The purpose of this guided essay is to enable students to consolidate nursing/midwifery issues covered in class materials and to determine students’ understanding of the topics and applications, in preparation for transition into the professional nursing and midwifery workforce. This is a guided essay based on a case study where the students respond by answering a series of questions.

Using EITHER Scenario A or Scenario B- please answer the following questions:

1. Investigate and outline the prevalence/incidence of depression / anxiety (depending on the scenario you have chosen) in Australia – Your answer needs to cover: gender, age groups, specific risk groups, hospitalisations.
2. Using current literature discuss TWO (2) factors that may have contributed to the development of the client’s presentation and mental health concerns.
3. Using current literature discuss TWO (2) ethico-legal issues related to your scenario.
4. Identify TWO (2) nursing/midwifery concerns / problems with evidence from your chosen scenario- Your risk identification should be focused on the next 1-5 days of nursing/midwifery care for your client.
5. For each nursing / midwifery concern / problem you have identified in Question 4, outline and describe TWO (2) evidence based nursing / midwifery interventions (ie; what you would actually do as a nurse / midwife to support the person and how you would do it). Your interventions should be focused on nursing / midwifery care for your client over the next 1-5 days. They must be interventions which you would actually undertake directly with your client within your role as a nurse or midwife. You are also required to provide a clear rationale for each nursing / midwifery intervention (ie. why have you chosen the particular nursing interventions? How will the interventions support the person or contribute positively to their current presentation or concern?) Each intervention and rationale must be supported by current literature.

Scenario A
David has been referred to you in the Emergency Mental Health Community Team by his GP. His GP is concerned about David’s mental health state and risks to self. David is a 23 year old man, currently living with his mother. Both David and his brother, Peter, have a positive relationship with their mum. David’s mother and father divorced when he was 15 years old. Before his parent’s divorce, David had a positive relationship with his dad. However at the time of his parent’s divorce David became very angry towards his dad. David also directed his anger towards his friends at the time and he quickly became isolated from his peers, ultimately leaving school at 15 years old, at the end of year 9. David and his older brother, Peter, aged 25, had shared interests of bike riding and computers during their teenager years. During your meeting with David, he stated that he did feel that he and his brother had a close relationship and friendship. However, he acknowledged that they had become more distance in recent years. David has had three past heterosexual relationships lasting several months. His last relationship finished two months ago. His most recent girlfriend has disclosed she is three months pregnant and does not wish for David to be involved in the care of the baby.
After leaving school, David had a number of part time labourer jobs. Each job lasted for two to three months. His most recent employment, over a year ago, was terminated by the employer as a result of conflict with his colleagues. David had left three of his previous jobs on his own accord as he felt “he just didn’t fit in”. He recalled a constant feeling of agitation and sadness at the time. During your contact with David, he has not worked for at least a year. He has contact with his father and brother every month or so. Many of the contacts with his father and brother end in verbal hostility. During the assessment with David, you notice he becomes distressed and tearful on your questioning. He reports recent weight loss. He discloses he has been having difficulties sleeping, feeling exhausted and increasingly depressed. You make further attempts to find out what has been happening for David and to engage with him. He asks you to stop questioning as he is ashamed of how he is currently feeling. He is worried about letting his mum down as they have always had a positive relationship. He declines to look at you while you ask him about thoughts of suicide. He does not wish for you to have any discussions with his family.