Nursing Study Guide: Depression

One of the biggest challenges facing the adult nurturing and caregiving patient populations is depression.
Careers and unemployment can both cause toxic stress in some people. Without positive well-being, a corrosive anxiety builds. Negativity can wind itself into behavior and thinking patterns.
The nurse in the Emergency Room and the nurse in the long term care facility will see depression at work in patients. And especially the home health nurse will see private pain and suffering on the part of their primary charges. Each kind of nurse will have to develop a technique for intake, analysis, interaction and treatment with a patient diagnosed with depression.

No longer is depression a disorder without a face. Tragedies in almost every state have appeared in bold face type. As a workplace hazard, across the United States,  an incident of violence or self-harm,  involving a depressed and mentally disordered person increases every day.

Nurse intake workers must carefully evaluate patients prone to addictive habits such as smoking, drinking, abuse of controlled substances, or unchararacreristic or destructive behavior.

The use of chemical substances and pharmaceuticals the treatment of depression has given rise to is a concern for many socially oriented activist groups and health maintenance organizations.

A variety  of caregiving professions, such as nurses, counselors, physicians, specialty providers, and treatment experts have been wrestling with the health problem that depression poses for centuries.
Today depression problems can cause an airline captain to plummet his plane and its passengers to their deaths. The depressed conductor of a rail train can lose focus and wreck the train cars, throwing everyone aboard off the track to injury or worse. Depression and other mental health issues are now squarely on the public eye.

First described in the literature of Freud as a “malaise”, postJungian medical practitioners regularly recognized symptoms of the disorder as far back as the early 1900’s. What became a cocktail party anecdote at first began to gain steam in the medical community. By the time World War One, military doctors were inventing wartime medications to combat this strange phenomenon.

Depression can present similarly in persons by unusual or destructive behavior, excessive alcohol and drug use, mood swings, or chemical imbalances in the blood. Lab tests can screen for these indicators,. which is why Emergency Room admissions will usually have a toxicity panel and blood gas analysis ordered before key triage decisions are made

It is the numbing of depressive individuals’ “inner world” that leads to an addiction to sleeping pills, diet pills, pain pills. and other abuses of limited- schedule prescriptipn medication.

Also, certain incidences of depression syndromes can affect people experiencing a significant life event. PTSD survivors survive traumatic combat ecperiences even though all persons with PTSD did not share the same exact event.

Depression can be suffered among persons who live similar but disparate lives. Today, patients can employ various strategies and methods to combat depression and the behaviors it exacurbates and the condition it worsens.

The patient groups and subgroups, as well as pools of invidividuals who have shared a significant life event, can fall into varying levels of depressive behavior.

People who survived the 9/11 terrorist attack on New York, for example, may have experienced a kind of depression called “survivor’s guilt.” Sufferers of this and many other types of depression are urged tovtalk to support groups and seek treatment from a licensed and qualified healthcare provider.

Nurses will often observe the symptoms of depression in both long-term and acute-care patients. In many cases, an acute-care life event such as a stroke, a heart attack, or a seizure might be triggered from conditions linked to depression.
The patient’s health and safety are paramount at all times. High blood pressure, drinking, drug abuse, atypical personality traits and characteristics of self harm might signal the presence of a depressive person or a depression disorder. Information regarding past treatments of depression be available in the medical chart.
The professional and care plan interventions for depression also can be psychological. A trained medical professional can analyze the patient’s history and recommend coping strategies. Together with a psychologist, the patient can try exercises aimed at breaking down the supporting anxieties of the depressive condition.
One thing a medical expert on treating depression will do is examine what circumstances or scenarios trigger the patient’s depression. Gaining perspective on one’s life and using physical and mental energy can give a patient a more level understanding of exactly a threat really is.
Mental health professionals have worked hard to remove the stigma of depression.Encouraging a patientbto get treatment is a much more effectice intervention.
After a treatment referral is done, outreach to a qualified provider is made. This depressopn therapist can devise techniques that eliminate the focus on negative patterns, self-destructive behavior, and developing a sad or poor attitude that can lead to a negative spiral.

