You are a PMHNP running a private clinic in the Bronx. A 34-year-old, Hispanic, single, woman was referred to your clinic by her primary care provider. She told you she lost her four-month-old to sudden infant death syndrome (SIDS) two months ago. Her husband divorced her and her family lives in Florida. The severe grief due to her loss has left her emotionally paralyzed. Her depressive symptoms such as being down, lack of interest in life, no energy, insomnia, and no appetite have not been improving. She feels as if her bereavement will continue to consume her and does not see any chance for a brighter future. As a provider you present to her the Patient Health Questionnaire (PHQ-9) in which she scores 18 meaning moderately- severe depressive state.

Disease management and health promotion:

As a provider, you want to improve the mood of the patient. Depression can be managed through pharmacology and psychotherapy. Pharmacology includes SSRIs, SNRIs, atypical antidepressants, tricyclic antidepressants, and MAOIs. When it comes to antidepressants, it will take around 4-8 weeks for the patient to feel any difference. You should educate your patient regarding possible side effects of medication while also fostering healthy activities to promote well being. Talking with a clinician helps identify negative beliefs, explore relationships/experiences, adjust to the crisis, identify coping mechanisms, set goals, identify what is contributing to depression and what changes can be made.

Population Setting: Community Mental Health Clinic

Theory Model: For our scenario we have decided to integrate Peplau's Theory of Interpersonal Relations, which centers on the therapeutic relationship between the provider and patient. Peplau's theory is separated into three phases: orientation, working, and termination phases (Vogelsang, 2022). During the orientation phase the provider can incorporate active listening and empathy to help engage the patient. Reflecting the client's experience of grief will help to build rapport. In the working phase, the provider becomes a collaborator with the client to decide the appropriate interventions including medication, psychotherapy, and attendance of bereavement and grief groups. The Termination phase will focus on evaluation of the treatments, reflection on the progress the patient has made and any concerns they may have before resuming a more independent life (DeNisco, 2024).

NP's Role: As the primary practitioner we want to build a trusting partnership with our patient to assure a positive outcome. After doing our initial assessment and identifying our patient's needs, we can develop a care plan based on attainable goals. We can prescribe antidepressants to help with her depression and offer education on grief and support groups. Our goal is to help her transition back to a productive life worked through her grief and conclude our relationship in a healthy beneficial manner.

References

DeNisco, S. M. (2024). Advanced practice nursing: Essential knowledge for the profession

(5th ed.). Jones & Bartlett Learning.

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