Nursing Care Plan Sample: Care Plan for a Patient With Depression

Model Answer

Patient Scenario

The following anonymised vignette is presented for educational purposes; all identifying details are fictional and any resemblance to a real patient is coincidental. “Patient A” is a 34-year-old adult admitted informally to an acute mental health ward following a two-month history of low mood, anhedonia, poor sleep and reduced appetite, with a recent deterioration marked by passive thoughts of not wanting to be alive but no current plan or intent. Patient A was signed off work six weeks ago, has withdrawn from usual social contact, and reports feeling like “a burden” to their family. There is no significant past psychiatric history and no known substance misuse. Observations on admission were within normal limits: blood pressure 118/76 mmHg, pulse 78 beats per minute, respiratory rate 16, oxygen saturation 98% on air, and temperature 36.7°C. Patient A has been commenced on an SSRI antidepressant by the admitting psychiatrist and is awaiting formal review by the multidisciplinary team.

Patient A lives with a partner in rented accommodation and works part-time in an administrative role that has felt increasingly unmanageable over recent months. There is a family history of depression in a parent, though Patient A has not previously required specialist mental health input. On the day before admission, Patient A’s partner became concerned after finding them tearful and withdrawn, having not left the bedroom for most of the day, and contacted the GP, who arranged an urgent mental health assessment. Patient A presented as cooperative but visibly distressed, describing a sense of hopelessness about the future and difficulty seeing “a way through” current difficulties, though able to identify their partner and their dog as reasons to keep going. This information formed an important protective factor within the risk assessment and safety planning discussed below.

Assessment

Assessment was structured using ADPIE, supplemented by a systematic A–E physical check on admission and a mental state examination. Appearance and behaviour were notable for a flat affect, poor eye contact and psychomotor slowing. Speech was slow and quiet but coherent. Mood was subjectively rated “about a 2 out of 10” and objectively appeared low and congruent. Thought content revealed feelings of worthlessness and guilt, with passive suicidal ideation as described above but no active plan, no access to means identified, and no perceptual disturbance. Cognition was grossly intact, and insight into the need for admission was present. A validated screening tool, the PHQ-9, was completed collaboratively and scored 19, consistent with moderately severe depression, and a structured risk assessment was undertaken in line with local trust policy and NICE (2022) guidance on depression in adults, which recommends routine, systematic assessment of risk to self alongside physical health monitoring. Sleep was assessed at three to four hours per night with early morning waking, and appetite was reduced with an estimated 4 kg weight loss over six weeks. Social assessment identified a supportive partner but limited wider network since withdrawing from usual activities.

Mapped against Roper-Logan-Tierney’s activities of living, several further needs emerged that shaped the wider plan of care. Under “maintaining a safe environment”, the primary concern was the risk to life discussed above. Under “eating and drinking”, the reduced appetite and recent weight loss were confirmed as clinically significant and warranting active monitoring rather than passive observation. Under “sleeping”, the pattern of early waking was consistent with a biological symptom of depression rather than simple insomnia, and under “working and playing”, Patient A’s complete withdrawal from valued roles, including employment and hobbies such as running, indicated a loss of the structure and sense of purpose that typically supports mental wellbeing. Under “expressing sexuality” and “communicating”, Patient A described feeling emotionally distant from their partner, which was noted as a further target for gentle, gradual re-engagement once the acute risk had reduced.

Physical health screening on admission is a core part of holistic mental health assessment, since physical and mental wellbeing are closely interlinked and depression can both cause and be worsened by physical decline. Baseline bloods, including full blood count, thyroid function and glucose, were requested to exclude an organic contributor to the presentation, and a baseline weight and BMI were recorded so the nutritional concern could be tracked accurately over the admission. Alcohol and substance use were screened using a brief structured tool and were negative, and Patient A confirmed no known allergies. A collaborative formulation was developed with Patient A using a bio-psycho-social framework, considering the interplay between recent work-related stress, the family history of depression, and the current physical symptoms of low mood, and this formulation directly informed the prioritisation of nursing diagnoses that follows.

Nursing Diagnoses

Three prioritised nursing diagnoses were identified, ranked by immediate safety and wellbeing needs in line with the ward’s risk-stratified approach to care planning, reflecting the principle that safety must always be addressed before lower-priority needs within a person-centred plan:

1. Risk of self-harm or suicide related to persistent low mood and passive suicidal ideation, as evidenced by expressed feelings of worthlessness and a PHQ-9 score of 19. This diagnosis was given the highest priority because it represents an immediate, potentially life-threatening risk requiring continuous monitoring and rapid escalation should the presentation change.

