Critically discuss one aspect of care identified from the case and set enigma your group were

working on (2000 words)

Introduction

A nurses’ main attribute is to assess and implement the planning of patient care (Nursing and
Midwifery Council (NMC), 2018). This was highlighted by the Nursing and Midwifery Council (NMC)
(2018a) which grouped care under seven aspects. This was to reflect attributes that nurses must
implement when caring for people across care settings (NMC, 2018). It consists of seven platforms
such as being an accountable professional, promoting health and preventing illness. The focal aspect
of care discussed will be ‘Assessing needs and planning effective care’ (NMC, 2018).

A key aspect of care that will be discussed is the third aspect whereby Marcus’s needs would have to
be assessed to plan effective care. This was emphasised to be the core standards in the nursing and
midwifery council (2018a) nursing proficiency standards (Ajibade, 2021). This is to promote Marcus’s
health and work capacity to improve his working and personal life (Jain et al., 2021).

Assessment and planning of care

For successful assessment and planning of care, an occupational nurse must prioritise the needs of
Marcus when reviewing his mental, social, and cognitive issues (NMC, 2018). Such assessment is a
type of conversation between a client and a practitioner in which they talk about the former's needs
to improve their health and what they hope to accomplish in their daily lives (National Institute for
Health and Care Excellence (NICE), 2019). An occupational nurses’ assessment entails data collection
and the judgement of the patients’ needs which could be referred to as problems (Ajibade, 2021). In
the planning of appropriate care, various strategies must be implemented to assist in solving the
highlighted “problems” (Ajibade, 2021). This can be executed using suitable nursing interventions.
The prioritization of the patient's needs and wants when planning treatment includes the individual
in the decision-making process to create a patient-centered approach. Person centred care is defined
as the treatment of patient as beings equally in the business of healing; being coordinated enabling
and personalised (Coulter and Oldham, 2016).

The patient's condition, personal characteristics, and preferences must all be considered while
planning care (Ajibade, 2021). These holistic needs assessment divides the patients’ needs by
assessing their physical, emotional, spiritual, practical, social, and environmental needs through a
holistic discussion which informs their care plan (Young et al., 2015). It is through this that a patients’
needs are met, in this case Marcus’s, and that due to non-concordance; treatments and care plans are
tailored to improve the quality of care administered (Ajibade, 2021).
However, to properly assess Marcus’s level of depression, not only will Marcus’s symptoms will be
considered but also how he is unable to function as an adult in society (NICE, n.d). Furthermore, his
past history of depression warrants the following questions to be used when performing a
comprehensive assessment:

During the last month, have you often been bothered by feeling down, depressed or hopeless?

During the last month, have you often been bothered by having little interest or pleasure in doing
things?

According to the NICE guidelines, there are four steps in interventions according to the level of
depression (NICE, n.d). In the first step Marcus would undergo assessments and monitoring. This is
coupled with any support framework that he would find useful in assessing the efficacy of treatment
plans. This would swiftly lead to the second part of the same of care which is ‘Planning of care’ (NMC,
2018).

Enigma- Case study analysis and discussion

Marcus has had history of depression four years ago which was properly intervened, however he is
experiencing symptoms that align with signs of depression reoccurring. depression is described to be
a serious mood disorder that can the ability to process negative information (National Institute of
Mental Health (NIMH), 2018; Compare et al., 2014). It creates significant symptoms that impact how
you feel, think, and deal with day-to-day tasks (NIMH, 2018). Marcus Wainwright was treated with
serotonin reuptake inhibitors four years ago which is a common class of medication that treats
depression (Chu and Wadhwa, 2022). Depression is a mental health condition which affects thoughts,
moods, and physical health (Cui 2015). Low mood, loss of energy, sadness, sleeplessness, and an
inability to enjoy life were among the symptoms that is experienced with depression. Marcus does
show signs of depression as he experiences tiredness and low moods as his colleagues have noticed
fluctuations on his moods. According to the NICE clinical guidelines [CG91] (n.d) (1.1.3.1) their
principles in assessing a case Marcus is to first conduct a comprehensive assessment. A key thing to
consider when performing this assessment is that Marcus has had a history with mental health
disorders and had been taking serotonin uptake inhibitors. Furthermore, Marcus has noted that his
gradual condition is hurting the relationship between his partner and work colleagues. this is
detrimental to his mental health as his depression can cause him to react strongly to negative social
interactions (Stegen and Kashdan, 2009). Making connections with others and gaining acceptance in
social groups is one of the important needs of humans (Deci and Ryan, 2000). In the initial assessment,
it is also advisable to ascertain whether he may have adequate support outside appointment hours.
This is because depressed people have increased sensitivity when these social bonds and the
deterioration of relationships are severed (Stegen and Kashdan, 2009). It is also important that if he
feels that he has no support, it is best to be assess if he has suicidal ideation or self-harm intent in the
initial assessment which can help in ascertaining care plan prioritisation (NICE, n.d.).

