How Mental and Physical Health Intertwine

                                                          Jenna Jacobsen

                                                University of New England

The career of nursing comes with a large responsibility revolving around the focus of holistic care. Holistic care involves a view of the patient as a whole. They may have a physical disease that is imposing poor health on them, but as a nurse, it is important to acknowledge that there are other forms of illness that can also be present. It has only been within the past few decades where healthcare systems have been really putting a good effort towards understanding mental health within the patient populations. It is a step in the right direction, but it does also tell us that there is a lot about mental health that we still might not know about. What we might not realize is that mental health can relate very closely with physical health. 

I recently had a patient who has had a lifelong diagnosis of cerebral palsy. As a result of this diagnosis, my patient faced repercussions of depression. I will use false initials that are not actually associated with my patient to help with his story. For this document, I am going to give him the initials of A.J.. As mentioned before, these are not his real initials and have no value towards his real identity. A.J. has cerebral palsy, which is a disorder that affects the muscle tone, movement, posture, and balance of those who are affected. Severe cases of people become wheelchair bound, and do not have the abilities to perform their everyday activities of self-care. Therefore, lots of people with this disorder live under the care of others. A disorder like cerebral palsy can come with second hand mental health effects. These types of patients ultimately lose their ability to care for themselves which usually alters their perceived self-view. For A.J., the effects of depression are a major factor as to why he is currently hospitalized. Although A.J. does have a disability, he has been admitted long term to a mental health floor at our local hospital.

Upon speaking with A.J., I do believe he has insight towards the connection of his physical and mental illness. I did not outright ask questions regarding the matter, as it could have been triggering for him. However, I truly feel that a lot of the negative thoughts that A.J. felt towards himself because he knew he was different from the other patients around him. He was the only patient who was confined to a wheelchair permanently. Whenever other patients were engaging in the therapy room, A.J. would be seated away at the far back of the room due to how large his medical chair was. Therefore, he did not have normal interactions with participants. He would appear to be sad from my personal observation when he was not able to participate. From an empathetic perspective, having no control over yourself can create intense emotions almost like an impending doom for most. Human beings want to feel independence, and it can be debilitating once that is truly taken away.

From a social perspective, A.J. was once married, but has since then been divorced. Although the reasoning for divorce is currently unknown by me, it can be easily said that divorces are never easy and can lead to immense stress. Sometimes, large life events like a divorce can further trigger and worsen effects of depression. The effects of A.J’s divorce should be assessed further by a healthcare professional as to determine if the effects of the event had potentially progressed his symptoms of depression farther than his previous baseline. Something else that I should have also looked into was more about A.J’s personal and occupational life prior to the admission. One thing that we were able to discuss were his current interests. Although A.J. is facing depression, he can find  joy out of the interactive activities that are performed in milieu therapy. A.J. enjoys exercising, sensory group, and his favorite activity is bingo. This gives me an idea on how A.J. is still able to feel enjoyment despite hard times that he is facing.

The highest priority for this patient is safety. As an original form of treatment, A.J. would undergo electroconvulsive therapy (ECT). During both two events of trial, A.J. had gone into cardiac arrest and had to be resuscitated. Therefore, ECT was later contraindicated for the risk of his safety. We will want to keep a close eye of A.J’s heart function after learning the effects of the procedure on him. If ECT was considered a “last resort” for A.J’s depression symptoms, A.J. must be experiencing hopelessness for his future. This further implies how important the suicide assessment exam is for this patient. A barrier to care this big can leave us with only a small number of options left for treatment. A.J. is at high risk for self-harm  and also has a past history of suicide ideation and intent. It is highly important that we perform a suicide assessment on him daily and take actions based on the information that results. A.J. is also facing extreme constipation which is enforcing abdominal distention and extreme pain. The next priority is to maintain bowel mobility, as well as pain relief. Another priority is maintaining skin integrity. A.J. remains in a wheelchair for most of the day, so it is important to maneuver him every two hours to prevent pressure ulcer wounds. The combination of the listed priorities above represents a combination of physical and psychological areas of care.

Overall, it is important to make A.J. feel welcome in our community at the hospital. We are more so focused on providing comfort care for quality of life if regards to his diagnosis of cerebral palsy. However, this is a wonderful example of why it is important to realize how complex the connections with mental illness and physical illness lie. A.J. is struggling most from a psychological standpoint, because of his original diagnosis. The combination of both illnesses has drawn A.J. to become hospitalized because it would be unsafe for him to live alone otherwise. At the moment, A.J. is performing well under the care of the nurses at the hospital and finds great joy in their daily activities. He is thriving under the treatment of milieu therapy. As nurses, it is crucial that we use our holistic seeking abilities to dive deeper into the health status of our patients. We are the healthcare providers that are the most involved with patient care out of all other fields. It is our responsibility to use these skills to make connections and potentially save lives. In conclusion, mental health is just as important as physical health, and as learning nurses, we should use these connections in our future care plans.