2. Imbalanced nutrition and disturbed sleep pattern related to depressive illness, as evidenced by reduced appetite, 4 kg weight loss and early morning waking. Left unaddressed, these physical symptoms can both worsen mood and slow the response to treatment, making them an important secondary priority.

3. Social isolation and reduced engagement in activity related to anhedonia and low motivation, as evidenced by withdrawal from family contact and previously enjoyed activities. Although lower risk than the first two diagnoses, addressing isolation is central to recovery and to preventing relapse after discharge.

The Care Plan

Evaluation and Review

This care plan was reviewed daily by the named nurse and formally at the weekly multidisciplinary team meeting, consistent with a person-centred, recovery-oriented approach to acute mental health care. By the end of the first week, Patient A’s risk profile had stabilised sufficiently for observation levels to be reduced from hourly to two-hourly, pending further review, and PHQ-9 re-scoring was planned for two weeks post-admission to track symptom trajectory objectively. Nutritional intake and sleep both showed measurable improvement, and engagement in structured activity increased, suggesting early response to the combination of pharmacological treatment, behavioural activation and consistent nursing support. Ongoing evaluation will continue to focus on risk, physical wellbeing, engagement and insight, with the care plan updated collaboratively with Patient A as their presentation evolves and as discharge planning, including relapse-prevention and community follow-up, is developed with the community mental health team.

Throughout this admission, care was delivered in line with the Nursing and Midwifery Council’s (2018) Code, which requires nurses to prioritise people, practise effectively, preserve safety and promote professionalism and trust. Patient A was involved as an active partner in each stage of assessment and planning, consistent with the principle of shared decision-making, and consent was sought before involving their partner in psychoeducation. Confidentiality was maintained throughout, with information shared only with the multidisciplinary team on a need-to-know basis in the patient’s best interests. Cultural, spiritual and personal preferences were explored sensitively and incorporated into the safety plan and activity schedule where relevant, reflecting a genuinely person-centred rather than purely protocol-driven approach to mental health nursing care.

Reflecting on this case, several points of good practice and learning emerge. The structured use of ADPIE alongside a validated tool such as the PHQ-9 provided an objective baseline against which change could be measured, reducing reliance on subjective impression alone. Equally, the identification of protective factors, such as the relationship with Patient A’s partner and pet, proved as clinically useful as the identification of risk factors, since these were incorporated directly into the safety plan and used to support engagement. A key limitation of any single-week evaluation is that mood disorders often take several weeks to respond fully to pharmacological treatment, so early improvements in behaviour and engagement should be interpreted cautiously and monitored over a longer timeframe before firm conclusions are drawn about treatment response.

Discharge planning began early in the admission rather than being left until the point of leaving, in keeping with best practice for reducing post-discharge relapse and readmission. This included liaison with the community mental health team to arrange follow-up within seven days of discharge, discussion with Patient A’s GP regarding ongoing SSRI monitoring, and exploration of a phased return to work with occupational health input once mood had stabilised further. Patient A’s partner was invited, with consent, to a joint discharge-planning conversation so that the safety plan and warning signs of relapse were understood by both the patient and their main support at home. This whole-system approach reflects the understanding that recovery from a depressive episode extends well beyond the ward and depends on continuity of care across inpatient and community services.

Finally, this case highlights the value of consistent, compassionate nursing presence in acute mental health care. Brief, frequent contact throughout each shift, rather than reliance on scheduled observations alone, allowed staff to build trust with Patient A and to notice subtle changes in mood or engagement that might otherwise have been missed. This aligns with recovery-focused models of mental health nursing, which emphasise therapeutic relationships and hope alongside clinical risk management, and it reinforces why individualised, regularly reviewed care plans, rather than generic protocols, remain central to safe and effective practice on an acute mental health ward.

References

National Institute for Health and Care Excellence (2022) Depression in Adults: Treatment and Management (NG222). London: NICE.

Nursing and Midwifery Council (2018) The Code: Professional Standards of Practice and Behaviour for Nurses, Midwives and Nursing Associates. London: NMC.

Nursing and Midwifery Council (2018) Standards of Proficiency for Registered Nurses. London: NMC.