Management Strategies on Psychiatric Nursing


Case Study: Belinda
Belinda is a 35 year-old married woman with two children, Ben (aged 8 years) and Sandra (4 years); her husband John is very supportive, but tends to work considerable hours because of large debts for their business and new home. After the birth of Sandra, Belinda developed post-natal depression, which improved with low doses of anti-depressants. Belinda was on these medications for a year, and felt better and stopped taking the medications with the support of her GP.
Now Belinda presents with major depression; she has not been able to sleep more than a few hours each night, leaving her tired and unable to effectively care for her children and maintain the house. She has lost 12kgs of weight over the past two and half months and says that she has no interest in food at all. Belinda describes her mood as miserable and cries easily, she feels the family would be better off without her. She has thought about killing herself. Additionally because of her depression her level of communication is reduced.
Belinda has been admitted voluntarily to the local acute mental health unit for treatment of her depression. She is to commence Sertraline, and the treating team think that she may require electroconvulsive therapy (ECT), but Belinda is reluctant to have this therapy.Develop a mental health nursing care plan, examining risk and other problems that Belinda has, providing rationales from current evidence.
How would you go about helping Belinda to better understand her treatment and care?
Lastly outline the discharge planning you would need to develop with Belinda.
Question Background:
From the information given in the case study, you should evaluate Belinda's needs and identify any risks that might arise during her time in the acute hospital setting. You will need to explore the academic literature around patient-centred, recovery-focussed management of patients like Belinda. You will need to determine key management priorities for Belinda, and recommend effective management strategies to be included when planning her care.
When you have a clear understanding of the information around this topic, you should develop your ideas into an essay responding to this question:
Essay Question:
How can mental health nurses provide effective person-centred care for someone with severe depression in an acute hospital setting?



Psychiatric nursing has been utilized as the counselling the interactions for assisting the patient in case to improve or regain the previous coping of abilities and also foster the mental health along with the prevention of the illness as well as disability for mental issue. In case of counseling interventions that can be occurred under the variety of settings which will include the following sections:

1.    Assertiveness training
2.    Conflict resolution
3.    Communication along with interviewing techniques
4.    Crisis interventions
5.    Relaxation techniques
6.    Behaviour modifications 
7.    Stress management
8.    Conflict of resolution

Also the counseling is the significant intervention under the one to one interaction along with the patients during the presentation of psycho education groups and also the planning, medications along with the discharge planning groups(Cross-Disorder Group of the Psychiatric Genomics Consortium., 2013). Thereby, the patients with the family members and also the other significant have the opportunity as per the concerned problems of the patient. The counselor or the nurse should provide the reassurance for the clarification as per the requirement has been arisen; the reassurance has helped with the patient for regaining the self-confidence with the decrement of the feelings for the guilt, fear and the anxiety. Also the clarification also helps with the patient that would gain the clearer picture as per the reality for understanding the behaviour and the feelings(Brown, Beck, Steer, & Grisham, 2000).
In this essay, the need analysis of Belinda who is suffering from acute mental problems is effectively identified and along with this the risks are classified during the nursing care or mental treatment of Belinda. In this context some management strategies are proposed which are related with the mental health nursing along with the acute hospital.


Diagnosis of Nursing: Belinda has been diagnosed with the following symptoms: 

•    Anxiety for taking care of family and children;
•    Belinda has taken lots of stress and cannot sleep properly at night;
•    Losing weight;
•    Lack of proper diet
•    Lack of proper sleep and rest.
•    Cannot communicate with an easy manner
•    Feeling lonely to be killed herself
•    Cries easily in any matter.

Primarily, the cause the major depressive disorder is remained unknown. The biopsychological model is being proposed in case of biological, psychological along with the social factors which are playing a significant role caused under depression. Under the diathesis-stress model, it has been specified that the depression results has ben preexisting the vulnerability might be caused from genetic issue and thus implies the interaction between the nature and nurture with the schematic condition. The views are resulted under the world that learned from the childhood(Demyttenaere, et al., 2004). 

In case of depression the followings can be the risk factors:
1.    Sexual
2.    Psychological or,
3.    Physical 
Sometimes the trauma is being seen correlated with the severity of the depression along with the lack of psychotic issues which may be occurred during the anxiety as well as the drug abuse(Pine & Cohen, 2002).

