Strengths-Based Approach to Health Promotion: A Case Study

Introduction to Strengths-Based Care and Resilience

A strengths-based approach to treatment resonates greatly with resiliency models involving patients and their families, as well as family-focused care grounded in mutually helpful practitioner–patient–family therapeutic relationships. In this sort of care setting, patients and their family members actively engage in identifying concerns or issues, making decisions, and formulating steps for patient health restoration and promotion (Swartz, 2017, p. 1). In particular, Ballantyne and Gan (2016, p. 233) delineate a solutions-oriented or strengths-grounded intervention approach for families of teenagers suffering from severe brain damage. According to the authors, every household possesses the strength, capability, and resources for recovering from adversity. Additionally, they explain that unlike the conventional clinical model, strengths-based therapy revolves around strengths as opposed to deficiencies, promotes teamwork as against hierarchy, makes use of resources as against expert opinion, emphasizes skills and solutions as opposed to what must be resolved, and concentrates on what works as against what does not.

The relationship between strengths-focused care and resilience theory within the context of nursing literature has been expounded upon further by Gottlieb (2014, p. 26), whose work describes a comprehensive strengths-based nursing care approach. In simple terms, strengths-based nursing care offers an alternative model to the traditional deficiencies-based one when collaborating with patients. It concentrates on a broad understanding of patient needs rather than deficits alone. Nursing personnel who apply this model attempt to identify patients' and their family members' skills, capabilities, and competencies. Through identification and mobilization of patient and family resources, capabilities, and strengths, nursing staff are able to guide and promote patient recovery in collaboration with patients and their families, whilst simultaneously supporting resiliency. As a result, the healthcare system responds better to individual patient families' distinctive needs, empowering them to manage their own healthcare requirements.

Health Promotion Framework

The process of health promotion entails enabling individuals to better control and improve their personal health. It is an all-encompassing political and social process that espouses actions aiming to strengthen individual capabilities and skills, as well as actions targeted at effecting changes in social, economic, and environmental conditions, with the aim of lessening their influence on individual and community health. Health promotion enables individuals to improve control over health determinants, thus improving their overall health. Involvement proves crucial to sustaining health promotion activities (World Health Organization, 1998, p. 11).

This paper adopts a strengths-based approach as well as the health promotion concept, grounded in a case study scenario analysis.

Case Study Overview and Depression Risk

This case study revolves around an unmarried mother of three children who is raising them by herself while her partner — the father of her children — serves a prison sentence for drug-related charges. One of her children has been brought to the emergency room for treatment of a foot burn that occurred a few days earlier, as the mother fears the wound has become infected. The ER staff member treating the wound notes a dirty dressing that is not well adhered to the child's skin. The mother has also brought her other two children, who are without shoes. She admits to struggling with finances and expresses uncertainty about how to manage without her partner. She struggles to cover basic grocery and rent costs and is uncertain how she will manage the following month. Her relationship with her partner's mother is strained. Additionally, a delayed menstrual period leads her to believe she may be pregnant again.

All of the information gathered suggests she is psychologically exhausted, vulnerable, and severely anxious. She cannot adequately care for her children in such a state of mind. She may be prone to depression, and one relevant theoretical framework — the Hopelessness Theory of Depression — may be applied to this case. According to this theory, the interaction of negative cognition with negative life events gives rise to a feeling of hopelessness which, in turn, is theorized to be sufficient, in itself, to cause depression. This theory, to the extent that a cognitive diathesis is a trait-like, stable construct, explains both the initial onset of depression and its recurrence or relapse (Liu, Kleiman, Nestor, & Cheek, 2015, p. 349).

In addition, the hopelessness theory proposes the existence of a discrete, cognitively mediated depression subtype — hopelessness depression — in which hopelessness specifically produces this subtype. The diagnostic criteria for hopelessness depression include a minimum of two weeks of experiencing hopelessness, along with at least 5 of the following 11 symptoms: unhappiness, tiredness, slowed voluntary reaction initiation, suicidal conduct or ideation, disturbed sleep with initial insomnia, self-blame, difficulty concentrating, anxiousness, psychomotor retardation, dependency, and low self-esteem. Nevertheless, hopelessness depression overlaps with other forms of depression to a certain degree; it is believed to encompass cases of acute depression, endogenous depression, and dysthymia (Liu et al., 2015, p. 349). The patient in this case study presents several of these symptoms. For instance, she is tired, utterly despondent, upset, blames herself for things going wrong in her life, and suffers from low self-esteem. Moreover, she cannot perform routine tasks linked to caring for herself and her three children.

