thoughts and get back to her normal life (Chibanda et al., 2011). At this stage of her therapy, the MHN would attempt to involve her family, friends and other near and dear ones, to feel her better. Once Angelina stats to understand the reason and importance of her wellbeing, she would be happy and start to feel better, upon encountering her near and dear ones in the therapeutic environment, thereby promoting her positive thoughts and overall well being.
In addition to the social groups, for ultimate recovery, the mental health nurse can provide her referrals for rehabilitation centres, where she would be motivated towards her mental well being (Stuart, 2014). The nurse can provide the referrals of the best rehabilitation centres, which is available and affordable for her.
Concluding the essay, it can be said that Angelina, who is the key focus of this essay, can have a better life and reduced depressive symptoms, through continuous support and therapeutic engagement. In this context, the therapeutic engagement is dependent upon the key mental health nursing attributes, including empathy, genuineness, trust building and positive regards. The essay involved the discussion about four different treatment modalities for Angelina, which could have a significant positive impact upon her psychological improvement. These modalities include CBT, pharmacotherapy, relaxing techniques, self management and social support and referrals. However, adherence of Angelina with the therapeutic procedures is the key determinant of her therapeutic outcome, which can only ensured by the MHN through a positive and trustworthy relation building along with motivation.
Reference List
Andersson, G., Paxling, B., Wiwe, M., Vernmark, K., Felix, C. B., Lundborg, L., … & Carlbring, P. (2012). Therapeutic alliance in guided internet-delivered cognitive behavioural treatment of depression, generalized anxiety disorder and social anxiety disorder. Behaviour Research and Therapy, 50(9), 544-550.
Beck, J. S. (2011). Cognitive-behavioral therapy. Clinical textbook of addictive disorders, 474-501.
Chibanda, D., Mesu, P., Kajawu, L., Cowan, F., Araya, R., & Abas, M. A. (2011). Problem-solving therapy for depression and common mental disorders in Zimbabwe: piloting a task-shifting primary mental health care intervention in a population with a high prevalence of people living with HIV. BMC public health, 11(1), 828.
Ciraulo, D. A., & Shader, R. I. (Eds.). (2011). Pharmacotherapy of depression. New York: Humana Press.
Dobkin, R. D., Menza, M., Allen, L. A., Gara, M. A., Mark, M. H., Tiu, J., … & Friedman, J. (2011). Cognitive-behavioral therapy for depression in Parkinson’s disease: a randomized, controlled trial. American Journal of Psychiatry, 168(10), 1066-1074.
Field, T., Diego, M., Hernandez-Reif, M., Medina, L., Delgado, J., & Hernandez, A. (2012). Yoga and massage therapy reduce prenatal depression and prematurity. Journal of bodywork and movement therapies, 16(2), 204-209.
Fortinash, K. M., & Worret, P. A. H. (2014). Psychiatric mental health nursing. Elsevier Health Sciences.
Keltner, N. L. (2013). Psychiatric nursing. Elsevier Health Sciences.
Stuart, G. W. (2014). Principles and practice of psychiatric nursing. Elsevier Health Sciences.
Tansey, M. J., & Burke, W. F. (2013). Understanding countertransference: From projective identification to empathy. Routledge.
Townsend, M. C. (2014). Psychiatric mental health nursing: Concepts of care in evidence-based practice. FA Davis.
Videbeck, S. (2013). Psychiatric-mental health nursing. Lippincott Williams & Wilkins.
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