Objective Structured Clinical Examination: Psychological, Physical And Social Needs Of Patients

Background and history of the individual

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Stacey is a 14 years old girl of British origin identified with impulsive behavior depicting self-harm (SH) tendency associated with suicide ideation. The study reveals Stacey to be on the medication of Sertraline 50mg and Propranolol 10 mg. Her family background constitutes of 5 members including herself, her parents, and two elder brothers studying in college. She seems to belong to a standard and financially stable background with both her parents employed and lived in a modern four bedroom house. Stacey shows an average standard of her education efficiency. However, in the recent year she depicts a marked decline in her progress. Taylor (2013) asserted that the mental status of an individual is highly influencing over the brain related efficiency as educative aspects of the person. Therefore, it is clear that the adverse effects on her education progress needs immediate focus to resolve the problem.

As per the medical history of Stacey, she reveals poor sleeping pattern and expresses a feeling of vulnerable with different mood swings, anxiousness, and variable appetite. A lack of energy and depressing attitude towards life is evident in Stacey. An incident of SH by Stacey is reported in 2014 putting her at a high risk of harm from self. Consuming tablets, falling out with friends and lack of interactions with her environment, family or others expose Stacey at a high risk of depression (Vitiello, 2011). On the confrontation with the health professional for assessment, Stacey showed a low tone, avoiding eye contact but appropriate dressing and possessing an insight into her problems. Issues such as anxiety, lack of confidence, depression, mood swings and low self-esteem seem to be concerning Stacey largely. Act of lethargy and unmotivated attitude is evident in Stacey.

The reporting of lonely feeling and interest to participate in outdoor activities external to school identifies the efforts present in Stacey to overcome the situation and get treatment for the issues. As per the view of DeFilippis and Wagner (2014), the intension of the patient to involve and commit to treatment procedures with relevant suggestions as participating in outdoor activities in this case enable faster and efficient recovery. Stacey being able to identify her problems can also benefits from the fact that she can be motivated and drove towards the correct path of recovery with coordination and cooperation from her side.

Considering the case study of Stacey, depiction of her psychological needs is clear. Although she seems to belong to a financially stable family, yet she lacks the closeness with her parents. Since both of them are full-time employed, she could spend very little time with them. Going by the opinion of Williams and Moroz (2009), a child considers the connection and presence of adults close to her/him as a protective factor. Stacey is experiencing the lack of protective factors since childhood is at a risk of developing low confidence. The reactions of anxiety, low self-esteem, lack of confidence when at her own in the absence of any adult indicates the vital need of extensive interactions with and the presence of her parents or protective factors in her life.

Psychological, physical and social needs of Stacey with the use of therapeutic approaches

The activities of resorting to consuming tablets and self-harm are indications that Stacey is very weak mentally. She lacks the strength of dealing efficiently with any stressful situation. The assessment of Stacey identifies the impulsive activities conducted by her as a result of her lack of confidence to handle the different situations in life. Her act of SH and suicidal tendency induces that she possesses a very low self-esteem and negative attitude towards herself. Therefore, she is in immense need of confidence development to prevent further acts of SH (Rutz, 2014). High level of depression depicted by Stacey reveals the need of motivating factors in her life to drive her out of depression.

The lack of interaction with family members, issues with friends and workloads at school seem to affect Stacey highly on her psychological detriments of health. It indicates the need of an effective stress management program for her. More interaction and time spending with her family members is a necessity for Stacey to improve her psychological status (Gomez et al. 2012).

The SH act of Stacey reveals the risk of physical detriment to her. Therefore, she needs a protective stand with her. Immediate addressing of her SH tendency is essential to prevent her from succumbing to suicidal thoughts and actions harming her physically. Huberty (2012) stated that genes, hormones and brain chemicals also play a highly influential role in depression creation in an individual. Stacey, however, shows no history of depression in her family thereby discarding the chances of genetic predisposition to depression. Her physical activities of sleep disturbances and effects on her appetite can be a result of depression that results in the reduction of a neurotransmitter. Stacey’s physical detriments as lack of energy, appetite changes and hormonal changes due to her developmental growth stage at the age of 14 years are necessary to consider while determining the most suitable intervention for her. Though Stacey denied the consumption of decanted bleach, yet a psychical assessment to ensure her safety is essential. As put forward by Taylor (2013), a poor level of physical health can affect the mental health status of an individual adversely. Since Stacey depicts a weak level of mental health status, her physical health needs to be at optimum to ensure improvement in her mental condition. Stacey living in the absence of adults’ presence with her is at a higher risk of physical harm due to SH activity tendency.

