1. Investigate and outline the prevalence/ incidence of depression AND suicide in Australia using current literature.
2. Discuss factors that may have contributed to the person’s presentation and mental helth concerns ( 2 factors are identified).
3. Discuss the ethico-legal issues related to your chosen scenario.
4. Identify two nursing/midwifery problems/ risks and rationales, with evidence from your chosen scenario.
5. For each nursing/ midwifery problem/ risk you have identified in Question 4, Outline and describe TWO evidenced based nursing/ midwifery interventions AND rationales for each.
1. This following report provides a profile of depression to refer various disorders and also supports the condition of Scenario A, through exemplify the links related to the patient Edward. It is imperative to analyse the protective factors that are concerned with the depressed state of mind during the research for depression in Australia. This systematic review over depression in Australia suggests some important factors that are needed to examine the cause of depression. Here the patient known as Edward is a 62 years old man and a proud owner of a small farm in Australia, but the sudden death of his youngest son has exposed his life to depression. Furthermore, his only living son Colin, is not interested in farming and left his family for better life in Sidney. Naturally, the hope gets shattered as he is facing “empty-nest syndrome” with his wife (Australian Bureau of Statistics, 2013). Thus, the report adhered to the common issues related to the geriatric group and correlates the factors of depression across the nation.
The most common mental illness in Australian community is recorded to be depression and anxiety disorder and often, a primary intervention helps to reduce these disorders to get better lifespan. The anxiety syndrome is very common with the patient with depression, but it is important to identify the various highlighted factors that are associated with morbidity and mortality. The reporting items about Edward have provided many significant reasons that are surely caused to depression. According to the researchers (Martin, et al 2010), the most prevalent anxiety disorder is post-traumatic stress disorder in Australia and recorded as (6.4%). In fact, the case study of Edward is the best example of post-traumatic stress disorder, as the unexpected suicide of his youngest son leaves him with no choice for expecting more from life. The other important depressive disorders such as agoraphobia (2.8%), social phobia (social anxiety disorder; 4.7%), obsessive–compulsive disorder (1.9%), panic disorder (2.6%) and GAD (2.7%) are to be found in Australia.
In Australia, the clinical diagnosis of depression has been made on the terms of collective data which signifies numerous signs and syndromes of depression. Presently, the Diagnostic and Statistical Manual of Mental Disorders has classified a defined array for depressive disorders, to allow various depression subtypes in Australia, such as:
- Severe depressive state of mind with psychotic symptoms
- Moderate and less severe depression but the absence psychotic symptoms
- State of melancholia
2. It may know to all that depression is a common problem in older group of people, and according to the survey, the patient with depressed conditioning fails to recognise the certain symptoms of depression (Trollor, et al 2007). For example, the life of Edward is quite challenging as he left his hometown Malta for better living. It is quite obvious that people do migrate for having better life and best future for their children, but fails to realise what they actually desire to look forward. The ‘yearn’ for establishment causes separation from his own parents and his relatives from Malta. Unfortunately, his small family gets smaller due to early demise of his youngest son and abandonment of his older son. Thus, depression is a common phenomenon to be observed in such situation where a man of 62 gets affected and losses his sleep, appetite, interest, relationship and hope. As a matter of fact, (Australian Bureau of Statistics, 2000) it is been observed that depression and sadness go hand in hand and confuses the treatment procedures. While in this case, it is determined prominently that Edward is facing huge depression and shows “lack of energy”, “low motivation” and some physical problems. Some predominant symptoms related to geriatric group are mentioned below:
- Feelings of helplessness and hopelessness
- Feelings of despair and Sadness
- Loss of appetite and Weight loss
- Unexplained pains and aggravated aches
- Staying asleep or difficulty falling asleep (Sleep disturbances)
- Loss of interest in hobbies, work or in socializing
- Thoughts of suicide or Fixation on death
- Feelings of worthlessness, or Loss of self-worth
- Slowed speech movement
- Memory problems
- Neglecting personal care
Recognising depression in the elderly people is full of uncertainty as they are too rigid to confront and distinguishing between clinical depression and grief is always not easy for the nurses to identify (McKenna, et al 2012). The following case study is one sort of example where grief is the only reason that affects the life of Edward like a roller coaster. The grieving process of Edward consists of variety of emotions with “suicidal thought process” and “loss of happiness”. As per the research, it is found that the content of despair has been diluted into his soul forever and constant emptiness has occupied his mind. Having depression in these cases is natural, and there are some significant risks to Edward, as he has lost moments of pleasure and hope for future (Butterworth, et al 2006).
3. For framing discussion, it is imperative to strengthen the topic by incurring ethical issues related to aging and health care. There have been ranges of debate on “Health Care and the Aging Population: What Are Today's Challenges?” to explode some of the relevant issues focus upon geriatric education, quality of life, successful aging behaviours, frail elder care and long-term care planning. Some imbedded ethical issues do require enhancing the care unit and so the Australian government specifies the ethical tradition of nursing to strengthen their culture of enduring, self-reflective and distinctive (Parker and Evans, 2007). It should be the primary goal for the health department to introduce values, obligations, morality and better understanding of various condition of geriatric syndrome.