At this point ending isolation and developing resources to prevent downswings in mood is a key dual goal. Gaining control of flexibility and less destruction to extremes can allow a person with depressive tendencies to steer themselves away from harmful behavior and towards goal-centric future rewards.

Nursing for Sports Medicine

Nursing for sports medicine is a big movement in local and general practice health. The popularity of gyms, sports, and teenage and high school league sports, as well as childhood league sports can crowd a waiting room with single patient injuries or an entire team of them. The demands of the nursing challenge for these situations test nurses on their diagnostic skills, patient communication skills, and observational aptitude for patients who may not want their physical conditions commented upon or checked out.

The high school and college professional team sports system is rife with excesses that endanger student health. Education system nurses should brush up on sports medicine for concussions, artificial performance enhancements in teenager and young adults, and other wellness related issues for young athletes and sports participants of any age. Anorexia, alcohol abuse, drug abuse, and illegal substances may cloud behavior and vital signs.  Nurses should learn to read patients of all ages that might conceal or confuse physicians who may not factor in other elements in the patient diagnosis due to a lack of information.

Occupational sports medicine can have a broad range of employment opportunities. A television show where the contestants lose weight should have a physical wellness consultant to examine patients during extreme events and competitions. A recreational cruise should have a competent nurse to review case of passengers who have disabilities or health issue before they come on board.

Nurses should know about the ramification of high school sports and college sports, and recreational sports play and how much delivers patents in pain to the hospital on a regular basis. Sadly, people have a mind to ignore hat their doctor tells them and play anyway. Nurse should be rote in the conditions of sports related concussions, trauma, bruising, bone breaks and sprains, muscle tears and the incidence and symptoms for a diagnosis of concussion.

Nurses for sports medicine might branch off after years of general health practitioner employment or LVN work in the treatment of sports-related concussions and other sports injuries. In children and teenage athletes, there is the potential for serious long-term outcomes, such as brain damage, dementia and other risks such as substance abuse after the injury or trauma. Weekend athletes are prone to even more injury because they are likely out of condition or aging, not warmed up or not wearing suitable support equipment.

Emergency rooms can be filled with skateboard kids, bikers, roller skaters and surfers who refuse to wear proper headgear, pads, knee guards, etc. Participating in sports activities in the wrong time and place can also result in physicial injury. Sports concussions have a window of serious concern following immediate hospitalization where the patient must be scrutinized for brain damage, motor neuron fluctuations, synapse irregularity, or other disorders of the brain.

The competent sports medicine nurse will be able to diagnose and define sports-related concussions and the seriousness of the and the sports in which they are most often found. Family friends, and the patient (and coach) will want to know the immediate and long-term symptoms of bone breaks, fractures, and sports-related concussions. Nurses can take the opportunity in seminars and clinicals to discuss expert recommendations for preventing and managing sports-related concussions, to pass onto students and patients.

When Nurse Training Fails

Nurses lacking training dealing with general population, the public by phone, patients specifically and staff can lose their performance rating or even their jobs by letting their “slips show”. There are some examples where proper training, research and learning might have saved the day. In many cases the motivation for a patient to care for themselves and look forward to recovery can be affected. Assertive nurse supervisors may care to review the following real-life scenarios.

1. Proper Device Maintenance

Recently a patient approached the ward office and asked for a blood sugar reading. But the patient was made to wait 45 minutes while the lost battery to operate the device was found. But it was never found. A line formed in the nursing area while the incompetent nurse floundered around asking other nurses what to do. The nurse responsible could not make the blood sugar machine work because they did not know what a “C” battery looked like. This is evidence of lack of training.

