Depressed patient. How to deal with them?

rpric7990 · Mar 13, 2009

That's a tough one. Generally, I try to keep my feelings at bay (in research call it bracketing). I keep an open ear to my patient, I try to be cheerful but not overly happy, as it wounds people if you are too cheerful around their emotional pain. I'm there, I touch when it's appropriate, sometimes that is painful for them also. One patient remarked "you sure like to touch a lot, and it bothers me" which is good, the patient talked and expressed feelings!! good start. sometimes you have to wait for the opportunity into someone's "heart". I keep looking for ways to serve, show caring, and eventually they respond. My very ill patient lost his wife, he was too ill to be with her the night she died. I came into the room, he had been despondent for all the nurses, but he remembered an act of kindness from my previous care of him, I had gotten him a piece of cake (we both knew it was cheating for him, renal diabetic). But here he was in his grief, cracking a joke to me, Got any Cake? It was the only conversation he had initiated all day. that kind of interaction opens the door to a connection.

leslie :-D · Mar 13, 2009

the only way a truly therapeutic relationship can happen, is if you are a steady presence in this pt's life over a longish period of time.

these folks need time to get to know you, even if from a distance.

and that requires you to consistently show up.

with time, he may start w/a "good morning" to you:

or brief eye contact;

or however he chooses to connect.

only after he feels comfortable with you, would you be able to intervene.

but even if/when he feels safe, you're still walking a delicate line.

at any moment, pt can/will feel threatened/suspicious and revert to place of desolation.

anyways, time and concern, will be the 2 criteria that will get you started.

much luck to you.

leslie

Tait, MSN, RN · Mar 14, 2009

I agree with the previous statements. You can't make a person open up to you, but you can make yourself peaceful, available and consistent.

Tait

rpric7990 · Mar 14, 2009

In the acute setting, you do have limited time. The patient may see you as part of the whole team who come in to care for him. The closer knit nursing team will have a better chance of making a difference.

BabyLady, BSN, RN · Mar 14, 2009

Sometimes, it's hard to lead them to a "happy place". During my psych rotation I ran into a young, beautiful woman with a very odd set of circumstances (too specific to post here)...she was a drug user, but only became one very late in life, after the set of circumstances, emotionally, pushed her over the edge.

The saddest part for me as a student....her story was so unique, so disheartening, that I focused my attention on her therapy because I was at a loss of what alternatives she had...b/c I would be suicidal too if I had been in her shoes...it was a miracle she was still here.

rpric7990 · Mar 14, 2009

I feel strongly, that treating mental health patients is a matter of building on what has worked in their lives. Find out the good stuff they do and focus on that. One I know of started his way out of depression by baking banana bread and giving loaves to people he dealth with...the pharmacist, the nurse, the neighbor..he thinks of that event as a turning point in how he dealt with some terrible disappointments in his life.

mrnursing · Mar 16, 2009

Thank you guys. I will try to use the ideas presented here.

I appreciate it. I hope that I can build a good therapeutic relationship with the client.

feralnostalgia · Mar 16, 2009

I agree with the previous statements. You can't make a person open up to you, but you can make yourself peaceful, available and consistent.
Tait

Tait got it right for sure. I had major depression in high school (didn't really leave my room for more than 6 months), and it was the people who were exactly how Tait described them, peaceful, available, and consistent who I felt comfortable with and opened up to.

Vito Andolini · Mar 18, 2009

the only way a truly therapeutic relationship can happen, is if you are a steady presence in this pt's life over a longish period of time. this or go through something together.
these folks need time to get to know you, even if from a distance.
and that requires you to consistently show up.
with time, he may start w/a "good morning" to you:
or brief eye contact;
or however he chooses to connect.
only after he feels comfortable with you, would you be able to intervene.
but even if/when he feels safe, you're still walking a delicate line.
at any moment, pt can/will feel threatened/suspicious and revert to place of desolation.
anyways, time and concern, will be the 2 criteria that will get you started.
much luck to you.
leslie

sometimes pet therapy or some music if you know what kind he likes or a pretty picture to look at might help. or if you share a tiny little tidbit about yourself, some patients respond to that. like, it's parent-teacher conferences tonight or the kids' school musical or your church happening. sometimes, we have to just let people be where they're at - sorrowful, worried or angry or both about the future that they fear they will spend helpless, impoverished, dependent, and alone. what do you do to pick yourslef up when your mood is low?