In the case study it was observed that the patient had been prescribed 60mgs of fluoxetine which is a
known antidepressant (Rossi, Barraco and Donda, 2004). A literature review conducted by Rossi,
Barraco and Donda (2004), collated studies and were able to find that studies using fluoxetine as a
treatment for depression on a short-term basis. This would bring into question whether the
medication, fluoxetine, is appropriate for Marcus. The study also assessed the significance of the
fluoxetine dosage and its effects on the participants. The study was able to discover that dosages are
correlated with participants experiencing cholinergic adverse effects (ADE) (Rossi, Barraco and Donda,
2004). Some ADEs included are abnormal vision, insomnia, drowsiness (somnolescence) and many
more. Marcus’s dosage is set at 60mg which can explain his experience with light-headedness and his
declining vision. Dosages between 20-80 mgs was discovered to coincide with more fatal outcomes
(Rossi, Barraco and Donda, 2004). In contrast, Lejoyeux and Adès (1997) refute the notion of the
dosage of the antidepressant is the cause of Marcus’s declining condition however it is stipulated that
it is whether there is an antidepressant discontinuation. Antidepressant discontinuation may affect a
persons’ mood, appetite or even sleep (Lejoyeux and Adès, 1997). These symptoms are said to
coincide with symptoms of depression which is why as an occupational health nurse the main issue to
assess Marcus according to prior arguments. The main information to garner from Marcus is whether
he had stopped taking his medication and is experiencing antidepressant discontinuation or whether
it is a result of ADEs from taking the said antidepressant. Incidence rates of antidepressant
discontinuation (withdrawal) was examined from 14 studies (Davies and Read, 2018). It was
discovered that effects after discontinuation range in severity depending on the duration of
discontinuation. Seven of the ten studies were able to ascertain that the effects were experienced
when antidepressants were not taken after two weeks or more (Davies and Read, 2018).

Care plan

After determining the patients’ needs following assessment, what needs to be considered is to plan
care (Ajibade, 2021). Care plans are recognised to be the third stage of the nursing process which is
used in the assisting the patient to ensure a positive outcome is achieved (Toney-Butler and Thayer,
2021). The care plans constructed aims to mitigate the present and potential problems that were
identified by the patient; in this case, Marcus (Ajibade, 2021). Care planning assists in the prioritisation
of Marcus’s needs which leads to a person-centred care goal. Care planning is the involvement of the
service user and the provider in the tailoring of their care plans (Social care institute for Excellence
(SCIE), 2014). A care plan is constructed by the patient communicating verbally to the service provider
(and any other individuals they wish to include) on the care expectations. A written record detailing
how care will be provided to the patient will be shared with the patient. In giving this information, it
would clearly preserve the service provider's responsibility and allows clients to express any concerns
they may have about the care plan or its delivery (SCIE, 2014). In the development of the care plan for
Marcus, it is essential that as an occupational nurse, a more open consultation approach should be
used. The consultation style would promote participation which may imply orienting the individual to
the solution (SCIE, 2014). If a more paternalistic consultation approach would be applied, it would
diminish the Marcus’s participation in the construction of the care plan and it would not address the
care needs that Marcus deems important (Leach, 2010). This is important as the paternalistic
consultation style may concede their outcomes or feelings of support which would not lead to Mental
Capacity Act compliancy (SCIE, 2014). In the development of the care plan, several factors need to be
taken into consideration and are depicted in the appendix (Box 1). Within the care plan considerations
one of the suggestions considered was to make sure the client prioritises on how they spend their
lives now. This could be through engaging in hobbies that the patient likes to do, seeing people that
they like and focusing on their likes and dislikes and so on (SCIE, 2014). This could help Marcus to
pinpoint what matters to him presently which can positively impact his depression. A study conducted
by Steger and Kashdan (2009) supports this notion as an induvial needs a sense of belonging and feel
isolated whenever stressors arise, or social exclusion is experienced.

The benefits of care planning aims to improve the quality of care and also improves patient outcomes
in individuals with long terms health conditions (Department of Health (DH), 2011). Marcus’s long-
term condition would be better planned by personalisation of the care plan (DH, 2011). Care planning
is an integral management strategy of the long-term health condition. In this way care planning can
be more proactive and can meet the patients’ needs (DH, 2011). Contrastingly, a cross-sectional study
conducted by Coffey et al., (2019), discussed how healthcare professionals have internal
organisational pressures and due to these demands, staff many not simply prioritise collaborative
consultations with the service users to meet these demands. Furthermore, the nursing staff that were
interviewed for the staff stipulated that the patient’s mental health condition severity should also be
considered. Additionally, some service users were unable to fully commit to the collaborative tasks
and were often unwillingly engaging in the task. This means that care planning may need to be
modified slightly based upon the nurses’ judgement on whether a person -centred approach is suitable
to implement for the patient (Coffey et al., 2019).

Conclusion
In conclusion, there are numerous aspects of care that an occupational nurse should consider when
treating a patient with a condition like Marcus. An aspect that was covered was the Nurses’ duty to
assess and plan effective care. In the assessment of a patient especially with a similar history to
Marcus, there are a lot of conditions to consider. According to Marcus, the symptoms experienced by
him coincide with research that support the notion of antidepressant withdrawal or side effects of
fluoxetine. It was also discussed that another possibility was signs of recurring depression. However,
within the aspect of care investigated which was assessing and planning effective care, it is best to
assess Marcus before administering the appropriate intervention and treatment plans. Once an
adequate assessment has been made for Marcus to ensure his needs are met, it is advisable for Marcus
to collaboratively develop a care plan with the occupational nurse. It is important for a collaborative
consultation to take place to avoid negative outcomes and to ensure that Marcus is more likely to
adhere to the care plan.

Word count: 2,031

Appendix

BOX 1. Care plans Considerations

• The person's ambitions and aspirations for the future, as well as the care and assistance they
need.
• What matters to the person in terms of how they spend their lives now: what they enjoy doing,
their interests, likes and dislikes, who they care about, whom they like seeing, and their preferred
schedules (such as when they like to get up and go to bed, whether they like a bath or a shower,
etc.).
• Dates and details of significant life events to aid chronological orienting.
• How to best assist and include the individual in decision-making.
• Critical information for ensuring continuity of treatment and in the event of an emergency.
• Roles and responsibilities to guarantee that the person gets coordinated care and support.
• If a person lacks the ability to articulate their wishes, how have their families and others
concerned about their welfare been consulted?
• The desired outcome, as well as any other choices examined.
• The advantages and disadvantages of each alternative.
(SCIE, 2014)
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