MHM95.pdf

11/14/23, 12:06 PM Realizeit for Student Application of the Nursing Process: Depression Assessment History The nurse can collect assessment data from the client and family or significant others, previous chart information, and others involved in the support or care. It may take several short periods to complete the assessment because clients who are severely depressed feel exhausted and overwhelmed. It can take time for them to process the question asked and to formulate a response. It is important that the nurse does not try to rush clients because doing so leads to frustration and incomplete assessment data. To assess the client’s perception of the problem, the nurse asks about behavioral changes: when they started, what was happening when they began, their duration, and what the client has tried to do about them. Assessing the history is important to determine any previous episodes of depression, treatment, and the client’s response to treatment. The nurse also asks about family history of mood disorders, suicide, or attempted suicide. General Appearance and Motor Behavior Many people with depression look sad; sometimes, they just look ill. The posture is often slouched with head down, and they make minimal eye contact. They have psychomotor retardation (slow body movements, slow cognitive processing, and slow verbal interaction). Responses to questions may be minimal, with only one or two words. Latency of response is seen when clients take up to 30 seconds to respond to a question. They may answer some questions with “I don’t know” because they are simply too fatigued and overwhelmed to think of an answer or respond in any detail. Clients may also exhibit signs of agitation or anxiety, such as wringing their hands and having difficulty sitting still. These clients are said to have psychomotor agitation (increased body movements and thoughts), which includes pacing, accelerated thinking, and argumentativeness. Mood and Affect Clients with depression may describe themselves as hopeless, helpless, down, or anxious. They may also say they are a burden on others or are a failure at life, or they may make other similar statements. They are easily frustrated, are angry with themselves, and can be angry with others. They experience anhedonia, losing any sense of pleasure from activities they formerly enjoyed. Clients may be apathetic, that is, not caring about themselves, activities, or much of anything. Their affect is sad or depressed or may be flat with no emotional expressions. Typically, depressed clients sit alone, staring into space or lost in thought. When addressed, they interact minimally with a few words or a gesture. They are overwhelmed by noise and people who might make demands on them, so they withdraw from the stimulation of interaction with others. Thought Process and Content Clients with depression experience slow thinking processes, their thinking seems to occur in slow motion. With severe depression, they may not respond verbally to questions. Clients tend to be negative and pessimistic in their thinking; they believe they will always feel this bad, things will never get any better, and nothing will help. Clients make self-deprecating remarks, criticizing themselves harshly, and focusing only on failures or negative attributes. They tend to ruminate, which is repeatedly going over the same thoughts. Those who experience psychotic symptoms have delusions; they often believe they are responsible for all the tragedies and miseries in the world. Rumination Often, clients with depression have thoughts of dying or committing suicide. It is important to assess suicidal ideation by asking about it directly. The nurse may ask, “Are you thinking about suicide?” or “What suicidal thoughts are you having?” Most clients readily admit to suicidal thinking. Sensorium and Intellectual Processes Some clients with depression are oriented to person, time, and place; others experience difficulty with orientation, especially if they experience psychotic symptoms or are withdrawn from the environment. Assessing general knowledge is difficult because of their limited ability to respond to questions. Memory impairment is common. Clients have extreme difficulty concentrating or paying attention. If psychotic, clients may hear degrading and belittling voices, or they may even have command hallucinations that order them to commit suicide. Judgment and Insight Clients with depression experience impaired judgment because they cannot use their cognitive abilities to solve problems or make decisions. They often cannot make decisions or choices because of their extreme apathy or their negative belief that it “doesn’t matter anyway.” https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IcqM4duLqEgtmTUufdz3T2w99LcE5RSvFnHdx2Dv4hNxB… 1/11 11/14/23, 12:06 PM Realizeit for Student Insight may be intact, especially if clients have been depressed previously. Others have limited insight and are totally unaware of their behavior, feelings, or even their illness. Self-Concept Sense of self-esteem is greatly reduced; clients often use phrases such as “good for nothing” or “just worthless” to describe themselves. They feel guilty about not being able to function and often personalize events or take responsibility for incidents over which they have no control. They believe that others would be better off without them, a belief that leads to