Case Scenario

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Severalpossible factors may lead to the condition experienced by Edward asdescribed in the case scenario. As such, the client’s preparation,mental health concerns have been brought about by a social(family) loss.As we have seen, he has lost both parents and also a son. His familyis apart and thus finding someone to share his problem is hard. Majorlife changes play a vital role in the feeling of hopelessness, lackof sleep and suicidal thoughts. Edward is facing challenges from allsides of life. Not only has he been separated from the loved ones buthis property and farming activities have dwindled. Nothing seems towork for right. The signs he shows are typical of depression whichusually includes anger, irritability, fatigue, restlessness, insomniaand recurring suicidal thoughts [ CITATION Kah16 l 1033 ].

Anotherfactor is the declineof health and property.Edward is an old man. His health and physical ability arecontinuously deteriorating. Coupled with the surrounding familyissues, the situation turns from bad to worse with the dwindlingfarm. Not only has the weather condition caused poor yield but alsothe lack of support and fatigue has led to poor outcomes. Edwardfeels neglected and alone, with no one to confide in and pour hisheart out. Although the material loss is not the initial factor, ithas been brought about by the family loss and lack of closerelations. Depressed individuals sometimes tend to be withdrawn anddo not interact with others efficiently [ CITATION Kah16 l 1033 ].Clearly, Edward doesnot confide in anyone. He keeps his thoughts to himself, and it isonly after being questioned that he reveals the problems he is goingthrough. Others reasons include thesuicide of his son and the rebellious attitude of the other one.He seems to be completely alone.



Ithas been established that one out of six people will go throughdepression in their lifetime. Many at times, these people are treatedusing antidepressants drugs. However, although antidepressant usedominates the market, another treatment known as Cognitive BehaviorTherapy exists and has been recognized as an effective remedy. Itattempts to teach patients how to deal with stress, negativethoughts, and causal stressors. As such ethical treatment ofdepression has been neglected by many healthcare practitioners. Theright to autonomy is commonly ignored and undermined by the involvedclinicians. Reliable literature has provided that clinicians areethically obligated to prescribe psychotherapy, and especially theuse of Cognitive Behavior Therapy (CBT). On the contrary, mostdoctors tend to write prescriptions for antidepressants rather thanproviding an alternative solution that might work just as well.Psychological sciences argue through comprehensive research findingsthat psychotherapy promotes autonomy and the emotions [ CITATION Pau11 l 1033 ].Edward’s case must also betabled in a way that he is not confined directly to medications. Onthe other hand, he should be advised on the available remedies sothat he can make an informed decision.


Theprinciples of consent and law are vital in mental health carepractice. Before any form of medical attention is provided andcommenced, permission should always be sought. Failure to establishthe client’s ability to provide a valid consent can ultimately leadto prosecution for assault and other related charges. The problemthat arises here is the conflict between the patient’s right tochoose the preferred treatment and the professional obligation to actin a manner that promotes the best interest. A clinician who fails tointervene for a patient who fails to provide valid consent can becharged with negligence. Therefore, mental health issues need to beaddressed using an approach that puts into consideration a properunderstanding of the Law and how to put it into use. The Law empowersboth the clinician and the patients. In this scenario, it isimportant to gain authority from the client Edward, throughconsenting. The process involves patient competency and capacity ofthe patient to assent. Secondly, he must also be provided withsufficient information that enables him to make an informed choicethrough disclosure of information. Lastly, the client must not bepressurized into complying with any of the available interventions.Common law will only come in when there is no one else to provideconsent. The clinician must, however, demonstrate the aspect of theduty of care or else, he/she will be held as negligent in Law (Doy etal., 2005).


Nursing/MidwiferyConcerns and Needs

Provisionof Nutrition and Physical Health Options

Mentalhealth patients require special attention in some aspects of theirlives to ensure positive outcomes. Promotion of mental and physicalhealth is one area that must be tackled. In this case, history takinghas established drastic weight loss and fatigue. This is a clearindication of poor nutrition and bodily health. A nurse is expectedto provide adequate and balanced diet options followed by exerciseand other physical remedies. As other interventions are beingimplemented, provision of information and services that promotephysical health should be incorporated. This concern is includedbecause it encompasses a vital component of depression treatment forthe patient. Psychotherapy and medication alone will not besufficient without addressing the constitutional requirements [ CITATION Hyw13 l 1033 ].Byproviding good nutrition and physical exercise, the response to otherinterventions will be boosted. In the long run, the outcome will bemore pronounced and desirable.

