How can the Mental Nurse Contribute to the Recovery of the Depressed Patient?
- Author:
Joan Evans
Staff Nurse, Hayes Park Nursing Home Winner ” Lord ” Memorial Essay Competition Prize, 1947 The doctor gives his orders?the nurse carries them out, but it is the way in which they are carried out, with all the considerations a nurse can give, which contribute to recovery.
Firstly, most mental patients are physically as well as mentally ill and the points to consider are : rest, nourishment, careful supervision and occupation.
From the time of admission the cause of the depression must be ascertained, as this may save the patient from a great deal of distress by avoiding a subject which brings back memories which are best forgotten. This will depend on the ability of the nurse to get into contact with the patient’s mind. To do this, she must be interested enough to learn facts about the patient, her ordinary life and surroundings, and to make the patient feel that she is talking as one human being to another. Admission to a patient is a very bewildering time. To put one at her ease, explain that it is routine and will soon be over. But it is an excellent time to ask the patient a few questions, and you will be able to tell whether conversation is going to be difficult. If the patient is being admitted to a room, endeavour to have fresh flowers there and, if cold weather, a hot bottle in the bed?don’t let it be a day that is looked back on with dread, but one?when recovery comes along?that is remembered as not so terrible after all.
A patient is sometimes reluctant to go to bed, but by tact this will be accomplished?then take a cup of tea along and allow the relatives in to see the patient for a few minutes before leaving, and assure the patient that recovery will not be long? although with this type of illness it sometimes takes a little while?and that by carrying out all she is asked to do not only will she help herself, but also help her relatives to realize that everything possible will be done for her and relieve their anxiety.
If it is possible for a nurse to remain with the patient on the first day, so much the better. This is possible in a ward, but in a private room more difficult, but it really is necessary, as the nurse can study the patient’s reactions and observe anything of importance. Some are very difficult in settling down to rest for a few days?concentration will be lacking so don’t give books to read ; take along a few magazines?something that does not need deep thought. The nurse who can forget herself and think first of the patient is invaluable?generosity will react on her behaviour and help recovery more than anything else. There must never be any display of sentiment, and authority must never be abandoned ; there must be an attitude which will inspire the patient with trust, confidence and the hope needed.
With the depressed client meals are sometimes a difficulty?refusal of food so often being made. Now it is very important to serve meals attractively find out the patient’s likes and dislikes and never serve large portions?more can be asked for, ^whereas a plate overfilled will probably turn the patient from the meal altogether. If there is complete refusal of food, see if a tonic could be given before meals, and if this has no effect explain that she is under your care and you cannot let her go without meals ; explain that this will have to be reported to the doctor who, if he thinks necessary, will resort to other methods and a little feed by a tube will be given. Don’t alarm the patient,-but just explain as simply as can be about this, and by great tact the patient will realize how foolish it is not to eat, and will like her food. But, on the other hand, some patients will think they know better and will find some reason for not doing what is asked ; it is a good plan then to try and strike a bargain and give in to her in small matters as, may be, a different arrangement of the food tray or any similar details regarding meals ; it is also perhaps a good plan to refer such matters to the doctor in the presence of the patient so that she knows exactly the doctor’s decision on the matter.
Strict supervision is sometimes needed, depressed patients being treated, at first anyway, as potential suicides. If this is necessary, it must be carried out in such a way that the patient will not feel she is always being watched. The nurse can?if in a ward?always be on duty there doing various jobs about the ward ; if a private room, suggest that patients are always with a nurse for a few days so as not to feel lonely, suggest that you do some mending for the patient, or perhaps take in a jigsaw puzzle. Try and keep her occupied as this will take the mind off morbid subjects and thoughts. If the patient will do her own mending so much the better, as it will show that interest is being taken. If the doctor has suggested any form of treatment, the patient will turn to the nurse, and will confide in her her nervousness regarding it. You can do such a lot to alleviate this by explaining as much as you possibly can about it, and assurance is always needed on the fact that she will not be left alone and that you will be there. To see a nurse she knows and can rely on is such a comfort to her.
Many patients worry very much when they know one nurse?the nurse who has done a lot got them? is going ” off duty ” ; they are worried that the nurse taking over will not understand them or give them the same consideration. Make a point, when handing over, of reporting all the little things you do, and the patient’s little faddy ways ; this will be much appreciated by the patient, and you will always have the knowledge that just the same will be done for her by any nurse taking over from you. When the patient is allowed up, this is the time to see that she is occupied all the time, and to see that interest is taken in her personal appearance. So many lose this interest and it is up to you to see that it is not lost. In a large hospital there is always a hairdresser on the premises?arrange a visit there. See the doctor regarding a daily visit to the therapeutic department where various forms of sprays and douches are given ; this will exhilerate the patient and help her very much.
Occupation and recreation are very necessary and, if the patient is pronounced physically fit by the doctor, should be encouraged as much as possible. In a large hospital the patient is handed over to the Occupational Therapist and Recreational Therapist in charge of either department, and from there various lessons in handicraft and sports are arranged ; but in a Nursing Home this falls on the nursing staff and is more difficult, but a very necessary item of treatment.
The patient, by this time, will have been introduced to someone whom she can look upon as a companion, and if fond of walks, outings can be arranged?of course the nurse accompanying them?but for the patient to ” get away ” from the surroundings of the home or hospital even for a short time during the day in the company of another patient who is suitable so that they can discuss everyday things, will do so much good ; also a visit to the cinema to see a suitable film ; looking at the shops. When they return their minds think in a different trend and interest will again be awakened. Let the patient help make her own bed, arrange the flowers and any suitable jobs which she would like to do. It is very essential to keep the mind occupied, but not overworked. See that letters received are answered and so keep the interest to the fore, and the patient will feel herself getting back to normal once more. Many patients like to go to church, so do arrange for her to be taken by a nurse of her religion?many feel so uncomfortable when taken by one not of their religion. There are social clubs arranged in many places,? take the patient along?she may be shy at first, but when she sees all the others joining in and the nurses, she will herself gradually be doing the same. These evenings which last about an hour are a great help to shy patients and they should be encouraged to join in.
During the course of the patient’s illness the relatives may be difficult, but try to treat them with the,same quiet confident manner hoping that they will follow your example, and ask them to avoid giving the patient any bits of news which will distress or irritate in any way.
Although any treatment given to the patient by the doctor will speed up recovery, it is the little things and acts of kindness done by the nurse that helps to make life in hospital for the patient not something to look back on with dread, but something to feel for ever grateful for.
A depressed patient is often difficult over medicines, but never deceive them by putting anything in food. Explain what it is given for and why it is given.
The task, which confronts the nurse is not an easy one, but by tact, constant kindness and perfect firmness the reward of seeing the patient discharged,, recovered, should be won.
“Community Care” in a Barnardo Village
” Slow or feeble-minded girls, were our joint responsibility. Mother, as well as the older more understanding people, felt them to be an added special care, and the encouragement and sense of personal responsibility for our ‘ Potty ‘ was a marked feature of our lives. Woe betide any other ‘ corrage’ who flurried or called out after our ‘ potty ‘/ She was ours and that was that From ” The Likes of Us By G. V. Holmes (a Barnardo child).
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