What factors are important when nursing someone with depression - page 3
Hi everyone !! I'm doing some research about mental illness, particularly depression. Can anyone please give me some feedback about how to manage and care for a patient diagnosed o/c depression? I... Read More
May 6, '09Once you have more than 15 posts you can reply to and send pms
May 13, '09great question, david. it is important to learn as much as you can in the library, but a lot of your nursing will be based on sharing experiences (good and bad) with your colleagues. you were right to post here!
so many great posts here ([color=#1750ff]nerdtonurse? and mi vida loca, thank you so much for your valuable insights and openness. either of you can nurse me or my kids anytime! here are just a couple of additional tidbits for your consideration, david:
- don't make the mistake some inexperienced people do of thinking that depression is a sad feeling that the patient has. it is much, much more than that. it is a disorder of mental function that, in addition to making the patient feel miserable, also retards motor responses, confuses thinking, impairs judgment and problem solving abilities, and distorts perceptions. not in the same way as psychosis, of course (depression is not defined as including delusions and hallucinations) but in profound ways never the less. the depressed patient is not just someone who feels real bad (though they do feel real bad) they are a person with an illness that robs them of the ability to make the choices, and initiate the actions, of which they would be capable if they were not sick.
- antidepressants are not "happy pills" or "mood elevators" or cheap and easy ways for lazy people to feel good without doing anything about their "real" problems (as though a disorder of brain chemistry was somehow not "real!") antidepressants do not make people feel good or happy, in fact, they often make the patient feel sick in unpleasant ways for a few days or weeks. (and yes, i am speaking from personal experience. i hate taking these damn pills, but if i do not, my disorder gets the better of me, and i cannot function properly, so i think that it is my responsibility to my family to comply with treatment.) antidepressants only inhibit the abnormal chemical events in the brain. being happy is a completely separate issue.
- finally, it is true that at the start of treatment, some patients experience "activated depression." this means their mental process is still abnormal, but they feel more irritable and may also feel driven in uncomfortable ways. as a result, some are at greater risk of suicide during early treatment than they were when they were too disabled by their disorder to get up and do much of anything. be vigilant!
david, never lose that curiosity you have, or the willingness to learn from the experiences of your colleagues. what an adventure you have ahead of you!
May 13, '09You are asking an excellent question. Depression is pervasive and yet oftentimes undiagnosed. The reason the face of depression can vary so much is because each of us have been rasied in different families that set differernt standards for behavior so there are many people who having learned to present a "fine and happy publice face" do not show their depression. That said, I would encourage you to look to the National Alliance for the Mentally Ill (NAMI) as the best resource. Other than that your best course is to be open, accepting and nonjudgemental. That attitude will provide a safe place for the patient who may decide to talk with you. If you are unable to answer their questions ask them if you can refer them to someone who can and honor their answer. The exception to that rule is if the patient is threatening imminent harm to themself. When a patient starts talking suicide you must take it seriously and initiate all suicide precautions. Welcome to nursing and I hope you maintian that level of inquisitiveness. Sadly, too many nurses start working and within a year or so decide they know everything and become a detriment to themselves, their patients and the profession. You are actually entering a profession where the education never stops and that is part of what makes it exciting.
May 13, '09One thing I'd like to mention is how hard decisions can be for someone who is really depressed. A patient once described it to me as being in a black hole that sucked almost all the light and sound away from him. If possible, let them control their daily lives but keep it simple. Everything can just be so hard that they can't even decide what to wear (just an example), so instead of saying, "What do you want to wear?", try "Would you rather wear this shirt or this shirt?" "Would you rather have a sandwich or some pasta?"
And don't talk too much, don't be too cheerful, and don't expect a lot of response. Gentle encouragement is good, but let them decide when they want to talk. Always tell the truth. Don't be one of those nurses who says, "I'll be right back," and never comes back. Do what you say you will. I find that's critical with all patients but especially fragile patients like these.
And watch out for...I dunno what you'd call them, people who will encourage your patient to feel worse, to suicide, who may even help them do it. I'm a big Pollyanna myself, so the first time I ever saw something like that I just could not believe it.
Most of the suicides I've been around, though, the patient was alone and it was quiet. If they really wanna do it, they will find a way. One guy at the VA took a rock and sharpened the edge of the toilet paper holder in the bathroom until he could cut his wrist. One guy slashed his neck with a fingernail file, while he was under the covers in bed. I don't know how long it must have taken him to saw his neck that like but it must have been quite a while. One schizophrenic (not a big guy either) tore out of his 4-point leathers, went right through me, and started groping around in all the needle boxes looking for something sharp. You could see he was doing what "somebody" was telling him.
Hope that helps a little
May 13, '09I have been diagnosed (years ago) with chronic major depression (also known as dysthymia). I work at 5 part-time jobs, between 36 and 50 hours per week. I take no antidepressants (have been on many, all they do is make me tired and I'm already tired. I have a "no harm" contract with my counsellor who I call when the depression is so deep I cannot get myself out after a week or so (have been seeing the same counsellor for 15 years.) I cannot remember a time when I have not been depressed (and I am in my 50s now.) We are no different form anyone else.
