Mental Health-Nursing Continued Period of Hopelessness

Question: Discuss about the Mental Health-Nursing for Continued Period of Hopelessness. Answer: Depression is a medical illness that negatively affects people thinking pattern and behavior. The continued period of hopelessness and grief often drive people to commit suicide. Depression and anxiety disorder is a common illness in the community and it is the third highest burden of disease in Australia. Due to major depressive disorder, every day at least six Australians die from suicide and an additional thirty people try to take their life (Cheung et al., 2013). Though suicide comprises only 1.6% of all deaths in Australia, it is the cause of the majority of deaths especially in specific age-groups (De Leo, 2015). Young people between the age of 15-25 are more likely to die from suicide rather than fatal disease in Australia. Gender wise, male are at greater risk of suicide which is evident from the fact that in 2010 about 77% of death in men occurred from suicide. In the year 2014, about 18.5% males and 5.9% females died by suicide (Causes of Death, Australia2016). Regarding th e age-specific rate of suicide in males, highest rate of suicide was seen in older people above the age group of 85 years. The next highest age-specific suicide rate was found in the age group of 40-44 years and 50-54 years. In females, higher rate of suicide was found among the age group of 35-39 years (Cheung et al., 2013). It was also found that majority of them dont seek medical help for mental disorder or depression. Other groups who are at more risk of suicide in Australia are the indigenous Australians living in rural and remote areas, people with drug abuse and mental illness, children and lesbian, gay bisexual, transgender, intersex people (LGBTI). Among Aboriginal and Torres Islander people, it is the fifth leading cause of death. A suicidal attempt is also the greatest public health concern for Australia because about 60,000 people try to take their lives every year. The rate of hospitalization due to self-harm has also increased. In 2010, about 26,000 hospitalizations in Australia were for self-harm (Sanna et al., 2014). However, majority of these cases are underreported because of the stigma associated with suicide and self-harm. It is necessary to identify and manage suicide ideation both in patients with or without major depressive disorder. On analysis of Mr. Edwardss mental health condition, it has been found that he has been suffering from depression due to his separation from his family members and loss of money in business. He has moved to Australia due to his work, but he misses his family. One of his sons committed suicide, and other moved to Sydney as he did not want to work in Mr. Edward's farm. Due to his age, he is not able to attend to his farm properly and for this reason, he is producing less milk and eggs to sell. Both family and financial problems in business have made Edward mentally depressed and stressful. During interaction with the mental health nurse, he was found to be tearful. Because of his mental trauma, his sleep pattern has changed, he has lost weight and he also feels exhausted most of the time. Another critical sign observed in Mr. Edward is that he has lost all hope for future, and he has been developing suicide ideation too. Many possible factors contribute to people's vulnerability to men tal illness or depression which includes genetics, neurological mechanism and life events such as trauma, loss of loved ones, stressful situation and early childhood experience (Gilbert, 2014). The two important factors that would lead to major depression are biopsychosocial factors and lifestyle factors. Research on important pathways associated with major depression also showed that it is caused by biopsychosocial and lifestyle factors. Diet, exercise, and sleep play a mediating role in the development and progression of the disease. Edward was also found to have irregular sleeping pattern since the last six months. This change has an influence on dysregulated pathways associated with depression. It has an impact on the immunoinflammatory pathway, neurotransmitter process, neuroprogression and antioxidant defence systems (Lopresti et al., 2013). Increased attention is required in the three areas to plan effective mental health intervention and treat such patients. Patient's biopsy chosocial factor also acts as a significant risk for depression. This factor affects individual people in different ways. According to biological factors patient may develop depression due to endocrine, immune and neurotransmitter functioning. Besides this, people with physical illness or disorder are more likely to develop depression. The psychological factors that might contribute to depression in people are negative thinking, lack of coping skills, impaired emotional intelligence and problem in judgments. Psychological factors might be influenced by both personality characteristics as well as social factors. Stressful situations in life trigger changes in brain functioning leading to the condition (Sowislo Orth, 2013). In case of treating patients like Mr. Edward with mental illness or major depression, several ethical issues might arise in the process. Issues might arise in the area of right to treatment, informed consent, and confidentiality. There is conflict between patients autonomy and nurses duty. Firstly ethical dilemma arises when nurses do not provide relevant