Discussion – Week 3
Depression is a common psychiatric condition seen in the elderly population. The rate of depression among the elderly is 10-20% (Avasthi & Grover, 2018). However, it is under-diagnosed and under-recognized and often misinterpreted as a normal sign of aging. The elderly population tends to have a higher rate of suicide-related to depression, along with more frequent hospitalizations (Avasthi & Grover, 2018). Recognizing the early signs of depression can improve quality of life, help maintain higher levels of functioning, and a reduction of morbidity and suicide rates. Therefore, it is very important to recognize the early signs of depression in the elderly.
Nurses often face delicate situations in which they must provide sensitive patient-centered care. One particular situation that has remained embedded in my mind for years now happened with a patient that was placed in hospice care. I worked with hospice for about three years when I had a patient transfer to a local nursing home and placed in my care. This patient was living at home alone and independent doing all activities of daily living until she had an unexpected fall that left her debilitated and unable to care for herself. Since the patient did not have any family, she immediately was transferred from the hospital to a local nursing home for rehabilitation. Within two weeks of being in rehabilitation, the patient stopped participating in her recovery then days later stopped eating, and within a few days was placed on hospice services for failure to thrive.
Upon admitting the patient to our services, I immediately recognized signs of depression, such as decreased energy, loss of interest in activities, insomnia, appetite changes, and difficulty making decisions. Since nursing home placement often increases feelings of hopelessness and loneliness due to loss of functions and social relations, depression often goes unrecognized (Haugan et al., 2013). I established a good rapport with my patient and began to develop a trusting relationship, which led to the discovery that the patient was on Zoloft before her injury. After reviewing her medical records from the hospital, I noticed a medication error that occurred when she was admitted post-fall. Before her hospital stay, the patient was taking Zoloft daily for depression, but there was no record at the hospital or nursing home of the patient taking this medication currently. By the time the symptoms were noticed, the patient had been off her antidepressants for over three weeks.
The strategy I used of establishing a trusting nurse-patient relationship immediately upon noticing the early signs of depression, lead to the discovery of the medication error. Once the medication error was noticed and reported to the physician, we were able to start the patient back on her antidepressant regimen. Within a few weeks, the patient had a decrease in depressive symptoms and was able to discharge from hospice and return to rehabilitation. I followed up with that patient for months even after her discharge from my services, and to my astonishment, she was able to return home and is back to her previous level of functioning. As a nurse advocate, I established a strong nurse-patient relationship early on and was able to prevent further decline in my patient’s health status and overall improved her quality of life.
Many strategies could have been used as a primary prevention method upon admission to the nursing home to prevent this medication error. Proper medication reconciliation should have been performed with the patient upon transitioning from care at home to the, along with communicating with the patient’s pharmacy regarding current medication usage. Once the patient transitioned to the nursing home, the same procedures should have been put in place. Medication errors cost the United States $40 billion a year in medical expenses (Tariq et al., 2020). Therefore, preventing medication errors will not only reduce the risk of physiological pain but also monetary cost. As a nurse advocate in this situation, I reported the medication error appropriately and followed protocol to get the medication restarted.
Many ethical implications need to be considered when caring for patients with depression. Ethics is considered essential in healthcare and includes respect for autonomy, informed consent, boundary violations, confidentiality, and the principles of justice (Bipeta, 2019). Since cognitive disorders are more common in the elderly, decision-making capacity should be assessed first, which could potentially be a major ethical issue in mental health.
In conclusion, nurses often blame signs of depression in nursing home patients on the loss of independence and functioning, feelings of isolation, and lack of activities (Haugan et al., 2013). However, depression is not a normal sign of aging, and any signs or symptoms should be evaluated and managed appropriately. Properly recognizing and treating depression early improves the patient’s overall quality of life.
Avasthi, A., & Grover, S. (2018). Clinical practice guidelines for management of depression in elderly. Indian Journal of Psychiatry, 60(Suppl 3), S341–S362. https://doi.org/10.4103/0019-5545.224474
Bipeta, R. (2019). Legal and ethical aspects of mental health care. Indian Journal of Psychological Medicine, 41(2), 108–112. https://doi.org/10.4103/IJPSYM.IJPSYM_59_19
Haugan, G., Innstrand, S.T., & Moksnes, U.K. (2013). The effect of nurse-patient interaction on anxiety and depression in cognitively intact nursing home patients. Journal of Clinical Nursing, 22(15-16). 2192-2205. https://doi.org /10.1111/jocn.12072
Tariq, R.A., Vashisht, R., & Scherbak, Y. (2020). Medication Errors. StatPearls [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK519065/
Discussion: Psychological Complications Resulting From Illnesses and Injuries
The nurse’s role goes far beyond that which is expected. Nurses are the main communicators between patients, doctors, and family, and they care for more than just physical ailments. Often, nurses are presented with difficult situations where being an advocate becomes paramount to the healing of the patient. One of the issues that patients with acute and chronic illnesses or extended hospitalization face is a tendency to become depressed. The nurse’s role in this situation requires more than just attention to the physical problem. Another situation where a nurse may need to shift his or her care is when a patient presents with a suspicious injury or illness. In addition to considering the legal and ethical responsibilities of the nurse, he or she must consider the psychological undertones that may be present.
