The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [156]
Box 5.9 Managing the patient with depression: NICE guidance, step 1
Key questions:
1. During the last month, have you often been bothered by:
feeling down, depressed or hopeless?
having little interest or pleasure in doing things?
2. How long have you felt like this for? (NICE 2009a, p.4)
If the patient answers ‘yes’ to question 1 and the time scale is longer than 2 weeks, it is important that a referral is made for further assessment by a healthcare professional with clinical competence in managing depression, such as a clinical psychologist or a registered mental health nurse, so they can determine if the patient has been bothered by ‘feelings of worthlessness, poor concentration or thoughts of death’ (NICE 2009a, p.4).
Other questions should assess for the following.
Other physical health problems that may be significantly affecting their mood such as uncontrolled pain, sleep disruption, excessive nausea and vomiting, physical limitations on their independence or body image disturbance.
A history of psychological illness such as depression.
A consideration of the medication the patient is taking, specifically medication for mental health problems. Have they been able to take it and absorb it or have they had any digestive issues?
Social support for the patient: who else is around to support the person, are they isolated?
(Adapted from NICE 2009a)
Assessment of how the patient’s low mood has affected their usual daily activities such as eating, dressing and sleeping is important. The nurse can also encourage the patient to engage with activities that would be the normal for them.
Suicidal ideation
Definition
This is where someone has thoughts about suicide – it does not necessarily mean they are intending to act upon them.
Related theory
National statistics for UK suicide indicate that there are approximately 11 suicides per 100,000 population per year. Males outnumber females by approximately 3:1 (Office for National Statistics: www.statistics.gov.uk/cci/nugget.asp?id=1092).
Anger, aggression and violence management
Definition
Anger is ‘an emotional state that may range in intensity from mild irritation to intense fury and rage. Anger has physical effects including raising the heart rate and blood pressure and the levels of adrenaline and noradrenaline’ (Mednet 2010).
Related theory
Nurses may be exposed to anger and aggression. Poor communication is frequently a precursor to aggressive behaviour (Duxbury and Whittington 2005). Aggression and abuse tend to be discussed synonymously in the literature and are reported to occur with some frequency in nursing (McLaughlin et al. 2009). Anger is felt or displayed when someone’s annoyance or irritation has increased to a point where they feel or display extreme displeasure. Verbal aggression is the expression of anger via hostile language; this language causes offence and may result in physical assault. Verbal abuse may actually be experienced as worse than a minor physical assault (Adams and Whittington 1995). Whatever the cause of anger or conflict, people can behave in a number of challenging ways and with varying degrees of resistance to social and hospital rules. People may simply refuse to comply with a request or may behave more aggressively, for example by pushing someone aside (without intent to harm) or by deliberately striking out at others. Mental capacity issues should be considered when assessing the causes of aggressive behaviours.
Principles table 5.7 Communicating with a patient who is expressing suicidal ideation
Principle Rationale
Explore low mood, anxiety and agitation with patients. These factors indicate increased risk (Hermes et al. 2009, R3a).
Assess for risk: this can be as simple as making a statement remarking upon the person’s low mood and asking them if they have ever thought of hurting themselves. Most people will answer truthfully (Sobczak 2009, R3a).
Explore any expressions of suicidal ideas for intention to act. This can be achieved