What factors are important when nursing someone with depression

nerdtonurse?, BSN, RN · May 5, 2009

Here's what we do....keep in mind I'm on a ICU stepdown/telemetry floor, not a psych unit, and just because someone's depressed doesn't mean they won't also need their appendix out, or have a flare up of their gallbladder...

Put the patient as close as possible to the nurse's station, and keep the door to their room open

Round frequently, but not on a set schedule...if the person knows, "okay, they won't be back for 1 hour" then they have a window of opportunity.

Ask the patient straight up if they want to hurt themselves. Don't sugar coat it. I had a patient who was depressed, and the wife told me he was, I thought he was not only depressed but suicidal, and voiced my concerns to the doc. Doc comes in, "have you ever given some thought to possibly doing yourself some injury..." Guy says "no." I sit down in front of the patient, take his hands, say, "Mr. Smith. Look at me. Do you want to kill yourself?" Guy doesn't answer. "Mr. Smith, have you ever felt that everyone would be better off if you were dead?" He said yes. I then said, "How do you plan on doing it?" He said, "save up my pills." Clear, direct, cut and dried speech. Guy got the help he needed.

Make super sure the pt doesn't have any meds with them, or anything they could use as a weapon. We're not a psych hospital, so there's mirrored glass over the sink, strings on the blinds. When you go in the room, say, "if I wanted to hurt myself in here, how would I do it?" And I've actually had facilities management come in and take the handle off a window, too.

I can't suggest strongly enough that you discuss the 800 pound gorilla in the room. Use the words "kill" and "die," not "hurt" or "injure." I've had suicidal patients before, and I've told them, "killing yourself will not make things better for you. You will spend all eternity feeling like you do right now, this very minute. It won't be better, it won't be a peaceful sleep, you'll feel like this for all time...." The allure of suicide is that the pt thinks it will make the pain stop. Convince them that it won't. I've also told patients, "Look at me. If you kill yourself, I will spend the rest of my life wondering what I could have done to stop you. I don't deserve that. If you feel like you're going to hurt yourself, call me, and I'll be right here. But don't make me feel like I failed you for the rest of my life because you killed yourself...." If I had my way, I'd make them go watch an autopsy. Break the death fantasy of "drifting off to sleep" and replace it with "if you overdose, you will die from drowning in your own vomit."

Finally, get help. Make sure every nurse, every aid knows what's going on, so if he goes into the bathroom and the CNA notices the sheet's missing, she doesn't think it just got dirty and thrown into the laundry. That happened to a friend of mine, and she said the worst thing she ever did was have to leave the noose on the pt's neck for it to be taken off by the coroner...no bath, no clean up, into the bag the way he was, dripping pee and poop. To this day, she'll swap out with someone if we've got a suicidal pt...she never got over it.

HumptyDumpty · May 5, 2009

Instead of coming on a forum and asking people to do your work for you because you can't figure out what some interventions are for a patient with depression (which shouldn't be hard at all to figure out), go into your psych book, go to the index, look up depression, and then right below it should be "interventions" TADAAAA, there are your answers....

davidthenurse · May 5, 2009

Hey, many thanks to Daytonite and nerdtonurse? !! You have both given me a clearer framework for some of the "extras" when caring for pts o/c depression, or who are suicidal.

Ask the patient straight up if they want to hurt themselves. Don't sugar coat it. I had a patient who was depressed, and the wife told me he was, I thought he was not only depressed but suicidal, and voiced my concerns to the doc. Doc comes in, "have you ever given some thought to possibly doing yourself some injury..." Guy says "no." I sit down in front of the patient, take his hands, say, "Mr. Smith. Look at me. Do you want to kill yourself?" Guy doesn't answer. "Mr. Smith, have you ever felt that everyone would be better off if you were dead?" He said yes. I then said, "How do you plan on doing it?" He said, "save up my pills." Clear, direct, cut and dried speech. Guy got the help he needed.

WOW!! I never really thought about this aspect !!

In nursing we generally try to be caring, thoughtful and gentle in our words, but yes, you're right, its so true - the direct to-the-point approach when dealing with suicidal pts works the best. It is simply because if you use gentle kind ways of asking them about their possible self-harm/suicide, they will tend to "duck-shove" the question - and usually give you a false response. But ask the question directly, and they can't help but hesitate because you've "hit the nail on the head". And then they know that the nurse has worked out their intentions, so there's no point in trying to hide their potential action.

I also have the rationales for each of these if you need them.

Thanks, Daytonite, I appreciate your input and feedback. You've given some very basic, and practical points. I will save you the time having to write up the rationales for me - I'm going to see if I can track down this book reference you have given me, and read the book through. It's obviously has some very valuable info in it !! Thanks again

Daytonite, BSN, RN · May 5, 2009

You cannot sweep problems under the rug because we get embarrassed about them. I learned years ago to get over my embarrassment and openly talk to patients just as nerdtonurse? has told you. I learned this when I worked at the VA hospitals after hearing the residents questioning some of the patients about their drug, alcohol and sexual histories.

I had a COPD patient who attempted suicide between 5 and 6am on my shift in the acute hospital. The shift before me failed to report to me that he was giving away his things. He had a plan and between 5 and 6am he executed it. I found him around 6am when I went in to give him his 6am meds. He had attempted to slit his throat with a razor blade. Fortunately, he was so weak he wasn't successful at cutting his jugular vein or artery. When it didn't work he took his oxygen off and slit his wrists. He totally missed cutting any arteries there also. I stayed until 10 am that morning assisting his doctor with his suturing because I felt so bad about the whole thing. I had only been out of nursing school for 3 years and I couldn't believe I had missed the signs.

