Community health case study - Depression: Nursing

Nurse Betty works in a community health clinic and is caring for James, a 65-year-old male who presents for a 3-month follow-up after being diagnosed with depression. After settling James in the room, Nurse Betty goes through the steps of the Clinical Judgment Measurement Model to make decisions about James’ care by recognizing and analyzing cues, prioritizing hypotheses, generating solutions, taking action, and evaluating outcomes.

First, Nurse Betty recognizes important cues, including James’ vital signs, which are temperature 98.9 F, or 37.2 C, heart rate 70 beats per minute, respirations 14 breaths per minute, blood pressure 112/68 mmHg, and oxygen saturation 99% on room air. She also notices that James avoids making direct eye contact.

Nurse Betty: Hi James, it’s good to see you back in the clinic. How are you doing?

James: I’m fine, I guess.

Nurse Betty: I remember from your last appointment you recently retired from your job. Tell me how you’re adjusting so far.

James: It’s been pretty lonely. I haven’t been sleeping much.

Nurse Betty: I’m sorry to hear that. Do you have any friends or family in this area?

James: No, not since my wife passed away last year and my daughter moved away.

Nurse Betty: That sounds very isolating. Have you ever thought about harming yourself or trying to take your own life?

James: No.

Next, Nurse Betty analyzes these cues. She reviews the electronic health record, or EHR, and notes that James is currently prescribed a low dose antidepressant to treat his depression. She also calculates that his score on the PHQ-9 scale today indicates a moderately severe level of depression. She also notes that he’s lost 7 pounds, or 3.2 kilograms, since his last clinic visit.

Nurse Betty knows that depression is a mental disorder that causes loss of interest in activities that were previously enjoyable, and persistent feelings of sadness that interfere with daily life.

In older adults, depression can be related to social situations like loss of a spouse, recent retirement, or isolation from family or friends. She also recognizes that older adults with depression may present with somatic symptoms, like insomnia or GI problems that can lead to weight loss.

Nurse Betty knows that James’ depression, along with his decreased socialization, can prevent him from receiving the care and support he needs. Nurse Betty recognizes that James needs help to effectively manage his depression.

Now, using the information she’s gathered, along with James’ medical history, Nurse Betty chooses a priority hypothesis of social isolation.

Next, Nurse Betty generates solutions to address James’ depression that will include pharmacologic and non-pharmacologic interventions; and she establishes the expected outcome that by his next appointment, James will report participating in one social activity per week.

Nurse Betty then takes action to implement these solutions. She speaks with the healthcare provider about James’ symptoms. After the healthcare provider visits James, Nurse Betty re-enters the room to review the plan of care.