Mental Health of Nurses - Case Study Example

Nursing Working as a Registered Nurse (RN), I was happy that I could render my services for alleviating pain and caring for all the people regardless of gender, social status, age or their cultural background. I was assigned to work in the Mental Health Department of a renowned hospital. I had many responsibilities to be handled in the course of my job. Every case was a learning experience for me. It was just a normal working day, when Tim* and Annie* came for a visit. They were a happily married couple, in their 30s, and were visiting for the first time. I wondered why they wished to meet the physician in this department, as they both "looked" normal to me. I was present in the physician's consulting room when they arrived. He made them comfortable and then slowly ventured to the actual problem. Tim added that Annie was hesitant to go to a physician at first, as she did not think she had any mood swings at all. But Tim persuaded her to just accompany him. The other symptoms were noticed by Tim, and hence he had planned this visit. According to what Tim said, he observed some changes in Annie's behavior in the last month. He listed them as follows: 1. Loss of interest in regular activities, which she normally enjoyed. 2. Incidences of being violent. 3. Inappropriate guilt in certain situations. 4. Withdrawal from social situations, and 5. Loss of appetite and sleep, to name a few. The physician thought it fit to perform certain medical examinations and selected investigations for Annie, before diagnosing a major depressive disorder. All the above symptoms were the same as that of clinical depression, which Annie might be suffering from, but these tests were necessary to rule out a medical illness. The following tests were performed: 1. Blood tests measuring TSH to rule out hypo or hyperthyroidism. 2. Basic Electrolytes and serum calcium to rule out a metabolic disturbance, and 3. Full Blood count including ESR to exclude a systemic infection or chronic disease. (Pagana and Pagana, 234-256) As expected, all the above tests had normal results. So any medical cause was ruled out. All this while, I had been observing Annie. She actually seemed to be just like any other woman you see on the road, but sometimes she suddenly became hyper and had a violent streak in her. I discussed about this with the physician, and I suggested that this case should be referred to a Psychologist. It would be better to handle this case in an interdisciplinary health care team comprising myself, a nurse, a psychologist, an occupational therapist and a social worker, if need be. I checked the schedule of the interdisciplinary team members and requested for a meeting with the psychologist and occupational therapist. I also sent a formal request for a meeting to both the doctors prior to this. I had prepared myself with all the relevant details of Annie's case, and had put down my questions on paper. I carried a file containing the information of the symptoms and physical examination reports of Annie, so that it would be easy for the consultants to decide on the further course of action. (Ackley and Ladwig, 376) The requirement of interdisciplinary medical help was posted to all concerned. All concerned departments were informed officially that there help is needed in dealing with this particular patient. In the meeting, we discussed the possibilities that Annie could be suffering from, in an informal way. At this stage it is important to point out that interdisciplinary care was a must for this patient. As a nurse I had not only to look after the administrative issues but also needed to worry about the patient's health as well as coordinating activities to make sure she got all the right things at right places. (Katz, Carter, Bishop and Krayits, 54) Now we had a resourceful health care team, including the psychologist, occupational therapist and me, a nurse, and all of us were focused on Annie. I handed over the copies of Annie's documents to each one present, so that they could have a reference. The psychologist then decided to go for a psychiatric assessment. A psychiatric assessment involves collecting information about the person like his social and personal details and direct observations. This assessment is vital for diagnosing the actual problem and deciding the line of treatment and care for the patient. From whatever information we gathered, we realized that Annie was facing a problem at her workplace. Due to some internal politics and red tape, she now had to report to somebody junior to her, who obviously, did not deserve that position at all. This had stressed her out totally. She loved Tim a lot, and did not want to bother him by complaining about all this happening. She kept on thinking about it all the time, and it led to clinical depression. She had started throwing things when she was angry, which was not at all like her usual self. The psychologist diagnosed it as Clinical Depression. Next step was to inform Annie's family about this. All of us went to meet them as a team. Our senior most team member, the psychologist, revealed the facts about Annie and about the treatment. They were ready for the treatment suggested and were very cooperative. Tim was much tensed, and I had the added responsibility of counseling him and assuring him that Annie would be fine soon. The psychologist suggested that we go for Cognitive Behavior Therapy (CBT). One of the aims of CBT is basically is to recognize and evaluate thoughts, beliefs, assumptions and behavior that is related to negative emotions. Also, it identifies the inappropriate or simply unhelpful ones and replaces them with self help methods for recovering. Now the time had come to perform my role as a