What factors are important when nursing someone with depression

pinkiepie_RN · May 5, 2009

*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.

davidthenurse · May 5, 2009

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.

Hi dolcebellaluna,

Yes, you are right, I found this out just last week - its truly amazing !! (Do you have any other tips, haha :blushkiss)

Thks

pinkiepie_RN · May 5, 2009

Hi dolcebellaluna,
Yes, you are right, I found this out just last week - its truly amazing !! (Do you have any other tips, haha :blushkiss)
Thks

Well, what do you know so far about caring for clients with depression? Are you in psych nursing clinical or just curious for your own personal development? :)

davidthenurse · May 5, 2009

Are you in psych nursing clinical or just curious for your own personal development?

Hi donnabellaluna,

No, I'm not currently in psych nursing clinicals just yet, but recently I had to care for a pt on Ward 5 (Cardiac/High Dependency) who was diagnosed o/c Psych issues - depression and schizophrenia...

It's just that for one of my nursing assignments, I am to research a mental health issue, so I am looking at depression (unless you can recommend a better topic for a mental illness !!) I have to include in my assignment things like (1) the causes, (2) the characteristics/signs/symptoms, (3) how it can be treated (the mental illness), and (4) how to manage someone on the ward with this illness.

I'm fine o/c the first 3 points, but the last one "(4) how to manage someone on the ward with this illness" is a bit of a different story. To be honest, aside from the one pt from Ward 5 of our hospital, I have never had to deal with pts with a psych history, so its a little difficult to fathom what is required in order to manage such a pt. (But what I DO know from other colleagues is that you NEVER turn your back on the pt :smackingf - for both your own safety, and for the safety of the pt. !!)

allnurses Guide · May 5, 2009

Never turn your back on a patient with depression? Why?

People with depression are no different than you, apart from having a chemical imbalance which affects their mood and motivation.

davidthenurse · May 5, 2009

Never turn your back on a patient with depression? Why?

Sorry, maybe my wording could have been a bit more clearer - I was referring to psych pts who are suicidal.

allnurses Guide · May 5, 2009

Still doesn't make sense. If someone is in a safe environment, there's no problem turning your back on a suicidal patient.

The fact that you said "for your own safety" seems to imply that you feel you would be at risk from a depressed patient if you turned your back on them. I doubt they'd have the inclination or energy to do much, let alone cause damage to you.

davidthenurse · May 5, 2009

If someone is in a safe environment, there's no problem turning your back on a suicidal patient.

Maybe I have much to learn yet about psych pts, including suicidal pts, but we were trained that whilst we create as "safe as possible" environment as we can, that suicidal pts. will sometimes go to extreme measures to carry out their will if they want to - so basically "safe" environment for these types of pts. is individual - depending on the circumstances (But I take your word to be true, as I guess that you must have lots of knowledge and experience in working with suicidal pts. )

As mentioned before, I am not directly referring to pts. who are depressed, but rather to psych pts. who are suicidal. In regards to "turning your back", I was thinking along the lines of "keeping an eye on their behaviour" that they will not harm themselves.

donnaclure · May 5, 2009

Yes, I agree, pts. who are suicidal will take extreme measures sometimes to do their deed. Keep ur eyes open and ur wits about when nursing them. Cheers!

PetuniaRN · May 5, 2009

Well, you certainly are correct about not turning your back on a psych patient for your own safety. As you mentioned in your posting your patient was depressed AND schizophrenic. People with mental diseases that can include hallucinations, (auditory and visual) may have no hold on reality and are very potentially dangerous. They may get what are referred to as "command" hallucinations in which they are literally hearing a voice (that they may believe is God, or the president, or someone they CANNOT disobey) telling them to do things directly to you, others in the vicinity or even indirectly to you as a means of escaping. If they think they are "being held hostage" they may think you are the enemy. Or they may think they are the "sane" ones, and you are in fact a person with mental disease since you are not believing them. If you enter a room with them, always align yourself in a position in which you can access the door first. I will never forget a situation in which I (as a student nurse) went to interview my paranoid schizophrenic patient in a tiny room, and I sat at a table accross from her...and the door was closed BEHIND her. She actually laughed at me and said in a very threatening voice, "You just made a huge mistake. I could kill you and no one could help you. Didn't they teach you anything at that fancy nursing school? I hold the power of this meeting."

Which brings me to the next point, never underestimate them even though you may consider them harmless. On the other hand, they are people, and deserve respect. That patient of mine was actually trying to warn me about other patients. She got up and left the room and told me I wasn't ready for an interview--and she was right! She taught me a lesson for sure!!

Sorry to go off on a tangent, since your thread was also about depression...

Don't forget that depressed people come in many different packages. They don't all look disheveled and unable to function. They don't all admit they are depressed. A sign to watch for possible impending suicide attempts includes them giving away favorite items/clothing/jewelry. It may be a sign of them having a plan and knowing they won't need those items if they are successful. Also remember that being overly cheerful and saying contrite things like,"I am sure everything is gonna be fine," or "It can't be that bad!" can turn the patient away from you and make them decide not to confide in you. You can't fix their problems so you shouldn't offer advice, but you can listen, give educational information, and encouragement. You will learn all of this in school, but it is helpful to have a heads up in case you come in contact with psych patients in a regular hospital. Good Luck. :rolleyes:

Daytonite, BSN, RN · May 5, 2009

i can give you quite a lot of interventions for depression and suicide patients if i am reading your posts accurately. these come from psychiatric principles and applications for general patient care, 4th edition, by bonnie fossett and marlene nadler-moodie, pages 40-41 and 49-50.

