What do you say to depressed/anxious patients?

dmiller77 · Nov 16, 2010

First, I want to say that you are doing a great thing. You are there for these patients, and that is wonderful. You're doing pretty good without any advice.

I work in a mental health treatment facility, so I deal with people who are anxious and suicidal. Sometimes, there is no right answer. It won't matter what you say. I guess that the biggest thing is to really consider that person's feelings. Never say "I understand" because you really don't. Never say "just relax" because that sounds to them like "you are overreacting, and you need to stop making a fool out of yourself" Never say "things will work out" because that sounds dismissive, like you weren't listening,

So, now that I have said all of the things not to say, here's what you can do. Ask open ended questions. Like "how does that make you feel", or "what can I do to help you?" I know it sounds stupid, but you get off the hook if you feel like you might say something dumb. Plus, it gets them talking. Secondly, listen, listen listen! Sometimes you don't have to say anything at all. Sometimes people just want to be heard. Third, don't ask "Why?" Why questions make the person feel like they are being interrogated, or that they shouldn't feel the way that they do. Fourth, show empathy, Think about all of the situations that you were in and put yourself in the other person's shoes. What would you have wanted someone to do or say?

Sometimes, you might need additional help. Let one of the Aides or Nurses know that the person is talking about suicide or hurting themselves. The tips that I have given fall under Therapeutic Communication, and I just scraped the surface. If you ever get to watch nurses or aides deliver care, pay attention to the ones that have a good rapport with their patients. They might be able to give you some tips too.

nurse2033, MSN, RN · Nov 16, 2010

I don't like to use cliches or useless phrases like "Things will work out". "Just relax" and "I understand." I also know when to just let a patient vent about things. It's just the things I mention above that get to me.

I agree those plattitudes suck. Try, "I'm sorry to hear you feel that way", "you're right, that sucks", "is there anything that might help you feel better?", sometimes it's better just to let them talk. Distraction is good, asking them where they're from can ofter bring back memories of happier times. Sound like you are doing a great job, keep it up.

ObtundedRN, BSN, RN · Nov 16, 2010

The suggestions above sound good. Silence can also be considered a therapeutic response. Maybe some physical contact, hold their hand, give them a hug. They know there is nothing you can say to fix things or make them suddenly feel better about the situation. Just letting them express their concerns and feelings is what they often need. Other times, they just need someone to sit with them quietly so they know they aren't alone in the end.

Davey Do · Nov 16, 2010

"Always be there for your patients." Pat Goebel, my first LPN instructor

gymnut:

What more needs to be said? Except maybe, "Practise provides opportunity for possible improvement."

You are on the right track and you've gotten some reinforcement for your approach with some parallel perspectives from your peers.

With that said, "keep on keeping on".

Dave

carolmaccas66, BSN, RN · Nov 16, 2010

I work in mental health a lot and am pursuing more studies in that area.

My best advice is to really try & take the time to listen to someone's problems. You can solve 70% of their worries just by listening - and this is almost impossible on a busy floor. The patients know you can't wave a magic wand and solve all their problems. But you can listen and I do agree saying 'I know how you feel' etc when you don't sounds lame and empty.

You did the right thing with the palliative care lady. She was simply suffering from what we all fear I think: dying at the end of your days, with no-one close there to comfort you. It was good you distracted her by talking about her youth. Talking re hobbies and things to fulfill before dying can help, but everyone reacts to the news they are going to die very differently. Sometimes you simply can't say anything to help dying people, a hug or holding their hand can help though. Remember that (in our hospitals anyway) there is always a pastor one can talk to, even if they are not religious. I've seen atheists say a prayer with the hospital pastor and they have felt much better.

The patient freaking out re her BP had no information re this and got upset. But I don't think hers is a normal response, and saying 'Im going to commit suicide if I'm not home on ....' indicates some sort of other mental health condition going on. She was projecting her guilt & fear onto you I think cos u were going home & she wasn't, and she wanted you to feel uncomfortable, or have u rush back to her bedside. Did she get a psych consult? Suggest one - hysterics over BP is definitely NOT normal. And, unfortunately, some psych patients (though I realise she wasn't a pscyh patient as you didn't say she was), can be extremely manipulative to achieve their own ends, ie: saying things like 'it's your fault that I have....or I can't....' Don't feel guilty. She needs some sort of pscyh intervention. You can even say clearly and firmly something like "I don't think your response is appropiate & I will be looking at having someone further assess you" then leave. Don't get sucked in too much! U have to retain ur own sanity to be able to look after yourself and other people :) & ur doing well by the sounds of it!