Nursing care in

The study also identifies Stacey depicting a severe lack of interactions with family members and friends. Shabani et al. (2011) opined that a lack of social interactions can lead a person towards depression and anxiety lowering self-esteem and confidence as evident in Stacey. Therefore, it emphasizes her need of increasing social mixing activities. Stacey stating interest in outdoor activities outside the school is a positive aspect that can be utilized to increase her social interactions. Enrolling her in group activities as volleyball, dance class or any team sports activity will enable her to mix with people and make new friends thus developing her confidence and self-esteem.

a) Critical identification of aims

Guidance to the structuring of critically determined goals for Stacey is highly essential. Going by the view of Williams and Moroz (2009), structured way of goal selection enable the clarity of roles and responsibilities in the following steps of goal achievement. It is because the prior determination of what to achieve and how to achieve is already executed. Considering the case study of Stacey, she depicts mental health issues majorly affecting her life and physical as well as social aspects. Therefore, the nursing care goal for Stacey must involve the achievement of a higher level of self-esteem and confidence to deal with her life and stressful incidences as per need. Stress management activities as participating in recreation games or acts and meditation along with psychological sessions with a qualified psychiatrist can facilitate goal achievement.

As stated by Vesely et al. (2014), physical issues are related to the mental health state of an individual. Therefore, the physical issue of Stacey as lack of energy, variation in appetite, etc. can be focused upon secondary to the goal of her mental stability and improvement. Since stress and too much of negativity can adversely affect the physical health of Stacey through sleep disturbances that she already experiences, mental health improvement of Stacey is of prime importance.

The therapeutic nursing intervention of Cognitive Therapy for Stacey can prove beneficial in managing her stress and depression that makes her suffers the most and associates the rest of the health issues. CBT (Cognitive Behavioral Theory), as identified in the study, can effectively assist Stacey in regaining her lost self-esteem and confidence by supporting her social, physical and behavioral needs. Family therapy is another effective intervention to apply on Stacey for addressing her mental health issues. Since she suffers mainly from the absence of her family making her feel abandoned, this intervention can benefit Stacey by providing her family support that she needs the most at present.

Medications as clomipramine, desipramine and as Prozac are found effective in reducing depression in the children (Personalityresearch.org, 2015). However, since Stacey seems to predispose to depression due to an excess of serotonin release, she can opt for the serotonin inhibiting medicines as Prozac, Lexapro, and Zoloft. Fluoxetine is another anti-depressant that can be prescribed to Stacey for treating her persistent depression. Nevertheless, an MDT (multidisciplinary treatment) plan can prove extremely efficient on Stacey driving her depression away thereby improving her mental state.

The care facility and procedure implemented on Stacey seems quite efficient in addressing her depression at present. The CBT intervention is highly effective in bring her back to her normal behavior as much possible. However, since she suffers the absence of her family’s support, Stacey need to be provided with a better and closer interaction with her family. The negligence in medicine intake depicted by Stacey indicates her repulsion towards medication intervention. At the same time, Stacey shows high interest in the active interventions of group o team sports participation.

The MDT review identified in the case study to employ on Stacey is a supportive intervention for addressing her issues with the mental health state and efficiency. Stacey showing decline in her education progress ability emphasizes that she needs help. The family intervention can also prove effective by enabling Stacey to consider her parents as the positive and protective factor in her life building on whom she can increase and modify her strength and confidence. With the correct identification of nursing care need the relevant interventions (Jefferson, 2014). Through the behavior therapy intervention, Stacey can be motivated for getting back to her normal life activities by effective handling the issues as school workloads and issues with friends pushing Stacey into depression. The major concern of Stacey regarding mood swings is seen t be handled effectively through the intervention of CBT.

