Psychiatric-Mental Health Nursing: From Suffering to Hope

Critical Thinking Elizabeth Elizabeth is a 35-year-old woman who immigrated to the United States from West Africa 10 years ago. She was recently hospitalized on a psychiatric unit for depression and suicidal ideation. She is married and has four children between the ages of 2 and 12. She is a student at the local community college and works as a dietary aid in another hospital. Her husband is not living in the home, and she is the sole economic support for the family. During the admissions interview, she told the nurse that she became depressed and suicidal because her husband was having an affair with another woman and that he no longer provides the family with any money. She has told the staff that she is currently not feeling suicidal. When asked about personal resources, Elizabeth indicated that she has many friends from her home country and that the people in her church are very supportive. When the nurse commented that it sounded like her faith and her church community were important to her, she responded, “I just need to get out of here so that I can pray. I have to trust God to make a way. They want me to take medicine, but I don’t need medicine. I need a miracle.” Elizabeth also shared that a friend had told her that someone had placed a spell on her husband and that consequently he was unable to resist having this affair. Application What information do you have about the 5 domains for Elizabeth? What assessment questions would you ask Elizabeth to gain more understanding of her spiritual domain? In what ways might Elizabeth’s faith and her church friends be a support to her? In what ways might it make her recovery more challenging? Answers What information do you have about the 5 domains for Elizabeth? Biological Domain – No information is given; additional information is needed to determine if there may be a biological illness impacting Elizabeth’s depression or if her depression manifests in any physical symptoms. Psychological Domain – Elizabeth’s hospitalization and suicidal ideation indicates her depression is severe, but there is insufficient information regarding her symptoms to begin to form any type of plan of care Sociological Domain – Elizabeth is estranged from her husband, and she is the sole financial support for her family of four children, ages 2 to 12 years old. Cultural Domain – An immigrant from West Africa, Elizabeth has many friends from there. Spiritual Domain – Elizabeth finds people in her church very supportive, but there is no information on her spiritual practices to inform the care plan. Elizabeth seems to engage in some magical thinking in terms of how she approaches life, and this may be related to her West African heritage. Assessment of Elizabeth related to the spiritual domain would begin with closed questions such as “Are there any spiritual practices that are important to you?” to provide a baseline understanding of the role religion and spirituality plays in her life. The nurse would continue with open-ended questions to assess how Elizabeth finds meaning and purpose in life and to what extent her faith helps her cope. Questions such as “How do your religious beliefs impact your day to day life,” and “Tell me more about the church you attend,” will help the nurse get a greater understanding of Elizabeth’s faith practices. Then the nurse can follow up by asking to what extent these help Elizabeth manage her depression and how they might inform Elizabeth’s treatment plan. Elizabeth’s faith and friends from church may support her by giving her greater satisfaction in life, by providing comfort, and by reducing some of the physiological effects of stress. However, if she feels that her faith is contrary to her treatment plan or if her friends are not supportive of her treatment plan, they may interfere with Elizabeth’s ability to recover sufficiently from her depression to return to function and care for her family.