suicidal thoughts. Roles and Relationships Clients with depression have difficulty fulfilling roles and responsibilities. The more severe the depression, the greater the difficulty. They have problems going to work or school; when there, they seem unable to carry out their responsibilities. The same is true with family responsibilities. Clients are less able to cook, clean, or care for children. In addition to the inability to fulfill roles, clients become even more convinced of their “worthlessness” for being unable to meet life responsibilities. Depression can cause great strain in relationships. Family members who have limited knowledge about depression may believe clients should “just get on with it.” Clients often avoid family and social relationships because they feel overwhelmed, experience no pleasure from interactions, and feel unworthy. As clients withdraw from relationships, the strain increases. Physiological and Self-Care Considerations Clients with depression often experience pronounced weight loss because of lack of appetite or disinterest in eating. Sleep disturbances are common; either clients cannot sleep, or they feel exhausted and unrefreshed no matter how much time they spend in bed. They lose interest in sexual activities, and men often experience impotence. Some clients neglect personal hygiene because they lack the interest or energy. Constipation commonly results from decreased food and fluid intake as well as from inactivity. If fluid intake is severely limited, clients may also be dehydrated. Nursing Care Plan: Depression Nursing Diagnosis Ineffective Coping: Inability to form a valid appraisal of the stressors, inadequate choices of practiced responses, and/or inability to use available r Assessment Data Suicidal ideas or behavior Slow mental processes Disordered thoughts Feelings of despair, hopelessness, and worthlessness Guilt Anhedonia (inability to experience pleasure) Disorientation Generalized restlessness or agitation Sleep disturbances: early awakening, insomnia, or excessive sleeping Anger or hostility (may not be overt) Rumination Delusions, hallucinations, or other psychotic symptoms Diminished interest in sexual activity Fear of intensity of feelings Anxiety Expected Outcomes Immediate The client will: Be free from self-inflicted harm throughout hospitalization. Engage in reality-based interactions within 24 hours. Be oriented to person, place, and time within 48 to 72 hours. Express anger or hostility outwardly in a safe manner, for example, talking with staff members within 5 to 7 days. Stabilization The client will: Express feelings directly with congruent verbal and nonverbal messages. https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IcqM4duLqEgtmTUufdz3T2w99LcE5RSvFnHdx2Dv4hNxB… 2/11 11/14/23, 12:06 PM Realizeit for Student Be free from psychotic symptoms. Demonstrate functional level of psychomotor activity. Community The client will: Demonstrate compliance with and knowledge of medications, if any. Demonstrate an increased ability to cope with anxiety, stress, or frustration. Verbalize or demonstrate acceptance of loss or change, if any. Identify a support system in the community. Implementation Nursing Interventions* Rationale Provide a safe environment for the client. Physical safety of the client is a priority. Many common manner. Continually assess the client’s potential for suicide. Remain aware of this suicide potential at all times. Clients with depression may have a potential for suicid that may change with time. Observe the client closely, especially under the following circumstances: You must be aware of the client’s activities at all times After antidepressant medication begins to raise the client’s mood Unstructured time on the unit or times when the number of staff on the unit is limited After any dramatic behavioral change (sudden cheerfulness, relief, or giving away personal belongings) self-injury. Risk for suicide increases as the client’s ene the client’s time is unstructured, and when observation may indicate that the client has come to a decision to c Reorient the client to person, place, and time as indicated (call the client by name, tell the client your name, tell the client where he or she is, and so forth). Repeated presentation of reality is concrete reinforcem Spend time with the client. Your physical presence is reality. If the client is ruminating, tell him or her that you will talk about reality or about the client’s feelings, but limit the attention given to repeated expressions of rumination. Minimizing attention may help decrease rumination. Pro and expression of feelings will encourage these behavi Initially assign the same staff members to work with the client whenever possible. The client’s ability to respond to others may be impaire initially will facilitate familiarity and trust. However, the n client should increase as soon as possible to minimize abilities to communicate with a variety of people. When approaching the client, use a moderate-level tone of voice. Avoid being overly cheerful. Being overly cheerful may indicate to the client that be feelings are not acceptable. Use silence and active listening when interacting with the client. Let the client know you are concerned and you consider the client a worthwhile person. The client may not communicate if you are talking too m listening will communicate your interest and concern. Be comfortable