The clinical environment at present, where Stacey receives the nursing care, seems favorable enough to facilitate implementing the interventions. As asserted by Austin et al. (2011) a favorable and supportive environment in clinical context acts productively to support the achievement of the desired outcomes. However, a separate outdoor activity space as a playground outside the school is necessary to let Stacey participate in group activities and sports or dance with other new friends.

As per to this model a person has unique biological, psychological and social elements. These elements include both potency and vulnerabilities for dealing with stress. Social activities, social support, involvement in meaningful activities can help the patient in getting out of stress. Some person is biologically vulnerable to some psychological disorders, major depression, and anxiety disorders. This is determined a t early stage of life by a number of factors. That includes genetics, prenatal nutrition, and stress. People can take steps to decrease the vulnerability by taking medications and maintaining a healthy lifestyle. The two factors biologically vulnerability and stress are influenced by many elements. The patient should try to have control over them. The various factors are drugs, alcohol and smoking, coping skills, social support, and meaningful activities. This model suggests that by controlling the above factors the person can get over the problems. Here the patient can take the help of social support, controlling medication, and she should take part in social activities. Social support can help her in getting out of stress.

A bio psychosocial model of the development of the chronic conduct issues is represented and maintained through a review of experimental findings. This model posits that biological dispositions and socio cultural contexts place certain child at risk in early stage of life. A transactional development model is a best to describe the emergence of chronic antisocial behavior across time. This theory helps in build a strong relationship between the family members. That may help the patient to get recover from stress and vulnerability (Dodge and Pettit, 2011).

 It is a concept in development psychology that involves the significance of attachment with the patent to develop his or her personal growth. The attachment of a person to another person gives the person stability and strength. This helps the person feeling safe. This theory can be applied for this case.

Considering the other care services provision, Stacey may benefit from a more integrated care approach focusing on implementing the nursing care interventions at her home with the involvement of her family members. Identifying the main reason of depression as the absence of parents and lack of sufficient interaction with them closely, the family therapy intervention can be used at home of Stacey. As per the view of Vitiello (2011), it will enable Stacey towards a faster and more effective recovery by providing her with the support of her family. The appointment of a qualified and experienced trainer or therapist always benefits the patient. Providing Stacey with the scope of going out of her home and school and mixing with new people to make new friends is the best possible option as of now.

In order to ensure the high success probability of these interventions, the nurse needs to keep a constant check and monitoring of the vitals of Stacey along with the occurrence of any unusual behavior or physical change in Stacey. Music (2012) conveyed that the service provision of relevant mental health service in hospital and care homes exclusively for children and adolescents suffering from issues of mental state and associated physical aspects shows high success rates. However, in this case of Stacey it may drive the patient the other way further deteriorating her condition. Therefore treating her at home is the best option for Stacey.

References

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DeFilippis, M. and Wagner, K. (2014). Management of Treatment-Resistant Depression in Children and Adolescents. Pediatric Drugs, 16(5), pp.353-361.

Gomez, R., Vance, A. and Gomez, A. (2012). Children's Depression Inventory: Invariance across children and adolescents with and without depressive disorders. Psychological Assessment, 24(1), pp.1-10.

Huberty, T. (2012). Anxiety and depression in children and adolescents. New York: Springer.

Jefferson, N. (2014). Benefit of a Contemporary Sleep Multidisciplinary Team (MDT): Patient and Clinician Evaluation. J Sleep Disor: Treat Care, 03(02).

Music, G. (2012). Childhood depression: A place for psychotherapy. Psychoanalytic Psychotherapy, 26(4), pp.343-346.

Personalityresearch.org, (2015). Depression in Children: Causes and Interventions. [online] Available at: https://www.personalityresearch.org/papers/sokolova.html [Accessed 28 Jul. 2015].

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Shabani, S., Ahmadi Gatab, T., Delavar, A. and Saleh Ahangar, K. (2011). P01-176 - Relationship between social support and social support in favorable interactions with the general depression,feel anxiety and lack of arousal. European Psychiatry, 26, p.176.

Taylor, A. (2013). Routledge Handbook of Physical Activity and Mental Health. Mental Health and Physical Activity, 6(2), pp.101-102.

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