information about the condition to patients and treatment planned for them. Since anxiety reduction is a vital part of treating mental illness, many nurses do not disclose their mental status to patients. Their right to treatment is hampered. This is a serious issues and patient has the right to know about clinical procedures, treatment. Informed consent is also as important element of ethical health care practices (Huston, 2013). So, nurse should learn to confidently state patients ailment and the cause for it. Ethical considerations for mental health nurses include adhering to ethical guidelines to the treatment of mentally ill pa tients. Autonomy, beneficence, nonmaleficence and justice are the central principles of biomedical ethics (Park et al., 2014). The conflict between these elements often leads to stressful situation among nurses as well as patients. For example, the nurse may strongly feel the need to start certain interventions of patient, but the patient may not agree with it. Dilemma arises when the nurse has to maintain patient's autonomy as well as provide justice in treatment. Nurse need to learn the skill to communicate information in such a way that the patient understands the need for it and how they will benefit from it. Informed consent and evaluating patients decision capacity may help to resolve ethical issues. The nurse can plan intervention with ethical decision making strategies such as analyzing cases by medical indications, patient's preference, and quality of life issues and identifying factors that affect patient's care (Stuart, 2014).According to legal perspective also, greater c onflict occurs between the patient's right to autonomy and the professional duty of care (Johnstone, 2015). Patients need to be treated under the Mental Health Act. However, the majority of patients are admitted as informal patients. Valid consent and Common law is essential part of mental health practice. Nurses should always seek patient consent before any intervention is commenced. But often involuntary admissions are made without consent when a person is in danger. Common law gives patient the right to treatment, right to informed consent, right to refuse treatment. Most common legal issues nurses face in case of failure to protect safety of patients. They can be penalized for negligence or malpractice after evaluating the legal cause of damage (Fogel et al., 2015).It is essential to follow the nursing board standard of practice to minimize these issues. On mental health nurse interview with patient, it has been found that Mr. Edward has been increasingly depressed since the death of his son. He is facing difficulty in sleeping and waking up at odd hours. He is hopeless, has developed ruminating thought about suicide, but not thought of a method to do so. After analyzing the detailed life history of Mr. Edward, two risks have been identified in patient. Firstly, since the client is completely dejected with his life, then there is a high possibility that the patient might attempt to harm himself. Therefore, assessment of suicide risk in Mr. Edward will be the first priority for mental health nurse. Severe depression and anxiety symptoms in patient are often the trigger for suicide ideation or behavior. Since Mr. Edward is dealing with negative life events, it comes under the suicide pathway model. Therefore, it will be necessary for nurse to monitor the patient carefully and keep self-harm object away from him (Hawton et al., 2013). A nother risk is that Mr. Edward may develop other associated comorbidities such as cardiovascular disease and diabetes. Resistance to treatment will also act as a risk for patients and a challenge for nurse. There will be high chance that Mr. Edward will develop panic attack and become aggressive if forced for any treatment (Miravitlles et al., 2014). Therefore, management of this risk will be essential for mental health nurse. To support Mr. Edward and minimize risk of suicide in patient, the nurse will have to assess the clinical symptoms related to suicide behavior in client and then teach them coping skills. This intervention is necessary because often nurses cannot identify stressors or reasons for depression in patients. Assessment and mental health examination help in identifying potential stressors in patient and then taking necessary actions. Patient with depression is also found to lack in concentration, and they have poor coping skills. Nursing intervention in the area of practical coping skills helps patient like Edward to verbalize their feelings so that they can interact with nurse and discuss their life stressors. Intervention in this area will also help Mr. Edward to come out of his depression and develop positive attitude towards the challenges in life (Fayers Machin, 2013). To carry out mental state assessment in Mr. Edward, the nurse will take several steps. In the first step, appearance and physical activity will be assessed. Observing Mr. Edward's appearance and behavior helps in determining whether he can conduct their activities or not. Assessing patient's affect and mood will provide the nurse with the information like whether Mr. Edward is depressed, euphoric, whether he has restricted emotions. Thought form and thought process analysis would help in determining whether patient is developing suicide ideation or not (Ekers et al., 2013). After mental health assessment, the intervention in coping strategy will assist in minimizing risk of suicide