For this Discussion, you will consider delicate situations that nurses often face and analyze the implications of these situations. Reflect on a patient care situation in which you have encountered one of the following:
A suspicious illness or injury
Depression resulting from illness or injury
Then, locate at least one scholarly journal article related to your patient care situation that offers strategies for managing the circumstances.
By Day 3
Respond to the following:
Explain your patient encounter, highlighting the challenges the situation presented, and briefly summarize the contents of your journal article.
What strategies did you employ to help handle the situation? What other strategies could you have used?
How did you advocate for the patient in the situation?
What are some of the legal and ethical implications that need to be considered when providing care for patients with depression resulting from illnesses or injuries or suspicious illnesses or injuries?
Note: Avoid using personal information (e.g., names, facility name, etc.) in your post.
Support your response with references from the professional nursing literature.
Note Initial Post: A 3-paragraph (at least 350 words) response. Be sure to use evidence from the readings and include in-text citations. Utilize essay-level writing practice and skills, including the use of transitional material and organizational frames. Avoid quotes; paraphrase to incorporate evidence into your own writing. A reference list is required. Use the most current evidence (usually ≤ 5 years old).
By Day 7
Read two or more of your colleagues’ postings from the Discussion question (support with evidence if indicated).
Respond with a comment that asks for clarification, provides support for, or contributes additional information to two or more of your colleagues’ postings.
Post a Discussion entry on three different days of the week. Refer to the Discussion Rubric found in the Course Information and Grading Criteria area.
Submission and Grading Information
Discussion – Week 3
Psychological Complications Resulting From Illnesses and Injuries
My first nursing job was at River Park, a mental health facility, caring for adolescents ranging from 5 to 12 years of age. The typical reasons for admission to the acute care unit included self-harm, depression, suicidal ideation, aggression, sexual abuse, and sexually acting out. First of all, I would like to acknowledge how heartbreaking it was to witness such young children’s behaviors. Secondly, it was equally as distressing to realize those behaviors were a direct result of being abused by someone that child once trusted.
I recall a few patients throughout the years who made suspicious statements regarding their medication regimens at home. The nurse was required to review each medication with the child as they were dispensed. Sometimes statements patients made included, “Mom only makes me take that in the morning.” “Mom gives me two of those before bed sometimes.” “I don’t take that one anymore.” indicating the parent dispensing the medication was giving their child an inadequate dose, an increased amount, or not giving the medication at all. According to UNICEF, those incidents were types of abuse.
Neglect or negligent treatment means the failure to meet children’s physical and psychological needs, protect them from danger or obtain medical, birth registration or other services when those responsible for their care have the means, knowledge and access to services to do so. (UNICEF, 2014, p. 4)
It is important to note that not receiving their medications as prescribed could have been why they exhibited unsafe behaviors that required admission to a mental health facility.
As mandated reporters, nurses are required by law to report concerns of abuse or neglect (WVDHHR, n.d.). This type of neglect was common. Our facility required a urine drug screen upon admission to the unit to determine which medications were in the child’s system before receiving any within the facility. It was also required to obtain a list of home medications from the caregiver to compare to the urine analysis results. Findings that did not match up were immediately reported to child protective services.
Unfortunately, the outcome is typically out of the nurse’s control. I have witnessed many parents lose custody of their children due to their abusive behaviors. However, I have seen many more children cycle from abusive homes into foster care, back to an abusive home, and then back to the mental health facility. All we can do as the nurse is continue to report the findings and provide therapeutic support and coping skills to the children while they are in our care.
UNICEF. (2014). Hidden in plain sight statistical analysis [PDF]. United Nations Children’s Fund. http://files.unicef.org/publications/files/Hidden_in_plain_sight_statistical_analysis_EN_3_Sept_2014.pdf
WVDHHR. (n.d.). Centralized intake for abuse and neglect. West Virginia Department of Health and Human Resources. https://dhhr.wv.gov/bcf/Services/Pages/Centralized-Intake-for-Abuse-and-Neglect.aspx
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