They didn’t know how to replace the battery. They didn’t know how to find a new “C” battery, replace it in the device, and return it to the ward counter. The patient stood there in shock. No other nurse could do it either. The blood sugar count machine, the reason for their admission actually, was never derived upon discharge because the nurses were not sufficiently trained to replace a required battery in a critical piece of hospital equipment used on the recorded vitals for every single patient on the ward.

True Story. They couldn’t find the key to the room with the battery in it. The nurse went twice to the room but could not identify the correct battery. The nurse got bored attending to the task and went off to do something else..

Now, imagine you are the patient. Is this chronic ineptitude at a crucial moment? Poor nurse training or laziness? Or merely habitual inattention to detail that costs a patient time and energy? These things matter. Proper nurse training is a needed element for contemporary hospital care that patients need.

2. Backing Up New Admissions

Emergency rooms all over the nation are overfilled. This is due to administrative shortfalls in overall hospital design and throughput which cannot be addressed fully in this arena. Yet the only route almost all patients have is through the Emergency Room, and through general care and primary care admissions to the a hospital or wards. Nurses must process these admissions. Nurse without proper training and support to do the best job possible do a disservice both to themselves and others.

Unprofessional nurses stave off new admissions because they are lazy and do not want the additional responsibility. When an administrator calls the ward to see if they can accept a new admission, the charge nurse must assess the condition of the wing. Poorly conditioned equipment and nurses creating patient/nurse disputes put their ward at risk for lowered ratio caregiving and lost hours. Supervisors tend to assign less effective, poorly trained nurses fewer hours and shifts,

The admission process involves a careful review of all needed medications and the programmed timing of each. Patients who are admitted are dependent on the nurses to fulfill their medical needs via pharmaceuticals in a capsule. Therefore as time passes, properly trained nurses are on a time clock from the moment a new admission is announced. Better trained nurses address their patient admission tasks promptly. Poorly trained nurses go smoke cigarettes and delay patient tasks as long as they can.

Nurses must submit the medicine orders for each patient in time for them to be administered to the patient on time. The patient may not have any other medications on them and be in pain or distress without this assistance. But the attending or resident physicians may not be the same primary care physicians familiar to the case. And many of the medications the patient needs require physician approval due to their qualities and restrictions(narcotics). Sitting on these orders and coordinating poorly with the pharmacy is a sign of poor nurse training.

In the incidence of the above example, a nurse the ward had tasked with restoring batteries to the devices on the ward was never completed. This had not been done overnight on the night shift. (We’ll call her Sue). When the new nursing shift came in for duty, all of their patient vital statistics recording were delayed until the battery issue could be addressed. This extended hours of all the nurses on shift, a further cost of inadequate nurse training.

This was not part of the nursing handoff report because it did nt accord to any patient records. But many blood sugar readings were not tracked because the machines were not working. The nurses (though their ineptitude) made sure that enough machines were offline to delay any incoming admissions. This would give them a break between new admissions and handling current patient cases.

3. Patient Baiting

The removing any standard of case with or without ward notice constitutes patient baiting. Since the onus of treatment ends when a patent discharges themselves, malicious nurses or simple even careless ones can harass a patient into leaving by providing care that is substandard enough to make a patient believe they are better off out of a hospital or doctor’s care.

Patient Baiting takes place largely while doctors and physicians are out of circulation. Since the current staffing model of any healthcare facility is spread so thin doctors are rarely hanging around, the patient can be long gone before the physician has noticed there is any problem. Since an onsite nursing administration faculty is prone to covering up the problem, only the patient loses.

Except in this era of online reporting, increased institutional oversight, and streamlined problem solving, a nurse’s performance may come up for review. Nurses cannot pick and chose which patients they want to be nice to, or respond to handsome or pretty people in preference to others. Nurse training should orient the caregiver to apply best nursing practices and standards to every patient, not just the “favorites”.

If two nurses, (Let’s call them Cynthia and Neemar), decide not to administer standard care to a patient and make them all a doctor or come to the nurse’s managerial wing to address problems, they have been guilty of patient baiting. It speaks to the poor training of a shift charge nurse that they let this happen. This drains nurse power because the attention of other nurses and the supervisory staff is distracted from care issues.

