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Depression

Depression or depressive symptoms is one of the major public health issues that impacts economically and socially on the individual, businesses, families and social services. It is a recurring or chronic disease and so is managed as chronic illness. Patients with depressive symptoms are at greater risk of less complete recovery or chronic course of depression. Psychotherapies and medications through antidepressants as well as ensuring optimum care and effective treatment of patients with depressive symptoms will enhance the entire recovery processes (Hart et al., 2019).

For specific analysis of optimal care to people suffering from depression through patient centred care, this research is based on case study 2 about Harry. Harry is a 68 years old man who lives in Wagga Wagga in New South wales Australia. From the case report, Harry has previous history of depression, and recently he has become hypochondriac which is attributed to being lonely since the passing of his wife.

Optimal care of depression in the primary care setting needs a systematic approach which involves case detection and diagnosis, education and engagement of depression patients, application of evidenced based treatment comprising psychotherapy, medications and case follow ups to ensure the patient is improving. Furthermore, evidenced-based self-management such as educating patients and family members about depression, overcoming barriers to adherence to medication, healthy nutrition and diet and exercise helps to improve health status of the patient (Chen et al., 2019).

Practicing nurses play important role in management of patient’s illnesses and so enhancing care intensity, clinical and self-management skills. Nurse led collaborative care incorporates follow up schedules, systematic management plan and inter-professional communication. Nurse led care improves recovery process from depression or depressive symptoms, enhances adherence to medication and treatment, response to treatment, quality of care and recovery from symptoms among patients (Gagliardi et al., 2019.

Patient centred care is widely accepted as the approach and practice that supports effective care. It creates a shared responsibility between the health professionals and the patient management either within or outside the health facility. Patient centered care is therefore a fundamental principle in management of chronic diseases such as depression since it involves the genuine concern of patients’ values and needs.

The overall process of primary care of people with depression involves evidence-based care and interventions comprising of development of a care plan, referral process, assessment, review and follow up management. In addition, their responsibility extends to systematic assessment, specific and accurate required assessment, holistic approach, continuity care and improved patient education (Gagliardi et al., 2019.

In most parts of the world, chronic conditions are among the leading causes of mortality, morbidity and inequitable health outcomes. Patients require to be engaged with nurses or healthcare providers who they can have a conversation about their health and needs which are within the context of their lives. Nurses should be willing to be guided by their patients’ perceptions about their needs and not by their own beliefs clinical management of the illness or not by assumption of similarity.

In patient centered care, self-management can be defined as set of processes and tasks that are used by the patient to manage and maintain wellness from a chronic condition such as depression. It involves management of attitudes, lifestyle, diet and behavior. Self-management is aimed at managing all the effects of the chronic condition such as depression on all aspects of living by the patient suffering from chronic illness. Nurses provide systematic approaches which patients can employ to ensure effective self-management skills that can improve their self-efficacy and in turn reduce health care cost implications (Chen et al., 2019). Through health professional trainings like training by nurses, a better uptake, adherence and implementation as well as effective self-management plans are achieved.

Nurses provide supportive interventions and education systematically to the patients so that they the patients gain skills and confidence to manage their health conditions. This education might include problem solving approaches, goal setting skills and regular assessment of problems and progress. Nurses also provide self-management support to the patients which involves the effective problem solving, monitoring patient’s health condition, patient education, shared decision making and group supports. These self-management methods provided by nurses takes into consideration the how effective are they, how cost effective and safety (Gagliardi et al., 2019).

Patient empowerment refers to the individual patient’s capacity to make decisions about his or her behavior, health and to take or have control over aspects of live that influence his or her health through incorporation of self-efficacy and personal control (Chen et al., 2019). Patient empowerment occurs when nurses focus on increasing patients’ capacity to make informed, autonomous decisions about their health issues. This ensures that the patient is not passive recipient of healthcare services but takes part in making self-decision as well as has control over his or her health progress or problems. Empowerment takes into consideration patients decision even if they choose to hand over responsibility its seen as their choice and so the patient is still empowered.

Patient empowerment is key in patient centered care since it improves management of chronic conditions such as depression. It promotes the health professionals’ and patients’ satisfaction as well as improved clinical outcomes. Empowerment is based on various factors such as age, socio-economic resources and culture. However, it is a process and an outcome and so patients can be empowered by the nurses and general health care providers (Chen et al., 2019).

