An integrated nursing model of depressive behavior in adults. Theory and implications for practice

Accumulating evidence suggests that cognitive processes or stimuli associated with a stressor may influence the neurochemical state. In addition, it has been suggested that a person's coping responses may protect him or her from the biologic dysregulations implicated in depression. From a nursing care perspective, the proposed model suggests the following practice components. First, assessment not only should include the symptom profiles of each client but should address both physical and psychosocial stressors. Second, once identified, individualized care needs to incorporate a variety of interventions that focuses on the target components (i.e., cognitive interventions for negative thought patterns, interventions to build interpersonal skills, sleep hygiene principles, pharmacologic interventions, and so forth). Finally, one needs to address how having experienced episodes of depression may influence the client's self-perception and ongoing quality of life. Nurses must begin to understand how the experience of having a depressive episode itself may serve as an ongoing stressor for the client. The factors that maintain depressive behavior and influence recurrence need to be the central focus of mental health nursing from a research and clinical perspective. It is this attention to integration and recurrence that will define nursing's unique contributions to this important area of mental health.