May 13, '09You will encounter patients with depression, diagnosed and undiagnosed, throughout your nursing career. It's important to understand that someone who is depressed and not compensated by his/her medications will have extreme difficulty with daily tasks. Taking a shower, getting dressed, eating, etc., all require too much thought and organization in order to complete them. So, as a nurse, you need to be matter-of-fact in your approach and instead of asking them whether they would like to shower, just stepping in and getting it ready for them, helping them out of their clothes, helping them get cleaned up, etc. The frustrating thing with depression is these patients may look fine, but they are often so overwhelmed by the slightest things that they are rendered basically inert; it takes too much thought and energy to do things like change clothes, decide what to watch on TV, or even whether or not they want to see a visitor. So, as a nurse, you have to facilitate those decisions. These patients are not trying to be difficult, and that is what everyone needs to understand. Once they are adequately treated (and they may have been before the stressful event that put them in the hospital) they are much more able to function on their own and make their own decisions. Until then, they need a caring, nonjudgmental nurse who will facilitate them performing the tasks they are capable of by breaking them down into small steps, i.e., what to do first, then after that, etc.
I appreciate your interest in this subject. As we joke sometimes on the floor, "Every day is a Psych day" and we're not even working in a psych area.
May 13, '09Quote from spenmomVery true !!As we joke sometimes on the floor, "Every day is a Psych day" and we're not even working in a psych area.
When I think back about my placements I remember that I actually went through a "mini mental-analysis" with each of my patients whilst I care for them - of course not being obvious, but purely by observations and general questions! But observations go a long way, and for some reason, I have always had an ability to observe other people (patients or not) and glean information about people which might not be obvious to others around me, but which I can discern quite easily. Maybe its a gift, but either way, I think it will be a valuable tool in nursing !!
May 13, '09Quote from countyratthanks countyrat, for your help and encouragement. i am really enjoying nursing, and its great to have the support of other colleague like you and everyone else on this forum !! it's the true element of teamwork support !! :icon_hug:great question, david. it is important to learn as much as you can in the library, but a lot of your nursing will be based on sharing experiences (good and bad) with your colleagues. you were right to post here!
Quote from kwkrncthanks too, kwkrnc ! i am always asking questions while nursing - haha, just hope no one at work gets sick of me asking questions !! on a serious note, one thing has really sunk down in me - that no question is a dumb question, because we are all still learning. that's what our lecturers have told us, and i believe its so true too !!welcome to nursing and i hope you maintian that level of inquisitiveness. sadly, too many nurses start working and within a year or so decide they know everything and become a detriment to themselves, their patients and the profession. you are actually entering a profession where the education never stops and that is part of what makes it exciting.
May 13, '09You are absolutely right. The only dumb question is the one that went unasked. You will know you have landed in an excellent unit when you see that all of the nurses are asking questions and looking for answers. The unit will have plenty of readily available resources plus access to the internet. Professional nurses think nothing of calling on a colleague for a second opinion. In that kind of environment you build trust and respect and every member of the team benefits. Therefore, the patients benefit. All the best to you!
May 13, '09Quote from dolcebellaluna*tongue in cheek* If they start feeling better like the antidepressants are working, watch out for suicidal behavior.
"I've been told that because AD's often bring back motivation and energy, patients may be more able or willing to complete a suicide" once on treatment for a little bit.
Also, depression has biological and psychosocial factors that contribute to the diagnosis. It's important to not only treat the symptoms but to teach coping skills and help prevent relapse.
This is also true of depressed patients that are not on antidepressants. Depressed patients who appear to suddenly feel better may be more likely to attempt or commit suicide, because they have decided that that is the answer to their problems.
May 13, '09Finding an opening to motivate the patient into
accepting an activity that they could enjoy seemed
to me to be the most difficult task . Depression seems to engulf
any positive ideation or positive activity & derails all. Very hard
to communicate with a depressed client, so i find. Good luck
May 13, '09While watching the medical model banner wave beautifully in the wind, don't forget the cognitive factors. It doesn't hurt to make the attempt to find distraction, to focus on something other than depressing topics. I liken it to a car and driver: the meds work on the machine, but the cognitive skills help the driver.
Try Googling Dialectical Behavior Therapy or DBT. Originally for Axis II stuff, but expanding to many areas of treatment.
May 13, '09Take care of them just as you would another patient. Depression disturbs sleep and appetite and energy. the old slandbys, mobility and exercise, nurition are paricularly helpful here.
Things to focus on: they may be withdrawn...so they may need more time and probing to answerr questions Work on contolling their pain... that won't help their mood..but they may be hopeless ans not expect their pain can be managed. Pay attention to how they are sleeping. If they have thought disorder/ schizophrenia, go slow, watch their body language/eye contact...give then choices where you can