be accepting. the patient may have a negative outlook and low self-esteem.
- rationale: an attitude of acceptance enhances feelings of self worth.
[*]be non-judgmental, develop a trusting relationship, and be open with the patient.
- rationale: trust is basic to a therapeutic relationship.
[*]assess the patient often.
- rationale: depressed patients need short frequent contacts to assure them that they are supported, safe, and attended to, even when they may feel that they are not worth your attention.
[*]screen patients for depression by asking:
- during the past 2 weeks, have you felt down, depressed or hopeless?
- during the past 2 weeks, have you felt little interest or pleasure in doing things?
  - rationale: the u.s. preventative services task force (agency for healthcare research quality - ahrqi) found that asking the previous two questions was an effective screening method to screen for depression. if your patient responds positively to the two questions, you can inform their physician, and they can receive appropriate treatment for depression.
[*]assess the patient for suicidal ideation, and initiate safety checks and procedures as needed.
- rationale: patients with depression may have suicidal feelings and thoughts. they may need protection from harm.
[*]assess the patient for any indications of thought disorder.
- rationale: some patients with depression have accompanying psychotic thoughts.
[*]assess the patient's ability to perform self-care tasks.
- rationale: depression may decrease a person's ability to continue usual activities of daily living.
[*]assess the patient's sleep patterns and determine methods to either reduce or increase sleep, for example, using relaxation techniques, decreasing stimulation at rest time, and drinking warm milk.
- rationale: disturbances in sleep patterns are common in patients with depression or bipolar disorder.
[*]provide the patient an opportunity to express pent-up emotions or discuss problems (e.g., grieving a loss, internal mood, isolation, dysfunctional thinking).
- rationale: if patients recognize possible precipitating events, they can take steps to:
  - reduce occurrence of the events
  - devise strategies that may reduce or eliminate the stressors
[*]allow the patient to cry in a supportive environment.
- rationale: the patient may relieve pent-up feelings by crying.
[*]help the patient determine appropriate ways of expressing anger.
- rationale: patients with a moderate amount of depression are often angry.
[*]if the patient has experienced a loss, describe the stages of grieving and teach the patient about them.
- rationale: knowledge of the process of normal grieving helps patients accept their own feelings.
[*]assist the patient in problem solving.
- rationale: problem solving reduces stresses and increases the patient's self-esteem.
[*]encourage the patients to make their own choices when they experience feelings of powerlessness.
- rationale: patient's gain a sense of control and mastery when they make choices.
[*]encourage patients to increase their interpersonal contacts.
- rationale: interpersonal relationships can reduce feelings of social isolation.
[*]administer prescribed medications
- assess the effectiveness of the medication
- monitior the patient for potential side effects
  - rationale: medications are an effective treatment for depression.
[*]teach the patient about self-administration of prescribed medications
- rationale: although quite beneficial for many patients, medications are quite potent and must be monitored carefully.

for suicidal patients:

assess the patient's suicidal intent
- ask the patient directly about suicidal thoughts
- always take threats of suicide seriously
- continually assess the patient's impulse control
  - rationale: once a correct assessment is maade of the patient's suicidal ideation, steps can be taken to ensure the patient's safety.
[*]establish a therapeutic relationship with the patient
- spend time with the patient
- encourage expression of feelings and verbalization of thoughts
  - rationale: the patient may experience an increase in self-esteem, feelings of safety, and feeling some relief from overwhelming thoughts and feelings if these interventions are implemented.
[*]create a safe environment by instituting safety precautions:
- the patient should be visible, within eyesight of staff members, or checked often or monitored by using some system in which staff members are accountable for the patient's whereabouts
- the patient may need one-on-one care or monitoring whereby he or she is with a staff member, at arms length, and in full view at all times
- medications should be taken in the presence of a nurse, and the patient should be checked for "cheeking" (not swallowing the pills, holding them in the corner of the mouth)
- the patient's property should be examined, and any potentially dangerous objects (e.g., glass, razor, scissors, knives, belts) should be removed
  - rationale: treatment can be sought or begun while the patient is protected from self-harm.
[*]provide nursing management for any possible sequelae from an unsuccessful suicide attempt
- rationale: emergency medical care needs to be instituted for life support.
[*]make a verbal behavioral contract with the patient, if appropriate
- rationale: the contract should include the expectation that the patient will not harm himself or herself and will seek out staff members to verbalize suicidal feelings. most suicidal patients experience ambivalence and can be prompted into remaining safe by having the give their word" to follow through on the safety contract.
[*]help the patient use effective coping methods
- help the patient recognize unhealthy coping mechanisms
- encourage the use of a problem-solving approach, with a focus on short-term resolution of the problem
  - rationale: suicidal patients often feel unable to see other ways out and need to build their way into the future.
[*]help the patient assess his or her strengths and weaknesses
- help patients recognize actual resources, both personal and social, and potential ones not yet considered
  - rationale: when coping methods are increased, solutions to some of life's problems can be attained.
[*]if the patient is cognitively impaired, evaluate the patient's mental status and institute reality testing along with reorientation.
- rationale: patients can be protected from inadvertently and unintentionally harming themselves as a result of a thought disorder.
[*]notify and alert appropriate caregivers about the risk for suicide and the plan of care.
- rationale: appropriate communication to other caregivers and consistency in approach will be helpful.
[*]make referrals for immediate and long-term discharge needs.
- rationale: the reason for a patient's suicidal ideation should be diagnosed and treated. the patient should be monitored continually until he or she is no longer suicidal.