How would you handle this? (depression)

allnurses Guide · Aug 19, 2009

I don't even know what you're asking. As someone with depression though, I find your post somewhat offensive.

"Regardless of why someone was admitted" - ???? If someone was admitted for, for example, a broken finger, I would not "console" them about their depression at all.

People with major depression get up every day and go to work just like anyone. They just happen to have a chemical imbalance in their brain. It's not "the blues". It's not situational sadness. It's a physiological problem requiring pharmacological treatment in most cases.

You do not need to discuss someone's depression if they are admitted for an unrelated issue, unless it's affecting their health negatively or unless they ask for your input.

SummerGarden, BSN, MSN, RN · Aug 19, 2009

a part of your problem is that you may not know what nurses do within a hospital setting. you will find that when you get out of nursing school, discussing unrelated matters with patients is very inappropriate many times. the only reason it is acceptable within nurisng school is because you are learning and you can always use the line that you are a student and it is apart of your homework assignment.

i worked psych before nursing school and that was the only time i was ever in-depth regarding depression because it was apart of my role and my patients were seeking treatment from my facility for that reason. as a rn i only discuss these issues with my patients if he/she brings them up first. otherwise, i administer his/her medications and focus on other aspects of his/her treatment. the one thing patients with any psychological issues do not want to do is draw attention to him/her self outside of a psychological setting regarding such matters.

however, if depressions is overwhelming you may find that your patient will say so or display inappropriate behaviors and so as a rn (or nursing student) you will then need to talk to the patient regarding his/her impressions of x,y,z .... but you are to never step out of your scope of practice and take on the role of psychiatrist or social worker. in fact, unless you work as a psych nurse, you are usually limited to a referral to a case manager/social worker within the hospital setting or a conversation with his/her physician so that an appropriate referral outside of the hospital setting can be made... that is all!

rachelgeorgina · Aug 19, 2009

I'm a nursing student and I'm curious, if you have a patient who has no documented medical history of depression but is clearly or possibly exhibiting symptoms, even if they are admitted for an unrelated condition, would it be good practice to follow this up? E.g. speaking to the patient about investigating, perhaps a screening test, referral to psych services for further assessment? Or perhaps outpatient referrals? Or would you ignore it because it's not what they're in for?

I ask because I assume that if a patient is admitted with acute pulmonary oedema and you discover on day 2 of admission that they have a broken wrist, you'd treat it. Is it the same or different with psych problems?

SlightlyMental_RN · Aug 19, 2009

I truly don't understand what you are asking. Could you restate your question? And what do you mean by consoling the patient?

Sparrowhawk · Aug 19, 2009

I don't get it. Besides, like someone said, we're supposed to treat what they present with...Console them? I'd be offended if someone consoled me for something that wasn't none of their business...if a patient SAID I am depressed..maybe..but it's none ofyour beeswax to dive in and assume you can talk to them about it..regardless if it's a previous diagnosis or not...You will learn this. *nods*

allnurses Guide · Aug 19, 2009

i'm a nursing student and i'm curious, if you have a patient who has no documented medical history of depression but is clearly or possibly exhibiting symptoms, even if they are admitted for an unrelated condition, would it be good practice to follow this up? e.g. speaking to the patient about investigating, perhaps a screening test, referral to psych services for further assessment? or perhaps outpatient referrals? or would you ignore it because it's not what they're in for?

come on now, you aren't curious - you are being disingenuous. that's clearly not the issue here. from what i can tell, the op asked if someone is admitted for any reason, and has a history of (presumably previously diagnosed, managed) depression, how would you "console" them about it.

that's obviously not the same as someone exhibiting overt signs of undiagnosed depression. i hope you are being facetious and are not quite so silly as to think that anyone would ignore that.

i ask because i assume that if a patient is admitted with acute pulmonary oedema and you discover on day 2 of admission that they have a broken wrist, you'd treat it. is it the same or different with psych problems?

that's a rather inane proposition. did you read:

you do not need to discuss someone's depression if they are admitted for an unrelated issue, unless it's affecting their health negatively or unless they ask for your input.

clearly if they have severe enough signs of undiagnosed depression that it's impacting their well being, the nurse would address it either directly or via referral.

