Depression: Case Study: Belinda
This assessment task is based on the following case study of Belinda.
Case Study: Belinda
Belinda is a 35 year-old married woman with two children, Ben (aged 8 years) and
Sandra (4 years); her husband John is very supportive, but tends to work considerable
hours because of large debts for their business and new home. After the birth of Sandra,
Belinda developed post-natal depression, which improved with low doses of anti-
depressants. Belinda was on these medications for a year, and felt better and stopped
taking the medications with the support of her GP.
Now Belinda presents with major depression; she has not been able to sleep more
than a few hours each night, leaving her tired and unable to effectively care for her
children and maintain the house. She has lost 12kgs of weight over the past two and half
months and says that she has no interest in food at all. Belinda describes her mood as
miserable and cries easily, she feels the family would be better off without her. She has
thought about killing herself. Additionally because of her depression her level of
communication is reduced.
Belinda has been admitted voluntarily to the local acute mental health unit for
treatment of her depression. She is to commence Sertraline, and the treating team think
that she may require electroconvulsive therapy (ECT), but Belinda is reluctant to have this
therapy.
Develop a mental health nursing care plan, examining risk and other problems that
Belinda has, providing rationales from current evidence.
How would you go about helping Belinda to better understand her treatment and
care?
Lastly outline the discharge planning you would need to develop with Belinda.
Question Background:
From the information given in the case study, you should evaluate Belinda’s needs
and identify any risks that might arise during her time in the acute hospital setting. You
will need to explore the academic literature around patient-centred, recovery-focussed
management of patients like Belinda. You will need to determine key management
priorities for Belinda, and recommend effective management strategies to be included
when planning her care.
When you have a clear understanding of the information around this topic, you
should develop your ideas into an essay responding to this question:
Essay Question:
How can mental health nurses provide effective person-centred care for someone
with severe depression in an acute hospital setting?
CASE STUDY 2
Depression: Case Study: Belinda
Depression is mood disorder that negatively affects an individual’s way of thinking and
feeling. Depression is characterized by weight loss, suicidal ideations, lack of sleep and interest
in almost everything, inappropriate feelings of unworthiness, fatigue, psychomotor agitation and
inability to concentrate (American Psychiatric Association, 2013). This paper is a discussion a
case scenario presenting with depression with the focus on the nursing care plan for the patient,
and the patient’s discharge plan from the mental health unit.
Nursing Care plan
Assessment 1
Through the clinical interview, the patient reports that she sleeps for few hours, states that
her mood is miserable and she cries quickly during the interview. Additionally, as part of the
objective data, the patient’s weight has weight reduced as a result of the loss of interest in eating.
Nursing Diagnosis 1
Ineffective personal coping related to the altered mental functioning as evidenced by
insomnia, loss weight, feeling of unworthiness, fatigue, and history of postnatal depression
(Marcus et al, 2012).
Expected outcome 1
CASE STUDY 3
As a nurse through the nursing intervention to be carried out, I expect the client to be
capable of coming up with daily life experience. The capability to cope will be indicated by
progressive weight gain, increased hours of sleep, the ability of the patient to enjoy the activities
that she did not enjoy before, and an enhanced feeling of self-worthiness.
Nursing Interventions and Rationale 1
The client will be assessed for the factors or stressors that are contributing to the current
state of depression. The factors could include: recent grief, lack of personal coping mechanisms,
and change of lifestyle lack of social, economic and interpersonal support (Katon et al, 2013).
