The relevant therapeutic engagement skills
The case provided shows a teenage girl who has begun her nursing course suffering from depression. Angelina’s friends realize that her condition worsened and contacted her parents who came and rushed her to the hospital for a mental health check-up. She is immediately rushed to the acute patient department because her condition seems worse. It is the responsibility of the mental health nurses within any facility to ensure that a client, suffering from any forms of mental illness receives positive mental outcomes after he or she is attended to by the nurses. The therapeutic engagement techniques and modalities used on such patients would be the key to positive mental outcomes (Rydon, 2015). Mental health nurses have the responsibility to ensure that a mental health client is attended to in the most appropriate way that would generate the positive outcomes. The therapeutic engagement techniques and treatment modalities that should be used on Angelina by the mental health nurses are the major issues that will be discussed in this essay.
The therapeutic engagement techniques should be focused on how Angelina would recover as soon as possible. Counseling is one of the therapeutic engagement techniques that could be applied in her case (Bowles, Mackintosh, & Torn, 2013). Though modern nursing facilities do not encourage the mental health nurses to depend on counseling, it might be effective in this case. The various forms of counseling that would be used in this case might include the solution focuses therapy where the mental health nurse would focus on finding a positive solution to Angelina (Shattell, Star, & Thomas, 2017). Dialectical behavior and group therapies would also be helpful for use by the mental health nurses in Angelina’s case. A careful counseling would be effective should Angelina be engaged effectively by the nurse.
Angelina has been brought to the hospital by her parents; she has a nine-year-old sister and her two friends from the college. It would, therefore, be necessary for the nurse to engage her family and friends in her recovery (Ingoldsby, 2013). The techniques to use to recover her through the family and friends include providing support for the family and friends, empowering them, encouraging them about Angelina’s condition such that they are hopeful of her recovery. Additionally, the nurse should inform her family and friends about depression especially how it would be prevented (Rydon, 2015). However, it would also be useful for the MHN to assist Angelina in developing useful coping skills that would help her overcome the results of the depression she has suffered from in the past. The coping skills would provide her with the needed recovery strength.
Modalities of Therapeutic Treatment
The MHN should nurture Angelina to be self-determined. Since she has lost interest in her studies, the determination would be necessary to provide her with a reason to focus on her studies. The MHN also needs to show her how to empower and manage herself properly; assisting her to realize the right direction, a meaning to life and a purpose to be strong in life would also improve her recovery (Rabin, Feldman, & Kaplan, 2012). The MHN also needs to nurture a relationship that is supportive of Angelina and her family, friends and the school environment. The supportive relation with the friends, school, and family would be helpful in socially engaging her into various activities (Hewitt, & Coffey, 2015). Her social engagement would ensure that she stays healthy and safe from any factors that might expose her to depression.
Another important issue that the MHN should consider about Angelina is that she is currently hopeless. She might have been depressed after being hopeless about life or other issues about her life. While engaging her, the MHN should consider nurturing hope within her to restore her confidence (Bowles, Mackintosh, & Torn, 2013). The nurse should also consider creating awareness for Angelina about depression and prevention actions; one of the ways through which such awareness would be created is through the internet. Online counseling for instance, from the internet, would have been useful in curbing her situation before it was acute (Rabin, Feldman, & Kaplan, 2012). The internet offers help inform of the CBT therapies among other depression prevention and recovery solutions. The MHN should cite the various instances where the internet solutions have helped depression clients such that Angelina, her friends, and family are encouraged to consider using the internet for solutions (Hewitt, & Coffey, 2015).
Other therapeutic engagement techniques for use by the MHN for the case of Angelina would be the performance of both physical and mental status assessment (Ingoldsby, 2013). The assessments would indicate her current situation and response to the recovery attempts implemented on her. It would also be necessary for the MHN to maintain his or her physical presence for Angelina so that she might feel that the nurse is concerned about her. Angelina should be encouraged to manage herself efficiently to prevent herself from being depressed. The MHN also needs to assess the possible risks that Angelina might be exposed to by the depression (Shattell, Star, & Thomas, 2017). Her aggression also needs to be minimized such that she does not engage in activities that might worsen her condition. Her loss of weight means that she had developed certain unhealthy lifestyle. As a result, she needs to develop a healthy lifestyle in addition to an insight into life through the help of an MHN.
There are various therapeutic modalities used in treating depressed patients (Sotsky, Glass, Shea, Pilkonis, Collins, Elkin, & Oliveri, 2013). The modalities used for every patient depend on the stage of an effect of the depression. The modalities used for acute patients differ from that used on other patients (Rush, Beck, Kovacs, & Hollon, 2017). Angelina’s situation was at the acute stage, and she was directly taken to the acute ward upon her arrival to the hospital. The various therapeutic modalities that she would be subjected to at the acute stage would target the induction remission of her main depression phase that will recover her to a normal patient (Krupnick, Sotsky, Simmens, Moyer, Elkin, Watkins, & Pilkonis, 2016). Some of the diagnoses that the MHN would consider are; pharmacotherapy, psychotherapy focused on depression, combined medications among other modes of diagnosis that concern depression.