sitting with the client in silence. Let the client know you are available to converse, but do not require the client to talk. Your silence will convey your expectation that the clien of the client’s difficulty with communication. When first communicating with the client, use simple, direct sentences; avoid complex sentences or directions. The client’s ability to perceive and respond to complex Avoid asking the client many questions, especially questions that require only brief answers. Asking questions and requiring only brief answers may feelings. Do not cut off interactions with cheerful remarks or platitudes (e.g., “No one really wants to die,” or “You’ll feel better soon.”). Do not belittle the client’s feelings. Accept the client’s verbalizations of feelings as real and give support for expressions of emotions, especially those that may be difficult for the client (like anger). You may be uncomfortable with certain feelings the clie to recognize this and discuss it with another staff mem communicating your discomfort to the client. Proclaimi or belittling them is detrimental. Encourage the client to ventilate feelings in whatever way is comfortable—verbal and nonverbal. Let the client know you will listen and accept what is being expressed. Expressing feelings may help relieve despair, hopeless inherently good or bad. You must remain nonjudgment this to the client. Allow (and encourage) the client to cry. Stay with and support the client if he or she desires. Provide privacy if the client desires and it is safe to do so. Crying is a healthy way of expressing feelings of sadne may not feel comfortable crying and may need encoura Interact with the client on topics with which he or she is comfortable. Do not probe for information. Topics that are uncomfortable for the client and probing communication. After trust has been established, the c topics. Talk with the client about coping strategies he or she has used in the past. Explore which strategies have been successful and which may have led to negative consequences. The client may have had success using coping strateg confidence in him or herself or in his or her ability to co https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IcqM4duLqEgtmTUufdz3T2w99LcE5RSvFnHdx2Dv4hNxB… 3/11 11/14/23, 12:06 PM Realizeit for Student coping strategies can be self-destructive (e.g., self-me Teach the client about positive coping strategies and stress management skills, such as increasing physical exercise, expressing feelings verbally or in a journal, or meditation techniques. Encourage the client to practice this type of technique while in the hospital. The client may have limited or no knowledge of stress used positive techniques in the past. If the client tries t she can experience success and receive positive feedb Teach the client about the problem-solving process: Explore possible options, examine the consequences of each alternative, select and implement an alternative, and evaluate the results. The client may be unaware of a systematic method for problem-solving process facilitates the client’s confide Provide positive feedback at each step of the process. If the client is not satisfied with the chosen alternative, assist the client in selecting another alternative. Positive feedback at each step will give the client many him or her to persist in problem-solving, and enhance c “survive” making a mistake. Depression Rating Scales Clients can complete some rating scales for depression; mental health professionals administer others. These assessment tools, along with evaluation of behavior, thought processes, history, family history, and situational factors, help create a diagnostic picture. Self-rating scales of depressive symptoms include the Zung Self-Rating Depression Scale and the Beck Depression Inventory. Self-rating scales are used for case finding in the general public and may be used over the course of treatment to determine improvement from the client’s perspective. The Hamilton Rating Scale for Depression (Box 17.1) is a clinician-rated depression scale used like a clinical interview. The clinician rates the range of the client’s behaviors, such as depressed mood, guilt, suicide, and insomnia. There is also a section to score diurnal variations, depersonalization (sense of unreality about the self), paranoid symptoms, and obsessions. BOX 17.1 Hamilton Rating Scale for Depression For each item, select the “cue” that best characterizes the patient. 1. Depressed mood (sadness, hopeless, helpless, worthless) 0 Absent 1 These feeling states indicated only on questioning 2 These feeling states spontaneously reported verbally 3 Communicates feeling states nonverbally—that is, through facial expression, posture, voice, and tendency to weep 4 Patient reports VIRTUALLY ONLY these feeling states in his or her spontaneous verbal and nonverbal communication 2. Feelings of guilt 0 Absent 1 Self-reproach, feels he or she has let people down 2 Ideas of guilt or rumination over past errors or sinful deeds 3 Present illness is a punishment; delusions of guilt 4 Hears accusatory or denunciatory voices and/or experiences threatening visual hallucinations 3. Suicide 0 Absent 1 Feels life is not worth living 2 Wishes he or she were dead or any thoughts of possible death to self https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IcqM4duLqEgtmTUufdz3T2w99LcE5RSvFnHdx2Dv4hNxB… 4/11 