The rationale for seeking to unveil the stressors behind the development of the depression helps
in developing individualized solutions and coping mechanisms in collaboration with the patient
(Townsend & Morgan, 2017). In general, the assessment of the contributing factors helps in
designing and developing an individualized treatment plan for the patient. Besides, the patient is
encouraged to report any difficulties in coming up, and any progression in eliminating the
symptoms associated with depression to their nurse. Reporting the progress and the challenges
experienced during the treatment pan helps the nurse to adjust the treatment plan for the patient
appropriately by the patient’s ability to respond to it. Furthermore, the patient is encouraged to
participate in the development of the nursing planning. The rationale behind participation in the
nursing care plan helps in encouraging the patient to gain control of their situation and therefore
coming up with a more realistic and achievable management plan for the depression. The patient
states the activities or factors that they have successfully applied in helping them relieve the
symptoms of depression that they are currently experiencing and the nurse strengthens such
factors that relieve depression forte patient (Busch et al, 2016). Finally, the nurse encourages the
patient to participate in physical exercises such as aerobic and receive massaging services. The
CASE STUDY 4
rationale for the patient to undergo physical exercises diverts the patient thinking process for the
everyday issues and directs the thinking process to other new thinking processes, and thus
replaces the earlier focus on the stressors and identifies new coping mechanisms. I addition, the
patient focuses on their bodies as another coping mechanism against the stressors (Moorhead,
Johnson, Maas, & Swanson, 2014).
Implementation 1
The implementation of the above-elaborated nursing interventions will be carried out in
collaboration with the patient and other healthcare providers, for instance, exercise therapists.
Evaluation 1
The patient will be evaluated for their ability to cope up through their verbalization of
increased ability to cope, the reduction of the symptoms associated with depression including;
increased number of hours spent to sleep, increase in the body weight, enhanced the feeling of
self-worthiness, and absence of suicidal ideation. Moreover, the patient will be evaluated for the
ability to participate in the general social activities and interactions and their ability to sustain
attention and concentration in activities that she undertakes.
Assessment 2
The patient reports that they do not wish to be with their family and confesses to having
attempted suicide previously.
Nursing diagnosis 2
Risk of injury to self, related to the feeling of unworthiness and loss of interest in social
engagements as evidenced by their clear plan to commit suicide.
CASE STUDY 5
Expected Outcomes 2
The patient will demonstrate the ability to cope up with life stressors, as indicated by the
ability to apply the coping mechanisms when faced with negative thinking. Besides, the patient
will be acquired coping mechanisms and support groups as indicated by their ability to identify
and name individualized strategies and steps and individuals who support against life stresses.
The patient will also accept their social circumstance and progress in her life demonstrated by
their contentment in their achievement. Finally, the patient will not verbalize the desire to live
and not to take away their lives.
Nursing Interventions and Rationale 2
Admit the patient to the mental and psychiatric hospital unit. The rationale for admitting
the patient to the psychiatric unit is to provide continuous monitoring to the patient thus,
providing safety to the patient since she has previously demonstrated intentions to commit
suicide. Additionally, the nurse should conduct psychological counseling to the patient (Keefe,
Brownstein-Evans, Lane, Carter, & Polmanteer, 2015). The counseling sections help the patient
to reveal the factors that are contributing to their state of feeling helpless and unworthy and also
appropriate individualized coping mechanism are identified in collaboration with the patient.
Furthermore, the nurse conducts family therapy with the patient close family members, for
instance, the patient’ partner. The origin of the stressors can be directly attributed to the lack of
social support from their partner, and therefore family therapy helps in rebuilding their
interactions with the husband and identifies ways of promoting social support and prevention of
CASE STUDY 6
occurrence of similar stressors within the family. Moreover, the patient is encouraged to apply
the identified and developed coping mechanisms whenever they experience the negative thinking
and stressors in their life (Papathanasiou, Tsaras, Neroliatsiou, & Roupa, 2015).
Implementation 2
The nurse will implement the admission process. Additionally, the nurse in conjunction
will implement the psychological counseling with the patient. Finally, the nurse, the patient, and
the patient’s partner will implement the family therapy.
Evaluation 2
The patient will be evaluated for the absence of the suicidal plans, the reduction and
relief of the negative thinking and the feeling of unworthiness. Moreover, the patient will be
evaluated for improved and enhanced social support and family relations. The patient will also
be evaluated for the ability to apply the coping mechanisms successfully in dealing with the
stressors.
