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Background

Person-centred care approach is considered to have deep roots in clinical practice and historically have been a major segment of both Western and Eastern medicine approach. Person-centred practice approaches have been provided a significant profile in the previous 60 years and presume specific importance as of now along with the proceedings towards personalised medications (Stuart, 2017). NSW, 2021, consider this approach as it takes into account every person’s age, life experience, culture, gender, language, heritage, beliefs as well as identity. Person-centred approach is based on strength of patient, where clients are acknowledged as the health professionals in their life specifically focuses on their ability, and any assistance they require on it. International support is there for person-centred clinical approaches by the side of World Health Organization (WHO). Person-centred care has significant importance in psychiatric setting. For example, mental health sectors has adopted an approach known as biopsychological approach is inherently person-centred. The main reason for adapting this approach is mainly due to having association of biopsychological determinants of an individual with both development and progression of mental health disorders (Stuart, 2017). However, despite its’ importance in psychiatric setting, psychiatry has a prolonged history of being criticised specifically due to its’ focus on classifications of disorders that are currently seen as dehumanising individuals and marking them as deviant while significantly avoiding major aspects of some subjective experiences of ethnicity, culture, trauma and political oppression. According to current evidences, even today, in many segments of the world individuals with psychological health illnesses are poorly resourced in comparison with physical health services.

The main objective of this study is to discuss the importance of person centred care and recovery oriented practice in individuals with psychiatric individuals.

Mr. X is a 67 years old retired individual who is currently experiencing clinical symptoms of clinical depression including isolation from society and peers, confusion, and disorientation. He has been diagnosed with some chronic illnesses such as diabetes and hypertension three years before. He currently lives with his wife as he had lost his son four years before following a car accident. Since that period, Mr. Y has shifted his place to a new community and currently lives in a rental place. He has been consulted with a general practitioner as was experiencing the clinical symptoms of the condition.  Mr. Y was recommended with both pharmacological and non-pharmacological interventions including anti-depressant drugs as well as yoga and cognitive behavioural approach as all the stated interventions are considered evidence-based and have significant impact in ensuring gradual recovery and wellbeing of the individuals. However, due to his reluctant behaviour, he had denied to follow the recommended therapeutic for the patient. However, as currently, he is experiencing clinical deterioration, wife of Mr. Y has become very worried thinking of Mr. Y’s health status and wellbeing. Mr. Y is currently eliciting aggressiveness and societal withdrawal associated symptoms; therefore, Mr. Y has been presented to a mental health centre where physicians have performed a thorough physiological and psychological assessment in order to investigate current health status of the individual and identify biopsychological, sociocultural, environmental and behavioural determinants that may be associated with the current health status of the patient. In the next section of this study, the author is going to discuss person centred care and recovery oriented practice considering the current situation of the patient.

Case Study Overview

Gordon’s health assessment pattern was followed in order to assess current health determinants and health status of the patient due to having generalizability and validity of the method in psychiatric setting and following the findings from the Gordon’s health assessment report, it was found that Mr. Y had complications associated with behavioural factors (e.g., Mr. Y has followed a sedentary lifestyle for a longer time that is known to increase both physiological and psychological health complication and risk for individuals having chronic health issues), emotional and psychological trauma following demise of son of him, social isolation and no direct relationship with neighbours and relatives that significantly increases risk of development and progression of depression and anxiety and associated complications (Gengo E Silva Butcher & Jones, 2021). As per current understanding, physician has recommended cognitive behavioural therapy (CBT) for the patient as it is known to improve psychological health status of patient suffering from clinical depression and associated complications and anti-depressant medications (Gautam et al., 2020).  Now, it is the role and responsibility of mental health nurse in order to ensure effective follow up of evidence-based practice and person-centred care for the patient.

