Major Depressive Disorder On Example Of Young Girl
Katie has been diagnosed with major depressive disorder evidence from the symptoms and behaviour that she is showing and also had past history of mental illness managed with pharmacological treatment. Katie is hopeless may be related to her diagnosed depression possibly evidence by loss of interest in life, sleep disorders, suicidal thoughts. She has lost interest in the things that she used to love once may be related to lack of purpose or goal in life. She also has impaired social interaction related to altered thought process, lack of motivation, feeling of worthlessness or lack of support system.
Major depressive disorder is a disorder where the mood, interest, thinking ways, believing in certain things will change for a bit long time. The symptoms that Katie is showing are the main symptoms for major depressive disorder and for anyone to be diagnosed with such kind of disorder will be showing more than one symptoms. The reason for having this kind of disorder can varies from person to person. Some can get it because of the stress. Stress can minimise the ability of controlling the mind, so some of the emotions like sadness and grief can be heightened. Some can get it because of some substance abuse like alcohol, while others can get it due to certain medical condition or certain medications. Major Depressive disorder not only affect the mood or behaviour but also impact on the physical health of the patient as it reduce the physical function, insomnia and loss of appetite. (Kerr, M. (2012, March 29)
Being a nurse, our assessment for Katie while she is in in-patient unit will be to conduct her Mental State Examination so we know her overall mental state. Here we will examine her appearance, mood, behaviour, speech, perception, insight, cognition, thought process, thought content, judgement. Our assessment will also be to determine the degree of impairment as it will help us to possess different symptoms scores or profiles before and after treatment, to assess the coping abilities and skills so we know we are using the best coping strategies that Katie can adapt. We will also conduct the suicide assessment to identify the level of suicidal risk. If Katie has high suicidal risk we will ask if there is any plan Katie has in mind, remove all the hazards from the nearby area, don’t leave her unattended, remove all the unnecessary items from the room. We will also go through all the risk assessment so we know the level of risk she has for self harm, harm for others, aggression, absconding, vulnerability, substance abuse or medical deterioration. While conducting the assessment we will also review her past medical history, any medications she is using or used to have, any allergy. We will also review her sleeping, eating patterns and her daily activities if possible (Lopresti, A. L., Hood, S. D., & Drummond, P. D. (2013). This can also give us the cause of her condition. Similarly, to get the baseline health condition of Katie, we will also perform physical examination like vital signs, Neuro observation. As this all couldn’t be possible to collect on the same day, we can keep her on behaviour chart, sleeping chart, food and fluid chart and review all the charting and send the copy of findings to her GP, psychiatrist. This will help them get the correct baseline data of Katie. While taking all these assessment it is important to keep in mind to make efficient use of resources, to avoid questioning the same thing again and again.
For providing recovery oriented care for Katie, we can use non pharmacology and pharmacology treatment. For non pharmacology treatment, we could use some of the interventions as follows: Behaviour therapy, family supports which will help to reduce the thinking of loneliness, Exercises which will help to divert her mind from the negative thoughts, self management or self control therapy that will help her to gain the worth of herself that she has lost, Emotion focused therapy so she can manage her emotion, Acceptance and commitment therapy, Cognitive behaviour therapy.
While Katie is in in-patient unit with us, we will focus on establishing the therapeutic relationship with her. For this we will try to maximise the communication with Katie as possible. Having a good communication with her will help us to know what she is going through, the cause that is triggering her a lot. Communication will play a vital role in managing or creating the best care plan possible for Katie. We will encourage Katie to express her feelings and explain her that sadness and grief can be reduced. For this we will try to engage her with some pleasurable activities as possible. We will let Katie to assume responsibilities for selfcare, encourage her for setting some goals. We won’t treat her as a patient but as a human being by letting her do the things independently that she can do or usually does. We will try to involve her in some activities that will require less concerntration because if we give something vast it will make her feel down and worthless again. Also we will use some of the coping strategies like providing awareness of her condition. If she is aware about her situation she can choose to neglect or accept them. We will also provide her with some relaxation exercise like breathing exercise or some sort of activities like music therapies that will relax her mind and body (Townsend, M. C., & Morgan, K. I. (2017).