in Mr. Edward. First nursing intervention is to observe cause of ineffective copings such as grief, change in life situation or other reasons. In Mr. Edward, it was found that he was suffering from depression due to separation from his family members. In the next step, it will be necessary for nurse to identify Mr. Edwards source of stressors and also observe his strengths. To minimize suicide, nurse will have to establish therapeutic relationship with clients (Townsend, 2014).In this way, nurse can intervene to raise his spirits to prevent suicide by helping him feel that life is worth living. It will also be necessary to identify what activities interest the patient. The nurse will monitor potential for suicide in patients by signs like poor social adjustment and mood disorders. Nurse need to be aware of warning signs in patient. Mr. Edward will also be referred to mental h ealth counselor if he is at major risk of attempting suicide. It will also be necessary to educate Mr. Edward's wife regarding restricting patients access to sharp objects and lethal weapons in home (Lefley Wasow, 2013). They should be encouraged to take part in activities that reduce his stress. To reduce risk of comorbidity associated with depression in Edward, non-pharmacological intervention will be critical. A study by Morgan et al., (2013) highlighted the effectiveness of collaborative care along with practice nurse as a case manager for managing comorbidities associated with depression. In a randomized clustered trial, nurses acted as case managers and reviewed pathology results, lifestyle risk factors, patient goal and priorities to determine continuum of care. Great improvement in psychological measure was seen in patients. For the treatment of depression in Mr. Edward also nurse can provide self-management intervention to reduce stress and grief symptoms. In severe case, antidepressant can be given to him. Counseling the patient will also help in reducing signs of depression (Dirmaier et al., 2012). Therefore, nurse role is to focus on safety needs of Mr. Edward and identify problems that prevent him from leading normal life. It is essential to manage long-term need s by maintenance of patient in the least depressive state as far as possible. Reference Causes of Death, Australia, 2013. (2016).Abs.gov.au. Retrieved 31 August 2016, from https://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/3303.0~2013~Main%20Features~Suicide%20by%20Age~10010 Cheung, Y. T. D., Spittal, M. J., Williamson, M. K., Tung, S. J., Pirkis, J. (2013). Application of scan statistics to detect suicide clusters in Australia.PloS one,8(1), e54168. De Leo, D. (2015). Australia revises its mortality data on suicide.Crisis. Dirmaier, J., Steinmann, M., Krattenmacher, T., Watzke, B., Barghaan, D., Koch, U., Schulz, H. (2012). Non-pharmacological treatment of depressive disorders: a review of evidence-based treatment options.Reviews on recent clinical trials,7(2), 141-149. Ekers, D., Murphy, R., Archer, J., Ebenezer, C., Kemp, D., Gilbody, S. (2013). Nurse-delivered collaborative care for depression and long-term physical conditions: a systematic review and meta-analysis.Journal of affective disorders,149(1), 14-22. Fayers, P. M., Machin, D. (2013).Quality of life: the assessment, analysis and interpretation of patient-reported outcomes. John Wiley Sons. Fogel, B. S., Greenberg, D. B. (2015).Psychiatric care of the medical patient. Oxford University Press. Gilbert, P. (2014).Depression: The Evolution of powerlessness. Psychology Press. Hawton, K., i Comabella, C. C., Haw, C., Saunders, K. (2013). Risk factors for suicide in individuals with depression: a systematic review.Journal of affective disorders,147(1), 17-28. Huston, C. J. (2013).Professional issues in nursing: Challenges and opportunities. Lippincott Williams Wilkins. Johnstone, M. J. (2015).Bioethics: a nursing perspective. Elsevier Health Sciences. Lefley, H. P., Wasow, M. (2013).Helping families cope with mental illness(Vol. 2). Routledge. Lopresti, A. L., Hood, S. D., Drummond, P. D. (2013). A review of lifestyle factors that contribute to important pathways associated with major depression: diet, sleep and exercise.Journal of affective disorders,148(1), 12-27. Miravitlles, M., Molina, J., Quintano, J. A., Campuzano, A., Prez, J., Roncero, C., DEPREPOC Study Investigators. (2014). Factors associated with depression and severe depression in patients with COPD.Respiratory medicine,108(11), 1615-1625. Morgan, M. A., Coates, M. J., Dunbar, J. A., Reddy, P., Schlicht, K., Fuller, J. (2013). The TrueBlue model of collaborative care using practice nurses as case managers for depression alongside diabetes or heart disease: a randomized trial.BMJ open,3(1), e002171. Park, M., Jeon, S. H., Hong, H. J., Cho, S. H. (2014). A comparison of ethical issues in nursing practice across nursing units.Nursing ethics,21(5), 594-607. Sanna, L., Stuart, A. L., Pasco, J. A., Kotowicz, M. A., Berk, M., Girardi, P., Williams, L. J. (2014). Suicidal ideation and physical illness: Does the link lie with depression?.Journal of affective disorders,152, 422-426. Sowislo, J. F., Orth, U. (2013). Does low self-esteem predict depression and anxiety? A meta-analysis of longitudinal studies.Psychological bulletin,139(1), 213. Stuart, G. W. (2014).Principles and practice of psychiatric nursing. Elsevier Health Sciences. Townsend, M. C. (2014).Psychiatric mental health nursing: Concepts of care in evidence-based practice. FA Davis.