NSG 4055 Creating a Plan of Care
NSG 4055 Creating a Plan of Care
Plan of Care
The identified health problem is depression in adults. Depression is a common problem that is affecting adults in the USA. The current statistics show that about 17.3 million adults in the US have experienced at least a major depressive episode. The population of adults with a history of major depressive episodes constitutes 7% of the adults in the US. The rate of depression is reported to be higher in females (8.7%) when compared to males (5.3%). The prevalence is also higher in adult individuals aged between 18 and 25 years (13.1%) when compared to any other age group of adults (NIMH, n.d.). I chose to write about depression among the adult population because of its severe health impacts on people. Depression is associated with severe impairment in adults. Accordingly, it is estimated that 11 million adults aged above 18 and above experienced episodes of significant impairment associated with severe impairment (NIMH, n.d.). Depression is also associated with the decline in the quality of life of patients. The evidence shows that depression increases the costs of care incurred by patients and their significant others to seek the care they need. It also lowers the productivity of the affected populations (CDC, 2019).
Healthy Vision 2030 Topic
The selected Healthyvision 2030 topic is mental health and mental disorders. Mental health and mental disorders are a critical concern in the US, as seen from the fact that about half of the US population will be diagnosed with a mental disorder in their lifetime. The topic of mental health and mental disorders was selected because it affects people of all ages as well as ethnic groups. Mental health problems also affect the ability of individuals to function optimally in their societies. They also contribute to premature disability and mortality. Part of the aims of the Healthypeople 2030 is increasing the proportion of adults with depression that get the needed treatment. As a result, it is important to explore the issues related with depression in adults to increase the understanding of the need for interventions to prevent and optimize its management.
Holistic Plan of Care
A diagnosis with depression can be devastating to patients, their families and community at large. The impacts of the diagnosis are high in communities characterized by stigma and stereotypes towards depression. Initially, patients enter into a stage of denial following their diagnosis with depression. As a result, there is an increased need for holistic mental care to the patient and their significant others to facilitate their acceptance. Psychiatric nurse practitioners have a role to play in facilitating acceptance among patients with diagnosis and their families. They provide evidence-based information to the patients that will facilitate their informed decision-making. The information focuses on aspects such as causes, effects, symptoms, and management of depression. Patient and family education empowers them to explore the available support systems that they can explore to facilitate the effective management of depression. PMHNP also prioritize the needs, beliefs, values, and practices of the patient and their families in the care process to increase their acceptance of the diagnosis and facilitate the provision of culturally appropriate care.
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Patients diagnosed with mental health problems and their families should be supported to cope effectively with the disorder. Accordingly, depression alters the normal functioning and behaviors of the affected interventions. Nurses should assist them in learning effective strategies that they can use in reducing the severity and recurrence of depressive symptoms. Interventions such as the provision of cognitive behavioral therapy are effective in helping the client to develop the needed skills for managing depressive symptoms. Educating the patient on the use of interventions such as eating healthy diets and engaging in physical activity minimizes the depressive symptoms in patients. Patients should also be linked with the existing social support systems to ensure that they learn from others on the effective interventions they can use to manage their depression. The impacts of the coping skills include reduction in severity and recurrence of symptoms of depression and improvement in the effectiveness of pharmacological interventions utilized for the disorder.
Summary of Information
The focus of my assignments from week 1 to 4 has been mainly on depression in adults. The focus on this area is attributed to the fact that the Healthypeople 2030 recognizes it a common problem that is affecting adults in the USA. The current statistics shows that 17.3 million Americans have experienced at least one major depressive episode. The effects of depression among adults are varied. They include major impairment in functioning, decline in quality of life, increased cost of healthcare, and loss of productivity. The morbidity and comorbidity of major depression is high. For example, the global risk of individuals developing major depression is estimated to range between 15 and 18%. Major depression is associated with adverse effects that include the lowering of the psychosocial functioning as well as quality of life of the affected populations. It also predisposes patients to other health problems that include anxiety and substance abuse disorders. Depression is also an independent risk factor as well as negative prognostic factor for somatic disorders that include cardiovascular disease, diabetes, chronic respiratory disorders, hypertension and arthritis (Gutiérrez-Rojas et al., 2020). The morbidity in depressive disorders is significantly high, as seen from the fact that up to 50% of the patients with major depressive disorders experience illnesses even after their discharge from the hospital. Patients may also present with depression with mixed features, which has been associated with poor response to recommended treatments such as the use of antidepressants (Baldessarini et al., 2017).
I interviewed K.H, a 35-year-old male diagnosed with schizoaffective disorder after exhibiting delusions and hallucinations, which alternated with depressive symptoms. K.H reported that accepting that he was suffering from depression was hard for him, as he had to live in denial for three years. However, he has accepted the diagnosis and currently engages in self-care activities that minimize the severity of depressive symptoms. His family has also accepted his diagnosis and providing him the support that he needs for the optimum management of the disorder. K.H has also developed effective coping skills for managing the disorder. Currently, K.H is undergoing pharmacotherapy and psychotherapy to manage depression. He also has access to adequate social support that has led to effective management and coping with depression.