When I worked on an alcohol detox unit we had another lady who was able to get her hands on a pair of scissors (not on my tour of duty) and stab herself in the chest and managed to give herself a pneumothorax.

I had a suicide attempt patient I took care of in ICU one night who ran into me while I was shopping several years later. She kept thanking me for taking care of her the night of her suicide attempt. Time had changed so much for her in her life. So, the immediate care of these patients and what we say to them is very important. They may not seem to be paying attention, but they are. My experience has been that people tend remember the things that are tied to their strongest emotional responses. So, when we talk with patients about what upsets or makes them happy they remember us.

benegesserit · May 6, 2009

This won't help you with a care plan, but a diagnosis of mental illness may not have any great effect on your care. Be aware of what everyone else has said of course, but, in cases where the individual is high functioning (because the illness is relatively mild or well-controlled by medication), there may be no real difference from caring for a patient who hasn't been diagnosed with a mental illness. There are many people who you wouldn't be able to tell were suffering from a mental illness unless you looked at their chart.

Treat them as people, not walking (or lying in bed, as the case may be) time bombs.

Some other things to be aware of are how their mental illness may effect their ability to learn or their compliance with treatment. Medication interactions and side effects. Also, insomnia may be a bigger problem for patients with mental illness, or stress/lack of sleep/monotony associated with a hospital stay may exacerbate their mental illness symptoms.

~Mi Vida Loca~RN, ASN, RN · May 6, 2009

I have dealt with depression since I was 9 years old, I was at one point suicidal as well, a few times I think were more for attention, 2 tries I didn't realize ODing Tylenol wouldn't do the job. My last attempt was my turning point, I thought it out long and hard, wrote my letters, had it all planned out, it was the timing of a phone call that saved my life, they called when I had just started dosing off but was not fully asleep yet, after the call it was ER that saved my life.

I am not really sure though any advice I can really give, I got through and now cope with my depression on my own. I had therapy all my adolescent years and I really got to be good at knowing what was what. Probably why I always aced my psych classes. I would be in therapy and the therapist would be encouraging me to take that route in my career. After my last attempt though I did check myself into an Outpatient 1 week long program. The week I went was the only week in the Hx of the hospital that their was no other patients. So I really got a lot of one on one counseling and more so I just needed people to listen while I worked through things.

Ever since then I have had my depression under control pretty well, I can sense when things are getting to much for me and I will get back on my meds for a few months, when I feel things have calmed down and I am ok, I wean back off of them. I have gotten really good though at intervening when things are going downhill.

Part of my depression I would venture is heridatry, Mental Illness is long standing in my family on both sides, my grandmother commited suicide 14 years ago. The other part would be from a long history of abuse, mental, sexual, and physical abuse from as far back as I can remember until my adult years.

I am sure this didn't help at all LOL Sorry. If you have any questions for me on MY expierience I would be more than happy to answer, I am not ashamed of my Hx nor am I closed to talking about it.

~Mi Vida Loca~RN, ASN, RN · May 6, 2009

Instead of coming on a forum and asking people to do your work for you because you can't figure out what some interventions are for a patient with depression (which shouldn't be hard at all to figure out), go into your psych book, go to the index, look up depression, and then right below it should be "interventions" TADAAAA, there are your answers....

It seems like this person is asking for insight and different opinions. Things you wont find in a book. That is what this student section is for, to ask for help, to get support and so on. I didn't at all get that they simply wanted people to do their work for them. What might not be hard for some might be hard for others. The rudeness is not helpful or necessary.

VickyRN, MSN, DNP, RN · May 6, 2009

Please avoid judgmental or off-topic posts that threaten to derail the thread. The purpose of the student forums is to assist students who are asking for help from those with more experience. If you cannot contribute in a positive way, then I respectfully ask that you don't contribute at all. Thank you.

cursedandblessed · May 6, 2009

daytonite's post was great, as usual.

each patient is different, there are those with mild chronic depression, and those who have severe depression, if it's newly diagnosed and treated with anti-depressants then there is def a need to keep the patient, as well as in some severe cases.

i have a mild chronic form which is usually handled well by an antidepressant. when stressed though, i can become introverted, and quiet and tend to dwell on things. i'm pretty in tune to my body and mind after dealing with depression for the last 20 or so years, so i can usually recognize it becoming a problem and when to get to the doctor.

imo the best thing you can do for a patient who is depressed is communicate with them, let them know you there to talk if needed, and watch for behavioral changes or abnormal behavior.

Daytonite, BSN, RN · May 6, 2009

Two times in my life I have gone through bouts of depression. The first time it was recognized by my doctor even though I denied it. I was put on medication and treatment kicking and screaming and it really helped. The second time it happened I was aware of the signs and asked for the help before things got worse. Approach and treatment is important just as it is with other medical conditions. If the nurse thinks about it as something secretive/mysterious, how can you expect the patient to respond?

davidthenurse · May 6, 2009

Wow !! Thanks so much everyone !! And I really appreciate the openness of some of the members here who are willing to discuss their Hx of depression and how they coped with it - thanks to Daytonite, cursedandblessed, and ~Mi Vida Loca~ !!

As is the case with all nursing care, I can see the importance of listening to the depressed pt., and spend time talking o/c them - and building up a positive interpersonal relationship that will allow for best care for that pt. (Empathy and/or symphathy) :icon_hug:

And many thanks to Daytonite for your efforts. I have found the input and opinions from you all to REALLY help. And it has been an eye-opener regarding this mental illness.

Kind regards to you all - David

davidthenurse · May 6, 2009

[color=gray]oh, and a special thanks to you, daytonnite ! i did receive your private message, but unfortunately i can't reply back to private messages due to my basic subscription level. maybe one day when i can afford to upgrade, then it will make it easier for me to reply !! thanks again, david