When an individual begins facing difficult times or a difficult stage of life, he or she will naturally shift focus toward the problems at hand, investing effort into resolving those issues. Just as a mechanic first determines the cause underlying a damaged motor and attempts to fix that damaged element, individuals tend to first attempt to identify the source of their symptoms — such as anxiety — and then seek strategies for diminishing their frequency and intensity, such as breathing techniques, logical analysis, or cognitive approaches. Though this strategy may prove useful, it may also cause one to solely concentrate on problems encountered, whilst neglecting other aspects of oneself — namely, one's strengths. In certain situations, this may result in decreased self-confidence and might even aggravate symptoms. A growing body of evidence supports the notion that concentrating on and building upon one's internal strengths may prove to be just as effective as, or even more effective than, concentrating solely on one's symptoms (Ditton, 2015).

The single most salient factor in the strengths-based approach is the client's responsibility to effect change, and the client must identify his or her own strengths. In this patient's case, resilience is her strong point. She demonstrated sufficient resilience to stay away from drugs for the sake of her children and to keep her life on track. She chose to avoid substance use knowing it would have long-term consequences both for herself and her entire family. Additionally, her strength is manifested in the fact that she is raising her children entirely by herself while their father serves a prison sentence. However, she is psychologically struggling and finding it increasingly difficult to cope. She can better control her life and its challenges if she recognizes the strengths she possesses and learns how to apply them. She also needs to take responsibility for her own wellbeing and health.

Depression-related risk factors in this patient's case include stress, prior substance use, and profound sadness. Stressful life events that overwhelm an individual and exceed their coping skills may lead to depression. According to experts, elevated cortisol levels — secreted when a person is under stress — can affect serotonin neurotransmitter levels, resulting in depression. This patient grieves over her partner's imprisonment. As a consequence of his conviction, he has also lost his apprenticeship, meaning he will not have employment upon release. The patient currently survives on government welfare payments made fortnightly, though some of these funds are being withheld as debt repayment because she was previously overpaid after failing to declare her de facto relationship. While her grief symptoms will likely diminish with time, an escalation of symptoms could lead to a depressive episode. Furthermore, her prior history of drug use constitutes an additional risk factor. All of the above risk factors make this patient vulnerable to depression.

Conclusion

This paper has described how a strengths-based therapeutic approach can be utilized to promote health and wellbeing in the case of a vulnerable patient. Mental health practice has largely been shaped by a clinical model that emphasizes the resolution of problems and the management of mental illness symptoms. The strengths-based approach, by contrast, concentrates on clients' positive attributes. Identifying and building upon these strengths can guide patients through a successful recovery. Nurses, by adopting a patient-focused care approach, are ideally positioned to champion this model. The forging of a partnership among providers, community agents, and patients — together with the implementation of specific practices and policies — can help minimize or entirely overcome the challenges potentially associated with the strengths-based therapeutic approach (Xie, 2013).

References

Ditton, L. (2015). Depression treatment: Strengths-based approaches. Retrieved from http://www.esteempsychology.com.au

Gan, C., & Ballantyne, M. (2016). Brain injury family intervention for adolescents: A solution-focused approach. NeuroRehabilitation, 38(3), 231–241.

Gottlieb, L. (2014). Strengths-based nursing: A holistic approach to care, grounded in eight core values. American Journal of Nursing, 114(8), 24–32.

Liu, R. T., Kleiman, E., Nestor, B., & Cheek, S. (2015). The hopelessness theory of depression: A quarter century in review. Clinical Psychology: Science and Practice, 22(4), 345–365. https://doi.org/10.1111/cpsp.12125

Swartz, M. K. (2017). A strength-based approach to care. Journal of Pediatric Health Care, 31, 1–1.

World Health Organization. (1998). Health promotion glossary. World Health Organization.

Xie, H. (2013). Strengths-based approach for mental health recovery. Iranian Journal of Psychiatry and Behavioral Sciences, 7(2), 5–10.