But this places more of a burden on other nurses, who must make up the shortfall if the charge nurse assigns them to the patient or if the patient is moved to a new wing. The time and energy this drains from other personnel can never be repaired.

4. IV Maintenance

Intravenous therapy was invented to deliver treatment to the vein. The IV machine is now used for everything from infection to hydration. The care treatment plan for any patient now requires in almost every state an IV plug/PICC line so at any time emergency administration of fluids or other medicine can be transmitted this way.

An IV machine placed in a patient room is under the operation of the nurse at all times. Visitors, patients, and family members must be made to know this. Dehydration drips are administered for patients even not under the care plan because changes in their condition may require it. Nurses who are poorly trained cannot handle the responsibility of checking the IV line periodically so that shifts in patient arm or hand positioning may change its effectiveness. Properly trained nurses will instruct patients how to rest their arms and hands so as to not disturb medical product distribution.

The administration of an IV line is the charge nurse’s alone. If the nurse observes a technical problem with the device, they should report it or exchange for a properly working one. There variable settings for IV usage that a nurse should be trained to use. In nursing practice, where patients are lodged more than one to a room, the noise should be kept to a minimum to afford proper rest for others.

Alarms on an IV machine go off when the power is disconnected or battery winds down, or the treatment product runs its course. The alarm setting on an IV machine is usually denoted by a small bell, which should be set to “off”. IV fluids can run concurrently. Set an alarm for when it will finish!

But when a machine is not running properly the noises and alarms can buzz in an annoying manner and create a need for the nurse to constantly return to the same room. Setting one or all of the medications to “Gravity drip” can assist in providing rest for all the patients in the room and reduce the need for technical review of the equipment through the night.

5. Inability to Admit/Report a Mistake

If a nurse notices they have made an error or committed a breach of institutional or care treatment policy, their best practice to to report it or advise a supervisor who can take action. Patients can report this to nursing administration. Simple mistakes can be rectified by peers if necessary. More important errors concerning medications, treatment, or patient interaction can be addressed by a supervisor. Without this accountability nurses should think of working in other professions.

 

What 4 Medical Skills Make You a Better Nursing Hire?