Assessment 3
During the clinical interview, the patient reports that they feel that the unworthy to be
part of their family and wish to take away their lives. Additionally, the patient cannot cope with
the stressors presenting in their lives.
Nursing Diagnosis 3
Disturbed thought process related to neurochemical imbalance as evidenced by the
inability to initiate and implement coping mechanisms on their own.
CASE STUDY 7
Expected Outcome
The patient will demonstrate the ability to think rationally and apply coping mechanism
appropriately. Additionally, the patient will be capable of verbalizing coping mechanism for
various and several negative thinking and stressors presenting in life. Besides, the patient will
demonstrate organized thinking and decision-making process
Nursing Intervention and Rationale 3
The client’s previous cognitive and behavioral capabilities are identified and recorded to
establish a baseline data upon which the patient should be restored to through the therapeutic
process. Moreover, the patient is assisted in identifying stressors in life and formulating coping
strategies to mitigate negative thinking to restore the patient’s capability of developing and
applying coping mechanisms (Rubio-Valera, Beneitez, Peñarrubia-María, Luciano, Mendive,
McCrone, & Serrano-Blanco, 2015). Furthermore, the patient is assisted in postponing necessary
and proportionally critical decisions in their lives, whose rationale is to restore the coping
capability through initially developing the ability to develop and apply coping mechanisms to
small task and after that nurture the ability to deal with more critical decisions (American
Psychiatric Association, 2012).
Implementation 3
The nurse in collaboration will perform the implementation of the nursing interventions
with the patient. The role of the nurse will be prompt the patient into enlisting their coping
strategies before the presentation of the symptoms of depression, assisting the patient in
CASE STUDY 8
identifying the decisions that they need to take in their lives and in helping the patient apply the
identified coping strategies in coping with life stressors.
Evaluation3
The patient will be evaluated by rating the improvement in their ability to cope with
stressors based other baseline data and their progression towards restoring their ability to cope.
Additionally, the patient will be evaluated for their ability to make gradual development in
coping with life stressors.
Helping patient understand Treatment
Firstly, proper communication to the patient will help her know the condition, and hence
the treatment. The patient should be informed of the possible contributing factors towards the
development of the condition. For instance, the factors leading to the development of these
factors include; lack of social support and the inability to develop and apply coping mechanisms.
The communication should be appropriate to the patient; buy using the language that the patient
understands (Kvam, Kleppe, Nordhus, & Hovland, 2016). While communicating with the
patient, assurance should be given to the patient that the information they give will be maintained
as confidential and is only meant for providing comprehensive history, and hence developing the
appropriate treatment. The patient should be informed that giving honest and thorough
information leads to more accurate diagnosis and proper treatment plan and therefore better
results in eliminating the symptoms associated with depression (Hallgren, Kraepelien, Öjehagen,
Lindefors, Zeebari, Kaldo, & Forsell, 2015).
Besides, before commencing the treatment plan, the patient should be explained what the
management interventions involved (Townsend & Morgan, 2017). The patient will be explained
CASE STUDY 9
the activities involved in the counseling processes physical exercises and the family therapy
processes. Furthermore, the rationale behind each of the interventions undertaken should be
explained to the patient, to facilitate and promote the patient’s cooperation in the process.
Another way of ensuring the corporation of the patient in the process of treatment is by
obtaining the consent of the patient before taking the history and commencing any nursing care
interventions. The principle of respect for the patient’s autonomy is one the basic ethical
considerations that should be accorded to patients and followed by all clinicians when providing
care. The patient’s choice to reuse to elicit any information or to participate and cooperate in any
of the nursing care interventions should be respected.
Discharge plan
One of the priorities in planning for the patient’s discharge is adherence to treatment plan.
