Advice for depression/borderline pts - thanks!

[pandora44]

Hi Everyone,

I'm a new psych nurse, having recently transfer from med-surg. I LOVE my new area and am so glad I switched.

However, I need some advise. My floor deals with a ton of depressed patients, many with borderline traits or a borderline diagnosis. I usually have 2-4 of these patients each shift. I've read through the sticky tread about borderlines, and talked with her nurses on the floor about them. For the most part, they aren't too much of a problem in the milieu for me, but I still feel stuck when talking with them in 1:1.

It's as if they are stuck, spinning their wheels, going over the same issues day after day. They never feel that they will get better, they almost always have positive SI and self-harm thoughts. I don't know what to say to them at this point as I usually have had them multiple days running so we've already been here, and they're right, they aren't getting better. What I want to say is, you know what, you're right. You're not going to get any better if all you focus on is every negative thing that's ever happened in your life. You need to start thinking about what you can do to actually improve your situation and then do it, in stead of just sitting here crying and passively waiting for the medication to magically help you.

Sorry if that seems harsh. I'm a little frustrated. I have been depressed and know how difficult it can be but I also see other depressed patients that are willing to work to get out of their depression.

I did finally tell my most challenging patient something like that above, but toned down and nicer. What do other nurses do with these patients? Any advice or suggestions about working with them in 1:1 would be great.

Thanks!

[Jules A, MSN]

I'm not the most therapeutic with these patients because I am tempted to say exactly what you have written. The thing is trying to get past the attention seeking aspect of their behavior without making them feel like they are being baited to see how serious their cries of wolf are.