Orange Tree · Nov 16, 2010

I acknowledge that life can be very difficult. Unfortunately, I don't have time for much else....it's always run, run run. And I realize that most of these people can't be "fixed" in a day, either.

ZippyGBR, BSN, RN · Nov 16, 2010

often being able to take the time to stop and sit and listen to someone can be very valuable, especially if the unit is high in acuity and often people are buzzing around job to job with a broom stuck up their bottom ....

people can also feel isolated by being in a single room if they have no infection cotrol need to be in a single room and can't mobilise ( even if 'mobilise' is transferred into a wheelchair and pushed out in a common area / day room / lounge ). but there is a balalnce to be struck there , i really like our new unit ( tertiary spinal injuries unit) which has 34 beds , 2of which are HDU of the other 32, 8 are single rooms with 'ensuite' wetroom showers and toilet and the rest are in 4-bedded bays - but the bays are huge and have a wetroom shower and a toilet directly off the bay ... we didn't go 50 /50 like the rest of the new build because we felt the 4 bedded bays were better from a social point of view - i hate to think what it would be like to be on flat bedrest or halo traction in a side room even with TV and internet and a a over head screen ...

Another factor especially if their admission has been for a significant period is the fact is the absence of normal things, i 've had patients who have felt it beneficial when i've 'moaned' about stuff happening at home 'because it's normal life' , that said the unit is 'odd' to work on in that people 's admissions initally for rehab can be several months to a year and we do see people back on a regular basis for physio assessments, out patients and things like baclofen pump refills never mind if we have to re admit them for pump insertion/ replacement urology procedures or for pressure sore repair ...

HollyHobby · Nov 16, 2010

First, I'll repeat what others have said: listening is important. Even if you don't say just the "right" words, the effort you've put forth is appreciated.

Second, when a patient has serious issues with depression or anxiety, talking/listening isn't going to cure it. In the case of the elderly lady you mentioned, the nurse should get involved. Terminal illness does NOT inevitably lead to major depression, and when it does, that depression should be treated. We shouldn't just say (not that YOU'RE saying this), "well, she's really old and sick so she's bound to be depressed". For the sake of her quality of life, her depression should be addressed clinically, the same way we'd address physical symptoms of pain or nausea.

Also, is the elderly lady a DNR? Is she on hospice? Is the treatment she's receiving compatible with her wishes? If she's saying, "I want to die" yet is still receiving aggressive treatment, something is obviously not matching up. This lady needs a nurse to advocate for her, first by getting treatment for her depression, then by ensuring her treatment plan is appropriate.

In short, any untreated or inadequately treated symptoms of depression or anxiety must be reported to the MD and addressed. Listening and talking are great, but to really treat these disorders we must take them seriously enough to get them medical help.

In the example you give about the woman who freaked out over her BP, although I am certainly not qualified to diagnose, she sounds like she has borderline personality disorder. Again, the nurse needs to be aware of her inappropriate comments and, especially since she threatened suicide, a psych eval is in order.

I don't mean to be dismissive of people with borderline personality disorder- I'm sure they suffer greatly- but I do want to warn you, gymnut, about patients like her. They will monopolize your attention and they are master manipulators. The more you feed in to them (and they know just the right words to say to get you to react) the more they will try to suck the life out of you. Then, too often, they will turn around and WRITE YOU UP. They will complain about you to other staff because it suits them to turn people against each other. (She complained to you about the tech- you can bet your life she complained to that tech about YOU.) They will not hesitate to complain to your manager about you, no matter how perfect you are with them.

To illustrate what I mean here, I've often had borderline patients tell me how wonderful I am, MUCH better than the horrible nurse they had last night. I WAS THE NURSE THEY HAD LAST NIGHT. So they're complaining about ME, to ME.

I've seen this so many, many times that I've become very wary around this sort of person. They are dangerous to your career, and they will try to take all of your time so your other patients suffer. Good documentation is crucial. More importantly, don't let your heart get broken when this kind of patient betrays you.

SexyAmy · Nov 16, 2010

Great tips in this thread, thanks guys! :)