This essay is based on the case study of Tracy 42 years old mother of two who has experienced a difficult upbringing and has been diagnosed with Depression and Anxiety. Depression is a mood disorder that causes a persistent feeling of sadness, low self-esteem, and loss of interest in daily activities . According to the Office for National Statistics ,19.7 % of people in the UK aged 16 and over had symptoms of depression and the percentage of females was higher (22.5%) than male (16.8%) .Tracy is experiencing a feeling of guilt over not being able to meet the needs of her child. Therefore, the smart objective is to reduce Tracy’s mood of guilt within 3 months and as this will help to improve her self-esteem. A rationale using evidence-based research will be used to support the four interventions to help Tracy’s behavioral distress. The interventions are designed firstly to engage Tracey in self-care grooming activities, secondly to assist Tracey to get a package of care for her father (Cedric), thirdly to discuss with General practitioner (GP) to review Tracey’s medication and lastly refer to Tracey to therapy for Cognitive Behavioural Therapy (CBT).Health promotion and appropriate communication strategies which will empower Tracey and provide family-centered care.
Self-care is defined as the engagement in behaviours that maintain and promote physical and emotional well-being including factors such as sleep, exercise and use of social support (Myles et al,2012).One of the interventions to decrease Tracy feeling of guilt would be to encourage her to engage in self-grooming activities. Tracy ability to attend to grooming activities is often an initial step in feeling better about oneself. In this case, Tracey will take 30 minutes’ walk every day for a period of three months in order to increase her level of endorphins which improves her physical looks and therefore increasing her self-esteem . Hence, this could help to increasing feelings of control and satisfaction, thereby decreasing the feelings of guilt.
Self-esteem is critical to the improvement of both mental and physical health . However, health education can be used to empower Tracey in order to strengthen her capacity to control her own health and develop the knowledge, values, skills and confidence required for Tracy’s decision-making. In addition, the nurse would encourage Tracy to participate in group meetings where other members share similar situations or feelings. This provides an atmosphere where positive feedback can be used, alongside a more realistic appraisal of self, in order to reduce her feelings of guilt. Positive reinforcement should be provided for all observable accomplishments, but not as do not flattery or give insincere praise. Rather, it is important to be honest with her and give positive feedback.
The second intervention demonstrates the importance Tracey receiving support to care for her father and how this can reduces her feeling of guilt Every thought and emotions Tracey experience changes our brain chemistry, the feel-good neurotransmitter serotonin which constantly fluctuates. Women feel more stressed, due to the “heavier daily life” burden that they must shoulder and the factors such as child-rearing duties. For example, in Tracey’s case, she has two children, Poppy and Kai who have their own health needs, Poppy has enuresis (the involuntary urination, that occurs mainly at night and is most prevalent in children) whilst Kai suffers from Attention deficit hyperactivity Disorder (ADHD) which is a neuro-behavioural disorder and Asthma (a chronic condition that make it hard to breathe). In addition to this, Tracey is the sole carer for her father and this new responsibility can have a negative impact on her ability y to cope .Tracey decided two years ago that her father should move in with her and, as he is currently at the end of his life, this occupies a large amount of her time. Hence, she is unable to take care of herself. As a nurse, it would be for the best interest to assist Tracey to secure a care package for her father liaising by social services and other multidisciplinary team members. Multidisciplinary team members. Collaborative working with multidisciplinary team has been shown to be an effective tool in the delivery of care hence improving care outcome. As a result of this, Tracey would, therefore, have more time to engage in self-grooming activities, improve her self-esteem and reduce her feeling of guilt.
However, according to Tracey, antidepressants such as SSRIs did not work for her. This could have been since the treatment plan for Tracey might have been solely medication rather than medication that is paired with a form of therapy. Consequently, from a nursing perspective, it is vital that a medication review is carried out by liaising with her GP to discuss other possible antidepressants as well as referrals to a form of therapy. This could involve Talking therapy in order to, alleviate the feelings of guilt and therefore reduce her depression.
Talking therapy is a general term to describe any psychological therapy that involves talking as known as psychotherapy. There are several types of talking therapy, which includes behavioural therapies (that focuses on thoughts and behaviours) such as Cognitive Behavioural Therapy (CBT), psychoanalytical and psychodynamic therapies which focus on way we make relationships from childhood. Other therapies also include: mindfulness- based therapies which focuses your thoughts and feelings without becoming overwhelmed by them and behavioural activation which encourages you to implement more positive behaviours by planning practical activities that you would normally avoid. One of the effective therapies that are used for depression is CBT. CBT is based on the idea that our thoughts, feelings, and behaviours are connected and if any of these is altered then all the others are also changed. Additionally, the aim of CBT is to aid patients like Tracey to reconstruct unhelpful patterns of thinking and behaviour in order to resolve current problems, and abilities to manage their health, in helping patients express concerns and preferences regarding treatment, empowering patients to ask questions about treatment options, and building up strategic patient–provider partnerships through shared decision making, for example, in Tracey’s case her feelings of guilt.
CBT is made up of 4 stages: Assessment stage, Cognitive stage, Behaviour Stage and Learning stage. The Assessment stage is where Tracey and her therapist familiarise themselves with each other and the therapist creates a treatment plan alongside Tracey and the length of the treatment. The Cognitive stage involves Tracey and her therapist working together to understand Tracey’s thoughts primarily the feelings of guilt which could potentially be due to her unemployment. The Behaviour stage, Tracey and her therapist work together to find new patterns of thinking so rather than the feeling guilt for not giving the children ideal version of parenting she can start to implement feelings of virtue and happiness by remembering the benefits of having children and how much she has done for them.
In the Learning stage, Tracey and her therapist will work together to make sure that the changes are permanent. In Tracey’ s case, the nurse would arrange revisits 4 weeks after the final therapy session in order to review how she is coping and therefore how her depression has reduced. In Addition to this, during the therapy sessions, there would be a discussion on determinants of health and how that affects her depression and the feelings of guilt, for example, in Tracey’s case, her lack of employment reduces income, therefore causing more stress which will lead to greater feelings of guilt. This could trigger a more severe stage of depression so by addressing this during therapy would improve her mindset towards her stage of unemployment and the nurse and the therapist can liaise with job centres in order to increase Tracey’s access to work.
In conclusion, depression is among one of the most common types of mental conditions that have been discovered during the study of mental health including symptoms regarding culpability. In the case study of Tracey, different methods were used to reduce her feeling of culpability as well as her depression. One of these is the idea of self-care, because as a nurse it is vital your patient is in an open state of mind in order to be able to respond to treatment better. Self-care requires Tracy to challenge her mindset about herself and, also her children leading to greater response to medication as well as to see the effectiveness of CBT.