11/14/23, 12:06 PM Realizeit for Student 3 Suicide ideas or gesture 4 Attempts at suicide (any serious attempt rates 4) 4. Insomnia early 0 No difficulty falling asleep 1 Complains of occasional difficulty falling asleep—that is, more than 1/4 hour 2 Complains of difficulty falling asleep at night 5. Insomnia middle 0 No difficulty 1 Patient complains of being restless and disturbed during the night 2 Waking during the night—any getting out of bed rates 2 (except for purpose of voiding) 6. Insomnia late 0 No difficulty 1 Waking in early hours of the morning but goes back to sleep 2 Unable to fall asleep again if gets out of bed 7. Work and activities 0 No difficulty 1 Thoughts and feelings of incapacity, fatigue, or weakness related to activities, work, or hobbies 2 Loss of interest in activity, hobbies, or work—either directly reported by patient, or indirect in listlessness, indecision, and vacillation (feels has t 3 Decrease in actual time spent in activities or decrease in productivity. In hospital, rate 3 if patient does not spend at least 3 hours a day in activi ward chores 4 Stopped working because of present illness. In hospital, rate 4 if patient engages in no activities except ward chores, or if patient fails to perform 8. Retardation (slowness of thought and speech; impaired ability to concentrate; decreased motor activity) 0 Normal speech and thought 1 Slight retardation at interview 2 Obvious retardation at interview 3 Interview difficult 4 Complete stupor 9. Agitation 0 None 1 “Playing with” hands, hair, etc. 2 Hand wringing, nail biting, hair pulling, biting of lips 10. Anxiety psychic 0 No difficulty 1 Subjective tension and irritability 2 Worrying about minor matters https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IcqM4duLqEgtmTUufdz3T2w99LcE5RSvFnHdx2Dv4hNxB… 5/11 11/14/23, 12:06 PM Realizeit for Student 3 Apprehensive attitude apparent in face or speech 4 Fears expressed without questioning 11. Anxiety somatic Physiological concomitants of anxiety, such as: 0 Absent None 1 Mild Gastrointestinal—dry mouth, wind, indigestion, diarrhea, cramps, belching 2 Moderate Cardiovascular—palpitations, headaches 3 Severe Respiratory—hyperventilation, sighing 4 Incapacitating Urinary frequency, sweating 12. Somatic symptoms gastrointestinal 0 None 1 Loss of appetite but eating without staff encouragement; heavy feelings in abdomen 2 Difficulty eating without staff urging; requests or requires laxatives or medication for bowels or medication for gastrointestinal symptoms 13. Somatic symptoms general 0 None 1 Heaviness in limbs, back, or head; backaches, headache, muscle aches; loss of energy and fatigability 2 Any clear-cut symptom rates 2 14. Genital symptoms Symptoms such as: 0 Absent None 1 Mild Loss of libido 2 Severe Menstrual disturbances 15 .Hypochondriasis 0 Not present 1 Self-absorption (bodily) 2 Preoccupation with health 3 Frequent complaints, requests for help, etc 4 Hypochondriacal delusions 16. Loss of weight A When rating by history 0 No weight loss 1 Probable weight loss associated with present illness 2 Definite (according to patient) weight loss B On weekly ratings by ward psychiatrist, when actual weight changes are measured 0 Weight loss < 1 lb in a week 1 Weight loss > 1 lb in a week https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IcqM4duLqEgtmTUufdz3T2w99LcE5RSvFnHdx2Dv4hNxB… 6/11 11/14/23, 12:06 PM 2 Realizeit for Student Weight loss > 2 lb in a week 17. Insight 0 Acknowledges being depressed and ill 1 Acknowledges illness but attributes cause to bad food, climate, overwork, virus, need for rest, etc 2 Denies being ill at all 18. Diurnal variation AM PM If symptoms are worse in the morning or evening, note which it is and rate severity of variation 0 0 Absent 1 1 Mild 2 2 Severe 19. Depersonalization and derealization Such as: 0 Absent None 1 Mild 2 Moderate Feeling of unreality 3 Severe Nihilistic ideas 4 Incapacitating 20. Paranoid symptoms 0 None 1 2 Suspiciousness 3 Ideas of reference 4 Delusions of reference and persecution 21. Obsessional and compulsive symptoms 0 Absent 1 Mild 2 Severe 22. Helplessness 0 Not present 1 Subjective feelings that are elicited only by inquiry 2 Patient volunteers his or her helpless feelings 3 Requires urging, guidance, and reassurance to accomplish ward chores or personal hygiene 4 Requires physical assistance for dress, grooming, eating, bedside tasks, or personal hygiene 23. Hopelessness 0 Not present https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IcqM4duLqEgtmTUufdz3T2w99LcE5RSvFnHdx2Dv4hNxB… 7/11 11/14/23, 12:06 PM Realizeit for Student 1 Intermittently doubts that “things will improve” but can be reassured 2 Consistently feels “hopeless” but accepts reassurances 3 Expresses feelings of discouragement, despair, pessimism about future, which cannot be dispelled 4 Spontaneously and inappropriately perseverates “I’ll never get well” or its equivalent 24. Worthlessness (ranges from mild loss of esteem, feelings of inferiority, self-depreciation to delusional notions of worthlessness) 0 Not present 1 Indicates feelings of worthlessness (loss of self-esteem) only on questioning 2 Spontaneously indicates feelings of worthlessness (loss of self-esteem) 3 Different from 2 by degree; patient volunteers that he or she is “no good,” “inferior,” etc. 4 Delusional notions of worthlessness—that is, “I am a heap of garbage” or its equivalen Data Analysis