Anxiety And Psychiatric Disorders: Postpartum Depression

Case Example The writer of this PICO paper is currently completing the final-semester nursing preceptorship in a standalone psychiatric mental health facility. The unit where the writer is receiving clinical training is a unit specifically for patients experiencing psychosis and it is a locked unit. The majority of the patients on the unit have diagnosis along the schizophrenia spectrum and bipolar and related disorders. Nonetheless, any other psychiatric disorders could warrant hospitalization on the unit if psychotic features exist (e.g. postpartum depression with psychosis or major depressive disorder with psychosis).

The patient, TM, for this case example, is a 26-year-old male with a history of schizoaffective disorder, depressed type.

During the course of hospitalization, patient was restrained once after assaulting a staff on the unit due to agitation associated with psychosis. In a patient interview with the writer, TM expressed persistent anxiety and suicidal ideation related to the delusional belief that he is the devil and, hence, does not belong to this earth. Anxiety and the associated social avoidance, agitation, and depression due to the delusion were primarily managed with PRN Lorazepam. The patient used these PRN medications on a regular basis to control anxiety. Although the immediate needs of this patient should be focused on creating a safe environment, the frequency of use of Lorazepam and persistent reports of moderate to severe anxiety by the patient illustrated that the patient could possibly benefit from adjunctive therapy that would not interfere with his medication regiment. Nonpharmacological interventions, which can be practiced by patients once learned, might also improve patient’s longer-term anxiety and depression. In order to better understand and assist with this patient, the writer will consider this patient using Meleis’ Transition Theory. Meleis’ Transition Theory looks at a patient’s current state as a transition from one state to another. By understanding the type of transition, pattern, and properties of the transition, transition conditions (facilitators and inhibitors), and patterns

These indicators include sociality, self-care activities, and coping and self-confidence. As TM returns to a stable state, there should be an increase in group attendance and social interaction with peers; additionally, TM will initiate self-care activities such as showering, brushing teeth, eating, and drinking; finally, TM will use coping methods to handle anxiety and delusional belief, be able to report no suicidal ideation, and report higher self-esteem. Nursing interventions are key to helping TM’s transition, and nurses’ understanding of the Transition Theory could help provide appropriate help to the patient. To address the transition from stable state to illness exacerbation, nurses should provide a safe environment with frequent checks, administer scheduled and as-needed medications, and assist with TM’s self-care activities. Because TM’s mother was involved, updates on the patient, education on current illness and treatment, and empathetic communication should be consistently