In case of Belinda, the risk is associated with her psychiatric problem is the depression or trauma that is generated as per the genetic issue or about the trauma that may be have arisen due to the excessive negative thinking during and after the  pregnancy period.
It is also noted that in acute psychiatric hospitals, the organization is not obliged always for accepting all kind of mental patients. There are patients with psychoses or addiction with major depression get admission to the psychiatric hospital for minimizing the possible risks. As per the level in case of depression, the risks can be associated with the suicidal tendencies or violence etc. in most of the cases(McAlpine & Mechanic, 2002).
Also in case of hospital, there is the risk of shortage of staff or prolonged absence from the work.
Other non-clinical types of risks are associated with that, economic, construction along with the infrastructural or fire risks.

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As per this model the Freud’s idea for the psychosexual development would not be followed. Moreover, the stages under the social development over the life span are considered as significant under the model. On the other hand, the lifetime experiences can be examined and identified with the defense mechanism. The patient is thus helped through the learning of appropriate decision making of skills along with the behaviour. The psychodynamic therapy has been involved in case of long term therapy, but it is not long therapy as psychoanalysis(Gronholm, Thornicroft, Laurens, & Evans-Lacko, 2017).


The model prefers the teachings under the influence of Sigmund Freud. Thereby, it has been emphasized on the experience of patient’s childhood and also their relationships along with their parents. On the other hand the psychosexual development of the patients is also important to be considered. Thus a psychoanalyst is needed to attempt for developing the relationship for the transference with their patients.


There are three most of common treatments for depression are associated are psychotherapy, medication along with the electroconvulsive therapy.
In case of Belinda, besides the electrotherapy, it is recommended of physical exercise for moderating effect on the symptoms. The exercise may have the effective for the unipolar major depression. It is also equivalent to use the medications or the therapies. Moreover, exercise is being recommended to the people who are willing to motivate along with physically healthy enough in case to participate with the exercise program as the treatment.
As Belinda is suffering for less amount of night sleep, this depressive symptom can also be improved by proper exercise and diet.
The counselling is most common psychotherapy which is mostly effective in any case of mental disorder.
On the other hand, the cognitive behavioral therapy or CBT along with the interpersonal psychotherapy or IPT are the most common treatment at present scenarios in case of preferred therapies in adolescent depression(DeMaso, et al., 2017).
CBT is mostly effective in case of depressed adolescents although the effects for severe episodes may not be known. The different variables can be predicted as per the success for the cognitive behavioral therapy, like higher levels for rational thoughts, fewer cognitive distortions, less hopelessness or suffering with fewer negative thoughts(Spinazzola, et al., 2017). 


Brown, G., Beck, A., Steer, R., & Grisham, J. (2000). Risk factors for suicide in psychiatric outpatients: a 20-year prospective study. . Journal of consulting and clinical psychology, 371-380.
Cross-Disorder Group of the Psychiatric Genomics Consortium. (2013). Identification of risk loci with shared effects on five major psychiatric disorders: a genome-wide analysis. . The Lancet, 1371-1379.
DeMaso, D., Calderon, J., Taylor, G., Holland, J., Stopp, C., White, M., . . . Newburger, J. (2017). Psychiatric disorders in adolescents with single ventricle congenital heart disease. Pediatrics, p.e20162241.
Demyttenaere, K., Bruffaerts, R., Posada-Villa, J., Gasquet, I., Kovess, V. L., Bernert, S., . . . Kikkawa, T. (2004). Prevalence, severity, and unmet need for treatment of mental disorders in the World Health Organization World Mental Health Surveys. . Jama, 2581-2590.
Gronholm, P. C., Thornicroft, G., Laurens, K. R., & Evans-Lacko, S. (2017). Mental health-related stigma and pathways to care for people at risk of psychotic disorders or experiencing first-episode psychosis: a systematic review. . Psychological medicine, 1867-1879.
McAlpine, D., & Mechanic, D. (2002). Utilization of specialty mental health care among persons with severe mental illness: the roles of demographics, need, insurance, and risk. . Health services research, 277-289.
Pine, D. S., & Cohen, J. A. (2002). Trauma in children and adolescents: Risk and treatment of psychiatric sequelae. . Biological psychiatry, 519-531.
Spinazzola, J., Ford, J., Zucker, M., van der Kolk, B., Silva, S., Smith, S., & Blaustein, M. (2017). Survey Evaluates: Complex Trauma Exposure, Outcome, and Intervention Among Children and Adolescents. Psychiatric Annals, 433-439.


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