registered nurse and carry out all the responsibilities as laid down by ANMC for nurses like me. My primary responsibility was to collaborate with the interdisciplinary health care team members and carry out the tasks assigned to me. It required a great deal of patience to explain the actual situation to Tim. This was an educating experience for me as I had not encountered such a psychological case before. I had to perform the dual role of a registered nurse for the interdisciplinary health care team on one hand and a leader for the junior nurses on the other. Annie's treatment began as an out patient, since her case was not as serious as to get her admitted for the same. Her appointments with the psychologist and therapist were taken care of by me. She was attending counseling sessions and that seemed to benefit her. It really requires a team effort for treating a patient, especially somebody having a psychological problem. I realized this when I noticed how everybody in our team was dependent on the other for professional purposes. The patient's family had to play a big part too, since their involvement was much more than all of us. But they were well balanced, matured and level headed people, which made my job easier. The care and management of the patient is a task that requires collaboration between all the members of the interdisciplinary health care team. In our case, Annie was taken care of well and was slowly recovering. The main challenge lied ahead. Annie was to join office again after the treatment. But she was fine that day. There were lesser mood changes and nobody was hurt due to her. It was a joyous moment for all of us, and much more for Tim. He was extremely happy and thanked our team for our untiring efforts and cooperation throughout the illness. I started analyzing the process of consultation after this case. When the patient had first come for a check-up, we had no idea what health problem she might have. After various rounds of tests and physical examinations by the physician, the psychologist was asked for his opinion. I noticed one thing though, that the physician had an inkling of the disorder in course of his physical examination, but he waited for all the symptoms to surface. (Berman, Snyder, Kozier, and Erb, 566) The timely intervention of the psychologist helped a great deal in treating Annie. He could diagnose the psychological disorder immediately after a psychiatric assessment. All this went smoothly due to a proper coordination between all the team members. One of my responsibilities as a nurse was ensuring synchronization in the health care team, as is laid down by ANMC. I must admit that the patient's spouse/parents were ready for the treatment option easily. You would argue that he had to comply, since it involved his wife's precious life, but that is not always true. I have seen parents and family of the patient asking for more and more clarification from the health care team regarding various treatment choices. In this case, Tim was totally supportive of the psychologist's decision. This helped our team to carry on the treatment for Annie without any hurdles peacefully. Annie was declared to have recovered after the psychologist and therapist confirmed that she was healthy enough to go home. Regular follow-up would be carried on as usual. My clinical knowledge base was greatly developed after this case. I got to know a few important things: Some perfectly normal people may be suffering from depression of any sort. Symptoms of clinical depression. Line of treatment in case of depression patients. With regards to competency, I have benefited a lot from this case. Now I understand the real meaning of teamwork and "working under pressure"! Especially, I have learnt to keep a balanced mind in a serious case like this, as we tend to get emotional with psychiatric patients. Coordination and cooperation are the two factors to make any task successful. This case of clinical depression also increased my knowledge in the following domains: 1. Critical thinking and analysis. 2. Provision and Coordination of care. 3. Collaborative and Therapeutic practice, and not to forget, 4. Professional Practice. As a student, I had studied the Competency standards for the Registered Nurse. But I brought them into practice only after I started working. As far as my Professional Practice is concerned, I was well aware of its definition according to ANMC standards, which reads as: "Professional Practice relates to the professional, legal and ethical responsibilities which require demonstration of a satisfactory knowledge base, accountability for practice, functioning in accordance with legislation affecting nursing and health care, and the protection of individual and group rights." However, this case had a great impact on my professional practice. I understood the nuances of my legal and ethical responsibilities. Also, there was a wide scope for utilizing whatever knowledge I had and being professional in everything I did. I gained a lot by working in an interdisciplinary health care team, in which each person was highly committed to his job. Now the definition of Professional Practice was clearer to me. (* - names have been changed to protect identity) References: 1. Katz, Janet, Carter, Carol, Bishop, Joyce, Krayits, Sarah. Keys to Nursing Success (2nd Edition). Prentice Hall, 2003. 2. Berman, Audrey, Snyder, Shirlee, Kozier, Barbara and Erb, Glenora. Kozier & Erb's Fundamentals of Nursing, 8th Edition. Prentice Hall, 2007. 3. Ackley, Betty and Ladwig Gail. Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care (Nursing Diagnosis Handbook). Mosby, 2007. 4. Pagana, Kathleen, and Pagana Timothy. Mosby's Manual of Diagnostic and Laboratory Tests. Mosby, 2005. Read More