The initial form of diagnosis that the MHN should consider is pharmacotherapy, which is an antidepressant form of medication recommended for acute depression patients like Angelina. The selection of the antidepressant will, however, depend on the effects that the depression has had on Angelina or the expected effects of her depression (Babyak, Blumenthal, Herman, Khatri, Doraiswamy, Moore, & Krishnan, 2012). While choosing the right antidepressant for Angelina, the safety level and tolerable capacity of the depression effects should be considered by the MHN. After a choice is made on the right antidepressant for use, the other factor to consider would be the age of the patient (Sotsky, Glass, Shea, Pilkonis, Collins, Elkin, & Oliveri, 2013). Angelina is eighteen years old; her diagnosis should be that of an adult. The MHN after diagnosing her should maintain a check up on her to assess her response and advancements (Rush, Beck, Kovacs, & Hollon, 2017). The response to medication by the patient would be gauged by the severity of the depression symptoms identified in her earlier.
In case Angelina does not respond to pharmacotherapy, the MHN would use the ECT mode of diagnosis. Her loss of weight is also another reason for using the ECT diagnosis. Psychotherapy should be used initially by the MHN because as she is brought to the hospital at an acute stage of depression (Krupnick, Sotsky, Simmens, Moyer, Elkin, Watkins, & Pilkonis, 2016). The bad moods she has always shown recommend that the MHN should consider using the cognitive behavioral therapy as well to improve her behaviors because the negative behaviors might have worsened her depression. There are various facilities for use by the MHN to ensure that Angelina received the most effective and efficient recovery. While diagnosing her, the MHN should be mindful of the depression symptoms as a way of ensuring that she responds to the treatment effectively.
Should Angelina’s condition become unbearable, the MHN would be forced to use a combination of psychotherapy and antidepressant medication on her. Her disorder might require such diagnosis at the initial stage to make sure that she recovers as soon as possible (Babyak, Blumenthal, Herman, Khatri, Doraiswamy, Moore, & Krishnan, 2012). The symptoms of her depression show the mild state of the depression hence the combination of antidepressant and psychotherapy in her treatment. The choice of the antidepressant for use should incorporate the symptoms and severity of the depression consequences on the patient. The MHN should remember that Angelina has lost weight, neglected her exams, and has not paid her rent among other consequences out of the depression (Murphy, Simons, Wetzel, & Lustman, 2014). These consequences are known to represent acute depressions in most cases. Therefore, while handling her, the most effective antidepressant that would result in the most effective and timely recovery should be implemented on her by the MHN.
Also, the MHN should regularly assess the adequacy of Angelina’s response to treatment. Once the MHN has provided the necessary diagnosis in the right way, the follow-up processes to assess the effectiveness of the treatment should be conducted (Goldapple, Segal, Garson, Lau, Bieling, Kennedy, & Mayberg, 2014). The response of Angelina towards the treatment would be estimated by examining the symptoms of her depression and her reaction to medication. The report on her assessment should be made every month so that effective diagnosis is always provided. For a normal patient, a period of four to eight weeks would be appropriate to conclude that the patient is responsive or unresponsive (Murphy, Simons, Wetzel, & Lustman, 2014). Within this time, it would be possible for the MHN to determine whether Angelina is unresponsive or responsive to her diagnosis as supported by (Goldapple, Segal, Garson, Lau, Bieling, Kennedy, & Mayberg, 2014).
Conclusion
In case Angelina is unresponsive, it is recommended that the MHN should continue with the diagnosis for an acutely depressed patient. The reappraisal of the treated with the assessment of its side effects and the various complications that might be involved would be useful in ensuring that she is diagnosed for positive outcomes. The MHN will contact a psychiatrist for further assistance if her condition is maintained with no response to treatment. Angelina’s case is at an acute stage the moment she has been forwarded to the hospital for help. Should she show minimal or no response to treatment, the MHN should consider contacting a psychiatrist without reappraising the diagnosis. It would only be through the psychiatrist that prompt help would be received. A quick attention is required for her condition. Otherwise, depression conditions should be handled by MHNs effectively with the engagement techniques discussed above and the treatment modalities.
References
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Shattell, M. M., Starr, S. S., & Thomas, S. P. (2017). ‘Take my hand, help me out’: mental health service recipients’ experience of the therapeutic relationship. International journal of mental health nursing, 16(4), 274-284.
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