Psychological complications

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  • 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?

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.

Resources:

· Buijck, B. I., Zuidema, S. U., Spruit-van Eijk, M., Bor, H., Gerritsen, D. L., & Koopmans, R. T. C. M. (2014). 

Determinants of geriatric patients’ quality of life after stroke rehabilitationLinks to an external site.

Aging & Mental Health, 18(8), 980–985. http://doi.org/10.1080/13607863.2014.899969

 

· Haugan, G., Innstrand, S.T. & Moksnes, U.K. (2013). 

The effect of nurse-patient interaction on anxiety and depression in cognitively intact nursing home patientsLinks to an external site.

Journal of Clinical Nursing, 22(15–16), 2192-2205. http://doi.org/10.1111/jocn.12072

 

· Frazao, S. L., Correia, A.M., Norton, P. & Magalhaes, T. (2015). 

Physical abuse against elderly persons in institutional settingsLinks to an external site.

Journal of Forensic and Legal Medicine, 36, 54-60. http://doi.org/10.1016/j.jflm.2015.09.002

 

· Liu, C. H. & Tronick, E. (2013). 

Rates and predictors of postpartum depression by race and ethnicity: Results from the 2004 to 2007 New York City PRAMS Survey (Pregnancy Risk Assessment Monitoring System)Links to an external site.

Maternal Child Health Journal, 17, 1599-1610. http://doi.org/10.1007/s10995-012-1171-z

 

· Spilman, S. K., Smith, H. L., Schirmer, L. L., & Tonui, P. M. (2015). 

Evaluation and treatment of depression in adult trauma patientsLinks to an external site.

Journal of Trauma Nursing, 22(1), 17–22. http://doi.org/10.1097/JTN.0000000000000102

 

· United Nations Children’s Fund. (2014). 


Hidden in plain sight: A statistical analysis of violence against childrenLinks to an external site.


. 
http://files.unicef.org/publications/files/Hidden_in_plain_sight_statistical_analysis_EN_3_Sept_2014.pdf

· Steiner, L. M. (2012). 

Why domestic violence victims don’t leave
Links to an external site.

. [Video]. TED conferences. https://www.ted.com/talks/leslie_morgan_steiner_why_domestic_violence_victims_don_t_leave?language=en#t-58672

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.

Note: Post a 3-paragraph (at least 350 words) response. Be sure to use 
evidence
Links to an external site.,
 

in-text citations
Links to an external site.
, and 


essay-levelLinks to an external site.

 writing skills, including the use of 


transitional materialLinks to an external site.

 and 


organizational framesLinks to an external site.

. Use the writing resources and the Discussion Rubric to develop your post.

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.



Octavia Henry

 Depression is a common psychiatric problem that can result from a wide range of individual experiences. A prolonged sense of sadness and loss of interest are symptoms of depression, a mood illness. Although you might only experience depression once in your lifetime, most people experience many bouts. As a healthcare professional, I have cared for many patients with varying psychopathological dimensions of this condition. One notable case that comes to mind involved a stroke-associated care scenario. The patient, a 59-year-old woman, was previously healthy and active before experiencing a brain attack. Despite improving relatively quickly after three weeks of intense physiotherapy, the initial experience had a profound emotional impact on her.

She spent days crying, ate very little, stopped getting out of bed, had trouble sleeping, and expressed self-criticism. It became clear that she had developed depression after screening with the Beck Depression Inventory–Fast Screen (BDI-FS). One scholarly article that relates to my patient care situation is Towfighi et al.’s (2017) work. In this article, the authors explore several topics related to post-stroke depression, including epidemiology, pathophysiology, outcomes, management, and prevention strategies. The article also provides key implications for clinical practice.

In my patient care situation, I taught the patient individualized problem-solving strategies and approaches to identifying and overcoming negative thoughts associated with her condition. I also helped her discover ways to maximize her functional capacity and establish pleasant, realistic activities and social interactions. Furthermore, I emphasized the value of structured moderate physical activity, while acknowledging the limits and complexities of her disabilities. Looking back, I could have recommended engaging in behavioral-psychosocial support programs as an adjunct to usual care.