General primary care providers and family setting are the key people that nurses approach to ensure a successful patient empowerment because they are the first group who interacts with the patient and they understand their social, cultural and economic background. Their goals are already oriented towards encouraging patient empowerment.

Depression in primary care is under detected, underdiagnosed and undertreated. Older adults like Harry who is living alone are at high risk of not being recognized as depressed or to get optimal care. They should therefore be routinely screened for depression in clinical settings which can provide effective treatment and optimal care through patient centred care (Frost et al., 2019). Practicing nurses play a vital role ensuring effective management of depression in primary care through various steps to ensure optimal care including detection and diagnosis, patient engagement and education in treatment, initiation and administration of evidenced based psychotherapy and pharmacotherapy and effective treatment (Frost et al., 2019).

They also, do consistent follow ups to ensure the patient is adhering to treatment prescriptions. From the case study, harry is living alone and he longer takes part in games as before, this is likely to worsen his health problems. Optimal care including ensuring he is not living alone, participates in regular games and exercise activities and following up on his daily health report will help him improve from depressive symptoms. This primary care should be a collaborative process between the family members and the nurses.

The case study about Harry is based in Wagga Wagga in NSW, Australia. Depression is less visible in rural and remote areas as compared to urban areas. Infrastructural and geographical limitations have great challenges to detection and treatment of depression. Treatment of depression is mostly at individual and family level rather community level. However, depression has a social problem which is influenced by the environmental and societies’ settings. Therefore, societal concepts such as social networks, social capital and social isolation are significant factors in treatment and management of depression (Heidara, 2019).

Treatment and management of depression in this region, research suggests Wagga Wagga region develop their own ways to manage depression such as informal support mechanisms and standard depression management general practices. Population in this region are considered conservatives and therefore depression management should involve traditional medical models because they are not willing to try other medical alternatives. There are health facilities within the region but they are very few and so their uptake for depression cases is very low and so general practitioners are of significance in management of depression through educating patients, family and society about depression as well as well as prescribing anti-depressants (Heidara, 2019).

Depression treatment and management in primary care setting and health care services involves an evidenced based collaborative approach where the general practitioners, nurses and other health care providers work together to provide patient centred care (Gagliardi et al., 2019). These collaborative approach ensures that the patient is not passive in treatment but involved in decision making which ensures patient satisfaction and better depression outcomes. Patient centred care is an effective approach in management of depression because it involves carers, patient and the family.

Incorporation of primary care providers and family in treatment and management of depression helps ensuring the patients is adhering to effective treatment for behavioral problems. Follow up services and tracking of treatment adherence and assessment of treatment effectiveness by the health care providers in collaboration with the patients and general practitioners to ensure patients achieve the desired clinical outcomes (Hart et al., 2019). Patient centred care approach can help in effectively managing and treating patients suffering from depression as it ensures there is patient empowerment, enhances patient self-management and gives power to patients to address their needs despite their health problems.

References

Chen, L., Wang, F., lv, L., Zhang, Y., & Shen, X. (2019). Abstract WP186: The Efficacy of a Patient-centered Self-Management Empowerment Intervention Program (pcsmei) for First-

time Stroke Survivors: A Randomized Controlled Trial. Stroke, 50(Suppl_1), AWP186-AWP186.

Frost, R., Beattie, A., Bhanu, C., Walters, K., & Ben-Shlomo, Y. (2019). Management of depression and referral of older people to psychological therapies: a systematic review of qualitative studies. Br J Gen Pract, 69(680), e171-e181.

Gagliardi, A. R., Green, C., Dunn, S., Grace, S. L., Khanlou, N., & Stewart, D. E. (2019). How do and could clinical guidelines support patient-centred care for women: Content analysis of guidelines. PloS one, 14(11), e0224507-e0224507.

Hart Abney, B. G., Lusk, P., Hovermale, R., & Melnyk, B. M. (2019). Decreasing depression and anxiety in college youth using the Creating Opportunities for Personal Empowerment Program (COPE). Journal of the American Psychiatric Nurses Association, 25(2), 89-98.

Heidari, T. (2019). The effect of family-centered empowerment program on depression, anxiety and stress among patients with obsessive-compulsive disorder and their caregiversʼ burden (Doctoral dissertation)

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