This essay also discusses a number of nursing skills needed for safe care delivery. These include nursing evaluation, effective communication, management, and approach to the needs of physical health as a basis for evidence-based approaches use. Engel (1977) stated that psychiatry should move from a biomedical health perspective to a bio-psycho-social one. That is, Engel (1977) suggests that a person’s thoughts, feelings, and behaviours can affect biological factors that contribute to health and illness.
It has been proven that school does not only educate students like Roshni, but also plays an important role in their psychosocial development as they grow up. This is why different psychological interventions have a goal of ensuring that as many people as possible continue full-time education as soon as possible (Limeri et al., 2020).
The main purpose of a nursing health evaluation is the collection of information to determine the overall level of a person’s functioning to help make a professional clinical judgment. For this to happen, a nurse collects physiological, psychological, sociocultural, developmental, and spiritual data about a client. The process of evaluation gives a nurse an opportunity to start building a therapeutic relationship with a patient (Coombs et al., 2011). A successful nurse-patient relationship empowers patients and allows nurses to plan, evaluate, and deliver care in collaboration with them (Cusack et al., 2017). When planning Roshni’s care, a nurse must ensure it includes setting goals as part of Roshni’s recovery and praising Roshni when she achieves her goals. It is crucial that goals are realistic, achievable, and measurable. Moreover, a nurse must make a plan with consideration of Roshni’s strengths and weaknesses (Berger et al., 2017). In implementing the plan, one is to continue to collect patient information and share it with a multidisciplinary team (Theodorou et al., 2020).
As per the Stress Vulnerability Model, there are three main factors responsible for the progression of mental disorders such as depression: biological vulnerability, stress, and protective factors (Goh and Agius, 2010). For Roshni to have developed depression, there must have been some biological predisposition to it. A person’s vulnerability is determined by genetic factors and early biological exposure to, for example, viral infection or alcohol or drug abuse when a baby is in the womb (Demke, 2022). Stress contributes to vulnerability as well, and it can cause or worsen Roshni’s depression. Stress can be seen as a body’s response to life situations that require adaptation or change. Unfortunately, Roshni was unable to adapt to her stress and psychiatric symptoms (Goh and Agius, 2010).
Protective factors that can reduce Roshni’s biological vulnerability and stress are drugs; they will relieve symptoms and lower relapse risks. Additionally, the nursing staff can help Roshni by teaching her and her family about coping skills, communication skills, and problem-solving skills. Another protective factor for Roshni is to be in a supportive environment, which will be useful for preventing stress from increasing symptoms. Giving Roshni a structure that is meaningful but not too demanding can protect her from stress as well (Demke, 2022).
The theory of monoamine deficiency states that the basis of the physiological pathway of depression is the depletion of neurotransmitters of norepinephrine, serotonin, or dopamine in the central nervous system. Because of this chemical imbalance, central serotonin synthesis is reduced. In its turn, it leads to the progression of depressive symptoms and an increased risk of depression. However, the mechanism of reduction of serotonin in depressed patients is unclear (David and Gardier, 2016). Studies of serotonin for metabolites in urine, plasma, and cerebrospinal fluid, as well as postmortem studies of the serotonergic system in depression, have been inconsistent in the outcomes. Initial evidence suggests that the increased availability of monoamine oxidases, which metabolize serotonin, in the brain can cause a serotonin deficiency. In addition, the loss of functional mutations in the gene coding for tryptophan hydroxylase, a brain’s specific enzyme, might explain the loss of serotonin production as a rare depression risk factor.
Depression affects people differently; however, common symptoms include unhappiness, hopelessness, and the loss of interest in things a person used to enjoy. Physical symptoms might include the feeling of permanent fatigue or not sleeping for a sufficient length of time; the latter was present in Roshni. Symptoms of depression can range from mild to severe, with the mildest one being a sense of constant lowering of spirits. In its turn, severe depression can be recognized when a person becomes suicidal, which is another symptom observed in Roshni. Roshni’s depression might have progressed from mild to moderate or severe due to a lack of any intervention throughout it, and her constant abuse led to its further deterioration. There is a recommendation for young people of Roshni’s age with moderate to severe depression to begin their treatment with individual CBT for at least three months while taking Fluoxetine (Cuijpers et al., 2019). Fluoxetine is an antidepressant that can only be prescribed to Roshni with simultaneous psychological intervention.
However, antidepressants might still be administered to her even if Roshni refuses psychological intervention. If she accepts it, she will need to be examined concerning her mental state and her prescribed Fluoxetine for side effects. If she refuses, she will have to be reviewed by a prescribing doctor who will monitor her progress. 10 mg is the initial dose for Roshni; however, it can increase to 20 mg daily after one week if there is a clinical necessity. If Roshni responds well to the drug, treatment should last for at least six months (Cuijpers et al., 2019). In case of side effects such as chills, the feeling of unwellness, or suicidal behaviour, it should be phased out within 6-12 weeks with an accurate dose titrated against the withdrawal symptoms level (Cuijpers et al., 2019). If CBT would not meet Roshni’s clinical needs or be unsuitable for her circumstances, other therapies should be considered. Among these are IPT-A (IPT for adolescents), interpersonal therapy, family therapy (attachment-based or systemic), short-term psychosocial intervention, and psychodynamic psychotherapy (Cuijpers et al., 2019).
Another therapy provided by Child and Adolescent Mental Health Services is art therapy, which is a way to express one’s inner self (Chiang et al., 2019). It is used as a means of communication through which a person can use art to express their inner experiences while supported and guided by their therapist. This is extremely important for cases in which the verbal expression of feelings can be difficult for an individual (Attard and Larkin, 2016). In this way, young people can use art to unveil painful events by providing images that help them understand their psychological problems (Marion, 2020).
Roshni will be encouraged to let her family participate in her treatment. Prior to her hospitalization, Roshni’s sister delivered vital information to the nursing team. There could be more beneficial information that the family can provide to professionals to support Roshni during her recovery. Another important potential contribution of Roshni’s family is their emotional support for her and communication between them and the nursing staff. After Roshni’s discharge, to ensure that she remains on the correct recovery trajectory, a healthy relationship has been developed between her, the family, and the nursing team. In this way, even without a subsequent review, if Roshni or her family have any concerns, there will be a mutual understanding that can help communication with the professionals proceed easily.
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