While making the appointment dates, for instance, the patient should be engaged in the process
to identify any barriers that may interfere with the ability of the patient to adhere to the apparent
meet dates. Additionally, the drug prescriptions should be discussed with the patient. The patient
should be educated on the importance of keeping what the dosage and how to minimize chances
of missing their dosages and the resultants effects of the skipping medication. The expected side
effects of the medication they are put under should be explained to. Before the discharge, the
patient’s convenience to the treatment plan should be considered (Yesufu-Udechuku, Harrison,
Mayo-Wilson, Young, Woodhams, Shiers, & Kendall, 2015). The coping strategies identified
and developed should be discussed within the home-based context. The patient should be
encouraged to report hindrances that they may face in the process of implementing the coping
strategies so that in collaboration with the nurse, appropriate solutions are sought. Methods of
CASE STUDY 10
avoiding factors that trigger stress and depression symptoms are discussed with the patient to
minimize the chances of relapse of the symptoms and the condition (Walton, 2014).
In summary, the patient in the case scenario presents with symptoms that conform to the
criteria for the diagnosis of depression. The nursing care plan for the patient addresses the
impaired coping capability, the risk of self-harm and harm to others and the disturbed thought
process. The treatment strategy devourers to developing coping capabilities, eliminating self-
inflicted harm and restoring the patient’s thought process. To ensure that the patient fully
understands the treatment, the nurse should communicate effectively, respect the patient’s
confidentiality and collaborate with the patient in developing the treatment plan. The
management process is entirely patient centered and evidence based. The patient is actively
involved in the disc-discharge planning.
CASE STUDY 11
References
American Psychiatric Association. (2012). Practice guideline for the treatment of patients with
major depressive disorder (revision). Am J Psychiatry, 157(4), 1-45.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders
(DSM-5®). American Psychiatric Pub.
Busch, F. N., Rudden, M., & Shapiro, T. (2016). Psychodynamic treatment of depression.
American Psychiatric Pub.
Hallgren, M., Kraepelien, M., Öjehagen, A., Lindefors, N., Zeebari, Z., Kaldo, V., & Forsell, Y.
(2015). Physical exercise and internet-based cognitive–behavioural therapy in the
treatment of depression: randomised controlled trial. The British Journal of Psychiatry,
207(3), 227-234.
Katon, W. J., Lin, E. H., Von Korff, M., Ciechanowski, P., Ludman, E. J., Young, B., … &
McCulloch, D. (2013). Collaborative care for patients with depression and chronic
illnesses. New England Journal of Medicine, 363(27), 2611-2620.
Keefe, R. H., Brownstein-Evans, C., Lane, S. D., Carter, D. B., & Polmanteer, R. S. R. (2015).
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educators. Advances in Social Work, 16(2), 202-213.
Kvam, S., Kleppe, C. L., Nordhus, I. H., & Hovland, A. (2016). Exercise as a treatment for
depression: a meta-analysis. Journal of affective disorders, 202, 67-86.
Marcus, M., Yasamy, M. T., van Ommeren, M., Chisholm, D., & Saxena, S. (2012). Depression:
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CASE STUDY 12
Moorhead, S., Johnson, M., Maas, M. L., & Swanson, E. (2014). Nursing Outcomes
Classification (NOC)-E-Book: Measurement of Health Outcomes. Elsevier Health
Sciences.
Papathanasiou, I. V., Tsaras, K., Neroliatsiou, A., & Roupa, A. (2015). Stress: Concepts,
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Rubio-Valera, M., Beneitez, I., Peñarrubia-María, M. T., Luciano, J. V., Mendive, J. M.,
McCrone, P., … & Serrano-Blanco, A. (2015). Cost-effectiveness of active monitoring
versus antidepressants for major depression in primary health care: a 12-month non-
randomized controlled trial (INFAP study). BMC psychiatry, 15(1), 63.
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in evidence-based practice. FA Davis.
Townsend, M. C., & Morgan, K. I. (2017). Psychiatric mental health nursing: Concepts of care
in evidence-based practice. FA Davis.
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& Kendall, T. (2015). Interventions to improve the experience of caring for people with
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