Considering the principle of person-centred care, it is essential to engage and/or involve the patient in therapeutic approach. As a mental health care nurse, I have followed effective communication strategy with both patient and his family members in order to increase his engagement in both pharmacological and non-pharmacological therapeutic approach for the patient. In this specific aspect, I have used both active verbal and non-verbal communication to draw attention of the patient and to collect effective information from him for administering recommended interventions in order to ensure gradual recovery and wellbeing of the patient (Vogel, Meyer & Harendza, 2018). All interventions I have followed were based on current evidences ranging from administration of cognitive-behavioural therapy, Ad-Din Cognitive psychological counselling on the depression, self-concept and resilience of the patient (Thase et al., 2018). While conducting an initial assessment and interview I have found that the patient has tendency to self-harm and suicidal tendency. Considered this findings, I have consulted with physician and administered intervention like pharmacological interventions such as citalopram and cognitive behavioural therapy as recommended above.  

According to current evidence, recovery oriented practice is considered and/or understood in the framework as encapsulating psychological health care that significantly maximises self-management and self-determination of psychological health practice and wellbeing and incorporates person-first, person-centred and evidence-based and strength-based intervention, rehabilitation and assistance to patients with mental health illnesses in order to ensure quick recovery and wellbeing of individuals (Gammon et al., 2018). Following the said guideline, I also have followed a strength-based approach in order to highlight on the strength of the patient in order to mitigate further progression of depression in Mr. X. For example, he has a previous habit in gardening and making animations. However, following the progression of current condition, he is experiencing withdrawal from the stated habits of the patient. Knowing about the creative habits of the patient, I tried to focus on the above mentioned particulars; therefore, they can further enhance engagement and attachment of the patient for the said hobbies. I have provided the patient with pictures of several animated characters and said him to colour those images as per his wishes and to identify the characters as per his knowledge. He has followed the instruction gently and it helped in facilitating gradual recovery of the patient that was reflected through the gradual improvement in cognitive score of the patient (Cuijpers et al., 2019). Apart from that, I have also involved the patient in group counselling intervention where a total of ten different patients of depression were involved in the process of psychological counselling and it also helped in the process of gradual recovery of the patient. I also focused on self-management of depression in the patient that requires having sufficient knowledge on disease development and progression. In this specific aspect, I have tried to engage wife of Mr Y’s wife in the process of treatment too and it has been elicited that partnership and/or collaboration in care has shown significant positive impact in facilitating recovery and wellbeing of the patient (Cuijpers et al., 2019). Both yoga and physical activities are known to have positive influence on psychological health of patients suffering from depression and other mental health complications (Bridges & Sharma, 2017). Due to that specific reason, I have also focused on recovery oriented approach and evidence-based care strategy in order to involve the patient in healthy active lifestyle strategy that would further improve his inclination and perception of both physiological and psychological health. As it has already been mentioned before, that Mr. Y is known to follow a sedentary lifestyle, considering its’ negative impact on psychological health and progression of depression, I as a mental health nurse has preferred to focus on this specific intervention and it significantly helped in ensuring quick recovery of the patient and I have recorded the log score of the mental health status of the patient as it helps in evaluating gradual improvement of the patient. Last but not the least, considering the principle of strength-oriented practice, I also focused on health promotion programme focusing on community demographics of the patient and other biopsyhcological and behavioural determinants that enhance risk of development and progression of clinical depression (e.g., social isolation, poor attachment with relatives and neighbours, getting withdrawal from all belongings). I promoted community activities and social engagement and it helped in facilitating improvement in psychological health status of the patient.

Mr. Y was admitted in primary healthcare for four days for initial assessment and evaluation of care-plan and intervention. In between this time as said above, mental health nurse professional was responsible for his current symptoms of clinical depression and as well as physician for developing plan considering current physiological status of the patient. However, after gradual recovery, in time of discharge Mr. Y needs to be provided with effective discharge plan and further recommendation.