The assessment of K.H revealed a number of his support needs. High priority needs include coping skills, positive reinforcement, and treatment adherence. Medium-priority needs include self-esteem, financial, and sleep issues. Low-priority needs include nutrition, physical exercise, and acceptance to treatment. Therefore, the appropriate interventions that were required to address the needs included encouraging the client to adhere to his treatment plan, giving positive reinforcement by reminding him of his positive qualities and his significance to his family and friends and assisting him in creating a low-stress environment, which will lower the severity of depressive symptoms.
Interventions to reduce to improve the mental health of patients as stated in Healthypeople 2030 should therefore be implemented. At the individual level, outreach activities can be implemented to increase access to mental health services and evidence-based treatment for individuals. Health providers can provide psycho-education for families to improve mental health literacy, reduce stigma, and increase help-seeking in mental health at the family level. At the policy level, policy-makers should provide technical and financial support for community-based organizations that focus on mental health to collaborate with the healthcare sector. Nurses should also play their proactive role in advocating the acceptance of their diagnoses by the patients and their families. They should adopt interventions such as modifying the patient environment and addressing social determinants of health that limit access to mental healthcare services. Nurses should also link patients to the existing support services in the state such as National Alliance on mental health that provide educational support for mental health patients.
- Activity intolerance related to lack of energy and amotivation as evidenced by decline in functioning and difficulties in concentrating
- Altered nutrition less than body requirements related to poor appetite
- Impaired social interaction related to loss of interest in pleasurable activities, including socialization
The subjective data from the patient included lack of interest in engaging in pleasurable activities more than half of the days and feeling depressed and hopeless nearly every day K.H reported having insomnia, poor appetite and feels bad about himself most of the days. K.H also stated that he has trouble in concentrating most of the days, which has adversely affected his occupational productivity. Nevertheless, he denied having psychomotor retardation or having suicidal and homicidal thoughts or ideations. The objective data obtained included four ticks in depressive symptoms occurring more than half the days and one tick in symptoms occurring nearly every day, which indicated major depression.
The interview results therefore lead to the diagnosis of major depression, since the client met the criteria for the disorder as stated in DSMV. He had symptoms of mood depression and lack of interest in activities.
One of the desired outcomes for treating K.H is the reduction and management of symptoms of depression. It is expected that the initiation of treatment will lower the symptoms of depression and their severity. The other outcome is the development of effective coping skills by K.H. The development of effective coping skills will minimize symptoms of the disorder. The other outcome is the prevention of recurrence of symptoms of depression. The last outcome is the increase in treatment adherence and consistency in use of behavioral interventions by the client.
Outcome and process measures will be used in evaluating the outcomes of the interventions. Outcome measures will determine whether the intended objectives of the adopted interventions were achieved or not. Process measures will assess the effectiveness of the interventions that were used to achieve optimum effectiveness of the interventions. An example is the evaluation of level of patient participation in the treatment process.
Actions and Interventions
One of the actions that were adopted for K.H is the administration of an antidepressant (Prozac 40 mg orally once daily) for depressive symptoms and an antipsychotic drug (Invega Sustenna 9 mg orally once daily) for hallucinations and delusions. The patient was also enrolled in individual and family psychotherapy to help him develop coping skills for managing negative thought processes, improve social skills and treatment adherence (Miller & Black, 2019). The family was also educated on the nature of support that K.H needs for his recovery and symptom management. The family was educated on issues such as supporting him in ensuring medication adherence, increasing his access to healthy diets, and participation in physical exercises to minimize severity of symptoms.
Evaluation of Patient Outcomes
The evaluation of patient outcomes will be both subjective and objective. Subjective evaluation will examine the perception of the client towards the effectiveness of the adopted treatments. A subjective improvement of symptoms will translate into treatment effectiveness in achieving the desired patient outcomes. The other strategy will be the administration of screening questionnaire for depression. A score of less than four will translate into treatment effectiveness.
Overall, depression is one of the disease burdens with high rate in the US. Depression is associated with significant morbidity and comorbidity. Nurses have critical roles to play in ensuring patient and family acceptance of their diagnosis with depression. They also explore the support systems and care that patients need for their recovery. Therefore, I will use the experience from this project to improve on the care given to patients with depression in my practice.
Baldessarini, R. J., Forte, A., Selle, V., Sim, K., Tondo, L., Undurraga, J., & Vázquez, G. H. (2017). Morbidity in Depressive Disorders. Psychotherapy and Psychosomatics, 86(2), 65–72. https://doi.org/10.1159/000448661
CDC. (2019, June 7). Products—Data Briefs—Number 303—February 2018. https://www.cdc.gov/nchs/products/databriefs/db303.htm
Gutiérrez-Rojas, L., Porras-Segovia, A., Dunne, H., Andrade-González, N., & Cervilla, J. A. (2020). Prevalence and correlates of major depressive disorder: A systematic review. Brazilian Journal of Psychiatry, 42(6), 657–672. https://doi.org/10.1590/1516-4446-2020-0650
Miller, J. N., & Black, D. W. (2019). Schizoaffective disorder: A review. Annals of clinical psychiatry: official journal of the American Academy of Clinical Psychiatrists, 31(1), 47-53. https://doi.org/10.3109/10401239109147967.
NIMH. (n.d.). NIMH » Major Depression. https://www.nimh.nih.gov/health/statistics/major-depression