On the other hand, there are some pharmacological treatment that can be provided to Katie. It can be provided if Non pharmacological treatment plan are not effective or with the combination of non-pharmacological. In this scenario, Katie’s history of depression was managed with medication. Katie could be provided with some antidepressant medicines. However those medicines can take time and also some of the antidepressant medicine can have side effects for some people (Gartlehner, G.2017). Antidepressant medicine should always be selected by having a detail look in clinical factors, drug to drug interactions, patient preferences. So we could refer her to GP or psychiatrist to review the medications, if the dose of antidepressant medicine that she was taking needs to be increased or it needs to be changed. Sometimes combination of some medicine can also be effective. So the proper review of medication for Katie is most important. Also after she is on medication, she should be monitored and should immediately be reported to GP or psychiatrist if any sign or symptom are noted. On the other hand, we can also use Electroconvulsive Therapy for Katie. As ECT is very effective for the person who are not responding to the medications and also do have some thoughts of self-harm. The action from the ECT is more rapid than the drugs. Even though we will have to consider the side effect that may arise from ECT.
This way to effectively manage the Katie’s depression, we will have to focus on patient engagement and also education, Use of evidence based treatment, provide both non pharmacological and pharmacological treatment whichever needed or effective, do regular follow up and monitoring so the strategies and treatment that we are using are actually working on Katie, consult with all the team member until the strategies in place seems to be working.
It is impossible to provide the whole care and treatment by a single nurse or team. So to provide the most excellent care possible we can refer her to different multidisciplinary team members such as Psychiatrist who will provide psychological treatment with some therapies like cognition behaviour therapy, dialectical behaviour therapy, Mental health worker who will provide therapeutic assistance for Katie, Social worker who will assist her to involve in activities and also help Katie to deal with some psychological problem by improving her quality of life, General practitioner will help to review her medication and also keep her physically health as mental health can impact physical health and sometime and be neglected which may later cause serious problems, clinical psychologist will find out if Katie psychological problem’s stage like if it is in the mild or severe, Physiotherapist will help to educate and encourage her to do some exercise that she is capable of so it will help to maintain her physical health and distract her mind and improve her mood, Self help group will help to gain tremendous support and insight from people sharing their experiences, Paediatrician will help to deal Katie with the issues of sleep and other behaviour problems, Occupational therapist will help to create activities that encourage independence and help to develop coping and social skills, Family therapist will help to create a strong bond between Katie and her family members, Counsellor will help to counsel and provide knowledge regarding the problem she is having in her life and also teach the ways to deal with them. Mental health nurse will help to create some programs that will help in developing behaviours and get the relevant information from patient by observing and monitoring.(Bailey, D. (2012).
While providing care for Katie we will also need to take care of her perspective and try to provide care that is beneficial and also try doing things of her choice. Having mental illness doesn’t mean, we can select whatever care available. It is our duty to select the best suitable care possible for her by keeping her interest in mind. No matter if she is diagnosed with some mental illness still she has her human rights to be treated with respect and be part of her treatment program. We will have to see the whole picture rather than concluding by their disorder. There are many circumstances that can play positive impact on Katie’s life like the language we use, considering all her needs not only mental but also physical, emotional, social and psychological. (Katsikitis, M., Lane, B. R., Ozols, I., & Statham, D. (2017).
Similarly Discharge planning is also very essential part of the care. Discharge doesn’t mean just letting Katie go her home but it means how are we going to help her promote her quality of living after going back from the hospital. We will start discharge planning from the day of admission and will keep it up to date until Katie stays in hospital. Our main aim will be to minimise the risk of re-occurring the illness or becoming worse. For this we will use our discharge planning strategies with following all the policies and guidelines of our organization. For Katie our strategies will be to educate her family member about her illness, To inform Katie and her family the importance of keeping in touch with all the Allied and mental health worker, To inform the importance of regular visit with GP, To provide all the follow-up appointments dates. On the same hand, it will be our duty to ensure the discharge for Katie should be on the right time with notice provided to all the team member working with Katie so all the other member will be prepared. We will have to make sure Katie will have pain free, risk free and convenient transfer from hospital to her home. We will have to make sure all the discussion or inquiry has been done with the family member and Katie regarding all the procedure and practice that needs to be after going to her home like the time for medication, the dose for the mediation, the time for the medication review. Also we will make Katie and her family understand how to contact us back, if they have queries or concern.
Finally, after taking aforementioned points into consideration, we can say that even if we are planning to treat a mental disorder patient it should not be different from the physically disorder patient. It is only possible to provide the best care for Katie, if we are non judgemental and we see her as a normal patient rather than a mental patient. All Katie needs is love, support, someone to listen her. So all we have to be is a good listener and active observer. So Being a Mental Nurse, I will always try to understand what Katie is suffering from, will always look the whole picture before judging her from her disorder and most importantly see the person but not the diagnosis.