I have identified the concept of coping with stressors, which related to mental illness from clinical experience. The clinical scenario highlights this concept. I have been assigned A 56 years old female patient diagnosed with “Depressive Episode Severe” at AKHU psychiatric ward. During the interview I explored that due to stressful life since from the teenage she was not been able to ventilate her emotions, behaviors, and end up with mental illness. She was suffering with depression since last 16 years. She had been hypertension since 5 years and 12 years angina. Her family history showed that her elder brother had also depression. Patient described about her stress full event that when she was around 16 or 17 years of age her mother died then she felt alone and spent her whole day in taking care of her father and household work, she did not marry because she thought if she will then who is going to take care of her father. Even after the death of her father she decided not to marry in her life and will only look after her brothers and sisters. She further explained that her younger brother died because of schizophrenia, and that’s her believed that he is in heaven. She was very much attached with him. In addition she was complaining of sleep alteration due to tension of household work while sleep. Based on the above scenario patient spent her whole life in taking care of her family and did not employ anywhere. This stressful life results in mental illness.
Introduction to the topic:
Every individual’s life has stressors but the problem is, few people cope up with these and few get indulge their lives. I found that this is the concept of coping, which is best fit as per the above scenario. Coping is the essential part of our life. It gives us the positive direction as well as negative direction to handle the stressors but it is our decision to select which way we proceed.
According to Boyd, M. A (2005) wrote in her book:
Coping is not usually in a person’s best interest to act on his or her initial impulse. Fortunately, thinking usually takes over, and the person begins coping, a cognitive process followed by action. The person begins thinking and acting ways to manage specific external or internal demands and conflicts that are taxing or exceeding personal resources. (p.780-781)
My patient’s coping mechanism was not that much strong to fight with her stressors. In this scholarly paper I will discuss the factors that lead to ill coping, its effects to mental health and coping strategies that could be implement to deal with these patients.
Significance of the issue in Pakistani context:
Firstly I am going to discuss the concept in the light of Pakistani context. It is proved that women have strong coping mechanism as compare to man as they ventilate her feelings through crying. However women also have higher rate of depression and anxiety in Pakistan. Khan.H et al. (2007) stated that “
The prevalence of anxiety for females 39.4% compared to 23.3% for males.” From this point we can say that women’s coping mechanism end up to depression and anxiety. My patient’s depression had developed due to her life stressors; one major stressor was losing of parents at adolescence. According to Pakistani research by Kausar, R., & Munir, R. (2004) stated that:
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In Pakistan, girls are subjected to discriminating attitude from family and culture for being a girl. The values, standards and expectations for boys and girls are different. Presence of mother can be support for a girl. In Pakistan, which is a patriarchal society, girls feel more attached to their mothers. Death of a mother could have added to their strains hence requiring them to use more efforts to cope with various stresses, which they would have been subjected to.
My patient has less coping mechanism that’s why she could not get rid from her stressors. Depression also affects her coping mechanism, in that the symptoms arisen as she told me in the scenario about her altered sleep due to household work and that is evident in Pakistani context.
According to Reza, H., & Khan, M.M. (2003) cited that:
It is quite possible that depressed mood may not be a presenting complaint of the patient. More commonly, difficulties in coping with day-to-day life are mentioned as presenting problems. There could be a feeling of tiredness or inability to cope with work and sleep difficulties occur quite frequently. It is only when you explore the details of these complaints that the evidence for depressive illness emerges.
Through in Pakistani context it is proved that some stressful circumstances detoriate the coping of females just like my patient.
Analysis of issue with literature:
During analyzing the concept in the light of literature I found the factors, which lead to ill coping. It guides me to understand the issue and its impact on mental health. There are some factors which impact on coping; these are the factors of stressors, which directly impair the coping as mentioned in Stuart, G.W. (2009) book like Biological (genetic background, biological sensitivities), Psychological (past experiences, psychological defenses), Sociocultural (age, gender, education, socialization experiences). My patient has Biological as her brother has depression, psychologically due to her past stressors mainly because of losing of her parents that affected on her personality greatly, which detoriate her health and Sociocultural aspect, being a female she confined herself into the house and had no interaction with others. These factors disturbed my patient’s coping, which directly affect on her mental health.
Impact of lack of coping on Mental Health:
My patient’s mental health has affected due to lack of coping and depression. As stated her stressors played major role on her mental health. In the research article of National institute of drug abuse USA (2006) they mentioned that, “A number of clinical and epidemiological studies show a strong association between psychosocial stressors early in life (e.g., parental loss, child abuse) and an increased risk for depression, anxiety, impulsive behavior, and substance abuse in adulthood.”