  1. Hand-out is given to Mr. Y’s wife on self-management of depression with effective pharmacological and non-pharmacological approach.
  2. Education is provided to the wife of Mr. Y on strength-based approach and to engage him in creative activities and creative discussion and/or conversation.
  3. Environment plays a major role on elevation in symptoms associated with mental health disorder. Therefore, the room environment needs to be calm and organized. No sharp elements are to be present in the room and Mr. Y’s wife needs to be careful about whether he is eliciting any aggressive or suicidal symptoms or not.
  4. In case of sustainable support, Beyond Blue is there in Australia who work for depressed or anxious people. Therefore, Mr. Y’s wife is provided with sufficient details and recommendation to communicate further with My Aged Care service and Beyond Blue in order to get rid of complications.
  5. SHINE community services is there in Australia that specifically work for seniors and meet some essential requirements (e.g., foods, health and social activities). Recommendation has also been given to the patient to further communicate with the NGO.
  6. Lastly, Mr. Y needs to stay adhere to all the non-pharmacological and pharmacological interventions ranging from physical activities, healthy nutrition, yoga to pharmacological interventions. In case of any difficulties, Mr. Y can also ask for residential nurse practitioner who would promote person-centred care in residential care considering the requirements of client.

Conclusion

Therefore, considering all the above mentioned facts and information, it can be stated that person-centred care and recovery-oriented practice are very important in clinical practice for assisting a patient with mental health disorder. In this study the case study of Mr. Y has been discussed who is suffering from clinical depression and in this study, I as a mental health practitioner, have reflected on my care-experiences and practical skills that have been shown to be beneficial for the patient in ensuring both health and social wellbeing.

Reference

Bridges, L., & Sharma, M. (2017). The Efficacy of Yoga as a Form of Treatment for Depression. Journal of evidence-based complementary & alternative medicine, 22(4), 1017–1028. https://doi.org/10.1177/2156587217715927

Cuijpers, P., Quero, S., Dowrick, C., & Arroll, B. (2019). Psychological Treatment of Depression in Primary Care: Recent Developments. Current psychiatry reports, 21(12), 129. https://doi.org/10.1007/s11920-019-1117-x

Desplenter, F. A., Laekeman, G. J., & Simoens, S. R. (2017). Following up patients with depression after hospital discharge: a mixed methods approach. International journal of mental health systems, 5(1), 28. https://doi.org/10.1186/1752-4458-5-28

Gammon, D., Strand, M., Eng, L. S., Børøsund, E., Varsi, C., & Ruland, C. (2017). Shifting Practices Toward Recovery-Oriented Care Through an E-Recovery Portal in Community Mental Health Care: A Mixed-Methods Exploratory Study. Journal of medical Internet research, 19(5), e145. https://doi.org/10.2196/jmir.7524

Gautam, M., Tripathi, A., Deshmukh, D., & Gaur, M. (2020). Cognitive Behavioral Therapy for Depression. Indian journal of psychiatry, 62(Suppl 2), S223–S229. https://doi.org/10.4103/psychiatry.IndianJPsychiatry_772_19

Gengo E Silva Butcher, R. C., & Jones, D. A. (2021). An integrative review of comprehensive nursing assessment tools developed based on Gordon's Eleven Functional Health Patterns. International journal of nursing knowledge, 32(4), 294–307. https://doi.org/10.1111/2047-3095.1232

health.nsw.gov.au. (2021). What is a person-centred approach? - Principles for effective support. Health.nsw.gov.au. Retrieved 29 January 2022, from https://www.health.nsw.gov.au/mentalhealth/psychosocial/principles/Pages/person-centred.aspx#:~:text=A%20person%2Dcentred%20approach%20is,their%20needs%20and%20unique%20circumstances.

nationalelfservice.net. (2021). Person-centred care in psychiatry mental health. National Elf Service. Retrieved 29 January 2022, from https://www.nationalelfservice.net/populations-and-settings/service-user-involvement/person-centred-care/.

Stuart H. (2017). What we need is person-centred care. Perspectives on medical education, 6(3), 146–147. https://doi.org/10.1007/s40037-017-0334-4

Thase, M. E., Wright, J. H., Eells, T. D., Barrett, M. S., Wisniewski, S. R., Balasubramani, G. K., McCrone, P., & Brown, G. K. (2018). Improving the Efficiency of Psychotherapy for Depression: Computer-Assisted Versus Standard CBT. The American journal of psychiatry, 175(3), 242–250. https://doi.org/10.1176/appi.ajp.2017.17010089

Vogel, D., Meyer, M., & Harendza, S. (2018). Verbal and non-verbal communication skills including empathy during history taking of undergraduate medical students. BMC medical education, 18(1), 157. https://doi.org/10.1186/s12909-018-1260

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