Psychotherapyand Responsive Needs

Anothersignificant concern that has to be considered is the provision ofsocial and practical emotional support. For this particular concern,the nurse/midwife has to involve the client in a therapeuticconversation as well as taking part in other helpful methods such asmusic, art, and drama among others. Residential services, mealarrangements, house meetings, outreach and community support can alsobe organized. This need is put in place because the client requiresclose monitoring together with moral and emotional supportconsistently. In this case scenario, the patient is having problemsrelated to the socio-economic sphere of life. It is imperative toattend to this concern by connecting him to better accommodation,offering support with personal financial management, assisting withwelfare benefits and other possible entitlements as well as supportfor leisure and recreational activities [CITATION May12 l 1033 ].This concern is selected because the individual has weak social andfamily ties as well as the lack of physical and emotional support.Taking into consideration this need will not only enhance theestablishment and sustenance of proper social networks but alsoimprove communication with others, including his family members.


Evidence-BasedNursing/Midwifery Interventions

Severalevidence-based interventions exist that can be used to treat thecondition in this case study. These methods are discussed below.

CognitiveBehavior Therapy (CBT)

Thisapproach is based on focusing on the fact that cognitions influenceemotions and behavior. The procedure involves assisting the patientto recognize negative thoughts and feelings. Since behavior islearned, then there is a possibility of changing it. Similarly,distressing emotions are caused by faulty thinking patterns thusmodification can be done. The therapeutic intervention includescognitive restructuring, self-instructional training, skillstraining, stress management, anger management and social skillstraining. In this way, dysfunctional thoughts are replaced by morerelevant cognitions [ CITATION Aus11 l 1033 ].This strategy is vital since it addresses some of the issueshighlighted by the patient such as suicidal thoughts, feeling guiltand hopelessness.

InterpersonalPsychotherapy (IPT)

Here,the main aim is to address interpersonal issues. This method isrelevant because the client is having problems interacting with hisfamily members. The procedure is brief and structured. The client ishelped to understand how the problems he is facing affect thesituation and cause distress. This phase is followed by theconceptualization of internal disputes, a transition of roles andinterpersonal shortcomings. Lastly, the person`s perceptions andexpectations are explored hence the communication and interpersonalskills are promoted [ CITATION Aus11 l 1033 ].

FamilyTherapy and Family-Based Interventions

Thisis an approach that specifically purposes to alter the interactionsbetween and among the family members. The functioning of the familyunit is improved in the long run. The steps involved in this mode oftherapy include the provision of psychoeducation, behavioral therapy,object relations, systemic treatments, structural andsolution-oriented interventions [ CITATION Aus11 l 1033 ].It is a relevant choice since the client has family issues that canbe solved using this plan.

Acceptanceand Commitment Therapy (ACT)

Thistreatment strategy makes use of a combination of several otherapproaches. It begins with the increment of recognition ofexperiences such as distressing thoughts, beliefs, and feelings,followed by a directed effort to promote behavior change to thedesired character that improves the quality of life. Additionally,unwanted experiences such as anxiety are controlled coupled withencouragement to connect fully with experiences without defense whilesimultaneously approaching the desired goals [ CITATION Aus11 l 1033 ].This intervention is chosen since it addresses the client’s problemof feeling hopeless and translates it to individual behavior goals.


Australian Psychological Society. (2011). Examination of the evidence base for psychological interventions in the treatment of mental disorders. Victoria: Australian Psychological Society.

Biegler, P. (2011). The Ethical Treatment of Depression: Autonomy Through Psychotherapy. London: MIT Press.

Doy, R., Burroughs, D. &amp Scott, J. . (2005). Mental Health- Consent, the law and depression- management in emergency settings. Emergency Medicine, 279-285.

Kahn, A. (2016, January 27). Suicide and Suicidal Behavior. Retrieved from Healthline:

Serrano, M. (2012, June 17). Depression Nursing Interventions. Retrieved from RNSpeak:

Thomas, H. (2013). Assessing and managing depression in older people. Nursing Practice Review, 32-39.

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