This study shows that the factors of stressors lead to severity in patient’s condition; patient can adopt the negative coping like substance abuse, increased risk of depression. That could be dangerous for mental health. But my patient did not indulge in substance abuse although she suffered from depression, which was controlling by medications however her psychosocial stressors detoriate her mental health.
According to Taylor, S. E., and Stanton, A. L. (2007) stated that:
People with a diverse array of mental disorders, including depression, schizophrenia, anxiety disorders, and autism lack coping resources for managing the challenges of daily living. Individual differences in coping resources such as optimism, personal control or mastery and a positive sense of self or high self-esteem and high levels of social support promote effective coping with stress and have direct effects on mental and physical health. Avoidance coping has generally been tied to increased distress and chronic disease progression and mortality.
From this statement my patient need the coping strategies, which can help her to move from maladaptive to adoptive state.
Coping strategies:
Some are the strategies, which I could apply on my patient but she discharged. I am sure that these strategies would help her to cope with stressors like guided imaginary, diary writing, deep breathing exercises, occupational therapy, art therapy, music therapy and recreation activities. These strategies could be planned in groups or at an institutional level. I wished that my patient were attending presentation on the guided imagery, which was conducted by my clinical group members, but unfortunately she was discharged. Coping strategies are also proved through researches.
According to Apóstolo, J. L.A., & Kolcaba, K (2009) conducted a study on guided imagery, which shows that, “Imagery creates a bridge between mind and body, linking perception and behavioral responses. It enhances patient’s comfort and decreasing symptoms when they have depressive disorders.” Another article on benefits of physical exercise in Voice of People in Pakistan Observer by Hussain, A. (2009) cited that:
Nardi (2002) describes, “regular physical exercise facilitates stress adaptation…”
Ransford and Morgan, as cited by Callaghan (2004) mention “evidence that biological factors may explain the beneficial effects of exercise on depression derives from research showing that exercise promotes the secretion of neurotransmitters like serotonin”.
Process of planning, implementing and evaluating the strategies:
Through nursing process patient who has lack of coping will adopt the coping strategies. Assessment is the pyramid of nursing process therefore I apply the Lazarus and Folk man’s stress, coping and adaptation model on my patient in this having four components namely appraisal, stress, coping and adaptation which taken from Boyd, M. A (2005). Firstly I identified the appraisal that was depression then stressful factors, in which mainly was losing of both the parents in stress physiological response, she has hypertension also has angina, and emotionally response, she adopt negative emotion that was anger. If my patient succeeded in coping through problem focused or emotion focused then she will under go into the continuum of adaptation (exercise, balance in life, meditation and time management) but unfortunately she showed lack of coping mechanism, which lead her in maladaption (long-term depression, decreased self esteem, decreased confidence, social dysfunction). If this were handled at the initial level she would not end up with longer depression.
In Stuart, G.W. (2009) book written that
This model identifies four possible treatment stages: 1. crisis, 2. acute, 3. maintenance and 4. health promotion. These stages reflect the range of the adaptive / maladaptive continuum and suggest a variety of nursing activities. For each stage the nurse identifies the treatment goal, focus of the nursing assessment, nature of the nursing intervention and expected outcome of nursing care. (p.53)
Some are the interventions, which I have planned for my patient with expected outcome; with the help of this my patient will gradually come from maladaptive to adaptive state. Interventions are as follows:
I will look for patient’s coping mechanism i.e. positive or negative and teach them proper coping strategies.
I will explore patient’s support system i.e. family, friends, community etc and help them in taking support from external and internal environment.
I will teach patient about resilience and help her to increase her resilience through activities and training programs.
I will improve patient’s communication skills, how to vent out their feelings to cope up in critical situations.
I will try to build the qualities of self-confidence, self-efficacy, optimism, encourage and hopefulness.
I will encourage socialization.
I will make sustainability plan to prevent from relapse.
The above jotted interventions can be dealt with the help of coping strategies for example vent out the patient’s feeling through writing a reflection.
Therefore all the nursing process needs strategies during patient’s care. In the end phase evaluation will lead the feedback about the patient’s coping.
Own thinking/ prejudice and learning:
From my perspective I think this concept helped me to learn the coping strategies, the model through I can assess and implement on these patients, who have less coping. I also learned that coping is very important and it greatly affects once physical as well as mental health. In my point of view nurse should take care every patient holistically because health care is not complete without mental health as every patient has a world in itself and needs to be tackle uniquely.
Summarize and Conclusion:
In summarization of this paper I have explored the factors that lead to ill coping, its effects to mental health and coping strategies, which could be implement to deal with my patient and to similar patients. To conclude this concept, positive coping always mold in that way our behavior and thinking process can manage the stressful event. As a nurse I suggest that we do help the patients to cope up their stressors through proper care (encourage positive coping) that they get into adaptation and not to stigmatize these patients, which drag them in to maladaptive.
(Word Count 1,996)
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