In many respects, the ALRC’s proposal has solved issues that are directly related to ethics and decorum, as they believe that “active case management” supports the treatment process of the care givers. However, there are three basic ethical principles and they are justice of treatment, respect for persons and beneficence (Mead, et al 2008). Specifically it states that “respect for the patient” is the most promising aspect of the treatment as elderly people can only absorbs emotional attributes from the concerned person. Thus, it is vital for the nurses to select their choice of words and perspective to get the best care for the elderly ones. Furthermore, researchers have endeavour many such autonomy where protecting the “self-determination right” is mandatory for providing the best treatment to the patient.
Despite a rapid interest in the geriatric problem, most nations have not restricted elderly abuse so far (Osborn, 2003). However, Australian code of law has introduces several privacy Act that regularise health or medical research, thoroughly. There are 95 crucial guidelines that help to develop certain statistical measures in concern for public safety and public health. Some comprehensive legislation is also been introduced to carry out better service to old and despair ones (Australian Law Reform Commission, 2000). It is very natural for the old people to avoid confession of their problem and so prosecution has developed civil laws to encourage older people with all the necessary help to eradicate the geriatric abuse. In this case study, Edward is non cooperative with his care giver (nurse) and provides little information about his state of mind, but as it is mentioned earlier that proper training and education provides Edward all sorts of help to vent out his problem for solvent. Hence, government of Australia has started public awareness campaigns and university courses to inform people regarding the ethical as well legal attributes of geriatric conditions.
4. This chapter provides the interesting aspect for the researchers as it is very difficult to introduce some of the risk taken by the nurses or midwives for treating a patient of depression. To improve the mortality or patient safety, the care giver tries every possible context within the code of ethics and law. However, it is important for the nurse to adopt certain Professional Doctorate route to treat such patient like Edward. As an outline of the present condition of Edward, it is obvious for the nurse to help Edward to communicate all the provided information of his distress. The general research surely asks the risk confronted by the nurse in such condition, and I have already considered some points as subsequent sections to reflect problems faced by the nurses during the intervening process with the patient (Unutzer, 2002). The latest NSW version has imposed strict discipline for nurses to follow and thus, it concretes the idea of risk as a “constant challenge” for this profession, because each patient has following rights that should be performed by the nurses and they are as follows:
Right to a written treatment plan
Right to confidentiality
Right to refuse treatment
Right to select health care team members
Right to personal mail
Right to obtain disability
Hence, it is very relevant that a nurse cannot force her patient to obtain certain treatment without his wish and at the same time acknowledgment of right prognosis is a challenging process by the nurse, so “Screening for depression” and Pharmacological and alternative treatments are some of the risk faced by the nurse during intervention of their patient. It is very important to make a powerful impact on the patient to get an inner understanding of the depression (Clinical Standards Advisory Group, 2000).
A proper communication is a much needed measure that can benefits the illness from its root. Here in this case study, Edward has mentioned every possible problems of his health to the appointed nurse, but at the same time feeling distressed and exhausted to communicate at some point of time. Thus, a nurse should realise his limits and try to find out medicinal support for his exhaustion and lack of sleep (Pignone, et al 2002). She cannot force him for any support, as that can aggravate the depressive state of mind. The appointed nurse should always be alert for his mental condition as he has seen losses and has lost all his hope to live.
5. The National Institute of Mental Health (NIMH) contributes some important points of risk faced by the nurses during treatment and also supports a vast research on older people during depression screening as the method includes electronic and manual searches. Here in this case, Edward desires to end his life and so it is the duty of the nurse to be watchful and observant over his moves and approaches. A nurse should remember his suicidal tendency before attempting further ailments, as that can beget risks during the treatment and cause a lot of damage to the patient. There are five powerful screening tools used by the nurses to determine the level of depression in the patient, but it is not easy to get followed as most of the patients are elderly and fails to understand the following procedures of treatment Lawrence, et al 2000). There are five screening tools and known as self assessment questionnaires which are “self completed”. Reasonably, it is difficult to enrol in treating geriatric depression as this particular group do not participate in such kind of measures to get them treated as that involves
- Patient Health Questionnaire
- The Geriatric Depression Scale (GDS)
- Beck Depression Inventory
- Zung Self Rating Depression Scale (ZSDS)
- Hospital Anxiety and Depression Scale (HADS)
The department of nursing also finds it difficult to introduce alternative treatment such as Pharmacological measures to reduce the symptoms of depression. Here the medicinal treatment do have a lesser impact than counselling process as it is important for the patient to confront their own deal of crisis. The acknowledgment of the cause can reduce the level of depression and here our patient called Edward still has two reasons to live upon: his wife and only living son. It is through counselling, a nurse can enrich psychologically about the better hopes for living, and Edward needs to understand that his son Collin has got the same “desire to live” like his father, as both of them have left their parents for better living. The patient has got supportive wife and needs to realise her gracious presence, so all these points need to get realised during the treatment without much constraint.
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