Jami RN, BSN, RN · Aug 19, 2009

OP, as a very functional and successful person who has coped with depression my whole life, I find your post somewhat offensive as well. I am not "more at ease when I'm down and out," which sounds like I'm attention-seeking and lazy and not suffering from a physical chemical imbalance. I don't need anyone to "console" me -- I have a great life and work very, very hard to overcome my disease process with the help of a supportive primary care provider and a wonderful cognitive-behavioral therapy counselor.

To answer your question, though... I would have no problem if I were in the hospital or any other care setting and a nurse inquired about my depression. For instance, "Is your depression well-controlled right now, or do you need resources or assistance in controlling it?" would be appropriate. Anything else is just simple-minded and demeaning.

To the nursing student who inquired, I frequently request a psych consult for patients that I feel are struggling with psych disorders in the hospital. I would certainly not ignore it or leave it untreated. But in regards to previously diagnosed patients who are functioning well, I would perhaps inquire as to their coping status, but not assume that they need to be "consoled" (which is a very ineffective way to address depression).

There are many, many people with well-controlled psychiatric conditions, including depression, bi-polar and schizophrenia. If their disease processes are not well-controlled, it is very demeaning to assume that they are just more comfortable being ill.

Diaper, RN · Aug 19, 2009

a part of your problem is that you may not know what nurses do within a hospital setting. you will find that when you get out of nursing school, discussing unrelated matters with patients is very inappropriate many times. the only reason it is acceptable within nurisng school is because you are learning and you can always use the line that you are a student and it is apart of your homework assignment.
i worked psych before nursing school and that was the only time i was ever in-depth regarding depression because it was apart of my role and my patients were seeking treatment from my facility for that reason. as a rn i only discuss these issues with my patients if he/she brings them up first. otherwise, i administer his/her medications and focus on other aspects of his/her treatment. the one thing patients with any psychological issues do not want to do is draw attention to him/her self outside of a psychological setting regarding such matters.
however, if depressions is overwhelming you may find that your patient will say so or display inappropriate behaviors and so as a rn (or nursing student) you will then need to talk to the patient regarding his/her impressions of x,y,z .... but you are to never step out of your scope of practice and take on the role of psychiatrist or social worker. in fact, unless you work as a psych nurse, you are usually limited to a referral to a case manager/social worker within the hospital setting or a conversation with his/her physician so that an appropriate referral outside of the hospital setting can be made... that is all!

i totally agree. before i studied nursing, i expected nurses have time to hold the patient's hand and talk to him/her. after started working, i realized that i was so busy running around checking orders, calling doctors and giving meds. so it's impossible to have time to sit down and 'console' the patient. however, if i suspect a patient has symptoms of psych issues, i'll address it to the md or the patient might have a psych consult.

however, to be fair, i don't think 'markukristan' meant that people are better off staying depressed. what he meant is that some people use depression as a coping mechanism to tackle emotional issues. (that's my assumption).

allright, i'm going to bed now (just finished working night shifts). have a nice day guys:nurse:

beachbutterfly · Aug 19, 2009

WHAT????

favflu · Aug 19, 2009

what kind of depression do you have, this is important to know in order for any particular medical approach to be effective

there is a july awake magazine entitled - "depression" help for sufferers.

website: www.watchtower.org

hope it will be helpful.

leslie :-D · Aug 19, 2009

i'm not even in ns yet... however this is something i realized about myself a while back.
depression is awful. however, perhaps some people have been depressed for such a time that being depressed and having the blues becomes their comfort zone. they're more at ease when they're down and out.
i have a feeling you are confusing "comfort zone" with being apathetic.
a classical sign of depression, is being unmotivated.
it is 'easier' to feel apathy than it is to feel anguish.
regardless of why the pt was admitted... when consoling with them, how would you go about handling a situation like this?

do you mean 'communicating' or 'conferring' with them?

if their affect is that flat, then i may pursue it, in hopes of obtaining proper referrals for discharge.

depression is debilitating, and as a nurse who fully believes in the holistic approach, i believe it is our duty to acknowledge any/all apparent ailments...

and to provide resources for the pt who wants help

leslie.