Occupational employees such as nurses should always keep an eye on the basic skills that make up the daily round of nursing tasks. The quality of how well a nurse or nursing student performs these skills can make their grades or wages rise. In nursing school, many is the time a student nurse can excel in all the academic book work, but the practical shortcomings of real-time nursing performance matter much more. Because patient-centric nursing must be perfect the first time around.
Here are four nursing skills that will make you a more marketable nurse. By rehearsing these skills while in nursing school and using peer guidance and skills review while on-the-job, any nurse can shore up the gaps in his or her work skills. Immediately after improving these nursing skills and demonstrating competence, any job candidate or nursing student becomes the best prospect for a new hire or promotion. For working nurses, this means additional hours on staff or a better rate of pay. Progressive improvement of these skills will allow any nurse to be considered as a medical skills trainer, or as a nursing supervisor or senior charge nurse.
1. Needle Skills
Every nurse gets a basic training in practical skills using needles. Are you good with a needle? Nurses have been improving technical skills with needles over the course of their careers, but the best nursing students will concentrate on administering medications with needles and leaving the patient with the least amount of distress, bruising, and needle point skin tears. A hospital or facility trusts every nurse, RN or LVN, with needles. Medical and nursing facilities must be assured any nurse can work with a needle efficiently on patients, without supervision. Protocols for sharps accidents and blood-born disease control are very severely controlled.
Patients everywhere need nurses who can perform needle injections with a minimum of pain, fuss, and after-puncture bruising. Needle skills and sharps handling is important for hospital wards, log term care floors, and clinic rooms. Many systems of portable pharmaceuticals depend on steady hands and precision administration of individual dosages. Sharps treatment include disposal and sterile storage, as well as delivering medication without unnecessary skin breakage, administration site pain, and resulting needle marks or bruises.
2. Wound Care Skills
Many patients with chronic and acute conditions involve wound care and skin based dressing treatments. Administering wound care means following physician orders, working with the patient, and completing the application of medication and bandages and wrapping in a time-sensitive manner. Some wounds such a pressure sores and ulcers are chronic. Some wounds are acute, and center around conditions that involve infection, surgical recovery, and/or peritoneal dialysis tube insertion sites.
Wound care generally involves preventing infection and utilizing medications and medical supplies to prevent spread of material, decaying skin cells, bacteria, and debridement matter from contact with open wounds, skin tears, or other breaks in the skin. The skin is the body’s largest organ, and often overlooked with respect to its ability to affect overall patient well-being and health. Patients need skilled nurses adept in good wound care. Managing wound care, in sum, means nurses reducing the infection risk and optimizing a patient’s overall chance of recovery.
3. Dialysis Skills
Inserting procedure tubes near the peritoneum and administering dialysis treatments is a marketable skill. Nearly two thirds of all long-term care patients are elderly and dependent on dialysis treatment on a weekly or daily basis. Ambulance fees and transportation logistics make this a nightmare for nursing desks and facilities, not to mention home health patients.
Independence from doctor’s appointments is the dream of every patient. A nurse that can reduce a patient’s schedule y two or three visits a week is a smart hire. The nurse that can administer the dialysis wire, tubes and machinery, as well as funnel a pleasant bedside manner with patients, can be a breadwinner for any medical nursing company or healthcare organization.
4. Admission Skills
Every nurse needs to periodically review their patient charts and submit shift changes in condition, as well as the ritual licensed nurse progress notes for each patient. but progressive experience at any desk means facing the responsibilities of an admission. Whether a patient is returning to the hospital ward, facility, or a new admission, the nurse involves need to be on point for every detail of patient admission processing
The admission nurse must advise the staff that a new bed is being filled; the placement managers will advise the ward or floor that a patient is being admitted and where they are going. It is the nurse’s responsibility to immediately advise the housekeeping staff about the bed, linens, and bed rails and/or bedside equipment required. The admission nurse must take the endorsement from the discharging facility and record and advise the incoming staff concerning all variances in treatment and nursing care the new patient requires.
The admission nurse must review the documents and make sure everything is in order for the next shift’s nursing medicine nurses to follow up and distribute medications. A chart for the patient must be made and the sections and document blanks put in. The nursing assistants must be briefed about that new patient’s special needs. The medications of the new patient must be conveyed to the facility or hospital pharmacy. Any contraindications or conflicts in treatment orders or medications with the patient’s stated condition list and MDS report must be resolved before time of admission.
These admission tasks must be done while ringing phones, audio speak announcements, patient vocalizations, and other distractions are occurring. Coordination with ambulance staff, as well as directing the paramedics to which room and section of the facility to place the patient in, is necessary. Lastly, the admitting nurse must assign a nurse or staff member to orient the patient and/or the family. Communication of Resident’s Rights and facility policy is then performed. Only then can the nurse report to the Director of Nursing, detail the notes in the patient’s chart, and tell the supervisor that admission has been efficiently finished.

Could You Be a Charge Nurse?

Student Nurses just ready to take qualifying exams are prudently planning their career steps in the years ahead. And suddenly the whole world of nursing occupations is open to them. But the administrative division of a leadership position in any nursing facility or medical institution is the position of charge nurse. Nursing students can focus their study courses on these supplemental electives when possible.

The charge nurse supervises other nursing staff, facility housekeeping staff, manages patient care for a ward or section or entire floor, and/or directs all activities. The nursing supervisor may be the charge at the same time, in smaller nursing homes. Student nurses with excellent grades and high score may be cleared to apply for the charge nurse level employment. The charge nurse is not an entry-level position.