The nurse analyzes assessment data to determine priorities and to establish a plan of care. Nursing diagnoses commonly established for the client with depression include the following: Risk for suicide Imbalanced nutrition: Less than body requirements Anxiety Ineffective coping Hopelessness Ineffective role performance Self-care deficit Chronic low self-esteem Disturbed sleep pattern Impaired social interaction Outcome Identification Outcomes for clients with depression relate to how the depression is manifested—for instance, whether or not the person is slow or agitated, sleeps too much or too little, or eats too much or too little. Examples of outcomes for a client with the psychomotor retardation form of depression include the following: The client will not injure him or herself. The client will independently carry out activities of daily living (showering, changing clothing, grooming). The client will establish a balance of rest, sleep, and activity. The client will establish a balance of adequate nutrition, hydration, and elimination. The client will evaluate self-attributes realistically. The client will socialize with staff, peers, and family/friends. The client will return to occupation or school activities. The client will comply with an antidepressant regimen. The client will verbalize symptoms of a recurrence. Intervention Providing for Safety The first priority is to determine whether a client with depression is suicidal. If a client has suicidal ideation or hears voices commanding him or her to commit suicide, measures to provide a safe environment are necessary. If the client has a suicide plan, the nurse asks additional questions to determine the lethality of the intent and plan. The nurse reports this information to the treatment team. Health care personnel follow hospital or agency policies and procedures for instituting suicide precautions (e.g., removal of harmful items, increased supervision). Promoting a Therapeutic Relationship It is important to have meaningful contact with clients who have depression and to begin a therapeutic relationship, regardless of the state of depression. Some clients are quite open in describing their feelings of sadness, hopelessness, helplessness, or agitation. Clients may be unable to sustain a long interaction, so several shorter visits help the nurse assess status and establish a therapeutic relationship. https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IcqM4duLqEgtmTUufdz3T2w99LcE5RSvFnHdx2Dv4hNxB… 8/11 11/14/23, 12:06 PM Realizeit for Student The nurse may find it difficult to interact with these clients because of empathy with such sadness and depression. The nurse may also feel unable to “do anything” for clients with limited responses. Clients with psychomotor are noncommunicative or may even be mute. The nurse can sit with such clients for a few minutes at intervals throughout the day. The nurse’s presence conveys genuine interest and caring. It is not necessary for the nurse to talk to clients the entire time; rather, silence can convey that clients are worthwhile even if they are not interacting. “My name is Sheila. I’m your nurse today. I’m going to sit with you for a few minutes. If you need anything, or if you would like to talk, please tell me.” After time has elapsed, the nurse would say: “I’m going now. I will be back in an hour to see you again.” It is also important that the nurse avoids being overly cheerful or trying to “cheer up” clients. It is impossible to coax or to humor clients out of depression. In fact, an overly cheerful approach may make clients feel worse or convey a lack of understanding of the despair. Promoting Activities of Daily Living and Physical Care The ability to perform daily activities is related to the level of psychomotor retardation. To assess ability to perform activities of daily living independently, the nurse first asks the client to perform the global task. For example, “Martin, it’s time to get dressed.” (global task) If a client cannot respond to the global request, the nurse breaks the task into smaller segments. Clients with depression can become overwhelmed easily with a task that has several steps. The nurse can use success in small, concrete steps as a basis to increase selfesteem and to build competency for a slightly more complex task the next time. If clients cannot choose between articles of clothing, the nurse selects the clothing and directs clients to put them on. For example, “Here are your gray slacks. Put them on.” This still allows clients to participate in dressing. If this is what clients are capable of doing at this point, this activity will reduce dependence on staff. This request is concrete, and if clients cannot do this, the nurse has information about the level of psychomotor retardation. If a client cannot put on slacks, the nurse assists by saying, “Let me help you with your slacks, Martin.” The nurse helps clients dress only when they cannot perform any of the above steps. This allows clients to do as much as possible for themselves and to avoid becoming dependent on the staff. The nurse can carry out this same process with clients when they eat, take a shower, and perform routine self-care activities. Because abilities change over time, the nurse must assess them on an ongoing basis. This continual assessment takes more time than simply helping clients dress. Nevertheless, it promotes independence