Nursing News

Watch and Listen: Four Steps to Caring for Your Patients’ Mental Health

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By Jennifer Larson, contributor 

May 25, 2012 - It’s fairly easy to determine if your patient’s blood pressure has spiked or if her blood glucose level is too high. It’s not as easy, however, to figure out if she might be suffering from depression.

APNA President Marlene Nadler-Moodie said, "I have a basic premise that everyone who comes into the hospital is anxious. Anxious and stressed.""

Based on statistics, nurses should expect to treat a large number of patients who are suffering from or developing signs of some type of mental disorder: The National Institute of Mental Health reports that as many as 1 in 4 adults experience a mental health disorder each year in the United States.

“It’s quite prevalent,” said Marlene Nadler-Moodie, MSN, APRN, president of the American Psychiatric Nurses Association.

In a statement released May 11 for Mental Health Month, U.S. Secretary of Health and Human Services Kathleen Sebelius said, “We know that mental health is essential for a person’s overall health; prevention works; treatment is effective; and people can recover from mental disorders and live full and productive lives.”

What can nurses do to help? Be vigilant about patients and notice the early signs that something may be wrong--and then help them get the help they need.

Here are four tips to help you be more aware of your patient’s mental health and provide the most appropriate care:

1. Recognize the stressful nature of the situation. 

“Even among the healthiest of us, I have a basic premise that everyone who comes to a hospital is anxious. Anxious and stressed,” Nadler-Moodie said.

Beth Cole, Ph.D., RN, a fellow in the American Academy of Nursing and the dean of the Brigham Young University College of Nursing, agreed, noting that nurses are quite comfortable in the hospital environment (or other setting) because they work there. But many patients are often fearful or nervous when they walk through the hospital doors, even in non-emergency situations.

“It’s very anxiety-producing or stressful,” she said. “How you’re feeling about where you are is usually quite different from how the patient is feeling about where they are. So keeping that in mind first is very helpful.”

2. Be a detective.  

It might be unrealistic to expect that all your patients will automatically tell you about any existing mental disorders they have. For one thing, they may not be aware of them.

And as Nadler-Moodie noted, “Even people who have a diagnosis…when they come to a hospital, they may not be forthcoming.”

“I think there’s probably still some stigma about it,” said Cole. “I think people still don’t want to talk openly about” certain aspects of their health.

That means that nurses may have to play detective. A patient may not tell you that she has bipolar disorder or depression or PTSD or something else. But she may be willing to talk about the symptoms, Cole said. She may tell you that she has difficulty sleeping or gets nervous in elevators or is feeling jittery or anxious. By listening carefully, you may pick up on some signs that are worth remembering.

Also, you don’t have to jump right in and tell the patient that you suspect she’s depressed or meets a certain number of criteria for a particular disorder, said Ken Duckworth, M.D., medical director of the National Alliance on Mental Illness.

“I might start with talking about the stress they’re under and how they’re coping with the stress,” he said.

He noted that sometimes he just listens and then follows the patient’s lead. “Frequently, they will lay it all out for you,” he said.

Nadler-Moodie also suggested medication reconciliation. Look at the list of medications that your patient has been taking.  Find out if the patient has been taking any psychiatric medications recently, and if so, which ones and for how long. This can give you a better sense of whether any particular behavior may be attributable to not taking a particular medication while they’re in the hospital.

3. Trust your gut feelings. 

If you’ve noticed that a patient doesn’t seem quite right, even though nothing seems overtly wrong, pay attention to that.

“I would tell nurses, ‘Follow your instinct,’” said Duckworth.
Look for behaviors that don’t seem quite right, especially if they have changed. A patient may start seeming confused, or disoriented, or erratic. It could be the result of a medical condition—for example, elderly patients may develop some temporary cognitive impairments as the result of a urinary tract infection, which is worth investigating. Or the environment could have triggered some anxiety or other feelings in them, which is not uncommon in a stressful situation, Cole noted.
Whatever the cause, mental distress can detract from their ability to heal.
“People don’t put their minds over on one side and their bodies on another side,” Cole said.

And if you find that a patient makes you feel sad just by being around him, that might be a sign that the patient might not be feeling very well, either.

“That could be a sign of untreated depression,” Duckworth added.

4. Ask for help. 

In an article that Nadler-Moodie wrote for American Nurse Today in 2010, she outlined four general care goals that could apply to all nurses, not just nurses with special psychiatric training:

  • Assess the situation early;
  • Make sure the environment is safe;
  • Intervene appropriately, using any resources that are available to you; and
  • Ensure the appropriate follow-up care.

Those steps are still useful, she said. You don’t have to have a psychiatric background to notice signs that something may be wrong and then ask someone for additional help or seek out resources. Your hospital or health care system may have a psychiatric team that can intervene, and you can seek them out and request a consultation.

And if you know that a patient does has a mental illness, “You want to make sure that everything is coordinated very well, with both medications and environment, so that the person can optimize their hospital experience,” Cole said.

© 2012. AMN Healthcare, Inc. All Rights Reserved.