A charge nurse is a multi-tasker on a whole new level. The nursing student preparing to become a new medical nurse will have to be spotless on their practicals, well above average on their anatomy and pharmaceutical knowledge, and excel at learning new tasks as well as retaining endorsements, special instructions, and handling special nursing cases. The charge nurse will perform or supervise and review all admission paperwork, as well as onsite bed placement and endorsement responsibilities.

Often the charge nurse is the only RN on a shift on any given ward or floor for a nursing institution or long term care facility. All emergencies, scheduled treatments, and call light actions fall to the RN on duty whether they are busy or not, whether they are involved in charting, on a break, or even otherwise engaged with another patient.  The new hires in a facility often will be observed for the capability and potential for serving as charge nurse in any institution. The pay rate is higher, and the night service for this function often has a pay differential for the overnight shift.

The charge nurse must be comfortable with supervising other nursing staff, even staff who are over twenty years older than them. In today’s new small business environment, many nursing homes and medical institutions will have a nurse who is barely twenty-three serving as supervisor over other nurses who are over twenty or even thirty years older than they are. This is a psychological challenge that tests the new nurse’s maturity. Hiring managers in nursing will look for skills like autonomy, independent ability to multi-tasks, good attendance and timekeeping, and a professional appearance and demeanor.

How can a student nurse train themselves to be chosen to serve as charge nurse? By preparing across disciplines of study to perform at a higher level of nursing professionalism. The charge nurse will be accountable to the facility for a higher level of performance at al times during their shift. The charge nurse must also be competent to communicate with other hospitals, the pharmacy, law enforcement, the coroner‘s office, and make family relations calls and other communications as necessary.

Any student nurse or new hire in the nursing profession will be working under the supervision of charge nurse. So, if you don’t like your supervisor, the only answer is to become the charge nurse. This can be done by proving yourself in a progressive level of responsibilities and absorbing training commands and endorsement details over time.

A charge nurse must perform their tasks as well as competently supervise med pass nurses, certified nursing assistants, manage any crises that come, and document all other aspects of their shift and endorse the details to the next shift‘s incoming charge nurse. If a student nurse feels their studies are too easy, or they feel they have enough grasp on their material to stop preparing, they need to think again. The practical application of nursing knowledge in the field tests any nurses‘ patience and skills. The test environment is not the same as performing work for hours on end, and meeting every challenge and task with a freshness and attention to detail the work deserves.

Many nursing homes and hospitals do not have time to train new nurses and spend time and energy allowing them to come up to speed without an endgame in view. Many nursing homes and hospitals view any new student nurse hire or new entry into their staff as a potential charge nurse, whether the candidate knows it or not. They may need any member of staff to fill in as charge nurse, when gaps in their nursing staff schedule occur.

In an emergency, a nursing home, assisted living facility, or hospital supervisor will look for the on-duty nurse to assign the charge nurse duties to. If the RN or LVN is not ready to perform at this level, the facility runs the risk of patient safety risks, medication problems, treatment gaps, and documentation errors. These issues put the facility license at risk.

In the new world of budgets cuts, understaffing, and high nursing staff turnover, the LVN often be asked to perform their own tasks at the charge nurse level, and report as such. Thus, any new student nurse must realize that they may be asked to perform at the charge nurse work level, professionally, even though their hiring title is med pass nurse, floater, or desk nurse.

The student nurse seeking work must understand that if the phone doesn’t ring, it’s because their experience and scores, course work and practical training does not measure up to this standard. The interview and review of student nursing experience , testing, skills and education will come under this scrutiny.

Student nurses should train while taking courses and performing internships to qualify for work at this level. Otherwise, they many see their fellow student nurses pass them by in the career path to a future in progressively responsible nursing jobs.  A student nurse could look back at the monetary investment in their nursing school, as well as the energy and effort to prepare for a career in nursing, and wish they had planned better.

 

 

 

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