and provides dynamic assessment data about psychomotor abilities. Often, clients decline to engage in activities because they are too fatigued or have no interest. The nurse can validate these feelings, yet promote participation. For example, “I know you feel like staying in bed, but it is time to get up for breakfast.” Often, clients may want to stay in bed until they “feel like getting up” or feel like engaging in activities of daily living. The nurse can let clients know that they must become more active to feel better rather than waiting passively for improvement. It may be helpful to avoid asking “yes-or-no” questions. Instead of asking, “Do you want to get up now?,” the nurse would say, “It is time to get up now.” Nursing Interventions For Depression Provide for the safety of the client and others. Institute suicide precautions if indicated. https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IcqM4duLqEgtmTUufdz3T2w99LcE5RSvFnHdx2Dv4hNxB… 9/11 11/14/23, 12:06 PM Realizeit for Student Begin a therapeutic relationship by spending nondemanding time with the client. Promote completion of activities of daily living by assisting the client only as necessary. Establish adequate nutrition and hydration. Promote sleep and rest. Engage the client in activities. Encourage the client to verbalize and describe emotions. Work with the client to manage medications and side effects. Reestablishing balanced nutrition can be challenging when clients have no appetite or do not feel like eating. The nurse can explain that beginning to eat helps stimulate appetite. Food offered frequently and in small amounts can prevent overwhelming clients with a large meal that they feel unable to eat. Sitting quietly with clients during meals can promote eating. Monitoring food and fluid intake may be necessary until clients are consuming adequate amounts. Promoting sleep may include the short-term use of a sedative or giving medication in the evening if drowsiness or sedation is a side effect. It is also important to encourage clients to remain out of bed and active during the day to facilitate sleeping at night. It is important to monitor the number of hours clients sleep as well as whether they feel refreshed on awakening. Using Therapeutic Communication Clients with depression are often overwhelmed by the intensity of their emotions. Talking about these feelings can be beneficial. Initially, the nurse encourages clients to describe in detail how they are feeling. Sharing the burden with another person can provide some relief. At these times, the nurse can listen attentively, encourage clients, and validate the intensity of the experience. For example, Nurse: “How are you feeling today?” (broad opening) Client: “I feel so awful … terrible.” Nurse: “Tell me more. What is that like for you?” (using a general lead; encouraging description) Client: “I don’t feel like myself. I don’t know what to do.” Nurse: “That must be frightening.” (validating) It is important at this point that the nurse does not attempt to “fix” the client’s difficulties or offer clichés such as, “Things will get better” or “But you know your family really needs you.” Although the nurse may have good intentions, remarks of this type belittle the client’s feelings or make the client feel more guilty and worthless. As clients begin to improve, the nurse can help them learn or rediscover more effective coping strategies such as talking to friends, spending leisure time to relax, taking positive steps to deal with stressors, and so forth. Improved coping skills may not prevent depression but may assist clients in dealing with the effects of depression more effectively. Providing Client and Family Teaching Teaching clients and families about depression is important. They must understand that depression is an illness, not a lack of willpower or motivation. Learning about the beginning symptoms of relapse may assist clients in seeking treatment early and avoiding a lengthy recurrence. Clients and families should know that treatment outcomes are best when psychotherapy and antidepressants are combined. Psychotherapy helps clients explore anger, dependence, guilt, hopelessness, helplessness, object loss, interpersonal issues, and irrational beliefs. The goal is to reverse negative views of the future, improve self-image, and help clients gain competence and self-mastery. The nurse can help clients to find a therapist through mental health centers in specific communities. Client and Family Education For Depression Teach about the illness of depression. Identify early signs of relapse. Discuss the importance of support groups and assist in locating resources. Teach the client and family about the benefits of therapy and follow-up appointments. Support group participation also helps some clients and their families. Clients can receive support and encouragement from others who struggle with depression, and family members can offer support to one another. The National Alliance for the Mentally Ill is an organization https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IcqM4duLqEgtmTUufdz3T2w99LcE5RSvFnHdx2Dv4hNx… 10/11 11/14/23, 12:06 PM Realizeit for Student that can help clients and families connect with local support groups. https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IcqM4duLqEgtmTUufdz3T2w99LcE5RSvFnHdx2Dv4hNx… 11/11

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