In terms of advocacy, I safeguarded my patient’s rights in the face of conflicts of interest involving her family. For example, her husband wanted her to be discharged from the hospital as soon as possible so that she could continue her recovery at home. However, I respectfully communicated my objections, urging him to follow medical advice and the overall counsel of the patient’s care team. Lastly, it is important to consider the implications of legal requirements, beneficence, nonmaleficence, justice, honesty, confidentiality, privacy, fidelity, and autonomy when dealing with depression attributed to illness or injury to ensure the best possible care for patients.

 

References

Towfighi, A., Ovbiagele, B., El Husseini, N., Hackett, M. L., Jorge, R. E., Kissela, B. M., Mitchell, P. H., Skolarus, L. E., Whooley, M. A., & Williams, L. S. (2017). Poststroke depression: A scientific statement for healthcare professionals from the American Heart Association/American Stroke Association. 
Stroke
48(2), e30-e43. 

https://doi.org/10.1161/STR.0000000000000113Links to an external site.


Rebecca Alice Rankin

Depression is a common mental disorder characterized by persistent sadness and a lack of interest or pleasure in previously enjoyable activities. Depression is among the most common mental illnesses affecting people aged 65 and older and can significantly impair this population’s functional ability and overall quality of life and increases the risk of mortality due to suicide. Depression in elderly patients is often difficult to diagnose because it frequently presents with somatic manifestations (Holzel, Bjerregaard, Bleich, Boczor, Harter, Konig, Kloppe, Niebling, Scherer, Tinsel, & Hull, 2018). 

 

As an Emergency Room nurse, I see many elderly patients who suffer from chronic illnesses and depression. Research consistently shows that people with chronic illness are up to three times more likely to experience depression than those without (Guthrie, Dickens, Blakemore, Watson, Chew-Graham, Lovell, Afzal, Kapur & Tomenson, 2016). One patient who stands out in my mind was a man in his early 80s. This patient’s wife had recently passed away. He was living by himself with family close by who would check on him daily. We saw the patient several times for symptoms such as shortness of breath, anxiety, and weakness which had been contributed to his chronic congestive heart failure and other chronic diseases. Every time the patient would present to the ER, he would make comments about feeling like a nuisance for having taken up our time and for bothering his daughter for having to accompany him to the ER. One night while I was working, the ambulance was paged to his address for reports of an unresponsive male. It turns out he had overdosed on prescription sleeping medication in an attempt to commit suicide. The patient recovered and spent several days in the hospital before willingly being admitted to a mental health hospital.

 

Looking back, I think the patient could have received help for mental health problems and depression prior to his suicide attempt. I personally recognized signs of depression and anxiety when he would present to the ER but assumed his family also noticed and that he was seeking help from his primary care provider since he had recently been prescribed an antidepressant. Elderly patients with depression are commonly treated solely in primary care but may also need psychosocial intervention (Holzel, Bjerregaard, Bleich, Boczor, Harter, Konig, Kloppe, Niebling, Scherer, Tinsel, & Hull, 2018). I learned from this situation that I should have voiced my concern to the family or the ER provider before this event. This may have helped him receive proper care before a crisis occurred.

Patients with depression, especially those who are elderly are particularly vulnerable. Legal and ethical implications for these patients include their right to proper care as well as confidentiality regarding their care and diagnosis. 

 

Guthrie, E. A., Dickens, C., Blakemore, A., Watson, J., Chew-Graham, C., Lovell, K., Afzal, C., Kapur, N., & Tomenson, B. (2016). Depression predicts future emergency hospital admissions in primary care patients with chronic physical illness. 
Journal of Psychosomatic Research
82, 54–61. https://doi.org/10.1016/j.jpsychores.2014.10.002

 

Holzel LP, Bjerregaard F, Bleich C, Boczor S, Harter M, Konig H-H, Kloppe T, Niebling W, Scherer M, Tinsel I, & Hull M. (2018). Coordinated Treatment of Depression in Elderly People in Primary Care. 
Deutsches Arzteblatt International
115(44), 741–747. https://doi.org/10.3238/arztebl.2018.0741

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